Abdomen Forum2012

Surface Anatomy Guy:

Document where the following organs/structures can be palpated:1. Liver Rib5-10 right

2. Spleen under 9th,10th, 11th ribs. Begins about midaxillary line. Posterior left

3. Gallbladder 9th rib, midclavicular right

Draw in:4. Linea alba5. Linea semilunaris6. McBurney’s point7. ASIS8. Deep Inguinal ring9. Superficial Inguinal ring

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Surface Anatomy Guy:

Draw in the 4 lines to create the “9-region pattern”

Name the 9 regions.

What organs are found in each?RH: R liver, kidney, Asc colon, GB?E: liver, kidney (R/L), GB, stomach, pancreas, Trans colonLH: Stomach, spleen, kidney, tip of liverRF: Asc colon, gutter, U: SI, ColonLF: Des colon, gutter, kidneyRG: Asc colon, ASIS, Ing Lig, appendix, cecumP: appendix, cecum, SI, bladder, Genital organs, femoral vesselsLG: des colon, ASIS, Ing Lig, sigmoid colon.

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Compare and Contrast!Patient A – 42 year-old male presenting after trying to move his dishwasher

Patient B – newborn male

Right: indirect inguinal hernia, most common, congenital, more in child and male. Lateral to inferior epigastric vessels via deep inguinal ring through entire inguinal canal. Same covering as spermatic cord. Enters the scrotum

Left: direct inguinal hernia, older male moving heavy things. Hernia out of Hesselbach’s triangle (rectus abdominis, inguinal ligament, inferior epigastric vessels) through superficial inguinal ring. Medial to inferior epigastric vessels. Cover by parietal peritoneum & transversalis fascia with external spermatic fascia

What fascial layers are cut in this procedure?

Lymphatic drainage of the wound site?

Vasetomy

SkinDarto’s fasciaESFCremasterISF

Superficial inguinal node

Identify!1

What's my lymphatic drainage?

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1. Liver (most-hepatic LN-celiac LN; bare area-phrenic LN-posterior mediastinal LN; Falciform lig-parasternal LN; round lig of liver-umbilicus & anterior ab wall)

2. Spleen, splenic artery3. L. kidney (Lumbar LN), renal

vein-IVC4. Aorta 5. IVC6. Ascending colon with

contrast (Sup Men LN), cecum

Identify.

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CT scan from a 27-year-old male reveals the image to the

left.

Identify; What’s wrong?58-year-old male with

abdominal pain. CT scans reveal:

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1: liver, cirrohsis2: spleen, enlarged due to liver cirohisis3: bladder4: Psoas major

65-year-old female presents with the chief compliant of abdominal

swelling and discomfort of two weeks duration. CT reveals:

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Identify!

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1. GB2. Aorta3. IVC4. Gall stone5. L. kidney6. Liver7. Spleen8. R. Crus,

diaphragm9. Portal vein

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Identify!

1. Aorta; plexus abdominal2. Erector spinae; extension3. Right kidney;

embryological origin? 4. Duodenum, annular

pancreas5. GB; proper hepatic, celiac6. Liver; T6-T9,

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Identify!

1. Pancreas; Celiac a. and splenic a.

2. Trav Colon; Middel colic a.?, SMA

3. Left renal vein. 4. SMA 5. Spleen; splenic vein

to Portal vein?

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Identify!1. Aorta2. R. Kidney3. L. Kidney4. (Duodenum)

descending, celiac artery and portal vein, Celiac LN, T5-T9, vagus

5. IVC6. Liver7. Psoas M8. Transverse colon

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Identify!1. L. common iliac2. R. common iliac3. IVC4. Ascending colon or

cecum5. Psoas Major6. External Oblique7. Internal Oblique8. Rectus abdominis

Imaging of a 75-year-old female with abdominal pain, weight loss and

dysphagia reveals:

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Barium enema in a 1-year-old male

with difficulty defecating reveals:

SUPER BONUS!Identify!

1. Celiac trunk (left)2. SMA

Draw the celiac trunk, its major branches and anastomoses.

Draw the IMA, its major branches and anastomoses.

CT scan of a 50-year-old male reveals:

Ascites!1. Where is the fluid? 2. What layers must be

traversed to drain this fluid? [Paracentesis]

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1. Spleen2. R. kidney3. Fluid?4. Arrow: liver or fluid?

Paracolic gutter left. 5. Paracentesis: Skin,

campers, scarpa’s, EO, IO, TA, Tran fascia, extraperinum fat, pariental peritonum

Imaging from a 55-year-old female with a history of breast cancer reveals

the images to the left.

Which breast?How does this happen?

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74-year-old female with rectal bleeding.

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Metastasis:• Lymphatic channels – • Venous channels –

Radiograph from a 73-year-old female with abdominal pain and elevated WBCs:

Hint:

1. Right diaphragm is higher than the left. Infection based on high WBC. Infection of liver or peritoneal cavity pushing diaphragm up? Perforated bowel (ulcer)causing air leaked in between diaphragm and peritoneal cavity (pneumoperitoneum)

CT scan from a 30-year-old female with complaints of vomiting and weight loss:

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1. Stomach 2. Duodenum3. Portal vein4. SMA

Strangulation of distal duodenum, SMA syndrome. Duodenum compressed by SMA or abdominal aorta

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1. Celiac trunk2. Splenic artery3. Left gastric4. Common hepatic5. Hepatic proper6. Gastroduodenal7. pancreaticduodenal

superior (ant.)

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1. SMA2. Ileocolic artery 3. Right colic artery4. Intestinal artery

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1. SMV2. IMV3. Splenic vein4. Portal vein

A 65-year-old female presents with her daughter who indicates her mother has a 2-year history of dementia, a recent seizure and a long history of alcoholism [she consumes only Natty Light]. Physical exam reveals the image to the left:

Varicose vein from liver damage. Paraumbilical vein backed up from portal vein blockage. Caput medusa.

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1. Common hepatic duct2. Cystic duct3. Common bile duct4. Main Pancreatic duct5. Super bonus: pars interarticularis

Draw the pattern of sympathetic

innervation to the ________________.

Structure to be decided DURING the forum!

Include pre and postganglionic

neurons and GVAs!

Referred Pain Guy:A 30-year-old male presents with pain in the region indicated. 1. What organ is indicated?2. What spinal cord levels are involved?3. Cell bodies in what location are

responsible for relay of pain from this organ?

Green: Liver, GB and duodenum contact with diaphragm (C3-5),

Yellow: Stomach, duodenum and head of pancreas, Dorsal (posterior) root ganglia T5-T9 (sympathetic)

Pink: Small intestine, appendix T10 dermatone; T9-T11 real; visceral pain, would turn to somatic pain.

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Referred Pain Guy:

A 16-year-old female presents with a fever and pain in the region indicated.1. Which organ is implicated?2. What spinal cord level is involved?3. Is this somatic or visceral pain?

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Referred Pain Guy:

A 36-year-old female presents with pain in the region indicated.1. Which organ is implicated?

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