ABDOMEN BERNARD SM HUTABARAT ; dr, PAKBOUNDARIES :3.1. SUPERIOR (CRANIAL) 3.1.1. XIPHOID PROCESS ( PROC.XIPHOIDEUS ) 3.1.2. DIAPHRAGM 3.1.3. COSTAL ARCH ( ARCUS COSTARUM ) 3.2.ANTERIOR ( VENTRAL ) : ABDOMINAL WALL 3.3.POSTERIOR ( DORSAL ) : 3.3.1. LUMBAR VERTEBRAS ( VERTT.LUMBALES ) 3.3.2. PSOAS MAJOR, PSOAS MINOR AND QUADRATUS LUMBORUM MUSCLES. ( MM. PSOAS MAJOR,MINOR ET QUADRATUS LUMBORUM ) 3.4. INFERIOR ( CAUDAL ) : PELVIC INLET ( APERTURA PELVIS SUPERIOR )

TOPOGRAPHIC POINTS OF REFERENCES

1. JUNCTURA XIPHISTERNALIS (XIPHISTERNAL JUNCTION):INTERVERT.DISC T9-10 ; COSTAL CARTILAGE VII

2. PLANUM TRANSPYLORICUM :IMAGINARY PLANE: . MID-POINT OF INCIS.JUG.STERNI SYMPH.PUBIS :L1-2

3. SUBCOSTAL PLANE:IMAGINARY PLANE THROUGH CAUDAL MARGIN OF RIB X : L3

4 UMBILICUS ( NAVEL ) : INTERVERT.DISC L3-4

5. CRISTA ILIACA ( ILIAC CREST ): L4

6. LINEA TRANSTUBERCULARIS : DRAWN THROUGH TUBERCLES OF ILIAC CRESTS : L5

7. PUNCTUM MID-INGUINALE ( MID-INGUINAL POINT ): MID-POINT OF LIG.INGUINALE POUPARTI (INGUINAL LIGAMENT OF POUPART )

ABDOMINAL WALLS1.STRATUM SUPERFICIALIS ( SUPERFICIAL / EXTERNAL LAYER ) 1.1. CUTIS ( SKIN ) : LINES OF SKIN TENSION LANGER ( LINEAE LANGER ) 1.2. SUBCUTIS ( FASCIA ABDOMINALIS SUPERFICIALIS, SUPERFICIAL ABDOMINAL FASCIA ) 1.2.1. LAMINA SUPERF ( FASCIA CAMPERI; FATTY SUPERFICIAL LAYER OF CAMPERI ) 1.2.2. LAMINA PROFUNDA ( FASCIA SCARPAE ; DEEP FIBROUS LAYER OF SCARPAE )

2.STRATUM INTERMEDIUS ( INTERMEDIATE / INTERNAL LAYER )

2.1. FASCIA ABDOMINALIS PROFUNDUS ( FASCIA INNOMINATA GALLAUDETI / INNOMINATE FASCIA OF GALLAUDET ). 2.2. APONEUROSES ET MUSCULI ABDOMINALES ( APONEUROSIS AND MUSCLES OF THE ABDOMINAL WALL )

3.STRATUM PROFUNDA ( DEEP / INNERMOST LAYER )

3.1. FASCIA TRANSVERSALIS ( TRANSVERSAL FASCIA OF ABDOMINAL WALL ) 3.2. PANNICULUS ADIPOSUS PREPERITONEALIS ( PREPERITONEAL FAT TISSUE ) 3.2. PERITONEUM PARIETALE ( PARIETAL PERITONEI )

MM. ABDOMINALES ( MUSCLES OF ABDOMINAL WALL )1.MM. VENTROLATERALES ( VENTROLATERAL MUSCLES ) : 1.1.MUSCULI OBLIQUA ( OBLIQUE MUSCLES ) - OBLIQUUS EXTERNUS ABDOMINIS (EXTERNAL OBLIQUE MUSCLE) - OBLIQUUS INTERNUS ABDOMINIS (INTERNAL OBLIQUE MUSCLE ) - TRANSVERSUS ABDOMINIS ( TRANSVERSE MUSCLE ) 1.2. MM.RECTI ABDOMINIS ( STRAIGHT ) - M. RECTUS ABDOMINIS ( STRAIGHT MUSCLE ) - M. PYRAMIDALIS (PYRAMIDAL MUSCLE)2. MM. DORSALES ( DORSAL MUSCLES )

INSCRIPTIONES TENDINEAE ( TENDINEOUS INTERSECTIONS }

MUSCULI ABDOMINALES2. MM.DORSALES ABDOMINALES (POSTERIOR ABDOMINAL MUSCLES.) 2.2. M. PSOAS MINOR ( PSOAS MINOR MUSCLE ) 2.1. M. PSOAS MAJOR ( PSOAS MAJOR MUSCLE ) 2.3. M. ILIACUS (ILIAC MUSCLE )

APONEUROSES OBLIQUE MUSCLES

VAGINA MM.RECTI ABDOMINIS ( RECTUS ABDOMINIS SHEATH ) LAMINA ANTERIOR ( ANTERIOR LAYER ) LAMINA POSTERIOR ( POSTERIOR LAYER )

LAMINA ANTERIOR VAGINA MM.RECTI ABD.FORMED BY :- CRANIAL : APONEUROSIS OF EXTERNAL OBLIQUE- CRANIAL : APONEUROSES OF : - EXTERNAL OBLIQUE - INTERNAL OBLIQUE. - CAUDAL : APONEUROSES OF : - EXTERNAL OBLIQUE - INTERNAL OBLIQUE - TRANSVERSUS ABDOMINIS .CONTENT OF RECTUS SHEATH :M. RECTUS ABDOMINISM. PYRAMIDALISA/V EPIGASTRICA SUPERIORA/V EPIGASTRICA INFERIOR RR NN INTERCOSTALES

POSTERIOR SHEATH OF RECTUS ABDOMINIS.- CRANIAL : APONEUROSES OF INTERNAL OBLIQUE. & TRANSVERSUS ABDOMINIS MUSCLES.- CAUDAL : TRANSVERSE FASCIA TRANSITION OF APONEUROSISOBLIQUE MUSCLES : LINEA SEMI-LUNARIS SPIGELI ( SEMILUNAR LINEOF SPIGEL )

INSCRIPTIONIS TENDINEA ( TENDINOUS INTERSECTION )

TRANSITION OF OBLIQUE MUSCLESAPONEUROSIS & TRANSVERSE FASCIA:LINEA SEMICIRCULARIS DOUGLASI( SEMICIRCULAR / ARCUATE LINE OF DOUGLAS )

CONJOINT TENDONAPONEUROSES OF INTERNALOBLIQUE AND TRANSVERSEABDOMINIS MUSCLES: FALX APONEUROTICA INGUINALIS( INGUINAL APONEUROTIC FALX , CONJOINT TENDON) : HERNIORRHAPHY( REPAIRMENT OF HERNIA )

CANALIS INGUINALIS ( INGUINAL CANAL )ANNULUS INGUINALIS PROFUNDUS ( DEEP INGUINAL RING )

CANALIS INGUINALIS

ANNULUS INGUINALIS SUPERFICIALIS ( SUPERFICIAL INGUINAL RING )

CONTENT : : FUNICULUS SPERMATICUS ( SPERMATIC CORD ) : LIGAMENTUM TERES UTERI ( LIG.ROTUNDUM, ROUND LIGAMENT OF THE UTERUS ) RUPTURA UTERI MEMBAKAT ( THREATENING OF UTERINE RUPTURE )

LOCUS MINORIS RESISTENSIAE INGUINALIAE (PART OF INGUINAL WITH MINOR RESISTENCY )

1. CANALIS INGUINALIS ( INGUINAL CANAL )2. TRIGONUM INGUINALE HASSELBACHI ( INGUINAL TRIANGLE OF HASSELBACH ) : 2.1. CAUDOMEDIAL LATERAL BORDER OF RECTUS ABDOMINIS MUSCLE 2.2. CRANIOLATERAL : A/V EPIGASTRICA INFERIOR ( INFERIOR EPIGASTRIC VESSELS ) 2.3. CAUDOMEDIOLATERALE : LIG.INGUINALE POUPARTI ( INGUINAL LIGAMENT OF POUPART )

LOCUS MINORIS RESISTENSIAE HERNIA INGUINALIS

HERNIA INGUINALIS ( INGUINAL HERNIA )

INDIRECTADIFFERENCESDIRECTACANALIS INGUINALISLOCATIONTRIGONUM INGUINALE HASSELBACHILATERALPOSITIONMEDIALCONGENITALBASED ONAQUISITA ( AQUIRED )YOUNG AGEAGEOLD AGEPOSITIVETOTALIS ( SCROTALIS; COMPLETE )NEGATIVE

CONTENT OF ABDOMINAL CAVITY1 . PARS ABDOMINALIS OESOPHAGEI ( ABDOMINAL PART OF ESOPHAGUS )2..TRACTUS GASTRO INTESTINALIS ( GASTRO-INTESTINAL TRACTS ). 2.1. GASTER 2.2. INTESTINUM TENUE MESOSTENIALE ( SMALL INTESTINES ) 2.2.1. DUODENUM 2.2.2. JEJUNUM 2.2.3. ILEUM 2.3. INTESTINUM CRASSUM (LARGE INTESTINES,LARGE BOWELS ) 2.3.1. APPENDIX VERMIFORMIS. 2.3.2. CAECUM 2.3.3. COLON ASCENDENS 2.3.4. COLON TRANSVERSUM 2.3.5. COLON DESCENDENS 2.3.6. COLON SIGMOID 2.3.7. RECTUM 2.3.8. CANALIS ANALIS. 2.3.9. ANUS 3. PARTS OF ORGANA DIGESTIVA ACCESSORIAE 3.1. HEPAR 3.2. VESICA FELLEA . 3.3.. PANCREAS 4. VESSELS AND NERVES OF ABDOMINAL ORGANS :

PROYECTION OF ABDOMINAL ORGANS1. REGION OF 4 QUADRANTS ( PERSONNEL HEALTH CARE ) HORIZ0NTAL VERTICAL LINES THROUGH NAVEL (UMBILICUS): 1.1. RIGHT UPPER QUADRANT: 1.2. LEFT UPPER QUADRANT - R-LOBE OF LIVER - L LOBE OF LIVER - VESICA FELLEA - GASTER (STOMACH) ( GALL BLADDER ) - CORPUS PANCREATICA - PYLORUS ( BODY OF PANCREAS ) - CAPUT PANCREATICA - FLEXURA SPLENICA COLI ( HEAD OF THE PANCREAS) (SPLENIC FLEX. OF COLON) - FLEXURA HEPATICA COLI - PARTES COLI TRANSV - PARTES COLI ASC.ET TRANSV DESC.( PORTIONS OF (PORTIONS OF ASC & TRANSV. TRANSV.&DESC.COLON) COLON ) 1.3. RIGHT LOWER QUADRANT 1.4. LEFT LOWER QUADRANT - CAECUM & APPENDIX - COLON SIGMOIDEA - PARS PROXIMALIS COLON ( SIGMOID COLON ) ASCENDENS ( PROXIMAL - PARS DISTALIS COLON PORTION OF ASCENDING DESCENDENS ( DISTAL COLON ) PORTION OF DESCEN. DING .COLON )

PROJECTION OF ABDOMINAL ORGANS 2. REGION OF 9: DETAIL & PRECISE : - 2 HORIZONTAL LINES : SUBCOSTAL & TRANSTUBERCULARIS : - 2 VERTICAL LINES THROUGH MID- INGUINAL POINTS. REGIONES ABDOMINALES :

2.1. CRANIALIS ( SUPERIOR ABDOMINAL ) 2.1.1. HYPOCHONDRICA DEXTRA 2.1.2. EPIGASTRICA 2.1.3. HYPOCHONDRICA SINISTRA 2.2. MEDIA ( MESOGASTRICA, MIDDLE ABD.) 2.2.1. LATERALIS (LUMBALIS) DEXTRA 2.2.2. UMBILICALIS 2.2.3. LATERALIS ( LUMBALIS ) SINISTRA 2.3. CAUDALIS ( HYPOGASTRICA,INFERIOR ABD) 2.3.1. INGUINALIS ( ILIACA ) DEXTRA 2.3.2. PUBICA 2.3.3. INGUINALIS ( ILIACA ) SINISTRA

LIVER ( HEPAR )LOCATION & SHAPE: RIGHT HYPOCHONDRIC, MOST OF EPIGASTRIC ,OFTEN EXPAND TO LEFT HYPOCHONDRIC TILL MAMMILLARY LINE.

WEIGHT : :1400 1600 GR :1200 1400 GR

CONSIST OF 2 LOBES 1. R - LOBE (LOBUS DEXTRA ) 1.1. QUADRATE LOBE ( LOBUS QUADRATUS ) 1.2. CAUDATE LOBE OF SPIGEL ( LOBUS CAUDATUS SPIGELI )2. LEFT LOBE ( LOBUS SINISTRA )

VESICA FELLEA ( GALL BLADDER )

PANCREASLOCATION : TRANSVERSELY AT THE DORSAL PART OF THE ABDOMINAL WALL IN EPIGAS-TRIC & LEFT HYPOCHONDRIC REGION.PARTS OF PANCREAS:1. HEAD OF PANCREAS ( CAPUT PANCREATIS ).

2. NECK OF PANCREAS ( COLLUM PANCREATIS ). 3. BODY OF PANCREAS ( CORPUS PANCREATIS ).

4. TAIL OF PANCREAS ( CAUDA PANCREATIS ).

DUCT OF PANCREAS ( DUCTUS PANCREATICUS )

VASCULARISATIO ORGANAE DIGESTIVAE ( BLOOD SUPPLY OF ABD.ORGANS ) AORTA THORACALIS

HIATUS AORTICUS DIAPHR. ( T12 )

AORTA ABDOMINALIS

1.TRIPUS HALLERI (A. COELIACA) ( T 12 ) 2.A. MESENTERICA SUPERIOR ( L 1 )3. A.MESENTERICA INFERIOR

A. COELIACA ( TRIPUS HALLERI,CELIAC ARTERY )

A. MESENTERICA SUPERIOR(SUPERIOR MESENTERIC ART.ORIGIN : Ao. ABDOMINALIS ( L1 )

BRANCHES :1. A. COLICA MEDIA ( MIDDLE COLIC ARTERY )2. A. PANCREATICODUODENALIS INFERIOR. ( INFERIOR PANCREATICODUODE NAL ARTERY ) 3. A. COLICA DEXTRA ( RIGHT COLIC ARTERY ) 4. A. ILEO-COLICA ( ILEO-COLIC ARTERY )5. AA.JEJUNALES ET ILEALES ( JEJUNO-ILEAL ARTERY )

A. MESENTERICA INFERIOR(INFERIOR MESENTERIC ARTERY )ORIGIN : AORTA ABDOMINALIS (ABDOMINAL AORTA) BRANCHES : 1. A. COLICA SINISTRA ( LEFT COLIC ARTERY ) 2. AA. SIGMOIDEAE ( SIGMOID ARTERY )

3. A. HAEMORRHOIDALIS SUPERIOR ( A. RECTALIS SUPERIOR,SUPERIOR RECTAL ARTERY )

A. MARGINALIS DRUMMONDI (MARGINAL ARTERY OF DRUMMOND )DEFINITION :ANASTOMOSES OF ARTERIALRAMIFICATION FROM BRANCHESOF SUPERIOR AND INFERIORMESENTERIC ARTERIES AT THEMARGIN OF INTESTINUMCRASSUM ( COLON ; LARGE BOWEL )

AXIOMA (ABSOLUT PRINCIPLES ):A. COELIACA : UPPER G I T AND ORGANA DIGESTIVA ACCESSO RIAE ( ACCESSORY DIGESTIVE ORGANS ).A.MESENT.SUP : LOWER G I T FLEX.COLI SIN ( SPLEENIC FLEXUREA. MESENT. INF. : THE REST OF LOWER G I T.

INNERVATION OF ABDOMINAL ORGANSAUTONOMIC NERVOUS SYSTEM :1. SYMPATHETIC NERVE SYSTEM:: NN.SPLANCHNICAE: 1.1. MAJOR ( T5-9 ) 1.2. MINOR ( T9-10 )

2. PARASYMPATHETIC NERVE SYSTEM: 2.1. N. VAGUS 2.2. N.SPLANCHNICUS PELVICUM (S2-4)

SOURCESBAMAJIAN ; J V : GRANTS METHOD OF ANATOMY; THE WILLIAMS & WILKINS COMPANY ; CALCUTTA.KAHLE, W; LEONHARDT, H & PLETZER, W : COLOR ATLAS AND TEXTBOOK OF HUMAN ANATOMY; GEORGE THIEM PUBLISHER; STUTTGART.ROGERS, A W : TEXTBOOK OF ANATOMY; CHURCHILL & LIVINGSTONE ; LONDON TOKYO.SPALTEHOLZ, WERNER : HANDATLAS UND LEHRBUCH DER ANATOMIE DES MENSCHEN ; SCHELTEMA & HOLKEMA NV ; AMSTERDAM.

Tim Adhoc Pelaksana Penyiapan Program Internsip Dokter Indonesia*

Tim Adhoc Pelaksana Penyiapan Program Internsip Dokter Indonesia