Abdomen: General description

Lies between the diaphragm and the pelvic inlet.

Is the largest cavity in the body and is continuous with the pelvic cavity.

Lined with parietal peritoneum, a serous membrane

Bounded superiorly by the diaphragm

Has a concave dome

Spleen, liver, part of the stomach, and part of the kidneys lies under the dome and
are protected by the lower ribs and costal cartilages.

Lower extent lies in the greater pelvis

o

Between the ala or wings of the ilia

Ileum, cecum, and sigmoid colon thus partly protected

Anterior and lateral walls composed of muscle

o

Viscera in these areas are more likely to be damaged by blunt force and
penetrating injuries.

Posterior wall comprised of vertebral column, the lower ribs, and associated muscles

Protect the abdominal contents.

Bony landmarks of the abdomen
Xiphoid process
o

Lower six costal cartilages

Anterior ends of the lower six ribs (ribs 7 to 12) (Section 3-3: Thorax-Body Wall)

Lumbar vertebrae (L1 to L5)

Pelvis
o

Iliac crest

Anterior superior iliac spine (ASIS)

Anterior inferior iliac spine

Pubic symphysis

o Pubic crest and pubic tubercle

Abdomen: Topographical anatomy

page 124

page 125
Costal margin: Formed by the medial borders of the 7th through 10th costal cartilages

Rectus sheath

From xiphoid process and 5th through 7th costal cartilages pubic symphysis
and pubic crest

Contains rectus abdominis muscle (Section 4-2: Abdomen-Body Wall)

Linea alba
o

A slight indentation that can sometimes be seen extending from the xiphoid
process to the pubic symphysis

A fibrous raphe where the aponeuroses of the external and internal abdominal
oblique and the transversus abdominis muscles on either side unite.

Semilunar line (linea semilunaris)

o

Vertical indentation seen as a curved line from the tip of the ninth rib cartilage to
the pubic tubercle on each side in well-muscled individuals

Represents the lateral edge of the rectus abdominus muscle

Tendinous intersections
o

Transverse attachments between the anterior rectus sheath and rectus abdominis
muscle

May be seen as transverse grooves in skin on either side of midline (six-pack)

Inguinal ligament
o

From ASIS to pubic tubercle of pelvis

Folded inferior edge of external abdominal aponeurosis

Separates abdominal region from thigh

Umbilicus
o

At approximate level of intervertebral disc between the L3 and L4

Marks the T10 dermatome

Liver
o

Mainly in the right upper quadrant, behind ribs 7 through 11 on the right side

Crosses the midline to reach towards the left nipple (Section 4-5: Abdomen-

Viscera (Accessory Organs))

Spleen
o

Beneath ribs 9 through 11 on the left side

10th rib is axis of spleen

Kidneys
o

Located in loin region

Left kidney is higher than right (pelvis at L1/2 on left and L2/3 on right) (Section
4-8: Abdomen-Kidneys and Suprarenal Glands)
Abdominal contents
page 125
o

page 126

Gastrointestinal tract
o

Stomach

Duodenum

Ileum

Jejunum

Cecum and appendix

Ascending, transverse and descending colon

Part of the sigmoid colon

Accessory digestive organs

o

Liver

Gallbladder

Pancreas

Spleen

Suprarenal glands

Urinary system-kidneys and ureters

o

Kidneys are the only organs developing beneath the parietal peritoneum

Never have a mesentery

Thus are primarily retroperitoneal

Organs that develop within the abdominal cavity and then become retroperitoneal
o

Are called secondarily retroperitoneal

Pancreas

Two thirds of the duodenum

Ascending and descending colon.

All the rest of the organs are peritoneal

o

Lie within the peritoneal cavity

Covered by a layer of visceral peritoneum

Visceral peritoneum is continuous with the parietal peritoneum lining the cavity
via a mesentery.
Abdominal regions
Abdominal quadrants
o

Clinicians usually divide the abdomen is into four quadrants for descriptive
purposes, using the following planes:

Median plane: imaginary vertical line following the line alba from the
xiphoid process to the pubic symphysis

Transumbilical plane: imaginary horizontal line at the level of the

umbilicus

These lines or planes create four quadrants

Right upper

Left upper

Right lower

Left lower

Abdominal regions
o

Clinicians may divide the abdomen into nine regions

For more accurate descriptive and diagnostic purposes

Use two vertical and three horizontal lines or planes

Horizontal planes (in descending order):

Subcostal plane: passes through the lower border of the 10th costal
cartilage on either side

Sometimes the transpyloric plane is used instead of the subcostal; passes

through the pylorus on the right and the tips of the ninth costal cartilage on
either side

Transumbilical plane: passes through the umbilicus at the level of the L3/4
intervertebral disc

Transtubercular (intertubercular) plane: passes through the tubercles of

the iliac crests and the body of L5

Vertical planes

Right midclavicular line

Left midclavicular line

Pass from the midpoint of the clavicle to the midpoint of inguinal

ligament.

These planes create nine abdominal regions:

Right and left hypochondriac regions, superiorly on either side

Right and left lumbar (flank) regions, centrally on either side

Right and left inguinal (groin) regions, inferiorly on either side

Epigastric region superiorly and centrally

Umbilical region, with the umbilicus as its center

Hypogastric or suprapubic region, inferiorly and centrally

Descriptive quadrants and regions are essential in clinical practice

o

Each area represents certain visceral structures

Allow correlation of pain and referred pain from these areas to specific organs.

Regions and quadrants are palpated, percussed, and auscultated during clinical
examination
page 126
page 127

Contents of the Abdominal Quadrants

Right Upper Quadrant (RUQ)
Liver (right lobe)

Left Upper Quadrant (lUQ)

Liver (left lobe)

Gallbladder
Spleen
Pylorus (of stomach)
Stomach
Duodenum (parts 1 through 3)
Jejunum and proximal ileum
Pancreas (head)
Pancreas (body and tail)
Right kidney and suprarenal gland
Left kidney and suprarenal gland
Colon: distal ascending colon, hepatic flexure Colon: left half of transverse colon, splenic
and right half of transverse colon
flexure and superior part of descending colon
Right Lower Quadrant (RLQ)
Left Lower Quadrant (LLQ)
Majority of ileum
Distal descending colon
Cecum with vermiform appendix
Sigmoid colon
Proximal ascending colon
Left ureter
Proximal right ureter
Ovaries
Uterine tubes
Right and left ductus deferens
Uterus (if enlarged)
Urinary bladder (if full, especially in women)
Peritoneum
page 138
page 139

Serous membrane
o

Lines the abdominopelvic cavity

Consists of two continuous layers of mesothelium:

Parietal peritoneum

Lines the internal abdominal wall

Receives its neurovascular supply from the region of the wall it lines

Visceral peritoneum

Invests abdominal viscera

Receives its neurovascular supply from that of organ

Peritoneal cavity
o

A potential space between the parietal and visceral layers of the peritoneum

Contains a thin film of fluid

No organs actually lie within this potential space

Males: peritoneal cavity is completely closed

Females: communicates with exterior of body via uterine tubes, uterus, and
vagina

Intraperitoneal organs
o

Are organs nearly totally covered by visceral peritoneum

Not actually inside the peritoneal cavity, but project into the peritoneal cavity

Are covered by peritoneum

Are attached to body wall and other organs by mesenteries and ligaments

Include:

Liver

Spleen

Stomach

First part of duodenum

Jejunum

Ileum

Transverse colon

Sigmoid colon

Superior rectum

Primarily retroperitoneal organs

o

Organs that develop and remain beneath the parietal peritoneum

Only the kidneys

Secondarily retroperitoneal organs

o

Organs that developed with a short mesentery

Become pushed against parietal peritoneum lining the body wall by growth of
other organs, primarily the small intestine.

Mesentery of organ fuses with parietal peritoneum: fusion fascia

Peritoneum covers only its anterior surface, hence, secondarily retroperitoneal

Organ can be freed at its lateral edge, along the plane of the fusion fascia

Include

Adrenal glands

Pancreas

Parts two through four of the duodenum

Ascending and descending colon

Omentum = double-layered fold of peritoneum

Lesser omentum: connects lesser curve of stomach and proximal duodenum to liver

Passes from the stomach and first part of the duodenum to adjacent organs

Consists of two parts:

Hepatogastric ligament

Hepatoduodenal ligament

Greater omentum
o

Hangs down from the greater curve of the stomach and proximal duodenum

o Folds back on itself to attach to the transverse colon

Mesenteries
Mesentery = double layer of peritoneum created by invagination of peritoneum by an
organ

Is the continuity of visceral and parietal peritoneum

Provides a pathway for neurovascular communication between organ and body wall

Contains lymph nodes and variable amounts of fat

The mesentery is the mesentery of the small intestine

The mesocolon is the mesentery of the large intestine

o

Transverse mesocolon

Sigmoid mesocolon
Peritoneal ligaments
o

page 139

page 140
Ligament = double layer of peritoneum connecting an organ to another organ or to the
abdominal wall

Ligaments of the liver:

o

Falciform ligament: from liver to anterior abdominal wall

Gastrohepatic ligament

From lesser curvature of stomach to liver

= a portion of lesser omentum

Hepatoduodenal ligament

From the liver to the first part of the duodenum

= Right, thickened free edge of lesser omentum

Contains portal triad (portal vein, hepatic artery, bile duct)

Ligaments of the stomach

o

Gastrophrenic ligament: from stomach to inferior diaphragmatic surface

Gastrosplenic ligament: from stomach to hilum of spleen

Gastrocolic ligament: from stomach as the greater omentum to the transverse

colon

Ligaments of the spleen

o

Gastrosplenic: from stomach to hilum of spleen

Splenorenal (lienorenal): from spleen to the left kidney

Phrenicocolic ligament (sustentaculum lienis)

o

From the left hepatic flexure of transverse colon to diaphragm

o Supports the spleen

Peritoneal subdivisions
Greater sac: main peritoneal cavity

Lesser sac (omental bursa)

o

Posterior to the stomach

Visible through the lesser omentum

Superior recess: limited by the diaphragm and posterior layers of the coronary
ligament of the liver (Section 4-4: Abdomen-Viscera (Gut))

Inferior recess: potential space between layers of the greater omentum

Communicates with the greater sac via the epiploic foramen (of Winslow)
Boundaries of the epiploic foramen
Boundary Structures
Anterior Hepatoduodenal ligament containing portal triad
Posterior Inferior vena cava (IVC) and right crus of diaphragm which is covered by the parietal
peritoneum
Superior Caudate lobe of liver which is covered by the visceral peritoneum
Inferior First part of duodenum, portal vein, hepatic artery, bile duct
o

Supracolic compartment
o

Greater sac above the transverse mesocolon

Contains stomach, liver, and spleen

Infracolic compartment
o

Greater sac below transverse mesocolon,

Contains small bowel, ascending and descending colon.

Divided into left and right divisions by the mesentery of the small intestine

Free communication between the supracolic and infracolic compartments via the
paracolic gutter

Grooves or recesses between the ascending and descending colon and the
posterior abdominal wall along their lateral borders

Abdomen: General description

Lies between the diaphragm and the pelvic inlet.

Is the largest cavity in the body and is continuous with the pelvic cavity.

Lined with parietal peritoneum, a serous membrane

Bounded superiorly by the diaphragm

Has a concave dome

o
Spleen, liver, part of the stomach, and part of the kidneys lies under the
dome and are protected by the lower ribs and costal cartilages.

Lower extent lies in the greater pelvis

Between the ala or wings of the ilia

Ileum, cecum, and sigmoid colon thus partly protected

Anterior and lateral walls composed of muscle

o
Viscera in these areas are more likely to be damaged by blunt force and
penetrating injuries.

Posterior wall comprised of vertebral column, the lower ribs, and associated
muscles
o

Protect the abdominal contents.

Bony landmarks of the abdomen

Xiphoid process

Lower six costal cartilages

Anterior ends of the lower six ribs (ribs 7 to 12) (Section 3-3: Thorax-Body
Wall)

Lumbar vertebrae (L1 to L5)

Pelvis

Iliac crest

Anterior superior iliac spine (ASIS)

Anterior inferior iliac spine

Pubic symphysis

Pubic crest and pubic tubercle

Abdomen: Topographical anatomy

page 124

page 125

Costal margin: Formed by the medial borders of the 7th through 10th costal
cartilages

Rectus sheath

o
From xiphoid process and 5th through 7th costal cartilages pubic
symphysis and pubic crest
o

Contains rectus abdominis muscle (Section 4-2: Abdomen-Body Wall)

Linea alba

o
A slight indentation that can sometimes be seen extending from the xiphoid
process to the pubic symphysis
o
A fibrous raphe where the aponeuroses of the external and internal
abdominal oblique and the transversus abdominis muscles on either side unite.

Semilunar line (linea semilunaris)

o
Vertical indentation seen as a curved line from the tip of the ninth rib
cartilage to the pubic tubercle on each side in well-muscled individuals
o

Represents the lateral edge of the rectus abdominus muscle

Tendinous intersections

o
Transverse attachments between the anterior rectus sheath and rectus
abdominis muscle
o

May be seen as transverse grooves in skin on either side of midline (six-pack)

Inguinal ligament

From ASIS to pubic tubercle of pelvis

Folded inferior edge of external abdominal aponeurosis

Separates abdominal region from thigh

Umbilicus

At approximate level of intervertebral disc between the L3 and L4

Marks the T10 dermatome

Liver

Mainly in the right upper quadrant, behind ribs 7 through 11 on the right side

o
Crosses the midline to reach towards the left nipple (Section 4-5: AbdomenViscera (Accessory Organs))

Spleen

Beneath ribs 9 through 11 on the left side

10th rib is axis of spleen

Kidneys

Located in loin region

o
Left kidney is higher than right (pelvis at L1/2 on left and L2/3 on right)
(Section 4-8: Abdomen-Kidneys and Suprarenal Glands)
Abdominal contents
page 125

page 126

Gastrointestinal tract

Stomach

Duodenum

Ileum

Jejunum

Cecum and appendix

Ascending, transverse and descending colon

Part of the sigmoid colon

Accessory digestive organs

Liver

Gallbladder

Pancreas

Spleen

Suprarenal glands

Urinary system-kidneys and ureters

Kidneys are the only organs developing beneath the parietal peritoneum

Never have a mesentery

Thus are primarily retroperitoneal

Organs that develop within the abdominal cavity and then become
retroperitoneal
o

Are called secondarily retroperitoneal

Pancreas

Two thirds of the duodenum

Ascending and descending colon.

All the rest of the organs are peritoneal

Lie within the peritoneal cavity

Covered by a layer of visceral peritoneum

o
Visceral peritoneum is continuous with the parietal peritoneum lining the
cavity via a mesentery.
Abdominal regions

Abdominal quadrants

o
Clinicians usually divide the abdomen is into four quadrants for descriptive
purposes, using the following planes:

Median plane: imaginary vertical line following the line alba from the xiphoid
process to the pubic symphysis

Transumbilical plane: imaginary horizontal line at the level of the umbilicus

These lines or planes create four quadrants

Right upper

Left upper

Right lower

Left lower

Abdominal regions

Clinicians may divide the abdomen into nine regions

For more accurate descriptive and diagnostic purposes

Use two vertical and three horizontal lines or planes

Horizontal planes (in descending order):

Subcostal plane: passes through the lower border of the 10th costal cartilage
on either side

Sometimes the transpyloric plane is used instead of the subcostal; passes

through the pylorus on the right and the tips of the ninth costal cartilage on either
side

Transumbilical plane: passes through the umbilicus at the level of the L3/4
intervertebral disc

Transtubercular (intertubercular) plane: passes through the tubercles of the

iliac crests and the body of L5
o

Vertical planes

Right midclavicular line

Left midclavicular line

Pass from the midpoint of the clavicle to the midpoint of inguinal ligament.

These planes create nine abdominal regions:

Right and left hypochondriac regions, superiorly on either side

Right and left lumbar (flank) regions, centrally on either side

Right and left inguinal (groin) regions, inferiorly on either side

Epigastric region superiorly and centrally

Umbilical region, with the umbilicus as its center

Hypogastric or suprapubic region, inferiorly and centrally

Descriptive quadrants and regions are essential in clinical practice

Each area represents certain visceral structures

o
Allow correlation of pain and referred pain from these areas to specific
organs.

Regions and quadrants are palpated, percussed, and auscultated during

clinical examination
page 126

page 127
Contents of the Abdominal Quadrants
Right Upper Quadrant (RUQ)

Left Upper Quadrant (lUQ)

Liver (right lobe)

Gallbladder
Pylorus (of stomach)
Duodenum (parts 1 through 3)
Pancreas (head)
Right kidney and suprarenal gland
Colon: distal ascending colon, hepatic flexure and right half of transverse colon
Liver (left lobe)
Spleen

Stomach
Jejunum and proximal ileum
Pancreas (body and tail)
Left kidney and suprarenal gland
Colon: left half of transverse colon, splenic flexure and superior part of descending
colon
Right Lower Quadrant (RLQ)

Left Lower Quadrant (LLQ)

Majority of ileum
Cecum with vermiform appendix
Proximal ascending colon
Proximal right ureter

Distal descending colon

Sigmoid colon
Left ureter
Ovaries
Uterine tubes
Right and left ductus deferens
Uterus (if enlarged)
Urinary bladder (if full, especially in women)
Peritoneum
page 138

page 139

Serous membrane

Lines the abdominopelvic cavity

Consists of two continuous layers of mesothelium:

Parietal peritoneum

Lines the internal abdominal wall

Receives its neurovascular supply from the region of the wall it lines

Visceral peritoneum

Invests abdominal viscera

Receives its neurovascular supply from that of organ

Peritoneal cavity

A potential space between the parietal and visceral layers of the peritoneum

Contains a thin film of fluid

No organs actually lie within this potential space

Males: peritoneal cavity is completely closed

o
Females: communicates with exterior of body via uterine tubes, uterus, and
vagina

Intraperitoneal organs

Are organs nearly totally covered by visceral peritoneum

Not actually inside the peritoneal cavity, but project into the peritoneal cavity

Are covered by peritoneum

Are attached to body wall and other organs by mesenteries and ligaments

Include:

Liver

Spleen

Stomach

First part of duodenum

Jejunum

Ileum

Transverse colon

Sigmoid colon

Superior rectum

Primarily retroperitoneal organs

Organs that develop and remain beneath the parietal peritoneum

Only the kidneys

Secondarily retroperitoneal organs

Organs that developed with a short mesentery

o
Become pushed against parietal peritoneum lining the body wall by growth of
other organs, primarily the small intestine.
o

Mesentery of organ fuses with parietal peritoneum: fusion fascia

o
Peritoneum covers only its anterior surface, hence, secondarily
retroperitoneal
o

Organ can be freed at its lateral edge, along the plane of the fusion fascia

Include

Adrenal glands

Pancreas

Parts two through four of the duodenum

Ascending and descending colon

Omentum = double-layered fold of peritoneum

Lesser omentum: connects lesser curve of stomach and proximal duodenum

to liver
o

Passes from the stomach and first part of the duodenum to adjacent organs

Consists of two parts:

Hepatogastric ligament

Hepatoduodenal ligament

Greater omentum

Hangs down from the greater curve of the stomach and proximal duodenum

Folds back on itself to attach to the transverse colon

Mesenteries


Mesentery = double layer of peritoneum created by invagination of
peritoneum by an organ

Is the continuity of visceral and parietal peritoneum

Provides a pathway for neurovascular communication between organ and

body wall

Contains lymph nodes and variable amounts of fat

The mesentery is the mesentery of the small intestine

The mesocolon is the mesentery of the large intestine

Transverse mesocolon

Sigmoid mesocolon

Peritoneal ligaments
page 139

page 140

Ligament = double layer of peritoneum connecting an organ to another organ

or to the abdominal wall

Ligaments of the liver:

Falciform ligament: from liver to anterior abdominal wall

Gastrohepatic ligament

From lesser curvature of stomach to liver

= a portion of lesser omentum

Hepatoduodenal ligament

From the liver to the first part of the duodenum

= Right, thickened free edge of lesser omentum

Contains portal triad (portal vein, hepatic artery, bile duct)

Ligaments of the stomach

Gastrophrenic ligament: from stomach to inferior diaphragmatic surface

Gastrosplenic ligament: from stomach to hilum of spleen

o
Gastrocolic ligament: from stomach as the greater omentum to the
transverse colon

Ligaments of the spleen

Gastrosplenic: from stomach to hilum of spleen

Splenorenal (lienorenal): from spleen to the left kidney

Phrenicocolic ligament (sustentaculum lienis)

From the left hepatic flexure of transverse colon to diaphragm

Supports the spleen

Peritoneal subdivisions

Greater sac: main peritoneal cavity

Lesser sac (omental bursa)

Posterior to the stomach

Visible through the lesser omentum

o
Superior recess: limited by the diaphragm and posterior layers of the
coronary ligament of the liver (Section 4-4: Abdomen-Viscera (Gut))
o

Inferior recess: potential space between layers of the greater omentum

Communicates with the greater sac via the epiploic foramen (of Winslow)

Boundaries of the epiploic foramen

Boundary

Structures

Anterior

Hepatoduodenal ligament containing portal triad

Posterior
Inferior vena cava (IVC) and right crus of diaphragm which is covered
by the parietal peritoneum
Superior

Caudate lobe of liver which is covered by the visceral peritoneum

Inferior

First part of duodenum, portal vein, hepatic artery, bile duct

Supracolic compartment

Greater sac above the transverse mesocolon

Contains stomach, liver, and spleen

Infracolic compartment

Greater sac below transverse mesocolon,

Contains small bowel, ascending and descending colon.

Divided into left and right divisions by the mesentery of the small intestine

o
Free communication between the supracolic and infracolic compartments via
the paracolic gutter

Grooves or recesses between the ascending and descending colon and the
posterior abdominal wall along their lateral borders

Abdomen: Gambaran umum

terletak antara diafragma dan inlet panggul.
Apakah rongga terbesar dalam tubuh dan kontinu dengan rongga panggul.
Berjajar dengan peritoneum parietal, membran serosa
Bounded superior oleh diafragma
o Memiliki kubah cekung
Limpa o, hati, bagian perut, dan bagian dari ginjal terletak di bawah kubah dan
dilindungi oleh tulang rusuk yang lebih rendah dan kartilago kosta.
sejauh rendah terletak di panggul yang lebih besar
o Antara ala atau sayap ilia
o ileum, sekum, dan kolon sigmoid sehingga sebagian dilindungi
anterior dan lateral dinding terdiri dari otot
o jeroan di daerah ini lebih mungkin rusak oleh benda tumpul dan luka tembus.
Posterior dinding terdiri dari tulang punggung, tulang rusuk yang lebih rendah,
dan otot yang terkait
o Melindungi isi perut.
Bony landmark perut
Proses Xifoid
Turunkan enam kartilago kosta
anterior ujung dari enam tulang rusuk yang lebih rendah (rusuk 7 sampai 12)
(Bagian 3-3: Thorax-Body Dinding)
Lumbar vertebrae (L1 untuk L5)

 Pelvis
o iliaka crest
o anterior spina iliaka superior (ASIS)
o anterior tulang rendah iliaka
o kemaluan simfisis
o kemaluan puncak dan kemaluan tuberkulum
Abdomen: anatomi topografi
halaman 124

halaman 125
Pesisir margin: Dibentuk oleh perbatasan medial 7 melalui kartilago kosta ke-10
rektus selubung
o Dari proses Xifoid dan ke-5 melalui kartilago kosta 7 simfisis pubis dan puncak
kemaluan
o Berisi otot rektus abdominis (Bagian 4-2: Abdomen-Body Dinding)
Linea alba
o lekukan sedikit yang kadang-kadang dapat dilihat membentang dari proses Xifoid
ke simfisis pubis
o raphe berserat mana aponeurosis dari miring perut eksternal dan internal dan
otot-otot transversus abdominis di kedua sisi bersatu.
semilunar line (linea semilunaris)
o Vertikal lekukan dilihat sebagai garis melengkung dari ujung tulang rawan rusuk
kesembilan ke tuberkulum pubikum di setiap sisi dalam berotot individu
o Merupakan tepi lateral dari otot rektus abdominus
tendon persimpangan
o Transverse lampiran antara selubung rektus anterior dan otot rektus abdominis
o Dapat dilihat sebagai alur melintang pada kulit di kedua sisi garis tengah (sixpack)
inguinalis ligamen
o Dari ASIS ke tuberkulum pubikum panggul
o Dilipat tepi inferior aponeurosis perut eksternal
o Memisahkan daerah perut dari paha
umbilikus
o Pada tingkat perkiraan disc intervertebralis antara L3 dan L4
o Menandai dermatom T10
Hati
o Terutama di kuadran kanan atas, di belakang tulang rusuk 7 hingga 11 di sisi
kanan
o Crosses garis tengah untuk mencapai ke arah puting kiri (Bagian 4-5: Abdomenjeroan (Organ Aksesori))
Limpa
o Di bawah rusuk 9 sampai 11 di sisi kiri
rusuk o 10 adalah sumbu limpa

 Ginjal
o Terletak di daerah pinggang
ginjal o kiri lebih tinggi dari kanan (panggul di L1 / 2 di sebelah kiri dan L2 / 3 di
kanan) (Bagian 4-8: Abdomen-Ginjal dan Kelenjar suprarenal)
Perut Isi
halaman 125

Halaman 126
Saluran cerna
o Perut
o Duodenum
o ileum
o jejunum
o sekum dan usus buntu
o Ascending, melintang dan usus menurun
o Bagian dari kolon sigmoid
organ pencernaan Aksesori
o Hati
o Kandung empedu
o Pankreas
Limpa
suprarenal kelenjar
urin sistem ginjal dan ureter
Ginjal adalah organ o hanya mengembangkan di bawah peritoneum parietal
o Tidak pernah mesenterium yang
o Jadi terutama retroperitoneal
Organ yang berkembang di dalam rongga perut dan kemudian menjadi
retroperitoneal
o Apakah disebut sekunder retroperitoneal
o Pankreas
o Dua pertiga dari duodenum
o Terkecil dan kolon desendens.
Semua sisa organ yang peritoneal
o Lie dalam rongga peritoneal
o Covered oleh lapisan peritoneum visceral
o Visceral peritoneum kontinu dengan peritoneum parietal yang melapisi rongga
melalui mesenterium a.
Perut daerah
abdomen kuadran
Dokter biasanya membagi o perut adalah menjadi empat kuadran untuk tujuan
deskriptif, dengan menggunakan pesawat sebagai berikut:
Median pesawat: garis vertikal imajiner mengikuti alba garis dari proses Xifoid ke
simfisis pubis

Transumbilical pesawat: garis horisontal imajiner pada tingkat umbilikus

o Garis-garis atau pesawat membuat empat kuadran
Kanan atas
Kiri atas
Kanan rendah
Kiri rendah
Perut daerah
Dokter o dapat membagi perut menjadi sembilan daerah
Untuk tujuan deskriptif dan diagnostik yang lebih akurat
Gunakan dua garis horizontal vertikal dan tiga atau pesawat
o Horizontal pesawat (dalam urutan):
pesawat subkostal: melewati batas bawah kartilago kosta ke-10 di kedua sisi
Kadang-kadang pesawat transpilorik digunakan bukan subkostal, melewati pilorus
di sebelah kanan dan ujung kartilago kosta kesembilan di kedua sisi
Transumbilical pesawat: melewati umbilikus pada tingkat disc L3 / 4
intervertebralis
Transtubercular (intertuberkularis) pesawat: melewati tuberkel dari puncak-puncak
iliaka dan tubuh L5
o pesawat Vertikal
linea Kanan
linea Kiri
Lulus dari titik tengah klavikula ke titik tengah ligamen inguinal.
o Pesawat ini membuat sembilan daerah perut:
hipokondriak daerah kanan dan kiri, superior di kedua sisi
kanan dan kiri lumbar (sayap) daerah, terpusat di kedua sisi
kanan dan kiri inguinal (selangkangan) daerah, inferior di kedua sisi
daerah epigastrik superior dan terpusat
umbilical wilayah, dengan umbilikus sebagai pusatnya
wilayah hipogastrikus atau suprapubik, inferior dan terpusat
kuadran deskriptif dan daerah sangat penting dalam praktek klinis
o Setiap daerah merupakan struktur visceral tertentu
o Biarkan korelasi rasa sakit dan nyeri alih dari daerah-daerah pada organ tertentu.
Daerah dan kuadran yang diraba, percussed, dan diauskultasi selama
pemeriksaan klinis
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halaman 127
Isi perut Kuadran
Kuadran kanan atas (kuadran kanan atas) Kiri Atas Quadrant (Luq)
Hati (lobus kanan)

Empedu
Pilorus (perut)
Duodenum (bagian 1 sampai 3)
Pankreas (kepala)
Kanan ginjal dan kelenjar suprarenal
Colon: distal kolon, ascending hati lentur dan setengah hak Hati kolon melintang
(lobus kiri)
Limpa
Perut
Jejunum dan ileum proksimal
Pankreas (badan dan ekor)
Kiri ginjal dan kelenjar suprarenal
Colon: kiri setengah dari melintang, lentur usus limpa dan bagian superior dari
kolon desendens
Kuadran kanan bawah (RLQ) Kiri Kuadran Bawah (LLQ)
Mayoritas ileum
Sekum dengan lampiran berbentuk ulat
Proksimal usus menaik
Proksimal usus ureter yang tepat turun distal
Sigmoid kolon
Kiri ureter
Ovarium
Uterine tabung
Kanan dan kiri duktus deferens
Uterus (jika diperbesar)
Kemih kandung kemih (jika penuh, terutama pada wanita)
Selaput perut
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Halaman 139
serosa membran
o Garis rongga abdominopelvic
o Terdiri dari dua lapisan terus menerus mesothelium:
o parietal peritoneum
Garis dinding perut internal yang
Menerima pasokan neurovaskular nya dari daerah dinding itu baris
o Visceral peritoneum
Investasi visera abdomen
Menerima pasokan neurovaskular dari bahwa organ
Peritoneal rongga
o ruang potensial antara parietal dan lapisan viseral dari peritoneum
o Berisi film tipis cairan

o Tidak ada organ sebenarnya terletak dalam ruang ini potensial

o Jantan: rongga peritoneal benar-benar tertutup
o Wanita: berkomunikasi dengan eksterior tubuh melalui tabung rahim, rahim, dan
vagina
intraperitoneal organ
o Apakah organ hampir benar-benar tertutup oleh visceral peritoneum
o Tidak benar-benar dalam rongga peritoneal, tetapi proyek ke dalam rongga
peritoneal
o Apakah ditutupi oleh peritoneum
o Apakah melekat pada dinding tubuh dan organ lainnya oleh polip dan ligamen
o Termasuk:
Hati
Limpa
Perut
Pertama bagian dari duodenum
jejunum
ileum
Transverse usus
sigmoid kolon
Unggul rektum
Terutama retroperitoneal organ
o Organ yang berkembang dan tetap di bawah peritoneum parietal
o Hanya ginjal
Sekunder retroperitoneal organ
o Organ yang berkembang dengan mesenterium singkat
o Menjadi mendorong terhadap peritoneum parietal yang melapisi dinding tubuh
oleh pertumbuhan organ lain, terutama usus kecil.
o Mesenterium sekering organ dengan peritoneum parietal: fasia fusion
o Peritoneum hanya mencakup permukaan anterior nya, maka, sekunder
retroperitoneal
o Organ dapat dibebaskan di tepi lateral, sepanjang bidang fasia fusi
o Sertakan
adrenal kelenjar
Pankreas
Bagian dua sampai empat dari duodenum
Terkecil dan kolon desendens
omentum = berlapis ganda kali lipat dari peritoneum
Lesser omentum: menghubungkan kurva yang lebih rendah dari lambung dan
duodenum proksimal ke hati
o Passes dari bagian perut dan pertama dari duodenum ke organ yang berdekatan
o Terdiri dari dua bagian:
Hepatogastric ligament

Hepatoduodenal ligamen
Greater omentum
o Hang turun dari kurva yang lebih besar dari perut dan duodenum proksimal
o melipat kembali pada dirinya sendiri untuk melampirkan ke kolon transversum
Polip
Mesenterium lapisan ganda peritoneum = diciptakan oleh invaginasi peritoneum
oleh organ
Apakah kelangsungan peritoneum viseral dan parietal
Menyediakan jalur untuk komunikasi neurovaskular antara organ dan dinding
tubuh
Berisi kelenjar getah bening dan jumlah variabel lemak
mesenterium adalah mesenterium usus kecil
mesokolon adalah mesenterium usus besar
o Transverse Mesokolon
o Sigmoid mesokolon
Peritoneal ligamen
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halaman 140
Ligamentum lapisan = peritoneum ganda yang menghubungkan organ ke organ
lain atau ke dinding perut
Ligamen dari hati:
o bengkok ligamen: dari hati ke dinding anterior abdomen
o Gastrohepatic ligamen
Dari kurvatura minor lambung ke hati
= sebagian kecil omentum
o Hepatoduodenal ligamen
Dari hati ke bagian pertama dari duodenum
= kanan tepi, bebas penebalan lebih rendah omentum
Mengandung Portal triad (vena portal, arteri hepatika, saluran empedu)
Ligamen dari perut
o Gastrophrenic ligamen: dari perut ke permukaan diafragma rendah
o gastrolienale ligamen: dari perut ke hilus lien
o Gastrocolic ligamen: dari perut sebagai omentum yang lebih besar pada kolon
transversal
Ligamen limpa
o gastrolienale: dari perut ke hilus lien
o Splenorenal (lienorenale): dari limpa ke ginjal kiri
Phrenicocolic ligamentum (sustentaculum lienis)
o Dari lentur hati kiri kolon melintang diafragma
o Mendukung limpa
Peritoneal subdivisi

 Greater sac: rongga peritoneal utama

Lesser kantung (omentum bursa)
o Posterior ke perut
o Terlihat melalui omentum minus
o Unggul istirahat: dibatasi oleh diafragma dan lapisan posterior ligamentum
koroner hati (Bagian 4-4: Abdomen-jeroan (Gut))
o Inferior istirahat: ruang potensial antara lapisan omentum yang lebih besar
o Berkomunikasi dengan kantung besar melalui foramen epiploika (dari Winslow)
Batas foramen epiploika
Batas Struktur
Anterior Hepatoduodenal ligamen mengandung Portal triad
Posterior inferior vena cava (IVC) dan kanan crus dari diafragma yang ditutupi oleh
peritoneum parietal
Berekor superior lobus hati yang ditutupi oleh peritoneum viseral
Inferior Pertama bagian dari duodenum, vena portal, arteri hepatika, saluran
empedu
Supracolic kompartemen
o lebih besar kantung atas mesokolon transversum
o Berisi lambung, hati, dan limpa
Infracolic kompartemen
o lebih besar kantung bawah melintang Mesokolon,
o Berisi usus kecil, usus besar naik dan turun.
o Terbagi dalam divisi kiri dan kanan oleh mesenterium usus kecil
o Gratis komunikasi antara kompartemen supracolic dan infracolic melalui selokan
paracolic
Grooves atau relung antara usus turun naik dan dinding perut posterior sepanjang
perbatasan lateral mereka