1、applied anatomyof abdomenDr. Craig G. AdamsDept of Surgery at RMH The University of Melbournetopics to be covered • anterior abdominal wall • peritoneal cavity • gastrointestinal tract • liver, biliary tract &pancreas • spleen5/5/2007 2 anterior abdominal wall•
2、what is the difference between somatic& visceral pain in the abdomen ? •what is the distribution of referred pain for abdominal viscera ? –esp.appendix& ureter5/5/2007 3 somatic & visceral pain somaticpain visceral pain •localized•poorly localized –can point–va
4、ed pain gut unpaired viscera (even ifnotinthe midline) refer to the midline •foregut (mouth to 2nd part of duodenum)Ô pain referred to epigastrium•midgut (2nd part duod. to prox. 2/3 transv. colon) Ô pain referred to umbilical region•hindgut (distal 1/3 colon
5、to proximal anal canal)Ô pain referred to suprapubic region5/5/2007 7 5/5/2007 8anterior abdominal wallwhatisthe nerve supplyofthe peritoneum? –comparing theinnervation of parietal & visceral peritoneum5/5/2007 9 nerve supply of peritoneum visceral parietal •?
6、no afferent •segmentallyby spinalnerve supplynerves that innervate • pain fromdiseased the overlying muscles: viscera due tomm–diaphragmatic peritoneumspasm,stretch,by C4 centrally & IC nnischaemia or peripherally subsequent –remainder ofperitoneum by IC & lumb
7、ar nninvolvementof–(pelvic peritoneummainly by parietal peritoneumobturator nerve)5/5/2007 10 anterior abdominal wallwhy does the pain inappendicitis typically start in the umbilical region, then shift to theright iliac fossa?5/5/2007 11 shifting pain in append
8、icitis•umbilicus–typicallybeginsinumbilical region (midgut) with vague (butoften severe) characteristics• obstruction/spasm leads to excitation of pain fibres running with s
