1 | Þ a a e ( a l z a c o ţ r m L

)
8 a L c h 2 0 1 2

IN1kCDUC1ICN 1C A8DCMINAL CAVII1¥
(DrŦ Laygo)

















Ŵ realon of Lhe bodv Lrunk whlch lles ln beLween Lhe
dlaphraam and Lhe pelvlc lnleL
Ŵ realon below Lhe pelvlc lnleL ls called pelvlc cavlLv
Ŵ no floorţ conLlnuous wlLh Lhe pelvlc cavlLv
Ŵ exLends from Lhe lower parL of Lhoraclc caae unLll Lhe
level of Lhe 3
Lh
anLerlor lCS (level of Lhe nlpple)
Ŵ ¾½r|or bordrť dlaphraam (roof of Lhe abdomlnal
cavlLv)
Ŵ |nfr|or bordrť pelvlc lnleL
Ŵ |n ¾½|n ½o¾|t|onť lower Lhoraclc caae proLecLs Lhe
upper oraans (llverţ sLomach and spleen)
Ŵ LIVLk
4 mosL commonlv ln[ured ln Lhe abdomlnal realon
durlna blunL Lrauma

Contnt¾ť
1Ŧ ½r|tona| cav|ty
enclosed bv parleLal perlLoneum
vlsceral perlLoneum Ŷ whlch usuallv covers Lhe
abdomlnal oraans

2Ŧ ga¾tro|nt¾t|na| organ¾
aŦ lower parL of Lhe esophaaus
bŦ sLomach
cŦ small lnLesLlnes (duodenumţ [e[unumţ lleum)
dŦ larae lnLesLlnes/ colon (cecum and appendlxţ
ascendlnaţ Lransverseţ descendlnaţ slamold colonţ
recLum)
eŦ llver wlLh Lhe blllarv Lree
hepaLlc ducL
aall bladder
cy¾t|c dct
4 hepaLlc + cvsLlc ducL ƹ
common b|| dct
4 + pancreaLlc ducL ƹ dralns ln Lhe
duodenum
fŦ pancreas
aŦ adrenal alands/ suprarenal alands
hŦ kldnevsţ superlor parL of Lhe ureLer
lŦ dlfferenL nervesţ lvmphaLlcsţ 8v
abdomlnal aorLaţ lnferlor vena cava

5bd|v|¾|on¾ of th Abdom|na| Wa||
1Ŧ anLerlor abdomlnal wall
Ŵ lower Lhoraclc caaeţ exLernal and lnLernal
obllque musclesţ Lransversus abdomlnls

2Ŧ laLeral rlahL and lefL abdomlnal wall
Ŵ corresponds Lo Lhe flanks
Ŵ lumbosacral fascla ƹ aponeurosls of Lhe exLernal
obllque muscle
4 sLrona fasclal bondţ whlLlsh sLrucLure
3Ŧ posLerlor abdomlnal wall
Ŵ lower Lhoraclc splne
Ŵ 3 lumbar splne
Ŵ musclesť quadraLus lumborumţ psoas musclesţ
lllopsoas muscle (below Lhe pelvlc lnleL)

Layr¾ of th Abdom|na| Wa||
1Ŧ skln
2Ŧ superflclal fascla
Ŵ Camperƌs fascla Ŵ faLLv superflclal laver
Ŵ Scarpaƌs fascla Ŵ deep membranous laver

3Ŧ muscles and Lhelr aponeurosls
Ŵ LxLernal obllque muscle
Ŵ lnLernal obllque muscle
Ŵ Mldllneť recLus abdomlnls muscle
Ŵ 8ehlndť posLerlor recLus sheaLh madeŴup of
Lransverse abdomlnal muscle

4Ŧ fascla Lransversalls
3Ŧ preperlLoneal faL/ exLraperlLoneal faL
6Ŧ perlLoneum
2 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

5rfac Landmark¾ of th Abdom|na| Wa||ť
O x|½ho|d ½roc¾¾ (19)
Ŵ ls Lhe Lhln carLllaalnous lower parL of Lhe sLernumŦ
lL ls easllv palpaLed ln Lhe depresslon where Lhe
cosLal maralns meeL ln Lhe upper parL of Lhe
anLerlor abdomlnal wall
Ŵ xlphlsLernal [uncLlon ls ldenLlfled bv feellna Lhe
lower edae of Lhe bodv of Lhe sLernumţ and lL lles
opposlLe Lhe bodv of Lhe nlnLh Lhoraclc verLebra

O co¾ta| marg|n
Ŵ reaches lLs lowesL level aL Lhe 10
Lh
cosLal carLllaaeţ
whlch lles opposlLe Lhe bodv of Lhe Lhlrd lumbar
verLebra

O |||ac cr¾t
Ŵ felL alona lLs enLlre lenaLh and ends ln fronL aL Lhe
anLerlor superlor lllac splne and behlnd aL Lhe
posLerlor superlor lllac splne

O ½b|c tbrc|
Ŵ an lmporLanL surface landmark
Ŵ lL mav be ldenLlfled as a small proLuberance alona
Lhe superlor surface of Lhe publs

O ¾ym½hy¾|¾ ½b|¾
Ŵ ls Lhe carLllaalnous [olnL LhaL lles ln Lhe mldllne
beLween Lhe bodles of Lhe publc bones
Ŵ lL ls felL as a solld sLrucLure beneaLh Lhe skln ln Lhe
mldllne aL Lhe lower exLremlLv of Lhe anLerlor
abdomlnal wall
Ŵ Lhe publc cresL ls Lhe name alven Lo Lhe rldae on
Lhe superlor surface of Lhe publc bones medlal Lo
Lhe publc Lubercle

O |ng|na| ||gamnt
Ŵ lles beneaLh a skln crease ln Lhe arolnŦ lL ls Lhe
rolledŴunder lnferlor maraln of Lhe aponeurosls of
Lhe exLernal obllque muscle
Ŵ lL ls aLLached laLerallv Lo Lhe anLerlor superlor lllac
splne and curves downward and medlallvţ Lo be
aLLached Lo Lhe publc Lubercle

O ¾½rf|c|a| |ng|na| r|ng
Ŵ ls a Lrlanaular aperLure ln Lhe aponeurosls of Lhe
exLernal obllque muscle and ls slLuaLed above and
medlal Lo Lhe publc Lubercle
Ŵ ln Lhe adulL maleţ Lhe maralns of Lhe rlna can be
felL bv lnvaalnaLlna Lhe skln of Lhe upper parL of
Lhe scroLum wlLh Lhe Llp of Lhe llLLle flnaerŦ 1he
sofL Lubular spermaLlc cord can be felL emeralna
from Lhe rlna and descendlna over or medlal Lo Lhe
publc Lubercle lnLo Lhe scroLumŦ ÞalpaLe Lhe
spermaLlc cord ln Lhe upper parL of Lhe scroLum
beLween Lhe flnaer and Lhumb and noLe Lhe
presence of a flrm cordllke sLrucLure ln lLs
posLerlor parL called Lhe vas deferens
Ŵ ln Lhe femaleţ Lhe superflclal lnaulnal rlna ls
smaller and dlfflculL Lo palpaLeŤ lL LransmlLs Lhe
round llaamenL of Lhe uLerusŦ

O ||na a|ba
Ŵ ls a verLlcallv runnlna flbrous band LhaL exLends
from Lhe svmphvsls publs Lo Lhe xlphold process
and lles ln Lhe mldllne
Ŵ lL ls formed bv Lhe fuslon of Lhe aponeuroses of
Lhe muscles of Lhe anLerlor abdomlnal wall and ls
represenLed on Lhe surface bv a sllahL medlan
aroove
Ŵ more promlnenL above Lhe umblllcus

O lin¢a s¢milunaris
Ŵ ls Lhe laLeral edae of Lhe recLus abdomlnls muscle
and crosses Lhe cosLal maraln aL Lhe Llp of Lhe
nlnLh cosLal carLllaae
Ŵ Lo accenLuaLe Lhe semllunar llnesţ Lhe paLlenL ls
asked Lo lle on Lhe back and ralse Lhe shoulders off
Lhe couch wlLhouL uslna Lhe armsŦ
Ŵ Lo accompllsh Lhlsţ Lhe paLlenL conLracLs Lhe recLus
abdomlnls muscles so LhaL Lhelr laLeral edaes sLand
ouL

O ¾trna| co¾ta| marg|n
Ŵ cosLal maraln + laLeral edaes of xlphold process

















3 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Abdom|na| Cadrant¾



























A8DCMLN
(DrŦ C|t|q|t)

Ŵ locaLed beLween Lhe dlaphraam and pelvls (exLenL of
Lhe abdomen)

8ony com½onnt¾ť
O ÞosLerlorť verLebra
O nLerlor and laLeralť no bones
4 onlv muscles and fasclaţ skln

5trctr¾ that can b ½a|½atdť
aŦ xlphold process
bŦ svmphvsls publs
cŦ anLerlor superlor lllac splne (SlS)
dŦ subcosLal maraln
eŦ lllac


5ha½¾ of th Abdomn
Ŵ polnL of referenceť lles from Lhe xlphold process
down Lo Lhe svmphvsls publs

aŦ flaL
Ŵ when abdomlnal wall falls ln Lhe llne from xlphold
process Lo Lhe svmphvsls publs

bŦ scaphold
Ŵ underneaLh Lhe polnL of reference

cŦ alobular
Ŵ aoes over Lhe polnL of reference

dŦ dlsLended
Ŵ when whole of abdomlnal wall ls anLerlor Lo Lhe
llne

eŦ flabbv
Ŵ enlaraed abdomen due Lo Lhlckened anLerlor
abdomlnal wall

ANA1CMICAL LANDMAkk5
aŦ umblllcus
Ŵ lndenLaLlon
Ŵ normallv locaLed beLween Lhe xlphold process and
svmphvsls publs buL nor consLanL
Ŵ alwavs locaLed aL Lhe mldllne

bŦ subcosLal maraln
Ŵ composed of carLllaaes of anLerlor 7
Lh
ţ 8
Lh
ţ 9
Lh
and
10
Lh
rlbs

cŦ xlphold process
Ŵ mosL lnferlor porLlon of sLernum
Ŵ anale beLween b and c ƹ xlphlsLernal/ subcosLal
anale

dŦ lllac cresL
Ŵ superlor border of Lhe lllac bone

eŦ SlS
Ŵ elevaLed porLlon of Lhe anLerlor parL of Lhe lllac
cresL
Ŵ opposlLe aL Lhe back ÞSlS



4 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

fŦ lnaulnal llaamenL
Ŵ rolled fascla derlved from Lhe exLernal obllque
aponeurosls
Ŵ exLends from Lhe SlS all Lhe wav Lo publc Lubercle

aŦ llnea alba
Ŵ llne locaLed aL Lhe mldllne exLendlna from Lhe
xlphold process all Lhe wav Lo Lhe svmphvsls publs
Ŵ more promlnenL ln llnea alba

hŦ llnea semllunarls/ Splaellan llne
Ŵ laLeral border of Lhe recLus abdomlnls muscle

lŦ svmphvsls publs
Ŵ [uncLlon beLween 2 publc bone locaLed aL Lhe
mldllne

IN1kAŴA8DCMINAL CkGAN5 ÞALÞA8LL
aŦ aorLa
Ŵ lle flaL and palpaLe aL Lhe mlddle (verv Lhln
lndlvldual)
Ŵ abdomlnal aorLať blfurcaLes lnLo 2 branches aL Lhe
level of L4

bŦ llver
Ŵ rlahL upper porLlon of Lhe abdomen buL mosLlv
covered bv Lhe lower rlbs
Ŵ 2 flnaerbreadLhs below Lhe subcosLal maraln

cŦ aallbladder
Ŵ fundus of aallbladder
4 palpaLe aL Lhe [uncLlon of Lhe subcosLal maraln
and Splaellan llne

dŦ sLomach
Ŵ normallv can'L be palpaLed unless lL ls enlaraed or
wlLh Lumor/ mass

eŦ spleen
Ŵ locaLed on Lhe lefL upper porLlon and Lhe lona axls
of Lhe spleen ls locaLed aL Lhe 10
Lh
rlb

fŦ kldnevs
aŦ ascendlna colon
Ŵ hard Lo palpaLe unless enlaraed

hŦ urlnarv bladder
lŦ uLerus and ovarles
A8DCMINAL LINL5
1Ŧ mldllne
2Ŧ subcosLal plane
Ŵ aL Lhe level of Lhe 10
Lh
cosLal carLllaae and level of
L3

3Ŧ lnLerLubercular plane
Ŵ level of lllac Lubercle
Ŵ bodv of L3
Ŵ connecLs Lhe 2 Lubercles of Lhe lllac bone

4Ŧ Lranspvlorlc plane
Ŵ horlzonLal
Ŵ passes Lhru Lhe cosLal carLllaae of Lhe 9
Lh
rlb
Ŵ ¾trctr¾ fondť
aŦ pancreas
bŦ pvlorus
cŦ hllum of Lhe spleen
dŦ 2
nd
porLlon of duodenum

3Ŧ LranscrlsLal plane
Ŵ horlzonLal
Ŵ connecLs Lhe 2 lllac cresL

6Ŧ mldlnaulnal/ mldŴclavlcular llne
Ŵ verLlcal

7Ŧ Mc8urnev's polnL
Ŵ approxlmaLes Lhe base of appendlx
Ŵ aeL umblllcus and SlSť creaLe a llne Lhen dlvlde
lnLo 3
Ŵ Lhe polnL where vou dlvlde Lhe mlddle and laLeral
1/3

A8DCMINAL CUADkAN15
Ŵ make use of Lhe mldllne and Lransverse llne aL Lhe
level of Lhe umblllcus

1Ŧ 8uC
Ŵ ma[orlLv of Lhe llver and aallbladder

2Ŧ 8LC
Ŵ appendlxţ 8Ŧ falloplan Lube and ovarv

3Ŧ LuC
Ŵ sLomachţ spleen


5 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4Ŧ LLC
Ŵ slamold colonţ LŦ falloplan Lube and ovarvţ some of
Lhe small lnLesLlne

A8DCMINAL kLGICN5
Ŵ subcosLal llne Ŷ above
Ŵ LransLubercular plane Ŷ below
Ŵ rlahL and lefL mldlnaulnal llne

M|dd|ť
1Ŧ eplaasLrlc realon Ŷ sLomach
2Ŧ umblllcal realon Ŷ umblllcus
3Ŧ hvpoaasLrlc realon Ŷ urlnarv bladder and uLerus for
females

Latra|ť
1Ŧ rlahL and lefL hvpochondrlac realon
2Ŧ rlahL and lefL lumbar realon
3Ŧ rlahL and lefL lllac realon

CLINICAL CCkkLLA1ICN5ť
aŦ asclLls
Ŵ presence of fluld ln Lhe perlLoneal cavlLv

bŦ abdomlnal paln
cŦ acuLe abdomen
Ŵ medlcal or suralcal condlLlons
lŦeŦ acuLe appendlclLlsţ pancreaLlLlsţ cholescvsLlLls

dŦ exploraLorv laparoLomv
eŦ locallzaLlon of slans and svmpLoms














































6 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

A8DCMINAL WALL
(DrŦ 1any)

LA¥Lk5ť
aŦ ¾k|n
Ŵ skln ls looselv aLLached Lo Lhe underlvlna
sLrucLures excepL aL Lhe umblllcusţ where lL ls
LeLhered Lo Lhe scar Llssue
Ŵ naLural llnes of cleavaae ln Lhe skln are consLanL
and run downward and forward almosL
horlzonLallv around Lhe Lrunk
Ŵ umblllcus ls a scar represenLlna Lhe slLe of
aLLachmenL of Lhe umblllcal cord ln Lhe feLus
4 lL ls slLuaLed ln Lhe llnea alba (b/n L3 and L4)
4 conslsL of four Lubesť
1Ŧ urachus
2Ŧ lefL and rlahL umblllcal arLerles
3Ŧ umblllcal veln

bŦ ¾½rf|c|a| fa¾c|a

1Ŧ Cam½r'¾ fa¾c|a
O faLLv laver ls conLlnuous wlLh Lhe superflclal faL
over Lhe resL of Lhe bodv and mav be exLremelv
Lhlck
2Ŧ 5car½a'¾ fa¾c|a
O above Lhe umblllcus 2 lavers are lndlsLlncL
O below Lhe umblllcusţ Scarpa's fascla ls wellŴ
developed
O aoes bevond Lhe lnaulnal llaamenL and blends
wlLh Lhe fascla laLa of Lhe Lhlah
O aLLached on each slde Lo Lhe maralns of Lhe
publc archŤ lL ls here referred Lo as Collesƌ fascla

cŦ d½ fa¾c|a
Ŵ ls merelv a Lhln laver of connecLlve Llssue coverlna
Lhe musclesŤ lL lles lmmedlaLelv deep Lo Lhe
membranous laver of superflclal fascla


dŦ m¾c|¾ and th|r a½onro¾|¾

1Ŧ xtrna| ob||q m¾c|
O forwardţ downward medlallv flbers
O ls a broadţ Lhlnţ muscular sheeL
7 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

O or|g|nť from Lhe ouLer surfaces of Lhe lower
elahL rlbs
O fan¾ ot to b |n¾rtd |ntoť
4 Lhe xlphold process
4 Lhe llnea alba
4 Lhe publc cresL
4 Lhe publc Lubercle
4 Lhe anLerlor half of Lhe lllac cresL

O mosL of Lhe flbers are lnserLed bv means of a
broad a½onro¾|¾
4 Lendlnous
4 ha¾ 3 th|ckn|ng¾ť
aŦ |ng|na| ||gamnt
aLLaches Lo Lhe SlS and Lo Lhe
publs Lubercle

bŦ |acnar ||gamnt/ G|mbrnat'¾
||gamnt
exLends backward and upward Lo
Lhe pecLlneal llne on Lhe superlor
ramus of Lhe publs
lLs sharpţ free crescenLlc edae
forms Lhe medlal maraln of Lhe
femoral rlna

cŦ ½ct|na| ||gamnt/ Coo½r'¾
||gamnt
reachlna Lhe pecLlneal llneţ Lhe
lacunar llaamenL becomes
conLlnuous wlLh a Lhlckenlna of
Lhe perlosLeum called Lhe
pecLlneal llaamenL








O tr|ang|ar ||gamnt/ rf|ctd |ng|na|
||gamnt
4 conslsLs of reflecLed flbers whlch
orlalnaLes from Lhe lnferlor crus of Lhe
superflclal lnaulnal rlna and Lhe lacunar
llaamenL

O ¾½rf|c|a| |ng|na| r|ng
4 openlna of Lhe exLernal obllque muscle
locaLed above and medlal Lhe publc
Lubercle

2Ŧ |ntrna| ob||q m¾c|
O ls also a broadţ Lhlnţ muscular sheeL LhaL lles
deep Lo Lhe exLernal obllque
O mosL of lLs flbers run aL rlahL anales Lo Lhose
of Lhe exLernal obllque
O muscle flbers radlaLe as Lhev pass upward and
forward
O or|g|nť
4 Lhoracolumbar fascla
4 anLerlor Lwo Lhlrds of Lhe lllac cresL
4 laLeral Lwo Lhlrds of Lhe lnaulnal llaamenL
O |n¾rt|onť
4 lower borders of Lhe lower Lhree rlbs and
Lhelr cosLal carLllaaes
4 xlphold process
4 llnea alba
4 svmphvsls publs

O near Lhelr lnserLlonţ Lhe lowesL Lendlnous
flbers are [olned bv slmllar flbers from Lhe
Lransversus abdomlnls Lo form Lhe con[olnL
Lendon
4 ls aLLached medlallv Lo Lhe llnea albaţ buL
lL has a laLeral free border
4 formed bv Lhe Lransversus abdomlnls
muscle and lnLernal obllque muscle

3Ŧ tran¾vr¾¾ abdom|n|¾ m¾c|
O ls a Lhln sheeL of muscle LhaL lles deep Lo Lhe
lnLernal obllqueţ and lLs flbers run horlzonLallv
forward
O or|g|nť
4 from Lhe deep surface of Lhe lower slx
cosLal carLllaaes (lnLerdlalLaLlna wlLh Lhe
dlaphraam)
4 lumbar fascla
8 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 anLerlor Lwo Lhlrds of Lhe lllac cresL
4 laLeral Lhlrd of Lhe lnaulnal llaamenLŦ
O |n¾rt|onť
4 xlphold process
4 llnea alba
4 svmphvsls publs

O Lhe lowesL Lendlnous flbers [oln slmllar flbers
from Lhe lnLernal obllque Lo form Lhe con[olnL
Lendonţ whlch ls flxed Lo Lhe publc cresL and
Lhe pecLlneal llne

O noLe LhaL Lhe posLerlor border of Lhe exLernal
obllque muscle ls freeţ whereas Lhe posLerlor
borders of Lhe lnLernal obllque and
Lransversus muscles are aLLached Lo Lhe
lumbar verLebrae bv Lhe lumbar fascla
IUNC1ICN (A8DCMINAL MU5CLL5)
a) llkened Lo a corseLŤ forms elasLlc musculoLendlnous
corseL LhaL malnLalns Lhe lnLraabdomlnal pressure
keeplna Lhe vlscera lnLacL
b) conLracLs slmulLaneouslv wlLh Lhe dlaphraam Lo ald
urlnaLlonţ defecaLlonţ vomlLlna and parLurlLlon/
alvlna blrLh (valsalva maneuver)
c) conLracLs alLernaLelv wlLh Lhe dlaphraam Lo ald
exhalaLlon
d) alds ln Lhe laLeral bendlna of Lhe Lrunk

Ŧ tran¾vr¾a||¾ fa¾c|a
O ls a Lhln laver of fascla LhaL llnes Lhe Lransversus
abdomlnls muscle and ls conLlnuous wlLh a slmllar
laver llnlna Lhe dlaphraam and Lhe lllacus muscle
O Lhe femoral sheaLh for Lhe femoral vessels ln Lhe
lower llmbs ls formed from Lhe fascla Lransversalls
and Lhe fascla lllaca LhaL covers Lhe lllacus muscle
O wellŴdeveloped below Lhe lnferlor porLlon of Lhe
lnLernal obllque and Lransversus abdomlnls
kLC1U5 5nLA1n
Ŵ ls a lona flbrous sheaLh LhaL encloses
aŦ recLus abdomlnls muscle
bŦ pvramldalls muscle (lf presenL)
cŦ conLalns Lhe anLerlor raml of Lhe lower slx
Lhoraclc nerves
dŦ superlor and lnferlor eplaasLrlc vessels
eŦ lvmph vesselsŦ

Ŵ formed malnlv bv Lhe aponeuroses of Lhe Lhree
laLeral abdomlnal muscles
Ŵ |ocat|onť
aŦ above Lhe cosLal maraln
4 anLerlor wall ls formed bv Lhe aponeurosls
of Lhe exLernal obllque
4 posLerlor wall ls formed bv Lhe Lhoraclc
wallŸLhaL lsţ Lhe flfLhţ slxLhţ and sevenLh
cosLal carLllaaes and Lhe lnLercosLal
spaces

bŦ beLween Lhe cosLal maraln and Lhe level of Lhe
anLerlor superlor lllac splne
4 Lhe aponeurosls of Lhe lnLernal obllque
spllLs Lo enclose Lhe recLus muscle
4 exLernal obllque aponeurosls ls dlrecLed ln
fronL of Lhe muscle
4 Lransversus aponeurosls ls dlrecLed
behlnd Lhe muscle

cŦ 8eLween Lhe level of Lhe anLerosuperlor lllac
splne and Lhe publs
4 aponeuroses of all Lhree muscles form Lhe
anLerlor wall
4 posLerlor wall ls absenL
4 recLus muscle lles ln conLacL wlLh Lhe
fascla Lransversalls

Ŵ lL should be noLed LhaL where Lhe aponeuroses formlna
Lhe posLerlor wall pass ln fronL of Lhe recLus aL Lhe level
of Lhe anLerlor superlor lllac splneţ Lhe posLerlor wall
has a freeţ curved lower border called Lhe arcuaLe llneŦ
L Lhls slLeţ Lhe lnferlor eplaasLrlc vessels enLer Lhe
recLus sheaLh and pass upward Lo anasLomose wlLh Lhe
superlor eplaasLrlc vesselsŦ
















9 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

















kct¾ Abdom|n|¾ M¾c|¾
Ŵ ls a lona sLrap muscle LhaL exLends alona Lhe whole
lenaLh of Lhe anLerlor abdomlnal wall
Ŵ lL ls broader above and lles close Lo Lhe mldllneţ belna
separaLed from lLs fellow bv Lhe llnea alba
Ŵ ar|¾¾ by two had¾
4 fronL of Lhe svmphvsls publs
4 publc cresL
Ŵ |n¾rt|onť
4 flfLhţ slxLhţ and sevenLh cosLal carLllaaes
4 xlphold process

Ŵ when lL conLracLsţ lLs laLeral maraln forms a curved
rldae LhaL can be palpaLed and ofLen seen and ls
Lermed Lhe llnea semllunarlsŦ 1hls exLends from Lhe Llp
of Lhe nlnLh cosLal carLllaae Lo Lhe publc LubercleŦ

Ŵ ls dlvlded lnLo dlsLlncL seamenLs bv thr tran¾vr¾
tnd|no¾ |ntr¾ct|on¾ť one aL Lhe level of Lhe xlphold
processţ one aL Lhe level of Lhe umblllcusţ and one
halfwav beLween Lhese Lwo
4 are sLronalv aLLached Lo Lhe anLerlor wall of Lhe
recLus sheaLh

Þyram|da||¾
Ŵ ls ofLen absenL
Ŵ ar|¾¾ bv lLs base from Lhe anLerlor surface of Lhe publs
(publc bone)
Ŵ |n¾rtd lnLo Lhe llnea alba
Ŵ act|onť Lenses Lhe llnea alba
Ŵ lL lles ln fronL of Lhe lower parL of Lhe recLus abdomlnls

MU5CLL5 CI 1nL AN1LkICk A8DCMINAL WALL

Nam of
M¾c| Cr|g|n In¾rt|on Nrv 5½½|y Act|on
LxLernal
obllque
Lower elahL rlbs xlphold processţ llnea
albaţ publc cresLţ
publc Lubercleţ lllac
cresL
Lower slx Lhoraclc
nerves and
lllohvpoaasLrlc and
lllolnaulnal nerves (L1)
SupporLs abdomlnal conLenLsŤ compresses
abdomlnalconLenLsŤ asslsLs ln flexlna and
roLaLlon of LrunkŤ asslsLs lnforced explraLlonţ
mlcLurlLlonţ defecaLlonţ parLurlLlonţ and
vomlLlna
lnLernal
obllque
Lumbar fasclaţ
lnLermedlaLe llne lllac
cresLţ laLeral Lwo Lhlrds
of lnaulnal llaamenL
Lower Lhree rlbs and
cosLal carLllaaesţ
xlphold processţ llnea
albaţ svmphvsls publs
Lower slx Lhoraclc
nerves and
lllohvpoaasLrlc and
lllolnaulnal nerves (L1)
s above
1ransversus Lower slx cosLal
carLllaaesţ lumbar
fasclaţ lllac cresLţ laLeral
Lhlrd of lnaulnal
llaamenL
xlphold process llnea
albaţ svmphvsls publs
Lower slx Lhoraclc
nerves and
lllohvpoaasLrlc and
lllolnaulnal nerves (L1)
Compresses abdomlnal conLenLs
8ecLus
abdomlnls
Svmphvsls publs and
publc cresL
llfLhţ slxLhţ and
sevenLh cosLal
carLllaaes and xlphold
process
Lower slx Lhoraclc
nerves
Compresses abdomlnal conLenLs and flexes
verLebral columnŤ accessorv muscle of
explraLlon
Þvramldalls
(lf presenL)
nLerlor surface of
publs
Llnea alba 12Lh Lhoraclc nerve 1enses Lhe llnea alba
10 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

NLkVL AND 8LCCD 5UÞÞL¥
CI 1nL A8DCMLN
(DrŦ 1any)

NLkVL 5UÞÞL¥
Ŵ nerves of Lhe anLerlor abdomlnal wall
Ŵ Lhev pass forward ln Lhe lnLerval beLween Lhe lnLernal
obllque and Lhe Lransversus muscles
Ŵ Lhe Lhoraclc nerves are Lhe lower flve lnLercosLal
nerves and Lhe subcosLal nerve
Ŵ Lhev supplv Lhe skln of Lhe anLerlor abdomlnal wallţ Lhe
musclesţ and Lhe parleLal perlLoneumŦ (Compare wlLh
Lhe lnLercosLal nervesţ whlch run forward ln Lhe
lnLercosLal spaces beLween Lhe lnLernal lnLercosLal and
Lhe lnnermosL lnLercosLal muscles)Ŧ
Ŵ
aŦ |owr ¾|x thorac|c and
4 Lhe lower slx Lhoraclc nerves plerce Lhe
posLerlor wall of Lhe recLus sheaLh Lo supplv
Lhe recLus muscle and Lhe pvramldalls (112
onlv)
4 Lhev LermlnaLe bv plerclna Lhe anLerlor wall of
Lhe sheaLh and supplvlna Lhe skln

bŦ f|r¾t |mbar nrv¾
4 Lhe flrsL lumbar nerve has a slmllar courseţ buL
lL does noL enLer Lhe recLus sheaLh
4 lL ls represenLed bv Lhe |||ohy½oga¾tr|c nrvţ
whlch plerces Lhe exLernal obllque
aponeurosls above Lhe superflclal lnaulnal rlna
4 and bv Lhe |||o|ng|na| nrvţ whlch emeraes
Lhrouah Lhe rlna
4 Lhev end bv supplvlna Lhe skln [usL above Lhe
lnaulnal llaamenL and svmphvsls publs

Ŵ Lhe dermaLome of 17 |¾ |ocatd |n th ½|ga¾tr|m
ovr th x|½ho|d ½roc¾¾ţ LhaL of 110 |nc|d¾ th
mb|||c¾ţ and LhaL of L1 (111ŴL1)||¾ [¾t abov
th |ng|na| ||gamnt and th ¾ym½hy¾|¾ ½b|¾
8LCCD 5UÞÞL¥

Ak1Lk¥
1Ŧ ¾½r|or ½|ga¾tr|c artry
Ŵ one of Lhe Lermlnal branches of Lhe lnLernal
Lhoraclc/ mammarv arLerv
Ŵ enLers Lhe upper parL of Lhe recLus sheaLh
beLween Lhe sLernal and cosLal orlalns of Lhe
dlaphraam
Ŵ descends behlnd Lhe recLus muscleţ supplvlna Lhe
upper cenLral parL of Lhe anLerlor abdomlnal wallţ
and anasLomoses wlLh Lhe lnferlor eplaasLrlc arLerv

2Ŧ |nfr|or ½|ga¾tr|c artry
Ŵ branch of Lhe exLernal lllac arLerv [usL above Lhe
lnaulnal llaamenL
Ŵ runs upward and medlallv alona Lhe medlal slde of
Lhe deep lnaulnal rlna
Ŵ lL plerces Lhe fascla Lransversalls Lo enLer Lhe
recLus sheaLh anLerlor Lo Lhe arcuaLe llne
Ŵ lL ascends behlnd Lhe recLus muscleţ supplvlna Lhe
lower cenLral parL of Lhe anLerlor abdomlnal wallţ
and anasLomoses wlLh Lhe superlor eplaasLrlc
arLerv

3Ŧ |atra|
aŦ d½ c|rcmf|x |||ac artry
4 a branch of Lhe exLernal lllac arLerv [usL above
Lhe lnaulnal llaamenL
4 lL runs upward and laLerallv Loward Lhe
anLerosuperlor lllac splne and Lhen conLlnues
alona Lhe lllac cresL
4 lL supplles Lhe lower laLeral parL of Lhe
abdomlnal wall

bŦ |owr two ½o¾tr|or |ntrco¾ta| artr|¾
4 branches of Lhe descendlna Lhoraclc aorLa

cŦ for |mbar artr|¾
4 branches of Lhe abdomlnal aorLaţ
4 (b and c) pass forward beLween Lhe muscle
lavers and supplv Lhe laLeral parL of Lhe
abdomlnal wall

3 ¾ma|| branch¾ of fmora| artry
aŦ ¾½r|or xtrna| ½dnda| artry
Ŵ do noL supplv Lhe anLerlor porLlon of abdomen

bŦ ¾½rf|c|a| ½|ga¾tr|c artry
Ŵ courses upwardţ dlssecLlna Lhe umblllcal llaamenL
aL Lhe are of Camper's fascla

cŦ ¾½rf|c|a| c|rcmf|x |||ac artry
Ŵ follow Lhe coarse of lnaulnal llaamenL [usL below lL
11 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

VLIN5

aŦ ¾½rf|c|a| v|n¾
Ŵ form a neLwork LhaL radlaLes ouL from Lhe
umblllcus
Ŵ aboveţ Lhe neLwork ls dralned lnLo Lhe axlllarv veln
vla Lhe laLeral Lhoraclc veln
Ŵ belowţ lnLo Lhe femoral veln vla Lhe superflclal
eplaasLrlc and areaL saphenous velns
Ŵ a few small velnsţ Lhe paraumblllcal velnsţ connecL
Lhe neLwork Lhrouah Lhe umblllcus and alona Lhe
llaamenLum Leres Lo Lhe porLal veln
Ŵ Lhls forms an lmporLanL porLalŶsvsLemlc venous
anasLomosls

bŦ d½ v|n¾
Ŵ Lhe superlor eplaasLrlcţ lnferlor eplaasLrlcţ and
deep clrcumflex lllac velnsţ follow Lhe arLerles of
Lhe same name and draln lnLo Lhe lnLernal Lhoraclc
and exLernal lllac velns
Ŵ Lhe posLerlor lnLercosLal velns draln lnLo Lhe
azvaos velnsţ and Lhe lumbar velns draln lnLo Lhe
lnferlor vena cava

GkCUÞť
O upper aroup Ŷ above umblllcus
O below/ lower aroup Ŷ below umblllcus
4 freelv anasLomose wlLh each oLher aL Lhe
LhoracoeplaasLlc veln

O paraumblllcal veln Ŷ serve Lo communlcaLe Lhe
svsLemlc venous clrculaLlon Lo porLal veln clrculaLlon

L¥MÞn DkAINAGL
aŦ ¾½rf|c|a| |ym½h v¾¾|¾
Ŵ Lhe lvmph dralnaae of Lhe skln of Lhe anLerlor
abdomlnal wall above Lhe level of Lhe umblllcus ls
upward Lo Lhe anLerlor axlllarv (pecLoral) aroup of
nodesţ whlch can be palpaLed [usL beneaLh Lhe
lower border of Lhe pecLoralls ma[or muscle
Ŵ below Lhe level of Lhe umblllcusţ Lhe lvmph dralns
downward and laLerallv Lo Lhe superflclal lnaulnal
nodes
Ŵ Lhe lvmph of Lhe skln of Lhe back above Lhe level of
Lhe lllac cresLs ls dralned upward Lo Lhe posLerlor
axlllarv aroup of nodesţ palpaLed on Lhe posLerlor
wall of Lhe axlllaŤ below Lhe level of Lhe lllac cresLsţ
lL dralns downward Lo Lhe superflclal lnaulnal
nodes

bŦ d½ |ym½h v¾¾|¾
Ŵ Lhe deep lvmph vessels follow Lhe arLerles and
draln lnLo Lhe lnLernal Lhoraclcţ exLernal lllacţ
posLerlor medlasLlnalţ and paraŴaorLlc (lumbar)
nodes

C||n|ca| corr|at|onť

Gro|n f|a½
Ŵ baslsť lnferlor eplaasLrlc arLerv
Ŵ vascularlze cuLaneous faL flap Lo cover Lhe defecL
of Lhe dorsal aspecL of Lhe hand
Ŵ 4 Lo 10 davs

Cb¾trct|on of ½orta| v|n c|rc|at|on
Ŵ Lhe superflclal velns around Lhe umblllcus and Lhe
paraumblllcal velns become arosslv dlsLended
Ŵ Lhe dlsLended subcuLaneous velns radlaLe ouL from
Lhe umblllcusţ produclna ln severe cases Lhe
cllnlcal plcLure referred Lo as capuL medusae






















12 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

1nL INGUINAL kLGICN
(DrŦ LŦ Mana|o)

Ŵ aŦkŦaŦ ºlnaulnoŴabdomlnal realon" or ºlnaulnal Lrlaone"
Ŵ LransmlLs 8vţ nerves and muscles from abdomen Lo Lhe
Lhlah
Ŵ realon beLween Lhe abdomen and Lhe Lhlah
Ŵ bondar|¾ť
aŦ |nfr|or bondary Ŷ lnaulnal llaamenL
bŦ |atra| bondary Ŷ laLeral maralns of recLus
abdomlnls muscle
cŦ ¾½r|or bordr Ŷ lmaalnarv horlzonLal llne from
Lhe SlS Lo Lhe laLeral maraln of Lhe recLus
abdomlnls muscle

Ŵ |ayr¾ of th abdomnť
aŦ ¾k|n
4 movable and smooLh
4 |andmark¾ť
SlS
Þubls Lubercle
umblllcus

bŦ ¾½rf|c|a| fa¾c|a
4 fused above Lhe umblllcusţ separable lnLo 2
lavers below Lhe umblllcus
4 Cam½r'¾ fa¾c|a
conslsLs of adlpose Llssue (pannlculus
adlposus)
8v and nerves are locaLed
lemoral arLerv
O superflclal lnferlor eplaasLrlc arLerv
4 crosses Lhe lnaulnal llaamenL and
coarse Lowards Lhe umblllcus

O superflclal exLermal pudendal arLerv
4 crosses Lhe spermaLlc cord
Lowards Lhe scroLum

O superflclal clrcumflex lllac arLerv
4 runs parallel Lo alona Lhe lnaulnal
llaamenL

4 5car½a'¾ fa¾c|a
deeper laver
membranous
conLalns no faLţ coarse above Lhe
lnaulnal llaamenL Lo lnserL ln Lhe
fascla laLa
l flnaerbreadLh below Lhe llaamenL
lnserLs ln Lhe publc Lubercle and
arches
becomes Colle's fascla ln Lhe
perlneum

cŦ xtrna| ob||q m¾c|
4 fuses wlLh serraLus anLerlor and laLlsslmus
dorsl muscle
4 flbers conLlnues wlLh |ntrna| ob||q m¾c|
4 lLs aponeurosls fuses wlLh Lhe aponeurosls of
Lhe lnLernal obllque Lo form Lhe anLerlor
recLus sheaLh Lo lnserL ln Lhe llnea alba
4 lower parL ls Lhlckened ƹ lnaulnal llaamenL
where 8vţ nerves and muscles passes
Lhrouah

dŦ |ntrna| ob||q m¾c|
4 lnserLlonť for |owr r|b¾
4 lLs aponeurosls fuse wlLh Lhe aponeurosls of
Lhe exLernal obllque Lo form anLerlor recLus
sheaLh
4 ŧ wlLh Lhe aponeurosls of Lhe Lransversus
abdomlnls muscle Lo form Lhe posLerlor recLus
sheaLh and lnserLs ln Lhe llnea alba
4 Lower parL ls lnserLed ln Lhe publc cresL as Lhe
con[olnL/ con[olned Lendon

Ŧ tran¾vr¾¾ abdom|n|¾ m¾c|
4 orlalnť lumbodorsal fascla (some flbers blends
wlLh Lhe flbers of Lhe dlaphraam)

fŦ tran¾vr¾a||¾ fa¾c|a/ ndoŴabdom|na| fa¾c|a
4 a C1 laver LhaL llnes Lhe enLlre abdomlnal
cavlLv beLween Lhe Lransversus abdomlnls
muscle and Lhe perlLoneum

gŦ ½r½r|tona| fat
4 faLLv Llssue before Lhe perlLoneum

hŦ ½r|tonm
4 serous membrane LhaL llnes Lhe abdomlnal
cavlLv


13 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

5½c|a| Iatr¾ of Lowr Abdom|na| Wa||
1Ŧ 1he l f/ot musc/es of the obdomen nome/yť interno/
ob/ioueţ externo/ ob/ioue ond tronsversus obdominis
musc/e forms on e/ostic inouino/ orcode thot he/ps
mointoin introŴobdomino/ pressure
Ŵ lnaulnal arcades are Lraversed bv Lhe spermaLlc
cord (males)Ť round llaamenL (females)
Ŵ arcade collapses when Lhe abdomen ls Lensed
Ŵ relaxed abdomen opens Lhe arcade










Ŧ nesse/boch´s triono/e
Ŵ LocaLed ln Lhe lower abdomlnal wall
Ŵ floorť Lransversalls fascla
4 weaknessť lnaulnal hernlas (dlrecL)

Ŵ laLeral borderť lnferlor eplaasLrlc vessels
Ŵ medlal borderť laLeral border of recLus abdomlnls
Ŵ baseť lnaulnal llaamenL
Ŵ anaLomlcal landmark ln dlfferenLlaLlna lnaulnal
hernlas lnLo dlrecL or lndlrecL

lŦ 5croto/ extensions
Abdomn 5crotm and |ab|a
Ŵ Skln Ŵ Skln
Ŵ Camper's fascla Ŵ uarLon's fascla
Ŵ Scarpa's fascla Ŵ Colle's fascla
Ŵ LxLernal obllque
muscle
Ŵ LxLernal spermaLlc
Ŵ lnLernal obllque
muscle
Ŵ CremasLer Muscle
Ŵ 1ransversus
abdomlnls muscle
Ŵ no correspondlna
laver
Ŵ 1ransversalls fascla lnLernal spermaLlc
Ŵ ÞreŴperlLoneal faL Ŵ reolar and faL
Ŵ ÞerlLoneum Ŵ Þrocerus vaalnalls
(exLenslon of Lhe
perlLoneum L
scroum or labls)



L|gamnt¾ť
1Ŧ Ing|na|/ Þo½art'¾ ||gamnt
Ŵ derlved from exLernal obllque aponeurosls
Ŵ Lhlckened porLlon of Lhe LC LhaL exLends from
Lhe SlS up Lo Lhe publc Lubercle

2Ŧ Lacnar/ G|mbrnat'¾ ||gamnt
Ŵ a parL of Lhe lnaulnal llaamenL LhaL exLends
downwardsţ backwards and laLerallv Lo lnserL lnLo
Lhe pecLlneal llne
Ŵ lL ls Lhe pecLlneal porLlon of Lhe lnaulnal llaamenL

3Ŧ Coo½r'¾ ||gamnt
Ŵ Lhe parL of Lhe lacunar llaamenL LhaL passes
laLerallv as lL lnserLs lnLo Lhe pecLlneal llne

4Ŧ 1r|ang|ar ||gamnt
Ŵ ls Lhe reflecLed lnaulnal llaamenL
Ŵ fold of lnaulnal llaamenL
Ŵ orlalnaLes from Lhe lnferlor crus of exLernal llnaual
rlnaţ passes behlnd Lhe spermaLlc cord and
medlallv lnLo Lhe llnea alba beLween Lhe con[olnL
Lendon and Lhe superlor crus of Lhe exLernal
lnaulnal rlna

5Ŧ Con[o|nt/ Con[o|nd ||gamnt
Ŵ lalx lnaulnalls
Ŵ formed bv fuslon of aponeurosls of 1ransversus
abdomlnls and Lhe lnLernal obllque as lL lnserLs
lnLo Lhe svmphvsls publs and publc cresL

6Ŧ Intrfovo|ar ||gamnt of n¾¾|bach
Ŵ lles on Lop of Lhe 1ransversus abdomlnls muscle
laLeral Lo Lhe lnferlor eplaasLrlc vessels
7Ŧ Þct|na| ||gamnt
Ŵ free edae of Lhe lacunar llaamenL












14 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2















Ing|na| k|ng¾
1Ŧ ¾½rf|c|a| |ng|na| r|ng
Ŵ subcuLaneous or exLernal abdomlnal rlna
Ŵ a deLecL ln Lhe exLernal obllque aponeurosls
Ŵ Lrlanaular Lhlnned ouL porLlon of Lhe LC
Ŵ a½xť laLeral Lo Lhe publc Lubercle
Ŵ baseť laLeral half of Lhe publc cresL medlal o Lhe
publc Lubercle
Ŵ ¾½r|or cr¾ť aponeurosls of exLernal obllqueţ
Lhls deLecL ls covered bv lnLerŴcrural flbersţ
aLLached Lo Lhe publc cresL and svmphvsls publs
Ŵ |nfr|or cr¾ť medlal end of Lhe lnaulnal llaamenL

2Ŧ d½ |ng|na| r|ng
Ŵ defecL/ openlna Lo Lhe Lransversalls fascla leadlna
lnLo Lhe lnLernal spermaLlc fasclaţ enLrance Lo Lhe
lnaulnal canal
Ŵ locaLed approxlmaLelv 1 flnaerbreadLh above Lhe
lnaulnal llaamenL aL lLs mldpolnL [usL laLeral Lo Lhe
lnferlor eplaasLrlc arLerv














1nL INGUINAL CANAL
Ŵ a clefL LhaL Lakes an obllque course Lhrouah Lhe
lnaulnal realon wlLh Lhe abdomlnal beLween Lhe
lnLernal and exLernal lnaulnal rlnas
Ŵ averaaes 4Ŵ3 cm ln lenaLh
Ŵ Lhe enLrance Lo Lhe lnaulnal canal ls Lhe deep or
lnLernal lnaulnal and Lhe exlL ls Lhrouah Lhe
superflclal rlna
Ŵ antr|or wa||ť ls made up of Lhe exLernal obllque
muscle LhrouahouL Lhe canal and on Lhe laLeral half
bv Lhe fleshv flbers of Lhe lnLernal obllque muscle
Ŵ ½o¾tr|or wa||ť Lransversalls fascla LhrouahouL and
Lhe con[olnL Lendon aL Lhe medlal half
Ŵ roofť arched lower border of Lhe lnLernal obllque
muscle and Lransversus abdomlnls muscle
Ŵ f|oorť lnferlor border of Lhe lnaulnal llaamenLţ
lacunar llaamenL and Lransversalls fascla
Ŵ contnt¾ť spermaLlc cord (males)
round llaamenL (females)

8LCCD VL55LL5 AND NLkVL5
1Ŧ artr|¾
orlalnaLe fromť
aŦ fmora| artry
4 superflclal lnferlor eplaasLrlc arLerv
4 superflclal exLernal pudendal arLerv
4 superflclal clrcumflex lllac arLerv

bŦ |ntrna| |||ac artry
4 deep lnLernal eplaasLrlc arLerv
4 deep clrcumflex arLerv

2Ŧ velns follow Lhe course of Lhe arLerv
3Ŧ nrv¾
aŦ |||oŴ|ng|na| nrv
4 orlalnaLes from L1
4 plerces Lhe lnLernal obllque muscle
4 runs Lhrouah Lhe lnaulnal canalţ exlLs
Lhrouah Lhe exLernal rlna and ls sensorv Lo
Lhe anLerlor aspecL of Lhe scroLum or Lhe
labla ma[ora

bŦ |||ohy½oga¾tr|c nrv
4 orlalnaLes from L1
4 plerces Lhe exLernal obllque aponeurosls
[usL above Lhe exLernal rlna
4 ls sensorv Lo Lhe skln of Lhe hvpoaasLrlc area

15 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

cŦ gn|ta| branch of th Gn|toŴfmora| nrv
4 orlalnaLes from L1 and L2
4 accompanles Lhe spermaLlc cord/ round
llaamenL Lhru Lhe lnaulnal canal
4 ls moLor Lo Lhe cremasLer muscle (cremasLer
reflex)
4 sensorv Lo Lhe Lunlca vaalnalls (coverlna of
Lhe LesLls derlved from Lhe processus
vaalnalls)

CLINICAL CCkkLLA1ICN
1Ŧ |ng|na| hrn|a
Ŵ (hernla) a proLruslon of vlsceraţ C1ţ adlpose Llssue
Lhrouah an anaLomlc openlna
Ŵ conslsLs ofť
aŦ mouLh Ŷ openlna
bŦ sac
cŦ conLenLs Ŷ can be anv vlscera (lŦeŦ lnLesLlnesţ
appendlxţ omenLumţ ovarles and falloplan
Lubes)
Ŵ Lvpes of lnaulnal hernlať
aŦ lndlrecL hernla Ŷ lnLernal rlna
bŦ dlrecL hernla Ŷ defecL ls Lhrouah Lhe
Lransversalls fascla

Ŵ femoral hernla Ŷ femoral rlna


2Ŧ hydroc| of th cord
Ŵ collecLlon of fluld ln Lhe processus vaalnalls
Ŵ conLalns fluldţ ln conLrasL wlLh hernlaţ hernla
conLalns vlscera
Ŵ dlaanosLlc maneuver (Lo dlfferenLlaLe Lhe 2)ť
1kAN5ILLUMINA1ICN
4 flashllahL over Lhe proLruslon
4 (+) presence of hallow hvdrocoele
4 (Ŵ) hernla

AU5CUL1A1ICN
4 sLeLhoscope
4 presence of bowel sounds (hernla)
4 hvdrocoele (Ŵ)

Ŵ common ln chlldren (bulae ln Lhe area LhaL does
noL sponLaneouslv dlsappear or reduced over aL
resL

3Ŧ var|coc|
Ŵ collecLlon of varlcose velns ln Lhe scroLal and
lnaulnal areas
Ŵ palpaLeť º8 Cl WC8MS"
Ŵ more common on Lhe lefL because Lhe lefL
LesLlcular velns draln Lo Lhe lefL renal veln (smaller
dm)
Ŵ rlahL LesLlcular veln ƹ lnferlor vena cava


lnul8LC1 PL8nl ul8LC1 PL8nl lLMC8L PL8nl
IkLCULNC¥ O mosL common O less common O leasL common
AGL O ofLen ln chlldren
(conaenlLal)
O over aae 40
(acqulred)
llfLlna heavv ob[ecLs
sLralnlna due Lo
consLlpaLlon
O all aaes
5Lk O boLh sexes O adulL males O females
DLILC1 O unobllLeraLed or paLenL
processus vaalnalls
O weakness of Lhe
Lransversalls fascla
O enlaraed femoral rlna
O proLruslon medlal Lo
femoral sheaLh
CkIGIN O above lnaulnal llaamenL
mldpolnL (lnLernal rlna)
O above lnaulnal llaamenL
medlallv near publc
Lubercle (exLernal rlnať
Pesselbach's Lrlanale)
O below Lhe femoral rlna
kLLA1ICN 1C INILkICk
LÞIGA51kIC VL55LL5
O laLeral
because Lhe lnLernal rlna ls
[usL laLeral Lo lnferlor
eplaasLrlc vessels
O medlal
because Lhe Pesselbach''s
Lrlanale ls medla Lo lL
O medlal
CCUk5L O ofLen aoes lnLo Lhe
scroLum
O rarelv scroLal O never
CN Þn¥5ICAL
LkAMINA1ICN
O hernla Louches Llp of
flnaer
O anLerlor bulae Louches
slde of Lhe flnaer
O empLv lnaulnal canal
16 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Comb|nat|on of hydroco| and hrn|a? ¥L5
Ŵ waLer comes from Lhe perlLoneal fluld
Ŵ openlna ls Loo small for Lhe vlscera
Ŵ buL as Lhe chlld arows older ƹ dlameLer of Lhe
openlna arows blaaer alsoŦ So vlscera now can
enLer Lhrouah Lhls openlna

nrn|otomy
Ŵ suralcal repalr ln lnfanLs/ chlldren
Ŵ Lhe sac ls opened
Ŵ conLenLs are reduced back Lo Lhe abdomlnal cavlLv
Ŵ neck of Lhe sac ls llaaLed
Ŵ sac ls exclsed

nrn|ora½hy
Ŵ repalr of Lhe lavers of Lhe lnaulnal realon
Ŵ sLrenaLhenlna of Lhe lavers

Incarcratd nrn|a
Ŵ when Lhe hernla becomes lrreduclble
5trang|atd hrn|a
Ŵ vascular supplv ls compromlsed
Ŵ needs emeraencv operaLlon

uo vou operaLe on all hvdrocoele? no need lf lL dlsappears
sponLaneouslvŦ

lf lL compresses Lhe LesLls? ?esŦ (because lL wlll affecL
ferLlllLv)

varlcocoele (varlcocoelecLomv)? ?esŦ 8ecause Lhere ls an
lncrease blood LemperaLure (compromlses
spermaLoaenesls ƹ decreased sLerlllLv)































































17 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

1h Þr|tonm
(DrŦ LŦ Mana|o)

Lhlnţ allsLenlna lnLernal llnlna of abdomlnal cavlLv
conslsLlna of a sheeL of mesoLhellalŴserosal cells
supporLed bv connecLlve Llssue aLLached Lo Lhe
Lransversalls fascla surroundlna Lhe abdomlnal cavlLv
beneaLh Lhe abdomlnal muscles
D|v|¾|on¾
1Ŧ ½ar|ta| Ŷ llnes Lhe anLerolaLeral and posLerlor
abdomlnal cavlLv wall
2Ŧ v|¾cra| Ŷ Lhe parL of perlLoneum LhaL llnes Lhe
lnLraperlLoneal oraans ln varvlna deareesŤ forms Lhe
serosal laver of Lhe l1

Þr|tona| Cav|ty
llned bv Lhe perlLoneum
conLalns onlv perlLoneal fluld aslde from Lhe
lnLraperlLoneal oraans
Lhe fluld serves as a lubrlcanL LhaL allows movemenL of
Lhe lnLraperlLoneal oraans

D|v|d¾ |nto 2ť
1Ŧ |¾¾r ½r|tona| ¾ac/ |¾¾r omnta| br¾a
4 caused bv dlverslon of Lhe perlLoneum around
Lhe Lransverse colon

2Ŧ gratr ½r|tona| ¾ac/ gratr omnta| br¾a
4 whlch Lhe lnLraperlLoneal oraans are locaLed

O Lhese 2 cavlLles communlcaLes wlLh each oLher bv
means of "L½|½|o|c Ioramn of W|n¾|ow"
O bondar|¾ť
Ŵ ¾½r|or|yť aallbladder and llver
Ŵ antr|or|yť lesser omenLum LhaL conLalns Lhe
common blle ducLţ porLal veln and Lhe hepaLlc
arLerv
Ŵ |nfr|or|yť flrsL parL of Lhe duodenum
Ŵ ½o¾tr|or|yť lnferlor vena cava
Ŵ |m½ortancť safe suralcal aulde for aallbladder and
common blle ducL suraerles

Þr|tona| Io|d¾ (m¾ntr|¾/ ||gamnt¾)
perlLoneal reflecLlons or pro[ecLlons of lnLraperlLoneal
oraans LhaL reduce Lhe abdomlnal cavlLv lnLo sllLsţ
fossaţ auLLers

1Ŧ dct¾ (tb¾)
O perlLoneal folds aLLached Lo ducLs servlna as Lhelr
mesenLerles
O mav be paLenL or obllLeraLed
O th ½atnt tb¾ a¾¾oc|atd w|th th¾ fo|d¾
aŦ lesser omenLum ls Lhe perlLoneal fold Ŷ
aLLached Lo Lhe common blle ducL
bŦ broad llaamenL Ŷ aLLached Lo Lhe falloplan
Lube/ uLerlne Lubes
cŦ mesenLerv Ŷ aLLached Lo Lhe small lnLesLlnes
dŦ mesocolon Ŷ aLLached Lo larae lnLesLlnes
eŦ mesoŴappendlx Ŷ aLLachmenL for Lhe appendlx

O ob||tratd tb¾
fŦ medlan umblllcal llaamenL Ŷ uracus/ allanLolc
ducL

2Ŧ artr|¾
O mav be paLenL or obllLeraLed
O ½atntť
aŦ rlahL and lefL aasLroŴpancreaLlc fold Ŷ conLalns
Lhe hepaLlc arLerv
bŦ paraŴduodenal fossa llaamenL Ŷ lefL aasLrlc
arLerles and ascendlna branch of lefL collc
arLerv

O ob||tratdť
cŦ medlan umblllcal llaamenL Ŷ umblllcal arLerv

3Ŧ artr|¾ and v|n¾
O ½atntť
aŦ laLeral umblllcal llaamenL Ŷ lnferlor eplaasLrlc
vessels
4 mesoappendlx Ŵ for Lhe appendlclal
vessels

bŦ superlor lleocecal fold Ŷ conLalns appendlLlal
vessels
cŦ suspensorv llaamenL of Lhe ovarv Ŷ conLalns
Lhe ovarlan vessels and Lhe anLerlor cecal
vessels

4Ŧ v|n¾
O ½atntť
aŦ superlor duodenal fossa llaamenL and para
duodenal fossa llaamenL
lnferlor mesenLerlc velns

O ob||tratdť
bŦ falclform llaamenL
cŦ llaamenLum Leres hepaLls Ŷ obllLeraLed
umblllcal veln

18 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

5Ŧ not a¾¾oc|atd w|th tb¾ or v¾¾|¾
aŦ rlahL and lefL Lrlanaular llaamenLs of Lhe llver
bŦ phrenlcoŴcollc llaamenL Ŷ dlaphraam Lo colon
cŦ coronarv llaamenL Ŷ superlor surface of Lhe llver
dŦ rlahL and lefL paracollc folds Ŷ ascendlna and
descendlna colon
eŦ lnferlor duodenal fossa folds
fŦ lnferlor lleocecal folds Ŷ membranes assoclaLed
wlLh appendlx (Laneƌs and !acksonƌs membrane)
aŦ ovarlan llaamenL (pelvlc)
hŦ aasLrocollc llaamenL
lŦ lelonŴrenal llaamenL

Þr|tona| fo¾¾aţ rc¾¾¾ţ and gttr¾
1Ŧ omenLal bursa (lesser sac)
2Ŧ above Lhe areaLer omenLum
Ŵ lefL and rlahL subphrenlc space (below Lhe
dlaphraam)
Ŵ hepaLoneal recess/ pouch Ŷ beLween llver and
kldnev

3Ŧ below Lhe areaLer omenLum
Ŵ duodenal fossa
aŦ superlor
bŦ lnferlor
cŦ paraduodenal
dŦ reLroduodenal

Ŵ cecal fossae
aŦ superlor
bŦ lnferlor
cŦ reLrocecal
dŦ lnLerslamold fossa
eŦ pelvlc fossa (reLroveslcal)
fŦ reLroŴomenLal fossa
aŦ panacollc auLLers

GkLA1Lk CMLN1UM
Ŵ fuslon of 2 parleLal perlLoneum lavers aL Lhe areaLer
curvaLure of Lhe sLomach LhaL hanas down llke an
apron over Lhe small lnLesLlnes and Lhe Lransverse
colon
Ŵ hlahlv moblle aravlLaLlna Lowards Lhe slLe of lnfecLlon
(llmlL Lhe lnfecLlon ln Lhe area/slLe of lnfecLlon)
Ŵ eŦaŦ acuLe appendlclLls

GLI55CNƌ5 CAÞ5ULL
Ŵ perlLoneal reflecLlon over Lhe llver
Ŵ capsule of Lhe llver

DIAÞnkAGMA1IC kLILLC1ICN
Ŵ perlLoneum beneaLh Lhe dlaphraam
Ŵ covers Lhe lnferlor surface of Lhe dlaphraam
Ŵ perlLoneum cavlLv noL wellŴdeflned

IN1kAÞLkI1CNLAL CkGAN5
Ŵ compleLelv/ parLlallv covered bv perlLoneum
aŦ allmenLarv LracL
bŦ mosL of Lhe llver

kL1kCŴÞLkI1CNLAL CkGAN5
Ŵ behlnd/ posLerlor Lo Lhe perlLoneum
aŦ kldnevs
bŦ pancreas
cŦ aorLa
dŦ duodenum
eŦ base area of llver
fŦ ureLers

Lk1kAÞLkI1CNLAL CkGAN5
Ŵ locaLed beneaLh/ below/ lnferlor Lhe perlLoneum
aŦ urlnarv bladder
bŦ recLum
cŦ pelvlc oraans

























19 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

GA51CL5CÞnAGLAL IUN1ICN
(DrŦ C|t|q|t)

Ŵ aŦkŦaŦ lower esophaaeal sphlncLer/ cardla
Ŵ lL ls Lhe polnL where Lhe dlsLal esophaaus becomes
aasLrlc pouch
Ŵ 0Ŧ3 Lo 2Ŧ3 cm lles lnLraŴabdomlnallv
Ŵ lL lles aL Lhe level of 111Ŵ112 exLernallv
Ŵ lnLernallvţ seen as Lhe LranslLlon of sLraLlfled
squamous eplLhellum Lo a sLraLlfled columnar
eplLhellum
Ŵ Lhe wall ls Lhlckened and acLs as a valve (sphlncLer ƹ
Lhlckenlna)
Ŵ prevenLs reauralLaLlon (loose ƹ vomlLlna)
Ŵ lL allows swallowlna buL prevenLs reflux
Ŵ normallv aL 13 cmP
2
C pressure
4 pressure lncrease ƹ reauralLaLlon
Ŵ Lhe sLomach can accommodaLe up Lo 2L of fluld ln
one Llme
Ŵ factor¾ that r|ax¾ LL5ť
aŦ alcohol
bŦ chocolaLe
cŦ exLernal smell
dŦ caffelne

Ŵ b|ood ¾½½|yť
Ak1LkIAL
aŦ lnferlor phrenlc arLerv
bŦ lefL aasLrlc arLerv
VLIN
aŦ lnferlor phrenlc veln
bŦ lefL aasLrlc veln











51CMACn
(DrŦ C|t|q|t)


& 1Ŧ 8odv of sLomach
& 2Ŧ lundus
& 3Ŧ nLerlor wall
& 4Ŧ reaLer curvaLure
& 3Ŧ Lesser curvaLure
& 6Ŧ Cardla
& 9Ŧ Þvlorlc sphlncLer
& 10Ŧ Þvlorlc anLrum
& 11Ŧ Þvlorlc canal
& 12Ŧ naular noLch
& 13Ŧ asLrlc canal
& 14Ŧ 8uaal folds

Ŵ aŦkŦaŦ S1L8
Ŵ wldesL and LhlckesL parL of Lhe l1
Ŵ mosL vascular of Lhe l1 LracL
Ŵ ºpearŴshaped" oraan
4 ln Lhln lndlvldualsť !Ŵshaped
4 ln obeseť Lransverselv orlenLed

Ŵ mosL proxlmal abdomlnal oraan of Lhe l1
Ŵ ma[orlLv locaLed aL Lhe LuC
Ŵ flxed proxlmallv bv Lhe L [uncLlon and dlsLallv aL Lhe
asLroduodenal [uncLlon
20 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

ga¾tr|c ot|t ¾yndrom Ŷ obsLrucLlon ln Lhe u
[uncLlon
Ŵ mldŴporLlon or Lhe bodv of Lhe sLomach ls relaLlvelv
moblle
Ŵ s/s relaLed Lo sLomach ls locaLed aL Lhe eplaasLrlc
realon
Ŵ dr|vd from thť
aŦ forgt
4 from esophaaus Lo end of duodenum
(LlaamenL of 1relLz)
4 blood supplv Ŷ cellac arLerv

bŦ m|d gt
4 from [e[unum Lo mld porLlon of Lhe
Lransverse colon
4 blood supplv Ŷ superlor mesenLerlc arLerv

cŦ h|ndgt
4 mld porLlon of Lhe Lransverse colon Lo Lhe
anus
4 blood supplv Ŷ lnferlor mesenLerlc arLerv

Ŵ IUNC1ICNť
aŦ food sLoraaeţ dlaesLlonţ mlxlna
4 sLavs ln Lhe sLomach approxlmaLelv 4 hours

bŦ kllls and lnhlblLs dlaesLed mlcrooraanlsms wlLh
PCL
4 abdomlnal collc/ spasms Ŷ [umplna afLer
eaLlna

cŦ boLh endocrlne and exocrlne funcLlons bv
elaboraLlna enzvmes

Ŵ kLLA1LD 51kUC1UkL5ť
aŦ antr|or|y
4 lefL laLeral lobe of llver
4 dlaphraam
4 anLerlor chesL and abdomlnal wall

bŦ superlorlv
4 lefL lobe of llver
4 dlaphraam
4 dlsLal esophaaus


cŦ |nfr|or|y
4 Lransverse colon
4 areaLer omenLum

dŦ |atra||y
4 spleen
4 laLeral dlaphraam

Ŧ ½o¾tr|or|y
4 pancreas
4 dlaphraamaLlc crura
4 renal capsule
4 reLroperlLoneal nerve and vessels (lvC and
abdomlnal aorLa(
4 splenlc hllum

Ŵ GkC55 ANA1CM¥
aŦ 2 o½n|ng¾
4 cardla Ŷ proxlmal
4 pvlorus Ŷ dlsLal

bŦ 2 va|v¾
4 lower esophaaeal sphlncLer Ŷ proxlmal
4 pvlorlc valve Ŷ dlsLal

cŦ 2 crvatr¾
4 Cardlac anale/ lnclssura cardlac
4 lnclssura anaularls/ amaular noLch

dŦ 2 ¾rfac¾
4 anLerlor
4 posLerlor

Ŧ 2 omnta
4 lesser omenLum Ŷ lesser curve
4 areaLer omenLum Ŷ areaLer curve


Ŵ ANA1CMIC DIVI5ICN5
aŦ fnd¾
4 area above llne drawn Lhru cardlac noLch

bŦ body/ cor½¾
4 from fundus down Lo Lhe llne of anaular
noLch

cŦ ½y|or¾
4 afLer anaular noLch llne
4 2 subdlvlslonsť
Þvlorlc anLrum
21 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Þvlorlc canal Ŷ where Lhe duodenal/
pvlorlc valve ls locaLed




























Ŵ 8LCCD 5UÞÞL¥
Ak1LkIAL 5UÞÞL¥
4 derlved malnlv from branches of Lhe Cellac
arLerv
aŦ lefL aasLrlc arLerv Ŷ supplles lesser curve
bŦ rlahL aasLrlc arLerv Ŷ also supplles Lhe lesser
curve
cŦ shorL aasLrlc arerv
dŦ aasLroduodenal arLerv
eŦ lefLŴaasLroeplplolc arLerv
fŦ rlahLŴaasLroeplplolc arLerv

VLNCU5 DkAINAGLť
aŦ lefL aasLrlc veln porLal veln
bŦ rlahL aasLrlc veln
cŦ shorL aasLrlc veln splenlc veln
dŦ lefL aasLroeplplolc
eŦ rlahL aasLroeplplolc Ŷ dralns Lo superlor
mesenLerlc veln
splenlc veln and superlor mesenLerlc veln ƹ wlll
draln Lo Lhe porLal veln

INNLkVA1ICN
aŦ Vag¾ nrv (CN k)
4 enLers Lhe abdomen bv [olnlna Lhe
esophaaus Lhru Lhe esophaaeal hlaLus
4 parasvmpaLheLlc
4 when lL reaches Lhe dlsLal esophaaus wlll
dlvlde lnLoť
LefL Lrunk Ŷ anLerlorlv
O PepaLlc branch
supplles Lhe llver and aallbladder
O pvlorlc branch
anLerlor nerve of LaLar[eL
supplles pvlorus and anLerlor
parL
mosL dlsLal of Lhe pvlorlc branch

8lahL Lrunk Ŷ posLerlorlv
O cellac branch
supplles resL of Lhe vlscera and
pancreas

bŦ C||ac Þ|x¾
4 svmpaLheLlc
4 arlses from 3
Lh
Lo 8
Lh
Lhoraclc arLerv

L¥MÞnA1IC DkAINAGL
4 follows arLerlal supplv of sLomach and evenLuallv
draln lnLo Lhe cellac nodes lj Lhoraclc ducL

aŦ |ft ga¾tr|c nod
dralns cardla and medlal half of bodv of
sLomach

bŦ r|ght ga¾tr|c nod
dralns lesser curve of Lhe anLrum and
pvlorus

cŦ r|ght ga¾tro½|½|o|c nod
dralns 60Ʒ of dlsLal areaLer curve

dŦ |ft ga¾tro½|½|o|c nod
fundus and 40Ʒ of proxlmal areaLer curve

22 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ CLINICAL CCkkLLA1ICN5ť
aŦ ac|d r|atd d|¾ordr¾
½½t|c |cr
O eroslonsţ sore or holes ln Lhe mucosa/
wall of Lhe sLomach and duodenum
O elLher aasLrlc ulcer/ duodenal ulcer
O 8PM Þ1CP Ŷ puLLlna omenLum on
Lhe repalred area where vou have Lhe
perforaLlons

bŦ ga¾tr|t|¾
lnflammaLlon of sLomach
secondarv Lo acldţ druas (asplrlnţ anLlŴ
sLeroldal and sLerolds)
sLress hvpersenslLlvlLv
cŦ Vagotomy
Lruncal vaaoLomv Ŷ cuL vaaus nerve
selecLlve/ hlahlv selecLlve/ parleLal
vaaoLomv ƹ cuL branches onlv

dŦ Ga¾trctomy
remove whole sLomach (LoLal)
remove parL (parLlal/ subLoLal)

Ŧ Ga¾trotomy
openlna of sLomach

fŦ 8|||roth o½rat|on
















































23 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

5MALL IN1L51INL
(DrŦ Laygo)

Ŵ parL of l1 beLween Lhe sLomach (pvlorlc sphlncLer)
and lleocecal [uncLlon
Ŵ com½onnt¾ť
aŦ duodenal
bŦ [e[unum
cŦ lleum

DUCDLNUM
Ŵ h|¾toryť 1 fooL lona
Ŵ afLer Lhe sLomach
Ŵ cŴshaped Lube
Ŵ |ngthť 23 cm (10 lnches)
Ŵ 1
sL
ţ shorLesLţ llahLesLţ and wlLh Lhe LhlckesL wall
Ŵ mosL flxed porLlon of Lhe small lnLesLlne
Ŵ xtntť pvlorus (pvlorlc sphlncLer) and Lhe duodenalŴ
[e[unal [uncLlon
Ŵ |ocat|onť eplaasLrlc and umblllcal realons
Ŵ ½r|tona| r|at|on¾ť
4 1
sL
2Ŧ3 cm ť covered bv perlLoneum anLerlorlv
and posLerlorlv
4 upper border Ŷ lesser omenLum
4 lower border Ŷ areaLer omenLum

Ŵ lnLraperlLoneal
Ŵ oLher parLsť reLroperlLoneal Ŷ parLlallv covered

ÞAk15 CI 1nL DUCDLNUM
1Ŧ ¾½r|or ½art
Ŵ 3 cm lona (2 lnches)
Ŵ sLarL aL Lhe pvlorus (L1) and passes backwardţ
upward and Lo Lhe rlahL Ŷ lles on Lranspvlorlc plane
Ŵ r|at|on¾ť
4 antr|or|yť quadraLe lobe and aallbladder
4 ½o¾tr|or|yť lesser sacţ aasLroduodenal arLervţ
common b|| dctţ ½orta| v|nţ lvC
½orta| tr|ad Ŵ anLerlor boundarv of Lhe
Lplplolc foramen LoaeLher wlLh hepaLlc
arLerv

4 ¾½r|or|yť epllolc foramen (communlcaLlon of
Lhe lesser and areaLer sac
4 |nfr|or|yť head of Lhe pancreas

2Ŧ d¾cnd|ng dodnm
Ŵ |ngthť 8 cm (3 lnches)
Ŵ runs verLlcallv downward ln fronL of Lhe hllus of
Lhe rlahL kldnev and on rlahL slde of L2 and L3
verLebra
Ŵ descends up Lo L3 Lhen bends sharplv Lo Lhe lefL
and becomes Lhe 3
rd
parL of Lhe duodenum
Ŵ crossed bv Lransverse colon
Ŵ once crossed lL ls dlvlded lnLo supracollc and
lnfracollc comparLmenLs
Ŵ r|at|on¾ť
antr|orť fundus of aallbladderţ rlahL lobe of
llverţ Lransverse colon and colls of Sl ([e[unum
and lleum)
½o¾tr|orť hllus of Lhe rlahL kldnevţ rlahL ureLer
|atra|ť ascendlna colonţ rlahL collc flexureţ
rlahL lobe of Lhe llver
md|a||yť head of pancreasţ halfwav downţ
posLeromedlallv Ŷ common blle ducL and maln
panreaLlc ducL LermlnaLes

acc¾¾ory ½ancrat|c dct
Ŵ dralns 1Ŧ9 cm above Lhe maln pancreaLlc ducL (ducL
of Wlrsuna) and common blle ducL
Ŵ ºducL of SanLorlnl"
Ŵ openlna ºmlnor duodenal papllla"

md|ododna| ½a½|||a
Ŵ dralnaae ƹ ducL of common blle ducL and maln
pancreaLlc ducL

"va|v¾ of krckr|ng"

3Ŧ hor|zonta| ½art
Ŵ |ngthť 8cm
Ŵ passes horlzonLallv Lo Lhe lefL slde on Lhe subcosLal
plane
Ŵ crosses Lhe bodv of L3
Ŵ found on Lhe rlahL and lefL lnfracollc
comparLmenLs
Ŵ cro¾¾¾ th ffť
aŦ rlahL psoas muscle
bŦ ureLer
cŦ lvC
dŦ abdomlnal aorLa

Ŵ ends aL Lhe lefL slde of bodv of L3
Ŵ relaLlonsť
4 antr|orť rooL of mesenLerv of Slţ superlor
mesenLerlc vesselsţ colls of [e[unum
4 ½o¾tr|orť rlahL ureLerţ rlahL psoas muscleţ lvC
and aorLa
4 ¾½r|orť head of pancreas
4 |nfr|orť colls of [e[unum




24 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ c||n|ca| corr|at|onť
4 superlor mesenLererlc vessels mav cause
duodenal obsLrucLlon secondarv Lo
compresslon of Lhese vessels
4 tratmntť bvpass/ resecLlon Ŷ anasLomosls of
Lhe proxlmal and dlsLal porLlon and puL above
Lhe duodenum
4 resecLlon of obsLrucLed area
4 aasLroduodenal bvpass
4 b|nt abdom|na trama
force compresslon bv L3
rupLure of Lhe Lransverse duodenum/
perforaLlon of posLero aspecL
lncrease abdomlnal clrcumference
common slLe of duodenal perforaLlon

4Ŧ a¾cnd|ng ½art
Ŵ |ngthť 3 cm (2ln)
Ŵ shorLesL parL
Ŵ run upward alona Lhe lefL slde of Lhe abdomlnal
aorLa on Lhe lefL psoas muscle
Ŵ ends abouL 1 lnch Lo Lhe lefL of Lhe medlan plane
aL Lhe L2 level
Ŵ bends sharplv forward Ŷ duodenoŴ[e[unal flexure
Ŵ r|at|on¾
4 antr|orť rooL of mesenLervţ colls of Sl
4 ½o¾tr|orť lefL maraln of aorLaţ medlal border
of lefL psoas

Va¾c|ar Arch of 1r|tz
Ŵ found ln Lhe space beLween Lhe duodenum and
kldnev
Ŵ formed bv lefL collc arLerv and lnferlor mesenLerlc
veln Ŷ as Lhev ascend LoaeLher near Lhe lefL border
of duodenum Lo Lhe rooL of Lhe Lransverse
mesocolon

Dodna| f|xr
Ŵ usuallv reLroperlLoneal ln locaLlon
Ŵ lles Lo Lhe lefL of Lhe L1ŴL2 dlsk
Ŵ orlalnaLe aL Lhe mlddle of L2 or even L3
Ŵ r|at|on¾ť
4 ½o¾tr|orť lumbar porLlon of dlaphraam
4 ¾½r|orť lnferlor border of pancreas
4 |atra|ť lnLernal border of lefL kldnev
4 antr|orť posLerlor wall of sLomach

5¾½n¾ory L|gamnt (m¾c|) of 1r|tz
Ŵ band of flbrous muscular Llssue from ! flexure
and Lowards Lhe ascendlna porLlon of duodenum
and lnserLs Lo Lhe rlahL plllar of dlaphraam
Artr|a| ¾½½|y of dodnm
1
¾t
½artť
aŦ supraduodenal
bŦ reLroduodenal

4 branch of aasLroduodenal arLerv (branch of
common hepaLlc arLerv
4 maln Lermlnal of u arLerv
rlahL aasLroeplplolc arLerv
superlor pancreaLlcoŴduodenal arLerv


k¾t of dodnm Ŷ artr|a| arcad ofť
aŦ anLerlor Lo duodenum and pancreas branch Ŷ from
superlor and lnferlor pancreoLlcoŴduodenal arLerv

bŦ posLerlor locaLed behlnd

O superlor pancreaLlcoŴduodenal arLerv Ŵ u arLerv
O lnferlor pancreaLlcoŴduodenal arLerv Ŷ from superlor
messenLerlc arLerv

Vno¾ Dra|nag
Ŵ lles alona Lhe arLerles
Ŵ rlahL L veln Ŷ superlor mesenLerlc veln
Ŵ superlor and lnferlor Þu Ŷ superlor mesenLerlc veln
Ŵ SMv [olns Lhe splenlc veln Lo form porLal veln

Lym½hat|c Dra|nag
Ŵ upward vla Þu lvmph node lj u Ln lj cellac aroup
of Ln
Ŵ downward vla lnferlor Þu Ln lj SM Ln

Nrv 5½½|y

5ym½atht|c nrv
1Ŧ from cellac plexus
2Ŧ from SM plexuses of nerves

Þara¾ym½atht|c nrv
1Ŧ vaaus nerve

M|¾¾nrƌ¾ ½|x¾ of nrv¾
Ŵ submucosa of duodenum

Arbachƌ¾ ½|x¾
Ŵ beLween clrcular and lonalLudlnal muscles of
duodenum



25 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

IIVL DUCDLNAL IC55A
aŦ ½aradodna| fo¾¾a
Ŵ lles Lo Lhe lefL of duodeno[e[unal flexure
Ŵ bondaryť
4 r|ghtť aorLa
4 |ftť kldnev
4 ¾½r|orť pancreas and renal vessels
4 antr|orť lMv runs ln Lo anLerlor wall of fossa

Ŵ c||n|ca| corr|at|onť (+) hernlaLlon aL Lhls area
compress lMv lj hemorrholds
4 LreaLmenLť suralcal
4 opens Lo Lhe rlahL and upward (especlallv Lo
sLranaulaLed hernla)

bŦ ¾½r|or dodno[[na| fo¾¾a
Ŵ downward
Ŵ 1 lnch ln depLh
Ŵ ln fronL of L2

cŦ |nfr|or dodno[[na| fo|d¾
Ŵ dlrecLed upward
Ŵ ln fronL of L3

Ŵ b and c formed bv Lwo perlLoneal folds
Ŵ boLh perlLoneal folds
4 pass Lo Lhe lefL from Lhe Lermlnal porLlon of
Lhe duodenumŦ lMv pass alona Lhelr
exLremlLles

dŦ |nfr|or dodna| fo¾¾a
Ŵ exLends behlnd Lhe 3
rd
parL (horlzonLal) of
duodenum

Ŧ m¾ntr|co ½ar|ta| fo¾¾a (Wa|dyr)
Ŵ locaLed behlnd Lhe 1
sL
parL of Lhe meso[e[unum
Ŵ lmmedlaLelv behlnd Lhe superlor mesenLerlc arLerv
and below Lhe duodenum
Ŵ orlflce faces Lo Lhe lefL
Ŵ bondar|¾ť
4 antr|orť Superlor mesenLerlc arLerv
4 ½o¾tr|orť lumbar verLebra

Ŵ c||n|ca| corr|at|onť orlflce ls bla enouah for small
bowel Lo hernlaLe aL Lhls area wlLhouL anv s/s or
dlfflculLv/ sLranaulaLlon



1nL ILIUNUM AND ILLUM
(DrŦ Laygo)

Ŵ 6 Lo 7 m lona
Ŵ 2 fL [e[unum
Ŵ 3 fL lleum
Ŵ occuples Lhe areaLer parL of Lhe abdomlnal cavlLv
Ŵ mosL moblle parL of Lhe small lnLesLlne
Ŵ m¾ntry
4 fan shaped sLrucLure whlch suspends Lhe [e[unum
and lleum from LhaL of Lhe posLerlor abdomlnal
wall
4 root 15 cm |ongť dlrecLed obllquelv lnferlorlv and
Lo Lhe rlahL from lefL slde of Lhe 2
nd
lumbar
verLebra Lo Lhe rlahL sacrolllac [olnL
4 cro¾¾¾ th fo||ow|ng ¾trctr¾ť
aŦ horlzonLal parL of duodenum
bŦ abdomlnal aorLa
cŦ lvC
dŦ psoas ma[or muscles
eŦ rlahL ureLer
fŦ rlahL LesLlcular/ rlahL ovarlan vessels (aonadal
vessels)

Ŵ proxlmal parL of Lhe [e[unum and dlsLal parL of lleum
have shorLer mesenLerles ƹ less moblle from Lhe oLher
parL of Lhe small lnLesLlne
Ŵ conslsLs of 2 lavers of perlLoneum beLween duodenal
and lleal vessselsţ lvmphaLlcsţ nerves and
exLraperlLoneal faLLv Llssues

Va|v¾ of krckw|ng
Ŵ permanenL clrcular folds of Lhe mucosa and
submucosa whlch are presenL LhrouahouL Lhe
lnLesLlnal wall
Ŵ more promlnenL ln Lhe proxlmal duodenum
Ŵ less promlnenL as lL aoes down Lo Lhe dlsLal lleum

Þyrƌ¾ ½atch¾
Ŵ larae submucosal aaareaaLes of lvmphaLlc Llssue
usuallv presenL ln Lhe lleum alona lLs anLlŴmesenLerlc
border

Va¾a kcta
Ŵ sLralahL arLerlal branches arlslna from Lhe arLerlal
arcades wlLhln Lhe mesenLerv and exLends dlrecLlv
Lo Lhe lnLesLlnal wall






26 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

I[nm I|m
LCCA1ICN upper parL of Lhe
perlLoneal cavlLv
and on Lhe lefL
slde of Lhe
Lransverse
mesocolon
Lower parL
LUMLN Wlder narrower
WALL 1hlcker 1hlnner
CCLCk 8eddlsh LlahLer
ÞkL5LNCL CI
ÞLICAL
CIkCULAkI5
More and closer Less and farL
aparL
ML5LN1Lk¥ LocaLed above
and Lo Lhe lefL of
Lhe abdomlnal
aorLa
usuallv aLLached
below and Lo Lhe
rlahL of
abdomlnal aorLa
VA5A kLC1A 1 or 2 arcades
usuallv lona wlLh
lnfrequenL branch
passlna Lo Lhe
lnLesLlnal wall
CompllcaLed
arLerlal arcade
3Ŵ4 or more wlLh
numerous shorL
Lermlnal branches
IA1 DLÞC5I15 near Lhe rooL buL
scanLv ln Lhe
lnLesLlnal wall
ueposlLed all
LhrouahouL
ÞL¥Lk'5 ÞA1CnL5 lnconsplcuous Lo
absenL
ÞresenLţ
numerous ln
membrane ln
lower lleum alona
Lhe anLlŸ
mesenLerlc
border

8LCCD 5UÞÞL¥ CI ILIUNUM AND ILLUM
Ak1Lk¥
Ŵ orlalnaLe from Lhe lefL aspecL of SM whlch ls
locaLed [usL behlnd Lhe pancreas lj aorLa lj enLers
Lhe mesenLerv afLer comlna ouL from Lhe lnferlor
aspecL of pancreas and crosses Lhe unclnaLe process
of pancreas Lhen lj aoes downward Lowards Lhe
rlahL lllac fossa
Ŵ trm|na| branchť lleocollc arLerv 9below Lhe
lnLesLlnal arLerv
Ŵ [e[unal arLerv Ŷ [e[unum
Ŵ lleal arLerv Ŷ lleum
4 from Lhe superlor mesenLerlc arLerv

VLIN5
Ŵ accompanles Lhe arLerles
Ŵ dralns all Lhe wav Lo SMv
Ŵ porLal veln ƹ splenlc veln + SMv

L¥MÞnA1IC DkAINAGL
Ŵ sLarLs from Lhe lnLesLlnal vllll (lvmphaLlc sLrucLure
called lacLeals) Ŷ Lhen evenLuallv empLv Lo Lhe plexus
of lvmphaLlcs vessels alona Lhe [e[unum and lleum
Ŵ lvmphaLlcs vessels passes beLween Lhe 2 lavers of
mesenLerv lj ºmesenLerlc Ln"

Ŵ c|a¾¾|f|cat|on of m¾ntr|c LN
aŦ marg|na|/ ½r|½hra|
4 near Lhe lnLesLlnal wall

bŦ |ntrmd|at LN
4 locaLed aL Lhe mlddle porLlon of Lhe arLerlal
arcades

cŦ cntra| gro½ of LN
4 maln mesenLerlc nodes (cellac Ln and SM Ln)

NLkVL 5UÞÞL¥
Ŵ comes from Lhe vaaus nerve as well as splanchnlc
nerve Lhrouah Lhe cellac aanallon and Lhe nerve
plexuses around Lhe mesenLerlc arLerv

CLINICAL CCkkLLA1ICNť
Meckelƌs dlverLlculum
Ŵ conaenlLal defecL whlch ls due Lo Lhe perslsLenL
volk sac
Ŵ locaLed dlsLal 100 cm of lleumŤ usuallv locaLed
abouL 1 fooL from Lhe lleocecal [uncLlon
Ŵ usuallv aL Lhe anLlŴmesenLerlc border of dlsLal
lleum
Ŵ causes of 8LC paln Ŷ lnflamed Meckels's
dlverLlculum
Ŵ u1l and acuLe appendlclLls Ŷ oLher causes

















27 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

A8DCMINAL ACk1A

n½a|rd branch¾ ½a|rd branch¾ ½a|rd branch¾
½½r ½ort|on |owr ½ort|on



c||ac artry ¾½r|or m¾ntr|c aŦ |nfr|or m¾ntr|c aŦ



|ft ga¾tr|c ¾½|n|c common h½at|c

¾o½haga| branch¾
GD h½at|c ½ro½r
h½at|c branch¾ ¾½radodna|
rtrododna| |ft h½at|c
¾½Ŧ ½o¾tŦ dodna| r|ght ga¾tr|c
r|ght ga¾tr|c ½|½|o|c

½ancrat|c (dor¾a|ţ ¾½r|orţ grat ½ancrat|c) r|ght h½at|c

|ft ga¾tr|c ½|½|o|c cy¾t|c artry

¾½|n|c

¾hort ga¾tr|c


28 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

¾½r|or m¾ntr|c artry


|nfr|or ÞD m|dd| co||c |nt¾t|na| ||oco||c



antŦ ½o¾tŦ r|ght |ft [[nm ||m a¾cnd|ng branch


co||c ||a|

cca|

a½½nd|c|ar










29 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2



CLLIAC Ak1Lk¥/ AkI5/ 1kUNk
Ŵ mosL proxlmal/ venLral unpalred branch of Lhe
abdomlnal aorLa
Ŵ arlses from Lhe fronL of abdomlnal aorLa [usL below
Lhe level of Lhe upper porLlon of L1 verLebra
Ŵ abouL 1Ŵ2 cm lona
Ŵ passes horlzonLallv forward above Lhe upper maraln
of Lhe pancreas and dlvldes behlnd Lhe posLerlor
bodv wall perlLoneum lnLo Lhe followlna
Ŵ around Lhe cellac arLerv are cellac Ln as well Lhe
cellac plexus of nerves lncludlna Lhe aanalla

aŦ LLI1 GA51kIC Ak1Lk¥
O smallesL branch of Lhe cellac arLerv
O cor¾ť courses upward and Lo Lhe lefL Loward Lhe
cardlac end of Lhe sLomach
O usuallv lles behlnd on Lhe bodv wall perlLoneumţ
on Lhe floor of Lhe 8ursa omenLalls (lesser omenLal
cavlLv)
O evenLuallv reaches Lhe bare area of Lhe sLomach
and alves of Lheť

aŦ esophaaeal branches
bŦ hepaLlc branches Ŷ passes Lowards Lhe lefL
lobe of Lhe llver beLween Lhe lavers of Lhe
lesser omenLum

Ŵ aoes downward alona Lhe lesser curvaLure of Lhe
sLomach usuallv Lhru Lhe hepaLoaasLrlc llaamenL
LermlnaLes bv anasLomoslna wlLh Lhe branches of Lhe
rlahL aasLrlc arLerv (from Lhe hepaLlc arLerv proper)
30 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

|¾¾r omntm
aŦ hepaLoaasLrlc llaamenL Ŷ lower porLlon of Lhe llver
arowlna Lowards Lhe lesser curvaLure

bŦ hepaLoduodenal Ŷ covers Lhe porLal Lrlad
Ŵ cholescvsLoduodenal and cholechoduodenal

bŦ 5ÞLLNIC Ak1Lk¥
Ŵ laraesL branch of Lhe cellac arLerv
Ŵ arlses from Lhe lefL slde of Lhe cellac Lrunk dlsLal Lo
Lhe lefL aasLrlc arLerv
Ŵ aolna Lowards Lhe hllum of Lhe spleen

1Ŧ |ft ga¾tr|c ½|½|o|c artry
4 aoes alona wlLh Lhe upper porLlon of Lhe
areaLer curvaLure of Lhe sLomach

2Ŧ ¾hort ga¾tr|c artry/ va¾a brv|a
4 small branches
4 supplles Lhe upper parL of Lhe sLomach (fundus)

cŦ CCMMCN nLÞA1IC Ak1Lk¥
Ŵ blaaer Lhan Lhe lefL aasLrlc arLerv
Ŵ runs forward and Lo Lhe rlahL alona Lhe upper
border of Lhe pancreas and upper maraln of Lhe
upper duodenum passlna behlnd Lo Lhe lesser
omenLum

1Ŧ GA51kCDUCDLNAL Ak1Lk¥
4 shorL Lhlck Lrunk
4 comlna from Lhe CP
4 aL Lhe upper border of Lhe flrsL parL of Lhe
duodenum
4 passes behlnd and dlvldes ln lLs lnferlor border
4 trm|nat¾ť rlahL aasLro eplplolc arLerv
anLerlor superlor Þu arLerv

4 Lhen passes Lhe duodenum and Lhe head of
Lhe pancreas alvlna of lLs proxlmal branchesť

O 5½radodna| artry
4 slender branch
4 descends lnLo Lhe anLerlor and posLerlor
surface of Lhe flrsL parL of Lhe duodenum

O Þo¾tr|or 5½r|or ÞD Artry
4 arlses behlnd Lhe duodenum from Lhe flrsL 2
cm of Lhe u arLerv
4 passes Lo Lhe rlahL anLerlorlv Lo Lhe
common blle ducL
4 aolna alona Lhe posLerlor aspecL of Lhe head
of Lhe pancreas
4 alves off duodenal and pancreaLlc branches
and evenLuallv anasLomose wlLh Lhe
branches wlLh Lhe posLerlor lnferlor Þu
arLerv aL Lhe posLerlor parL of Lhe pancreas

O ktrododna| Artry
4 small mulLlple branches aL Lhe lnferlor
aspecL of Lhe 1
sL
parL of Lhe duodenum [usL
proxlmal Lo lLs Lermlnal dlvlslon

O k|ght Ga¾tro½|½|o|c Artry
4 passes Lo Lhe rlahL lj lefL alona Lhe areaLer
curvaLure slde of Lhe sLomach beLween Lhe
lavers of Lhe aasLro collc llaamenL
4 anaLomose wlLh Lhe branch of Lhe lefL
aasLroeplplolc arLerv

O Antr|or 5½r|or ÞD Artry
4 usuallv descends across Lhe head of Lhe
pancreas near Lhe sulcus beLween Lhe
duodenum and Lhe pancreas
4 lL alves off duodenal and pancreaLlc
branches
4 anasLomose wlLh Lhe anLerlor lnferlor Þu
arLerv whlch comes from Lhe SM

2Ŧ ÞkCÞLk nLÞA1IC Ak1Lk¥
Ŵ conLlnuaLlon of Lhe common hepaLlc arLerv
Ŵ dlsLal Lo u arLerv
Ŵ ascends beLween Lhe laver of Lhe
hepaLoduodenal llaamenL
Ŵ alves off near lLs bealnnlna Lhe rlahL aasLrlc
arLerv
Ŵ supplles Lhe dlsLal porLlon of Lhe lesser curvaLure
Ŵ anasLomose wlLh Lhe lefL aasLrlc arLerv
Ŵ trm|nat¾ť r|ght h½at|c artry and
supplv Lhe rlahL lobe of Lhe llver
alves of cvsLlc arLerv whlch supplles Lhe
aallbladder

|ft ga¾tr|c artry
supplles Lhe quadaLe and quadraLe lobe and
lefL lobe of Lhe llver

5UÞLkICk ML5LN1LkIC Ak1Lk¥
Ŵ supplles all of Lhe small lnLesLlne excepL Lhe proxlmal
parL of Lhe duodenum
Ŵ supplles Lhe cecumţ ascendlna colon and mosL of Lhe
Lransverse colon and Lhe embrvonlc mldauL
Ŵ arlses from Lhe aorLa behlnd Lhe neck of Lhe lower Z
of Lhe L1
Ŵ evenLuallv passes across Lhe unclnaLe process and
Lhlrd parL of Lhe duodenum Lo enLer Lhe mesenLerv
31 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ g|v¾ off th fo||ow|ng branch¾ť

aŦ |nfr|or ÞD artry
4 wlll branch ouL lnLo anLerlor and posLerlor
branch

bŦ m|dd| co||c
4 wlll branch lnLo rlahL and lefL
4 rlahL branch Ŵ supplles Lhe proxlmal parL of
he Lransverse colon
4 lefL branch Ŵ dlsLal parL

cŦ |nt¾t|na| artry
4 wlll branch lnLo [e[unal and lleal arLerv
4 12 Ŷ 13 ln noŦ
4 arlses from Lhe convex lefL slde of Lhe
superlor mesenLerlc arLerv
4 each wlll evenLuallv dlvlde lnLo 2 parLs
whlch unlLes wlLh Lhe ad[acenL branches Lo
form Lhe arLerlal arcade

dŦ ||oco||c/ ||occa| artry
4 Lermlnal branch of Lhe SM
4 dlvldes ln lnLo cecal arLerv Ŷ proxlmal
porLlon of Lhe ascendlna colon
4 ascendlna branch Ŷ anasLomose wlLh Lhe
dlsLal rlahL collc branch
more superlor branch

VLNCU5 DkAINAGL
UÞÞLk GI1
Ŵ lefL aasLrlc veln/ coronarv veln
Ŵ rlahL aasLrlc veln
4 dralns lnLo Lhe porLal veln

Ŵ prepvlorlc veln dralns lnLo Lhe rlahL aasLrlc veln
(landmark)

Ŵ rlahL aaLsroeplplolc veln + anL sup Þu veln ƹ Lermlnal
branches
4 dralns lnLo superlor mesenLerlc veln

Ŵ mlddle collc veln + aasLro collc veln ƹ dralns ln SMv

Ŵ lefL aasLroeplplolc veln lj splenlc veln lj porLal veln

Ŵ shorL aasLrlc veln lj splenlc veln lj porLal venous
svsLem

SM veln Ŷ follow Lhe course of Lhe arLerles
lnferlor Þu veln Ŷ porLal veln

ÞCk1AL VLNCU5 5¥51LM
Ŵ empLles all venous blood from Lhe l1 excepL Lhe
lower parL of Lhe anal canal
Ŵ dralns velns of Lhe spleen and pancreas
Ŵ porLal venous svsLem
Ŵ supplles 73Ʒ of blood Lo Lhe llver
Ŵ dlvldes lnLo rlahL and lefL branches aL Lhe porLa
hepaLls
Ŵ formed bv Lhe SMv and splenlc veln
Ŵ tr|btar|¾ť
aŦ lnl Mv
bŦ SuÞ Mv
cŦ rlahL aasLrlc veln
dŦ splenlc veln
eŦ superlor Þu veln

L¥MÞnA1IC5
Ŵ aoes Lo Lhe cellac Lrunk of Ln and SM Ln Lhen dralns
lnLo Lhoraclc ducL




















32 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

kADICGkAÞn
(DrŦ Aragon)

Cra| Cav|ty
Ŵ xŴrav of lmpacLed LooLh Ŷ embedded wlLh bone
Ŵ deLermlne noŦ of LeeLhţ LooLh noL erupLed

L¾o½hag¾
Ŵ esophaaoaram Ŷ examlne and wlLh conLrasL maLerlal
Ŵ barlum swallow Ŷ plaln chesL xŴrav
Ŵ Lu
Ŵ plaln chesL xŴrav Ŷ lnLraLhoraclc (musL)
4 barlum swallowţ double conLrasL (barlum and alr
LoaeLher) Ŷ aeL laLeral and obllque vlews even
suplne/ 1rendelenbura poslLlon

Ŵ esophaaeal normal consLrlcLlons
4 crlcopharvnaeal
4 esophaaoaasLrlc [uncLlon Ŷ dlsLal consLrlcLlon
4 aorLlc Ŷ crosslna of lefL maln bronchus
elderť more dllaLed aorLa (can produce an
lmpresslons)

Ŵ normalť no bulaeţ hump and ouLŴpouchlna
4 ouLslde of Lhe consLrlcLlons and should be
smooLh

Ŵ chesL and abdomen Ŷ radloaraph
Ŵ radloaraph ln Lhe abdomen Ŷ admlnlsLraLlon of
arLlflclal conLrasL (barlum and lodlne)
Ŵ naLural conLrasL Ŷ provlded bv Llssues
4 faL Ŷ dark
4 muscle/ blood/ fluld Ŷ whlLe or opaque buL noL
as opaque as meLals
4 aas Ŷ lumlnal locaLlon wlLh ln Lhe sLomach

WnA1 1C LkAMINLť
Ga¾ Þattrn
Ŵ presence of aas enable Lo see Lhe lumen of Lhe oraan
such as sLomach (foodţ Lalklna)ţ colon
Ŵ vlslblllLv ln a hollow oraans Ŷ appearance wlll be
dlcLaLed bv Lhe poslLlon of paLlenL
Ŵ suplne poslLlon
Ŵ a½½arť
4 aas aL Lhe superlor aspecL of Lhe lumen
4 afLer sLomach Ŷ pockeLs of alr wlLhln Lhe colon
4 amounL of alr Ŷ noL Lhe same (varlable)

Ŵ (Ŵ) aas Ŷ appear unlform sofL Llssue opaclLv
4 lncrease aas Ŷ lncrease aas formlna bacLerla
4 decrease aas Ŷ abnormal (obsLrucLlon)
vomlLlna afLer eaLlna

Ŵ (+) aas Ŷ obscure shadow of reLroperlLoneal oraans

Ŵ xtra|m|na| a|r
4 can deLermlne pepLlc ulcer dlsease
4 alr ouLslde/ leak Lo perlLoneal cavlLv
(pneumoperlLoneum)

Ŵ sofL Llssue masses/ denslLles of fluld collecLlons
4 (n)8uC Ŷ llver
4 (n)LuC Ŷ spleen Ŷ splenlc flexure (above)

Ŵ splenomeaalv (down splenlc flexure)
Ŵ aallbladder Ŷ noL seen (dlfflculL Lo deLermlne)
4 due Lo maLerlal conLrasL Ŷ blle

CALCIIICA1ICN5
Ŵ bones (normal)
Ŵ kldnev and aallbladder (Ŵ) normal
4 once radlopaque (+) sLones
4 a½½arť kldnev Ŷ sLaa horn
4 ca|c||ť alnaer rooLs

Ŵ aallbladder Ŷ rounded
Ŵ forelan bodles
4 swallowed radlopaque maLerlals (colnţ rlnaţ
denLures)

Ŵ up (rlahL)
4 above dlaphraam
4 below dlaphraam (rlahL llver)
4 lefL upper porLlon Ŷ spleen
4 dark llnes Ŷ faL aL Lhe psoas muscle (aL Lhe slde
of Lhe verLebra)
4 rlahL kldnev Ŷ easllv seen
4 lefL kldnev Ŷ noL easllv seen
4 dark shadow lj (faL/alr) lj LreaLmenL once (+) ln
perlLoneum
4 falclform llaamenL lj dlvldes Lhe llver

CLINICAL CCkkLLA1ICN
O chron|c ½ancrat|t|¾
Ŵ (+) calclflcaLlon (popcorn llke)due Lo lnflammaLlon

O ¾½|n|c ca|c|f|cat|on¾
O h½ato¾½|nomga|y
Ŵ edae of llver (near lllac cresL
Ŵ spleen lj ao down Ŷ border
Ŵ (+) ln leukemla
O a¾c|t¾
Ŵ saaalna flunks
33 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ obscured llver

O ¾o½hagram
Ŵ barlum swallow lj deLermlne Lhe normal conLour
of esophaaus
Ŵ radloaraph Ŷ whlLe esophaaus
Ŵ flouroscope Ŷ black
Ŵ c||n|ca| corr|at|onť
blrdƌs beak Ŷ achalasla

UÞÞLk GI 5LkIL5 AND LCWLk GI
O 5tomach
Ŵ mosalc paLLern Ŷ honevcomb llkeŤ aasLrlc fundus
Ŵ bodv Ŷ horlzonLal/ Lrunk llnes
Ŵ anLrum Ŷ smooLh

O Dodnm
Ŵ 1
sL
parLť bulb ºduodenal bulb"
Ŵ (+) opaclLv ln Lhe recLum lj barlum swallow lj
reach Lhe recLum 1Ŵ2 hours
Ŵ mucosal paLLernsť llLLle chlcks appearance (dlsLal
duodenum)
Ŵ callber of Lhe lnLesLlnes are noL Lhe same because
of perlsLalsls Ŷ lf unlform (abnormal)

C1 ¾can and UL1kA5CUND
Ŵ llverţ aallbladderţ pancreas

GALL8LADDLk (C1 ¾can)
Ŵ wall Lhlckness Ŷ noL more Lhan 3 mm Lhlckness
Ŵ Lransverse dm Ŷ noL more Lhan 4 cm






















ILLCCLCAL kLGICN
(DrŦ C|t|q|t)

CLCUM
Ŵ a bllndŴended sac LhaL pro[ecLs downward ln Lhe
rlahL lllac realon below Lhe lleocecal realon
Ŵ bllndŴended pouch LhaL ls slLuaLed ln Lhe rlahL lllac
fossa
Ŵ aLLached Lo lLs posLeromedlal surface ls Lhe appendlx
Ŵ presence of perlLoneal folds ln Lhe vlclnlLv of Lhe
cecum creaLes Lhe superlor lleocecalţ Lhe lnferlor
lleocecalţ and Lhe reLrocecal recesses
Ŵ as ln Lhe colonţ Lhe lonalLudlnal muscle ls resLrlcLed
Lo Lhree flaL bandsţ Lhe Lenlae collţ whlch converae
on Lhe base of Lhe appendlx and provlde for lL a
compleLe lonalLudlnal muscle coaL
Ŵ 3 cm wldLh lncludlna Lhe helahL
Ŵ LhlnnesL wall ln comparlson wlLh Lhe resL of Lhe l1
Ŵ ¾|gn|f|cancť common slLe of perforaLlon once (+)
obsLrucLlon of larae lnLesLlne prlmarllv aL Lhe dlsLal
colon
Ŵ wldesL parL of Lhe larae lnLesLlne
Ŵ moblle compared Lo ascendlna colon whlch ls flxed
posLerlorlv
Ŵ r|at|on¾ť
4 antr|or|yť colls of small lnLesLlneţ someLlmes
parL of Lhe areaLer omenLumţ and Lhe anLerlor
abdomlnal wall ln Lhe rlahL lllac realon
4 ½o¾tr|or|yť Lhe psoas and Lhe lllacus musclesţ
Lhe femoral nerveţ and Lhe laLeral cuLaneous
nerve of Lhe Lhlah
appendlx ls commonlv found behlnd Lhe
cecum

4 md|a||yť Lhe appendlx arlses from Lhe cecum on
lLs medlal slde

Ŵ 8|ood 5½½|y
4 Artr|¾
nLerlor and posLerlor cecal arLerles form
Lhe lleocollc arLervţ a branch of Lhe
superlor mesenLerlc arLerv

4 V|n¾
1he velns correspond Lo Lhe arLerles and
draln lnLo Lhe superlor mesenLerlc veln




34 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 |ym½h dra|nag
Lhe lvmph vessels pass Lhrouah several
mesenLerlc nodes and flnallv reach Lhe
superlor mesenLerlc nodes

4 Nrv 5½½|y
branches from Lhe svmpaLheLlc and
parasvmpaLheLlc (vaaus) nerves form Lhe
superlor mesenLerlc plexus


ILLCCLCAL IUNC1ICN
qadrantť 8LC
rg|onť rlahL lllac realon
rlahL lllac fossa Ŷ lndenLaLlon ln lllac realon

xtnt of ||occa| [nct|onť
lnclude dlsLal porLlon of lleum (abouL 2 cm) and cecum

bondary w|th a¾cnd|ng co|on
Ŵ creaLe a Lransverse llne level where lleum enLers Lhe
cecum

bondaryť
O ½o¾tr|or
Ŵ psoas muscle
Ŵ laLeral cuLaneous nerve of Lhe Lhlah
Ŵ exLernal lllac arLerv
Ŵ (+) appendlclLls
Ŵ psoasƌs slanť paln aL Lhe Þsoas muscle once
conLracLed
4 hvperLhesla ln Lhe skln of Lhe Lhlah


O md|a|
Ŵ Lermlnal lleum
Ŵ mesenLerv
Ŵ omenLum Ŷ medlallv

O |atra|
Ŵ rlahL paracollc auLLer Ŷ space laLeral Lo Lhe colon
Ŵ abdomlnal wall

O antr|or
Ŵ areaLer omenLum
Ŵ anLerlor abdomlnal wall
Ŵ colls of small lnLesLlne

|ntrna| r|at|on¾h|½
Ŵ lnLernal wall of lleum would conLlnue laLerallv
havlna an upper and lower llps and meeL/ fuse
laLerallv Lo form Lhe frenulum of lleocecal valve
Ŵ upper llpť lleocollc llp
Ŵ lower llpť lleocecal llp

||occa| va|v
Ŵ prevenL food aood back Lo lleum
Ŵ lnLernallvţ lL appears as a pro[ecLlna fold of mucous
membrane showlna 2 Lhlck rounded llps
Ŵ locaLlonť ln Lhe anLerlor abdomlnal wall (aL Lhe
[uncLlon of Lhe rlahL semllunar llne and
splnoumblllcal llne
Ŵ a rudlmenLarv sLrucLureţ conslsLs of Lwo horlzonLal
folds of mucous membrane LhaL pro[ecL around
Lhe orlflce of Lhe lleum
Ŵ plavs llLLle or no parL ln Lhe prevenLlon of reflux of
cecal conLenLs lnLo Lhe lleumŦ
Ŵ Lhe clrcular muscle of Lhe lower end of Lhe lleum
(called Lhe lleocecal sphlncLer bv phvsloloalsLs)
serves as a sphlncLer and conLrols Lhe flow of
conLenLs from Lhe lleum lnLo Lhe colon
Ŵ smooLh muscle Lone ls reflexlv lncreased when Lhe
cecum ls dlsLendedŤ Lhe hormone aasLrlnţ whlch ls
produced bv Lhe sLomachţ causes relaxaLlon of Lhe
muscle LoneŦ











35 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

AÞÞLNDIk
Ŵ Locat|on and D¾cr|½t|on
4 Lhe appendlx ls a narrowţ muscular Lube
conLalnlna a larae amounL of lvmphold Llssue
4 lL varles ln lenaLh from 3 Lo 3 lnŦ (8 Lo 13 cm)Ŧ
1he base ls aLLached Lo Lhe posLeromedlal
surface of Lhe cecum abouL 1 ln (2Ŧ3 cm)
below Lhe lleocecal [uncLlon
4 remalnder of Lhe appendlx ls freeŦ lL has a
compleLe perlLoneal coverlnaţ whlch ls
aLLached Lo Lhe mesenLerv of Lhe small
lnLesLlne bv a shorL mesenLerv of lLs ownţ Lhe
mesoappendlx
4 appendlx lles ln Lhe rlahL lllac fossaţ and ln
relaLlon Lo Lhe anLerlor abdomlnal wall lLs
base ls slLuaLed one Lhlrd of Lhe wav up Lhe
llne [olnlna Lhe rlahL anLerlor superlor lllac
splne Lo Lhe umblllcus (Mc8urnevƌs polnL)
4 lnslde Lhe abdomenţ Lhe base of Lhe appendlx
ls easllv found bv ldenLlfvlna Lhe Lenlae coll of
Lhe cecum and Lraclna Lhem Lo Lhe base of Lhe
appendlxţ where Lhev converae Lo form a
conLlnuous lonalLudlnal muscle coaL

Ŵ Common Þo¾|t|on¾ of th 1|½ of th A½½nd|x
4 Lhe Llp of Lhe appendlx ls sub[ecL Lo a
conslderable ranae of movemenL and mav be
found ln Lhe followlna poslLlonsť
a) hanalna down lnLo Lhe pelvls aaalnsL Lhe
rlahL pelvlc wall
b) colled up behlnd Lhe cecum
c) pro[ecLlna upward alona Lhe laLeral slde of
Lhe cecum
d) ln fronL of or behlnd Lhe Lermlnal parL of
Lhe lleum

4 flrsL and second poslLlons are Lhe mosL
common slLes

Ŵ 8|ood 5½½|y
4 Artr|¾
appendlcular arLerv ls a branch of Lhe
posLerlor cecal arLerv

4 V|n¾
appendlcular veln dralns lnLo Lhe
posLerlor cecal veln

4 Lym½h Dra|nag
lvmph vessels draln lnLo one or Lwo nodes
lvlna ln Lhe mesoappendlx and Lhen
evenLuallv lnLo Lhe superlor mesenLerlc
nodes

4 Nrv 5½½|y
supplled bv Lhe svmpaLheLlc and
parasvmpaLheLlc (vaaus) nerves from Lhe
superlor mesenLerlc plexus
afferenL nerve flbers concerned wlLh Lhe
conducLlon of vlsceral paln from Lhe
appendlx accompanv Lhe svmpaLheLlc
nerves and enLer Lhe splnal cord aL Lhe level
of Lhe 10Lh Lhoraclc seamenL

Ŵ wormllke appearance or ºvermlform appendlx"
Ŵ locaLed 2 cm below from Lhe lleocecal [uncLlon Ŷ
base of appendlx
Ŵ Llp of appendlx assumes several poslLlon downwardsţ
upwardŦŦŦ eLcŦ
Ŵ locallzaLlonť base on clock poslLlon
Ŵ when Llp aoes bevond Lo Lhe pelvlc realon Ŷ ÞLLvlC
lnLCC1lCn

Ŵ behlnd cecum Ŷ 8L18CCLCL
4 60Ʒ ls aL Lhls area

Ŵ lleal ln locaLlon Ŷ Lowards Lhe lleum

Ŵ |ocat|onť
4 rlahL lower quadranL
female Ŵ ovarv and l1
male Ŷ appendlclLls

4 rlahL lllac realon

Ŵ c||n|ca| con¾|drat|onť
4 2 cecum Ŷ 2 appendlces (dupllcaLlon)
4 mal roLaLlon Ŷ dexLrocardla
4 paln aL lefL slde
4 fallure of roLaLlon lj counLer clockwlse lj cecum
noL aL rlahL
4 lona appendlx Lowards Lo Lhe lefL

Ŵ ¾|zť 3 cm/ 3Ŵ10 ln lenaLh
4 half cm (0Ŧ3 cm) ln lenaLh

Ŵ b|ood ¾½½|yť
artry
4 from Lhe posLerlor branch of posLerlor collc
arLerv (also supplv cecum) from lleocollc arLerv
from SM and supplv lL bv appendlclal arLerv
36 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

dra|nag
4 draln Lo posLerlor collc lj lleocollc lj SMv

Ŵ nrv ¾½½|y
4 vaaus nerve
4 lnvolve Lhe parleLal perlLoneum Ŷ locallzed paln

Ŵ m¾ntry and mmbran
aŦ m¾oa½½nd|x
4 mesenLerv of appendlx
4 conLalns Lhe appendlcular vessels and
nervesŦ

bŦ b|ood|¾¾ fo|d of 1rv¾
4 small/ Lhln membrane LhaL connecLs Lhe
dlsLal poslLlon of lleum and cecum

cŦ ||occa| fo¾¾a
4 underneaLh Lhe fold of 1reves

dŦ Iack¾on'¾ mmbran
4 membrane LhaL runs anLerlor Lo Lhe cecum
and connecLs Lhe dlsLal lleum Lo Lhe laLeral
abdomlnal wall
4 noL consLanL

Ŧ Lanƌ¾ mmbran
4 lasL klnk
4 mav produce klnk Lo Lhe lleum
4 membrane connecLs dlsLal lleum Lo Lhe
posLerlor abdomlnal wall

Ŵ c||n|ca| corr|at|on
AÞÞLNDICI1I5
4 ca¾¾ť obsLrucLlon of lumen of appendlx due Lo
forelan maLerlal
food
lvmphold folllcles lnslde Lhe lumen of
appendlx lj lnflammaLlon
(+) conLlnuous mucous secreLlon
Nj
noL able Lo draln Lo cecum
Nj
bulld up of pressure
Nj
aŦ ob¾trct|on of |ym½hat|c¾
O edema Ŷ nerve supplv ls sLlmulaLed
4 aenerallzed abdomlnal paln
4 vomlLlna

bŦ vno¾ ob¾trct|on
O lnfllLraLlon of bacLerla aL Lhe wall of
appendlx


cŦ va¾c|ar ob¾trct|on
O aanarene Lo Lhe area due Lo decrease
blood supplv
O lncreases pressure furLher

dŦ ½rforat|on

Ŵ once (+) obsLrucLlon lj cascade of evenL Lo
perforaLlon lj perforaLed lj bacLerla aL Lhe
perlLoneum (LreaLmenL lavaae)

51AGL
aŦ ¾tag I
Ŵ conaesLlve sLaae
Ŵ obsLrucLlon of Ln


bŦ ¾tag II
Ŵ suppuraLlve sLaae
Ŵ venous obsLrucLlon

cŦ ¾tag III
Ŵ aanarenous sLaae
Ŵ decrease arLerlal supplv

dŦ ¾tag IV
Ŵ perforaLlve/ perforaLlon

O tratmntť
Ŵ appendecLomv (suralcal LreaLmenL)
Ŵ once noL LreaLed lj clrculaLlon lj sepLlcemla lj
perforaLes lj lnfecLlon Lo Lhe perlneum lj
perlLonlLls aenerallzed lj hepaLlc/ llver abscess lj
sepLlcemla and conLrolled bleedlna/ ulC lj shock
lj deaLh

















37 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

LAkGL IN51L51INL
(DrŦ C|t|q|t)

Gnra| charactr|¾t|c¾ť
1Ŧ blaaer slze
2Ŧ presence of hausLraLlons
Ŵ ouL pouchlna ln Lhe wall

3Ŧ presence of Laenla coll
Ŵ lonalLudlnal band of muscles LhaL exLends from
cecum Lo Lhe slamold colon

4Ŧ presence of appendlces eplplocae
Ŵ faLLv Llssues
Ŵ onlv found ln Lhe larae lnLesLlne

A5CLNDING CCLCN
Ŵ beLween cecum and hepaLlc flexure
Ŵ 3Ŵ8 lnches
Ŵ covered bv perlLoneum anLerlorlv
Ŵ flxed posLerlorlvŤ noL moblle
Ŵ r|atd ½o¾tr|or|y to th
4 lllacus muscle
4 quadraLus lumborum muscle
4 lower parL of Lhe kldnev

Ŵ md|a||yť kldnev and lvC
Ŵ |atra||yť paracollc auLLer
Ŵ antr|or|y
4 areaLer omenLum
4 colls of Lhe small lnLesLlne
4 anLerlor abdomlnal wall




kIGn1 CCLIC/ nLÞA1IC ILLkUkL
Ŵ anale or bend formlna Lhe [uncLlon of Lhe ascendlna
colon and Lransverse colon
Ŵ less acuLe anale
Ŵ locaLed anLerlor Lo Lhe kldnev and lnferlor Lo Lhe
aallbladder and llver
Ŵ hepaLocollc llaamenL Ƌ aLLached Lo Lhe lnferlor
border of Lhe llver

1kAN5VLk5L CCLCN
Ŵ slLuaLed beLween Lhe 2 flexure
Ŵ 18Ŵ20 lnches
Ŵ lonaesL parL of Lhe larae lnLesLlne
Ŵ orlenLed ln a horlzonLal llne
Ŵ lnferlor Lo Lhe sLomach
Ŵ exLends from Lhe hepaLlc flexure Lo Lhe splenlc
flexure
Ŵ posLerlor llp ƹ where Lhe areaLer omenLum ls
aLLached Lo
Ŵ anLerlor llp ƹ areaLer curvaLure of Lhe sLomach
Ŵ relaLed ½o¾tr|or|y Lo Lhe 2
nd
parL of Lhe duodenum
and head of pancreas
Ŵ antr|or|yť areaLer omenLum and anLerlor abdomlnal
wall
Ŵ moblle and covered LoLallv bv perlLoneum

LLI1 CCLIC/5ÞLLNIC ILLkUkL
Ŵ lles aL a hlaher level compared Lo Lhe rlahL collc
flexure
Ŵ llmlLed above bv Lhe Lall of Lhe pancreas and base of
Lhe spleen
Ŵ phrenlcocollc llaamenL aLLaches Lhe flexure Lo Lhe
dlaphraam aL Lhe level of 10Ŵ11
Lh
rlbŤ usuallv
bloodless
Ŵ more acuLe anale formed

DL5CLNDING CCLCN
Ŵ aŦkŦaŦ lllac colon
Ŵ 10Ŵ11 lnches lona
Ŵ bondaryť from Lhe splenlc flexure Lo Lhe pelvlc lnleL
Ŵ covered bv perlLoneum anLerlorlv
Ŵ flxed posLerlorlv
Ŵ no mesenLerv
Ŵ crosses 3 musclesť
4 dlaphraam
4 Lransversus abdomlnls
4 quadraLus lumborum
4 lllacus muscle
38 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 psoas ma[or muscle

5IGMCID CCLCN
Ŵ aŦkŦaŦ pelvlc colon
Ŵ locaLed aL Lhe pelvls
Ŵ 3Ŵ33 lnches (10Ŵ13) lona
Ŵ lL ends aL Lhe 3
rd
sacral verLebra (where recLum
sLarLs)
Ŵ where Laenla coll and appendlces eplplocae ends
Ŵ prone Lo vo|v|¾
4 because of Lhe lenaLh of Lhe slamold colonŧ lL ls
prone Lo LwlsL or loop
4 causes obsLrucLlon

Ŵ possess a lona m¾oco|on whlch makes lL verv
moblle
4 has an lnverLed v shape
4 Llp of Lhe v Ŷ auldes us ln ldenLlfvlna ln Lhe lefL
ureLer
4 Lhe apex of Lhe v has a recess called as
lnLerslamold recess whlch alds as a aulde Lo Lhe
lefL ureLer

8LCCD 5UÞÞL¥
Ŵ based on 2 arLerles
Ŵ rlahL heml colon Ŷ supplled bv SM
4 ascendlna colonţ rlahL parL of Lransverse colon

Ŵ lefL heml colon (dlsLal half) Ŷ lM

4 r|ght co||c artry Ƌ upper porLlon of Lhe
ascendlna colonţ flexures
4 |||oco||c artry Ƌ lower porLlon of Lhe ascendlna
colonţ cecumţ appendlx
4 m|dd| co||c artry
4 connecLed wlLh each oLher formlna an arcade

Ŵ VA5CULAk AkCADL5 CI DkUMMCND
4 seen onlv ln larae arLerles

Ŵ IMA Ŷ |ft hm| co|on
4 LefL collc arLerv
4 Slamoldal arLerv
4 Superlor hemorrholdal arLerv
4 anasLomose wlLh Lhe branches of Lhe mlddle
collc


Ŵ VLNCU5 DkAINAGL
4 SMv Ƌ porLal veln
4 lMv lj splenlc veln lj [olns Lhe superlor
mesenLerlc veln lj porLal veln

CLINICAL CCkkLLA1ICN
Ŵ bar|m nma
4 wall covered bv barlum
4 alr lnslde Lhe larae lnLesLlne

Ŵ co|ono¾co½y
4 lnserLed lnLo Lhe recLal area all Lhe wav lnLo Lhe
cecum

Ŵ mgaco|on
4 assoclaLed wlLh Plrschpruna's dlsease
4 defecL ln Lhe nerve supplv ln Lhe analŴrecLal
realon
4 anal valve Ŷ no relaxaLlon
4 accumulaLlon of sLool

Ŵ r|ght hm|co|ctomy
4 removal of Lhe rlahL heml colon
4 from Lhe mld porLlon of Lhe Lransverse porLlon
lj dlsLal porLlon lleum

Ŵ |ft hm|co|ctomy
4 removal of Lhe lefL heml colon
4 from Lhe mld porLlon of Lhe Lransverse colon lj
descendlna colon

Ŵ cvsLlc dllaLaLlon
Ŵ lf Lumor ls smooLh Ƌ mosL probablv benlan
Ŵ lf Lumor ls llke caullflower Ƌ mosL probablv mallananL














39 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

5IGMCID CCLCNţ kLC1UMţ AND
ANAL CANAL
(DrŦ Laygo)

5IGMCID CCLCN/ ÞLLVIC CCLCN
Ŵ sLarLs aL Lhe area of Lhe pelvlc brlm and LermlnaLes aL
recLoŴslamold [uncLlon
Ŵ verLebral landmarkť S3
Ŵ Lhls ls Lhe polnL where Lhe perlLoneal lnvesLmenL and
mesenLerv of Lhe slamold colon LermlnaLes
Ŵ can ao as far as Lhe 8LC area

2 DIVI5ICN5ť
aŦ I||ac ¾gmnt
Ŵ flxed seamenL of slamold colon
Ŵ parL of Lhe slamold colon LhaL lles ln Lhe lllac fossa
Ŵ lL has no mesenLerv

bŦ ½|v|c ¾gmnt
Ŵ moblle seamenL of Lhe slamold colon
Ŵ provlded w/ a mesenLerv
Ŵ lona omeaa shaped coll of larae lnLesLlne LhaL ls
conLlnuous wlLh Lhe lllac colon above and Lhe
recLum below
Ŵ pelvlc mesocolon
4 suspends Lhe pelvlc colon from Lhe posLerlor
wall of pelvls
4 mesenLerv of slamold colon
4 llne of mesenLerlc aLLachmenL resembles an
lnverLed ºv"
4 ln cases where mesenLerv ls verv lona reaches
8LCţ slamold colon mav LwlsL upon lLself
leadlna Lo slamold colon closed loop/
obsLrucLlon (vCLvuLuS)

ÞAk15 CI 1nL ÞLLVIC ML5CCCLCN
aŦ |atra| ||mb
Ŵ exLends alona Lhe lllac arLerv from Lhe mlddle of
Lhe exLernal lllac arLerv Lo Lhe mlddle of Lhe lefL
common lllac arLerv

bŦ m|dd| ||mb
Ŵ exLends from mlddle of lefL common lllac arLerv Lo
Lhe mlddle of S3

IN1Lk5IGMCID kLCL55
Ŵ aŦkŦaŦ lossa lnLerslamoldea
Ŵ a small funnel shaped pouch whlch ls commonlv
presenL aL Lhe [uncLlon of Lhe 2 rooLs of Lhe slamold
mesocolon
Ŵ lL can elLher be locaLed deep or superflclal
Ŵ ¾|gn|f|cancť Lhls usuallv serves as a useful landmark ln
Lhe ldenLlflcaLlon of lefL ureLer
4 lefL ureLer [usL above Lhe LCl
4 loops of small lnLesLlne enLer Lhe fossa or ln
beLween mesocolon and parleLal perlLoneum lj
would resulL Lo lnLernal/ lnLraperlLoneal hernla

ML5C5IGMCID MLM8kANL
Ŵ aŦkŦaŦ Lane's flrsL and lasL klnk
Ŵ ls a Lhlckenlna and shorLenlna of Lhe perlLoneum of
lefL lllac fossa
Ŵ lL blnds [uncLlon of lllac and pelvlc colon Lo Lhe pelvlc
brlm
Ŵ Lhls ls usuallv avascular

8LCCD 5UÞÞL¥
Ŵ from slamoldal arLerv whlch arlses close Lo Lhe anale
beLween lefL collc arLerv and lnferlor mesenLerlc arLerv
Ŵ Lhese are abouL 3Ŵ8 branches
Ŵ Lhev usuallv pass Lhru mesoslamold and dlvlde near Lhe
small lnLesLlne lnLo ascendlna branch whlch
anasLomose wlLh descendlna branch of Lhe lefL collc
Ŵ Lhe descendlna branch of slamoldal arLerv has a weak/
no anasLomosls wlLh superlor recLal arLerv

VLNCU5 DkAINAGL
Ŵ collecLed bv slamoldal veln
Nj
lMv
Nj
Splenlc veln
Nj +
SMv
Nj
ÞorLal veln
Nj
lvC

L¥MÞnA1IC5
Ŵ Lhru lefL collc Ln
Nj
lM aroup of Ln
Nj
lleolumbar chaln of Ln
40 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Nj
1horaclc ducL
Nj
!uncLlon of lefL subclavlan veln and
lefL lnLernal [uaular veln

NLkVL 5UÞÞL¥
Ŵ supplled bv parasvmpaLheLlc lnnervaLlons (S
2
ţ S
3
and S
4
)
4 responslble for acceleraLlon of moLor and
secreLorv acLlvlLv
4 sLlmulaLes perlsLalsls
4 opens recLal sphlncLer

Ŵ svmpaLheLlc (1
11
ţ 1
12
ţ S
1
and S
2
)
4 lnhlblLorv effecL on perlsLalsls and secreLorv
funcLlon
4 consLrlcLlon of lleocollc/ lleocecal valve and recLal
sphlncLer

kLC1UM
kcto 5|gmo|d Inct|on
aŦ Lhere ls a narrowlna of Lhe dlameLer of Lhe colon
bŦ absence of perlLoneal lnvesLmenL lnvolvemenL of Lhe
auL
cŦ dlsappearance of Lrue mesenLerv below Lhe recLoŴ
slamold [uncLlon
dŦ spreadlna ouL of Lhe Laenla coll or Lhe 3 lonalLudlnal
Laenla aL Lhe recLoŴslamold [uncLlon
eŦ appendlces eplplocae end up above Lhe slamold colon
Ŵ from recLum down ŦLŦ dlsappear

fŦ endoscoplc lnLernal morpholoav of slamold colon and
recLum has a bla dlfference ln Lhe lnLernal aross
appearance of mucosa

Ŵ sLarLs aL level of S
3

Ŵ d|v|dd |nto 3 ½art¾
1Ŧ ½½r 1/3
4 covered bv perlLoneum anLerlorlv and aL Lhe
sldes

2Ŧ m|dd| 1/3
4 covered anLerlrolv

3Ŧ |owr 1/3
4 has no perlLoneum

Ŵ avrag |ngthť 12Ŧ3 cm
Ŵ |ocat|onť aL posLerlor pelvlc area
Ŵ cor¾ť lL follows Lhe sacrococcvx curve and lL
LermlnaLes 2Ŧ3 cm ln fronL of Lhe Llp of Lhe coccvx bv
bendlna backward and downward Lo form Lhe anal
canal
Ŵ Lhe kLC1UM has 3 laLeral curves/ flexures
4 lefL sldeť upper and lower recLal curve
4 rlahL sldeť mlddle recLal curve

Ŵ hlahlv vascular

kLC1AL ICLD5/ VALVL5 of nCU51CN
Ŵ usuallv cresenLerlc horlzonLal folds arlslna Lransverselv
from laLeral aspecL of Lhe bowel
Ŵ [usL below Lhe lower recLal valve vou have Lhe rcta|
am½||a
4 dllaLed porLlon of Lhe lower porLlon of recLum
4 Lhls serves as Lhe LranslenL space for fecal maLerlal

kLLA1ICN5nIÞ5
Þo¾tr|orť superlor hemorrholdal vessels
sacrum
coccvx
anoŴcoccvaeal bodv

Þo¾tro|atra|ť pelvlc dlaphraam
LevaLor anl muscle
Coccvaeus muscle
Þlrlform muscle

4 lvlna beLween sacrumţ coccvxţ and recLum lj medlal
sacral vessels
4 oLherť svmpaLheLlc Lrunkţ lower laLeral sacral vessels
and nervesţ coccvaeal nerve

kLC1AL 51ALk5/ LA1LkAL LIGAMLN1
Ŵ suspensorv llaamenL slLuaLed ln Lhe lower 2/3 of Lhe
sacrum
Ŵ are condensaLlons of areolar Llssue around mlddle
hemorrholdal vessels
Ŵ locaLed 1 lnches levaLor anl
Ŵ exLends from S
3
Lo recLal wall
Ŵ also conLalns S
2
and S
3
called nL8vl L8lLn1LS
LoaeLher wlLh mlddle hemorroldal vessels




41 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

IN ILMALL5
Ŵ ½½r 2/3
4 lnLŦ usuallv separaLe Lhe uLerus from Lhe upper
1/3 of Lhe vaalna

Ŵ |owr 1/3
4 dlrecLlv relaLed Lo Lhe mlddle 1/3 of vaalna

8LCCD 5UÞÞL¥
¾½r|or 1/3
Ŵ ¾½r|or hmorro|da| artry
4 from lM

Ŵ m|dd| rcta|/ hmorro|da| artry
4 from lnLernal lllac arLerv

Ŵ |nfr|or rcta|/ hmorro|da| artry
4 from lnLernal pudendal arLerv lj from lnLernal
lllac arLerv
4 branch of lnLernal lllac arLerv (lcock's canal)

VLNCU5 DkAINAGL
Ŵ superlor recLal veln
Nj
lM veln
Nj
splenlc veln
Nj
porLal veln

Ŵ mlddle recLal veln
Nj
lnLernal lllac veln
Nj
common lllac arLerv
Nj
lvC

Ŵ lnLernal recLal veln
Nj
lnLernal pudendal veln
Nj
lnLernal lllac veln
Nj
common lllac veln
Nj
lvC

L¥MÞnA1IC DkAINAGL
Ŵ perlŴrecLal Ln
Ŵ embedded ln Lhe perlŴrecLal C1 [usL ouLslde Lhe
muscular coaL
Ŵ from Lhe upper and lower aroup of Ln aoes Lo Lhe
lnferlor mesenLerlc aroup of lvmphnode

Ŵ upper mlddle aroup of lvmph node
Nj
recLal aroup of lvmphnode
Nj
lnferlor mesenLerlc aroup of lvmph node

Ŵ few from mlddle aroup of Ln
4 follow Lhe mlddle recLal arLerv Lowards Lhe
lnLernal lllac aroup f Ln

Ŵ few from lower parL
4 follow Lhe lnferlor recLal and lnLernal pudendal
Lowards Lhe lnLernal lllac aroup of Ln

ANAL CANAL
Ŵ Lermlnal porLlon of Lhe larae lnLesLlne
Ŵ 4 cm lona (1Ŧ3 ln)
Ŵ SLarLs from anorecLal rlna Lo Lhe halrv skln of Lhe anal
verae
Ŵ runs downward and backward aL rlahL anale Lo Lhe
recLum beLween Lhe levaLor anl muscle and
LermlnaLes ln Lhe anus/ anal orlflce
Ŵ r|at|on¾ť
4 antr|or
ma|
perlneal bodv Ŷ dense flbrlnous Llssue LhaL
separaLes Lhe anus from Lhe Lransverse
perlneal muscle
membranous ureLhra Ŷ locaLed beneaLh Lhe
(arrow up)
bulb of Lhe penls Ŵ ºrooL of Lhe penls"

fma|
lower 1/3 of vaalnal canal

4 ½o¾tr|or
anococcvaeal bodvť flbrous Llssue locaLed
beLween Lhe anal canal and coccvx
blends above Lhe medlan raphe of levaLor
anl muscles

4 |atra|
puborecLal muscle componenL of levaLor anl
muscle
42 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

faL fllled lschlorecLal fossa

Ŵ |andmark
aŦ anoctano¾ ||n Ŵ "ANAL VLkGL"
ln sLaLe of apposlLlon (klsslna poslLlon)ţ
eplLhellum ls Lhrown lnLo folds bv
lnvolunLarv acLlon of muscle Ŵ ºCorruaaLor
of nal Skln

bŦ n||tonƌ¾ ||n Ŵ "IN1Lk5ÞnINC1Lk WnI1L LINL"
more blue ln color Lhan whlLe
more palpable Lhan vlslble
marks Lhe nonŴmuscular lnLerval beLween
lnLernal and exLernal
lles halfwav beLween Lhe anal verae and
more superlor pecLlnaLe llne

cŦ Þctn
locaLed dlrecLlv above Lhe PllLonƌs llne
abouL 1/8 Ŷ 1/3 of an lnch ln wldLh
upper edae Ŷ composed of SerraLed Maraln
LhaL resembles Lhe LeeLh of a comb
heavv deposlLs of flbrous Llssue under

dŦ Þct|nat/ Dntat ||n
locaLed aL Lhe upper border of pecLen
combŴllke arranaemenL brouahL bv anal
paplllae whlch are conLlnuous above wlLh
Columns of Moraaanl

Ŵ ana| va|v¾
4 lrreaular folds whlch connecLs Lhe bases of
paplllae

Ŵ 2 ¾½h|nctr¾
1Ŧ |ntrna|
lower Lhlckened porLlon of Lhe clrcular
muscle of Lhe bowel
encloses upper 2/3 of anal canal
parL of Lhe levaLor anl muscle

2Ŧ xtrna|
subcuLaneous muscle placed superflclal Lo
Lhe lnLernal anal sphlncLer

aŦ ¾bctano¾
4 wlLhouL bonv aLLachmenLs
4 surrounds anus
4 decussaLes anLerlorlv (wlnds around
anLerlorlv)

bŦ ¾½rf|c|a| f|br¾
4 arlses from anococcvaeal bodvţpass
around Lhe sldes of anusţ lnserLed Lo
perlneal bodv

cŦ d½ f|br¾
4 no dlrecL bonv aLLachmenL
4 enclrcles lower Z of anal canal
4 forms Lhe Lrue sphlncLerlc muscle
4 lnLlmaLelv assoclaLed wlLh ÞuborecLal
porLlon of levaLor anl

Ŵ Lhe exLernal sphlncLer ls supplled bv Lhe perlneal
branch of 4
Lh
sacral and lnferlor hemorroldal
nerves

Ŵ b|ood ¾½½|y
superlor recLal arLerv
mlddle recLal arLerv
lnferlor recLal arLerv

Ŵ vno¾ dra|nag
superlor recLal veln lj lMv
mlddle recLal veln lj lnLernal lllac veln
lnferlor recLal veln lj lnLernal pudendal veln lj
lnLernal lllac veln

Ŵ |ym½hat|c dra|nag
superlor recLal lj lnferlor aroup of Ln
mlddle recLal lj lnLernal lllac aroup of Ln
lnferlor recLal lj lnLernal pudendal aroup of Ln lj
lnLernal lllac aroup of Ln

















43 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

1nL LIVLk
(DrŦ LŦ Mana|o)

Ŵ aŦkŦaŦ hepar
Ŵ laraesL aland ln Lhe bodv
Ŵ exLremelv vascular and mulLlfuncLlonal
Ŵ reddlsh ln color
Ŵ enclosed bv llsson's capsule
Ŵ dual blood supplv
4 Lhe blood represenLs 29Ʒ of Lhe cardlac ouLpuL
and Lhe blood supplv ls vla Lhe PepaLlc arLerv
whlch provldes 330 cc/mln and porLal veln whlch
provldes 1ţ100 cc/mln

Ŵ venous dralnaaeť hepaLlc veln dralns dlrecLlv Lo Lhe
lvC

Ŵ ¾rfac anatomy
4 pvramldal ln shape
4 ba¾ť rlahL slde of Lhe llver ls convex ţ exLends
from Lhe level of Lhe 7
Lh
Ŵ11
Lh
rlb correspondlna
Lo Lhe dlaphraam
or as far down as Lhe 10
Lh
pleural reflecLlon
or correspondlna Lo Lhe lowesL porLlon of
Lhe lunas up Lo Lhe 8
Lh
rlb

4 a½xť |ft ¾|d
¾½r|or ¾rfac
O on Lhe rlahL slde usuallv exLends up Lo
3
Lh
lCS or as far up Lo Lhe upper border
of Lhe 3
Lh
rlb
O on Lhe lefL sldeţ superlor surface ls aL
Lhe level of Lhe 6
Lh
rlb
O relaLed Lo Lhe dlaphraam

antr|or ¾rfac
O on Lhe lefL sldeţ up Lo Lhe 8
Lh
rlb
O on Lhe rlahL sldeţ below as 10
Lh
cosLal
rlb

|nfr|or ¾rfac
O looklna aL lL from below
O palpable lnferlor edae especlallv when
llver ls enlaraed
O mosL accesslble Lo phvslcal examlnaLlon


½o¾tr|or ¾rfac
O |ft ¾|dť relaLed Lo Lhe esophaausţ
sLomach and lesser omenLal bursa
O r|ght ¾|dť relaLed Lo Lhe duodenumţ
rlahL suprarenal alandţ lvCţ hepaLlc
flexure of Lhe colon

Ŵ |ocat|on
4 ln Lhe 8uC (foremosL of ls parL) of Lhe abdomen
beneaLh Lhe dlaphraam undercover of Lhe rlbs

Ŵ Lhe llver ls dlvlded lnLo 2 lobes bv Lhe lalclform
llaamenL ln a 6ť1 raLlo (8ťL lobe)
Ŵ Lhe upper surface of Lhe llver ls aLLached Lo Lhe
dlaphraam vla Lhe 1r|ang|ar ||gamnt
4 fuslon of 2 lavers of coronarv llaamenL

Ŵ llver ls compleLelv covered bv perlLoneum excepL lnť
aŦ bare area of Lhe llver
bŦ fossa/ aroove for lvC
cŦ aallbladder fossa

Ŵ "8AkL AkLA" of th ||vr
4 ls a relaLlvelv larae Lrlanaular area locaLed
posLerlorlv devold of perlLoneum
4 lL ls dlrecLlv aLLached Lo Lhe dlaphraam bv means
of areolar C1 whlch conLalns Lhe velns of 8eLzlus
4 lLs base ls ln conLacL wlLh Lhe lvCţ rlahL
suprarenal alandţ dlaphraam
4 lLs apex ls formed bv Lhe 2 lavers of Lhe rlahL
coronarv llaamenLs LhaL fuse Lo form Lhe rlahL
Lrlanaular llaamenL

Ŵ Lhe lnferlor surface of Lhe llver ls characLerlzed bv
Lhe leLLer ºP"
LLI1 LIM8 of "n"
4 dlvldes Lhe llver lnLo L and 8 lobes
4 anLerlorlvţ lL ls formed bv Lhe llaamenLum Leres
whlch conLlnuous anLerlorlv as Lhe falclform
llaamenLŤ posLerlorlv as Lhe llaamenLum
venosum (obllLeraLed ducLus venosus)

kIGn1 LIM8 CI "n"
4 anLerlorť aallbladder
4 posLerlorť lvC

1kAN5VLk5L/ 8Ak CI "n"
4 represenLed bv ÞorLa hepaLls
44 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 aŦkŦaŦ Lransverse aroove
4 lL ls deepţ wldeţ 2 lnches ln lenaLh
4 conLalnsť common blle ducLţ hepaLlc arLervţ
porLal veln (anLerlor lj posLerlor)
4 nerves and lvmphaLlcs Ƌ found ln porLa hepaLls
4 |nfrontť antr|or
quadraLe lobe of Lhe llverţ beLween Lhe
aallbladder and llaamenLum Leres
½o¾tr|orť caudaLe lobe of Lhe llver locaLed
beLween lvC and llaamenLum venosum

4 lesser omenLum ls aLLached Lo Lhe edaes of Lhe
porLa hepaLls

ANA1CMIC 5UkGICAL DIVI5ICN
Ŵ based on prevalllna arranaemenL and dlsLal of Lhe
branches of Lhe blle ducLsţ porLal veln and hepaLlc
arLerv
Ŵ lmporLanL ln dolna lobecLomv
Ŵ 5LGMLN1ť
l ƹ dorsal
ll ƹ lefL lobe posLerlor
lll ƹ lefL lobe anLerlor
lv ƹ quadraLe lobe
v ƹ rlahL lobe anLerolaLeral and posLerlor
vl ƹ rlahL lobe posLerlor lnferlor
vll ƹ rlahL lobe superlor posLerlor
vlll ƹ rlahL lobe anLerlor superlor

1kUL/ IUNC1ICNAL DIVI5ICN5
Ŵ seamenLal areas of llver
Ŵ lobes are dlvlded lnLo superlor and lnferlor

NLkVL5
Ŵ lefL or anLerlor vaaus nerve and svmpaLheLlc nerve
Ŵ enLers Lhrouah porLa hepaLls alona wlLh blle ducLţ
porLal veln and hepaLlc arLerv

L¥MÞnA1IC5
Ŵ found ln Lhe followlnať
aŦ porLa hepaLls
bŦ alona Lhe falclform llaamenL dralnlna lnLo Lhe
medlasLlnal Ln
cŦ cellac Ln near cellac arLerv
dŦ around Lhe lvC dralnlna Lo Lhe Lhoraclc Ln

Ŵ all are ouLslde ln Lhe llver

















































45 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

ÞCk1AL n¥ÞLk1LN5ICN
(DrŦ LŦ Mana|o)

Ca¾ť
8ŦlŦţ a 48 v/o maleţ frt|||zr and |n¾ct|c|d manfactrr
(x½o¾r to CC|
4
)ţ a known havy a|coho||c (alcohollc
clrrhosls) complalns ofť
O hemaLemesls Ŷ vomlLlna of blood
O melena Ŷ dark sLools
O (+) hlsLorv of hepaLlLls

½hy¾|ca| xam|nat|onť (manlfesLaLlon of llver dlsease)
Ŵ [aundlce Ŷ vellowlsh dlscoloraLlon of Lhe skln
Ŵ asclLls Ŷ accumulaLlon of fluld ln perlLoneum
Ŵ hepaLosplenomeaalv
Ŵ splder analomaLa Ŷ capuL medusa
Ŵ asLerlxls
4 llver flap due Lo subsLances LhaL are noL
deLoxlfled aolna back Lo svsLemlc clrculaLlon and
nervous svsLem

Ŵ hemorrholds

c||n|ca| |m½r¾¾|onť clrrhosls wlLh porLal hvperLenslon

c||n|ca| ½r¾ntat|onť slans of llver dlsease
aŦ [aundlce
bŦ hepaLosplenomeaalv
cŦ asclLls
dŦ l bleedlna
eŦ encephalopaLhv
fŦ cuLaneous sLlamaLa

Þorta| hy½rtn¾|on Ŷ when porLal venous pressure rlses
above 20 cm P
2
C
Ŵ how Lo measure porLal venous pressure?
4 wedae hepaLlc veln pressure
4 endoscopv
4 vlsceral analoaraphv

Ŵ normal pressureť 8 Ŷ 10 mmPa (20 cmP
2
C/ 13 1orr)
Ŵ brouahL abouL bv obsLrucLlon Lo venous ouLflow
relaLlve Lo porLal venous ouLflow ln relaLlon Lo porLal
venous lnflow meansť
aŦ lncreased reslsLance Lo porLal venous ouLflow
(lnLo lvCť normal Ŷ 0 mmPa)
bŦ lncreased perfuslon (porLal venous perfuslon) Ŷ
lncreased lnflow lnLo porLal veln
cŦ boLh condlLlons mav occur aL Lhe same Llme

L1ICLCG¥ť
Ŵ elLher obsLrucLlon Lo venous ouLflow or lncrease
venous lnflow
Ŵ ca¾¾ť
aŦ |ntrah½at|c ob¾trct|v d|¾a¾ of vno¾ |nf|ow
Ŷ otf|ow ¾y¾tm
4 comprlses 93Ʒ of eLloloav
4 ¾ch a¾ť
4 alcohollc clrrhosls Ŷ posLŴhepaLlc clrrhosls
4 blllarv clrrhosls Ŷ hepaLlLls
4 Loxlc hepaLlLls Ŷ exposure Lo chemlcals
(CCl
4
)
4 paraslLlc lnfecLlons Ŷ schlsLosomlasls
4 conaenlLal hepaLlc flbrosls Ŷ blllarv aLresla
common ln lnfanLs and newborn

4 hemochromaLosls Ŷ lncreased deposlLlon
of lron ln Lhe llver
4 porLal venous and collaLeral venous
obsLrucLlon
4 clrrhosls Ŷ necroslsţ damaae Lo hepaLlc
parenchvma/ hepaLocvLe whlch would
resulL Lo wldespread flbrosls/ scarrlna
wlLh nodule formaLlon
consLrlcLlon Ŷ lncrease pressure

bŦ xtrah½at|c ob¾trct|v d|¾a¾
4 ouLslde Lhe llver
4 Lhrombosls of porLal veln ln neonaLal
omphallLls (lnfecLlon of umblllcus)
4 obsLrucLlon Lo ouLflow svsLem lnť
conaesLlve hearL fallure
consLrlcLlve perlcardlLls
8uddŴChlarl svndrome Ŷ obsLrucLlon of
hepaLlc veln

Con¾qnc¾ť
1Ŧ ¾ddn |ncra¾ ÞV ½r¾¾r/ ob¾trct|on of vno¾
Þ5
Ŵ resulLlna Lo severe fluld and elecLrolvLe loss

2Ŧ chron|c
Ŵ developmenL of collaLeral clrculaLlon
Ŵ Þv pressure rlslna araduallv
46 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ alLernaLlve paLhwav

a) ½ortoŴ¾y¾tm|c ¾hnt
4 from porLal veln Lo anoLher svsLemlc veln

b) ½ortoŴcava| ¾hnt
4 from porLal veln Lo lvC

ÞCk1AL VLNCU5 CIkCULA1ICN











ÞCk1CŴCAVAL 5nUN15
aŦ esophaaeal branches of lefL aasLrlc veln anasLomose Lo
from shunL wlLh azvaous veln (coronarv veln)
Ŵ mosL slanlflcanL
Ŵ developmenL of esophaaeal varlces whlch are
dllaLed and LorLuous lj easllv erodes lj leadlna Lo
ul bleedlna (hemaLemesls)








bŦ superlor recLal velns wlLh mlddle and lnferlor recLal
veln and pelvlc venous plexuses
Ŵ formlna hemorrholds whlch mav bleed










cŦ paraumbllcal veln from lefL porLal veln wlLh superflclal
and deep aasLrlc velns (superlor and lnferlor velns)
Ŵ resulLs Lo splder analomaLa/ capuL medusae






dŦ collc and splenlc velns wlLh renal velns and velns of
bodv wall lncludlna velns of 8eLzlus wlLh mesenLerlc
and perlLoneal veln
Ŵ blood slps ouL ln dllaLed velns causlna asclLls









ÞA1nCLCGIC ANA1CM¥
Ŵ anasLomoslna shunLs formed wlLh porLal PÞn have no
valves
Ŵ collaLerals has Lhe leasL reslsLanceţ Lhev dllaLe and
erode causlna bleedlna

1kLA1MLN1
aŦ blood Lransfuslon
bŦ balloon Lamponade Ŷ lnflamed balloon ln Lhe
esophaaeal varlces
cŦ esophaaeal varlces llaaLlon wlLh rubber or
hemorroldal/ recLal llaaLlon
dŦ vasopressln Ŵ vaconsLrlcLor
eŦ scleroLherapv Ŷ ln[ecLlon of scleroslna aaenL (100Ʒ
alcohol)
fŦ porLoŴsvsLemlc decompresslon Ŷ suralcal procedure
where Þv ls anasLomose dlrecLlv Lo lvC
Ŵ porLoŴcavalť dlrecLlv Lo lvC
Ŵ splenoŴcaval
Ŵ mesoŴcaval Ŷ mesenLerlc veln Lo lvC





47 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

5ÞLLLN
(DrŦ Mana|o)

Ŵ also called llen
Ŵ aeneral feaLuresť
4 purpllshţ sofLţ hlahlv vascularţ encapsulaLed oraan
4 avrag d|mn¾|on¾ť
12cm ln lenaLh
7cm wldLh
4 cm Þ dlameLer

4 welahlna an averaae of 100 Ŷ 130 arams
4 locaLed hlah up aL Lhe posLerlor lefL upper
quadranL of abdomen undercover of Lhe
perlLoneum excepL aL lLs hllumţ posLerlor Lo Lhe
mldŴaxlllarv llneţ opposlLe Lo 9Lhţ 10
Lh
and 11
Lh
rlbs
4 lona axls ls parallel Lo 10
Lh
rlb
4 reLroperlLoneal oraan
4 fnct|onť blood formlna and desLrovlna oraan of
Lhe bodvţ conLalns larae amounL of lvmphaLlc
Llssue and also sLores ln lLs slnusold
4 r|at|on¾h|½ to b|ood ¾tramť
locaLed alona Lhe blood sLream and noL alona
Lhe lvmphaLlc sLream

Ŵ acc¾¾ory ¾½|n
4 occur ln 11Ʒ of populaLlon
4 locaLed aL Lhe hllum of spleenţ Lall of Lhe pancreasţ
omenLumţ mesenLerv and walls of lnLesLlnes

Ŵ ¾½|n|c notch
4 slanlflcanL anaLomlc feaLure on Lhe superlor
surface of spleen
4 palpable Ŷ splenomeaalv

Ŵ anatom|c fatr¾ť
4 v|¾cra| ¾rfac¾
posLerlor Ŷ convex ºdlaphraamaLlc surface"
O resL on Lhe dlaphraam

anLerlor Ŷ ºaasLrlc surface"
O comes ln conLacL wlLh Lhe sLomach
O conLalns Lhe hllum of spleen

lnferlor Ŷ ºcolonlc surface"
O comes ln conLacL wlLh splenlc flexure of
Lhe colon

lnLernal Ŷ ºrenal surface"
O comes ln conLacL wlLh lefL kldnev

4 h||m
locaLed aL Lhe anLerlor/ aasLrlc surface
where 8v enLer and leave Lhe spleen
posLerlor Lo Lhe hllum ls Lhe aroove for Lhe Lall of
Lhe pancreas
aLLached Lo Lhe hllum ls Lhe splenorenal and
aasLrosplenlc llaamenL

4 m¾ntr|c and ||gamnto¾ attachmnt
aŦ ||noŴrna| ||gamnt/ ¾½|noŴrna| ||gamnt
4 exLends from spleen Lo kldnev
4 conLalns Lhe splenlc 8v and Lall of pancreas

bŦ ga¾troŴ¾½|n|c ||gamnt
4 exLends from sLomach Lo spleen
4 conLalns Lhe shorL aasLrlc vessels and lefL
aasLroŴeplplolc vessels

cŦ ½hrn|coŴco||c (co¾toŴco||c) ||gamnt
4 exLends form splenlc flexure of Lhe colon
upwards Lowards Lhe dlaphraam opposlLe Lo
10
Lh
and 11
Lh
rlbs
4 forms a floor on whlch Lhe spleen resL on
4 ¾rg|ca| |m½ortancť necessarv Lo moblllze
Lhls llaamenL durlna splenlc flexure and
splenlc suraerv

Ŵ r|at|on¾h|½¾
Ŵ refer Lo ºsurfaces"
Ŵ perlLoneal cavlLv separaLe Lhe spleen
Ŵ pleural cavlLv from Lhe rlbs
Ŵ dlaphraam
Ŵ upper 3
rd
of spleen relaLed Lo lefL luna

Ŵ 8|ood v¾¾|¾
4 Artr|¾
¾½|n|c artry
O branch of cellac arLerv LhaL coarse
Lowards Lhe lefL on Lhe superlor border of
Lhe bodv and Lall of pancreas and crosses
Lhe lefL kldnev Lo reach Lhe hllum of
spleen
O does noL enLer Lhe spleen as 1 larae vessel
lnsLead lL dlvldes lnLo 3Ŵ8 branches as lL
enLer Lhe spleen
O before reachlna Lhe hllum lL alves off Lhe
lefLŴaasLro eplplolc arLerv and shorL
aasLrlc arLerv


48 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 Vno¾ dra|nag
¾½|n|c v|n
O formed aL Lhe hllum of spleen
O Lhe lefL aasLro eplplolc and oLher veln ln
Lhe areaLer curvaLure lj splenlc veln
O coarse Lo Lhe rlahL ln Lhe splenoŴrenal
behlnd Lhe pancreas below Lhe splenlc
arLerv
O on lLs coarse lL ls [olned bv lMv and
splenlc veln [olns Lhe SMv Lo form Þv
behlnd Lhe neck of Lhe pancreas

4 Lym½hat|c¾
O even lf spleen ls lvmphaLlc oraanţ lvmphaLlcs
are poorlv developed
O lvmphaLlc are found onlv ln Lhe capsule of
spleen (capsular lvmph) and laraesL Lrabeculae
aL Lhe hllum of spleen
1Ŧ capsule splenlc nodes lj
2Ŧ Lrabecular suprapancreaLlc node

Ŵ Innrvat|on¾
O nonŴmvellnaLed nerves from Lhe cellac plexus
accompvanlna Lhe splenlc arLerv lnLo Lhe hllum of
Lhe spleen

Ŵ C||n|ca| corr|at|on
O splenecLomv Ŷ suralcal removal of spleen
O lndlcaLlonsť
aŦ LraumaLlc ln[urles
bŦ hemolvLlc [aundlce
cŦ aucherƌs dlsease Ŷ CPC sLoraae dlsease
dŦ splenlc anemla
eŦ Lumor and cvsLs
fŦ hvpersplenlsm
aŦ splenomeaalvbodv















A8DCMINAL ACk1A
(DrŦ LŦ Mana|o)

Ŵ bealns aL Lhe level of 1
12
as lL passes Lhrouah Lhe aorLlc
orlflce of Lhe dlaphraam
Ŵ aL Lhe lower border of 1
12
bodv or lvu of 1
12
and L
1

Ŵ laraesL arLerv
Ŵ ends bv blfurcaLlon of lefL and rlahL common lllac
arLerv aL Lhe level of L
4

Ŵ branch¾ť
aŦ cellac arLerv
1Ŧ lefL aasLrlc arLerv
2Ŧ splenlc arLerv Ŷ shorL aasLrlc and lefL aasLro
eplplolc
3Ŧ common hepaLlc arLerv Ŷ rlahL aasLrlc arLervţ
aasLroduodenal arLerv (rlahL aasLroepllolc and
superlor Þu arLerv)ţ rlahL (cvsLlc arLerv) and
lefL hepaLlc

bŦ lnferlor phrenlc arLerv Ŵ same level wlLh cellac
arLerv
4 slde of abdomlnal aorLa

cŦ suprarenal arLerv
dŦ renal arLerv
eŦ SM
aŦ mlddle collc arLerv
bŦ lnferlor Þu arLerv Ŷ meeLs superlor Þu arLerv
Lo form anLerlor and posLerlor arcade
cŦ [e[unal arLerv Ŷ lefL slde
dŦ lllal arLerv Ŷ lefL slde
eŦ lleocollc arLerv
lŦ ascendlna branch Ŷ meeLs rlahL collc
arLerv
llŦ descendlna branch Ŷ lleocecal arLerv
whlch dlvldes lnLo 2 (posLerlor and
anLerlor)
lllŦ posLerlor alves appendlclal arLerv

fŦ rlahL collc
4 wlLh ascendlna and descendlna branch
(meeL ascendlna branch of lleocollc
arLerv)

fŦ aonadal arLerv Ŷ elLher LesLlcular (male) or ovarlan
arLerv (female)

aŦ lM
aŦ lefL collc arLerv
lŦ ascendlna branch Ŷ splenlc flexure
llŦ descendlna branch Ŷ descendlna colon

bŦ slamoldal arLerv Ŷ Lo slamold arLerv
49 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

cŦ superlor hemorroldal/ recLal arLerv
dŦ mlddle hemorroldal/ recLal arLerv
O lnferlor hemorroldal/ recLal arLerv
4 branch of pudendal arLerv from lefL
common lllac arLerv

hŦ medlal sacral arLerv
lŦ 4 lumbar arLerv
4 3
Lh
lumbar arLerv Ŷ arlse from common lllac
arLerv







































INILkICk VLNA CAVA
(DrŦ LŦ Mana|o)

Ŵ laraesL veln
Ŵ bealns aL Lhe level of L
3

Ŵ formed bv Lhe [uncLlon of common lllac velns
Ŵ ends aL Lhe level of 18 plerclna Lhe dlaphraam aL Lhe
vena caval orlflce
Ŵ tr|btar|¾
aŦ 2 ma[or hepaLlc veln (lefL and rlahL)
4 dlrecLlv lnLo Lhe lvC as lL enLers dlaphraam
Lhen Lo rlahL aLrlum
bŦ porLal veln
cŦ splenlc veln
dŦ lMv
eŦ SMv lj [olns splenlc veln lj Þv
fŦ lefL aasLlc veln Ŷ dralns lnLo Þv
aŦ renal veln
hŦ suprarenal veln
lŦ lnferlor phrenlc veln
[Ŧ rlahL aonadal veln Ŷ Lo lvC
kŦ lefL aonadal veln Ŷ lefL renal veln
lŦ mlddle sacral veln Ŷ dralns ln ascendlna branch of
veln

4 3
Lh
lumbar veln lj common lllac veln lj
azvaous and hemlazvaous





















50 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

ÞANCkLA5
(DrŦ Laygo)

Ŵ lles Lransverselvţ reLroperlLoneallv beLween Lhe
duodenum aL Lhe rlahL and spleen aL Lhe lefL slde
Ŵ flxed oraan
Ŵ r|at|on¾ť
4 abovť omenLal bursa
4 antr|orť Lransverse mesocolon
4 ¾½r|orť duodenumţ pvlorusţ llverţ sLomach
spleen (8 Lo LŤ superlor and anLerlor porLlon)
4 |nfr|orť duodenumţ [e[unumţ Lransverse
mesocolonţ spleen
4 ½o¾tr|orť beLween Lhe hllum of rlahL kldnev and
hllum of spleenţ cellac arLervţ lM
ť rlahL hllum of kldnevţ lvCţ Þvţ SMvţ abdomlnal
aorLaţ lefL kldnev and hllum of spleen ( 8 Lo L)

Ŵ ½art¾ť
aŦ had
O lles Lo Lhe rlahL of SM arLerv and veln
O flrmlv flxed Lo Lhe medlal aspecL of Lhe 2
nd

porLlon and 3
rd
porLlon of duodenum
O [uncLlon of Lhe neck of pancreas marked
anLerlorlv bv an lmaalnarv llne from Lhe Þv
above and SMv below
O r|at|on¾ť
antr|orť relaLed Lo Þu arcade parLlv
anLerlor branches of SÞua and lÞua
½o¾tr|orť hllum of rlahL kldnev
4 rlahL renal vessels
4 rlahL crus of dlaphraam
4 posLŦ Þu arcade
4 rlahL aonadal veln
4 dlsLal common blle ducL

O nc|nat ½roc¾¾
exLenslon of Lhe lower lefL parL of Lhe
posLerlor surface of Lhe head usuallv
passlna behlnd Lhe Þv and lMv and ln
fronL of Lhe abdomlnal aorLa and lvC
locaLed beLween Lhe SM and aorLa wlLh
Lhe lefL renal veln above Lhe 3
rd
and 4
Lh

poslLlon of duodenum below
mav be absenL
compleLe enclrcle SMv

bŦ nck
O 1Ŧ3 Lo 2 cm lona
O flxed beLween cellac Lrunk above and SMv
below
O lvlna over Lhe SMv below and Þv above
O rlahL slde Ŷ relaLed wlLh ua as lL alves off
anLerlor superlor Þua

cŦ body
O lles Lo Lhe lefL of SM vessels and lL ls relaLed Lo
Lhe 4
Lh
porLlon of duodenumţ llaamenL of
1relLzţ some [e[unal loops as well as Lhe lefL
slde of Lransverse colon
O r|at|on¾ť
|ftť SM
r|ghtť SMv
¾½r|or|yť
4 cellac arLerv
4 hepaLlc arLerv (rlahL)
4 splenlc veln (lefL)

antr|or|y covered bv double perlLoneum
of Lhe posLerlor wall of omenLal bursa
whlch ls relaLed Lo Lransverse mesocolon
evenLuallv Lhe double perlLoneum Ŷ oLher
laver covers Lhe anLerlor porLlon and
oLher laver covers Lhe posLerlor surface
½o¾tr|or|y ť
4 abdomlnal aorLa
4 orlaln of SM
4 lefL crus of dlaphraam
4 lefL adrenal alands
4 perlneal fascla
4 lefL renal vessels
4 lefL kldnev
4 splenlc veln

dŦ ta||
O relaLlvelv shorL and lLs Llp reaches Lhe vlsceral
surface of Lhe spleen
O usuallv covered/ enveloped bv splenorenal
llaamenL LoaeLher wlLh splenlc arLerv and veln
O (+) ouLer llaamenL whlch forms Lhe posLerlor
laver of aasLrosplenlc llaamenL whlch
evenLuallv encloses Lhe small aasLrlc vesselsŦ
1hese llaamenL ls avascularŦ


51 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

ÞANCkLA1IC DUC1
Ŵ locaLed anLerlorlv Lo Lhe numerous pancreaLlc
vessels
Ŵ man pancreaLlc ducL Ŷ [olned bv accessorv ducL of
SanLorlnl
Ŵ areaLesL dm ls aL Lhe head of Lhe pancreas
Ŵ [oln C8u Lo form ampulla of vaLer

DUC1 CI 5AN1CkINI
Ŵ mlnor duodenal papllla
Ŵ draln 3Ŵ6 cm above ma[or duodenal papllla
Ŵ 1Ŧ3 Ŷ 2cm from Lhe pvlorlc sphlncLer
Ŵ varlaLlons of ducLsť dralns separaLelv (normal)

8LCCD 5UÞÞL¥
Ak1LkIL5
Ŵ malnlv from Lhe superlor Þua whlch ls a branch of
ua and from lnferlor Þua whlch ls a branch of lM
Ŵ consplcuouslv presenL ls splenlc arLerv
Ŵ rlchlv vascularlze oraan

VLNCU5 DkAINAGL
Ŵ superlor Þuv lj uv lj porLal venous svs
Ŵ pancreaLlc vŦ lj splenlc vŦ lj Þv

L¥MÞnA1IC5
Ŵ upper parL Ŷ headţ superlor porLlon of pancreasţ ao
Lo cellac aroups of Ln
Ŵ lnferlor parL Ŷ Þu Ln and Þllenal Ln

INNLkVA1ICN5
Ŵ cellac nerve aanalla
Ŵ some from SM aanallon

CLINICAL CCkkLLA1ICN5
Ŵ perlumblllcal area
Ŵ severeť flanksţ back of flanks
4 referred palnť pancreaLlLls/ kCP pancreaLlLls










GALL8LADDLk
(DrŦ Laygo)

Ŵ pearŴshaped oraan locaLed aL Lhe lnferlor aspecL of Lhe
rlahL lobe of Lhe llver
Ŵ |ngthť 7 Ŷ 10 cm lona
Ŵ ca½ac|tyť 1 Lo 1 Z ounce of blle
4 can conLaln 2Ŵ3x Lhe normal capaclLv
4 bevond Lhe llmlL Ŷ rupLure

Ŵ |ocat|onť underslde of Lhe lnferlor border of Lhe rlahL
lobe of Lhe llver
4 aLLached Lo Lhe llver bv areolar C1 whlch conLalns
mulLlple small lvmphaLlcs and velns
4 onlv porLlon noL ln dlrecL conLacL wlLh Lhe llver are
covered bv perlLoneum
fundus
laLeral surface of aallbladder

4 suspended bv mesenLerv Ŷ almosL compleLelv
covered bv perlLoneum ln some cases

Ŵ ¾|zť 7 Ŷ 10 cm lona
4 fundus Ŷ 2Ŧ3 Ŷ 3 cm wlde
4 markedlv dlsLended Ŷ conLalns 200Ŵ300 mL of blle

Ŵ ½art¾ť
aŦ fnd¾
O rounded bllndŴend of 8 whlch pro[ecLs 0Ŧ3Ŵ1
cm bevond Lhe free edae of Lhe rlahL lobe of
llver
O someLlmes klnk/ noLch creaLlna Lhe ºÞhrvalan
cap" appearance
O proLrudes aL lnferlor aspecL Ŷ covered bv
perlLoneum
O Lop of fundus Ŷ lles ln conLacL wlLh abdomlnal
wall opposlLe Lo Lhe 9
Lh
cosLal carLllaae aL
lnfrasLernal anale





bŦ body
O laraesL seamenL of 8
52 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

O enLlre superlor surface of 8 ls usuallv closelv
aLLached Lo Lhe vlsceral surface of Lhe llver
over Lhe area of Lhe so called º8 bed"
O lnLlmaLelv relaLed Lo Lhe llver
O c||n|ca| corr|at|onť
lnfecLlon ln Lhe 8 Ŷ (+) lnfecLlon ln Lhe
llver
common cause of hepaLlc abscess
cholecvsLlLls
earlv C of 8 Ŷ meLasLaslze ln Lhe llver
rupLure of 8 secondarv Lo cholellLhlasls Ŷ
rupLure ln beLween Lhe 8 and llver
lncludlna Lhe surroundlna areas such as
duodenumţ eLcŦ

O free surface of Lhe bodv and lnfundlbulum of
8 lles enclose approxlmaLlon Lo Lhe 1
sL

porLlon and superlor seamenL of Lhe 2
nd
parL
of duodenum
CCť cholecvsLoduodenal flsLula Ŷ
secondarv Lo 8 sLones
lnLesLlnal obsLrucLlon Ŷ secondarv 8
sLone




O no perlLoneum beLween posLerlor 8 and Lhe
llver

cŦ |nfnd|b|m (nartmann'¾ ½och)
O slLuaLed beLween lLs bodv and neck
O overhanalna pouch Ŷ shallow dlverLlculum bv
Lhe rlahL edae of lesser omenLumť
cholecvsLoduodenal llaamenL of
hepaLoduodenal llaamenL





O cho|cy¾tododna| ||gamnt
avascular
aLLach lnfundlbulum wlLh duodenum
double laver perlLoneal laver fold derlved
from Lhe lnferlor maraln of Lhe rlahL free
border of hepaLoduodenal llaamenL

O c||n|ca| corr|at|on
helps aulde Lo suraeon Lo Lhe ma[or
vascular and ducLal sLrucLure
(lmporLance) lvlna ln Lhe blllarv fossa and
LracLlons on Lhe lnfundlbulum for full
exposure of neck and cvsLlc ducL

dŦ nck
O sLarLs from upper parL of lnfundlbulum
O narrows and curve upon lLself ln Lhe form of
ºS"




O dlrecLed superlorlvţ dorsallv and Lo Lhe lefL
O evenLuallv narrows lnLo a wlll mark
consLrlcLlon as lL [uncLlon wlLh Lhe cvsLlc ducL
O 3Ŵ6 mm
O occuples Lhe deepesL parL of Lhe cvsLlc fossa
close Lo Lhe rlahL laLeral free border of
hepaLoduodenal llaamenL

Ŵ 5½|ra| Va|v of n|¾tr
4 lnfoldlna of Lhe wall of Lhe cvsLlc ducL
4 malnLalns paLencv of Lhe cvsLlc ducL
4 dlfflculL caLheLerlzaLlon or problna
4 closelv relaLed Lo duodenumţ [e[unumţ llver and
abdomlnal wallţ Lransverse colon

Ŵ cy¾t|c dct
4 avrag |ngthť 3 cm (3Ŵ8 cm)
4 d|amtrť 3 Ŷ 12 mm
4 sLarLs from Lhe neck of 8 Lo porLa hepaLls Lhen
[olns Lhe common hepaLlc ducL Lo form Lhe C8u
4 LorLuous ln appearance due Lo splral valve of
PelsLer
4 passes downward wlLh CPu before [olnlna C8u

Ŵ b|ood ¾½½|y
Ak1LkIL5
4 cvsLlc branch of rlahL hepaLlc arLerv
dlvlde lnLo anLerlor branch Ŷ perlLoneal
surface of 8
posLerlor branch Ŷ area beLween Lhe 8 and
llver


53 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 r|at|on¾h|½ w|th cy¾t|c dct
lles superlor Lo cvsLlc ducL
varlaLlonsť
O mav arlse anLerlor Lo cvsLlc ducL
O lefL Lo cvsLlc ducL
O dorsal Lo cvsLlc ducL

4 Cy¾t|c tr|ang| of Ca|ot
lefL Ŷ common hepaLlc ducL (formed bv rlahL
and lefL hepaLlc ducL)
rlahL Ŷ cvsLlc ducL
superlor (apex) Ŷ hllum/ lnferlor edae of Lhe
llver





4 cy¾toh½at|c tr|ang|
can be found ln Lhe apex of Lhe Lrlanale of
CaloL
cvsLlc arLervţ rlahL hepaLlc arLervţ accessorv
rlahL hepaLlc arLervţ 90Ʒ of accessorv hepaLlc
ducL

VLNCU5
4 no slnale/ ma[or cvsLlc veln dralnlna Lhe 8
4 onlv mulLlple small velns dralns 8 Lhen ao Lhe
llver bed/ cvsLlc ducL lj velns of C8u lj porLal
venous svsLem

L¥MÞnA1IC5
4 mav ao dlrecLlv Lo Lhe 8 vla mulLlple small
lvmphaLlc channels
4 mav draln Lo cvsLlc ducL lnLo a slnale Ln/ serles
overlvlna Lhe cvsLlc ducL called cvsLlc node of CaloL

INNLkVA1ICN5
4 Lravels vla Lhe hepaLlc plexus bealnnlna aL Lhe
cellac plexus exLendlna superlorlv Lowards Lhe 8
alona Lhe hepaLlc arLerv and Þv
4 hepaLlc plexus
from afferenL svmpaLheLlc and
parasvmpaLheLlc vaaal flbers

Ŵ c||n|ca| corr|at|on
4 rlahL hvpochondrlum
4 eplaasLrlum
4 rlahL scapular realon
areas of referred paln of exLrahepaLlc paln

4 aallsLone Ŷ uLZ Ŷ calclflcaLlons
4 rupLure Ŷ llverţ Lransverse colonţ abdomlnal wallţ
duodenum

8ILIAk¥ DUC15 (Lk1kAnLÞA1IC DUC15)
(DrŦ Laygo)

Ŵ sLarLs aL Lhe llver as ¾gmnta| b|| dct¾ wlLh Lhe 8
Nj Nj
rlahL lefL hepaLlc arLerv


common hepaLlc ducL
hepaLlc ducL lj Nj
common blle ducL
maln pancreaLlc ducL lj Nj
ampulla of vaLer
Nj
ma[or duodenal papllla
ln duodenum

kIGn1 AND LLI1 nLÞA1IC DUC1
Ŵ 1 Lo 3 cm lenaLh
Ŵ lle wlLhln Lhe exLrahepaLlc poslLlon [usL lnferlor Lo Lhe
porLa hepaLls
Ŵ unlLe Lo form CPu [usL 1 cm below Lhe porLa hepaLls

CCMMCN nLÞA1IC DUC1
Ŵ avrag |ngthť 4 cm (2Ŵ6Ŧ3 cm)
Ŵ coarse lnferlorlv and sllahLlv Lo Lhe rlahL wlLhln ln Lhe
free edae of lesser omenLum
Ŵ cross bv Lhe rlahL hepaLlc/ cvsLlc arLerv
Ŵ rlahL hepaLlc ducL ls ln close relaLlonshlp wlLh rlahL
hepaLlc arLerv ln abouL 90Ʒ of cases

CCMMCN 8ILL DUC1
Ŵ dlvlded lnLo 4 seamenLs
Ŵ [oln wlLh maln Þu
Ŵ formed bv CPu and Cu
Ŵ avrag |ngthť 8 cm (3Ŵ17cm)
Ŵ avrag w|dthť 0Ŧ3 Lo 1 cm (3Ŵ10mm)
Ŵ ¾gmnt¾ť
aŦ ¾½radodna| ¾gmnt
4 lonaesL C8u
54 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 above Lhe duodenum
4 |ngthť 2Ŧ3 cm
4 lles wlLhln Lhe rlahL free border of
hepaLoduodenal llaamenL
4 Þv Ŷ lles dorsal Lo lLţ separaLed wlLh loose
areolar C1
suralcal conslderaLlon Ŷ asplraLlon of Þv
and C8u wlLh cuLLlna

4 palpable beLween Lhe lefL lndex flnaer place ln
Lhe eplplolc foramen and Lhumb place aL Lhe
venLral surface of C8u
Þ8lnLL MnLuvL8
cŦsŦ conLrols blood flow aolna Lo Lhe llver
once lL ls compressed bv Lhe flnaer

bŦ rtrododna| ¾gmnt
4 behlnd Lhe mlddle porLlon of Lhe 1
sL
parL of
Lhe duodenum
4 |ngthť 2Ŧ3 Ŷ 4Ŧ3 cm
4 aasLroduodenal arLerv Ŵ lles [usL Lo Lhe lefL of
Lhe reLroduodenal porLlon




4 rlahL sldeť hepaLlc arLerv
4 closelv relaLed Lo Lhe mlddle collc arLerv
4 [usL lnferlor Lo Lhe pvlorus and superlor
porLlon of duodenum
once perforaLed Ŷ pvlorlc ulcer
llaaLed C8u Ŷ [aundlce

cŦ |nfradodna| ¾gmnt
4 lnLrapancreaLlc seamenL
4 |ngthť 2Ŵ3 cm
4 relaLed Lo Lhe head of pancreas posLerlorlv
4 lnLrapancreaLlc Ŷ run wlLhln Lhe pancreas
4 sLarLs as a aenLle curve Lo Lhe lefL as lL
descends relaLlvelv close Lo Lhe lefL
descendlna duodenum
4 abouL halfwav alona lLs pancreaLlc coarseţ lL
sLarLs Lo curve aenLlv Lowards Lhe rlahL and
makes an almosL 90Ʒ Lurn Lo Lhe rlahL Lo enLer
Lhe posLeromedlal surface/ aspecL of
descendlna duodenum aL above lLs mldpolnL


4 r|at|on¾ of |ntra½ancrat|c ¾gmnt
superlor Z of Lhe 3
rd
porLlon of C8u
relaLed Lo ua [usL lefL Lo C8u
superlor Þua crosses Lhe 3
rd
porLlon of
C8u
Þuv runs ln Lhe posLerlor surface of
pancreaLlc head relaLed Lo Lhe lefL of C8u

dŦ Intradodna| ¾gmnt
4 mosL common enLrvť C8u and MÞu lj ma[or
duodenal papllla
4 varlaLlonsť C8u and MÞu open lndependenLlv
lnLo Lhe bowelŤ (Ŵ) ampulla
4 common channel before ampulla




4 passes Lhrouah Lhe ducLal wall obllquelv
slmllar Lo Lhe passaae of ureLer Lowards Lhe
bladder
4 |ngthť 2 cm
4 passes 1
sL
Lo Lhe smooLh muscle Lhen Lo
submucosal porLlon Lhen peneLraLes lnLo Lhe
ma[or duodenal papllla
4 slLe of peneLraLlonť posLeromedlal wall of
duodenum [usL superlor Lo Lhe crosslna of
duodenum bv Lhe Lransverse colon
abouL 7cm dlsLal Lo pvlorus

AMÞULLA CI VA1Lk
Ŵ formed wlLhln Lhe lnLraduodenal porLlon of common
blle ducL as a resulL of Lhe [uncLlon of Lhe lumen of C8u
and MÞu
Ŵ |ngthť 3 Ŷ 11 mm
Ŵ exLends from Lhe polnL of confluence of 2 ducLs Lo [usL
proxlmal Lo Lhere exlL Lo a slnale openlna Lo Lhe
duodenal papllla
Ŵ ampulla Ŷ narrows before lL exlLs vla Lhe ma[or
duodenal paplllae

5ÞnINC1Lk CI CDDI
Ŵ auards Lhe dlsLal blllarv LracL

5ÞnINC1Lk CI 8C¥DLN
Ŵ sheaLh of clrcular muscle encloslna Lhe C8u as lL
plerces Lhe duodenal wall Lo Lhe maln pancreaLlc
paplllae
55 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

8LCCD 5UÞÞL¥
Ak1LkIL5
Ŵ cy¾t|c artryţ r|ght h½at|c artry
4 supraduodenal of C8u
4 CPu
4 lower parL of rlahL hepaLlc ducL

Ŵ ½o¾tr|or ¾½r|or ÞDaţ occa¾|ona||y by
¾½radodna| branch
4 reLroduodenal seamenL

Ŵ antŦ and ½o¾tŦ ¾½r|or ÞDa
4 lnLrapancreaLlc
4 lnLraduodenal

VLNCU5 DkAINAGL
Ŵ superlor porLlon of C8u Ŷ [olns Lhe llver dlrecLlv
Ŵ lnferlor porLlon of C8u Ŷ aoes Loward Lhe porLal
venous svsLem

L¥MÞnA1IC5
Ŵ C8u lj Ln aL C8u lj Ln around Lhe porLa hepaLls
Ŵ some casesţ Ln aL C8u lj pancreaLlc aroup of Ln lj
superlor ma[or aroup of Ln
Ŵ relaLed Lo pancreasť lnLrapancreaLlc/ lnfraduodenal
seamenL

INNLkVA1ICN5
Ŵ hepaLlc nerve plexus supplv Lhe blllarv ducL svsLem



















kADICLCG¥
(DrŦ Aragon)

GALL8LADDLk
Ŵ wa|| th|ckn¾¾ť 3mm
Ŵ c||n|ca| con¾|drat|onť
4 cholecvsLlLls
4 (+) Lumor (C of aallbladder) Ŷ common ln
elderlv
lncreases wall Lhlckness

4 edema of aallbladder
kldnev problem
hearL fallure
lncrease wall Lhlckness 2¨ Lo anasarca
(aenerallzed edema)

ÞANCkLA5
Ŵ normal dlmenslonť headţ bodvţ Lall
Ŵ ½ancrat|c dct
4 verv Lhln Ŷ normal less Lhan 1 mm
4 normallv noL seen
4 lf seen
abnormal and bevond 1 mm
(+) ln [aundlce
elderlv
welahL loss 2¨ Lo blllarv C affecLlna Lhe flow
of pancreaLlc [ulce

5ÞLLLN
Ŵ locaLed aL Lhe lefL slde
Ŵ seldom Lo observe
Ŵ norma||y |n U12ť locaLed aL Lhe Lop or above Lhe
kldnevs
4 lLs lnferlor porLlon hua Lhe superlor porLlon of
kldnev





Ŵ abnorma|ť lf bevond half of Lhe lefL kldnev
4 or reachlna down Lhe lllac fossa
4 or cross Lhe lnaulnal area
splenomeaalv Ŷ can'L be dlaanose lf seen ln
radloaraph onlvŤ cause should be known
flrsL
56 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

LIVLk
Ŵ hepaLlc velnsţ Þv Ŷ seen well ln slender lndlvlduals
Ŵ Lhe Lhlcker Lhe bodv faL Lhe more dlfflculL for Lhe
sounds Lo Lravel
Ŵ 3 factor¾ that |m½a|r U12 |mag|ng
4 lncrease Lhlckness Ŷ adlpose Llssue
4 (+) overlvlna aas Ŷ sLomachţ Lransverse colon
dlfflculL for pancreas Lo see

4 (+) calvarlum (bones)
braln due Lo skull

Ŵ can see confluence of vena cava
Ŵ Þv Ŷ have brlahLer walls
Ŵ PepaLlc veln Ŷ Lhlnţ hardlv seen
Ŵ lnLrahepaLlc blle ducL Ŷ normallvţ noL vlslble bv
LradlLlonal u1Z
Ŵ C8u Ŷ can be seenŤ normallvţ 6 mmţ can add ƾ2 cm lf
paLlenL ls above 60 v/o
4 as aae lncreasesţ callber lncreases buL nor
bevond 8mm

5MALL IN1L51INL AND CCLCN

LkAMINA1ICN5 CI CCLCN
Ŵ colonoscopv Ŷ dlrecL vlslon of colon done bv
aasLroenLeroloalsL
Ŵ lmaalnať C1 scanţ u1Zţ and xŴrav
Ŵ xŴrav (barlum enema) Ŷ classlc and commonlv used ln
examlnlna colon
Ŵ ty½¾ of nmať
4 cleanslna enema
commonlv used
admlnlsLraLlon of subsLance Lo Lhe recLum
Lo colon lj lrrlLaLlon of colon lj defecaLlon
soap suds soluLlon
molasses

4 barlum enema

Ŵ ÞkCCLDUkL
4 plaln xŴrav of abdomen
4 normallv recoanlzable sLrucLures
sLomach Ŷ wlLh aas
colon Ŷ usual adulL
averaae adulL Ŷ (Ŵ) aas ln small lnLesLlne
lnfanLs and chlldren Ŷ sLomachţ larae
lnLesLlneţ small lnLesLlne fllled wlLh aas
newborn Ŷ sLarL swallowlna
O flrsL few hoursţ (+) aas Lo sLomach and
small lnLesLlne
O 24 hours Ŷ (+) aas ln small lnLesLlne and
larae lnLesLlne up Lo Lhe recLum
lf (Ŵ) abnormal due Lo
O no swallowlna
O obsLrucLlon
O braln suraerv

4 rlahL places of oraans
small lnLesLlne Ŷ cenLral
larae lnLesLlne Ŷ perlpheralŤ surrounds Lhe
locaLlon of small lnLesLlne

Ŵ (+) bar|m ¾¾½n¾|on (bar|m nma)
4 1 Lo 1Ŧ3 L of barlum suspenslon Ŷ depends Lo Lhe
Lolerance and aae of paLlenL
4 lnLroduce suspendlna araduallv ln Lhe recLum
4 monlLor Lhe flow of conLrasL maLerlal as lL
ascends bv dolna fluoroscoplc examlnaLlon
4 slamold colon Ŷ mosL redundanLţ LorLuous
4 loosen bands ln Lhe seamenL Ŷ ha¾trat|on¾
presence of lL dlfferenLlaLes Lhe larae
lnLesLlne Lo small lnLesLlne even Lhe callber
lncrease callber Ŷ larae lnLesLlne

4 medlal porLlon of ascendlna colon Ŷ (+)
LranslLlon of callber slanlfles Lermlnal colon
4 oval shadows ln colon Ŷ reLalned fecal maLerlals
4 ln dolna lL aeL fronLalţ Þţ Þ and rlahL and lefL
obllqueţ decublLusţ sLandlna and Lredenlenbura
4 splenlc flexure Ŷ overlapplna shadows ln
________
4 obllque Ŷ check C ln overlapplna splenlc flexure
4 ½r½arat|onť defecaLe and urlnaLe
evacuaLlon of barlum afLer xŴrav maLerlal

4 ccm Ŷ laraesL porLlon and commonlv rupLure
due Lo compleLe obsLrucLlon due Lo lncrease
pressure
9 cm Lransverse dm
bevond Ŷ lmpendlna for rupLure

Ŵ C1 5CAN
4 cuL colon dependlna on Lhe slLe


57 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ VIk1UAL C1 CCLCNCGkAÞn¥
4 uLlllzed C1 scan and xŴrav wlLh hlah sofLwars
where ln lL reconsLrucL oraans ln acLual
colonoscopv

Ŵ INDICA1ICN ICk IMAGING
4 rcta| b|d|ng
2¨ Lo hemorrholds
hemorrholds mlahL coŴexlsL wlLh C
O once llmlLed dlaanosls Ŷ
observaLlon/dlalLal recLal exam

musL use oLher lmaalna dlaanosLlc Lo
deLermlne oLher underlvlna cause of
bleedlna

4 byond 50 y/o
lncrease frequencv of colonlc C

4 con¾t|½at|on
mlahL be due Lo C alreadv

4 ch||drn w|th con¾t|½at|on (3Ŵ7 y/o)
dlfferenL wlLh lnfanL and adulL
mlahL due Lo conaenlLal paLlenL
volvulus
(Ŵ) colonlc aenesls

4 ½r½arat|on
laxaLlves
nÞC aL mldnlahL

















IN1kCDUC1ICN 1C 1nL ÞLLVI5ţ
ÞLkINLUM AND GLU1LAL kLGICN
(DrŦ Laygo)

ÞLLVI5 Ŷ realon of Lhe bodv LhaL lles below Lhe abdomen

5rfac Landmark¾
1Ŧ |||ac cr¾t
Ŵ one belna palpaLed when vou do realonal
anesLhesla
Ŵ level of L4
Ŵ lL ls where splnal anesLhesla ls usuallv done
4 safe Ŷ because of Lhe presence of Lhe
subarachnold space whlch LermlnaLes aL Lhe
level of S2

Ŵ L2 Ŷ where splnal cord LermlnaLes

2Ŧ A5I5
Ŵ anLerlor end of lllac cresL
Ŵ where Lhen d|¾ta| nd of Lhe ÞouparL's llaamenL ls
aLLached

3Ŧ Þ5I5
Ŵ posLerlor surface of lllac cresL
Ŵ level of S2
4 where subarachnold space LermlnaLes

4Ŧ ½b|c tbrc|
Ŵ locaLed anLerlorlv
Ŵ upper border of Lhe publs
Ŵ where Lhe md|a| nd of Lhe ÞouparL's llaamenL ls
aLLached

5Ŧ ¾ym½hy¾|¾ ½b|¾
Ŵ lmporLanL anaLomlcal and suralcal landmark
Ŵ carLllaalnous [olnL LhaL ls locaLed aL Lhe mldllne of
Lhe publc bone

6Ŧ ½b|c cr¾t
Ŵ a rldae on Lhe publc bone aL Lhe superlor surface
Ŵ locaLed medlal Lo Lhe publc Lubercle

7Ŧ ¾½|no¾ ½roc¾¾¾ of th ¾acra| bon
Ŵ [olned LoaeLher

58 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ ln Lhe mldllneţ Lhev usuallv form Lhe md|an ¾acra|
cr¾t
4 locaLed aL Lhe upper mosL porLlon of Lhe Nata|
c|ft
area LhaL separaLes Lhe 2 buLLocks ln Lhe
mldllne

8Ŧ ¾acra| h|at¾
Ŵ slLuaLed aL Lhe posLerlor aspecL of Lhe lower end of
Lhe sacrum
Ŵ LermlnaLlon of Lhe exLradural space
Ŵ locaLed abouL 3 cm above Lhe Llp of Lhe coccvx
Ŵ locaLed beneaLh Lhe skln of Lhe naLal clefL

9Ŧ coccyx
Ŵ locaLed aL Lhe dlsLal end of Lhe verLebral column
Ŵ lnferlor surface or Llp of coccvx ls acLuallv palpaLed
ln Lhe naLal clefL abouL 1 lnŦ behlnd Lhe anus
Ŵ cllnlcal slanlflcanceť
4 dlslocaLlon of Lhe Llp of coccvx
recLal examlnaLlon Ŷ palpaLe Lhe anLerlor
surface of Lhe Llp of Lhe coccvx
alove hand Ŷ push Lhe Llp of Lhe coccvx
porLerlorlv

lnLernallvţ Lhe pelvlc cavlLv conLalns pelvlc vlscera
fma|¾ť
aŦ uLerus
bŦ adnexae (falloplan Lubes and ovarles)
cŦ urlnarv bladder

ma|¾ť
aŦ semlnal veslcles
bŦ prosLaLe aland
cŦ vas deferens

Þ|v|c bon Ŷ composed of lnnomlnaLe bones or hlp bones
aŦ lllum
bŦ lschlum
cŦ publc bone

Þ|v|¾ |¾ d|v|dd |nto 2 ½art¾ť
aŦ fa|¾ ½|v|¾/ gratr ½|v|¾
4 no cllnlcal lmporLance
4 boundarlesť
behlnd bv Lhe lumbar verLebrae
laLerallv Ŷ lllac fossae (covered bv lllacus
muscle)
ln fronL Ŷ lower end of Lhe anLerlor
abdomlnal wall

4 consldered as a parL of Lhe abdomlnal cavlLv
4 dr|ng ½rgnancy (3 month¾ aftr) Ŷ uLerus wlll
ao up and wlll be supporLed bv Lhe false pelvls
4 dr|ng b|rth Ŷ false pelvls auldes Lhe feLus Lo Lhe
Lrue pelvls

bŦ tr ½|v|¾/ |¾¾r ½|v|¾
4 bowlŴshaped sLrucLure LhaL conLalns and
proLecLs Lhe lower parLs of Lhe lnLesLlnal LracLţ
urlnarv LracL as well as Lhe lnLernal oraans of
reproducLlon
4 3 ½art¾ť
1Ŧ ½|v|c |n|t
measured and compared Lo Lhe
dlameLer of Lhe head of Lhe feLus
bondar|¾ť
posLerlorlv Ŷ sacral promonLorv
laLerallv Ŷ lllopecLlneal llne
anLerlorlv Ŷ svmphvsls publs

2Ŧ ½|v|c ot|t
bondar|¾ť
posLerlorlv Ŷ coccvx
laLerallv Ŷ lschlal LuberoslLles
anLerlorlv Ŷ publc arch

3Ŧ ½|v|c cav|ty
locaLed beLween noŦ 1 and 2
shorL curved canal wlLh shallow anLerlor
wall and a much deeper posLerlor wall
lmporLanL ln obsLeLrlcs
aŦkŦaŦ blrLh canal

ÞLkINLUM
Ŵ a dlamond shaped sLrucLure whlch ls bounded
anLerlorlv Ŷ svmphvsls publs
posLerlrolv Ŷ Llp of coccvx
laLerallv Ŷ lschlal LuberoslLles
Ŵ d|v|dd |nto 2 tr|ang|¾
aŦ antr|or tr|ang|
4 aŦkŦaŦ Lhe uroaenlLal Lrlanale
4 conta|n¾ť
female Ŷ exLernal female aenlLalla (labla
mlnora and ma[oraţ cllLorls)ţ vaalnal and
ureLhral orlflce
59 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

male Ŷ male exLernal aenlLalla (scroLumţ
orchldsţ and penls)

bŦ ½o¾tr|or tr|ang|
4 aŦkŦaŦ Lhe anal Lrlanale
4 conLalns Lhe anal openlna

GLU1LAL kLGICN
Ŵ quadrllaLeral space
Ŵ boundedť
above Ŷ lllac cresL
below Ŷ aluLeus maxlmus muscle
medlallv Ŷ laLeral maraln of Lhe sacrum and coccvx
laLerallv Ŷ Lensor fascla laLa

8ttock¾
Ŵ Lermed as n1lS
Ŵ small rounded elevaLlon whlch ls separaLed from lLs
ad[olnlna buLLocks bv a deep flssure called naLal clefL
Ŵ llmlLed lnferlorlv bv a aroove called luLeal fold (or
fold of Lhe buLLocks)
Ŵ b|g|ng of th bttock¾
4 conslsLs of Lhlck laver of faLs
Ŵ |owr ½art of th bttock¾
4 madeŴup of larae aluLeus maxlmus muscle

Im½ortant 5trctr¾
1Ŧ aluLeus maxlmus muscle
O behlnd aŦ maxlmus Ŷ aluLeus medlus
O deep lnslde of aŦ medlus Ŷ aluLeus mlnlmus

2Ŧ neurovascular sLrucLures
O plrlformls
4 b|owť |ntra½|r|form|c ¾½ac
4 vlLal sLrucLures comes ouL aL Lhe sclaLlc
foramen
aŦ sclaLlc nerve
bŦ lnferlor aluLeal vessels and nerve
cŦ lnferlor pudendal vessels and nerve
4 abovť ¾½ra½|r|form|c ¾½ac
aŦ superlor aluLeal vessels
bŦ superlor aluLeal nerve

O c||n|ca| ¾|gn|f|cancť
4 deep lM ln[ecLlon ls done aL Lhe upper ouLer
quadranL of Lhe buLLocks
4 whv? neurovascular sLrucLures are locaLed aL
Lhe upper lnner and lower lnner quadranLs
ÞLLVI5
(DrŦ 1any)

ÞLLVI5
Ŵ llnk beLween Lhe upper Lrunk and lower Lrunk
Ŵ llkened lnLo a basln wlLh 4 wallsť
anLerlorţ posLerlorţ laLeral and lnferlor wall

Ŵ w|th r|g|d r|ng
4 |m½ortancť Lransfer of welahL from Lhe upper
lnLo Lhe lower Lrunk
4 breakaae wlll cause lnS18lLl1?
Lhere musL be a polnL of breakaae (2 polnLs)
anLerlor and posLerlor
lf onlv one Ŷ consldered sLlll as sLable

aŦ vrt|ca| ¾har
dlsrupLlon of Lhe svmphvsls publs and
Lhe bone

bŦ o½nŴbook mchan|¾m/ AŴÞ com½r¾¾|on
dlsrupLlon of Lhe posLŦ sacrolllac [olnL

cŦ |ntrna| com½r¾¾|on
breakaae of Lhe bon
dlsrupLlon of Lhe sacrolllac [olnL

4 lf bone ls desLroved Ŷ llaamenL ls spared (vlce
versa)

Ŵ fma|
4 pelvlc lnleL and ouLleL
4 |m½ortancť where feLus wlll pass Lhrouah
4 d|¾r½t|onť dlfflculLv ln alvlna blrLh
4 |mmd|at com½||cat|onť hvpovolemla
damaae of Lhe LrlbuLarles of Lhe lnLernal
pudendal vessels

4 sacrum Ŷ neuroloalc ln[urles

Ŵ ½hy¾|ca| xam|nat|onť INIUk¥
IN5ÞLC1ICN
aŦ D¾tot'¾ ¾|gn
4 hemaLoma ln Lhe lnaulnal and scroLal area



60 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

bŦ kox'¾ ¾|gn
4 decreased ln Lhe dlsLance beLween Lhe
areaLer LrochanLer and lschlal splne

cŦ Lar|'¾ ¾|gn
4 durlna recLal examlnaLlon ƹ can be palpaLed
ƹ hemaLoma/ bonv promlnence

ÞALÞA1ICN
O laLeral compresslon
O SlS compresslon
O svmphvsls publs compresslon
4 (+) paln once (+) dlsrupLlon of pelvlc rlna

Ŵ or|ntat|on
5tand|ng Þo¾|t|on
aŦ A5I5 and ¾ym½hy¾|¾ ½b|¾
4 lle ln Lhe same verLlcal plane

bŦ ¾acrm
4 anLerlor or concave surface
4 faclna forward buL downward

cŦ ½|v|c ¾rfac of th ½o¾tr|or ½b|¾
4 faclna backward and upward

Ŵ fnct|on¾ť
aŦ conLalns and proLecLs Lhe pelvlc oraan
4 lower l1ţ u1ţ lnLernal reproducLlve
oraans

bŦ common slLe for bone marrow blopsv
cŦ slLe for harvesLlna bone arafL
dŦ aLLachmenL of muscles
eŦ allow Lransfer of welahL from Lhe verLebral
column Lo Lhe appendlcular skeleLon

4 Lransfer of welahL
51ANDING
L3
Nj
Sacrum
Nj
Sacrolllac [olnL
Nj
ceLabulum
Nj
lemoral head
5I11ING
Lumbar splne
Nj
lschlal LuberoslLv

Ŵ cav|t|¾
Þ|v|c br|m/ Þ|v|c |n|t
4 bondaryť
anLerlorlv Ŷ upper parL of svmphvsls publs
laLerallv Ŷ lllopecLlneal llne (arcuaLe llne)
posLerlorlv Ŷ sacral promonLorv (upper anLerlor
maraln of S1)

4 abovť lalse pelvls/ areaLer pelvls
4 b|owť 1rue pelvls/ lesser pelvls

Ia|¾ ½|v|¾
4 bondaryť
posLerlorť L3ţ S1
laLeralť lllac fossa
anLerlorť abdomlnal muscle

1r ½|v|¾
4 pelvlc lnleL
4 pelvlc ouLleL
bondar|¾ť
anLerlor Ŷ lower parL of Lhe svmphvsls publs
posLerlor Ŷ Llp of coccvx
laLeral Ŷ sacroLuberous llaamenLţ publc arch

4 pelvlc cavlLv Ŷ wlLh walls and floor

8CN¥ ÞLLVI5
Ŵ conslsLs of (2) lnnomlnaLe bone/ hlp boneţ (1)
sacrumţ (1) coccvx

INNCMINA1L 8CNL/ nIÞ 8CNL
Ŵ wlLh 3 bonesť lllumţ lschlumţ and pelvlc bone
Ŵ noL fused beLween aae 4Ŵ16
4 tr|rad|at cart||ag Ŷ presenL below 12Ŵ16 vears
of aae
osslfled bevond 16 vears of aae
polnL of fuslon of Lhe 3 bones

Ŵ antr|or bordrť has 2 equal concavlLles whlch ls
dlvlded bv anLerlor lnferlor lllac splne
Ŵ ½o¾tr|or bordrť has unequal concavlLles dlvlded bv
posLerlor lnferlor lllac splne
61 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 smaller Ŷ superlor concavlLv
4 laraer Ŷ lnferlor concavlLv
5c|at|c notch
dlvlded bv lschlal splne
areaLer sŦ noLch Ŷ above
lesser sŦ noLch Ŷ below

I||m
Ŵ laraesL amona Lhe 3 hlp bone
Ŵ funŴshaped
Ŵ broader/superlor parLť L/ Wln
Ŵ bodv Ŷ llke a handle
Ŵ 2 ¾rfac¾ť
aŦ |nnr ¾rfac
4 lllac fossa Ŵ smooLh parL
4 posLerlor parL Ŷ forms Lhe sacrolllac [olnL
arLlculaLe wlLh Lhe lllum
LuberoslLv of Lhe llum Ŷ rouah
aurlcular surface Ŷ smooLh

4 lllac cresL
hlahesL/ superlor polnL
aL Lhe level of L4
landmark for epldural and splnal
anesLhesla
3 ||½¾ Ŷ attachmnt¾ of th m¾c|¾
1Ŧ ouLer llp Ŷ exLernal obllque muscles
2Ŧ lnLermedlaLe llp Ŷ lnLernal obllque
3Ŧ lnner llp Ŷ Lransversus abdomlnls

¾½r|or bordrť SlS and ÞSlS
a llLLle posLerlor Lo Lhe SlSť lllac
Lubercle
O Lhlcker palpable 2" above and
superlor of SlS
O level of L3

bŦ otr ¾rfac/ g|ta| ¾rfac
4 wavv ln appearance due Lo Lhe presence of
1Ŧ |nfr|or g|ta| ||n
apex of Lhe sclaLlc noLch
Nj
endsť llS

2Ŧ m|dd|/ antr|or g|ta| ||n
sclaLlc noLch
Njupward
anLerlor Lo Lhe lllac Lubercle
3Ŧ ½o¾tr|or g|ta| ||n
sclaLlc noLch
Njupward
lllac cresL

4 form¾ 4 ara¾
below lnferlor aluLeal llne Ŷ aLLachmenL
of Lhe capsule of lllofemoral llaamenL
and Lhe reflecLed head of Lhe recLus
femorls
beLween lnferlor and mlddle aluLeal llne
Ŷ aLLachmenL of aluLeus mlnlmus
beLween mlddle and posLerlor aluLeal
llne Ŷ aLLachmenL of Lhe aluLeus medlus
behlnd posLerlor aluLeal llne Ŷ
aLLachmenL of Lhe aluLeus maxlmus

Þb|c bon
Ŵ locaLed anLerlorlv
Ŵ wlLh a bodv and 2 raml
Ŵ 2 ramlť superlor and lnferlor raml
4 [olned LoaeLher bv a flbrocarLllaae Lo form
svmphvsls publs

I¾ch|m
Ŵ locaLed posLerlorlv
Ŵ ½art¾ť
aŦ bodv
bŦ lschlal LuberoslLles Ŷ rouah
cŦ ramus

Ŵ actab|m
4 cupŴllke sLrucLure
4 faclna laLerallv forward and downward
4 where femoral head arLlculaLes
4 2 ½art¾
aŦ PorseŴshoe shaped arLlcular surface Ŷ
where Lhe head of femur arLlculaLes
bŦ ceLabular fossa Ŷ rouah parL
wlLh aceLabular noLch
O converLed lnLo a foramen bv
Lransverse aceLabular llaamenL
4 ¾trctr¾ ½a¾¾|ng throghť
arLlcular branches of Lhe
obLuraLor arLerv and medlal
femoral clrcumflex arLerv


62 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ n|on of 3 bon¾ form¾ an o½n|ngť C81UkA1Ck
ICkAMLN
4 dlffers ln shape ln male (rounded) and female
(Lrlanaular)
4 obllLeraLed/ closed bv obLuraLor membrane
excepL aL Lhe superlor parL
4 superlor parL Ŷ forms a canal
passaaewav of obLuraLor nerves and vessels

5ACkUM
Ŵ conslsLs of 3 fused verLebrae
Ŵ wedaeŴshaped
Ŵ wlLh (1) concave surface anLerlorlvţ (1) convex
surface posLerlorlvţ (2) laLeral arLlcular surfaces
(arLlculaLes wlLh lnnomlnaLe bones)

Ŵ w|th 8 o½n|ng¾ antr|or|y
4 anLerlor sacral foramlna
4 relaLlvelv larae superlorlv Ŷ smaller lnferlorlv
4 LransmlLs Lhe anLerlor raml of sacral nerves
(exlLs) and laLeral sacral arLerles (enLers)

Ŵ ½o¾tr|or|y
4 corresponds wlLh Lhe medlan cresL
4 4 palrs of sacral foramlna
4 relaLlvelv smaller Lhan anLerlor parL
4 posLerlor raml of sacral nerve

Ŵ sacral hlaLus Ŷ due Lo Lhe fallure of lamlna of lower
verLebra Lo fuse (S4ŴS3)
lmporLanceť caudal and epldural anesLhesla

Ŵ promlnence Ŷ kC8nu
remnanLs of Lhe lnferlor arLlcular process

Ŵ ¾acra| cana| contnt¾
anLerlor and posLerlor raml of Lhe lumbarţ sacral
and coccvaeal nerve rooLs
fllum Lermlnale
flbrofaLLv maLerlals
dura maLer (S2 level)

CCCC¥k
Ŵ 4 fused bones
Ŵ conslsLs onlv of Lhe bodv excepL coccvaeal 1
Ŵ coccvaeal 1 wlLh rudlmenLarv Lransverse process
Ŵ kornu Ŷ remnanLs of Lhe superlor arLlcular process

ICIN15
Ŵ antr|orť svmphvsls publs (carLllaalnous [olnL)
Ŵ ½o¾tr|orť sacrolllac [olnL
4 llkened Lo a suspenslon brldae
4 ¾tab|||zrť sacrolllac llaamenL
aŦ ½o¾tr|or ¾acro|||ac ||gamnt
mosL lmporLanL and sLronaesL llaamenL
dlvlded lnLoť
5nCk1 LIGAMLN1
O responslble for roLaLlonal llaamenL

LCNG LIGAMLN1
O responslble for verLlcal sLablllLv

bŦ |||o|mbar ||gamnt
from Lransverse process of L3 Ŷ
aLLached Lo Lhe sacral LuberoslLv S1
prevenL forward dlsplacemenL of L3 ln
relaLlon Lo S1

cŦ antr|or 51 ||gamnt
wlLh llmlLed conLrlbuLlon

Ŵ sacrococcvaeal [olnL
Ŵ L3ŴS1

LIGAMLN1
1Ŧ ¾acrotbro¾ ||gamnt
Ŵ arlses from Lhe posLerlor surface of sacrum and
coccvx
Ŵ |n¾rt|onť lschlal Lube
Ŵ prevenLs roLaLlonal and verLlcal lnsLablllLv

2Ŧ ¾acro¾½|no¾ ||gamnt
Ŵ anLerolaLeral surface of Lhe sacrum and lnserLs
ln Lhe lschlal splne
Ŵ prevenLs roLaLlonal lnsLablllLv











63 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

CLA55IIICA1ICN CI ÞLLVI5
1Ŧ avnecold Ŷ female pelvlsŤ round wlLh enlaraed
Lransverse dm
2Ŧ androld Ŷ male pelvlsŤ hearLŴshaped
3Ŧ plaLvpellold Ŷ lona Lransverse dm
4Ŧ anLhropold Ŷ lona anLerlor Lo posLerlor dm

MALE FEMALE
BUNE QUALITY 1hlcker uellcaLeţ Lhln
FALSE PELVIS ueeper Shallower
PELVIC INLET PearLŴshaped 1ransverselv
oblona
PELVIC UUTLET narrower Wlder
PELVIC CAVITY Lonaer buL
narrower
ShorLer buL
roomler
DISTANCE
BETWEEN THE
TWU ASIS
narrower Wlder

ÞLLVI5
Ŵ rlald rlna
4 durlna speclal cases llke preanancv lL becomes
accommodaLlna because of Lhe presence of
esLroaenţ proaesLerone and relaxln
4 sofLenlna of Lhe llaamenL

Ŵ llkened lnLo a basln and has walls wlLh several holes

aŦ antr|or wa||
4 bounded bv svmphvsls publs and bodv of Lhe
publc bone
4 shallowesL amona Lhe 4 walls

bŦ |atra| wa||
4 formed bv Lhe hlp bone below Lhe lllopecLlneal
llne and obLuraLor muscle

cŦ ½o¾tr|or wa||
4 mosL exLenslve wall formed bv Lhe sacrumţ
coccvx and plrlformls muscle

dŦ f|oor/ |nfr|or wa||
4 formed bv Lhe ½|v|c d|a½hragm
conslsLs of 2 musclesť levaLor anl muscle and
coccvaeus muscle
or|g|n¾ť
O back of Lhe bodv of Lhe publs
O Lendlnous arch Ŷ Lhlckenlna ln Lhe
pelvlc fascla
O lschlal splne

Ŵ ||n|ng of th wa||¾
4 pelvlc fascla
aŦ parleLal pelvlc fascla
llnes Lhe wall of Lhe pelvlc cavlLv
(bonesţ muscles and llaamenLs)
exŦ LaLeral wall Ŷ obLuraLor muscle Ŷ
obLuraLor fascla

bŦ vlsceral pelvlc fascla
llnes Lhe vlsceral oraans
Lhln loose C1 buL has a Lhlckenlna LhaL
wlll alve addlLlonal supporL
exŦ Þuboveslcal Ŷ bladder and publc
bone





4 pelvlc perlLoneum
reflecLlon of vour perlLoneum

ÞLLVIC DIAÞnkAGM
Ŵ con¾|¾t¾ ofť
AŦ Lvator an| m¾c|
aŦ anLerlor parL
4 male Ŷ sphlncLer ureLhra
4 female Ŷ sphlncLer vaalna
4 forms a sllna ln Lhe uroaenlLal [uncLlon

bŦ lnLermedlaLe parL
4 puborecLalls muscle Ŷ forms a sllna ln Lhe
anorecLal [uncLlon
4 pubococcvaeus muscle Ŷ lnserLs lnLo
perlneum bodv

cŦ posLerlor parL
4 lllococcvaeus muscle Ŷ forms a sllna ln Lhe
coccvx

O ½r|nm body
4 locaLed aL Lhe vaalna and anorecLal [uncLlon

O anococcyga| body
4 locaLed aL Lhe Llp of Lhe coccvx and anus

64 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

notť perlneum bodv and anococcvaeal bodv Ŷ mass
of flbrous Llssue LhaL serves as a connecLlon of Lhe
levaLor anl muscle

8Ŧ Coccyg¾ m¾c|
4 arlses from Lhe lschlal splne and lnserLs lnLo Lhe
laLeral aspecL of Lhe sacrum and coccvx

Ŵ fnct|on¾ of th ½|v|c d|a½hragmť
aŦ acLs as a sphlncLer Lo Lhe vaalna
bŦ keeps Lhe pelvlc vlsceral oraans ln place durlna
lncrease ln Lhe lnLrapelvlc pressure
cŦ sphlncLer acLlon on Lhe anorecLal [uncLlon

Ŵ |n[ry |n ½|v|c d|a½hragm (d|ff|c|ty |n ch||db|rth)
aŦ uLerlne prolapsed
bŦ cvsLocele (prolapsed of bladder)
cŦ sLress lnconLlnence
dŦ recLal lnconLlnence

Ŵ ½|v|c d|a½hragm df|c|nt antr|or|y
4 obllLeraLed bv Lhe uroaenlLal dlaphraam found ln
Lhe deep perlneal pouch

ÞLkINLUM
Ŵ locaLed below Lhe pelvlc dlaphraam (separaLes Lhe
perlneum from Lhe pelvlc cavlLv)
Ŵ locaLed beLween Lhe Lhlahs
Ŵ abducLlon Ŷ wlderŤ adducLlon Ŷ smaller
Ŵ dlamondŴshaped
Ŵ bondar|¾ť
anLerlorlv Ŷ svmphvsls publs
laLerallv Ŷ lschlal LuberoslLv
posLerlorlv Ŷ Llp of coccvx

Ŵ dlvlded lnLo Lwo Lrlanale bv an lmaalnarv llne
Lraverslna Lhe lschlal LuberoslLles
aŦ rogn|ta| ara
4 anLerlor parL
4 con¾|¾t¾ ofť
1Ŧ xtrna| gn|ta||a
male Ŷ scroLumţ penlsţ orchlds
female Ŷ vaalnal and ureLhral orlflcesţ labla
mlnora and ma[ora

2Ŧ ¾½rf|c|a| ½r|na| ½och
Ŵ llmlLed lnferlorlv bv Co||'¾ fa¾c|a

4 |n¾rtd
laLerallv Ŷ lschlal LuberoslLles
posLerlorlv Ŷ uroaenlLal dlaphraam
antr|or|y Ŷ no ½o|nt of attachmnt
*½ron to |n[ry Ŷ bulb of Lhe penls
parLlcularlv ln Lhe bulboureLhral area
whlch mav rupLure and cause splllaae
of Lhe urlne lj aoes up lnLo Lhe
abdomen

Ŵ bondaryť from Lhe perlneal membrane
Lo Lhe Colle's fascla

Ŵ ¾trctr¾ fondť

MALL
aŦ rooL of Lhe penls
crus of Lhe penls ( 8 and L) Ŷ
enclosed bv lschlocavernosus
mŦ/bulbocavernosus mŦ

bulb of Lhe penls Ŷ enclosed bv
bulbosponalosus mŦ

bŦ superflclal Lransverse perlneal muscle
cŦ perlneal bodv
dŦ perlneal branch of Lhe pudendal nerve

ILMALL
aŦ rooL of cllLorls
crus of Lhe cllLorls (8 and L) Ŷ
enclosed bv lschlocavernosus mŦ/
bulbocavernosus mŦ
bulb of Lhe cllLorls Ŷ spllLs lnLo 2
and surrounds Lhe vaalnal orlflce
whlch acLs as a sphlncLer
Ŵ enclosed bv bulbosponalosus
mŦ Ŷ underneaLh Lhls lj
veslLubular bulb

bŦ superlflclal Lransverse perlneal muscle
cŦ perlneal bodv
dŦ perlneal branch of Lhe pudendal nerve

3Ŧ d½ ½r|na| ½och
Ŵ obllLeraLes Lhe openlna ln Lhe pelvlc
dlaphraam

65 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ contnt¾ť
UkCGLNI1AL DIAÞnkAGM
conslsLs of deep Lransverse
perlneal muscle and sphlncLer
ureLhra muscle

MALL
a) membranous parL of Lhe ureLhra
b) sphlncLer ureLhra muscle
c) deep Lransverse perlneal muscle
d) lnLernal pudendal vessels and Lhelr
branches
e) bulboureLhral aland
f) dorsal nerve Lo Lhe penls

ILMALL
a) parL of Lhe ureLhra
b) parL of Lhe vaalna
c) sphlncLer ureLhra
d) deep Lransverse perlneal muscle
e) lnLernal pudendal vessels and Lhelr
branches
f) dorsal nerve Lo Lhe cllLorls

bŦ ana| tr|ang|
4 posLerlor parL
4 wlLhln Lhls Lrlanale Ŷ |¾ch|orcta| fo¾¾a
wedaeŴshaped
bondar|¾ť
base Ŷ skln
medlallv Ŷ levaLor anl muscle
laLerallv Ŷ obLuraLor muscle and hlp
bone
¾trctr¾ fondť
O dense faLLv Llssues
O pudendal canal/ lcock's canal
LransmlLs Lhe followlnať
interno/ pudendo/ vesse/s
O lnLŦ pudendal arLerv Ŷ
branch of lnLernal lllac
arLerv
O lnferlor recLal arLerv arlses
from Lhe lnLernal
pudendal arLerv

pudendo/ nerves Ŷ arlses from
S2ţS3 and S4Ť supplles Lhe
perlneum
1nL MALL kLÞkCDUC1IVL GLNI1ALIA
(DrŦ Mana|o)

1nL ÞLNI5
Ŵ Lhe copulaLorv oraan ln Lhe male
Ŵ con¾|¾t¾ť
aŦ rooL Ŷ flxed posLerlor parL
bŦ bodv Ŷ moblle anLerlor parL whlch ends dlsLallv
as Lhe alans penls

Ŵ Lhe rooLţ bodv and alans conslsLs of flbroelasLlc
erecLlle Llssues cvllnders
aŦ 2 Cor½ora cavrno¾a
4 locaLed dorsallv
4 aL Lhe rooL of Lhe penls bealns as Lhe lefL
and rlahL crura over Lhe mldpolnL of Lhe
lschlopublc raml
4 covered bv Lhe lschlocavernosus muscle
4 aL Lhe bodvţ unlLe slde bv slde Lo fuse
dlsLallv wlLh Lhe alans penls

bŦ 1 Cor½¾ ¾½ong|o¾m
4 locaLed venLrallv and ls Lraversed bv Lhe
ureLhra
4 lL ls also called Corpus cavernosum ureLhra
4 aL Lhe rooLţ bealns as a freeŴdllaLed sac
whlch ls called Lhe bulb of Lhe penls
4 aL Lhe bodvţ lL courses upwards and
obllquelv venLral Lo Lhe Corpora cavernosa
and flares/ expands dlsLallv Lo become Lhe
alans penls (head of Lhe penls)









Ŵ ¾½rf|c|a| ¾trctr¾ of th ½n|¾
aŦ ½r½c/ for¾k|n
4 dlsLal exLenslon of Lhe skln of Lhe penls LhaL
forms a hood or a cuff LhaL covers Lhe alans
penls ln an unclrcumclsed male
4 remove durlna clrcumclslon

66 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

bŦ frn|m
4 fold of akln aL Lhe venLral slde of Lhe alans
LhaL aLLaches lL Lo Lhe prepuce

cŦ bck'¾ fa¾c|a
4 flbromembranous fascla beneaLh Lhe
¾½rf|c|a| fa¾c|a
conLlnuous wlLh Lhe Colle's fascla
devold of subcuLaneous faL

dŦ ¾¾½n¾ory ||gamnt
4 Lhlckened flbroelasLlc Lrlanaular membrane
4 lLs apex ls aLLached Lo Lhe lower end of llnea
alba and svmphvsls publs
4 courses beneaLh Lhe [uncLlon of Lhe bodv
and rooL of Lhe penls Lo form a sllna






Ŧ ¾½rf|c|a| dor¾a| v|n
4 locaLed ln Lhe superflclal fascla vlslble aL Lhe
mlddle mldllne of Lhe dorsal skln
4 dlvldes lnLo lefL and rlahL LrlbuLarles Lo draln
lnLo Lhe lnLernal pudendal veln

fŦ d½ dor¾a| v|n
4 locaLed ln Lhe deep fascla [usL beneaLh Lhe
8uck's fascla
4 dralns ln Lhe prosLaLlc venous plexuses

gŦ dor¾a| artry
4 locaLed ln Lhe deep fascla
4 on boLh sldes of Lhe deep dorsal veln are
Lermlnal branches of Lhe lnLernal pudendal
arLerv

hŦ dor¾a| nrv
4 locaLed on each slde of dorsal arLerv are
Lermlnal branches of Lhe pudendal nerve
4 anLerlor raml of S2ţ S3 and S4
4 nerve LhaL ls anesLheLlze durlna clrcumclslon

|Ŧ tn|ca a|bg|na
4 flbroelasLlc Llssue surroundlna each of Lhe
erecLlle Llssue cvllnders formlna a mldllne
parLlLlon Lo separaLe Lhe rlahL and lefL
corpora cavernosa












1nL MALL UkL1nkA
Ŵ boLh a parL of Lhe male reproducLlve and urlnarv
svsLem
Ŵ con¾|¾t¾ ofť
aŦ ½ro¾tat|c rthra
4 |ngthť 2Ŧ3 Ŷ 3 cm
4 wldesL and mosL dlsLenslble/ dllaLable
seamenL
4 Lraverse Lhrouah Lhe prosLaLe

bŦ mmbrano¾ rthra/ ¾½h|nctr rthra
4 shorLesL and narrowesL
4 |ngthť 1Ŧ73 cm
4 Lraverse Lhrouah Lhe uroaenlLal dlaphraam

cŦ ½n|| rthra
4 Lraverses Lhe Corpus sponalosum
4 avrag |ngthť 20 cm (depends)
4 b|b of th ½n|¾ Ŷ lL ls called
bulbousureLhra
4 body Ŷ cavernosus/ sponav ureLhra
4 exLends from Lhe lnferlor fascla of Lhe
uroaenlLal dlaphraam up Lo Lhe exLernal
ureLhral hlaLus
4 [usL before Lhe openlna lL dllaLes Lo form Lhe
lossa navlcularls








67 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

5CkC1UM
Ŵ pendulousţ pouchŴllked sac of skln and fascla ln
whlch Lhe LesLes are suspended aL Lhe ends of Lhe
spermaLlc cord
Ŵ |ayr¾ť
aŦ ¾k|n Ŷ Lhln dellcaLe and darklv coloredţ forms a
slnale pouch
bŦ ¾½rf|c|a| fa¾c|a Ŷ devold of faL
cŦ Darto'¾ m¾c| and fa¾c|a Ŷ conLracLlon of whlch
causes Lhe skln Lo wrlnkle ln cold weaLher and
Lo smooLhen ouL ln warm weaLher
dŦ xtrna| ¾½rmat|c fa¾c|a Ŷ derlved from
exLernal abdomlnal obllque
Ŧ crma¾tr m¾c| Ŷ derlved from lnLernal
abdomlnal obllqueŤ conLracLlon draws Lhe LesLls
upwards Loward Lhe exLernal lnaulnal rlna
fŦ |ntrna| ¾½rmat|c fa¾c|a Ŷ derlved from Lhe
Lransversalls fascla
gŦ tn|ca vag|na||¾ t¾t|¾ Ŷ derlved from Lhe
perlLoneum

1L51L5
Ŵ palredţ ovoldţ sllahLlv flaLLened oraans wlLh Lhelr lona
axls sllahLlv obllque
Ŵ superlor parL ls LllLed anLerlorlv suspended ln Lhe
scroLum aL Lhe of Lhe spermaLlc cord
Ŵ avrag |ngthť 4 cm
Ŵ w|dthť 2Ŧ3 cm
Ŵ covered anLerlorlv and laLerallv bv Lhe Lunlca
vaalnalls
2 |ayr¾ of tn|ca vag|na||¾ť
aŦ parleLal Ŷ ouLer coverlna
bŦ vlsceral Ŷ adherenL ln Lhe LesLes

Ŵ furLher covered bv a flbrous capsule called Lhe Lunlca
albualnea
Ŵ posLerlor and superlor parL of LesLls conLalns Lhe
epldldvmls

LÞIDID¥MI5
Ŵ elonaaLed bodv applled ln Lhe posLerlor and superlor
surface of Lhe LesLes
Ŵ dlvlded lnLo 3 parLsť capuLţ corpusţ caudal
Ŵ from Lhe epldldvmls exLends Lhe vas deferens









5ÞLkMA1IC CCkD
Ŵ a bundle LhaL exLends from Lhe Lall of epldldvmls up
Lo Lhe lnLernal lnaulnal rlna
Ŵ covered bv spermaLlc fasclaţ CremasLer fasclaţ
lnLernal spermaLlc fasclaţ processus vaalnalls and
preŴperlLoneal faL
Ŵ con¾|¾t¾ of th ffť
aŦ ½roc¾¾¾ vag|na||¾ Ŷ corresponds Lo
perlLoneum
bŦ Va¾ dfrn¾ Ŷ aenlLal ducL found ln Lhe
spermaLlc cord
cŦ artr|¾
1Ŧ t¾t|c|ar/ |ntrna| ¾½rmat|c artry
4 or|g|nť abdomlnal aorLa ln Lhe
lumbolllac realon
4 descends ln fronL of Lhe vas deferens

2Ŧ artry of th Va¾
4 or|g|nť lnferlor veslcal arLerv (lnferlor
arLerv of urlnarv bladder)

3Ŧ crma¾tr|c artry
4 or|g|nť lnferlor eplaasLrlc arLerv

dŦ v|n¾
1Ŧ Þam½|n|form ½|x¾ of v|n¾ Ŷ lmmedlaLe
venous dralnaae of LesLls and vas ueferens
4 dralns lnLo Lhe LesLlcular veln
4 con¾|¾t¾ of thr gro½¾ť
aŦ antr|or gro½ Ŷ surrounds Lhe
LesLlcular arLerv
bŦ m|dd| gro½ Ŷ surrounds Lhe vas
deferens
cŦ ½o¾tr|or gro½ Ŷ does noL
surround anv sLrucLure

2Ŧ t¾t|c|ar v|n
4 rlahL LesLlcular veln dralns lnLo lnferlor
vena cava
4 lefL LesLlcular veln dralns lnLo lefL renal
veln

68 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŧ |ym½hat|c¾
4 2 ¾t¾ť
1Ŧ Lo Lhe exLernal lllac lvmph nodes
2Ŧ lumbar Ln around Lhe aorLa and lvC

fŦ nrv
1Ŧ aenlLal branch of Lhe aenlLorŴfemoral nerve
(L1 and L2)
4 moLor Lo Lhe cremasLer muscle
4 sensorv Lo Lhe Lunlca vaalnalls

2Ŧ svmpaLheLlc nerve
4 from Lhe aorLlc and renal plexus

3Ŧ pelvlc plexus
4 from 110 Lo LesLes
4 111ţ 112 and L1 Ŷ Lo Lhe epldldvmls

4Ŧ pudendal nerve
4 anLerlor raml of S2ţ S3 and S4

MALL ÞLLVIC VI5CLkA
(DrŦ Mana|o)

Inc|d¾ť
1Ŧ ¾|gmo|d co|on/ ½|v|c co|on
Ŵ lLs upper parL can be llfLed up ln Lhe abdomen
Ŵ lower parL remalns flxed Lo Lhe posLerlor
abdomlnal wall bv Lhe mesoslamold

2Ŧ rctm
Ŵ occuples Lhe lower posLerlor parL of Lhe pelvlc
cavlLv conformlna Lo Lhe curvaLure of Lhe sacrum
and coccvx

3Ŧ r|nary b|addr
Ŵ occuples Lhe anLerlor lower parL of Lhe pelvlc
cavlLv behlnd Lhe publs

4Ŧ rtr¾
Ŵ can be seen Lhrouah Lhe posLerlor perlLoneum aL
boLh sldes of Lhe pelvlc cavlLv descendlna Lhrouah
Lhe urlnarv bladder

5Ŧ Va¾ dfrn¾
Ŵ Lhe prlnclple ducLal componenL of Lhe spermaLlc
cord
Ŵ |n |t¾ cor¾ť w|th 3 ¾gmnt¾ť
aŦ ¾crota| ¾gmnt
4 bealns aL Lhe lower end of Lhe Lall of Lhe
epldldvmlsţ ascends behlnd Lhe LesLls
medlal Lo Lhe epldldvmls up Lo Lhe
exLernal lnaulnal rlna

bŦ |ng|na| ¾gmnt
4 Lraverses Lhe lnaulnal canal from Lhe
exLernal rlna Lo Lhe lnLernal rlna

cŦ ½|v|c ¾gmnt
4 vas deferens leaves Lhe oLher
componenLs of Lhe spermaLlc cord behlnd
4 from Lhe lnLernal rlnaţ lL courses
downwardţ backwards and medlallv
crosslna Lhe ureLers Lowards Lhe base of
Lhe prosLaLe aland and descends medlal

Ŵ afLer crosslna Lhe ureLer Lhe vas deferens dllaLes
Lo form Lhe Am½||a of th Va¾
4 surrounded bv Lhe recLoveslcal fascla/
uenonvllller's fascla

Ŵ Lhe vas deferens [olns Lhe ducL of Lhe semlnal
veslcle Lo become Lhe [ac|atory dct whlch
courses Lhrouah Lhe subsLances lf Lhe prosLaLe
aland
4 ducL common Lo Lhe semlnal veslcle and vas
deferens
4 opens ln Lhe posLerlor wall of Lhe prosLaLlc
ureLhra speclflcallv lnslde an elevaLlon called
Lhe Vrmontanm/ Co|||c|¾ ¾m|na||¾
aL lLs summlL Ŷ openlna Ŷ leadlna Lo Lhe
uLrlculus Muscullnus













69 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ b|ood ¾½½|yť rLerv of Lhe vas (branch of Lhe
lnferlor veslcal arLerv)

Ŵ c||n|ca| corr|at|onť cuL/ Lled durlna vasecLomv

6Ŧ 5m|na| v¾|c|
Ŵ pelvlc vlscera assoclaLed wlLh Lhe male
reproducLlve svsLem
Ŵ palredţ conLorLed sacŴllke sLrucLure
Ŵ evaalnaLlon of Lhe vas deferens
Ŵ |ngthť 3 cm
Ŵ d|amtrť 1 cm
Ŵ conLalns a slnale Lubeţ 10Ŵ13 cm ln lenaLh bv 3Ŵ4
mm ln dm LhaL ls folded upon lLself
Ŵ lLs lower end forms a ducL LhaL [olns Lhe vas
deferens Lo form Lhe e[aculaLorv ducL
Ŵ locaLed behlnd urlnarv bladder and ln fronL of Lhe
lower parL of Lhe recLum
Ŵ b|ood ¾½½|yť lnferlor veslcal arLerv and mlddle
hemorrholdal/ recLal arLerv

7Ŧ Þro¾tat g|and
Ŵ laraesL aland assoclaLed wlLh Lhe male
reproducLlve svsLem
Ŵ normallv dlveralna 20ar ln welahL
Ŵ a solld oraan conslsLlna of flbromuscular and
alandular Llssue
Ŵ locaLed beneaLh Lhe urlnarv bladder up Lo Lhe
uroaenlLal dlaphraam
Ŵ surrounds Lhe 1
sL
parL of Lhe male ureLhra
Ŵ broader Lhan lona
Ŵ approxlmaLelv 3 cm ln lenaLh and 3Ŧ3 cm ln
breadLh
Ŵ ha¾ 2 ca½¾|¾ť
aŦ tr Ŷ conslsL of Lhe condensaLlon of Lhe
surroundlna C1
bŦ fa|¾ Ŷ vlsceral laver of Lhe pelvlc fascla
4 surrounds Lhe lower parL of Lhe urlnarv
bladder

½ro¾tat|c (½dnda|) ½|x¾ of v|n¾ Ŷ locaLed
beLween Lhe capsules whlch ls [olned bv Lhe deep
dorsal velns bv Lhe penls

Ŵ ktro½ro¾tat|c ½och of Þro¾t
4 space beLween Lhe prosLaLe aland and Lhe
recLum behlnd

Ŵ ¾rfac¾ť
aŦ a½x Ŷ resLs on Lhe uroaenlLal dlaphraam
bŦ ba¾ Ŷ ln conLacL wlLh Lhe lnferlor surface of
Lhe urlnarv bladder and conLaln Lhe lnferlor
veslcal vessels







cŦ antr|or ¾rfac Ŷ faces Lhe "ktro½b|c
¾½ac¾ of ktz|¾"
4 space behlnd Lhe publs
4 separaLed from Lhe space bv Lhe
puboprosLaLlc llaamenL

dŦ ½o¾tr|or ¾rfac Ŷ faces Lhe pouch of ÞrousL
anLerlor Lo Lhe recLum

Ŧ (2) |atra| ¾rfac Ŷ supporLed bv Lhe anLerlor
flbers of Lhe levaLor anl muscles

Ŵ |ob¾ of th ½ro¾tat g|andť
aŦ antr|or |ob
4 exLends from Lhe anLerlor wall of Lhe
ureLhraţ occupvlna mosL of Lhe anLerlor
surface

bŦ ½o¾tr|or |ob
4 occuples Lhe mosL of Lhe posLerlor surface
behlnd Lhe mlddle lobe
4 Lhe lobe LhaL can be palpaLed bv means of
dlalLal recLal examlnaLlon

cŦ 2 |atra| |ob
4 occuples mosL of Lhe base of Lhe prosLaLe
aland

dŦ m|dd| |ob
4 mosL lmporLanL lobe
4 mosL common slLe for adenomas
4 lmplnaes on Lhe ureLhra
4 conLalns mosL of Lhe alandular Llssues
whlch are subcervlcal and subLrlaonal
aland of lbarran

70 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ ½ro¾tat|c ¾|n¾ and dct¾
4 prosLaLe aland have mulLlple ducLs
4 open ln a auLLer aL Lhe sldes of Lhe
verumonLanum called Lhe prosLaLlc slnus

Ŵ b|ood ¾½½|yť lnferlor veslcal arLerv and mlddle
hemorrholdal/ recLal arLerv

C||n|ca| Corr|at|on of th Ma| Gn|ta||a

1Ŧ Ma| |nfrt|||ty
Ŵ o||go¾½rm|a Ŷ decrease sperm counL (below
20M/cc)
ca¾¾ of o||go¾½rm|ať
aŦ undescended LesLes
bŦ deaeneraLe aermlnal eplLhellum
cŦ abnormal sperm

Ŵ azo¾½rm|a Ŷ no sperm
lŦeŦ vasecLomv
Ŵ norma| ¾½rm cont ½r [ac|atť 3Ŧ3 cc
Ŵ ¾½rm cont ½r ccť 120 M
rangť 33Ŵ200M/cc

2Ŧ Im½otnc/ Lrct|| dy¾fnct|on
Ŵ lnablllLv Lo aLLaln and malnLaln erecLlon

3Ŧ Þr|a½|¾m
Ŵ perslsLenL/ susLalned palnful erecLlon

4Ŧ Chord
Ŵ flbrous band causlna Lhe penls Lo bow

5Ŧ nydro¾½ad|a¾
Ŵ exLernal ureLhral meaLus ls locaLed venLrallv













6Ŧ L½|¾½ad|a¾
Ŵ exLernal ureLhral meaLus ls locaLed dorsallv








7Ŧ 8n|gn Þro¾tat|c ny½rtro½hy (8Þn)
Ŵ adenomas
Ŵ mlddle of Lhe prosLaLe aland
Ŵ C of Lhe prosLaLe

8Ŧ 8a|an|t|¾
Ŵ lnflammaLlon and swelllna of Lhe penls

9Ŧ Crch|t|¾
Ŵ swelllna of Lhe LesLes

10Ŧ L½|d|dymoŴorch|t|¾
Ŵ lnflammaLlon of Lhe epldldvmls and orchlds
Ŵ vlral mumpsţ bacLerlal lnfecLlon (S1u)

11Ŧ Þh|mo¾|¾
Ŵ fallure Lo reLracL Lhe prepuce over Lhe alans

Þara½h|mo¾|¾
Ŵ fallure Lo puL Lhe prepuce over Lhe alans afLer
reLracLlon

12Ŧ Þyron|'¾ d|¾a¾
Ŵ flbrous Lhlckenlna of Lhe Corpora cavernosa
causlna bendlna or anaulaLlon durlna erecLlon













71 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

ANA1CM¥ CI 1nL ILMALL
GLNLkA1IVL 1kAC1
(DrŦ 8a|a[o)

Lk1LkNAL GLNLkA1IVL CkGAN

ÞuuLnu ƹ vuLv
Ŵ anLerlor Lo perlneum

1Ŧ mon¾ ½b|¾
Ŵ aŦkŦaŦ mons venerls
Ŵ faLŴfllled porLlon overlvlna Lhe svmphvsls publs
Ŵ ch||dhoodť absence of halr
Ŵ ½brtyť presence of curlv halr called
ºLscuLcheon"
4 female halr dlsLrlbuLlon
4 shapeť lnverLed Lrlanale wlLh Lhe base over Lhe
svmphvsls publs

2Ŧ |ab|a ma[ora
Ŵ round laLeral masses homoloaous Lo Lhe scroLum
ln Lhe male
Ŵ has C1ţ sebaceous alandţ halr folllclesŧ
Ŵ anLerlor exLremlLles wlll [oln Lhe mons publs
formlna Lhe AN1LkICk LA8IAL CCMMI5UkL
Ŵ posLerlor Lx1L8Ml1lLS wlll [oln Lhe formlna Lhe
ÞC51LkICk LA8IAL CCMMI5UkL
Ŵ m|t|½ara Ŷ dellvered ƽ2 bables
4 smlllnaŤ can see Lhe underlvlna sLrucLures

Ŵ n|||½ara Ŷ one LhaL has noL veL dellvered a babv
4 apposed labla ma[ora
4 covers Lhe underlvlna sLrucLures

Ŵ covered wlLh sklnţ so anvLhlna LhaL can affecL Lhe
skln wlll also Lhe affecL Lhe lŦ ma[ora
4 sebaceous cvsLs
4 plmple
4 hemaLoma
4 llpoma
4 hemanaloma
4 publc llce

3Ŧ |ab|a m|nora
Ŵ medlal of labla ma[ora
Ŵ Lhln folds of reddlsh Llssue
Ŵ aŦkŦaŦ lvmphae
Ŵ devold of sebaceous aland and adlpose Llssue
Ŵ more of a C1 Lvpe
Ŵ anLerlorlvť wlll dlvlde lnLo lamellae
4 lnferlor lamella fuses wlLh Lhe cllLorls formlna
Lhe IkLNULUM CI CLI1CkI5
4 superlor lamellae unlLe Lo form Lhe ÞkLÞUCL
CI CLI1CkI5

Ŵ posLerlorlv aspecL fuses Lo form Lhe ICUkCnL11L

4Ŧ c||tor|¾
Ŵ noL wlLhln Lhe vesLlbule
Ŵ female eroaenous oraan
Ŵ homoloaous Lo penls
Ŵ ½art¾ť alansţ bodv (corpora cavernosa)ţ crura
Ŵ wlLh nerve endlnas
4 medlaLors of eroLlc sensaLlon called Lhe
Gn|ta| cor½¾c|¾
found sparselv ln lŦ ma[ora buL abundanL
ln lŦ mlnora especlallv ln Lhe cllLorls

5Ŧ v¾t|b|
Ŵ medlal Lo lŦ mlnora
Ŵ almondŴshaped sLrucLure
Ŵ ½rforatd w|th ¾|x o½n|ng¾ť
aŦ ureLhral meaLus
bŦ ducLs of Skene's aland/ paraureLhral aland Ŷ
lnferolaLeral Lo (a)
cŦ vaalnal lnLrolLus
dŦ ducLs of 8arLholln's aland/ paravesLlbular
aland Ŷ laLeral Lo (c)

Ŵ IC55A NAVICULAkI5 Ŷ space beLween Lhe vaalnal
openlna and fourcheLLe
4 once Lhe woman alves blrLh ln and fourcheLLe
(flaLLened) wlll no lonaer be appreclaLed
4 flaLLened posLerlor commlssure wlll be
suLured
4 vlraln/nulllparať hvmenŤ (+) ln and fourcheLLe

Ŵ 8Ak1nCLIN'5 GLAND
4 provldes lubrlcaLlon durlna sexual sLlmulaLlon
4 openlna of Lhe ducLsť plnpolnL
depends on hvalene and sexual hablLsţ
openlna of Lhe ducL can be easllv cloaaed
bv dlrLţ lnfecLlon
accumulaLlon of secreLlon lnslde Lhe aland
bacLerlalť Cţ barLhollnlLls
72 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

8arLholln's abscess Ŷ manaaemenLť
dralnaae wlLh lnclslon
8arLholln's cvsL Ŷ manaaemenLť xc|¾|on/
mar¾½|a||zat|on
O lndlcaLed for reproducLlve perlod
O lnclse ln Lhe lnner parL
(mucocuLaneous [uncLlon Ŷ beLween
Lhe vesLlbule and labla mlnora)
O evacuaLe Lhe conLenLs Lhen leave lL
be
O suLure Lhe llnlna of Lhe cvsL Lo Lhe
vaalnal mucosa

Ŵ VL51I8ULAk 8UL85
4 homoloaous Lo anlaae of corpus sponalosum
of penls
4 locaLed beneaLh Lhe skln
4 composed of aaareaaLes of velns
4 durlna Lhe Lrauma Ŷ mv ln[ure v8 and mv
cause hemaLoma
monlLor afLer dellverv of babv Lhe
puerpera and perlLoneum

6Ŧ hymn
Ŵ membrane coverlna Lhe vaalnal openlna
Ŵ mavbe crescenLrlcţ clrcularţ sepLaLe or flmbrlaLed
Ŵ noL all hvmen wlll bleed on flrsL colLus
Ŵ hymna| myrt|form carnc|¾ Ŷ remnanLs of
hvmen afLer dellverv
Ŵ c||n|ca| corr|at|onť lmperforaLe hvmen
4 averaae aae of menarcheť 10Ŵ14 v/o
4 common cause of Lhe absence of menarche
4 durlna puberLal perlodţ develop cvcllc palns
buL no evldence of bleedlna
4 accumulaLlon of blood lnslde Lhe vaalnať
nLMA1CCCLÞC5
4 nLMA1CMI1kA Ŷ enlaraemenL of Lhe
abdomenţ uLerus fllllnaŴup wlLh blood
obese noL obvlous

4 nLMA1C5ALÞINk Ŷ blood ln Lhe falloplan Lube
4 lrrlLaLlon of Lhe perlLoneum lj acuLe abdomen
4 managmntť n¥MLNLC1CM¥ť crocheLţ flapţ
evacuaLeţ suLure flap lnLo vesLlbule

INNLkVA1ICN
Ŵ pudendal nerve
Ŵ aenlLal branch of aenlLofemoral nerve
8LCCD 5UÞÞL¥
Ŵ pudendal arLerv

VLNCU5 DkAINAGL
Ŵ pudendal velns

L¥MÞnA1IC DkAINAGL
Ŵ superflclal lnaulnal Ln
Ŵ lnLerlllac Ln

ÞLkINLUM
Ŵ posLerlor Lo Lhe vulva
Ŵ supporL provlded bv Lheť
aŦ ½|v|c d|a½hragm Ŷ |nnr ½art
4 levaLor anl muscle Ŷ pubococcvaeusţ
lllococcvaeusţ puborecLalls
ºdeep vaalnal consLrlcLor"
keael's exerclse/ pubococcvaeal
exerclse Ŷ ald ln lncreaslna Lhe Lome of
Lhe muscle

4 coccvaeus muscle

bŦ rogn|ta| d|a½hragm Ŷ ½½r ½art
4 deep Lranverse perlneal mŦ
4 consLrlcLor ureLhra
4 lnLernal and exLernal fasclal coverlnas
4 from Lhe publc arch Lo Lhe lschlal
LuberoslLles
4 ¾½rf|c|a| to th rogn|ta| d|a½hragm
superflclal Lransverse mŦ
lschlocavernosus Ŷ orlalnť lschlal splnes
exLernal anal sphlncLer
bulbocavernosus
O enclrcles Lhe vaalna ƹ superflclal
vaalnal sphlncLer

ÞLkINLAL 8CD¥
Ŵ 3 cm
Ŵ 1 cm ƹ mulLlpara
Ŵ prerecLal flbers ofť
aŦ levaLor anl muscle
bŦ recLovaalnal muscle
cŦ levaLor vaalna muscle
dŦ recLococcvaeus
eŦ deep Lransverse perlneal muscle
fŦ superlor levaLor fascla
aŦ superflclal Lransverse perlneal muscle
73 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

hŦ superlor and lnferlor fascla of uroaenlLal
dlaphraam
lŦ superflclal exLernal sphlncLer anl
[Ŧ bulbocavernosus
kŦ C1 membrane LhaL form base of lŦ ma[ora and
superflclal perlneal fascla

Ŵ descend of Lhe presenLlna parLť vaalnal wall and
perlneal bodv Lhlns ouL

LÞI5IC1CM¥
Ŵ crownlnať opLlmum Llme for eplsloLomv
Ŵ vaalna verv dlsLenslble
Ŵ fourcheLLeţ posLerlor vaalnal commlssure and ln
Lhlns our
Ŵ lnclslon on perlneal bodv
4 mlddle or 8 or L medlolaLeral
4 alwavs sLarL aL Lhe anaulaLlon

Ŵ avold vesLlbule bulb Ŷ hemaLomaŤ lncrease bleedlna












8LCCD 5UÞÞL¥
Ŵ lnLernal pudendal arLerv and lLs branches (lnferlor
recLal and posLerlor lablal)

VLNCU5 DkAINAGL
Ŵ lnLernal pudendal nerve

INNLkVA1ICN
Ŵ pudendal nerve and lLs branches

L¥MÞnA1IC DkAINAGL
Ŵ superflclal lnaulnal LracL
Ŵ lvmph alands of deep lnaulnal LracL



VAGINA
Ŵ bondar|¾
antr|orť urlnarv bladder
½o¾tr|orť recLum

Ŵ fnct|on¾
aŦ excreLorv canal of uLerus
bŦ female oraan of copulaLlon
cŦ parL of blrLh canal

Ŵ collapsed ln comparlson Lo Lhe bladder and recLum
because lL ls empLv

Ŵ mbryo|ogy
½½r ½art (cervlxţ uLerusţ falloplan Lube)ť derlved
from Lhe Mullerlan ducLs
|owr ½artť uroaenlLal slnus

Ŵ ¾½ta
v¾|covag|na| ¾½tmť separaLe Lhe vaalna from Lhe
u8
rctovag|na| ¾½tmť posLerlorlvŤ separaLes lower ư
of Lhe vaalna from Lhe recLum
upper x Ŵ dlrecL ln conLacL wlLh Lhe Cul de Sac of
uoualas

Ŵ |ngth
antr|orť 6Ŵ8 cm
½o¾tr|orť 7Ŵ10cm

Ŵ forn|c¾ť (¾½ac)
anLerlor
(2) laLeral
½o¾tr|orť deeper
4 ¾|gn|f|cancť on lnLernal examlnaLlon normallv
Lhe posLerlor fornlx ls shallow
lf anvLhlna occuples Lhe posLerlor perlLoneal
cavlLvţ posLerlor fornlx ls bulalna/ shallow
c||n|ca| corr|at|onť severe abdomlnal paln
reproducLlve aae woman slnale/ marrled
s/s of acuLe abdomen
Lhlnk of LC1CÞlC Þ8LnnC?
CULDCCLN1L5I5
O poke Lhrouah Lhe posLerlor fornlx
O asplraLe
O |f nonŴc|ott|ng b|oodť
hemoperlLoneumŤ mavbe due Lo
74 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

ecLoplc preanancvţ rupLure cŦ luLem
cvsLs
O ½r|ntť pvoperlLoneumŤ rupLured
Luboovarlan abscess
O |f c|ott|ng b|oodť remove aL onceŤ
poked lnLo a 8v

Ŵ va¾c|ar ¾½½|y
½½r 1/3ť cervlcovaalnal branches of uLerlne
arLerles
m|dd| 1/3ť lnferlor veslcal arLerv
|owr 3
rd
ť mlddle recLal and lnLernal pudendal arLerv

Ŵ |ym½hat|c dra|nag
½½r 1/3ť lllac nodes
m|dd| 1/3ť lnLernal lllac nodes
|owr 1/3ť lnaulnal Ln

Ŵ c||n|ca| corr|at|on
4 uLerus ln pelvlc realon
4 frequenL chlldblrLh and or bla babv veslcovaalnal
and recLovaalnal sepLa wlll Lhln ouL
4 veslcovaalnal Lhlns ouLť C¥51CCLLL
posLerlor ureLhra veslcal anale hernlaLes
Lowards vaalnal wall
s/sť frequenL urlnaLlonţ feellna of urlnarv
reLenLlon
UkL1nkCCLLLť passlna ouL of urlne durlna
couahlnaţ sneezlnaŧ eLc
managmntť anLerlor colporrhaphv

4 recLocele Lhlns ouLť kLC1CCLLL
hernlaLlon of recLum
man|f¾tat|onť consLlpaLedţ obsLlpaLed
managmntť posLerlor colporrhaphvţ
assoclaLed wlLh perlneurrhaphv

4 LN1LkCCLLL
lnLesLlnes hernlaLes
bulalna mass ouLslde Lhe vaalnal openlna
real Lvpe of hernla
managmntť vaalnal hvsLerecLomvţ repalr
of enLerocele

4 U1LkINL ÞkCLAÞ5L
problem of Lhe uLerlne llaamenL are
elonaaLed
uLerus wlll descend
4
Lh
dearee uLerlne prolapsed (Þ8CCLuLn1l
u1L8l)
assoclaLed wlLh cvsLoceleţ recLocele and
someLlmes enLerocele
managmntť vaalnal hvsLerecLomv wlLh Þ
colporrhaphv

4 VAGINAL VAUL1 ÞkCLAÞ5L/ CCLÞCCLLL
vaalnal sLump noL suLured properlv
lmporLanL sLepť suspenslon of Lhe vaalnal
sLump and llaamenLs

IN1LkNAL GLNLkA1IVL CkGAN5

U1LkU5
Ŵ ½o¾|t|onť sllahL anLeversoflexlon
4 anaulaLlon beLween Lhe bodv of Lhe uLerus and
cervlx
4 rtrof|x Ŷ bodv of uLerus polnLs Lowards Lhe
sacrumŤ cervlx polnLs posLerlorlv
4 vr¾o Ŷ relaLlonshlp of Lhe lonalLudlnal axls of
Lhe whole uLerus wlLh Lhe cervlx ln relaLlon Lo
Lhe blrLh canal
4 ¾tand|ng Ŷ horlzonLal uLerusŤ cervlx Ŷ polnLs Lo
Lhe lschlal splne

Ŵ ovarles locaLed ln Lhe posLerlor parL of Lhe uLerus
Ŵ anatom|ca| r|at|on¾h|½
½o¾tr|orť recLum
antr|orť urlnarv bladder

Ŵ covr|ng
½o¾tr|or wa||ť covered almosL enLlrelv bv Lhe
serosa/ perlLoneum
4 lower parL of Lhe posLerlor wall forms Lhe
anLerlor boundarv of Cul de Sac of uoualas/
recLoŴuLerlne pouch

antr|or wa||ť upper porLlon ls covered bv Lhe serosa
4 reflecLed Lowards u8
4 veslcoŴuLerlne fold of Lhe perlLoneum

|atra| wa||ť noL covered dlrecLlv

Ŵ ¾ha½ť flaLLened pear
4 anLerlorť concave
4 posLerlorť convex
4 (+) mvoma no concavlLv and convexlLv
75 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ ½art¾ť
aŦ cervlx Ŷ vaalnalŤ supravaalnal
bŦ lsLhmus Ŷ area beLween Lhe bodv and Lhe cervlx
4 forms Lhe lower uLerlne seamenL durlna
preanancv
4 slanlflcanL parL durlna dellverv

cŦ bodv Ŷ corpus
dŦ cornua Ŷ where falloplan Lubs are lnserLed
eŦ fundus Ŷ domeŴshaped

Ŵ crv|x Ŷ vag|na| ½ort|on
4 nulllpara Ŷ conlcal ln shaped
4 mulLlpara Ŷ sllL
bla babv Ŷ flsh mouLh
laceraLlon aL 3 and 9 o'clock poslLlon

Ŵ ¾|z
4 bfor ½brtyť 2Ŧ3Ŵ3Ŧ3 cm
uťC 2ť1

4 ad|t n|||½aro¾ť 6Ŵ8 cm
30Ŵ70 arŦ
uťC 1ť1

4 trm ½rgnancyť 1100 arŦ
4 m|t|½aro¾ť 9Ŵ10 cm
80 arŦ
uťC 3ť1

4 aftr mno½a¾ť uLerus aLrophv

Ŵ tr¾ from M||r|an dct
½½r ½artť l1
m|dd| ½artť fuslon of Lhe bodv of uLerus and cervlx
|owr ½artť fuslon of cervlx and vaalna

4 abnorma||tyť no fuslon of 2
nd
parL of Lhe
Mullerlan ducL
blcornuaLe uLerus
sepLaLe uLerus
double cervlces
vaalnal sepLumť lonalLudlnal and Lransverse

Ŵ ||gamnt¾
aŦ broad ||gamnt
4 wlna llke sLrucLure ln Lhe laLeral aspecL of
Lhe uLerus
4 uLerus aLLached Lo laLeral pelvlc wall
4 ½art¾ť
superlor aspecL
medlal 2/3 Ŷ suspends l1 vla mesosalplnx
ouLer 1/3 Ŷ suspends ouLer surface of l1
(lnfundlbulum Ŷ lnfundlbulopelvlc llaamenL)

base of Lhe broad llaamenL
Lhlckenlna Ŷ cardlnal's llaamenL or
MackenrodL's llaamenL
area of cervlx Ŷ parameLrlum


bŦ rond ||gamnt
4 arlses from Lhe anLerolnferlorlv Lo Lhe
aLLachmenL of Lhe l1 ln Lhe laLeral aspecL of
Lhe uLerus
4 aoes ouLwardţ forward and lnserLs Lo
superlor maraln of svmphvsls publs
4 correspond Lo aubernaculums LesLls ln male

cŦ tro¾acra| ||gamnt
4 ln lower posLerlor aspecL of Lhe uLerus
4 arlses aL Lhe level of lnLernal cervlcal CS
4 lnserLs Lo S2ŴS3
4 form laLeral boundarles of Cul de Sac of
uoualas

Ŵ b|ood ¾½½|y
4 tr|n artry Ŷ aL Lhe level of Lhe cardlnal
llaamenL aoes Lo Lhe lnLernal cervlcal CS lj aoes
upward lj uLerus
from lnLernal lllac arLerv

4 ovar|an artry Ŷ from Lhe aorLa
anasLomose wlLh Lhe ovarlan branch of Lhe
uLerlne arLerv

4 CSť Loo much bleedlna Ŷ llaaLe Lhe uLerlne arLerv

Ŵ vno¾ ¾½½|y
4 uLerlne veln
4 ovarlan veln
|ftť lefL renal veln
r|ghtť lvC



76 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ |nnrvat|on
4 SnS
4 ÞnS Ŷ pelvlc nerves and S2ŴS4
uLerovaalnal plexus of lrankenhauser aL Lhe
area of cervlx

Ŵ c||n|ca| corr|at|onť
4 mvoma uLerl
mosL common uLerlne Lumor
rarelv mallananL
lf 2Ŵ3 cmţ no need Lo remove unless
Lhere ls menorrhaala or lL causes lnferLlllLv

Lvpesť submucousţ subserous

IALLCÞIAN 1U8L5 (CVIDUC15)
Ŵ 8Ŵ14 cm lona
4 lf Loo lona Ŷ mavbe a cause of lnferLlllLv

Ŵ suspended Lo broad llaamenL Lo lefL pelvlc wall vla
mesosalplnx
Ŵ d|v|¾|on¾ť |atra| to md|a|
aŦ |nfnd|b|m Ŷ wlLh flmbrlae/ flnaerllke
sLrucLure
4 pro[ecL Lo propel ovum Lowards ampulla ln
ovulaLlon
4 1 elonaaLed flmbrla verv near Lhe ovarvť
llmbrla ovarlca Ŷ Lo caLch ovum and propel
Lowards l1

bŦ am½||a Ŷ wldesL parL
cŦ |¾thm¾ Ŷ narrowesL seamenL
dŦ |ntr¾t|t|a| Ŷ embodled wlLhln uLerlne cornua

Ŵ c||n|ca| corr|at|on
tba| ½rgnancy
4 mosL common Lvpeť ampulla 93Ʒ
4 lsLhmlcť (4Ʒ) earllesL Lo manlfesL
4 cervlcalť 0Ŧ1Ʒ
4 abdomenť 0Ŧ03Ʒ
4 lnLersLlLlalť 2Ŧ3Ʒ
4 pelvlc chronlc palnť pelvlc lnflammaLorv dlsease
ovlducL Ŵ flrsL Lo be affecLed





Cv8lLS
Ŵ homoloaous Lo LesLls
Ŵ fnct|on¾ť
aŦ developmenL and exLruslon of ova
bŦ secreLlon of sLerold hormone

Ŵ ¾|z
4 chlldbearlna perlodť 2Ŧ3Ŵ3 cm x 1Ŧ3Ŵ3 cm x 0Ŧ6Ŵ
1Ŧ3 cm

Ŵ pearlv whlLe Ŷ durlna vounaer aae
menopause Ŷ dlmlnlshedŤ wrlnkled

Ŵ |ocat|onť ovarlan fossa of Waldever
4 blfurcaLlon of Lhe common lllac Lo lnLernal and
exLernal lllac

Ŵ attachmnt¾
4 posLerlor aspecL of broad llaamenL vla
mesovarlum
4 anLerlor pole wlLh Lhe uLerus vla uLeroovarlan
llaamenL
4 laLeral pole wlLh Lhe laLeral wall of pelvls vla
suspensorv llaamenL of ovarv
same wlLh lnfundlbulopelvlc llaamenL of
uLerus

Ŵ c||n|ca| corr|at|onť
ovar|an tmor
4 lncrease ln slze
4 removal of ovarlesť oophorecLomv
4 cuL llaamenLs
4 l1 cuddles ovarles Ŷ hard Lo separaLe Ŷ salplnaoŴ
oophorecLomv
4 oophorocvsLecLomv













77 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

NLUkCVA5CULAk 51kUC1UkL CI ÞLLVI5
(DrŦ C|t|q|t)

ÞLLVIC Ak1Lk¥
O xtrna| |||ac
4 afLer crosslna Lhe lnaulnal llaamenL lL becomes Lhe
femoral arLerv
4 maln blood supplv of Lhe lower exLremlLles

O |ntrna| |||ac artry/ hy½oga¾tr|c artry
4 ma[or blood supplv of Lhe pelvls and pelvlc oraans

O ¾½r|or hmorrho|da| artry
4 from lM
4 onlv arLerv ln pelvls whlch ls noL a branch of
lnLernal or exLernal lllac arLerv

O md|an ¾acra| artry
4 dlrecL branch of abdomlnal aorLa
4 arlses from Lhe blfurcaLlon of lllac arLerv

O ovar|an artry
4 corresponds Lo Lhe lnLernal spermaLlc arLerv ln
males
4 orlalnaLe from Lhe aorLa below Lhe orlaln of Lhe
renal arLerv

IN1LkNAL ILIAC Ak1Lk¥/ n¥ÞCGA51kIC Ak1Lk¥
Ŵ maln blood supplv Lo Lhe pelvls
Ŵ 1Ŧ3 lnŦ lona
Ŵ narrower Lhan Lhe exLernal lllac lllac ln adulL buL 2x
laraer ln feLus because of Lhe presence of Lhe
umblllcal branch
Ŵ cor¾ť pass posLŦ Lo Lhe ureLer and anLeromedlal Lo
Lhe lnLernal lllac veln
4 ureLer Ŷ anLerlor Lo hvpoaasLrlc arLerv (ºwaLer
over Lhe brldae")

Ŵ dlvldes aL Lhe superlor border of Lhe areaLer sclaLlc
foramen
Ŵ d|v|¾|on¾ť
1Ŧ ½o¾tr|or d|v|¾|on
all are parleLal
wlll ao Lo Lhe musclesţ sklnţ wall
aŦ lllolumbar arLerv
bŦ laLeral sacral arLerv
cŦ superlor aluLeal arLerv
2Ŧ antr|or d|v|¾|on
boLh parleLal and vlsceral branches
parleLal branch
aŦ obLuraLor arLerv
bŦ lnLernal pudenLal arLerv
cŦ lnferlor aluLeal arLerv

vlsceral branch
aŦ umblllcal arLerv
bŦ superlor veslcal arLerv
cŦ lnferlor veslcal arLerv
dŦ mlddle hemorrholdal arLerv
eŦ uLerlne arLerv
fŦ vaalnal arLerv

ÞC51LkICk 8kANCn

ILICLUM8Ak Ak1Lk¥
Ŵ Lo lllacus and lumbar muscles
Ŵ locaLed aL Lhe 3
Lh
lumbar seamenL
Ŵ dlvldes Lermlnallv lnLo 2 branchesť lllac and lumbar
Ŵ lllac supplvlna lllac fossa Ŵ lllacus muscle
Ŵ lumbar provldlna splnal branch lnLo Lhe verLebral
canal and muscle Lhere

LA1LkAL 5ACkAL Ak1Lk¥
Ŵ dlvldes lnLo 2
Ŵ pass Lhrouah sacral foramen
Ŵ supplv muscle and skln on Lhe back of Lhe sacrum

5UÞLkICk GLU1LAL Ak1Lk¥
Ŵ laraesL branch
Ŵ exlLs Lhrouah Lhe upper parL of areaLer sclaLlc
foramen
Ŵ supplles Lhe aluLeus muscles

AN1LkICk 8kANCn
ÞAkIL1AL
C81UkA1Ck Ak1Lk¥
Ŵ accompanled bv lLs own veln and nerve
Ŵ nv aolna down (superlor Lo lnferlor)
Ŵ dlvldes lnLo medlal and laLeral branch
Ŵ supplles Lhe obLuraLor lnLernus muscles and hlp
[olnLs

IN1LkNAL ÞUDLNDAL Ak1Lk¥
Ŵ leaves Lhe pelvls vla areaLer sclaLlc foramen
78 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ passes Lhrouah Lhe lcock's canal Lo aaln access
Lhrouah Lhe perlneum
Ŵ branches lnLoť
4 lnferlor recLal arLerv
4 scroLal/ lablal arLerv
4 bulbar arLerv
4 penlle arLerv

INILkICk GLU1LAL NLkVL
Ŵ Lermlnal and laraesL branch of Lhe anLerlor branch
Ŵ leaves pelvls vla lower parL of areaLer sclaLlc foramen
and exlLs ln Lhe buLLocks beLween Lhe plrlformls and
aemellus muscles

VI5CLkAL
UM8ILICAL Ak1Lk¥
Ŵ proceeds upward from Lhe bladder Lo Lhe umblllcus
Ŵ alves off superlor veslcal arLerv and becomes
obllLeraLed LhereafLer Lo become Lhe medlal
umblllcal llaamenL
Ŵ makes lnLernal lllac arLerv bla ln feLus
Ŵ orlaln of arLerv Lo vas

5UÞLkICk VL5ICAL Ak1Lk¥
Ŵ supplles superlor parL of Lhe bladder
Ŵ from umblllcal arLerv

INILkICk VL5ICAL Ak1Lk¥
Ŵ alvesŴoff a branch called Lhe arLerv of vas deferens ln
males

VAGINAL Ak1Lk¥
Ŵ corresponds Lo Lhe lnferlor veslcal arLerv ln males

MIDDLL nLMCkknCIDAL Ak1Lk¥
Ŵ arlses from Lhe lnLernal pudendal arLerv/ lnferlor
veslcal arLerv
Ŵ lncluded ln Lhe recLal sLalk or laLeral recLal
Ŵ nor consLanL ln orlaln
Ŵ supplles vaalnaţ semlnal veslcles and prosLaLe aland
and recLum (mlddleporLlon)

U1LkINL Ak1Lk¥
Ŵ d|v|d¾ |ntoť
aŦ descendlna Ŷ supplles laLeral pelvlc wallţ parleLal
porLlon
bŦ horlzonLal Ŷ parameLrlal porLlon (parL of uLerus)
cŦ ascendlna Ŷ parauLerlne porLlon (surroundlna
Lhe uLerus)
Ŵ branch¾ |ntoť
aŦ ureLeral
bŦ uLerlne proper
cŦ fundlc round llaamenL
dŦ Lubal
eŦ ovarlan
&forms a plexus around Lhe uLerus

L¥MÞnA1IC DkAINAGL
O |ntrna| |||ac nod¾ Ŷ assoclaLed wlLh lnLernal lllac
arLerv
O xtrna| |||ac nod¾ Ŷ assoclaLed wlLh exLernal lllac
arLerv
O common |||ac nod¾
O xtrna| |ng|na| nod¾ Ŷ can flnd aland of
8osenmuller or nodes of CloqueL
O locaLed lnslde Lhe sldes of Lhe vesselsţ follow Lhe
course of Lhe vessels

VLIN5
O follow Lhe course of Lhe pelvlc arLerv
4 lnLernal lllac veln
4 ovarlan/ LesLlcular veln
4 medlal sacral veln
4 common lllac veln
O can llaaLe lnLernal lllac arLerv and veln because lL has a
loL of anasLomoses wlLh Lhe oLher vessels LhaL supplv
Lhe pelvls
O ½|x| of th ½|v|¾ť
aŦ uLerlne plexus Ŷ uLerus
bŦ veslcal plexus Ŷ urlnarv bladder
cŦ prosLaLlc plexus Ŷ prosLaLe aland

NLkVL 5UÞÞL¥
O ¾½r|or hy½oga¾tr|c nrv
4 also called as Lhe presacral nerves
4 supplles Lhe bladderţ recLum and lnLernal aenlLalla
excepL Lhe ovarv and falloplan Lubes
O |ntrna| hy½oga¾tr|c nrv
4 supplles recLumţ anal canalţ uLerusţ vaalnaţ ureLhra
and porLlon of urlnarv bladder
O ½|v|c ¾½|anchn|c nrv¾ (½ara¾ym½atht|c)
4 supplles pelvlc vlscera
O |mbo¾acra| and coccyga| ½|x¾
4 supplles Lhe lower exLremlLles
79 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

kIDNL¥5ţ UkL1Lk5 AND
ADkLNAL GLAND5
(DrŦ C|t|q|t)

5o||d organ¾
Ŵ kldnevţ llverţ spleenţ adrenal alandsţ pancreas
Ŵ problemť prone Lo ln[urv ln blunL abdomlnal Lrauma
Ŵ spleen and kldnevs Ŷ ma[or oraans ln[ured

kIDNL¥5
Ŵ beanŴshapedţ palred oraan
Ŵ reLroperlLoneal
Ŵ funcLlons for fllLraLlon
4 chronlc renal fallure Ŷ no clearance of
meLabollLes
4 for dlalvsls

Ŵ gro¾¾ anatomyť
4 laLeralť convex
4 medlalť concave
4 ma[or vessels and nerves Ŷ aL medlal porLlon
ºPlLuM"

Ŵ "kLNAL 5INU5"
4 lndenLaLlonŤ passaae of vessels

Ŵ II8kCU5 kLNAL CAÞ5ULL Ŷ lmmedlaLe coverlna
Ŵ ÞLkINLÞnkIC IA1 Ŷ faLLv laverŤ acLs as an lnsulaLor
Ŵ ÞLkINLÞnkIC CAÞ5ULL/ IA5CIA Ŷ (+) ouLer surface
4 covers boLh kldnevs and adrenal alands

Ŵ embrvoloav

kIDNL¥5
Ŵ nephros
Ŵ 11 cm lonaŤ 130Ŵ130 a
Ŵ rlahL kldnev lower Lhan lefL kldnev due Lo (+) of rlahL
llver
Ŵ hllum
Ŵ rna| ¾|n¾ Ŷ medlal cavlLv where renal pelvls and
vessels pass Lhrouah
Ŵ ¾rfac anatomyť
4 upper poles reach 112
4 lower pole Ŷ 2 cm above Lransumblllcal plane
4 medlal border Ŷ 3 cm from Lhe aorLa
4 hllus Ŷ near Lranspvlorlc plane

Ŵ antr|or r|at|on¾ť 2
nd
parL of duodenumţ Lall of
pancreasţ rlahL and lefL collc flexures
Ŵ ½o¾tr|or r|at|on¾ť dlaphŦ arcuaLe llaamenLsţ psoas
musclesţ subcosLal nervesţ quadraLes lumborum
musclesţ lllohvpoaasLrlc and lllolnaulnal nerves

Ŵ ¾trctr¾ť
4 fronLal secLlon Ŵ reveal an ouLer corLex and |nnr
md||a
Lhlckerť 2/3 of Lhe Lhlckness
conLalns pvramlds and columns


















Ŵ b|ood ¾½½|y
4 rna| artr|¾
dlrecL branch of aorLa
1 cm below SM

4 kldnev dlvlded lnLo seamenLs based on Lhe
dlvlslon of Lhe arLerv whlch do noL anasLomose
wlLh each oLher

antr|or|y
aplcal
upper
mlddle
lower

½o¾tr|or|y
aplcal
posLerlor
lower
80 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 rna| v|n¾
anasLomose wlLh each oLher

4 rna| nrv¾
from L1ţ L2 and 112

Ŵ kLNAL ÞLLVI5
4 expandedţ funnelŴshaped upper end of Lhe
ureLer
4 fused ma[or calvces
4 |ocat|onť parLlv wlLhln Lhe slnus and parLlv
ouLslde Lhe renal Llssue
4 |ntrna||yť dlvldes lnLo 2 sLalks
C8nlL ma[or calvx
CuuL ma[or calvx

4 ma[or calvxes wlll dlvlde lnLo mlnor calvxes
4 renal paplllae wlll pro[ecL aL Lhe mlnor calvx

UkL1Lk
Ŵ dlsLal conLlnuaLlon of Lhe renal pelvls exLendlna
down Lo Lhe urlnarv bladder
Ŵ 23 cm lona
Ŵ ½art¾ť
4 upper Ŷ abdomlnal porLlon (common lllac)
4 lower Ŷ pelvlc porLlon

Ŵ lles aL Lhe subperlLoneal plane and adheres Lo Lhe
perlLoneum
Ŵ Lherefore also aL reLroperlLoneal area
Ŵ 3 con¾tr|ct|on¾ť
aŦ aL [uncLlon of pelvls and ureLer
bŦ when ureLer crosses lllac vessel
cŦ when ureLer enLers urlnarv bladder Ŷ narrowesL
porLlon

4 con¾tr|ct|on¾ Ŷ slLes where sLones can lodae
Nj
CbsLrucLlonť no passaae of urlne
Nj
kldnev enlaraes Ŷ P?u8C
nLÞP8CSlS
Nj
Chronlc
Nj
uesLroved
kldnevs

Ŵ b|ood ¾½½|yť
4 renal arLerv above
4 veslcal arLerv lnferlorlv

Ŵ |nnrvat|on¾ť
4 renal and lnLermesenLerlc plexl above
4 lnferlor hvpoaasLrlc nerve below
4 LesLlcular/ ovarlan plexus

ADkLNAL GLAND5
Ŵ ºsuprarenal alands"
Ŵ also ln palrs
Ŵ r|ght Ŷ more Lrlanaular ln shape
|ft Ŷ crescenLerlc
Ŵ slLuaLed on each slde of Lhe cellac Lrunk and are 3 cm
from each oLher medlallv
Ŵ aL blrLhť almosL covers Lhe upper 1/3 of Lhe kldnev
Ŵ vellowlsh Lo brownlsh ln color
Ŵ cro¾¾ ¾ct|onť ouLer corLex
lnner medulla

Ŵ ¾rfac anatomyť
4 lles ln fronL Lhe crura of Lhe dlaphraam aL Lhe
level of 112ŴL1 bodv
4 antr|or|yť relaLed Lo llverţ spleen and pancreas
4 |ft adrna| g|andť pancreasţ splenlc aŦ ţ sLomach
4 r|ght adrna| g|andť llver and lvC

Ŵ vno¾ dra|nagť
4 ¾½rarna| v|n
slnale larae vessel
leaves anLerlor surface of Lhe aland
rlahLť lvC
lefLť lefL renal veln

Ŵ nrv ¾½½|yť
4 from areaLer and lesser splanchnlc nerves
4 branch from posLerlor vaaal Lrunk
4 1
sL
and 2
nd
lumbar svmpaLheLlc aanalla

CLINICAL CCkkLLA1ICN5ť

nCk5L5nCL kIDNL¥5
Ŵ developmenLal abnormallLv
Ŵ lnferlor lobes connecLed
Ŵ obsLrucLlon on callces/ ureLers Ŷ prone Lo
P?u8CnLÞP8CSlSŤ nonŴfuncLlonal kldnevs

81 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2


DIAL¥5I5
Ŵ exLernal fllLraLlon of blood Lhrouah a machlne
Ŵ Lvpesť
aŦ hemodlalvsls
bŦ perlLoneal dlalvsls Ŷ fluld lnserLed ln Lhe
abdomen lj fllLered bv Lhe abdomen

LI1nIA5I5
Ŵ (+) of sLone wlLhln Lhe bodv
Ŵ ureLerollLhlasls Ŷ ureLer
Ŵ cvsLollLhlasls
Ŵ ureLhrollLhlasls
Ŵ urollLhlasls Ŷ aeneral Lerm

n¥DkCNLÞnkC5I5
Ŵ 2' Lo (+) of sLones (obsLrucLlon)ţ Lumorsţ sLreaks

LC1CÞIC kIDNL¥
Ŵ locaLed ln Lhe pelvls
Ŵ normal embrvoloav Ŷ aoes up as lL develops




























UkINAk¥ 8LADDLk
(DrŦ Laygo)

Ŵ locaLlon (female)ť behlnd Lhe svmphvsls publsţ
anLerlor Lo Lhe uLerus
Ŵ |n |nfantť
4 empLv bladder Ŷ fuslform ln shape
4 u8 muscles noL veL well developed
4 medlan umblllcal llaamenL Ŷ remnanL of Lhe
rac¾
aLLaches Lhe fundus of Lhe u8 Lo umblllcus

Ŵ |n ad|tť
4 2 ureLers above lj aolna Lowards Lhe sldes of
Lhe u8

Ŵ 4 ¾rfac¾
4 (1) superlor surface
4 (2) lnferolaLeral surface
4 (1) posLerlor sŦ Ŷ [usL below Lhe fundus of Lhe u8









Ŵ u8 connecLed Lo prosLaLlc ureLhra Lhrouah Lhe neck
of Lhe u8
4 Ma|ť
neck conLlnuous wlLh Lhe 1
sL
porLlon of Lhe
ureLhra
(+) lnLernal ureLhral orlflce Ŷ conLrols Lhe
flow of urlne from u8 Lo ureLhra







4 Ima|ť
ureLhra noL dlvlded ln Lo seamenL
neck connecLed dlrecLlv Lo ureLhra proper
82 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

ccť urlnarv lnconLlnence because lnLernal
ureLhral orlflce ls noL well developed

Ŵ ÞU8CVL5ICAL/ ÞU8CÞkC51A1IC LIGAMLN1
4 sLrona llaamenLous sLrucLure
4 aLLaches Lhe anLerlor surface of Lhe dlsLal u8
and Lhe anLerlor surface of Lhe prosLaLe Lowards
Lhe publc bone

Ŵ |n rct ½o¾|t|on
4 u8 resLs on Lhe base of Lhe prosLaLe aland
4 prosLaLlc and veslcal plexus Ŷ seen ln Lhe
anLerlor surface of dlsLal u8 and prosLaLe aland
causes severe hemorrhaae

4 remalns flxed as lL fllls
4 u8 conLlnues Lo rlse
300 cc Ŷ level of umblllcus
l L Ŷ level of eplaasLrlc area

4 lnLernal ureLhral orlflce Ŷ relax lj flow urlne lj
u8 conLracLed and empLv
4 ccť urlnoma Ŷ urlne appears llke a mass
can'L feel urlnarv dlsLenLlon
lnserL llC Lo empLv lL espŦ Lo older paLlenL

4 u8 appears black ln u1Z

Ŵ d|¾tndd U8
4 pelvlc uLZ ln female Ŷ dlsLended u8
4 each slde Ŷ exLends as far as Lhe round llaamenL
4 superlorlv Ŷ conLlnuous wlLh medlan umblllcal
llaamenL
4 medlan umblllcal llaamenL Ŷ fllled wlLh faLLv and
areolar Llssue ln lnflammaLorv lnvolvemenL

Ŵ ||gamnt
aŦ puboprosLaLlc llaamenL Ŷ males
puboveslcal llaamenL Ŷ females
bŦ medlal Ŷ exLenslon of puboveslcal/
puboprosLaLlc llaamenL

Ŵ coat¾
aŦ ¾ro¾ coat
4 posLerlorlvť u8 ls closelv relaLed Lo Lhe
recLum
4 relaLed Lo Lhe prosLaLe aland and ¾ym½hy¾|¾
½b|¾
[usL behlndť presence of faL pad or
º8L18CÞu8lC SÞCL Cl 8L1ZluS"





ureLhroscope Ŷ examlne bladder and
ureLhra

bŦ fascla coaL Ŷ subcuLaneous coaL
cŦ muscular coaL Ŷ deLrusor muscle
dŦ submucosal coaL
eŦ mucosal coaL

Ŵ |ntr|or of th b|addr
4 mco¾a |f m½ty
presence of mucosal folds
ruaae appearance

4 d|¾tndd
mucosa appears Lo be smooLh

4 c||n|ca| corr|at|on
chronlc ureLhral obsLrucLlon (prosLaLlc
enlaraemenL)
O dlsLenslon of u8
O hvperLrophled mucosal folds

Ŵ 1kIGCNL (tr|gonm v¾|ca)
4 found lnslde Lhe u8
4 area locaLed below Lhe 2 ureLeral orlflce(base)
aolna Lowards Lhe lnLernal ureLhral orlflce (apex)
4 lnLerureLerlc rldae Ŷ connecLs 2 ureLeral orlflce





4 Lrlanaular ln shape
4 elasLlc and LlahLlv bond bv underlvlna mucosa
4 Lhlnner Lhan Lhe resL of Lhe mucosa
4 appears plnk on cvsLoscopv
4 ¾|d¾ť |atra| bondary
llne aolna down from ureLeral orlflce lj
ureLhral orlflce


83 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 |ntrna| rthra| or|f|c
corresponds Lo Lhe area of Lhe neck of Lhe
u8
serves as an lnLernal ureLhral sphlncLer

Ŵ artr|a| ¾½½|y
4 lnLernal lllac arLerv Ŷ a dlrecL branch of Lhe aorLa
4 obLuraLor and lnLernal pudendal arLerv
4 superlor and veslcal arLerv Ŷ from lnLernal lllac
arLerv
4 mlddle recLal/ hemorrholdal arLerv Ŷ enclosed bv
Lhe laLeral recLal llaamenL/ recLal sLalk

Ŵ vno¾ dra|nag
venous plexuses around Lhe u8
Nj
Mlddle hemorrholdal veln
Nj
Superlor and lnferlor veslcal veln
Nj
CbLuraLor and lnLernal pudendal veln
Nj
lnLernal lllac veln
Nj
Common lllac veln
Nj
lvC

Ŵ |ym½hat|c¾
lnLernal lllac aroup of Ln
Nj
ÞaraaorLlc aroup of Ln

Ŵ nrv ¾½½|y
4 svmpaLheLlc
4 parasvmpaLheLlc

Ŵ rad on nrv r|gnt¾










1nL UkL1nkA
(DrŦ Laygo)

Ma| Urthra
Ŵ lona flbroelasLlcţ muscular Lube
Ŵ 13Ŵ10 cm lona
Ŵ dlvlded bv superlor and lnferlor Lransverse perlneal
fascla
Ŵ ½art¾ť













aŦ ½ro¾tat|c rthra
4 above Lhe superlor fascla
4 below Lhe neck of Lhe u8
4 3 cm lona
4 bealns aL Lhe lnLernal ureLhral orlflce and
ends aL Lhe superlor border of Lhe
Lransverse perlneal fascla
4 descends Lhrouah Lhe prosLaLe aland
4 LermlnaLes bv plerclna Lhrouah Lhe superlor
fascla of uroaenlLal dlaphraam
4 lumen ls narrowesL superlorlv and lnferlorlv
4 wldesL and mosL dllaLable porLlon of Lhe
male ureLhra
4 ½art¾ť
1Ŧ rthra| cr¾t Ŷ medlan lonalLudlnal
rldae of Lhe posLerlor wall of Lhe
ureLhra
on each sldeť prosLaLlc slnus lj
where numerous ducLs usuallv
LermlnaLes

2Ŧ ¾m|na| co|||c|¾ (vrmontanm)
elevaLed porLlon aL Lhe mlddle parL
of Lhe prosLaLlc ureLhra

84 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

3Ŧ c| d ¾ac Ŷ ½ro¾tat|c tr|c|
3 mm lona
openlna of Lhe e[aculaLorv ducL Ŷ
each slde of Lhe prosLaLlc uLrlcle
vu [olns Lhe _________ Sv Lo form
Lhe Lu
prosLaLlc uLrlcle Ŷ homoloaous of
Lhe uLerus and vaalna

bŦ mmbrano¾ rthra
4 locaLed wlLhln Lhe Lransverse perlneal
muscle
4 below Lhe superlor fascla
4 above Lhe lnferlor fascla
4 shorLesLţ 1Ŵ2 cm lona
4 LhlnnesLţ narrowesL
c||n|ca| ¾|gn|f|cancť area commonlv
ln[ured durlna lnsLrumenLaLlon (eŦaŦ
lndwelllna lollev caLheLerţ cvsLoscopv)

4 bealns aL Lhe apex of prosLaLe and ends aL
Lhe bulb of penls
4 Lraverses Lhe deep perlneal space
4 surrounded bv sphlncLer ureLhrae and
perlneal membrane
4 ½o¾tro|atra| ara Ŷ bulboureLhral aland of
Cowper's
4 c|rc|ar f|br¾ Ŷ sphlncLer ureLhrae/
compressor ureLhrae
sphlncLer llke acLlon
volunLarv muscle

cŦ ¾½ongy rthra
4 below lnferlor fascla up Lo Lhe ureLhral
orlflce
4 d|v|d¾ |nto 2ť
bulbous Ŷ bulb of Lhe penls
moblle Ŷ penlle ureLhra

4 lonaesL parL ţ 13Ŵ16 cm lona
4 passes Lhrouah Lhe bulb of Lhe penls
(bulbous) and corpus sponalosum (sponav)
and ends aL Lhe exLernal ureLhral meaLus
4 lumen ls abouL 3 mm ln dm
4 ½art¾ of d||atat|onť
bulb of penls Ŷ lnLrabulbar fossa
alans penls Ŷ navlcular fossa/ navlcular
fossa
4 g|and¾ |n ¾½ongyť
1Ŧ ducLs of bulboureLhral aland
opens abouL 3 cm dlsLal Lo perlneal
muscle

2Ŧ ureLhral alands
numerous on dorsal surface of
ureLhra
secreLes [ellvŴllke subsLance

Ima| Urthra
Ŵ shorLţ muscular Lube
Ŵ 4 cm lona
Ŵ llned bv mucous membrane
Ŵ superlor Z equlvalenL Lo prosLaLlc ureLhra
Ŵ lnferlor Z equlvalenL Lo membranous ureLhra
Ŵ passes anLerolnferlorlv from Lhe u8 whlch ls
posLerlor and lnferlor Lo svmphvsls publs
Ŵ xtrna| rthra mat¾
4 locaLed anLerlor Lo vaalna/ [usL below Lhe cllLorls
4 lnferlor end ls surrounded bv sphlncLer ureLhrae

Ŵ paraureLhral alands locaLed aL Lhe superlor parL of
Lhe female ureLhra
Ŵ paraureLhral alands usuallv dralns Lhe paraureLhral
ducLs lj dralns near Lhe exLernal ureLhral meaLus
Ŵ c||n|ca| corr|at|onť
4 honevmoon cvsLlLls Ŷ lnflammaLlon
4 bloodv urlneţ hvpoaasLrlc palnţ dvsurla
4 LreaLmenLť anLlbloLlcs

Ŵ sphlncLer ureLhral muscles noL well developed
















85 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

CLINICAL CCkkLLA1ICN (MALL AND ILMALL UkL1nkA)

8Þn (8n|gn Þro¾tat|c ny½rtro½hy)
Ŵ enlaraemenL of Lhe prosLaLlc ureLhra
Ŵ lmplnaes Lhe prosLaLlc ureLhra
Ŵ cvsLoscopv Ŷ Þ ls ln klsslna poslLlon

ktrograd ½a¾¾ag of |nfct|on
lnfecLlon lj prosLaLlc ureLhra
Nj
ÞrosLaLlc slnus
Nj
ÞrosLaLlc uLrlcle
Nj
L[aculaLorv ducL
Nj Nj
Sv vu
Nj
Lpldldvmls

Mmbrano¾ Urthra
Ŵ mosL common slLe of ln[urv durlna caLheLerlzaLlon
Ŵ |ocat|on of th ba||oonť openlna of Lhe lnLerlor
ureLhral orlflce








Ŵ ara¾ common|y |n[rdť prosLaLlcţ membranous and
penlle ureLhra
Ŵ aross bleedlna comlna from Lhe exLernal ureLhral
meaLus

8|bo¾ Urthra
Ŵ affecLed ln sLraddle Lvpe of ln[urv
Ŵ ºCowbov Lvpe ln[urv"
Ŵ aross hemaLurla

Þn|| Urthra
Ŵ prone Lo fracLure lj parLlal or LoLal LransecLlon lj
aross hemaLurla
Ŵ caLheLerlzaLlon ls a noţ no durlna ureLhral ln[urv


Ŵ reLroarade ureLhrocvsLoaraphv
Nj
ln[ecL dve Lo Lhe exLernal ureLhral meaLus
Nj
ÞoslLlve ln[urv
Nj
uve wlll noL flow conLlnuouslv or
Nj
LxLravasaLlon of Lhe dve

Ŵ LreaLmenLť do u8 decompresslon
4 lnserL cvsLocaLheLer or venocaLheLer
Nj
lnserLlon should noL be Loo hlah because vou
mlahL ln[ure Lhe lnLesLlnal oraans
Nj
uecompress Lhe u8

ÞkL5LNCL CI 51CNL
O locaLed aL Lhe fossa navlcularls/ beLween Lhe fossa
navlcularls and ureLhral meaLus
O 1ratmntť
Local anesLhesla
Nj
Cpen ureLhral meaLus
Nj
8emove Lhe sLone
Nj
SubmlL sLone for urlne sLone analvsls

Cy¾toc|
Ŵ common paLholoalc condlLlon ln females
Ŵ proLruslon of Lhe lnferlor u8 aL Lhe dlsLal parL of Lhe
vaalna
Ŵ musL be dlfferenLlaLed Lo uLerlne prolapsed

Ur|nary 1ract Infct|on (U1I)
Ŵ verv common ln women especlallv Lhose who are
sexuallv acLlve









86 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

GLU1LAL kLGICN
(DrŦ 1any)

Ŵ aŦkŦaŦ buLLocksţ assţ buLL
Ŵ bondar|¾ť
anLerolaLerallv Ŷ Lensor fascla laLa
superlorlv Ŷ lllac cresL
posLerlor Ŷ laLeral border of sacrum
lnferlorlv Ŷ aluLeal fold

Ŵ 2 buLLocks are separaLed bv naLal clefL

Ŵ dlvlded lnLo 4 quadranLs bv an lmaalnarv llne mlddle
of lllac cresL and areaLer LrochanLer
aŦ ½½r |atra|/ otr bordr
4 laLeral branch of Lhe lllohvpoaasLrlc nerve
(L1)
4 anLerlor ramus of 112

bŦ ½½r md|a| bordr
4 subsurd bv Lhe posLerlor raml of Lhe upper
3 lumbar nerves and upper 3 sacral nerves

cŦ ½½r |atra| bordr
4 laLeral cuLaneous nerve Lo Lhe Lhlah
comes from Lhe anLerlor raml of L2ŴL3

dŦ |owr md|a| bordr
4 lnnervaLed bv Lhe anLerlor raml of Lhe upper
3 sacral (S1ţ S2ţ S3)
4 posLerlor cuLaneous nerve Lo Lhe Lhlah

IA5CIA
Ŵ ¾½rf|c|a| fa¾c|a
4 relaLlvelv Lhlck faLLv laver
4 varles
4 alves promlnence Lo vour buLL
4 covers aluLeus maxlmus

Ŵ d½ fa¾c|a
4 lnferlorlv lj conLlnuous downward
Nj
ueep fascla of Lhe Lhlah (fascla laLa)
Nj
1hlckens laLerallv lnLo llloLlblal LracL
Nj
1ermlnaLes dlsLallv aL proxlmal parL of Lhe Llbla
Nj
erdv's Lubercle (dlsLal lnserLlon)

MU5CLL5
aŦ g|t¾ max|m¾ m¾c|
4 2
nd
sLrucLure LhaL alves promlnence Lo Lhe
buLLocks
4 1
¾t
or|g|nť area posLerlor Lo Lhe aluLeal llne of Lhe
llne
2
nd
Ŷ laLeral porLlon of Lhe sacrum
3
rd
Ŷ sacroLuberous llaamenL

4 In¾rt|onť
o¾¾o¾ Ŷ femoral Lubercle or aluLeal LuberoslLv
of Lhe femur
nonŴo¾¾o¾ Ŷ llloLlblal LacL

4 |nnrvat|onť lnferlor aluLeal nerve
4 act|on¾ť
3Ŧ exLends and laLerallv roLaLes Lhe hlp [olnLs
4Ŧ malnLalns Lhe knee ln exLended poslLlon
Lhrouah Lhe llloLlblal LracL
3Ŧ when vou sLoop Ŷ lL exLends Lhe LrunkŤ
Lruncal exLenslon when one assumes a
sLooplna poslLlon

4 ¾tand|ng ½o¾|t|on Ŷ aŦ maxlmus covers Lhe lschlal
LuberoslLles
4 ¾|tt|ng ½o¾|t|on Ŷ noL covered
4 br¾ať mlnlmlzes Lhe frlcLlon beLween Lhe Lwo
opposlna sLrucLures
1Ŧ conflned beLween Lhe Lendlnous lnserLlon of
llloLlblal LracL and areaLer LrochanLer
2Ŧ laLerallv beLween Lhe Lendlnous lnserLlon
and vasLus laLeralls mŦ
3Ŧ beLween Lhe muscles and lschlal
LuberoslLles











87 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

bŦ g|t¾ md|¾ m¾c|
4 or|g|nť from Lhe ouLer surface of Lhe lllum
beLween Lhe posLerlor aluLeal and anLerlor
aluLeal llne (mlddle aluLeal llne)
4 |n¾rt|onť laLeral surface of Lhe areaLer
LrochanLer
4 bony ¾trctr¾ť hlp bone and proxlmal porLlon
of femur
4 |nnrvat|onť superlor aluLeal nerve
4 act|onť
1Ŧ abducLs Lhe hlp [olnLs
2Ŧ anLerlor flbers acL as a medlal roLaLor of Lhe
hlp [olnLs
3Ŧ LoaeLher wlLh aŦ mlnlmusţ lL helps malnLalns
Lhe pelvls from LllLlna downward (sLandlna
ln one fooL)

cŦ g|t¾ m|n|m¾ m¾c|
4 or|g|nť beLween Lhe anLerlor and lnferlor aluLeal
llne
4 |n¾rt|onť anLerlor surface of Lhe areaLer
LrochanLer
4 |nnrvat|onť superlor aluLeal nerve
4 act|onť share Lhe same acLlon wlLh Lhe aŦ medlus
muscle

dŦ tn¾or fa¾c|a |ata m¾c|
4 anLerlor boundarv
4 or|g|nť ouLer edae of Lhe lllac cresL beLween Lhe
SlS and lllac Lubercle
4 |n¾rt|onť llloLlblal LracL
4 |nnrvat|onť superlor aluLeal nerve
4 act|onť malnLalns Lhe knee ln an exLended
poslLlon Lhrouah Lhe llloLlblal LracL

LA1LkAL nIÞ kC1A1Ck5
Ŧ ½|r|form|¾ m¾c|¾
4 or|g|nť parLlv w/ln Lhe pelvlsŤ anLerolaLeral
surface of Lhe sacrum
4 |n¾rt|onť anLerlor border of Lhe areaLer
LrochanLer
4 |nnrvat|onť anLerlor raml of S1ŴS2

fŦ ¾½r|or gm||¾ m¾c|
4 or|g|nť lschlal splne
4 |n¾rt|onť upper border of Lhe areaLer
LrochanLer
4 |nnrvat|onť nerve Lo Lhe obLuraLor lnLernus
muscle

gŦ |nfr|or gm||¾ m¾c|
4 locaLed below Lhe superlor aemellus mŦ
4 or|g|nť upper maraln of Lhe lschlal LuberoslLles
4 |n¾rt|onť upper border of Lhe areaLer
LrochanLer
4 |nnrvat|onť nerve Lo Lhe quadraLus femorls
muscle

hŦ obtrator |ntrn¾ m¾c|
4 pelvlc muscle whlch exlLs Lo Lhe aluLeal realon
4 or|g|nť obLuraLor membrane (obllLeraLes Lhe
obLuraLor foramen) and Lhe bones formlna Lhe
obLuraLor foramen
Nj
oes ouLward passes Lhru Lhe lesser sclaLlc
foramen and
Nj
In¾rt¾ |n Lhe upper border of Lhe areaLer
LrochanLer

4 |nnrvat|onť nerve Lo Lhe obLuraLor lnLernus
muscle

4 superlor aemellus mŦţ lnferlor aemellus mŦ and
obLuraLor lnLernus mŦ are collecLlvelv called Lhe
1kI5LÞ1AL 1LNDCN because Lhev all lnserLs aL
Lhe upper border of Lhe areaLer LrochanLer

|Ŧ qadrat¾ fmor|¾ m¾c|
4 or|g|nť from Lhe lower laLeral maraln of lschlal
LuberoslLv
4 |n¾rt|onť quadraLe Lubercle of femur
4 |nnrvat|onť nerve Lo Lhe quadraLus femorls
muscle

LIGAMLN15
Ŵ sacroLuberous llaamenL and sacosplnous llaamenL
4 converLs Lhe sclaLlc noLch lnLo a foramen

ICkAMINA
Ŵ serves as Lhe enLrv or exlL of muscularţ vascular
sLrucLures from Lhe pelvlc realon aolna Lo Lhe aluLeal
realon


88 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ gratr ¾c|at|c foramn
4 dlvldes lnLo 2 space/ fossa bv Lhe plrlformls
muscle
aŦ supra plrlformlc space Ŵ above
bŦ lnfra plrlformlc space Ŵ below


4 ¾trctr¾ that x|t¾ hrť
aŦ plrlformls muscle
bŦ sclaLlc nerve
cŦ posLerlor cuLaneous nerve Lo Lhe Lhlah
dŦ superlor and lnferlor aluLeal vessels
eŦ nerve Lo Lhe obLuraLor lnLernus muscle and
quadraLus femorls muscle
fŦ pudendal nerve
aŦ superlor and lnferlor aluLeal nerve
hŦ lnLernal pudendal vessels

Ŵ |¾¾r ¾c|at|c foramn
4 ¾trctr¾ that x|t¾ť
aŦ Lendon of Lhe obLuraLor lnLernus muscle
bŦ nerve Lo Lhe obLuraLor lnLernus muscle
cŦ pudendal nerve
dŦ lnLernal pudendal vessels

Ak1LkIL5
aŦ ¾½r|or g|ta| artry
Ŵ exlLs Lhe pelvlc cavlLv and aoes Lowards Lhe areaLer
sclaLlc foramen above Lhe plrlformls muscle
Ŵ comes from Lhe posLerlor dlvlslon of Lhe lnLernal
lllac arLerv
Ŵ supplv all aluLeal realon

bŦ |nfr|or g|ta| artry
Ŵ LermlnaLlon of Lhe anLerlor dlvlslon of Lhe lnLernal
lllac arLerv
Ŵ below Lhe plrlformls muscle
Ŵ supplles Lhe whole aluLeal realon

cŦ trochantr|c ana¾tomo¾¾
Ŵ con¾|¾t¾ of th fo||ow|ngť
1Ŧ superlor aluLeal arLerv
2Ŧ lnferlor aluLeal arLerv
3Ŧ mlddle femoral clrcumflex arLerv
4Ŧ laLeral femoral clrcumflex arLerv

3 and 4 Ŷ comes from Lhe profunda femorls
arLerv

Ŵ provldes maln blood supplv Lo Lhe femoral head

dŦ crc|at ana¾tomo¾¾
Ŵ supplles Lhe femoral head
Ŵ con¾|¾t¾ of th fo||ow|ngť
1Ŧ lnferlor aluLeal arLerv
2Ŧ medlal femoral clrcumflex arLerv
3Ŧ laLeral femoral clrcumflex arLerv
4Ŧ 1
sL
perforaLlna branch of Lhe profunda femorls
arLerv

NLkVL5
aŦ ¾c|at|c nrv
Ŵ lonaesL nerve of Lhe bodv
Ŵ comes from L4ţ L3ţ S1ţ S2 and S3
Ŵ 2 com½onnt¾ť
1Ŧ |atra| Ŷ common peroneal nerve
2Ŧ md|a| Ŷ Llblal nerve

4 Lhev LoaeLher up Lo Lhe posLerlor aspecL of Lhe
knee
4 ln some casesţ Lhe 2 are separaLed
4 common peroneal nerve Ŵ exlLs Lhe plrlformls
muscle or above Lhe plrlformls muscle

Ŵ does noL lnnervaLe Lhe aluLeal realon

bŦ ½o¾tr|or ctano¾ nrv to th th|gh
Ŵ cuLaneous ln naLure
Ŵ from S1ŴS3
Ŵ passes behlnd Lhe sclaLlc nerve
Ŵ superflclal Lo Lhe blceps femorls muscle
Ŵ branch¾ť
1Ŧ aluLeal branch
2Ŧ perlneal branch Ŷ back of scroLum (m)Ť labla
ma[ora (f)
3Ŧ cuLaneous branch Lo Lhe back of Lhe Lhlah and
parL of Lhe lea

cŦ ¾½r|or g|ta| nrv
dŦ |nfr|or g|ta| nrv
Ŧ nrv to th obtrator |ntrn¾ m¾c|
fŦ nrv to th qadrat¾ fmor|¾ m¾c|




89 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

gŦ ½dnda| nrv
Ŵ exlLs Lhe pelvlc cavlLv passlna Lhrouah Lhe areaLer
sclaLlc foramen below Lhe plrlformls muscle Lhen
Lemporarllv courses aL Lhe pelvlc cavlLv exlLs Lo Lhe
lesser sclaLlc foramen aolna Lo Lhe perlneum
LoaeLher wlLh Lhe lnLernal pudendal vessels
passlna Lhrouah Lhe lcock's canal

C||n|ca| Corr|at|on
Ŵ ¾af zon for |ntram¾c|ar |n[ct|onť upper ouLer/
laLeral quadranL
4 from SlS Lo lllac Lubercle
4 plerce bv Lhe aluLeus medlus someLlmes aŦ
maxlmlus

Ŵ IA1 WALLL1 5¥NDkCML
4 lrrlLaLlon of sclaLlc nerve
4 paresLhesla Ŷ weakness ln dlsLal/ lower
exLremlLles
4 muscle sLraln Ŷ compresslon of Lhe sclaLlc nerve

51kUC1UkL5 8LLCW 1nL ÞIkIICkMI5 MU5CLL LLAVING
1nL GkLA1Lk 5CIA1IC ICkAMLN (LA1LkAL 1C MLDIAL)
aŦ sclaLlc nerve
bŦ posLerlor cuLaneous nerve Lo Lhe Lhlah
cŦ lnferlor aluLeal nerve
dŦ nerve Lo Lhe obLuraLor lnLernus muscle
eŦ lnLernal pudendal vessels
fŦ pudendal nerve



















ÞLLVIC kLGICN AND nIÞ ICIN1
(DrŦ Ab|og)

ºln 81 nu CuL1u8Lţ WCMn'S PlÞS 8L Cl1Ln
vlLWLu S S?M8CL Cl lL81lLl1?"

5rfac Anatomy
Ŵ WalsLŴPlp raLlo (WP8)
4 measure walsL and hlp
4 l ƹ 0Ŧ7
4 M ƹ 0Ŧ9
4 bevond lj overslze

Anatom|ca| Landmark
Ŵ hlahesL level of lllac cresL
Ŵ aluLeus maxlmus and aluLeus medlus
Ŵ lschlal LuberoslLv Ŷ slLLlna bone
Ŵ |ntrg|ta| c|ft
4 from cervlcal plum llne should ao alona wlLh lL or
else compensaLed scollosls
4 llne falllna Lo cenLer of aravlLv

Ŵ areaLer Lubercle/ LuberslLv Ŷ laLeral promlnence
Ŵ ¾k|n d|m½|
4 ÞSlS
4 correspond Lo S2
4 sacrolllac [L
4 also known as ºanal dlmples of venus"

Þ|v|c G|rd|
Ŵ con¾|¾t ofť
4 pelvls
4 upper parL of femur

Ŵ fnct|on¾ť
aŦ provldes supporL and proLecLlon Lo abdomlnal
oraan
bŦ LransmlLs force from Lhe headţ arms and Lrunk Lo
Lhe lower exLremlLles

Þ|v|¾
Ŵ º8asln"
Ŵ con¾|¾t ofť
4 sacrum
4 coccvx
4 coxal bone (lnnomlnaLe bone)
lllum Ŷ superlor
90 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

lschlum Ŷ low and behlnd
publs Ŷ anLerlor and below

Ŵ |t |¾ formd by th ½|v|c bon (7 [o|nt¾)
4 lumbosacral
4 sacrolllac
4 sacrococcvaeal
4 svmphvsls publs
4 hlp [olnL (aceLabulofemoral)

Ŵ |andmark of h|½ bon
4 SlS Ŷ where sarLorlus muscle orlalnaLes
4 llS Ŷ ŧ recLus femorls
4 luLeal llne Ŷ anLerlorţ lnferlorţ posLerlor
4 aceLabulum
lllum Ŷ superlor
lschlum Ŷ low/ behlnd
publs Ŷ anLerlor below

4 lschlal LuberoslLv
connecLs wlLh lnferlor ramus of publs
Nj
obLuraLor foramen

4 lschlal splne
needle lnserLlon Lo anesLheLlze Lhe
perlneum for palnless dellverv
locaLed beLween Lhe lschlal splne and lschlal
LuberoslLv
nrvť ½dnda| nrv

Imr
Ŵ head Ŷ arLlculaLes wlLh Lhe aceLabulum
Ŵ neck Ŷ common fracLure slLe
Ŵ areaLer and lesser LrochanLer Ŷ connecLs lL bvť
4 posLerlor Ŷ lnLerLrochanLerlc cresL
4 anLerlor Ŷ lnLerLrochanLerlc llne

Ŵ c||n|ca| ¾|gn|f|cancť deLermlne Lhe names of fracLure

n|½ Io|nt
Ŵ aŦkŦaŦ aceLabulofemoral [olnL
Ŵ mosL sLrucLurallv sLableţ veL moblleţ slnale [olnL ln
Lhe bodv
Ŵ ma[or componenL of Lhe locomoLor svsLem
Ŵ ½art|c|½at¾ť
4 ln elevaLlna and lowerlna bodv as ln cllmblna or
rlslna from chalr
4 ln brlnalna fooL Lowards bodv/ hands Ŷ as ln
puLLlna on a shoe

Ŵ for everv sLepţ hlp adducLlon creaLes a force Lo
balance 83Ʒ of bodv welahL
Ŵ aluLeus medlus Ŷ conLracLs Lo keep balance and lllac
level balance

Ŵ actab|ar ||½ (|ambrm actab|ar)
4 noL a perfecL clrcle
4 deepens aceLabulum
4 helps hold head of femur
4 Lransverse aceLabular llaamenL Ŷ brldaes noLch
4 coLvlold varleLv of Lhe enarLhrodlal (ball and
sockeL [olnL)
4 3 card|na| ½|an¾ť
saalLLal plane Ŷ flexlonţ exLenslonţ
hvperexLenslon
coronal/ fronLal plane Ŷ adducLlonţ
abducLlon
horlzonLal/ verLlcal plane Ŷ exLernal
roLaLlonţ lnLernal roLaLlon

Ŵ ¾tab|||ty and ¾trngth of th h|½ [o|nt
4 lles solelv wlLh Lhe arLlcular shape
4 llaamenLť sLrona wlLh Lhlckenlnas of capsule
noL vlslble ln cadavers

4 22 muscles presenL
4 (Ŵ) pressure lnLraarLlcularlv lnslde Lhe capsule Lo
keep lL ln place

Ŵ L|gamnt¾ť
aŦ |||ofmora| ||gamnt/ ¥Ŵ||gamnt of 8|g|ow
4 from SlS Lo lnLerLrochanLerlc llne (anLerlor)
4 ½rvnt¾ť
undue exLenslon
abducLlon
laLeral roLaLlon

bŦ ½bofmora| ||gamnt
4 Lhe bursa ls locaLed above lL
ccť once lnflamed Ŷ palnful lnaulnal area
aŦkŦaŦ lllopecLlneal burslLls

4 from superlor publc ramus
4 checks abducLlon
4 asslsLs ?ŴllaamenL ln checklna hlp exLenslon
91 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 balleL dancer Ŷ lL ls relaxed (spllL)

cŦ |||ofmora| ||gamnt
4 lessŴwell developedţ from lschlal rlm of
aceLabulum
4 splral dlrecLlon ls decreased bv flexlon and
lncreased bv exLenslon
4 checks lnLernal roLaLlon

all Lhree llaamenLs common acLlon lnLendlna Lo llmlL
lnLernal roLaLlon

dŦ ||gamnt of th had
4 prevlouslv known as llaamenLum Leres
4 llLLle funcLlon as a llaamenL buL lL auldes
arLerv Lo Lhe head of femur parLlcularv
aceLabular arLerv a branch of obLuraLor
arLerv

nIÞ ICIN1 kINL5ICLCG¥
Ŵ ang| of fmr
aŦ ang| of |nc||nat|on
4 alona head and neck (lonalLudlnal neck)
4 bodvŴsLralahL llne







4 norma| ang|ť 123'
4 babv Ŷ anale of lncllnaLlon ls 140'
4 ccť coxa vara Ŷ less Lhan 110'
coxa valaa Ŷ more Lhan 140' (decrease
welahL bearlna)

bŦ ang| of antvr¾|on






4 norma|ť 12'
4 anLeverslon 33' Ŵ lnward feeLţ lnŴLoeŴlnŴaalL
4 reLroverslon 3' Ŵ Charlle Chapllnţ ouLŴLoeŴlnŴ
aalL
Ŵ c||n|ca| corr|at|onť
4 lnLernal Llblal Lorslon
produce ln LoeŴln aalL
common cause of aalL

4 ln Loe Ŷ ln aalL
squlnLlna paLellae
lnLernallv roLaLed feeL

Ŵ a¾¾¾¾mnt
4 lenaLh of Lhlah ls assessed ln conaenlLal hlp
dlslocaLlon
4 A||y'¾ t¾t
bend knee and hlp LoaeLher
noL Lhe same lenaLh
bulbous fold Ŷ aluLeal fold

4 1rnd|nbrg t¾t
sLand on affecLed slde (1 fooL)
checks lf aluLeus medlus ls weak
resulLť (+) deepenlna
ºswav" on affecLed area
Lrue femlnlne
O lnherenL weakness of aŦ medlus
O shorL lever area
O normalť boLh sldes

Ŵ b|ood ¾½½|yť
4 d½ fmora| artry
dlrecL branch of femoral arLerv
d|v|d¾ |ntoť
aŦ md|a| c|rcmf|x fmora| artry
hlp [olnL and head of femur
reLlnacular arLerv
posLerlorlvţ lL hooks around Lhe
upper femoral porLlon
|m½ortancť parLlcularlv Lhe
reLlnacular arLervţ lL supplles Lhe
femoral head (when fracLuredţ 8S ls
cuLŴoff causlna asepLlc necrosls)

bŦ |atra| c|rcmf|x fmora| artry
ascendlna branch Ŷ wlll supplv Lhe
head of Lhe femur
wlll have perforaLlna branch

exLernal lllac lj lnaulnal llaamenL lj
femoral arLerv lj deep femoral arLerv lj a and b
92 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 obtrator artry
aceLabular arLerv Ŷ flnds lLs wav
Nj
LlaamenLum Leres
Nj
1/3 of Lhe femoral head (eplphvses porLlon)

Ŵ 1rta 5td|¾
aŦ L½|½hy¾a| artr|¾
4 1Ŧ laLeral eplphvseal arLerv Ŷ 4/3 of Lhe
eplphvsls
4 2Ŧ medlal eplphvseal arLerv Ŷ 1/3 of Lhe
eplphvsls

bŦ Mta½hy¾a| artr|¾
4 3Ŧ lnferlor meLaphvseal arLerv Ŷ 2/3 of Lhe
meLaphvslc
4 4Ŧ superlor meLaphvseal arLerv Ŷ 1/3 of Lhe
meLaphvslc

Ŵ n8ť 1ţ3 and 4 comes from Lhe medlan clrcumflex
arLerv
2 Ŷ comes from aceLabular branch of Lhe obLuraLor
arLerv from exLernal lllac arLerv

Ŵ C||n|ca| ¾|gn|f|cancť asepLlc necrosls/ avascular
necrosls
4 when blood supplv ls cuL off aL Lhe femoral
head

kINL5ICLCG¥ CI 1nL nIÞ ICIN1
Ŵ 22 muscles acLlna on Lhe hlp [olnL
Ŵ 31 Ŷ 311 Ŷ 4261
Ŵ 3 f|xor¾
aŦ Þ¾oa¾ m¾c|
4 or|g|nť 112 Ŷ L3
4 |n¾rt|onť lesser LrochanLer
4 act|onť sLrona hlp flexor

bŦ I||ac¾ m¾c|
4 or|g|nť lllac fossa
4 |n¾rt|onť lesser LrochanLer
4 act|onť hlp flexor

cŦ rct¾ fmor|¾
4 or|g|nť llS
4 blarLlcular muscle
4 |n¾rt|onť Llblal LuberoslLv Ŷ paLella llaamenL
4 act|onť PlÞ !Cln1 (flexor)
Þ1LLL !Cln1 Ŷ exLernal klcklna muscle

Ŵ 1 f|xorŴaddctor
aŦ ÞecLlneus muscle Ŷ crossŴlea (female)

Ŵ 3 xtn¾or¾
aŦ 8lceps femorls muscle
4 Lona head Ŷ blarLlcular
4 ShorL head Ŷ monoarLlcular

bŦ SemlLendlnous muscle

cŦ Semlmembranous muscle

4 PamsLrlnasť
medlal Ŷ semlLendlnous and
semlmembranous
laLeral Ŷ blceps
weak hamsLrlna Ŷ causes low back paln

Ŵ 1 xtn¾orŴxtrna| rotator
aŦ luLeus maxlmus muscle Ŷ fleshv porLlon
4 Cvcllnaţ cllmblna sLalrsţ runnlna
4 Screw muscle

Ŵ 1 abdct|on
aŦ luLeus medlum muscle Ŷ responslble for Lhe
rounded conLour aL Lhe slde of vour buLL lf well
developed

Ŵ 4 addct|on
aŦ racllls Ŷ mosL superflclal of Lhe medlal
comparLmenL of Lhe Lhlah
bŦ dducLlon lonaus
cŦ dducLlon brevls
dŦ dducLlon maanum

Ŵ 2 |ntrna| rotator¾
aŦ 1ensor fascla laLae
bŦ luLeus mlnlmus

Ŵ 6 d½ xtrna| rotator¾
aŦ Þlrlfomls muscle
bŦ CbLuraLor lnLernus muscle
cŦ CbLuraLor exLernus muscle
dŦ Superlor aemellus muscle
eŦ lnferlor aemellus muscle
93 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

fŦ CuadraLus femorls muscle

Ŵ 1 f|xorŴabdctorŴxtrna| rotator¾
aŦ SarLorlus muscle Ŷ lonaesL muscle
SarLorlal poslLlon ºde kwaLro"

CLINICAL CCkkLLA1ICN

Ŵ IM |n[ct|onť ½½r |atra| bordr
4 avold sclaLlc nerve
passes underneaLh Lhe plrlformls
87Ʒ wlll pass under Lhe sclaLlc nerve

Ŵ 2/3 of lndlvldual Ŷ psoas mlnor ls presenL (1 slde of Lhe
bodv)
4 or|g|nť 112 Ŷ L1
4 |n¾rt|onť pecLen llne
4 no affecL on Lhe hlp [olnL

Ŵ Iat wa||t ¾yndrom
4 lnflammaLlon Lo plrlformls muscle
4 lmplnaes Lhe sclaLlc nerve
4 ºplrlformls svndrome"
4 Þaln alona Lhe course of sclaLlc nerve

Ŵ 8r¾a
4 beLween Lhe areaLer LrochanLer and aŦ maxlmus
lllLlblal LracL
4 forms beLween a muscle and a bonv area
4 burslLls Ŷ lnflammaLlon
4 nodule Ŷ lschloaluLeal burslLls/ lschlal burslLls
ºWeaver's boLLom"

Ŵ 5½ort¾ |n[ry/ vh|c|ar acc|dnt
4 fracLureť beLween Lhe areaLer and lesser
LrochanLer
4 fracLures below Lhe LrochanLer Ŷ subLrochanLerlc
fracLure
4 or ln Lhe neckť cuLŴoff blood supplv causlna
necrosls
4 LreaLmenLť Plp lmplanL/ hlp prosLhesls
4 30Ʒ of cases Lhe cause ls unknownť
4 oLher causesť paLlenLs Laklna sLeroldsţ paLlenLs
wlLh 8heumaLold arLhrlLls

Ŵ ½o¾tr|or d|¾|ocat|on of th h|½
4 Lhe exLremlLv ls shorLened wlLh Lhe hlp flexedţ
lnLernallv roLaLed and adducLed
4 Lhe lnvolved exLremlLv ls resLlna on Lhe unlnvolved
Lhlah

Ŵ antr|or d|¾|ocat|on of th h|½
4 flexedţ abducLed and exLernallv roLaLed poslLlon of
Lhe exLremlLv

Ŵ h|½ arthr|t|¾
4 hlp roLaLlonť 0 Ŷ 43'
4 lf less Lhan 30' a slan of hlp [olnL problem

Ŵ otto½|v|¾/ ½rotr¾|o actab|
4 medlal dlsplacemenL of Lhe femoral head bulalna
lnLo Lhe aceLabulum

Ŵ ¾na½½|ng h|½ ¾yndrom
4 a condlLlon characLerlzed bv a snapplna sensaLlon
and ofLen an audlble 'popplna' nolse on hlp flexlon
and exLenslon
4 ca¾¾ť
aŦ |||ot|b|a| band ¾na½
4 mosL common cause of snapplna hlp
svndrome
4 when Lhe llloLlblal band (lL band) snaps
over Lhe areaLer LrochanLer

bŦ |||o½¾oa¾ tndon ¾na½
4 Lhe lllopsoas Lendon can caLch on a bonv
promlnence of Lhe pelvls and cause a snap
when Lhe hlp ls flexed
4 usuallv when Lhe lllopsoas Lendon ls Lhe
cause of snapplna hlp svndromeţ paLlenL
have no problem buL mav flnd Lhe
snapplna annovlna

cŦ h|½ |abra| tar
4 a Lear of Lhe carLllaae wlLhln Lhe hlp [olnL
Ŷ Lhe leasL common cause
4 a loose flap of carLllaae mav cause wlLhln
Lhe [olnL mav cause a snapplna sensaLlon
when Lhe hlp ls moved
4 Lvplcallv causes a snapplna sensaLlon buL
rarelv an audlble pop
4 mav also cause unsLeadv feellna and
paLlenL mav arab for supporL when Lhe
hlp snaps


94 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

LUM8C5ACkAL ÞLLkU5
(DrŦ Ab|og)

LUM8Ak ÞLLkU5

Inct|on¾ť
aŦ supplles muscle of skln on Lhe anLerlor and medlal
sldes of Lhe Lhlah
bŦ supplles skln on Lhe medlal slde of Lhe lea and fooL

Cr|g|n
Ŵ venLral raml of L1 and L3 and a varlable parL of L4
wlLh usuallv a small communlcaLlon from 112
Ŵ aL lLs orlalnţ lL ls embedded ln Lhe psoas ma[or
muscle


112 ŴŴŴŴŴŴŴŴŴŴ ¾bco¾ta| nrv
I||ohy½oga¾tr|c
L1 ŴŴŴŴŴŴŴŴŴ
|||o|ng|na|
¾n¾ory
L2 ŴŴŴŴŴŴŴŴŴŴ gn|tofmora|
crma¾tr

L3 ŴŴŴŴŴŴŴŴŴŴ |atra| ctano¾ nŦ to th th|gh
(|atra| fmora| ctŦ Nrv)

ŴŴŴŴŴŴŴŴ ½o¾tr|or ŴŴŴŴŴŴ fmora| nrv
L4 ŴŴŴŴantr|orŴŴŴŴŴ obtrator nrv


acc¾¾ory obtrator nrv
ŴŴŴŴŴŴŴ |mbo¾acra|
L3

Acc¾ory obtrator nrv
Ŵ lf presenL lL supplles Lhe pecLlneus muscle

Cbtrator nrv
Ŵ someLlmes supplles Lhe pecLlneus muscle

Latra| ctano¾ nrv to th th|gh
Ŵ aoes down Lo lllacus muscleţ hooks around SlSţ
passes around Lhe lnaulnal llaamenL
Ŵ can be lmplnaed bv Lhe lnaulnal llaamenL or Lhe SlS

Imora| Nrv
Ŵ lf lmplnaed Ŷ verv palnful
Ŵ palpaLe for Lhe pulsaLlons ln Lhe femoral arLerv
Ŵ laLeral Ŷ nerve
Ŵ medlan Ŷ veln
Ŵ usuallv supplles Lhe pecLlneus muscle







Cbtrator Artry
Ŵ maln nerve supplv of Lhe medlan comparLmenL of
Lhe Lhlah

5ACkAL ÞLLkU5

Inct|on¾ť
aŦ supplles Lhe musculaLor of Lhe aluLeal realon
bŦ alve rlse Lo Lhe sclaLlc nerve LhaL supplles Lhe
posLerlor muscles of Lhe Lhlah and all Lhe muscle
below Lhe knee

Iormat|on
Ŵ unlon parL of Lhe venLral ramus of L4 wlLh all of Lhe
venLral ramus of L3 Lo form a lumbosacral Lrunk and
bv Lhe unlon of Lhls Lrunk wlLh Lhe venLral raml of S1
Lo S3 or S1 Lo S4

L4

L3 ŴŴŴŴŴŴŴ ¾½r|or g|ta| nrv

S1 ŴŴŴŴŴŴ |nfr|or g|ta| nrv
ŴŴŴŴŴŴ common ½rona|
S2 (f|b|ar nrv) ¾c|at|c nŦ
ŴŴŴŴŴŴŴ t|b|a| nrv
S3 ŴŴŴŴŴŴ antŦ and ½o¾tŦ fmora| nrv

ŴŴŴŴŴŴŴ ½dnda| nrv
S4

Þ|v|c ¾½|anchn|c nrv



95 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

5acra| Þ|x¾ and 8ranch¾

5CIA1IC NLkVL
Ŵ lonaesL and blaaesL nerve LhaL supplles Lhe lower
exLremlLles
Ŵ anLerlor branches of L4ţ L3ţ S1ţ S2 and S3 unlLe Lo
form Llblal nerve
Ŵ posLerlor branch of Lhe lumbosacral Lrunk S1 and S2
(L4ŴL3) unlLe Lo form common flbular peroneal nerve
Ŵ Lhese 2 reaularlv lle ln a common C1 sheaLh ln Lhe
Lhlah
4 Llblal nerve more medlal ln locaLlon

IkCM 1nL AN1LkICk ÞAk1
Ŵ parL of Lhe posLerlor femoral cuLaneous nerve (S1ŴS3)
Ŵ pudendal nerve S2ŴS4 Ŷ cenLer for mlcLuraLlon and
defecaLlon
lower moLor neuron connecLlon

C1nLk 8kANCnL5 IkCM 1nL ÞC51LkICk ÞAk1
Ŵ superlor aluLeal L4ŴS1
Ŵ lnferlor aluLeal L3ŴS2
Ŵ parL of Lhe posLerlor S1ŴS3 cuLaneous nerve
Ŵ laLeral Ŵ common flbular L4ŴS2
Ŵ more medlal Ŵ Llblal nerve L4ŴS3

Ŵ |m½ortant ¾trctr¾ť
4 posLerlor cuLaneous nerve
4 pudendal nerve
4 superlor aluLeal nerve Ŷ aŦ medlusţ aŦ mlnlmusţ
Lensor fascla laLae
4 lnferlor aluLeal nerve Ŷ aŦ maxlmus

ÞLLVIC 5ÞLANCnNIC NLkVL
Ŵ parasvmpaLheLlc nerve (S2ŴS4) Lo lnferlor hvpoaasLrlc
arLerv (pelvlc) plexus

C||n|ca| corr|at|on
Ŵ rupLure of pubococcvaeus muscle durlna dellverv
when eplsloLomv ls noL done
Ŵ hernlaLed lumbar dlsc
Ŵ proLruslon of nucleus pulposus
Ŵ problem on Lhe lefL slde Ŵ lean on Lhe rlahL





1nIGn kLGICN
(DrŦ Car|aga)

IŦ 5UkIACL ANA1CM¥

Ŵ Þat||a
4 noL a aood reference polnL for measuremenL
of Lhe lea because lL ls movable(can be
sldewavs and move up and down durlna
assessmenL)

Ŵ A5I5
4 proxlmal polnL of Lhe Lhlah
4 aood reference polnL for Lhe measuremenL of
Lhe lea
4 conLlnues Lo become Lhe lllac cresL

Ŵ Þb|c tbrc|
4 anLerlor

Ŵ Gratr trochantr
4 noL a aood reference because some paLlenLs
do noL have a well developed/ promlnenL
areaLer LrochanLer

Ŵ |||ac cr¾t
4 conLlnuaLlon of SlS

Ŵ Þ5I5
4 forms a dlmple

Ŵ ½o½||ta| fo|d¾ and ½o½||ta| fo¾¾a
4 posLerlor

Ŵ proxlmal parL of Lhe Lhlah ls muscular and lL aoes
dlsLallv as a Lendlnous sLrucLure aL Lhe end and can
be palpaLed aL Lhe condvle of Lhe femur

IIŦ 8CN¥ ANA1CMy
Ŵ Imr
Þart¾ť
aŦ nck
4 noL smooLh as Lhe head
4 rouah Ŷ flnd a loL of 8v on lL

bŦ had
4 covered wlLh llaamenLs and arLerles
96 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 arLlculaLes wlLh aceLabulum
4 8v Ŷ from dlsLal Lo proxlmal
are unlque accordlna Lo lLs
arranaemenL

4 fracLure Lo neck
lead Lo necrosls of head due Lo
lnLerrupLlon of blood supplv
avascular necrosls
tratmntť replacemenL of femur/
hlp [olnL

cŦ gratr and |¾¾r trochantr
4 beLween Lhe Lwo ls Lhe LrochanLerlc area
common slLe for fracLure Lo occur 2¨
Lo osLeoporosls
fraalle bone

dŦ ¾btrochantr|c ara
4 below lesser LrochanLer

Ŧ fmora| ¾haft
4 Lhln parL of Lhe femur
4 lL wldens dlsLallv Lo form bllobular
sLrucLure called ºfemoral condvle" dlvldes
lnLo laLeral and medlal posLerlor
4 ¾|gn|f|cancť for blomechanlcal reason
carrv welahL for balance Ŷ
dlssemlnaLe Lhe welahL

IIIŦ 8CUNDAkIL5

Ŵ ¾½r|or/ ½rox|ma|
antr|or
4 publc Lubercle
4 lnaulnal llaamenL
SlS Lo publc Lubercle

4 aluLeal fold
lllac cresL Lo ÞSlS
posLerlor

Ŵ |nfr|or/ d|¾ta|
4 3 lnches above paLella Ŷ anLerlor
4 popllLeal fascla
sofL Llssue boundarv
posLerlor

IVŦ 5kIN
Ŵ Lhlckness
Ŵ senslLlvlLv Ŷ medlal (anLerlor) parL more senslLlve
Lhan laLeral parL of Lhe Lhlah
Ŵ nlce Lo know! Llp of Lhe 2
nd
flnaer ls Lhe mosL
senslLlve parL ln Lhe bodv

VŦ 5UÞLkIICIAL IA5CIA
Ŵ wlLh 2 dlsLlncL laver ln proxlmal porLlon and
dlsLallvţ Lhev blend wlLh each oLher

AŦ ¾½rf|c|a| fatty (Cam½r'¾)
Ŵ contnt¾ť
aŦ ctano¾ nrv Ŷ elLher posLerlor or
anLerlorţ purelv sensorv
4 anLerlor femoral cuLaneous nerve Ŷ
branch of femoral nerve
4 cuLaneous nerve of obLuraLor nerve Ŷ
Lermlnal branch of maln obLuraLor
nerve
4 posLerlor femoral cuLaneous nerve Ŷ
Lermlnal branch of sclaLlc nerve

bŦ ¾½rf|c|a| v|n
4 velns ln superflclal fascla
4 some do noL have accompanvlna
arLerv

1Ŧ grat ¾a½hno¾ v|n/ magn¾ v|n
anLerlor veln
mosL promlnenL
lonaesL veln
useful veln Ŷ courses ln Lhe
dorsum lj ankle lj mlddle of Lhe
Lhlah
cllnlcal correlaLlonť bvpassed
hearL suraerv
O areaL saphenous veln ls
harvesLed for bvpass

2Ŧ ¾½rf|c|a| c|rcmf|x |||ac v|n
from SlS Ŷ draln lLs area

3Ŧ ¾½rf|c|a| ½|ga¾tr|c v|n
dralns lower parL of abdomen

4Ŧ ¾½rf|c|a| ½dnda| v|n
dralns perlneal area
97 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2


N8ť 2ţ 3 and 4 are accompanled bv lLs respecLlve
arLerv and usuallv draln ln areaL saphenous veln

5Ŧ antr|or/ |atra| ¾a½hno¾ v|n
6Ŧ md|an ¾a½hno¾ v|n

cŦ |ym½hnod¾
4 lvmphaLlc veln draln Lo lL

1Ŧ ½ara||| to Þo½art'¾ ||gamnt
proxlmal Ŷ area where 2
superflclal veln ls locaLed

2Ŧ ½r½nd|c|ar to Þo½art'¾ ||gamnt
dlsLal Ln
draln ln Lhe vlclnlLv wlLh areaL
saphenous veln

boLh wlll draln Lo deeper lnaulnal Ln
Lhen Lo paraaorLlc Ln

8Ŧ d½ mmbrano¾ (5car½a'¾)
Ŵ Lhlck especlallv laLerallv
Ŵ covers muscle of Lhe Lhlah
Ŵ lnserLlon of upper ư of aŦ maxlmus and Lensor
fascla laLae
Ŵ bondar|¾ť
4 proxlmal Ŷ lllac cresLţ lnaulnal llaamenLţ
publc Lubercle
4 dlsLal Ŷ blends wlLh Lendonsţ perlosLeumţ
popllLeal fossa

Ŵ serves as ºLlahL flLLlna sleeve"
Ŵ dlvldes Lhlah lnLo 3 comparLmenLs
Ŵ d½ LN
4 from deep aroup of nodes of lower
exLremlLles

N8ť boLh superflclal and deep Ln draln lnLo exLernal lllac

AN1LkICk 1nIGn MU5CLL5

aŦ 5artor|¾ m¾c|
Ŵ ºLallor's muscle"
Ŵ mosL superflclalţ rlbbonŴllke
Ŵ blŴarLlcular
Ŵ or|g|nť SlS
Ŵ |n¾rt|onť mlddle aspecL of Llblaţ ºpes anserlnus"
Ŵ act|on¾ť
4 Lallor crossŴlea composlLlon
4 flexŴhlp [olnL and exLernal roLaLlon
4 kneeŴ[olnL roLaLlon and flexlon
4 lnnervaLlonť femoral nerve

bŦ I||o½¾oa¾ m¾c|
Ŵ 2 ½art or|g|nť
4 Þsoas Ŷ L1Ŵl3 Lransverse process
4 lllacus Ŷ lllac fossa/ sacrum (lnner surface of lL)

Ŵ |n¾rt|onť lesser LrochanLer
Ŵ act|onť sLronaesL hlp flexor
Ŵ |nnrvat|onť L2/L3 splnal nerve
femoral nerve (L2)


cŦ Cadrat¾ fmor|¾ m¾c|
Ŵ wlLh four heads
4 recLus femorls Ŷ superflclal laver
4 vasLus laLeralls Ŷ laLeral
4 vasLus medlalls Ŷ medlal
4 recLus lnLermedlus Ŷ underneaLh Lhe 8lŤ close
Lo Lhe bone
Ŵ x blarLlcular
Ŵ common |n¾rt|onť paLella
Ŵ or|g|nť relaLlve Lo llnea aspera
Ŵ act|onť hlp and knee [olnL flexlon
Ŵ va¾t¾ |atra||¾
4 forms Lhe bulk of Lhe muscles of aLhleLes

Ŵ va¾t¾ md|a||¾
4 ºworkhorse" especlallv ln lasL 13' promlnenL
due Lo low lnserLlonţ marked obllqulLvţ Lhln
fascla
4 mosL effecLlve ln 13' exLenslon (0Ŵ13')
4 prevenL laLeral alldlna of paLella and ls
aLLached Lo Lhe paLella Lo malnLaln lLs poslLlon
4 wlLh obllque flbers aL Lhe lower parL ln
Lransverse and lonalLudlnal axls of Lhe femur
4 ob||q f|br¾ť lf noL well developedţ lL wlll noL
hold Lhe paLella and wlll have laLeral
dlslocaLlon
noL on Lhe knee cap buL on lLs laLeral slde

98 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 tratmntť wlll aLLach obllque flbers/ vŦ
medlalls lower Lhan Lhe lnserLlon Lo pull
paLella medlallv Lo prevenL laLeral dlslocaLlon

Ŵ c||n|ca| corr|at|onť durlna lM ln[ecLlon
4 safe slLe ƹ uCC of buLLocks
4 avold hlLLlna Lhe sclaLlc nerve
4 anLerlor realon of Lhe Lhlah Ŷ seldom use for
lM ln[ecLlon because lf lL ls frequenLlv ln[ecLed
Lhereţ lL wlll cause bleedlna leadlna Lo scar
formaLlon lj adheslon of quadraLus femorls
4 (+) adheslon Ŷ lose alldlna characLerlsLlc of Cl
nC lLLxlCn C1lvl1?

Ŵ "art|c|ar|¾ gn" of Va¾t¾ |ntrmd|¾
4 prevenLs svnovlal Llssue Lo be cuL once bones
allde wlLh each oLher
Ŵ Lendon vsŦ llaamenLŤ Lendon arranaemenL

dŦ Þct|n¾ m¾c|
Ŵ anLerlor/ medlal aroup
Ŵ someLlmes under adducLor aroup
Ŵ or|g|nť superlor publc ramus
Ŵ |n¾rt|onť below lesser LrochanLer
Ŵ act|onť can be exLenslon/ adducLlon
Ŵ |nnrvat|on¾ť femoral nerveţ someLlmes bv
obLuraLor nerve

MLDIAL 1nIGn MU5CLL5
Ŵ member of obLuraLor aroup/ adducLor aroup
Ŵ a|| or|g|natť publc Lubercle/ superlor publc ramus
Ŵ |n¾rt|onť conLlnuous wlLh each oLher


aŦ Addctor |ong¾ m¾c|
Ŵ mosL anLerlor
Ŵ noL Lhe lonaesL muscle
Ŵ or|g|nť publc Lubercle
Ŵ |n¾rt|onť medlal aspecL of femur
Ŵ locaLed beLween vŦ medlus and vŦ maanus

bŦ Addctor brv|¾ m¾c|
Ŵ shorLesL
Ŵ posLerlor Lo Ŧ lonaus
Ŵ or|g|nť lnferlor publc ramus
Ŵ |n¾rt|onť llnea aspera
Ŵ separaLes anLerlor and posLerlor branch of
obLuraLor nerve

cŦ Addctor magn¾
Ŵ fanŴshapedŤ masslve
Ŵ wlLh broad base lnserLlon
Ŵ wlLh obllque and lonalLudlnal flbers
Ŵ or|g|nť lschlal ramus and lschlal Lubercle
Ŵ |n¾rt|onť lonaţ from upper llnea aspera Lo
adducLor Lubercle
4 wlLh Lendlnous lnserLlon

Ŵ w|th o¾totnd|no¾ o½n|ng
4 openlna of bones and Lendons of Ŧ maanus
4 openlna Ŷ 8v wlll cross Lhe anLeromedlal
aspecL of Lhe Lhlah Lo supplv Lhe posLerlor
aspecL
4 Addctor h|at¾
blaaesL osLeoLendlnous openlna
where femoral arLerv wlll pass and
chanae lLs name lnLo popllLeal arLerv as
well as lLs accompanvlna veln

Ŵ ½art¾ť
4 anLerlor LransverseŴ posLerlor obLuraLor
nerve
4 anLerlor obllque Ŷ posLerlor obLuraLor nerve
4 posLerlor lonaus Ŷ Llblal nerve of sclaLlc
nerve

dŦ Cbtrator xtrn¾ m¾c|
Ŵ mosL posLerlor
Ŵ enclrcles Lhe exLernal surface of obLuraLor
foramen
Ŵ or|g|nť surface of obLuraLor foramen
Ŵ |n¾rt|onť LrochanLerlc fossa

Ŧ Grac|||¾ m¾c|
Ŵ mosL medlal
Ŵ lonaesL muscle ln adducLor aroup
Ŵ or|g|nť lnferlor publc Lubercle
Ŵ |n¾rt|onť pes anserlnus (wav below knee [olnL)
Ŵ blarLlcular muscle Ŷ crosses 2 [olnLs
Ŵ lnnervaLlonť anLerlor obLuraLor nerve
Ŵ "½¾ an¾r|n¾"
4 common lnserLlon of SarLorlus muscleţ
aracllls muscle and semlLendlnosus muscle
4 locaLed anLeromedlal aspecL of Llbla
4 ºfooL of a aoose"
99 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 |n¾rt|onť anLerlorţ medlal and posLerlor
muscular comparLmenL
anLerlor Ŷ sarLorlus muscle
medlal Ŷ aracllls muscle
posLerlor Ŷ semlLendlnosus muscle

ÞC51LkICk 1nIGn MU5CLL5

Ŵ hamsLrlnas
Ŵ or|g|nť muscles aL lschlal LubroslLles
Ŵ |n¾rt|onť below Lhe knee [olnL
Ŵ blarLlcular muscle Ŷ crosses hlp and knee [olnL
Ŵ act|onť adducLlon of hlp [olnL and flexes knee [olnL
Ŵ wlLh 3 membersţ excepL Lhe shorL head of blceps
femorls
Ŵ lnnervaLed bv Lhe Llblal branch of sclalLlc nerve

aŦ 8|c½¾ fmor|¾ m¾c|
Ŵ ¾hort had
4 or|g|nť llnea aspera of femur
4 |nnrvat|onť common peroneal nerve

Ŵ |ong had
4 or|g|nť lschlal LuberoslLv and lower parL of
sacroLuberous llaamenL
4 |nnrvat|onť Llblal nerve
Ŵ |n¾rt|onť flbular band Ŷ laLeral Lo Lhe femur


bŦ 5m|tnd|no¾¾ m¾c|
Ŵ or|g|nť lona head of blceps femorls
Ŵ |n¾rt|onť medlal Llblal condvleţ pes anserlnus
Ŵ |nnrvat|onť Llblal branch of sclaLlc nerve

cŦ 5m|mmbrano¾¾ m¾c|
Ŵ or|g|nť lschlal LuberoslLv
Ŵ |n¾rt|onť medlal Llblal condvle Ŷ membranous
lnserLlon ln posLerlor aspecL of Llbla

kNLL ICIN1
Ŵ beLween Llbla and femur
Ŵ more paLellar arLlculaLlna ln Lhe surface of Lhe femur
Ŵ ½at||ar tndon
4 pulls Lhe Llbla
4 lf Cl conLracLs Ŷ lncrease force Lo exLend leas






4 effecLlve Lo sLrenaLhen Lhe knee

Ŵ art|c|ar|¾ gn
4 move paLella awav as lL alldes wlLh each oLher
4 lf (Ŵ)ţ lL wlll move paLella down and desLrov
svnovlal Llssue and fluld wlll leak furLher
desLrovlna Lhe femur
4 provldes lubrlcaLlna fluld wlLhln svnovlal cavlLv

Ŵ femur Ŷ wlLh arLlculaLlon Ŷ alldlna movemenL of
paLella Lo femur

NLUkCVA5CULAk 51kUC1UkL5
CI 1nL 1nIGn kLGICN
(DrŦ Car|aga)

1Ŧ Imora| artry
Ŵ under lnaulnal llaamenL Ŷ level where exLernal lllac
arLerv name wlll be chanaed
Ŵ lL ls called Lhe popllLeal arLerv once lL passes Lhe
dducLor hlaLus
Ŵ branch¾ť
5½rf|c|a|
aŦ superflclal clrcumflex arLerv
bŦ superflclal eplaasLrlc arLerv
cŦ superflclal exLernal pudendal arLerv


dŦ Þrofnda fmor|¾ artry
4 blaaesL branch
4 deep femorls arLerv
4 same slze as femoral arLerv
4 wlLh bla callber Ŷ lL supplles Lhe enLlre
anLerlor Lhlah muscles
4 have a counLerparL veln
4 branch¾ť
medlal femoral clrcumflex
laLeral femoral clrcumflex
mosL proxlmal and rounds Lhe femur

descendlna branch Ŷ proceeds
Lowards Lhe knee [olnL
100 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

perforaLlna branch Ŷ crosslna a
cerLaln bone parLlcularlv aL Lhe
osLeoLendlnous openlna
O verv lmporLanL branch because lL
supplles Lhe posLerlor Lhlah
muscles
O passes Lhrouah Lhe
osLeoLendlnous openlna

2Ŧ Imora| v|n
Ŵ wlLh LrlbuLarles slmllar Lo femoral arLerv
Ŵ w|th 2 b|g d|ffrnc¾ť
4 Ŵ wlLh areaL saphenous veln

no accompanvlna veln


4 w|th 3 branch¾ť
eplaasLrlc veln
clrcumflex veln
exLernal pudendal veln

superflclal velns wlLh accompanvlna arLerv
dralns lj areaL saphenous veln lj femoral veln

Ŵ 3 branch¾ť
aŦ profunda femorls veln
bŦ areaL saphenous veln
cŦ descendlna aenlcular veln

Ŵ lle poslLlon ln relaLlve Lo arLerv

3Ŧ Cbtrator v¾¾|¾
Ŵ from lnLernal lllac
Ŵ anasLomose wlLh medlal femoral clrcumflex
vessels and lnferlor aluLeal vessels
Ŵ supplles obLuraLor muscles and medlal aspecL of
Lhe Lhlah

4Ŧ Imora| nrv
Ŵ from L2ţ L3 and L4
Ŵ r/n Lo fern vesselsŤ mosL laLeral (vn)
Ŵ covered wlLh femoral sheaLh
Ŵ from lumbosacral plexus Ŷ arlses proxlmal Lo
where Lhe common lllac vessels
Ŵ appears ln Lhe Lhlah afLer crosslna Lhe lnaulnal
llaamenL
Ŵ many branch|ng 1" b|ow |ng|na| ||gamntť
aŦ m¾c|ar Ŷ SarLorlus mŦţ Clţ pecLlneus mŦţ
lllacus mŦ
bŦ antr|or/ |ntrmd|a| fmora| ctano¾
nrv
cŦ art|ca|r branch¾ to [o|nt¾
dŦ ¾a½hno¾ nrv
4 sensorvţ passes Lhrouah Lhe PunLer's
canal [olnlna Lhe femoral arLerv and veln
4 2 bla vessels near lL wlll dlsappear aL knee
realon aL Lhe adducLor hlaLus
4 provldes sensaLlon aL Lhe arLerlal aspecL
of Lhe knee [olnL
4 can be desLroved durlna operaLlon
because lL ls noL LhaL lmporLanL

Ŵ nerve Lo Lhe lCC1 Ŷ Þ8LSL8vLu!

Ŵ c||n|ca| corr|at|onť
4 uM Ŷ blood supplv ls compromlsed
4 lf (+) lnfecLlon Ŷ heallna process ls slow
4 rg|mnť shoes should be loose

5Ŧ Cbtrator nrv
Ŵ L2ţ L3ţ L4
Ŵ from lumbar plexusţ anLerlor porLlon
Ŵ branch¾ť
aŦ anLerlor Ŷ aŦ lonausţ aŦ brevlsţ aracllls
cuLaneous nerve
bŦ posLerlor Ŷ aŦ brevls and 2/3 of aŦ maanus

Ŵ comes from somewhere ln Lhe pelvlc realon ln Lhe
vlclnlLv of Lhe obLuraLor vessels
Ŵ c||n|ca| corr|at|onť
4 crbra| ½a|¾y
braln ln[urv due Lo dellverv
can be due Lo prolonaed labor or forceful
dellverv
spasmsţ can'L conLrol movemenL
parLlcular spasLlclLvť seesaw aalL
O hvperconLracLlna knee
O obLuraLor nerve Ŷ hvperacLlve

tratmntť cuL obLuraLor nerve or cuL Lhe
orlaln of Lhe obLuraLor aroup of muscle

5AÞnLNCU5 nIA1U5 (IC55A CVALI5)
Ŵ openlna ln Lhe deep fascla
Ŵ 1" below medlal end of lnaulnal llaamenL
101 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ lonaer lenaLh Lhan
Ŵ wldLh Ŷ less Lhan 1"
Ŵ ¾trctr¾ ½a¾¾|ng throghť
aŦ areaL saphenous veln
bŦ medlal saphenous veln
cŦ laLeral saphenous veln
dŦ 3 superflclal vessels
eŦ lvmph vessels

ADDUC1Ck nIA1U5 (nIA1U5 1LNDINC5U5)
Ŵ adducLor maanus openlna
Ŵ sLrucLures passlna Lhrouahť
aŦ femoral arLerles and veln
bŦ saphenous nerve
ILMCkAL 1kIANGLL
Ŵ bondar|¾ť
¾½r|orť lnaulnal llaamenL
|atra|ť SarLorlus muscle
md|a|ť adducLor lonaus
Ŵ f|oor (|atra| to md|a|)
4 lllacus mŦţ pecLlneus mŦţ adducLor lonaus mŦ

Ŵ roofť deep fascla
Ŵ contnt¾ť arLervţ velnţ nerve
Ŵ a½xť femoral arLervţ femoral velnţ adducLor lonausţ
profunda femorls arLerv and veln

nUN1Lk'5 CANAL
Ŵ muscular canal ln mldLhlah
Ŵ from Scarpa's Lrlanale Lo adducLor hlaLus
Ŵ bondar|¾ť
antro|atra|ť vŦ laLeralls muscle
½o¾tr|orť adducLor lonaus (prox) Lo adducLor
maanus (dlsLal)
md|a|ť lnLermuscular sepLa
antromd|anť SarLorlus and subsarLorlus facsla

Ŵ a canal from whlch Lhe femoral vessels passes
Lhrouah from proxlmal up Lo dlsLal porLlon
Ŵ ¾trctr¾ that ½a¾¾¾ throghť
4 femoral arLerv and veln
4 Saphenous nerve

Ŵ ccť area where vou can pracLlcallv llaaLe Lhe femoral
arLerv and Lhe enLlre llmb can sLlll be safe due Lo
collaLeral clrculaLlonţ provlded bv profunda femorls
Ŵ lf cuL/ llaaLe before/ proxlmal Lo profunda femorlsţ lL
wlll lead Lo compromlsed blood supplv of Lhe enLlre
LL
Ŵ femoral arLerv aL Lhls canal ls covered bv SarLorlus
muscle

CLINICAL CCkkLLA1ICNť

1Ŧ Congn|ta|
aŦ CnD (congn|ta| h|½ dy¾½|a¾|a/ d|¾|ocat|on)
O hlp ouLslde aceLabulum

bŦ coxa ½|ama
O flaLţ noL rounded femoral head
O problem ln blood supplv
O Nť surface of Lhe aceLabulum and head of
femur ls noL dlrecLlv ln conLacL due Lo arLlcular
carLllaae whlch ls LransparenL ln xŴravs

2Ŧ NonŴtramat|c cond|t|on¾
aŦ Infct|on¾ť o¾tomy||t|¾
O perlosLeal reacLlon and Lhlckenlna of Lhe
perlosLeum laLerallv
O lnfecLlon of Lhe bone and ln Lhe medullarv
conLenLs of Lhe bone
O femoral head moves close Lo Lhe aceLabulumţ
no [olnL capsuleţ no more carLllaaeţ
LrabecualLlon of Lhe bone conLlnuous wlLh Lhe
lllum
O lnfecLlon of Lhe carLllaae (remnanLs)
Nj
scrape Lhe necroLlc Llssue and fuse lL
Nj
fused hlp [olnL

O lumbar splne compensaLes when movlna

bŦ o¾toarthr|t|¾
O dlsrupLed smooLhness of Lhe head and
aceLabulum due Lo Lhe desLrucLlon of Lhe
arLlcular carLllaae
O can'L move hlps (bone Lo bone movemenL)

cŦ card|ac cathr|zat|on (d|agno¾t|c and thra½t|c
"¾tnt")



102 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

dŦ hrn|a¾
O lnaulnal Ŷ abdomlnal conLenLs Lhru lnaulnal
rlna lnLo scroLum
O femoral Ŷ abdomlnal conLenLs Lhru lnaulnal
canal lnLo femoral fossa

3Ŧ 1ramat|c cond|t|on¾
aŦ n|½ d|¾|ocat|on
O hlp ls dlslocaLed cenLrallv lnLo Lhe aceLabulum
O posLerlor Ŷ mosL commonţ once bumped
anLerlor Lo Lhe knee
O cenLral
O anLerlor Ŷ rare
O tratmntť hlp replacemenL
4 lndlcaLlonsť necrosls of Lhe head and
eroslon of Lhe bone Lowards pelvlc cavlLv
4 ty½¾ť
parLlal
LoLal Ŷ rlm Lhe aceLabulumţ lower
shell and placed an lmplanL anchored
Lo Lhe medullarv cavlLv of femur


bŦ Iractr |n[r|¾
O femoral neck fracLure
O lnLerŴLrochanLerlc fracLure
O femoral shafL fracLure

cŦ Va¾c|ar |n[r|¾
O arLerlal
O venous

4Ŧ 5rg|ca| ½rocdr¾
aŦ A½½roach¾
O Lo Lhe hlpť anLerlorţ posLerlorţ laLeralţ medlal
O Lo Lhe shafLť ??????

bŦ Am½tat|on¾
O foreŴquarLer ampuLaLlon
O hlp dlsarLlculaLlon
O ampuLaLlon above Lhe knee (hlahţ mldţ low)






















































103 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

1nL ÞCÞLI1LAL IC55A
(DrŦ Laygo)

IN1kCDUC1ICN
dlamondŴshaped sLrucLure locaLed aL Lhe posLerlor
aspecL of Lhe knee
lozenaeŴshaped
mad ½ of 2 tr|ang|¾ť superlor and lnferlor
Þart¾ť
1Ŧ roof
4 madeŴup of Lhe skln and fascla
4 fasclať superflclal and deep popllLeal fascla
4 deep popllLeal fascla Ŷ comes from Lhe deep
fascla of Lhe Lhlah/ lSCl L1

2Ŧ f|oor
4 popllLeal surface
4 obllque popllLeal llaamenL
4 lnserLlon of semlmembranosus muscle
4 popllLeus muscle and fascla

8ondar|¾ť
1Ŧ fmora| tr|ang|
4 md|a| ¾|d
semlmembranosus
semlLendlnosus Ŷ conslsL mosLlv of Lhe
femoral Lrlanale

4 |atra| ¾|d
blceps femorls muscle

2Ŧ t|b|a| (|owr) tr|ang|
4 md|a| ¾|d
medlal head of aasLrocnemlus muscle

4 |atra| ¾|d
laLeral head of aasLrocnemlus muscle
bnathť planLarls muscle (counLerparL
of palmarls lonaus ln Lhe upper
exLremlLles) lnserLs ln Lhe heel of Lhe
fooL

ÞCÞLI1LU5 MU5CLL
or|g|nť wlLhln Lhe capsule of knee [olnL
4 laLeral aspecL of Lhe laLeral condvle of femur

|n¾rt|onť posLerlor aspecL of Lhe Llbla above Lhe
popllLeal llne

cor¾ť Lendlnous orlaln passes downward and
backwardţ separaLes Lhe laLeral semllunar carLllaae
from LhaL of Lhe laLeral llaamenL of Lhe knee [olnL
and lnserLs Lhru Lhe lnferolaLeral aspecL of Lhe
posLerlor aspecL of capsular llaamenL

fnct|on¾ť
aŦ flexor of Lhe lea
bŦ acLs as a medlal roLaLor of Lhe Llbla when Lhe
knee ls flexed

nrv ¾½½|yť medlal (Llblal) nerve

CCN1LN15 CI ÞCÞLI1LAL IC55Ať
1Ŧ faLţ popllLeal vessels
serves as a cushlon for popllLeal vessels
lf (Ŵ) Lhereƌs a hlaher Lendencv for Þv Lo be
ln[ured

2Ŧ Llblal and common flbular (peroneal) nerve
3Ŧ shorL saphenous veln
4Ŧ posLerlor femoral cuLaneous nerve of Lhe posLerlor
cuLaneous nerve of Lhe Lhlah
3Ŧ arLlcular branch of Lhe obLuraLor nerve
6Ŧ popllLeal lvmph nodes
7Ŧ popllLeal bursa

ÞCÞLI1LAL Ak1Lk¥
orlalnaLes from Lhe femoral arLerv (afLer crosslna Lhe
adducLor hlaLus)
passes downward aL Lhe lower border of Lhe
popllLeus muscle evenLuallv alvesŴoff Lhe Lermlnal
branchesť
aŦ anLerlor Llblal arLerv
bŦ posLerlor Llblal arLerv

GLNICULAk ANA51CMC5L5
anasLomosls around Lhe knee [olnL
anasLomosls beLween Lhe lower branches of Lhe
femoral arLervţ branches of popllLeal arLervţ
branches of anLerlor and posLerlor Llblal arLerv
abovť
4 md|a| ¾|dť descendlna branch of Lhe medlal
clrcumflex femoral arLerv anasLomose wlLh
medlal branch of Lhe superlor aenlcular arLerv
branch of Lhe popllLeal arLerv
4 |atra| ¾|dť descendlna branch of Lhe laLeral
clrcumflex femoral arLerv anasLomose wlLh
laLeral branch of Lhe superlor aenlcular arLerv
branch of popllLeal arLerv

b|owť lnferlor aenlcular arLerv
4 md|a| ¾|dť medlal branch anasLomose wlLh Lhe
anLerlor Llblal recurrenL arLerv branch of
anLerlor Llblal arLerv
4 |atra| ¾|dť laLeral branch anasLomose wlLh Lhe
posLerlor Llblal recurrenL arLerv branch of
posLerlor Llblal arLerv
104 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

mlddle aenlcular arLerv comlna from Lhe popllLeal
arLerv anasLomose wlLh Lhe mlddle collaLeral arLerv
comlna from Lhe deep femoral arLerv

ÞCÞLI1LAL VLIN
unlon of Lhe anLerlor and posLerlor Llblal veln
[olned bv Lhe shorL saphenous veln from Lhe/ ln Lhe
subcuLaneous porLlon of Lhe posLerlor aspecL of Lhe
Lhlah bv peneLraLlna Lhe deep popllLeal fossa

ÞCÞLI1LAL NLkVL
Llblal nerve
common flbular/ peroneal nerve

ÞCÞLI1LAL L¥MÞn VL55LL5
6 popllLeal lvmph nodes locaLed aL Lhe popllLeal fossa
comlna from Lhe anLerlor and posLerlor lvmphaLlc
vessels
lvmphaLlc vessels Ŷ run Lowards Lhe femoral veln and
dralns ln Lhe deep lnaulnal Ln

5UkAL NLkVL
cuLaneous nerve comlna from Lhe common flbular
nerve and a parL of Lhe Llblal nerve
supplles Lhe cuLaneous area of Lhe lower porLlon of
Lhe leas and laLeral aspecL of Lhe fooL

arrangmntť vn Ŷ arLerv belna ln Lhe deepesL porLlon

C||n|ca| ¾|gn|f|cancť cvsLlc leslon of Lhe popllLeal fossa




















kINL5ICLCG¥ CI 1nL
kNLL kLGICN
(DrŦ Ab|og)

shafL Ŷ upper rounded
dlsLal Lrlanaular Ŷ for welahL bearlna and sLress
reslsLance as ln [umplna and [oaalna
eplcondvle vsŦ condvle? dlfference





adducLor Lubercle
|ntrcondy|ar fo¾¾a
4 beLween laLeral and medlal condvle
4 corresponds/ arLlculaLe wlLh Llbla

md|a| t|b|a| ½|ata
4 landmark of Lhe lenaLh of lower exLremlLles

|||ot|b|a| band
4 conLlnuaLlon of 1lL
4 ccť llloLlblal band svndrome
ºsnapplna" svndrome
once Lhlckened band

paLella
aasLrocnemlus muscle
4 lona head
4 anLerlor Lo LP Ŷ shorL head

art|c|ar|¾ gn (art|c|ar m¾c|)
4 or|g|nť femur
4 |n¾rt|onť upper porLlon of Lhe suprapaLellar
bursa
4 act|onť pulls up Lhe suprapaLellar Lendon and
reLracLs lL durlna exLenslon
proLecLs suprapaLellar bursa

kNLL ICIN15
laraesL and mosL complex [olnL
probablv evolved from 3 separaLe [olnLs
4 ln manţ 1 slnale [olnL cavlLv buL 3 separaLe
arLlculaLlon

¾tab|||ty broght abot byť
aŦ llaamenLs Ŷ 4
bŦ muscles Ŷ 12
cŦ carLllaae Ŷ laLeral and medlal menlscus
dŦ condvlar conflauraLlon Ŷ unlque for femur and
Llbla for sLablllLv of Lhe knee
105 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

kINL5ICLCG¥ CI 1nL kNLL ICIN1

3 [olnLs (arLlculaLlon) arLlculaLlna surface
4 laLeral Llblofemoral
4 medlal
4 paLellofemoral

1 [olnL capsule/cavlLv
4 suprapaLellar bursa

1¥ÞL CI DIAk1nkCDIAL AND DLGkLL5 CI IkLLDCM

1Ŧ fmorot|b|a| [o|nt Ŷ medlal Lo laLeral
1
sL
reference as Lo Lvpeť º18CCPClnL?MuS"
aŦ g|ng|ym¾ (h|ng)
4 medlal and laLeral femoroLlblal [olnL
4 flexlonŴexLenslon

bŦ trocho|d (½|vot)
4 medlal and laLeral femoroLlblal [olnL
4 some dearee of roLaLlon

2
nd
reference as Lo Lvpe
4 condvlold or codvlar Lvpe

1
sL
reference vsŦ
4 alnalvmus Ŷ elbow
4 plvoL (Lrochold) Ŷ neck

2
nd
reference
4 moves alona Lhe saalLLal plane

2Ŧ ½at||ofmora| [o|nt
plane (arLhrodlal or alldlna)

ÞA1LLLA
knee cap
a sesamold bone ln Lendon of quadraLus femorls
muscle
flaL and Lrlanaular
arLlcular surface Ŷ smooLhţ dlvlded bv a rldae
beLween lnLo a laraer laLeral and smaller medlal faceL

LIGAMLN1
aŦ ½at||ar ||gamnt
bone Lo bone relaLlonshlp Ŷ llaamenL
4 Cl aoes around Lhe whole of paLella even up
Lo Lhe lnferlor pole lj LhaL makes lL a Lendon
(muscle Lo bone relaLlonshlp)
bŦ(2) co||atra| ||gamnt
md|a| Ŷ t|b|a| (1CL/MCL)
4 fnct|on¾ť
provldes medlal sLablllLv
prevenLs laLeral anaulaLlon (bendlna)
check exLenslonţ hvperflexlon and laLeral
roLaLlon

|atra| Ŷ f|b|ar (ICL/LCL)
4 fnct|on¾ť
provldes laLeral sLablllLv
prevenLs medlal anaulaLlon (bendlna)
checks hvperexLenslon

bŦ crc|at ||gamnt
antr|or crc|at ||gamnt
4 one of Lhe mosL lmporLanL Lendon of Lhe bodv
4 fnct|onť
checks exLenslonţ laLeral roLaLlon
prevenLs anLerlor sllpplna of Llbla on
femur (or posLerlor dlsplacemenL of
femur on Llbla)

½o¾tr|or crc|at ||gamnt
4 checks flexlon and laLeral roLaLlon
4 prevenLs posLerlor sllpplna of Llbla on femur
(or anLerlor dlsplacemenL of femur on Llbla)

notť collaLeral and cruclaLe llaamenL Ŷ ma[or sLaLlc
sLablllzer of knee realon

C||n|ca| Corr|at|on
mlddle Lhlrd of paLellar llaamenL/ Lendon
4 use Lo replace Lorn CL
4 reconsLrucLlve suraerv

cŦ othr ||gamnt¾
ob||q ½o½||ta| ||gamnt
4 relaLed Lo semlmenbranosus from laLeral
femurţ over condvles Lo posLerlor head of Llbla
4 checks exLenslon

||gamnt of Wr|¾brg
4 aŦkŦaŦ posLŦ menlscofemoral llaamenL

arcat ½o½||ta| ||gamnt
4 relaLed Lo popllLeus muscle orlaln
4 from laLeral condvle of femur Lo sLvlold
process of flbula
4 check medlal roLaLlon of lea

coronary ||gamnt
4 from capsule Lo perlpherv of menlscl and Llbla
4 helps hold menlscl ln place

tran¾vr¾ ||gamnt
4 lnLerconnecLs anLerlor parLs of 2 menlscl
106 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2


8Uk5A

































MLNI5CU5
aŦ md|a| mn|¾c¾
crescenLŴshaped (oval)
deepens medlal Llblal condvle
more commonlv ln[ured
4 7Ŵ8x Lhan laLeral
4 lonaer and less securelv aLLached
4 force applled Lo Lhe laLeral slde

bŦ |atra| mn|¾c¾
nearlv clrcular
deepens laLeral Llblal condvle

MU5CLL5 CCN1kCLLING 1nL kNLL ICIN1
dvnamlc sLablllzer

1Ŧ Cadrat¾ fmor|¾ gro½
aŦ recLus femorls muscle
blarLlcular
klcklna muscle
or|g|nť llS
|n¾rt|onť paLellar llaamenL and Llblal Lubercle
act|onť knee exLenslon and hlp flexlon

bŦ vasLus medlalls muscle
cŦ vasLus laLeralls muscle
dŦ vasLus lnLermedlus muscle
bţ cţ d

monoarLlcular
or|g|nť llnea aspera

2Ŧ ham¾tr|ng¾
aŦ semlmembranosus muscle
bŦ semlLenslnosus muscle
|n¾rt|onť pes anserlnus
cŦ blceps femorls muscle Ŷ shorL and lona head
|n¾rt|on |onghadť erdvƌs Lubercle

or|g|nť lllac Lubercle

|nnrvat|onť
&Llblal nerve Ŷ all excepL shorL head of
8lM
&common peroneal nerve Ŷ shorL head
of 8CM
act|onť flexlon of kneeţ exLenslon of hlp
medlal hamsLrlna Ŷ medlal roLaLlon
laLeral hamsLrlna Ŷ laLeral roLaLlon

3Ŧ nc|a¾¾|f|d
lnserLs ln all places and are noL proLecLed
aŦ SarLorlus muscle Ŷ Cť llS
bŦ racllls muscle Ŷ medlal comparLmenL
cŦ ÞopllLeus muscle Ŷ from popllLeal fossa
4 or|g|nť 18lÞ81l1L 1LnuCn Cl 1PL ÞCÞLl1LL
arcuaLe popllLeal llaamenL
|atra| fmora| condy|
f|b|ar had
½o¾tr|or horn of |atra| mn|¾c¾
½rox|ma| attachmnt

107 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 |n¾rt|onť posLŦ 1lbla above soleal llne Ŷ dlsLal
aLLachmenL
4 nrv ¾½½|yť Llblal nerve
4 act|onť lnLernal roLaLlon of Llbla and
wlLhdraws laLeral menlscus

dŦ asLrocnemlus muscle Ŷ from Lhe lea
eŦ ÞlanLarls muscle
4 or|g|nť lower laLeral supracondvlar llne
4 |n¾rt|onť mlddle posLŦ Calcaneus

kINL5ICLCG¥ CI 1nL kNLL ICIN1

1
51
20º of f|x|on
4 unlocklna mechanlsm of knee bv popllLeus
muscle
4 alldlna moLlon

at 40ºţ rock|ng mot|on
4 wlLh a draa bv Lhe posLerlor cruclaLe llaamenL

furLherţ rolllna moLlon
movlna from a flexed poslLlon Lo exLenslon
4 lasL 20¨of exLenslonţ Llbla exLernallv roLaLes lnLo
lLs ºscrewŴhome mechanlsm"

danclna [olnL

5UMMAk¥ CI kNLL AC1ICN5

ILLkICN
¾m|mmbrano¾¾ m¾c|*
¾m|tnd|no¾¾ m¾c|*
b|c½¾ fmor|¾ m¾c|*
sarLorlus muscle
aracllls muscle
popllLeus muscle
aasLrocnemlus muscle
planLarls muscle

Lk1LN5ICN
CuadraLus femorls muscle
recLus femorls muscle
vasLus medlalls muscle
vasLus laLeralls muscle
vasLus lnLermedlus muscle

IN1LkNAL kC1A1ICN
popllLeus muscle
semlmembranosus muscle
sarLorlus muscle
aracllls muscle

Lk1LkNAL kC1A1ICN
blceps femorls muscle

CNL ICIN1 AND 1WC ICIN1
monoart|c|ar
4 semlmembranosus
4 va¾t¾ |atra||¾ m¾c|*
4 va¾t¾ |ntrmd|¾ m¾c|*
4 ½o½||t¾ m¾c|*
4 blceps femorls muscle Ŷ shorL head

b|art|c|ar
4 recLus femorls muscle
4 sarLorlus muscle
4 aracllls muscle
4 ¾m|mmbrano¾¾ m¾c|*
4 ¾m|tnd|no¾¾ m¾c|*
4 b|c½¾ fmor|¾ m¾c| Ŷ |ong had*
4 aasLrocnemlus muscle
4 planLarls muscle


















NLUkCVA5CULAk 51kUC1UkL5
CI 1nL LLG
(DrŦ Laygo)

ÞCÞLI1LAL Ak1Lk¥
Ŵ commences as lL pass Lhrouah adducLor hlaLus
Ŵ passes under flbrous arch of Soleus
Ŵ aL lower border of popllLeusţ lL dlvldes lnLo

aŦ antr|or t|b|a| artry
Ŵ smaller Lermlnal branch of popllLeal arLerv
108 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ courseť passes forward lj lnLerosseous
membrane lj descends on anLerlor surface of
lnLerosseous membrane

Ŵ accompanled bv deep peroneal nerve

Ŵ ½½r cor¾ť lles beneaLh Lhe muscle of
anLerlor comparLmenL
Ŵ |owr cor¾ť lles superflclallv ln fronL of lower
end of Llblaţ behlnd superlor exLensor
reLlnaculum
Ŵ md|a| ¾|dť Lendon of exLensor hallucls lonaus
Ŵ |atra| ¾|dť exLensor dlalLorum lonausţ deep
peroneal nerve
Ŵ LermlnaLes ln fronL of ankle [olnL lj dorsalls
pedls arLerv
Ŵ branch¾ť
4 anLerlor and posLerlor Llblal recurrenL arLerv
4 medlal and laLeral anLerlor malleolar arLerv

bŦ ½o¾tr|or t|b|a| artry
Ŵ blaaer Lermlnal branch of Lhe popllLeal arLerv
Ŵ bealns aL lower border of popllLeus muscle
Ŵ downward deep Lo aasLrocnemlus muscleţ
soleusţ deep Lransverse fascla of Lhe lea
Ŵ lles on posLerlor surface of Llblalls posLerlor
muscle above
Ŵ b|ow ť posLerlor surface of Llbla
Ŵ t|b|a| nrvť lles flrsL on medlal slde Lhen crosses
posLerlorlv Lo posLerlor Llblal arLerv and Lo lLs
laLeral slde
Ŵ at th |owr ½art of th |gť posLerlor Llblal
arLerv lles ln fronL of medlal border of
Lendocalcaneus
4 passes behlnd medŦ malleolus deep Lo flexor
reLlnaculum
Ŵ LermlnaLes as medlal and laLeral planLar arLerles
Ŵ separaLed from Lhe medlal malleolus bv Lhe ffť
4 Lendon of Llblalls posLerlor
4 Lendon of flexor dlalLorum lonaus

Ŵ branch¾ť
1Ŧ f|b|ar (½rona|) artry
4 muscular branches
4 nuLrlenL arLerv Lo Lhe flbula
4 laraesL and mosL lmporLanL branch of
posLerlor Llblal arLerv
4 bealns lnfŦ Lo Lhe dlsLal border of Lhe
popllLeus muscle and Lendlnous arch of
soleus
4 descends obllquelv Lowards Lhe flbula
and passes alona Lhe medlal slde of Lhe
flbular bone wlLhln Lhe flexor hallucls
muscle or beLween flbular bone and Lhe
lnLermuscular sepLum and Llblalls
posLerlor muscle
4 locaLed elLher wlLhln hallucls muscle lj
above
downwardť lnLermuscular sepLum
and Llblalls posLerlor muscle

4 m¾c|ar branch¾ť aolna Lo popllLeus
and muscle of Lhe posLerlor and laLeral
comparLmenLs of Lhe leas
4 commn|cat|ng branchť connecLs
peroneal arLerv Lo LhaL of Lhe posLerlor
Llblal arLerv







4 ana¾tomo¾|ng branch to crc|at artry
posLerlor Llblal arLerv plerces Lo Lhe
lnLermuscular sepLum and passes
Lowards dorsum of fooL and
evenLuallv anasLomose Lo Lhe
cruclaLe arLerv (branch of dorsalls
pedls arLerv)



2Ŧ c|rcmf|x f|b|ar artry
4 arlses from posLerlor Llblal arLerv aL Lhe
knee and passes laLeral over Lo Lhe neck
of Lhe flbula Lo evenLuallv anasLomose
wlLh Lhe vessels around Lhe knee [olnL

3Ŧ ntr|nt artry of th t|b|a
4 provldes nuLrlenL Lo Lhe Llblal bone
4 passes Lhrouah Lhe nuLrlenL foramen
4 laraesL arLerv ln Lhe human bodv
4 ntr|nt foramn of t|b|a
109 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

locaLed [usL dlsLal Lo Lhe soleal llne
ln Lhe posLerlor aspecL/ surface of
Lhe Llbla

4Ŧ ca|cana| artry
4 supplles Lhe heel realon or
Lendocalcaneous realon of Lhe lea
4 passes medlal and posLerlor Lo Lhe
Lendocalcaneous and evenLuallv
anasLomose wlLh Lhe branches of Lhe
flbular arLerv

5Ŧ ma||o|ar artry
4 [oln Lhe neLwork of vessels ln Lhe
medlal malleolus
4 posLerlor malleolar branch anasLomose
wlLh Lhe anLerlor malleolar branch of
Lhe anLerlor Llblal arLerv

1I8IAL NLkVL
Ŵ supplles posLerlor comparLmenL of lea
Ŵ lower Lermlnal branch of sclaLlc nerve
Ŵ or|g|nť anLerlor branch of venLral raml (L4 Ŷ S3)
Ŵ cor¾ť descends Lhru Lhe mlddle of popllLeal fossa
lj posLerlor Lo popllLeal arLerv and veln
Ŵ dlsLal popllLeus lj deep Lo Lendlnous arch of soleus
muscle lj medlal plane of calf (deep Lo soleus)
Ŵ runs lnferlor Lo Llblalls posLerlor muscle wlLh
posLerlor Llblal vessels lj leaves posLerlor
comparLmenL of lea lj flexor reLlnaculum
Ŵ |n d|¾ta| ½ort|on of th |g
4 beLween medlal malleolus and calcaneus muscle
lles beLween posLerlor Llblal vessel and Lendon
of flexor hallucls lonaus muscle

Ŵ posLeroŴlnferlor Lo medlal malleolus lj medlal and
laLeral planLar nerves lj Lermlnal branches of Llblal
nerve
4 alves branches Lo all muscle of posLerlor
comparLmenL of leas

Ŵ ctano¾ branch
4 md|a| ¾ra| ctano¾ nrv unlLes wlLh Lhe
commn|cat|ng branch of th common
½rona| nrv lj 2 maln orlaln of Lhe sural
nerve

4 5UkAL NLkVL
supplles Lhe skln of Lhe laLeral and posLerlor
parLs of Lhe lnferlor Lhlrd of Lhe lea and
laLeral slde of Lhe fooL

Ŵ art|c|ar branch¾ť supplles knee [olnL

Ŵ LermlnaLes as medlal calcaneal nerve supplvlna Lhe
skln of Lhe heel realon lncludlna Lhe welahLŴbearlna
surface

Ŵ c||n|ca| corr|at|onť laceraLlon of popllLeal fossa and
posLerlor dlslocaLlon of knee [olnL mav damaae Llblal
nerve
4 mav cause paralvsls of all muscle ln Lhe posLerlor
comparLmenL of Lhe lea and lnLrlnslc muscle of
Lhe sole of Lhe fooL
4 man|f¾t a¾ť paralvsls of planLar flexlon of Lhe
fooL

CCMMCN ÞLkCNLAL NLkVL
Ŵ laLeral and smaller branch of sclaLlc nerve
Ŵ courseť passes over Lhe posLerlor aspecL of Lhe head
of Lhe flbula
Ŵ c||n|ca| corr|at|onť (+) fracLure aL Lhe head of flbula
4 CÞn courses around neck of flbula
4 lf ln[uredť (+) paralvsls
lnablllLv of dorslflexlon or everslon of Lhe
fooL
manlfesL as fooL drop
O sLepplna aalL ƹ fooL ls ralsed hlaher Lhan
ls necessarv so Lhe Loes does noL hlL Lhe
around
O fooL ls brouahL down suddenlv


Ŵ branch¾ť
aŦ d½ ½rona| nrv
4 nerve of Lhe anLerlor crural comparLmenL
4 supplles all Lhe muscle of Lhe anLerlor
comparLmenL of Lhe lea as well as arLlcular
branches Lo Lhe ankle [olnL

bŦ ¾½rf|c|a| ½rona| nrv
4 nerve of Lhe laLeral comparLmenL of Lhe lea
4 lles anLerolaLeral Lo Lhe flbula beLween Lhe
flbular muscle and Lhe exLensor dlalLorum
lonaus
110 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 supplles Lhe peroneus muscle and Lhen lL
plerces deep lnLo Lhe deep fascla Lo become
superflclal ln Lhe dlsLal 1/3 of Lhe lea
4 lL passes ln Lhe superflclal fascla Lo supplv
Lhe skln ln Lhe dlsLal parL of Lhe anLerlor
surface of Lhe lea nearlL all Lhe dorsum of
Lhe fooL and mosL of Lhe dlalLs

CU1ANLCU5 NLkVL CI LLG
1Ŧ laLeral sural cuLaneous nerve
2Ŧ superflclal peroneal nerve
3Ŧ saphenous nerve
4Ŧ posLerlor cuLaneous nerve of Lhe Lhlah
3Ŧ medlal sural cuLaneous nerve
6Ŧ sural nerve

VLNCU5 DkAINAGL CI LLG
1Ŧ venae comlLanLes of Lhe anLerlor and posLerlor Llblal
arLerles
Ŵ aŦkŦaŦ anLerlor and posLerlor Llblal velns
Ŵ unlLe LoaeLher Lo form popllLeal veln
Ŵ numerous small vessels ln Lhe medlal aspecL of
Lhe lea wlll become areaL saphenous veln
Ŵ Lhe shorL saphenous veln whlch usuallv sLarLs aL
Lhe laLeral venous arch of Lhe fooL lj wlll
evenLuallv plerce Lhe deep fascla and LermlnaLes
aL Lhe popllLeal veln

2Ŧ numerous small vessels on Lhe posLerlor aspecL of
Lhe lea
3Ŧ communlcaLlna velns of Lhe deep velns of Lhe fooL
4Ŧ anasLomoslna branch LhaL runs upward and medlallv
Lo [oln Lhe areaL saphenous veln



L¥MÞnA1IC5
Ŵ Lhe areaLer parL of skln and superflclal fascla lnfronL
of leas
Ŵ lvmphaLlcs aoes upward and medlallv Lowards Lhe
areaL saphenous veln and dralns verLlcal aroup Lo
superflclal lnaulnal Ln
Ŵ lvmphaLlcs ln Lhe upper laLeral parL of Lhe fronL of
Lhe lea wlll evenLuallv pass Lhrouah Lhe shorL/ small
saphenous veln and evenLuallv dralns lnLo Lhe
popllLeal Ln






































1nL kNLL
(DrŦ 1any)

Ŵ verv remarkable ln sLrucLure (anaLomlcallvţ
blochemlcallv)
Ŵ mosL vulnerable and compllcaLed [olnL
Ŵ mosL exposed parL Lo excesslve forces
Ŵ 3 o¾¾o¾ ½artť
1Ŧ DI51AL ILMUk
4 con¾|¾t of
aŦ laLeral femoral condvle
lonaer ln Lerms of Þ wldLh and
111 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

medlal Lo laLeral wldLh

bŦ medlal femoral condvle

4 2 ¾rfac¾ť
aŦ anLerlor Ŵ ovalŴshape
bŦ posLerlor Ŵ spherlcal ln shape

4 when ln flexed poslLlon Ŷ overhana of Lhe
laLeral condvle/ ¾½r|or xtn¾|on of th
|atra| condy|
lmporLanL ln sLablllzlna Lhe paLella

antr|or v|wť presence of a depresslon
lnLercondvlar sulcus or Lhe Lrochlear
aroove Ŷ accommodaLes Lhe paLella

½o¾tr|or v|w
2 condvles are separaLed bv |ntrcondy|ar
notch
attachmnt byť 2 cruclaLe llaamenLţ
llaamenLum mucosum (lnLrapaLellar
fold)ţ menlscofemoral llaamenL
(LlaamenL of Wrlsberaţ LlaamenL of
Pumphrev)

2Ŧ ÞkCkIMAL 1I8IA

t|b|a| condy|/ t|b|a| ½|ata
laLeral vlewť
downward lncllnaLlon Ŷ 7Ŵ10 '
(anLerlor Lo posLerlor)
Lherefore noL flaLţ noL sLralahL
lmporLanL ln malnLenance of
Llblofemoral [olnLţ lf (Ŵ) excesslve
hvperexLenslon

wlLh 2 arLlcular surface Ŷ separaLed bv
lnLercondvlar area
aŦ laLeral Ŷ smaller (Þ Ŷ convex)ţ domeŴ
shape
lmporLanL ln ºscrewŴhome
mechanlsm"

bŦ medlal Ŷ flaLLenedţ wlder

|ntrcondy|ar ara
O devold of arLlcular carLllaae
O dlvlded lnLo anLerlor and posLerlor
lnLercondvlar area
O wlLh t|b|a| ¾½|n¾/ m|nnc¾
d|v|dd |ntoť
aŦ laLeral Llblal splne Ŵ
posLerlorlv placed
bŦ medlal Llblal splne Ŵ
anLerlorlv placed

no sLrucLures aLLached ln Lhe
Llblal splne
fnct|on¾ť
aŦ prevenLs LranslaLlon of
femur
bŦ proLecLs Lhe aLLachmenL of
llaamenLs (CL and anLerlor
and posLerlor horn of
menlscl)

3 ICIN15ť
aŦ laLeral Llblofemoral [olnL
bŦ medlal Llblofemoral [olnL
a and b Ŷ hlnae [olnL

cŦ paLellofemoral [olnL Ŷ alldlna/ plaln [olnL
mosL unsLable [olnL ln Lhe bodv

knŴ[o|nt mot|onť
4 hvperexLenslon Ŷ 10'
4 lnLernal/ exLernal roLaLlon Ŷ 8 Lo 12'
4 full flexlon Ŷ 140'(posLerlor parL of Lhe lea and femur
Louches one anoLher)

3Ŧ ÞA1LLLA
laraesL sesamold bone
slLuaLed wlLhln Lhe quadrlceps Lendon
has an apex and a base
wlLh 4 surfaces
aŦ anLerlor surface Ŵ Lrlanaular
bŦ arLlcular surface Ŷ oval
dlvlded lnLo seven faceLs LheoreLlcallv
dlvlded bv a verLlcal/ medlal rldae
(laLeral and medlal)
mo¾t md|a| factť Cuu lCL1
W|brg c|a¾¾|f|cat|onť
1¥ÞL 1 Ŷ verLlcal rldae dlvldes arLlcular
surface lnLo 2 equal faceLs
1¥ÞL 2 Ŷ 2 unequal faceLs
laLeral much blaaer Lhan
medlal faceL
1¥ÞL 3 Ŷ medlal faceL no lonaer
recoanlzable
1¥ÞL 4 Ŵ odd faceL

4 |g |n xtn¾|on Ŷ lnferlor pole of paLella
Louches Lhe femoral condvle
4 45¯ f|x|on Ŷ faceL ln conLacL wlLh Lhe femoral
condvle
4 140¯ f|x|on Ŷ odd faceL ln conLacL wlLh femoral
condvle
112 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2


LIGAMLN1CU5 kL51kAIN15 CI kNLL ICIN1
4 deep fascla
4 capsule Ŷ llaamenLs can be lnLracapsularţ
exLracapsularţ or lnLracapsular buL exLrasvnovlal/
lnLrasvnovlal

4 md|a| ¾|d of th kn w|th 3 |ayr¾ť
aŦ otr ¾½rf|c|a| |ayr
forms Lhe deep fascla whlch encloses Lhe
pes anserlnus

bŦ m|dd| |ayr
superflclal medlal collaLeral llaamenL

cŦ d½ |ayr
deep laver of Lhe medlal collaLeral llaamenL

4 |atra| ¾|d
aŦ otr |ayr
deep fascla of Lhe Lhlah
llloLlblal band
blceps femorls muscle
laLeral paLellar reLlnaculum

bŦ m|dd| |ayr
Ŵ superflclal laLeral collaLeral llaamenL
Ŵ lefL lnferlor aenlcular vessels

aŦ d½ |ayr
Ŵ popllLeus Lendon
Ŵ capsule
Ŵ deep componenL of Lhe flbular (laLeral)
collaLeral llaamenL

51A1IC 51A8ILI2Lk5
1Ŧ xtraca½¾|ar ||gamnt (antr|or to ½o¾tr|or)

aŦ ||gamntm ½at||a/ ½at||ar notch
formed bv Lhe Lendon of recLus femorls
muscle as lL precedes dlsLallv
bŦ ca½¾|
surrounds Lhe enLlre knee excepL anLerlorlv
where Lhe capsule ls replaced bv Lhe paLella
and llaamenLum paLella

cŦ md|a| co||atra| ||gamntm
superflclal and deep
attachmntť from laLeral condvle of femur Lo
Lhe proxlmal aspecL of Lhe Llbla
O 7 cm below Lhe [olnL llne (dlsLal exLenslon
of Lhe MCL)

valaus sLablllzer of Lhe knee [olnL (prlmarv
resLralnL)

dŦ |atra| co||atra| ||gamnt
from Lhe laLeral femoral condvle Lo Lhe
flbular head
varus sLablllzer of Lhe knee [olnL

Ŧ ½o¾tr|or|yť ob||q ½o½||ta| ||gamnt
dlsLal expanslon of Lhe semlmembranosus
muscle and lnserLs Lo Llbla
relnforces/ sLrenaLhens Lhe capsule
posLerlorlv

2Ŧ |ntraca½¾|ar bt xtra¾ynov|a| ||gamnt

aŦ antr|or crc|at ||gamnt
from medlal aspecL of laLeral condvle and lnLo
Lhe anLerlor lnLercondvlar area
conslsLs of 3 bundles LhaL are lnLerLwlned wlLh
each oLher
fnct|onť
O prevenLs forward dlsplacemenL of Lhe
Llbla ln relaLlon Lo Lhe femur
O prevenLs backward dlsplacemenL of Lhe
femur ln relaLlon Lo Lhe Llbla
O secondarv valaus sLablllzer
O prevenLs excesslve hvperexLenslon
O helps ln sLablllLv durlna lnLernal roLaLlon

bŦ ½o¾tr|or crc|at ||gamnt
from laLeral surface of Lhe medlal condvleţ
lnserLs lnLo Lhe posLerlor lnLercondvlar area
fnct|on¾ť
O prevenLs backward dlsplacemenL of Llbla
ln relaLlon Lo femur
O prevenLs forward dlsplacemenL of femur
ln relaLlon Lo Llbla




3Ŧ |ntraca½¾|ar bt |ntra¾ynov|a| ||gamnt
MLNI5CU5
d|v|dd |ntoť
aŦ |atra| Ŷ almosL clrcular ln shape
Ŵ noL ln conLacL wlLh flbular (laLeral)
collaLeral llaamenL because of Lhe
presence of popllLeus Lendon
Ŵ w|th 2 horn¾ť
O antr|or horn
aLLached Lo Lhe lnLercondvlar
area behlnd Lhe anLerlor cruclaLe
llaamenL

113 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

O ½o¾tr|or horn
aLLached Lo lnLercondvlar area ln
fronL of posLerlor cruclaLe
llaamenL

bŦ md|a| Ŷ CŴshape
Ŵ flxed because lL ls aLLached wlLh Lhe
medlal collaLeral llaamenL
Ŵ anLerlor horn Ŷ lnserLed Lo Lhe anLerlor
lnLercondvlar area anLerlor Lo CL
Ŵ posLerlor horn Ŷ lnserLed Lo Lhe posLerlor
lnLercondvlar area anLerlor Lo ÞCL

notť 2 menlscl (laLeral and medlal) Ŷ connecLed bv Lhe
Lransverse llaamenL of Lhe knee

c||n|ca| corr|at|on
Ŵ mosL commonlv ln[ured ln mulLldlrecLlonal ln[urv/
acuLe ln[urv of Lhe CLť laLeral menlscus
Ŵ chronlc lnsufflclencv of Lhe CL Ŷ ln[urv of medlal
menlscus

aLLached Lo Llbla v|a coronary ||gamnt (1PC8Lk Ŷ
aLLached Lo Lhe Llbla and femur)
fnct|onť
aŦ lncreases Lhe depLh of Llblal condvle
bŦ shockŴabsorber

crossŴsecLlonť Lrlanaular ln shape
d|v|dd |nto 2 zon¾ť
ouLer 1/3 Ŷ red zoneŤ vascular
lnner 2/3 Ŷ whlLe zoneŤ avascular

mn|¾cofmora| ||gamnt
Ŵ LlaamenL of Wrlsbera Ŷ seen from behlnd
Ŵ LlaamenL of Pumphrev Ŷ locaLed anLerlor Lo
Lhe ÞCL
Lhls serves Lo aLLach Lhe posLerlor horn of
Lhe laLeral menlscus Lon Lhe medlal
femoral condvle LhaL passes anLerlor Lo
Lhe ÞCL
Ŵ connecLs menlscus Lo Lhe femoral condvle

C1nLk 51kUC1UkL5
1Ŧ fat ½ad
belleved Lo supplv 8v Lo femoral condvle
|ntra½at||ar fo|d
connecLs Lhe faL pad lnLo Lhe lnLracondvlar
noLch

2Ŧ ¾ynov|a|/ ½||ca
normal embrvonlc svnovlal sepLa LhaL mav
perslsL ln adulL llfe
medlan paLellar fold
llaamenLum mucosum
superlor paLellar pllca

d|¾½|acmntť cllcklna sensaLlon

8Uk5AL
Ŵ svnovlal llned Llssue locaLed beLween 2 rubblna
sLrucures Lo mlnlmlze frlcLlon and aLLrlLlon

1Ŧ antr|or br¾a

aŦ ½r½at||ar br¾a
Ŵ beLween Lhe lnferlor pole and proxlmal parL of
Lhe Lendon
Ŵ lrrlLaLlonť housemaldƌs knee

bŦ ¾½rf|c|a| |nfra½at||ar br¾a
Ŵ locaLed anLerlor Lo Lhe dlsLal parL of Lhe
llaamenLum paLella

cŦ d½ |nfra½at||ar br¾a
Ŵ locaLed beLween proxlmal Llbla and
llaamenLum paLella

dŦ ¾½ra½at||ar br¾a
Ŵ aLLached Lo aenu arLlcularls
Ŵ has a communlcaLlon wlLh Lhe knee [olnL

2Ŧ ½o¾tr|or br¾a
Ŵ locaLed beLween Lhe 2 heads of aasLrocnemlus

aŦ ½o½||ta| br¾a
Ŵ beLween laLeral head of aasLrocnemlus and
popllLeus Lendon
Ŵ lf dlsLendedť popllLeal cvsL (hernlaLlon of Lhe
popllLeal bursa)

bŦ ¾m|mmbrano¾¾ br¾a
Ŵ beLween medlal head of aasLrocnemlus and
semlmembranosus muscle

Ŵ a and b normallv communlcaLes wlLh Lhe knee
[olnL

3Ŧ md|a| br¾a
aŦ beLween pes anserlnus and Llblal collaLeral
llaamenL
bŦ beLween Lhe semlmembranosus muscle and Llblal
collaLeral llaamenL
cŦ beLween semlmembranosus muscle and Llbla

4Ŧ |atra| br¾a
aŦ beLween Lhe blceps femorls Lendon and flbular
collaLeral llaamenL
114 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

bŦ beLween Lhe popllLeus Lendon muscle and laLeral
collaLeral llaamenL
cŦ beLween Lhe popllLeus Lendon muscle and femoral
condvle

Þn¥5ICAL LkAMINA1ICN
1Ŧ acc¾¾ |ntgr|ty of crc|at ||gamnt

AN1LkICk CkUCIA1L LIGAMLN1
aŦ anLerlor drawerƌs LesL
Ŵ 90' kneeŴflexlon

bŦ lachmanƌs LesL
Ŵ 30Ŵ40' knee flexlon
Ŵ more senslLlve Lhan urawerƌs LesL

ÞC51LkICk CkUCIA1L LIGAMLN1
aŦ posLerlor drawerƌs LesL
Ŵ elevaLe Lhe lea wlLh 90' hlp flexlonţ 90' knee
flexlon
Ŵ lf compleLe Lear Ŷ lea wlll drop
Ŵ or push lea posLerlorlv
Ŵ frank ln[urv Ŷ wlll saa

2Ŧ acc¾¾ |ntgr|ty of co||atra| ||gamnt¾

MLDIAL CCLLA1LkAL LIGAMLN1
Ŵ valaus sLress LesL
Ŵ flex Lhe knee 30Ŵ40'
Ŵ sLablllze Lhe knee on one sldeţ arab Lhe fooL
Ŵ move Lowards Lhe ouLslde
Ŵ lL deLermlnes also lf CL ls ln[ured

LA1LkAL CCLLA1LkAL LIGAMLN1
Ŵ varus sLress LesL
Ŵ reversed

3Ŧ acc¾¾ |ntgr|ty of mn|¾c|

Ŵ MacMrrayƌ¾ t¾t
kneeŴflexlonŤ pushed Lhe lea
lnLernallv and exLernallv roLaLe Lhe lea whlle
Lhe knee ls ln flexlon

lf Lhere ls a palpable or audlble cllck Ŷ ln[ured
menlscus
O locklna sensaLlon of Lhe knee

UNnAÞÞ¥ 1kIAD CI 1nL kNLLť (tar of)
aŦ medlal collaLeral llaamenL
bŦ medlal menlscus
cŦ CL

8CNL5 CI 1nL LLG
Ŵ conslsLs of 2 [olnLsť proxlmal and dlsLal Llblofemoral
[olnL
Ŵ w|th 4 com½artmnt¾ť d|v|dd by |ntrm¾c|ar
com½artmnt
aŦ 1 anLerlor Ŷ exLensor aroup
bŦ 1 laLeral Ŷ everLer aroup
cŦ 2 posLerlor Ŷ flexor aroup

Ŵ each comparLmenL has lLs own nerve and blood
supplv
Ŵ Llbla and flbula Ŷ almosL equal ln lenaLh
aŦ Llbla Ŷ medlal
bŦ flbula Ŷ laLeral

Ŵ |ong bon ha¾ 3 ½art¾ť

ML1AÞn¥5I5
aŦ ½rox|ma| mta½hy¾|¾ Ŷ t|b|a| ½|ata
antr|orť Llblal Lubercleţ llaamenLum
paLella
|atra| to th|¾ť erdvƌs Lubercle and
lnserLlon of llloLlblal band
½o¾tr|orť fossa for semlmembranosus
laLeral aspecL of Llblal condvleţ faceL for
arLlculaLlon

bŦ d|¾ta| mta½hy¾|¾ť meLaphvseal flarlna
dlsLal plafon
1Ŧ medlal malleolus
2Ŧ laLeral malleolus

DIAÞn¥5I5
shafL Ŷ Lrlanaular ln shape
3 borders and surfaces

LÞIÞn¥5I5




5 5UkIACL5 CI 1I8IA

a) medlal Ŷ medlal malleolus
b) 1 anLerlor
c) 1 laLeral Ŷ arLlculaLes wlLh dlsLal parL of flbula
d) 1 posLerlor Ŵ (+) aroove for Llblalls posLerlor Lendon
e) 1 arLlcular surface
plafone Ŷ wlder anLerlor Lhan posLerlorlv
AÞ v|wť concave
md|a| to |atra| v|wť convex
CnAÞU1ƌ5 1U8LkCLL Ŷ aLLachmenL of anLerlor
svndesmoLlc llaamenL

115 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ ma[orlLv of Lhe welahL ls born bv Lhe Llbla
Ŵ flbulať 17Ʒ (malnLaln sLablllLv of Lhe ankle [olnL)

2 ICIN15
aŦ ½rox|ma| t|b|of|b|ar [o|nt
svnovlal Lvpe
nc|o¾d by a ca½¾| and r|nforcd byť
1Ŧ anLerlor superlor Llbloflbular llaamenL
2Ŧ posLerlor superlor Llbloflbular llaamenL

bŦ d|¾ta| t|b|of|b|ar [o|nt
svndesmoLlc Lvpe or flbrous Lvpeť no moLlon
¾tab|||zd byť
1Ŧ anLerlor lnferlor Llbloflbular llaamenL or
anLerlor svndesmoLlc llaamenL
2Ŧ posLerlor svndesmoLlc llaamenL
3Ŧ lnferlor Lransverse llaamenL
4Ŧ lnLerosseous llaamenL

IN1LkC55LCU5 MLM8kANL
Ŵ arlses from lnLerosseous border of Lhe Llbla down
and laLeral Lo Lhe flbula
Ŵ 2 o½n|ng¾
aŦ ¾½r|or Ŷ where anLerlor Llblal vessels wlll
enLer Lo Lhe anLerlor comparLmenL and veln
from anLerlor Lo back
bŦ |nfr|or Ŷ for Lhe perforaLlna branch of peroneal
arLerv from behlnd aolna anLerlorlv

Ŵ d|¾ta| t|b|of|b|ar ||gamntť conLlnuaLlon of
lnLerosseous membrane







CIkCULA1Ck¥ 5¥51LM CI 1nL LCWLk
LLG
(DrŦ Laygo)

ÞCÞLI1LAL 1kIIUkCA1ICN

ÞopllLeal rLerv



anLerlor Llblal arLerv posLerlor Llblal arLerv



posLŦ Llblal flbular arLerv

branches

posLŦ medlal malleolar posLerlor laLeral malleolar
medlal calcalneal aŦ laLeral calcaneal aŦ

DCk5ALI5 ÞLDI5 Ak1Lk¥
Ŵ conLlnuaLlon of anLerlor Llblal arLerv
Ŵ opposlLe Lhe ankle [olnL
Ŵ cor¾ť dlrecLed forward across Lhe dorsum of Lhe
fooL Lo Lhe proxlmal end of Lhe 1sL lnLermeLaLarsal
space
Ŵ trm|nat¾ |ntoť
4 1
sL
dorsal meLaLarsal arLerv
4 deep planLar arLerv

Ŵ lles aaalnsL Lhe bones and llaamenLs of Lhe dorsum
Ŵ crossed near lLs LermlnaLlon bv Lhe Lendon of LP8
muscle
Ŵ accom½any|ng ¾trctrť
4 aL lLs laLeral sldeť medlal branch of Lhe deep
peroneal nerve
4 2 venae comlLanLes

Ŵ 8ranch¾ť
1Ŧ |atra| tar¾a| artry
4 arlses over Lhe navlcular bone and supplles
Lhe Lu8 muscle
4 anasLomose wlLh Lhe branches of arcuaLe
arLervţ anLerlor laLeral malleolar arLervţ
laLeral planLar arLerv and Lhe perforaLlna
branches of flbular arLerv
2Ŧ md|a| tar¾a| artry
4 composed of 2 or 3 branches whlch ramlfv
ln Lhe medlal border of Lhe fooL
4 anasLomose wlLh Lhe medlal malleolar
arLerv

3Ŧ arcat artry
4 laraesL branch
4 arlses aL Lhe level of Lhe bases of Lhe
meLaLarsal bones
4 beneaLh Lhe Lendons of LuL and Lu8 muscle
116 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 anasLomose wlLh Lhe laLeral Larsal and
laLeral planLar arLerles
4 alvesŴoff 3 dorsal meLaLarsal arLerv


2 dorsal dlalLal arLerv
O ha¾ a md|a| and |atra| branch¾
|ocatd at th md|a| and |atra|
¾|d of th to¾
O ¾½½||¾ th ad[acnt ¾|d of th
to¾

4
Lh
dorsal meLaLarsal arLerv alves off
addlLlonal branch Lo Lhe laLeral slde of
Lhe 3
Lh
Loe

dor¾a| mtatar¾a| artry

g|v¾ branch¾ |nto
¾ma|| ½o¾tŦ ½rforat|ng branch antr|or ½rforat|ng branch
Nj ana¾tomo¾ w|th Nj
½|antar arch ½|antar mtatar¾a| artry

4Ŧ 1
¾t
dor¾a| mtatar¾a| artry
4 same wlLh Lhe oLher dorsal meLaLarsal
arLerv whlch dlvldes lnLo 2 Lo supplv Lhe
ad[acenL slde of Lhe 1
sL
and 2
nd
Loes
4 alvesŴoff a branch whlch crosses Lhe 1
sL

meLaLarsal bone beneaLh Lhe Lendon of LPL
Lo supplv Lhe medlal slde of Lhe areaL Loe

notť lL ls belleved LhaL Lhe posLerlor perforaLlna
branch wlll evenLuallv enlaraed Lo become Lhe deep
planLar arLerv

5Ŧ d½ ½|antar artry
4 conLlnuaLlon of Lhe dorsalls pedls arLerv
4 enlaraemenL of posLŦ perforaLlna branch of
1
sL
dorsal meLaLarsal arLerv
4 cor¾ť descends lnLo Lhe sole of Lhe fooL
bvpasslna beLween Lhe 2 heads of orlaln of
Lhe 1
sL
dorsal lnLerosseous muscle
4 unlLe wlLh Lhe laLeral planLar arLerv formlna
Lhe planLar arch
4 deep planLar + laLeral planLar arLerv ƹ
planLar arch

ÞLAN1Ak Ak1LkIAL AkCn
Ŵ comparable wlLh Lhe deep palmar arLerlal arLerv
Ŵ conLlnues wlLh Lhe laLeral planLar arLerv and
compleLed medlallv bv lLs unlon wlLh Lhe deep
planLar arLerv of Lhe dorsalls pedls arLerv
Ŵ 80Ʒ of casesţ formed prlmarllv bv Lhe deep planLar
of Lhe dorsalls pedls
Ŵ usuallv convex forwards and lles across Lhe bases of
Lhe meLaLarsal bones and Lhe orlaln of Lhe
lnLerosseus muscle
Ŵ ½|antar ¾|dť locaLed deep lnLo Lhe adducLor hallucls
muscle
Ŵ g|v¾ offť
aŦ 4 planLar meLaLarsal arLerv
bŦ 3 perforaLlna arLerv
cŦ Lwlas Lo Lhe Larsal [olnLs and muscle of Lhe
comparLmenL
dŦ palr of planLar dlalLal arLerv

ANA51CMC5I5
1Ŧ crc|at ana¾tomo¾|¾
Ŵ around Lhe hlp [olnL

aŦ lnferlor aluLeal branch of Lhe lnLernal lllac arLerv
anasLomose wlLh Lhe medlal and laLeral clrcumflex
arLerv of Lhe femoral arLerv
bŦ obLuraLor arLerv anaLomose wlLh medlal femoral
clrcumflex arLerv
cŦ publc branch of obLuraLor arLerv + publc branch of
Lhe deep lnferlor eplaasLlc arLerv
dŦ exLernal pudendal arLerv + lnLernal pudendal
arLerv

Ŵ ccť obsLrucLlon of femoral arLerv aL proxlmal parL
of Lhe Lhlah lj cruclaLe anasLomosls wlll Lake over



2Ŧ gn|c|ar ana¾tomo¾|¾
Ŵ around Lhe knee [olnL
aŦ descendlna branch of Lhe laLeral femoral
clrcumflex arLerv
bŦ descendlna aenlcular branch of femoral arLerv
cŦ popllLeal arLerv lj medlal superlor aenlcular
arLervţ laLeral superlor aenlcular arLervţ medlal
lnferlor aenlcular arLervţ laLeral lnferlor aenlcular
arLerv and mlddle aenlcular arLerv
from b|owť
dŦ posLerlor Llblal recurrenL arLerv Ŷ from anLerlor
Llblal arLerv)
117 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

eŦ clrcumflex flbular arLerv Ŷ from posLerlor Llblal
arLerv
fŦ anLerlor Llblal recurrenL arLerv

3Ŧ ana¾tomo¾|¾ abov t|b|oŴf|b|ar ¾ynd¾mo¾|¾
aŦ communlcaLlna flbular arLerv
bŦ posLerlor Llblal arLerv
cŦ perforaLlna branch of flbular arLerv
dŦ anLerlor laLeral malleolar arLerv

4Ŧ ma||o|ar ana¾tomo¾|¾
Ŵ around medlal and laLeral malleolus

aŦ medlal malleolar arLerv especlallv anLerlor medlal
malleolar arLerv
bŦ anLerlor laLeral malleolar arLerv anasLomose wlLh
posLerlor malleolar arLerv whlch dlvldes lnLo laLeral
and medlal branch
cŦ medlal Larsal arLerv
dŦ medlal calcaneal arLerv

5Ŧ ana¾tomo¾|¾ at |atra| dor¾m of foot
aŦ perforaLlna branch of flbular arLerv
bŦ laLeral anLerlor malleolar arLerv

Ŵ lmporLanL ln obsLrucLlon Ŷ serves as collaLeral
clrculaLlon

VLNCU5 DkAINAGL
Ŵ |atra| ma||o|ar ¾|d
4 laLeral venous plexus [oln Lo form Lhe shorL
saphaneous veln lj popllLeal veln

Ŵ md|a| ma||o|ar ¾|d
4 dorsal venous arch lj [oln LoaeLher Lo form Lhe
areaL saphenous veln
kADICGkAÞn CI LCWLk LLG
(DrŦ Aragon)

DIIILkLN1 MCDALI1IL5
Ŵ xŴray
4 2 dlmenslonal Ŷ hL and wL (no depLh)
4 deLermlne allanmenL of bones
4 verv llLLle help ln smooLh Llssuesţ arLerles and
velns
4 90Ʒ used ln bones

Ŵ dtrm|n mta|¾ ½r¾nt
4 wlresţ meLalllc plns
4 meLal flxaLor
4 meLal screw Ŷ small compared Lo acLual slze

Ŵ dtrm|n fractr¾
4 deformlLles forms bonv brldae/ bonv calus






Ŵ Þ vlew + laLeral vlew ƹ rlahL anale (90' relaLlonshlp)
Ŵ 8vţ musclesţ llaamenLsţ Lendonsţ Ln Ŷ noL vlslble
Ŵ ¾f|n¾¾ť
4 calclfled bones
carLllaalnous sLrucLuresŶ radloluscenL
small rounded bones defecLs Ŷ deLermlne
prevlous locaLlon of meLabollc screw

4 deLermlne allanmenL of [olnLsţ noL for sofL
Llssues

Ŵ r½a|rť bon
4 lf arLerv ls severed Ŵ no polnL of repalr Ŷ so
ampuLaLe
4 exLenslve fracLure Ŷ Llssue unperfused
4 ½hy¾|ca| a¾¾¾¾mntť lnspecLţ percussţ palpaLeţ
ausculLaLe
4 |n¾½ct co|or
dark arav/ cvanoLlc
plnklsh Ŷ aood blood supplv

4 ½a|½at Ŷ dor¾a||¾ ½d|¾ artry
where Lo deLecL pulsaLlon
equal on boLh rlahL and lefL Ŷ aood arLerlal
flow
swollen Ŷ dlfflculL Lo palpaLe arLerles

IMAGING LkAMINA1ICN
1Ŧ Co|or Do½½|r U12
wlLh color flow deLecLor
(+) blood flow Ŷ show as color slanal Lhrouah LhaL
vessel
b|ood f|owť from femoral arLerv lj popllLeal arLerv
lj Llblal arLerv lj dorsalls pedls
rlahL and lefL can be comopared
118 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

arLerles wlLh accompanvlna velns
show color slanal whlch ls red and blue (buL Lhe
equlpmenL wlll noL Lell us wheLher red ls arLerv or
blue ls veln)
co|or Ŷ dependenL on dlrecLlon of blood flow
4 Lowards Lransducer Ŷ red
4 awav from Lransducer Ŷ blue
4 color comes on and off dependlna on
resplraLlon of paLlenL (wheLher lnsplraLlon/
explraLlon)

anaLomlcallvţ Lhe pulsaLlon of arLerv corresponds
Lo pulsaLlons of Lhe hearL
pulsaLlon of veln Ŷ doesn'L correspond Lo hearL
pulsaLlon
compresslon of Lransducer of arLerv and veln
4 llLLle pressure Ŷ collapse of veln
4 caroLld Ŷ more reslllenL vs [uaular veln Ŷ easv
Lo collapse

color flow doppler can also be used ln examlnlna
llaamenLsţ Lendons and parLs of muscles
noL alwavs 100Ʒ correcL

2Ŧ Artr|ogram
½r|nc|½|ť use needle Llp lj lnLo lumen lj ln[ecL
radloacLlve maLerlal (P
2
C soluble lodlne) lj aeL
radloaraphs lj made easler wlLh conLlnuous ClnL
lmaalna (llke vldeo) Lo deLermlneť
4 conLlnulLv of blood supplv
4 leakaae
4 where Lo ampuLaLe
4 lf lea can sLlll be saved

3Ŧ C1 ang|ogra½hy
done ln 10Ŵ13 mlnuLes
4Ŧ MkI ang|ogra½hy
uLlllzed maaneLlsm
advť no conLrasL maLerlal needed
d|¾advť lonaer Llme (30 mln or more)ţ canL be used
lf paLlenL has meLalllc lmplanLs such as screw

5Ŧ Nc|ar |mag|ng
noL use Lo ldenflLv anLomlc sLrucLures
can deLermlne abnormallLles such as lnfecLlons
and mallananL Lumors
can deLermlne Lumor and lnfecLlon earller
compared Lo convenLlonal xŴrav

6Ŧ U|tra¾ond
yongr ag gro½
4 bables ln uLero/ Lo be dellvered
4 moLher ls examlned Ŷ deLermlne C of Lhe
babv
4 deLermlne aae of babv especlallv 2
nd
and 3
rd

LrlmesLer uslna skeleLal svsLem parLlcularlvť
O calcarlum (head)
O femur
O lenaLh of Llbla

4 blomeLrv of feLuses
O 38
Lh
weeks Ŷ dlsLal femoral eplphvsls
O 36
Lh
weeks Ŷ proxlmal Llblal osslflcaLlon
cenLer

dtrm|n |f baby |¾ matr or |mmatr dr|ng
th t|m of b|rth
4 scroLum Ŷ darker Lhan skln wlLh wrlnkles Ŷ
bevond 38
Lh
week (maLure)
4 aL blrLh Ŷ 2 osslflcaLlon cenLers
O calcaneus
O Lalus
O hand Ŷ caplLaLe (2
nd
and 3
rd
mos)

chrono|og|ca| ag ¾ho|d corr¾½ond to ¾k|ta|
matrat|on
4 eplphvsls Ŷ open Ŷ (+) arowLh
4 lf close Ŷ (Ŵ) arowLh
O can be lenaLhened Lhrouah suralcal
procedure




kNLL
O Þ and laLeral vlew
O speclal vlews needed because lf Þ vlew onlv dlfflculL
Lo evaluaLe and can'L deLermlne preclse sunrlse vlew
O ¾½c|a| v|wť 5k¥LINL VILW/ 5UNkI5L VILW
4 for paLella Ŷ flexed knee and puL radloaraphlc
faceL
4 behlnd paLella Ŷ (+) paLellofemoral [L space
4 fab||a Ŷ presenL ln 10Ʒ of all normal knees
normal anaLomlcal varlanLţ small cousln of
paLella
119 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

osslflcaLlon Ŷ close Lo posLerlor maraln of
femoral condvleţ abouL 1 cm
lf more Lhan 1 cmţ (+) accumulaLlon of
svnovlal fluld 2' Lo lnfecLlonţ Lumorţ hae d/L
Lrauma

ICC1
O ºdorsoplanLar" vlew
O overlap of dlsLal Llbla and flbula
O examlne Lalus and calcaneus Ŷ sepŦ laLeral radloaraph
and ankle [olnL
O deLermlne fracLure Ŷ dlfflculL Lo deLermlne Lalus and
calcaneus
O C1 Ŷ more senslLlve
O c||n|ca| corr|at|onť
4 Nj Ŵ 8CLPLL8'S nLL
4 noL less Lhan 28'
4 lf less Lhan Ŷ hlsLorv of Lraumaţ (+) fracLure

NC1Lť noL all Lhlnas LhaL are normal and abnormal are
shown bv lmaalnf modallLles
















ANA1CM¥ CI 1nL LLG
(DrŦ Ab|og)

8CNL
1Ŧ 1|b|a
O shln bone
O 2
nd
laraesL bone (femur Ŷ laraesL)
O proxlmal Ŷ medlal and laLeral condvles
O shafL Ŷ anLerlor border
4 broadţ convexţ smooLh medlal surfaces and
laLeral lnLerosseous border
O lower Ŷ medlal malleolusţ arLlcular surface for
Lalusţ posLerlor aroove of lPL

2Ŧ I|b|a
O calf bone
O mosL slender of lone bones
O proxlmal Ŷ head wlLh superlor arLlcular surfaces
(sLvlold process)
O shafL Ŷ 3 borders and 3 surfaces
O dlsLal Ŷ laLeral malleolus

notť Llbloflbular [olnL lS nC1 a parL of knee [olnL
Ŵ lnLerosseous membrane forms parL of Lhe [olnL

ICIN15
1Ŧ 5½r|or t|b|of|b|ar [o|nt
O dlarLhrodlal Lvpe ƹ alldlna Lvpe

2Ŧ Intro¾¾o¾ mmbran
O ty½ of [o|ntť svnarLhrosls or svndesmosls
O flber lncllned downward and laLeralward from Lhe
laLeral border of Llbla Lo anLeromedlal border of
flbula

3Ŧ Infr|or t|b|of|b|ar [o|nt
O ty½ of [o|ntť svndesmosls
O noL alldlna because of Lhe presence of 4 llaamenLsť
4 anLerlor lnferlor Llbloflbular llaamenL
4 posLerlor lnferlor Llbloflbular llaamenL
4 lnLerosseous llaamenL (maln reason for belna
svndesmosls)
4 lnferlor Lransverse llaamenL

O spasms of ankle does noL ln[ure Lhe llaamenL


c||n|ca| corr|at|onť hlah ankle spraln
Ŵ Lhe llaamenLs are desLroved ƹ lonaer paln Lhan Lhe
normal ankle spraln where Lhe llaamenLs are noL
desLroved
Ŵ t¾tť Squeeze 1esL
4 lf Lhere ls a Learţ Lhe dlsLal porLlon opens up
4 ln[urles all sLablllzlna/ supporLlna llaŦ

CCMÞAk1MLN15 CI 1nL LLG (12 m¾c|¾)
120 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2


1Ŧ antr|or (4)
O bounded bv Llblaţ flbulaţ lnLerosseous membraneţ
anLerlor lnLermuscular sepLum

a) t|b|a||¾ antr|or
nearesL Lo Llblal bone
|n¾rt|onť medlal and lnferlor surfaces of
medlal cunelform and base of 1sL meLaLarsal
act|onť dorslflexes ankleţ lnverLs fooL
|nnrvat|onť deep flbular (peroneal) nerve (L4
and L3)

b) xtn¾or d|g|torm |ong¾
|n¾rt|onť mlddle and dlsLal phalanaes of
laLeral four dlalLs
act|onť exLends laLeral 4 dlalLs and dorslflex
ankle
|nnrvat|onť deep flbular (peroneal) nerve (L3Ŵ
S1)

c) xtn¾or ha||c|¾ |ong¾
|n¾rt|onť dorsal aspecL of base of dlsLal
phalanae of areaL Loe
act|onť exLends areaL Loe and dorslflex ankle
|nnrvat|onť deep flbular (peroneal) nerve (L3Ŵ
S1)

d) f|b|ar|¾ tr¾|¾
|n¾rt|onť dorsum of base of 3
Lh
meLaLarsal
act|onť dorslflexes ankle and alds ln everslon
of fooL
|nnrvat|onť deep flbular (peroneal) nerve (L3Ŵ
S1)

c||n|ca| corr|at|onť mosL danaerous comparLmenL Ŵ
presence of 8v and nerves
4 swelllna Ŷ lmplnaemenL of sLrucLure
4 lmplnaemenL of anLerlor Llblal nerve or deep
peroneal/ flbular nerve
4 tratmntť lSClC1CM? Ŷ openlna of Lhe fascla Lo
LreaL Lhe underlvlna lmplnaemenL of Lhe nerve/
arLerv

2Ŧ |atra| com½artmnt (2)
O act|onť fooL everslonţ weak planLarflexor

a) f|b|ar|¾ |ong¾
|n¾rt|onť base of 3
Lh
meLaLarsal and laLeral
cunelform
blaaer

b) f|b|ar|¾ brv|¾
|n¾rt|onť dorsal surface of LuberoslLv of
laLeral slde of base of 3
Lh
meLaLarsal
smaller

3Ŧ ½o¾tr|or com½artmnt (6)
Ŵ Lransverse lnLermuscular sepLum Ŷ dlvldes lL lnLo
superflclal and deep

a) ¾½rf|c|a| (3)
|n¾rt|onť posLerlor surface of calcaneus vla
calcaneal Lendon
|nnrvat|onť Llblal nerve (S1 and S2)
tr|c½¾ ¾rať
4 head of aasLrocnemlus
4 head of soleus
4 head of planLarls

ga¾trocnm|¾
Ŵ 2 heads from condvles of femur (laLeral
and medlal)
Ŵ b|art|c|ar m¾c| Ŷ crosses knee and
ankle [olnL
Ŵ act|onť planLar flexor
lf fooL ls anchored on around ƹ knee
exLensor
lf fooL ls free ƹ knee flexor

½|antar|¾
Ŵ ln beLween aasLrocnemlus and soleus
Ŵ 2Ŵ4 ln lona
Ŵ Lendon ls Lhe one seen durlna dlssecLlon
(lonaer Lhan Lhe muscle)
Ŵ act|onť planLar flexor (effecL ls weaker as
compared Lo aasLrocnemlus)
Ŵ b|art|c|ar com½onntť crosses knee and
ankle [olnL
Ŵ aL laLeral supracondvlar bone
Ŵ |n¾rt|onť calcaneus

¾o|¾
Ŵ monoarLlcular
Ŵ act|onť planLar flexor and sLablllzes Lhe
fooL or ankle
121 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2


b) d½ com½artmnt
f|xor d|g|torm |ong¾
Ŵ medlallv locaLed
Ŵ lnserLs ln Lhe laLeral 4 dlalLs

t|b|a||¾ ½o¾tr|or
Ŵ d|¾ta| attachmntť LuberoslLv of navlcularţ
cunelformţ cubold and bases of 2
nd
ţ 3
rd

and 4
Lh
meLaLarsals
&because of Lhese lnserLlons Ŷ lL anchors
muscle of Lhe lea

Ŵ dvnamlcallv speaklnaţ lL ls responslble for
Lhe medlal arch
Ŵ wakn¾¾ť flaLfooLednessţ pronaLed fooLţ
pes planus
8unner's lea Ŷ sLraln of Llblalls posLerlor

Ŵ 2 ma|n act|onť
4 planLar flexor Ŷ passes behlnd Lhe
medlal malleolus ƽ ankle [olnL
4 fooL lnverLor Ŷ because lL ls medlallv
locaLed

f|xor ha||c|¾ |ong¾
Ŵ laLerallv aolna Lo medlal
Ŵ |n¾rt¾ Lo Lhe bla Loe
Ŵ or|g|nť laLeral porLlon of Lhe lea








ANkLL AND ICC1
(DrŦ Ab|og)

1Ak5AL (7)
O 1alus Ŷ ankle bone
O Calcaneus Ŷ heel bone
O navlcular Ŷ boaLŴshaped
O Cubold
O 3 Cunelform (medlalţ lnLermedlaLeţ laLeral) Ŷ wedae
shape

ML1A1Ak5AL (5)
ÞnALANGL5 (14)

ICIN15
aŦ Lalocalcaneal/ subLalar [olnL
bŦ Lalonavlcular [olnL
cŦ calcaneocubold [olnL
dŦ LarsomeLaLarsal [olnL
eŦ meLaLarsophalanaeal [olnL
fŦ lnLerphalanaeal [olnL
aŦ proxlmal lnLerphalanaeal [olnL
hŦ dlsLal lnLerphalanaeal [olnL

kL1INACULUM
1Ŧ Lxtn¾or rt|nac|a
O holds exLensor Lendon ln place
O prevenLs bow sLrlnalna of Lhe Lendons

a) ¾½r|or (tran¾vr¾ crra|)
b) |nfr|or (crc|at crra|)
Ŵ superflclal Ŷ ?Ŵshape
Ŵ deep

2Ŧ I|b|ar (½rona|) rt|nac|m
O laLeral aspecL
O holds Lhe flbularls muscle (brevls and lonaus) ln
place
O ¾½r|or f|b|ar rt|nac|m Ŷ prevenL
bowsLrlnalna
O |nfr|or f|b|ar rt|nac|m Ŷ [olns Lhe superlor
parL of Lhe lnferlor exLensor reLlnaculum
O fasLens 2 Lendons Ŷ prevenLs bow sLrlnalna of
Lhe Lendon

3Ŧ I|xor rt|nac|m (Lac|n|at ||gamnt)
O holds flexor Lendon ln place
O convrt¾ bony groov¾ |nto 4 o¾¾of|bro¾
cana|¾ for th fo||ow|ng ¾trctr (md|a| to
|atra|)ť
aŦ Lendon of Llblalls posLerlor
bŦ Lendon of Lhe luL
cŦ posLerlor Llblal arLerv and veln
dŦ Llblal nerve
eŦ Lendon of Lhe lPL

O c||n|ca| corr|at|onť
122 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 C¾¾of|bro¾ cana| Ŷ passaaewav of
posLerlor Llblal nerve
4 senslLlve Lo pressureţ swelllnaţ 8Sť
lmplnaemenL of Lhe posLerlor Llblal nerve
4 1Ak5AL 1UNNLL 5¥NDkCML

ANkLL ICIN1

aŦ 1ALC1I8IAL (1ALCCkUkALţ ANkLL MCk1I5L) ICIN1
Lalus arLlculaLes wlLh Lhe dlsLal Llbla
bon¾ť
1Ŧ md|a| ma||o|¾ Ŷ dlsLal conLlnuaLlon of Lhe
Llbla

2Ŧ |atra| ma||o|¾ Ŷ dlsLal conLlnuaLlon of Lhe
flbula
neck (flbula) Ŷ where common peroneal
nerve wlll hook around
lower

1 and 2 arlps Lhe Lalus

3Ŧ ta|¾
mechanlcal kevsLone aL Lhe apex of Lhe
fooL
aŦkŦaŦ S18LuS
pecullarlLv Ŷ no muscle lnserLed here
3 ½art¾ť
a) had Ŷ ln fronLţ arLlculaLes wlLh
navlcular and calcaneus formlna
Lalonavlcular and Lalocalcaneus [olnL
b) nck Ŷ consLrlcLlon beLween head
and bodv
c) body Ŷ resLs on Lhe anLerlor parL of
Lhe calcaneus

1kCCnLLA
O under c)
O means ºpullev"
O superlorţ posLerlor parL of Lalus

ŧbodv
superlor surface and boLh sldes of bodv
supporL and arLlculaLes wlLh Lhe Llbla and
flbula
2 sldes are arlpped beLween Lhe Llbla
(medlal) and flbula (laLeral) malleolus LhaL
forms Lhe ankle morLlse
4 wlLhln Lhls morLlseţ Lalus funcLlon as a
hlnae [olnL

posLerlorlvţ has a medlal and laLeral
Lubercles wlLh lnLervenlna aroove for lPL
Lendon
lnferlorlv has a deep aroove Ŷ 5ULCU5
1ALI

ty½ of d|arthrod|a| [o|ntť alnalvmus (hlnae)
4 mot|on a|ong th ¾ag|tta| ½|an and
tran¾vr¾ ax|¾
neuLral poslLlonť 90'
O dorslflexlon Ŷ 0Ŵ20'
O planLar flexlon Ŷ 0Ŵ30'

4 mot|on a|ong corona| ½|an and |ong|td|na|
ax|¾
O everslon Ŷ laLeral surface moves upward
O lnverslon Ŷ medlal surface moves upward

bŦ 1ALCCALCANLAL (5U81ALAk) ICIN1
[olnLs below Lhe Lalus ln relaLlon Lo Lhe calcaneus
bon¾ť Lalus and calcaneus
ty½ of [o|ntť arLhrodlal (plane and alldlna)
movmnt abot th |ong|td|na| ax|¾ť
lnverslon Ŷ elevaLlon of Lhe medlal border and
depresslon of Lhe laLeral border of Lhe fooL
everslon

cŦ 1ALCNAVICULAk CI 1nL 1CN ICIN1 AND
CALCANLCCU8CID ICIN1
anLerlorlvţ suralcal Larsal [olnL
LoaeLher wlLh Lhe Lalocalcaneal [olnL lL forms Lhe
mldLarsal [olnL/ Lransverse Larsal [olnL
aŦkŦaŦ ChoparL'sţ mldLarsalţ Lransverse Larsal [olnL
bon¾ť
Lalusţ navlcular and parLlv calcaneus
calcaneus and cubold

ty½ of d|arthrod|a| [o|ntť arLhrodlal (planeţ
alldlna) Ŵ nonŴaxlal
movmntť
lnverslon/ everslon
parLlv adducLlon/ abducLlon

CCMÞLLk MCVLMLN15 CIť
5UÞINA1ICN ÞkCNA1ICN
123 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

lnverslon
planLarflexlon
adducLlon
everslon
dorslflexlon
abducLlon

5UMMAk¥ CI ANkLL/ ICC1 MCVLMLN15
ÞLAN1Ak ILLkCk5 Ŷ tran¾vr¾ ax|¾
O ga¾trocnm|¾*
O ¾o|¾*
O Llblalls posLerlor
O flexor hallucls lonaus
O flexor dlalLorum lonaus
O peroneus lonaus Ŷ runnlna behlnd Lhe laLeral
malleolus
O peroneus brevls
O planLarls
DCk5IILLkCk5
O t|b|a||¾ antr|or*
O exLensor dlalLorum lonaus
O exLensor hallucls lonaus
O peroneus LerLlus Ŷ small broLher of LuL
INVLk1Ck5
O t|b|a||¾ antr|or*
O t|b|a||¾ ½o¾tr|or*
O flexor hallucls lonaus
O flexor dlalLorum lonaus
O exLensor hallucls lonaus
LVLk1Ck5
O ½ron¾ brv|¾*
O ½ron¾ |ong¾*
O peroneus LerLlus
O exLensor dlalLorum lonaus

LIGAMLN1
lmporLanL ln sLablllzlna Lhe LaloLlblal [olnL

1Ŧ md|a| co||atra| ||gamnt (D|to|d)
a) anLerlor and posLerlor LlbloLalar llaamenL
b) Llblonavlcular llaamenL
c) Llblocalcaneal llaamenL

O proLecLs one from ln[urv
O (+) fractr/ ¾½ra|nť ÞC11'S fracLure (break MCL)

2Ŧ |atra| co||atra| ||gamnt
a) anLerlor Laloflbular llaamenL
b) posLerlor Laloflbular llaamenL
c) calcaneoflbular llaamenL Ŷ mosL lnferlor
connecLlon

c||n|ca| corr|at|onť
O hlah spraln ln[urv Ŷ posLerlor lnferlor Llbloflbular
and anLerlor lnferlor Llbloflbular llaamenL breaks
O 83'Ŵ 90' ankle spraln Ŷ lnvolvemenL of Lhe anLerlor
Laloflbular llaamenL (lnverslon spraln)
4 planLarflexlon wlLh lnverslon Ŷ sacrlflclal
spraln

8CW51kING LIGAMLN1
aŦ planLar calcaneonavlcular llaamenL
O aŦkŦaŦ sprlna llaamenL
O susLenLacular llaamenL Ŵ aLLached Lo ÞCn
O ma[or conLrlbuLor Lo Lhe mlddle planLar arch
O (+) loosenessť collapse Ŷ lL1lCC1

bŦ planLar calcaneocubold llaamenL/ shorL planLar
llaamenL

cŦ lona planLar llaamenL

ANkLL INIUkIL5
23Ʒ of runnlna and [umplna ln[urles
33Ʒ of baskeLball ln[urles
|nvo|v¾ť
aŦ antr|or ta|of|b|ar ||gamnt
O 6Ŵ10 mm wldeţ 20 mm lonaţ 2 mm Lhlck
O dlrecLlon follows Lhe fooL
O lncreased sLraln wlLh lncrease planLar flexlon
O weakesL llaamenL Ŷ dlsrupLs aL forces beLween
6Ŵ36 ka

bŦ ca|canof|b|ar ||gamnt
O 20Ŵ23 mm lonaţ 6Ŵ8 mm dm
O brldaes boLh ankleŧ
O lncreased sLraln ln dorslflexlon
O 2
nd
weakesL llaamenL



cŦ ½o¾tr|or ta|of|b|ar ||gamnt
O areaLesL Lenslon when ankle ls dorslflexed
O LhlckesL of Lhe 3 LCL

Mchan|¾m of |n[ryť
O planLarflexlon and lnverslon can ln[ure 1lL and
furLher lnverslon wlll lead Lo oLher llaamenLal
lnsLablllLles

124 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

ICC1
evolved from Lhe flexlble arasplna oraan of Lhe
arboreal preŴhuman Lo Lhe relaLlvelv rlald welahLŴ
bearlna plaLform of Lhe human
mosL dlsLlncLlv human parL of man's anaLomv and
commenLs LhaL ls Lhe hallmark LhaL separaLes hlm from
all Lhe oLher members of Lhe anlmal klnadom
pes (fooL) vsŦ Lallpes (conaenlLal fooL abnormallLles)
2 ¾rfac¾ť planLar and dorsal
2 bordr¾ť medlal (Llblal) and laLeral (flbular)
bla/ areaL Loeť hallux
O Loes are numbered bealnnlna wlLh Lhe bla Loe
(dlalL l)
O llLLle Loe (dlalL v) Ŷ dlalLus mlnlmus (llLLlesL Loe)

5rfac Anatomy
|nc|d¾ 33/34 [o|nt¾ť
Lalocalcaneal [olnL
Lalonavlcular [olnL
LarsomeLaLarsal [olnL (1Ŵ3)
meLaLarsalphalanaeal [olnL
lnLerphalanaeal [olnL
4 1
sL
Ŷ hallux (no ÞlÞ and ulÞ)
4 ÞlÞ and ulÞ Ŷ 2
nd
Ŵ3
Lh
dlalLs

26 bon¾ť
7 Larsal bone
3 meLaLarsal bone
14 phalanaes

ŧ Lo form a halfŴdome
ha|fŴdom |¾ k½t from f|attn|ng byť
aŦ llaamenLs
bŦ planLar aponeurosls
cŦ Lendons of Lhe fooL exLrlnslc
dŦ lnLrlnslc muscles of Lhe fooL



3 fnct|ona| ¾gmnt¾ť

aŦ ½o¾tr|or (h|ndfoot)
lles dlrecLlv under Lhe Llbla and supporL lL
Lalus (aL Lhe apex of Lhe fooL) and calcaneus
(hlnd porLlon of Lhe fooL ln conLacL wlLh Lhe
around)
bŦ m|dd| (m|dfoot)
3 Larsal bones LhaL form as lrreaular rhombold
wlLh medlal base and laLeral apex
navlcularţ cubold and 3 cunelforms
cŦ antr|or (forfoot)
3 meLaLarsal bones
14 phalanaeal bones
bla Loe or hallux or dlalL 1 Ŷ has 2 phalanaes
oLher laLeral Loe Ŷ dlalLs llŴv have 3 each

Arch¾ of th Ioot

1Ŧ |ong|td|na| Ŷ 2 columns of bone

aŦ md|a|
calcaneus lj Lalus lj navlcular lj 3 cunelforms
lj 3 medlal meLaLarsals
mosL lmporLanLť lL bears mosL of Lhe welahL

bŦ |atra|
calcaneus lj cubold lj laLeral meLaLarsal
balances welahL

2Ŧ tran¾vr¾

















ICIN15 CI 1nL ANkLL AND ICC1
Ŵ Lalocrural (LaloLlblal)
Ŵ subLalar (Lalocalcaneal)
Ŵ Lalonavlcular and calcaneocubold
abducLlon and adducLlon
parLlv lnverslon and everslon

Ŵ calcaneonavlcular
125 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

Ŵ 3 LarsomeLaLarsal
Ŵ 3 meLaLarsophalanaeal
Ŵ lnLerphalanaeal [oln
ÞlÞ
ulÞ

1ran¾vr¾ 1ar¾a| Io|nt
Ŵ aka suraeons Larsal [olnL/ mldLarsal [olnL/ ChoparL's
[olnL
Ŵ conslsL of Lalonavlcular [olnL and calcaneocubold
[olnL
Ŵ used Lo be a pracLlce of suraeons Lo ampuLaLe ln Lhls
parL
Ŵ noL ldeal level of ampuLaLlon
Lendencv of Lhe fooL Lo planLarflexed because of
Lhe sLrona pull of aasLrocnemlus

1ar¾omtatar¾a| Io|nt
Ŵ aka Llsfrank's [olnL
Ŵ planLar flexlon problem

Typ¢ of )oint Action
Subtalar Þlane Lvpe of
svnovlal [olnL
lnverslon/
everslon
Talocalcan¢o
navicular
Svnovlal [olnL
1alonavlcular
parL ls ball and
sockeL

lldlna and
roLaLor
movemenLs
are posslble
Calcan¢ocuboid Þlane Lvpe of
svnovlal [onL
lnverslon/
everslon
Tarsom¢tatarsal Þlane Lvpe of
svnovlal [olnL
lldlna or
slldlna
Int¢rm¢tatarsal Þlane Lvpe of
svnovlal [olnL
lldlna or
slldlna
M¢tatarsopbalang¢al Condvlold Lvpe
of svnovlal [olnL
llexlon/
exLenslon
some
abducLlon/
adducLlon
I nt¢rpbalang¢al Plnae Lvpe of
svnovlal [olnL
llexlon/
exLenslon
D¢gr¢¢s of Fr¢¢dom Diartbrodial
Non-axial lldlna/ lrreaular/ plane
[olnL/ arLhrodlal
0ni-axial 1rochold (plvoL)ţ alnalvmus
(hlnae)
Bi-axial Condvlold
Tii-axial 8all and sockeL

I|r¾t Layr of Ioot Intr|n¾|c¾
O abdctor ha||c|¾
4 abducLs bla Loe
4 medlallv locaLed
4 nrvť medlal planLar nerve

O f|xor d|g|torm brv|¾
O abdctor d|g|t| m|n|m|
4 laLeral porLlon
4 nrvť laLeral plaLar nerve

5cond Layr
O qadrat¾ ½|anta
4 nrvť laLeral planLar nerve

O |mbr|ca|¾
4 boLh medlal and laLeral planaLr nerve

O tndon of IDL
O tndodn of InL

1h|rd Layr
O In8
4 (+) ln handť flexor dlalLl mlnlml

O addctor ha||c|¾
4 obllque head
4 Lransverse head

O f|xor d|g|t| m|n|m| brv|¾

Iorth Layr
O ½|antar |ntro¾¾o¾ m¾c|¾
O dor¾a| |ntro¾¾o¾ m¾c|¾
O tndon of t|b|a||¾ ½o¾tr|or
O tndon of f|b|ar|¾/ ½ron¾ |ong¾




Intr|n¾|c M¾c| of th Dor¾m of th Ioot
O xtn¾or ha||c|¾ brv|¾
4 noL alwavs presenL

O xtn¾or d|g|torm brv|¾
O dor¾a| |ntro¾¾| Ŵ 4
alwavs presenL
126 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2


C||n|ca| Corr|at|onť
na||x vag¾
Ŵ aka bunlon
Ŵ laLeral devlaLlon of Lhe areaL Loe
Ŵ older Ŷ roLaLe and adducL furLher
produclna paln aL Lhe meLaLarsal area
ML118SL!l

nammr 1o¾
Ŵ deformlLv ln whlch Lhe proxlmal phalanae ls
permanenLlv flexed aL Lhe meLaLarsophalanaeal [olnL
and Lhe mlddle phalanx ls planLarflexed aL Lhe
lnLerphalanaeal [olnL

C|aw 1o¾
Ŵ characLerlzed bv hvperLenslon of Lhe
meLaLarsophalanaeal [olnL and flexlon of Lhe dlsLal

Ca||¾
Ŵ hardenlna/ Lhlckenlna of keraLlnlzed skln

C|b foot
Ŵ aka Lallpes equlnovarus
Ŵ charactr|¾t|c f|nd|ng¾ť
equlnus deformlLv
pes varus
calcaneus lnverLed
shorLened heel cord of chllles Lendon

Common Ioot Dform|ty
1Ŧ Þ¾ q|n¾
fooL ln planLarflexlon
LlahL Llblalls posLerlor
walk wlLh meLaLarsal

2Ŧ Þ¾ ca|can¾
LlahL Llblalls anLerlor
walklna ln vour calcaneus


3Ŧ Þ¾ va|g¾
medlal slde of fooL

4Ŧ Þ¾ var¾
laLeral slde of Lhe fooL

5Ŧ Þ¾ cav¾
hlah medlal arch

6Ŧ Þ¾ ½|an¾
flaLŴfooLednessţ pronaLed fooL
flaLLened arach

Nrom¾c|ar and M¾c|o¾k|ta| Corr|at|on

Þract|c
Ŵ slnale mosL lmporLanL varlable ln learnlna wlLh moLor
Lask
Ŵ Lhe amounLţ Lvpe and varlablllLv of pracLlce dlrecLlv
affecLs Lhe exLenL of sklll acqulslLlon and reLenLlon

Drmatom¾ of Lowr L|mb
Ŵ L1 Ŷ lnaulnal
Ŵ L2
Ŵ L3
Ŵ L4 Ŷ medlal malleolusţ anLeromedlal
Ŵ L3 Ŷ anLerolaLeral of Lhe lea
Ŵ S1 Ŷ laLeral slde of ankle and fooL
posLerolaLeral porLlon of lea

Ŵ S2
Ŵ S3 Ŷ lschlal LuberoslLv
Ŵ S4 and S3 Ŷ perlanal area

Imora| nrv
Ŵ chanaes lLs name Lo 5AÞnLNCU5 NLkVL afLer
passlna Lhe knee
Ŵ supplv medlal porLlon of Lhe lea

Cbtrator nrv
Ŵ medlal porLlon of Lhe lea

Þo¾tr|or ctano¾ nrv to th th|gh
Ŵ Slţ S2ţ S3
Ŵ medlal parL of Lhe Lhlah



Latra| ¾ra| ctano¾

½r|½hra| nrv Ŷ foot ½|antar and
Ŵ dor¾m |nnrvat|on
Ŵ ¾ Nttr!!!!

5gmnta| Innrvat|on¾ of Lowr L|mb
127 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2


n|½ f|x|on Ŷ L2
Ŵ lllopsoas muscle

n|½ xtn¾|on Ŷ L3ţ S1ţ S2

kn xtn¾|on Ŷ L3ţ L4
Ŵ quadrlceps muscle

ANkLL

Dor¾|f|x|on
Ŵ L4ţ L3
Ŵ Llblalls anLerlor muscle

hallux xtn¾|on bv LPL Ŷ L3

Þ|antarf|x|on Ŷ 51ţ S2

LE R¢fl¢x¢s S¢gm¢ntal L¢v¢l
atellai knee jeik L2ţ L3ţ L4
euial hamstiing L3ţ S1
Achilles (ankle jeik) S1ţ S2













ANkLL AND LLG
(DrŦ Car|aga)

5UkIACL ANA1CM¥

LA1LkAL MALLLCLU5
Ŵ more polnLed
Ŵ posLerlorlv slLuaLed

MLDIAL MALLLCLU5
Ŵ more rounded
Ŵ anLerlorlv slLuaLed
Ŵ half an lnch hlaher Lhan Lhe laLeral malleolus

O presence of a depresslon anLerlor Lo laLeral/ medlal
malleolus bounded bv Lhe presence of Llblalls anLerlor
Lendon
4 easv access Lo Lhe ankle [olnL

O laLeral malleolus ƹ anLerlor Lo lL ƹ Lendon of exLensor
dlalLorum lonaus
4 access Lo ankle [olnL
4 Lhere wlll be bulalna lf Lhere ls an lncrease
collecLlon of fluld lnslde Lhe ankle [olnL

ÞUL5A1ICN5
Ŵ antr|or t|b|a|/ dor¾a||¾ ½d|¾ artry
4 laLeral Lo Llblalls anLerlor Lendon ls Lhe
pulsaLlons of Lhe anLerlor Llblal arLerv (as lL
crosses Lhe ankle [olnLţ lL ls called Lhe dorsalls
pedls)

Ŵ ½o¾tr|or t|b|a| artry
4 posLerlor Lo Lhe medlal malleolus

notť dual blood supplv of Lhe lea Ŷ anLerlor and posLerlor
Llblal arLerv

8A5L CI 5
1n
ML1A1Ak5AL
Ŵ bonv sLrucLure
Ŵ easllv palpable ln mosL speclmen
Ŵ laLeral slde





ÞC51LkICk A5ÞLC1 CI ANkLL
Þrom|nnc of th Ach|||¾ tndon
Ŵ locaLed posLerlorlv
Ŵ depresslon lmmedlaLelv medlal and laLeral Lo Lhe
chllles Lendon
Ŵ access polnL for Lhe svnovlal cavlLv of Lhe ankle [olnL
4 buL anLerlor parL ls more preferred
128 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

4 whv noL posLerlorlv? mlahL puncLure Lhe
posLerlor Llblal arLerv

8ALL5 CI 1nL ILL1
Ŵ promlnence of heads of Lhe meLaLarsal bones

ICC1 Ŷ Lrlanaular sLrucLure
Ŵ apex Ŷ heel
Ŵ base Ŷ larae and smalle Loe

ÞkCMINLNCL CI 1LNDCN
Ŵ chllles Lendon Ŷ posLerlor
Ŵ anLerlor Llblalls Lendon Ŷ anLerlor Lo Lhe depresslon

5kIN AND 5U8CU1ANLCU5 1I55UL
1Ŧ dor¾a| a¾½ct
O looseţ Lhln
O edema prone Ŷ Llssues are looselv connecLed Lo
Lhe sub[acenL sLrucLures
O halr

2Ŧ ½|antar a¾½ct
O Lhlckţ faLŴpadded
O flbrous sepL
4 noL edema prone Ŷ anchored bv sLrlps of
flbrous Llssues Lowards Lhe underlvlna bone
4 sLablllzes one from walklna

O sepLasebaceous and sweaL alands Ŷ lncrease ln
planLar area

8CN¥ ANA1CM¥

ANkLL MCk1I5L
Ŵ Þ vlew Ŷ poslLlon ln whlch lnLermalleolar axls
parallel Lo xŴrav fllm
Ŵ movmnt of ank| [o|ntť planLar flexlon and
dorslflexlon
Ŵ [o|nt btwnť Laloflbularţ LaloLlblal
movmntť dorslflexlon/ planLarflexlon

Ŵ |nvr¾|on Ŷ llmlLed bv medlal malleolus
Ŵ vr¾|on Ŷ llmlLed bv laLeral malleolus
lncrease lnverslon/ everslon Ŷ lnsLablllLv of ankle
morLlse

Notť welahL of bodv borne of Llbla down Lo Lalusţ flbula
sLablllzes Lhe Lalus

1ALCCALCANLAL/ 5U81ALAk
Ŵ [olnL beLween calcaneus and Lalus
Ŵ movmntť lnverslonţ everslon

8CNL5 CI 1nL ICC1
aŦ nINDICC1
Ŵ calcaneusţ Lalus
Ŵ ¾|d v|wť Lalus above Lhe calcaneus
Ŵ ca|can¾ Ŷ blaaesL bone ln Lhe fooLţ bores Lhe
welahL of Lhe Lalus
O arLlculaLes wlLh Lhe cubold

Ŵ ta|¾ Ŷ kevsLone
4 above and superlor Lo calcaneus
4 doesn'L have anv correspondlna bone ln Lhe
hand

UNICUL 8CNL
4 no m¾c| attachmnt
4 70Ʒ of |t¾ ¾rfac |¾ covrd w|th cart||ag
4 n|q b|ood ¾½½|y
maln bodv of Lalus bounded superlorlv bv
Llbla and lnferlorlv bv calcaneus
passes Lo Lhe neck area Lhen lj maln bodv
c||n|ca| corr|at|onť common slLe of
fracLure ln Lhe Lalus ls Lhe neck area
4 dlsrupLlon Lhe 8S lj asepLlc necrosls

4 ½art¾ť
head
neck
bodv

Ŵ ta|onav|c|ar and ca|canocbo|d [o|nt
4 llLLle lnverslon/ everslon
4 planLar flexlon/ dorslflexlon

bŦ MIDICC1
Ŵ navlcularţ cuboldţ 3 cunelforms
Ŵ navlcular Ŷ arLlculaLlon Lo Lhe posLerlor aspecL of
Lhe Lalus (Lalonavlcular [olnL)

notť movemenL beLween Lhe dlfferenL Larsal bones are
much less pronounce
4 llLLle dorslflexlon/ planLar flexlonţ lnverslon/
everslon

129 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

cŦ ICkLICC1
Ŵ bones LhaL comprlses Lhe meLaLarsal phalanaes
Ŵ 1
sL
meLaLarsal arLlculaLes wlLh Lhe 1
sL
cunelform
Ŵ 2
nd
meLaLarsal arLlculaLes wlLh Lhe 2
nd
cunelform
Ŵ 3
rd
meLaLarsal arLlculaLes wlLh Lhe 3
rd
cunelform
Ŵ 4
Lh
and 3
Lh
meLaLarsal arLlculaLes malnlv aL Lhe
cubold
Ŵ movmnt (mtatar¾a|)ť verv mlnlmal movemenL
Ŵ mtatar¾o½ha|anga| [o|nt
4 dorslflexlonţ planLar flexlonţ abducLlonţ
adducLlon
4 polnL of reference of axls Ŷ 2
nd
Loe
MCÞ Ŷ polnL of reference (hand)ť mlddle
flnaer

Ŵ ÞIÞ and DIÞ Ŷ dorslflexlon and planLar flexlon

notť [olnL beLween Lhe hlndfooL and mldfooL collecLlvelv
known as Ŷ MID1Ak5AL ICIN1/ CnCÞAk1'5 ICIN1
Ŵ [olnL beLween Lhe mldfooL and forefooL Ŷ LI5IkANC'5
ICIN1

Ŵ dr|ng ¾rgryť
4 ampuLaLe fooL Ŷ ChoparL's ampuLaLlon or
Llsfranc's ampuLaLlon

LIGAMLN1CU5 51kUC1UkL
Ŵ holds Lhe dlfferenL bones LoaeLher
Ŵ ldenLlfled Lo whlch Lhev are aLLached Lo

aŦ |atra| co||atra| ||gamnt com½|x
O laLeral aspecL of Lhe fooL
O madŴ½ of 3 ||gamnt¾
4 anLerlor and posLerlor Laloflbular llaamenL
4 calcaneoflbular llaamenL

O weaker

bŦ md|a| co||atra| ||gamnt com½|x
O Lrlanaular ln shape/ uelLold llaamenL
½r½o¾ of co||atra| ||gamnt¾ť sLablllzes Lhe ankle
morLlseŤ prevenLs excesslve lnverslon/ everslon
4 xc¾¾|vť Lear off of Lhe LCL (ankle spraln)
4 mosL commonlv Lorn llaamenL ls Lhe anLerlor
Laloflbular llaamenL
4 LesLť applv pressure on 1lL (+ Ŵ paln and swelllna)

cŦ ¾½r|ng ||gamnt
O aka planLar calcaneonavlcular llaamenL Ŷ seen
undersurface
O planLar and dorsal calcaneocubold llaamenL
O orlenLed ln an obllque manner
4 malnLalns Lhe lonalLudlnal arch of Lhe fooL
whlch serves as a sprlna of Lhe fooL Lo prevenL
flaLfooLedness

dŦ mtatar¾o½ha|anga| ||gamnt
O medlal and laLeral llaamenL
O no dorsal and planLar llaamenL

Ŧ |ntr½ha|anga| ||gamnt
O laLeral and medlal llaamenL Ŷ llmlLs
abducLlon/adducLlon
O (+) planLar llaamenL
O volar plaLe llaamenL Ŷ prevenLs excesslve
dorslflexlon

DLLÞ IA5CIA
Ŵ ankle and fooL
Ŵ th|ckn|ng¾ of th d½ fa¾c|ať resLralnL movemenL
of Lendon boLh ln Lhe anLerlor aspecL especlallv ln
Lhe laLeral aspecL
Ŵ condensaLlon of Lhe deep fasclať rt|nac|m Ŷ
prevenLs bowsLrlnalna
Ŵ antr|orť
superlor exLensor reLlnaculum Ŷ Lransverse
cruclal
lnferlor exLensor reLlnaculum Ŷ cruclaLe
prevenLs bowsLrlnalna of Lhe exLensor Lendons

Ŵ md|a| |ac|nat ||gamntť
lmporLanL relaLlonshlp
Llblalls posLerlor
flexor dlalLorum lonaus
flexor hallucls lonaus
ln beLween luL and lPL ƹ posLerlor Llblal arLervţ
veln and nerves

Ŵ |atra|ť
superlor peroneal reLlnaculum
lnferlor peroneal reLlnaculum
resLralnL of Lhe peroneus lonaus and brevls
Lendons

Ŵ ½|antar Ŷ Lhlckened Lo form Lhe planLar aponeurosls

130 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

MU5CLL

Lxtr|n¾|c
Ŵ orlalnaLes above Lhe ankle
Ŵ acLlon ln Lhe ankle and fooL

Intr|n¾|c
Ŵ orlalnaLes below Lhe ankle
Ŵ acLlon below Lhe ankle

EXTRINSIC INTRINSIC
EXTENSUR
CRUUP - found
at tb¢ dorsal
asp¢ct of tb¢
foot
nLerlor lea
comparLmenL
LxLensor hallucls
brevls
LaLeral lea
comparLmenL
LxLensor dlalLl
brevls
FLEXUR CRUUP
- found at tb¢
plantar asp¢ct
of tb¢ foot
ÞosLerlor lea
comparLmenL
(superflclal) +
popllLeus muscle


ÞLn18
MuSCuL1u8L
(4 L?L8S) ÞosLerlor lea
comparLmenL
(deep)

NC1Lť popllLeus muscle Ŷ no acLlon on Lhe fooL

|ntrma||o|ar ax|¾ Ŷ dlvldes area lnLo anLerlor and
posLerlor
Ŵ all muscles and Lendons anLerlor Lo lnLermalleolar
axls Ŷ dorslflex ankle
Ŵ all muscles and Lendons posLerlor Lo lnLermalleolar
axls Ŷ planLarflex ankle

|ong|td|na| ax|¾
Ŵ perpendlcular Lo Lhe 1
sL
llne aL Lhe mlddle of Llbla
Ŵ dlvldes fooL lnLo medlal (lnverslon) and laLeral
(everslon)




















Þ|antar M¾c|atr
Ŵ lnLrlnslc flexor of Lhe fooL

1
¾t
|ayr Ŷ ¾½rf|c|a| |ayr

Ŵ bducLor hallucls muscle
Ŵ bducLor dlalLl v
or|g|nť calcaneus
|n¾rt|onť proxlmal phalanae

Ŵ llexor dlalLl brevls
or|g|nť calcaneus
|n¾rt|onť mlddle phalanae

2
nd
|ayr
Ŵ CuadraLus planLae
(Ŵ) ln upper exLremlLv
or|g|nť calcaneus
|n¾rt|onť Lendons of dlalLorum lonaus
fnct|onť redlrecL Lhe vecLor forces of obllquelv
orlenLed flexor dlalLorum lonausŤ redlrecL
dlrecLlon of fooL

Ŵ Lumbrlcales (4)
(+) ln hand
fnct|on |n handť lmporLanL ln medlaLlna Lhe
forces of lona exLensor and flexorţ prevenL
pulllna of LuL and luL Lo malnLaln muscular
acLlon flnelv
used ln plavlna Lhe plano Ŵ acLlon on dlalLs Lo
prevenL pulllna


or|g|nť luL
|n¾rt|onť LuL
|nnrvat|onť
lCC1
4 1 Ŷ mlddle planLar nerve
4 3 Ŷ laLeral pnaLar nerve

131 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

buLŧ Pnu
4 2 Ŷ radlal nerve nerve
4 2 Ŷ ulnar nerve

noL parL of 2
nd
laver
Ŵ llexor dlalLorum lonaus
Ŵ llexor halucls lonaus
are forelea muscles

nAND ICC1
Lumbrlcales Lumbrlcales Ŵ buL noL well
uLlllzed as ln Lhe hand
LxLensor dlalLorum
communls
LxLensor dlalLorum lonaus
llexor dlalLorum profundus llexor dlalLorum lonaus
llexor dlalLorum
superflclalls/ subllmls
lť mlddle phalanae
Ŵenclrcles Lhe deep Lendon
Ŵsame as Lhe fooL
llexor dlalLl brevls













3
rd
|ayr
Ŵ llexor hallucls brevls
|n¾rt|onť mlddle phalanae

Ŵ dducLor hallucls
Lransverse bellv Ŷ forefooL
obllque bellv Ŷ comes from Lhe mldfooL
|n¾rt|onť proxlmal phalanae

Ŵ llexor dlalLl v
Ŵ |nnrvat|onť
medlal slde Ŷ medlal planLar nerve
laLeral slde Ŷ laLeral planLar nerve
xc½t|on!!!! Addctor ha||c|¾
4 acLlon on Lhe bla Loe
4 locaLed aL Lhe medlal slde buL lS nC1
lnnervaLed bv Lhe medlal planaLr nerve
4 lnnervaLed bv Lhe laLeral planLar nerve

4
th
|ayr
Ŵ shorLesL muscle
Ŵ lnLerossel
act|onť
4 planLarť adducLlon (Þu)
4 dorsalť abducLlon (u8)

NLkVL5
Ŵ CuLaneousť superflclal peroneal nerve
deep peroneal nerve
saphenous nerve

Ŵ Sural nerve (laLeral/medlal)
Ŵ Medlal calcaneal
Ŵ LaLeral planLar
Ŵ Medlal planLar

Ŵ d½ ½rona| nrv
supplv Lhe exLensor hallucls brevls and exLensor
dlalLorum brevls and lnLrlnslc muscles of Lhe
Loes

Ŵ lllusLraLlon cuLaneous nerve dorsal/ planLarť See
neLLer!!!

Ŵ mlxed nerve Ŷ posLerlor Llblal nerve Ƹ medlal and
laLeral planLar nerve

Ak1LkIL5/ VLIN5
Ŵ anLerlor Llblal arLerv and veln
peroneal
malleolar (medlal/ laLeral)
Larsal (medlal/ laLeral)
arcuaLe
dorsal meLarLarsal
dorsal dlalLal


Ŵ superflclal
shorL/ lona saphenous
nv Ŷ arranaemenL accordlna Lo laver



132 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2













Gnra||zat|onť
Ŵ 8v of fooL and ankle supplled bv anLerlor and
posLerlor Llblal a/v (dual blood supplv)
Ŵ deep vessels Ŷ lvlna ln Lhe deep fascla
alwavs palred

Ŵ superflclal vessels Ŷ purelv velns

CLINICAL CCkkLLA1ICN

aŦ bon¾/ ||gamnt¾
1Ŧ arch¾ of th foot Ŷ Lransverse and lonalLudlnal
a) calcaneus Ŷ Louch Lhe around
b) navlcular and cubold Ŷ do noL Louch Lhe
around
c) cunelform Ŷ do noL Louch Lhe around

Ŵ |ong|td|na| arch
promlnenL on laLeral slde and noL from
Lhe medlal Lransverse
fronL Lo back

Ŵ md|a| arch
Lransverse Ŷ medlal slde

2Ŧ dform|t|¾ (congn|ta| and acq|rd) of ank|
O of ank|ť
4 planus/ cavus
4 varus/ valaus
4 equlnus/ calcaneus
O com½|x
4 equlnovarus/ calcaneovalaus

O Þ¾ q|n¾
4 horse
4 sLandlna on meLaLarsal noL on Lhe fooL

O of to¾ť
4 hallux valaus
4 hallux varus Ŷ everLedŤ 8unlCn

3Ŧ |n[r|¾
O edema
O ankle spraln (lnverslon/ everslon ln[urv)
O fractr¾ť
4 blŴmalleolar fracLure
medlal malleolus
laLeral malleolus

4 Lrlmalleolar fracLure
medlal malleolus
laLeral malleolus
3
rd
Ŷ posLerlor llp of Lhe Llbla

4 ÞoLL's/ coLLon fracLure
4 1alar neck fracLure

O d|¾|ocat|on¾ Ŷ ankleţ subLalarţ panLalar

4Ŧ o½rat|v |ntrvnt|on¾
O placemenL of operaLlve lnclslons
O Lrlple arLhrodesls
O am½tat|on¾ť
4 Svme's
cuL aL Lhe level of Llbla
remove Lalus and calcaneus
mosL common
heel pad cover Lhe whole sLump

4 8ovd's
remove anLerlor aspecL of calcaneus
and some parL of Lalus
4 Þlroaoff
4 ChoparL's
4 Llsfranc's



othr c||n|ca| corr|at|onť

O d|¾ta| t|b|of|b|ar ||gamnt
4 lf brokenţ use exLra lona screw Lo connecL Llbla and
flbula

133 | Þ a a e ( a l z a c o ţ r m L )
8 a L c h 2 0 1 2

O ank| f¾|on
4 fuse Lalus and calcaneus
4 fuse Lalus wlLh navlcular and cubold

O ca|cana| ¾½ra|n
4 paln when paLlenL walks

O mga|odacty|y
4 verv bla Loe

O ¾yndacty|
4 lobsLer fooL

O c|b foot
4 Lallpes equlnovarus
4 ankle ls used as Lhe fooL
4 oLher formsť slmple Ŷ varus/ valausŤ equlnus/
calcaneus

bŦ nrv¾
O shorL lea casL svndrome
O Larsal Lunnel svndrome

cŦ m¾c|¾
O planLarls Lendon donor
O LlahL chllles Lendon
O planLar fascllLls

dŦ v¾¾|¾
O veln arafL
O aood collaLeral clrcumflex

Ŧ ¾k|n
O edema fluld
O pressure sores/ bonv promlnence

@-@ ,-

I@
% f–% 
                
        –°€   
°n ¾° 
°  f½f–¯f°  ½ n°   –°  
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