ABDOMEN - PELVIS

Lecturer : Prof. dr. Wahyuni Lukita Atmodjo, Ph.D

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 BODY
CAVITY
Cavum Thoracis
Cavum Abdominis
Cavum Pelvicum

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 Arteries of abdominal wall.
• Superior epigastric
• Inferior epigastric
• Posterior intercostal
• Subcostal
• Superficial epigastric

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 Layers of abdominal wall
• Skin
• Fat / Camper’s fasc
• Scarpa’s fasc
• M. OAE
• M. OAI
• M. Transversus abdominis
• Transversal Fascia
• Peritoneum parietale

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 Anterior abdominal wall
 EOM:
○ 4th –12th riblinea alba
 IOM:
○ Inquinale lig, crista iliaca, fasc. Thoracolumbal  9th-12th ribs, linea
alba, os pubis, linea pectinea
 Transversus abdominis
○ Inquinale lig, crista iliaca, fasc. Thoracolumbal  linea alba, os pubis,
linea pectinea
 Rectus abdominis
○ Os pubis, interpubic lig cartilago 5th-7th ribs, proc. xiphoideus
 Pyramidalis
○ Os pubis, ant pubic lig  linea alba

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 Posterior abdominal wall
 Iliopsoas mayor
 Psoas head : Proc. Transversus VT12- L4  trochanter
minor femur
 Iliac head : illiac fossa  trochanter minor femur

 Diaphragm
 Costal margin VL1-L4  central tendon

 Quadratus lumborum
 Iliolumbar lig, crista iliaca posterior  12th rib, proc
transversus VL1-4

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 inguinal region
Lateral: M. iliopsoas, N. femoralis
Medial: A.V. femoralis, Femoral ring
Superior : lig. inguinal

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 CANALIS INGUINALIS
ANNULUS INGUINALIS PROFUNDUS
( DEEP INGUINAL RING )

CANALIS INGUINALIS

ANNULUS INGUINALIS SUPERFICIALIS

( SUPERFICIAL INGUINAL RING )

 Length 4 cm from deep inguinal ring to superficial inguinal ring,

above inguinal ligament
 Anterior : OAE, OAI
 Posterior: Fascia Transversals
 Inguinal triangle
• The site of direct inguinal
hernia
• Boundaries
– Medial: linea semilunaris
– Lateral: Inferior epigastric a
– Inferior: Inguinal ligament
– Anterior: Covered by Ext.
Obliq. Apo.

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 Inguinal Hernia

 Indirect inguinal hernia

○ Congenital and Acquired
○ Through inguinal canal
○ lateral to Inf epigastric a.

 Direct inguinal hernia

○ Always acquired
○ medial to the inferior
epigastric artery
○ Common in middle age men

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 Femoral Hernia
• Common in female, rare in male
• Enter femoral ring and femoral canal
• Inferior to inguinal ligament and lateral
to the pubic tubercle
• Usually lie in the thigh and presenting
through fossa ovalis

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 Inguinal Hernia Femoral Hernia
 Common in male  Common in female
 Superior to inguinal ligament  Enter femoral canal
 Superficial inguinal ring  Inferior to inguinal ligament
 Usually lie in the thigh
 TRACT DIGESTIVIVUS

 Mouth
 Pharynx
 Esophagus
 Stomach
 duodenum, jejenum, ileum
 Cecum and appendix
 colon ascendens,
transversus, descendens
 Sigmoid, Rectum, Anal
canal, Anus
 Accessory organ: Liver,
Pancreas, Spleen

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Upper left ; Upper right
Lower left ; Lower right Plane
Vertical : Median plane
Horizontal: Transumbilical plane

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 Quadrant
• RUQ (Right upper quadrant)
– Right lobe of liver, gallbladder, pylorus, duodenum,
pancreas, right supraren, right kidney
• LUQ (Left upper quadrant)
– Left lobe of liver, spleen, stomach, jejenum and ileum,
pancreas, left supraren, left colic, transverse colon,
descending colon
• RLQ (Right lower quadrant)
– Cecum, appendix, ileum, ascending colon, r-ovary, r-uterine
tube, r-ureter, uterus, urinary bladder, r-spermatic cord
• LLQ (Left lower quadrant)
– Sigmoid colon, descending colon, l-ovary, l-uterine tube, l-
ureter, l-spermatic cord, urinary bladder, uterine

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 Plane of the Regions
Vertical
Right midclavicular
Left midclavicular

Horizontal:
Subcostal
Transtubercular

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 9 Regions
For specific localisation of a finding,
abdomen is devided into 9 regions
• Epigastric
• RH : right hypochondriaca
• LH : left hypochondriaca
• Umbilical
• RL : right lumbar
• LL : left lumbar
• Hypogastric
• RI : right inquinal
• LI : left inquinal

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 Peritoneum
 Abdominal cavity :
Closed sac containing
serous fluid covered by
Peritoneum parietal.
 Peritoneum visceral
attach to the organ
 Location of visceral organ
 Intraperitoneal
 Retroperitoneal

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 Blood supply GI tract:
Aorta abdominalis
 Celiac artery (VL 1)
 Gaster / stomach
 Duodenum
 Pancreas
 Spleen / lien
 Hepar / liver
 Superior mesenteric artery (VL 2)
 Small intestine
 Inferior mesenteric artery (VL 3)
 Large intestine

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 Parasympathetic
 N. VII  submandibular and
Nerve supply
sublingual glands
 N. IX  parotid gland, oral
mucosa
 N. Vagus  digestive tract
 S2-S4  rectum, anus
 Contraction of smooth
muscle
 Secretion of digestive juice

 Sympathetic
 Thoracolumbal  Ganglion
Coeliacus, mesenterica sup
and mesenterica inf
 Reduce contraction and
secretion

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 HEPAR dan VESICA FELLEA,

 Length 6-10 cm
 Capacity 45 ml
 Lies within fossa vesica fellea
 Divided into 3 parts: fundus, body and neck
 PANCREAS
 Epigastricleft Hypochondriaca
 Head , Body, Tail
• Primary pancreatic duct
• Accessory pancreatic duct
 LIEN
• Lies in the left hypochondriaca adjacent to
stomach, from ribs 9, 10,11,12
• 11 cm in length. weighs between 150 -200
gr,
• Composed of lymphoid tissue
• Supplied by A. lienalis

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 Tulang Pelvis
1. Os coxae kiri dan kanan, membentuk dinding
lateral dan anterior rongga panggul.
2. Os coccygis dan os sacrum, membentuk
dinding posterior rongga panggul.

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 Pelvis
• Pelvis mayor (greater/false)
– Lateral, fossa iliaca
– Anterior, abdominal wall anterior
– Posterior, VL 3,4,5
– Large intestine
• Pelvis minor (lesser/true)
– Pelvic inlet
– Pelvic cavity
– Pelvic outlet
– Pelvic ogan

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 Pelvic inlet
• Boundaries
– Linea terminalis (pubic crest, iliopectineal
line and arcuate line)  towards
promontorium

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 REPRODUCTIVE SYSTEM
• Male
– External: penis, scrotum
– Internal: prostat, testis, epididimis, vas deferens, vesicula
seminalis.

• Female
– External: Labia mayor, labia minor, clitoris,
orificium urethra, introitus vagina
– Internal : Vagina, cervix, uterus, tuba uterina , ovarium

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Sagital section of female genital
Vagina
Uterine
Fundus, corpus, cornu, cervix
Broad lig, round lig
Uterine Tube (2)
Isthmus, ampulla, infundibulum, fimbriae,
mesosalphinx
Ovarium (2)
Suspensory lig, proper lig
Mesovarium

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 VULVA
1. Clitoris
2. Labium minus
3. Labium mayus
4. Orificium urethra externa
5. Introitus vagina

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 Female genitalia interna

• Vagina
• Cervic
• Uterine
• Tuba uterina
• Ovarium

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 External structure of penis
• Composition
– Begins as the Radix of penis in the superficial perineal
space
– Body
• Bilateral corpora cavernosa are dorsal, begins as crus and covered
by ischiocavernosus muscles
• Central corpus spongiosum is ventral, begins as bulb of penis

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 Genitalia Interna
Urethra prostatica,
membranacea,
spongiosa
prostat

testis

epididimis

vas deferens

vesicula seminalis

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 Arteries in pelvis.

Anterior division
 Obturator a
 Umbilical a
 Vaginal a
 Ovarica uterine a
 Inferior vesical a
 Middle rectal a
 Internal pudendal a
 Inferior gluteal a

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