The abdominal cavity has the following structure: it is a special zone located below the diaphragm and consisting of many organs. The diaphragm is the upper part of it and separates this zone from the sternum.

The main area of ​​the peritoneum consists of tendons and abdominal muscles.

The anatomy of some organs of the human abdominal cavity is a separate subject of study in the medical literature.

What is included in the abdominal cavity?

The abdominal cavity consists of 2 main parts:

Peritoneum.
. Retroperitoneal space

The organs in the abdominal cavity are located between the peritoneum and the walls of the abdomen. With an increase in volume, they begin to lag behind the main part, connect with the tissues of the peritoneum and form a single whole with it. Thus, a serous fold appears, which includes two sheets. These folds are called mesentery.

Complete coverage of the organs by the peritoneum indicates an intraperitoneal location. An example of this is the intestines. When closed by the peritoneum, only three sides indicate a mesoperitoneal position. Such an organ is the liver. When the peritoneum is located in the anterior part of the organs, it indicates an extraperitoneal structure. These organs are the kidneys.
The abdominal cavity is lined with a smooth layer called epithelium. Its high humidity is provided by a layer of capillaries of the serous substance. The peritoneum promotes easy movement of the internal organs relative to each other.

What and what main organs are included in the abdominal cavity?

When studying the anatomy and structure of the human body, the human abdominal cavity is divided by specialists into several parts:

The structure of its upper region includes: the liver bag, omental gland, pre-gastric fissure. The liver bag is located to the right of the liver. It is connected to the peritoneum with a special hole. In its upper part is the liver. In the anterior part, it is separated by various ligaments.

The liver is located on the right, between the ribs. It is closed by the visceral peritoneum. The lower region of this organ is connected to a vein and part of the diaphragm. It is divided by the falciform ligament into two parts. All of it is permeated with many different vessels of the circulatory system, fibers and nodes of the lymphatic system. With their help, it connects with other organs located in the abdominal region. On palpation of the liver, the adrenal gland is easily detected.

The pancreatic fissure consists of the spleen, stomach, left hepatic lobe.
The spleen is the main organ in supplying the body with blood and ensures the proper functioning of the lymphatic system. It is all permeated with many capillaries and has nerve endings. The splenic artery is involved in providing this organ with a large amount of blood. The main organ of the digestive system is the stomach. It is involved in supplying the body with nutrients. With its help, food is processed with the participation of gastric juice. It also processes food and moves it to the intestines.

Many people think that the pancreas is located under the stomach, but this is not entirely true. It is located near the back of the stomach at the level of the first lumbar vertebra. Anatomy of this organ: divided into 3 main zones: tail, body and head. The head has a continuation in the form of a small hook-shaped process. The stomach is completely permeated with capillaries located in the dorsal surface of the glands. It separates it from the inferior vena cava. The pancreatic duct is located throughout the stomach. It ends in the area of ​​the intestines.

In the intestine, organic elements enter the bloodstream and the formation of feces. Masses are removed from the body through the anus in a natural way.

The anatomy of the posterior part is the parietal sheet, which covers the entire abdominal aorta, pancreas, kidneys on the left side, adrenal glands and inferior pudendal vein. The greater omentum enters the region of the colon. It covers some areas of the small intestine. This organ is represented by 4 connected serous sheets. Between the petals there is a zone connected to the stuffing bag. Most often, you can observe the absence of this cavity, especially in adults. In the region of the omentum there are nodes of the lymphatic system, which are necessary for the elimination of lymph from the body.

The structure of the main part: it includes the ascending, descending cavities of the colon and the mesentery of the small intestine. The abdominal cavity is divided into several main sections: the lateral canals and the two mesenteric sinuses. The mesentery is a fold consisting of 2 serous sheets. It is necessary for fixing the small intestine at the back of the human abdomen. The basis of attachment is called the root of the mesentery. It consists of the circulatory and lymphatic systems, as well as many different nerve fibers. The posterior region of the abdominal cavity consists of a huge number of heterogeneities that are of particular importance for the human body.

Most often, retroperitoneal hernias appear in them.

The lower part is represented by many organs that make up the human pelvic region.
In order for all organs inside the human abdominal cavity to be located strictly horizontally and in a normal structure, it is necessary to have a good press.
In order for the internal organs to be reliably protected, the cavity from the outside is closed by the following organs:
. spine
. pelvic bones
. Press muscles

The gallbladder, located on the right side, is attached to the right lower wall of the liver. Usually in the pictures it is presented in the form of a small pear. It consists of a neck, body and bottom. It is also associated with such important organs as: the liver, blood vessels and the peritoneal region.

If a person has pathologies in the structure of organs located in the abdominal cavity, one should resort to the help of a doctor.

Improper development and location can be the cause of adhesions that form in the small intestine.
In order to identify abnormalities in the formation of internal organs, they resort to the help of ultrasound diagnostics.
The structure of the abdominal cavity in men and women and their main differences.
All organs included in this part of the body are equipped with a thin serous membrane. It is represented by soft connective tissue with a large number of dense differentiated fibers and one-sided epithelial tissue. The epithelial tissue is called mesothelial. Its main advantage is a high degree of absorption of nutrients. Only in it is the development of useful substances that prevent the friction of organs against each other. Due to this, there is no pain in this area in a person.

The organs of the abdominal cavity in a woman are slightly different in structure than in men. Initially, in women in this area, especially in its lower part, the fallopian tubes are located, which are connected to the uterus. They are necessary for the normal functioning of the ovaries, the process of fertilization and bearing a child. The reproductive system of a woman in the external manifestation is highlighted by the vaginal opening. When conducting a complete examination of a woman, ultrasound diagnostic methods are performed. They help to identify the state of the human body at the moment, identify existing problems and prescribe the necessary treatment.

When studying the anatomy of the abdominal organs of a man, it should be noted that they are in a closed space and are interconnected.
The similarity between the male and female systems is that the internal organs have a serous membrane. However, in women they are only partially covered, either only on one side or on some organs.
In addition, the main difference is the cells that arise in the body of a man and a woman. For example, in a woman it is the eggs, and in men it is the spermatozoa.

Another difference, according to experts, is that most women have a large belly, unlike men. And this happens for the following reasons:
. A woman's large intestine is 10 times longer than a man's.
. Women drink more fluids
. In men, the intestines are located in the form of a horseshoe, while in women it is even, but has many loops.
. This feature is associated with the anatomy and structure of a woman and the ability to bear a child and protect him from possible damage.
. hormonal factor.

Diagnostics.

The main diagnostic method is an ultrasound examination of a person.

Treatment.

If the diagnosis is made: appendicitis, then only surgical intervention can help in this case.
Inflammation of the stomach can go away on its own and a visit to the doctor is required if the symptoms continue for 2-3 days. Due to the large loss of water, a person is recommended to consume as much liquid as possible. With the development of inflammation, it is necessary to consult a specialist for a comprehensive examination and the appointment of the correct treatment. Usually this is taking medications.

The most unpleasant manifestation of a disease in a person in the abdominal cavity is hemorrhoids. It gives the patient a lot of trouble. Usually treatment is done at home. It includes the use of medicines, various lotions and compresses with medicinal and herbal preparations. If hemorrhoids are in a progressive stage and cause severe pain, then a person is recommended surgical intervention.

Currently, the anatomy of the human abdominal cavity is studied in detail in many scientific laboratories. Interest in it is associated with the progression of diseases in this area. Due to the fact that this area will be well studied by doctors, it will be possible to accurately diagnose even in the early stages of the development of the disease and prescribe the correct and competent treatment to a person. This will help to reduce the time for treating people and get rid of severe cases of the manifestation of the disease, in which the only way out can only be surgical intervention.

For each person, it is important to know the name of the internal organs and their location. This is necessary for the timely detection of a particular disease. Most of the important viscera are located in the abdominal cavity: the digestive organs and the genitourinary system. The peritoneum is a space in the human body that closes at the top with a diaphragm. The bottom of the cavity falls on the pelvic region. The organs of the abdominal cavity every day ensure the normal functioning of the entire human body.

The peritoneum is a cavity with viscera, the walls of which are covered with a sulfuric membrane, penetrated by muscles, fatty tissue and connective tissue formations. The mesothelium (sulfur shell) produces a special lubricant that prevents the organs from rubbing against each other. This protects a person from discomfort and pain, provided that the organs are healthy.

The abdominal space contains the stomach, spleen, liver, pancreas, abdominal aorta, organs of the digestive tract and the human genitourinary system. All organs perform their function, important for the life of the body. Since their main role is digestion, speaking of them in general, they are usually called.

Important! The abdominal press serves as a protective membrane for the entire internal organ system in front. Behind the protective function is performed by the bones: the pelvis and spine.

The digestive system does the following:

• digest food;
• performs a protective and endocrine function;
• helps to absorb nutrients;
• manages the process of hematopoiesis;
• eliminates toxins and poison that enter the body.

The genitourinary system, in turn, performs a reproductive and endocrine function, removes metabolic products from the body.

A distinctive feature of the male and female composition of the abdominal cavity are only the genitals. All organs of the digestive system are identical and located in the same way. An exception can only be a congenital pathology of the internal organs.

Anatomical structure of the abdominal organs

The study of the structure and location of the viscera in the human body is the science of anatomy. Thanks to her, people can find out the location of the insides and understand what hurts them.

Stomach

A cavity consisting of muscles that performs a storage, mixing and digestion function. In people with an addiction to eating food, the stomach is enlarged in size. It is located between the esophagus and the duodenum. Thanks to the pulsating contractions that enter into the motor activity of the organ, it removes chemicals, poisons and other harmful substances from the body. Thus, a protective (immune) function is carried out.

In the gastric sac, proteins are broken down and water is absorbed. All incoming food is mixed and passed into the intestines. The quality and speed of digestion of food depends on the gender and age of the person, the presence or absence of diseases, the capacity, and efficiency of the stomach.

The stomach is pear-shaped. Normally, its capacity does not exceed one liter. When overeating or absorbing a large amount of fluid increases to 4 liters. This also changes its location. A crowded organ can descend to the level of the navel.

They can be very painful, so you need to be attentive to any unpleasant symptoms that arise in it.

gallbladder

Serves as a cavity for the accumulation of bile excreted by the liver. Therefore, it is located next to it, in a special hole. Its structure consists of a body, a bottom and a neck. The walls of the organ include several shells. These are sulfuric, mucous, muscular and submucosal.

Liver

It is an important digestive gland for the functioning of the body. The mass of an organ in an adult often reaches one and a half kilograms. It is able to eliminate poisons and toxins. Participates in many metabolic processes. It is engaged in hematopoiesis in the unborn baby during the period of its gestation by the mother, the absorption of glucose and cholesterol, and the maintenance of normal lipid levels.

The liver has an amazing ability to regenerate, but can seriously undermine a person's health.

Spleen

Parenchymal lymphoid organ located behind the stomach, under the diaphragm. This is the upper part of the abdomen. The composition includes the diaphragmatic and vesceral surface with an anterior and posterior pole. The organ is a capsule filled with red and white pulp inside. It is engaged in protecting the body from harmful microorganisms, creates blood flow in the future baby in the womb and an adult. It has the ability to renew the membranes of erythrocytes and platelets. It is the main source of production of lymphocytes. Capable of trapping and purifying microbes.

Pancreas

An organ of the digestive system second in size only to the liver. Its location is the retroperitoneal space, slightly behind the stomach. The mass reaches 100 grams, and the length is 20 centimeters. The structure of the organ looks like this:

The pancreas has the ability to produce a hormone called insulin. It is involved in the regulation of blood glucose levels. The main function of the organ is the production of gastric juice, without which food cannot be digested.

A person cannot live without a pancreas, so you should know for this organ.

Small intestine

There is no longer organ in the digestive system. It looks like a tangled pipe. Connects the stomach and large intestine. In men it reaches seven meters, in women - 5 meters. The composition of the tube includes a couple of departments: the duodenum, as well as the ileum, skinny. The structure of the first section is as follows:

The second two sections are called the mesenteric part of the organ. The jejunum is located at the top on the left side, the ileum at the bottom in the right region of the peritoneum.

Colon

The organ reaches one and a half meters in length. Connects the small intestine to the anus. Consists of . Feces accumulate in the rectum, from where they are excreted from the body through the anus.

What is not included in the digestive system

All other organs "living" in the peritoneal area belong to the genitourinary system. These are the kidneys, adrenal glands, bladder, and also the ureters, female and male genital organs.

Kidneys are shaped like beans. They are located in the lumbar region. The right organ is comparatively smaller than the left. Paired organs perform the cleansing and secretory function of urine. Regulate chemical processes. The adrenal glands produce a number of hormones:

• norepinephrine;
• adrenalin;
• corticosteroids;
• androgens;
• cortisone and cortisol.

From the name you can understand the location of the glands in the body - above the kidneys. Organs help people adapt to different living conditions.

Important! Thanks to the adrenal glands, a person remains resistant in stressful situations, which protects the central nervous system from negative effects.

The appendix is ​​a small organ of the peritoneum, an appendage of the caecum. Its size in diameter is not more than one centimeter, in length it reaches twelve millimeters. Protects the gastrointestinal tract from the development of diseases.

How are the organs of the peritoneum checked for pathology?

The main method for diagnosing the health of the abdominal organs is ultrasound. The study does not damage the structural units of tissues, therefore it is safe for the body. The procedure can be carried out repeatedly, if necessary. When eventration develops, methods of tapping (percussion), palpation and listening (auscultation) of the peritoneal organs are used. The correct location of the viscera, the presence of foci of infection can also be checked by MRI (magnetic resonance imaging) and CT (computed tomography).

Important! Diseases of the abdominal organs can threaten human life. Therefore, at the first symptoms, pain in the areas of the peritoneum, immediately seek help from medical professionals.

What diseases affect the abdominal cavity?

When a bacterial infection enters the body, appendicitis can develop. The treatment is carried out using the surgical method, that is, the appendix is ​​removed. Often, organ prolapse is diagnosed. The stomach usually goes down first. The therapy includes proper nutrition prescribed by a nutritionist, exercise therapy and wearing a special belt - a bandage.

With the development of intestinal obstruction or the appearance of adhesions, an operation is performed. If adhesions have caused obstruction, they are removed, but only for health reasons. In such cases, relapses are possible. With frequent exacerbations of obstruction, doctors recommend slag-free nutrition.

When contacting a doctor, it is not necessary if the symptoms disappear within a couple of days. It is important to drink plenty of fluids to avoid dehydration. If the patient does not feel better on the third day, it is necessary to go to the clinic. Doctors will prescribe the necessary tests, complex treatment. In most cases, these are drugs.

The most common disease of the retroperitoneal area is hemorrhoids. Pathology brings a lot of discomfort. With unbearable pain syndrome, doctors perform surgical treatment. If the progression of the disease is moderate, they are treated with drugs, lotions, compresses and baths using herbal preparations.

Abdominal hernia is a congenital or acquired disease, as a result of which the large or small intestine protrudes through an opening in the abdominal cavity. It occurs during pregnancy, obesity or heavy physical exertion due to constant pressure on a certain point in the peritoneum. Another reason is the strong pressure on the membrane of the internal organs. Pathology is treated through surgery.

How and what to eat for healthy digestion?

In order for the body to feel comfortable, it is worth acquiring several useful habits:

1. Watch what you eat. Include more vegetables, fruits, cereals in your diet. Avoid fatty, salty and sugary foods.
2. Chew thoroughly. All foods should be eaten slowly and grind well with the help of teeth. This will help to avoid bloating, gastrointestinal disorders.
3. Have a snack. Instead of three standard meals, switch to 5-6 meals a day. Reduce portions for breakfast, lunch and dinner, and in between satisfy your hunger with vegetables, fruits, dairy products, nuts.
4. Eliminate fatty foods. Fats only bring problems with digestion, excess weight and develop pathologies of the heart muscle. Try steaming or baking.
5. Prepare yourself. Food prepared by yourself is healthier and more nutritious for the body. Semi-finished products, being high-calorie, oversalted, harm the digestive system and the body as a whole.

The anatomical structure of the abdominal organs is carefully studied in many laboratories by modern scientists. This will contribute to the possibility of diagnosing the pathologies of this zone at the early stages of the development of diseases. As a result, the preparation and treatment of patients will be carried out faster, preventing the pathology from moving to more severe stages of progression. At the same time, radical methods of solving problems will fade into the background.

The health of the organs largely depends on the person. Timely diagnosis and therapeutic procedures increase the chances of a complete restoration of the functioning of organs. Therefore, one should seek help at the first symptoms of malaise.

Anton Palaznikov

Gastroenterologist, therapist

Work experience more than 7 years.

Professional skills: diagnosis and treatment of diseases of the gastrointestinal tract and biliary system.

Borders of the abdomen. The outer upper border of the abdomen is: in front - the xiphoid process, the edges of the costal arches, behind - the edges of the XII ribs. XII thoracic vertebra. The outer lower border of the abdomen runs along lines drawn from the symphysis of the pubic bones to the sides to the pubic tubercles, then to the anterior superior iliac spines, along their crests and the base of the sacrum. The abdominal cavity - the abdominal cavity - is limited in front, from the sides and behind by the abdominal walls, at the top - by the diaphragm, at the bottom it passes into the cavity of the small pelvis. From the inside, the abdominal cavity is lined with intra-abdominal fascia.

The abdominal cavity is divided on the peritoneal cavity, limited by the peritoneum, and retroperitoneal space. In the abdominal cavity, two floors are distinguished: upper and lower. The border between them is the mesentery of the transverse colon.

The walls of the abdomen are divided into two sections: anterolateral and posterior, or lumbar region. The boundaries between them are the right and left posterior axillary lines.

When diagnosing diseases of the abdominal organs, the doctor, in order to identify the localization of the pathological process, must mentally imagine the spatial relationships of the organs with each other and their projections on the abdominal wall.

In clinical practice, they use division of the anterolateral wall of the abdomen into regions, formed as a result of drawing conditional two horizontal and two vertical lines (Fig. 84). The upper horizontal line connects the lowest points of the X ribs; the lower horizontal line is drawn through the highest points of the iliac crests. Thus, three regions are distinguished: the upper one is epigastric (region epigastrium), the middle one is celiac (region mesogastrium) and the lower one is hypogastric (region hypogastrium).

Lines drawn along the outer edges of the rectus abdominis divide each of these areas into three more areas.

Projections of organs on the anterior-lateral wall of the abdomen(see fig. 84). The following are projected into the epigastric region proper: the stomach, the lesser omentum, part of the duodenum and pancreas, the left lobe of the liver and part of the right lobe of the liver, the gallbladder, the aorta, the celiac artery with arteries extending from it, the portal vein, the inferior vena cava.

The following are projected onto the right hypochondrium: the right lobe of the liver, the gallbladder, part of the duodenum, the hepatic flexure of the colon, the upper section of the right kidney.

Projected onto the left hypochondrium: part of the stomach, spleen, tail of the pancreas, splenic flexure of the colon, upper section of the left kidney.

Rice. 84. Areas of the anterolateral wall of the abdomen and the projection of some organs of the abdominal cavity on them.

The following are projected onto the umbilical region: loops of the small intestine, greater omentum, transverse colon, aorta, superior mesenteric artery with its branches, inferior vena cava. The following are projected onto the upper section of this area: the pancreas and the greater curvature of the stomach (especially when it is full).

The following are projected onto the right lateral region: the ascending colon, part of the loops of the small intestine, the right kidney with the ureter.

The following are projected onto the left lateral region: the descending colon, part of the loops of the small intestine, the left kidney with the ureter.

In the suprapubic region are projected: loops of the small intestine, bladder, uterus.

The following are projected onto the right ilio-inguinal region: the caecum with the appendix, the terminal ileum, the right ureter, the right uterine appendages, the right iliac vessels.

Projected onto the left ilio-inguinal region: sigmoid colon, left ureter, left uterine appendages, left iliac vessels.

The projections of the abdominal organs on the abdominal walls depend on the physique and change with the age of the patient.

Handbook of clinical surgery, edited by V.A. Sakharov

The abdominal cavity (or abdominal cavity) is the largest cavity in the human body. It contains the digestive and urinary organs, the adrenal glands. From above, the abdominal cavity is limited by the diaphragm, below it continues into the cavity of the small pelvis, in front and from the sides it is limited by the muscles of the abdomen, behind - by the muscles of the lower back and the corresponding section of the spinal column. On the back wall of the cavity are the aorta, the inferior vena cava, the nerve plexuses, lymphatic vessels and nodes lie. The inner surface of the abdominal cavity is lined with retroperitoneal fascia, adipose tissue and parietal peritoneum.

The peritoneum (peritoneum) is a serous membrane that lines the abdominal cavity and covers the internal organs located in it. The peritoneum is formed by a serous plate and covered with a single-layered squamous epithelium. The peritoneum that lines the internal organs is called the visceral peritoneum, and the peritoneum that lines the walls of the abdominal cavity is called the parietal peritoneum. Connecting, the visceral and parietal peritoneum forms a limited closed peritoneal cavity. In an adult, the total area of ​​the visceral and parietal peritoneum is about 1.7 m2. The peritoneal cavity contains a small amount of serous fluid, which reduces friction between the surfaces of the internal organs covered by the peritoneum.

The peritoneum, passing from the walls of the abdominal cavity to organs or from organ to organ, forms ligaments, mesentery, folds and pits. The peritoneum covers the internal organs differently. A number of organs are covered with peritoneum on one side only (kidneys, adrenal glands, pancreas, part of the duodenum). This arrangement of organs is called extraperitoneal, and the organs themselves are called retroperitoneal.

Organs covered with peritoneum on three sides (ascending colon, descending colon, middle part of the rectum, bladder) have a mesoperitoneal location. If the organs are covered with peritoneum on all sides, then they are located intraperitoneally, or intraperitoneally (stomach, small and caecum, appendix, transverse colon, sigmoid colon, upper rectum, spleen, liver, fallopian tubes and uterus).

In the abdominal cavity, three floors are conditionally distinguished: upper, middle and lower. The upper floor is limited from above by a diaphragm; on the side - by the side walls of the abdominal cavity, covered with the parietal peritoneum; below - the transverse colon and its mesentery. Here are the stomach, liver, spleen, pancreas and upper part of the duodenum. Connecting with the anterior and posterior walls of the abdomen, the peritoneum passes to the diaphragm, and then to the liver and forms the coronal, falciform, right and left triangular ligaments of the liver. At the gates of the liver, the posterior and anterior layers of the peritoneum are connected and pass to the stomach and duodenum in the form of the hepatogastric and hepatoduodenal ligaments. These ligaments are located between the gates of the liver, the lesser curvature of the stomach and the upper part of the duodenum and form the lesser omentum. In the latter pass the hepatic artery, common bile duct and portal vein.

The greater omentum is a long fold of peritoneum hanging in front of the transverse colon and the apron-like loops of the small intestine. It consists of four sheets of peritoneum, between which there is fatty tissue.

The middle floor of the abdominal cavity is limited by the mesentery of the transverse colon and the entrance to the small pelvis. It contains the small intestine and part of the large intestine, as well as many pits, depressions, which are formed by the folds of the peritoneum and internal organs. More permanent are the pits around the jejunum (upper and lower duodenal recesses), the terminal ileum (upper and lower ileocecal recesses), the caecum (behind - the caecal recess) and in the mesentery of the sigmoid colon (intersigmoid recess).

The lower floor of the abdominal cavity is located in the small pelvis. It contains the rectum, bladder, seminal vesicles (in men), uterus with fallopian tubes and ovaries (in women). The peritoneum in the lower surface covers not only the upper and part of the middle section of the rectum, but also the organs of the genitourinary apparatus.

In men, the peritoneum from the rectum passes to the seminal vesicles and the posterior wall of the bladder and forms the rectovesical depression. In women, the peritoneum from the rectum passes to the vagina and the posterior wall of the uterus, forming first the recto-uterine, and then the vesico-uterine depression.

BORDERS, AREAS AND SECTIONS OF THE ABDOMINAL

From above, the abdomen is limited by the costal arches, from below - by the iliac crests, inguinal ligaments and the upper edge of the pubic fusion. The lateral border of the abdomen runs along vertical lines connecting the ends of the XI ribs with the anterior superior spines.

The abdomen is divided into three sections by two horizontal lines: the epigastrium (epigastrium), the womb (mesogastrium) and the hypogastrium (hypogastrium). The outer edges of the rectus abdominis go from top to bottom and divide each section into three areas.

Rice. 15.1. The division of the abdomen into departments and regions:

1 - projection of the dome of the diaphragm;

2 - linea costarum; 3 - linea spmarum; a - epigastrium; b - womb; in - hypogastrium; I - the actual epigastric region; II and III - right and left hypochondria; V - umbilical region; IV and VI - right and left side areas; VIII - suprapubic region; VII and IX - ilioinguinal regions

ANTERELATERAL ABDOMINAL WALL

The anterolateral abdominal wall is a complex of soft tissues located within the boundaries of the abdomen and covering the abdominal cavity.

Projection of organs on the anterolateral abdominal wall

The liver (right lobe), part of the gallbladder, hepatic flexure of the colon, right adrenal gland, part of the right kidney are projected into the right hypochondrium.

The left lobe of the liver, part of the gallbladder, part of the body and the pyloric part of the stomach, the upper half of the duodenum, the duodenal-jejunal junction (bend), the pancreas, parts of the right and left kidneys, the aorta with the celiac trunk, the celiac plexus, are projected into the epigastric region proper. a small section of the pericardium, inferior vena cava.

The bottom, cardia and part of the body of the stomach, spleen, tail of the pancreas, part of the left kidney and part of the left lobe of the liver are projected into the left hypochondrium.

The ascending colon, part of the ileum, part of the right kidney and the right ureter are projected into the right lateral region of the abdomen.

Part of the stomach (greater curvature), transverse colon, loops of the jejunum and ileum, part of the right kidney, aorta, and inferior vena cava are projected into the umbilical region.

The descending colon, loops of the jejunum, and the left ureter are projected into the left lateral region of the abdomen.

The caecum with the appendix and the terminal ileum are projected into the right ilio-inguinal region.

Loops of the jejunum and ileum are projected into the suprapubic region, the bladder is in a full state, part of the sigmoid colon (transition to the straight line).

The sigmoid colon and loops of the jejunum and ileum are projected into the left ilio-inguinal region.

The uterus normally does not protrude beyond the upper edge of the pubic symphysis, but during pregnancy, depending on the period, it can be projected into the suprapubic, umbilical or epigastric region.

Topography of layers and weaknesses of the anterolateral abdominal wall

The skin of the area is mobile, elastic, which allows it to be used for plastic purposes in the plastic surgery of facial defects (the Filatov stem method). The hairline is well developed.

The subcutaneous adipose tissue is divided into two layers by the superficial fascia, the degree of its development may vary from person to person. In the umbilical region, fiber is practically absent, along the white line it is poorly developed.

Superficial fascia consists of two sheets - superficial and deep (Thompson's fascia). The deep leaf is much stronger and denser than the superficial one and is attached to the inguinal ligament.

Own fascia covers the muscles of the abdomen and fuses with the inguinal ligament.

The most superficially located is the external oblique muscle of the abdomen. It consists of two parts: muscular, located more laterally, and aponeurotic, lying anterior to the rectus abdominis muscle and participating in the formation of the rectus sheath. The lower edge of the aponeurosis thickens, turns down and inward and forms the inguinal ligament.

The internal oblique muscle of the abdomen is located more deeply. It also consists of a muscular and aponeurotic part, but the aponeurotic part has a more complex structure. The aponeurosis has a longitudinal fissure located about 2 cm below the navel (Douglas line, or arcuate). Above this line, the aponeurosis consists of two sheets, one of which is located anterior to the rectus abdominis muscle, and the other is posterior to it. Below the Douglas line, both sheets merge with each other and are located anterior to the rectus muscle.

The rectus abdominis is located in the middle part of the abdomen. Its fibers are directed from top to bottom. The muscle is divided by 3-6 tendon bridges and lies in its own vagina, formed by aponeuroses of the internal and external oblique and transverse abdominal muscles. The anterior wall of the vagina is represented by an aponeurosis

external oblique and partially internal oblique abdominal muscles. It is loosely separated from the rectus muscle, but fuses with it in the area of ​​the tendon bridges. The posterior wall is formed due to the aponeurosis of the internal oblique (partially), transverse abdominal muscles and intra-abdominal fascia and does not grow together with the muscle anywhere, forming a cellular space in which the upper and lower epigastric vessels pass. In this case, the corresponding veins in the navel are connected to each other and form a deep venous network. In some cases, the rectus abdominis is reinforced from below by the pyramidal muscle.

The transverse abdominal muscle lies deeper than all the others. It also consists of muscular and aponeurotic parts. Its fibers are located transversely, while the aponeurotic part is much wider than the muscular one, as a result of which there are small slit-like spaces at the place of their transition. The transition of the muscular part into the tendon has the form of a semicircular line, called the lunate, or Spiegel's line.

According to the Douglas line, the aponeurosis of the transverse abdominis muscle also splits: above this line it passes under the rectus abdominis muscle and participates in the formation of the posterior wall of the vagina of the rectus muscle, and below the line it participates in the formation of the anterior wall of the vagina.

Under the transverse muscle is the intra-abdominal fascia, which in the area under consideration is called the transverse (according to the muscle on which it lies).

It should be noted that the aponeuroses of the left and right oblique and transverse abdominal muscles fuse with each other along the midline, forming the white line of the abdomen. Considering the relative paucity of blood vessels, the presence of a connection between all layers and sufficient strength, it is the white line of the abdomen that is the site of the fastest surgical access for interventions on the internal organs of the abdomen.

abdominal cavity is the largest cavity in the human body. From above, the abdominal cavity is limited by the diaphragm, below it continues into the cavity of the small pelvis, in front and from the sides it is limited by the muscles of the abdomen, behind - by the muscles of the lower back and the corresponding section of the spinal column. The inner surface of the abdominal cavity is lined with retroperitoneal fascia, adipose tissue and parietal peritoneum.

The abdominal cavity is divided into the peritoneal cavity and the retroperitoneal space. The peritoneal cavity is limited by the parietal peritoneum. Retroperitoneal space - part of the abdominal cavity, lying between the parietal fascia of the abdomen at its posterior wall and the parietal peritoneum.

Peritoneum- a serous membrane that covers the inside of the walls of the abdominal cavity (parietal peritoneum) or the surface of internal organs (visceral peritoneum). Both sheets of the peritoneum, passing one into the other, form a closed space, which is the peritoneal cavity. Normally, this cavity is a narrow gap filled with a small amount of serous fluid, which acts as a lubricant to facilitate the movements of the abdominal organs relative to the walls or each other. The amount of serous fluid usually does not exceed 25-30 ml, the pressure is approximately equal to atmospheric.

Laparotomy (abdominal surgery)- a mandatory stage of all operations on the abdominal organs. In some cases, it serves as an access to a specific organ or pathological process, in others it is used to revise the abdominal organs in order to exclude damage to internal organs or determine the possibility of surgery for a tumor process.

Access. Most often, an incision is used along the midline of the abdomen - a median laparotomy.

With an upper median laparotomy, that is, an incision along the midline above the navel, the skin, subcutaneous tissue, aponeurosis (or white line of the abdomen), preperitoneal tissue and peritoneum are dissected. This incision provides access to the upper abdominal organs. The lower median incision also runs along the white line, however, after dissection of the white line, which is very narrow below the navel, it is often necessary to use Farabef lamellar hooks to retract the edges of the rectus muscles. The incision provides access to the intestines and pelvic organs. With mid-median laparotomy, the incision starts above the navel, bypasses the navel on the left and ends below it by 3-4 cm. This access is intended for revision of the entire abdominal cavity: if necessary, it can be extended up or down.

Ways of distribution of pus in the abdominal cavity with peritonitis (scheme)

Peritoneal exudate can spread from the right hypochondrium to the right subdiaphragmatic cavity or penetrate through the right lateral canal into the iliac fossa and descend into the pelvis. With the progression of the process and the accumulation of exudate, pus moves along the left lateral canal into the left subdiaphragmatic cavity (Fig. 95). Significant changes occur in the blood and lymphatic vessels of the intestine, omentum and adjacent tissues and organs. Initially, the vessels overflow with blood, then blood clots appear. This process can move to large venous trunks and even the portal vein. The purulent thrombophlebitis frolicking in these cases leads to the formation of multiple liver abscesses. The defeat of the purulent process of the lymphatic vessels and nodes leads to mesenteric and retroperitoneal lymphangitis and lymphadenitis.

The concept of rational drainage of the abdominal cavity includes a set of techniques that ensure unhindered outflow of fluid from the abdominal cavity. First of all, we mean ensuring the outflow of pus in peritonitis - the primary task of treating any purulent process.

Successful drainage of the abdominal cavity is possible only under the following conditions: the drainage must be in places where fluid accumulates, be passable. It is installed in the sloping areas of the abdominal cavity and some of its pockets, and the patient is recommended a position in bed that contributes to the best drainage. With peritonitis, as a rule, an elevated position is shown, in some cases, a position on the side, back is required. It is more difficult to ensure the patency of the drainage. For drainage purposes, the introduction of rubber tubular drains, as well as drains made of synthetic materials, is widespread.