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Anatomy_Gray_800 | Anatomy_Gray | How to find the superficial inguinal ring The superficial inguinal ring is an elongate triangular defect in the aponeurosis of the external oblique (Fig. 4.177). It lies in the lower medial aspect of the anterior abdominal wall and is the external opening of the inguinal canal. The inguinal canal and superficial ring a... | Anatomy_Gray. How to find the superficial inguinal ring The superficial inguinal ring is an elongate triangular defect in the aponeurosis of the external oblique (Fig. 4.177). It lies in the lower medial aspect of the anterior abdominal wall and is the external opening of the inguinal canal. The inguinal canal and supe... |
Anatomy_Gray_801 | Anatomy_Gray | The superficial inguinal ring is superior to the pubic crest and tubercle and to the medial end of the inguinal ligament: In men, the superficial inguinal ring can be easily located by following the spermatic cord superiorly to the lower abdominal wall—the external spermatic fascia of the spermatic cord is continuous w... | Anatomy_Gray. The superficial inguinal ring is superior to the pubic crest and tubercle and to the medial end of the inguinal ligament: In men, the superficial inguinal ring can be easily located by following the spermatic cord superiorly to the lower abdominal wall—the external spermatic fascia of the spermatic cord i... |
Anatomy_Gray_802 | Anatomy_Gray | How to determine lumbar vertebral levels Lumbar vertebral levels are useful for visualizing the positions of viscera and major blood vessels. The approximate positions of the lumbar vertebrae can be established using palpable or visible landmarks (Fig. 4.178): A horizontal plane passes through the medial ends of the ni... | Anatomy_Gray. How to determine lumbar vertebral levels Lumbar vertebral levels are useful for visualizing the positions of viscera and major blood vessels. The approximate positions of the lumbar vertebrae can be established using palpable or visible landmarks (Fig. 4.178): A horizontal plane passes through the medial ... |
Anatomy_Gray_803 | Anatomy_Gray | A plane through the tubercles of the crest of the ilium passes through the body of the LV vertebra. Visualizing structures at the LI The LI vertebral level is marked by the transpyloric plane, which cuts transversely through the body midway between the jugular notch and pubic symphysis, and through the ends of the nint... | Anatomy_Gray. A plane through the tubercles of the crest of the ilium passes through the body of the LV vertebra. Visualizing structures at the LI The LI vertebral level is marked by the transpyloric plane, which cuts transversely through the body midway between the jugular notch and pubic symphysis, and through the en... |
Anatomy_Gray_804 | Anatomy_Gray | The superior mesenteric artery originates at the lower border of the LI vertebra. The renal arteries originate at approximately the LII vertebra. The inferior mesenteric artery originates at the LIII vertebra. The aorta bifurcates into the right and left common iliac arteries at the level of the LIV vertebra. The left ... | Anatomy_Gray. The superior mesenteric artery originates at the lower border of the LI vertebra. The renal arteries originate at approximately the LII vertebra. The inferior mesenteric artery originates at the LIII vertebra. The aorta bifurcates into the right and left common iliac arteries at the level of the LIV verte... |
Anatomy_Gray_805 | Anatomy_Gray | The stomach and spleen are in the left upper quadrant. The cecum and appendix are in the right lower quadrant. The end of the descending colon and sigmoid colon are in the left lower quadrant. Most of the liver is under the right dome of the diaphragm and is deep to the lower thoracic wall. The inferior margin of the l... | Anatomy_Gray. The stomach and spleen are in the left upper quadrant. The cecum and appendix are in the right lower quadrant. The end of the descending colon and sigmoid colon are in the left lower quadrant. Most of the liver is under the right dome of the diaphragm and is deep to the lower thoracic wall. The inferior m... |
Anatomy_Gray_806 | Anatomy_Gray | McBurney’s point, which is one-third of the way up along a line from the right anterior superior iliac spine to the umbilicus. Defining surface regions to which pain from the gut is referred The abdomen can be divided into nine regions by a midclavicular sagittal plane on each side and by the subcostal and intertubercu... | Anatomy_Gray. McBurney’s point, which is one-third of the way up along a line from the right anterior superior iliac spine to the umbilicus. Defining surface regions to which pain from the gut is referred The abdomen can be divided into nine regions by a midclavicular sagittal plane on each side and by the subcostal an... |
Anatomy_Gray_807 | Anatomy_Gray | The kidneys project onto the back on either side of the midline and are related to the lower ribs (Fig. 4.183): The left kidney is a little higher than the right and reaches as high as rib XI. The superior pole of the right kidney reaches only as high as rib XII. The lower poles of the kidneys occur around the level of... | Anatomy_Gray. The kidneys project onto the back on either side of the midline and are related to the lower ribs (Fig. 4.183): The left kidney is a little higher than the right and reaches as high as rib XI. The superior pole of the right kidney reaches only as high as rib XII. The lower poles of the kidneys occur aroun... |
Anatomy_Gray_808 | Anatomy_Gray | Fig. 4.1 Abdomen. A. Boundaries. B. Arrangement of abdominal contents. Inferior view. Fig. 4.2 The abdomen contains and protects the abdominal viscera. Fig. 4.3 The abdomen assists in breathing. InspirationExpirationDiaphragmRelaxation of diaphragmContraction ofdiaphragmContraction of abdominal musclesRelaxation ofabdo... | Anatomy_Gray. Fig. 4.1 Abdomen. A. Boundaries. B. Arrangement of abdominal contents. Inferior view. Fig. 4.2 The abdomen contains and protects the abdominal viscera. Fig. 4.3 The abdomen assists in breathing. InspirationExpirationDiaphragmRelaxation of diaphragmContraction ofdiaphragmContraction of abdominal musclesRel... |
Anatomy_Gray_809 | Anatomy_Gray | Fig. 4.7 A series showing the progression (A to C) from an intraperitoneal organ to a secondarily retroperitoneal organ. MesenteryVisceral peritoneumGastrointestinal tractGastrointestinal tractGastrointestinal tractParietal peritoneumArtery to gastrointestinal tractRetroperitoneal structuresMesentery before fusion with... | Anatomy_Gray. Fig. 4.7 A series showing the progression (A to C) from an intraperitoneal organ to a secondarily retroperitoneal organ. MesenteryVisceral peritoneumGastrointestinal tractGastrointestinal tractGastrointestinal tractParietal peritoneumArtery to gastrointestinal tractRetroperitoneal structuresMesentery befo... |
Anatomy_Gray_810 | Anatomy_Gray | RectumPeritoneumPelvic inletBladderUterusShadow of ureterShadow of internal iliac vessels Fig. 4.12 Structures passing between the abdomen and thigh. Fig. 4.13 A series (A to H) showing the development of the gut and mesenteries. Fig. 4.14 Innervation of the anterior abdominal wall. Fig. 4.15 Inguinal region. A. Develo... | Anatomy_Gray. RectumPeritoneumPelvic inletBladderUterusShadow of ureterShadow of internal iliac vessels Fig. 4.12 Structures passing between the abdomen and thigh. Fig. 4.13 A series (A to H) showing the development of the gut and mesenteries. Fig. 4.14 Innervation of the anterior abdominal wall. Fig. 4.15 Inguinal reg... |
Anatomy_Gray_811 | Anatomy_Gray | Fig. 4.16 Vertebral level LI. Jugular notchRightkidneyLI (transpyloric)planePubic symphysisCostal marginPyloric orifice betweenstomach and duodenumPosition of umbilicus Fig. 4.17 Blood supply of the gut. A. Relationship of vessels to the gut and mesenteries. B. Anterior view. Fig. 4.18 Left-to-right venous shunts. Fig.... | Anatomy_Gray. Fig. 4.16 Vertebral level LI. Jugular notchRightkidneyLI (transpyloric)planePubic symphysisCostal marginPyloric orifice betweenstomach and duodenumPosition of umbilicus Fig. 4.17 Blood supply of the gut. A. Relationship of vessels to the gut and mesenteries. B. Anterior view. Fig. 4.18 Left-to-right venou... |
Anatomy_Gray_812 | Anatomy_Gray | Fig. 4.22 Four-quadrant topographical pattern. Fig. 4.23 Nine-region organizational pattern. Fig. 4.24 Layers of the abdominal wall. Fig. 4.25 Superficial fascia. Superficial fasciaFatty layer(Camper's fascia)Membranous layer(Scarpa's fascia)SkinPubic symphysisPenisDartos fasciaScrotumInguinal ligamentAponeurosis of ex... | Anatomy_Gray. Fig. 4.22 Four-quadrant topographical pattern. Fig. 4.23 Nine-region organizational pattern. Fig. 4.24 Layers of the abdominal wall. Fig. 4.25 Superficial fascia. Superficial fasciaFatty layer(Camper's fascia)Membranous layer(Scarpa's fascia)SkinPubic symphysisPenisDartos fasciaScrotumInguinal ligamentApo... |
Anatomy_Gray_813 | Anatomy_Gray | Fig. 4.28 Ligaments formed from the external oblique aponeurosis. Fig. 4.29 Ligaments of the inguinal region. Fig. 4.30 Internal oblique muscle and its aponeurosis. External oblique muscleRib XInternal oblique muscleand aponeurosisLinea albaExternal oblique muscleAponeurosis of external obliqueAnterior superior iliac s... | Anatomy_Gray. Fig. 4.28 Ligaments formed from the external oblique aponeurosis. Fig. 4.29 Ligaments of the inguinal region. Fig. 4.30 Internal oblique muscle and its aponeurosis. External oblique muscleRib XInternal oblique muscleand aponeurosisLinea albaExternal oblique muscleAponeurosis of external obliqueAnterior su... |
Anatomy_Gray_814 | Anatomy_Gray | External oblique musclePosterior wall of rectus sheathRectus abdominis muscleTendinous intersectionInternal oblique muscle Arcuate lineTransversalis fasciaLinea albaPyramidalis muscle Fig. 4.33 Organization of the rectus sheath. A. Transverse section through the upper three-quarters of the rectus sheath. B. Transverse ... | Anatomy_Gray. External oblique musclePosterior wall of rectus sheathRectus abdominis muscleTendinous intersectionInternal oblique muscle Arcuate lineTransversalis fasciaLinea albaPyramidalis muscle Fig. 4.33 Organization of the rectus sheath. A. Transverse section through the upper three-quarters of the rectus sheath. ... |
Anatomy_Gray_815 | Anatomy_Gray | Fig. 4.38 Dermatomes of the anterolateral abdominal wall. Fig. 4.39 Arterial supply to the anterolateral abdominal wall. Fig. 4.40 Superior and inferior epigastric arteries. Fig. 4.41 Descent of the testis from week 7 (postfertilization) to birth. Fig. 4.42 Inguinal canal. Linea albaSuperficialinguinal ringDeep inguina... | Anatomy_Gray. Fig. 4.38 Dermatomes of the anterolateral abdominal wall. Fig. 4.39 Arterial supply to the anterolateral abdominal wall. Fig. 4.40 Superior and inferior epigastric arteries. Fig. 4.41 Descent of the testis from week 7 (postfertilization) to birth. Fig. 4.42 Inguinal canal. Linea albaSuperficialinguinal ri... |
Anatomy_Gray_816 | Anatomy_Gray | Inguinal ligamentFemoral artery and veinInternal oblique muscleAponeurosis of internal oblique Spermatic cordConjoint tendonAnterior superior iliac spine Fig. 4.46 Transversus abdominis muscle and the inguinal canal. Fig. 4.47 A. Spermatic cord (men). B. Round ligament of uterus (women). Internal spermatic fasciaPariet... | Anatomy_Gray. Inguinal ligamentFemoral artery and veinInternal oblique muscleAponeurosis of internal oblique Spermatic cordConjoint tendonAnterior superior iliac spine Fig. 4.46 Transversus abdominis muscle and the inguinal canal. Fig. 4.47 A. Spermatic cord (men). B. Round ligament of uterus (women). Internal spermati... |
Anatomy_Gray_817 | Anatomy_Gray | Internaloblique muscleParietal peritoneumGenital branch ofgenitofemoral nerveGenital branch ofgenitofemoral nerveInferior epigastric vesselsRound ligament of uterusExternal obliqueaponeurosisTransversusabdominis muscleMembranous layerof superficial fasciaSuperficial fascia(fatty layers) Fine connectivetissue strandsBCo... | Anatomy_Gray. Internaloblique muscleParietal peritoneumGenital branch ofgenitofemoral nerveGenital branch ofgenitofemoral nerveInferior epigastric vesselsRound ligament of uterusExternal obliqueaponeurosisTransversusabdominis muscleMembranous layerof superficial fasciaSuperficial fascia(fatty layers) Fine connectivetis... |
Anatomy_Gray_818 | Anatomy_Gray | Fig. 4.51 Coronal CT shows a large inguinal hernia containing loops of large and small bowel (arrow) on the left side of a male patient. Fig. 4.52 Right indirect inguinal hernia. T2, fat saturated, weighted magnetic resonance image in the coronal plane of a male groin. Fig. 4.53 A. Intraperitoneal. B. Retroperitoneal. ... | Anatomy_Gray. Fig. 4.51 Coronal CT shows a large inguinal hernia containing loops of large and small bowel (arrow) on the left side of a male patient. Fig. 4.52 Right indirect inguinal hernia. T2, fat saturated, weighted magnetic resonance image in the coronal plane of a male groin. Fig. 4.53 A. Intraperitoneal. B. Ret... |
Anatomy_Gray_819 | Anatomy_Gray | Peritoneal metastasison surface of liverAortaInferior vena cavaLiverSpleenLeft kidney Fig. 4.58 Radiograph of subdiaphragmatic gas. Fig. 4.59 Greater omentum. Fig. 4.60 Lesser omentum. Liver (retracted )GallbladderStomachLesser omentumDuodenumDescending colonAscending colonOmental foramenLesser curvature of the stomach... | Anatomy_Gray. Peritoneal metastasison surface of liverAortaInferior vena cavaLiverSpleenLeft kidney Fig. 4.58 Radiograph of subdiaphragmatic gas. Fig. 4.59 Greater omentum. Fig. 4.60 Lesser omentum. Liver (retracted )GallbladderStomachLesser omentumDuodenumDescending colonAscending colonOmental foramenLesser curvature ... |
Anatomy_Gray_820 | Anatomy_Gray | Fig. 4.64 Stomach. Fig. 4.65 Radiograph, using barium, showing the stomach and duodenum. A. Double-contrast radiograph of the stomach. B. Double-contrast radiograph showing the duodenal cap. Fundus of stomachPyloric orificeSuperior part of duodenumABPyloric antrumEsophagusNormal duodenal capPyloric antrum of stomachInf... | Anatomy_Gray. Fig. 4.64 Stomach. Fig. 4.65 Radiograph, using barium, showing the stomach and duodenum. A. Double-contrast radiograph of the stomach. B. Double-contrast radiograph showing the duodenal cap. Fundus of stomachPyloric orificeSuperior part of duodenumABPyloric antrumEsophagusNormal duodenal capPyloric antrum... |
Anatomy_Gray_821 | Anatomy_Gray | Fig. 4.67 Arterial supply to the duodenum. Fig. 4.68 Radiograph, using barium, showing the jejunum and ileum. Fig. 4.69 Differences in the arterial supply to the small intestine. A. Jejunum. B. Ileum. Fig. 4.70 Ileocecal junction. A. Radiograph showing ileocecal junction. B. Illustration showing ileocecal junction and ... | Anatomy_Gray. Fig. 4.67 Arterial supply to the duodenum. Fig. 4.68 Radiograph, using barium, showing the jejunum and ileum. Fig. 4.69 Differences in the arterial supply to the small intestine. A. Jejunum. B. Ileum. Fig. 4.70 Ileocecal junction. A. Radiograph showing ileocecal junction. B. Illustration showing ileocecal... |
Anatomy_Gray_822 | Anatomy_Gray | Fig. 4.74 Endoscopic image of the pyloric antrum of the stomach looking toward the pylorus. Fig. 4.75 Endoscopic image showing normal appearance of the second part of the duodenum. Fig. 4.76 Small bowel visualization using MRI in coronal plane. Fig. 4.77 Axial CT shows sigmoid colon wall thickening caused by tumor. Fig... | Anatomy_Gray. Fig. 4.74 Endoscopic image of the pyloric antrum of the stomach looking toward the pylorus. Fig. 4.75 Endoscopic image showing normal appearance of the second part of the duodenum. Fig. 4.76 Small bowel visualization using MRI in coronal plane. Fig. 4.77 Axial CT shows sigmoid colon wall thickening caused... |
Anatomy_Gray_823 | Anatomy_Gray | Fig. 4.82 Cecum and appendix. Fig. 4.83 Mesoappendix and appendicular vessels. Fig. 4.84 Positions of the appendix. Fig. 4.85 Arterial supply to the cecum and appendix. Fig. 4.86 Inflamed appendix. Ultrasound scan. Fig. 4.87 Axial CT shows inflamed appendix. Fig. 4.88 Colon. Fig. 4.89 Right and left colic flexures. Fig... | Anatomy_Gray. Fig. 4.82 Cecum and appendix. Fig. 4.83 Mesoappendix and appendicular vessels. Fig. 4.84 Positions of the appendix. Fig. 4.85 Arterial supply to the cecum and appendix. Fig. 4.86 Inflamed appendix. Ultrasound scan. Fig. 4.87 Axial CT shows inflamed appendix. Fig. 4.88 Colon. Fig. 4.89 Right and left colic... |
Anatomy_Gray_824 | Anatomy_Gray | Fig. 4.94 Small bowel malrotation. Radiograph of stomach, duodenum, and jejunum using barium. Fig. 4.95 This radiograph of the abdomen, anteroposterior view, demonstrates a number of dilated loops of small bowel. Small bowel can be identified by the plicae circulares that pass from wall to wall as indicated. The large ... | Anatomy_Gray. Fig. 4.94 Small bowel malrotation. Radiograph of stomach, duodenum, and jejunum using barium. Fig. 4.95 This radiograph of the abdomen, anteroposterior view, demonstrates a number of dilated loops of small bowel. Small bowel can be identified by the plicae circulares that pass from wall to wall as indicat... |
Anatomy_Gray_825 | Anatomy_Gray | Fig. 4.98 This oblique radiograph demonstrates contrast passing through a colonic stent that has been placed to relieve bowel obstruction prior to surgery. Fig. 4.99 This double-contrast barium enema demonstrates numerous small outpouchings throughout the distal large bowel predominantly within the descending colon and... | Anatomy_Gray. Fig. 4.98 This oblique radiograph demonstrates contrast passing through a colonic stent that has been placed to relieve bowel obstruction prior to surgery. Fig. 4.99 This double-contrast barium enema demonstrates numerous small outpouchings throughout the distal large bowel predominantly within the descen... |
Anatomy_Gray_826 | Anatomy_Gray | Fig. 4.103 Diaphragmatic surface of the liver. Fig. 4.104 Visceral surface of the liver. A. Illustration. B. Abdominal computed tomogram, with contrast, in the axial plane. Left lobe of liverLeft lobe of liverRight lobeof liverCaudate lobeRight lobe of liverQuadrate lobeQuadrate lobeGallbladderAnteriorPosteriorFundusBo... | Anatomy_Gray. Fig. 4.103 Diaphragmatic surface of the liver. Fig. 4.104 Visceral surface of the liver. A. Illustration. B. Abdominal computed tomogram, with contrast, in the axial plane. Left lobe of liverLeft lobe of liverRight lobeof liverCaudate lobeRight lobe of liverQuadrate lobeQuadrate lobeGallbladderAnteriorPos... |
Anatomy_Gray_827 | Anatomy_Gray | Fig. 4.106 Arterial supply to the liver and gallbladder. A. Schematic. B. Laparoscopic surgical view of cystic duct and cystic artery. Fig. 4.107 Pancreas. Fig. 4.108 Abdominal images. A. Abdominal computed tomogram, with contrast, in the axial plane. B. Abdominal ultrasound scan. GallbladderPancreasPortal veinSplenic ... | Anatomy_Gray. Fig. 4.106 Arterial supply to the liver and gallbladder. A. Schematic. B. Laparoscopic surgical view of cystic duct and cystic artery. Fig. 4.107 Pancreas. Fig. 4.108 Abdominal images. A. Abdominal computed tomogram, with contrast, in the axial plane. B. Abdominal ultrasound scan. GallbladderPancreasPorta... |
Anatomy_Gray_828 | Anatomy_Gray | Fig. 4.112 Spleen. Fig. 4.113 Splenic ligaments and related vasculature. Fig. 4.114 Surfaces and hilum of the spleen. Fig. 4.115 Arterial supply to the spleen. Fig. 4.116 Division of the liver into segments based upon the distributions of the bile ducts and hepatic vessels (Couinaud’s segments). Fig. 4.117 Gallbladder ... | Anatomy_Gray. Fig. 4.112 Spleen. Fig. 4.113 Splenic ligaments and related vasculature. Fig. 4.114 Surfaces and hilum of the spleen. Fig. 4.115 Arterial supply to the spleen. Fig. 4.116 Division of the liver into segments based upon the distributions of the bile ducts and hepatic vessels (Couinaud’s segments). Fig. 4.11... |
Anatomy_Gray_829 | Anatomy_Gray | Fig. 4.121 Anterior branches of the abdominal aorta. Fig. 4.122 Divisions of the gastrointestinal tract into foregut, midgut, and hindgut, summarizing the primary arterial supply to each segment. Fig. 4.123 Celiac trunk. A. Distribution of the celiac trunk. B. Digital subtraction angiography of the celiac trunk and its... | Anatomy_Gray. Fig. 4.121 Anterior branches of the abdominal aorta. Fig. 4.122 Divisions of the gastrointestinal tract into foregut, midgut, and hindgut, summarizing the primary arterial supply to each segment. Fig. 4.123 Celiac trunk. A. Distribution of the celiac trunk. B. Digital subtraction angiography of the celiac... |
Anatomy_Gray_830 | Anatomy_Gray | Fig. 4.129 Arterial supply to the abdominal parts of the gastrointestinal system and to the spleen. Fig. 4.130 Enlarged marginal artery connecting the superior and inferior mesenteric arteries. Digital subtraction angiogram. Fig. 4.131 Portal vein. Fig. 4.132 Venous drainage of the abdominal portion of the gastrointest... | Anatomy_Gray. Fig. 4.129 Arterial supply to the abdominal parts of the gastrointestinal system and to the spleen. Fig. 4.130 Enlarged marginal artery connecting the superior and inferior mesenteric arteries. Digital subtraction angiogram. Fig. 4.131 Portal vein. Fig. 4.132 Venous drainage of the abdominal portion of th... |
Anatomy_Gray_831 | Anatomy_Gray | Fig. 4.135 Sympathetic trunks. Fig. 4.136 Splanchnic nerves. Fig. 4.137 Abdominal prevertebral plexus and ganglia. Fig. 4.138 Parasympathetic innervation of the abdominal portion of the gastrointestinal tract. Fig. 4.139 The enteric system. Fig. 4.140 Posterior abdominal region. Fig. 4.141 Osteology of the posterior ab... | Anatomy_Gray. Fig. 4.135 Sympathetic trunks. Fig. 4.136 Splanchnic nerves. Fig. 4.137 Abdominal prevertebral plexus and ganglia. Fig. 4.138 Parasympathetic innervation of the abdominal portion of the gastrointestinal tract. Fig. 4.139 The enteric system. Fig. 4.140 Posterior abdominal region. Fig. 4.141 Osteology of th... |
Anatomy_Gray_832 | Anatomy_Gray | Fig. 4.145 Right and left domes of the diaphragm. Chest radiograph. Fig. 4.146 Fetal diaphragmatic hernia in utero. T2-weighted MR image. Fetus in coronal plane, mother in sagittal plane. Fetal vertebralcolumnFetal abdominalcontents (fluid-filledloops of intestine)in left side ofthoracic cavityFetal headNormal fetal lu... | Anatomy_Gray. Fig. 4.145 Right and left domes of the diaphragm. Chest radiograph. Fig. 4.146 Fetal diaphragmatic hernia in utero. T2-weighted MR image. Fetus in coronal plane, mother in sagittal plane. Fetal vertebralcolumnFetal abdominalcontents (fluid-filledloops of intestine)in left side ofthoracic cavityFetal headN... |
Anatomy_Gray_833 | Anatomy_Gray | Fig. 4.150 Structures related to the anterior surface of each kidney. StomachLiverPancreasDescending colonSmall intestineSpleenJejunumRight colic flexureLeft colic flexureDescending part of duodenumRight suprarenal glandLeft suprarenal gland Fig. 4.151 Structures related to the posterior surface of each kidney. Fig. 4.... | Anatomy_Gray. Fig. 4.150 Structures related to the anterior surface of each kidney. StomachLiverPancreasDescending colonSmall intestineSpleenJejunumRight colic flexureLeft colic flexureDescending part of duodenumRight suprarenal glandLeft suprarenal gland Fig. 4.151 Structures related to the posterior surface of each k... |
Anatomy_Gray_834 | Anatomy_Gray | Fig. 4.156 Low-dose axial CT of urinary tract (CT KUB) displays stone in left renal pelvis. Fig. 4.157 Tumor in the right kidney growing toward, and possibly invading, the duodenum. Computed tomogram in the axial plane. Fig. 4.158 Tumor in the right kidney spreading into the right renal vein. Computed tomogram in the a... | Anatomy_Gray. Fig. 4.156 Low-dose axial CT of urinary tract (CT KUB) displays stone in left renal pelvis. Fig. 4.157 Tumor in the right kidney growing toward, and possibly invading, the duodenum. Computed tomogram in the axial plane. Fig. 4.158 Tumor in the right kidney spreading into the right renal vein. Computed tom... |
Anatomy_Gray_835 | Anatomy_Gray | Fig. 4.161 Kidney transplant. A. This image demonstrates an MR angiogram of the bifurcation of the aorta. Attaching to the left external iliac artery is the donor artery for a kidney that has been transplanted into the left iliac fossa. B. Abdominal computed tomogram, in the axial plane, showing the transplanted kidney... | Anatomy_Gray. Fig. 4.161 Kidney transplant. A. This image demonstrates an MR angiogram of the bifurcation of the aorta. Attaching to the left external iliac artery is the donor artery for a kidney that has been transplanted into the left iliac fossa. B. Abdominal computed tomogram, in the axial plane, showing the trans... |
Anatomy_Gray_836 | Anatomy_Gray | Fig. 4.162 Coronal view of 3-D urogram using multidetector computed tomography. Fig. 4.163 Arterial supply to the suprarenal glands. Fig. 4.164 Abdominal aorta. Fig. 4.165 Volume-rendered reconstruction using multidetector computed tomography of patient with an infrarenal abdominal aortic aneurysm before (A) and after ... | Anatomy_Gray. Fig. 4.162 Coronal view of 3-D urogram using multidetector computed tomography. Fig. 4.163 Arterial supply to the suprarenal glands. Fig. 4.164 Abdominal aorta. Fig. 4.165 Volume-rendered reconstruction using multidetector computed tomography of patient with an infrarenal abdominal aortic aneurysm before ... |
Anatomy_Gray_837 | Anatomy_Gray | Fig. 4.169 Sympathetic trunks passing through the posterior abdominal region. Fig. 4.170 Prevertebral plexus and ganglia in the posterior abdominal region. Fig. 4.171 Nerve fibers passing through the abdominal prevertebral plexus and ganglia. Fig. 4.172 Prevertebral ganglia associated with the prevertebral plexus. Fig.... | Anatomy_Gray. Fig. 4.169 Sympathetic trunks passing through the posterior abdominal region. Fig. 4.170 Prevertebral plexus and ganglia in the posterior abdominal region. Fig. 4.171 Nerve fibers passing through the abdominal prevertebral plexus and ganglia. Fig. 4.172 Prevertebral ganglia associated with the prevertebra... |
Anatomy_Gray_838 | Anatomy_Gray | Fig. 4.175 Cutaneous distribution of the nerves from the lumbar plexus. L1T12T12T12T11T11T10T10Ilio-inguinal nerve (L1)Ilio-inguinal nerve (L1)Genitofemoral nerve (L1,L2)Lateral cutaneous nerve of thigh (L2,L3)Obturator nerve (L2 to L4)Cutaneous branch of obturator nerve (L2 to L4)Femoral nerve (L2 to L4)Lateral cutane... | Anatomy_Gray. Fig. 4.175 Cutaneous distribution of the nerves from the lumbar plexus. L1T12T12T12T11T11T10T10Ilio-inguinal nerve (L1)Ilio-inguinal nerve (L1)Genitofemoral nerve (L1,L2)Lateral cutaneous nerve of thigh (L2,L3)Obturator nerve (L2 to L4)Cutaneous branch of obturator nerve (L2 to L4)Femoral nerve (L2 to L4)... |
Anatomy_Gray_839 | Anatomy_Gray | Fig. 4.177 Groin. A. In a man. B. In a woman. C. Examination of the superficial inguinal ring and related regions of the inguinal canal in a man. Deep inguinal ringAponeurosis of external obliqueAponeurosis of external obliqueSuperficial inguinal ringPosition of pubic symphysisABCAnterior superior iliac spineSpermatic ... | Anatomy_Gray. Fig. 4.177 Groin. A. In a man. B. In a woman. C. Examination of the superficial inguinal ring and related regions of the inguinal canal in a man. Deep inguinal ringAponeurosis of external obliqueAponeurosis of external obliqueSuperficial inguinal ringPosition of pubic symphysisABCAnterior superior iliac s... |
Anatomy_Gray_840 | Anatomy_Gray | Fig. 4.179 LI vertebral level and the important viscera associated with this level. Anterior view of the abdominal region of a man. KidneyEnd of ninth costal cartilageLI9Pubic symphysisJugular notchDuodenumTranspyloric planeNeck of pancreasSuperior mesenteric artery Fig. 4.180 Major vessels projected onto the body’s su... | Anatomy_Gray. Fig. 4.179 LI vertebral level and the important viscera associated with this level. Anterior view of the abdominal region of a man. KidneyEnd of ninth costal cartilageLI9Pubic symphysisJugular notchDuodenumTranspyloric planeNeck of pancreasSuperior mesenteric artery Fig. 4.180 Major vessels projected onto... |
Anatomy_Gray_841 | Anatomy_Gray | Fig. 4.181 Abdominal quadrants and the positions of major viscera. Anterior view of a man. Fig. 4.182 The nine regions of the abdomen. Anterior view of a woman. Fig. 4.183 Surface projection of the kidneys and ureters. Posterior view of the abdominal region of a woman. Fig. 4.184 Surface projection of the spleen. Poste... | Anatomy_Gray. Fig. 4.181 Abdominal quadrants and the positions of major viscera. Anterior view of a man. Fig. 4.182 The nine regions of the abdomen. Anterior view of a woman. Fig. 4.183 Surface projection of the kidneys and ureters. Posterior view of the abdominal region of a woman. Fig. 4.184 Surface projection of the... |
Anatomy_Gray_842 | Anatomy_Gray | eFig. 4.191 A computed tomogram, in the axial plane, of the pelvis demonstrates a loop of sigmoid colon with numerous diverticula and a large abscess in the pelvic cavity. Fig. 4.186 This postcontrast computed tomogram, in the axial plane, demonstrates two metastases situated within the right lobe of the liver. The lef... | Anatomy_Gray. eFig. 4.191 A computed tomogram, in the axial plane, of the pelvis demonstrates a loop of sigmoid colon with numerous diverticula and a large abscess in the pelvic cavity. Fig. 4.186 This postcontrast computed tomogram, in the axial plane, demonstrates two metastases situated within the right lobe of the ... |
Anatomy_Gray_843 | Anatomy_Gray | Table 4.3 Branches of the abdominal aorta Table 4.4 Lymphatic drainage Table 4.5 Referred pain pathways (visceral afferents) Table 4.6 Branches of the lumbar plexus In the clinic Access to the abdomen and its contents is usually obtained through incisions in the anterior abdominal wall. Traditionally, incisions have be... | Anatomy_Gray. Table 4.3 Branches of the abdominal aorta Table 4.4 Lymphatic drainage Table 4.5 Referred pain pathways (visceral afferents) Table 4.6 Branches of the lumbar plexus In the clinic Access to the abdomen and its contents is usually obtained through incisions in the anterior abdominal wall. Traditionally, inc... |
Anatomy_Gray_844 | Anatomy_Gray | In the clinic Laparoscopic surgery, also known as minimally invasive or keyhole surgery, is performed by operating through a series of small incisions no more than 1 to 2 cm in length. As the incisions are much smaller than those used in traditional abdominal surgery, patients experience less postoperative pain and hav... | Anatomy_Gray. In the clinic Laparoscopic surgery, also known as minimally invasive or keyhole surgery, is performed by operating through a series of small incisions no more than 1 to 2 cm in length. As the incisions are much smaller than those used in traditional abdominal surgery, patients experience less postoperativ... |
Anatomy_Gray_845 | Anatomy_Gray | During the operation, a camera known as a laparoscope is used to transmit live, magnified images of the surgical field to a monitor viewed by the surgeon. The camera is inserted into the abdominal cavity through a small incision, called a port-site, usually at the umbilicus. In order to create enough space to operate, ... | Anatomy_Gray. During the operation, a camera known as a laparoscope is used to transmit live, magnified images of the surgical field to a monitor viewed by the surgeon. The camera is inserted into the abdominal cavity through a small incision, called a port-site, usually at the umbilicus. In order to create enough spac... |
Anatomy_Gray_846 | Anatomy_Gray | Laparoscopic surgery has been further enhanced with the use of surgical robots. Using these systems the surgeon moves the surgical instruments indirectly by controlling robotic arms, which are inserted into the operating field through small incisions. Robot-assisted surgery is now routinely used worldwide and has helpe... | Anatomy_Gray. Laparoscopic surgery has been further enhanced with the use of surgical robots. Using these systems the surgeon moves the surgical instruments indirectly by controlling robotic arms, which are inserted into the operating field through small incisions. Robot-assisted surgery is now routinely used worldwide... |
Anatomy_Gray_847 | Anatomy_Gray | Laparoendoscopic single-site surgery, also known as single-port laparoscopy, is the most recent advance in laparoscopic surgery. This method uses a single incision, usually umbilical, to introduce a port with several operating channels and can be performed with or without robotic assistance. Benefits include less posto... | Anatomy_Gray. Laparoendoscopic single-site surgery, also known as single-port laparoscopy, is the most recent advance in laparoscopic surgery. This method uses a single incision, usually umbilical, to introduce a port with several operating channels and can be performed with or without robotic assistance. Benefits incl... |
Anatomy_Gray_848 | Anatomy_Gray | In the clinic In men, the cremaster muscle and cremasteric fascia form the middle or second covering of the spermatic cord. This muscle and its associated fascia are supplied by the genital branch of the genitofemoral nerve (L1/L2). Contraction of this muscle and the resulting elevation of the testis can be stimulated ... | Anatomy_Gray. In the clinic In men, the cremaster muscle and cremasteric fascia form the middle or second covering of the spermatic cord. This muscle and its associated fascia are supplied by the genital branch of the genitofemoral nerve (L1/L2). Contraction of this muscle and the resulting elevation of the testis can ... |
Anatomy_Gray_849 | Anatomy_Gray | The cremasteric reflex is more active in children, tending to diminish with age. As with many reflexes, it may be absent in certain neurological disorders. Although it can be used for testing spinal cord function at level L1 in men, its clinical use is limited. In the clinic Masses around the groin Around the groin the... | Anatomy_Gray. The cremasteric reflex is more active in children, tending to diminish with age. As with many reflexes, it may be absent in certain neurological disorders. Although it can be used for testing spinal cord function at level L1 in men, its clinical use is limited. In the clinic Masses around the groin Around... |
Anatomy_Gray_850 | Anatomy_Gray | In men, it is wise to examine the scrotum to check for a lump. If an abnormal mass is present, an inability to feel its upper edge suggests that it may originate from the inguinal canal and might be a hernia. By placing the hand over the lump and asking the patient to cough, the lump bulges outward. An attempt should b... | Anatomy_Gray. In men, it is wise to examine the scrotum to check for a lump. If an abnormal mass is present, an inability to feel its upper edge suggests that it may originate from the inguinal canal and might be a hernia. By placing the hand over the lump and asking the patient to cough, the lump bulges outward. An at... |
Anatomy_Gray_851 | Anatomy_Gray | A femoral hernia (see below) appears through the femoral canal below and lateral to the pubic tubercle. A hernia is the protrusion of a viscus, in part or in whole, through a normal or abnormal opening. The viscus usually carries a covering of parietal peritoneum, which forms the lining of the hernial sac. Hernias occu... | Anatomy_Gray. A femoral hernia (see below) appears through the femoral canal below and lateral to the pubic tubercle. A hernia is the protrusion of a viscus, in part or in whole, through a normal or abnormal opening. The viscus usually carries a covering of parietal peritoneum, which forms the lining of the hernial sac... |
Anatomy_Gray_852 | Anatomy_Gray | One of the potential problems with hernias is that bowel and fat may become stuck within the hernial sac. This can cause appreciable pain and bowel obstruction, necessitating urgent surgery. Another potential risk is strangulation of the hernia, in which the blood supply to the bowel is cut off at the neck of the herni... | Anatomy_Gray. One of the potential problems with hernias is that bowel and fat may become stuck within the hernial sac. This can cause appreciable pain and bowel obstruction, necessitating urgent surgery. Another potential risk is strangulation of the hernia, in which the blood supply to the bowel is cut off at the nec... |
Anatomy_Gray_853 | Anatomy_Gray | The differentiation between an indirect and a direct inguinal hernia is made during surgery when the inferior epigastric vessels are identified at the medial edge of the deep internal ring: An indirect hernial sac passes lateral to the inferior epigastric vessels. A direct hernia is medial to the inferior epigastric ve... | Anatomy_Gray. The differentiation between an indirect and a direct inguinal hernia is made during surgery when the inferior epigastric vessels are identified at the medial edge of the deep internal ring: An indirect hernial sac passes lateral to the inferior epigastric vessels. A direct hernia is medial to the inferior... |
Anatomy_Gray_854 | Anatomy_Gray | A direct hernia is medial to the inferior epigastric vessels. Inguinal hernias occur more commonly in men than in women possibly because men have a much larger inguinal canal than women. A femoral hernia passes through the femoral canal and into the medial aspect of the anterior thigh. The femoral canal lies at the med... | Anatomy_Gray. A direct hernia is medial to the inferior epigastric vessels. Inguinal hernias occur more commonly in men than in women possibly because men have a much larger inguinal canal than women. A femoral hernia passes through the femoral canal and into the medial aspect of the anterior thigh. The femoral canal l... |
Anatomy_Gray_855 | Anatomy_Gray | The groin can loosely be defined as the area where the leg meets the trunk near the midline. Here the abdominal muscles of the trunk blend in with the adductor muscles of the thigh, the medial end of the inguinal ligament attaches to the pubic tubercle, the pubic symphysis attaches the two pubic bones together, and the... | Anatomy_Gray. The groin can loosely be defined as the area where the leg meets the trunk near the midline. Here the abdominal muscles of the trunk blend in with the adductor muscles of the thigh, the medial end of the inguinal ligament attaches to the pubic tubercle, the pubic symphysis attaches the two pubic bones tog... |
Anatomy_Gray_856 | Anatomy_Gray | Umbilical hernias are rare. Occasionally, they are congenital and result from failure of the small bowel to return to the abdominal cavity from the umbilical cord during development. After birth, umbilical hernias may result from incomplete closure of the umbilicus (navel). Overall, most of these hernias close in the f... | Anatomy_Gray. Umbilical hernias are rare. Occasionally, they are congenital and result from failure of the small bowel to return to the abdominal cavity from the umbilical cord during development. After birth, umbilical hernias may result from incomplete closure of the umbilicus (navel). Overall, most of these hernias ... |
Anatomy_Gray_857 | Anatomy_Gray | Abdominopelvic cavity hernias can also develop in association with the pelvic walls, and sites include the obturator canal, the greater sciatic foramen and above and below the piriformis muscle. In the clinic A small volume of peritoneal fluid within the peritoneal cavity lubricates movement of the viscera suspended in... | Anatomy_Gray. Abdominopelvic cavity hernias can also develop in association with the pelvic walls, and sites include the obturator canal, the greater sciatic foramen and above and below the piriformis muscle. In the clinic A small volume of peritoneal fluid within the peritoneal cavity lubricates movement of the viscer... |
Anatomy_Gray_858 | Anatomy_Gray | Patients with obstructive hydrocephalus (an excessive accumulation of cerebrospinal fluid within the cerebral ventricular system) require continuous drainage of this fluid. This is achieved by placing a fine-bore catheter through the skull into the cerebral ventricles and placing the extracranial part of the tube benea... | Anatomy_Gray. Patients with obstructive hydrocephalus (an excessive accumulation of cerebrospinal fluid within the cerebral ventricular system) require continuous drainage of this fluid. This is achieved by placing a fine-bore catheter through the skull into the cerebral ventricles and placing the extracranial part of ... |
Anatomy_Gray_859 | Anatomy_Gray | People who develop renal failure require dialysis to live. There are two methods. In the first method (hemodialysis), blood is taken from the circulation, dialyzed through a complex artificial membrane, and returned to the body. A high rate of blood flow is required to remove excess body fluid, exchange electrolytes, a... | Anatomy_Gray. People who develop renal failure require dialysis to live. There are two methods. In the first method (hemodialysis), blood is taken from the circulation, dialyzed through a complex artificial membrane, and returned to the body. A high rate of blood flow is required to remove excess body fluid, exchange e... |
Anatomy_Gray_860 | Anatomy_Gray | In the second method (peritoneal dialysis), the peritoneum is used as the dialysis membrane. The large surface area of the peritoneal cavity is an ideal dialysis membrane for fluid and electrolyte exchange. To accomplish dialysis, a small tube is inserted through the abdominal wall and dialysis fluid is injected into t... | Anatomy_Gray. In the second method (peritoneal dialysis), the peritoneum is used as the dialysis membrane. The large surface area of the peritoneal cavity is an ideal dialysis membrane for fluid and electrolyte exchange. To accomplish dialysis, a small tube is inserted through the abdominal wall and dialysis fluid is i... |
Anatomy_Gray_861 | Anatomy_Gray | Peritoneal spread of disease The large surface area of the peritoneal cavity allows infection and malignant disease to spread easily throughout the abdomen (Fig. 4.57). If malignant cells enter the peritoneal cavity by direct invasion (e.g., from colon or ovarian cancer), spread may be rapid. Similarly, a surgeon excis... | Anatomy_Gray. Peritoneal spread of disease The large surface area of the peritoneal cavity allows infection and malignant disease to spread easily throughout the abdomen (Fig. 4.57). If malignant cells enter the peritoneal cavity by direct invasion (e.g., from colon or ovarian cancer), spread may be rapid. Similarly, a... |
Anatomy_Gray_862 | Anatomy_Gray | The peritoneal cavity can also act as a barrier to, and container of, disease. Intraabdominal infection therefore tends to remain below the diaphragm rather than spread into other body cavities. A perforated bowel (e.g., caused by a perforated duodenal ulcer) often leads to the release of gas into the peritoneal cavity... | Anatomy_Gray. The peritoneal cavity can also act as a barrier to, and container of, disease. Intraabdominal infection therefore tends to remain below the diaphragm rather than spread into other body cavities. A perforated bowel (e.g., caused by a perforated duodenal ulcer) often leads to the release of gas into the per... |
Anatomy_Gray_863 | Anatomy_Gray | In the clinic The greater omentum When a laparotomy is performed and the peritoneal cavity is opened, the first structure usually encountered is the greater omentum. This fatty double-layered vascular membrane hangs like an apron from the greater curvature of the stomach, drapes over the transverse colon, and lies free... | Anatomy_Gray. In the clinic The greater omentum When a laparotomy is performed and the peritoneal cavity is opened, the first structure usually encountered is the greater omentum. This fatty double-layered vascular membrane hangs like an apron from the greater curvature of the stomach, drapes over the transverse colon,... |
Anatomy_Gray_864 | Anatomy_Gray | The greater omentum is also an important site for metastatic tumor spread. Direct omental spread by a transcoelomic route is common for carcinoma of the ovary. As the metastases develop within the greater omentum, it becomes significantly thickened. In computed tomography imaging and during laparotomy, the thickened om... | Anatomy_Gray. The greater omentum is also an important site for metastatic tumor spread. Direct omental spread by a transcoelomic route is common for carcinoma of the ovary. As the metastases develop within the greater omentum, it becomes significantly thickened. In computed tomography imaging and during laparotomy, th... |
Anatomy_Gray_865 | Anatomy_Gray | In the clinic Epithelial transition between the abdominal esophagus and stomach The gastroesophageal junction is demarcated by a transition from one epithelial type (nonkeratinized stratified squamous epithelium) to another epithelial type (columnar epithelium). In some people, the histological junction does not lie at... | Anatomy_Gray. In the clinic Epithelial transition between the abdominal esophagus and stomach The gastroesophageal junction is demarcated by a transition from one epithelial type (nonkeratinized stratified squamous epithelium) to another epithelial type (columnar epithelium). In some people, the histological junction d... |
Anatomy_Gray_866 | Anatomy_Gray | Duodenal ulcers usually occur in the superior part of the duodenum and are much less common than they were 50 years ago. At first, there was no treatment and patients died from hemorrhage or peritonitis. As surgical techniques developed, patients with duodenal ulcers were subjected to extensive upper gastrointestinal s... | Anatomy_Gray. Duodenal ulcers usually occur in the superior part of the duodenum and are much less common than they were 50 years ago. At first, there was no treatment and patients died from hemorrhage or peritonitis. As surgical techniques developed, patients with duodenal ulcers were subjected to extensive upper gast... |
Anatomy_Gray_867 | Anatomy_Gray | Anatomically, duodenal ulcers tend to occur either anteriorly or posteriorly. Posterior duodenal ulcers erode either directly onto the gastroduodenal artery or, more commonly, onto the posterior superior pancreaticoduodenal artery, which can produce torrential hemorrhage, which may be fatal in some patients. Treatment ... | Anatomy_Gray. Anatomically, duodenal ulcers tend to occur either anteriorly or posteriorly. Posterior duodenal ulcers erode either directly onto the gastroduodenal artery or, more commonly, onto the posterior superior pancreaticoduodenal artery, which can produce torrential hemorrhage, which may be fatal in some patien... |
Anatomy_Gray_868 | Anatomy_Gray | Anterior duodenal ulcers erode into the peritoneal cavity, causing peritonitis. This intense inflammatory reaction and the local ileus promote adhesion of the greater omentum, which attempts to seal off the perforation. The stomach and duodenum usually contain considerable amounts of gas, which enters the peritoneal ca... | Anatomy_Gray. Anterior duodenal ulcers erode into the peritoneal cavity, causing peritonitis. This intense inflammatory reaction and the local ileus promote adhesion of the greater omentum, which attempts to seal off the perforation. The stomach and duodenum usually contain considerable amounts of gas, which enters the... |
Anatomy_Gray_869 | Anatomy_Gray | Examination of the bowel lumen Barium sulfate solutions may be swallowed by the patient and can be visualized using an X-ray fluoroscopy unit. The lumen can be examined for masses (e.g., polyps and tumors) and peristaltic waves can be assessed. Patients may also be given carbon dioxide–releasing granules to fill the st... | Anatomy_Gray. Examination of the bowel lumen Barium sulfate solutions may be swallowed by the patient and can be visualized using an X-ray fluoroscopy unit. The lumen can be examined for masses (e.g., polyps and tumors) and peristaltic waves can be assessed. Patients may also be given carbon dioxide–releasing granules ... |
Anatomy_Gray_870 | Anatomy_Gray | Examination of the bowel wall and extrinsic masses Endoscopy is a minimally invasive diagnostic medical procedure that can be used to assess the interior surfaces of an organ by inserting a tube into the body. The instrument is typically made of a flexible plastic material through which a light source and eyepiece are ... | Anatomy_Gray. Examination of the bowel wall and extrinsic masses Endoscopy is a minimally invasive diagnostic medical procedure that can be used to assess the interior surfaces of an organ by inserting a tube into the body. The instrument is typically made of a flexible plastic material through which a light source and... |
Anatomy_Gray_871 | Anatomy_Gray | Assessment of the colon (colonoscopy) is performed by passage of the long flexible tube through the anus and into the rectum. The endoscope is then advanced into the colon to the cecum and sometimes to the terminal ileum. The patient undergoes bowel preparation before the examination to allow good visualization of the ... | Anatomy_Gray. Assessment of the colon (colonoscopy) is performed by passage of the long flexible tube through the anus and into the rectum. The endoscope is then advanced into the colon to the cecum and sometimes to the terminal ileum. The patient undergoes bowel preparation before the examination to allow good visuali... |
Anatomy_Gray_872 | Anatomy_Gray | Cross sectional imaging using computed tomography or magnetic resonance is another way to assess the bowel lumen and wall. Magnetic resonance is particularly useful in assessment of the small bowel because it allows dynamic assessment of bowel distention and motility and provides good visualization of segmental or cont... | Anatomy_Gray. Cross sectional imaging using computed tomography or magnetic resonance is another way to assess the bowel lumen and wall. Magnetic resonance is particularly useful in assessment of the small bowel because it allows dynamic assessment of bowel distention and motility and provides good visualization of seg... |
Anatomy_Gray_873 | Anatomy_Gray | CT colonography (also called virtual colonoscopy or CT pneumocolon) is an alternative way to visualize and assess the colon for abnormal lesions such as polyps or strictures with the use spiral CT to produce high-resolution 3D views of the large bowel. It is less invasive than traditional colonoscopy, but to achieve go... | Anatomy_Gray. CT colonography (also called virtual colonoscopy or CT pneumocolon) is an alternative way to visualize and assess the colon for abnormal lesions such as polyps or strictures with the use spiral CT to produce high-resolution 3D views of the large bowel. It is less invasive than traditional colonoscopy, but... |
Anatomy_Gray_874 | Anatomy_Gray | In the clinic A Meckel’s diverticulum (Fig. 4.78) is the remnant of the proximal part of the yolk stalk (vitelline duct) that extends into the umbilical cord in the embryo and lies on the antimesenteric border of the ileum. It appears as a blind-ended tubular outgrowth of bowel. Although it is an uncommon finding (occu... | Anatomy_Gray. In the clinic A Meckel’s diverticulum (Fig. 4.78) is the remnant of the proximal part of the yolk stalk (vitelline duct) that extends into the umbilical cord in the embryo and lies on the antimesenteric border of the ileum. It appears as a blind-ended tubular outgrowth of bowel. Although it is an uncommon... |
Anatomy_Gray_875 | Anatomy_Gray | In the clinic These imaging techniques can provide important information about the wall of the bowel that may not be obtained from barium or endoscopic studies. Thickening of the wall may indicate inflammatory change or tumor and is always regarded with suspicion. If a tumor is demonstrated, the locoregional spread can... | Anatomy_Gray. In the clinic These imaging techniques can provide important information about the wall of the bowel that may not be obtained from barium or endoscopic studies. Thickening of the wall may indicate inflammatory change or tumor and is always regarded with suspicion. If a tumor is demonstrated, the locoregio... |
Anatomy_Gray_876 | Anatomy_Gray | In the clinic Carcinoma of the stomach Carcinoma of the stomach is a common gastrointestinal malignancy. Chronic gastric inflammation (gastritis), pernicious anemia, and polyps predispose to the development of this aggressive cancer, which is usually not diagnosed until late in the course of the disease. Symptoms inclu... | Anatomy_Gray. In the clinic Carcinoma of the stomach Carcinoma of the stomach is a common gastrointestinal malignancy. Chronic gastric inflammation (gastritis), pernicious anemia, and polyps predispose to the development of this aggressive cancer, which is usually not diagnosed until late in the course of the disease. ... |
Anatomy_Gray_877 | Anatomy_Gray | The diagnosis may be made using barium and conventional radiology or endoscopy, which allows a biopsy to be obtained at the same time. Ultrasound scanning is used to check the liver for metastatic spread, and, if negative, computed tomography is carried out to assess for surgical resectability. If carcinoma of the stom... | Anatomy_Gray. The diagnosis may be made using barium and conventional radiology or endoscopy, which allows a biopsy to be obtained at the same time. Ultrasound scanning is used to check the liver for metastatic spread, and, if negative, computed tomography is carried out to assess for surgical resectability. If carcino... |
Anatomy_Gray_878 | Anatomy_Gray | In the clinic Acute appendicitis is an abdominal emergency. It usually occurs when the appendix is obstructed by either a fecalith or enlargement of the lymphoid nodules. Within the obstructed appendix, bacteria proliferate and invade the appendix wall, which becomes damaged by pressure necrosis. In some instances, thi... | Anatomy_Gray. In the clinic Acute appendicitis is an abdominal emergency. It usually occurs when the appendix is obstructed by either a fecalith or enlargement of the lymphoid nodules. Within the obstructed appendix, bacteria proliferate and invade the appendix wall, which becomes damaged by pressure necrosis. In some ... |
Anatomy_Gray_879 | Anatomy_Gray | The treatment for appendicitis is appendectomy. In the clinic Congenital disorders of the gastrointestinal tract The normal positions of the abdominal viscera result from a complex series of rotations that the gut tube undergoes and from the growth of the abdominal cavity to accommodate changes in the size of the devel... | Anatomy_Gray. The treatment for appendicitis is appendectomy. In the clinic Congenital disorders of the gastrointestinal tract The normal positions of the abdominal viscera result from a complex series of rotations that the gut tube undergoes and from the growth of the abdominal cavity to accommodate changes in the siz... |
Anatomy_Gray_880 | Anatomy_Gray | Malrotation is incomplete rotation and fixation of the midgut after it has passed from the umbilical sac and returned to the abdominal coelom (Figs. 4.93 and 4.94). The proximal attachment of the small bowel mesentery begins at the suspensory muscle of duodenum (ligament of Treitz), which determines the position of the... | Anatomy_Gray. Malrotation is incomplete rotation and fixation of the midgut after it has passed from the umbilical sac and returned to the abdominal coelom (Figs. 4.93 and 4.94). The proximal attachment of the small bowel mesentery begins at the suspensory muscle of duodenum (ligament of Treitz), which determines the p... |
Anatomy_Gray_881 | Anatomy_Gray | In some patients, the cecum ends up in the midabdomen. From the cecum and the right side of the colon a series of peritoneal folds (Ladd’s bands) develop that extend to the right undersurface of the liver and compress the duodenum. A small bowel volvulus may then occur as well as duodenal obstruction. Emergency surgery... | Anatomy_Gray. In some patients, the cecum ends up in the midabdomen. From the cecum and the right side of the colon a series of peritoneal folds (Ladd’s bands) develop that extend to the right undersurface of the liver and compress the duodenum. A small bowel volvulus may then occur as well as duodenal obstruction. Eme... |
Anatomy_Gray_882 | Anatomy_Gray | A functional obstruction is usually due to an inability of the bowel to peristalse, which again has a number of causes, and most frequently is a postsurgical state due to excessive intraoperative bowel handling. Other causes may well include abnormality of electrolytes (e.g., sodium and potassium) rendering the bowel p... | Anatomy_Gray. A functional obstruction is usually due to an inability of the bowel to peristalse, which again has a number of causes, and most frequently is a postsurgical state due to excessive intraoperative bowel handling. Other causes may well include abnormality of electrolytes (e.g., sodium and potassium) renderi... |
Anatomy_Gray_883 | Anatomy_Gray | Vomiting and absolute constipation, including the inability to pass flatus, will ensue. Early diagnosis is important because considerable fluid and electrolytes enter the bowel lumen and fail to be reabsorbed, which produces dehydration and electrolyte abnormalities. Furthermore, the bowel continues to distend, comprom... | Anatomy_Gray. Vomiting and absolute constipation, including the inability to pass flatus, will ensue. Early diagnosis is important because considerable fluid and electrolytes enter the bowel lumen and fail to be reabsorbed, which produces dehydration and electrolyte abnormalities. Furthermore, the bowel continues to di... |
Anatomy_Gray_884 | Anatomy_Gray | Large bowel obstruction is commonly caused by a tumor. Other potential causes include hernias and inflammatory diverticular disease of the sigmoid colon (Fig. 4.97). The treatment is intravenous replacement of fluid and electrolytes, analgesia, and relief of obstruction. The passage of a nasogastric tube allows aspirat... | Anatomy_Gray. Large bowel obstruction is commonly caused by a tumor. Other potential causes include hernias and inflammatory diverticular disease of the sigmoid colon (Fig. 4.97). The treatment is intravenous replacement of fluid and electrolytes, analgesia, and relief of obstruction. The passage of a nasogastric tube ... |
Anatomy_Gray_885 | Anatomy_Gray | In the clinic Diverticular disease is the development of multiple colonic diverticula, predominantly throughout the sigmoid colon, though the whole colon may be affected (Fig. 4.99). The sigmoid colon has the smallest diameter of any portion of the colon and is therefore the site where intraluminal pressure is potentia... | Anatomy_Gray. In the clinic Diverticular disease is the development of multiple colonic diverticula, predominantly throughout the sigmoid colon, though the whole colon may be affected (Fig. 4.99). The sigmoid colon has the smallest diameter of any portion of the colon and is therefore the site where intraluminal pressu... |
Anatomy_Gray_886 | Anatomy_Gray | Because of the anatomical position of the sigmoid colon there are a number of complications that may occur. The diverticula can perforate to form an abscess in the pelvis. The inflammation may produce an inflammatory mass, obstructing the left ureter. Inflammation may also spread to the bladder, producing a fistula bet... | Anatomy_Gray. Because of the anatomical position of the sigmoid colon there are a number of complications that may occur. The diverticula can perforate to form an abscess in the pelvis. The inflammation may produce an inflammatory mass, obstructing the left ureter. Inflammation may also spread to the bladder, producing... |
Anatomy_Gray_887 | Anatomy_Gray | Gastrostomy is performed when the stomach is attached to the anterior abdominal wall and a tube is placed through the skin into the stomach. Typically this is performed to feed the patient when it is impossible to take food and fluid orally (e.g., complex head and neck cancer). The procedure can be performed either sur... | Anatomy_Gray. Gastrostomy is performed when the stomach is attached to the anterior abdominal wall and a tube is placed through the skin into the stomach. Typically this is performed to feed the patient when it is impossible to take food and fluid orally (e.g., complex head and neck cancer). The procedure can be perfor... |
Anatomy_Gray_888 | Anatomy_Gray | There are a number of instances when a colostomy may be necessary. In many circumstances it is performed to protect the distal large bowel after surgery. A further indication would include large bowel obstruction with imminent perforation wherein a colostomy allows decompression of the bowel and its contents. This is a... | Anatomy_Gray. There are a number of instances when a colostomy may be necessary. In many circumstances it is performed to protect the distal large bowel after surgery. A further indication would include large bowel obstruction with imminent perforation wherein a colostomy allows decompression of the bowel and its conte... |
Anatomy_Gray_889 | Anatomy_Gray | An end colostomy is necessary when the patient has undergone a surgical resection of the rectum and anus (typically for cancer). An ileal conduit is an extraanatomical procedure and is performed after resection of the bladder for tumor. In this situation a short segment of small bowel is identified. The bowel is divide... | Anatomy_Gray. An end colostomy is necessary when the patient has undergone a surgical resection of the rectum and anus (typically for cancer). An ileal conduit is an extraanatomical procedure and is performed after resection of the bladder for tumor. In this situation a short segment of small bowel is identified. The b... |
Anatomy_Gray_890 | Anatomy_Gray | When patients have either an ileostomy, colostomy, or ileal conduit it is necessary for them to fix a collecting bag onto the anterior abdominal wall. Contrary to one’s initial thoughts these bags are tolerated extremely well by most patients and allow patients to live a nearly normal and healthy life. In the clinic Th... | Anatomy_Gray. When patients have either an ileostomy, colostomy, or ileal conduit it is necessary for them to fix a collecting bag onto the anterior abdominal wall. Contrary to one’s initial thoughts these bags are tolerated extremely well by most patients and allow patients to live a nearly normal and healthy life. In... |
Anatomy_Gray_891 | Anatomy_Gray | Sometimes an annular pancreas is diagnosed in utero by ultrasound scanning. The obstruction of the duodenum may prevent the fetus from swallowing enough amniotic fluid, which may increase the overall volume of amniotic fluid in the amniotic sac surrounding the fetus (polyhydramnios). In the clinic | Anatomy_Gray. Sometimes an annular pancreas is diagnosed in utero by ultrasound scanning. The obstruction of the duodenum may prevent the fetus from swallowing enough amniotic fluid, which may increase the overall volume of amniotic fluid in the amniotic sac surrounding the fetus (polyhydramnios). In the clinic |
Anatomy_Gray_892 | Anatomy_Gray | In the clinic Pancreatic cancer accounts for a significant number of deaths and is often referred to as the “silent killer.” Malignant tumors of the pancreas may occur anywhere within the pancreas but are most frequent within the head and the neck. There are a number of nonspecific findings in patients with pancreatic ... | Anatomy_Gray. In the clinic Pancreatic cancer accounts for a significant number of deaths and is often referred to as the “silent killer.” Malignant tumors of the pancreas may occur anywhere within the pancreas but are most frequent within the head and the neck. There are a number of nonspecific findings in patients wi... |
Anatomy_Gray_893 | Anatomy_Gray | Given the position of the pancreas, a surgical resection is a complex procedure involving resection of the region of pancreatic tumor usually with part of the duodenum, necessitating a complex bypass procedure. In the clinic Segmental anatomy of the liver For many years the segmental anatomy of the liver was of little ... | Anatomy_Gray. Given the position of the pancreas, a surgical resection is a complex procedure involving resection of the region of pancreatic tumor usually with part of the duodenum, necessitating a complex bypass procedure. In the clinic Segmental anatomy of the liver For many years the segmental anatomy of the liver ... |
Anatomy_Gray_894 | Anatomy_Gray | Indeed, with detailed knowledge of the segments, curative surgery can be performed in patients with tumor metastases. The liver is divided by the principal plane, which divides the organ into halves of approximately equal size. This imaginary line is defined by a parasagittal line that passes through the gallbladder fo... | Anatomy_Gray. Indeed, with detailed knowledge of the segments, curative surgery can be performed in patients with tumor metastases. The liver is divided by the principal plane, which divides the organ into halves of approximately equal size. This imaginary line is defined by a parasagittal line that passes through the ... |
Anatomy_Gray_895 | Anatomy_Gray | The caudate lobe is defined as segment I, and the remaining segments are numbered in a clockwise fashion up to segment VIII. The features are extremely consistent between individuals. From a surgical perspective, a right hepatectomy would involve division of the liver in the principal plane in which segments V, VI, VII... | Anatomy_Gray. The caudate lobe is defined as segment I, and the remaining segments are numbered in a clockwise fashion up to segment VIII. The features are extremely consistent between individuals. From a surgical perspective, a right hepatectomy would involve division of the liver in the principal plane in which segme... |
Anatomy_Gray_896 | Anatomy_Gray | The easiest way to confirm the presence of gallstones is by performing a fasting ultrasound examination of the gallbladder. The patient refrains from eating for 6 hours to ensure the gallbladder is well distended and there is little shadowing from overlying bowel gas. The examination may also identify bile duct dilatio... | Anatomy_Gray. The easiest way to confirm the presence of gallstones is by performing a fasting ultrasound examination of the gallbladder. The patient refrains from eating for 6 hours to ensure the gallbladder is well distended and there is little shadowing from overlying bowel gas. The examination may also identify bil... |
Anatomy_Gray_897 | Anatomy_Gray | From time to time, gallstones impact in the region of Hartmann’s pouch, which is a bulbous region of the neck of the gallbladder. When the gallstone lodges in this area, the gallbladder cannot empty normally and contractions of the gallbladder wall produce severe pain. If this persists, a cholecystectomy (removal of th... | Anatomy_Gray. From time to time, gallstones impact in the region of Hartmann’s pouch, which is a bulbous region of the neck of the gallbladder. When the gallstone lodges in this area, the gallbladder cannot empty normally and contractions of the gallbladder wall produce severe pain. If this persists, a cholecystectomy ... |
Anatomy_Gray_898 | Anatomy_Gray | From time to time, small gallstones pass into the bile duct and are trapped in the region of the sphincter of the ampulla, which obstructs the flow of bile into the duodenum. This, in turn, produces jaundice. | Anatomy_Gray. From time to time, small gallstones pass into the bile duct and are trapped in the region of the sphincter of the ampulla, which obstructs the flow of bile into the duodenum. This, in turn, produces jaundice. |
Anatomy_Gray_899 | Anatomy_Gray | Endoscopic retrograde cholangiopancreatography (ERCP) can be undertaken to remove obstructing gallstones within the biliary tree. This procedure combines endoluminal endoscopy with fluoroscopy to diagnose and treat problems in the biliary and pancreatic ducts. An endoscope with a side-viewing optical system is advanced... | Anatomy_Gray. Endoscopic retrograde cholangiopancreatography (ERCP) can be undertaken to remove obstructing gallstones within the biliary tree. This procedure combines endoluminal endoscopy with fluoroscopy to diagnose and treat problems in the biliary and pancreatic ducts. An endoscope with a side-viewing optical syst... |
Subsets and Splits
Textbook Content Analysis
Provides useful aggregations showing document length statistics grouped by title, helping identify variations in content length across different documents.
Textbook Chunk Counts
Identifies the most frequently occurring titles in the training dataset, which could reveal common themes or topics that dominate the data.
Short Textbook Content Examples
Retrieves short content entries from the training dataset, useful for identifying very brief samples but providing limited analytical value beyond basic filtering.