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Mj final seminar 20 01-17
1. SECTION OF RADIOLOGY (I.M.)
DEPARTMENT OF SHALYATANTRA, IMS-BHU
Presented by – Guided by –
Dr . Madan jakhar Prof S.S. MISHRA
2. INDEX
A)Landmarks of abdomen
B).Radiological modalities use for abdomen
C)Surface and radiological anatomy of different organs of
abdomen
1) Liver
2) Gall bladder
3) Pancreas
4) Spleen
5) Stomach
6) Small Intestine
7) Large Intestine
8) Kidney & Ureter –Right & Left
9) Urinary Bladder
3. Surface Anatomy-Quadrants & Regions
Upper transverse
plane.
Lower transverse
plane.
Sagittal planes at
right angles to
transverse planes
divide the abdomen
into four quadrants
and nine regions .
4. Transverse planes
Trans pyloric plane-lies
A lower border of L1
Trans tubercular plane-lies
Upper border of L5
Sagittal planes-
Median vertical planes-
Symphysis pubis to supra –
Sternal notch
Rt & LtVerticalplanes -
6. Imaging Modalities for the Abdomen and Pelvis.
Commonly utilized modalities :
• Ultrasound
• CT (computed tomography)
• Abdominal plain film
• Fluoroscopy
• Hysterosalpingography
Other modalities:
•MRI [Magnetic resonance imaging]
•Nuclear medicine
•Gallium scan
•Positron EmissionTomography (PET).
7. X ray Abdomen
The most common plain radiograph of the
abdomen is an anteroposterior (AP) view with the
patient in the supine position.
The AP view of the abdomen is also called a KUB
film because it includes the kidneys, ureters, and
bladder.
When acute abdominal disease is suspected
clinically, an erect film of the abdomen and a
posteroanterior (PA) view of the abdomen are also
required.
8. Abdomen - plain film Anatomy
A Normal plain film of the
abdomen.The lower margins of
the posterior portion of the
liver, the hepatic angle (H), and
the lower part of the spleen (S)
are delineated by a fat shadow.
Both kidneys (K) and the psoas
muscle shadows (arrowheads)
are outlined by a fat shadow.
The properitoneal fat stripe is
also shown bilaterally (arrows).
13. Abdomen Anatomy-Liver
Liver- present in RUQ.
Two major lobes two
minor lobes.
Falciform ligament
separates larger Rt lobes
from Lt lobe ,small
quadrate lobe lies inferior
to Rt lobe and posterior
to quadrate lobe lies
caudate lobe
14. Liver-Introduction
Occupies the right hypochondrium, epigastrium & left
hypochondrium.
Most part of the liver is covered by ribs & costal cartilages.
It is covered by network of connective tissue (Glisson’s Capsule)
19. BiliaryApparatus :
It collects bile from the liver ,stores in the
gallbladder & transmits to 2nd part of duodenum.
Gall bladder.
Cystic duct.
Right and left hepatic ducts which unite to form
Common Hepatic Duct.
Common Bile duct formed by the union of cystic
duct and common hepatic duct.
20. Parts of Gall Bladder
Fundus
Body
Neck
Infundibulum
Cystic duct
21. Gall Bladder
Gall bladder – a pear shaped sac and reservoir of bile and is
responsible for concentration of bile. It can hold upto 30-50
ml.
9-10 cm long , 4 cm in diameter.
Wall thickness < 3mm.
Hangs from inferior surface of liver – fundus usually anterior
and inferior to body and neck.
Cystic duct arises from the neck of the gallbladder.
Neck and cystic duct has spiral appearance to the mucosal
folds (spiral valve of heister); on ultrasound it is highly
echogenic and may be mistaken for gallstones.
24. Gross Anatomy of the Stomach
cardiac end - at the level ofT11
pylorus end – at the level of L2
Lesser curvature -
1. Greater curvature
2. Cardia - end under the heart
3. Fundus - bulge above the esophageal opening
4. Body - largest region
5. Pylorus - J curve, inferior end, terminates in
6. Pyloric sphincter and superior end terminates in
7. Cardiac spincter.
8. Rugae – highly extendable interior folds Figs 25-10/11
25. Abdomen Anatomy-Pancreas
PPancreas is transversely placed between L1
and L2. it has three parts head,body and tail .
It is partly exocrine and partly endocrine .
Endocrine part secretes insulin and glucagon .
Exocrine part secretes pancreatic juice .
The pancreatic duct opens in to second part
of duodenum .
26.
27.
28. Pancreas and its proportions + neighboring anatomical
structures in classic transverse epigastrial plain.
29. Spleen :
Spleen is the largest organ of lymphatic system
in human body.
Location: Lies along the axis of 10th rib.
Size: normally varies from 7 to 12 cm in
length,7.5 cm broad and 2.5 cm thick.
In usg - . Homogenous, moderately echogenic
( pancreas > liver > spleen )
•Visualized best obliquely in the 9th or 10th inter
costal spaces
31. Kidneys, Ureters and Urinary
Bladder Tract (KUB)
KIDNEY -Usual
location – between
upper border of 12th
thoracic vertebra and
lower border of 3rd
lumbar vertebra
On either side of the
lower thoracic and
upper lumbar spine
37. Ureters
25-30 cm in length and 2-8 mm diameter
Course downwards from the most dependent
portion of the pelves to the midsacral region
Then turn posterolaterally and course in an
arc downwards
Then inward and anteriorly to enter the
trigone of the bladder on either side of the
midline
38. Urinary Bladder
Neck of bladder - lies 3-4 cm behind lower part of
symphysis pubis and rests on the prostate in the
male
It has the urethral orifice
In females the peritoneum is reflected from the
superior surface of the bladder to the anterior
wall of the uterus at the junction between the
body and cervix
The enclosed space is the vesicouterine pouch
41. Regions of Small Intestine
SI is longest part of dig. tube
Duodenum (short, 12 inches)
fixed shape & position
Mixing bowl for chyme
Jejunum (2.5 m long)
Most of digestion
Ileum (longest at 3.5 m)
Most of absorption, ends in
Ileocecal valve – slit valve into large intestine (colon)
42. Cecum – pocket at proximal end with
Appendix
Colon
Ascending colon - on right, between
cecum and right colic flexure
Transverse colon - horizontal portion
Descending colon - left side, between
left colic flexure and
Sigmoid colon - S bend near terminal
end
Regions of Large Intestine
Fig 25-17
Rectum – terminal end is anal canal - ending at the anus - which has
internal involuntary sphincter and external voluntary sphincter
43.
44. Summary of this ppt
-
Liver - < 14.5 cm
12- 15 mild
Spleen - < 12 cm >15 modrate
>18 gross spleenomegaly
Kidney - 8 – 12 cm
30 mm head
Pancrease - 20 mm body
25 mm neck
45. wall thikness
GALL BLADDER
URINARY BLADDER 3 MM
SMALL BOWEL
Luminal diameter
SMALL BOWEL 3 CM
LARGE BOWEL 6 CM
CACEUM 9 CM
-
46. DIAMETERS OFTUBULAR STRUCTURES: -
PORTALVEIN - < 12 MM
HEPATIC VEIN - < 9 MM
< 6 MM - ADULT
CBD - < 8 MM - OLD
< 10 MM – POST
CHOLECYSTECTOMY
• IVC - <25 MM
• PANCREATIC DUCT - < 2 MM