Dinding Ventral Abdomen
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Dinding VentralAbdomen
Hary Nugroho
PSKU UNMUL Samarinda
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Dinding Ventrolateral AbdomenLapisan dinding ventrolateral abdomen:- Kulit/ cutis- Fascia subcutan
a. Fascia superficial (fascia dari Camper) b. Fascia profundus (fascia dari Scarpa)
- Musculature :• Lateral :
a. M.obliquus externus abdominisb. M.obliquus internus abdominisc. M.transversus abdominis
• Ventral/anterior :a. M.rectus abdominisb. M.pyramidalis
- Fascia transversa abdominis- Peritoneum parietale
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M. Obliquus Externus Abdominis• Origo : Tepi external 8 costae terakhir (selang seling
dengan origo m.serratus anterior & m.latissimus dorsi)• Insertio :
labium ext.crista iliacaLine albaLig.inguinalis
• Inn:N. Intercostalis V-XIN. SubcostalisN. IliohypogastricusN. Ilioinguinalis
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M. Obliquus Internus Abdominis• Origo :
Fascia lumbodorsalis Labium internus crista iliaca Lig.inguinale bag.lateral Fascia iliaca
• Insertio : Permukaan dalam 3 costae terbawah Rectus sheath Os pubis
• Inn:N. Intercostalis X-XIIN. IliohypogastricusN. IlioinguinalisR. femoralis n. genitofemoralis (N. spermatica externa)
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M. Transversus Abdominis• Origo :
Fascia iliaca Lig.inguinale bag.lateral Crista iliaca (labium internus) Fascia lumbodorsalis Facies interna cartilago costae (6 terbawah)
selang-seling dengan diafragma• Insertio :
linea alba Os pubis
• Inn: Nn. Intercostalis V-XII
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M. Rectus Abdominis
• Origo : Processus xyphoideus Cartilago costae V - VII
• Insertio : Symphysis pubis Pecten ossis pubis
• Inervasi :Nn. Intercostalis V - XII
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M. Pyramidalis
• Origo :Crista pubica
• Insertio : Linea alba
• Inervasi :Nn. Intercostalis XII
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Vagina m.recti (Rectus Sheath)
• = pembungkus m.rectus abdominis• Dibentuk oleh aponeurosis dari 3 otot lateral
abdomen• Isi :
• M. Rectus abdominis• AV Epigastrica superior et inferior• M. Pyramidalis
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Vagina m.recti (Rectus Sheath)
• Lamina anterior :- 2/3 bag.atas :
• aponeurosis m.obliquus externus abdominis• aponeurosis m.obliquus internus abdominis
- 1/3 bag.bawah :• aponeurosis m.obliquus externus abdominis • aponeurosis m.obliquus internus abdominis• aponeurosis m.transversus abdominis
• Lamina posterior:- 2/3 bag.atas :
• aponeurosis m.obliquus internus abdominis• aponeurosis m.transversus abdominis• fascia transversa abdominis
- 1/3 bag.bawah : fascia transversa abdominis
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Struktur lain-lain
• Linea semilunaris (Spigel) : tepi lateral m.rectus abdominis
• Linea alba : pertemuan lapisan anterior & posterior aponeurosis musculi dinding ventral abdomen pada garis medioanterior, terdapat antara processus xyphoideus & symphysis pubis
• Linea semicircularis (Douglasi) / linea arcuata: batas caudal lamina posterior rectus sheath
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Anulus Inguinalis Preperitonealis/ Interna
- Celah di pertengahan lig.inguinale
- Lateral dari AV epigastrica inf.
- Batas :• m.transversus abdominis• Lig.interfoveolare Hesselbach (= refleksi dari
fascia transversa menjadi fascia spermatica interna)
gambar
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Anulus Inguinalis Subcutaneus/ Externa
- Celah pada aponeurosis m.obliquus ext.abdominis- Letak : subcutan & cranial dr tuberculum pubicum- Batas :
• Lateral : crus lat./inf. aponeurosis m.obliquus externus abdominis
• Medial : crus med./sup. aponeurosis m.obliquus externus abdominis
• Superior : fibrae intercruralis• Inferior : bagian medial lig.inguinale
gambar
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Canalis Inguinalis (1)
• Celah memanjang, serong, ± 3-5 cm
• Cranial dr lig.inguinale
• Antara anulus inguinalis subcutaneus & anulus inguinalis preperitonealis
• Pria : funiculus spermaticus & n.ilioinguinalis (locus minoris resistentiae)
• Wanita : lig.teres uteri & n.ilioinguinalis
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Canalis Inguinalis (2)- Anterior :
• Aponeurosis m.obliquus externus abdominis• Aponeurosis m.obliquus internus abdominis
- Posterior :• Fascia transversa abdominis• Lig.reflexum• Conjoint tendon
- Inferior : • lig. Inguinale• Lig.lacunare
- Cranial : busur otot • m.obliquus int.abdominis• M.transversus abdominis
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Funiculus Spermaticus (1)• Asal: jar.ikat preperitoneal & extraperitoneal• Masuk melalui anulus preperitonealis polus
cranialis testis
• Pembungkus 3 lapis :- Fascia spermatica interna (dari fascia transversa
abdominis)- Fascia cremasterica / m.cremaster (dari apponeurosis
m.obliquus internus abdominis)- Fascia spermatica externa (dari apponeurosis
m.obliquus externus abdominis)
gambar
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Funiculus Spermaticus (2)
• Isi :- ductus deferens- a. spermatica interna & externa- a. deferentialis- Plexus pampiniformis- Pembuluh limfe- Plexus nervosus
gambar
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Conjoint Tendon
• = Falx inguinalis• Dorsal dari anulus inguinalis externa• Dibentuk oleh penggabungan :
• Aponeurosis m.obliquus internus abdominis bagian medial/inferior
• Aponeurosis m.transversus abdominis bagian medial/inferior
gambar
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M. Cremaster
• Otot tipis, derivat dari m. obliquus abdominis internus bag.inferolateral
• Membungkus funiculus spermaticus sampai testis makin tipis
• Fungsi : mengangkat testis ke superior mendekati tubuh & menggantung testis
• Inervasi : r.genitalis n.genitofemoralis
gambar
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H
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Hernia Pada Dinding Abdomen
• Hernia Umbilicalis
• Hernia Linea Alba
• HerniaTrigonum Lumbalis
• Hernia Inguinalis
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Hernia Inguinalis Directa
• = Hernia Inguinalis Medialis
• Terjadi krn kelemahan dinding abdomen (terutama dinding dorsal canalis inguinalis) pd fovea inguinalis medialis
• Kantong hernia langsung menonjol melalui anulus inguinalis subcutaneus (tanpa melalui canalis inguinalis)
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Hernia Inguinalis Indirecta
• = Hernia Inguinalis Lateralis• Processus vaginalis peritonei terisi oleh
viscera/intestinum• Indirect melalui anulus inguinalis lat.• Kantong hernia melalui canalis inguinalis, dapat
sampai ke scrotum• Jika obliterasi hanya pd bagian proximal/distal
processus vaginalis peritonei terjadi hydrocele bisa hydrocele funiculi,testis, atau kombinasi dg hernia indirecta
• Sering pd pria
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Trigonum lumbalis
Anterior : m.obliquus ext.abdominisPosterior : m.latissimus dorsiInferior : crista iliacaDasar : m.obliquus int.abdominisInervasi : • n. Intercostalis V-XII• n. ilioinguinalis• n. Iliohypogastricus
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Vaskularisasi Dinding Ventral Abdomen
Arteri
- a.circumflexa ilium superficialis
- a.epigastrica sup.
- a.epigastrica inf.
- a.musculophrenica
- a.intercostalis
- a.lumbalis
- a.circumflexa ilium profundus
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Vaskularisasi Dinding Ventral Abdomen
Vena- Daerah di bawah umbilicus : v.epigastrica
inf. v.saphena magna v.femoralis- Daerah di atas umbilicus :
v.thoracoepigastrica v.thoracica lat. v.axillaris
- Sekitar umbilicus : v.paraumbilicalis v.porta
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Aliran Limfe
• Daerah di bawah umbilicus : lnn.subinguinalis superficialis tractus horizontalis
• Daerah di atas umbilicus : lnn.axillaris superficialis
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Innervasi Dinding Ventral Abdomen
• Nn.intercostales VI-XII (berjalan inferoanteromedial diantara m.Transversus Abdominis & m.Obliquus Abdominis Internus
• N.iliohypogastricus
• N.ilioinguinalis (segmen L-I)
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Orientasi Organ Viscera Abdomen
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Peritoneum
• Membran serous yg terdiri dari stratum mesothelium selapis & jar.ikat kolagen/elastis
• Fungsi peritoneum :- mengurangi pergeseran antar organ visceral
- Tempat menyimpan lemak
- Melokalisir proses infeksi
- Absorbsi bahan2 larutan >> injeksi ip kecepatannya ~ iv
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Cavum Peritonei Generalis
• = Greater Sac• Batas :
• cranial : diaphragma• Caudal : aditus pelvis• Ventral : dinding ventrolateral abdomen• Dorsal : dinding dorsal abdomen
• Diliputi oleh peritoneum parietale• Dinding caudal terbuka hubungannya
dg.cavum pelvis peritonei
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Perluasan Greater Sac• Di bawah colon transversum:
– Cavum abdominis peritonei : linea alba bag. Dalam dinding abdomen caecum & appendix colon ascenden duodenum, m.psoas major, v.cava inferior, aorta intestinum tenue collumna vertebralis mesostenium colon descenden linea alba
– Cavum abdominis pelvicus
• Di atas colon transversum– Greater sac for. Winslowi lesser sac
– Greater sac ren & gld.suprarenalis D dinding ventral abdomen lig.teres hepatis lig.falciforme dinding ventrolateral ren & gld.suprarenalis S lien & hilus curvatura major ventrocranial gaster curvatura minor fac.visceralis hepar & v.cava inferior.
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Bursa Omentalis• = Lesser Sac• Batas :
- ventral : peritoneum yg meliputi ddg dorsal gaster,omentum minus & lobus caudatus hepatis (omentum minus lap.dorsal)
- Dorsal : peritoneum yg meliputi omentum majus (lap.dorsal), diaphragma,pancreas,ren & gld.suprarenalis (S), dan mesocolon transversum
- Lateral :
• Kanan : foramen epiploicum
• Kiri : hilus lienalis, lig.phrenicolienalis, lig.gastrolienalis
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Foramen Winslowi• Lobang yg menghubungkan greater sac &
lesser sac• Batas :
- ventral : omentum minus / lig.hepatoduodenale
- Dorsal : peritoneum yg menutupi v.cava inferior
- Cranial : lobus caudatus hepar- Caudal : pars cranialis duodeni
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FIM
FIL
FSV
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SELAMAT BELAJAR