Abdomen
Đã giới thiệu| English | Ý nghĩa |
|---|---|
| epigastric | epigastric |
| coeliac trunk | coeliac trunk |
| superior mesenteric artery | superior mesenteric artery |
| inferior mesenteric artery | inferior mesenteric artery |
| parietal peritoneum | parietal peritoneum |
| pectinate line | pectinate line |
A map and three pipes
- The abdomen holds the digestive organs on a nine-region grid, fed by three unpaired arteries.
- The arteries' territories explain where pain is felt and where surgeons cut.
Nine regions
- Three central regions run top to bottom: epigastric 腹上区, umbilical and hypogastric. On each side are the hypochondriac, lumbar and inguinal regions.
- Four quadrants are a quicker version. Say which system you are using.
How many regions does the abdominal grid have?
Độ khó 2/5 · 140 xu + phần thưởng nhỏ khi hoàn thành lần đầu tiên hôm nay
Two vertical and two horizontal lines make a 3 × 3 grid of nine regions; quadrants divide it into four.
Three arteries, three gut parts
- The coeliac trunk 腹腔干 supplies the foregut (down to the middle of the duodenum). The superior mesenteric artery 肠系膜上动脉 supplies the midgut (to two-thirds of the way along the transverse colon).
- The inferior mesenteric artery 肠系膜下动脉 supplies the hindgut, down to the upper anal canal. Veins and lymph follow the same territories.
Match each artery to its gut territory.
Độ khó 2/5 · 140 xu + phần thưởng nhỏ khi hoàn thành lần đầu tiên hôm nay
One artery per embryonic gut part, and the same split explains referred pain.
Why pain is felt where it is
- Organs report pain to the spinal segments they came from in the embryo: foregut T5–9 (epigastric), midgut T10–12 (umbilical), hindgut L1–3 (hypogastric).
- Early organ pain is dull and in the midline. It becomes sharp and one-sided only when the inflamed organ touches the parietal peritoneum 壁腹膜.
Why does early appendicitis cause pain around the umbilicus?
Độ khó 1/5 · 100 xu + phần thưởng nhỏ khi hoàn thành lần đầu tiên hôm nay
Visceral pain goes to the segments of embryonic origin; it moves to the right iliac fossa only when the parietal peritoneum is involved.
Worked example: three classic pains
- (Fictional cases) Appendicitis: a midgut organ, so a dull umbilical ache first, then sharp pain in the right iliac fossa once the parietal peritoneum is involved.
- Gallbladder: foregut, so epigastric ache, then right upper quadrant, and right shoulder-tip pain if the diaphragm is irritated (C3–5). Ureteric stone: pain from loin to groin.
Put the course of appendicitis pain in order.
Độ khó 3/5 · 200 xu + phần thưởng nhỏ khi hoàn thành lần đầu tiên hôm nay
Visceral nerves give vague midline pain; somatic nerves in the parietal peritoneum give sharp, localised pain.
Worked example: the line that splits the anal canal
- (Fictional patient) Painless bright-red bleeding from internal haemorrhoids. The inferior mesenteric artery ends as the superior rectal artery, which supplies the canal above the pectinate line 齿状线.
- Above the line the nerves are visceral, so pain is dull or absent; below it they are somatic and very sensitive. Anatomy predicts which lesions hurt.
Why are internal haemorrhoids usually painless?
Độ khó 1/5 · 100 xu + phần thưởng nhỏ khi hoàn thành lần đầu tiên hôm nay
Above the line the canal is gut-like, with visceral nerves; below it the skin-like lining has sensitive somatic nerves.
Three common slips
- Quadrants for regions. Answer in the system you were asked for.
- Forgetting drainage. Veins and lymph follow the arteries' territories, to the portal system and the matching node groups.
- Kidney pain as gut pain. Kidney and ureter pain sit in the loin and groin, not in the midline bands.
A ureteric stone typically causes pain that runs from the loin to the groin.
Độ khó 1/5 · 100 xu + phần thưởng nhỏ khi hoàn thành lần đầu tiên hôm nay
The ureter's nerves enter around T11–L2, so the pain follows its course from loin to groin rather than a midline band.
Recap
- Nine regions; coeliac, superior and inferior mesenteric arteries feed foregut, midgut and hindgut.
- Gut pain is referred to T5–9, T10–12 and L1–3: epigastric, umbilical, hypogastric.
- The pectinate line splits blood supply and sensation in the anal canal.