Diagrams of the structure and location of the internal organs of the human abdominal cavity. Where is the abdominal cavity located. Peritoneum, structure, functions

Abdomen ( lat. cavitas abdominis) - a space located in the body below the diaphragm and completely filled with abdominal organs. It is divided into the abdominal cavity proper and the pelvic cavity (Latin cavitas pelvis). The cavity is lined with a serous membrane - the peritoneum, which separates the peritoneal cavity (abdominal cavity in the narrow sense) from the retroperitoneal space. abdominal cavity includes the peritoneal cavity, cavitas peritonealis, internal organs and retroperitoneal space, spatium extraperitoneale. The peritoneal cavity is a slit-like space enclosed between the parietal peritoneum, image. The walls of the peritoneal sac, and the visceral peritoneum covering the organs of this sac. The transverse colon and its mesentery form a septum that divides the abdominal cavity into two floors - upper and lower. This division is not carried out in a horizontal plane, since the transverse intestine on its mesentery descends downwards. The upper and lower floors of the abdominal cavity are interconnected only in front - through the preomental gap and from the sides - through the left and right side channels. On the top floor In the abdominal cavity, three interconnected bags, or bags, can be distinguished: hepatic (bursa hepatica), pregastric (bursa pregas-trica) and omental (bursa omentalis). The first two lie closer to the surface of the abdomen, the third is deep. The hepatic and pancreatic sacs are separated from each other by the supporting and coronary ligaments of the liver. The hepatic bursa surrounds the right lobe of the liver, the pregastric bursa is in front of the stomach and surrounds the left lobe of the liver and spleen. The walls of the liver bag are the diaphragm (its costal and lumbar parts) and the anterior abdominal wall; the walls of the pancreatic sac are formed by the diaphragm, the anterior abdominal wall and the stomach with its ligaments. From top to bottom, each of these bags passes in front of the transverse colon into the preomental space. In addition, the right bag (liver) communicates with the right lateral canal of the abdominal cavity, the left (pregastric) - with the left lateral canal. Communication between both bags is carried out through a narrow gap located between the liver and the pyloric part of the stomach, in front of the lesser omentum. The omental sac, otherwise known as the small peritoneal sac, limits a slit-like space located mainly behind the stomach and hepatogastric ligament. The bag communicates with the large peritoneal sac through the omental opening - foramen epiploicum (Winslowi). This hole is located near the gates of the liver and is limited in front by the hepatoduodenal ligament, behind - by the inferior vena cava with the peritoneum covering it, from above - by the caudate lobe of the liver, from below - by the initial section of the duodenum. In the absence of adhesions, the omental opening passes more often one, less often - two fingers; in the presence of adhesions, the hole can be closed. The omental bag is limited directly in front and behind by two sheets of peritoneum - anterior and posterior, involved in the formation of the anterior and posterior walls of the bursa omentalis. The anterior leaf of the stuffing bag covers the caudate lobe of the liver from the posterior edge of the organ to the hepatic gate. From here, the anterior leaf goes to the lesser curvature of the stomach, along the way forming the posterior plate of the lesser omentum, then covers the posterior wall of the stomach to its greater curvature and goes down, forming the posterior plate lig. gastrocolicum. Further, this front sheet is wrapped up and forms the third (inner) plate of the greater omentum, then passing into the back sheet of the stuffing box. This sheet covers the front of the pancreas and reaches the posterior edge of the liver, where it merges with the anterior leaf of the omental sac. The walls of the stuffing bag are; in front - the stomach and the lesser omentum; behind - a sheet of parietal peritoneum covering the pancreas, left kidney, left adrenal gland, aorta, inferior vena cava; below - the left side of the mesentery of the transverse colon; on the left - the spleen with its ligaments; the upper and right walls are not expressed independently. At the top, the cavity reaches the diaphragm, on the right - the duodenum. If separated along the greater curvature of the stomach lig. gastrocolicum and pull the stomach up, you can see two folds of the peritoneum stretched between the lesser curvature of the stomach and the anterior surface of the pancreas - plicae gastropancreaticae. One of them, the left one, goes to the pancreas from the lesser curvature of the inlet part of the stomach; in its free edge pass a. gastrica sinistra and v. coro-naria ventriculi, and in the thickness of the ligament there are nodi lymphatici gastropancreatici. Another ligament goes to the pancreas from the pyloric part of the stomach and the initial part of the duodenum and a. hepatica communis. Between both folds there is a hole - foramen gastropancrcticum. The cavity of the stuffing bag is divided by the indicated folds into two sections - upper (right) and lower (left), the communication between which is carried out by means of foramen gastropancreaticum. The vestibule of the omental bag (vestibulum bursae omentalis) belongs to the upper section - the initial section of the cavity, located behind the lesser omentum. Above it there is an upper torsion of the stuffing bag located behind the caudate lobe of the liver and reaching the esophagus and diaphragm. The lower part of the cavity of the stuffing bag (the cavity itself), located behind the stomach and gastrocolic ligament, has a lower volvulus, continuing to the left into the splenic volvulus. The cavity of the stuffing bag also includes a slit-like space enclosed between the leaves of the greater omentum (the cavity of the greater omentum). It exists in newborns, in adults, usually due to gluing of the sheets of the greater omentum, the slit-like space disappears for most of its length, remaining only in its left section. Subdiaphragmatic space Extraperitoneal subdiaphragmatic space located behind the liver. Both subdiaphragmatic spaces play an important role in surgical pathology: abscesses can occur here, which are called subdiaphragmatic abscesses. extraperitoneal most often are complications of paracolitis and paranephritis. Small and large omentums, their contents The small omentum consists of three ligaments, directly passing one into the other; left - lig. phrenicogastricum (from the diaphragm to the inlet of the stomach) 1, middle - lig. hepatogastricum (from the gate of the liver to the lesser curvature of the stomach) and right - lig hepatoduodenale. In the thickness of the lig hepatogastricum are a. gastrica dextra, a. gastrica sinistra, v. coronaria ventriculi and lymph nodes. Between leaves lig. hepatoduo-denale are located: on the left - a. hepatica, on the right - ductus chole-dochus, between them and behind - v. portae. In addition, in the thickness of the renal-duodenal ligament there are the hepatic and cystic ducts, which form the common bile duct, branches of the hepatic artery, lymphatic vessels and several lymph nodes, one of which almost always lies at the confluence of the cystic and hepatic ducts, and the other - at free end of the ligament. The hepatic artery is surrounded by the plexus hepaticus anterior, and behind the portal vein and in the groove between it and the common bile duct is the plexus hepaticus posterior. In the thickness of lig. gastrolienale are vasa gastrica brevia and vasa gastroepiploica sinistra. The upper section of the greater omentum, lig. gastrocolieum, contains between its leaves vasa gastroepiploica dextra and sinistra, lymph nodes.

97. Topographic anatomy of the upper floor of the abdominal cavity. Organs: holotopy, syntopy, skeletopy. Access to the organs of the upper floor of the abdominal cavity. The upper floor of the abdominal cavity is located between the diaphragm and the mesentery of the transverse colon. In it intra-peritoneally lie the stomach, spleen and mesoperitoneally - the liver, gallbladder, upper part of the duodenum. The pancreas also belongs to the upper floor of the abdominal cavity, although part of its head is located below the root of the mesentery of the transverse colon. The listed organs, their ligaments and mesocolon limit in the upper floor of the abdominal cavity to a greater or lesser extent isolated spaces, cracks, bags. Stomach.(According to Guyvor) 1) Holotopia: the organ is located in the abdominal cavity in the left subcostal and epigastric regions. 2) skeletopia: - card hole at the level of 11-12 vertebral piles; - pyloric opening at the level of 12 chests - 1 lumbar; 3) syntopy: lane is adjacent to the liver, diaphragm and lane br wall; butt with spleen, pancreas with gland, lion with kidney, adrenal gland, aorta and inferior vena cava; to the bol curvature - pop about the gut. Spleen: 1) holotopia: located in the left hypochondrium, in its posterior (deep) section. , not reaching the posterior midline at a distance of 4-5 cm. 3) syntopia: The outer surface of the spleen is adjacent to the costal part of the diaphragm. In front, from the upper edge to the gate, the spleen is in contact with the posterior and lateral surface of the bottom and body of the stomach, behind and below, from the gate to the lower edge, with the lumbar part of the diaphragm and the upper pole of the left kidney and adrenal gland, in front and below - with flexura coli sinistra and with the tail of the pancreas. liver: 1) holotopia: right subcostal region, part of the epigastric region and part of the left subcostal region 2) Skeletotopia: upper border - lin medioclavicul dextra - cartilage of the 5th rib; lin mediana ant - main xiphoid otr-ka; lin paraster sin - cartilage of the 6th rib; lower border - on the right - the lower edge of the ribs of the arch, comes out from under the ribs at the place of the joint cartilage of 8-9 ribs on the right and goes to the left and up through the top of the sword process to the junction of cartilage of 7-8 ribs of the left side 3) Syntopy: left and square the lobe of the liver - the stomach, to the rear edge - the esophagus, to the right lobe - the colon, the right kidney, adrenal gland, duodenum. gallbladder: 1) holotopia 6 right sub-region 2) skeletotopia: the bottom on the right at the junction of the cartilage of the 8th and 9th ribs 3) syntopia: to the visceral surface of the liver, in the filled condition and to the first br st. WPC: 1) holotopia: right subcostal, in the right lateral and near-umbilical regions 2) skeletonotopia: upper part 1 belt pos-k; descending part - 1-3 belt, mountains part - 3 belt pos-k; rise from 3 to 2 belt position 3) syntopy: upper part - square lobe of the liver, neck of the gallbladder and pop on the intestine (below), nisd part to the right kidney and cross in front with the mesentery pop on the intestine, m / at the head and the descent of part of the duodenum - the common bile duct, inside the horseshoe - the goal of the podzhel zhel, behind the mountains of the part - the aorta and the inferior vena cava, in front - the top of the mesenteric artery and the vein. Podzhel Zhel: 1) holotopia: epigastrium and lion subcostal region; 2) skeletopia: 1-3 lumens; 3) syntopy: head - horseshoe duodenum, lane turn - to the pyloric part and the body of the gall, behind the yellow was yellow - with a belt part of the diaphragm. Thief vein, common duct and br part of the aorta, tail to the left kidney, adrenal and spleen. Access:(tutorial for Lopukhin) laparotomy. Median: upper midline (to the organs on the upper floor), central midline (upper and lower floor), paramedial laparotomy along the lenander (to the stomach and subdiaphragm pr-vu), transrectal laparotomy (to the zhel or to the pope about the intestine), upper transversely along the sprengel (biliary tract, pylorus, bile, sel-ki, pop on the intestines), oblique according to Courvoisier-Kocher, Fedorova, tidied up, comb incision according to Quin (for the liver), comb according to Petrovsky-Pochechuev (opening the pleural cavity and br cavity) . Endovideosurgeon accesses.

98. Topographic anatomy of the spleen liver. Ways to stop bleeding from parenchymal organs. Splenectomy. Ways to stop bleeding from parenchymal organs. Can be differentiated as mechanical, physical, biological and chemical). One of the oldest ways to mechanically stop bleeding is ligation or stitching of bleeding vessels in the wound. In 1896, Kuznetsov MM and Pensky Yu R. developed a U-shaped hemostatic suture of the liver. The method is based on stopping bleeding by compressing the vessels together with the parenchyma in the resected area. These methods have a number of disadvantages. Most often, necrosis of the parenchyma is observed distal to the suture line, bleeding in the intra- and postoperative period, the formation of biliary fistulas. Necrosis of the parenchyma leads to relaxation of the sutures, which can also be complicated by postoperative bleeding and formed biliary fistulas. Therefore, suturing wounds of the liver and spleen is often performed with interrupted sutures, using a lining in the form of an omentum to avoid eruption of the parenchyma and a thin capsule. Suturing the kidney, which has a dense connective tissue capsule, often leads to the development of bleeding along the suture line due to intense blood flow in the tissues. In surgical practice, for the purpose of hemostasis, direct action on the wound surface and bleeding vessels of physical means is widely used. Currently, the following methods are used for trauma of parenchymal organs: electrocoagulation, argon coagulation, microwave and radiofrequency coagulation, contact infrared radiation, ultrasonic, harmonic and jet scalpels, laser coagulation, plasma flows, radiofrequency ablation. With the help of electrocoagulation, it is not always possible to stop bleeding from vessels of medium and large diameter. In this case, vessels with a diameter greater than 0.5-1.0 mm are not coagulated, and to stop ongoing bleeding, an increase in exposure and coagulation power is required, which increases the area of ​​necrosis. Lasers used in surgery are represented by two large groups: high-energy and low-energy lasers. Laser irradiation also inevitably causes parenchymal necrosis, the prevalence of which ranges from 4 mm to 8 mm. In this case, vessels with a diameter of more than 1 mm are insufficiently coagulated, which excludes the possibility of bloodless resection of the organ. Some success in achieving effective hemostasis was obtained using an argon electrocoagulator, which simultaneously uses a high-frequency electric current and an argon jet. The high-frequency electric current coagulates and cuts tissues, and the argon stream removes blood and tissue particles. Due to its inertness, argon causes destructive changes in tissues, expressed in a smaller volume. Physical methods of hemostasis during operations on parenchymal organs do not meet the requirements of the "ideal method", which should be accompanied by minimal blood loss or its absence, minimal necrosis of the parenchyma and a reduction in the time of surgical intervention.

Of the chemical methods of hemostasis abroad and in our country, the most widely used adhesive compositions and, in particular, cyanoacrylate adhesives. Hemostasis when using hydrophobic cyanoacrylate adhesives is carried out due to the formation of an adhesive film on the wound surface. At the same time, cyanoacrylate adhesives are characterized by general and local toxicity and cause necrotic changes in the application area. Due to the rapid glazing of such adhesives on wound surfaces and poor tissue bonding, observations have been made of early rejection of the adhesive film with the resumption of life-threatening bleeding. Biological methods of hemostasis can be divided into groups depending on the type of materials used: the body's own biological tissues, blood products and its fractions, processed animal tissues, drugs based on substances contained in plants, and combined drugs. hemostatic properties. Of these, fibrin glue (FC) has received the most widespread use. The mechanism of action of blood products is to accelerate, under the influence of thrombin, the enzymatic conversion of the soluble plasma protein fibrinogen into fibrin monomer, the molecules of which then form a fibrin network. The use of multi-component and expensive FC is associated with the need to have special equipment in the operating room, and operating surgeons and staff must master the technique of mixing its components. One of the directions in the search for means for local hemostasis was the use of biopolymers - collagen and gelatin. The revealed hemostatic effect of a hemostatic sponge made of gelatin is associated with its cellular structure, absorption on it of quantities of blood many times greater than its own weight on the surface of the preparation, destruction of blood cells with the release of thrombolystin. In surgery of parenchymal organs, many different methods of final hemostasis are used. But effective means of combating profuse bleeding have not yet been found. It should be noted that in case of profuse bleeding from large vessels (with a diameter of more than 1.0 - 1.5 mm), no adhesive composition or combined preparations, as it turned out, are able to provide reliable hemostasis . Splenectomy. Open and laparoscopic. Open. Goodbye. Splenomegaly, essential thrombopenia, rupture of the spleen, malignant tumors, tuberculosis, echinococcosis, abscesses, etc. Thoracoabdominal incision - splenomegaly. Technique: if during the initial examination there are no additional sources of bleeding, the patient's condition is not critical - mobilization of the spleen. Reb arc up, pop on the gut and yellow - to the right and down - we estimate the size of the pov-I. Long scissors cut the sel-renal ligament between the clamps. Dissection of the gland-spleen ligament and parietal peritoneum behind the spleen. The hole between the glandular rim and the glandular ligaments, the stuffing bag is opened, the ligament is mobilized, the ligament is ligated and the intersection of the glandular ligaments is performed. Ligation of vessels and dissection of the leg - removal of the spleen. ! control of hemostasis! restore the continuity of the peritoneum. Donkey. Bleeding, plus it is impossible to carry out a subtotal resection of the gallbladder due to the intersection of the corzh yellow art. Laparoscope. Pok-i: blood obstruction (TCpenic purpura, primary spleen pancytopenia), lymphomas, trauma - rupture of the spleen, without profuse bleeding, cysts and tumors. Counter-I. AMI, onmk, ncorrigir coagulopathy, spelomegaly, hemorrhagic shock. Technique. Intub anesthesia. Roller in the lumbar region, left semi-lateral position. A pneumoperitoneum is applied and a trocar is inserted paraumbilically. Trocars along an arc - in the center of a cut gate of a village. ra-e sat-on the ligamentous bottom of the gall-ka - soft pulp. They pull the yellow-sat ligament. Clip and cross core yellow art. Ras-e-zhel-sat ligaments. with the help of a retractor - they give out a vein and an art. And they stitch and reseat. Rase sat down - part of the bundle. Introduce the container into it sat-ku. Then the sel-diaphragm ligament is crossed. Donkey. Pov-e capsules of sel-ki and bleeding, pancreatitis (tail injury podzhl zhel), subdiaphragm abscess with incomplete hemostasis.

99. Gastrostomy. Classification. Types of fistulas. Pok-I to the operation. According to Witzel, Stamm-Kader, Topprover. Gastro-I - impose a zhel fistula. Pok-I: lasts arts pit-I hurt with neo-operable tumors of the pharynx, esophagus, bile, cicatricial narrowing of the esophagus. The severity of the craniocerebral trauma, with burns, injuries of the esophagus. Classification: according to the type of fistula - tubular (temporary, witzel, Strain-kader) or labial (permanent Topprover). By Witzel. technique. Upper transrect laparotomy on the left. A rubber tube is laid in the ranu-per st-ku of the gall and on the middle of the distance m / y with a large and small curvature of the gall. On both sides of the tube there are 6-8 ser-mycete suture knots; when tying, the tube is immersed for 4-5 cm in the ser-muscular canal, the end protrudes from the canal into the pyloric soron. At the end - a semi-purse-string seam, until we tie. In the center of the semi-purse - dissect the st-ku zhel-ka. Otsas-yut sod-e zhel-kai immerse the end of the tube in the zhel-to. tie a half pouch, on top of another 2-3 serr-mouse seam. The tube is out through the additional incision of the brst. For the handles, they pull up the st-ku of the jelly, it fits snugly against the pariet of the chest. The threads of the handles are tied after flashing the skin above or below the tube, circled around the tube and tightened. A piece of gall is sutured to pariet bru-not ser-mice with sutures. The wound is tight. Clamp on the tube - so that the soda does not flow out. Minuses. Clamp on the cut tube, which falls off. According to Stamm-Kader. Unlike the Witzel, the tube is inserted into the front-back direction. With small sizes of the gallbladder, with cancer of the gallbladder wall. Technique. Upper transrectal laparotomy on the left. After opening the br, half a penis of the gallbladder is pulled to the wound in the form of a cone and 2-3 pouches of ser-mice are applied at a distance of 1.5 cm from each other. In the center of the first pouch, the ser-mys layer is dissected and the mucus membrane is separated. A tube is inserted into the gallbladder, the first pouch is tightened (the edge should be invaginated into the gallbladder), the same with the second and third. A piece of bile is sutured to the peritoneum (gastropexy). The free end of the tube is fixed to the skin. Minus - the possibility of the tube falling out and the flow of yellow soda. According to the checker. Dya large zhel-ka.lev top transrectal incision. The finger is brought into the wound and with 3 cysts a cone is formed. The ends of the threads are on the clamps. The tube is inserted and the pouches are tightened. Obr-Xia cylinder, sutured to the front br st-kinny pouch sutured to the peritoneum at the level of the second pouch sutured to the straight line of the abdomen. The third pouch - to the skin. The tube is removed and inserted at the time of feeding.

100. Resection of the gallbladder according to Billroth1 and Billroth2. Pok-I, the stages of the operation. Types of gastroenteroanastomoses. Comparative evaluation. Indications: - complicated ulcers of the stomach and duodenum (bleeding, penetrating, callous, pyloric stenosis); - benign tumors (polyps, adenomas); - cancer of the stomach. Resection of the stomach according to Billroth 1. An upper median laparotomy is performed. Mobilization of the stomach along the greater curvature. The stomach and transverse colon are brought out into the wound. The gastrocolic ligament is opened at the level of the middle third of the stomach. Between the clamps, the ligament and arteries are crossed to the intended level along the left half of the greater curvature. The branches of a.gastroepiploica dextra are also tied up and dissected to the right from the beginning of mobilization to the level of the pylorus. At the level of the pylorus, the main trunk of a.gastroepiploica dextra is ligated separately. The branches running from the central section of a. gastroepiploica dextra to the pylorus and duodenum are dissected between clamps and tied up. Bandage and cross 2-3 branches of the artery going to the posterior surface of the duodenum. The lesser omentum is first dissected in the avascular zone, and then clamps are applied, squeezing the left gastric artery between them, which is cut and ligated. The right gastric artery is ligated between clamps. The resection is started from the side of the greater curvature, perpendicular to the axis of the stomach, a clamp is applied to the width of the anastomosis. The second clamp captures the rest of the diameter from the side of the lesser curvature. Distal to these clamps, a crushing Pyre pulp is applied to the part of the stomach to be removed, along which the stomach is cut off. On the part of the stomach stump to be sutured, a marginal twist suture is applied. The upper edge of the lesser curvature of the stomach is immersed with a semi-purse-string suture. Separate serous-muscular sutures are applied to the rest. Create an anastomosis between the stump of the stomach and the duodenum (the width of the anastomosis on the stump of the stomach is more than 12 duodenal). Resection of the stomach according to Billroth 2 Resection of the stomach according to the method of Billroth II in the modification of the Hofmeister-Finsterer. An upper median laparotomy is performed. Mobilization of the stomach and duodenum. The stump of the duodenum is sutured with a continuous twisting suture. The stump is immersed either with Z-shaped and circular purse-string silk sutures, or with two semi-purse-string sutures with an additional imposition of serous-serous sutures. The stomach is removed and its stump is treated. A gastrointestinal anastomosis is applied, so that the leading end is at the lesser curvature (not reaching it by 2-3 cm), and the outlet is at the greater curvature. The leading part of the intestine is sutured above the level of the anastomosis to the lesser curvature of the stomach. Gastroenteroanastomosis is applied using a double-row suture (a continuous catgut suture to the posterior edges of the anastomosis through all layers with a transition to the anterior edges according to the type of Schmiden screwing suture and interrupted silk serous-muscular sutures to the anterior semicircle of the anastomosis).

Types of gastroenterostomy. 1. Anterior anterior colic 2. Posterior anterior colic. 3. Anterior retrocolic 3. Posterior retrocolic. Most often, an anterior anterior and posterior posterior colon are used, as an exception, an anterior posterior colon. At the same time, the posterior anterior collateral is practically not used. Anterior collateral - technically simple. Posterior posterior - anastomosis can be applied both in the transverse and in the longitudinal direction.

101. topographer anatomy of extrahepatic bile-excretion tracts. Variants of distribution of the cystic artery. The concept of the Callot triangle. Ante - and retrograde methods of cholecystectomy. for now, technique. Extraorgan biliary tract. 1. Common hepatic duct (fusion of ductus hepaticus dexter et sinister) 2. Fusion of common hepatic duct with cystic duct = common bile duct. 3. The common bile duct merges with the podgel duct and forms a hepatic-podgel ampulla of the edge opens into the duodenum . Cystic artery and Callot's triangle. 89% cystic artery behind the cystic duct. In 8% it was in front of the cystic duct and in 3% the artery passed along the cystic duct directly adjoining its anterior or posterior surface. The significance of this area for surgeons was first described Kahlo(Calot) in 1891. The three boundaries of the vesicohepatic triangle are; from below the cystic duct and the wall of the gallbladder; from above, the lower edge of the right lobe of the liver (cystic artery); medially common hepatic duct. In this region pass: right hepatic artery, cystic artery. Cholecystectomy - removal of the gallbladder. Goodbye. With stones or inflammation of the gallbladder. ZHKB.hr. cholecystitis. Good and malignant tumors. Ways: from the neck, from the bottom, subserous cholecystectomy, coagulation of the mucous membrane of the bladder, laparoscope cholecystectomy. 1. From the neck - more profitable, from the very beginning we proceed to the selection of the bile duct and bladder art. As well as examination of the common bile duct. technique. Under the back, at the level of 12 piles, the patient has a roller. = To the lane, all organs approach, lying on the top floor of the cavity. Access - Fedorov, Courvoisier-Kocher, Sprengel, pribram, upper middle laparotomy, right pararectal access. Revision and palpation of the gallbladder. Exposure and ligation of the extrahepatic bile ducts. A ligature is applied 0.5 cm distal from the confluence of the bladder and common bile duct. Stepping back 0.5 cm from the first ligarure in a hundred, well, we bandage the belly again. And cut between 2 ligatures. in treug Kallo allocate perevyz-yut and cross the bubble art. Isolation of bile bellies and its bed. Above the gallbladder, the peritoneum is spread along its circumference, stepping 0.5 cm from the line, along which the peritoneum passes from the liver to the gallbladder. Peel off the wall of the bubble from the bed. Revision of the bed for hemostasis. The peritoneum is sutured continuously or with nodular catgut. The bladder stump is left free. 2. From the bottom. In case of adhesions in the cervical area. + we have the ability to accurately identify the elements. - it is impossible to conduct a diagnostician of the biliary tract, which means bleeding. Technique. Same access. Vyd-e gall ways, husking gall bladder from the bed. Along the length of the axis of the gallbladder on the left and on the right, the peritoneum is incised in the fundal part, both lines of the incision coincide. Vyd-yut yellow belly from the bed, moving towards the belly duct. The belly artery is bandaged and crossed near the bladder liver. And the belly duct is 0.5 cm from the common bile duct. The gallbladder is cut off and removed. Further, the same as in the neck. 3. Subserous cholecystectomy. The entire bubble is pulled out of the peritoneal cover, while the outer layer remains on the hepatic bed. Only in the early stages of the primary attack of cholecystitis! - it means bleeding, since the cystic art can be bandaged only after the bladder has been expelled. 4. Coagulation of mucous membranes. So far, the recurrence is complicated with changes in both the surrounding tissues and the gallbladder. Technique. The empty stomach is opened all over and freed from stones. After ligation of the vesicles of the duct and the vesicles, the mucus membrane of the vesicle is laid down on the liver, coagulated to the peritoneum of the cover with a thermocoagulator. The edges of the bubble are sewn with the help of turning the seams. 5. Laparoscopic. Pok-I xp calculus cholecystitis, cholesterosis of the gallbladder, polyposis of the gallbladder, acute cholecystitis. Contrapoid-I. Absolut - AMI, stroke, non-correction coagulopathy, pancreatic cancer, dense infiltrate in the gallbladder area, late pregnancy, refers to - intolerance to general anesthesia, peritonitis, tendency to bleeding, fur jaundice, choledocholithiasis, cholangitis, ost and pseudotumorous pancreatitis …Access. 4 accesses. After the imposition of pneumoperitoneum - paraumbilically below the navel along the white line -1 trocar. Then everything is injected under the control of a video monitor! 2 trocar (instrumental) - in the epigastrium close to the xiphoid process. The stylet of the trocar is to the right of the round ligament of the liver. 3 and 4 trocars - along the midkey line 4-5 cm above the ribs of the arc and along the axillary line at the level of the umbilicus. Stages. 1. Traction - raise the gallbladder. Expose the portal of the liver and the area of ​​the Callot triangle for dissection. 2. Resection of the peritoneum. Above the belly duct or elements of the hepato-duode fold. 3. Dissection of the Callot triangle. 4. Extraction of the elements of the GB neck - the most important moment of the operation. 2 rules! Not a single tubular arr-e is cross-checked. We don't know what it is yet. Make sure that after mobilization, only 2 mods approach the ZhP - art and duct. 5. Crossing the artery. Clipping. 6. Crossing of the bladder duct. 6. Mobilization of the ZhP. 7. Fluid aspiration and drainage of the abdominal cavity. 8. Extraction of the drug. 9. The end of the operation - a control examination of the abdominal cavity, remove the instruments, remove the gas.

102. Operations for obstruction of the common bile duct. Choledochotomy, choledochostomy. Variants of biliodigestive anastomoses. Choledochotomy. Pok-I - intraoperative. cholangiography, the presence of prolonged jaundice, dilatation of the common bile duct. cholangitis, multiple stones in the gallbladder. Supraduoden choledochotomy. The most common type of intervention on the Zh ducts. Technique. Exposure of the hepatoduodenal ligament. Exposing and ligating the duct vesicles so that the stones do not pass into the common bile duct. The gallbladder is removed after the examination of the common bile duct on the passage, puncture with a needle of the bile duct, to confirm the presence of bile. Ras-yut between 2 holders spread the wall of the common duct. The stones are removed using forceps, a catheter is inserted into the common bile duct so that the end passes into the duodenum papilla. The introduction of T arr drainage according to Keru. We suture the incision of the wall around the tube. Cholangiography.retroduodenal choledochotomy. More difficult, since the retroduode part of the duct is in contact with the back of the duodenum only at an insignificant distance. Pok-I - large stones to-rye cannot be removed with supraduodenal. Technique. Mobilization of the DPC. We introduce a catheter opened into the supravoduct and move it to the intestine. Defining the end of the catheter and the stone. They are trying to move the stone into the supravod from to the incision site, from where we are trying to remove it. If it fails, a small incision of the bowel part of the duct. Choledochostomy.

Goodbye. When the obstruction of the common bile duct and the major duodenal papilla cannot be eliminated by another method. Conditions - sufficient width of the common duct (2-3 cm). use supraduode choledochoduodenostomy. + created bypassing the zone of the most frequent location of the outflow of bile (terminal of the common bile duct), the retroperitoneum is well demarcated. Realize side to side. Types - the method of Finsterer, Flerken, Yurash, sasse. According to Finsterer. - the imposition of an anastomosis m / y with longitudinally opened lumens of the duct and duodenum. Sufficient mobilization of the duodenum is needed to prevent deformity of the anastomosis. The fistula at the junction of the duct and the intestine is sutured with sutures. Then longitudinally 2-2.5 cm open. The edges are sutured with a continuous twisting catgut suture through all layers of the walls. The imposition of ser-mouse sutures through the anastomosis semicircle on the lane = narrowing of the lumen! According to Flerken. In order not to narrow the lumen of the anastomosis, we open the lumen of the duodenum so that the longitudinal section of the duct falls in the middle of the distance between the wall and the intestine. Technically difficult! According to Yurash. Widely open (2-3 cm) longitudinally in the supraduode of the part of the common bile duct to the transition of the fold m / at it and later by the edge of the intestine. Transverse section of the duodenum. The fistula is formed with thin synthetic threads through all layers of the wall and duct. Seams at a distance of 2-3 mm from each other, stitch the wall inward, and bring the needle out. The sutures are not tied, after all the sutures are applied, they are tied at the same time by the surgeon and the assistant. By Sasse. At the border of the supraretroduode and retroduoden parts of the common duct, which requires the mobilization of the duodenum. As low anastomosis as possible, as it is necessary to reduce the blind section of the common duct. Ligation of the gastro-duoden arti top pancreato-duod art. Vyd-e 2 cm retroduod part of the common duct. Incision of the common duct 1.5 cm and dissection of the duodenum across the direction opposite the incision of the common duct. Near nodal catgut sutures connect the edges of the incisions. vvora chilling. Knots outside. From above ser-mouse silk seams.

Knowledge of the structural features and location of the abdominal organs is important for understanding many pathological processes. The abdominal cavity contains the digestive and excretory organs. must be described taking into account the relative position of these organs.

General information

The abdomen is the space between the sternum and the pelvis

The abdomen refers to the space of the body between the chest and the pelvis. The basis of the internal structure of the abdomen is the abdominal cavity, which contains the organs of digestion and excretion.

Anatomically, the area is limited by the diaphragm, located between the chest and abdominal cavities. At the level of the pelvic bones, the pelvic region begins.

Features of the structure of the abdomen and abdominal cavity determine many pathological processes. The digestive organs are held together by a special connective tissue called the mesentery.

This tissue has its own characteristics of blood supply. The organs of other important systems are also located in the abdominal cavity - the kidneys and.

Many large blood vessels nourish the tissues and organs of the abdominal cavity. In this anatomical region, the aorta and its branches, the inferior pudendal vein and other large arteries and veins are isolated.

The organs and main vessels of the abdominal cavity are protected by muscular layers that form the external structure of the abdomen.

External structure and abdominal muscles

The structure of the abdomen: internal organs

The external structure of the abdomen is no different from the structure of other anatomical regions of the body. The most superficial layers include the skin and subcutaneous fat.

The subcutaneous fat layer of the abdomen can be developed to varying degrees in people with different constitutional types. Skin, fat and subcutaneous fascia contain a large number of arteries, veins and nerve structures.

Muscles are represented in the next layer of the abdomen. The abdominal area has a sufficiently powerful muscular structure that allows you to protect the abdominal organs from external physical influences.

The abdominal wall consists of several paired muscles, the fibers of which are intertwined in different places. Main abdominal muscles:

• External oblique muscle. It is the largest and most superficial paired abdominal muscle. It originates from the eight lower ribs. The fibers of the external oblique muscle are involved in the formation of a dense aponeurosis of the abdomen and inguinal canal, which contains the structures of the reproductive system.
• Internal oblique muscle. This is the structure of the intermediate layer of paired abdominal muscles. The muscle originates from the iliac crest and part of the inguinal ligament. Individual fibers are also associated with the ribs and pubic bones. Like the external muscle, the internal oblique muscle is involved in the formation of a wide aponeurosis of the abdomen.
• Transverse abdominal muscle. This is the deepest muscle of the superficial layer of the abdomen. Its fibers are connected with the ribs, iliac crest, inguinal ligament, fascia of the chest and pelvis. The structure also forms the aponeurosis and the inguinal canal.
• Rectus abdominis. It is a long muscle associated with the ribs, sternum, and pubic bone. It is this muscle layer that forms the so-called abdominal press, which is clearly visible in physically developed people. The functions of the rectus abdominis muscle are associated with flexion of the body, obstetric processes, defecation, urination and forced exhalation.
• Pyramidal muscle. It is a triangular muscle structure located in front of the lower part of the rectus abdominis. The fibers of the pyramidal muscle are connected to the pubic bones and the linea alba. The muscle may be absent in 20% of people, which is associated with the individual characteristics of the structure of the abdomen.
• The aponeuroses and muscular lines of the abdomen are of particular importance in protecting and maintaining the shape of the structures of the abdominal cavity. In addition, the abdominal muscles form the inguinal canal, which contains the spermatic cord in men and the round ligament of the uterus in women.

Abdomen

The structure of the abdomen: muscles

The internal structure of the abdomen is represented by the abdominal cavity. The cavity is lined from the inside with peritoneum, which has inner and outer sheets.

Between the layers of the peritoneum are the organs of the abdomen, blood vessels and nerve formations. In addition, the space between the sheets of the peritoneum contains a special fluid that prevents friction.

The peritoneum not only nourishes and protects the structures of the abdomen, but also fixes the organs. The peritoneum also forms the so-called mesenteric tissue associated with the abdominal wall and abdominal organs.

The boundaries of the mesenteric tissue extend from the pancreas and small intestine to the lower colon. The mesentery fixes the organs in a certain position and nourishes the tissues with the help of blood vessels.

Some organs of the abdomen are located directly in the abdominal cavity, others - in the retroperitoneal space. Such features determine the position of the organs relative to the sheets of the peritoneum.

abdominal organs

Abdomen

The organs located in the abdominal cavity belong to the digestive, excretory, immune and hematopoietic systems.

Their mutual arrangement ensures the performance of many joint functions.

Main organs of the abdomen:

• Liver. The organ is located in the right abdomen directly below the diaphragm. The functions of this organ are associated with the processes of digestion, detoxification and metabolism. All the nutritional components formed as a result of digestion enter the liver cells with the blood, where chemical compounds harmful to the body are neutralized. The liver is also involved in the formation of bile, which is necessary for the digestion of fats.
• Stomach. The organ is located in the left abdomen under the diaphragm. This is an enlarged part of the digestive tract associated with the esophagus and the initial section of the small intestine. Key processes of chemical decomposition of food substrates take place in the stomach. In addition, the cells of the stomach help absorb vitamin B12, which is necessary for the functioning of body cells. The hydrochloric acid found in the stomach helps to kill bacteria.
• Gallbladder. The organ is located under the liver. The gallbladder is a storehouse of bile. When food components enter the duodenum for digestion, the gallbladder secretes bile into the intestinal cavity.
• Pancreas. This structure is located below the stomach between the spleen and duodenum. The pancreas is an indispensable digestive organ necessary for the final processes of food digestion. Iron produces enzymes that make it possible to turn large food components into structural units necessary for cells. The role of the pancreas in glucose metabolism is also very important. The gland secretes insulin and glucagon, which control blood sugar levels.
• Spleen. The organ is located in the left abdomen next to the stomach and pancreas. This is an organ of hematopoiesis and immunity, which allows you to deposit blood components and utilize unnecessary cells.
• Small and large intestine. In the departments of the small intestine, the main processes of digestion and assimilation of food substrates take place. The large intestine forms and stores stool and absorbs water.
• Kidneys. These are paired excretory organs that filter the bloodstream and utilize metabolic waste products. The kidneys are connected to the ureters, bladder and urethra. In addition, the kidneys secrete a number of important substances necessary for the synthesis of vitamin D and the formation of red blood cells.

The close location of the abdominal organs determines the features of many diseases. Inflammatory processes associated with the entry of bacteria into the abdominal cavity can be deadly.

Methods for examining the abdominal organs

Intestine: human anatomy

Numerous diagnostic methods allow you to assess the condition of the abdominal organs and, if necessary, confirm the presence of the disease.

Doctors begin with a physical examination of the patient, which allows to detect external manifestations of pathologies. The next stage of diagnosis is the appointment of instrumental research methods.

Methods for examining the abdominal organs:

• Esophagogastroduodenoscopy. A flexible tube equipped with a camera is inserted through the oral cavity into the patient's digestive tract. The device allows you to assess the condition of the esophagus, stomach and duodenum.
• Colonoscopy. In this case, the tube is inserted into the lower digestive tract through the anus. The procedure allows you to examine the rectum and large intestine.
• Radiography and computed tomography. Methods allow you to get pictures of the abdominal cavity.
• Magnetic resonance imaging. This highly accurate method is often used for detailed examination of the liver, pancreas, and gallbladder.
• Ultrasound diagnostics. With the help of the procedure, the general condition of the abdominal organs is assessed.

Specialized methods, including biopsy and breath test, can be used to diagnose certain diseases.

Thus, the structure of the abdomen is important not only in terms of anatomical features, but also in terms of diagnosing diseases.

The video material will acquaint you with the anatomy of the human abdominal cavity:

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.

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?

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 makes up 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 somewhat 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.

Treatment.

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 doctors will study this area well, 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 reduce the time for treatment of people and get rid of severe cases of manifestation of the disease, in which the only way out can only be surgery.

Each person sooner or later begins to think about why it pricks in one side or another and where the appendix is ​​located. Knowing the exact location of the abdominal organs, you will communicate with the doctor much faster, especially if this communication takes place over the phone, and you will be able to provide first aid to the patient long before the doctors arrive.

What is the abdominal cavity?

In medicine, this term refers to the space under the diaphragm in which the insides are located. The walls of the retroperitoneal space are covered with a serous membrane, which extends to all the insides. The lower region of the peritoneum smoothly passes into the small pelvis.

The natural physiology and anatomy of the abdominal organs and the sternum of any healthy person are arranged in such a way that their surfaces do not rub against each other. This is due to the presence of serous fluid and the epithelial layer. The abdominal and thoracic cavities are separated by the diaphragm.

Location of the abdominal organs

Doctors know three possible options for the location of the viscera of the peritoneum and retroperitoneal space:

• Extraperitoneal. In this case, the peritoneum covers only the anterior part of the internal organ. The best example of this arrangement is the kidneys.
• Mesoperitoneal. This arrangement of the abdominal organs implies the presence of one side of the viscera, not covered with a serous membrane. The best example is the liver.
• Intraperitoneal, which is characterized by a comprehensive fitting of the organ by the peritoneum. The most striking example of such an arrangement can be considered the small intestine.

What organs are in the abdominal cavity?

On the left, under the diaphragm, is the stomach, which is a bag-like extension of the digestive tract. The volume of this organ depends on the degree of its fullness. It is here that the accumulation and initial digestion of food takes place.

Behind, just below the stomach, is the pancreas, which belongs to the digestive system. It is endowed with the function of external secretion. In the process of its work, pancreatic juice is released, containing many digestive enzymes. In addition, the pancreas performs the functions of internal secretion, due to which carbohydrate, fat and protein metabolism occurs.

On the right, under the diaphragm, is the liver, which is responsible for cleansing the body. It consists of two parts. The dimensions of the right lobe are much larger than the dimensions of the left. The liver belongs to the category of vital organs. Its function is to remove allergens, toxins and other unnecessary substances from the body. In addition, the liver takes part in the processes of digestion and provides the human body with glucose.

The anatomy of the human abdominal cavity is arranged in such a way that the gallbladder is located in the lower part of the liver. It is here that a viscous greenish liquid called bile is concentrated.

In the upper left part, behind the stomach, is the spleen, which has the shape of a flattened and elongated hemisphere. This organ performs immune and hematopoietic functions. The spleen filters foreign particles and is involved in the synthesis of lymphocytes.

A little lower than the stomach is the small intestine, resembling a tangled long tube. This organ gradually passes into the large intestine. Our health depends on how well the intestines function.

Where are the human organs located?

Those who attended school anatomy lessons will surely remember the existence of the so-called paired organs. One of them is the kidneys. The location of the abdominal organs is arranged so that they are located behind the parietal sheet of the peritoneum. This paired organ responsible for filtering and secreting urine is located on the sides of the lumbar region. The kidneys are vital organs, they control chemical homeostasis.

Above, in the region of the kidneys, are the adrenal glands, which regulate metabolic processes. They synthesize cortisol, cortisone, corticosteroids and adrenaline.

The most common pathologies of the peritoneal organs

One of the most common diseases of organs located in this anatomical zone is appendicitis. As a rule, it develops as a result of a bacterial infection. This disease is treated exclusively by surgery.

No less common are problems such as acute intestinal obstruction and adhesive disease. When there is a threat of developing female infertility or acute obstruction, adhesions are separated through surgical intervention. Adhesions that provoked the development of an acute form of intestinal obstruction are removed solely for health reasons. It should be understood that the operation in most cases leads to their re-education. When symptoms of partial obstruction appear, doctors recommend following a slag-free diet.

Symptoms characteristic of the prolapse of the abdominal organs begin to develop with the prolapse of the stomach. Treatment of this pathology consists in wearing a special bandage, performing special therapeutic exercises and dieting.

Abdominal Examination Methods

Ultrasound diagnostics is used to detect pathologies of the abdominal organs. This method allows you to view the topography of the peritoneum. This safe and harmless study can be performed quite often, since ultrasound does not affect the structure of cells in any way. Eventration of the abdominal organs is diagnosed by percussion, auscultation and palpation. How correctly this or that organ is located can be judged not only by the results of ultrasound, but also by the data of magnetic resonance and computed tomography.

The posterior wall of the abdominal cavity is formed by the lumbar spine and muscles (square muscles of the lower back and iliopsoas muscles), the anterior and lateral - by the abdominal muscles. From the inside, the abdominal cavity is lined with intra-abdominal fascia, which is adjacent to adipose tissue and peritoneum. The space bounded in front by the peritoneum and intra-abdominal fascia is called retroperitoneal. It contains some organs (kidneys, adrenal glands, pancreas, and others) and fatty tissue, significant amounts of which are located on the posterior abdominal wall near the internal organs located there. Both sheets of the peritoneum pass continuously from the walls of the abdominal cavity to the organs and from the organs to the walls of the abdominal cavity, limiting the peritoneal cavity (Fig. 178), which is a narrow gap. It contains a small amount of serous fluid that oozes from the blood capillaries and wets the peritoneum, which facilitates the movement of organs and prevents their friction. In women, the peritoneal cavity is open - it communicates with the external environment through the fallopian tubes, the uterine cavity and the vagina. In men, the peritoneal cavity is closed. It is moistened with a small amount of serous fluid, which facilitates the movement of organs and prevents their friction. The parietal peritoneum covers the anterior wall of the abdominal cavity, at the top passes to the lower surface of the diaphragm, and then to the posterior and lateral walls of the abdominal cavity and internal organs, and below - to the walls and organs of the pelvic cavity. On the posterior wall of the abdominal cavity, the peritoneum covers the organs lying retroperitoneally (retroperitoneally) and passes to other organs lying meso- and intra-peritoneally. Organs covered by the peritoneum on only one side (pancreas, most of the duodenum, kidneys, adrenal glands, empty bladder, aorta, inferior vena cava, other vessels, nerves, and lymph nodes) lie outside the peritoneum, retroperitoneally (retro, or extraperitoneally ). Other organs are covered by the peritoneum only on three sides and are called mesoperitoneally lying organs (ascending and descending colons, middle part of the rectum, filled bladder, uterus). The third group of organs is covered by the peritoneum on all sides and occupies an intraperitoneal, intraperitoneal position (stomach, small intestine, caecum with a appendix that has its own mesentery, transverse and sigmoid colons, the initial section of the rectum, spleen, liver). Two sheets of peritoneum that go from the parietal peritoneum covering the posterior abdominal wall to the intraperitoneally located organ form its mesentery (for example, the mesentery of the small, transverse colon, sigmoid colon). Between the gates of the liver, on the one hand, the lesser curvature of the stomach and the upper part of the duodenum, on the other, a duplication (two sheets) of the peritoneum is formed - the lesser omentum. Enveloping the stomach, both layers of the peritoneum in front and behind again converge at its greater curvature and go down in front of the transverse colon and loops of the small intestine. Having reached the level of the navel, and sometimes below, these two layers of the peritoneum are bent backwards and rise up behind the descending layers, and also in front of the transverse colon and loops of the small intestine. This long fold, hanging in front of the transverse colon and the apron-like loops of the small intestine, and formed by four sheets of peritoneum, is called the greater omentum. Between the sheets of the omentum is fatty tissue.

In the cavity of the small pelvis, the peritoneum covers the upper and partially middle sections of the rectum, urinary and genital organs. In men, the peritoneum passes from the anterior surface of the rectum to the posterior and upper walls of the bladder and continues into the parietal peritoneum, which lines the anterior abdominal wall behind (Fig. 179). A rectovesical depression forms between the bladder and the rectum. In women, the peritoneum from the anterior surface of the rectum passes to the back wall of the upper part of the vagina, rises up, covering the back and then the front of the uterus, and passes to the bladder. Between the uterus and the rectum, a recto-uterine depression (Douglas space) is formed, limited on the sides by the recto-uterine folds. A vesicouterine cavity forms between the uterus and the bladder. The peritoneum of a newborn child is much thinner than that of an adult, the subperitoneal fatty tissue is poorly developed. The greater omentum is thin, short, the folds and pits are weakly expressed, as the age of the child increases, they deepen.