clinical anatomy of git and urinary tract [autosaved]
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7/22/2019 Clinical Anatomy of GIT and Urinary Tract [Autosaved]
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Embriology
Foregut : Pharynxprimordial (cavum oris,lingua, glandulasalivarius), respiratorysystem, esofagus sampai
papilla duodeni mayor,hepar, pankreas
Midgut: Duodenumsisanya sampai 2/3proksimal colon
transversum Hindgut: sisanya
ditambah epitel vesicaurinaria dan uretra
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Conted
Cavitas peritonii:Coeloem intraembryonic Peritoneum parietal: mesoderm somatic
Peritoneum visceral: mesoderm splachnic
Mesenterium: double layer peritoneum
Mesogastrium dorsal omentum majus, lig.Gastrolienalis, lig. Gastrophrenica, lig. Gastrocolica
Mesogastrium ventral lig. Falciformis, lighepatoduodenal, lig hepatogastrica
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Esophagus
VC6-VT11 Pars cervical, thoracal, abdominal
Inner circular, outer longitudinal
Penyempitan (angustia) superior, media, inferior
Klinis Fistula tracheoesophageal
GERD, kelemahansphincter lower. Ygmana sphincterlower? Achalasia Varises esofageal(portocaval shunt)
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Gaster Fundus, cardia, corpus,
pars pylorus, pylorus
Incissura cardiaca &incissura angularis
Tunica mucosa: rugae
gastrica, canalisgastricus
Tunica muscularis: outerlongitudinal, middlecircular, inner oblique
Tunica serosa:peritoneum visceral
Vaskularisasi a. gastrica dexter & sinisteranastomosis di curvatura minor a. gastroepiploica dex & sinanastom di curvatura mayor a. gastrica brevis & posteriorsuplai fundus v. gastrica dex et sin v. Portahepatica v. gastroepiploica sin & brevis v.Lienalis v. gastroepiploica dex v.Mesenterica sup
InervasiParasimpatis: trunkus vagusant & postSimpatis: T6-T9 n. splachnicus
mayor
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Cont ed
Klinisnyaa.. Hiatal hernia
Hernia diafragma congenital (bochdalek)
Hypertrophic pyloric stenosis
Ca gaster, sering di pylorus Gastroscope (nasally/orally)
Gastrectomy (total dan parsial)
Gastritis dan gastric ulcer
Vagotomy
truncal: jarang!
selective: Cuma dipilih yg menuju ke segmen
gaster tertentu
Slidinghernia
Paraesophageal
hernia
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Duodenum Pars superior (ada ampullanya lho), pars descenden, pars
horizontal, pars ascenden
Yang mana yg intraperitoneal dan retro?
Lig. hepatoduodenal
Flexura duodeni superior (L1) et inferior (L3)
Flexura duodenojejunales (L2) ligamentum suspensoriumduodenojejunales (Treitz)
Papilla duodeni mayor dan acessorius
Plica circularisVaskularisasi
A. GastroduodenalA. Pancreaticoduodenalsup infVenanya ke v. PortahepatisInervasi
n. Vagus dan n.S lachnicus ma or et
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Lanjoot..
Klinisnya apaan dong?
Duodenal ulcer: bisa erosi ke a. gastroduodenal
Peptic ulcer: karna asam lambung berlebih
Hernia paraduodenal: di sekitar flexuraduodenojejunales melalui fossa duodeni sup etinf, fossa paraduodenal, plica paraduodenal
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Conted
Nah klinisnya.. Diverticulum ilei
(Meckel):gagalnyapenutupan ductomphalomecentericus
74% free 26% nempelke umbilicus
Mucosa: ileal type,gastric type,pancreatic, jejunale,atw colonic
Iskemia small intestine: occlusivasa recta oleh emboli nekrosis
ileusIleus: nyeri colic, distensi,vomiting, fever dan dehidrasi
Ileostomy: stoma dari ileum kekulit dinding anterolateral
Megacolon (Hirschprung)
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Large Intestine Caecum, appendix, colon
ascenden, transversum,descenden, sigmoid,rectum, dan canalis analis
Haustra & incissurasemilunaris
Appendices epiploica Taenia coli (libera,
mesocolica, omentalis)
Plica semilunaris
Mesocolon transversum
Mesocolon sigmoid
Flexura hepatica &lienalis
Junctio rectosigmoid
Posisi appendix?Retrocaecal, preileal,
retroileal, pelvica, dll
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Klinisnyaa Appendicitis, McBurney
di garis Monroe
Colectomy (removal)
Colitis
Colostomy, pembuatan
stoma di pars terminalcolon
IBD
Diverticulosis,diverticulitis
Volvulus, hanya untukyg intra
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Rectum & Anus
Retroperitoneal dansubperitoneal
Canalis analis
Linea pectinata
(dentata), batasembriologis
Junctio anocutan
M. Levator ani
M. Sphincter ani internus
(involunter) M. Sphincter ani externus
(volunter)
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Klinisss
Atresia ani
Stenosis ani
Hemorrhoid
Internal: plexus
venosus rectalisinternal
Eksterna: plexusvenosus rectalisexterna, sakit
Batesnya si lineadentata
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Hepar
Intraperitoneal Fascies
diaphragmatica &visceralis
Recessussubphrenicus &
hepatorenal Area nuda, sulcus
vena cava inferior Fossa vesica fellea,
porta hepatis (apa aja?)
Impressio Lobus anatomis,
fisiologis Segmen?
Blood flowTruncus coeliacus - a. Hepaticacommunis a. Hepatica propria portahepatis - ramus dex et sinv. Mes sup + v. Lienalis = v. Portahepatica
v. Mes inf ke v. lienalisVena2 abdomen v. Porta he atica
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Portocaval shunt
Letak Porta Cava
Esofagus v. gastrica sinistra v. esofageales
Paraumbilical v. paraumbilicalis v. Epigastricasuperficialis
Anus v. Rectalis sup v. Rectalis med&inf Retroperitoneal v. Colica sinistra v. Lumbalis ascenden
Klinisnya..
sirosis hepatis hepatomegaly hepatitis
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Organ aksesoris lainnya
Lien: splenomegaly(inget schuffnernya),splenectomy
Vesica fellea:cholecystitis,
cholelithiasis (termasukcholedocolithiasis,cholecystolithiasis)bikin nyeri colic biliarryReferred Painnyakemana?Gaster : T6-T9 ke epigastric
Cholelithiasis, hepar, ductuscysticus: T6, bisa sampescapula dorsal dexter
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Summary Inervasi danVaskularisasForegut badan sel preganglionik di nucleus intermediolateralis (IML) T6-9 serabut preganglionik : T6-9 (N. Splachnici mayor) badan sel postganglionik : Ganglion coeliacum
Midgut bdn sel preganglionik : IML T10-12 serabut preganglionik : T10-12 (n. Splachnici minor)Bdn sel postganglionik : Ganglion mesentericus superior
Hindgut IML L1-3 L1-3 (N. Splachinici lumbales) G. Mesentericus sup
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URINARY & ABDOMINAL
WALLLanjut dikit lagii, smangat!
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Abdominal Wall
9 Regio
M. Obliqus externus(V)
M. Obliqus internus (A)
M. TransversusSubcostal (costa10)
2 versi garis transversa:
transpyloric &interspinosasubcostal &transtubercular
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Clinical oriented? Incisi abdomen Peritonitis Adhesi peritoneum:
perlekatan viscera, bsajadi volvulus
Adhesiotomy Ascites: excavatio douglas
(cewe), excavatiorectovesica, recessushepatorenal (supine)
Abdominal paracentesis :untuk ambil cairan, admantibiotik. Melalui dinding
abdomen anterolateral(linea alba) Intraperitoneal dialysis:
seperti menyaring cairan(darah). Peritoneumsebagai membransemipermeabel.
Digunakan temporer Injeksi intraperitoneal
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Hernia Abdominales
Locus minoris resistante
Fossa inguinalis media(trigonum Hasselbach)
Fossa inguinalis lateral
Trigonum lumbales
Annulus femoralis
Annulus umbilicales
Maka jenis hernianya..
Hernia direct
Hernia indirect
Hernia lumbales Hernia femorales
Hernia umbilicalis
Hernia epigastrica
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Urinary System
Embriologi
Pronephros
Mesonephros: glomeruli dan tubulus mesonephros,ductus mesonephricus
Metanephros: primordia ren permanen
Ren permanen berkembang dari 2 sumber:
Diverticulum metanephric (ureteric bud): ureter, pelvisrenalis, sistema collectivus
Metanephrogenic blastema: parenkim (nephron)
Ren migrasi week 9
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Kelainan congenital
Bifid renal pelvis andureter: complete incomplete
Horseshoe kidney :tertahan di bawah a.
Mesenterica inf (L3-L5) Ectopic pelvic kidney:
ren di pelvis
Retrocaval ureter
Polycystic kidney:
autosomal dominan
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Anatomy normalnya?
T12-L3
Retroperitoneal
Lemak pararenal,fascia renalis
(Gerotta), lemakperirenal, capsularenalis (capsulafibrosa)
Fiksasi ren : fascia2
dan lemaknya,tekanan intraabdm,vasa renalis danureter
Collecting system :
Papilla renalis, calixminor, calix mayor,
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Conted
Ureter (pars abdominalis & parspelvica)
Vesica urinari: ingat detrusor + reflexmiksi?
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Langsung klinisnya aja ya..
Nephroptosis: turun lebihdari 3cm
Glomerulonephritis,Pyelonephritis
Hydronephrosis +Hydroureter, obstrusi
Ureterolithiasis, predileksiada 3
Vesicolithiasis
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Suprapubiccystostomy
Cystoscopy(transurethra)
Incontinensia
True: fistula, extrofibladder
Stress: kelemahandiafragma pelvis
Urge: hiperrefleks m.Detrusor, spasticUMN, flaccid LMN
Overflow: udh penuhga bisa kontraksi, atw
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ESWL
Cystoscopy
Bladder extrofi
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ALHAMDULILLAH