Visceral Manipulation Abdomen Barral Institute

Front 1

Peritoneum

Back 1

The peritoneum supports the abdominal organs and serves as a conduit for their blood vessels, lymph vessels, and nerves.

Hint 1

Perimeter

Front 2

Omentum

Back 2

A fold of peritoneum connecting the stomach with other abdominal organs.

Front 3

Mesentery

Back 3

A fold of the peritoneum... Mesentery: In general, a fold of tissue that attaches organs to the body wall. The word mesentery usually refers to the small bowel mesentery, which anchors the small intestines to the back of the abdominal wall. Blood vessels, nerves, and lymphatics branch through the mesentery to supply the intestine. http://www.theodora.com/anatomy/the_abdomen.html

Hint 3

Front 4

Diaphragm crus

Back 4

The crus of diaphragm (pl. crura), refers to two tendinous structures that extends below the diaphragm to the vertebral column. There is a right crus and a left crus, which together form a tether for muscular contraction. They take their name from their leg-shaped appearance – crus meaning leg in Latin.

Hint 4

Legs

Front 5

Liver

Back 5

3-5 lbs!

Major provider of fuel to brain

Deep chi energy

Rules ligaments and tendons

Emotionally:

Relationship to self

Root to personality

Anguish

Cyclic rage

Deep fears/unbearable difficulties

Right scalp sensitivity

Achy

Allergy

SI disfunction

ALWAYS WORK THE LIVER BEFORE L SIATIC NERVE from backing up the portal vein. Too much veinus conjestion of epidural veins around the sciatic nerve

Front 6

Glisson's Capsule

Back 6

The capsule of the liver. A layer of connective tissue surrounding the liver and ensheathing the hepatic artery, portal vein, and bile ducts within the liver. Named for the British physician, anatomist, physiologist, and pathologist Francis Glisson (1597-1677).

Front 7

Coronary ligament

Back 7

The coronary ligament of the liver refers to parts of the peritoneal reflections that hold the liver to the inferior surface of the diaphragm.

Front 8

Right and Left Triangular Ligaments

Back 8

The left triangular ligament is a fold of some considerable size, which connects the posterior part of the upper surface of the left lobe of the liver to the diaphragm; its anterior layer is continuous with the left layer of the falciform ligament.

The right triangular ligament is situated at the right extremity of the bare area, and is a small fold which passes to the diaphragm, being formed by the apposition of the upper and lower layers of the coronary ligament.

Front 9

Falciform Ligament

Back 9

Hint 9

Front 10

Cardiac Sphincter

Back 10

The cardiac sphincter is a circular muscle located at the distal end of the esophagus. It relaxes to allow the passage of ingested food into the stomach, and constricts so that contents of stomach do not move back to the stomach.

stomach.

Front 11

Stomach: Fundus of, Cardia of, Greater and Lesser, Curvature

Back 11

Fundus (Latin for "bottom") is an anatomical term referring to that part of a concavity in any organ, which is at the far end from its opening. Examples include: Fundus (stomach), the portion of the stomach which bulges up past the point of entry of the Esophagus.

Front 12

F and H

Back 12

Omentum

Front 13

Back 13

Cardia, Cardiac Sphincter

Front 14

Pylorus

Back 14

the opening from the stomach into the duodenum (small intestine).

Front 15

Pyloric Antrum

Back 15

The initial portion of the pylorus. It is near the bottom of the stomach, proximal to the pyloric sphincter, which separates the stomach and the duodenum. It may temporarily become partially or completely shut off from the remainder of the stomach during digestion by peristaltic contraction of the prepyloric sphincter; it is demarcated, sometimes, from the pyloric canal by a slight groove.

Front 16

Omental Bursa

Back 16

The lesser sac, also known as the omental bursa, is the cavity in the abdomen that is formed by the lesser and greater omentum.

Front 17

Gastrophrenic ligament

Back 17

Part of the greater omentum that binds the left crus of the diaphragm to the fundus of the stomach.

Hint 17

Front 18

Part of the greater omentum that binds the left crus of the diaphragm to the fundus of the stomach.

Back 18

Gastrophrenic ligament

Front 19

A layer of connective tissue surrounding the liver

Back 19

Glisson's Capsule

Front 20

Back 20

Diaphragm crus

Front 21

Motility

Back 21

Intrinsic visceral movements (instead of organs moving extrinsically from an outside force).

Front 22

Inspir/Expir

Back 22

Movement of the organs while in flexion or extension of the cranialsacral rythem

Front 23

Hepatogastric Ligament

Back 23

The cranial part of the lesser omentum is formed by the hepatogastric ligament, extending between the liver and stomach. The ligament itself consists of a dense cranial portion and the caudal portion (pars flaccida). Near the stomach, it carries both the right gastric artery and the left gastric artery.

Front 24

Hepaduadenal Ligament

Back 24

The portion of the lesser omentum extending between the porta hepatis of the liver and the superior part of the duodenum.

Front 25

Hepa

Back 25

Liver

Front 26

Latin prefix for liver

Back 26

Hepat

Front 27

Duadenum

Back 27

The first part of the small intestine immediately beyond the stomach, leading to the jejunum.

Front 28

The first part of the small intestine immediately beyond the stomach, leading to the jejunum.

Back 28

Duodenum

Front 29

Retroperitoneal

Back 29

The retroperitoneal space (retroperitoneum) is the anatomical space (sometimes a potential space) in the abdominal cavity behind (retro) the peritoneum. It has no specific delineating anatomical structures. Organs are retroperitoneal if they have peritoneum on their anterior side only.

Front 30

Sphincter of oddi

Back 30

A muscular valve that controls the flow of digestive juices (bile and pancreatic juice) through the ampulla of Vaterinto the second part of the duodenum.

Front 31

Duct of Wirsung

Back 31

19The pancreatic duct, or duct of Wirsung (also, the major pancreatic duct due to the existence of an accessory pancreatic duct), is a duct joining the pancreas to the common bile duct to supply pancreatic juices which aid in digestion provided by the exocrine pancreas. The pancreatic duct joins thecommon bile duct just prior to the ampulla of Vater, after which both ducts perforate the medial side of the second portion of theduodenum at the major duodenal papilla. There are many anatomical variants reported but these are quite rare.[1]

Hint 31

There is a more obvious name as well

Front 32

Pancreas

Back 32

Behind the stomach, it is an endocrine gland producing several important hormones, includinginsulin, glucagon, somatostatin, andpancreatic polypeptide which circulate in the blood. The pancreas is also a digestive organ, secreting pancreatic juice containingdigestive enzymes that assist digestion and absorption of nutrients in the small intestine. These enzymes help to further break down the carbohydrates, proteins, and lipids in thechyme.

Hint 32

What does it do?

Front 33

Duadnenojejunal Junction (flexure)

Back 33

The border between the duodenum and the jejunum.

Front 34

Ligament of Treitz

Back 34

The suspensory muscle of duodenum is a thin muscle connecting the junction between the duodenum, jejunum, and duodenojejunal flexure to connective tissue surrounding thesuperior mesenteric artery and coeliac artery. It is also known as the ligament of Treitz.[1]The suspensory muscle most often connects to both the third and fourth parts of the duodenum, as well as the duodenojejunal flexure, although the attachment is quite variable.The suspensory muscle marks the formal division between the first and second parts of the small intestine, the duodenum and thejejunum. This division is used to mark the difference between the upper and lower gastrointestinal tracts, which is relevant inclinical medicine as it may determine the source of bleeding in the gastrointestinal tract.

Hint 34

Front 35

Gall Bladder

Back 35

The small sac-shaped organ almost imbedded beneath the liver, in which bile is stored after secretion by the liver and before release into the intestine.

Front 36

Hepatic Ducts, Cystic Duct

Back 36

1. Bile ducts: 2. Intrahepatic bile ducts, 3. Left and right hepatic ducts, 4. Common hepatic duct, 5. Cystic duct, 6. Common bile duct, 7. Ampulla of Vater, 8. Major duodenal papilla9. Gallbladder, 10–11. Right and left lobes of liver. 12. Spleen.13. Esophagus. 14. Stomach. Small intestine: 15. Duodenum, 16. Jejunum17. Pancreas: 18: Accessory pancreatic duct, 19: Pancreatic duct.20–21: Right and left kidneys (silhouette).The anterior border of the liver is lifted upwards (brown arrow). Gallbladder with Longitudinal section, pancreas and duodenum with frontal one. Intrahepatic ducts and stomach in transparency.

The common hepatic duct is the duct formed by the convergence of the right hepatic duct (which drains bile from the right functional lobe of the liver) and the left hepatic duct (which drains bile from the left functional lobe of the liver). The common hepatic duct then joins the cystic duct coming from the gallbladder to form the common bile duct. The duct is usually 6–8 cm length and 6mm in diameter in adults.

Front 37

5

Back 37

1. Bile ducts: 2. Intrahepatic bile ducts, 3. Left and right hepatic ducts, 4. Common hepatic duct, 5. Cystic duct, 6. Common bile duct, 7. Ampulla of Vater, 8. Major duodenal papilla9. Gallbladder, 10–11. Right and left lobes of liver. 12. Spleen.13. Esophagus. 14. Stomach. Small intestine: 15. Duodenum, 16. Jejunum17. Pancreas: 18: Accessory pancreatic duct, 19: Pancreatic duct.20–21: Right and left kidneys (silhouette).The anterior border of the liver is lifted upwards (brown arrow). Gallbladder with Longitudinal section, pancreas and duodenum with frontal one. Intrahepatic ducts and stomach in transparency.

Front 38

Mesenteric Root

Back 38

The root of the mesentery (or mesenteric root)—the part connected with the structures in front of the vertebral column—is narrow, about 15 cm. long, and is directed obliquely from the duodenojejunal flexure at the left side of the second lumbar vertebra to the right sacroiliac articulation.

The root of the mesentery is part of a peritoneal fold. It should be remembered that the peritoneum is a serous membrane with two layers, one parietal attached to the posterior abdominal wall and one visceral lining the intraperitoneal organs. The parietal peritoneum has reflections or folds that fix intraperitoneal organs to the posterior abdominal wall, forming the anterior limit of the retroperitoneum. The mesenteric root corresponds to the attachement of one of these folds.

The peritoneum and peritoneal reflections are not themselves visible on CT. We can see them due to the vascular structures that run through them and the surrounding fat. They become more evident when there is ascites or are thickened by inflammatory or neoplastic processes.

The mesenteric root is located in the center of the abdomen, in close relation to other intraperitoneal spaces (supra and inframesocolic) and retroperitoneum. It is a common route of spread of patrologic conditions. Furthermore, we find typical primary pathology of the root of the mesentery of varied etiology.

Front 39

Superior Mesenteric Artery and Vein

Inferior Mesenteric Artery and Vein

Back 39

Superior mesenteric artery (SMA) arises from the anterior surface of the abdominal aorta, just inferior to the origin of the celiac trunk, and supplies the intestine from the lower part of the duodenum through two-thirds of the transverse colon, as well as the pancreas.

Inferior mesenteric artery, often abbreviated as IMA, is the third main branch of the abdominal aorta and arises at the level of L3, supplying the large intestine from the left colic (or splenic) flexure to the upper part of the rectum, which includes the descending colon, the sigmoid colon, and part of the rectum. Proximally, its territory of distribution overlaps (forms a watershed) with the middle colic artery, and therefore the superior mesenteric artery. The SMA and IMA anastomose via the marginal artery of the colon (artery of Drummond) and via Riolan's arcade (also called the "meandering artery", an arterial connection between the left colic artery and the medial colic artery). The territory of distribution of the IMA is more or less equivalent to the embryonic hindgut.

The inferior mesenteric vein (IMV) is a blood vessel that drains blood from the large intestine. It usually terminates when reaching the splenic vein, which goes on to form the portal vein with the superior mesenteric vein (SMV). Anatomical variations include the IMV draining into the confluence of the SMV and splenic vein and the IMV draining in the SMV.

Hint 39

Front 40

Portal vein

Back 40

The top blue part in the picture.

The hepatic portal vein is a blood vessel that conducts blood from the gastrointestinal tract and spleen to the liver. This blood is rich in nutrients that have been extracted from food, and the liver processes these nutrients; it also filters toxins that may have been ingested with the food. 75% of total liver blood flow is through the hepatic portal vein, with the remainder coming from the hepatic artery proper. The blood leaves the liver to the heart in the hepatic veins.

The hepatic portal vein is usually formed by the confluence of the superior mesenteric and splenic veins and also receives blood from the inferior mesenteric, gastric, and cystic veins

The hepatic portal vein is not a true vein, because it conducts blood to capillary beds in the liver and not directly to the heart.

Front 41

Terminal ileum

Back 41

The terminal ileum is the distal end of the small intestine that intersects with the large intestine. It contains the ileocecal sphincter, a smooth muscle sphincter that controls the flow of chyme into the large intestine.

Front 42

Cecum

Back 42

An intraperitoneal pouch, that is considered to be the beginning of the large intestine. It receives chyme from the ileum, and connects to the ascending colon of the large intestine. It is separated from the ileum by the ileocecal valve (ICV) or Bauhin's valve. It is also separated from the colon by the cecocolic junction. The appendix is connected to the cecum. While the cecum is usually intraperitoneal, the ascending colon is retroperitoneal.In herbivores, the cecum stores food material where bacteria are able to break down the cellulose. This function no longer occurs in the human cecum (see appendix), so in humans it is simply a dead-end pouch forming a part of the large intestine.

Front 43

ileocecal valve

Back 43

A sphincter muscle valve that separates the small intestine and the large intestine. Its critical function is to limit the reflux of colonic contents into the ileum.[1]The ileocecal valve is distinctive because it is the only site in the gastrointestinal tract that is used for Vitamin B12 and bile acid absorption.[2][3] Roughly two litres of fluid enters the colon daily through the ileocecal valve.

Front 44

Phrenicocolic ligament

Back 44

A fold of peritoneum, the phrenicocolic ligament is continued from the left colic flexure to the thoracic diaphragm opposite the tenth and eleventh ribs; it passes below and serves to support the spleen, and therefore has received the name of sustentaculum lienis.

Front 45

Transverse Mesocolon

Back 45

A broad, meso-fold of peritoneum, which connects the transverse colon to the posterior wall of the abdomen.It is continuous with the two posterior layers of the greater omentum, which, after separating to surround the transverse colon, join behind it, and are continued backward to the vertebral column, where they diverge in front of the anterior border of the pancreas. This fold contains between its layers the vessels which supply the transverse colon.

Front 46

Hepatic Flexure

Back 46

Hepatic (or the right colic) flexure is the sharp bend between the ascending and the transverse colon. The right colic flexure is adjacent to the liver, and is therefore also known as the hepatic flexure. Thus, the left colic flexure is also known as the splenic flexure (as it is close to the spleen).

Hint 46

Hepatitis

Front 47

Splenic Flexure

Back 47

The right colic flexure is adjacent to the liver, and is therefore also known as the hepatic flexure. Thus, the left colic flexure is also known as the splenic flexure (as it is close to the spleen).

Front 48

Sigmoid Colon

Back 48

The sigmoid colon is the part of your large intestine that connects your descending colon to your rectum.The name "sigmoid" refers to the S-like shape of this part of the intestine, which is about 18 inches (45 centimeters) long.

EditDiverticulosis often occurs in the sigmoid colon in association with increased intraluminal pressure and focal weakness in the colonic wall. It is a common cause of hematochezia.

On account of its freedom of movement it is liable to be displaced into the abdominal

Volvulus occurs when a portion of the bowel twists around its mesentery, which can lead to obstruction and infarction. Volvulus in the elderly commonly occurs in the sigmoid colon, whereas in infants and children it is more likely to occur in the midgut.

Front 49

Sigmoid Mesocolon

Back 49

A fold of peritoneum that attaches the sigmoid colon to the pelvic wall.

Front 50

Autonomic Nervous system

Back 50

the part of the nervous system responsible for control of the bodily functions not consciously directed, such as breathing, the heartbeat, and digestive processes.