SISTEM DIGESTIF

CAVUM ABDOMEN & PERITONEUM

FAKULTAS KEDOKTERAN

Oleh : dr. Achmad Hendra H.W., Sp.B, M.Si., FINACS

Lab. Anatomi
Blok Biomedik 2
Fakultas Kedokteran Universitas Surabaya
2019
 Capaian Pembelajaran
Mahasiswa mampu mengenali, menjelaskan dan mengintegrasikan ilmu
Biomedik Kedokteran (Embriologi, Anatomi, Histologi dan Fisiologi, serta
Biokimia dalam sistem tubuh)

Tujuan Umum
1. Mahasiswa mampu menjelaskan tentang Embriologi, Anatomi, Histologi, Fisiologi,
dan Biokimia tubuh

2. Mahasiswa mampu menjelaskan struktur dan fungsi normal tubuh

FAKULTAS KEDOKTERAN UNIVERSITAS SURABAYA 2016

 Tujuan Khusus
1. Mampu menjelaskan embriologi singkat sistem digestif

2. Mampu menjelaskan struktur makroskopis landmark dinding abdomen

3. Mampu menjelaskan struktur makroskopis dinding abdomen

4. Mampu menjelaskan fungsi dinding abdomen

5. Mampu menjelaskan struktur makroskopis peritoneum

6. Mampu menjelaskan struktur makroskopis canalis inguinalis

FAKULTAS KEDOKTERAN UNIVERSITAS SURABAYA 2016

 Referensi
1. Henry Gray. 1988. Gray’s Anatomy, The Classic Collector Edition. Publisher: Bounty Books;
Revised from the Fifteenth English Ed edition (1977). Publisher: Gramercy; 15 Revised edition
(Nov. 23 1988)
2. R. Putz, R. Pabst, Andreas H. 2000. Sobotta Atlas of Human Anatomy. Vol 1 and 2.
Publisher: LWW; Publisher: Thirteenth Edition. Publisher: Lippincott Williams and Wilkins; 13th
edition edition (15 Mar. 1941)
3. Johannes W. Rohen, Elke Lütjen-Drecoll, Chichiro Yokochi. 2010. Color Atlas of Anatomy: A
Photographic Study of the Human Body Seventh Edition, Publisher: Lippincott Williams and
Wilkins.
4. Frank H. Netter. 2014. Atlas of Human Anatomy: Including Student Consult Interactive
Ancillaries and Guides, 6e. Publisher: Saunders 
5. Spaltzeholz Werner. 1923. Hand Atlas Of Human Anatomy Vol III. Publisher Leipzig, S. Hirzel
; New York, G. E. Stechert

FAKULTAS KEDOKTERAN UNIVERSITAS SURABAYA 2016

 Topik Kuliah
1. Embriologi singkat
2. Landmark abdomen
3. Struktur dinding anterior & posterior abdomen
4. Fungsi dinding anterior abdomen 
5. Peritoneum
6. Canalis Inguinalis

FAKULTAS KEDOKTERAN UNIVERSITAS SURABAYA 2016

• SISTEM DIGESTIVUS

• DINDING & CAVUM ABDOMEN PERITONEUM

• SALURAN
• CAVUM ORIS
• PHARYNX
• OESOPHAGUS
• GASTER
• INTESTINUM TENUE
- Duodenum
- Jejenum
- Ileum
• INTESTINUM CRASSUM
- Colon
- Caecum
• CANALIS ANALIS

• KELENJAR
• GLANDULA SALIVARIUS 8
• HEPAR + APPARATUS EXCRETORIUS HEPATIS
• PANCREAS 8
 INTRODUCTION
• The anterior abdominal wall extends from the costal
margins and xiphoid process superiorly to the iliac crests,
pubis and pubic symphysis inferiorly.

• It overlaps and is connected to both the posterior

abdominal wall and paravertebral tissues.

• It forms a continuous but flexible sheet of tissue across

the anterior and lateral aspects of the abdomen.

• The anterior abdominal wall is made up of skin,

superficial fascia, deep fascia, muscles, extraperitoneal
fascia, and parietal peritoneum.
LANDMARKS
1. Xiphoid process.
2. Costal margin.
3. Tip of the ninth costal
cartilage.
4. Tendinous intersections.
5. Umbilicus.
6. Iliac crest.
7. Anterior superior iliac
spine.
8. Linea semilunaris.
9. Linea alba.
10. Inguinal ligament.
11. Pubic tubercule.
12. Pubic crest.
13. Pubic symphysis.
 Abdominal regions
• The abdomen can be divided into nine arbitrary
regions by the subcostal and transtubercular planes
and the two midclavicular planes projected onto the
surface of the body

• The nine regions thus formed are:

• epigastrium;
• right and left hypochondrium;
• central or umbilical;
• right and left lumbar;
• hypogastrium or suprapubic;
• right and left iliac fossa.
REGIONES ABDOMINIS

14

14
The anterior abdominal wall is made up of :

1. Skin
2. Superficial fascia
3. Deep fascia
4. Muscles
5. Extra/Pre-peritoneal fat/fascia
6. Parietal peritoneum
1. Skin

• The skin is loosely attached to the underlying structures except

at the umbilicus, where it is tethered to the scar tissue.

• The umbilicus is a scar representing the site of attachment of

the umbilical cord in the fetus; it is situated in the linea alba
Nerve Supply to Skin

• The cutaneous nerve supply to the anterior abdominal wall is

derived from the anterior rami of the lower six thoracic and
the first lumbar nerves.
• The dermatome of T7 is located over the xiphoid process.

• The dermatome of T10 includes the umbilicus.

• That of L1 lies just above the inguinal ligament and the

symphysis pubis.
Blood Supply of Skin

• The skin near the midline is supplied by branches of the

superior and the inferior epigastric arteries.

• The skin of the flanks is supplied by branches of the

1. Intercostal arteries
2. Lumbar arteries
3. Deep circumflex iliac arteries
• Veins
• The venous drainage passes above mainly into the axillary
vein via the lateral thoracic vein

&

• Below into the femoral vein via the superficial epigastric and
the great saphenous veins
2. Superficial Fascia

• The superficial fascia is divided into:

1. Superficial fatty layer (fascia of Camper)

2. Deep membranous layer (Scarpa's fascia)
• The fatty layer is continuous with the superficial fat over the
rest of the body and may be extremely thick [8 cm] or more in
obese patients

• The membranous layer is thin and fades out laterally and

above, where it becomes continuous with the superficial fascia
of the back and the thorax, respectively
3. Deep Fascia

• It lies immediately deep to the membranous layer of

superficial fascia.
4. Muscles
• The muscles of the anterior abdominal wall consist of three
broad thin sheets.

• From exterior to interior they are the

1. External oblique
2. Internal oblique
3. Transversus abdominis
• On either side of the midline anteriorly is, in
addition, a wide vertical muscle, the rectus
abdominis.

• As the aponeuroses of the three sheets pass

forward, they enclose the rectus abdominis to
form the rectus sheath.

• The lower part of the rectus sheath might contain

a small muscle called the pyramidalis.
 Muscles of abdominal wall

• Rectus abdominus--
vertical midline
• Three layers form tube
• External oblique
(“hands-in-pocket”)
• Internal oblique (fibers
perpendicular to
external)
• Transverse abdominus
(wraps around)
Muscles of abdominal wall--details
A. External Oblique

• Origen : the outer surfaces of the lower eight ribs and fans out
to be

• Insertion : the xiphoid process, the linea alba, the pubic crest,
the pubic tubercle, and the anterior half of the iliac crest

• Most of the fibers are inserted by means of a broad

aponeurosis.
• A triangular-shaped defect in the external oblique aponeurosis
lies immediately above and medial to the pubic tubercle.

• This is known as the superficial inguinal ring

• The spermatic cord passes through this opening and carries

the external spermatic fascia (or the external covering of the
round ligament of the uterus) from the margins of the ring.
• Between the anterior superior iliac
spine and the pubic tubercle, the
lower border of the aponeurosis is
folded backward on itself, forming
the inguinal ligament
B. Internal Oblique

• Origin : lumbar fascia, the anterior two thirds of the iliac crest,
and the lateral two thirds of the inguinal ligament.

• Insertion : the lower borders of the lower three ribs and their
costal cartilages, the xiphoid process, the linea alba, and the
symphysis pubis.
C. Transversus
• Origin : the deep surface of the lower six costal cartilages, the
lumbar fascia, the anterior two thirds of the iliac crest, and the
lateral third of the inguinal ligament.

• Insertion : the xiphoid process, the linea alba, and the

symphysis pubis.
D. Rectus Abdominis

• The rectus abdominis is a long strap muscle that extends along

the whole length of the anterior abdominal wall.

• It is broader above and lies close to the midline, being

separated from its fellow by the linea alba.
• The rectus abdominis muscle is divided into distinct segments
by three transverse tendinous intersections:
1. One at the level of the xiphoid process,
2. One at the level of the umbilicus
3. One halfway between these two

• These intersections are strongly attached to the anterior wall of

the rectus sheath
E. Pyramidalis
• The pyramidalis muscle is often absent.

• Origin : anterior surface of the pubis and is

• Insertion : linea alba

• It lies in front of the lower part of the rectus abdominis.

Rectus Sheath

• The rectus sheath is a long fibrous sheath that encloses the

rectus abdominis muscle and pyramidalis muscle (if present).

• It is formed mainly by the aponeuroses of the three lateral

abdominal muscles.
• Between the costal margin and the level of the anterior
superior iliac spine, the aponeurosis of the internal oblique
splits to enclose the rectus muscle; the external oblique
aponeurosis is directed in front of the muscle, and the
transversus aponeurosis is directed behind the muscle.
Muscles of
Posterior
Abdominal Wall
Function of the Abdominal Wall
Muscles
• The oblique muscles laterally flex and rotate the trunk.

• The rectus abdominis flexes the trunk and stabilizes the pelvis.

• The pyramidalis keeps the linea alba taut during the process.

• The muscle of posterior abdominal wall keeps the body erect

and protect the viscera from posterior.
• The muscles of the anterior and lateral abdominal walls assist the
diaphragm during inspiration by relaxing as the diaphragm
descends so that the abdominal viscera can be accommodated

• The muscles assist in the act of forced expiration that occurs during
coughing and sneezing by pulling down the ribs and sternum

• Their tone plays an important part in supporting and protecting the

abdominal viscera
• By contracting simultaneously with the diaphragm, with the
glottis of the larynx closed, they increase the intra-abdominal
pressure and help in
1. Micturition,
2. Defecation,
3. Vomiting
4. Parturition
Nerve Supply of Anterior Abdominal
Wall Muscles
• The oblique and transversus abdominis muscles are supplied by the
lower six thoracic nerves and the iliohypogastric and ilioinguinal
nerves (L1)

• The rectus muscle is supplied by the lower six thoracic nerves

• The pyramidalis is supplied by the 12th thoracic nerve

• The fascia transversalis is a thin layer of fascia that lines the

transversus abdominis muscle
5. Extraperitoneal Fat

• The extraperitoneal fat is a thin layer of connective tissue that

contains a variable amount of fat and lies between the fascia
transversalis and the parietal peritoneum.
6. Parietal Peritoneum

• The walls of the abdomen are lined with parietal peritoneum

• This is a thin serous membrane and is continuous below with

the parietal peritoneum lining the pelvis.
OMENTUM
 Lymphatic Drainage
• Lymphatics in the region above the
umbilicus
Drain into the axillary lymph nodes
which can be palpated just beneath the
lower border of the pectoralis major
muscle
• Lymphatics in the region below the
umbilicus
Drain into the superficial inguinal nodes.
Their efferent vessels primarily enter
the external iliac nodes and, ultimately,
the lumbar (aortic) nodes.
• The deep lymph vessels follow the
arteries and drain into the internal
thoracic, external iliac, posterior
mediastinal, and para-aortic (lumbar)
nodes.
 Inguinal Canal
• The inguinal canal is an oblique passage through the lower part
of the anterior abdominal wall.
• In the males, it allows structures to pass to and from the testis
to the abdomen.
• In females it allows the round ligament of the uterus to pass
from the uterus to the labium majus.
• The canal is about 1.5 in. (4 cm) long in the adult and extends
from the deep inguinal ring , downward and medially to the
superficial inguinal ring.
• It lies parallel to and immediately above the inguinal ligament.
• In the newborn child, the deep ring lies almost directly
posterior to the superficial ring so that the canal is considerably
shorter at this age.
• Later, as the result of growth, the deep ring moves laterally.
• The deep inguinal ring is an oval opening in the fascia
transversalis, lies about 0.5 in. (1.3 cm) above the inguinal
ligament midway between the anterior superior iliac spine and
the symphysis pubis.

• Related to it medially are the inferior epigastric vessels.

• The margins of the ring give attachment to the internal

spermatic fascia (or the internal covering of the round
ligament of the uterus).

• The superficial inguinal ring is a triangular-shaped defect in

the aponeurosis of the external oblique muscle and lies
immediately above and medial to the pubic tubercle.

• The margins of the ring, sometimes called the crura, give

attachment to the external spermatic fascia.
 Walls of the Inguinal Canal
• Anterior wall: Skin,Superficial fascia External oblique aponeurosis
and fleshy fibre of Internal oblique laterally. This wall is therefore
strongest where it lies opposite the weakest part of the posterior
wall, namely, the deep inguinal ring.

• Posterior wall: Conjoint tendon medially, fascia transversalis

laterally. This wall is therefore strongest where it lies opposite the
weakest part of the anterior wall, namely, the superficial inguinal
ring.

• Roof or superior wall: Arching lowest fibers of the internal oblique

and transversus abdominis muscles.

• Floor or inferior wall: Upturned lower edge of the inguinal

ligament and, at its medial end, the lacunar ligament
Inguinal canal showing the arrangement of
the external oblique muscle (A), the internal
oblique muscle (B), the transversus muscle
(C), and the fascia transversalis (D)
Parts of external and internal oblique muscles
removed
Deep structures of the inguinal canal. The
aponeurosis of external oblique has been
removed
Function of the Inguinal Canal

• The inguinal canal allows structures of the spermatic

cord to pass to and from the testis to the abdomen in the
male. (Normal spermatogenesis takes place only if the
testis leaves the abdominal cavity to enter a cooler
environment in the scrotum.)

• In the female, the smaller canal permits the passage of

the round ligament of the uterus from the uterus to the
labium majus.