Simon Menno Yutzy.

A manual and atlas of dissection online

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FIG. 139. SECTION OF NECK THROUGH THE SIXTH CERVICAL VERTEBRA. (One-half.)

(Braune.) (Morris.}

RECURRENT LARYNGEAL NERVE

PHARYNX i LARYNX



Longus colli muscle
Superior thyroid artery
DESCENDENS NON1

VAGUS
PHRENIC NER VE



Soalenus anticus
Sterno-oleido-mastoid



BRACHIAL PLEXUS

Scalentia medius
External jugular rein

SPINAL ACCESSORY
NERVE




SpleniuB

PART OF ARTICULAR SURFACE OF SEVENTH CERVICAL VERTEBRA

Semi-spinalis and multifidua

SIXTH CERVICAL VERTEBRA



Thyro-aryteuoid muscle

CRICOID CARTILAGE (and omo-hyoid muscles

Sterno-hyoid (just posterior are seen the thyro-
Crico-arytenoideus lateralis

Muscular process of the thyroid cartilage



THYROID GLAND



Common carotid artery
Internal jugular vein

BRACHIAL PLEXUS

Scalenus medius
External jugular vein
Scalenus posticus

SPINAL ACCESSORY
NER VE



Levator anguli scapulae



Cervicalis ascendens
Transversalis cervicis and traehelp-
Profunda cervicis vessels
Trapezius



Biveuter cervicis and complexus



FIG. 140. DIAGRAM SHOWING RELATION OF KIDNEY TO CAPSULE. (Morris.)



TRANSVERSE COLON



DESCENDING COLON

PERITONEUM

FATTY CAPSULE

KIDNEY
PERITONEAL CAVITY



Diaphragmatic
fascia



Parietal muscle




CUT EDGE OF
PERITONEUM

Muscular fibre in
subperitoneal
tissue

PANCREAS



Sup. mesenteric vein
DUODENUM



LYMPHATIC GLAND



LUMBAR VERTEBRA



SUBPERITONEAL TISSUE FATTY CAPSULE Renal vessels embedded in mbperitoneai tissue



TRANSVERSE AND SAGITTAL SECTIONS



123



FIG. 141. TRANSVERSE SECTION OF THE ABDOMEN THROUGH THE KIDNEYS AND PANCREAS.
AT THE LEVEL OF THE FIRST LUMBAR VERTEBRA. (Braune.) (Morris.)

Inferior caro



Bound ligament
RectuB

EIGHTH RIB



STOMACH



8I6MOID FLEXURE

DESCENDING COLON
External oblique

PANCREAS



SPLEEN



TRANSVERSE COLON
/ SEVENTH RIB

ASCENDING COLON



DUODENUM




EIGHTH RIB

Obliquus eiternns
NINTH RIB
PLEURA
TENTH RIB



Splenic rtin

Descending aorta
BODY OF FIRST LUMBAR VERTEBRA TWELFTH RIE



LIVER
Diaphragm



ELEVENTH RIB



FIG. 142. SAGITTAL SECTION OF MALE PELVIS IN THE MESIAL LINE. (One-third.) (Braune.)

(Morris.)



BLADDER



F.ES



BULB




- POUCH OF DOUGLAS

- RECTUM

- FOLD OF HOUSTON

- VESICULA SEMINAUS

!J~ DUCTUS EJACULATORIUS
L. PROSTATE

External sphincter

| Internal sphincter

External sphincter



i2 4 SAGITTAL AND TRANSVERSE SECTIONS

FIG. 143. SECTION OF THE FEMALE PELVIS. (After Henle.) (Morris.}




VESICAL WALL

CAVITY OF BLADDER

Prevesical fat



Deep transver-
sus perinaei



RECTUM

COCCYX

Recto-coccy-
geal muscle
POSTERIOR LIP OF 08

UTERI
ANTERIOR LIP

VAGINA

External
sphincter ani

Internal
sphincter ani



LABIUM MAJUS
Unstriped muscular fibre



URETHRA
LABIUM MINUS



ANUS

Internal sphincter ani
Fart of external sphincter ani



Unstriped muscular fibre Vessels

VAGINAL ORIFICE



FIG. 144. SECTION SHOWING THE ISCHIO-RECTAL FOSSA IN ITS RELATIONS TO THE PELVIC

VISCERA. (Morris.)



OS PUBIS
Muscles



Levator ani with recto-vesical
and ischio-rectal fasciae



Obturator internus



Internal pudie vessels and

NER VES in obturator fascia

TUBER ISCHII

Ischio-rectal fossa with its
anterior and posterior ex-
tensions



Gluteus maximus




SYMPHYSIS PUBIS



Pubo-prostatic ligaments
Proslatic plexus
PROSTATE

Capsule of prostate formed

by recto-vesical fascia
Fat



RECTUM INVESTED BY RECTO-
VESICAL FASCIA



SECTION OF SHOULDER-JOINT



125



FIG. 145. TRANSVERSE SECTION THROUGH THE RIGHT SHOULDER-JOINT, SHOWING THE
STRUCTURES IN CONTACT WITH IT. (Braune.) (Morris.)



CLAVICLE

ACROMION
Supra-spinatus

Trapezius
Infra-spinatus



Teres minor 4



Teres major
Latiasimus dorsi




Pectoral is major

Axillary vessels and NER VES Tendon of subscapularis blended with

the scapular ligament
Coraco-brachialis and short head of biceps



FIG. 146. DIAGRAMMATIC SECTION OF SHOULDER THROUGH BICIPITAL GROOVE.

(Anderson.) (Morris.)



Deltoid

SUBACROMIAL BURSA

CAPSULE OF SHOULDER-JOINT
Long tendon of biceps

Synovial membrane lining
capsule and synovial
membrane



Extra-articular portion of
bicepa tendon




Glenoid ligament



GLENOID CAVITY



Glenoid ligament



Inner fold of capsule and
synovial membrane



126



ARM AND ELBOW



FIG. 147. SECTION THROUGH THE MIDDLE OF THE RIGHT UPPER ARM. (Heath.)

(Morris.)



Cephalic vein

MUSCULO-CUTANEO US
NER VE
Brachialis anticus



MUSCULO-SPIRAL NERVE
Superior profunda vessels



Triceps, with fibrous intersection




Biceps

Brachial vessels

- MEDIA N NER VE
ULNAR NERVE
Basilic vein, u-ith internal
cutaneous nerves



Inferior profunda vessels
FIG. 148. VERTICAL SECTION OF THE ELBOW. . (One-half.) (Braune.) (Morris.)



Tendon of biceps

Brachio-radialis
RADIAL NERVE

Brachialis anticus
Extensor carpi radialis longior



Anconeus




Pronator teres
MEDIAN NERVE



- Flexor carpi radialis



Internal lateral ligament
ULNAR NERVE

OlECRANON
Tendon of triceps



FIG. 149. LONGITUDINAL SECTION OF THE ELBOW-JOINT. (One-half.) (Braune.)

(Morris.)



Triceps



Extensor carpi nlnaris




Biceps



Brachialis anticus



MUSCUL 0-SPIRA L NER VE
Brachio-radialis



Supinator brevis



Extensor carpi radialis longior



FOREARM AND }VRIST



127



FIG. 150. SECTION -THROUGH THE MIDDLE OF THE RIGHT FOREARM. (Heath.) (Morris.)



Brachio-radlalis



Supinator brevis

Extensor carpi radialis
longior and brevier

Extensor ossis metacarpi
pollicis



Extensor communis digitorum

Extensor carpi ulnaris
Posterior interosseous vessels and NERVE




Flexor sublimis digitorum



Flexor carpi ulnaris



Ulnar vessels and NERVE
Flexor profundus digitorum
MEDIAN NERVE



Extensor secundi iuternodii pollicis



FIG. 151. SECTION THROUGH REGION OF WRIST, A LITTLE ABOVE THE JOINT. RIGHT
SIDE, UPPER HALF OF THE SECTION. (Tillaux.) {Morris.)



Flexor carpi radialis
Radial artery



Brachio-radialis



Flexor longus pollicis
/ Flexor sublimis

Flexor profundus

Pronator quadratus



RADIAL NERVE



Extensor ossis meta-
carpi pollicis
Extensor primi
internodii pollicis



Extensor carpi radialis

longior
Extensor carpi radialis

brevior



Extensor secundi internodii
pollicis




Ulnar artery, mnrr
internal ly the NERVE

Anterior interosseout
artery



Flexor carpi ulnaris



RADIUS



Extensor carpi ulnaris
Extensor minimi digiti



Extensors corn-
munis and indicis



128



SECTION OF THE WRIST



FIG. 152. TRANSVERSE SECTION OF THE WRIST, THROUGH THE MIDDLE OF THE PISIFORM

BONE. (Morris,}



Sheath of flexores sublimis and profundus digitorum and flexor longus pollicis,
enclosed by the annular ligament



Cut tendon of palmaris longu

SEMILUNAR BONE



ULNAR NERVE

Ulnar vessels



Sheath for flexor carpi radialis
Radial origin of annular ligament

Sheath for extensor ossis metacarpi
and primi internodii pollicis

Radial vessels

Sheath for extensor ossis metacarpi
and primi internodii pollicis

OS MAGNUM

Sheath of extensor secundi
internodii pollicis



Sheath of extensores carpi radialis, longior and brevior



Sheath of extensor communis and indicator




- CUNEIFORM



Sheath of extensor carpi
ulnaris



Sheath of extensor minimi digiti

CUNEIFORM
UNCIFORM



FIG. 153. SECTION OF CARPUS, THROUGH THE UNCIFORM BONE.

after Henle.) (Morris.)



(Two-thirds.) (Bellamy



MEDIAN NERVE
Plexor longus pollicis Flexores sublimis and profundus



Flexor carpi radialis

Thenar muscles
BASE OF FIRST METACARPAL BONE



Ulnar vessels and NER VE



Palmaris brevis

Hypothenar muscles



Extensor ossis
metacarpi pollici
TRAPEZIUM

Extensor primi internodii

pollicis

Radial vessel,

Extensor carpi radialis longior-




TRAPEZOID
External carpi radialis brevior



Extensor carpi ulna via
Extensor minimi digiti
UNCIFORM



OS MAGNUM Extensor communis digitorum
Extensor indicis



SECTION OF HAND



129



FIG. 154. HORIZONTAL SECTION OP THE HAND THROUGH THE CARPO-METACARPAL JOINTS.

(Bellamy after Henle.) {Morris.)



Volar aponeurosis
Flexor tendon in the sheath Inter-osseous

Lumbricales
Flexor tendon in the sheath



Deep volar aponeurosis

Lumbricales
Anterior carpal ligament

Flexor tendon in the sheath
Deep volar aponeurosis I
Iiumbric



Lumbricales

Anterior carpal ligament
f Flexor tendon in the sheath
Hypothenar muscles




FIG. 155. DIAGRAM OF A VERTICAL SECTION THROUGH THE MIDDLE OF THE HAND.

(Morris.)



Posterior annular ligament



Deep transverse ligament
Attachment of common extensor
to first phalanx



Superficial transverse ligament



Vincula accessoria



Attachment of common extensor
to second phalanx



Attachment of common extensor
to third phalanx




Great palmar bursa



Anterior annular ligament



Dorsal inter-osseous
Lumbricalis
Palmar fascia

Flexor profundus digitorum
Flexor sublimis digitorum



Theca



Ligameutum vaginale
Vincula accessoria



PART II.



ABDOMEN, ABDOMINAL VISCERA, PELVIS, PELVIC VISCERA,
AND LOWER EXTREMITIES.



DEMONSTRATION I.
THE ABDOMEN.

Surface Anatomy. Umbilicus, linea alba, recti muscles, and linea semi-
lunaris, should be located. The external abdominal ring can be felt above
and external to the spine of the pubis. Passing from the spine of os pubis
to the anterior superior spine of the ilium is Poupart's ligament.

The external abdominal ring in the male can be felt by passing your
finger along the spermatic cord beginning at the testes.

In order that the viscera in the abdomen may be more easily located
the abdomen is divided into regions by drawing one line horizontally across
the abdomen on a level with the cartilages of the ninth ribs ; another on
a level with the anterior superior spines of the ilia. Then draw a vertical
line on each side from the cartilages of the eighth ribs to the middle of
Poupart's ligament. This divides the abdomen into epigastric, umbilical,
hypogastric, right and left hypochondrium, right and left lumbar, right
and left inguinal regions.

FIG. 156. (Holden.)




134 THE ABDOMEN

Another division can be made, shown in figure 157, from Morris:



FIG. 157. DIAGRAM OF THE ABDOMINAL REGIONS. (Morris.}




Joint between meeo-Bter-
num and ensiform cartilage



Tip of ensiform cartilage
Costal border



UPPER HORIZONTAL PLANE



LOWER HORIZONTAL PLANE A, Al
LEVEL OF TUBERCLES OF ILIAC
CREST

LOWER HORIZONTAL PLANE B, AT
LEVEL OF ANTERIOR ILIAC SPINES



VERTICAL PLANE A, FROM MIDDLE OF
POUPART'S LIGAMENT



VERTICAL PLANE B, AT OUTER BOR-
DER OF RECTUS (SEMILUNAR LINE)



SUMMIT OF SYMPHYSIS PUBIS



What viscera are in each region ?



THE ABDOMINAL WALLS



135



DEMONSTRATION II.

ABDOMINAL WALLS.

Make a circular incision through the skin around the umbilicus one and
one-half inches in diameter; turn the skin toward the umbilicus. This serves
to hold a string. Now make a puncture through the umbilicus, insert a blow-
pipe, distend the abdomen with air, remove blow-pipe, and draw the string
tight.

Dissection. Make an incision through the skin from the ensiform
cartilage to the os pubis, another midway between the umbilicus and os
pubis, transversely outward to the anterior superior iliac spine and along
the crest of the ilium to its posterior third. Another from the umbilicus
upward and outward to the sixth rib. Dissect off the skin, exposing the
superficial fascia.

Study the superficial fascia and note in it the following:

Superficial arteries (Fig. 158):
Superficial epigastric.
Superficial circumflex iliac.
Superficial external pudic.



FIG. 158. SUPERFICIAL VESSELS AND GLANDS OF THE GROIN. (Holden.)
Saphenous opening of the fascia lata. 2. Saphena vein. 3. Superficial epigastric a.
4. Superficial circumflexa ilii a. 5. Superficial external pudic a. 6. External ab-
dominal ring. 7. Fascia lata of the thigh.




136



THE ABDOMINAL WALLS



Superficial nerves (see Fig. 81):

Lower dorsal.

Ilio-hypogastric .

Ilio-inguinal.
Superficial lymphatics.



FIG. 159. LYMPHATIC VESSELS AND GLANDS OF THE GROIN. (Holden.}




THE ABDOMINAL WALLS



137



Dissect the skin 'down only one inch below Poupart's ligament. Do not
go onto the thigh.

Expose the external abdominal muscle.

Carefully locate and study Poupart's ligament.

Locate and study the external abdominal ring, noting its position and
its boundary. Note spermatic cord or round ligament. Feel the opening
by pushing your finger up along the spermatic cord into the ring.



FIG. 160. POUPART'S LIGAMENT, THE APONEUROSIS OF THE EXTERNAL OBLIQUE AND
THE EXTERNAL ABDOMINAL RING. (Holden.)

i. External abdominal ring. 2. Its inferior or external pillar, curvilinear, attached to the
spine of the pubis. 3, 3. Its superior or internal straight pillar, prolonged to the
median line attached to the symphysis pubis, and interlacing with the one of the oppo-
site side. 4, 4. Ligament of Colles, situated behind the preceding pillar and interlacing
with it, attached to the crest of the pubis of the opposite side, thus forming an internal
pillar. 5,5. Attachment of Colles' ligament. 6. Arched fibers connecting the internal
and external pillars, forming the external boundary of the ring. 7. Linea alba. 8.
Symphysis pubis. Q. Spermatic cord. 10. Poupart's ligament, n, n. Cribriform
fascia. 12. Internal saphenous vein.



331 6





*/.. i

12 j A



Study the external abdominal muscle and then detach it by cutting
it halfway between its origin and the linea semilunaris; turn it outward,
and inward to the linea semilunaris. Do not destroy Poupart's ligament,
but make an incision about one-half inch above the lower border of the
aponeurosis of the external oblique and parallel with its lower border,
thus making Poupart's ligament.

Study the internal oblique muscle and then detach this muscle the
same as the external oblique.

Observe the fibres of the cremaster muscle, the conjoined tendon and
triangular fascia. (See Figs. 161 and 162.)



138



THE ABDOMINAL WALLS



FIG. i6i. DISSECTION OF INGUINAL CANAL. (Wood.) (Morris.)

,A\



Ext. oblique
(turned down)




Hectus abdominis
(with sheath opened)



Int. oblique
Transversalis

Conjoined tendon
Triangular fascia
Cremaster



FIG. 162. DIAGRAM OF THE LOWER FIBRES OF THE INTERNAL OBLIQUE AND TRANSVERSALIS,

WITH THE CREMASTER MUSCLE. (Holden.)

i. Conjoined tendon of internal oblique and transversalis. 2. Cremaster muscle passing

down in loops over the cord.




THE ABDOMINAL WALLS 139

Locate the internal abdominal ring; study its boundary. (See Fig. 16 1 .)

What is the inguinal canal?

Study the transversalis muscle and detach it same as the oblique
muscles. (See Fig. 161.)

Observe the transversalis fascia and note that the internal abdominal
ring is bounded by this fascia. Note the spermatic cord in the male and
the round ligament in the female as they pass along the inguinal canal.

Expose the rectus abdominis muscle by cutting through its sheath
lengthwise. Note the linea transversae. (See Fig. 163.)

What forms the sheath of rectus abdominis muscle?

Observe and study the pyramidalis muscle.

Study rectus abdominis muscle and then cut it across at the um-
bilicus and turn it upward and downward. Observe in the muscle above
the umbilicus the superior epigastric artery, and in the sheath behind
the muscle below the umbilicus the deep epigastric artery. Note the
relation of the deep epigastric to the internal abdominal ring. (See Fig.

165.)

Also observe the plica semilunaris, or fold of Douglas.



FIG. 163 DEEP MUSCLES OF THE ABDOMINAL WALL. (Holden.)

Rectus abdominis. .2, 2. Internal oblique. 3,3. Anterior leaflet of the aponeurosis of
the internal obliq.ue. 4,4. Cut external oblique. 5,5. Spermatic cord. 6,6. Inferior
part of the external oblique aponeurosis turned back on the thigh. 7. Rectus abdom-
inis; the upper part has been excised to show the aponeurosis of the transversalis. 8, 8.
Fleshy portion of this muscle. 9. Its aponeurosis. 10 Umbilicus, n. Linea alba
above umbilicus. 12. Infraumbilical linea alba separating below the two pyramidales.
13, 13. Serratus magnus. 14. Cut right latissimus dorsi. 15. Cut left latissimus
dorsi. 16. Cut serratus magnus. 17, 17. External intercostals, 18, 18. Femoral
aponeurosis. 19. Cut internal oblique.







140



THE ABDOMIXAL WALLS



Deep arteries of abdomen:

Deep epigastric (A. epigastrica inferior}.
Deep circumflex iliac.
Superior epigastric.
Intercostalis, lower.
Lumbar, terminal branches.



FIG. 164. SIDE VIEW OF PELVIS AND UPPER THIRD OF THIGH, WITH THE EXTERNAL ILIAC,
INTERNAL ILIAC, AND FEMORAL ARTERIES AND THEIR BRANCHES, LEFT SIDE. (Morris.}
(From a dissection by W. J. Walsham in the Museum of St. Bartholomew's Hospital.)
The bladder is hooked over to expose back of pelvis.



Common iliac artery
SYMPA THETIC SER VE
Middle sacral artery






Common iliac vein
URETER

Internal iliac artery
External iliac vein

External iliac artery

Potterior branch of internal iliac dividing into
gluteal and ilio-lumbar arteries

Lateral sacral artery

SAGRAL PLEXUS
OBTURA TOR NER VE -

Obturator artery
Obliterated hypogastric

Superior vesical artery
Edge of levator ani

Pudic artery

BLADDER

Middle vesical artery

Deep epigastric artery
Pubic branch of epi-
gastric artery
Common femoral artery

Long snphenoiis vein
Peetineus muacle

Obturator artery

Adductor maguus

Internal circumflex artery

Adductor brevis

OBTURATOR NERVE (ant. branch)

Profunda artery

Adductor longus, hooked aside

Superficial femoral artery and vein



Graeilis muscle
Lower part of sartoriua





Psoaa muscie
Iliu-lumbar artery

EXTERSA 7, f'UTA-
SEOL'K SERVE

Iliacus muacle

ESI TO-CRURAL ,.
SERVE

ASTER I OR CRU-
RAL SERVE

Deep circnnifli-jc iliac
artery

Superficial circumflex

ilia,-
A \TKRIOR CRURAL N.

Hint: <:/. artery and

x,,,, -I:.,- ,,l,lt,,,l ,,;;

Tenaor faciae femoria

(hooked aside)
Gluteus medius and

minimus
Sariorius muscle
MlhDLI-: / CTA- '
SEOUS SERVE

SERVE TO RECTUS

KERVE Til 1M.V/T5
BXTBSNU8

Efli'fnnl cin-ii in flex ar.

XERVE TO CRl'REl'S

Rectus, hooked aside
I'm ,;,, la rein

L<>.\<; SAI'llESOUS
SERVE AM>
SERVE Tit VAS-
TUS



Vastus internus
muscle



THE ABDOMIXAL CAVITY



141



Study carefully the anatomy concerned in inguinal hernia. (See Figs.
161 and 165.)



FIG. 165. POSTERIOR PART OF LOWER WALL OF ABDOMEN WITH THE DIFFERENT STRUC-
TURES ON IT. (Blandin.) (Morris.}



Deep epigastric vessels
Internal abdominal ring



INNER BORDER OF INGUINAL CANAL
\



External iliac vein
ILIUM

VAS DEFERENS
CRURAL CANAL

Pelvic fascia




Obturator fascia

Leu
Hecto-vesi



Fascia iliaca

Obliterated hypogastrie artery



RECTUM
ISCHIO-RECTAL FOSSA



BLADDER



INTERNAL PUDIC VESSELS AND
SERVE



DEMONSTRATION III.

ABDOMINAL CAVITY.

General description; boundaries.

Open the abdomen by making an incision through the transversalis
fascia and peritoneum, lying below it, a little to the left of the median line
and extending from the ensiform cartilage to a level of the umbilicus.
From this point make an incision on each side extending obliquely outward
to the anterior superior spine of the ilium.

Examine the inner surface below the umbilicus and note :

Urachus.

Hypogastrie artery obliterated.

Fossae.

(See Fig. 165.)



CONTENTS OF ABDOMEN.

Study the position of each viscus, noting the relations to each other
and to external landmarks:

Stomach: Shape, position in abdomen, and relation to surrounding
parts.



142



THE ABDOMINAL VISCERA



Liver: Position in relation to ribs, stomach, colon, and kidney.

Large Intestines: Relation to small intestines, liver, spleen, kidney,
and stomach.

Small Intestines: Duodenum, jejunum, ileum, junction with large in-
testines.

Vermiform Appendix: Relation to caecum.

Kidney: Position as to crest of ilium, ribs, and vertebras.

Spleen: Relation to ribs, colon, stomach, and pancreas.

Pancreas: Relation to stomach, duodenum, and superior mesentery
artery.



FIG. 166. THE VISCERA AS SEEN ON FULLY OPENING THE ABDOMEN WITHOUT DISARRANGE-
MENT OF THE INTERNAL PARTS. (After Sarazin.) (Morris.)



DIAPHRAGM

STOMACH
SPLEEN

GREAT OMENTUM
SMALL INTESTINE




THE ABDOMINAL VISCERA



J 43



FIG. 167. VIEW OF THE DEEPER ABDOMINAL VISCERA. (Rudinger.) (Morris.)



Superior vena cava



THORACIC DUCT



Inferior vena caret




ASCENDING COLON



Aorta

LEFT BRONCHUS



aSOPHAGUS



SPLKN

KIDNEY
DUODENUM
DESCENDING COLON

SIGMOiD FLEXURE
3LADDER



i 44 THE PERITONEUM

FIG. 168. THE VISCERA OF THE FCETUS. (Rudinger ) (Morris.}



THYROID



LUNG



LIVER
Suspensory ligament



SMALL INTESTINE



BLADDER




TRACHEA



THYMUS



LUNG

RIGHT AURICLE



RIGHT VENTRICLE



STOMACH



PART OF TRANSVERSE
COLON



Hypttyastric artery



PERITONEUM.

General character. The following is taken from Holden's " Anatomy " :
"A certain range of motion being necessary to the abdominal viscera,
they are provided with a serous membrane, called peritoneum. This mem-
brane, like other serous membranes, is a closed sac, one part of which lines
the containing cavity, the other is reflected over the containing viscera.
These are respectively termed the parietal and the visceral layers. In the
female, however, it is not, strictly speaking, a closed sac, since it communi-
cates with the cavity of the uterus through the Fallopian tubes. The in-
ternal surface of the peritoneum is smooth and polished, and lined by
squamous endothelium; the external surface the subperitoneal tissue-
is composed of areolar tissue, which connects the internal layer to the in-
vested viscera or abdominal parietes. There is nothing between the par-
ietal and visceral layers in other words, inside the sac but just sufficient
moisture to lubricate its smooth and polished surface. The viscera are
all, more or. less, outside the sac ; some lie altogether behind it, as the



THE PERITONEUM



145



pancreas, kidneys, suprarenal capsule; others, as the lower parts of the
duodenum, caecum, ascending and descending colon, are only partially
covered by it; while others, as the stomach, liver, jejunum, ileum, and
some parts of the large intestines, are completely invested by it; these
latter push the visceral layer before them, and so give rise to membranous
folds; the larger the fold, the freer is the mobility of the viscus which
occasions it."

To properly understand the peritoneum a knowledge of its formation
is necessary. The student should therefore study some good description
of the development of the peritoneum.

Trace the peritoneum vertically.



FIG. 169. DIAGRAM TO SHOW THE PERITONEUM AS SEEN IN A VERTICAL SECTION. (Allen

Thomson.) (Morris.)



LIVER



GASTRO-HEPATIC OMENTUM
STOMACH



TRANSVERSE COLON
MESENTERY

SMALL INTESTINE




FORAMEN OF WINSLOW
PANCREAS

DUODENUM

TRANSVERSE MESO-COLON

A orta



RECTUM



BLADDER



146



THE PERITONEUM



Trace the peritoneum in transverse sections at different levels, using
the figures below as guides.



FIG. 170. TRANSVERSE SECTION OF THE PERITONEAL SAC AT ABOUT THE LEVEL OF THE

UMBILICUS. (Morris.)




FIG. 171. TRANSVERSE SECTION OF THE ABDOMEN AT THE LEVEL OF THE FORAMEN OP

WINS LOW. (Morris.)



GASTRO-HEPATIC OMENTUM



bASTRO-SPLENIC
OMENTUM




Greater sac.
Lesser sac.

Trace each.

What viscera, and what parts of what viscera are covered by the greater
sac ; what by the lesser sac ?

Where and what is the foramen of Winslow?
Great omentum (Fig. 175).

Position.

Description.
Lesser omentum or gastro-hepatic.

Position.

Description.
Gastro-splenic omentum.

Position.



THE PERITONEUM 147

Gastro-phrenic ligament.
Position.

Phreno-colic ligament.
Position.

Peritoneal ligaments connected with the liver, bladder, and uterus are
described with those organs.

There are several pouches formed in the development of the peritoneum
which may become the seat of intra -abdominal herniae. Locate these.

They are named from their positions:

Fossa duodeno-jejunalis. (See Fig. 172.)



FIG. 172. THE FOSSA DUODEXO-JEJUXALIS. (Treves.) (Morris.)



THE FOSSA



THE DUODENAL
FOLD




Inferior mesenteric
rein



Fossa subcaecalis or ileo-caecal.
Fossa intersigmoidea.



148



THE MESENTERY ARTERIES



Expose by cutting through the anterior layer of mesentery the follow,
ing blood-vessels:

Superior mesentery artery and branches.



FIG. 173. THE SUPERIOR MESENTERIC ARTERY AND VEIN. (Morris.)
(The colon is turned up, and the small intestines are drawn over to the left side.)


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Online LibrarySimon Menno YutzyA manual and atlas of dissection → online text (page 6 of 11)