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Abdomen and Cavity Grays

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					   The Abdomen

Surface Anatomy, Vessels,
Muscles, and Peritoneum
Abdominopelvic Cavity
           • Ventral body cavity
              – Thoracic
              – Abdominopelvic
           • Abdominopelvic
              – Abdominal
                  • Liver
                  • Stomach
                  • Kidneys
              – Pelvic cavity
                  • Bladder
                  • Some reproductive organs
                  • Rectum
     Abdominopelvic
         Cavity
         • Surrounded by the
           abdominal walls and
           pelvic girdle
         • The two cavities are
           continuous
         • Most organs
           surrounded by a
           peritoneal cavity
           – Visceral peritoneum
           – Serous peritoneum
pg 242     – Peritoneal cavity
Abdominal Quadrants
              • 9 regions
              • 4 quadrants
                – Draw “line” through
                  navel
                – Right upper quadrant
                – Left upper quadrant
                – Left lower quadrant
                – Right lower quadrant




     pg 242
         Surface Anatomy
                 • Anterior abdominal wall
                   extends from costal
                   margin to inferior
                   boundaries:
                    –   Iliac crest
                    –   Anterior superior iliac spine
                    –   Inguinal ligament
                    –   Pubic crest
                 • Superior boundary
                    – Diaphragm
                 • Central landmark
                    – Umbilicus
                 • Linea alba (white line)
pg 345              – Tendinous line
                    – Extends from xiphoid
                      process to pubic symphysis
         Muscles
             • Function:
                – Help contain abdominal
                  organs
                – Move trunk
                – Forced breathing
                – Increase intra-abdominal
                  pressure
             • Abdominal wall
                – Anterior (4)
                    • Innervated by intercostal
                      nerves
                    • Continuous with layers of
                      intercostal muscles
                    • Fibers of layers run in
                      different directions for
                      strength
pg 250              • Ends in aponeurosis which
                      contains rectus abdominis
                      muscle
                – Posterior (3)
   Anterior Abdominal Wall Muscles
                 Rectus Abdominis
                   – Origin
                       • Pubic crest, symphysis
                   – Insertion
                       • Xiphoid process, costal cartilages of
                          ribs 5-7
                   – Function
                       • Flex, rotate trunk, fix and depress
                          ribs, stabilize pelvis, compress
                          abdomen
                • Internal oblique
                   – Origin
pg 250, 251            • Lumbar fascia, iliac crest, inguinal
                          ligament
                   – Insertion
                       • Linea alba, pubic crest, last 3-4 ribs,
                          costal margin
                   – Function
                       • Same for external obliques
         Anterior Abdominal Wall
                  • External oblique
                     – Origin
                         • Lower 8 ribs
                     – Insertion
                         • Aponeurosis to linea alba, pubic and
                           iliac crest
                     – Function
                         • Flex trunk, compress abdominal wall
                           (together), Rotate trunk (separate sides)
                  • Transversus abdominis
                     – Origin
                         • Inguinal ligament, lumbar fascia,
                           cartilage of last 6 ribs, iliac crest
                     – Insertion
                         • Linea alba, pubic crest
pg 249               – Function
                         • Compress abdominal contents
         Posterior Abdominal Wall
                 • Iliopsoas
                    – Psoas major
                        • Origin
                            – Lumbar vertebrae, T12
                        • Insertion
                            – Lesser trochanter of femur via iliopsoas tendon
                        • Function
                            – Thigh flexion, trunk flexion, lateral flexion
                        • Innervation
                            – Ventral rami L1-L3
                    – Iliacus
                        • Origin
                            – Iliac fossa, ala of sacrum
                        • Insertion
                            – Lesser trochanter of femur via iliopsoas tendon
                        • Function
                            – Thigh flexion, trunk flexion
                        • Innervation
                            – Femoral nerve (L2 and L3)
                    – Psoas minor – variable (40-60% do not have)
pg 316
         Posterior Abdominal Wall
                   • Quadratus lumborum
                     – Origin
                        • Iliac crest and lumbar fascia
                     – Insertion
                        • Transverse process of upper
                          lumbar vertebrae, lower
                          margin of rib 12
                     – Function
                        • Flex vertebral column,
                          maintains upright posture,
                          assists in inspiration
                     – Innervation:
                        • T12 and upper lumbar spinal
                          nerves (ventral rami)
pg 316
                  Peritoneum
• Mesenteries
  – Double layer of peritoneum (2 serous membranes
    fused together)
  – Extend to the digestive organs from the body wall
  – Function:
     • Hold organs in place
     • Sites of fat storage
     • Provide a route for vessels and nerves
  – Dorsal mesenteries:
     • Lesser omentum and Falciform ligament
  – Ventral mesenteries:
     • Greater omentum, Transverse mesocolon, Mesentary, and
       Sigmoid mesocolon
         Dorsal Mesenteries




pg 269                        pg 291
         Ventral Mesenteries
                               pg 271




pg 269
                      Peritoneum
• Peritoneal
  – Remains surrounded by peritoneal cavity
  – Liver, stomach, ileum and jejunum
• Retroperitoneal
  – Some organs lay behind/outside peritoneum
     • Primarily retroperitoneal
         – Organs NEVER within the cavity
         – Kidneys, bladder, ureter
     • Secondarily retroperitoneal
         – Organs once suspended within the abdominal cavity by mesentery
         – Migrate posterior to the peritoneum during the course of
           embryogenesis to become retroperitoneal
         – Lack mesenteries
         – Duodenum, ascending and descending colon, rectum, pancreas
pg 226
Organs of the Abdomen

Urinary and Digestive Systems
Urinary System
         Urinary System
          • Kidney (2)
            – Purify blood
          • Ureter (2)
            – Drains urine from
              kidney to bladder
          • Urinary Bladder
            – Stores urine
          • Urethra
pg 314      – Drains urine from
              bladder to outside
              body
                   Kidneys
• Filter waste from blood
  – Water, toxins, urea, uric acid, creatinine,
    metabolic waste, ions
• Excretion of waste
• Homeostasis
  – Acid-base balance
  – Blood pressure
  – Plasma volume
Kidneys: Gross Anatomy
               • Lie in retroperitoneal,
                 superior lumbar region
               • Extend from T11 or T12 to
                 L3
               • Laterally convex, medially
                 concave
               • Hilus
                  – Where blood vessels,
                    ureters, and nerves enter
                    and leave kidney
               • Adrenal gland
      pg 325
                  – On superior portion
         Kidney: Gross Anatomy

                    • Separated into lobes
                    • Blood supply
                      – Renal artery and vein
                      – ¼ heart’s systematic
                        output reaches the
                        kidney
                    • Innervation
                      – Branches of renal
pg 323                  plexus
         Kidney: Gross Anatomy
                 Internal
                            • Supportive tissue
                               – Renal capsule
                                  • DCT
                                  • Adheres directly to kidney
                                    surface
                                  • Maintains shape and
                                    forms barrier
                               – Adipose capsule
                                  • Perirenal fat
                                  • Cushions kidney
                                  • Keeps kidney in place
pg 322                         – Renal fascia
                               – Pararenal fat
                                  • Cushions kidney
                                  • Keeps kidney in place
                 External
    Kidney: Internal Gross Anatomy

                    • Cortex
                      – Superficial
                      – Lighter zone
                      – Functional portion
                    • Medulla
                      –   Deep
pg 323
                      –   Darker zone
                      –   Pyramid shaped
                      –   Contains collecting
                          tubules
   Kidney: Internal Gross Anatomy
                  • Medullary pyramid
                     – Makes up the medulla
                     – Base: against cortex
                     – Apex: inward
                         • Papilla = tip
                         • Drips urine into minor calyx
                  • Calices
                     – Collect urine draining from
                       papillae and empty into renal
                       pelvis
                     – Major calices
                         • Branching extensions of renal
                           pelvis
                     – Minor calices
pg 323                   • Divisions of major calices
                         • Surround papilla of pyramids
                         • Collect urine from papilla
                  • Renal pelvis
                     – Expanded superior part of ureter
     Kidney: Internal Vasculature
                   • Renal arteries
                   • Segmental arteries
                     – Enter through the hilus
                     – Branch into:
                        • Lobar arteries
                        • Interlobar arteries
                        • Arcuate arteries
                            – At border of cortex and
                              medulla
pg 323                  • Interlobular arteries
Kidney: Microscopic Anatomy
• Uriniferous tubules
  – Produces urine through filtration, reabsorption, and
    secretion
  – 2 major part:
     • Nephron
     • Collecting duct
    Ureters
         • Carry urine from the kidneys
           to the bladder
         • Begins superiorly at L2 as a
           continuation of renal pelvis
         • Opens into the bladder
         • Retroperitoneal
         • Enters the bladder at an
           oblique angle
            – This prevents backflow into the
              ureters
         • Increased pressure in bladder
           lead to the distal end of ureter
           closing
            – Not only gravity at work here!!
pg 325
Ureters: Microscopic Anatomy
              • Another tubular organ!!
              • Mucosa
                 – Lamina epithelialis
                     • Transitional epithelium
                     • Stretches when ureters are
                       full
                 – Lamina propria
              • Muscularis
                 – Inner longitudinal
                 – Outer circular
                 – External longitudinal layer
                   (inferior third)
                 – Function in peristalsis
              • Adventitia
                 – CT
         Urinary Bladder
                 • Stores and expels urine
                 • Posterolateral angle receives
                   the ureter
                 • Inferior angle drains into the
                   urethra
                 • Located:
                     –   Inferior to peritoneal cavity
                     –   On pelvic floor
                     –   Posterior to pubic symphysis
                     –   Male:
                          • Anterior to rectum
                     – Female:
                          • Anterior to vagina and uterus

pg 400
         Urinary Bladder
                 • Full bladder expands
                   into abdominal cavity
                 • Empty bladder lies
                   within pelvic cavity
                 • Vasculature:
                   – Internal iliac branches
                     of arteries and veins
                 • Innervation:
                   – Branches of the
                     hypogastric plexus
pg 399
  Urinary Bladder: Internal Anatomy
                 • Tubular organ!!!!!
                 • Trigone area
                 • 3 layers:
                    – Mucosa
                       • Transitional epithelium
                       • Lamina propria
                    – Muscular layer
                       • Detrusor muscle (smooth);
                         3 layers:
                           – Inner and outer longitudinal,
                             middle circular
                    – Adventitia
                       • Fibrous CT
                       • Parietal peritoneum on superior
pg 400                   surface
         Urethra
             • Drains urine from
               bladder to outside of
               body
             • Female:
                – Short tube
             • Male
                – 3 regions
                    • Prostatic urethra
                    • Membranous urethra
                    • Spongy/penile urethra
                – Opens at the external
pg 400            urethral orifice
                – Also carries ejaculating
                  semen
              Urethra Landmarks
• Internal urethral sphincter
   –   At bladder/urethral junction
   –   Thickening of detrusor muscle
   –   Involuntary; keeps urethra closed when urine is not being passed
   –   Prevents dribbling!
• External urethral sphincter
   – Surrounds urethra within the urogenital diaphragm
   – Inhibits voluntary urination until ready
• External urethral orifice
   – Males:
        • End of the penile urethra
   – Females:
        • Anterior to vaginal opening and posterior to clitoris
Males versus Females:




                        pg 403
       Micturition = Urination
• Contraction of the detrusor muscle to raise intra-
  abdominal pressure
• Controlled by the brain
• Urine accumulation leads to distention of the
  bladder
  – Activates stretch receptors
  – Send sensory impulses to micturition center (MC) in
    the pons
• MC sends signals to parasympathetic neurons
  – Stimulate detrusor muscle to contract (involuntary)
  – Internal urinary sphincter opens (also inhibits
    sympathetic pathways that would prevent urination)
      Micturition = Urination
• Other brain receptors (pons, cerebral
  cortex) can inhibit urination
  – Relaxing of the detrusor, keeping external
    urinary sphincter closed
• Voluntary contraction of abdominal wall
  muscles increases abdominal pressure
• Voluntary relaxation of external urethral
  sphincter
Digestive System
Digestive System
           • Alimentary Canal
               –   Mouth
               –   Pharynx
               –   Esophagus
               –   Stomach
               –   Small Intestine
               –   Large Intestine
           • Accessory Organs
               –   Teeth, Tongue
               –   Salivary Glands
               –   Gallbladder
               –   Liver
               –   Pancreas

      pg 222
Digestive Processes – 6 Steps
         • Ingestion
            – Taking food into the mouth
         • Propulsion
            – Movement of food through GI tract
                • Swallowing and peristalsis
         • Mechanical digestion
            – Prepares food for chemical digestion
            – Chewing, churning, segmentation
         • Chemical digestion
            – Enzymes break down complex food molecules
         • Absorption
            – Digested end products from lumen to blood
         • Defecation
            – Elimination of indigestible substances
         Alimentary Canal Wall
                  • ANOTHER tubular organ!
                  • Layers:
                    – Mucosa
                       • Epithelium
                       • Lamina propria (MALT)
                       • Lamina muscularis mucosa
                    – Submucosa
                       • CT with elastic fibers, nerves,
                         vessels
                    – Muscularis
                       • Inner circular
pg 313                 • Outer longitudinal
                       • Creates sphincters
                    – Serosa / Adventitia
Peristalsis vs Segmentation
         • Peristalsis
            – Propulsion
            – Adjacent segments of the alimentary
              canal contract and relax
            – Moves food distally along the canal
         • Segmentation
            – Part of mechanical breakdown
            – Food-mixing process
            – Nonadjacent segments of the intestine
              alternatively contract and relax
            – Moves food on and back
            – Mixes rather than propels
                 Innervation
• Nerve plexuses
  – Occur within wall of alimentary canal
  – Parasympathetic, Sympathetic, Visceral
    Sensory fibers
  – 2 types:
    • Myenteric nerve plexus
       – Between 2 muscle layers of the tunica muscularis
       – Controls segmentation and peristalsis
    • Submucosal nerve plexus
       – Between submucosa and muscularis mucosa
       – Signals glands to secrete and LMM to contract
pg 313
                 Innervtion
• Enteric Nervous System (ENS)
  – Internal neurons in wall of canal (100 million!!)
  – Within the above plexuses
  – Form independent arcs of sensory, intrinsic, and
    motor neurons
  – Controls glandular secretion, peristalsis,
    segmentation
  – Autonomic Nervous System speeds up or slows
    activity controlled by enteric system
    • Allows the CNS to influence it
         Stomach
             • J-shaped
             • Temporary storage tank
             • Regions:
                – Cardiac
                    • Cardiac orifice
                    • Junction of esophagus
                – Fundus
                    • Under diaphragm
                – Body
                    • Large midportion
                – Pyloric
                    • Ends at the stomach
                    • Pyloric sphincter
                – Greater curvature
pg 272          – Lesser curvature
Stomach – Internal Anatomy
             • Mucosa
                – Epithelium
                    • Simple columnar
                – Rugae
                    • Folds that allow for volume
                      changes
                – Intrinsic glands
                    • Goblet cells
                    • Gastric glands
                – Submucosa
             • Muscularis
                – Oblique layer
                – Circular layer
                    • Pyloric sphincter
                – Longitudinal layer
             • Serosa
            Stomach Function
• Storage of chyme
  – Food paste
• Breakdown of food proteins
  – Done by pepsin
     • Protein-digestion under acidic conditions
• Absorption of nutrients
  – H2O, electrolytes
  – Alcohol, other drugs
• Food remains for about 4 hours
• Holds from 1.5 to 4 liters
               Small Intestine
• Longest portion of GI tract
• Site of most enzymatic digestion and absorption
  of nutrients
  – Bile: emulsifier (gallbladder, liver)
  – Enzymes (pancreas)
• Undergoes segmentation
  – Allows for an increase contact with intestinal walls
• Peristalsis propels chyme through in about 3 to 6
  hours
• 2.6 to 6 meters long!!
Small Intestine
  • Location:
         – From pyloric sphincter
           to first part of the
           large intestine
  • Regions:
         – Duodenum (5%)
            • Proximal
         – Jejunum (almost 40%)
            • Middle
         – Ileum (almost 60%)
            • Distal

pg 274
         Small Intestine
              • Duodenum
                –   C – shaped
                –   Short, straight
                –   Mostly retroperitoneal
                –   Receives:
                     • Digestive enzymes from pancreas
                       via main pancreatic duct
                     • Bile from liver via the bile duct
              • Ileum and jejunum
                – Highly coiled
                – Fewer modifications
                – Hang by mesentery in peritoneal
                  cavity
                – Mesentery Arcades
                     • Arteries + veins
pg 283               • Nerves
                     • Store fat
   Small Intestine Internal Anatomy
                    • Intestinal flora
                        – produces vitamin K
                    • Epithelium:
                        – Simple columnar epithelium
                          with many modifications for
                          absorption
                    • Lymph tissue in submucosa
                    • Muscularis externa has 2
                      layers
                    • Innervation:
                        – Some parasympathetic
                          innervation from vagus
                    • Arterial supply:
                        – Superior mesenteric
                        – Rt (cranial)
                          pancreaticoduodenal
pg 283
SI Absorption Modifications
           • Length
              – More length, more area for
                absorption!
           • Circular folds
              –   Plicae circulares
              –   Transverse ridges of mucosa
              –   Increase surface area
              –   Force chyme to slow down
           • Villi
              – Move chyme and increase contact
              – Contain lacteals
                   • Remove fat
           • Microvilli
              – More increasing of the surfcae area
                  Modifications decrease distally
         Large Intestine
                 • Regions:
                   – Cecum
                   – Vermiform appendix
                   – Colon
                      • Ascending
                      • Transverse
                      • Descending
                      • Sigmoid
                   – Rectum
                   – Anal Canal
pg 279
         Large Intestine
         • Functions:
           – Absorbs remaining nutrients
              • Most material largely digested
           – Absorbs water and
             electrolytes
           – Forms, stores and expels feces
             from body
              • Propulsion is slow and weak
                through LI except for mass
                peristaltic movements


pg 283
         LI: Internal Features
• Intestinal flora
• No intestinal villi or modifications for
  absorption
• Many goblet cells
• Simple columnar epithelium except lower half of
  anal canal
• Significant lymph tissue in mucosa and
  submucosa
• Muscularis mucosae has 2 layers
• Some parasympathetic innervation from vagus
         LI Special Features
                   • Teniae coli
                      – 3 Longitudinal strips
                      – Thickenings of
                        longitudinal muscle layer
                      – Maintain muscle tone
                      – Cause LI to pucker into
                        sacs…….
                   • Haustra
                      – Saclike divisions
                   • Epiploic appendages
                      – Fat-filled pouches of
                        visceral peritoneum
pg 279                – Hang from the intestine
  Cecum and Vermiform Appendix
             • Cecum
               – Sac-like pouch (blind pouch)
               – Ileocecal valve
                  • 2 raised edges of the mucosa
                  • Sphincter keeps closed until food in
                    stomach
                  • Prevents reflux of feces from cecum
                    to ileum
             • Vermiform Appendix
               – Blind tube
               – Opens into cecum
               – Contains large masses of lymphoid
                 tissue


pg 276
         Colon Segments
                • Ascending
                   – Right side of posterior
                     abdominal wall
                   – Makes right angle turn
                       • Right colic / hepatic flexure
                • Transverse
                   – Extends left across the
                     peritoneal cavity
                   – Bends downward at the
                     spleen
                       • Left colic / splenic flexure
                • Descending
                   – Left side
                • Sigmoid
                   – S-shaped
                   – “True pelvis”
pg 279
          Colon Functions
• Absorb H2O and electrolytes
• Some digestion by bacteria
• Mass Peristaltic Movements (2-3x day)
• Moves through in 12-24 hours
• 1.5 meters
Rectum
   • Joins with the sigmoid
     colon
   • Descends into the pelvis
   • Complete and well-
     developed longitudinal
     muscle layer
   • Rectal valves
      – 3 transverse folds
      – Prevent feces from being
        passed along with gas



    pg 283
         Anal Canal
          • Begins where rectum passes
            through the levator ani muscle
          • Releases mucus to lubricate
            feces
          • Internal anal sphincter
             – Made of smooth muscle
             – Involuntary
          • External anal sphincter
             – Made of skeletal muscle
             – Voluntary
             – Toilet training!!!
          • Stratified squamous
            epithelium at lower half


pg 398
                   Defecation
• Stretching of rectal wall initiates defecation reflex
• Mediated by the spinal cord
   – Parasympathetic reflex signals walls of sigmoid colon and
     rectum to contract and anal sphincters to relax
   – Involuntary
• If not ready, reflective contraction ends and rectum
  relaxes
   – Reflex initiated again until you actually defecate
• Contraction of diaphragm, levator ani and
  abdominal muscles assist
   – Voluntary
Accessory Digestive Organs
Liver
   • Largest gland in the body!
      – Weighs about 3 pounds
   • Highly vascular
   • Location:
      – Inferior to diaphragm
      – In right superior part of
        abdominal cavity
      – Mostly upper rib cage
   • Functions: (Over 500!)
      –   Produce bile
      –   Pick up glucose
      –   Detoxify poison, drugs
      –   Produce blood proteins
    pg 242
pg 285
         Liver Gross Anatomy
                   • 2 surfaces:
                       – Diaphragmatic
                       – Visceral
                   • Lobes:
                       – Right lobe
                       – Left lobe
                            • Divided by:
                                – Falciform ligament on
                                  diaphragmatic surface
                                – Fissure on the visceral surface
                       – Quadrate lobe
                       – Caudate lobe
                            • Both part of left lobe and
                              visceral surface

                   pg 287
pg 286
         Liver – Visceral Surface
                     • Hepatic Vein (into
                       inferior vena cava)
                     • Porta Hepatis
                        – Hepatic Artery (from
                          abdominal aorta )
                        – Hepatic Portal Vein
                            • Carries nutrient-rich
                              blood from stomach and
                              intestines to liver
                            • Hepatic portal system = 2
                              capillary beds!
                        – Hepatic Ducts (carry bile)
pg 285   Gallbladder
               • Muscular sac
               • Rests in depression of
                 right liver lobe
               • Has many ducts
                 associated with it
               • Stores and concentrates
                 bile
                   –   Breaks down fats
                   –   Emulsification
                   –   Produced in liver
                   –   Stored in gallbladder
                   –   Secreted in duodenum

              pg 287
         Gallbladder
                • Mucosa
                  – Simple columnar
                    epithelium
                  – Lamina propria
                  – Expandable mucosal
                    folds
                • Smooth muscle layer
                • Thick connective
                  tissue
                  – Covered by serosa in
                    places
pg 287
             Bile Ducts
          • Hepatic duct
pg 289        – Carries bile from liver
          • Cystic duct
              – Joins hepatic duct
                from liver to form the
                bile duct
              – Carries bile from
                gallbladder
          • Common Bile duct
              – Empties into the
                duodenum

         pg 290
          Movement of Bile
• Bile secreted by liver continuously
• Hepatopancreatic (Vater) ampulla
   – common bile + main pancreatic duct meet and
     enter duodenum
   – Sphincter of Oddi around it
   – closed when bile not needed for digestion
• Bile then backs up into gallbladder via cystic
  duct
• When needed gallbladder contracts, sphincters
  open
pg 288
         Pancreas
             • Both exocrine and
               endocrine gland
             • Exocrine
                – Produce enzymes that
                  digest food
             • Endocrine
                – Produce hormones that
                  regulate blood sugar
                  (insulin and glucagon)
             • Secondarily
               retroperitoneal
             • Location:
                – Curve of duodenum
                – Extends to spleen
                  Pancreatic Ducts
• Main pancreatic duct
   – Extends length of pancreas
   – Joins bile duct to form the hepatopancreatic ampulla
   – Empties into duodenum
• Accessory pancreatic duct
   – Lies in head of pancreas
   – Drains into the main duct
   – Enters duodenum also




                                           pg 289
    Spleen
         • Largest lymphoid organ
         • Location:
             – Left superior quadrant of
               abdominal cavity
             – Posterior to stomach
         • Highly vascular
         • Function:
             – Removes blood-borne
               antigens
             – Removes and destructs aged
               blood cells
             – Site of hematopoiesis in
               fetus
             – Stores blood platelets
pg 297
         Arterial Blood Supply to
           Abdominal Viscera
• All branches of Abdominal Aorta
• Anastomoses
  –   Left + Middle colic
  –   Left + Right gastric
  –   Left + Right gastroepiploic
  –   Cranial + Caudal pancreaticoduodenal
  –   Deep Iliac Circumflex + Adrenolumbar


• Remember your zoological roots: YOU MUST
  KNOW WHAT SUPPLIES WHAT!!
          Names give hints!

• Hepato = liver         • Epiploic =
• Pancreatico =            membrane-covered
  pancreas               • Mesenteric =
• Cystic = gallbladder     mesentery
• Gastro = stomach       • Duodenal =
• Splenic = spleen         duodenum
• Adreno = adrenal gl    • Ileo = ileum
• Lumbar = lumbar        • Colic = colon
  region                 • Rectal = rectum

				
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