Liver Ayurvedic Part

 

LIVER(yakRt)

Ayurvedic:

A)     Avayava:It Is Matruj Avayav      Su.Sha. 3/43

B)     Utpatti:

gaBa-sya yakRtPlaIhanaaO SaaoiNatjaaOlSu. Sha. S 4/24

Its utpatti occurs from Rakta

C)     Srotas:

r@tvaho vdo tyaaomaU-laM yakRtPlaIhanaaO r@tvaaihnyaSca Qamanya : l  Su. Sha. 9/16

It is Moolsthan of Raktavaha srotas.

D)     Ashaya: It is one of the Ashaya.

E)      Koshtanga: Yakrut is one of the Koshtanga among Panchdash Koshtangas

Liver ( Ayurvedic Part, Introduction And Development)

Ayurvedic:

A)     Avayava:It Is Matruj Avayav      Su.Sha. 3/43

B)     Utpatti:

gaBa-sya yakRtPlaIhanaaO SaaoiNatjaaOlSu. Sha. S 4/24

Its utpatti occurs from Shonit ( Blood)

C)      Srotas:

r@tvaho vdo tyaaomaU-laM yakRtPlaIhanaaO r@tvaaihnyaSca Qamanya : l  Su. Sha. 9/16

It is Moolsthan of Raktavaha srotas.

D)     Ashaya: It is one of the Ashaya.

E)      Koshtanga: Yakrut is one of the Koshtanga among Panchdash Koshtangas

Introduction

·        Liver is a large, solid gland situated in right upper quadrant of abdominal cavity.

·        Colour: Reddish brown ( In living subjects)

·        It is largest gland, soft in consistency & very friable.

·        Wt. – 1600gm. In males, 1300gm in females.

·        It secretes bile &performs various other metabolic functions.

System

Liver is a part of:-

·        Digestive system ( accessory  )(on the basis of development & bile)

·        Reticular endothelial system.

Location

Right hypochondrium, epigastrium, and left hypochondrium up toleft lateral line.

Most of liver covered by ribs &costal cartilages except epigastrium.

 

Another name- Liver is also called ‘Hepar’

 

Development

·        Liver developes from an endodermal bud that arises from the ventral aspect of the foregut (junction between foregut & midgut). Again this bud divide into a large cranial part called pars hepatic & smaller caudal port called pars cystica.

Pars hepatic divides into Right and left parts, each of which forms one lobe of the 

Coeliac Trunk

1. THE COELIAC TRUNK (artery of foregut)

v  DERIVATIVES OF THE FOREGUT: Lower part of Esophagus, Stomach AND Upper part of the Duodenum.2.Liver .3.Spleen 4.Greater part of Pancreas.

At the level: T12 to L1

v  Main 3 branches :

1) Left Gastric 2) Hepatic 3)Splenic

1)Left Gastric

v  IT RUNS ALONG THE LESSER CURVATURE OF STOMACH.

v  IT ENDS BY ANASTOMOSING THE RIGHT GASTRIC ARTERY.

v  IT GIVES OFF : a)Oesophageal branches b)Numerous Gastric branches

2) Hepatic

It terminates by dividing into right and left Hepatic branches

A)The Gastroduodenal artery:.The part of hepatic artery proximal to the origin of the Gastroduodenal artery is called the Common Hepatic artery.

Gastroduodenal artery divides into: 1)Right Gastroepiploic. And Superior PancreatoDuodenal.

2)Superior PancreatoDuodenal artery runs down and ends by anastomosing with Inferior Pancreatoduodenal artery

B)The right Gastric artery: It is a small branch.it runs along the lesser curvature and ends by anastomosing with left Gastric Artery.

3. The Splenic Artery

v  It is the largest and runs behind the lesser sac.It reaches the Helium of the spleen. Branches:

v  A)Numerous Pancreatic branches B)5 to 7 short Gastric arteries.

v  C)Left Gastroepiploicruns along the greater curvature of stomach and ends by anastomosing with the right Gatsroepiploic arteries.

Introduction of Thorax and Abdomen/////////

THORAX AND ABDOMEN

For descriptive purpose, the human body is divided into head, neck, trunk and limbs. The trunk is divided by the diaphragm into an upper part called the thorax, and the lower part is called the abdomen.

THE SKELETON OF THE THORAX (thoracic cage).-  It is an osseocartilaginous, elastic cage.

1.  Formation:-      Anteriorly-  by the sternum.                                                                                                               Posteriorly- by the 12 thoracic vertebrae and intervertebral discs.                                                       one each side- by 12 ribs with their cartilage.

2.      THE SUPERIOR APERTURE(INLET)OF THE THORAX:The narrow upper end of the thorax, which is continuous with the neck ,is called the inlet of the thorax.

     3. DIAPHRAGM OF THE INLET OF THE LIVER:  The diaphragm is in two halves, right and left. Each half is also known as Sibson’s fascia or supra pleural membrane. The membrane is triangular in shape. Its apex is attached to the tip of the transverse process of C7 vertebra and base to the inner border of 1^st rib.

BOUNDARIES:-   Anteriorly- upper border of manubrium sterni .                                                         Posteriorly – superior surface of body of 1^st thoracic vertebra.                                                                         On each side- 1^st rib with its costal cartilage.

4. INFERIOR APERTURE (OUTLET) OF THORAX: It is the broad end of the thorax which surrounds the upper part of the abdominal cavity, but is separated from it by the diaphragm.

BOUNDARIES: Anteriorly-    Infra sternal angle .                                                                                      Posteriorly- inferior surface of the body of the 12^th thoracic vertebra.                                                             On each side- coastal margin formed (7, 8,9,10) and 11^th to 12^th ribs.

DIAPHRAGM OF THE OUTLET OF THORAX:-The outlet is closed by a large musculotendinous partition, called the diaphragm-which separates the thorax from the abdomen .                           Structure passing through the inlet:

§  Trachea, oesophagus, apices of the lungs.

§  Brachiocephalic artery, left common carotid artery and subclavian artery, right and left brachiocephalic veins.

§  Right phrenic nerve, right and left vagus nerve.                                                                            Structure passing through the outlet: Large openings: in the diaphragm.

§  Aortic openings: It transmits 1. The aorta, 2. The thoracic duct,(level-12^th thoracic vertebra).

§  The oesophageal openings: It transmits 1.oesophagus 2. The vagus nerve (level-10^th thoracic vertebra).

§  The vena caval opening: It transmits 1. Inferior vena cava, 2. Branches of right phrenic nerve (level- 8^th thoracic vertebra).

INTRODUCTION OF ABDOMEN:-

It is the lower part of the trunk and lies below the diaphragm. It is divided by the plane of the pelvic inlet into a larger upper parts, the abdomen proper and the smaller lower part the true (lesser)pelvis.

ABDOMINAL WALL:- Extends

1.      In the anterior median plane the abdominal wall extends from xiphoid process to the pubic symphysis.

2.      Superolateral margins of anterior abdominal wall are formed by right and left coastal margins.

3.      The iliac crest forms the lower limit of the abdominal wall at the side.

4.      Inguinal ligament extends from the anterior superior iliac spine to pubic tubercle. It is placed at the junction of the anterior abdominal wall with the front of the thigh.

5.      Transpyloric plane is an imaginary transverse plane, it passes through the tips of the 9^th coastal cartilage, and posteriorly through the lower part of the body of the 1^st lumber vertebra.

NINE REGIONS OF ABDOMEN:-

For the purpose of describing the location of viscera, the abdomen is divided into nine regions by imaginary planes, two horizontal and two vertical.

1.      Transpyloric plane:- passes midway between the suprasternal notch and the pubic symphysis. Anteriorly it passes through the tips of 9^th coastal cartilages and Posteriorly through the body of vertebra L1.(lower)

2.      Trans tubercular plane:- passes through the tubercles of the iliac crest and body of vertebra L5 (upper) .

3.      Right and left lateral planes:- passes through the mid inguinal point and crosses the tip of the 9^th coastal cartilage.

NINE REGION:- epigastric , umbilical, hypogastric, right and left hypochondriac, right and left lumbar (lateral) and right and left iliac(Inguinal).

(Median regions are….. Rt. & Lt. regions are……..)

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Skeletal System

SKELETAL SYSTEM

DEFINITION:

The framework of bones and cartilages that protects the organs and allows movement is called the Skeletal System.

TYPES OF BONES:

1.       Long Bones-Long Bones have greater length than width and consist of a shaft and a variable number of extremities (ends). Long Bones include those in the thigh (Femur), leg (Tibia and Fibula), toes (Phalanges), arm (Humerus), forearm (Radius and Ulna) and the fingers (Phalanges).

2.       Short Bones-Short Bones are somewhat cube shaped and nearly equal in length and width. E.g. - Carpal and Tarsal bones.

3.       Flat Bones-Flat Bones are generally thin and composed of two nearly parallel plates of compact bone enclosing a layer of spongy bone. Flat Bones afford considerable protection and provide extensive areas of muscle attachment. E.g. - Cranial Bones, Sternum and ribs, and Scapula.

4.       Irregular Bones-Irregular Bones have complex shapes and cannot be grouped into any of the three categories just described. E.g. - Vertebrae.

5.       Sutural Bones-Sutural Bones are small bones located within the joints (Sutures) of certain Cranial Bones.

6.       Sesamoid Bones-Sesamoid Bones are small bones that are embedded in tendons. E.g.- Patellae (Knee Cap).

DIVISIONS OF SKELETAL SYSTEM:

*        Total No. - 206

*        Acc. to Sushruta – 300

*        Acc. to Charaka – 360

Grouped in Two Principal Divisions-

1.       The Axial Skeleton.

2.       The Appendicular Skeleton.

THE AXIAL SKELETON:

·         The Longitudinal Axis or center of the human body is a straight line that runs through the body’s center of gravity.

·         This imaginary line extends through the head and down to the space between the feet.

THE APPENDICULAR SKELETON:

The Appendicular Skeleton contains the bones of the upper and lower limbs, plus the bones called Girdles whose function is to connect the limbs to the axial skeleton.

AXIAL SKELETON

1.       Skull- i) Cranium – 8,  ii) Face – 14

2.       Hyoid – 1

3.       Auditory Ossicles – 6

4.       Vertebral Column – 26

5.       Thorax- i) Sternum – 1  ii) Ribs – 24

SUBTOTAL= 80

                                                                             APPENDICULAR SKELETON

1.       Pectoral (Shoulder Girdles)-

                                 i.            Clavicle – 2

                               ii.            Scapula – 2

2.       Upper Limbs-

                                 i.            Humerus – 2

                               ii.            Radius – 2

                              iii.            Ulna – 2

                             iv.            Carpals – 16

                               v.            Metacarpals – 10

                             vi.            Phalanges – 28

3.       Pelvic (Hip) Girdle-

Hip, Pelvic, or Coxal Bone – 2

4.       Lower limbs-

                                 i.            Femur – 2

                               ii.            Fibula – 2

                              iii.            Tibia – 2

                             iv.            Patella – 2

                               v.            Tarsals – 14

                             vi.            Metatarsals – 10

                            vii.            Phalanges – 28

SUBTOTAL= 126

अस्थीप्रकार:एतानिपंचविधानिभवन्ति; तद्यथा–कपाल रुचक तरुणवलयनलकसंज्ञानि।-सुशा५/२२

·         कपाल– Flat Bones , eg – Skull Bones, Scapula, Hip Bone.

·         रुचक– Teeth.

·         तरुण–Cartilages, eg – Nasal Cartilage, Ear Auricle.

·         वलय– Vertebrae and Ribs.

·         नलक– Long Bones, eg – Humerus, Radius, Ulna etc.

The Rectum

THE RECTUM (उत्तर गुदम्)

1. AYURVEDA : a. Koshthang : It is one of the koshthang..

                                       b. Avayava : It is matruja avayava..

                                       c. Srotas : Annavaha & Punshvaha..

                         

2. INTRODUCTION : Length : 12 cm

The rectum is the distal part of the large gut. It is placed between the sigmoid colon above & anal canal below. The three cardinal features of the large intestine i.e sacculations, appendices epiploicae & taeniae coli are absent in the rectum. In the upper part it has the same diameter (4 cm) as that of the sigmoid colon, but in the lower part it is dilated to form the rectal ampulla.

3. DEVELOPMENT : The distal part of the hindgut is known as cloaca which is divided by the urorectal septum into primitive anorectal canal posteriorly & vesicourethral canal anteriorly.

Upper part of rectum i.e part above the middle fold of rectum, develops from endoderm of hindgut. This part is related to peritoneum. Lower part, below the middle fold is formed from the dorsal part of the cloaca. It is devoid of peritoneum..

4. LOCATION : It is situated in the posterior part of the lesser pelvis. The rectosigmoid junction (S3) to anorectal junction (in front of tip of coccyx).

❖  COURSE & DIRECTION :

The rectum runs first :-

         1. Downwards then backwards, 2 Downwards & 3. Finally downwards & forwards.

5. RELATIONS : a. Peritoneal :

                        1. The upper 1/3rd is covered with peritoneum.

                        2. The middle 1/3rd is covered only in front.

                        3. The lower 1/3rd which is dilated to form the ampulla which is devoid of peritoneum.

b. Visceral relations :

1. In males : Ant. – upper 2/3rd to the rectovescicle pouch. Lower 1/3rd to the base of urinary bladder, the terminal parts of the ureters, the seminal vesicles, the different ducts & the prostate.

2. In females : Ant – upper 2/3rd to the rectouterine pouch. Lower 1/3rd to the lower part of the vagina. (the pouch seperates rectum from the uterus & upper part of vagina.)

Posterior - (same in male & female) :

1. Lower 3 pieces of sacrum & coccyx. 2. Piriformis, the coccygeous & levator ani.  3. The median sacral, the superior rectal and the lower lateral sacral vessels..

6. MUCOSAL FOLDS : Two types of folds, 1. Longitudinal folds are present in the lower part of an empty rectum, and are obliterated by distention.

                        2. The transverse or horizontal folds : are permanent and most marked when the rectum is distended. A. Upper fold lies near the upper end of the rectum and projects the right or left wall. B. The middle or the largest fold lies at the upper end of the rectal ampulla and projects from the anterior and right walls. C. The lowest fold lies 2.5cm below the middle fold and projects from the left wall.

                         

7. FUNCTIONS : It’s distention causes the desire to defeacate.

8. A. ARTERIAL SUPPLY :

1. Superior rectal artery : It’s main artery (Branch of Inferior messenteric artery).

2. Middle rectal arteries : Branches of anterior division of internal iliac artery.

3. Median sacral artery : Small branch of aorta.

B. VENOUS DRAINAGE :

1. Superior rectal vein drain into inferior messenteric vein .

2. Middle rectal veins drain into internal iliac veins.

C. LYMPHATIC DRAINAGE :

1. Lymphatics from upper half drains into pararectal & sigmoid nodes.

2. Lymphatics from the lower half drains into iliac nodes.

D. NERVE SUPPLY : 1. Sympathetic – L1 & L2.  2. Parasympathetic – S2, S3 & S4.

❖  Supports of Rectum:

1. Pelvic floor.

2. Fascia of waldeyer : It attaches the lower part of rectum to the sacrum. ( condensation of pelvic fascia)

3. Lateral ligaments of rectum : Rectum to posterolateral walls of lesser pelvis.

4. Rectovesical fascia (of Denovilliers) : It extends from the rectum behind to the seminal vesicles & prostate in front.

5. The pelvic peritoneum.

❖  Applied Anatomy:

1. P.R. examination : A. In males - we can palpate prostate, seminal vesicles & vasa deferential.

B. In females - perineal body, cervix.

C. In both – anorectal ring, coccyx, sacrum, ischiorectal fossae.

                         

2. Proctoscopy & Sigmoidoscopy.

3. Prolapse of rectum : A. Incomplete - prolapse of rectum through the anus may occur following violent straining. This is due to imperfect support of the rectal mucosa by submucosa which is made up of loose areolar tissue.

B. Complete – is the condition in which the whole thickness of rectal wall protrudes through the anus. The contributory factors in its causation are : 1. Laxity of the pelvic floor.

2. Excessively deep rectovesical pouch.