We got to the pyloric valve here and all of a sudden we couldn't really see, we couldn't see the, uh, we couldn't see the small intestine anymore. So the small intestines starts after the pilot pyloric valve and then the Jejunum is over here. The jejunum is here. What's in between? It's behind the bag. [inaudible] what's in between is the duodenum and the duodenum is behind the bag. Here's one aspect of it is look, I've got the DJ junction right here. The transition point from the duodenum to the Jejunum.
The transition point from retro peritoneal to intra peritoneal. Inside the bag behind the bag, inside the bag, all this inside the bag, the bag of the peritoneum, the bag of the parietal peritoneum behind the bag. Okay, behind it, behind the Mezzo Colon here we have this tunnel, the TJ junction in this tunnel, and I've got the transverse colon here and this is the only thing that's really intervening at this point. If we peek here, look, I've got my transverse colon, I've sketched it out of the way and we can see simultaneously the DJ junction here and I just scooch my transverse colon over and I'm looking at the pylorus here, the pylorus and the DJ junction with the transverse colon running in between them. So if I were to peel away the peritoneum here, we'd see two things. We'd see our duodenum and the head of the pancreas
I'm tracing the duodenum here and here it's like a c at this point. Can you see the Duodenum, the first loop of the small intestine and I'm fluffing the duodenum now just tearing away all the peritoneum [inaudible] from draw it and the now you can see the duodenum getting, having its edge flopped up here. Sort of peeling up the duodenum off of the spine. Here we've got our transverse colon and our stomach stomach too by Laura, part of the stomach to the pylorus cross, the border of the peritoneum, which has been torn away into the duodenum. The duodenum is
I'm noticing what's overlying this transition point. It's the superior mesenteric artery. See the superior mesenteric artery here on the portal vein here, two of them together. It's a busy place. And we see then that this root of the mesentery is vascular root of the mesentery. Like a twisting point.
We can just get my finger through here. I've got the vascular route, the whole bouquet, the vascular route of the bouquet immediately over lives that draw no juvenile junction where the intestines from their retro peritoneal place. You're good to around the duodenum here. When we get to the Latin, the end of the Duodenum, then we slide under these vascular roots. It's the mesentery and there we are out on the [inaudible], which we can follow forever.
So when the watery cam comes into the SICAM here, this is a grand dehydrator bag and it draws the water off and concentrates the material inside until it becomes what we refer to as a feces. So we come from our SICAM and once we, we pass out of the boldest quality of this dehydrator back here and we go up, we just ascend for a little bit and we ascend, we go northward towards the liver. Here would go head word towards the liver, the incident ascending colon, but, but then a colon c, it's, it's a quite wide, so wide bag here. It's wide and floppy and it's having a joint with the liver and where it bent, where it begins here at the liver, we call it the hepatic flexor. So we have the SICAM, the ascending colon. This is the ascending portion.
Then at the ascending colon transitions to the transverse colon. We call that the hip paddick Fletcher, the bend that deliver hepatic Fletcher means nothing more than the bend at deliver. So the the intestine, Ben's that deliver the large intestine and we come across the body seek, um, a sending colon hepatic flexture transverse colon. We follow the transverse colon here and there's always little bitty tabs coming off of here. And these little bitty tabs, these little fat tabs around everybody. We come across the transverse colon here or working our way along the, the greater omentum of course, which we pull up a greater our greater omentum. And then we see the skin, the Ph, the visceral peritoneum of the transverse colon, uh, uh, arising into the greater omentum here or descending, depending upon which way you hold it.
So our transverse colon comes across and it's a continuous, you're going to pull our small intestines out of our view here. Now we're filing the transverse colon across and it bends again, it bends right here. It takes a little turn and starts going down. Now where does it bend? It bends at the spleen. And the spleen. O Colic at the splenic, we had the spleen Okalik ligament where it ties in together, the spleen in the colon and we can just see this grand pathway from the transverse colon sweeping down past the spleen. At which point we're no longer a sending now or descending.
So we have our descending colon here, the descending colon and we're, and I've got the peritoneum here and I had been previously here. So the descending colon, we keep going, we keep going, we get to the brim of the pelvis now and we take a term and it changes name again. This is called a sigmoid calling me cause this is the part of the colon. It's like a sigma or or an s form as it sorta swirls past the anterior superior Iliac spine and into the deep pelvis. So they call that, it's like an ask form going down and then up and around. So the sigmoid colon from the descending, all these different names seek um, a ascending colon, hepatic flexure, transverse colon, splenic Fletcher, descending colon, sigmoid colon, rectum. These are all just geographical points along a common pathway of the large intestine, which is nothing more than uh, uh, the, uh, the larger part of the tube, which is the, the, the tube from the mouth of the anus and we're headed towards the anus.
So I'll scoop my small intestines out here a bit and we can see all of these little tabbies, these little fluidity tabs of fat along here. And right at this point we looked at, we sort of disappear here, we disappeared, but I know that, I know that, that the, the rectum is in here somewhere. So if I scoop of, I scoop my hand down here, I can, I can pull up and I see that there's, there's another, there's another little loop in here. So the rectum isn't particularly wrecked, meaning straight in this case, right? Cause it comes down here is deep to the peritoneum. Now, and I could slide my hand in here and I see we have another, just another loop. It's doubled back on itself right here before it goes straight out the anus. So that's the path.
Much as the superficial fashion envelops the whole body. The preserved tissue reveals the particularly fluid quality of the alimentary pathway as the muscle tissue is flacid. I always make a point to palpation along the entire length of the god of every body that I dissect both to appreciate its continuity and to note it's relationships. This particular form had endured numerous surgical interventions, the upshot of which were numerous adhesions, both intentional and accidental.
Having finally sorted out and undone the various adhesions of the small intestines, we can now see the transition point from the small to large intestines at the ileocecal valve, the internal transit from the Ilium to the SeaComm. Unlike the pyloric valve which has a substantial thickness to its muscle wall. The ileocecal valve is a more simple and less dense configuration gathering up the loops or the small intestines at their root. The intestines never fail to impress me as both a form of nature as well as an incredible repository of intelligence. Got Intelligence at a physical level, coordinates myriad physiological events in our world at an emotional level.
Got Intelligence, indicates our relationship to events in our outer world. Tracing the path of the colon, we can anticipate now it's somewhat predictable circuit around the abdominal space. Even though the quality of the tissue is very fluid, not to mention its contents, the normal structural orientations are maintained. That orientation is a function of completed development in relationship to the surrounding tissues. The peritoneal ligamentous relationships within the colon enable us generally to predict its position here.
While the position is normal, I find an adhesion of the descending colon to the parietal peritoneum. This adhesion, while it does represent something of a fixation of the tissue, has no profound bearing upon the normal position of the organ itself. That having been said, there are numerous known positional variation, some with developmental origins. One being that the sequin is undescended and so found noticeably higher in the abdomen as in this example, the second was visible at the thumb of the white gloved hand as the costal margin is reflected. One consequence of this variation is that the ileocecal valve is closer to where one would normally find the hepatic Fletcher.
This example of that variation has an exceptionally long Verma form appendix as well visible at center frame as a thin prolongation of tissue on the bottom edge of the [inaudible] and wandering along the posterior abdominal wall to the tip of the right blue glove. The contingencies of every particular form should serve as an important reminder to anyone who does visceral work. Why don't you to avoid being overly committed to one's mental projection of where things should be in the body. Variety is the spice of life and actual bodies. Always Trump textbook. Generalizations that drawings in the books are averaged over thousands of bodies and therefore actually portrayed no one individual.
The average images appoint us towards the general idea, but every body brings to the table its own version of the truth.
Do we see that? Now what we see is peritoneum. See this para can look, I'm getting my hand behind the peritoneum because the kidney is retro peritoneal and this is the proof of it. Here's the parents and, and then the kidneys down here. But where is the kidney bean? It is always
This massive tissue, we call it subserosal fashion, you say, but that's not fascia. Fascia is white and shiny, and I'm telling you that this is a loose aerial or Fascia with fatty deposition, just like the superficial fascia that surrounds the whole body. We can think of the kidney as a homonculus. It's a little man or a little woman inside of our body and just like the greater man or greater woman, it's surrounded with a fatty body around it and that's the subserosal fashion. I think it's best friends with the superficial fashion. So if I get my hands now underneath the whole mass of the kidney here, look at that. So Big Oregon, when we include the Fascia around it, and if I look right here, I see well go liver, which has it's sliding surface
It sits on top of the fashion. Now, if I to intrude into this space with my finger, I can open up the space where that famous shape is hiding here. See, look, peel it back and the kidney is encapsulated within another Fascia. The renal capsule. As I push away, the subs are also fashioned here to create a window into more famous tissue. I don't think we can rank the importance of the tissues of our body as we have become accustomed to. I think that all the tissues work together. I want to go and find that adrenal friend and there is the tip of it right there. I see a little brown color there. That's not the kidney.
Kidney is over here, but look, there's a little brown tip here. I can scratch away here a little bit and sure enough, what am I on? Now
The skin of the kidney, the renal capsule, I probably the other organs, we have a skin on this organ. As I work my way around it, I feel that skin and I see there's a, it doesn't seem to be related in the same way to the Subserosa Fascia that the adrenal gland is does it? I don't see if I go this way, I don't get strings coming off of it. Right. I have this very nice tidy capsule and I just broke there. But then when I go back to the adrenal gland itself, we have this corona of vasculature that relates the adrenal gland to the surrounding fashion. Well, as I peel, we might as well have a peek at this. Yeah, thank you. I'll have a peek at this and we'll see right here. A great vessel, an incredible vessel, inferior Vena Cava. I'm looking for that blonde, Oregon. Let's see.
There we go. Yeah, right here. Here's the aorta here. Yeah, so the aorta is wider, right, so that makes sense. So that's our renal vein here going on with the draining the kidney, kidney to renal vein, and then up here that maybe in a cave is
Now there are vessels in there of course, and just remember the kidney is retroperitoneal, so now that's easy. I break through the Mezzo Colon and what am I on? I break through a fatty layer and I encounter a fatty layer rather than a peritoneal. I break through the peritoneal fatty layer. That is the mezzo colon in reveal, the fatty layer. That is the subserosal fascist surrounding the kidney on the left side.
But I'm getting my hand underneath the subserosal fashion fluffing up from behind. Now one thing I've also learned about the peritoneum is that it wraps around the kidney so that the kidney is under it, but it's also above it in the back, you know, skin it in some sense it's deep to it, but it's circumambulating by, it was like he'll look on peeling peritoneum. So here's what we learned about those vessels. The vessels are in the para to medium, but the peritoneum itself is highly vascular. Look at that beautiful, gorgeous, because have something that's amazing. [inaudible] peritenoneum. Yeah, the fatty layer and the fiber slayer or the Cirrus membranous wire. That's pretty cool.
I'm going to break those connections so we can get the bigger picture. Oh look, here we have a little window through the subserosal also fascia onto the kidney itself. Can you see this beautiful, these beautiful vessels. I'll have to look over here at the right. We have to look for our left adrenal gland. I've just peeled away the parents and now and I can see this change of color and I free to completely adrenal gland, kidney inside of its subserosal fashionable body.
And then we work our way into the excellent. All right, well we opened the kit, we opened the subserosal fashion to find the capsule and then we can open the capsule. I'm pushing the subserosal Fascia away from the kidney pushing, pushing. Sure. And as I do so I'm that I have the adrenal
See how I'm killing the capsule here? Yes, the capsule is over my thumb. I'm pulling at it and I expose them to parent-time of the kidney, the kidney tissue itself. There's that incredible organ, so important to our life. When we see then the capsule here and if we come close to it and see as many little beautiful blood vessels spotting and dotting their way through here,
But also I'm suggesting for communication, this capsule C is still adherent to the subserosal fashion. They're built into each other. So you have to add to appeal the, the capsule away from the subserosal fashion. And I have to appeal the kidney away from the [inaudible]
The whole group of them together slide up and down with the breath.
We can appreciate the close positional and ligamentous relationships of these tissues. The preserved ovaries of this elderly woman are perfectly intact. The uterine tubes have several inches of length extending laterally from the Fundus of the uterus, which is draped in the spanning peritoneal covering. Each uterine tube has a frilly top in the living. These FIM Bray dynamically pal pate the ovary to draw the emergent egg through the small opening at their center.
Thus bringing the egg from the abdominal space in which the ovaries lie into the pelvic space and the uterine interior. The uterus itself demonstrated here is relatively small in the elderly. It's more pair sized in the younger woman. The transition of hormonal expression results in the shrinkage of the tissue dropping to a deeper dissection of the same form. We can see how her left ovary and FIM Bray directly over live lower abdominal portion of her soul as muscle. The, so as is a famous favorite target for the attention of massage therapists and structural integrators who would do well to be aware that in addition to having the ovarian articular veins and the ureteric draped across it, there may well be an ovary perched there as well.
All of which cry out for caution to the overzealous hand. You wouldn't want to pin those tissues. That would be to your client's detriment. The ligaments of the ovary, like most visceral ligaments are folds or spans of the peritoneum. The South Pingo ovarian ligament is the parents' Neal tissue.
Here relating the ovary to the uterine tube. The uterus is positioned between two other pelvic organs, the urinary bladder and the rectum. The urinary bladder lies deflated and buried within its peritoneal and loose area or coverings between the pubic bones and the uterus, the rectum curls neatly within the deep pelvic space posterior to the uterus. Not only was this form completely intact in terms of the organic structures, there were also no presenting adhesions. All the tissues were free and mobile relative to each other.
The tiny awesome of the uterine tube testifies to the near miraculous passage each one of us has undergone to blossom into the fullness and perfection of our human form. Having enjoyed the clarity of shape afforded by the preserve tissues we've just observed, we can have a look at the uterus or the unpreserved tissue to demonstrate some of the sequelae of surgical intervention, adhesion and pathology and pelvic space.
Isn't that nice round looking under the uterus. So it's within the peritoneum. The uterus is sub peritoneal or in the pelvic space. So as we create tension on the, on the round ligament, it pops up for us. And interestingly, if there were a pregnancy here and the uterus became very large, then the round ligament would stretch and stretch and stretch on either side, like a giant slingshot.
So we have the ovary here over reason. Abdominal Oregon, the uterus is a pelvic organ and the communication between them happens through the office of the uterine tube.
So I'm gonna Hook under the round ligament on side and follow the trajectory of pool as a draw as the England [inaudible] inguinal canal here. Feel about them right hand and also, yes, see I'm tugging you over here. They're round ligament on this side and this pathway and the round ligament here on this side going through the inguinal canal, much like the spermatic cord and grounding until the and major. So if I scratched through the broad, like I meant here some more, we'll work our way into pelvic space. So I use my probe and draw back the tissues and now I can pal, pate feel, yeah. Servants.
The neck of the uterus down this way. No. The fundus embodied and the neck of the uterus and from behind. No, we've read it up quite completely. Got a real clear sense of viewers here. I'm tractioning the colon and it's pulling up the uterus.
So we see how these pelvic organs that are working together, the bladder, the uterus and the rectum. So I'm going to pull a little, I see a little bit of adhesion here between the, the ovary and the at the Plone like a little brain. See it's Silk Seas and Gyri. It reminds me of the intestines as well. What uh, arises from the ovary, the egg, the poorer potential cell. That's incredible. Wow. That's just fantastic. What a treat.
If I Peyto down and not feel the texture of an ovary, I feel this bubble and perhaps the bubble is the ovary and the tissues have dissolved into it, but I also don't see the break or the uterine tubes. No. See the Fundus and body of the uterus around ligament on the left round ligament on the right. Assist on the right ovary on the left. What an incredible array of tissues.
Is that true or is that just the arcane portion of tests and seem to have a free talk? Does it see, so I'm going to have to do a little tugging there. We see there is a normal continuity by let's seem to be adhering and I ain't going to have to peel it away, filling away the long from the chorus, so now it's free. See the difference. You see how there was material connecting the parietal Pleura and the visceral Pleura and that will make for a limitation on the movement of the long.
That should be a free sliding aspect, right? So I have to, it's gotten some strength to it, Huh? There we go. Now it's the free.
And I'm separating them because they're adherent in this form. Although there are normally sliding surfaces and when I do that and I sort of slowly released the long from the central structures and look, it's also adherent down here to the diaphragm. This whole long is adhered and all sorts of ways and I'm freeing up these adhesions with my hands because blunt dissection is I just, you run my finger through here to create freedom where there would normally be freedom. So now we see the top of the diaphragm on this side having moved the lung out of the way and in the top of the diaphragm on this side. So look, now we have a clear sense of all the abdominal contents and how high up they come. Now what's this is seems like a fatty body in the central portion of the thorax.
And people often say at this point, where's the thymus? And I indicate these a lobular fatty bodies right here and say, well that's the remnant of the thymus right here. These lobules where fatty substance has displaced over time, the thymus tissue, which was at its largest when she was about five years old. So where's the heart? We have our lungs, we're in the thorax, we're above the diaphragm. It must be deep to some of this loose aerial or Fascia that's surrounding it.
And I can use my fingers and open that loose Fascia. I'll reveal the fibrous wrappings of the heart. That's incredible, Huh? So soft. And we all have a little fatty deposition around our heart. We remember she was large in her abdomen, but this isn't very much fat here.
Just a little filmy Fascia, a little fatty filmy Fascia, and now we see this Oregon inside. My Gosh, the fiber's pericardium is translucent. We can see right through it. Is that incredible? Oh, holy cow. When they're in the embalmed tissue, you normally can't see, right? You can't see through there. It's, it's opaque and it's dried. But here it's translucent and I can see the heart and imagine it's motion.
This fibrous pericardium, the wrapping here around the heart is continuous with the diaphragm. And at this point they are a common fabric. Look, I'm pulling on the diaphragm. I'm pulling on the fibrous pericardium. Every beat of your heart and every emotion of the diaphragm constitute a common motion.
We created these images having fried the presenting adhesions. The air induces the spiraling motions native to the living organs, even without the action of the diaphragm and play. The heart is lifted upon the inflating pillows of the lungs because the breath is introduced from without and the lung movements are not contained as they normally are by the bony rib basket. The internal massage of the heart induced by a full inhalation would involve a contact even more thorough going than we are now witnessing, not to mention the downward motion induced by the added of the diaphragm. Seeing these movements bring me to a level of heightened awareness with respect to the movements within me even in this moment, and I hope they do the same for you.
Some 20,000 times a day we breathe and are so moved. The quality of the motion induced by the breath is dependent upon a host of factors, not least of which is ones
The normal motion of the liver occurs both through the shortening of the fibers of the respiratory diaphragm as well as through the simultaneous filling of the lungs whose expansion naturally displaces the surrounding tissues. The liver cannot help but move and then its movements are as a matter of course translated further through every tissue proximate to it.
And you see this sac, this is a double layered sac. It's the fibrous pericardium on the outer surface. And then on the inner surface it's the parietal pericardium. So I'm going to open up this space and expose the surface of the heart. See how I introduced air and they're opening up. The fibrous pericardium is very thin, double sack, fibrous pericardium. And this cirrus right here, the parietal pericardium well creates a window into the heart space.
It's an incredible place. My heart space. Oh my gosh, it's so beautiful. And you brought up a little higher in here. Now we see beautiful center of Motion Afar, right? Anything within our chest, soft to supple Oregon. It's incredibly soft and tender. When we see windows on the heart musculature through the visceral pericardium, this scan of the heart, which has sad embedded in it, that fat is surrounding the cardiac arteries as they wind their way to the heart musculature.
So this inner surface of the sac around the heart would be the parietal pericardium. And then this services that visceral hair cardium and we see some of these immediate features. The oracle on the right side, the heart's orientation as it is in the chest. Here we have the the right atrium, right ventricle is centrally oriented and the left ventricle is on the left side. So where is the left atrium that's in the back so that the vessels from the lungs are feeding the heart from behind like this. And if we displaced the heart upwards, we can see that pathway of the venous return.
And here we have the venous return coming from low down from the liver. We have the Vena Cava in Quebec right here, VA draining the lower part of the body. And then we'll have, that's the inferior Vena cave. And then we'll have the superior Vena Cava right here. Superior Vena Cava from above the inferior VNK Brown from below, draining the blood into the right atrium, to the right ventricle, out the pulmonary trunk to the lungs, to the venous drainage of the lungs, spraying the oxygenated blood into the left atrium and down to the left ventricle and out the aorta. So where is the aorta? It's in a metal right here. Yeah, your day is this large vessel here. It's deflated.
It's very large. If I disrupt the tissue a little bit, I can actually get my finger around it. And they see the breadth of the aorta coming and arking out of the top of the heart here and this great crazy Straw of motion that is this central place where the blood spins itself.
So now we can talk that away and see the lungs in relationship to the heart out of ITSAC and see how every motion of a breath implies itself into the heart space. And every motion of the heart generates an impact of percussive motion on the liver, beating through the hollow space of the stomach and echoing its waves reiterating into the fort very form of the rib cage there like waves in a puddle that going out from this hard space. My fingers are the ribs, so the wave forms leaving this hard space and communicating into a space us are very feelings. Pulmonary trunk, the Aorta and the superior Vena column is three major major vessels. The heart itself, very beautiful on the inside and on the outside. Look at these incredible vessels here, those branches. Have we seen that somewhere else? Sure.
Just look out the window plane. You'll see the rivers and streams down below. As you pass over where you see the very shape of the mountains. You see the mountain ridge and then the ridges coming off the mountains. The mountains themselves are like rivers on our planet, so incredible because the water runs from the top down the bottom and carves up the mountains and leaves these very identical impressions as these vessels in our bodies, which are nothing more than the life of water on our planet moving through us and here they're feeding the heart.
Now when we see the heart's so soft and supple, I hope it intrudes a little bit upon our descriptions of the heart as a pump, right? When have you ever seen a pump that had this quality? It just adds to my, my appreciation of the incredible dynamics spiraling motion of the blood. When I see how flexible us a central place, it moves through. All right, so there's no rigidity here in the nature of the form. If there's rigidity, it's from the way we hold ourselves, but the nature of the form itself is completely, um, motion, capable fluid. Thank you. Fluid. That's it.
This is a place of fluid motion and I get it. I can feel it in my hands. What a fantastic place for fluid to move through. It's just, I never felt anything like