Regional anatomy of abdomen

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Regional anatomy of abdomen

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Relations of abdominal viscera

• First layer-live, gallbladder, stomach
• Second layer-duodenum, pancreas, spleen
• Third layer-suprarenal gland, kidney, ureter,
  inferior vena cava, abdominal aorta, nerves and
  lymphatics

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Relations of the stomach

• Anteriorly
• Live (right part)
• Diaphragm (left upper part)
• Anterior abdominal wall (left lower part)
• Posteriorly-separated by peritoneum of lesser sac
  from the following (stomach-bed)
• Pancreas
• Left suprarenal gland
• Left kidney
• Spleen
• Transverse colon and transverse mesocolon

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Arteries of stomach

• Left and right gastric arteries
• Arise from celiac trunk and proper hepatic
  artery, respectively.
• These two vessels run in lesser omentum along
  lesser curvature , and anastomose end-to-end.

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Arteries of stomach

• Right and left gastroepiploic arteries
• Arise from the gastroduodenal and splenic
  artery, respectively.
• These two vessels pass into the greater omentum,
  run parallel to the greater curvature, and
  anastomose end-to-end.

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Arteries of stomach

• Short gastric arteries
• Branches of splenic artery
• Course through the gastrosplenic ligament
• Supply the fundus of stomach.
• Posterior gastric artery (72)
• Arise from the splenic artery
• Course through the gastrophrenic ligament and
  supply the posterior wall of fundus of stomach.

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Venous drainage of stomach

• Right and left gastric veins empty directly into
  hepatic portal vein.
• Left gastroepiploic and short gastric veins drain
  into hepatic portal vein via the splenic vein.
• Right gastroepiploic vein drain into superior
  mesenteric vein.

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Lymph drainage of stomach

• Right and left gastric ln. lie along the same
  vessels and finally to the celiac ln.
• Right and left gastroomental ln. lie along the
  same vessels, the former drain into subpyloric
  ln., the latter drain into splenic ln.
• Suprapyloric and subpyloric ln. receive
  lymphatics from pyloric part and finally to the
  celiac ln.
• Splenic ln. receive lymphatics from fundus and
  left third of stomach, and finally to the celiac
  ln.

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Nerve supply of stomach

• Parasympathetic innervation
• The anterior vagal trunk divides into anterior
  gastric and hepatic branches
• The posterior vagal trunk divides into posterior
  gastric and celiac branches
• The anterior and posterior gastric branches
  descend on the anterior and posterior surfaces of
  the stomach as a rule about 1 to 2 cm from the
  lesser curvature and parallel to it in the lesser
  omentum as far as the pyloric antrum to fan out
  into branches called crows foot to supply the
  pyloric part
• Sympathetic innervation
• Mainly from celiac ganglia
• Afferent and efferent fibers derives from
  thoracic segments (T5 -L1)

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Relations of duodenum

• Relations of superior part
• Anteriorly
• Quadrate lobe of live
• Gallbladder
• Posteriorly
• Common bile duct
• Gastroduodenal a.
• Hepatic portal v.
• Inferior vena cava
• Superioely
• Omental foramen
• Inferiorly
• Head of pancreas

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Relations of duodenum
Relations of descending part

• Anteriorly
• Live
• Transverse colon and transverse mesocolon
• Loops of small intestine
• Posteriorly
• Right renal hilum and ureter
• Right renal vessels
• Medially
• Head of pancreas
• Common bile duct and pancreatic duct
• Laterally
• Right colic flexure

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Relations of duodenum

• Relations of horizontal part
• Superiorly
• Head of pancreas
• Inferiorly
• Loops of small intestine
• Anteriorly
• Radix of mesentery
• Superior mesenteric a. and v.
• Posteriorly
• Right ureter
• Inferior vena cava
• Abdominal aorta

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Relations of duodenum

• Relations of ascending part
• Right Head of pancreas and abdominal aorta
• Left left kidney and ureter

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Blood supply of duodenum

• Arteries
• Superior pancreaticoduodenal a.
• Inferior pancreaticoduodenal a.
• Veins-follow arteries, draining directly into
  superior mesenteric and hepatic portal veins

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Relations of liver

• Diaphragmatic surface -separated by
  diaphragm from the following
• Right costodiaphramatic recess and lung
• Cardiac base
• Visceral surface
• Left lobe is related to the stomach and abdominal
  part of esophagus
• Right lobe is related to the right colic flexure
  anterioly, gallbladder and superior duodenal
  flexure medially, right kidney, superarenal gland
  posteriorly

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Divisions and relations of common bile duct

• Divisions
• Supraduodenal segment ??????
• Retroduodenal segment ??????
• Pancreatic segment ???
• Intraduodenal segment ??????

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Relations of common bile duct

• Supraduodenal segment
• Descends along the right margin of hepatoduodenal
  lig.
• To the right of proper hepatic a.
• Anterior to hepatic portal v.
• Retroduodenal segment
• Behind the superior part of duodenum
• Anterior to the vena cava
• To the right of the hepatic portal v.

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Relations of common bile duct

• Pancreatic segment
• Lies in a groove between posterior surface of
  head of pancreas and duodenum
• Intraduodenal segment
• Enters the wall of descending part of duodenum
  obliquely where jions the pancreatic duct to form
  the hepatopancreatic ampulla
• Opens at the major duodenal papilla

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Cystohepatic triangle (Calots Triangle)????

• Boundaries
• Common hepatic duct on the left
• Cystic duct on the right
• Live superiorly
• Content cystic artery

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The Pancreas ?

• Four parts
• Head
• Lies within the cancavity of the C-shaped
  curvatune of duodenum
• Uncinate process- a projection to the left from
  the lower part of the head behind the superior
  mesenteric vessels.
• Neck-narrow part, overlies the superior
  mesenteric vessels and beginning of the portal
  vein
• Body-triangular in cross section, passes upward
  and to the left across the midline
• Tail-extends to the hilum of spleen in the
  splenorenal ligament

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Relations of pancreas

• Head of pancreas
• Located in C-shapes curvature of doudenum
• Anteriorly
• Transverse mesocolon
• Posteriorly
• Inferior vena cava
• Right renal vessels
• Common bile duct

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Relations of pancreas

• Neck of pancreas
• Anteriorly-pylorus
• Posteriorly-beginning of hepatic portal v.

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Relations of pancreas

• Body of pancreas
• Anteriorly
• Separated from stomach by omental bursa
• Posteriorly
• Abdominal aorta
• Left suprarenal gland
• Left kidney
• Left renal vessels
• Spleen vein
• Superiorly
• Celiac trunk
• Celiac plexus
• Splenic a.

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Relations of pancreas

• Tail of pancreeas
• Runs in splenorenal ligament to reach hilum of
  spleen
• Accompanies with splenic vessels

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Relations of spleen

• Diaphragmatic surface-diaphragm
• Visceral surface
• Anteriorly-fundus of stomach
• Posteriorly-left suprarenal gland and kidney
• Inferiorly-tail of pancreas and left colic
  flexure

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Retroperitoneal space ????

• Position-it lies between the parietal peritoneum
  and transvers fascia of the posterior abdominal
  wall, from diaphragm to promontory of sacrum,
  continuation with extraperitoneal fascia.
• Contents
• Kidney
• Suprarenal gland
• Ureter
• Abdominal aorta
• Inferior vena cava
• Nerves and lymphatics
• Loose connective tissue

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Suprarenal gland ???

• Shape and position
• Right is pyramidal in shape, left one semilunar
  in shape, consisting of out cortex and inner
  medulla
• Located retroperitoneally, superomedial to
  superior poles of each kidney, enclose with the
  kidney by the renal fascia
• Blood supply
• Arteries
• Superior suprarenal a.
• Middle suprarenal a.
• Inferior suprarenal a.
• Venous drain
• Right suprarenal v. drains into inferior vena
  cava
• Left suprarenal v. joins left renal v.

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• Axial CT scan of the upper abdomen.
• On soft-tissue windows, to demonstrate
  retroperitoneal anatomy. IVC, inferior vena cava.

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Dissection
Live
Stomach
Gallbladder
Greater omentum
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Dissection
Omental foramen
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Dissection
Transverse colon
Right mesenteric sinus
Radix of mesentery
Ascending colon
Vermiform appendix
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Dissection
Transverses colon
Left mesenteric sinus
Radix of mesentery
Descending colon
Sigmoid colon
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Celiac trunk

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?You must identify follow structures!

• Stomach
• Lesser curvature
• Greater curvature
• angular incisure
• cardiac incisure
• Cardiac part
• Fundus of stomach
• Body of stomach
• Pyloric part
• Duodenum
• Superior part
• Descending part
• Major duodenal papilla
• Horizontal part
• Ascending part

• Large Intestine
• Colic bands
• Haustra of colon
• Epiploic appendices
• Cecum
• ileocecal valve
• Vermiform appendix
• Ascending colon
• Transverse colon
• Descending colon
• Sigmoid colon

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?You must identify follow structures!

• Liver
• Falciform lig. of liver
• ligamentum teres hepatic
• porta hepatic
• Notch for ligamentum teres hepatis
• Nothch for gallbladder
• Gallbladder
• Fundus of gallbladder
• Body of gallbladder
• Neck of gallbladder
• Cystic duct
• Right and left hepatic ducts
• Common hepatic duct
• Common bile duct

• Pancreas
• Head
• Uncinate process
• Neck
• Body
• Tail
• Peritoneum
• Lessor omentum
• Omental foramen
• Greater omentum
• Mesentery
• Mesoappendix
• Gastrosplenic ligament
• rectovesical pouch
• Rectouterine pouch
• Vesicouterine pouch

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?You must identify follow structures!

• Kidney
• Renal hilum
• Renal sinus
• Renal cortex
• Renal pyramid
• Renal papilla
• Minor renal calices
• Major renal calicle
• Renal pelvis
• Bladder
• Apex
• Fundus
• Body
• Neck
• Trigone of bladder
• Interureteric fold

• Ureters
• Peritoneum
• Lessor omentum
• Omental foramen
• Greater omentum
• Mesentery
• Mesoappendix
• Gastrosplenic ligament
• rectovesical pouch
• Rectouterine pouch
• Vesicouterine pouch
• Spleen
• Splenic notch

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?You must identify follow structures!

• Celiac trunk
• Left gastric artery
• Common hepatic artery
• Proper hepatic artery
• Right gastric artery
• Left and right branches
• Cystic artery
• Gastroduodenal artery
• Right gastroepiploic artery
• Splemic artery
• Short gastric arteries
• Left gastrioeploic artery
• Superior mesenteric artery
• Jejunal and ileal arteries
• Ileocolic artery
• Right colic artery
• Middle colic artery

• Inferior mesenteric artery
• Left colic artery
• Sigmoid arteries
• Superior rectal artery
• Renal artery
• Testicular (ovarian) artery
• Inferior vena cava
• Right and left renal veins
• Right suprarenal vein
• Hepatic portal vein
• Superior mesenteric vein
• Inferior mesenteric vein
• Splenic vein