Regional anatomy of abdomen

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 Relations of abdominal viscera

First layerlive, gallbladder, stomach

Second layerduodenum, pancreas, spleen
Third layersuprarenal 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)
Posteriorlyseparated 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.
Veinsfollow 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.
Necknarrow part, overlies the
superior mesenteric vessels and
beginning of the portal vein
Bodytriangular in cross section,
passes upward and to the left
across the midline
Tailextends 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
Anteriorlypylorus
Posteriorlybeginning 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
surfacediaphragm
Visceral surface
Anteriorlyfundus of
stomach
Posteriorlyleft suprarenal
gland and kidney
Inferiorlytail of pancreas
and left colic flexure

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 Retroperitoneal space
Positionit 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
Left branch Left gastric a.

Right branch Short gastric a.

Common
hepatic a.
Cystic a. Splenic a.
Right gastric a.

Proper hepatic a.

Gastroduodenal a.
Splemic branches

Left gastroepiploic a.
Right gastroepiploic a.
Superior pancreaticoduodenal a.
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 Middle colic a. Superior
Mesenteric v.

Inf. pancreaticodudenal a.
Superior
mesenteric a.
Right colic a.

Jejunal and ileal a.

Ileocolic a.

Appendicular a.

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 Inferior mesenteric v.

Inferior mesenteric a.
Left colic a.

Sigmoid a.

Superior rectal a.

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 You must identify follow structures
Stomach Large Intestine
Lesser curvature Colic bands
Greater curvature Haustra of colon
angular incisure Epiploic appendices
cardiac incisure Cecum
Cardiac part ileocecal valve
Fundus of stomach Vermiform appendix
Body of stomach Ascending colon
Pyloric part Transverse colon
Duodenum Descending colon
Superior part Sigmoid colon
Descending part
Major duodenal papilla
Horizontal part
Ascending part

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 You must identify follow structures
Liver Pancreas
Falciform lig. of liver Head
ligamentum teres hepatic Uncinate process
porta hepatic Neck
Notch for ligamentum teres Body
hepatis Tail
Nothch for gallbladder Peritoneum
Gallbladder Lessor omentum
Fundus of gallbladder Omental foramen
Body of gallbladder Greater omentum
Neck of gallbladder Mesentery
Cystic duct Mesoappendix
Right and left hepatic ducts Gastrosplenic ligament
Common hepatic duct rectovesical pouch
Common bile duct Rectouterine pouch
Vesicouterine pouch

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 You must identify follow structures
Kidney Ureters
Renal hilum Peritoneum
Renal sinus
Lessor omentum
Renal cortex
Omental foramen
Renal pyramid
Greater omentum
Renal papilla
Mesentery
Minor renal calices
Mesoappendix
Major renal calicle
Renal pelvis Gastrosplenic ligament

Bladder rectovesical pouch

Apex Rectouterine pouch

Fundus Vesicouterine pouch
Body Spleen
Neck
Splenic notch
Trigone of bladder
Interureteric fold

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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
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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