Anatomy of The Abdomen
Anatomy of The Abdomen
Anatomy of The Abdomen
• INGUINAL CANAL.
• HIATAL HERNIA.
• The abdominal cavity is contained in a fibrous membrane called
PERITONEUM.
• There are 2 types of peritoneal lining: Parietal peritoneum and Visceral
peritoneum separated by a space btn them called peritoneal cavity/ space
containing peritoneal fluid.
Parietal peritoneum: Deep lining/ internal surface of abdominopelvic wall.
Visceral peritoneum: Invests the viscera e.g. stomach & spleen
Intraperitoneal organs are
almost completely covered with
visceral peritoneum (e.g., the
stomach and spleen).
Intraperitoneal in this case does
not mean inside the peritoneal
cavity (although the term is used
clinically for substances injected
into this cavity).
Extraperitoneal [retroperitoneal,
and subperitoneal] organs are
also outside the peritoneal cavity/
external to the parietal
peritoneum and are only partially
covered with peritoneum (usually
on just one surface).
OMENTUM
• Omentum is a double-layered extension or fold of peritoneum that passes from the
stomach and proximal part of the duodenum to adjacent organs in the abdominal cavity.
• It is divided into greater and lesser omentum.
NB- Omentum also plays a role in immunity to localize intraperitoneal infections and
prevent spread.
• The greater omentum is a prominent, four-layered peritoneal fold that hangs down like
an apron from the greater curvature of the stomach and the proximal part of the
duodenum. After descending, it folds back and attaches to the anterior surface of the
transverse colon and its mesentery.
• The lesser omentum is a much smaller, double-layered peritoneal fold that connects the
lesser curvature of the stomach and the proximal part of the duodenum to the liver. It
also connects the stomach to a triad of structures that run between the duodenum and
liver in the free edge of the lesser omentum.
clinical anatomy
• RECTUM: Plays a role for temporary storage of feces until passed out during
defication. When it distends, the persons feel urge to deficate.
- It is the largest of the lymphatic organs, it participates in the body's defense system as a
site of lymphocyte (white blood cell) proliferation and of immune surveillance and
response ie clearing of encapsulated bacteria.
- Blood cell formation (hematopoiesis) in utero and early childhood.
- Clearance of old, abnormal blood cells and non functional blood cells from the
circulation.
- The spleen serves as a blood reservoir, storing RBCs and platelets, and, to a limited
degree, can provide a sort of “self-transfusion” as a response to the stress imposed by
hemorrhage.
NB:
01. In spite of its size and the many useful and important functions it provides, it is not a
vital organ (not necessary to sustain life).
02. When it is hardened and enlarged, it moves inferior to the left costal margin, and its
superior (notched) border lies inferomedially.
• Arterial supply: The arterial supply of the spleen is from the splenic artery,
the largest branch of the celiac trunk.
• Venous drainage from the spleen flows via the splenic vein, formed by
several tributaries that emerge from the hilum. It is joined by the IMV and
runs posterior to the body and tail of the pancreas throughout most of its
course. The splenic vein unites with the SMV posterior to the neck of the
pancreas to form the hepatic portal vein.
Clinical anatomy
• Splenomegally.
• Splenectomy.
PANCREAS
• The pancreas is an elongated, accessory digestive gland that lies
retroperitoneally, overlying and transversely crossing the bodies of the L1
and L2 vertebra.
• It lies posterior to the stomach between the duodenum on the right and the
spleen on the left.
• Function of pancreas: Pancreas has both an endocrine and exocrine functions.
- Endocrine function; secretes insulin and glucagon via Inslet of langerhan
cells (plays role in glucose metabolism).
- Exocrine function; secretes digestive juices (lipase, amylase, protease etc)
via acinar cells.
• For descriptive purposes, the pancreas is divided into four parts: head, neck,
body, and tail.
• The main pancreatic duct begins in the tail of the pancreas and runs through
the parenchyma of the gland to the pancreatic head: here it turns inferiorly and
is closely related to the bile duct.
• The main pancreatic duct and bile duct usually unite to form the short, dilated
hepatopancreatic ampulla (ampulla of Vater), which opens into the descending
part of the duodenum. [sphincter in ampulla of vater = sphincter of Oddi]
• Arterial supply: The arterial supply of the pancreas is via pancreatic arteries
which are branches from tortuous splenic artery.
• Venous drainage: Venous drainage from the pancreas occurs via
corresponding pancreatic veins, tributaries of the splenic and superior
mesenteric parts of the hepatic portal vein; most empty into the splenic vein.
LIVER
• The liver is the second largest organ in the body after the skin.
• It weighs approximately 1500 g and accounts for approximately 2.5% of adult
body weight. In a mature fetus when it serves as a hematopoietic organ, it is
proportionately twice as large (5% of body weight).
• Due to its many key functions, the liver is considered vital (necessary for life
and body functions).
• The liver lies mainly in the right upper quadrant of the abdomen, where it is
protected by the thoracic (rib) cage and the diaphragm. The normal liver lies
deep to ribs 7–11 on the right side and crosses the midline toward the left
nipple. The liver occupies most of the right hypochondrium and upper
epigastrium and extends into the left hypochondrium.
• The liver has 2 main lobes: right and
left lobes.
NB- Hepatic portal vein system: portal vein → liver → hepatic vein → IVC.
• The hepatic portal vein collects blood with reduced oxygenation but rich in
nutrients from the abdominal part of the alimentary system, including the
gallbladder and pancreas, as well as the spleen, and carries it to the liver.
• Within the liver, its branches are distributed in a segmental pattern and end in
expanded capillaries, the venous sinusoids of the liver.
• Portal–systemic anastomoses, in which the portal venous system
communicates with the systemic venous system includes:
i. Veins in the submucosa of the inferior esophagus.
ii. Veins in the submucosa of the anal canal.
iii. Veins in the peri-umbilical region.
iv. Veins on the posterior aspects (bare areas) of secondarily retroperitoneal
viscera.
• When portal circulation through the liver is diminished or obstructed because
of liver disease or portal vein pathology, blood from the gastrointestinal tract
can still reach the right side of the heart through the IVC by way of these
collateral routes.
NB- These alternate routes are available because the hepatic portal vein and its
tributaries have no valves; hence blood can flow in a reverse direction to the
IVC. However, the volume of blood forced through the collateral routes may
be excessive, resulting in potentially fatal varices (abnormally dilated veins).
Clinical anatomy
• Hepatitis
• Chronic liver diseases and liver failure
• Hepatomegally
• Portal hypertension
• Gall stones: cholelithiasis [in gallbladder] vs choldocholithiasis [in
CBD]. Risks- 5F = fat, female, fertile, forty, fair.
• Cholecystitis: “+ve murphy sign”.
• Cholangitis: charcot’s triad.
• Obstructive jaundice.
QN
• Elaborate blood supplies to the:
1. Small intestine
2. Large intestine
3. Liver
4. Spleen
• Name the
structures labeled:
• Name the vessels labelled:
Thank you
(ahiJn)