Anatomy of the abdomen

• Abdominal cavity
• Anterolateral abdominal wall
• Peritoneum and peritoneal cavity
• Abdominal viscera
• Digestive system organs
• Spleen
• Urinary system organs
• Posterior abdominal wall
 Introduction
• Abdomen is part of the trunk between
the thorax and the pelvis
• It is a flexible, dynamic container,
housing most of the organs of the
digestive system and part of the
urogenital system
• The abdomen is able to enclose and
protect its contents while allowing the
flexibility between the more rigid thorax
and pelvis required by respiration,
 Abdominal cavity
• Located between the diaphragm and the pelvic
inlet
• Separated from the thoracic cavity by
diaphragm

• Continuous inferiorly with the pelvic cavity

• Undercover of thoracic cage superiorly
extend to 4th intercostal space
• Supported and partially protected inferiorly
by the greater pelvis

• Enclosed anterolaterally by multi-layered,

musculoaponeurotic, abdominal walls
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 Regions of abdomen
• Clinicians subdivide abdomen into 9 regions to locate
abdominal organs, pain sites, swelling or incision
• Delineated by 4 planes
• Two horizontal
• Subcostal plane: passing through inferior border of 10th costal
cartilage
• Transtubercular plane: passing through iliac tubercles and body
of L5 vertebra
• Two vertical
• Midclavicular planes: passing from midpoints of clavicles to
midinguinal points
Regions of abdomen
• For general clinical descriptions, clinicians divide abdomen into 4
quadrants defined by 2 planes

• Transumbilical plane: passing through umbilicus and disc between

L3 and L4 vertebrae

• Median plane: longitudinal plane dividing the body into right and left
halves
 Abdominal aorta:Location
• Continuation of thoracic aorta
• Lies in the midline against vertebral bodies
• It enters the abdomen through aortic hiatus at T12 and L1
level
• Ends at L4, left of the midline by dividing into the 2
common iliac arteries.
• The main continuation of the aorta is the median or
middle sacral artery
Abdominal aorta: Branches
• Subdivided into groups of 4:
• 3 unpaired visceral
• paired visceral
• paired parietal
• unpaired parietal
 Unpaired visceral branches
• Ventral branches; arise from
anterior surface
• Celiac trunk
• Superior mesenteric
• Inferior mesenteric
• Coeliac trunk:
• Foregut oesophagus to
Duodenum 2nd part
• Superior mesenteric
• Midgut Duodenum 3rd part to
distal 1/3 transverse colon
• Inferior mesenteric
• Hindgut distal 1/3 transverse
colon to upper 2/3 of rectum
 Inferior Vena Cava
• Returns blood from
lower limbs, abdominal
wall and abdominopelvic
viscera

• Begins in front of the

body of L5 by union of
common iliac veins

• Pierce the central tendon

at T8 forming vena caval
foramen
 Tributaries
• Ventral tributary: right testicular or ovarian vein
• Lateral tributaries: renal and right suprarenal and hepatic
veins
• The left where the suprarenal and gonadal veins open
into the left renal vein
• Tributaries from the body wall: the inferior phrenic and
lumbar veins
• the median sacral opens into the left common iliac vein
Lymphatic drainage
• Lymph from the posterior abdominal wall drain into
right and left lumbar lymph nodes (lie along the aorta,
IVC)

Efferent lymphatic vessels from the large lumbar lymph

nodes form the right and left lumbar lymphatic trunks.

Cisterna
chyli

Thoracic Duct
 Peritoneum and peritoneal cavity
• All ventral body cavities contain serous
membranes
• It lines the abdominopelvic cavity and invests
the viscera
• Two layers
• Visceral peritoneum: covers the external surface
of most digestive organs
• Parietal peritoneum: lines the walls of the
abdominopelvic cavity
• The parietal peritoneum is served by the
same blood and lymphatic vasculature and the
same somatic nerve supply as is the region of
the wall it lines
• Parietal layer is sensitive to pressure, pain,
heat and cold, and laceration

• The visceral peritoneum and the organs it

covers are served by the same blood and
lymphatic vasculature and visceral nerve
supply.

• The visceral layer is insensitive to touch, heat,

cold, and laceration
 Peritoneal cavity
• Between the two layers is the peritoneal
cavity,

• A slit like potential space containing fluid

secreted by the serous membranes

• The serous fluid lubricates the mobile

digestive organs, allowing them to glide
easily across one another as they carry
out their digestive activities
 Peritoneal and retroperitoneal organs
• Intraperitoneal organs are almost completely
covered with visceral peritoneum (e.g.,
stomach and spleen).

• Extraperitoneal, retroperitoneal, and

subperitoneal organs are also outside the
peritoneal cavity—external to the parietal
peritoneum—and are only partially covered
with peritoneum
• E.g. kidneys
 Peritoneal folds
• Peritoneum contains large folds that weave between
viscera
• The folds binds organs to each other and to the walls
Mesentery
of abdominal cavity

• A double layer of peritoneum that encloses small

intestine to the posterior abdominal wall
• Mesenteries provide routes for blood vessels,
lymphatics and nerves to reach the digestive
viscera
• Mesenteries also suspend the visceral organs in
place as well as serving as a site for fat storage
 Cont…
• The small intestine mesentery is usually
referred to simply as “the mesentery”;
• however, mesenteries related to other specific
parts of the alimentary tract are named
accordingly—for example,
 Transverse and sigmoid mesocolons
 Mesoesophagus
 Mesogastrium
 Mesoappendix
 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
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
Lesser
sac
 lesser omentum
• Is a much smaller, double-layered peritoneal
fold

• It connects the lesser curvature of stomach and

proximal part of duodenum to the liver.

• The lesser omentum contains the major hepatic

vessels –bile duct, portal vein, hepatic artery
and gastric vessels

• Its free edge forms the boundary between the

greater and lesser sacs at the omental foramen
• Falciform ligament: a double layer of peritoneum that
connects the liver with the anterior abdominal wall.
 Subdivisions of peritoneal cavity
• Transverse mesocolon and transverse
colon divides peritoneal cavity into Supracolic
and Infracolic compartments
Supracolic compartment
• Containing the stomach, liver, and spleen
Infracolic compartment
• containing the small intestine and ascending and
descending colon
• lies posterior to the greater omentum
 Division of Peritoneal cavity
• The peritoneal cavity is
divided into the greater
and lesser peritoneal
sacs.

• The greater sac is the

main and larger part of
the peritoneal cavity.

• The omental bursa

(lesser sac) lies
posterior to the
stomach and lesser
omentum
 The Digestive
system
Function:
• The digestive system performs 6
basic processes:
• Ingestion: taking in food
• Secretion: water, acid, buffers and enzymes
• Mixing and propulsion: mix food and secretions
and move materials
• Digestion: break down food into nutrient molecules
• Absorption: entrance of the nutrient molecules into the
bloodstream
• Defecation: removal of indigestible remains
 Organs
• The organs of the GIT
• Mouth
• Pharynx
• Esophagus
• Stomach
• Small and large intestine
• The accessory digestive
organs
• Teeth
• Tongue
• Salivary glands
• Gallbladder
• Liver
• Pancreas
 General description of digestive
process
• Absorption of nutrients occurs principally in the small intestine

• Most reabsorption of water occurs in the ascending colon.

• Feces form in the descending and sigmoid colon & accumulate

in the rectum before defecation.

• Peristalsis, a series of ring-like contraction waves, begins

around the middle of the stomach and moves slowly toward the
pylorus.
Function
• Mixing the masticated (chewed) food mass with gastric juices
• Emptying the contents of the stomach into the duodenum.
 Esophagus
 Muscular tube, food passage
between pharynx and stomach
 Has about-25 -30 cm long
 Extends from the level of C6-
T11
 2-3 cm in the abdominal
cavity
Three part
 Cervical
 Thoracic
 Abdominal
Pierces the diaphragm at the
•level
Joins
of Tstomach
10 at gastroesophageal junction
Arterial supply
1. Cervical part– inferior thyroid arteries
2. Thoracic part – esophageal branches of thoracic aorta
3. Abdominal part – esophageal branches of left gastric artery
Venous drainage
1. Upper part – brachiocephalic veins
2. Middle part – azygos veins
3. Lower end – left gastric vein (portal drainage)
Lymphatic drainage
•Cervical – deep cervical lymph nodes
•Thoracic- posterior mediastinal lymph nodes
•Abdominal – left gastric lymph nodes

Nerve supply – autonomic

Parasympathetic
 Upper ½ - recurrent laryngeal nerve
 Lower ½- esophageal plexus (formed by the two vagi)
Sympathetic
upper ½ - middle cervical ganglion
Lower ½- upper 4 thoracic ganglia (esophageal plexus)
 Stomach
• The stomach is involved in the whole range of digestive
activities
• Serves as a holding area for ingested food
• Breaks down food further chemically and mechanically
• Delivers chyme to the small intestine at a controlled rate
• Produce HCL, pepsin, protein digesting enzyme

• Is the J-shape sac & most expandable parts of digestive

tract that stored, mixes, & digests the ingested nutrients.

• Digestion mostly occurs in the stomach and duodenum

 Stomach: Gross Anatomy
• The diameter and volume of stomach
depend on how much food it contains
• Empty may contain 500 ml
• But can expand to hold about 4 liters of
food

• When empty, the stomach collapses

inward, throwing its mucosa into large,
longitudinal folds called rugae

• Is covered entirely by peritoneum

 Stomach
• In supine position it
located in the left upper
quadrant at the left
hypochondriac and
epigastric regions of the
• 4abdomen.
major region of the
stomach
• Cardia:
• Fundus:
• Body:
• Pyloric region:
• 2 curvatures
Greater and lesser
curvatures
 Stomach: Blood supply
• Rich blood supply
• Arterial supply
• From celiac trunk and its branches

• The arterial arch on the lesser curvature is formed by

• Right and left gastric arteries

• The arterial arch on the greater curvature is formed by

• Right and left gastro-omental (gastroepiploic)
arteries

• Fundus and upper body receive blood from short and

posterior gastric arteries
Venous drainage: Gastric veins parallel the arteries
• Left and right gastric veins drain into portal vein
• Short gastric veins & left gastro-omental veins drain into splenic
vein
• Right gastro-omental vein drain into superior mesenteric vein
Innervation
Parasympathetic
Anterior vagal trunk and Posterior vagal trunk
• Sympathetic – T6-T9 through greater splanchnic nerves

Gastric lymph nodes and

Gastro-omental lymph nodes
• Lymph from stomach drains
into
Celiac lymph nodes
 Small Intestine
• Major digestive organ

• In the small intestine, usable food is finally prepared for its

journey into the cells of the body

• Here digestion is completed and virtually all absorption

occurs

• However, this vital function cannot be accomplished

without the aid of secretions from the liver (bile) and
pancreas (digestive enzymes)
 Small Intestine
• Convoluted tube extending from pyloric sphincter in the
epigastric region to the ileocecal valve

• It is the longest part of the alimentary tube, but its

diameter is only about 2.5 cm

• In cadaver, the small intestine is 6 - 7 m long because of

loss of muscle tone, while it is only 2 - 4 m long in living
individual.
• Has three subdivisions
• Duodenum
• Jejunum
• Ileum
 Duodenum
• C- shaped
• Curves about the head of the pancreas
• The shortest, widest and most fixed part of small
intestine
• It extend from the pylorus to the duodenojejunal
flexure
• Has about 25 cm length
• Is retroperitoneal except the first part
Parts of duodenum
• First part
• Duodenal cap or bulb

• Second (descending) part

• where the bile duct and
pancreatic duct join the
duodenum through the
ampulla of Vater

• Third part (inferior or

transverse)

• Fourth part (ascending)

 Duodenum
Features associated with Duodenum
• Bile duct: receive bile from the liver

• Main pancreatic duct: carries pancreatic juice from the pancreas

• Hepatopancreatic ampulla: union of bile duct and main pancreatic

duct in the wall of the duodenum

• Sphincter of Oddi: at opening of hepatopancreatic ampulla

• Major duodenal papilla: elevation formed when hepatopancreatic

ampulla enters the duodenum
 Arterial Supply of Duodenum
• Celiac artery
Gastroduodenal artery: Superior Pancreaticoduodenal
• Superior Mesenteric artery: Inferior Pancreaticoduodenal (Anterior and
Posterior)
The veins of the duodenum follow the arteries and drain into the hepatic
portal vein, some directly and others indirectly, through the superior
mesenteric and splenic veins
The nerves of the duodenum derive from the vagus and greater and
lesser (abdominopelvic) splanchnic nerves by way of the celiac and
superior mesenteric plexuses.

Lymphatic drainage
• The anterior lymphatic
vessels drain into the
pancreaticoduodenal
lymph nodes,

• Then to pyloric lymph

nodes

• The posterior lymphatic

vessels drain into superior
mesenteric LN

• Celiac lymph nodes

 Jejunum
Mainly in left upper quadrant

Responsible for absorbing most of the intestinal contents

2 ½ meters long

Extends from the duodenum to the ileum

Twists back and forth within the abdominal cavity

Makes up the proximal 2/5th of the small intestine

 Ileum
Is longer than the jejunum
More in right lower quadrant of abdomen

3 ½ meters in length
No sharp division from the jejunum

Specialised function is to absorb bile salts and vitamin

B12
Joins the caecum at the ileocecal valve
The jejunum and ileum are suspended from the posterior
abdominal wall by the fan shaped mesentery
• The jejunum and ileum hang in coils in the central and
lower part of the abdominal cavity
 Small Intestine: blood supply
Arterial supply
• Superior mesenteric artery: supplies the jejunum
and ileum via jejunal and ileal arteries
Venous drainage
• The veins run parallel to the arteries and drain
into superior mesenteric vein

• From the mesenteric vein, the nutrient rich

venous blood from the small intestine drains
into the hepatic portal vein which carries it to
the liver
 Lymphatic vessels
• Specialized lymphatic vessels in the intestinal villi that absorb fat are
called lacteals

• They empty their milk-like fluid into the lymphatic plexuses in the
walls of the jejunum and ileum

• Within the mesentery, the lymph passes sequentially through three

groups of lymph nodes
 Juxta-intestinal lymph nodes
 Mesenteric lymph nodes
 Superior central nodes

• Efferent lymphatic vessels from the mesenteric lymph nodes drain to

the superior mesenteric lymph nodes
 Small Intestine: innervation
• Parasympathetics: from the vagus nerves
• Sympathetic: from the splanchnic nerves
These are relayed through the superior mesenteric
and celiac plexus
Large Intestine
• The large intestine frames the small intestine on three
sides and extends from the ileocecal valve to the anus
• About 1.5 meters long
• Two main functions:
1. Reabsorption of water and electrolytes from indigestible
food residues to turn semi liquid small intestinal contents
into formed faeces

2. Store & eliminate stool from the body as semisolid feces

Over most of its length,
the large intestine
exhibits three features

• Teniae coli
• Haustra
• Epiploic appendages
• Teniae coli
• Three bands (narrow strap) of smooth muscle that run the
length of the large intestine
• Because the teniae (= ribbon or tape) are shorter than the
intestine the colon becomes sacculated between the teniae
forming “haustra”
• The teniae fuse at the appendix (useful in locating the
appendix)
• Haustra
• Pocket like sacs formed by the tonic contraction of the teniae
coli
• Epiploic appendages
• Small fat-filled pouches of visceral peritoneum that hang from
its surface
• Small, fatty, omentum-like projections
• Significance is not known
Large Intestine: subdivisions
• Cecum with appendix
• Colon
• Ascending colon
• Transverse colon
• Descending colon
• Sigmoid colon
• Rectum
• Anal canal
Cecum
• The first part of the large intestine
• Saclike blind pouch
• Lies below the ileocecal valve in the right iliac fossa

• It is an intraperitoneal structure

• The cecum is continuous with the ascending colon at the

entrance of the ileum

• The appendix is attached to the posteromedial wall of the

cecum, just inferior to the end of the ileum
 Appendix
• Is a blind intestinal diverticulum and
• Narrow hollow muscular tube which
connected to the cecum by a triangular
mesentery mesoappendix
• Contains the appendicular vessels, large
masses of lymphoid tissue, short and few
glands
• Has about 6-10 cm in length
• Has no teniae coli
• Because it is blind-ended, its contents are
not renewed rapidly thus it becomes a
 • Innervation lower thoracic part
of the spinal cord, and vagus
nerves via the superior
mesenteric plexus

McBurney’s point
• The appendix is
normally situated at
McBurney’s point
• 1/3 of the way along a line
from the anterior superior
iliac spine to the umbilicus
Location appendix
• Is highly
variable.
• It may be
found:
• (1%)
• (0.5)
• (64%)
• (32%)
• (2%)
 Colon
• The colon extends superiorly from the cecum and
consists of the ascending, transverse, descending,
and sigmoid colon
• Ascending & descending segments are
retroperitoneal
1 . Ascending
• Transverse colon:-
and sigmoid segments are intraperitoneal
Extend from cecum to the right lobe of the liver
in 25% of people, has a short mesentery.
12.5 cm length

2. The descending colon

lies between the left colic flexure and the left iliac
fossa.
3. Sigmoid colon
• Begins above the pelvic inlet and extends to the
level of vertebra S3, where it is continuous with the
rectum
• Is S-shaped structure
• Quite mobile except at its beginning where it
continues from the descending colon, and at its end
, where it continues as the rectum
•4It. Transverse colon
is suspended by the sigmoid mesocolon
• Is the third, longest (50cm), and most mobile part of the
large intestine
• It crosses the abdomen from the right colic flexure to
the left colic flexure.
• Being freely movable, the transverse colon is variable
in position, usually hanging to the level of the
 Rectum
• Extending from the sigmoid colon is the rectum
• Internally are transverse folds called rectal valves
• Rectal valves separate feces from flatus, thus
allowing gas to pass
 Anal canal
• The continuation of the large intestine inferior to the
rectum
• Lies entirely external to the abdominopelvic cavity
• About 3 cm long the canal begins where the rectum
penetrates the muscles of the pelvic floor

• The anal canal has two sphincters

• External anal sphincter (skeletal muscle) : Voluntary
• Internal anal sphincter (smooth muscle): Involuntary

• These sphincters which act to open and close the anus, are
ordinarily closed excepts during defecation
Select this paragraph to edit
Select this paragraph to edit
 Accessory Organs of the
Digestive System
A) Liver
Is surrounded by the peritoneum
Functions of liver:-
Detoxification
Destruction of spent aged RBCs
Synthesis of bile
Synthesis of plasma proteins, heparin
Metabolic activities
Liver: gross anatomy
• Reddish, blood rich & the largest gland in
the body
• Weighing about 1.5 kg in the average adult
• Lies mainly in the right upper quadrant of
the abdomen deep to ribs 7-11 on the right
side
• Occupies the right hypochondriac and
epigastric regions
• Protected by thoracic cage and diaphragm
Relation:-
• Superior: diaphragm
 Liver: gross
anatomy
• The liver has four lobes; right, left,
caudate and quadrate

• Falciform ligament separates the right

and left lobes anteriorly and suspends
the liver from the diaphragm

• Running along the free inferior

edge of the falciform ligament is
the ligamentum teres, a remnant
 Cont.
• Has two surface:-
• Convex
diaphragmatic
• Concave visceral
Portal triads
include:-
portal vein
hepatic artery
bile duct
from posterior
to anterior
 Liver receive blood from:-
Hepatic artery (20%) oxygen rich blood
Portal vein (80%) nutrient rich
deoxygenated blood some times toxic
nutrient containing blood
Liver cells secrete bile - right and left
hepatic ducts-form common hepatic duct
Common hepatic duct and cystic
duct(From gallbladder)- will form
common bile duct
 Gallbladder
• Thin-walled, pear-shaped green
muscular sac
• 10cm length and 3cm width
• Store and concentrate bile
• Lies in a shallow fossa on visceral
surface of liver
• Expels bile when acidic chyme enters
the duodenum or as a result of
cholecystokinin release
Blood
supply
• Cystic artery a
branch of the
right hepatic
artery
• Cystic veins
drain into the
portal vein
 All venous blood from the abdomen drains into
the portal vein and into the liver

The Inferior mesenteric vein drains into the Splenic vein which joins the
Superior mesenteric vein to form the Portal vein
 The portal venous system
• The portal vein is formed by the union of the
splenic vein and the superior mesenteric vein
posterior to the neck of the pancreas at the level of
vertebra L1.
• Blood from the intestine is nutrient rich
• It all drains into the portal vein which flows into the
hilum of the liver
• On approaching the liver, the portal vein divides
into right and left branches, which enter the liver
 The portal veins
• The portal vein then
branches eventually
forming the liver sinusoids
that perfuse each liver cell
• After processing by the
liver cells, the blood is
collected again in the
hepatic veins which flow
into the inferior vena cava
and on to the right atrium
• Other tributaries to the
portal vein include:
• right and left gastric veins
Portacaval system (portosystemic
anastomosis)
• Connections between portal and systemic
venous systems
• The sites of anastomosis are:
• Gastroesophageal junction
• Between esophageal veins draining into the
azygos vein (systemic) and left gastric vein
(portal)
• When dilated results in esophageal varices
• Anal canal
• Between rectal veins, the inferior and middle
draining into the inferior vena cava
(systemic) and the superior continuing as
 Cont.
Anterior abdominal
wall around the
umbilicus
• Paraumbilical
veins (portal)
anastomosing with
small epigastric
veins of the
anterior abdominal
wall (systemic)
• These may
produce the "
caput medusae
Portal hypertension
• If portal vein pressure is very high (e.g.
in cirrhosis), the portal blood cannot all
get through the liver
• Back pressure in the portal vein opens
up small pre-existing connections
between the portal venous system and
the systemic/caval venous system
• Blood then bypasses the liver through
these connections
• Anastomotic veins become engorged,
dilated, or varicose; as a consequence,
B) Pancreas
• Is a soft, lobulated, tadpole-shaped mixed
gland
• It extends from the duodenum to the spleen.
• Is retroperitoneal
• lies deep to the greater curvature of
stomach and situated in the posterior
abdominal wall
• Mixed gland, contains both exocrine and
endocrine
• Exocrine portion secret pancreatic juice
• Endocrine portion (islets of
• Parts
• Head
• Expanded part
• Embraced by C-shaped curve of
duodenum
• Neck
• Overlies superior mesenteric
vessels
• Body
• Main part
• Tail
• Related to hilum of spleen
• Structure
• Highly lobulated
• Invested by thin collagenous capsule which
 Blood supply and innervation
• Artery
 Pancreatic arteries
from splenic artery
 Pancreaticoduodenal
arteries from hepatic
and superior
mesenteric artery
• Vein:
superior mesenteric
veins
• Nerves
• From vagus and
splanchnic nerves
 Spleen
• Lies the left upper quadrant, or left hypochondrium,
of the abdomen deep to rib 9-11.
• Is intraperitoneal purplish color, oval shaped
lymphoid organ
• Is the most frequently injured organ in the abdomen.
• Has about 180-250gram weight
Function:-
Provide immune response
Lymphocyte proliferation (B&T cells)
Destruction of aged erythrocytes and platelets
Recycling iron and globin
RBC formation in early fetal life and reservoirs of