po RTAL vE No u s sysrEM

;i$1i!g;rlj.,:=
The hepatic portal vein collects btood from the abdominal reduced in oxygen. The btood is processed through the liver
gastrointestinal tract as wetl as the spteen, pancreas, and before moving through the hepatic veins to the inferior vena
gatlbladder and carries it to the liver. This blood is rich in cava and the heart.
nutrients from absorption through the small intestines, but

# coioi áicn o¡tie fáii¿Nvini;li;ciirii usinj a iWiáni'iái,lor ¡iir eai,itt,

@ 1. Hepaticpartatvein: Drains venous blood fronr the gas- S9.

Rightcalicvein
qallblaslder
trointestinal tract, splqen , pa?creas-, and &19. Middle colicvein
to the Wer.lt forms anterior to the inferior vena cava
and posterior to the neck of the pancreas. Thesuperior The superior mesenteric vein atso receives btood from
mesenteric and splenic veins unite to form the hepatic the pancreaticoduodenal veins and variably from the inferior
porlalvein, with the inferior mesenteric vein joining at
mesenteric vein.
or near the junction of the two veins.
@ 2. §pfenicvein drains venous blood primarily from areas g 11. lnferiarmesentericyein drains venous btood primarity
supptied by the splenic artery including the spteen, from areas supplied by the infericr mesenteric artery,
stamach, and pancreas: including the desce!¡ilinE c"olan, sigmoid colqn, and
c> 3. Leftgastro-omentalvein superior rectum:
e 4. §frorf gástricvein ?^12. superíor rectalvein
ClS. Sigmaidvein
The splenic vein also receives blood from the pancreatic e1a. Láftcolicvein
veins and variabty from the inferior mesentericvein. g 1 5. Righf and Ieft gastricveins typical§ drain directty into
the hepatic portalvein or into the splenic vein because
O §. Superior rnesentericveir drains venous biood primarily there is not a venous equivatent to the cetiac trunk.
from areas supptíed by the SMA, inctuding the dusdenum,
pancreas, smatl intestine, geqgm, qppendix, ascendina
cal.oq, and transverse coion:
C 6. Ríg ht gastra*o m e ntal veí n
@Y.Jejunaland ileal
Q8. lleocalicvein
 PORTAI. VENOU§ §Y§TEM ABDOMEN t6r

rs-Noyrr:rS ir$ y cter.

$crStr{ro\

z.\hrn eptr nrco

.lefrl ffUlr tco Orto

s. Vetln rH$hcronrc,ulüal
. u t¿q.
\(no ocrr{ro-orwYthl s. Verur rrex**pi"¡ro S,rp.
^
@ rr. {¿vn wv¡¿n*+virrr ivr G.

a. t&m t\mroltrn

{ }r"ru lti
 162 Abdomen

ffi PoRTAcAVAL sYsrEM

Fortions of the hepatic portal venous system and the caval venutes, where structures and organs that drain portally are
venous system are shown. Communication between the portal in ctose proximity to structures and the body watl that drain
venous system and the caval system occurs at the level of the through the caval system.

ffi ¿ó¿óR ilh lrinifálilirii;iiiliiálilñ á ariiili ioi;; ro;;;;i,

The following areas of the caval system are most tikety to
communicate with the hepatic portal venous system:

Q 1, lnferiorvenacava lll. Recta[

@ 2. Common iliac vein: Right and left unite to form the ()1A. Middle and inferior rectalyeins: Drain anal canai and
inferior vena cava lower rectum to the internal itiac artery (caval)
@ 3. Externaliliacyein: Drains lower limb and unites with
Q 1 1. Supe rior rectal vain: Dra i ns rectu m to i nferior mesen -
interna[ iliac vein to form common í[!ac vein teriqvein (portat)
@ 4. Inüernaliliacvein: Drains the pelvis and perineum and
unites with external itiac vein to form the cornmon iliac lV. Retroperitoneal
vein
@12. Retroperitoneal yeins: Veins of posterior abdominat
Q S.Azygosvein
wall drain into inferior vena cava
There are four sites of portocaval (pomat-systemic) @ 13. Colic yerhs: Veins draining the ascending and descending
colon drain into the portalvein and are in ctose approx-
anast0moses:
imation to the veins of the posterior abdominalwall
l. Esophageal
@ 6. Esopáageatveinsi Drain into azygos vein (caval) The-hÉpatie portal vein:cair]es - 1 50ú mLlmin of blood to the tiver. Obstruc-
@ 7. Left gastric vein: Esophageal branches (portal) ¡jan sf pórtat venousftow, commonly from cirrhosis, results in an increase
in po-rtal venous pressure. Normal portal vein pressure is between 5 and
ll. Umbiticat '10 rnrn Hg:,Complicatbns suchas varices and ascites acclr at '12 mm Hg
.or §reater. Asthe pressure riseE in the hepatic portat vein, the pressure
§8. Epigastricveins: Drain umbilicus and anterior abdominal aiss.rises in iUtributaries. The increased votume of blood in the tributaries
watl to branches of external iliac vein {cavat) ma¡4,produce varicose vrins (entarged, gnarted veins), especiatty at the
lo<ations of .portacaval anastomoses. The veins may become so en[arged
9.
@ Paraumbilicalveins: Course from umbiticalarea with thqt their ryetls r:upture. resulting in hemorhage that may be fafal in the
round ligament of liver to portal vein cáse óf'ruPtUr€d esophageal varices.
 PORTACAVAL §YSTEM ABDOMEN rs

z Vern-ErdrUa irq

Superior mesenteric vein

r. \lun0 rnur tn f
lnferior mmer¡teric vein

{pur r} rYnhi lica tp q

rr Vprqs dl'ro!
s. r
frYcr
rz. Verrnq t¿#.ryr.ihn¿Al¿5
¿=i
,-r-7?¡'\
\
¡,.
,,,'ltl N/'i
l[-#:f,
2.

¿.Y¿m rtrhm rn}¿vn¿l

tbnCU
11. \klu rrc{ol SUp.
a. efr$rr{rlr't

ro. NüqJ f¿elnkJ Ynedll

t lnFer[ur

( ]l¡iiri
164 Abdomen PO§TERIOR ABDOMINAL WALL

" r'.' ,. ,,r FOSTERIOR ABDOMINAL WALL

The abdominal portion of the gastrointest¡nal tract has been origin from the abdomina[ aorta. The pancreas, ga[lbtadder,
removed, except the descer¡dins and §lgryq§-colgn The celiac and liver have also been remsved, with the áepatrc veins cut
trunk and superior mesenteric arleries have been cut near their as they drained to the inferior vena cava.

COI"OR eac h of the fotlowing structures using a different calar for each:

@ 1. Abdominal aarta: Begins at the aortic hiatus of the @ 9. Suócostalarteries: Paired arteries that arise inferior to the
diaphragm at T'12 and ends at the levet of L4 vertebra SMA and course along the inferior aspect of the l Zth rib
by dividing into the right and leftSEvrngnü¡1_ertetrlg§ @10. Mediansacralarte4y: Arises from the posterior aspect
of the aorta immediately superior to the bifurcation of
The abciominaI aorta gives rise to several branches: the aorta and descends atong the sacrum into the pelvis
@11. lnferiorvena caua; Begins anterior to the L5 vertebra
o 2. Celiactrun&: Arises immediately below the aortic hiatus by the union of the camma! iliqFvei!!§
of the diaphragm
C3" Cad¡ac ganglion: Collection of postganglionic syrn- Most veins of the posterior abdominalwa[[ drain into the
pathetic celi bodies at the base of the celiac trunk inferior vena cava:
ínvotved in sending postganglionic sympathetic fibers @12. Ríghtrenalvein
along the branches of the celiac trunk to foregut e13. Rightgonadalvein
structures and spleen C14. Lefirenal yein; Courses anterior to the aorta and
e 4" S u peri or m e se nte ri c a rteryr: Ari ses i m med iately i nferio r posterior to the SMA to drain into the inferior vena
to the celiac trunk and passes anterior to left renalvein cava. Receives the venous draÍnage of the fotlowing:
along with the third part of duodenum and uncinate C'l 5. Left gonadal vein
process of pancreas (not shown) @16. Left suprarenal vein
@ 5. lnferiarmesenüeric artery: Arises one vertebral [eve[ S17. Rightkidney: Related to the liver, duodenum, and as-
superior to the bifurcation of the aorta into the common cending coton anteriorly
iliac arteries @tA. Leftkidney: Related to the stomach, spleen, pancreas,
B 6. Renalarteries: Paired arteries that arise immediate§ jejunum, and descending colon anteriorly
inferior to the SMA and initially course posterior to the qJ19. Ureter; Muscutar ducts that run inferiorly from the
renalveins renal hilum tCI pass over the pelvic brirn into the petvis
c 7. üothat arise(testicular/ovarian)
nadal
between the
arferies: Pai red arteries to the bladder
r)ZA. Right suprarenal g{and: Pyramidat shaped; situated
renal arteries and the inferior
rnesenteric artery and course inferiorty over the superior aspect of the right kidney
@ 8. lnferiar phrenic arteries; Paired arteries that arise at the QZ1 " Lefr. su p ra re n a I g land: Crescent sha ped ; si tu ated med ial
[eve[ of the celiac trunk and course atong the inferior to the superior aspect of the teft kidney
aspect of diaphragm
 u. flYktie n¿nt¿o-inl ñ Wnr. §{twc,vre,t¡fl\ rtq.
z *vnnco rpldneo
,,. Glor'&rto qufYawtr'ül t¿+'

openinssof
s Av\qviu F«him i[F

rz. tiñón
ds
,. novf0
qbdornmol
t§. _
13.
rs. Vrrtl gp,tú)
deh ,t ¿4.-

g. Atkrtq, rs.Llf€k&
xtbrulu.l¿¡
z. Avlettq
Descending
C'
colon

il
Common iliac t'l ll
arterie§
íii
l¡
,i.

u. t ttxrrkrffi ir,S

Sigmoid colon

z Ar\¿¡rrru
$orvt\alaS

io Arl*io socrn wYdto'

( il'iuÉs
 Abdomen KTDNEY

ln Figure A, a portion of the anterior aspect of the kidney has structures within the sinus. Figure B depicts a coronal section of
been removed to reveat the space of the renalsinus and the the kidney denronstratingthe internat structures ofthe kidney.

fi COIOR ea ch of the following straüures uslng a dlfferent calor for each:

@ 1. Ffürouscapsule: Adhered to the surface of the kidney a g. Renalpelvis: Merging of ¡¡,ro to three major calyces to
;) 2. Ranalcorfe¡r: Outer portion of the kidney deep to the form the superior ditated portiCIn of the ureter within
fibrous capsule the space of the renal sinus
S l. neralcolumn:Extension of the renal cortex interiorty O10. UreterFormed by the narrowíng of the renal pelvis
between the renat medullary pyramids 6ptt. Perinephriclaf; Surrounds the kidneys, renal vessets,
f 4. Renalmedulla:lnnermost portion of the kidney usua§ and cotlecting system {illing the renal sinus
segmented
f,) 5. Renat pyramids: Typical formation of renal medulla in
between the renal columns
(} 6. Renalpapilla: Apex of the renal pyramid that protrudes kr'-If re¡. ne;is,talgertlran
and excretes urine into a minor calyx P$s¡qn. of **. n¡uccular tube
includ§s.§udd*¡
) 7. Minarca$x: First component of the co[ectingsystem y md anteÍorly with or
that forms the ureter to 85% of kidnev stones
ü 8. Majorcalyx: Merging of two to four rninor ca§ces

,t: ,,:-t:1
i::.,i_r
': - .. . . ,'
,1,:,
|'...: ail. I : i,:i-r-l.,.ir'
 z. B,t ttro vrnel

o Miduto r¿nal

, §elulg &nal-
, ftrl-uzn tetul
u fl¿nol ?opilo
q
- !-ai¿'Í ¡. '¡j. ^!
--E{. ,'dü
*- .. s , R¿nol folurnn
1ñ l),veIpv

J Q.+rnl h\urnnn
,0. Uvehrr

, C¡ilir úanov

B n Pelvig renol { ir"i¡;¡l!

 t6S Abdomen NERVE§ AND MU§CLE§ OF POSTER¡OR ABDOMINAL WALL

ffi NERvES AND Musctss oF posrE*ron ABDoMINAT wArr

Abdominopelvic cavity contents have been removed to reveal the teft, the psoas major muscte has also been removed to
the muscles and nerves of the posteriCIr abdominat wat{. On
reveatthe formation of the lumbar ptexus.

ffi COIOR e ach of the following structures using a different colar for each:

Muscles of the Posterior Abdsminat Watt

t . Psoas major muscle; Lies lateral to the lumbar vertebrae

1

and passes inferotateralty deep to inguinal ligament to

@ 3. /liacus muscle: Lies lateral to the inferior part of the
psoas major muscle, with most of its fibers joining the
the tesser trochanter of the femur psoas major to form the itiopsoas muscte
@ ?.. Psaas¡nínor muscle; Lies superficialto the psoas rnajor, qp 4. Quadratuslumbaru*t: Lies lateralto the superior part of
if present the psoas major muscle and mediatto the trarrsyersus
abdominismusele

; Psoas major Transverse processes of Lesser trochanter of Anterior rami of L1-13 '1.
Acting with iliacus,
¡

I
lumbar vertebrae and femur fiexes thigh
i vertebral bodies T1 2-15 2. Acting superior§,
flexes vertebrai coiumn
lateraily
i Psoas minor Vertebral bodies of Pectineal line and Anterioi rami of Ll-12 Balances the trunk with
T12-11 itiopectineal eminence psoas major
Superiortwo-thirds of Lesser trochanter of Femoralnerve (12-14) Acting with psoas majo¿
iliac fossa and ala of femur flexes thigh
sacrum
i Quadratus iurnbarurn Mediat hatf of 12th ribs lliac crest Anterior rami of T12 and Extends and laterat§
and tumbar transverse L1 -14 flexes vertebral column
processes

Nerves of Posterior Abdominal Watl (p 8. €eritof,emoralnerve: Forms f¡'om L] to 12, pierces the
@ 5. Su&costalnewe: Anterior ramus of T1Z that arises in the psoas major, courses atong its anteríor surface, and
thorax, passes posterior t o the lateral arcuate tiqament divides into qenital and femaral branehes
of the diaphragm, and courses inferotaterall_v on the $ 9. lareralcutaneausnerveofthethígá; Arises from L2 to
anterior surface of quadratus lumborum 13, runs lateratto the psoas major and atong the anterior
surface of the iliacus muscte to enter the thigh deep to
Lumbar plexus is composed of the anterior rami of Ll-14 the inguinaltigament
and forrns severat named branches: (}'10. Fentoraf,nerve: Forms from LZ to 14, runs deep to the
psoas major, and then emerges from the lateraiborder
{} 6. ttiahypagastricnerve: Branch of the anterior ramus of L1; of the psoas major to pass deep to the inguinal tigament
enters abdomen posteriorto ryegliAlarguatellqArqE rÍ to the anterior thigh
and ccurses inferolateratly on the anterior st¡rface cf OII. Obturatornerve;Arises from L2 to 14, emerges medial
the quadratus lumborum inferior to the subcostal nerve tü the psoas rnajor, and passes into the lesser petvis
Q Z ftioinguinalnervs: Branch of anterior rarnus of L1; (}12. Lumbosacraltrunk: F'órms from L4 to L5 passing over
enters abdomen posterior to medial arcuate ligarnent the ala of the sacrum, descends into the lesser pelvis,
and courses inferolateralty on the anterior surface of and participates in the sacral plexus
quadratus [umborum i¡ferior to the iiiohypogastric nerve
 ABDOMEN

Aortic hiatus'
Left crus of diaphragm
Right cru§ o{

Medial arcuate
Lateral arcuate ligameni
ligament
s. \le-YVF a. @rrrrrtYct{¡'s I r, rnboturn
Subco)tol

6. hlPXUn

rliohiPorpslvtro
N¿YUÍ}
z. t\oln$utnol

t-r#*r*sB
s.i,;a&:k§btt
i.ie§.i* # *kf. z. ttgtuln ?soo,
t\,tlrU{o rwJ1Ór
8.gültt'tf,s¿Ymtor

r.t{rf5{rdn prodf
t¡rolY9Y
s. ttñsuto thao

Psoas major
muscle (cut)

ro. \IÜtd

-.-'
6l¡^.:¡il
17§ Abdomen INFERIOR VIEW OF DIAPHRACM

ffi TNFERToR vrrw oF DTAPHRAcM

The inferior view'of the diaphragm demonstrates the struc- cage and superior tumbar vertebra. lhe psoas maior muscie
tures formed as the diaphragm attaches to inferior thoracic has been removed.

ffi COIOR ea ch af the fallawing structures using a different color for each:

@ 1. Centra I tendon: Central apon e u rotic porti o n s u rrou nded @ 8. Medialarcuateligament'. Thickening of fascia over the
by the muscutar portion of the diaphragm periphera[[y psoas major muscie
@ 2. Cavatopening: Aperture located in the centrattendon @ 9. latera I arcuate tigament: Thickening of fascia over the
primarily for the inferior vena cava located at the level ouadratus lumborum muscle
of the T8/9 lV disk
@ 3, fsopáagealhiatus Aperture in the muscutar portion of
the right crus at the [eve[ of T10 vertebra B,fri§,§t tikaiy to-oceur from btunt or pene-
4.
ffi Aartichiatus: Aperture posterior to the median arcuate trauma injuhes to the diaphragm are from
irllipátt"eithár distqq3 the chest walL créating
ligament of the diaphragm at the T'12 vertebra level
áad.its a-ttrchrfiants, or crcates tesrs
@ 5. Leftcrus: Musculotendinous band arising from L1 to L2 'of,ihE diapklagm; üre posterolateral wall of
vertebrae, forming a portion of the aortic hiatus €Si ll$l]t*f tiiediephragm beeause of its
@ 6. Rightcrus: Musculotendinous band arising from Ll to n¡u s of.the postgrior abdorninal
en,t¡e {§ft,§¡dc.(8$96 to 9o%)
L4 vertebrae forming a portion of the aortic hiatus and
#rr-*ks.r] é*:d¡ür righf sideih close relati onsft p
i

forms the esophageal hiatus p¡-fti.is,tg_f, ia.traumat¡ed¡aphragmaüc

@ 7, Median arcuate ligarflerrt Arches over the anterior aspect ilx*m*oh:¡ma{t intestifiE,' transverse cslon,
!e lup,ture ihto the thoracic cavity.
of the aorta uniting the right and left crura
 INFERIOR VIEW OF DIAPHRACM ABDOMEN

Stemum'

o . tr i"-t
3. i':. if : $ : i ?*
f,
$*.:i,,;i'.-"!

*?"

1.

Gap for psoas major

1 2th rib

0uadrstus lDmbDrum

6. l r:'

¿ *{,ü$§* *ir'§{',s

l -'r.lf '!!'-: