abdominal organs jan 5 2016

8/16/2019 Abdominal Organs Jan 5 2016

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C AGAYAN STATE UNIVERSITY –

COLLEGE OF MEDICINE AND SURGERY

ANATOMY – Abdominal Organs

Dr. Anonio !ag"irigan

LARGE INTESTINES• The shorter portion of the

digestive tract

• Measures only about 5 to 5.5

feet long • It extends from the ilio-cecal

junction ( junction between

the Ilium and the cecum)

which is located at the right iliac

fossa upto the anus; thats part

of the large intestine!

"ut li#e the small intestine it is a

widest at its proximal portion and it

also gradually diminishes in caliber

towards the anal canal!

It is divided anatomically into the$

a. Cecumb. Vermiform appendixc. Colon% itself which includes;

&! 'scending colon! ight *exure+! Transverse colon,! eft *exure.! /escending colon

0! 1elvic part of the large

intestine (ectum and the

'nus)

2ow these are the characteristics of

the large intestines which we dont

3nd in the small intestines!

&! The A!STRA (sacculations)• The presence of the

sacculations or pouches

along the wall is due to the

distinctly shorter outer

longitudinal muscle 3bers of

the large intestine! 4o there

are 5'64T' or

sacculations!! The presence of TAENIAE C"LI

• These are free discrete

longitudinal branch of

smooth muscles that are

seen along the outer surface

of the large intestine

• It is formed by the outer

muscular layer which is not

uniformly distributed as a

complete coat around the

large intestine;

• They are e7uidistant from

one another in the extent

from the base of the

vermiform appendix upto the

rectum where they merge to

form a complete coat+! The presence of A##EN$I%ES

E#I#L"ICA• These are small serous out-

pouchings of the peritoneum

Talo&ig' Tango' Tungpalan' !danga' Villanue(a' Vinarao' )aga&on' *abala


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that are 3lled with adipose

tissues

• They are attached to the

colon between the internal

margin and the anteriortaeniae coli! These are

appendices epiploica

,! The presence of #LICA

SE+IL!NARIS• These are crescentic folds

along the internal surface of

the large intestine and this

corresponds to the

separation between the two

5'64T' externally

• 4o what we 3nd as

sacculations or 5'64T'

outside% we 3nd the

mar#ings inside the bowel as

plica semilunaris!

4o these are the four characteristics of

the large intestine that we dont 3nd in

the small intestine!

The other di8erences between the

small intestine and the large intestine

besides the presence of (&)

Sacculation% () Taenia coli% (+)

Appendice& epiploica' ,,) #lica&emilunari&;

• The large intestine is only &9.

the length of the whole

intestinal canal! 4o ,9. is made

up of the small intestine!

4tructures that are :2 found in the

small intestines$

&! Intestinal villi!


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• it is located in the right iliac region

resting on the right psoas major

muscle just at the rim of the pelvis!

• This is generally covered

completely by the peritoneum but

sometimes the posterior part of the

cecum is uncovered

• It is only bound down to the

posterior abdominal wall by a 3bro-

areolar tissues!

The RELATI"N of t/e CEC!+ is

also important especially in surgery$

ANTERI"RL2 $ elated to the (&)

>reater omentum% () 'nterior

abdominal wall and (+) some coils of

the small intestines!

LATERALL2 $ It is also in relation to the

abdominal wall immediately above the

lateral third of the inguinal ligament!

#"STERI"RL23 The (&) Iliopsoas

muscle and () the femoral nerve!

+E$IALL23 It is determination of

course of the ileum!

• 2ow there are two crescentic folds

that lie above and below the

ileocecal ori3ce and this consists of

the elements of the walls of the

ileum except the peritoneum and

the longitudinal muscle layer

projecting into the cecum!

• This is called the ILE"CECAL

VALVE! These are crescentic folds

above and below the ileocecal

ori3ce!

• The upper part of the valve is

usually hori?ontally placed and

the lower part is obli7uely-

placed;

• =hile the loer part i&

bigger4larger and it is

obli7uely-placed!

4o these surrounds the slit-li#e

opening which runs antero-posteriorly;

on each side of the opening the two

folds will unite to form what we call

the REN!L!+ of t/e VALVE

2ow attached to the cecum is the

vermiform appendix or what we

usually #nown as the A##EN$I%!

-. VER+I"R+

A##EN$I%• Is a worm-li#e blind tube that is

about 6 inc/e& in lengt/ and it

springs postero-medial!

• It is attached to the postero-medial

part of the cecum about &!. inches

below the ileo-cecal junction!

• 2ormally it is at the right iliac

region!



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• The free portion of the appendix%

may be pointed in any direction but

it is enclosed by peritoneum and its

mesentery% which is called the

+ES"7A##EN$I%!• The meso-appendix is triangular

in shape and it is attached to

the left side of the lowest part

of the mesentery!

• The ARTER2 of t/e

A##EN$I% is called the

'11@2/I


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• It is related ANTERI"RL2 to the

anterior abdominal wall and the

structures that intervene between

them are the intestinal loops

• #"STERI"RL2 to the lateral wall%and the (&) Iliacus muscle% ()

Cuadratus lumborum muscle% and

also the (+) 1soas muscle in the

posterior part; even the lower part

of the right #idney is related

posteriorly to the ascending colon!

• Medial to the ascending colon are

coils of the small intestines and thepsoas major muscle!

C:. epatic lexure• It is also called the RIGT

C"LIC LE%!RE • It is the ascending of the colon as it

becomes the transverse colon

• This is the acute bending%

anteriorly to the left of t/e

large inte&tine below the right

lobe of the liver!

• This mar#s the transition between

the ascending colon and the

transverse colon!

• It lies in the right hypochondriac

region;

•

It is at t/e le(el of t/e >t/

co&tal cartilage and :nd

lumbar (ertebrae• 4o% ANTERI"R to the hepatic

*exure% is the right lobe of the liver!

• LATERALL2 % it is the part of the

liver also and the lateral abdominal

wall!

• =hile #"STERI"R to the hepatic

*exure% is the right cecum!• =hile +E$IALL2 % it is the nd part

of the duodenum!

C?. Tran&(er&e Colon• Is the loop portion of the large

intestine

• It lies transversely across the

abdominal cavities extending from

the right colic (hepatic *exure) to

the left colic (splenic *exure)

• The transverse colon measures

about :@ inc/e& in lengt/; and

due to the slightly longer meso-

colon along its middle part% it loops

or hangs downwards!

• It occupies the$

&! ight hypochondriac region! @pigastric region+! 4ometimes upto the umbilical

region and eft hypochondriac

region of the abdomen

• The posterior two layers of the

greater omentum% ascend towards

the inferior border of the

transverse colon and then it will

split to enclose the gut and reuniteagain at the postero-superior

margin as it passes to the posterior

abdominal wall as the

TRANSVERSE +ES"C"L"N



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• Then the superior (upper) layer is

continuous upwards to form part of

the posterior boundary of the

omental bursa;

• =hile the inferior (lower) layer

passes downwards along the lower

part of the posterior abdominal

wall;

• The right part of the transverse

mesocolon is short and it is

de3cient; and it is indirect contact

with the nd part of the duodenum!

• =hile the left part is short again

bringing the mesocolon close to

the body of the pancreas!

C6. Splenic lexure• It is also called the LET C"LIC

LE%!RE• Is the acute bending also of the

colon upwards and bac#wards

towards the left of the large

intestine below the stomach and

the lower part of the spleen!

• It mar#s the transition of the

transverse colon into the ascending

colon;

• It lies at the left hypochondriac

region but at the slightly higher

level compared to that of the right*exure!

• The left colic (splenic) *exure is

3xed to the posterior abdominal

wall by a ligament which we call

the #RENIC"LIC

LIGA+ENT• ' triangular fold of peritoneum

and the free border is attached

medially to the left *exure and

laterally to the diaphragm

oppo&ite to t/e 88t/ rib.

C5. $e&cending Colon• The next part after the left colic

*exure is the $ESCEN$ING

C"L"N •

It is the part of the large intestinethat descends along the left side of

the abdominal cavity!

• It occupies the$&! eft hypochondriac region! eft lumbar region+! eft iliac region

• 'nd it extends from the left colic

(splenic) *exure up to the pelvic

inlet!

• 4o it measures about >78:

inc/e& in lengt/ and it is

covered by peritoneum along the

anterior aspect only

• Brom the *exure it will pass

medially to the lateral border

of t/e left Bidne! • Then it will run straight downwards

until the crest of the ilium and;• It will pass obli7uely medially along

the iliac fossa!

CD. #el(ic Colon



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• 'lso called the SIG+"I$

C"L"N • It is the part of the large intestine

that lies in the pelvic cavity

• It measures about 85 inc/e& inlengt/

• It extends from the pel(ic inlet

up to t/e le(el of t/e ?rd

&acral (ertebrae where it will

pass on to become the RECT!+!• 4o the pelvic (sigmoid) colon

follows an irregular and tortuous

course starting from the medialborder of the left psoas muscle and

descending into the true pelvis

crossing the left% to the right and

then it bends bac#wards along the

posterior wall to end into the

rectum!

T/e &igmoid colon i&

completel &urrounded b

peritoneum.4o therefore% it is provided with a

#ELVIC +ES"C"L"N!

'nterior to the mesocolon is the

urinary bladder (male) and

uterus (female)!

1osteriorly% is the external iliac

blood vessels and the posterior

pelvic wall;=hile superiorly% are the coils of

the small intestine!

This pelvic mesocolon is a fan-

shaped peritoneal fold that

connects the pelvic colon and

direct to the posterior

abdominal wall!

It is short at both ends; but it

longer along the middle part

and it gives a great mobility tothe sigmoid and the rectum!

The posterior attachment of the

pelvic mesocolon is D-shaped;

'nd the left or ascending limb

passes the medial border of the

left psoas muscle as far as the

bifurcation of the common iliac

artery!

C. Rectum• Is the lower part of the large

intestine

• It lies in the pelvic cavity from the

le(el of t/e ?rd &acral

(ertebrae at the continuation of the pelvic colon up to a point

where it pierces the pelvic

diaphragm and becomes

continuous as the anal canal!

• The main parts of the rectum%

together with the di8erent

curvatures of the rectum% its

peritoneal connections% and itsrelations will be ta#en up in more

detail when we are in the pelvis!

-- END --



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The Structure of t/e Large

Inte&tine& is also made up of ,

coats!

&! 4erous coat! Muscular coat+! 4ub-mucous coat,! Mucous coat

The -lood Suppl of t/e Large

Inte&tine comes from the$

8. S!#ERI"R +ESENTERIC

ARTER2

Then it gives o8 the following

branches$

a! Ileocolic arter (ascending A

descending branch)b! Rig/t colic arter (ascending

A descending branch that

anastomoses with the

corresponding branches of the

Ileocolic and the middle colic

artery)c! +iddle colic arter (gives o8

a right and left branch; and it

anastomoses with the

corresponding branches of the

right colic and the superior

colic)

:. INERI"R +ESENTERIC

ARTER2 % are the$a. Superior left colic arterb. Inferior left colic arter

4o% those are the arteries that supply

the large intestine! "oth coming from

the superior mesenteric artery and the

inferior mesenteric artery!

The Venou& $rainage of t/e

Large Inte&tine&; the veins that

drain the large intestines are the veins

that accompany the branches and the

sub-branches of the arteries that

supply the large intestine!

8. S!#ERI"R +ESENTERIC VEINa. Ileocolic (einb. Rig/t colic (einc. +iddle colic (ein

:. INERI"R +ESENTERIC VEINa. Superior left colic (einb. Inferior left colic (ein

4o the tributaries of the superior

mesenteric vein will join together to

form & large vein which joins the

splenic vein behind the nec# of the

pancreas to form the #"RTAL

VEIN.

• Tributaries of superior mesenteric

vein E 4plenic vein 1:T' D@I2

'nd the veins that accompany the

branches of the inferior mesenteric

artery will join together to form a large

vein that ultimately drains into the

S#LENIC VEIN.



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• 4uperior left colic vein E Inferior

left colic vein 41@2I< D@I2

The Ner(e Suppl of t/e

Large Inte&tine& are both derived

from the Autonomic Ner(ou&

S&tem.

a! The sympathetic 3bers arises

from the loer t/oracic

&egment and upper lumbar

&egment of the spinal cord;

and they reach the celiac plexus

by way of the LESSER and the

LEAST S#LANCNIC NERVES.

The superior and inferior mesenteric

plexus9es are extensions of the celiac

plexus and they follow the course of

the artery and its branches!

b! The parasympathetic 3bers are

derived from the VAG!S and

#ELVIC NERVE; that join the

pelvic plexus to become

distributed with the sympathetic

3bers going to the bowel!

The Lmp/atic $rainage of

t/e Large Inte&tine&; there are

small lymph glands that are found

along the walls of all parts of the colon

and together with the blood vessels

that supply the large intestines!

4o the lymph that comes from the (&)

cecum% () appendix% (+) ascending

colon% (,) transverse colon; they are

all drained into groups of glands that

join those that are located at the root

of the mesentery and they drain into

the INTESTINAL L2+# TR!NF !

=hile the lymph coming from the (&)

descending colon and () pelvic colon;

they will pass to the glands at the left

lumbar lymph trun#% and ultimately

drain into the CISTERNA C2LI.

-- END --

The main artery to the small intestine

and the right half of the large intestine

is the Superior +e&enteric

Arter!

• It is given o8 about F inch

below the celiac artery!

• 4o the superior mesenteric

artery comes from the



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abdominal aorta and it starts

opposite the &st lumbar

vertebra!

• 'nd it will terminate close to the

ileocecal junction byanastomosing with the ileocolic

branch!

• 4o from its origin% with curves

downward and to the right% with

the convexity looping towards

the left side; these are the

branches of the superior

mesenteric artery!

• :n each convex side% we have

the (a) jejunal artery and (b)

ileal artery

• There are &G H &0 branches that

pass obli7uely forward and

downwards between the layers

of the mesentery!

• 'nd these branches

anastomose with one another

forming a series of arterial loops

that branches from the arcades

to form other loops!

• Brom the concave side of the

artery% the following branches

are given out$a! Inferior pancreatico-duodenal

artery

b! Middle colic arteryc! ight colic arteryd! Ileocolic artery

'! INERI"R #ANCREATIC"7

$!"$ENAL ARTER2 • 4upplies the head of the

pancreas and the duodenum

• 'nastomose with the similar

branches of the superior

pancreatico-duodenal artery!

"! +I$$LE C"LIC ARTER2 • eaches the transverse

mesocolon and it gives

branches to the transverse

colon

• 'nastomose with the right colic

and the left superior colic artery!


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• It originates from the abdominal

aorta% and it commences & F

inches above the bifurcation of

the aorta behind the +rd part of

the duodenum!• This is at the le(el of t/e ?rd

lumbar (ertebrae 0u&t abo(e

t/e umbilicu&!• Then it will terminate at the left

side of the left common iliac

artery in front of the psoas

major muscle% where it becomes

continuous as the superiorrectal artery!

• It gives o8 the following

branches$&! 4uperior left colic artery! Inferior left colic (sigmoidal)

artery+! 4uperior rectal (superior

hemorrhoidal) artery

'! S!#ERI"R LET C"LICARTER2• /ivides into an ascending and

descending branches

• 4upplies the descending colon

proper!

"! INERI"R LET C"LIC

,SIG+"I$< ARTER2 ;•

There are or + branches thatis given o8 by inferior left colic

(sigmoid) arteries% and they

pass behind the peritoneum

supplying the iliac and pelvic

colon; and anastomose with one

another!

ARTER2<• ' direct continuation of the

inferior mesenteric artery% and

so it enters the pelvic meso-

colon% descends into the true

pelvis and opposite at the level

of the +rd sacral vertebrae it will

divide into branches that

surrounds the rectum!

4o those are the branches of the

inferior mesenteric artery!

-- END --

GALL -LA$$ER• This is a pear-shape organ which

acts as a re&er(oir for bile!• It is intimately attach to the

visceral surface of the liver by

areolar tissues and by peritoneal

coverings!

• It is about ? or 6 inc/e& long

and it presents the following parts$a! Bundus

b! "odyc! Infundibulum (5artmanns

pouch)d! 2ec#e!


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A. !N$!S• The !N$!S is the anterior lower

part of the gall bladder and it is a

wider part!

• It usually protrudes beyond the

margin of the liver!

• 4o it comes in contact with the

anterior abdominal wall at t/e

le(el of t/e >t/ co&tal cartilage%

and at t/e lateral border of t/e

rectu& abdominu& mu&cle!

-. -"$2 • The -"$2 of the gall bladder

usually tapers

• This is the main part of the gall

bladder that passes bac#wards%

upwards and to the left!

• It is indirectly in contact with the

liver and the inferior surface is

related to the tran&(er&e colon

and the :nd part of t/e

duodenum.

C. IN!N$I-!L!+

,ART+ANN9S #"!C<• The IN!N$I-!L!+

,ART+ANN9S #"!C< is the

part of the gall bladder between

the body and the nec# of the gall

bladder!

• It is bound down to the 8&t part of

t/e duodenum b t/e rig/t

edge of t/e Le&&er "mentum

which we call the

C"LEC2ST"$!"$ENAL

LIGA+ENT (because it bind the

gall bladder to the duodenum)!

• This ligament is surgically

important because it runs parallel

to the cystic duct which it hides!

Bor operation involving the cystic duct%

you should locate 3rst the

c/olec&toduodenal ligament

$. NECF • The NECF of the gall bladder is the

constricted part that curves

medially towards the #orta

/epati&!• The spiral constriction that is seen

along the external surface of the

nec# of the gall bladder indicates

the beginning of the cystic duct!

• It also mar#s the crescentic fold of

mucosa which guards the opening

of the gall bladder! 'nd this fold of

mucosa is called the S#IRAL

VALVE " EISTER. This spiral valve of 5eister is

continuous to the &st part of the

cystic duct!

E. C2STIC $!CT• The C2STIC $!CT is the duct of

the gall bladder!

• 'nd it measures about a little o(er

8 inc/ in lengt/



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• It has an irregular 4-shaped course

within the free margin of the

hepato-duodenal ligament!

• ' short distance from the 1orta

hepatis% it will join the common

hepatic duct to form the

C"++"N -ILE $!CT.

-- END –

The -lood Suppl of t/e Gall

-ladder is the C2STIC ARTER2 .

This is a branch of the right hepatic

artery!

• It divides into an anterior and a

posterior branch and supplies

the upper and lower surfaces of

the gall bladder!

The Venou& $rainage of t/eGall -ladder accompany the artery

and enter into the substance of the

liver to join the INTRAE#ATIC

-RANCES of t/e #"RTAL VEIN.

The Ner(e Suppl of t/e Gall

-ladder also comes from the

sympathetic and parasympathetic

3bers that are all derived from the

hepatic *exure!

-- END –

C"++"N -ILE $!CT• The C"++"N -ILE $!CT is

formed by the union of the cystic

duct and the common hepatic duct!

• It measures about 6 inc/e& inlengt/!

• It starts a short distance below the

porta hepatis and then it descends

within the free margin of the

hepato-duodenal ligament towards

the duodenum!

In company with the hepatic artery

and the portal vein% both of which go

upward the liver% the bile duct will

pass downwards behind the &st part of

the duodenum up to the head of the

pancreas and through the substance

of the pancreas! 'nd after a slight

inclination to the right% it will end into

the nd part of the duodenum along

the posteromedial surface!

Then it will be joined by the main

pancreatic duct just below the

termination and the dilated common

passage!

There is a common passage of the

pancreatic duct and the common bile

duct into the duodenum! This part of

the duodenum is called the

A+#!LLA " VATER.



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It joins into an elevated portion of the

mucosa of which we call the

$!"$ENAL #A#ILLAE.

4o the part of the duodenum where

they open is called the 'M16' :B

D'T@; and there is an elevated part

of the mucosa in the ampulla of Dater

called the /6:/@2' 1'1I'@!

It i& /ere t/e common bile duct

and t/e pancreatic duct open into

t/e duodenum

#"RTAL VEIN• The #"RTAL VEIN is a wide

venous channel that drains the

blood coming from the digestive

tract and conveys it to the liver!

• It is about ? inc/e& long and it

starts (is formed) as the union of

the S!#ERI"R +ESENTERIC

VEIN and the S#LENIC VEIN!• It commences behind and to the

left of the nec# of the pancreas

which is at the level of the &st

lumbar vertebrae and it will

terminate at the right end of the

porta hepatis by dividing into a

right and a left branch!

T/e rig/t branc/ i& &/orter

/ile t/e left branc/ i& longer

The right branch after receiving the

cystic vein will enter the right lobe

of the liver where it will brea# out

into numerous branches! 'nd these

veins will join the sub-lobular veins

which is therefore in the hepatic

veins!

The left branch will pass to the leftlobe of the liver and after receiving

branches% it will go to the 7uadrate

and caudate lobes of the liver!

4o these are the tributaries of the

portal vein!

The Tributarie& of t/e #ortal

Vein$

&! 4uperior mesenteric vein! 4plenic vein+! eft gastric vein (coronary vein),! ight gastric vein.!


15/25

• 'll the veins that accompany

the branches of the artery

@J


16/25

=e can actually outline the liver on

the surface of the body by ma#ing use

of + landmar#s!

&! #"INT "N TE RIGT+A+ILLAR2 LINE crossing

the .th rib

! #"INT "N TE LET

+A+ILLAR2 LINE at the .th

intercostal space

+! #"INT "N TE RIGT

LATERAL )ALL just about &

3ngerbreadth below the costalmargin which is the &Gth rib!

If you connect the 3rst points by

a curve line with the concavity

directed upwards% this will

represent the S!#ERI"R

+ARGIN of t/e li(er.If you connect the &st and the +rd

point by another curve linemar#edly convex laterally% this will

represent the RIGT LATERAL

+ARGIN of t/e li(er.If you connect the nd and the +rd

point by a straight line% it will

represent the INERI"R

+ARGIN of t/e li(er.

The various forms of peritoneum that

attaches the liver to the other organs%

as well as to the abdominal wall% are

assumed di8erent names!

These are the peritoneal connections

of the liver that attaches it to the

other organs and to the abdominal

wall!

8. ALCI"R+

LIGA+ENT• Is a double-layered fold of

peritoneum;

• Is crescentic in shape;

• It is attached to the anterior and

upper surfaces of the liver

attaching it to the inferior surface

of the diaphragm and the bac# of

the Linea alba% as far down as

the umbilicus!

• The free margin of the falciform

ligament contains the round

ligament of the liver!

:. C"R"NAR2

LIGA+ENT• It is the re*ection of peritoneum

from the superior surface of the

liver up to the undersurface of the

diaphragm!

• 4o the importance of this coronary

ligament location is that it limit&

t/e Huadrangular area of t/e

po&tero7&uperior &urface of t/e

li(er H delineated by the coronary

ligament H is called the -ARE

AREA " TE LIVER.



17/25


18/25

Surface& of t/e Li(er3

a! ight surfaceb! 6pper surfacec! 'nterior surface

d! 1osterior surface

RIGT S!RACE• Is the convex 7uadrilateral area

(roughly 7uadrilateral) and it is

closely related to the diaphragm

which separates it from the pleura

of the thoracic region;

• 4eparates it also from the lungs%

and lower 0 ribs and their

intervening intercostal spaces!

!##ER S!RACE• Is the area of the liver that is

closely applied to the inferior

surface of the diaphragm!• The right and the left part of the

upper surface are convex% so they

3t into the right and the left cupula

of the diaphragm which separates

it from the pleura and the lungs!

• The middle part is concave% and it

is separated from the pericardium

and the heart by the diaphragm!

ANTERI"R S!RACE• Is the roughly triangular *at area of

the liver whose larger right part

and smaller left part are protected

by the costal cartilages!

#"STERI"R S!RACE• Is smaller% somewhat triangular

also% and it represents a deep

concavity that is produced by the

vertebral column!• 4o it represent a large convex right

part (which is the part of the base

area of the liver and is immediately

connected to the diaphragm) which

separates the liver from the right

pleura and the right lung!

Then we have a GR""VE for t/e

INERI"R VENA CAVA; we #now

that ID< is embedded in the liver% so it

produces a deep groove for the

inferior vena cava on the posterior

surface of the liver!

Then we have the CA!$ATE L"-E

of t/e LIVER' which is part of the

liver% between the groove for the

inferior vena cava and the 3ssure for

the ligamentum venosum!

Then we have the ISS!RE for

t/e LIGA+ENT!+ VEN"S!+

which is a deep cleft on the left side of

the caudate lobe!

Then the ES"#AGEAL

I+#RESSI"N (shallow groove) that



19/25

is at the left side of the ligamentum

venosum% this is caused by the

impression of the abdominal portion of

the esophagus! KThats why it is called

esophageal impressions!L

2ow in the lower part of the liver% you

will 3nd the di8erent 3ssures and

fossae!

VISCERAL S!RACE of t/e

LIVER• '#a$ INERI"R #ART " TE

LIVER• It is oblong% and it is irregular% and

all the parts are in relation to some

de3nite organs!

• The surface is obli7uely place and

it is directed bac#wards and

downwards to the left!

• It presents these di8erent parts$

8. #"RTA E#ATIS• Is the hilum of the liver;

• It is a wide% deep% transverse cleft

that is placed towards the posterior

part of the inferior surface of the

liver!

• It transmits the terminal portion of

the portal vein% hepatic artery%

common hepatic duct% nerves and

lymph vessels!

• 4o these are the structures that are

located in the porta hepatis or the

hilum of the liver!

:. C"++"N E#ATIC $!CT

• The C"++"N E#ATIC $!CT is

formed at the right side of the

porta hepatis by the union of the

right and left hepatic duct!

?. ISS!RE for LIGA+ENT!+

TERES

• This is a deep% narrow slit%

extending from the left end of the

porta hepatis going downwards to

the inferior margin of the liver!

• It lodges the ligamentum teres

which is the remnant of the

umbilical vein!

6.ISS!RE for LIGA+ENT!+

VEN"S!+

• ' narrow vertical cleft that extends

bac#wards from the left end of the

porta hepatis to the superior

surface of the liver!• It lodges the ligamentum venosum

which is the remnant of the ductus

venosus that conveys blood

directly from the umbilical vein to

the inferior vena cava!

5. "SSAE of t/e GALL

-LA$$ER

• It is a wide% shallow fossa that

extends from the inferior margin of

the liver upto the right end of the

porta hepatis% this is for the gall

bladder!



20/25

• It lodges the gall bladder% it is

intimately connected to it by

areolar tissues and small blood

vessels and ducts!

D. "SSAE for t/e INERI"R

VENA CAVA

• It is a wide% deep fossa that lodges

the upper part of the inferior vena

cava but this does not extend to

the porta hepatis!

The fossa of the gall bladder anteriorly

and the fossa of the inferior vena cava

posteriorly will form the right

boundary of the lobes of the liver

dividing the liver into the$

a! ight lobeb! Cuadrate lobec!


21/25

2ow we can divide the liver into lobes%

anatomically$

The division of the liver into smaller

parts that are recogni?able only in theinferior and visceral and posterior

surfaces of the liver!

RIGT L"-E of t/e

LIVER• It is the larger part of the liver;

• @xtends to the right of the sagittal

cleft formed by the 3ssure for the

ligamentum teres anteriorly% and

the 3ssure for the ligamentum

venosum posteriorly!

• It is subdivided into 7uadrate lobe

and caudate lobe!

&! The J!A$RATE L"-E is

bounded by the$a! Inferior margin of the liver

b! >all bladderc! 1orta hepatisd! Bissure for the ligamentum teres

The inferior part of the 7uadrate lobe

is in contact with the ploru& of t/e

&tomac/ and the 8&t part of t/e

duodenum.

! The CA!$ATE L"-E is bounded

also by$a! 1orta hepatisb! Inferior vena cava

c!


22/25

The -lood Suppl of t/e LIVER

comes from the E#ATIC ARTER2

that conveys blood from the aorta

through the celiac artery!

The Venou& $rainage of t/e

LIVER convey blood from the

digestive tract and goes to the liver%

and this is through the #"RTAL VEIN!


LIVER% also sympathetic and

parasympathetic 3bers% coming from

the CELIAC #LE%!S and the VAG!S

NERVE!


t/e LIVER are also important

especially in cases of malignancy of

the liver! Brom the capillaries of the

liver and the blood vessels% they come

to the surface of the liver to form the

peritoneal vessels which pass through

the falciform ligament to the

S!#ERI"R +ESENTERIC and

RETR"STERNAL L2+# GLAN$S!

The other vessels will go to the glands

around the porta hepatis% passing

through the lesser omentum and join

the left gastric lymph glands!

Those from the posterior part of the

liver% will follow the right phrenic blood

vessels going to the CELIAC L2+#

GLAN$S!

'nd those that accompany the hepatic

vein will pass upwards together withthe inferior vena cava to the +I$$LE

$IA#RAG+ATIC L2+# GLAN$S

of the thorax!

$!"$EN!+• It is the 3rst part of the small

intestine!

• It is the widest and shortest%

thic#est and most 3xed part of the

small intestine!

• It measures only about 8@ to 88

inc/e&% extending from the

pylorus upto the duodeno-jejunal

*exure!

• 4o it occupies the epigastric and

umbilical region of the abdomen!

• Except for t/e 8&t /alf of t/e

1r&t part of t/e duodenum%

which is completely covered by

peritoneum% t/e re&t of t/e

organ i& entirel retro7

peritoneal (it is outside the

peritoneum)!

So it i& onl t/e 8&t

/alf of t/e 8&t

part of t/e duodenum t/at i&

completel co(ered b

peritoneum



23/25

4o for the purpose of description% we

divide the organ into , parts$

&! 4uperior part! /escending part

+! 5ori?ontal part,! 'scending part

8. S!#ERI"R #ART•

Is continuous from the pylorus atthe level of the &st lumbar

vertebrae just to the right of the

median plane;

• It is only about : inc/e& long

and it ta#es a bac#ward and

upward direction to the right!

• It is related to the$

a! eft lobe of the liver and the

7uadrate lobe of the liverb! 5ead of the pancreas below itc! 2ec# of the pancreasd! 1ortal veine! "ile ductf! Inferior vena cava posteriorly

:. $ESCEN$ING #ART• Measures about ? inc/e& long;

• It extends downward at the side of

the vertebral column% from thenec# of the gall bladder up to the

level of the 8&t lumbar (ertebrae.• :nly parts of the anterior and

lateral surfaces of the nd part of

the duodenum are covered by

peritoneum!

• The bile duct and pancreatic duct

enters the descending part of the

duodenum on the postero-medialaspect% a little below the middle of

the duodenum!

• :cassionally the accessory

pancreatic duct will open about N

of an inch above the opening that

we have just mentioned!

?. "RI*"NTAL #ART• Is the longer part;

• It is about 6 inc/e& long and it

runs transversely thats why it is

called hori?ontal% from right to left!

• It is at t/e le(el of t/e ?rd

lumbar (ertebrae;

• It is in relation to the superior

mesenteric blood vessels and coils

of intestine at the root of themesentery;

• It is also in relation to the head of

the pancreas!

• It has a very important relation to

the head of the pancreas because

in cases of malignancy or tumors at

the head of the pancreas you can

see this as an indentation when

you perform an upper >I


24/25

• It measures about onl 8 inc/

long • It runs upward on the left side

of the vertebral column! Brom

the +rd upto the nd lumbar

vertebrae% where it will abruptly

bend and become the duodeno-

jejunal *exure!

• This is a triangular band of

3brous tissue!

• It is a 3bromuscular tissue! The

muscles are made up of smooth

muscles and it attaches the

duodeno-jejunal *exure to the

right crux of the diaphragm!

4o it joins the duodeno-jejunal *exure

to the right side (crux) of the

diaphragm! This is called the

S!S#ENS"R2 LIGA+ENT "

TREIT*.

• The suspensory ligament of

treit? has a broad base at the

superior surface of the

duodeno-jejunal *exure and it

passes upwards behind the

pancreas and in front of the

aorta!

• This is also a very important

landmar# in surgery% especially

in areas of the duodenum and

the pancreas!

'nd there are small spaces that are

formed by peritoneal folds and they

are located around the terminal part of

the duodenum!

There are , constant duodenal

recesses (spaces) around the

duodenum!

a! S!#ERI"R $!"$ENAL

RECESSb! INERI"R $!"$ENAL

RECESS

c! #ARA7$!"$ENAL RECESSd! RETR"7$!"$ENAL RECESS

These are also important landmar#s in

surgery

4o the structure of the duodenum is

also the same% it has a$

&! 4erous coat! Muscular coat+! Mucous coat

The SER"!S C"AT is made up of

peritoneal covering that encloses the

anterior and lateral surfaces of the

duodenum!

The +!SC!LAR C"AT of theduodenum is well-developed; it is also

provided with vascular 3bers that

surrounds the ampulla of Dater! These

muscular tissues that surround the



25/25

ampulla of Dater is called the

S#INCTER "$$I.

• S#INCTER "$$I these are

the muscular tissues that

surround the ampulla of Dater!

Then the +!C"!S C"AT of the

duodenum is thic#er than in other

parts of the small intestine! 'nd it is

provided with a short% broad villi!

The -lood Suppl of t/e

$uodenum comes from the$

&! S!#ERI"R #ANCREATIC"7

$!"$ENAL ARTER2

! INERI"R #ANCREATIC"7

$!"$ENAL ARTER2

The S!#ERI"R #ANCREATIC"7

$!"$ENAL ARTER2 comes from the

gastro-duodenal artery% which is a

branch of the hepatic artery;

=hile the INERI"R #ANCREATIC"7

$!"$ENAL ARTER2 comes from the

superior mesenteric artery% and it is

the one that accompanies the vein

that drains the portal and superiormesenteric veins!


$uodenum comes from the

sympathetic 3bers!

a! CELIAC #LE%!Sb! S!#ERI"R +ESENTERIC

#LE%!S


t/e $uodenum follow the course

of the arterial supply% together with

the blood vessels coming from the

lower half of the duodenum and they

drain directly into the +ESENTERICR""T L2+# N"$ES4GLAN$S

that come from the upper part and

they go to the sub-pyloric glands in

front and the gediary glands behind!

abdominal organs jan 5 2016

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