In the name of AllahIn the name of Allah

Pancreas

Grayish – pink 12-15 cm Situation- Epigastric - Lt hypochondriac- Umbilical

Pancreas

Consists:- Head,

Uncinate process - Neck,

Constricted part - Body &

Triangular - Tail

In the splenorenal

Pancreas Relations: Anterior;- Duodenum,- Sup. Mesentric VV.,- Sup. & inf. Pancreaticoduodenal

AA- Transeverse colon, - Transeverse mesocolon- Jejunum- Stomach- Lt. colic flexure

……………..- Celiac trunk- Splenic art.

-

Pancreas

Relations: Posterior;- Bile duct,- Prtal vein- Splenic vein - IVC, - Aorta,- Sup. Mesentric VV.,- Left suprarenal gland- Left kidney - Renal vein,

Pancreas

Tail - In (splenorenal)

lienorenal lig.

Main pancreatic duct

Accessory duct

ascending in front of main

Liver (hepar) Liver (hepar)

Occupying:Occupying:- Rt. HypochodriumRt. Hypochodrium- EpigastriumEpigastrium- Lt. HypochodriumLt. Hypochodrium weigh:weigh:- 1.4- 1.8 kg 1.4- 1.8 kg ♂♂- 1.2- 1.4 kg 1.2- 1.4 kg ♀♀- Average 1- 2.5kgAverage 1- 2.5kg- ?% of body weight ?% of body weight

Liver Liver Reddish brownReddish brown Easily lacerated Easily lacerated Its position maintained by Its position maintained by

intra-abdominal pressure, intra-abdominal pressure, ligaments and vessels ligaments and vessels

Liver is attached to the:Liver is attached to the:- ant. Abdominal wallant. Abdominal wall- DiaphragmDiaphragm- Stomach & 1Stomach & 1stst part of part of

duodenum duodenum

Liver Liver

Peritoneal connectionPeritoneal connection- Is almost completely Is almost completely

covered by peritonium covered by peritonium and has: and has:

- falciform lig.falciform lig.- Coronary ligCoronary lig- Triangular ligs.Triangular ligs.- Lesser omentum Lesser omentum

Liver Liver

SurfaceSurface• Diaphragmatic Diaphragmatic - AnteriorAnterior- SuperiorSuperior- Right Right - PosteriorPosterior• Visceral (InferiorVisceral (Inferior))

Liver Liver

Anterior surfaceAnterior surface- TriangularTriangular- Relations:Relations:- DiaphragmDiaphragm- Ant abdominal Ant abdominal

wallwall- Xiphoid Xiphoid

Liver ant. surface Liver ant. surface LinesLines

Superior Superior - Rt. 4Rt. 4thth intercostal space intercostal space- Xiphisternal jointXiphisternal joint- Lt. 5Lt. 5th th intercostal spaceintercostal space

-

Liver ant. surface Liver ant. surface LinesLines

Inferior Inferior - Rt. 10Rt. 10thth costal cartilage costal cartilage- Lt. 8Lt. 8thth costal cartilage costal cartilage- Crossing midline at transepyloric Crossing midline at transepyloric

planeplane- Gallbladder notch (4-5cm right to Gallbladder notch (4-5cm right to

midline)midline)- Ligamentum teres Notch Ligamentum teres Notch

Right Right - Rt. 4Rt. 4thth intercostal space intercostal space- Rt. 10Rt. 10thth rib rib

فردا جبرانی فردا کالس جبرانی کالسطبق طبق 88--1010ساعت ساعت 93/7/1693/7/16

همین در تنظیمی همین برنامه در تنظیمی برنامهگردد می برگزار گردد مکان می برگزار مکان

Liver superior Liver superior surfacesurface

Cardiac impressionCardiac impression- Relations: Relations:

Rt. Pleura, lungRt. Pleura, lung

Liver posterior surfaceLiver posterior surface

- Bare areaBare area- Groove for vertebral Groove for vertebral

columncolumn- Caval grooveCaval groove- Caudate lob, Caudate lob, - Fissure for lig. VenosumFissure for lig. Venosum- Oesophageal impressionOesophageal impression

Liver right Liver right surfacesurface

1/3 upper: diaphragm, 1/3 upper: diaphragm, pleura, lungpleura, lung

- 1/3 middle: diaphragm, 1/3 middle: diaphragm, pleurapleura

- 1/3 inferior: diaphragm1/3 inferior: diaphragm

Liver visceral Liver visceral surfacesurface

- Fissure for lig teresFissure for lig teres- Lig. VenosumLig. Venosum- Fossa for gallbladderFossa for gallbladder- Gastric impressionGastric impression- DuodenumDuodenum- Colic impression Colic impression - Renal impressionRenal impression- caudate processcaudate process- Porta hepatis Porta hepatis -

LiverLiver

Lobation Lobation • AnatomicallyAnatomically- RightRight- Left Left • FunctionallyFunctionally- RightRight- LeftLeft- QuadrateQuadrate- Caudate Caudate

Liver SegmentationLiver Segmentation

Left Left - Medial superiorMedial superior- Medial inferiorMedial inferior- Lateral superiorLateral superior- Lateral inferiorLateral inferior Right Right - Superior anteriorSuperior anterior- Superior posterior Superior posterior - Inferior anteriorInferior anterior- Inferior posteriorInferior posterior

Waterfall of Margoon (winter)Waterfall of Margoon (winter)

Biliary systemBiliary system

Intrahepatic Extrahepatic - Rt. & Lt. hepatic ducts- Common hepatic duct- Gallbladder- Cystic duct- Bile duct

Biliary systemBiliary system

Common hepatic duct:Common hepatic duct:- Rt. hepatic ductRt. hepatic duct- Lt. hepatic ductLt. hepatic duct- 3 cm3 cm

Biliary systemBiliary system

GallbladderGallbladder- Flask-shaped sacFlask-shaped sac- Sunk in fossa Sunk in fossa - Extend to the inf. Extend to the inf.

border of liverborder of liver

Biliary systemBiliary system

GallbladderGallbladder- Occasionally has Occasionally has

mesentery mesentery - 7-10cm, 7-10cm, - 30-50ml30-50ml

Biliary systemBiliary system

GallbladderGallbladder- Has: Has: - FundusFundus- BodyBody- Neck Neck

Biliary systemBiliary system

Related to the:Related to the:

transverse colontransverse colon

DuodenumDuodenum

liverliver

Biliary systemBiliary system

- neck- neck

Up forward, back,Up forward, back,

downwarddownward

Biliary systemBiliary system

Gallbladder fundus• Surface marking:- Opposite of the tip of ninth

right costal cartilage- Where the lateral border of

rectus abdominis crosses ninth rib.

- Where the transpyloric plane crosses right midclavicular plane

-

Biliary systemBiliary system

Cystic ductCystic duct- 3-4cm long3-4cm long- Back, down, leftBack, down, left- Has spiral mucosal Has spiral mucosal

foldsfolds

Biliary systemBiliary system

Common bile duct Common bile duct

- Cystic + common - Cystic + common hepatic ductshepatic ducts

- 6-8 cm6-8 cm- Diameter 6 mmDiameter 6 mm

Biliary Biliary systemsystem

Common bile duct Common bile duct - Behind first part of Behind first part of

duodenum & head of duodenum & head of pancreaspancreas

- Ant. to the IVCAnt. to the IVC- Forms Forms

hepatopancreatic hepatopancreatic (Vater) ampulla with (Vater) ampulla with main pancreatic ductmain pancreatic duct

spleenspleen

Situation Situation - Between gastric fundus and Between gastric fundus and

diaphragmdiaphragm- Upper left posterior quadrant Upper left posterior quadrant - Long axis follows 10Long axis follows 10thth rib rib- Posterior extremity 4cm from Posterior extremity 4cm from

mid-dorsal line at the level of T10mid-dorsal line at the level of T10- Ant. Extremity midaxillary line Ant. Extremity midaxillary line

SpleenSpleen

Size 12* 7* 3.5 cmSize 12* 7* 3.5 cm Wt. 150, 80-300 g. Wt. 150, 80-300 g. Has;Has;- Upper & lower poleUpper & lower pole- Anterior and posterior Anterior and posterior

border border - Diaphragmatic and Diaphragmatic and

visceral surfacesvisceral surfaces- Hilum Hilum

Spleen

Related to the;Related to the;- 99thth – 11 – 11thth ribs ribs- Lt. pleura, lungLt. pleura, lung- Lt. kidneyLt. kidney- StomachStomach- Lt. colic flexure Lt. colic flexure - PancreasPancreas

- Phrenicocolic ligPhrenicocolic lig. .

SpleenSpleen

- Covered by peritoneumCovered by peritoneum- Ligs.Ligs.

GastrosplenicGastrosplenic

Splenorenal (LienorenalSplenorenal (Lienorenal))