ABDOMEN II

11-19-2015

PERITONEAL CAVITY

Serous membrane lining

peritoneal cavity
peritoneum
Parietal and visceral layers
Mesenteries double layers
of serous membrane that
suspends organs
Omentum mesentery that
attaches to stomach

Specialized mesentaries

Intraperitoneal organs
almost completely surrounded
by peritoneum; suspended by
mesentery
Retroperitoneal organs only
partially covered by
peritoneum; no mesentery

Duodenum, pancreas
Pressed up against posterior abdominal
wall
Aren't suspended by a mesentery

PERITONEAL CAVITY

Embryonic gut tube suspended from posterior abdominal wall by

mesentery
At this point entire gut tube is an intraperitoneal structure
At end of development some organs remain intraperitoneal
(retain mesentery), other organs get pushed up against posterior
abdominal wall
Become retroperitoneal no mesentery; only covered on
one surface by peritoneum

REGIONS OFABDOMINAL WALL

Inferior border
10th costal cartila

L2/3 IV disc

Iliac tubercles/
L5 vertebra

AUTONOMICS TO ABDOMINAL VISCERA

Parasympathetics
Cranial
Preganglionic fibers in vagus
nerve
Postganglionic neuron in
ganglion within wall of organ
All thoracic organs,
foregut and midgut
structures
Sacral
Preganglionic fibers in
anterior rami S2-4 (pelvic
splanchnic nerves)
Postganglionic neuron in
ganglion within wall of organ
Hindgut structures and
pelvic organs

AUTONOMICS TO ABDOMINAL VISCERA

Sympathetics
Preganglionic fibers in anterior rami
of T5-L2
Preganglionic fibers do not
synapse in sympathetic trunk;
pass thru it
Form
Thoracic splanchnic nerves
Lumbar splanchnic nerves
Splanchnic nerves go to
prevertebral ganglia
Celiac ganglion
postganglionic fibers to
foregut structures,
kidneys, spleen
Superior mesenteric
ganglion midgut
structures
Inferior mesenteric
ganglion hindgut
structures

ESOPHAGUS

Courses thru esophageal hiatus of diaphragm to empty into stomach

Primary blood supply esophageal arteries (descending / thoracic
aorta); esophageal veins drain into azygos system
Innervated by esophageal plexus: (coming from the vegas nerves)
Sympathetics from T3-6 ganglia of sympathetic trunk;
parasympathetics from vagal trunks

STOMACH

Mostly left upper quadrant

Intraperitoneal
Chief function is enzymatic digestion; converting food into chyme
2 prominent double layers of peritoneum:
Lesser omentum lesser curvature to liver
Greater omentum greater curvature to transverse colon

 4 parts:

STOMACH

Cardia
Fundus
Body
Pylorus
Pyloric antrumpassageway
Pyloric canal
Pyloric sphincter

Internal features rugae or

gastric folds
Allows for the stomach to expand

Curvatures:
Lesser curvature
Greater curvature

Rugae (gastric folds)

STOMACH ARTERIAL SUPPLY

All 3 branches celiac trunk

Left gastric artery*

Supply the lesser curvature of the

stomach

Splenic artery
Short gastric arteries*
Upper part of the greater
curvature of the stomach

Left gastro-omental artery*

Lower part of the greater
curvature of the stomach

Pancreatic arteries
Common hepatic artery

*supply stomach

STOMACH ARTERIAL SUPPLY

Common hepatic artery

Gastroduodenal artery
Right gastro-omental artery*
Greater curvature of stomach
anastomose with right gastroomental

Superior pancreaticoduodenal artery

Hepatic artery proper

Right gastric artery*
Left and right hepatic arteries
Cystic artery off right hepatic artery

*supply stomach

STOMACH

Arterial supply
Lesser curvature
Left gastric artery
Right gastric artery

Greater curvature
Right gastro-omental
artery
Left gastro-omental
artery
Short gastric arteries

HEPATIC PORTAL SYSTEM

STOMACH

Venous drainage
Similarly named veins into hepatic portal system: left and right
gastric veins, right and left gastro-omental veins, short
gastric veins

STOMACH

Innervation
Sympathetics: thoracic splanchnic nerves >> celiac
ganglion
Parasympathetics: vagal trunks (both anterior and posterior)

DUODENUM

Right and left upper quadrants

Breakdown of chyme in small intestine
4 parts: superior (attaches to pyloric part of stomach),
descending, inferior (horizontal), ascending
Mostly retroperitoneal

DUODENUM

Arterial supply
Celiac trunk
Gastroduodenal
artery
Supradudoenal
artery*
Superior
pancreaticoduo
denal artery*
Superior mesenteric
Inferior
pancreaticoduoden
al artery*
*supply duodenum

DUODENUM

Similarly named veins into

hepatic portal system

Innervation
Sympathetics: thoracic
splanchnic nerves >>
celiac and superior
mesenteric ganglia
Parasympathetics: vagal
trunks

JEJUNUM AND ILEUM

Most jejunum in upper left; most ileum in lower right

Suspended by a mesentery; intraperitoneal
Nutrient absorption

JEJUNUM AND ILEUM

Arterial supply:
Superior mesenteric artery
Jejunal arteries
Ileal arteries

Similarly named veins drain into

superior mesenteric vein of
hepatic portal system

Innervation
Sympathetics: thoracic
splanchnic nerves >>
superior mesenteric
ganglion (synapse in)
Parasympathetics: vagal
trunks

LARGE INTESTINE

Courses thru all 4 quadrants

Absorbs water, ions, vitamins
Compacts chyme into feces

Consists of :
Cecum
Vermiform appendix
Midgut
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Hindgut
Rectum
Upper anal canal

Bold = intraperitoneal parts; others retroperitoneal

LARGE INTESTINE

Ileocecal junction

Ilium dumps into the

ascending part of colon

2 unique external features

Taeniae coli 3 bands of
longitudinal smooth
muscle
Tissues running lengthwise
on surface of large intestine
Peristalsis/ movement
through intestine

Haustra sacculations of
the wall
Sac-like structures
Visible from x-rays

Right colic (hepatic)

flexure

Right above is liver

Left colic (splenic) flexure

Spleen rests by it

LARGE INTESTINE

Superior mesenteric artery

Middle colic artery*
Right colic artery*
Ileocolic artery*
Appendicular artery*

Inferior mesenteric artery

Left colic artery*
Sigmoid arteries*
Superior rectal artery*

All join to form marginal

artery
* supply large intestine

LARGE INTESTINE

Similarly named veins drain

into hepatic portal system

Sympathetics:
Midgut part thoracic
splanchnic nerves >>
superior mesenteric
ganglia
Hindgut part lumbar
splanchnic nerves >>
inferior mesenteric
ganglion
Parasympathetics:
Midgut part -- vagal
trunks
Hindgut part -- pelvic
splanchnic nerves

LIVER

Located mostly upper right

quadrant
Mostly intraperitoneal
Receives all nutrients (except
lipids) from digestive tract directly
from portal veins
Stores and modifies vitamins
Degrades toxins and drugs
Metabolism
Bile production

LIVER
Anterior view

4 lobes
Diaphragmatic surface
Right and left lobes
Separated by falciform
ligament (2 layers of
serous membrane)
Contains ligament teres
(round ligament) of
liver
Reminant of the
umbilical vein
Coronary ligaments are
serous membrane that reflect
off liver onto underside of
diaphragm
Visceral surface
Underside of the liver

Quadrate and caudate lobes

Inferior view

Quadrate and caudate

lobes separated from left
lobe by
Ligamentum teres of
liver
Ligamentum
venosum

LIVER

More superior/closer to
Ligamentum
inferior vena cava
venosum

Hilum (porta hepatis)

separates quadrate and
caudate lobes
Hepatic arteries
Hepatic ducts
Hepatic portal vein
Autonomics

Inferior vena cava and

gall bladder separate
right lobe from quadrate
and caudate lobes

Visceral surface

LIVER

Arterial supply
Hepatic artery proper
Right and left
hepatic arteries
Hepatic portal vein
Carrying nutrients into
liver

Venous drainage hepatic

veins >> inferior vena
cava

Sympathetics: thoracic
splanchnic nerves >>
celiac ganglion
Parasympathetics: vagal
trunks

GALL BLADDER

Upper right quadrant

Visceral surface liver
Mostly intraperitoneal

Stores and concentrates bile

Cystic duct joins common

hepatic duct to form
common bile duct

Common bile duct receives

main pancreatic duct
common area is
hepatopancreatic ampulla

Opening into duodenum

(descending part) is major
duodenal papilla

Hepatopancreatic ampulla

GALL BLADDER

Arterial supply
Cystic artery off
right hepatic artery
Venous drainage
Cystic vein into
hepatic portal
system
Sympathetics:
thoracic splanchnic
nerves >> celiac
ganglion
Parasympathetics:
vagal trunks

Cystic artery

PANCREAS

Right and left upper

quadrants
Mostly retroperitoneal

Secretes digestive
enzymes (exocrine) and
glucagon and insulin
(endocrine)

PANCREAS

Head curvature duodenum

(superior, descending, inferior
parts)
Neck pyloric region stomach;
superior mesenteric artery/vein
Body anterior to splenic
artery and vein
Tail anterior to left kidney
Accessory pancreatic duct
Main and accessory
pancreatic ducts

Tail
Body
Neck
Head
Main pancreatic duct

PANCREAS

Arterial supply
Pancreatic arteries off
splenic artery
Superior
pancreaticoduodenal
artery off
gastrodudodenal artery
Inferior
pancreaticoduodenal
artery superior
Superior pancreaticoduodenal artery
mesenteric
artery

Inferior pancreaticoduodenal artery

Pancreatic arteries

PANCREAS

Similarly named veins drain

into hepatic portal system

Sympathetics: thoracic
splanchnic nerves >>
celiac and superior
mesenteric ganglia
Parasympathetics: vagal
trunks

SPLEEN

Left upper quadrant

Intraperitoneal

Largest lymphoid organ

Removes old RBCs

SPLEEN

Arterial supply
Splenic artery off
celiac trunk
Venous drainage
Splenic vein >>
hepatic portal vein
Sympathetics: thoracic
splanchnic nerves >>
celiac ganglion
Parasympathetics: vagal
trunks