ORGAN STOMACH

LOCATION It occupies the left upper quadrant, epigastric, and umbilical regions, and much of it lies under cover of the ribs

VERTEBRAL LEVEL Cardiac: T11 Fundus: T10

ARTERIES Left and gastric artery Short gastric arteries Left and right gastroepiploic artery

VEINS The veins drain into the portal circulation The left and right gastric veins drain directly into the portal vein. The short gastric veins and the left gastroepiploic veins join the splenic vein. The right gastroepiploic vein joins the superior mesenteric vein. Hepatic vein

INNERVATION Right and left Vagus nerves

SUPPORT Greater and lesser omentum

FUNCTION Food storage Chemical and mechanical digestion of food

LIVER

Beneath the diaphragm

T10

Hepatic artery

Celiac plexus

Falciform ligament

GALL BLADDER

Lying on the undersurface of the liver

T12-L1

Cystic artery

Cystic vein

Sympathetic and parasympathetic vagal fibers form the celiac plexus

Peritoneum

PANCREAS

Stretches obliquely across the posterior abdominal wall in the epigastric region. It is situated behind the stomach and extends from the duodenum to the spleen

L1-L2

The splenic and the superior and inferior pancreaticoduodenal arteries

The splenic and the superior and inferior pancreaticoduodenal vein

Sympathetic and parasympathetic (vagal) nerve fibers supply the area

Transverse mesocolon

SPLEEN

Occupies the left upper part of the abdomen between the stomach and the diaphragm . It lies along the long axis of the 10th left rib. 1st part Begins at the pylorus and runs upward and backward on the transpyloric plane Runs vertically downward in front of the hilum of the right kidney Runs horizontally to the left on the subcostal plane, passing in front of the vertebral column and following the lower margin of the head of the pancreas Runs upward and to the left to the duodenojejunal flexure Left upper quadrant of the infracolic compartment Right lower quadrant

T12-L1

DUODENUM L1

2 part

nd

Right of L2, L3

The large splenic artery is the largest branch of the celiac artery. It has a tortuous course as it runs along the upper border of the pancreas. The splenic artery then divides into about six branches, which enter the spleen at the hilum. The upper half is supplied by the superior pancreaticoduodenal artery, a branch of the gastroduodenal artery (Figs. 5-20 and 5-26). The lower half is supplied by the inferior pancreaticoduodenal artery, a branch of the superior mesenteric artery.

The splenic vein leaves the hilum and runs behind the tail and the body of the pancreas. Behind the neck of the pancreas, the splenic vein joins the superior mesenteric vein to form the portal vein. The superior pancreaticoduodenal vein drains into the portal vein; the inferior vein joins the superior mesenteric vein

The nerves accompany the splenic artery and are derived from the celiac plexus

Gastrosplenic ligament Splenorenal Ligament

Production and secretion of bile Metabolism Blood filtration Concentrates bile; stores bile; selectively absorbs bile salts, keeping the bile acid; excretes cholesterol; and secretes mucus An exocrine secretion (pancreatic juice from the acinar cells) that enters the duodenum through the main and accessory pancreatic ducts. Endocrine secretions (glucagon and insulin from the pancreatic islets [of Langerhans]) that enter the blood Site of lymphocyte Immune surveillance and response

The nerves are derived from sympathetic and parasympathetic (vagus) nerves from the celiac and superior mesenteric plexuses.

Lesser and greater omentum Peritoneum

Receives the openings of the bile and the pancreatic ducts

3rd part

Anterior to L3

JEJUNUM

4th part

Left of L3 Between L3-S3 The arterial supply is from branches of the superior mesenteric artery. The intestinal branches arise from the left side of the artery and run in the mesentery to reach the gut. They anastomose with one another to form a series of arcades. The lowest part of the ileum is also supplied by the ileocolic artery. Branches of the SMA, the ileocolic and right colic arteries The veins correspond to the branches of the superior mesenteric artery and drain into the superior mesenteric vein The nerves are derived from the sympathetic and parasympathetic (vagus) nerves from the superior mesenteric plexus

Suspensory muscle of Dodenum Mesentery Carbohydrate and protein absorption Vitamin B12 absorption Responsible for the finalization of the digestion process Waste storage Maintaining water balance Vitamin absorption (e.g. Vit. K) Intestinal flora fermentation

ILIUM

COLON ASCENDING COLON Extends upward from the cecum to the inferior surface of the right lobe of the liver, occupying the right lower and upper quadrants Extends from the left colic flexure to the pelvis. It occupies the left upper and lower quadrants Crosses the abdomen in the umbilical region from the right colic flexure to the left colic flexure L1-L6 Tributaries of the SMV, the ileocolic and right colic veins Superior mesenteric nerve plexus Peritoneum

DESCENDING COLON

T12-S3

The left colic and the sigmoid branches of the inferior mesenteric artery

Inferior mesenteric vein

The nerve supply is the sympathetic and parasympathetic pelvic splanchnic nerves through the inferior mesenteric plexus The proximal two thirds are innervated by sympathetic and vagal nerves through the superior mesenteric plexus; the distal third is innervated by sympathetic and parasympathetic pelvic splanchnic nerves through the inferior mesenteric plexus.

Peritoneum

TRANSVERSE COLON

L2-L3

The proximal two thirds are supplied by the middle colic artery, a branch of the superior mesenteric artery. The distal third is supplied by the left colic artery, a branch of the inferior mesenteric artery

Middle colic vein Left colic vein

Transverse mesocolon

RECTUM

Occupies the posterior part of the pelvic cavity; continuous with the sigmoid colon and descends in front of the sacrum to leave the pelvis by piercing the pelvic floor

S3

Superior, middle, and inferior rectal arteries

Superior, middle, and inferior rectal veins

Inferior hypogastric plexuses

SUPRARENAL GLANDS

Lie on the upper poles of the kidneys on the posterior abdominal wall.

L: T10-T11 R: T11-T12

The arteries supplying each gland are three in number: inferior phrenic artery, aorta, and renal artery

A single vein emerges from the hilum of each gland and drains into the inferior vena cava on the right and into the renal vein on the left. The renal vein emerges from the hilum in front of the renal artery and drains into the inferior vena cava

Preganglionic sympathetic fibers derived from the splanchnic nerves supply the glands. Most of the nerves end in the medulla of the gland. The nerve supply is the renal sympathetic plexus. The afferent fibers that travel through the renal plexus enter the spinal cord in the 10th, 11th, and 12th thoracic nerves. Celiac plexus and ganglion

Levator ani muscle Fascia of waldeyer Lateral ligament of rectum Retrovesicle fascia of denovillers Pelvic perineum Perineal body Renal

Receives and holds accumulating fecal mass

Hormone and catecholamine secretion

KIDNEY

Posterior abdominal wall, one on each side of the vertebral column

T12-L3

Renal artery

Thoracic cage

Excrete waste products of metabolism

ABDOMINAL AORTA

Anterior abdominal wall

DIAPHRAGM

Varies

begins at the aortic hiatus in the diaphragm at the level of the T12 vertebra and ends at the level of the L4 vertebra T8-T12

N/A

N/A

Thoracic cage

Provides oxygenated blood and nutrients to the lower half of the body

Superior surface: pericardiacophrenic , superior phrenic arteries and musculophrenic arteries Inferior surface: inferior phrenic arteries Ovarian artery

Superior and inferior phrenic

Phrenic and lower intercostal nerves

Thoracic cage

Most important muscle of respiration Site for the reception, retention, and nutrition of the fertilized ovum

UTERUS

Position changes with the degree of fullness of the bladder and pregnancy

S1-S5

Uterine vein

Uterovaginal plexus Inferior hypogastric plexus

OVARIES

VAGINA

Lies against the lateral wall of the pelvis in a depression called the ovarian fossa Extends upward and backward between the vulva and the uterus

S3-S4

Ovarian artery

Ovarian vein

Aortic plexus

Sacrocervical Ligaments Pubocervical Ligaments Transverse Cervical (Cardinal) Ligaments Levator Ani Muscles Suspensory Ligament of ovary Upper third: Levatores ani muscles and transverse cervical, pubocervical, and sacrocervical ligaments Middle third: Urogenital diaphragm Lower third: Perineal body Lateral ligament of bladder Tendinous arch of the pelvic fascia, puboprostatic ligament (male), pubovesicular ligament(female) Interstitial tissue

Coccyx

The vaginal artery, a branch of the internal iliac artery, and the vaginal branch of the uterine artery

Vaginal veins drain into the internal iliac veins

Inferior hypogastric plexuses

Production of female germ cell, estrogen, and progesterone Canal for menstrual fluid Part of the birth canal Communicates posteriorly with the cervical canal and inferiorly with the vestibule of the vagina

URINARY BLADDER

Behind the pubic bones

Coccyx

Superior and inferior vesicle arteries, branches of the internal iliac arteries

The veins form the vesical venous plexus which drains into the internal iliac vein

Inferior hypogastric plexuses

Stores urine

PROSTATE GLAND

UROGENITAL DIAPHRAGM

Lies between the neck of the bladder above and the urogenital diaphragm below Anterior part of the perineum

Coccyx

Branches of the inferior vesical and middle rectal arteries Branches of inferior pudendal artery

Prostatic venous plexus

Inferior hypogastric plexuses

Coccyx

Inferior pudendal vein

Perineal nerve

Produce fluid that is part of the seminal fluid during ejaculation Voluntary control of micturition

ORGAN STOMACH ANTERIOR Anterior abdominal wall, the left costal margin, the left pleura and lung, the diaphragm, and the left lobe of the liver POSTERIOR The lesser sac, the diaphragm, the spleen, the left suprarenal gland, the upper part of the left kidney, the splenic artery, the pancreas, the transverse mesocolon, and the transverse colon Diaphragm, right kidney, hepatic flexure of the colon, duodenum, gallbladder, inferior vena cava, and esophagus and fundus of the stomach The transverse colon and the first and second parts of the duodenum From right to left: the bile duct, the portal and splenic veins, the inferior vena cava, the aorta, the origin of the superior mesenteric artery, the left psoas muscle, the left suprarenal gland, the left kidney, and the hilum of the spleen The diaphragm; left pleura (left costodiaphragmatic recess); left lung; and 9th, 10th, and 11th ribs The lesser sac (first inch only), the gastroduodenal artery, the bile duct and portal vein, and the inferior vena cava The hilum of the right kidney and the right ureter Renal vessels Psoas major The right ureter, the right psoas muscle, the inferior vena cava, and the aorta The left margin of the aorta and the medial border of the left psoas muscle Posterior abdominal trunk and wall Kidney Posterior abdominal trunk and wall Kidney The iliacus, the iliac crest, the quadratus lumborum, the origin of the transversus abdominis muscle, and the lower pole of the right kidney. The iliohypogastric and the ilioinguinal nerves cross behind it The lateral border of the left kidney, the origin of the transversus abdominis muscle, the quadratus lumborum, the iliac crest, the iliacus, and the left psoas. The iliohypogastric and the ilioinguinal nerves, the lateral cutaneous nerve of the thigh, and the femoral nerve The second part of the duodenum, the head of the pancreas, and the coils of the jejunum and ileum Spleen Kidney, liver The rectum is in contact with the sacrum and coccyx; the piriformis, coccygeus, and levatores ani muscles; the sacral plexus; and the sympathetic trunks SUPERIOR Diaphragm

RELATIONS INFERIOR Transverse colon LATERALLY Spleen Liver MEDIALLY

LIVER

GALL BLADDER PANCREAS

Diaphragm, right and left costal margins, right and left pleura and lower margins of both lungs, xiphoid process, and anterior abdominal wall in the subcostal angle Anterior abdominal wall and the inferior surface of the liver From right to left: the transverse colon and the attachment of the transverse mesocolon, the lesser sac, and the stomach

Diaphragm

Hepatic flexure Transverse colon

Abdominal wall

Stomach

Liver Superior stomach Lesser omentum

Hepatic flexure Jejunum

Right lobe of liver Spleen

Middle pylorus of stomach Pylorus

SPLEEN

Stomach, tail of the pancreas, and left colic flexure. The left kidney lies along its medial border Quadrate lobe of the liver and the gallbladder Peritoneum Fundus of the gallbladder and the right lobe of the liver, the transverse colon, and the coils of the small intestine Root of the mesentery of the small intestine, the superior mesenteric vessels contained within it, and coils of jejunum Beginning of the root of the mesentery and coils of jejunum Greater omentum Greater omentum

Diaphragm

Splenic flexure

Abdominal wall

Stomach Left kidney

DUODENUM 1ST PART

The entrance into the lesser sac (the epiploic foramen)

Kidney Neck of pancreas

The ascending colon, the right colic flexure, and the right lobe of the liver

The head of the pancreas, the bile duct, and the main pancreatic duct Pylorus 1st and 3rd part of duodenum Head of pancreas Bile duct Pancreatic duct Iliocolic artery and vein

2ND PART

Liver Superior part of duodenum

Hepatic flexure Inferior part of duodenum

Liver Kidney

3RD PART

The head of the pancreas Process of pancreas Superior mesenteric vessels Body of pancreas

Coils of ilium

Right colic artery and vein

4TH PART

Coils of jejunum

Duodenojejunal junction

Superior mesenteric artery and veins Uncinate Process of pancreas

JEJUNUM ILIUM COLON ASCENDING

Transverse colon Transverse colon

Bladder rectum, cecum Bladder rectum, cecum

Abdominal wall Abdominal wall

Peritoneum Anterolateral: greater omentum

Hepatic flexure

Superiorly on the right side of the abdominal cavity from the cecum to the right lobe of the liver, where it turns to the left at the right colic flexure Posterior abdominal wall

Right paracolic gutter

Transverse colon

DESCENDING

Coils of small intestine, the greater omentum, and the anterior abdominal wall

Superior splenic flexure

Left paracolic gutter

Abdominal trunk

TRANSVERSE

SPLENIC FLEXURE HEPATIC FLEXURE RECTUM

Greater omentum and the anterior abdominal wall (umbilical and hypogastric regions) Transverse colon Liver gbladder Male: the upper two thirds of the rectum, which is covered by peritoneum, is related to the sigmoid colon and coils of ileum that occupy the rectovesical pouch. The lower third of the rectum, which is devoid of peritoneum, is related to the posterior surface of the bladder, to the

Inferior border of pancreas

Greater omentum, jejunum and ilium

Hepatic and splenic flexure Liver n spleen Spleen, abdominal wall Liver, abdominal wall Pelvic bone Ureters

N/A

Spleen stomach Kidney Bladder Ilium Jejunum Sigmoid colon

Kidney Ascending colon Kidney Anus

Transverse colon Transverse colon, stomach N/A

SUPRARENAL GLANDS

termination of the vas deferens and the seminal vesicles on each side, and to the prostate R:anterolateral: right crus of the diaphragm and liver Anteromedial: inferior vena cava

R: Diaphragm, abdominal wall

R: diaphragm, liver, right superior suprarenal arteries

R: right psoas major, right renal vein

R: diaphragm

R: inferior vena cava, right crus of diaphragm, celiac ganglion

L: Diaphragm, abdominal wall

L: diaphragm, phrenic artery and plexus, left suprarenal arteries Diaphragm

L: left psoas major, left renal vein

L: superior half of left kidney, spleen, stomach, tail of pancreas Psoas major

KIDNEY

R: the suprarenal gland, the liver, the second part of the duodenum, and the right colic flexure L: the suprarenal gland, the spleen, the stomach, the pancreas, the left colic flexure, and coils of jejunum

ABDOMINAL AORTA

Lesser omentum

R: the diaphragm; the costodiaphragmatic recess of the pleura; the 12th rib; and the psoas, quadratus lumborum, and transversus abdominis muscles. The subcostal (t12), iliohypogastric, and ilioinguinal nerves (l1) run downward and laterally L: the diaphragm; the costodiaphragmatic recess of the pleura; the 11th (the left kidney is higher) and 12th ribs; and the psoas, quadratus lumborum, and transversus abdominis muscles. The subcostal (t12), iliohypogastric, and ilioinguinal nerves (l1) run downward and laterally Anterior longitudinal ligament

Ureter

L: celiac ganglion, celiac trunk, superior mesenteric artery, left crus of the diaphragm Aorta Inferior vena cava

Inferior vena cava

Right and left common iliac arteries Left common iliac vein

DIAPHRAGM

Abdominal wall, sternum

Aorta, azygos vein, esophagus, pleural folds

Pericardium, basal lung segment

R: liver, suprarenal gland, kidney L: stomach, suprarenal gland, kidney, spleen Vagina, urinary bladder, rectum Perineal body M: prostate, pubic symphysis, rectum F: pubic symphysis, urethra The apex of the prostate lies on the upper surface of the urogenital diaphragm. The urethra leaves the prostate just above the apex on the anterior surface

R: azygos vein, cisterna chyli, thoracic duct, right crus of diaphragm L: coils of small intestine, left crus of diaphragm, left celiac ganglion, ascending part of duodenum Thoracic cage (ribs 7-11)

N/A

UTERUS VAGINA URINARY BLADDER

PROSTATE GLAND

Vesicouterine pouch, superior surface of bladder, supravaginal part of cervix Fundus of the urinary bladder and urethra Empty: retropubic space (of retzius), pubic symphysis Full: Linea alba The prostate is related to the symphysis pubis, separated from it by the extraperitoneal fat in the retropubic space (cave of retzius). The prostate is connected to the posterior aspect of the pubic bones by the fascial puboprostatic ligaments

Retrouterine pouch Anal canal, rectum, rectouterine pouch M: supravesical fossa F: ureter, vagina Is closely related to the anterior surface of the rectal ampulla and is separated from it by the rectovesical septum (fascia of denonvilliers). This septum is formed in fetal life by the fusion of the walls of the lower end of the rectovesical pouch of peritoneum, which originally extended down to the perineal body Rectum

Round ligament 1-2 cm of its posterior wall Supravesical fossa

Peritoneal broad ligament Levator ani, visceral pelvic fascia, ureters Pubic bone, fascia covering the levator ani and superior obturator internus muscle The prostate is embraced by the anterior fibers of the levator ani as they run posteriorly from the pubis

Interior medial: Liver, inferior vena cava, abdominal aorta, spleen, suprarenal glands, kidneys N/A N/A N/A

The base of the prostate is continuous with the neck of the bladder, the smooth muscle passing without interruption from one organ to the other. The urethra enters the center of the base of the prostate

N/A

DEEP PERINEAL POUCH (UROGENITAL DIAPHRAGM)

Symphysis pubis, rectovesical septum M: fundiform ligament of penis

Inferior fascia of pelvic diaphragm

Perineal membrane

Inferior portion of obturator fascia

Male and female genital organs

2. Discuss the anatomical and clinical significance of the right and left hypogastric nerves The main part of the superior hypogastric plexus is the prolongation of the intermesenteric plexus which lies inferior to the bifurcation of the aorta. The superior hypogastric plexus enters the pelvis dividing into the right and left hypogastric nerves which descends on the anterior surface of the sacrum. These nerves descends lateral to the rectum with the hypogastric sheath and then spread in a fan-like fashion as they merge with the pelvic splanchnic nerves to form the right and left inferior hypogastric plexus. The superior hypogastric plexus supplies ureteric and testicular plexuses and the plexus on each common iliac artery. 3. Ligaments derived from external oblique aponeurosis: * Inguinal ligament: dense band consisting of the inferior most part of the external oblique aponeurosis a. Lacunar ligament: deeper fibers pass posteriorly to attach to the superior pubic ramus lateral to the tubercle b. Pectineal ligament (of Cooper): continuous from the most lateral fibers of the Lacunar Ligament and continue to run along the pectin pubis. c. Reflected inguinal ligament: more superior fibers; fan upward bypassing the pubic tubercle and crossing the Linea alba to blend with the lower fibers of the contralateral external oblique. * The inguinal ligament together with the inguinal canal spans the myopectineal orifice. This is the site of direct and indirect inguinal hernias. 4. Friction on the glans penis, results in a discharge along the sympathetic nerve fibers to the smooth muscle of the duct of the epididymis and the vas deferens on each side, the seminal vesicles, and the prostate. The smooth muscle contracts, and the spermatozoa, together with the secretions of the seminal vesicles and prostate, are discharged into the prostatic urethra. The fluid now joins the secretions of the bulbourethral glands and penile urethral glands and is then ejected from the penile urethra as a result of the rhythmic contractions of the bulbospongiosus muscles, which compress the urethra. 5. found in the table 6. MUSCLE Urethral sphincter ORIGIN Pubic arch INNERVATION Perineal branch of the pudendal nerve ACTION Compresses the membranous part of the urethra and relaxes during micturition Voluntary sphincter of urethra Compresses urethra and assist in erection of the penis

Bulbospongiosus

Perineal body

Perineal branch of the pudendal nerve

7. quadratus: L12, Psoas Major: L1; Aorta: t12