Anatomy of the Abdomen and pelvis

35 Pages·2012·4.87 MB·English

Anatomy of the Abdomen and pelvis
03 May 2012
08:48
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For the Anatomy of The Abdomen and Pelvis notes I used a mixture of
Gray's, Netter's and Clinically Orientated Anatomy. In addition some detail
is taken from Instant Anatomy for android written by Dr. Robert Whitaker
who teaches anatomy at Cambridge.
I organise my notes so that you should read the learning objectives on the
left then proceed down the right hand side for a few learning objectives
and then cross back over to the left and continue like that.
Anything in this highlighted green is a definition or explains basically
something's function.
Text highlighted in yellow or with a star is what I would deem important
and key to your learning.
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Good luck with first year
Stuart Taylor
Stuart's Anatomy of the Abdomen and Pelvis Page 1
Abdominal wall, inguinal region and hernias
03 May 2012
08:58
Describethe rectus sheath and its contents.
Describethe rectus sheath and its contents.
Definethe linea alba and the linea semilunaris
Demonstratein the living subject and in dissected material the nature and
3 levels
course of the inguinal canal making correct use of the following terms:
• Above costal margin
superficial and deep inguinal rings, mid-inguinal point, pubic tubercle, testis,
• Between costal margin and arcuate line
testicular vessels, scrotum, spermatic cord, ductus deferens, round ligament • Below arcuate line
of the uterus.
Distinguishbetween direct and indirect inguinal hernias. • Arises from costal cartilages 5-7 and the xiphoid processand descends lateral to the
Distinguishbetween acquired and congenital inguinal hernia linear alba to insert on the pubic crest and the front of the pubic symphysis.
Summarisethe anatomical basis for femoral hernia. • Divided into segments bytransverse tendinous intersections
Explainthe importance of the distinction between the fatty and
membranous layers of the superficial fascia
General information on hernias
• Hernia-A protrusion of a viscus through a defect in its containing compartment such
that it lies in an abnormal position.
• Reducible-sac returns to containing cavity
• Irreducible-sac cannot be returned to containing cavity
• Obstructed-sac contains blocked bowel
• Strangulated-sac 's contents with strangulated blood supply
• Children can be born with a defect in the groin.
• 10x more common in males because of embryological descent of testes.
Distinguishbetween direct and indirect inguinal hernias.
Indirect
• This is the most common type • Rectus abdominis lies deep to the aponeurosis of the external oblique throughout its
• Tend to be in younger adults and children length.
• Due to lax deep ring or patent processus vaginalis. • In the upper two-thirds of the anterior abdominal wall it lies anterior to the transversus
• More common on the right hand side. abdominis aponeurosis while the internal oblique aponeurosis splits to enclose it.
• The deep ring is too large, peritoneum pushes through. • Rectus abdominis therefore lies in a fibrous tunnel called the rectus sheath. The
• Indirect hernia defect is always the deep/internal ring which is always LATERAL to anterior wall of the sheath consists of the aponeurosis of external oblique fused with
the inferior epigastric vessels. the anterior leaf of the internal oblique aponeurosis. Similarly the posterior wall
comprises the posterior leaf fused with the transversus abdominis aponeurosis.
Direct • In the lower part of the sheath, all the aponeuroses pass anterior to rectus so that this
• Groin hernias that occur in old people. part is ‘backless’.
• Acquired defect in posterior wall of the inguinal canal. • The free lower posterior margin of the posterior layer of the rectus sheath is known as
• Associated with chronic straining. the arcuate line.
• A direct hernia defect tends to go through Hesselbach's triangle, which is always
MEDIAL to the inferior epigastric vessels.
Definethe linea alba and the linea semilunaris
Medial Lateral
• At the lateral margin of the rectus abdominis the aponeuroses of the three flat muscles
fuse to form the linea semilunaris before enclosing the rectus muscle and fusing again
in the midline at thelinea alba.
Contents:
• Arteries and veins lying posteriorto the muscle. These are the epigastric vessels.
• There is an anastomosis between the superior epigastric artery, which is a branch of the
internal thoracic, and the inferior epigastric, which forms an interesting though
relatively useless bypass of the abdominal and descending aortas.
Inferior epigastric
• Nerve supply to the muscles are fromT6-L1
Vessels • Intercostal nerves are from T6-T12and the main trunks of these lie between the
Internal oblique and Transversus abdominis layers (like the intercostal nerves in the
chest wall)
Hesselbach’sTriangle Arrangement of the sheet muscles
Distinguishbetween acquired and congenital inguinal hernia
• Most often occurs in male babies due to a patent processus vaginalis.
• Processus is required for testicular descent and if it does not close properly the baby can
get an indirect hernia.
• Testes start out at the level of the kidneys which migrate to the scrotum.
• They descend at the back of the abdomen.
• There is a finger of peritoneum and the testes descend behind it which acts as a guide.
• The finger of peritoneum is supposed to seal off which can be filled with bowel.
Patent Processus
Vaginalis
The three sheet muscles, from superficial to deep, are:
Stuart's Anatomy of the Abdomen and Pelvis Page 2
NORMAL PATENT PROCESSUS
Patent Processus
Vaginalis
The three sheet muscles, from superficial to deep, are:
 External oblique
• Slips off of ribs 5-12and descends antero-inferiorly. Has an important free posterior
border which runs from the anterior superior iliac spine (ASIS) to the pubic tubercle
forming the inguinal ligament.
NORMAL PATENT PROCESSUS  Internal oblique
• Originates from lumbar fascia, anterior 2/3 of iliac crest and lateral 2/3 of the inguinal
ligament.
Factors associated with hernia • Highest ascend to ribs 10-12 lowest descend to the crest and medial part of pectineal line
• Chronic cough-COPD, asthma of the pubis.
• Prostatic disease
• Constipation  Transversus abdominis
• Muscular effort e.g. job • Runs medially from the inner aspect of the costal margin from ribs 7-12, the lumbar
• Previous hernia repair fascia and from the anterior 2/3 of the iliac crest to the lateral 1/3 of the inguinal
• Obesity ligament.
• Ascites • Lowest fibres insert on the pubic crest and the pectineal line with the lower part of the
internal oblique muscle as the conjoint tendon.
Treatment is to stich or clip in a mesh of polyproponene low chance of recurrence is 1%.
The arrangement is homologous with the three layers of muscles found in the intercostal
Distinguishbetween acquired and congenital inguinal hernia spaces. All three originate from the margins of the anterolateral wall, turn into aponeuroses
Summarisethe anatomical basis for femoral hernia. (sheet-like tendons) in the anterior abdominal wall, and insert into a tough fibrous band called
the linea alba(white line) that extends in the mid-line from the xiphoid process of the
sternum to the pubic symphysis.
• Femoral hernia protrudes through the femoral canal.
• Very tight hole which is dangerous because it causes bowel to lose its blood supply.
• Below and lateral to pubic tubercle is femoral above and medial is inguinal. Demonstratein the living subject and in dissected material the nature and
course of the inguinal canal making correct use of the following terms:
superficial and deep inguinal rings, mid-inguinal point, pubic tubercle, testis,
Borders of the femoral canal
testicular vessels, scrotum, spermatic cord, ductus deferens, round ligament of
Superior-Inguinal ligament the uterus.
Inferior-Pectineus fascia
Medial-Lacunar ligament Inguinal canal
Lateral-Femoral vein • A canal formed by the layers of the abdominal wall muscle.
• Approximately 4cm long.
• It runs from the deep ring to the superficial ring.
• Transmits the spermatic cord in the male and round ligament of the uterus in females.
Also transmits into ilioinguinal nerve.
ANTERIOR SUPERIOR ILIAC
SPINE
DEEP RING
INGUINAL CANAL
PUBIC
TUBERCLE
History
• Lump in the groin
• May come and go
Deep ring-The deep (internal) ring is an opening in the back wall of the inguinal canal
• There all the time
through which the canal's contents enter.
• Painful
Superficial ring-V shaped slit in the external oblique aponeurosis that allows the content of
• Vomiting/ constipation
the canal to exit e.g. to the scrotum.
• Associated conditions.
Summary of the borders of the inguinal canal
Anterior-External oblique aponeurosis + internal oblique
Floor-Inguinal ligament
Roof-Internal oblique arching over
Posterior-Transversalis fascia and conjoint tendon medially
(Transversalis is the same thing as transversus abdominis)
• On examination femoral hernias tend to be irreducible, and hot and painful if
strangulated.
Stuart's Anatomy of the Abdomen and Pelvis Page 3
• On examination femoral hernias tend to be irreducible, and hot and painful if
strangulated.
• They can be distinguished from inguinal hernias because they appear below and lateral
to the pubic tubercle.
• Inguinal hernias are above and medial to the pubic tubercle.
ANTERIOR
SUPERIOR
PUBIC ILIAC SPINE
TUBERCLE
FEMORAL HERNIA
BELOW AND LATERAL
TO PUBIC TUBERCLE
Explainthe importance of the distinction between the fatty and membranous
layers of the superficial fascia
• The superficial facia of the abdominal wall (subcutaneous tissue of the abdomen) is a
layer of fatty connective tissue. It is usually a single layer similar to, and continuous with
the superficial fascia throughout other regions of the body. However in the lower region
of the anterior part of the abdominal wall, below the umbilicus, it forms two layers: a
superficial fatty layer and a deeper membranous layer.
Superficial fatty layer
• This layer contains fat and varies in thickness. It is also known as Camper's fascia.
• It is continuous over the inguinal ligament with the superficial fascia of the thigh and
with a similar layer in the perineum.
• In men, this superficial layer continues over the penis and, after losing its fat and fusing
with the deeper layer of superficial fascia, continues into the scrotum where it forms a
specialised fascial layer containing smooth muscle fibres (the dartos fascia). In women,
this superficial layer retains some fat and is a component of the labia mayor.
Deeper Layer
• The deeper membranous layer of superficial fascia (Scarpa's fascia) is thin and
membranous, and contains little or no fat. Inferiorly, it continues into the thigh, but just
below the inguinal ligament, it fuses with the deep fascia of the thigh.
• In the mid-line, it is firmly attached to the linea alba and the symphysis pubis. It
continues into the anterior part of the perineum where it is firmly attached to the
isciopubic rami and to the posterior margin of the perineal membrane. Here, it is
referred to as the superficial perineal fascia (Colles' fascia)
• In men, the deeper membranous layer of superficial fascia blends with the superficial
layer as they both pass over the penis, forming the superficial fascia of the penis, before
they continue into the scrotum where they form the dartos fascia.
• Also in men, extensions of the deeper membranous layer of superficial fascia attached to
the pubic symphysis pass inferiorly onto the dorsum and sides of the penis to form the
fundiform ligament of penis.
• In women, the membranous layer of the superficial fascia continues into the labia
majora and the anterior part of the perineum
Stuart's Anatomy of the Abdomen and Pelvis Page 4
Living Anatomy
31 May 2012
12:34
Iliac tubercle is 5cm behind the Anterior Superior Iliac Spine
Transpyloric plane is from the 9th costal cartilages across.
Subcostal plane is the horizontal plane at level of costal margin in the Mid axillary line Structure Vertebral Structures at Transpyloric Plane:
Transtubercular plane is the plane across the iliac tubercles. level • L1 vertebrae
• 9th CC
Supracrestal plane-Transverse plane running along the top of the iliac crests just 1 Xiphisternum T8/9
• Origin of SMA
below the umbilicus. 2 Transpyloric plane L1 • Formation of Portal Vein
3 Tip of 9thcostal cartilage L1 • Neck of the Pancreas
• Hilum of the Kidney
4 Subcostal plane (Rib 10) L2
• Hilum of the Spleen
5 Umbilicus L3/4 • Duodenal-jejunal flexure
6 Supracristal plane L4 • Pylorus
7 Iliac tubercles L5 • Transverse Colon
• Fundus of gall bladder
8 ASIS and PSIS/ Sacral Dimple S2
• End of spinal cord
9 Midpoint of sacroiliac joint S2
That’s 12 bitches.
• Formed from the transtubercular plane, subcostal plane and two midclavicular
vertical planes.
Stuart's Anatomy of the Abdomen and Pelvis Page 5
Gut and Peritoneum
08 May 2012
09:00
Defineparietal and visceral peritoneum and explainthe functions of the
Learning Objectives peritoneum and peritoneal cavity
• Normally elements of the gastrointestinal tract and its derivatives completely fill the
Defineparietal and visceral peritoneum and explainthe functions of
abdominal cavity, making the peritoneal cavity a potential space, and visceral
the peritoneum and peritoneal cavity
peritoneum on organs and parietal peritoneum in the adjacent abdominal wall slide
Drawdiagrams to explain different relationships to the peritoneum freely against one another.
(mesenteries and retroperitoneal positions) and listthe structures • The peritoneum is a epithelial like single layer of cells (the mesothelium) together with
contained within a typical mesentery a supportive layer of connective tissue. Peritoneum is similar to the pleura and serous
pericardium in the thorax.
Describethe peritoneal reflections in relation to major parts of the gut • The peritoneum reflects off the abdominal wall to become a component of the
and associated organs from the oesophagus to the rectum, with mesenteries that suspend the viscera.
special attention to the attachments and contents of the greater and • Components of the GI tract are suspended in peritoneal reflections called
lesser omenta and the mesentery proper mesenteries.
Describethe boundaries of the lesser sac and of the epiploic foramen
Parietal Peritoneum
(of Winslow)
Namethe regions of the gut from oesophagus to rectum and
summarise their main functions Visceral Peritoneum
Describethe sources and distribution of arteries to important
structures or organs derived from the foregut, midgut and hindgut.
Mesentery Viscera
e.g. Bowel
Describethe peritoneal reflections in relation to major parts of the gut and
associated organs from the oesophagus to the rectum, with special attention to Peritoneal Cavity
the attachments and contents of the greater and lesser omenta and the
mesentery proper
• Parietal peritoneum lines the abdominal wall
• Visceral peritoneum covers suspended organs.
Foregut-Distal 3rd of oesophagus to the 2nd part of the duodenum at the entrance of the bile
duct (Major duodenal papilla) • GI tract is suspended from the posterior/dorsal aspect.
Midgut-2nd part of the duodenum to two-thirds along transverse colon. • Peritoneal folds attaching viscera to the abdominal wall.
Hindgut-Distal 3rd of transverse colon to the rectum. • Filled with peritoneal fluid secreted by the mesothelium.
• Epithelial layer secretes the fluid and circulates into the lymphatic vessels especially at
the inferior surface of the diaphragm.
Drawdiagrams to explain different relationships to the peritoneum
(mesenteries and retroperitoneal positions) and listthe structures contained
within a typical mesentery
Intra vs. Retroperitoneal
endoderm • Intraperitoneal-structures e.g. most of small intestine, suspended from the abdominal
wall by mesenteries.
• Retroperitoneal-structures e.g. kidneys and great vessels i.e. aorta and vena cava that
+ 4 wk IUL lie between parietal peritoneum and posterior abdominal wall.
Anterior/Ventral
• Endoderm, ectoderm and mesoderm.
• Yolk sac has no defined function INTRAperitoneal
• The gut originates from the endoderm and splanchnic mesoderm.
• It is suspended from the posterior abdominal wall by a peritoneal fold-the dorsal mesentery.
• Blood supply, lymphatics and nerve supply all run through the mesentery.
RETROperitoneal
Great Vessels
• The entire gut tube is suspended from a dorsal mesentery.
• In addition the foregut has a ventral mesentery.
Kidneys
Retroperitoneal structures:
Primary
Intraperitoneal organs
• Suprarenal glands (the adrenals)
• Stomach
• Kidneys
• Ureter • 1st part of duodenum
• Jejunum
• Bladder
• Ileum
• Aorta
• Cecum
lartneV Dorsal mesentery ••• IEReVsxeCotcrptauhpmaegr (uiptsoanrte, alolwer 3rd is ••• ATSirpgapmnesonvidedir xCseo lCoonlon
• Rectum (Upper 1/3)
Secondary * • Liver
• Spleen
• The head, neck, and body of the pancreas
• Tail of pancreas
but not the tail which is located in
the splenorenal ligament.
In women-Uterus, Fallopian Tubes,
• Duodenum apart from the proximal
• The foregut has a ventral mesentery containing the liver, which splits into the falciform first segment which is intraperitoneal Ovaries
ligament and the lesser omentum. • Ascending and descending portions of
colon (but not the transverse or cecum)
Formation of the Omental Bursa (Lesser sac)
• Secondary fusion of the duodenum to the body wall, massive growth of the liver in the ventral • Good memory aide is SAD PUCKER.
mesentery, and fusion of the superior surface of the liver to the diaphragm restrict the
opening to the space enclosed by the ballooned dorsal mesentery associated with the *These organs originally had a mesentery, then became secondarily retroperitoneal when
stomach. This restricted opening is the omental foramen (epiploic foramen) the mesentery fused with the body wall.
GI tract Basic Plan
Stuart's Anatomy of the Abdomen and Pelvis Page 6
opening to the space enclosed by the ballooned dorsal mesentery associated with the
stomach. This restricted opening is the omental foramen (epiploic foramen) the mesentery fused with the body wall.
GI tract Basic Plan
Mesentery
Muscularis:
Mucosa:
Serosa:
• The part of the abdominal cavity enclosed by the expanded dorsal mesentery, and posterior to
the stomach, is the omental bursa (lesser sac). Access through the omental foramen to this submucosa
space from the rest of peritoneal cavity (greater sac) is inferior to the free edge of the ventral
mesentery.
• Part of the dorsal mesentery that initially forms part of the lesser sac greatly enlarges in an • Mucosa:
inferior direction, and the two opposing surfaces of the mesentery fuse to form an apron like  Made up of epithelium
structure (the greater omentum).  Lamina propia
• The greater omentum is suspended from the greater curvature of the stomach, lines every  Muscularis mucosae which is a layer of muscle needed to mobilise
other viscera in the abdominal cavity, and is the first structure observed when the abdominal mucous.
cavity is opened anteriorly.
• THE TWO GREATERS GO TOGETHER-GREATER OMENTUM AND GREATER CURVATURE • Mesentery:
• As the liver grows it moves to the right while the dorsal mesentery and spleen move to the  Contains arteries and nerves that supply the tissue
left. The original right side of the upper peritoneal cavity is now posterior-the lesser sac of the
peritoneal cavity. • Serosa:
 Areolar connective tissue
 Serosa is a connective tissue layer with epithelium which also lines the
visceral peritoneum.
• Muscularis:
• Controlled by the autonomic nervous system. Contraction of two layers of
muscle (circular and longitudinal) are needed to initiate peristalsis.
Namethe regions of the gut from oesophagus to rectum and summarise
their main functions
Oesophagus
• Oesophagus pierces diaphragm at T10.
• Pierces muscular part of diaphragm and contributes to Lower Oesophageal
Sphincter which helps prevent gastro-oesophageal reflux.
• Acts as a conduit for food and water which allows food to be digested in the
stomach.
Apparently this is a rage comic drawing of Nicholas Cage!!!
Note this knowledge is not examinable unfortunately.
Lower part of dorsal foregut mesentery extends down as a double fold called the greater
omentum anterior to the intestine. Stomach
The lesser omentum is part of the ventral foregut mesentery. • A ring of smooth muscle at distal end of Pyloric Canal prevents food entering
duodenum.
• Four main parts:
a. Cardia surrounding the opening
b. The fundus which is superior to cardia
c. The body
d. Pyloric region consisting of pyloric antrum and pyloric canal.
• Sphincter controls flow of food into duodenum.
Fundus
Pyloric Pyloric Body
canal antrum
• Functions of greater omentum:
i. Fat deposition, having varying amounts of adipose tissue Duodenum
ii. Immune contribution, having milky spotsof macrophage collections • First part is more horizontal and is known as the duodenal cap and is where most
iii. Infection and wound isolation; It may also physically limit the spread of duodenal ulcers occur.
intraperitoneal infections. The greater omentum can often be found wrapped • Second part of duodenum contains entrance for common bile duct -Major
around areas of infection and trauma. Duodenal Papilla
• Most of the duodenum is retroperitoneal.
Describethe boundaries of the lesser sac and of the epiploic foramen (of • 1-2 cm at beginning is intraperitoneal.
Winslow)
Stuart's Anatomy of the Abdomen and Pelvis Page 7 1
2
4
3
• Most of the duodenum is retroperitoneal.
Describethe boundaries of the lesser sac and of the epiploic foramen (of • 1-2 cm at beginning is intraperitoneal.
Winslow)
1
2
4
3
lesser
omentum
• The portal vein, hepatic artery and bile duct run between the posterior abdominal wall
and liver within the lesser omentum near its free edge. This free edge is present because
the ventral mesentery ends at the start of the midgut.
1
2
lesser sac
4
3
Jejunum Vs Ileum
Jejunum Ileum
Proximal 2/5 Distal 3/5
Larger in diameter Smaller in diameter
Upper left quadrant of abdomenLower right quadrant of abdomen
greater sac
Less prominent arterial arcades Prominent arterial arcades
Longer vasa recta Shorter vasa recta.
Large Intestine:
Haustra pocketed walls)
Epiploic right
foramen
The greater and lesser sacs of the peritoneal cavity
communicate through a narrow opening called the epiploic • Distinguishing features of large intestine from small intestine include fatty tags,
foramen(entry to the lesser sac). This lies just below the (appendices epiploicae), ribbons of longitudinal muscle (taeniae coli) and
segmented or pocketed walls. Diameter is not always a reliable guide.
liver, posterior to the free edge of the lesser omentum.
• Sigmoid colon is so named because it is S shaped.
• Ileocecal orifice does not allow passage of waste back up-no defined sphincter
arrangement although it does passively stop waste returning.
• The lesser omentum(small omentum; gastrohepatic omentum; omentum minus) is the
• Transverse colon has a mesentery and therefore intraperitoneal with the sigmoid
double layer of peritoneum that extends from the liver to the lesser curvatureof the
colon.
stomach and the start of the duodenum.
• Lesser sac (Omental Bursa)-Is the cavity in the abdomen that is formed by the lesser and
greater omentum. Usually found in mammals, it is connected with the greater sac via the
epiploic foramen (also known as the Foramen of Winslow).
○ It is demarcated anteriorly by the caudate lobe of the liver, the stomach and lesser
omentum. Posteriorly it is marked by the pancreas. Its left lateral margin is made by
the left kidney and adrenal gland. Its boundary on the right is made by the epiploic
foramen and lesser omentum.
• Greater sac-This is the general cavity of the abdomen or peritoneal cavity. It is connected
with the lesser sac via the omental foramen also known as the Foramen of Winslow or
Epiploic Foramen.
Describethe sources and distribution of arteries to important structures or
organs derived from the foregut, midgut and hindgut.
3 unpaired arteries arising from the anterior of the aorta
Stuart's Anatomy of the Abdomen and Pelvis Page 8
Describethe sources and distribution of arteries to important structures or
organs derived from the foregut, midgut and hindgut.
3 unpaired arteries arising from the anterior of the aorta
• Coeliac trunk-Foregut, liver, pancreas and spleen.
• Superior mesenteric artery(SMA)= Midgut
• Inferior mesenteric artery(IMA)= Hindgut
Venous return, lymphatics and nerve fibres
Venous System
• All veins drain back to the liver.
• Liver will process the nutrients and pass them all back into the systemic
circulation.
• Portal vein= gut -> liver.
Splenicv
Portal vein
Inferior
mesenteric vein
Superior
mesenteric v
• Splenic vein drains into the superior mesenteric which drains into the portal
vein.
• The portal vein arises from the superior mesenteric and splenic veins posterior
to the 1st part of the duodenum/ pylorus of the stomach. It then runs in the
free edge of the lesser omentum to the liver.
Splenicv
Portal vein
Inferior mesenteric vein
Superior mesenteric v
Porto-systemic anastomoses
• The portal systemic anastomoses are where veins draining to the portal vein and
the IVC communicate.
• Liver or portal obstruction causes these veins to dilate widely, possibly leading to
severe haemorrhage from oesophagus or rectum.
A
• Inferior is the smallest one.
Coeliac trunk
• Supplies the entire foregut (lower oesophagus, stomach, upper duodenum) and its
derivatives (liver and part of pancreas). The spleen, though not part of the alimentary
system, develops close to the foregut and shares its blood supply from the coeliac trunk.
C
Coeliac D
trunk
SIPEE
Common hepatic B
artery
Stuart's Anatomy of the Abdomen and Pelvis Page 9
A
C
Coeliac D
trunk
SIPEE
Common hepatic B
artery
• Esophageal branches of left gastric -Esophageal branches of azygos vein.
• Superior Rectal-Inferior Rectal
• The main branches of the Coeliac trunk are the Left Gastric Artery, Splenic Artery and the • Paraumbilical -Epigastric
Common Hepatic Artery. • Portal on left systemic on right.
• Systemic circulation meets portal circulation.
GI Overview
• Varicose veins on the wall of the gut can bleed easily if you cough hard enough.
• This can happen if you are an alcoholic with an inflamed liver that diverts blood
to other channels.
• Portal hypertension.
Lymphatics:
Lymphatics
Thoracic
duct Cnoodeelisac As in other parts of
Cisterna
chyli the body, the
Superior
Coeliac mesenteric lymphatic drainage of
nodes
trunk the bowel follows the
arterial supply, not
the venous drainage.
Superior Mesenteric
Artery & vein This is particularly
important in the gut,
inferior where the two routes
mesenteric
• This block of structures forms the posterior relations of the liver and stomach and is part of nodes are very different.
the retroperitoneum.
• The aorta bifurcates at the level of L3 into the inferior mesenteric and then at L4 to common
iliac artery which means you cannot have an abdominal aortic aneurysm below the
umbilicus which rules out one diagnosis. Nerves:
• Abdominal viscera is supplied by autonomic nervous system.
Superior Mesenteric Artery • Sensory fibres most important.
• Branches include: • Parasympathetic sensory (regulate reflex gut function)
 Middle colic artery ○ Vagus Nerve
 Right colic artery ○ Pelvic Splanchnic Nerves (S2-S4)
 Ileocolic artery
 Jejunal arteries • Sympathetic sensory (mediate pain)
 Ileal arteries ○ Thoracic splanchnic (T5-T12)
○ Lumbar splanchnic (L1+L2)
Middle colic Thoracic SplanchnicNs.
artery •Thoracic Splanchnic
N. (T5-T12) •Greater SplanchnicN.
(T5-T9)
Right colic
artery
•Lesser SplanchnicN.
Jejunal (T10-T11)
arteries
ileocolic •Least SplanchnicN.
(T12)
artery •Lumbar Splanchnic
N. (L1 + L2)
Ileal arteries
Inferior Mesenteric Artery
• The junction of the mid and hind gut is near the left splenic flexure of the colon. There is a
change from superior to inferior mesenteric artery supply at this level, but with anastomoses • Innervation: the sensory fibres are most important.
between them. • In the viscera the sensory fibres running with the sympathetic (T1-L2) mediate
pain.
• Sensory fibres running with the parasympathetic (vagus or sacral) are involved in
reflex regulation of gut function.
Stuart's Anatomy of the Abdomen and Pelvis Page 10