practical ANATOMY of the ABDOMEN (after mid yr) ppsx - RuQaYa FaLaH

Practical Anatomy

(Abdomen )

Sacral promontery

ureter

Vas defferens

Keep in mind that vas ddeferens is originated from spermatic cord but directed toward the back

Spermatic cord

Coverings of spermatic cord
Lacunar ligament

ILIOHYPOGASTRIC NERVE

ILIO INGUINAL NERVE
It enters through the superficial inguinal ring

Sup.inguinal ring

LIES MEDIAL TO DEEP INGUINAL RING

Above inguinal ligament
Inguinal ligament=pouparts ligament

Floor or inf.surface of inguinal canal

Extends upward ..backward med.margin of femoral ring
Forms the sup.wall

Lies above pubic tubercle

Ex.oblique aponeurosis will form :-
• Inguinal ligament..
• sup.inguinal ring…
• sup.spermatic fascia

Note :- cremasteric artery is branch from inf.epigastric artery.

The anastmosis between superior & inferior epigastric arteries is between umbilicus & xiphoid process.
Arteries are found deeep to int.oblique muscle…
Theortical notes

Psoas muscle

Quadratus lumborum
iliacus
Between iliacus & psoas muscle lies femoral nerve

Genitofemoral nerve

Always on psoas muscle
Lat.cutaneous nerve of thigh
Femoral nerve
Iliohypogastric nerve
Lumbar artery
Rectum

Sigmoid

Ilioinguinal nerve

Pararectal fossa

Fascia from which arises the transversus abdominis muscle

Inguinal ligament fuses with fascia lata

Spermatic cord

Deep circumflex iliac a

Inf.epigastric artery

Tunica albuginea

Tunica vaginalis that covers the

lat & ant surface of testes
Pectinate ligament =cooper’s ligament

Note that testes are not tethered to subcutaneous tissue or skin

Subcostal nerve

Ileohypogastric nerve
Ilioinguinal nerve
Femoral nerve
Genitofemoral nerve
Arcuate line

Deep circumflex iliac a

Inf.epigastric a

Inguinal ligament

Sup inguinal ring
Femoral artery when it crosses the inguinal ligament
Ex.iliac artery

Inf.epigastric artery

Genitofemoral nerve
This region contains the median, medial,lat. umbilical ligament …

Arcuate line

Median is remnant of urachus..while medial are
remnant of umbilical arteries ..lateral contain the
Inf.epigastric vesselsextends from deep inguinal ring to
Arcuate line
Every vessels lie in camper’s fascia
Fatty layer

Sup.epigastric artery goes to ant.abominal wall.

Musculophrenic artery
This division of int.mammary artery occurs at level of 6th intercostal space

Deep inguinal ring lat.to inf.epigastric vessels

Inf.epigastric artery

Deep circumflex iliac a

Inf.epigastric a

Deep circumflex a
Both are branches from ex.iliac artery
Obturator artery & nerve

Lumbar fascia

Free post.border of ex.oblique (not connected to lumbar fascia

Int.oblique muscle)

Int.thoracic artery that is branch from subclavian artery…at the level of xiphosternal joint will be divided into :musculophrenic artery that runs laterallly & sup.epigastric artery runs in the ant abdominal wall (level of6th intercostal space .).
Note:-sup.inguinal ring transmits L1 while deep inguinal ring not transmit it
Theoritical Notes :imp

Note :- there is 3 differences between sup.inguinal ring&deep inguinal ring.
L1 is the iliohypogastric & ilioinguinal nerves that supply all muscles except rectus +pyramidalis.

Contents of rectus sheath:imp

1)sup.epigastric vessels & inf.epigastric vessels.
2)lymph vessels.
3)ant.rami of lower six thoracic nerves .
4)rectus muscle.
5)pyramidalis (if present).

1st inch of duodenum..stomach..Liver & gallbladder are intraperitoneal strcture

Round ligament of liver that in the inf part of faciform ligament is remnant of left umbilical vein

Greater omentum

Transverse colon

spleen

Gastrosplenic ligament goes to the hilum of spleen
Extends from lower greater curvature to transverse colon.

Greater omentum

Transverse mesocolon
Proper mesentry of intestine
Jejunum +ilium are intraperitoneal organs.

Mesentry of intestine

Transverse mesocolon
Ascending colon +descending colon are retroperitoneal organ.

Fan shaped mesentry

Testicular vein (left side that drains in the left renal vein

Renal vein
Suprarenal vein

Testicular vein (left side that drains in the left renal vein

Left renal vein

ureter

The right testicular vein drains in the inf.vena cava
Lies at L3-L4

Aorta & inf.vena cava are retroperitoneal organs

Faciform ligament

Ligamentum teres
peritoneum
Sup.pancreatoduodenal artery
Rt gastroepiploic artery
Gastroduodenal artery

Sup.mesenteric vessels on ant of third part of duodenum

Faciform ligament

Ligamentum teres

Falciform ligament ascends on the upper border of liver divided into 2 branches:-right one is coronary ligament…left one :-left triangular ligament.
Falciform ligament connects the liver to front of body wall & to diphragm

Celiac trunk :- imp imp

Sup.mesenteric artery

Left renal artery

Right renal artery

Inf.suprarenal artery

Lumbar arteries

ureter
Sacral arteries & veins

Ceiliac trunk

Splenic artery

Hepatic artery

Inf.vena cava at level of L5 will bifuracate
Inf.mesenteric vein

IMP….

Renal arteries arises at L2…OVARIAN AT L1

Femoral ring lies below & lat.to pubic tubercle

Middle colic artery
Jejunal & ileal branches

The first part of duodenum lies at L1 …upward back ward to right

مهم جدا

Lat.cutaneus nerve of thigh

Femoral nerve
Aorta
RT common iliac
Left common iliac

jejunum

Ileum
Greater omentum
cecum

Descending colon

Hepatic flexure
Splenic flexure

Taienia colli

Ileocecals valve

Cecum

Ascending colon

Taiena colli

Terminal part of ileum

Ileocecal valve
Appendicular orifice
Appendices epiploicae
Taienia colli

Mesentery of small intestine:-parietal peritoneum

Sup.mesenteric artery & vein

Inf.mesenteric artery
Branches of inf.mesenteric artery
Branches of sup.mesenteric artery
Meso appendix

Middle colic artery

Rt colic artery
Ileocolic artery
Lt colic artery
Sigmoidal branches
Sup.rectal artery

Rugae longitudinal in direction

Imp notes:-
The parietal surface under the diaphragm is supplied by phrenic nerve

The shoulder is supplied by supraclavicular n.

The segmental nerves supplying the ant.abdominal wall is T11,T12,L1…RIGHT LOWER QUADRANT

notes

The level above umbilicus is the 10th costal cartilage.
The herneal sac when is formed in right groin includes coils of small intestine
In femoral hernial sac ,the hernia lies lat & below the pubic tubercle.

Rt lobe of liver

Lt lobe of liver
Rt coronary ligament
Lt triangular ligament
Rt triangular ligament
Bare area of liver
Bare area of liver lies post

Papillary process of caudate lobe

Omental tuberosity

Gastric area

Caudate lobe of liver

Papillary process of caudate lobe

Caudate process of caudate lobe

Bare area

Fissure for ligamentum teres

Ligamentum teres was left umbilical vein
Cystic artery
Lt hepatic artery

fundus

Body
neck

GB lies between the quadrate lobe of liver & RT lobe of liver 
Fundus of GB is at level of elbow

Fissure for ligamentum venosum

Area for transverse colon

Pyloric area

Triangle between the cystic duct & CBD is calots triangle

Gastric impression

Extremity of CL is Triangular area of liver

Lesser omentum

Pelvis of ureter

The hilum of kidney located at level of transpyloric plane
Sup.mesenteric a. lies at level of transpyloric plane

Left renal vein longer than rt renal coz inf.vena cava is not am idline structure

Left suprarenal vein

Gonadal vein…ovarian vein

Right gonadal vein drains directly in inf.vena cava

Rt suprarenal vein directly from inf.vena cava

Inf.mesenteric a at level of L3

Abdominal aorta bifuracates at level of L4

Ceiliac trunk

Sup.mesenteric artery

Left renal artery

Right renal artery

Left renal vein

Inf.vena cava

Sup.mesenteric vessels

3rd part of duodenum
4th part of duodenum
Variations !!!!!

Phrenic arteries

Splenic artery & splenic vein

Common hepatic artery

Left gastric artery
Lumbar artery
Inf.mesenteric artery

Sup.mesenteric artery & vein

Splenic artery

Branches of splenic artery 5 or six

Right gastroepiploic artery

Peritoneum

Common bile duct
Major duodenal papilla
Sympathetic chain always lies lat.to aorta (lumbar arteries)

In area of ant.notch is the stomach area

Visceral surface of spleen

Location of kidneys ….t12 –L3

Int.iliac artery

Ex.iliac artery
بالامتحان ماننسى نكتب الاتجاهات مال الشرايين 
Obturator nerve & artery

Cardiac sphinecter

Fundus of stomach

Body of stomach

Incisura angularis

Antrum

Tubular portion :the pylorus ..its lumen is called :the pyloric canal
Fundus projects upward & to left….

Rt gastroepiploic artery

Body of stomach extends from cardiac orifice incisura angularis….a notch in lesser curvature of stomach.

Peritoneum

Inf.phrenic artery
Splenic artery
Falciform lig
Ligamentum teres

Ceiliac trunk

Splenic artery

Sup.pancreatoduodenal artery

Right gastroepiploic artery

Sup.mesenteric vessels

Portal vein & bile duct
Common hepatic artery
Inf.pancreatoduodenal artery
Gastroduodenal artery
Gastroduodenal artery lies above pylorus …..descends behind duodenum

Gastric impression

Pylorus area & area for 1st part of duodenum
Renal area
Colic area

Esophageal area

Cystic duct

Inf.vena cava

Portal vein

Right gastroepiploic artery

Descending colon it is lat .to psoas . Always

Pubic bones

Retropubic pad of fats
Retropubic space (cave of retzius
Puboprostatic ligament
Rectal ampulla
Fascia denonvillier

For review of relation of prostate & bladder surafce

Bladder in female

Renal pelvis

Minor calyces
Major calyces

Arcuate artery

Left testicular vein
Median artery & vein

Subcostal nerve
Iliohypogastric nerve
Ilioinguinal nerve

• Right renal artery

• Celiac trunk
• Superior mesenteric artery
• Left renal artery
• Right gonadal artery
• Left gonadal artery
• Inferior mesenteric artery

• Right renal vein

• Inferior vena cava
• Left renal vein
• Right gonadal vein
• Left gonadal veinNote: The right gonadal vein empties into the inferior vena cava, while the left gonadal vein empties into the left renal vein.

Umbilical artery

Obturator artery
Middle rectal artery
Inf.vesical artery

Obturator artery & nerve

Inf.vesical artery
Umbilical artery
Middle rectal artery
Lat.sacral artery
Ex.iliac vein
Int.iliac vein
Sup.vesical artery
Sup.gluteal artery the most largest