Fundamental Philosophy Surgery Series
Abdomen
Topographic Anatomy | Abdomen
Deltopectoral triangle
Sternum Body
Xiphoid process
Rectus abdominis muscle
Anterior superior iliac spine
Superficial circumflex iliac vein
Superficial epigastric veins
Pubic symphysis
Sternocleidomastoid muscle
Sternal head
Clavicular head
Trapezius muscle
Deltoid muscle
Pectoralis major muscle
Serratus anterior muscle
Tendinous intersection
External oblique muscle
Linea alba
Semilunar line
Umbilicus
Iliac crest
Inguinal ligament
Pubic tubercle
Body Wall | Bony Framework of Abdomen
Costal cartilages
Inner lip of Iliac crest
Intermediate zone of Iliac crest
Outer lip of Iliac crest
Tuberculum of Iliac crest
Anterior superior iliac spine
Anterior inferior iliac spine
Iliopubic eminence
Superior pubic ramus
Obturator foramen
Pubic tubercle
Inferior pubic ramus
Inferior pubic ligament
Pubic arch
Coccyx
Sacrum
Sacral promontory
T11
T12
L1
L2
L3
L4
L5
Body of sternum
Xiphoid process
12th rib
Transverse processes of lumbar vertebrae
Iliac tuberosity Iliac crest
Wing (ala) of ilium
Greater sciatic notch
Arcuate line
Ischial spine
Lesser sciatic notch
Greater trochanter of femur
Pecten pubic (pectineal line)
Pubic symphysis
Ischial tuberosity
Lesser trochanter of femur
Body Wall | Anterior Abdominal Wall: Superficial Dissection
Serratus anterior muscle
Latissimus dorsi muscle
Muscular part of External oblique muscle
Aponeurotic part of External oblique muscle
Anterior superior iliac spine
Inguinal ligament (Poupart’s)
Intercrurual fibers
Superficial inguinal ring
External spermatic fascia on spermatic cord
Cribriform fascia in saphenous opening
Fascia lata
Great saphenous vein
Superficial dorsal vein of penis
Pectoralis major muscle
Xiphoid process
Rectus sheath
Linea alba
Subcutaneous tissue (superficial fascia) of abdomen
Thoracoepigastric vein
Compater’s (fatty) layer of subcutaenous tissue of abdomen
Scarpa’s (membranous) layer of subcutaneous tissue of abdomen
Attachment of Scarpa’s layer to fascia lata
Superficial circumflex iliac vessels
Superficial epigastric vessels
Superficial external pudendal vessels
Fundiform ligament
Superficial fascia of penis and scrotum (dartos fascia) (cut)
Deep (Buck’s) fascia of penis with deep dorsal vein of penis showing through
Body Wall | Anterior Abdominal Wall: Intermediate Dissection
Latissimus dorsi muscle
Serratos anterior muscle
External oblique muscle (cut away)
External intercostal muscles
External oblique aponeurosis (cut edge)
Rectus sheath
Internal oblique muscle
Anterior superior iliac spine
Inguinal ligament (Poupart’s)
Cremaster muscle (lateral origin)
Inguinal falx (conjoint tendon)
Reflected inguinal ligament
Femoral vein (in femoral sheath)
Saphenous opening
Cremaster muscle (medial origin)
Fascia lata
Great saphenous vein
Pectoralis major muscles
Anterior layer of rectus sheath (cut edges)
Linea alba
Rectus abdominis muscle
External oblique muscle (cut away)
Tendinous intersection
Internal oblique muscle
Pyramidalis muscle
Inguinal falx (conjoint tendon)
Inguinal ligament (Poupart’s)
Anterior superior iliac spine
External oblique aponeurosis (cut and turned down)
Pectineal ligament (Cooper’s)
Lacunar ligament (Gimbernat’s)
Reflected inguinal ligament
Pubic tubercle
Suspensory ligament of penis
Cremaster muscles and cremasteric fascia
Deep (Buck’s) fascia of penis
External spermatic fascia (cut)
Superficial fascia of penis and scrotum (cut)
Body Wall | Anterior Abdominal Wall: Deep Dissection
Superior epigastric vessels
External oblique muscle (cut away)
Rectus abdominis muscle
External oblique aponeurosis (cut)
Internal oblique aponeurosis (cut)
Transversus abdominis muscle
Internal oblique muscle (cut)
Posterior layer of rectus sheath
Arcuate line
Inferior epigastric vessels
Anterior superior iliac spine
Inguinal ligament (Poupart’s)
Superficial circumflex iliac arteries
Superficial epigastric arteries
Superficial external pudendal arteries
Inguinal falx (conjoint tendon)
Pectineal ligament (Cooper’s)
Lacunar ligament (Gimbernat’s)
Reflected inguinal ligament
Reflected inguinal ligament
Pubic tubercle
Cremaster muscle and fascia
External spermatic fascia (cut)
Deep (Buck’s) fascia of penis
Superficial fascia of penis and scrotum (cut)
External spermatic fascia (cut)
Cremaster muscle and fascia (cut)
Internal spermatic fascia
Pectineal fascia
Fat in retropubic space (of Retzius)
Pectineal ligament (Cooper’s)
Lacunar ligament (Gimbernat’s)
Inguinal ligament (Poupart’s)
Femoral sheath (contains femoral artery and vein)
Cremasteric and pubic branches of inferior epigastric artery
Site of deep inguinal ring (origin of internal spermatic fascia)
Inferior epigastric artery and vein (cut)
Medial umbilical ligament (occluded part of umbilical artery)
Extrapertioneal fascia (areolar tissue)
Transversalis fascia (opened on left)
Transversus abdominis muscle (cut)
Anterior layer of rectus sheath
Linea alba
Anterior layer of rectus sheath (cut)
Body Wall | Rectus Sheath: Cross Sections
Section above arcuate line
Aponeurosis of transversus abdominis muscle
Aponeurosis of internal oblique muscle
Aponeurosis of external oblique muscle
Anterior layer of rectus sheath
Rectus abdominis muscle
Linea alba
Skin
Transversus abdominis muscle
Internal oblique muscle
External oblique muscle
Extraperitoneal fascia
Peritoneum
Transversalis fascia
Posterior layer of rectus sheath
Falciform ligament
Subcutaneous tissue (fatty layer)
Aponeurosis of internal oblique muscle splits to form anterior and posterior layers of rectus sheath. Aponeurosis of external oblique muscle joins anterior layer of sheath; aponeurosis of transversus abdominis muscle joins posterior layer. Anterior and posterior layers of rectus sheath unite medially to form linea alba
Section below arcuate line
Aponeurosis of transversus abdominis muscle
Aponeurosis of internal oblique muscle
Aponeurosis of external oblique muscle
Anterior layer of rectus sheath
Rectus abdominis muscle
Skin
Transversus abdominis muscle
Internal oblique muscle
External oblique muscle
Extraperitoneal fascia
Peritoneum
Transversalis fascia
Median umbilical ligament (obliterated urachus) in median umbilical fold
Medial umbilical ligament and fold
Subcutaneous tissue (fatty and membranous layers)
Aponeurosis of internal oblique muscle does not split at this level but passes completely anterior to rectus abdominis muscle and is fused there with both aponeurosis of external oblique muscle and that of transversus abdominis muscle. Thus, posterior wall of rectus sheath is absent below arcuate line, and rectus abdominis muscle lies on transversalis fascia.
Body Wall | Anterior Abdominal Wall: Internal View
Diaphragm
Diaphragmatic fascia
Falciform ligament
Peritoneum (cut edges)
Transversalis fascia and its cut edge
Arcuate line
Rectus abdominis muscle
Inferior epigastric vessels
Inguinal triangle (Hesselbach’s)
Transversalis fascia (cut)
Interfoveolar ligament
Deep circumflex iliac vessels
Deep inguinal ring
Cremasteric and pubic branches of inferior epigastric artery
Testicular vessels
External iliac vessels
Spermatic cord
Femoral sheath
Lacunar ligament (Gimbernat’s)
Pectineal ligament (Cooper’s)
Inguinal falx (conjoint tendon)
Umbilical artery (occluded part distal to this point)
Obturator nerve and vessels
Ureter (cut)
Anterior recess of ischioanal fossa
Superior vesical artery
Ductus (vas) deferens
Perineal membrane
Urinary bladder
Prostate and sphincter urethrae muscle
Seminal vesicle
Bulbourethral (Cowper’s) gland embedded in deep transverse perineal muscle
Levator ani muscle
Obturator internus muscle
Transverse vesical fold
Supravesical fossa
External iliac vessels
Iliopsoas muscle
Femoral nerve
Lateral umbilical fold (contains inferior epigastric vessels)
Umbilical prevesical fascia
Median umbilical ligament (obliterated urachus) and paraumbilical veins in median umbilical fold
Right medial umbilical fold
Left medial umbilical ligament (obliterated left umbilical artery)
Transversus abdominis muscle
External oblique muscles
Internal oblique muscles
Transversalis fascia
Peritoneum
Umbilicus
Rough ligament (ligamentum teres) of liver and paraumbilical veins
Parietal pleura
Body Wall | Posterolateral Abdominal Wall
Serratus anterior muscle
Infraspinous fascia
Rhomboid major muscle
Auscultatory triangle
Lateral cutaneous branch of dorsal ramus of T7 spinal nerve
Medial cutaneous branch of dorsal ramus of T7 spinal nerve
Trapezius muscle
Latissimus dorsi muscle
External oblique muscle
Thoracolumbar fascia (posterior layer)
Lateral cutaneous branch of subcostal nerve (ventral ramus of T12)
Lumbar triangle (of Petit)
Iliac crest
Lateral cutaneous branch of iliohypogastric nerve (L1)
Superior clunial nerves (lateral cutaneous branches of dorsal rami of L1-L3 spinal nerves)
Gluteal aponeurosis over gluteus medius muscle
Gluteus maximus muscle
Latissimus dorsi muscle
Latissimus dorsi muscle (cut and turned back)
Serratus posterior inferior muscle
Digitations of costal origin of latissimus dorsi muscle
Digitations of costal origin of external oblique muscle
External oblique muscle (cut and turned back)
Tendon of origin of transversus abdominis muscle
Internal oblique muscle
Lateral cutaneous branch of subcostal nerve (ventral ramus of T12)
Lateral cutaneous branch of iliohypogastric nerve (L1)
Iliac crest
Superior clunial nerves (lateral cutaneous branches of dorsal rami of L1-L3)
Gluteus maximus muscle
Body Wall | Arteries of Anterior Abdominal Wall
Axillary artery
Lateral thoracic artery
Subscapular artery
Thoracodorsal artery
Anterior intercostal arteries
External Intercostal muscles
Internal Intercostal muscles
Innermost Intercostal muscles
Anastomoses with lower intercostal, subcostal, and lumbar arteries
External oblique muscles
Internal oblique muscles
Transversus abdominis muscle
Ascending branch of deep circumflex iliac artery
Superficial circumflex iliac artery
Superficial epigastric artery (cut)
Femoral artery
Cremasteric and testicular arteries and artery to ductus deferens in spermatic cord
Subclavian artery
Internal thoracic arteries
Pericardiacophrenic artery with phrenic nerve
Transversus thoracis muscle
Branch to falciform ligament of liver
Musculophrenic arteries
Superior epigastric arteries
Diaphragm
Transversus abdominis muscle and aponeurosis
Rectus abdominis muscles
Internal oblique muscle
External oblique muscle
Posterior layer of rectus sheath
Arcuate line
Inferior epigastric artery
Superficial epigastric artery
Femoral artery
Superficial external pudendal artery
Deep external pudendal artery
Dorsal arteries of penis (deep to Buck’s fascia)
Body Wall | Veins of Anterior Abdominal Wall
Subclavian vein
Axillary vein
Cephalic vein
Intercostal tributaries to axillary vein
Lateral thoracic vein
Anterior intercostal veins
Internal thoracic vein
Musculophrenic vein
Superior epigastric veins
Thoracoepigastric vein
Paraumbilical veins in round ligament of liver
Inferior epigastric veins
Tributaries to deep circumflex iliac veins
Thoracoepigastric vein (cut)
Superficial circumflex iliac vein
Superficial epigastric vein
External pudendal vein
Saphenous opening
Femoral vein
Great saphenous vein
Pampiniform (venous) plexus
Deep dorsal vein of penis (deep to Buck’s fascia)
Superficial dorsal vein of penis
External Jugular veins
Internal Jugular veins
Anterior Jugular veins
Cephalic vein
Axillary vein
Lateral thoracic vein
Areolar venous plexus
Perforating tributaries to internal thoracic vein
Thoracoepigastric vein
Tributaries of paraumbilical veins
Thoracoepigastric vein
Superficial epigastric vein
Superficial circumflex iliac vein
External pudendal vein
Cribriform fascia over saphenous opening
Great saphenous vein
Anterior scrotal veins
Body Wall | Nerves of Anterior Abdominal Wall
Medial brachial cutaneous nerve
Intercostobrachial nerve (T1, 2)
Long thoracic nerve
Latissimus dorsi muscle
Lateral cutaneous branches of intercostal nerve (T2-11)
Anterior cutaneous branches of intercostal nerve (T1-11)
Lateral cutaneous branch of subcostal nerve (T12)
Lateral cutaneous branch of iliohypogastric nerve (L1)
Anterior cutaneous branch of subcostal nerve
Lateral femoral cutaneous nerve (L2, 3)
Anterior cutaneous branch of iliohypogastric nerve (L1)
Femoral branches of genitofemoral nerve (L1, 2)
Anterior scrotal branch of ilioinguinal nerve (L1)
Genital branch of genitofemoral nerve (L1, 2)
Serratus anterior muscle
External oblique muscle (cut)
Posterior layer of rectus sheath
Anterior layer of rectus sheath (cut)
Rectus abdominis muscle
Transversus abdominis muscle
Internal oblique muscle and aponeurosis (cut)
Anterior and lateral cutaneous branches of subcostal nerve (T12)
Anterior branch of iliohypogastric nerve (L1)
Ilioinguinal nerve (L1)
External oblique aponeurosis (cut)
Anterior cutaneous branch of iliohypogastric nerve (L1)
Cremasteric muscle of spermatic cord
External spermatic fascia of spermatic cord
Body Wall Thoracoabdominal Nerves
Ventral root
Dorsal root
Spinal sensory (dorsal root) ganglion
Meningeal branch
Spinal nerve trunk
Erector spinae muscle
Medial branch of Dorsal (posterior) ramus
Lateral branch of Dorsal (posterior) ramus
Dorsal (posterior) ramus
Ventral (anterior) ramus of spinal nerve (intercostal nerves)
Collateral branch
External intercostal muscle
Internal intercostal muscle
Innermost intercostal muscle
Latissimus dorsi muscle
Subcostal muscles
Serratus anterior muscle
Lateral cutaneous branch
Innermost intercostal muscle
Internal intercostal muscle
External intercostal muscle
External intercostal membrane
External oblique muscle
Anterior cutaneous branch
Linea alba
Rectus abdominis muscle
Transversus abdominis muscle
Collateral branch of rejoining intercostal nerve
Internal intercostal muscle
Window cut in innermost intercostal muscle
Communicating branch
Internal intercostal membranes anterior to external intercostal muscles
Gray and white rami communicantes
Sympathetic trunk
Greater and lesser thoracic splanchnic nerves
Body Wall | Inguinal Region: Dissections
Anterior view
External oblique muscle
Aponeurosis
Anterior superior iliac spine
Internal oblique muscle (cut and reflected)
Transversus abdominis muscle
Deep inguinal ring (in transversalis fascia)
Cremaster muscle (lateral origin)
Inferior epigastric vessels (deep to transversalis fascia)
Inguinal ligament (Poupart’s)
Lacunar ligament (Gimbernat’s
Cremaster muscle (medial origin)
Superficial inguinal ring
Lateral crus
Medial crus
Pubic crest
Linea alba
Rectus sheath (anterior layer)
Transversalis fascia within inguinal triangle (site of direct inguinal hernia)
Inguinal falx (conjoin tendon)
Reflected inguinal ligament
Intercrural fibers
External spermatic fascia on spermatic cord exiting
Superficial inguinal ring
Fundiform ligament of penis
Posterior (internal) view
Rectus sheath (posterior layer)
Arcuate line
Medial umbilical ligament
Anterior superior iliac spine
Transversalis fascia (cut away)
Rectus abdominis muscle
Iliopubic tract
Inferior epigastric vessels
Inguinal (Hesselbach’s) triangle
Femoral nerve
Genital branch of genitofemoral nerve and testicular vessels
Deep inguinal ring
Iliopsoas muscle
External iliac vessels
Femoral ring (dilated) (broken line)
Lacunar ligament (Gimbernat’s)
Rectineal ligament (Cooper’s)
Ductus (vas) deferens
Obturator-pubic anastomosis
Obturator vessels
Pubic branches of inferior epigastric vessels
Median umbilical ligament
Pubic symphysis
Body Wall | Inguinal Canal and Spermatic Cord
Superficial inguinal rings
Median umbilical ligament (urachus)
Pyramidalis muscle
Rectus abdominis muscle
Urinary bladder
Umbilical prevesical fascia
Medial umbilical ligament (occluded part of umbilical artery
Inferior epigastric vessels
Ductus (vas) deferens covered by peritoneum
External iliac vessels covered by peritoneum
Cremasteric vessels
Ductus (vas) deferens
Testicular vessels and genital branch of genitofemoral nerve
Testicular vessels covered by peritoneum
Peritoneum
Extraperitoneal fascia (loose connective tissue)
Transversalis fascia
Transversus abdominis muscle
Internal oblique muscle
External oblique muscle
Pubic symphysis (covered by intermingling fibers of external oblique aponeurosis)
Pubic tubercle
External spermatic fascia enveloping spermatic cord
Inguinal falx (conjoint tendon)
Intercrural fibers
Inguinal ligament (Poupart’s)
Cremaster muscle and cremasteric fascia on spermatic cord
Femoral vessels
Spermatic cord
Ilioinguinal nerve
Origin of internal spermatic fascia from transversalis fascia at deep inguinal ring
Anterior superior iliac spine
Body Wall | Indirect Inguinal Hernia
Origin of internal spermatic fascia from transversalis fascia at deep inguinal ring
Inferior epigastric vessels
Neck of hernial sac
Loop of bowel entering hernial
Ductus (vas) deferens, testicular vessels, and genital branch of genitofemoral nerve form spermatic cord
Peritoneum
Extraperitoneal fascia
Transversalis fascia
Hook retracting transversus abdominis muscle
Deep inguinal ring
Hook retracting internal oblique muscle
Hook retracting external oblique aponeurosis
External spermatic fascia
Cremaster muscle and fascia
Internal spermatic fascia
Ductus (vas) deferens and vessels of spermatic cord
Hernial sac
Superficial inguinal ring
Body Wall | Femoral Sheath and Inguinal Canal
Transervalis fascia (cut edge)
Extraperitoneal fascia
Parietal peritoneum
Median umbilical ligament (urachus)
Medial umbilical ligament (occluded part of umbilical artery)
Inferior epigastric vessels
Deep circumflex iliac vessels
Testicular vessels
Cremasteric artery
Ductus (vas) deferens
External iliac vessels
Pubic (obturator anastomotic) vessels
External oblique aponeurosis (cut)
Internal spermatic fascia on spermatic cord
Femoral nerve (deep to iliopsoas fascia)
Femoral vessels in femoral sheath
Falciform margin of saphenous opening (cut and reflected)
Transversalis fascia forms anterior wall of femoral sheath (posterior wall formed by iliopsoas fascia)
Inguinal ligament (Poupart’s)
Lacunar ligament (Gimbernat’s)
Pectineal ligament (Cooper’s)
Urinary bladder
Body Wall | Posterior Abdominal Wall: Internal View
Ureter
Genitofemoral nerve
Lateral femoral cutaneous nerve
Iliac fascia
Genital branch of genitofemoral nerve
Femoral branch of genitofemoral nerve
Testicular vessels
External iliac vessels
Inferior epigastric vessels
Ductus (vas) deferens and cremasteric artery
Pectineal ligament (Cooper’s)
Femoral ring
Transversalis fascia forms anterior wall of femoral sheath
Lacunar ligament (Gimbernat’s)
Inguinal ligament (Poupart’s)
Lymph node (Cloquet’s) in femoral canal
Femoral sheath (cut open)
Pectineal fascia
Body Wall | Arteries of Posterior Abdominal Wall
Caval opening
Diaphragm
Central tendon of diaphragm
Esophagus and vagal trunks
Right crus of diaphragm
Left crus of diaphragm
Median arcuate ligament
Aorta and thoracic duct
Greater, lesser, and least thoracic splanchnic nerves
Medial arcuate ligament
Lateral arcuate ligament
Sympathetic trunk
Quadratus lumborum muscle
Psoas minor muscle
Psoas major muscle
Transversus abdominis muscle
Internal oblique muscle
External oblique muscle
Iliacus muscle
Anterior superior iliac spine
Piriformis muscle
Coccygeus (ischiococcygeus) muscle
Ischial spine
Inguinal ligament (Poupart’s)
Obturator internus muscle
Tendinous arch of levator ani muscle
Opening for femoral vessels
Pectineal ligament (Cooper’s)
Lacunar ligament (Gimbernat’s)
Levator ani muscle
Lesser trochanter of femur
Pubic symphysis
Perinal membrane
Urethra
Rectum
Pubic tubercle
Anterior inferior iliac spine
Body Wall | Veins of Posterior Abdominal Wall
Anterior abdominal wall (turned down)
Diaphragm
Hepatic veins
Esophagus
Left suprarenal veins and anastomosis with inferior phrenic vein
Left renal vein
Ovarian (testicular) veins
Ascending lumbar veins
Common iliac vein
Internal iliac vein
Superior gluteal vein
Inferior gluteal vein
Internal pudendal vein
External iliac vein
Middle rectal vein
Uterine vein
Superior vesical vein
Deep circumflex iliac vein
Obturator vein
Round ligament of uterus
Inferior epigastric vein
Rectal venous plexus
Uterovaginal venous plexus
Vesical venous plexus
External pudendal vein
Great saphenous vein
Femoral vein
Pubic (obturator anastomotic) vein
Superficial epigastric vein (cut)
Inferior epigastric vein (cut)
Superficial circumflex iliac vein
Deep circumflex iliac vein
Lateral sacral veins
Median sacral vein
Internal iliac vein
Ovarian (testicular) veins and ureter (cut)
Common iliac vein
Iliolumbar vein
1st to 4th right lumber veins
Subcostal vein
Quadratus lumborum muscle
Psoas major muscle (cut)
Right renal vein
Right inferior suprerenal vein
Inferior vena cava
Inferior phrenic nerve
Body Wall | Lymph Vessels and Nodes of Posterior Abdominal Wall
Thoracic duct
Right subclavian trunk
Tracheobronchial nodes
Thoracic duct
Cisterna chyli
Right lumbar trunk
Left lumbar trunk
Common iliac nodes
Middle sacral nodes
Lateral sacral nodes
Inferior epigastric node
Node of Cloquet, or Rosenmüller (highest deep inguinal node)
Deep inguinal
Inferior phrenic nodes
Celiac nodes of Visceral (preaortic) lymph nodes
Superior mesenteric nodes of Visceral (preaortic) lymph nodes
Inferior mesenteric node of Visceral (preaortic) lymph nodes
Lumbar nodes (lateral aortic nodes)
Common iliac nodes
Internal iliac nodes
External iliac nodes
Superficial inguinal nodes (superior, horizontal, and inferior [vertical] groups)
Body Wall | Nerves of Posterior Abdominal Wall
Femoral nerve (L2-L4)
Lateral femoral cutaneous nerve (L2, 3)
Gray rami communicantes
Gray and white rami communicantes
Intermesenteric (paraaortic) plexus
Subcostal nerve (T12)
Lateral cutaneous branch of Subcostal nerve (T12)
Transversus abdominis muscle (cut)
Genitofemoral nerve (L1, 2)
Ilioinguinal nerve (L1)
Iliohypogastric nerve (L1)
Subcostal nerve (T12)
Sympathetic trunks
Greater thoracic splanchnic nerves
Lesser thoracic splanchnic nerves
Least thoracic splanchnic nerves
Celiac ganglia
Superior mesenteric ganglia
Aorticorenal ganglia
Iliohypogastric nerve (L1)
Ilioinguinal nerve (L1)
Muscular branches from lumbar plexus
Subcostal nerve (T12)
Psoas major muscle (cut)
Quadratus lumborum muscle
Iliohypogastric nerve (L1)
Ilioinguinal nerve (L1)
Genitofemoral nerve (L1, 2)
Lateral femoral cutaneous nerve (L2, 3)
Femoral branch of genitofemoral nerve
Genital branch of genitofemoral nerve
Lumbosacral trunks (L4, 5)
Obturator nerves
Accessory obturator nerve (L3, 4)(occasional)
Femoral nerve
Sacral plexus (L4-S4)
Pudendal nerve (S2, 3, 4)
Obturator nerve (L2, 3, 4)
Anterior cutaneous branch if iliohypogastric nerve (L1)
Anterior scrotal (labial) branches of ilioinguinal nerve (L1)
Genital branch of genitofemoral nerve (L1, 2)
Femoral branch of genitofemoral nerve (L1, 2)
Peritoneal Cavity | Regions and Planes of Abdomen
Right upper quadrant
Left upper quadrant
Right lower quadrant
Left lower quadrant
Right lateral rectus plane (semilunar line)
Left lateral rectus plane (semilunar line)
Right midclavicular line
Left midclavicular line
Epigastric region
Right hypochondrium
Transpyloric plane
Subcostal plane
Umbilical region
Right flank (lumbar region)
Intertubercular plane
Interspinous plane
Right groin (inguinal region)
Pubic (hypogastric region)
Left hypochondrium (hypochondriac region)
Left flank (lumbar region)
Left groin (inguinal region)
Peritoneal Cavity | Greater Omentum and Abdominal Viscera
Falciform ligament
Left lobe of liver
Right lobe of liver
Stomach
Gallbladder
Greater omentum overlying transverse colon and small intestine (jejunum and ileum)
Greater omentum (turned up)
Transverse colon (turned up)
Transverse mesocolon
Left colic (splenic) flexure
Right colic (splenic) flexure
Small intestine (jejunum and ileum)
Ascending colon
Cecum
Small intestine (covering descending colon)
Sigmoid colon
Urinary bladder
Peritoneal Cavity | Mesenteric Relations of Intestines
Transverse colon (elevated)
Transverse mesocolon
Superior duodenal fold
Superior duodenal fossa
Left colic (splenic) flexure
Paraduodenal fossa
Inferior duodenal fossa
Inferior duodenal fold
Mesentericoparietal recess (fossa)
Superior mesenteric artery in root of mesentery
Inferior mesenteric artery and vein
Abdominal aorta
Exposure of suspensory muscle of duodenum (ligament of Treitz)
Esophagus
Right crus of diaphragm (part passing to right of esophageal hiatus)
Right crus of diaphragm (part passing to left of esophageal hiatus)
Left crus of diaphragm
Celiac trunk
Suspensory muscle of duodenum (ligament of Treitz)
Superior mesenteric artery
Duodennojejunal flexure
Ascending (4th) part of duodenum
Jejunum
Inferior (horizontal, or 3rd) part of duodenum
Descending (2nd) part of duodenum
Peritoneal Cavity | Mesenteric Relations of Intestines (continued)
Greater omentum (elevated)
Free taenia (taenia libera)
Omental (epiploic) appendices
Right colic (hepatic) flexure
Right paracolic gutter
Ascending colon
Terminal part of ileum
Cecum
Retrocecal recess
Vermiform appendix
Transverse colon (elevated)
Transverse mesocolon (elevated over pancreas)
Jejunum (cut)
Mesentery (cut and small intestine removed)
Left colic (splenic) flexure
Descending colon
Left paracolic gutter
Sigmoid mesocolon
Sigmoid colon
Rectum
Sigmoid colon (reflected)
Sigmoid mesocolon
Intersigmoid recess
Ureter
Common iliac vessels
Parietal peritoneum
Peritoneal Cavity | Omental Bursa: Stomach Reflected
Inferior vena cava (retroperitoneal)
Common hepatic artery (in peritoneal fold)
Hepatoduodenal ligament (right margin of lesser omentum)
Probe in omental (epiploic) foramen
Gallbladder
Diaphragm
Liver
Gastro-omental (gastroepiploic) arterial anastomosis (enclosed in gastrocolic ligament)
Stomach (posterior surface)
Caudate lobe liver
Probe in superior recess of omental bursa
Left gastric artery (in gastropancreatic fold)
Left inferior phrenic artery (retroperitoneal)
Gastrophrenic ligament
Left suprarenal gland and superior pole of kidney (retroperitoneal)
Gastrosplenic (gastrolienal) ligament
Spleen
Right colic (hepatic) flexure
Kidney (retroperitoneal)
Descending (2nd) part of duodenum
Right gastro-omental (gastroepiploic) artery (covered by peritoneum)
Anterior superior pancreatico-duodenal artery (retroperitoneal)
Head of pancreas (retroperitoneal)
Body of pancreas (retroperitoneal)
Transverse mesocolon
Posterior layers of gastrocolic ligament
Anterior layers (cut) of gastrocolic ligament
Tail of pancreas (intraperitoneal)
Splenorenal (lienorenal ligament)
Phrenicocolic ligament
Left colic (splenic) flexure
Peritoneal Cavity | Omental Bursa: Cross Section
Right kidney
Diaphragm
Inferior vena cava
Vertebral body of L1
Abdominal aorta
Splenic vein
Left kidney
Spleen
Parietal peritoneum
Transverse colon
Transverse mesocolon
Duodenum
Omental (epiploic) foramen (of Winslow)
(Common) bile duct of a Portal triad
Hepatic portal vein of Portal triad
Proper hepatic artery of Portal triad
Lesser omentum (hepatoduodenal and hepatogastric ligaments)
Omental bursa (lesser sac)
Pancreas
Stomach
Visceral peritoneum (cut edges)
Greater omentum
Gastrosplenic (gastrolienal ligament)
Peritoneal Cavity | Peritoneum of Posterior Abdominal Wall
Hepatic veins
Inferior vena cava
(Common) bile duct and proper hepatic artery
Coronary ligament of liver
Right suprarenal gland
Omentum (epiploic) foramen behind right free margin of lesser omentum
Right triangular ligament
Attachment of transverse mesocolon and right gastro-omental (gastroepiploic vessels)
Duodenum
Right kidney
Parietal peritoneum
Root of mesentery
Site of ascending colon
Common iliac artery (retroperitoneal)
External iliac artery (retroperitoneal)
Testicular vessels (retroperitoneal)
Ureters (retroperitoneal)
Site of deep inguinal ring
Median umbilical fold (contains urachus)
Abdominal aorta and celiac trunk
Falciform ligament
Superior recess of omental bursa (lesser sac)
Attachment of lesser omentum and left gastric artery
Esophagus
Left triangular ligament of liver
Gastrophrenic ligament and left inferior phrenic artery
Short gastric vessels
Splenorenal (lienorenal) ligament and splenic vessels
Phrenicocolic ligament
Pancreas and splenic artery (retroperitoneal)
Attachment of transverse mesocolon
Superior mesenteric vessels
Site of descending colon
Attachment of sigmoid mesocolon and sigmoid vessels
Superior rectal vessels
Sacrogenital fold (ligament)
Lateral umbilical fold (contains inferior epigastric vessels)
Medial umbilical fold (contains occluded part of umbilical artery)
Viscera (Gut) | Stomach in Situ
Right colic (hepatic) flexure
Right kidney (retroperitoneal)
Duodenum
Pylorus
Omental (epiploic) foramen (of Winslow)
Gallbladder
Right lobe of liver
Quadrate lobe of liver
Inferior border of liver
Round ligament of liver (obliterated umbilical vein)
Falciform ligament
Left lobe of liver
Hepatoduodenal ligament of Lesser omentum
Hepatogastric ligament of Lesser omentum
Abdominal part of esophagus
Cardiac notch (incisure)
Fundus of stomach
Diaphragm
Spleen
Cardiac part of stomach
Body of stomach
Angular notch (incisure)
Lesser curvature
Greater curvature
Pyloric canal
Pyloric part of stomach Pyloric antrum
Greater omentum
Left colic (splenic) flexure
Variations in position and contour of stomach in relation to body habitus
Hypertonic stomach
Orthotonic stomach
Hypotonic stomach
Atonic stomach
Viscera (Gut) | Mucosa of Stomach
Superior (1st) part of duodenum (ampulla, or duodenal cap)
Pyloric orifice
Pylorus
Gastric canal (magenstrasse)
Gastric folds (rugae)
Cardiac orifice
Zigzag (Z) line (junction of gastric and esophageal mucosa)
Cardiac zone
Gastric and fundic zones
Pyloric zone
Surface epithelial cell
Mucous cell
Parietal cell (between mucous cell and chief cell)
Chief cell
Solitary lymph follicle (nodule)
Neuroendocrine G cell
Muscularis mucosae
Submucosa
Pyloric glands
Gastric (fundic) glands
Viscera (Gut) | Musculature of Stomach
Longitudinal muscle of esophagus
Outer longitudinal muscle layer of stomach (concentrated chiefly at lesser and greater curvatures and at pyloric part)
Middle circular muscle layer of stomach
Longitudinal muscle of duodenum
Collar of Helvetius (middle circular and innermost oblique fibers blend here)
Outerlongitudinal muscle layer (cut away)
Middle circular muscle layer
Innermost oblique muscle layer
Circular muscle of duodenum
Longitudinal muscle of duodenum (cut away)
Windows cut in middle circular muscle layer
Viscera (Gut) | Duodenum in Situ
Psoas major muscle
Ascending colon
Transverse colon (cut)
Right colic (hepatic) flexure
Transverse mesocolon and its cut edges
Kidney
Pylorus
Suprarenal gland
Liver (cut)
Right free margin of lesser omentum (hepatoduodenal ligament)
Hepatic portal vein of a Portal triad
Proper hepatic artery of Portal triad
(Common) bile duct of Portal triad
Head of pancreas
Superior mesenteric vessels
Celiac trunk
Splenic artery
Suprarenal gland
Kidney
Transverse mesocolon and its cut edges
Transverse colon (cut)
Left colic (splenic) flexure
Superior (1st) part of Duodenum
Descending (2nd) part of Duodenum
Inferior (horizontal, or 3rd) part of Duodenum
Ascending (4th) part of Duodenum
Root of mesentery (cut edges)
Inferior vena cava
Abdominal aorta
Inferior mesenteric artery
Duodenojejunal flexure and jejunum (cut)
Inferior duodenal fold and fossa
Descending colon
Viscera (Gut) | Mucosa and Musculature of Duodenum
Common hepatic artery
Right gastric artery
Gastroduodenal artery
Proper hepatic artery
Hepatic portal vein
(Common) bile duct
Right free margin of lesser omentum (hepatoduodenal ligament)
Superior duodenal flexure
Superior (1st) part (ampulla, or duodenal cap) (no circular folds)
Descending (2nd) part
Minor duodenal papilla (inconstant)
Circular folds (valves of Kerckring)
Major duodenal papilla (of Vater)
Head of pancreas
Inferior duodenal flexure
Inferior (horizontal, or 3rd) part
Pyloric orifice
(Common) bile duct
Accessory pancreatic duct (of Santorini)
(Principal) pancreatic duct (of Wirsung)
Duodenojejunal flexure
Jejunum
Ascending (4th) part
Superior mesenteric artery and vein
Layers of duodenal wall
Outer longitudinal muscle layer (with window cut)
Inner circular muscle layer (with window cut)
Submucosa with duodenal (Brunner’s) glands
Barium radiograph of stomach, duodenum, and proximal jejunum
Body of stomach
Duodenal cap (1st part)
Descending (2nd) part of duodenum
Fundus of stomach
Proximal jejunum
Pylorus
Pyloric antrum
Viscera (Gut) | Mucosa and Musculature of Small Intestine
Jejunum
Mesentery
Anastomotic loop (arcade) of jejunal arteries
Straight arteries (arteriae rectae)
Serosa (visceral peritoneum)
Longitudinal muscle layer
Circular layer
Submucosa
Mucosa
Circular folds (valves of Kerckring)
Solitary lymphoid nodule
Barium radiograph of jejunum
Ileum
Mesentery
Anastomotic loops (arcades) of ileal arteries
Straight arteries (arteriae rectae)
Serosa (visceral peritoneum)
Longitudinal muscle layer
Circular muscle layer
Submucosa
Mucosa
Circular folds
Solitary lymphoid nodules
Aggregate lymphoid nodules (Peyer’s patches)
Barium radiograph of ileum
Viscera (Gut) | Ileocecal Region
Ileocolic artery
Colic branch
Ileal branch
Superior mesenteric artery
Posterior cecal artery
Appendicular artery
Anterior cecal artery
Vascular fold of cecum
Superior ileocecal recess
Ileocecal fold (bloodless fold of Treves)
Terminal part of ileum
Inferior ileocecal recess
Mesoappendix
Appendicular artery
Vermiform appendix
External iliac vessels
Retrocecal recess
Cecum
Cecal folds
Right paracolic gutter
Retrocecal recess
Cecal folds
Posterior cecal artery
Omental taenia
Free taenia (taenia libera)
Appendicular artery
Mesocolic taenia
Viscera (Gut) | Ileocecal Region (continued)
Free taenia (taenia libera)
Ileocecal lips: labial form of ileal orifice (as seen commonly postmortem and occasionally in vivo)
Terminal part of ileum
Orifice of vermiform appendix
Frenulum
Free taenia (taenia libera)
Vermiform appendix
Schema of muscle fibers at ileal orifice
Circular muscle of colon
Mesocolic taenia
Fibers to papilla
Fibers to ileum
Fibers around ileocecal junction
Fibers to taenia of Longitudinal muscle of ileum
Fibers to papilla of Longitudinal muscle of ileum
Circular muscle of ileum
Ileal papilla: papillary form of ileal orifice (found most commonly in vivo)
Viscera (Gut) | Vermiform Appendix
Variations in position of appendix
McBurney’s point (on spinoumbilical line)
Barium radiograph of unusually long appendix (A Appendix; C Cecum)
Fixed retrocecal appendix
Mesoappendix
Serosa (visceral peritoneum)
Longitudinal muscle
Circular muscle
Submucosa
Aggregate lymphoid nodules
Crypts of lieberkühn
Viscera (Gut) | Mucosa and Musculature of Large Intestine
Ileum
Vermiform appendix
Cecum
Ileal orifice
Ascending colon
Omental taenia (exposed by hook)
Peritoneum (cut away)
Haustra
Omental (epiploic) appendices
Right colic (hepatic) flexure
Greater omentum (cut away)
Transverse mesocolon
Transverse colon
Omental taenia
Left colic (splenic) flexure
Haustra
Peritoneum
Descending colon
Mesocolic taenia (exposed by hook)
Free taenia (taenia libera)
Sigmoid colon
Sigmoid mesocolon
Rectosigmoid junction (taeniae spread out and unite to form longitudinal muscle layer)
Rectum
Levator ani muscle
External anal sphincter muscle
Viscera (Gut) | Sigmoid Colon: Variations in Position
Typical
Short, straight, obliquely into pelvis
Looping to right side
Ascending high into abdomen
Viscera (Accessory Organs) | Topography of Liver
Anterior view
Lateral rectus (semilunar) plane
Diaphragm
Transpyloric plane
Liver covered by diaphragm, pleura and lung (percussion dullness)
Liver covered by diaphragm and pleura (percussion flatness)
Liver covered by diaphragm percussion flatness or intestinal resonance)
Gallbladder
Liver
Posterior view
Diaphragm
Liver covered by diaphragm, pleura, and lung (percussion dullness)
Liver covered by diaphragm and pleura (percussion flatness)
Diaphragm
Liver covered by diaphragm, pleura, and lung (percussion dullness)
Liver covered by diaphragm and pleura (percussion flatness)
Gallbladder
Inferior border of liver
Viscera (Accessory Organs) | Surfaces and Bed of Liver
Anterior view
Gallbladder (fundus)
Costal impressions
Right lobe of liver
Right triangular ligament
Diaphragm (pulled up)
Coronary ligament
Left triangular ligament
Fibrous appendix of liver
Left lobe of liver
Falciform ligament
Round ligament (ligamentum teres) of liver (obliterated umbilical vein) forming free border of falciform
ligament
Visceral surface
Colic impression
Round ligament of liver
Gallbladder
Quadrate lobe
Duodenal impression
Renal impression
Cystic duct
Common hepatic duct
(Common) bile duct
Right triangular ligament
Hepatorenal portion of coronary ligament
Suprarenal impression
Bare area
Inferior vena cava
Hepatic veins
Porta hepatis
Fissure for ligamentum teres
Hepatic portal vein
Proper hepatic artery
Caudate process
Papillary process
Caudate lobe
Fissure for ligamentum venosum
Esophageal impression
Gastric impression
Left triangular
Coronary ligament
Posterior view
Falciform ligament
Left triangular ligament
Fissure for ligamentum venosum
Groove for (inferior) vena cava
Coronary ligament
Bare area
Right triangular ligament
Bed of liver
Coronary ligament
Bare area
Inferior vena cava
Suprarenal gland
Right kidney
Right triangular ligament
Superior recess of omental bursa
Duodenum
Left triangular ligament
Stomach
Viscera (Accessory Organs) | Liver in Situ and Variations in Form
Right colic (hepatic) flexure
Greater omentum
Duodenum
Kidney (retroperitoneal)
Omental (epiploic) foramen (of Winslow)
Right lobe of liver
Round ligament (ligamentum teres) of liver (obliterated umbilical vein)
Quadrate lobe
Gallbladder
Left lobe of liver
Caudate lobe seen through lesser omentum (hepatogastric ligament)
Window cut in lesser omentum (hepatoduodenal ligament)
Proper hepatic artery
(Common) bile duct
Hepatic portal vein
Lesser omentum (hepatogastric ligament)
Spleen
Stomach
Left colic (splenic) flexure
Variations in form of liver
Very small left lobe, deep costal impressions
Complete atrophy of left lobe (left portal vein compression)
Transverse, “saddlelike” liver, relatively large left lobe
“Tonguelike” process of lobe
Very deep renal impression and “corset constriction”
Diaphragmatic grooves
Viscera (Accessory Organs) | Liver Segments and Lobes: Vessel and Duct Distribution
Division into segments is based upon ramifications of bile ducts and hepatic vessels. It does not entirely correspond with division into anatomic lobes.
Parietal surface
Anatomic lobes
Right lobe
Left lobe
Functional surgical segments
Right (part of) liver
Lateral division
Posterior lateral segment (VII)
(Posterior superior area)
Right anterior lateral segment (VI)
(Posterior inferior area)
Medial division
Posterior medial (VIII)
(Anterior superior area)
Anterior medial segment (V)
(Anterior inferior area)
Left (part of) liver
Medial division
(Medial superior area)
Medial segment (IV)
(Medial inferior area)
Lateral division
Lateral segment (II)
Lateral superior area
Left anterior lateral segment (III)
(Lateral inferior area)
Visceral surface
Right lobe
Medial segment (IV)
(Medial inferior area)
Quadrate lobe
Anterior medial segment (V)
(Anterior inferior area)
Right anterior lateral segment (VI)
(Posterior inferior area)
Posterior lateral segment (VII)
(Posterior superior area)
Caudate process
Posterior (caudal) segment (I)
Right Caudate lobe
Left Caudate lobe
(Medial superior area)
Left lobe
Left anterior lateral segment (III)
(Lateral inferior area)
Lateral segment (II)
(Lateral superior area)
Distribution of vessels and ducts
Right branch
Left branch
Anterior segment
Medial segment
Posterior segment
Lateral segment
Anterior inferior area
Medial inferior area
Anterior superior area
Medial superior area
Posterior inferior area
Lateral inferior area
Posterior superior area
Lateral superior area
Caudate lobe (right and left)
Caudate process
Phantom division between anterior and posterior superior areas
Inferior vena cava
Common hepatic duct, hepatic portal vein, and proper hepatic artery
Viscera (Accessory Organs) | Intrahepatic Vascular and Duct Systems
Portal triads
Central vein
Sinusoids
Portal triad
Sublobular veins
Hepatic vein
Sublobular vein
Central vein
Sinusoids
Portal triad
Perivascular fibrous (Glisson’s) capsule extending into porta hepatis along vessels and bile duct
Proper hepatic artery
Hepatic portal vein
Common hepatic duct
Normal lobular pattern of liver
Hepatic artery branch of Portal triad
Portal vein branch of Portal triad
Bile ductules of Portal triad
Sinusoids
Liver cell “plates”
Central veins (tributary to hepatic vein via sublobular veins)
Viscera (Accessory Organs) | Liver Structure: Schema
Central vein
Sinusoids
Perisinusoidal spaces (of Disse)
Sublobular vein (tributary to hepatic vein)
Central vein
Lymph vessel
Connective tissue
Limiting plate of portal space
Periportal space (of Mall)
Central vein
Periportal bile ductule (canal of Hering)
Branch of portal vein
Bile duct
Branch of hepatic artery
Portal arteriole
Periportal arteriole
Intralobular arteriole
Distributing vein
Inlet venule
Periportal bile ductule (canal of Hering)
Intralobular bile ductule (cholangiole)
Central vein
Viscera (Accessory Organs) | Intrahepatic Biliary Systems: Schema
Branch of portal vein
Bile ducts
Periportal bile ductules (canals of Hering)
Limiting plate of portal space
Bile canaliculi
Sinusoid
Intralobular bile ductules (cholangioles)
Note: In the above illustration, bile canaliculi appear as structures with walls of their own. However, as shown in the histologic section at right, boundaries of canaliculi are actually a specialization of surface membranes of adjoining liver parenchymal cells.
Low-power section of liver
Branch of portal vein
Bile ducts
Bile ductules
Bile canaliculi
Branch of hepatic artery
Viscera (Accessory Organs) | Schematic Cross Section of Abdomen at T10
Body of T10 vertebra
Inferior lobe of right lung in costodiaphragmatic recess
Latissimus dorsi muscle
Diaphragm
Azygos vein
Serratus anterior muscle
Inferior vena cava
Right crus of diaphragm (forming right boundary of esophageal hiatus)
Liver
Rectus abdominis muscle
Diaphragm
Xiphoid process
Costal cartilages
Esophagogastric junction
Gastric folds (rugae)
Fundus of stomach
Right crus of diaphragm (forming left boundary of esophageal hiatus)
Thoracic aorta
Left crus of diaphragm
Spleen
Inferior lobe of left lung in costodiaphragmatic recess
Erector spinae muscle
Thoracic duct
Viscera (Accessory Organs) | Gallbladder and Extrahepatic Bile Ducts
Head of pancreas
Transverse colon (cut)
Superior (1st) part of duodenum
Gallbladder
(Common) bile duct
Liver
Hepatic portal vein
Cystic duct
Cystic artery
Common hepatic duct
Right and left hepatic ducts
Right and left hepatic arteries
Proper hepatic artery
Anterior layer of lesser omentum (cut edge)
Right gastric artery
Common hepatic artery
Gastroduodenal artery
Stomach
Right Hepatic ducts
Left Hepatic ducts
Smooth part of Cystic duct
Spiral fold of Cystic duct
Neck
Infundibulum (Hartmann’s pouch) of Gallbladder
Body of Gallbladder
Fundus of Gallbladder
Descending (2nd) part of duodenum
Hepatopancreatic ampulla (of Vater)
Major duodenal papilla (of Vater)
Pancreatic duct
(Common) bile duct
Gland orifices
Common hepatic duct
Viscera (Accessory Organs) | Junction of (Common) Bile Duct and Duodenum
Interior of descending (2nd) part of duodenum
Minor duodenal papilla
Circular folds
Major duodenal papilla
Longitudinal fold
Dissection
Longitudinal duodenal muscle seen through opening in circular muscle
Reinforcing fibers
Fibers to longitudinal bundle
(Common) bile duct (ductus choledochus)
Longitudinal muscle of duodenum
Circular muscle of duodenum
Pancreatic duct
Sphincter of (common) bile duct (choledochus)
Longitudinal bundle
Sphincter of pancreatic duct (inconstant)
Reinforcing fibers
Duodenal muscle fibers to longitudinal bundle
Sphincter of hepatopancreatic ampulla
Reconstruction
(Common) bile duct
Pancreas
Longitudinal Duodenal muscle
Circular Duodenal muscle
Longitudinal bundle
Sphincter of (common) bile duct (choledochus)
Pancreatic duct
Fibers to longitudinal bundle
Section, level A
Duodenal mucosa
(Common) bile duct
Sphincter of (common) bile duct
Longitudinal bundle
Pancreatic duct
Duodenal muscle
Pancreas
Sphincter of pancreatic duct (inconstant)
Section, level B
(Common) bile duct
Sphincter of hepatopancreatic ampulla
Longitudinal bundle
Pancreatic duct
Sphincter of hepatopancreatic ampulla
Section, level C
Sphincter of hepatopancreatic ampulla
Hepatopancreatic ampulla (common channel)
Major duodenal papilla
Variations in union of bile and pancreatic ducts
(Common) bile duct
Pancreatic duct
Sphincter of ampulla
Short common channel
(Common) bile duct
Pancreatic duct
Duodenal wall
No common channel
Sphincter of ampulla
Long common channel
Viscera (Accessory Organs) | Variations in Cystic and Hepatic Ducts
Variations in cystic duct
Low union with common hepatic duct
Adherent to common hepatic duct
High union with common hepatic duct
Cystic duct absent or very short
Anterior spiral joining common hepatic duct on left side
Posterior spiral joining common hepatic duct on left side
Accessory (aberrant) hepatic ducts
Joining common hepatic duct
Joining cystic duct
Joining (common) bile duct
Joining gallbladder
Two accessory hepatic ducts
Viscera (Accessory Organs) | Schematic Cross Section of Abdomen at T12
Transverse Section: Level of T12, Inferior to Xiphoid
Pyloric canal
Pylorus
Right colic (hepatic) flexure of colon
Gallbladder
Superior (1st) part of duodenum
Hepatoduodenal ligament
Liver
(Common) bile duct of Portal triad
Proper hepatic artery of Portal triad
Portal vein
Inferior vena cava
Right suprarenal gland
Right crus of diaphragm
Pancreas
Thoracic aorta
Left crus of diaphragm
Superior pole of left kidney
Left suprarenal gland
Splenic artery and vein
Spleen
Descending colon (descending from left colic flexure)
Bifurcation of celiac trunk
Transverse colon (ascending to left colic flexure)
Jejunum
Stomach
Viscera (Accessory Organs) | Pancreas in Situ
Uncinate process of pancreas
Superior mesenteric artery and vein
Middle colic artery and vein
Transverse colon (cut)
Right colic (hepatic) flexure
Attachment of transverse mesocolon
Right kidney retroperitoneal
Duodenum
Suprarenal gland
Right free margin of lesser omentum
Hepatic portal vein of Portal triad
Proper hepatic artery of Portal triad
(Common) bile duct of Portal triad
Inferior vena cava
Celiac trunk
Splenic artery
Stomach (cut)
Spleen
Left colic (splenic) flexure
Head
Neck
Pancreas Body
Tail
Transverse colon (cut)
Left kidney (retroperitoneal)
Attachment of transverse mesocolon
Inferior mesenteric vein (retroperitoneal)
Jejunum (cut)
Duodenojejunal flexure
Root of mesentery (cut)
(Common) bile duct
Pancreatic notch
Pancreatic (of Wirsung)
Accessory pancreatic duct (of Santorini)
Low-power section of pancreas
Acini
Islets (of Langerhans)
Interlobular duct
Interlobular septum
Viscera (Accessory Organs) | Spleen
Visceral surface
Anterior extremity
Colic impression
Splenic vein
Left gastro-omental (gastroepiploic) vessels
Splenic artery
Splenorenal (lienorenal) ligament
Inferior border
Renal impression
Short gastric vessels
Posterior extremity
Gastrosplenic ligament
Superior border
Gastric impression
Hilum
Diaphragmatic surface
Superior border
Posterior extremity
Inferior border
Anterior extremity
Cross section
Serosa (visceral peritoneum)
Fibrous capsule
Splenic pulp
Splenic trabeculae
Splenic vein and artery
Hilum
Spleen in situ
9th rib
Spleen
Diaphragm
Short gastric vessels in gastrosplenic ligament
Stomach (cut)
Suprarenal gland
Left kidney
Splenic artery and vein
Splenorenal (lienorenal) ligament
Attachment of transverse mesocolon (cut)
Visceral Vasculature | Arteries of Stomach, Liver, and Spleen
Short gastric arteries
Recurrent branch of left inferior phrenic artery to esophagus
Esophageal branch of left gastric artery
Splenic artery
Left gastric artery
Right and left inferior phrenic arteries
Abdominal aorta
Celiac trunk
Left hepatic artery
Right hepatic artery
Cystic artery
Cystic duct
Proper hepatic artery
(Common) bile duct
Hepatic portal vein
Right gastric artery
Supraduodenal artery
Posterior superior of pancreaticoduodenal arteries
Anterior superior of pancreaticoduodenal arteries
Gastroduodenal artery
Right gastro-omental (gastroepiploic) artery
Common hepatic artery
Dorsal pancreatic artery
Left gastro-omental (gastroepiploic) artery
Splenic branches of splenic artery
Visceral Vasculature | Arteries of Liver, Pancreas, Duodenum, and Spleen
Short gastric arteries
Abdominal aorta
Celiac trunk
Right and left inferior phrenic arteries (shown here from common stem)
Left gastric artery
Common hepatic artery
Hepatic portal vein
Left hepatic artery
Intermediate hepatic artery
Proper hepatic artery
Right hepatic artery
Cystic artery
Gallbladder
Cystohepatic triangle (of Calot)
Cystic duct
Common hepatic duct
(Common) bile duct
Right gastric artery
Supraduodenal artery
Gastroduodenal artery
Posterior superior pancreaticoduodenal artery (phantom)
Anterior superior pancreaticoduodenal artery
Right gastro-omental (gastroepiploic) artery
Anterior inferior pancreaticoduodenal artery
Posterior inferior pancreaticoduodenal artery
Inferior pancreaticoduodenal artery
Superior mesenteric artery
Middle colic artery (cut)
Anastomotic branch
Inferior pancreatic artery
Dorsal pancreatic artery
Splenic artery
Greater pancreatic artery
Artery to tail of pancreas
Left gastro-omental (gastroepiploic) artery
Visceral Vasculature | Variations in Celiac Trunk
Common origin of celiac trunk and superior mesenteric artery
Celiacomesenteric trunk
Splenic artery takes origin from superior mesenteric (note replaced left hepatic artery from left gastric)
Hepatogastric trunk
Lienomesenteric trunk
Splenic and hepatic arteries take origin from superior mesenteric
Gastrophrenic trunk
Hepatolienomesenteric trunk
Replaced hepatic artery takes origin from superior mesenteric (note inferior pancreaticoduodenal artery from 1st jejunal)
Lienogastric trunk
Hepatomesenteric trunk
Replaced hepatic artery takes origin from superior mesenteric (note inferior pancreaticoduodenal artery from 1st jejunal)
Lienogastric trunk
Hepatomesenteric trunk
Replaced right hepatic artery takes origin from superior mesenteric; inferior pancreaticoduodenal and 1st jejunal arteries from replaced right hepatic
Incomplete celiac trunk
Hepatomesenteric trunk
Accessory right hepatic artery takes origin from superior mesenteric
Complete celiac trunk
Hepatomesenteric trunk
Accessory right hepatic artery takes origin from superior mesenteric; inferior pancreaticoduodenal arteries from accessory right hepatic; 1st jejunal artery from anterior inferior pancreaticoduodenal
Complete celiac trunk
Hepatomesenteric trunk
(Note accessory left gastric artery from left hepatic)
Right gastroepiploic (gastro-omental) artery takes origin from superior mesenteric (note accessory left hepatic artery from left gastric)
Visceral Vasculature | Celiac Arteriogram
Common hepatic artery
Celiac trunk
Left gastric artery
Gastroduodenal artery
Proper hepatic artery
Right gastric artery
Splenic artery
Visceral Vasculature | Arteries of Duodenum and Head of Pancreas
Duodenum and head of pancreas reflected to left
(Common) bile duct
Gastroduodenal artery
Posterior superior pancreaticoduodenal artery
Anterior superior pancreaticoduodenal artery
Anterior superior pancreaticoduodenal artery (phantom)
Superior mesenteric artery
Inferior pancreaticoduodenal artery
Posterior inferior pancreaticoduodenal artery
Anterior inferior pancreaticoduodenal artery (partially in phantom)
Inferior vena cava
Posterior view
Celiac trunk
Splenic artery
Greater pancreatic artery
Inferior pancreatic artery
Dorsal pancreatic artery
Superior mesenteric artery
Inferior pancreaticoduodenal artery
Anterior inferior pancreaticoduodenal artery (phantom)
Posterior inferior pancreaticoduodenal artery
Anastomotic branch
Anterior superior pancreaticoduodenal artery (phantom)
Right gastro-omental (gastroepiploic) artery (phantom)
(Common) bile duct
Posterior superior pancreaticoduodenal artery
Gastroduodenal artery (partially in phantom)
Supraduodenal artery
Common hepatic artery
Proper hepatic artery
Visceral Vasculature | Arterial Variations and Collateral Supply of Liver and Gallbladder
Umbilicus (turned up)
Right, middle (variable), and left hepatic arteries
Cystic artery
Inferior phrenic artery
Gastroduodenal artery
Common hepatic artery
Posterior superior pancreaticoduodenal artery
Anterior superior pancreaticoduodenal artery
Right gastric artery
Right gastro-omental (gastroepiploic) artery
Inferior pancreaticoduodenal artery
Omental (epiploic) arteries
Omental (epiploic) parietal arc
Internal thoracic arteries
Falciform and round ligaments with arteries
Short gastric arteries
Intercostal arteries
Left gastro-omental (gastroepiploic) artery
Left gastric artery
Celiac trunk
Splenic artery
Dorsal pancreatic artery
Superior mesenteric artery
Inferior pancreatic artery
Accessory or replaced arteries
Right or common hepatic
Left hepatic
Right hepatic
Cystic
Anastomoses of corresponding arteries
Inferior phrenic/left gastric ↔ left hepatic
Right ↔ left/hepatic
Effects of hepatic artery obstruction
Zone of relative safety
Zone of questionable effects
Zone of inevitable reflection
Cystic
Capsular
Right gastric
Gastroduodenal
Visceral Vasculature | Arteries of Small Intestine
Middle colic artery (cut)
Superior mesenteric artery and vein
Inferior pancreatic artery
Dorsal pancreatic artery
Splenic artery and vein
Celiac trunk
Common hepatic artery
Supraduodenal artery
Gastroduodenal artery
Posterior superior pancreaticoduodenal artery
Right gastro-omental (gastroepiploic) artery
Anterior superior pancreaticoduodenal artery
(Common portion) of Inferior pancreaticoduodenal arteries
Posterior Inferior pancreaticoduodenal arteries
Anterior Inferior pancreaticoduodenal arteries
Anastomosis (inferior pancreaticoduodenal to 1st jejunal artery)
Right colic artery
Ileocolic artery
Superior mesenteric artery
Anterior cecal artery
Posterior cecal artery
Appendicular artery
Jejunal and ileal (intestinal) arteries
Anastomotic loops (arcades)
Straight arteries (arteriae rectae)
Visceral Vasculature | Arteries of Large Intestine
Middle colic artery
Transverse mesocolon
Straight arteries (arteriae rectae)
(Common portion) of Inferior pancreaticoduodenal arteries
Posterior of Inferior pancreaticoduodenal arteries
Anterior of Inferior pancreaticoduodenal arteries
Marginal artery
Right colic artery
Ileocolic artery
Colic branch
Ileal branch
Marginal artery
Anterior cecal artery
Posterior cecal artery
Appendicular artery
Internal iliac artery
Median sacral artery (from abdominal aorta)
Middle rectal artery
Branch of superior rectal artery
Inferior rectal artery
Superior rectal artery
Straight arteries (arteriae rectae)
Sigmoid mesocolon
Sigmoid arteries
Marginal artery
Descending branch
Ascending branch
Left colic artery
Inferior mesenteric artery
Marginal artery
Jejunal and ileal (intestinal) arteries
Superior mesenteric artery
Marginal artery
Visceral Vasculature | Variations in Colic Arteries
Common trunk for right colic and middle colic arteries
Ileocolic artery
Right colic artery
Middle colic artery
Superior mesenteric artery
Common trunk for right colic and ileocolic arteries
Ileocolic artery
Right colic artery
Middle colic artery
Absence of middle colic artery replaced by large branch from left colic artery
Ileocolic artery
Right colic artery
Middle colic artery absent
Large branch from left colic artery
Absence of right colic artery
Ileocolic artery
Right colic artery absent
Middle colic artery
Arc of Riolan between middle colic and left colic arteries
Ileocolic artery
Right colic artery
Middle colic artery
Arc of Riolan
Superior mesenteric artery
Inferior mesenteric artery
Left colic artery
Visceral Vasculature | Veins of Stomach, Duodenum, Pancreas, and Spleen
Superior mesenteric vein
Anterior inferior pancreaticoduodenal vein
Posterior inferior pancreaticoduodenal vein
Right gastro-omental (gastroepiploic) vein
Anterior superior pancreaticoduodenal vein
Prepyloric vein
Right gastric vein
Posterior superior pancreaticoduodenal vein
Hepatic portal vein
Hepatic veins
Inferior vena cava
Left gastric vein and esophageal tributary
Short gastric veins
Left gastro-omental (gastroepiploic) vein
Short gastric veins
Splenic vein
Left gastric vein
Hepatic portal vein
Right gastric vein
Posterior superior pancreaticoduodenal vein
Superior mesenteric vein
Right gastro-omental (gastroepiploic) vein
Anterior superior pancreaticoduodenal vein
Anterior inferior pancreaticoduodenal vein
Posterior inferior pancreaticoduodenal vein
Inferior mesenteric vein
(Great) pancreatic vein
Left gastro-omental (gastroepiploic) vein
Visceral Vasculature | Veins of Small Intestine
Right gastric vein
Middle colic vein (cut)
Right colic vein
Ileocolic vein
Hepatic portal vein
Left gastric vein
Splenic vein
Superior mesenteric vein
Jejunal and ileal (intestinal) veins
Anastomotic loops
Straight veins (venae rectae)
Relations of superior mesenteric vein and artery in root of mesentery
Jejunal and ileal (intestinal) vessels
Superior mesenteric artery and vein
Transverse colon (elevated)
Transverse mesocolon
Visceral Vasculature | Veins of Large Intestine
Hepatic portal vein
Prepyloric vein
Superior mesenteric vein
Right gastro-omental (gastroepiploic) vein
Anterior superior pancreaticoduodenal vein
Tributary from colon (cut)
Posterior inferior pancreaticoduodenal vein
Middle colic vein (cut)
Right colic vein
Ileocolic vein
Anterior cecal vein
Posterior cecal vein
Appendicular vein
Right testicular (ovarian) vessels
External iliac vessels
Internal iliac vein
Superior gluteal vein
Obturator vein
Right middle rectal vein
Right inferior rectal vein (to internal pudendal vein)
Left gastric vein
Splenic vein
(Dorsal or superior) pancreatic vein
Inferior mesenteric vein
Jejunal and ileal (intestinal) veins
Left colic vein
Left testicular (ovarian) vessels
Inferior mesenteric vein
Sigmoid veins
Median sacral vein
Superior rectal vein
Tributaries of left and right superior rectal veins
Perimuscular rectal venous plexus
Left middle rectal vein
Left internal pudendal vein in pudendal canal (Alcock’s)
External rectal venous plexus
Visceral Vasculature | Hepatic Portal Vein Tributaries: Portacaval Anastomoses
Umbilicus
Falciform ligament and round ligament of liver
Paraumbilical veins
Right gastric vein
Hepatic portal vein
Posterior, Anterior superior pancreaticoduodenal veins
Superior mesenteric vein
Posterior inferior pancreaticoduodenal veins
Anterior inferior pancreaticoduodenal veins
Middle colic vein
Right colic vein
Ileocolic vein
Anterior cecal veins
Posterior cecal veins
Appendicular vein
Esophageal veins
Left gastric vein
Short gastric veins
Left gastro-omental (gastroepiploic) vein
Splenic vein
Right gastro-omental (gastroepiploic) vein
Inferior mesenteric vein
Left colic vein
Sigmoid veins
Left and right superior rectal veins
Middle rectal veins
Levator ani muscle
Inferior rectal veins
Blood from superior mesenteric vein
Blood from splenic, gastric, and inferior mesenteric veins
Mixture of above two
Caval tributaries
Portacaval anastomoses
Esophageal
Paraumbilical
Rectal
Retroperitoneal
Visceral Vasculature | Variations of Hepatic Portal Vein
Typical arrangement
Short gastric veins
Splenic vein
Left gastric vein
Esophageal vein
Right gastric vein
Cystic vein
Hepatic portal vein
Posterior superior pancreaticoduodenal vein
Superior mesenteric vein
Right gastro-omental (gastroepiploic) vein
Inferior pancreaticoduodenal veins
Middle colic vein
Right colic vein
Ileocolic vein
Jejunal and ileal (intestinal) veins
Left colic vein
Inferior mesenteric vein
Left gastro-omental (gastroepiploic) vein
Pancreatic veins
Inferior mesenteric vein may enter junction of splenic and superior mesenteric veins
Hepatic portal vein
Superior mesenteric vein
Inferior mesenteric vein
Splenic vein
Inferior mesenteric vein may enter superior mesenteric vein
Hepatic portal vein
Superior mesenteric vein
High intestinal veins
Splenic vein
Inferior mesenteric vein
Left gastric vein may enter splenic vein (24% of cases)
Hepatic portal vein
Right gastric vein
Splenic vein
Left gastric vein
Left gastric vein often enters junction of splenic and superior mesenteric veins
Hepatic portal vein
Superior mesenteric vein
Splenic vein
Left gastric vein
Visceral Vasculature | Lymph Vessels and Nodes of Stomach
Celiac nodes
Hepatic nodes
Right superior pancreatic node
Supra-pyloric nodes
Sub-pyloric nodes
Right gastro-omental (gastroepiploic) nodes
Nodes around cardia
Left gastric nodes
Splenic nodes
Left gastro-omental (gastroepiploic) node
Zones and pathways of gastric lymph drainage (zones not sharply demarcated)
To cisterna chyli
Left gastric nodes
Nodes around cardia
Left gastro-omental (gastroepiploic node)
Splenic nodes
Left superior pancreatic
Celiac nodes
Superior mesenteric nodes
Right superior pancreatic node
Suprapyloric, rretropyloric, and subpyloric nodes
Right gastro-omental (gastroepiploic) nodes
Visceral Vasculature | Lymph Vessels and Nodes of Pancreas
Anterior view
Left gastric nodes
Hepatic nodes
Pyloric nodes
Pancreaticoduodenal nodes
Splenic nodes
Superior pancreatic nodes
Celiac nodes
Superior mesenteric nodes (central superior group)
Posterior view
Superior mesenteric nodes (central superior group)
Superior mesenteric artery and vein
Inferior mesenteric vein
Splenic vein
Superior pancreatic nodes
Celiac nodes
Hepatic portal vein
Cystic node (of Calot)
Hepatic nodes around bile ducts and proper hepatic artery
Pancreaticoduodenal nodes
Visceral Vasculature | Lymph Vessels and Nodes of Small Intestine
Thoracic duct
Right lymphatic duct
Thoracic duct
Cisterna chyli
Intestinal lymphatic trunk
Right and lumbar lymphatic trunks
Celiac nodes
Superior mesenteric nodes (central superior group)
Superior mesenteric nodes (juxtaintestinal group)
Visceral Vasculature | Lymph Vessels and Nodes of Large Intestine
Epicolic nodes
Paracolic nodes
Middle colic nodes
Superior mesenteric nodes (central superior group)
Right colic nodes
Ileocolic nodes
Prececal nodes
Appendicular nodes
Inferior mesenteric nodes
Left colic nodes
Preaortic nodes
Sigmoid nodes
Paracolic nodes
Superior rectal nodes
Inferior mesenteric nodes
Left colic nodes
Preaortic nodes
Superior rectal nodes
Middle rectal nodes
Common iliac nodes
Internal iliac nodes
External iliac nodes
Middle rectal nodes
Superficial inguinal nodes
Perineal lymph vessels (drain largely to inguinal nodes)
Innervation | Autonomic Nerves and Ganglia of Abdomen
Right sympathetic trunk
Thoracic duct
Right greater and lesser thoracic splanchnic nerves
Right phrenic nerve
Inferior phrenic arteries and plexuses
Right greater and lesser thoracic splanchnic nerves
Right suprarenal plexus
Right aorticorenal ganglion
Right least thoracic splanchnic nerve
Right renal artery and plexus
Right sympathetic trunk
White and gray rami communicantes
Cisterna chyli
Gray ramus communicans
3rd lumbar ganglion of sympathetic trunk
2nd and 3rd lumbar splanchnic nerves
Right ureter and plexus
Right testicular (ovarian) artery and plexus
4th lumbar splanchnic nerve
1st sacral ganglion of sympathetic trunk
Gray rami communicantes
Anterior vagal trunks
Posterior vagal trunks
Left gastric artery and plexus
Celiac ganglia
Left greater thoracic splanchnic nerve
Left lesser thoracic splanchnic nerve
Splenic artery and plexus
Common hepatic artery and plexus
Superior mesenteric ganglion and plexus
Left aorticorenal ganglion
Left sympathetic trunk
Intermesenteric (aortic) plexus
Inferior mesenteric ganglion
Left colic artery and plexus
Inferior mesenteric artery and plexus
Superior rectal artery and plexus
Superior hypogastric plexus
Internal and external iliac arteries and plexuses
Right and left hypogastric nerves to inferior hypogastric (pelvic) plexus
Innervation | Nerves of Stomach and Duodenum
Left gastric artery and plexus
Celiac branch of anterior vagal trunk
Celiac branch of posterior vagal trunk
Anterior vagal trunk
Hepatic branch of anterior vagal trunk
Right and left inferior phrenic arteries and plexuses
Anterior and posterior layers of lesser omentum
Right greater thoracic splanchnic nerve
Vagal branch from hepatic plexus to pyloric part of stomach
Hepatic plexus
Right gastric artery and plexus
Anterior gastric branch of anterior vagal trunk
Left greater thoracic splanchnic nerve
Left lesser thoracic splanchnic nerve
Splenic artery and plexus
Celiac ganglia and plexus
Plexus on gastro-omental (gastroepiploic) arteries
Superior mesenteric artery and plexus
Plexus on anterior superior and anterior inferior pancreaticoduodenal arteries (posterior pancreaticoduodenal arteries and plexuses not visible in this view)
Innervation | Nerves of Stomach and Duodenum (continued)
View with stomach reflected cephalad
Right gastric artery and plexus
Hepatic plexus
Plexus on gastro-omental (gastroepiploic) arteries
Posterior gastric branch of posterior vagal trunk
Hepatic branch of anterior vagal trunk via lesser omentum
Branch from hepatic plexus to cardia via lesser omentum
Right inferior phrenic artery and plexus
Posterior vagal trunk
Celiac branch of posterior vagal trunk
Celiac branch of anterior vagal trunk
Left gastric artery and plexus
Left inferior phrenic artery and plexus
Celiac ganglia and plexus
Greater, lesser, and least thoracic splanchnic nerves
Aorticorenal ganglia
Splenic artery and plexus
Superior mesenteric ganglion and plexus
Plexus on posterior superior and posterior inferior pancreaticoduodenal arteries
Plexus on gastroduodenal artery
Plexus on anterior superior and anterior inferior pancreatico-duodenal arteries
Superior mesenteric ganglion and plexus
Right aorticorenal ganglion
Celiac ganglion
Right greater, lesser, and least thoracic splanchnic nerves
Phrenic ganglion
Branch from right inferior phrenic plexus to cardia of stomach
Right and left inferior phrenic arteries and plexuses
Anterior vagal trunk
Posterior vagal trunk
Celiac branches of anterior and posterior vagal trunks
Left gastric artery and plexus
Left greater, lesser, and least thoracic splanchnic nerves
Left aorticorenal ganglion
Innervation | Innervation of Stomach and Duodenum: Schema
Sympathetic fibers
Preganglionic Sympathetic fibers
Postganglionic Sympathetic fibers
Parasympathetic fibers
Preganglionic Parasympathetic fibers
Postganglionic Parasympathetic fibers
Afferent fibers
Right 6th thoracic ganglion of sympathetic trunk
Gray rami communicantes
White rami communicantes
Spinal sensory (dorsal root) ganglion
Anterior (ventral) root of spinal nerve
Right greater thoracic splanchnic nerve
Celiac ganglia
Least thoracic splanchnic nerve
Common hepatic artery
Proper hepatic artery
Superior mesenteric ganglion
Aorticorenal ganglia
Right gastric artery
Right renal artery
Gastroduodenal artery
Posterior and anterior superior pancreaticoduodenal arteries
Esophageal plexus
Left greater thoracic splanchnic nerve
Aortic plexus
Left 9th thoracic ganglion of sympathetic trunk
Posterior vagal trunk and celiac branch
Anterior vagal trunk and celiac branch of vagus nerve (X)
Left gastric artery
Celiac trunk
Splenic artery
Short gastric arteries
Left gastro-omental (gastroepiploic) arteries
Right gastro-omental (gastroepiploic) arteries
Innervation | Nerves of Small Intestine
Anterior vagal trunk
Posterior vagal trunk
Celiac branches of anterior and posterior vagal trunks
Hepatic plexus
Greater thoracic splanchnic nerves
Celiac ganglia and plexus
Gastroduodenal artery and plexus
Lesser thoracic splanchnic nerves
Least thoracic splanchnic nerves
Aorticorenal ganglia
Superior mesenteric ganglion
Intermesenteric (aortic) plexus
Inferior pancreaticoduodenal arteries and plexuses
Superior mesenteric artery and plexus
Middle colic artery and plexus (cut)
Right colic artery and plexus
Ileocolic artery and plexus
Superior mesenteric artery and plexus
Peritoneum (cut edge)
Mesenteric branches
Mesoappendix (contains appendicular artery and nerve plexus)
Innervation | Nerves of Large Intestine
Anterior vagal trunk and hepatic branch
Posterior vagal trunk
Right greater thoracic splanchnic nerve
Celiac ganglia and plexus
Right aortico-renal ganglion
Superior mesenteric ganglion
Middle colic artery and plexus
Right colic artery and plexus
Ileocolic artery and plexus
Cecal and appendicular arteries and plexuses
Sacral sympathetic trunk
Right sacral plexus
Pelvic splanchnic nerves
Middle rectal artery and plexus
Right inferior hypogastric (pelvic) plexus
Vesical plexus
Rectal plexus
Urinary bladder
Marginal artery and plexus
Esophagus
Left greater thoracic splanchnic nerve
Left suprarenal plexus
Left lesser and least thoracic splanchnic nerves
Left aorticorenal ganglion
Left renal artery and plexus
1st left lumbar splanchnic nerve
Left lumbar sympathetic trunk
Intermesenteric (aortic) plexus
Left colic artery and plexus
Inferior mesenteric ganglion, artery, and plexus
Sigmoid arteries and plexuses
Superior hypogastric plexus
Superior rectal artery and plexus
Right and left hypogastric nerves
Nerves from inferior hypogastric (pelvic) plexuses to sigmoid colon, descending colon, and left colic (splenic) flexure
Innervation | Innervation of Small and Large Intestines: Schema
Thalamus
Hypothalamus
Sympathetic
Parasympathetic
Posterior (dorsal) nucleus of vagus nerve
Vagus nerve (X)
Myelencephalon (medulla oblangata)
Spinal sensory (dorsal root) ganglion
Thoracolumbar spinal cord
Sacral spinal cord
T9
T10
T11
T12
L1
L2
L3
L4
L5
S1
S2
S3
S4
White Rami communicantes
Gray Rami communicantes
Sympathetic trunk
Greater Thoracic splanchnic nerves
Lesser Thoracic splanchnic nerves
Least Thoracic splanchnic nerves
Abdominopelvic splanchnic nerves
Lumbar splanchnic nerves*
Sacral splanchnic nerves*
Pelvic splanchnic nerves
Pudendal nerve
Abdominal aorta
Celiac ganglia
Celiac trunk
Superior mesenteric ganglion
Aorticorenal ganglion
Intermesenteric (aortic) plexus
Inferior mesenteric ganglion
Superior hypogastric plexus
Hypogastric nerves
Inferior hypogastric (pelvic) plexus
Innervation | Innervation of Small and Large Intestines: Schema
Sympathetic efferents
Parasympathetic efferents
Somatic efferents
Afferents and CNS connections
Indefinite paths
T12, L1 Afferents and CNS connections
T9 (8) Afferents and CNS connections
T9, 10 Afferents and CNS connections
T10-12 Afferents and CNS connections
T10 (11) Afferents and CNS connections
L1, 2 Afferents and CNS connections
L1, 2 Afferents and CNS connections
Superior rectal artery and nerves
Rectal plexus
Inferior anal (rectal) nerve
Levator ani muscle
External anal sphincter muscle
Chief segmental sources of sympathetic fibers innervating different regions of intestinal tract are indicated. Numerous afferent fibers are carried centripetally through approximately the same sympathetic splanchnic nerves that transmit preganglionic fibers.
Innervation | Autonomic Reflex Pathways: Schema
Sympathetic fibers
Preganglionic Sympathetic fibers
Postganglionic Sympathetic fibers
Sympathetic trunk
Ganglion of sympathetic trunk
Spinal nerve to vessels and glands of skin
White ramus communicans
Gray ramus communicans
Ganglion of sympathetic trunk
Ganglion of sympathetic trunk
Parasympathetic fibers
Preganglionic Parasympathetic fibers
Postganglionic Parasympathetic fibers
Afferent fibers
Spinal sensory (dorsal root) ganglion
Dorsal (posterior) root
Thoracic part of spinal cord
Intermediolateral cell column
Ventral (anterior) root
Meningeal branch to spinal meninges and spinal perivascular plexuses (usually arises from spinal nerve)
Stretch (distention)
Abdominopelvic (greater, lesser, and least) thoracic splanchnic nerves
Vagus nerve (X)
Pain
Celiac ganglion
Enteric plexuses of gut
Superior mesenteric ganglion
Innervation | Intrinsic Autonomic Plexuses of Intestine: Schema
Peritoneal layers of mesentery
Branch of straight artery (arteriae rectae) to intestine and accompanying nerves
Subserous plexus
Longitudinal intramuscular plexus
Myenteric (Auerbach’s) plexus [Abby 😄!]
Circular intramuscular plexus
Submucous (Meissner’s) plexus
Periglandular plexus
Visceral peritoneum (serosa)
Subserous connective tissue
Longitudinal muscle
Intermuscular stroma
Circular muscle
Submucosa
Muscularis mucosae
Mucosa and intestinal glands
Lumen
Note: Intestinal wall is shown much thicker than in actuality.
Innervation | Innervation of Liver and Biliary Tract: Schema
Sympathetic fibers
Preganglionic Sympathetic fibers
Postganglionic Sympathetic fibers
Parasympathetic fibers
Preganglionic Sympathetic fibers
Postganglionic Sympathetic fibers
Afferent fibers
Common areas of referred pain in biliary disease
Right greater thoracic splanchnic nerve
Posterior vagal trunk
Right phrenic nerve to diaphragmatic part of parietal (and visceral?) peritoneum
T7 Ganglion
T8 Ganglion
T9 Ganglion
T10 Ganglion
T7 Spinal section
T8 Spinal section
T9 Spinal section
T10 Spinal section
Sympathetic trunk
Dorsal root (spinal) ganglion
Thoracic part of spinal cord
Left greater thoracic splanchnic nerve
Anterior vagal trunk
Hepatic branch of anterior vagal trunk
Diaphragm
Phrenic ganglion
Celiac ganglia
Common hepatic artery
Splenic artery
Anterior hepatic plexus
Posterior hepatic plexus
Aorta
Gastroduodenal artery and plexus
Sphincter of hepatopancreatic ampulla
Ramification of nerve fibers around fine branch of hepatic artery
Innervation | Innervation of Pancreas: Schema
Common areas of pancreatic pain
Right sympathetic trunk
Right greater thoracic splanchnic nerve
Posterior vagal trunk
T5 Spinal section
T6 Spinal section
T7 Spinal section
T8 Spinal section
T9 Spinal section
Dorsal root (spinal) ganglion
Left sympathetic trunk
Thoracic part of spinal cord
Left greater thoracic splanchnic nerve
Anterior vagal trunk
Celiac trunk
Celiac ganglia
Splenic artery
Superior mesenteric ganglion
Superior mesenteric artery and plexus
Sympathetic fibers
Preganglionic Sympathetic fibers
Postganglionic Sympathetic fibers
Parasympathetic fibers
Preganglionic Parasympathetic fibers
Postganglionic Parasympathetic fibers
Afferent fibers
Schema of intrinsic nerve supply
Kidneys and Suprarenal Glands | Kidneys in Situ: Anterior Views
Diaphragm
Right suprarenal gland
Right kidney
Right renal artery and vein
Right subcostal nerve
Transversus abdominis muscle
Quadratus lumborum muscle
Iliac crest
Psoas major muscle
Iliacus muscle
Right ureter
Right common iliac artery
Right external iliac artery
Right internal iliac artery
Urinary bladder
Esophagus
Left suprarenal gland
Celiac trunk
Left kidney
Left renal artery and vein
Superior mesenteric artery (cut)
Subcostal nerve
Abdominal aorta
Iliohypogastric nerve
Ilioguinal nerve
Lateral femoral cutaneous nerve
Genitofemoral nerve
Left testicular (ovarian) artery and vein
Inferior mesenteric artery (cut)
Peritoneum (cut)
Sigmoid mesocolon (cut)
Rectrum
Anterior relations of kidneys
Esophagus
Inferior vena cava
Area for bare area of liver
Right suprarenal gland
Peritoneum (cut)
Area for liver
Duodenum
Peritoneum (cut)
Area for colon
Area for small intestine
Gastrophrenic ligament
Left suprarenal gland
Splenorenal ligament
Area for stomach
Area for spleen
Tail of pancreas
Transverse mesocolon
Area for small intestine
Area for descending colon
Kidneys and Suprarenal Glands | Kidneys in Situ: Posterior Views
Latissimus dorsi muscle
Serratus posterior inferior muscle
External oblique muscle
Aponeurosis of transversus abdominis muscle
Internal oblique muscle
Thoracolumbar fascia (posterior layer)
Iliac crest
Erector spinae muscle
Gluteal aponeurosis (over gluteus medius muscle)
Gluteus maximus muscle
Pleura (costo-diaphragmatic recess)
Lumbocostal ligament
Quadratus lumborum muscle (cut)
Diaphragm
Subcostal nerve
Right kidney
Ascending colon
Transversus abdominis muscle
Iliohypogastric nerve
Ilioinguinal nerve
Quadratus lumborum muscle (cut)
Psoas major muscle
Iliolumbar ligament
Posterior relations of kidneys
Aorta
Projection of 11th rib
Area for diaphragm
Projection of 12th rib
Area for aponeurosis of transversus abdominis muscle
Area for quadratus lumborum muscle
Area for psoas major muscle
Inferior vena cava
Area for diaphragm
Projection of 12th rib
Area for aponeurosis of transversus abdominis muscle
Area for quadratus lumborum muscle
Area for psoas major muscle
Kidneys and Suprarenal Glands | Schematic Cross Section of Abdomen at T12
Liver
Falciform ligament
Superior epigastric vessels
Transversalis fascia
Parietal peritoneum
Visceral peritoneum of liver
Proper hepatic artery (bifurcation)
Common hepatic duct
Gallbladder
Cystic duct
Hepatic portal being
Costodiaphragmatic recess of pleural cavity
Intercostal vessels and nerve
Omental (epiploic) foramen (of Winslow)
Common hepatic artery (retroperitoneal)
Hepatorenal recess (Morison’s pouch)
Inferior vena cava
Omental bursa (lesser sac)
Right sympathetic trunk
Right crus of diaphragm
Azygos vein
Thoracic duct
Anterior longitudinal ligament
Celiac ganglia
Abdominal aorta
Body of T12 vertebra
Linea alba
Rectus abdominis muscle
Lesser omentum
Left gastric artery and vein
7th costal cartilage
External oblique muscle
Diaphragm
Stomach
Gastrosplenic ligament and short gastric vessels
Spleen Pleura
Intercostal muscles
Splenorenal ligament with splenic vessels
Parietal peritoneum on posterior wall of omental bursa
Left kidney
Left suprarenal gland
Latissimus dorsi muscle
Iliocostalis of Erector spinae muscle
Longissimus of Erector spinae muscle
Spinalis of Erector spinae muscle
Kidneys and Suprarenal Glands | Renal Artery and Vein in Situ
Inferior vena cava
Right and left inferior phrenic arteries
Celiac trunk
Right superior suprarenal arteries
Right middle suprarenal vein
Right inferior suprarenal artery
Esophagus
Left inferior phrenic vein
Left superior suprarenal arteries
Left middle suprarenal artery
Left inferior suprarenal artery
Ureteric branch of right renal artery
Right renal artery and vein
Right testicular (ovarian) artery and vein
Inferior vena cava
Abdominal aorta
Superior mesenteric artery (cut)
Inferior mesenteric artery
Left 2nd lumbar vein and communication to ascending lumbar vein
Left testicular (ovarian) artery and vein
Left renal artery and vein
Ureteric branch of left renal artery
Kidneys and Suprarenal Glands | Variations in Renal Artery and Vein
Low accessory right renal artery may pass anterior to inferior vena cava instead of posterior to it
Inferior phrenic artery with superior suprarenal arteries may arise from renal artery (middle suprarenal artery absent)
Proximal subdivision of renal artery
Double left renal vein may form ring around abdominal aorta
Multiple renal veins
Persistent left inferior vena cava may join left renal vein
Kidneys and Suprarenal Glands | Gross Structure of Kidney
Anterior surface of right kidney
Superior pole
Lateral pole
Stellate veins visible through capsule
Inferior pole
Fibrous capsule (cut and peeled back)
Medial border
Hilum
Renal artery
Renal vein
Renal pelvis
Medial border
Ureter
Suprarenal gland and lobulated kidney of infant
Right kidney sectioned in several planes, exposing parenchyma and renal pelvis
Cortex
Medulla (pyramids)
Renal papilla
Renal column (of Bertin)
Base of pyramid
Fibrous capsule
Minor calices
Blood vessels entering renal parenchyma
Renal sinus
Major calices
Renal pelvis
Fat in renal sinus
Minor calices
Ureter
Kidneys and Suprarenal Glands | Intrarenal Arteries and Renal Segments
Frontal section of left kidney: anterior view
Superior (apical) segmental artery
Anterior superior segmental artery
Capsular and perirenal branches
Inferior suprarenal artery
Anterior branch of renal artery
Renal artery
Posterior branch of renal artery (posterior segmental artery)
Pelvic and ureteric branches
Anterior inferior segmental artery
Posterior segmental arteries
Inferior segmental artery
Interlobar arteries
Arcuate arteries
Cortical radiate (interlobular) arteries
(Capsular) perforating radiate artery
Vascular renal segments
Superior
Anterior superior
Anterior inferior
Posterior
Inferior
Kidneys and Suprarenal Glands | Nephron and Collecting Tubule: Schema
Fibrous capsule
Renal cortex
Subcapsular zone
Proximal convoluted tubule
Cortical renal corpuscle
Neck
Distal convoluted tubule
Neck
Juxtamedullary renal corpuscle
Proximal convoluted tubule
Distal convoluted tubule
Henle’s loop
Descending limb
Ascending limb
Outer zone
Outer stripe
Collecting tubule
Inner stripe
Henle’s loop
Renal medulla (pyramid)
Inner zone
Descending limb
Ascending limb
Openings of papillary ducts
Cribriform area of renal papilla
Renal (malpighian) corpuscle; glomerular (Bowman’s) capsule with glomerulus
Afferent and efferent glomerular arterioles
Proximal segment
Neck
Proximal convolution
Thick segment of descending limb
Henle’s loop
Thin segment
Distal segment
Thick segment of ascending limb
Distal convolution
Macula densa
Collecting tubules
Kidneys and Suprarenal Glands | Blood Vessels in Parenchyma of Kidney: Schema
Renal cortex
Fibrous capsule
Juxtamedullary glomerulus (efferent glomerular arteriole descends into renal pyramid)
Efferent glomerular arteriole
Afferent glomerular arteriole
Efferent glomerular arteriole (joins cortical capillary plexus)
Cortical glomerulus
Cortical capillary plexus
Stellate veins
Corticomedullary glomerulus
Efferent glomerular arteriole (joins cortical capillary plexus and also descends into renal pyramid)
Capsular and perforating veins
Cortical radiate (interlobular) arteries and veins
Subcapsular zone
Renal medulla (pyramid)
Arcuate artery and vein
Vasa rectae spuria (from juxtamedullary efferent glomerular arterioles)
Vasa rectae vera (from arcuate and cortical radiate arteries)
Venulae rectae
Medullary capillary plexus
Interlobar artery and vein
Renal column (of Bertin)
Henle’s loop of nephron
Collecting tubule
Interlobar artery and vein in perirenal fat of renal sinus
Kidneys and Suprarenal Glands | Schematic Cross Section of Abdomen of T12-L1
Superior mesenteric vein (becoming portal vein)
Pancreas (head)
Transverse colon
Ascending colon (right colic flexure)
(Common) bile duct
Descending (2nd) part of duodenum
Inferior vena cava
Right suprarenal gland
Liver
Superior pole of right kidney
Right crus of diaphragm
T12-L1 intervertebral disc
Celiac trunk
Splenic vein
Transverse colon
Jejunum
External oblique muscle
Descending colon
Left suprarenal gland
Spleen
Renal cortex of Left kidney
Renal medulla of Left kidney
Abdominal aorta
Kidneys and Suprarenal Glands | Schematic Cross Section of Abdomen at L1-2
Greater omentum
Pancreas with uncinate process
Transverse colon
Junction of 2nd and 3rd parts of duodenum
Ascending colon
Liver
Right renal vein
(entering inferior vena cava)
Right kidney
Inferior vena cava
Right crus of diaphragm
Psoas major muscle
L1-2 intervertebral disc
Conus medullaris and cauda equina
Superior mesenteric vein
Superior mesenteric artery
Transverse colon Ileum
Jejunum
Perirenal fat
Ureteropelvic junction
Descending colon
Renal fascia
Left kidney
Major calyx and renal pelvis
Pararenal fat
Left renal artery
Left renal vein (entering inferior vena cava)
Left crus of diaphragm
Abdominal aorta
Kidneys and Suprarenal Glands | Ureters
Ureters in male: anterior view
Right kidney
Duodenum
Superior mesenteric artery
Right colic artery
Right ureter
Ileocolic artery
Testicular vessels
Common iliac artery
Internal iliac artery
External iliac artery
Middle rectal artery
Left kidney
Left ureter
Inferior mesenteric artery
Left colic artery
Sigmoid arteries
Superior rectal artery (cut)
Genitofemoral nerve
Inferior vesical artery
Ductus deferens
Urinary bladder
Diagonal course of ureter through bladder
Bladder mucosa
Ureter
Ureters in female: superior view
Urinary bladder
Medical umbilical ligament (occluded part of umbilical artery)
Round ligament of uterus
Superior vesical artery
Uterine artery
Umbilical artery
Obturator artery and nerve
Ureter
Vaginal artery and inferior vesical branch
External iliac artery
Ovarian vessels
Internal iliac artery
Common iliac artery
Root of mesentery
Ovary
Broad ligament
Uterosacral (sacrogenital) fold
Ureter (retroperitoneal)
Intersigmoid recess
Sigmoid mesocolon
Kidneys and Suprarenal Glands | Arteries of Ureters and Urinary Bladder
Abdominal aorta
Superior mesenteric artery
Renal artery and vein
Ureteric branch from renal artery
Ovarian artery
Ureter
Inferior mesenteric artery (cut)
Ureteric branch from aorta
Ureteric branches from ovarian and common iliac arteries
Common iliac artery
Median sacral artery
Internal iliac artery
Iliolumbar artery
Superior gluteal artery
Lateral sacral artery
Inferior gluteal and internal pudendal arteries
Umbilical artery (patent part)
Uterine artery
Inferior vesical artery and ureteric branch
Superior vesical arteries
Inferior epigastric artery
Ureteric branch from superior vesical artery
Medial umbilical ligament
Kidneys and Suprarenal Glands | Renal Fascia
Transverse section through 2nd lumbar vertebra demonstrates horizontal disposition of fascia
Quadratus lumborum muscle
Liver
Right colic (hepatic) flexure
Right kidney
Duodenum
Inferior vena cava
Superior mesenteric vein and artery
Abdominal aorta
Duodenojejunal flexure
Left renal vein and artery
Left kidney
Peritoneum
Descending colon
Transversalis fascia
Pararenal fat (retroperitoneal)
Perirenal fat
Fibrous capsule of kidney
Anterior and posterior layers of renal (Gerota’s) fascia
Psoas major muscle and fascia
Crura of diaphragm
Sagittal section through right kidney and lumbar region demonstrates vertical disposition of renal fascia
Diaphragm
Diaphragmatic fascia (continuation of transversalis fascia)
Costodiaphragmatic recess
Suprarenal gland
Perirenal fat
12th rib
Pararenal fat (retroperitoneal)
Transversalis fascia
Quadratus lumborum muscle
Iliac crest
Lung
Liver
Bare area of liver
Fibrous capsule of kidney
Peritoneum
Anterior and posterior layers of renal (Gerota’s) fascia
Right kidney
Right colic (hepatic) flexure
Kidneys and Suprarenal Glands | Lymph Vessels and Nodes of Kidneys and Urinary Bladder
Medullary lymph vessels
Lymph vessels along interlobar arteries
Lymph vessels along arcuate arteries
Cortical lymph vessels along cortical radiate (interlobular) arteries
Subcapsular lymphatic plexus
Note: Arrows indicate direction of flow.
Lumbar lymph trunks to cisterna chyli and thoracic duct
Lateral aortic (lumbar), precaval, and postcaval nodes
Common iliac nodes
Promontorial (middle sacral) node
Internal iliac nodes
External iliac nodes
Lymph vessels from dorsal part and trigone of bladder
Lymph vessels from superior and anterior parts of bladder
Lateral vesical and prevesical nodes
Kidneys and Suprarenal Glands | Nerves of Kidneys, Ureters, and Urinary Bladder
Anterior vagal trunk
Posterior vagal trunk
Greater thoracic splanchnic nerve
Celiac ganglia and plexus
Lesser thoracic splanchnic nerve
Superior mesenteric ganglion
Least thoracic splanchnic nerve
Superior mesenteric ganglion
Least thoracic splanchnic nerve
Aorticorenal ganglion
Renal plexus and ganglion
2nd lumbar splanchnic nerve
Renal and upper ureteric branches from intermesenteric plexus
Intermesenteric (aortic) plexus
Inferior mesenteric ganglion
Sympathetic trunk and ganglion
Middle ureteric branch
Superior hypogastric plexus
Sacral splanchnic nerves (branches from upper sacral sympathetic ganglia to hypogastric plexus)
Gray ramus communicans
Hypogastric nerves
Sacral plexus
Pelvic Splanchnic nerves
Inferior hypogastric (pelvic) plexus with periureteric loops and branches to lower ureter
Rectal plexus
Vesical plexus
Prostatic plexus
Kidneys and Suprarenal Glands | Innervation of Kidneys and Upper Ureters: Schema
Sympathetic fibers
Preganglionic Sympathetic fibers
Postganglionic Sympathetic fibers
Parasympathetic fibers
Preganglionic Sympathetic fibers
Postganglionic Sympathetic fibers
Afferent fibers
Spinal sensory (dorsal root) ganglion
Gray ramus communicans
Ventral ramus of T10 (intercostal nerve)
White ramus communicans
Ganglia of sympathetic trunk
1st lumbar splanchnic nerve
Renal artery, plexus, and ganglion
Nucleus of solitary tract
Posterior (dorsal) nucleus of vagus nerve
Medulla oblongata
Vagus nerve (X)
Descending fibers
Ascending fibers
Spinal cord segments T10-L1
Lesser thoracic splanchnic nerve
Celiac ganglia and plexus
Superior mesenteric ganglion
Aorticorenal ganglion
Intermesenteric plexus
Superior hypogastric plexus
T10 Spinal section
T11 Spinal section
T12 Spinal section
L1 Spinal section
Inferior hypogastric (pelvic) plexus
Sacral plexus
Pelvic splanchnic nerves
Kidneys and Suprarenal Glands | Nerves of Suprarenal Glands: Dissection and Schema
Right phrenic nerve
Anterior vagal trunk
Right inferior phrenic artery and plexus
Right suprarenal gland
Right greater thoracic splanchnic nerve
Right lesser thoracic splanchnic nerve
Right least thoracic splanchnic nerve
Right renal ganglion and plexus
Right sympathetic trunk
Right 1st lumbar splanchnic nerve
Left phrenic nerve
Posterior vagal trunk
Left inferior phrenic artery and plexus
Left suprarenal gland
Left greater thoracic splanchnic nerve
Celiac plexus and ganglia
Left lesser thoracic splanchnic nerve
Aorticorenal ganglia
Left least thoracic splanchnic nerve
Left renal ganglion and plexus
Left sympathetic trunk
Left 1st lumbar splanchnic nerve
Superior mesenteric ganglion
Spinal cord
T5 Spinal section
T6 Spinal section
T7 Spinal section
T8 Spinal section
Intermediolateral cell column (lateral horn of gray matter)
Thoracic splanchnic nerves (preganglionic fibers)
Sympathetic trunk
Celiac ganglion
Suprarenal gland
Postganglionic fibers supply blood vessels
Medulla
Cortex
Preganglionic fibers ramify around cells of medulla
Kidneys and Suprarenal Glands | Arteries and Veins of Suprarenal Glands in Situ
Abdominal exposure of right suprarenal gland
Liver (retracted superiorly)
Superior suprarenal arteries (from inferior phrenic artery)
Inferior vena cava (retracted medially)
Suprarenal vein
Branches of middle suprarenal arteries (from abdominal aorta)
Peritoneum (cut edge)
Duodenum (pulled down)
Inferior suprarenal artery (from renal artery)
Suprarenal gland
Right kidney (pulled down)
Renal (Gerota’s) fascia
Cross section through suprarenal gland
Capsule
Cortex
Medulla
Abdominal exposure of left suprarenal gland
Left kidney
Renal (Gerota’s) fascia
Suprarenal gland
Superior suprarenal arteries
Left inferior phrenic artery
Pancreas and spleen (retracted superiorly)
Splenic vein
Aorta
Duodenojejunal flexure
Left colic (splenic) flexure (pulled medially)
Middle suprarenal artery
Suprarenal vein
Inferior suprarenal artery
Left renal artery and vein
Peritoneum (cut edges)
Abdominal Sections | Abdominal Wall and Viscera: Paramedian (Sagittal) Section
Diaphragm (central tendon)
Parietal peritoneum
Liver
Lesser omentum
Hepatic portal vein and proper hepatic artery in right margin of lesser omentum
Omental bursa (lesser sac)
Stomach
Middle colic artery
Transverse mesocolon
Parietal peritoneum (of anterior abdominal wall)
Transverse colon
Greater omentum
Small intestine
Rectus abdominis muscle
Transversalis fascia
Median umbilical ligament (urachus)
Fatty layer of subcutaneous tissue (Camper’s fascia)
Membranous layer of subcutaneous tissue (Scarpa’s fascia)
Urinary bladder
Pubicbone
Retropubic (prevesical) space (cave of Retzius)
Deep (Buck’s) fascia of penis
Coronary ligament enclosing bare area of liver
Esophagus
Superior recess of omental bursa (lesser sac)
Omental (epiploic) foramen (of Winslow)
Celiac trunk
Splenic vessels
Renal vessels
Pancreas
Superior mesenteric artery
Inferior (horizontal, or 3rd) part of duodenum
Abdominal aorta
Parietal peritoneum (of posterior abdominal wall)
Mesentery of small intestine
Rectovescial pouch
Rectum
Rectoprostatic (Denonvilliers’) fascia
Levator ani muscle
Prostate
Deep External anal sphincter muscle
Superficial External anal sphincter muscle
Subcutaneous External anal sphincter muscle
Bulbospongiosus muscle
Perineal membrane and bulbourethral (Cowper’s) gland
Puborectalis muscle (thickened medial edge of left levator ani muscle)
Testis
Tunica vaginalis testis
T10
T11
T12
L1
L2
L3
L4
L5
S1
S2
Abdominal Sections | Schematic Cross Section of Abdomen at L3, 4
Round ligament (ligamentum teres) of liver
Transverse colon
Branches of inferior epigastric vessels
Rectus sheath
Transversus abdominis aponeurosis
External oblique aponeurosis
Internal oblique aponeurosis
Mesentery of small intestine
Superior mesenteric vessels
Small intestine (ileum)
Lymph node
Ascending colon
Right paracolic gutter
Linea alba
Rectus abdominis muscle
Omental appendices
Greater omentum
Parietal peritoneum
Transveralis fascia
Transversus abdominis muscle
Internal oblique muscle
External oblique muscle
Small intestine (jejunum)
Descending colon
Left paracolic gutter
Left ureter
Quadratus lumborum muscle
Latissimus dorsi muscle
Testicular (ovarian) vessels
Psoas minor muscle
Parietal peritoneum
Psoas major muscle
Left sympathetic trunk
Erector spinae muscle
Intervertebral disc between L3 and L4 vertebrae
Intermesenteric (aortic) plexus
Spinous process of L3 vertebra
Abdominal aorta
Ligamentum flavum
Anterior longitudinal ligament
Inferior vena cava
Right genitofemoral nerve
Combined Layers of thoracolumbar fascia
Middle Layers of thoracolumbar fascia
Posterior Layers of thoracolumbar fascia
Ilioguinal nerve
Iliohypogastric nerve
Tendon of origin of transversus abdominis muscle
Abdominal Sections | Abdominal Scans: Axial CT Images
Series of abdominal axial CT images from superior (A) to inferior (D)
Aorta
Ascending colon
Body of vertebra
Descending colon
Ileum
Inferior vena cava
Linea alba
Left common iliac artery
Left kidney
Left lobe of liver
Deep back muscles
Psoas muscle
Rib
Rectus abdominis muscle
Right common iliac artery
Right kidney
Right lobe of liver
Spleen
Stomach
Transverse colon
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