Starts at the Related to:level of: Posteriorly Anteriorly

Body of C6 Vertebrae

Cricoid cartilage Recurrent laryngeal n.

Trachea

Anterior relations:
Lt. bronchus

Trachea

Heart

Posterior relations:

Vertebrae

Lateral relations: Right side

Rt. vagus

Left side
Lt. vagus

Azygos

Aortic arch

Rt. lung & pleura

Lt. lung & pleura

It pierces the diaphragm at T10

T10
Diaphragm

Diaphragm

It is about 4 5 cm. long

It ends at the gastroesophageal junction

Cricopharyngeus muscle

Aortic arch

Left main bronchus

Opening in diaphragm

Lt. hypochondrium

Epigastrium

Umbilical region

Cardiac orifice at T10

Lesser curvature

Pyloric orifice at L1

Greater curvature

Angle of Hiss

Incisura angularis

Fundus

Body

Pyloric portion

Anterior

Liver

Diaphragm

Anterior abdominal wall

Posterior (stomach bed)

Lt. crus of diaphragm

Left suprarenal gland Spleen Left kidney

Splenic artery
Body of pancreas Transverse mesocolon Transverse colon

Posterior (stomach bed)

Lt. crus of diaphragm

Left suprarenal gland Spleen Left kidney

Splenic artery
Body of pancreas Transverse mesocolon Transverse colon

Prepyloric vein of Mayo

It is an intraoperative landmark of pylorus

Short gastric
Lt. gastric

Rt. gastric Lt. gastroepiploic

Rt. gastroepiploic

It forms a C - shaped curve around the head of the pancreas

It is fixed in the front surface of the structures of the posterior abdominal wall

Rt Kidney

Quadratus Lumborum
Vertebrae

1st Part:
Starts at the level of L1

L1

1st Part:
Its 2 inches long 1st inch is the only mobile part

1st Part:
covered anteriorly by the peritoneum of the greater sac

1st Part:
covered posteriorly by the peritoneum of the lesser sac

1st Part:
1.Superior

Relations

Epiploic foramen

1st Part:
2.Posterior

Relations

Portal Vein IVC

CBD

Gastroduodenal a.

1st Part:
3.Anterior

Relations

Quadrate lobe
Neck of G.B

1st

2nd Part:
It is 3 inches long

2nd Part:
It descends vertically from L1 L3

L1 L2 L3

2nd Part:

The bile duct units with main pancreatic duct to form ampulla of Vater Which open in the posteromedial aspect of 2nd part

C.B.D Main pancreatic duct

Ampulla of Vater

2nd Part:
The accessory pancreatic duct opens separately 1 inch above the ampulla of Vater

2nd Part:
1.Anterior

Relations

Liver Transverse colon

2nd

2nd Part:
2.Posterior

Relations

Rt. kidney

2nd
Rt. Psoas major m.

3rd Part:
It is 4 inches long

3rd Part:
Relations

1.Anterior

Superior mesenteric vein

Superior mesenteric artery

3rd Part:
Relations

2.Superior

Head of pancreas

3rd Part:
Relations

3.Posterior

Rt. ureter

Aorta

Rt. Psoas major m. 3rd I.V.C Inferior mesenteric a.

3rd Part:
Relations

4.Inferior

3rd Small intestine

4th Part:
The duodenojejunal flexure It ends supported at the It is by duodenojejunal 1 inch ligament long of Treitz flexure from Rt. Crus of diaphragm

Rt. Crus of diaphragm

Superior pancreaticodudenal

Inferior pancreaticodudenal

Jejunum
Proximal 2/5

Ileum
Distal 3/5

Jejunum
Has 1 or 2 arterial arcades

Ileum
Has 2 or 3 arterial arcades

Jejunum
Large diameter with few lymphoid follicles

Ileum
Small diameter with Peyers patches

Jejunum
Large villi

Ileum
Small villi

At the end of ileum

By the anal canal

Transverse colon Hepatic flexure Splenic flexure

Ascending colon

Descending colon

Caecum

Sigmoid colon

Appendix
Rectum

Teniae coli

Haustrations Appendices epiploicae

No teniae coli in the rectum

1.Transverse mesocolon attached to anterior border of pancreas

2. Ascending & descending colons are covered on front & side by peritoneum

3. Sigmoid mesocolon has 2 limbs forming inverted V-shaped mesentery

Arterial supply
Inferior mesentric artery Superior mesentric artery Lt. colic artery Middle colic artery Rt. colic artery Ileocolic artery Sigmoid arteries

Venous drainage
Veins are parallel to arteries & have similar names & drain in portal vein Portal v.
Superior mesentric vein Inferior mesentric vein

Middle colic vein Lt. colic vein Rt. colic vein

Ileocolic vein

Sigmoid veins

Proximal group

Intermediate group

Distal group

Rt. Iliac fossa

Subhepatic
Lt. iliac fossa in Situs inversus totalis

Attached to posteromedial aspect of caecum 2 cm below the iliocaecal valve

2 20 cm (average 10 cm)

The tip points to one of the following positions

Retrocaecal

Preileal Postileal

Paracaecal

Pelvic

Mc Burneys point: at junction of lateral 1/3 & medial 2/3 of line extending from
A.S.I.S to umbilicus

Stops shortly at tip of appendix

Mucosa

Musculosa

Serosa

Submucosa (rich in lymphoid tissue)

From appendicular artery

Begins at S3

Ends 1 inch below & infront of coccyx

Length: 5 inches

Anteroposteriorly: concave anteriorly

Side to side: concave 1st to Rt. The to Lt. then to Rt. Forming valves of Houston

Valves of Houston

Upper 1/3: Middle 1/3: covered covered by by peritoneum peritoneum from from front front & side

Lower 1/3: devoid of peritoneal coverage

Anteriorly

Posteriorly

Fascia of Denonvillier

Fascia of Waldeyer

Anterior 1-Male Coils of ileum &sigmoid colon

Base of bladder Seminal vesicles Vas deferens Prostate

Anterior 2-Female

Coils of ileum & sigmoid colon Uterus & upper part of vagina(with rectouterine pouch in between) Lower part of vagina(no peritoneum in between)

Posterior 1-Bones and ligaments

Lower of sacrum

Coccyx

Anoccygeal Ligament

Posterior 2-Muscles

Piriformis

Coccygeus

Levator Ani

Posterior 3- Vessels

Superior Rectal

Median Sacral Lateral Sacral

Posterior

4- Nerves
Sympathetic Trunk Lower 3 sacral nerves

Coccygeal nerves

On each side

Para-rectal fossa

On each side

Inferior Hypogastric Nerve Plexus Coccygeus

Levator Ani

Begins 1 inch below and in front of tip of coccyx

Ends at Anal Verge

Length = 4 cm

Mucosa

Dentate Line

Pectin

At the level of puborectalis the anorectal ring is formed of:

1- Internal sphincter 2- Deep external sphincter 3- puborectalis