CAGAYAN STATE UNIVERSITY

COLLEGE OF MEDICINE AND SURGERY

ANATOMY Abdominal Organs

Dr. Antonio Paguirigan

Now these are the characteristics of

the large intestines which we dont
find in the small intestines.
1. The HAUSTRA (sacculations)
The
presence
of
the

LARGE INTESTINES

sacculations

or

pouches

The

along the wall is due to the

digestive tract
Measures only about 5 to 5.5

feet long

longitudinal muscle fibers of

shorter

portion

of

the

distinctly

It extends from the ilio-cecal

junction

(junction

which is located at the right iliac

fossa upto the anus; thats part

outer

the large intestine. So there

between

the Ilium and the cecum)

shorter

are

HAUSTRA

or

sacculations.
2. The presence of TAENIAE COLI
These are free discrete
longitudinal

of the large intestine.

smooth

branch

muscles

that

of
are

But like the small intestine it is a

seen along the outer surface

widest at its proximal portion and it

of the large intestine

It is formed by the outer

also gradually diminishes in caliber

muscular layer which is not

towards the anal canal.

uniformly distributed as a
It is divided anatomically into the:
a. Cecum
b. Vermiform appendix
c. Colon, itself which includes;
1. Ascending colon
2. Right flexure
3. Transverse colon
4. Left flexure
5. Descending colon
6. Pelvic part of the large
intestine (Rectum and the
Anus)

complete coat around the

large intestine;
They are equidistant from
one another in the extent
from

the

base

of

the

vermiform appendix upto the

rectum where they merge to
form a complete coat

3. The presence of APPENDIXES

EPIPLOICA

These are small serous outpouchings of the peritoneum

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that are filled with adipose

intestinal canal. So 4/5 is made

tissues
They are attached to the

up of the small intestine.

colon between the internal

Structures that are ONLY found in the

margin

small intestines:

and

taeniae
4. The

the

coli.

anterior

These

are
1. Intestinal villi
2. Circular folds
3. Aggregate lymphatic nodules

appendices epiploica
presence
of
PLICA

SEMILUNARIS

These are crescentic folds

While

along the internal surface of

appendices

the large intestine and this

semilunaris are found in the large

corresponds

intestines.

to

the

the

sacculation,
epiploica

taenia
and

coli,
plica

separation between the two

5. The CALIBER (quality) of the

HAUSTRA externally
So
what
we
find
sacculations
outside,

or

as

large intestine
The caliber (quality) of the large

HAUSTRA

we

find

intestine is twice that of the

the

small intestine (twice wider).

markings inside the bowel as

plica semilunaris.

Now we go to the different parts of the

So these are the four characteristics of

large intestines.

the large intestine that we dont find in

the small intestine.

A. CECUM

Is the elbow-like portion of the

The other differences between the

large intestine below the level

small intestine and the large intestine

of the ileocecal junction and it

besides

forms a lined-pouch.
The lower and outer

directed downward and medially.

It is the first part of the large

the

presence

Sacculation,

(2)

Taenia

Appendices

epiploica,

of

(1)

coli,

(3)

(4)

Plica

semilunaris;

part

is

intestine and is the widest

The large intestine is only 1/5

the

length

of

the

part;

whole

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it is located in the right iliac region

the

resting on the right psoas major

projecting into the cecum.

This is called the ILEOCECAL

muscle just at the rim of the pelvis.

This
is
generally
covered

longitudinal

muscle

layer

VALVE. These are crescentic folds

completely by the peritoneum but

above

sometimes the posterior part of the

orifice.
The upper part of the valve is

cecum is uncovered
It is only bound down to the

and

below

the

areolar tissues.

lower

placed;
While the

part

bigger/larger

also important especially in surgery:

obliquely-placed.

Greater

omentum,

to
(2)

the

(1)

So

these

is

obliquely-

lower

The RELATION of the CECUM is

Related

ileocecal

usually horizontally placed and

posterior abdominal wall by a fibro-

ANTERIORLY:

the

surrounds

part

and

is

it

the

is

slit-like

Anterior

opening which runs antero-posteriorly;

abdominal wall and (3) some coils of

on each side of the opening the two

the small intestines.

folds will unite to form what we call

LATERALLY: It is also in relation to the

abdominal wall immediately above the
lateral third of the inguinal ligament.
POSTERIORLY:

The

(1)

the FRENULUM of the VALVE

Now attached to the cecum is the
vermiform

Iliopsoas

It

is

determination

what

we

B. VERMIFORM
APPENDIX

of

course of the ileum.

or

usually known as the APPENDIX.

muscle and (2) the femoral nerve.

MEDIALLY:

appendix

Is a worm-like blind tube that is

about 4 inches in length and it

Now there are two crescentic folds

that

lie

above

and

below

the

part of the cecum about 1.5 inches

ileocecal orifice and this consists of

the elements of the walls of the
ileum except the peritoneum and

springs postero-medial.
It is attached to the postero-medial

below the ileo-cecal junction.

Normally it is at the right iliac
region.

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The free portion of the appendix,

1. Superior

may be pointed in any direction but

fossa
2. Inferior

it is enclosed by peritoneum and its

mesentery,

which

ileocecal
ileocecal

fold

&

fold

&

fossa
3. Retrocecal fossa

is called the

MESO-APPENDIX.

The meso-appendix is triangular

C. COLON

in shape and it is attached to

the left side of the lowest part

of the mesentery.
The
ARTERY

APPENDIX
APPENDICULAR

is

Now we go to the next part of the

large intestine which is the ascending

of

the

called

ARTERY;

colon;

the
artery

comes from the Ileocolic artery and

C1. Ascending Colon

opening

of

cecum

abdomen:
1. Right iliac region
2. Right lumbar region
3. Right hypochondriac regions
From the level of the ileocecal

ileocolic orifice.
The

the

abdominal cavity
It occupies three regions of the

on the back of the cecum about 1

of

appendix is a very small opening

inch below and lateral to the

continuation

upward along the right side of the

it reaches the appendix along the

meso-appendix proper.
Now the orifice of the vermiform

junction, at the intertubercular line

the

appendix

it ascends to the inferior surface of

maybe guarded by a crescentic fold

the right lobe of the liver where it

of mucous membrane which forms

will end forward and medially as

its valve and we call the valve of

the

appendix

as

the

GERLACHS

VALVE.

RIGHT

COLIC

FLEXURE

(Hepatic flexure)
It measures about 5-8 inches in
length

Now there are peritoneal folds and

And it is covered by peritoneum

recesses around the cecum. These are

along the anterior aspect only. So

also important surgically, especially if

the ascending colon is covered by

you are operating on the appendix.

peritoneum only in the anterior

part/aspect, it is not covered by

So these peritoneal folds and recesses

peritoneum on the lateral, medial

around the cecum are:

and posterior part.

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It is related ANTERIORLY to the

anterior abdominal wall and the

liver also and the lateral abdominal

structures that intervene between

them are the intestinal loops

POSTERIORLY to the lateral wall,
and the (1) Iliacus muscle, (2)

wall.
While POSTERIOR to the hepatic

flexure, is the right cecum.

While MEDIALLY, it is the 2nd part
of the duodenum.

Quadratus lumborum muscle, and

also the (3) Psoas muscle in the
posterior part; even the lower part
of

the

right

kidney

is

related

posteriorly to the ascending colon.

Medial to the ascending colon are

C3. Transverse Colon

Is the loop portion of the large

intestine
It lies transversely

It

is

also

called

the

due to the slightly longer meso-

COLIC FLEXURE
It is the ascending of the colon as it

becomes the transverse colon

This
is
the
acute
bending,
anteriorly

to

the

colon along its middle part, it loops

left of the

large intestine below the right

lobe of the liver.

This marks the transition between
the

ascending

colon

and

the

transverse colon.
It lies in the right hypochondriac

region;
It is at the level of the 9th

costal

cartilage

and

2nd

So,

ANTERIOR

to

or hangs downwards.
It occupies the:
1. Right hypochondriac region
2. Epigastric region
3. Sometimes upto the umbilical
region and Left hypochondriac

region of the abdomen

The posterior two layers of the
greater omentum, ascend towards
the

inferior

border

of

the

transverse colon and then it will

split to enclose the gut and reunite
again

at

the

postero-superior

margin as it passes to the posterior

lumbar vertebrae

the left colic (splenic flexure)

The transverse colon measures
about 20 inches in length; and

RIGHT

the

the right colic (hepatic flexure) to

psoas major muscle.

across

abdominal cavities extending from

coils of the small intestines and the

C2. Hepatic Flexure

LATERALLY, it is the part of the

the

hepatic

flexure, is the right lobe of the liver.

abdominal

wall

as

the

TRANSVERSE MESOCOLON

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the

continuous upwards to form part of

LIGAMENT

the

posterior

boundary

of

the

and the free border is attached

passes downwards along the lower

laterally

part of the posterior abdominal

opposite to the 11th rib.

medially to the left flexure and

wall;
The right part of the transverse
is

short

and

it

is

DESCENDING

COLON;
It is the part of the large intestine
the abdominal cavity.
It occupies the:
1. Left hypochondriac region
2. Left lumbar region
3. Left iliac region
And it extends from the left colic

It is also called the LEFT COLIC

FLEXURE
Is the acute bending also of the
upwards

towards

the

and

left

of

backwards
the

large

(splenic) flexure up to the pelvic

inlet.
So it

measures

the lower part of the spleen.

It marks the transition of

covered by peritoneum along the

level compared to that of the right

flexure.
The left colic (splenic) flexure is

anterior aspect only

From the flexure

it

and

will

it

pass

of the left kidney.

Then it will run straight downwards
until the crest of the ilium and;
It will pass obliquely medially along
the iliac fossa.

fixed to the posterior abdominal

wall by a ligament which we call

is

medially to the lateral border

colon;
It lies at the left hypochondriac
region but at the slightly higher

length

9-12

inches

the

in

about

intestine below the stomach and

transverse colon into the ascending

the

that descends along the left side of

colon

is

the body of the pancreas.

C4. Splenic Flexure

diaphragm

bringing the mesocolon close to

the

The next part after the left colic

flexure

nd

with the 2 part of the duodenum.

While the left part is short again

to

C5. Descending Colon

deficient; and it is indirect contact

A triangular fold of peritoneum

omental bursa;
While the inferior (lower) layer

mesocolon

PHRENICOLIC

Then the superior (upper) layer is

C6. Pelvic Colon

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Also

called

direct

SIGMOID

the

It is the part of the large intestine

that lies in the pelvic cavity

It measures about 15 inches in

and it gives a great mobility to

the sigmoid and the rectum.
The posterior attachment of the

It extends from the pelvic inlet

pelvic mesocolon is V-shaped;

And the left or ascending limb

up to the level of the 3rd

sacral vertebrae where it will

posterior

longer along the middle part

length

the

abdominal wall.
It is short at both ends; but it

COLON;

to

passes the medial border of the

pass on to become the RECTUM.

So the pelvic (sigmoid) colon

left psoas muscle as far as the

bifurcation of the common iliac

follows an irregular and tortuous

artery.

course starting from the medial

border of the left psoas muscle and
descending into the true pelvis
crossing the left, to the right and
then it bends backwards along the
posterior

wall

to

rectum.
The
sigmoid

end

into

C7. Rectum

Is the lower part of the large

intestine
It lies in the pelvic cavity from the

the

colon

is

surrounded

by

vertebrae at the continuation of

peritoneum.
So therefore, it is provided with a

the pelvic colon up to a point

completely

level

where

PELVIC MESOCOLON.
Anterior to the mesocolon is the
urinary

bladder

(male)

and

uterus (female).
Posteriorly, is the external iliac
blood vessels and the posterior
pelvic wall;
While superiorly, are the coils of
the small intestine.
This pelvic mesocolon is a fanshaped

peritoneal

fold

that

of

3rd

the

it

pierces

diaphragm

and

sacral

the

pelvic

becomes

continuous as the anal canal.

The main parts of the rectum,
together
curvatures
peritoneal

with
of

the
the

different

rectum,

connections,

and

its
its

relations will be taken up in more

detail when we are in the pelvis.
-- END --

connects the pelvic colon and

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of the Large

So, those are the arteries that supply

Intestines is also made up of 4

the large intestine. Both coming from

The Structure

the superior mesenteric artery and the

coats.

inferior mesenteric artery.

1.
2.
3.
4.

Serous coat
Muscular coat
Sub-mucous coat
Mucous coat

The Venous Drainage of the

Large Intestines; the veins that

drain the large intestines are the veins

The Blood Supply of the Large

that accompany the branches and the

Intestine comes from the:

sub-branches

of

the

arteries

that

supply the large intestine.

1. SUPERIOR

MESENTERIC
1. SUPERIOR MESENTERIC VEIN

ARTERY
Then

it

gives

off

the

a. Ileocolic vein
b. Right colic vein
c. Middle colic vein

following

2. INFERIOR MESENTERIC VEIN

branches:

a. Superior left colic vein

b. Inferior left colic vein

a. Ileocolic artery (ascending &

descending branch)
b. Right colic artery (ascending
&

descending

that

mesenteric vein will join together to

the

form 1 large vein which joins the

corresponding branches of the

splenic vein behind the neck of the

anastomoses

branch

So the tributaries of the superior

with

Ileocolic and the middle colic

artery)
c. Middle colic artery (gives off

pancreas

to

form

the

PORTAL

VEIN.

a right and left branch; and it

anastomoses

with

the

corresponding branches of the

right

colic

and

the

superior

colic)
2. INFERIOR

Tributaries of superior mesenteric

vein + Splenic vein PORTAL VEIN

And the veins that accompany the

branches of the inferior mesenteric

MESENTERIC

ARTERY, are the:

a. Superior left colic artery
b. Inferior left colic artery

artery will join together to form a large

vein that ultimately drains into the

SPLENIC VEIN.

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Superior left colic vein + Inferior

So the lymph that comes from the (1)

left colic vein SPLENIC VEIN

cecum, (2) appendix, (3) ascending

colon, (4) transverse colon; they are

the

all drained into 2 groups of glands that

Large Intestines are both derived

join those that are located at the root

Autonomic

of the mesentery and they drain into

The

from

Nerve
the

Supply

of

Nervous

the INTESTINAL LYMPH TRUNK.

System.
a. The sympathetic fibers arises

While the lymph coming from the (1)

thoracic

descending colon and (2) pelvic colon;

segment and upper lumbar

they will pass to the glands at the left

segment of the spinal cord;

lumbar lymph trunk, and ultimately

and they reach the celiac plexus

drain into the CISTERNA CHYLI.

from

the

lower

by way of the LESSER and the

-- END --

LEAST SPLANCHNIC NERVES.

The superior and inferior mesenteric
plexus/es are extensions of the celiac
plexus and they follow the course of
the artery and its branches.
b. The parasympathetic fibers are
derived from the VAGUS and
PELVIC NERVE; that join the
pelvic

plexus

to

become

distributed with the sympathetic

The main artery to the small intestine

and the right half of the large intestine

fibers going to the bowel.

is
The

Lymphatic

Drainage

of

the

Superior

Mesenteric

Artery.

the Large Intestines; there are

small lymph glands that are found
along the walls of all parts of the colon
and together with the blood vessels
that supply the large intestines.

It is given off about inch

below the celiac artery.

So the superior mesenteric
artery

comes

from

the

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abdominal aorta and it starts

opposite

lumbar

vertebra.
And it will terminate close to the
ileocecal

1st

the

junction

by

branches

branch.
So from its origin, with curves

branches

the left side; these are the

branches

of

the

superior

superior

and
to

the

it

gives

transverse

colon
Anastomose with the right colic

that of the ileocolic and middle

the (a) jejunal artery and (b)

D. ILEO-COLIC ARTERY
Supplies the terminal part of the

ileal artery
There are 10 16 branches that
obliquely

forward

colic artery.

ileum and the lower part of the

and

of the mesentery.
And
these

branches

anastomose with one another

forming a series of arterial loops
that branches from the arcades

ascending colon together with

1.
2.
3.
4.
5.

to form other loops.

From the concave side of the

A. INFERIOR

part of the superior mesenteric

head

Inferior

Mesenteric

Artery, is the main artery that

PANCREATICOthe

artery.
The

supplies the left half of the large

intestine.

DUODENAL ARTERY
Supplies

the

anastomosing with the terminal

are given out:

a. Inferior
pancreatico-duodenal
artery
b. Middle colic artery
c. Right colic artery
d. Ileocolic artery

the cecum and appendix

It gives off 5 branches:
Ascending colic artery
Ileal artery
Anterior cecal artery
Posterior cecal artery
Appendicular artery
The ILEAL BRANCH of

ileocolic artery will terminate by

artery, the following branches

the

similar

and the left superior colic artery.

C. RIGHT COLIC ARTERY
Supplies the ascending colon
Its branches anastomose with

downwards between the layers

of

the

mesenteric artery.
On each convex side, we have

pass

with

pancreatico-duodenal artery.
B. MIDDLE COLIC ARTERY
Reaches
the
transverse
mesocolon

the convexity looping towards

Anastomose

anastomosing with the ileocolic

downward and to the right, with

of

the

pancreas and the duodenum

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It originates from the abdominal

colon; and anastomose with one

aorta, and it commences 1

another.

inches above the bifurcation of

C. SUPERIOR

the aorta behind the 3rd part of

(SUPERIOR

the duodenum.
This is at the level of the 3rd

ARTERY

HEMORRHOIDAL

ARTERY)

lumbar vertebrae just above

RECTAL

A direct continuation of the

inferior mesenteric artery, and

the umbilicus.
Then it will terminate at the left

so it enters the pelvic meso-

side of the left common iliac

colon, descends into the true

artery in front of the psoas

pelvis and opposite at the level

major muscle, where it becomes

of the 3rd sacral vertebrae it will

continuous

divide

as

rectal artery.
It gives off

the

superior

the

rectal

that

following
So those are the branches of the
inferior mesenteric artery.
-- END --

(superior

hemorrhoidal) artery
A. SUPERIOR

branches

surrounds the rectum.

branches:
1. Superior left colic artery
2. Inferior left colic (sigmoidal)
artery
3. Superior

into

LEFT

GALL BLADDER

COLIC

This is a pear-shape organ which

Divides into an ascending and

acts as a reservoir for bile.

It is intimately attach to the

descending branches
Supplies the descending colon

ARTERY

visceral surface of the liver by

areolar tissues and by peritoneal

proper.
B. INFERIOR

LEFT

COLIC

(SIGMOID) ARTERY;

There are 2 or 3 branches that

is given off by inferior left colic
(sigmoid)
pass

arteries,

behind

the

and

they

peritoneum

coverings.
It is about 3 or 4 inches long
and it presents the following parts:
a. Fundus
b. Body
c. Infundibulum
(Hartmanns
pouch)
d. Neck
e. Cystic duct

supplying the iliac and pelvic

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CHOLECYSTODUODENAL

A. FUNDUS

The FUNDUS is the anterior lower

LIGAMENT (because it bind the

part of the gall bladder and it is a

gall bladder to the duodenum).

This
ligament
is
surgically

wider part.
It usually protrudes beyond the

margin of the liver.

So it comes in contact with the

to the cystic duct which it hides.

anterior abdominal wall at the

For operation involving the cystic duct,

level of the 9

th

costal cartilage,

and at the lateral border of the

important because it runs parallel

you

should

locate

first

the

cholecystoduodenal ligament!!!

rectus abdominus muscle.

D. NECK
B. BODY

The NECK of the gall bladder is the

The BODY of the gall bladder

constricted

usually tapers
This is the main part of the gall

medially

bladder

that

passes

backwards,

and

the

part

of

the

Porta

The spiral constriction that is seen

neck of the gall bladder indicates

the

the beginning of the cystic duct.

It also marks the crescentic fold of
mucosa which guards the opening

duodenum.

of the gall bladder. And this fold of

mucosa

C. INFUNDIBULUM
(HARTMANNS POUCH)

curves

along the external surface of the

liver and the inferior surface is

nd

towards

that

hepatis.

upwards and to the left.

It is indirectly in contact with the
related to the transverse colon

part

is

called

the

SPIRAL

VALVE OF HEISTER.
This spiral valve of Heister is

The

INFUNDIBULUM

continuous to the 1st part of the

(HARTMANNS

POUCH)

cystic duct.

is

the

part of the gall bladder between

E. CYSTIC DUCT

the body and the neck of the gall

bladder.
It is bound down to the 1st part of

The CYSTIC DUCT is the duct of

the

the gall bladder.

And it measures about a little over

duodenum

by

the

right

edge of the Lesser Omentum

which

we

call

1 inch in length

the

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within

COMMON BILE DUCT

It has an irregular S-shaped course

the

free

margin

of

the

hepato-duodenal ligament.
A short distance from the Porta
hepatis, it will join the common
hepatic

duct

to

form

COMMON

BILE

DUCT

is

formed by the union of the cystic

the

COMMON BILE DUCT.

The

duct and the common hepatic duct.

It measures about 4 inches in

length.
It starts a short distance below the
porta hepatis and then it descends
within

-- END

the

free

margin

of

the

hepato-duodenal ligament towards

The Blood Supply of the Gall

Bladder is the CYSTIC ARTERY.

This is a branch of the right hepatic
artery.

the duodenum.
In company with the hepatic artery
and the portal vein, both of which go
upward the liver, the bile duct will

It divides into an anterior and a

posterior branch and supplies
the upper and lower surfaces of
the gall bladder.

pass downwards behind the 1st part of

the duodenum up to the head of the
pancreas and through the substance
of the pancreas. And after a slight
inclination to the right, it will end into

The Venous Drainage of the

the 2nd part of the duodenum along

Gall Bladder accompany the artery

the posteromedial surface.

and enter into the substance of the

liver

to

join

the

INTRAHEPATIC

BRANCHES of the PORTAL VEIN.

The Nerve Supply of the Gall

Then it will be joined by the main

pancreatic

duct

just

below

the

termination and the dilated common

passage.

the

There is a common passage of the

parasympathetic

pancreatic duct and the common bile

fibers that are all derived from the

duct into the duodenum. This part of

hepatic flexure.

the

Bladder
sympathetic

also
and

comes

from

duodenum

is

called

the

AMPULLA OF VATER.
-- END

Talosig, Tango, Tungpalan, Udanga, Villanueva, Vinarao, Wagason, Zabala

It joins into an elevated portion of the

into numerous branches. And these

mucosa

veins will join the sub-lobular veins

of

which

we

call

the

DUODENAL PAPILLAE.

which is therefore in the hepatic

So the part of the duodenum where

veins.
The left branch will pass to the left

they open is called the AMPULLA OF

lobe of the liver and after receiving

VATER; and there is an elevated part

branches, it will go to the quadrate

of the mucosa in the ampulla of Vater

and caudate lobes of the liver.

So these are the tributaries of the

called the DUODENAL PAPILLAE.

portal vein.

It is where the common bile duct

and the pancreatic duct open into

PORTAL VEIN
The

PORTAL

VEIN

is

wide

venous channel that drains the

blood coming from the digestive

The Tributaries of the Portal

Vein:

the duodenum!

tract and conveys it to the liver.

It is about 3 inches long and it

1.
2.
3.
4.
5.
6.
7.

Superior mesenteric vein

Splenic vein
Left gastric vein (coronary vein)
Right gastric vein
Cystic vein
Right gastro-epiploic vein
Pancreatico-duodenal
vein
(ocassional)

starts (is formed) as the union of

the

SUPERIOR

MESENTERIC

portal vein.

VEIN and the SPLENIC VEIN.

So these are the 6 tributaries of the

It commences behind and to the

left of the neck of the pancreas
which is at the level of the 1 st
lumbar

vertebrae

and

it

A. SUPERIOR MESENTERIC VEIN

Is the one that accompanies the
superior mesenteric artery and

will

terminate at the right end of the

its branches;
It lies in the right side of the

porta hepatis by dividing into a

artery and begins in the right

right and a left branch.

The right branch is

iliac fossa, and runs obliquely

while the left branch is longer!

The right branch after receiving the

shorter

cystic vein will enter the right lobe

upwards to join the splenic vein

behind

the

neck

of

the

pancreas.

of the liver where it will break out

Talosig, Tango, Tungpalan, Udanga, Villanueva, Vinarao, Wagason, Zabala

LIVER

All the veins that accompany

the

branches

of

the

artery

It is the largest glandular organ of

the body
It lies immediately

EXCEPT the occasional artery,

which

is

the

epiploic

right

gastro-

vein

pancreatico-duodenal
will

all

join

the

portal

respiratory diaphragm occupying

vein,

the:
1. Right hypochondriac region
2. Epigastric region
3. Left hypochondriac region of the

vein

superior rectal vein;

It is at the left side of the artery
and at the left side also of the

Aorta.
This will

end

behind

the

pancreas by joining the splenic

the

and

directly.
B. INFERIOR MESENTERIC VEIN
Is a direct continuation of the

below

vein.
So all the veins that accompany
also the branches of the artery

abdomen.
So you should palpate the liver
below the ribs, NOT in the pelvic
area!!!

vascular and in the living specimen

it is reddish-brown in color.
Normally it should have a uniform
consistency and almost completely

are the tributaries of the inferior

mesenteric vein.

It is a large organ, it is highly

covered by peritoneum.
Actually it makes up about 1/15 of

the adult weight (full weight of

C. SPLENIC VEIN
Is the vein that lies below the

the body);
The liver somewhat resembles and

splenic artery and along its

irregular pyramid with the base

course, it is formed by 5 or 6

located on the right side projected

tributaries

by the lower part of the right

arising

from

the

spleen.
So the tributaries of the splenic

a.
b.
c.
d.

veins are:
Short gastric vein
Pancreatic vein
Left gastro-epiploic vein
Inferior mesenteric vein

thoracic

wall

and

the

apex

is

directed to the left under the left

copula of the diaphragm.

It has 4 surfaces:
1. Anterior surface
2. Superior surface
3. Posterior surface
4. Inferior surface

-- END --

Talosig, Tango, Tungpalan, Udanga, Villanueva, Vinarao, Wagason, Zabala

We can actually outline the liver on

These are the peritoneal connections

the surface of the body by making use

of the liver that attaches it to the

of 3 landmarks.

other organs and to the abdominal

wall.

1. POINT

ON

THE

RIGHT

MAMILLARY

LINE

crossing

1. FALCIFORM
LIGAMENT

th

the 5 rib
2. POINT

ON

THE

LEFT

MAMILLARY LINE at the 5

intercostal space
3. POINT
ON THE

Is

peritoneum;
Is crescentic in shape;
It is attached to the anterior and

th

RIGHT

double-layered

upper

fingerbreadth below the costal

attaching it to the inferior surface

margin which is the 10th rib.

of the diaphragm and the back of

represent

upwards,
the

this

will

the

liver

the Linea alba, as far down as

If you connect the first 2 points by

directed

of

of

LATERAL WALL just about 1

a curve line with the concavity

surfaces

fold

the umbilicus.
The free margin of the falciform
ligament

SUPERIOR

contains

the

round

ligament of the liver.

MARGIN of the liver.

If you connect the 1st and the 3rd

point

by

another

curve

2. CORONARY
LIGAMENT

line

markedly convex laterally, this will

It is the reflection of peritoneum

represent the RIGHT LATERAL

from the superior surface of the

MARGIN of the liver.

liver up to the undersurface of the

If you connect the 2nd and the 3rd

point by a straight line, it will
represent

the

INFERIOR

MARGIN of the liver.

diaphragm.
So the importance of this coronary
ligament location is that it limits
the quadrangular area of the
postero-superior surface of the

The various forms of peritoneum that

attaches the liver to the other organs,
as well as to the abdominal wall, are
assumed different names.

liver delineated by the coronary

ligament is called the BARE

AREA OF THE LIVER.

Talosig, Tango, Tungpalan, Udanga, Villanueva, Vinarao, Wagason, Zabala

3. RIGHT TRIANGULAR
LIGAMENT

It is also a peritoneal reflection;

It is at the right posterior surface of

the liver;
Corresponds to the right angle of

There

are

also

non-peritoneal

ligaments that are attached to the

liver. And they are the:

the quadrangular reflection of the

1. LIGAMENTUM

coronary ligament.

HEPATIS
2. LIGAMENTUM VENOSUM

4. LEFT TRIANGULAR
LIGAMENT

Is the peritoneal reflection towards

the left
Corresponds to the angle of the
quadrangular

reflection

of

the

coronary ligament.

Is a fibrous cord that occupies the

free

margin

of

the

falciform

ligament;
It extends from the umbilicus up to
end by fusing with the left branch

Is

peritoneum;
It is short, and it connects the

wide

LIGAMENTUM TERES
HEPATIS

the inferior surface of the liver to

5. LESSER OMENTUM
a

TERES

double-fold

of

of the portal vein.

It represents the remains of the

UMBILICAL

VEIN

in

the

FETUS.

inferior surface of the liver and the

lesser curvature of the stomach;

LIGAMENTUM VENOSUM
-- END --

Is a fibrous cord which connects

the left branch of the portal vein
with

the

upper

ends

of

the

abdominal portion of the inferior

vena cava.

It represents the remains of the

DUCTUS

VENOSUS

in

the

FETUS.
-- END --

Talosig, Tango, Tungpalan, Udanga, Villanueva, Vinarao, Wagason, Zabala

Surfaces of the Liver:

POSTERIOR SURFACE

a.
b.
c.
d.

Is

smaller,

somewhat

triangular

also, and it represents a deep

Right surface
Upper surface
Anterior surface
Posterior surface

concavity that is produced by the

vertebral column.
So it represent a large convex right
part (which is the part of the base
area of the liver and is immediately

RIGHT SURFACE

connected to the diaphragm) which

Is the convex quadrilateral area

(roughly quadrilateral) and it is

separates the liver from the right

pleura and the right lung.

closely related to the diaphragm

which separates it from the pleura

_____________________________________________________________

of the thoracic region;

Separates it also from the lungs,

Then we have a GROOVE for the

and

lower

ribs

and

their

intervening intercostal spaces.

INFERIOR VENA CAVA; we know

that IVC is embedded in the liver, so it
produces

UPPER SURFACE

applied

to

the

surface of the diaphragm.

The right and the left part of the
fit into the right and the left cupula
of the diaphragm which separates
it from the pleura and the lungs.
The middle part is concave, and it
is separated from the pericardium
and the heart by the diaphragm.

ANTERIOR SURFACE

groove

for

the

surface of the liver.

inferior

upper surface are convex, so they

deep

inferior vena cava on the posterior

Is the area of the liver that is

closely

Then we have the CAUDATE LOBE

of the LIVER, which is part of the

liver, between the groove for the
inferior vena cava and the fissure for
the ligamentum venosum.
Then we have the FISSURE for

the LIGAMENTUM VENOSUM

which is a deep cleft on the left side of
the caudate lobe.

Is the roughly triangular flat area of

the

ESOPHAGEAL

the liver whose larger right part

Then

and smaller left part are protected

IMPRESSION (shallow groove) that

by the costal cartilages.

Talosig, Tango, Tungpalan, Udanga, Villanueva, Vinarao, Wagason, Zabala

is at the left side of the ligamentum

venosum,

this

is

caused

by

the

2. COMMON HEPATIC DUCT

The COMMON HEPATIC DUCT is

impression of the abdominal portion of

formed at the right side of the

the esophagus. Thats why it is called

porta hepatis by the union of the

esophageal impressions.

right and left hepatic duct.

3. FISSURE for LIGAMENTUM

TERES

Now in the lower part of the liver, you

will find the different fissures and
fossae.

This

is

deep,

narrow

slit,

extending from the left end of the

VISCERAL SURFACE of the

LIVER

Aka: INFERIOR PART OF THE

LIVER
It is oblong, and it is irregular, and

porta hepatis going downwards to

the inferior margin of the liver.

It lodges the ligamentum teres
which

is

the

remnant

of

the

umbilical vein.

all the parts are in relation to some

it

4.FISSURE for LIGAMENTUM

VENOSUM

definite organs.
The surface is obliquely place and
is

directed

backwards

and

backwards from the left end of the

downwards to the left.

It presents these different parts:

1. PORTA HEPATIS

Is the hilum of the liver;

It is a wide, deep, transverse cleft

porta

the

superior

that

conveys

blood

directly from the umbilical vein to

the inferior vena cava.

liver.
It transmits the terminal portion of

5. FOSSAE of the GALL

BLADDER

the portal vein, hepatic artery,

to

surface of the liver.

It lodges the ligamentum venosum
venosus

part of the inferior surface of the

common hepatic duct, nerves and

hepatis

which is the remnant of the ductus

that is placed towards the posterior

A narrow vertical cleft that extends

It is a wide, shallow fossa that

lymph vessels.
So these are the structures that are

extends from the inferior margin of

located in the porta hepatis or the

porta hepatis, this is for the gall

hilum of the liver.

bladder.

the liver upto the right end of the

Talosig, Tango, Tungpalan, Udanga, Villanueva, Vinarao, Wagason, Zabala

It lodges the gall bladder, it is

intimately

connected

to

it

by

areolar tissues and small blood

vessels and ducts.

6. SUPRA-RENAL IMPRESSION
These are marks of the liver by the
different structures that are in relation
to it.

6. FOSSAE for the INFERIOR

VENA CAVA

It is a wide, deep fossa that lodges

the upper part of the inferior vena

The Borders of the Liver:

cava but this does not extend to

ANTERIOR MARGIN is thin, and it

the porta hepatis.

is sharp, and it separates the anterior

The fossa of the gall bladder anteriorly

from the visceral surface. It is in close

and the fossa of the inferior vena cava

relation to the anterior abdominal wall,

posteriorly

right

so it runs obliquely from the left and to

boundary of the 2 lobes of the liver

the right; and it present these 2

dividing the liver into the:

important notches and incisura.

will

form

the

a. Right lobe
b. Quadrate lobe
c. Caudate lobe

a. INCISURA UMBILICALIS is a
small notch, marking the place
where the falciform ligament
crosses the anterior margin; it is
located slightly to the right of

Now these are the impressions that

you will find (but you will never find

the median line.

b. NOTCH
for

the

GALL

because there is no cadaver!) but are

BLADDER it is a wide notch

proposed to be located on the LEFT

marking the place of the fundus

LOBE of the LIVER:

of the incisura

1. GASTRIC IMPRESSIONS
2. TUBEROMENTAL
IMPRESSIONS

of the gall bladder to the right

(omental

tuberosity)
3. COLIC IMPRESSIONS
4. DUODENAL IMPRESSION
5. RENAL IMPRESSION

POSTERO-SUPERIOR MARGIN
is not as sharp or as well-defined as
the anterior margin. It is ill-defined
and it separates the posterior surface
from the visceral surface of the liver.

Talosig, Tango, Tungpalan, Udanga, Villanueva, Vinarao, Wagason, Zabala

Now we can divide the liver into lobes,

c. Connections

anatomically:

of

the

ductus

venosus with inferior vena cava.

The division of the liver into smaller

There are also 2 parts of the caudate

parts that are recognizable only in the

lobe that can be identified and these

inferior and visceral and posterior

are:

surfaces of the liver.

a. Papillary processes which

RIGHT LOBE of the

LIVER

are part of the caudate lobe

that projects downwards into

It is the larger part of the liver;

Extends to the right of the sagittal

the lesser omentum.

b. Processus caudatus which

cleft formed by the fissure for the

is rich of liver tissue extending

ligamentum teres anteriorly, and

from the right hand of the

the

papillary process to the right

fissure

for the

ligamentum

lobe of the liver

venosum posteriorly.
It is subdivided into quadrate lobe
and caudate lobe.

1. The

QUADRATE

LOBE

is

bounded by the:
a. Inferior margin of the liver
b. Gall bladder
c. Porta hepatis
d. Fissure for the ligamentum teres
The inferior part of the quadrate lobe
is in contact with the pylorus of the

LEFT LOBE of the LIVER

Smaller part of the liver;

It lies to the left of the sagittal
cleft.

Now the liver is also made up of a

serous coat, fibrous coat, and hepatic
lobules.

stomach and the 1st part of the

HEPATIC LOBULES these are

duodenum.

the unit part of the liver, are smaller

lobules that makes up the whole liver.

2. The CAUDATE LOBE is bounded

also by:
a. Porta hepatis
b. Inferior vena cava

Talosig, Tango, Tungpalan, Udanga, Villanueva, Vinarao, Wagason, Zabala

The Blood Supply of the LIVER

vessels going to the CELIAC LYMPH

comes from the HEPATIC ARTERY;

GLANDS.

that conveys blood from the aorta

through the celiac artery.

vein will pass upwards together with

The Venous Drainage of the

LIVER

convey

blood

And those that accompany the hepatic

from

the

digestive tract and goes to the liver,

the inferior vena cava to the MIDDLE

DIAPHRAGMATIC LYMPH GLANDS
of the thorax.

and this is through the PORTAL VEIN.

The

Nerve

LIVER,

also

DUODENUM

of

the

It is the first part of the small

sympathetic

and

intestine.
It is the

Supply

parasympathetic fibers, coming from

the

Lymphatic
LIVER

are

Drainage
also

of

the liver. From the capillaries of the

liver and the blood vessels, they come
to the surface of the liver to form the
peritoneal vessels which pass through
the

falciform

SUPERIOR

ligament
MESENTERIC

to

the
and

RETROSTERNAL LYMPH GLANDS.

The other vessels will go to the glands
around the porta hepatis,

passing

through the lesser omentum and join

the left gastric lymph glands.

extending

from

the

pylorus upto the duodeno-jejunal

important

especially in cases of malignancy of

shortest,

small intestine.
It measures only about 10 to 11

inches,
The

and

thickest and most fixed part of the

the CELIAC PLEXUS and the VAGUS

NERVE.

widest

flexure.
So it occupies the epigastric and

umbilical region of the abdomen.

Except for the 1st half of the
first

part

of

the

duodenum,

which is completely covered by

peritoneum,
organ

the

is

peritoneal

rest

entirely
(it

is

of

the

retro-

outside

the

peritoneum).
So it is only the 1st half of the 1st
part

of

the

completely

duodenum
covered

that

is
by

peritoneum!!!

Those from the posterior part of the

liver, will follow the right phrenic blood
Talosig, Tango, Tungpalan, Udanga, Villanueva, Vinarao, Wagason, Zabala

So for the purpose of description, we

the

divide the organ into 4 parts:

1.
2.
3.
4.

Superior part
Descending part
Horizontal part
Ascending part

duodenum

are

covered

by

peritoneum.
The bile duct and pancreatic duct
enters the descending part of the
duodenum on the postero-medial
aspect, a little below the middle of

the duodenum.
Ocassionally

the

accessory

pancreatic duct will open about

of an inch above the opening that
we have just mentioned.

1. SUPERIOR PART

the

level

of

the

1st

lumbar

vertebrae just to the right of the

median plane;
It is only about 2 inches long
and

3. HORIZONTAL PART

Is continuous from the pylorus at

it

takes

backward

and

upward direction to the right.

It is related to the:
a. Left lobe of the liver and the
b.
c.
d.
e.
f.

quadrate lobe of the liver

Head of the pancreas below it
Neck of the pancreas
Portal vein
Bile duct
Inferior vena cava posteriorly

Is the longer part;

It is about 4 inches long and it
runs transversely thats why it is

called horizontal, from right to left.

It is at the level of the 3rd

lumbar vertebrae;
It is in relation to the superior
mesenteric blood vessels and coils
of intestine at the root of the

mesentery;
It is also in relation to the head of

the pancreas.
It has a very important relation to
the head of the pancreas because

2. DESCENDING PART

Measures about 3 inches long;

It extends downward at the side of
the vertebral column, from the
neck of the gall bladder up to the
st

level of the 1 lumbar vertebrae.

Only parts of the anterior and
lateral surfaces of the 2nd part of

in cases of malignancy or tumors at

the head of the pancreas you can
see this as an indentation when
you perform an upper GI CTs.
Indentation in the 2nd part of
the duodenum!

4. ASCENDING PART

Is the shortest part;

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It measures about only 1 inch

And there are small spaces that are

long

formed by peritoneal folds and they

It runs upward on the left side

are located around the terminal part of

of the vertebral column. From

the duodenum.

the 3rd upto the 2nd lumbar

vertebrae, where it will abruptly

There

bend and become the duodeno-

recesses
duodenum.

jejunal flexure.
This is a triangular band of

fibrous tissue.
It is a fibromuscular tissue. The
muscles are made up of smooth
muscles and it attaches the
duodeno-jejunal flexure to the

are

constant

(spaces)

duodenal

around

the

a. SUPERIOR

DUODENAL

RECESS
b. INFERIOR

DUODENAL

RECESS
c. PARA-DUODENAL RECESS
d. RETRO-DUODENAL RECESS

right crux of the diaphragm.

These are also important landmarks in
So it joins the duodeno-jejunal flexure
to

the

right

diaphragm.

side
This

(crux)
is

of

called

the
the

SUSPENSORY LIGAMENT OF
TREITZ.

The

suspensory

ligament

of

treitz has a broad base at the

superior

surface

of

the

duodeno-jejunal flexure and it

passes

upwards

behind

the

pancreas and in front of the

aorta.
This is also a very important
landmark in surgery, especially
in areas of the duodenum and
the pancreas.

surgery!!!
So the structure of the duodenum is
also the same, it has a:
1. Serous coat
2. Muscular coat
3. Mucous coat
The SEROUS COAT is made up of
peritoneal covering that encloses the
anterior and lateral surfaces of the
duodenum.
The

MUSCULAR COAT of the

duodenum is well-developed; it is also

provided

with

vascular

fibers

that

surrounds the ampulla of Vater. These

muscular tissues that surround the

Talosig, Tango, Tungpalan, Udanga, Villanueva, Vinarao, Wagason, Zabala

ampulla

of

Vater

is

called

the

2. INFERIOR

SPHINCTER ODDI.

PANCREATICO-

DUODENAL ARTERY

SPHINCTER ODDI these are

The

the

DUODENAL ARTERY comes from the

muscular

tissues

that

surround the ampulla of Vater.

SUPERIOR

PANCREATICO-

gastro-duodenal artery, which is a

branch of the hepatic artery;

Then the MUCOUS COAT of the

duodenum is thicker than in other

While the INFERIOR PANCREATICO-

parts of the small intestine. And it is

DUODENAL ARTERY comes from the

provided with a short, broad villi.

superior mesenteric artery, and it is

the one that accompanies the vein
that drains the portal and superior
mesenteric veins.
The

Nerve

Supply

of

the

comes

from

the

Duodenum

sympathetic fibers.

a. CELIAC PLEXUS
b. SUPERIOR
MESENTERIC
PLEXUS
The

Lymphatic

Drainage

of

the Duodenum follow the course

of the arterial supply, together with
the blood vessels coming from the
lower half of the duodenum and they
The

Blood

Supply

of

the

Duodenum comes from the:

drain directly into the MESENTERIC

ROOT

LYMPH

NODES/GLANDS

that come from the upper part and

1. SUPERIOR

PANCREATICO-

DUODENAL ARTERY

they go to the sub-pyloric glands in

front and the gediary glands behind.

Talosig, Tango, Tungpalan, Udanga, Villanueva, Vinarao, Wagason, Zabala