The Abdominal Organs

Functional Anatomy 212

Overview

Oesophagus
10

inches from pharynx to stomach narrow at cricoid cartilage where left bronchus crosses oesophageal hiatus in diaphragm mucous membrane folded (normally collapsed) stratified squamous epithelium striated above smooth below trachea on right, lower aorta on left medial to L. lung, behind left atrium

Stomach

Variable size and shape, distensible J shaped related to body form Lesser and greater curvature gastroesophageal junction fundus,cardiac part, body, pyloric part pyloric antrum and sphincter rugae and gastric pits

Stomach rotates and distends

Front
Ventral Mesentary Dorsal Mesentary Back

Splenic tissue

Epiploic Foramen

Omentum

Omentum

Under the OMENTUM

The Peritoneal cavity is divided in two

Rotation

of stomach forms the greater omentum (allows stomach distension and infection control) Omental bursa or Lesser sac is inside omentum (a potential space)
Lesser

omentum runs from stomach to liver (note free lower border above epiploic foramen contains portal vein, hepatic artery and bile duct
Falciform

ligament runs from liver to ant abd. wall

Blood Supply of Stomach

Superior Mesenteric Artery Territory

Inferior mesenteric artery territory

Venous system
Portal

Vein
vein

Splenic

inferior

mesenteric vein

Superior

mesenteric vein Gastric veins

Hepatic

Inf. Vena Cava

Veins

Anastomoses

Duodenum

first 12 inches of gut four parts form C shape duodenal cap radiologically identified, ulcers form here mobile descending part pancreatic and bile ducts horizontal part crosses psoas, IVC and aorta crossed by mesentery, sup mesen. art. ascending part

Jejunum

2/5ths of small intestine gradual transition to ileum many small villi increasing numbers of lymph nodules no submucosal glands lacteals in each villus columnar epithelium

Ileum
distal

3/5ths of intestine narrower, thinner, less vascular, slower, more fat and arterial arcades in mesentery than jejunum. Peyers patches of lymphoid tissue

Colon

ascending colon retroperitoneal right colic or hepatic flexure transverse colon (mesocolon) droops towards pelvis? left colic or splenic flexure descending colon retroperitoneal pelvic or sigmoid colon S shaped

Colonoscopy Barium enema outlines structures on X-rays

Appendix

The Liver

Largest Gland (one of largest organs) Right upper abdomen under diaphragm Grows as outgrowth of gut plus mesoderm Diaphragmatic surface Visceral surface down and left related to stomach, duodenum, r. kidney, r. colonic flexure bears gall bladder

Liver

pg 610

Largest

gland (3 lbs) Location

Upper

Right Quadrant Mostly under ribcage

Highly

vascular Some functions

produce

bile pick up glucose detoxify poison, drugs make blood proteins many others pg 635

Liver: External Features

Diaphragmatic
Right

surface

lobe (larger) Left lobe Falciform ligament Fissure between

Visceral

surface

Quadrate

lobe Caudate lobe Both part of left lobe pg 635

Liver: Visceral Surface

pg 636
Hepatic

Vein (into inferior vena cava) Porta Hepatis

Hepatic

Artery (from abdominal aorta ) Hepatic Portal Vein

Carries nutrient-rich blood from stomach + intestines to liver Portal system = 2 capillary beds!
Hepatic

Ducts (carry bile)

Gallbladder

Muscular

sac Between right + quadrate liver lobes Bile is stored + concentrated Bile: breaks down fats = emulsification Bile
Produced

by liver Stored in gallbladder

pg 610

Bile Ducts

Cystic

duct
bile from gallbladder

carries

Hepatic
carries
joins

duct
bile from liver

Common

Bile duct
pg 628

cystic and hepatic carries bile into duodenum

Movement of Bile

pg 628

Bile secreted by liver continuously Hepatopancreatic (Vater) ampulla common bile + main pancreatic duct meet and enter duodenum Sphincter of Oddi around it closed when bile not needed for digestion Bile then backs up into gallbladder via cystic duct When needed gallbladder contracts, sphincters open

Pancreas

Retroperitoneal Gland
Exocrine

digestive enzymes

Endocrine

hormone insulin hormone glucagon

Location
curve

of duodenum extends to spleen

pg 639

 Main

Ducts of Pancreas

pg 628

duct joins common bile duct enters duodenum Hepatopancreat ic (Vater) ampulla Accessory Pancreatic duct enters duodenum in other location

Pancreatic

Biliary System

R and L Hepatic ducts Common hepatic duct Joined by cystic duct (to gall bladder) Forms bile duct (common bile duct) Gall Bladder body and fundus, salts and water absorbed store for bile, released in response to cholecystokinin

Pancreas

Pancreas
Head

in concavity of duodenum body across vertebrae tail reaches the spleen pancreatic duct (+ accessory?) ampulla duodenal papilla

Spleen

Spleen

Largest

organ Highly vascular Function

remove

lymph

blood-borne antigens (immune) remove and destroy old/damaged blood cells stores blood platelets In fetus: site of hematopoiesis

pg 639

The Spleen
Lies

in left hypochondriac region between gastric fundus and diaphragm at level of 9th-10th rib (not normally palpable) Soft, friable, highly vascular, dark purple Diaphragmatic surface convex and smooth facing diaphragm Visceral surface gastric, renal, pancreatic and colic impressions

The Spleen (2)

Hilum

of spleen long fissure through which vessels and nerves pass Suspended from stomach by gastrolienal ligament (contains short gastric and left gastro-epiploic branches of spenic artery) Suspended from posterior abdominal wall by lienorenal ligament Covered by adherent peritoneum

Relationship to the Spleen

Urinary System
Kidneys

Purify
Ureters Drain

blood

urine from kidney to bladder Urinary Bladder Store urine Urethra Drain urine from bladder to outside body

pg 5

Kidneys: major excretory organs

Remove

ions

toxins, metabolic waste, excess H2O,

Urea,

uric acid, creatinin

Regulates

volume + makeup of blood

balance between

Maintains

Salts and water Acids and bases

Kidneys
In fat capsule Suprarenal glands superiorly

Direct Arterial and venous supply

Kidneys: Gross Anatomy

Located superior lumbar region Posterior abdominal wall (T12-L3) Retroperitoneal Hilus Adrenal Gland: superomedial to kidney Renal Artery + Vein Innervation: branches of renal plexus

pg 648

Kidneys External View

Artery

- Vein - Ureter

Kidney Internal Structure

Renal pyramids between renal columns Renal Cortex Renal papillae drain into minor calix Major calix join to form renal pelvis Ureter as outlet

Relationships of the Kidneys

CLINICAL ANATOMY
Peritonitis:

Inflammation of the covering of the abdominal structures, causing rigidity and severe pain. Acute abdomen:
Appendicitis:

Inflammation of the appendix, in the lower right colon.

Inflammation of the gallbladder, causing severe right-sided abdominal pain.

Cholecystitis:

 Dyspepsia:

The feeling of an upset stomach or indigestion. Constipation: Having fewer than three bowel movements per week. Gastritis: Inflammation of the stomach, often causing nausea and/or pain. Peptic ulcer disease: Ulcers are erosions and peptic refers to acid. Intestinal obstruction: A single area of the small or large intestine can become blocked Vomiting and abdominal distension are symptoms.

 Gastroparesis:

The stomach empties slowly due to nerve damage from diabetes or other conditions. Nausea and vomiting are symptoms. Pancreatitis: Inflammation of the pancreas. Alcohol and gallstones are the most common causes of pancreatitis. Other causes include drugs and trauma; about 10% to 15% of cases are from unknown causes. Hepatitis: Inflammation of the liver, usually due to viral infection. Drugs or immune system problems can also cause hepatitis.

 Cirrhosis:

Scarring of the liver caused by chronic inflammation. Heavy drinking or chronic hepatitis are the most common causes. Ascites: Abdominal fluid buildup often caused by cirrhosis. Abdominal hernia: A weakening or gap in the abdominal fascia allows a section of the intestine to protrude. Abdominal aortic aneurysm: A weakening of the aorta's wall creates a balloon-like expansion of the vessel that grows over years.