Anatomy Coaching Program

D. Abdomen

I. The Visceral Organs

A. Esophagus (abdominal portion)
a. a muscular tube- 10 inches or 25 cm long, extends from the pharynx to the stomach
b. has a physiologic esophageal sphincter, a circular layer of smooth muscle that prevents the
stomach contents regurgitating into the esophagus

B. Stomach
a. rests on the stomach bed in supine position: formed by the pancreas, spleen, left
suprarenal gland, transverse colon and its mesocolon, and diaphragm
b. covered entirely by peritoneum, located in the left hypochondriac and epigastric regions
abdomen
c. four regions: cardia, fundus, body , and pylorus.
d. the pyloric sphincter is a thickened circular smooth muscle that controls the rate of discharge
of stomach contents into the duodenum and constricts by sympathetic stimulation and relaxed
by parasympathetic action.
e. Blood supply: right and left gastric, right and left gastroepiploic, and short gastric arteries
f. Produces hydrochloric acid (which destroys many bacteria in food and drink) and a protein-
digestive pepsin (which converts proteins to polypeptides), in its fundus and body.
g. Produces the hormone gastrin (which stimulates gastric acid secretion) in its pyloric antrum.
h. vagus nerve stimulate gastric secretion

C. Small Intestine
a. extends from the pyloric opening to the ileocecal junction.
b. For complete digestion and absorption of most of the products of digestion and electrolytes,
and minerals such as calcium and iron.
c. consists of the duodenum, jejunum , and ileum
d. Parts:
1. Duodenum: C-shaped tube surrounding the head of the pancreas and is the shortest (25
cm [10 inches]; widest part of the small intestine; retroperitoneal except for the beginning
of the first part, which is connected to the liver by the hepatoduodenal ligament of the
lesser omentum; receives blood from the celiac (foregut) and superior mesenteric
(midgut) artery; Parts of the duodenum: first, second, third and fourth part
2. Jejunum: makes up the proximal two fifths of the small; emptier, larger in diameter, and
thicker walled than the ileum; has plicae circulares (circular folds); has no Peyer's patches
(aggregations of lymphoid tissue); has translucent areas called windows between the
blood vessels of its mesentery; has less prominent arterial arcades (anastomotic loops) in
its mesentery compared with the ileum; has longer vasa recta (straight arteries, or arteriae
rectae) compared with the ileum
3. Ileum: longer than the jejunum; makes up the distal three fifths and occupies the false
pelvis in the right lower quadrant of the abdomen; with Peyer's patches (lower portion);
shorter plicae circulares; has more mesenteric fat and arterial arcades when compared
with the jejunum; ileocecal fold: is the bloodless fold of Treves

D. Large Intestine
a. extends from the ileocecal junction to the anus and is 1.5 m (5 feet) long
b. Parts: cecum, appendix, colon , rectum , and anal canal.
c. Functions: convert the liquid contents of the ileum into semisolid feces by absorbing water,
electrolytes; stores and lubricates feces with mucus.
d. Cecum

1. the blind pouch of the large intestine.
2. lies in the right iliac fossa and is usually surrounded by peritoneum but has no mesentery
e. Appendix

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 - a narrow, hollow, muscular tube with large aggregations of lymphoid tissue suspended
from the terminal ileum by the mesoappendix containing appendicular vessels.
- causes spasm and distention when inflamed and pain
- has a base that lies deep to McBurney's point , which occurs at the junction of the lateral
one third between the right anterior superior iliac spine and the umbilicus
f. Colon:
1. Has ascending and descending colons which are retroperitoneal and transverse and
sigmoid colon surrounded by peritoneum (they have their own mesenteries, the transverse
mesocolon and th mesocolon , respectively)
2. ascending and transverse colons are supplied by the superior mesenteric artery and the
vagus nerve; the descending and sigmoid colons are supplied by the inferior mesenteric
and the pelvic splanchnic nerves.
3. Characteristics of the colon:
a. Teniae coli: three narrow bands of the outer longitudinal muscular coat
b. Sacculations or haustra: produced by the teniae, which are slightly shorter than the
gut
c. Epiploic appendages: peritoneum-covered sacs of fat, attached in rows along the
teniae

II. Clinical Correlates

1. Gastroesophageal reflux disease (GERD):
a. a digestive disorder caused by a lower esophagus dysfunction (relaxation or weakness) and
hiatal hernia, causing reflux of stomach contents
b. symptoms: heartburn or acid indigestion, painful swallowing, burping
c. treatment: surgically by moving the herniated area of stomach back into the a cavity and then
tightening the esophageal hiatus.
2. Hiatal or esophageal hernia:
a. a herniation of a part of the stomach through the esophageal diaphragm into the thoracic
cavity
b. cause: abnormally large esophageal hiatus, relaxed and weakened lower esophageal
sphincter, or by an increased pressure in the abdomen from coughing, vomiting, straining,
constipation, pregnancy, and obesity
3. Peptic ulcer:
a. erosion in the lining of the stomach or duodenum
b. cause: infection with a bacterium called Helicobacter pylori (H. pylori); stress, and pepsin
c. occurs most commonly in the pyloric region of the stomach (gastric ulcer) or the first
duodenum (duodenal ulcer) and less frequently in the distal esophagus
d. more common in men than women
e. symptoms: epigastric pain (burning, cramping, or aching); abdominal indigestion, vomiting,
loss of appetite, weight loss, and fatigue
f. treatment: antibiotics or surgical including a partial gastrectomy and vagotomy

4. Small bowel obstruction

a. Cause: postoperative adhesions, tumors, Crohn's disease, gallstones, volvulus, congenital
malrotation, stricture, and intussusception (invagination part of the intestine into another).
b. Strangulated obstructions are surgical emergencies and may if untreated, because the arterial
occlusion leads to bowel ischemia and necrosis.
c. Symptoms: abdominal pain and cramping, nausea and vomiting, constipation, dizziness,
abdominal distention and high pitched bowel sounds
5. Diverticulitis:
a. inflammation of diverticula (external evaginations or out-pocketings) found in the colon,
especially the sigmoid colon
b. Symptoms abdominal pain usually in the left lower abdomen, chills, fever, nausea,
constipation
c. Complications: bleeding, perforations, peritonitis, and fistula formation.
6. Megacolon (Hirschsprung's disease)
a. Caused: absence of enteric ganglia in the lower colon, which leads to dilation of the colon
proximal to the inactive segment
b. of congenital, from failure of neural crest cells to form the myenteric plexus
c. symptoms: constipation or diarrhea, abdominal distention, vomiting, not passing meconium,
7. Colostomy:
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 a. the most effective treatment; the surgeon removes the affected part of the colon, proximal
part of the colon is then connected to a surgically created hole, called a stoma
b. after the lower part of the colon heals, the surgeon reconnects the colon inside the body and
stoma

III. Accessory Organs of the Digestive System

1. Liver
a. largest visceral organ and the largest gland in the body.
b. plays an important role in 1. production and secretion of bile (used in emulsification and
digestion detoxification (by filtering the blood to remove bacteria and foreign particles that
have gained the intestine); 2. storage of carbohydrate as glycogen and lipids astriglycerides;
3. protein synthesis fibrinogen and prothrombin (blood coagulants), albumin, and
lipoproteins; 4. production of heparin (anticoagulant) and bile pigments (bilirubin and
biliverdin) from the breakdown of hemoglobin; 5. a certain vitamins, iron, and copper
c. receives oxygenated blood from the hepatic artery and deoxygenated, nutrient-rich blood
from the portal vein
d. its venous blood is drained by the hepatic veins into the IVC
e. contains the portal triad , which is a group of the branches of the portal vein, hepatic artery ,
and bile duct at every corner of the lobule
f. Lobes of the liver
1. Right lobe: divided into anterior and posterior segments
2. Left lobe: divided into medial and lateral segments
2. Gallbladder:
a. a pear-shaped sac on the inferior surface of the liver in a fossa between the right and
with a capacity of about 30 to 50 mL
b. consists of the fundus, body, and neck
c. receives bile, concentrates it (by absorbing water and salts), and stores it
d. contracts to expel bile as a result of stimulation by the hormone cholecystokinin
e. blood supply: the cystic artery, which arises from the right hepatic artery

3. Pancreas
a. a retroperitoneal organ except for a small portion of its tail ligament
b. receives blood from branches of the splenic artery and the superior and inferior pancreatic
arteries
c. both an exocrine gland , which produces digestive enzymes that help digest fats, proteins,
d. a carbohydrates, and an endocrine gland (islets of Langerhans), which secretes the hormones
in glucagon, which help the body to use glucose for energy, and also secretes somatostatin.
e. the main pancreatic duct ( Wirsung ): begins in the tail, runs to the right along the entire
pancreas, and carries pancreatic juice; joins the bile duct to form the hepatopancreatic
ampulla (ampulla of Vater) before entering the 2nd part of the duodenum at the greater papilla
f. the accessory pancreatic duct ( Santorini ): begins in the lower portion of the head and drains
a small portion of the head and body; empties at the lesser duodenal papilla about 2 cm above
the greater papilla
4.Spleen
a. a large vascular lymphatic organ lying against the diaphragm and ribs 9 to 11 in the left
hypochondriac region
b. composed of white pulp
c. hematopoietic in early life and later destroys aged (i.e., worn out) red blood cells
d. Functions:
1. filters blood (removes aged erythrocytes, particulate matter, and cellular residue from
the blood and platelets;
2. produces lymphocytes, macrophages, and antibodies in the white pulp
e. supplied by the splenic artery and is drained by the splenic vein.

IV. Duct system for bile passage

1. Right and left hepatic ducts
a. formed by union of the intrahepatic ductules from each lobe of the liver and drain bile from
corresponding halves of the liver
2. Common hepatic duct
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 a. formed by union of the right and left hepatic ducts, accompanied by the proper hepatic artery
and the portal vein
3. Cystic duct
a. has spiral folds (valves) to keep it constantly open, and thus bile can pass upward into the
gallbladder
b. runs alongside the hepatic duct before joining the common hepatic duct
c. common site of impaction of gallstones.
4. Common bile duct (ductus choledochus)
a. formed by union of the common hepatic duct and the cystic duct.
b. located lateral to the proper hepatic artery and anterior to the portal vein in the right free
margin of the lesser omentum.
c. descends behind the first part of the duodenum and runs through the head of the pancreas.
d. joins the main pancreatic duct to form the hepatopancreatic duct (hepatopancreatic ampulla)
in the second part of the duodenum at the greater papilla.
5. Hepatopancreatic duct or ampulla (ampulla of Vater)
a. formed by the union of the common bile duct and the main pancreatic duct and enters the
second part of the duodenum at the greater papilla
b. represents the junction of the embryonic foregut and midgut
c. contains the sphincter of Oddi

V. Celiac and Mesenteric Arteries

1. Celiac trunk
a. arises from the front of the abdominal aorta below the aortic hiatus of the diaphragm
b. divides into the left gastric, splenic, and common hepatic arteries
1. Left gastric artery: the smallest branch of the celiac trunk; runs upward and to the left
toward the cardia, giving rise to esophageal and hepatic branches
2. Splenic artery: largest branch of the celiac trunk; runs a tortuous course along the
superior border of the pancreas; gives rise to the following:
 a. dorsal pancreatic artery
b.short gastric arteries , which pass through the lienogastric ligament to reach the fundus
stomach; 3. left gastroepiploic (gastro-omental) artery
3. Common hepatic artery: runs to the right along the upper border of the pancreas and
divides into the proper hepatic artery, gastroduodenal artery, and the right gastric artery.
2. Superior mesenteric artery
a. rises from the aorta behind the neck of the pancreas
b. branches:
1. Inferior pancreaticoduodenal artery
2. Middle colic artery
3. Ileocolic artery
4. Intestinal arteries: 12 to 15 in number and supply the jejunum and ileum.
3. Inferior mesenteric artery
a. Passes to the left behind the peritoneum and distributes to the descending and sigmoid colons
andportion of the rectum.
b. Branches:
1. Left colic artery
2. Sigmoid arteries
3. Superior rectal artery

VI. Hepatic Portal Venous System

A. Portal vein

1. Drains the abdominal part of the gut, spleen, pancreas, and gallbladder and is 8 cm (3.2
inches)
2. formed by the union of the splenic vein and the superior mesenteric vein posterior to the neck
pancreas
3. carries deoxygenated blood containing nutrients.
4. carries three times as much blood as the hepatic artery and maintains a higher blood pressure
B. Superior mesenteric vein: Accompanies the superior mesenteric artery
C. Splenic vein: formed by the union of tributaries from the spleen; receives the short gastric, left
gastroepiploic, and pancreatic veins.
D. Inferior mesenteric vein: formed by the union of the superior rectal and sigmoid veins.
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 E. Left gastric (coronary) vein: drains into the portal vein.
F. Paraumbilical veins

VII. Portal-caval (systemic) anastomoses

Location:
1. The left gastric vein and the esophageal vein of the azygos system.

2. The superior rectal vein and the middle and inferior rectal veins.

3. The paraumbilical veins and radicles of the epigastric (superficial and inferior) veins.
4. The retroperitoneal veins draining the colon and twigs of the renal, suprarenal, and gonadal veins

VIII. Retroperitoneal Viscera

1. Kidney
a. retroperitoneal extending from T12 to L3 vertebrae in the erect position.
b. consists of the medulla and the cortex , containing 1 to 2 million nephrons , which are the
anatomical and functional units of the kidney.
c. each nephron consists of a renal corpuscle, a proximal convolu Henle's loop , and a distal
convoluted tubule.
d. has arterial segments including the superior, anterosuperior, anteroinferior, inferior , and
posterior segments , which are of surgical importance.
e. filters blood to produce urine ; reabsorbs nutrients, essential ions, and water; excretes urine
metabolic [toxic] waste products are eliminated) and foreign substances; regulates the salt,
ions , and water balance ; and produces vasoactive substance (angiotensin II) that regulates
blood
f. produces renin by juxtaglomerular (JG) cells
2. Ureter: muscular tube that begins with the renal pelvis,
3. Suprarenal (adrenal) gland: a retroperitoneal organ: pyramidal on the right and semilunar on the
left: has a cortex that is essential to life and produces three types of steroid hormones; medulla
derived from embryonic neural crest cells, receives preganglionic sympathetic fibers, and
secretes epinephrine and norepinephrine.
4. Blood supply: the superior suprarenal artery from the inferior phrenic middle suprarenal artery
from the abdominal aorta , and the inferior suprarenal artery

IX. Posterior Abdominal Blood Vessels

A. Abdominal Aorta
Branches: Inferior phrenic arteries, Middle suprarenal arteries, Renal arteries, Testicular or
ovarian arteries, Lumbar arteries, Middle sacral artery
B. Inferior vena cava
a. formed on the right side of L5 by the union of the two common iliac
b. ascends along the right side of the aorta.
c. passes through the opening for the IVC in the central tendon of the diaphragm to the right
atrium of the heart.
d. receives the right gonadal, suprarenal, inferior phrenic veins, three (left, middle, and
right)hepatic veins, right and left renal veins

X. Nerves of the Posterior Abdominal Wall

A. Lumbar plexus
a. formed by the union of the ventral rami of the first three lumbar nerves and a part of the
fourth nerve.
1. Subcostal nerve (T12): runs behind the lateral lumbocostal arch and in front of the
quadratus lumborum; innervates the external oblique, internal oblique, transverse, rectus
abdominis , and pyramidal muscles.
2. Iliohypogastric nerve (L1): emerges from the lateral border of the psoas muscle;
innervates the internal oblique and transverse muscles of the abdomen and divides into an
anterior cutaneous branch , which innervates the skin above the pubis, and a lateral
cutaneous branch innervates the skin of the gluteal region
3. Ilioinguinal nerve (L1): runs in front of the quadratus lumborum; accompanies the
spermatic cord (or the round ligament of the uterus) , continues through the canal, and
emerges through the superficial inguinal ring; innervates the internal oblique and
transverse muscles and gives off femoral cutaneous branch for the upper medial part of
the thigh and anterior scrotal or labial branches

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4. Genitofemoral nerve (L1-L2); emerges on the front of the psoas muscle and descends on
its anterior surface; divides into a genital branch , which enters the inguinal canal through
the deep inguinal ring to spermatic cord and supply the cremaster muscle and the scrotum
(or labium majus), and a femoral branch which supplies the skin of the femoral triangle
5. Lateral femoral cutaneous nerve (L2-L3): emerges from the lateral side of the psoas
muscle and runs in front of the iliacus; innervates the skin of the anterior and lateral thigh
6. Femoral nerve (L2-L4): emerges from the lateral border of the psoas major; innervates
the skin of the thigh and leg, the muscles of the front of the thigh; innervates the
quadriceps femoris, pectineal, and sartorius muscles and gives rise to the anterior
cutaneous nerve and the saphenous nerve
7. Obturator nerve (L2-L4): rises from the second, third, and fourth lumbar nerves and
descends along the medial border of muscle; divides into anterior and posterior branches
and innervates the adductor group of muscles, the hip and knee joints, and the skin of the
medial side of the thigh.
8. Accessory obturator nerve (L3-L4): present in about 9% of the population; supplies the
the pectineus muscle
9. Lumbosacral trunk (L4-L5): formed by the lower part of the fourth lumbar nerve and all
of the fifth lumbar nerve