THE ABDOMEN (2012 edition)

DIVISIONS OF THE ALIMENTARY TRACT

Foregut
Midgut
Hindgut

FOUR QUADRANTS OF THE ABDOMEN

Right Upper Quadrant

• Liver
• Gallbladder
• Cystic duct, hepatic duct, and Common bile duct
• Hepatic flexure
• Portion of the ascending and transverse colon
• Portion of the small intestines
• Right kidney posteriorly
• Pylorus of the stomach
• Small part of the pancreas
• Portion of the right ureter

Left Upper Quadrant

• Body and cardia of the stomach

• Portion of the esophagus
• Spleen
• Splenic flexure
• Portion of the descending and transverse colon
• Portion of the small intestines
• Most of the pancreas
 • Left kidney posteriorly
• Portion of the left ureter

Right Lower Quadrant

• Portion of the ascending colon

• Cecum
• Appendix
• Portion of the small intestines
• Right spermatic cord
• Right adnexa
• Portion of the right ureter

Left Lower Quadrant

• Portion of the descending colon

• Sigmoid colon
• Left spermatic cord
• Left adnexa
• Portion of the small intestines
• Portion of the left ureter

NINE REGIONS OF THE ABDOMEN

REFERRED PAIN OF DIFFERENT ORGANS OF THE ABDOMEN

RUQ –cholecystitis, hepatitis, liver tumors, choledocholithiasis, pyelonephritis,

nephrolithiasis

LUQ –splenic disease or rupture, pyelonephritis, nephrolithiasis, hiatal hernia,

Mallory-Weiss tear

LLQ –diverticulitis, sigmoid volvulus, ruptured ectopic pregnancy, referred hip

pain, UTI

RLQ –appendicitis, cecal diverticulitis, intussusception, Meckel’s Diverticulum,

ruptured ectopic pregnancy, referred hip pain, UTI

MUSCLES OF THE ABDOMEN

External oblique

1. Origin
• Lower eight ribs

2. Insertion
• Xiphoid process, linea alba, pubic crest, pubic tubercle, iliac crest

3. Innervation
• Anterior rami of lower six thoracic spinal nerves (T7 to T12)

4. Action
• Compress abdominal contents; both muscles flex trunk; each muscle
bends trunk to same side, turning anterior part of abdomen to opposite
side

Internal oblique

1. Origin
• Thoracolumbar fascia; iliac crest between origins of external and
transversus; lateral two-thirds of inguinal ligament

2. Insertion
• Inferior border of the lower three or four ribs; aponeurosis ending in linea
alba; pubic crest and pectineal line

3. Innervation
• Anterior rami of lower six thoracic spinal nerves (T7 to T12) and L1

4. Action
• Compress abdominal contents; both muscles flex trunk; each muscle
bends trunk and turns anterior part of abdomen to same side

Transversus abdominis

1. Origin
• Thoracolumbar fascia; medial lip of iliac crest; lateral one-third of inguinal
ligament; costal cartilages lower six ribs (ribs VII to XII)

2. Insertion
• Aponeurosis ending in linea alba; pubic crest and pectineal line

3. Innervation
• Anterior rami of lower six thoracic spinal nerves (T7 to T12) and L1
4. Action
• Compress abdominal contents

Rectus abdominis

1. Origin
• Pubic crest, pubic tubercle, and pubic symphysis

2. Insertion
• Costal cartilages of ribs V to VII; xiphoid process

3. Innervation
• Anterior rami of lower seven thoracic spinal nerves (T7 to T12)

4. Action
• Compress abdominal contents; flex vertebral column; tense abdominal
wall

Pyramidalis

1. Origin
• Front of pubis and pubic symphysis

2. Insertion
• Into linea alba

3. Innervation
• Anterior ramus of T12

4. Action
• Tenses the linea alba

Psoas major

1. Origin
• Transverse process of L1-L5 vertebrae
• Vertebral bodies of T12-L5

2. Insertion
• With Iliacus at the lesser trochanter of femur

3. Innervation
• L2-L4 nerves

4. Action
• Flexes the hip joint

Iliacus

1. Origin
• Anterior 2/3 of iliac fossa

2. Insertion
• With Psoas major at the lesser trochanter of femur

3. Innervation
• L2-L3 nerves

4. Action
• Flexes the hip joint
Quadratus lumborum

1. Origin
• Iliac crest
• Iliolumbar ligament

2. Insertion
• Rib #12
• L1-L4 vertebrae

3. Innervation
• T12-L3 nerves

4. Action
• Elevation of the pelvis as in hip hiking

Diaphragm

• Primary inspiratory muscle

• Divided into three parts:

1. Sternal part –with right and left small slips arising from the posterior
surface of the xiphoid process
2. Costal part –arises from the deep surfaces of the lower six ribs and their
costal cartilages
3. Vertebral part –arising by means of vertical columns or crura and from
the arcuate ligaments

• Right crus –arises from the sides of the bodies of L1-L3 vertebra and
intervertebral discs
• Left crus –arises from the sides of the bodies of L1-L2 vertebra and
intervetebral discs
• Right dome –reaches as high as the upper border of the fifth rib
• Left dome –reaches as high as the lower border of the fifth rib
• Central tendon lies at the level of the Xiphisternal joint
• Domes support the right and left lungs, central tendon supports the heart
• On contraction, the diaphragm pulls down its central tendon and increases
the vertical diameter of the thorax
• Supplied by the Phrenic nerve (C3-C5)

Openings of the Diaphragm

1. At the level of T8 –transmits the following:

• Inferior vena cava and terminal branches of the right phrenic nerve

2. At the level of T10

• Esophagus, right and left Vagus nerves

3. At the level of T12

• Aorta, azygos vein, and thoracic duct

Functions of the diaphragm

• Muscle of inspiration
• Muscle of abdominal straining
• Weight-lifting muscle –increases intra-abdominal pressure to help support
the vertebral column and prevent flexion
• Thoraco-abdominal pump –compresses blood in the IVC and forces it
upward to the right atrium
ARTERIAL SUPPLY OF THE ABDOMEN AND ITS ASSOCIATED ORGANS

VENOUS DRAINAGE OF THE ABDOMEN AND ITS ASSOCIATED ORGANS

NERVES AND GANGLIA OF THE ABDOMEN AND ITS ASSOCIATED
ORGANS

Ganglia

• A part of the autonomic nervous system controlling the involuntary

functions of smooth muscles and glands
• Sympathetic vs Parasympathetic nervous system effect on the abdominal
organs they innervate

Splanchnic Nerves

1. Thoracic splanchnic nerves

2. Lumbar splanchnic nerves
3. Sacral splanchnic nerves
4. Pelvic splanchnic nerves

Thoracic Splanchnic Nerves

• Carry preganglionic sympathetic fibers from the sympathetic trunk to

ganglia in the prevertebral plexus, and also visceral afferent fibers
• Greater splanchnic nerve –arises from the T5-T10 ganglion
• Lesser splanchnic nerve –arises from the T9-T11 ganglion
• Least splanchnic nerve –arises from the T12 ganglion

Lumbar Splanchnic Nerves

• Carry preganglionic sympathetic fibers from the sympathetic trunk to

ganglia in the prevertebral plexus, and also visceral afferent fibers
• Nerves enter the prevertebral plexus

Sacral Splanchnic Nerves

• Carry preganglionic sympathetic fibers from the sympathetic trunk to

ganglia in the prevertebral plexus, and also visceral afferent fibers
• Nerves enter the inferior hypogastric plexus

Pelvic Splanchnic Nerves

• The pelvic splanchnic nerves (parasympathetic root) carry preganglionic

parasympathetic fibers from the S2 to S4 spinal nerves to an extension of
the prevertebral plexus in the pelvis
• For motility functions of the hindgut, bladder, and rectal functions

END!