BCA-Human Structural Biology- Abdominal Organs by: Dr.

Catherine Lucas
Basic Course Audit Anatomy-FEUNRMF
Abdominal Organs
by: Catherine Lucas, MD
ABDOMINAL ESOPHAGUS
 a muscular tube
lined with nonkeratinizing
squamous epithelium
 fixed only at its
upper and lower ends
Innervation: The esophagus has both sympathetic
and parasympathetic innervation.
o The sympathetic nerve supply is through the
cervical and thoracic sympathetic chain and
from the celiac plexus and ganglia.
o The parasympathetic innervation is
primarily through the vagus nerve.
STOMACH

• Normal constrictions
 most proximal -
represents the
narrowest portion
the entire GI tract
 2nd - located 20 cm
from the incisors
 lowermost
narrowing - which  a J-shaped dilation of the alimentary tract
is not constant,  location of the GE junction
located at about 44  contiguous proximally with the esophagus and
cm from the distally with the duodenum
incisors  4 anatomic regions
 cardia
• What is the clinical significance of these  fundus
narrowings?  corpus/body
• Abdominal portion:  antrum
 length - approx 2 cms
 surrounded by phrenoesophageal
ligament
o consists primarily of three layers
o The arterial blood supply to the
esophagus is segmental with three main
sources supplying the upper, middle, and
lower sections of the esophagus
o The venous drainage of the esophagus
follows the arterial capillary network.
o The lymphatic drainage of the
esophagus is abundant and forms a dense
submucosal plexus.

Reference: PPT from HSB Department Page 1 of 16

BCA-Human Structural Biology- Abdominal Organs
STOMACH: VASCULAR SUPPLY
o the stomach has a rich vascular supply with
an extensive collateral network.
o the majority of the stomach receives blood
from branches of the celiac trunk
 left gastric artery
 common hepatic artery
 splenic artery
 lesser curvature
 left gastric artery from above
 right gastric artery from below
 greater curvature
o left gastroepiploic artery from
above
o right gastroepiploic artery from
below
 fundus and upper aspect of the greater
curvature
o short gastric branches of the
splenic artery
Reference: PPT from HSB Department
by: Dr. Catherine Lucas
STOMACH: VENOUS DRAINAGE
 corresponds to the arterial supply
 the veins empty either
o directly into the portal vein or
o into one of its tributaries - the splenic
or SMV
 lesser curvature
o left gastric vein (coronary vein) and
right gastric vein —> portal vein
 superior pancreaticoduodenal veinsm—>
portal vein
 left gastroepiploic veins + short gastric veins
—> splenic vein
 right gastroepiploic vein and inferior
pancreaticoduodenal vein —> SMV
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BCA-Human Structural Biology- Abdominal Organs by: Dr. Catherine Lucas
STOMACH: Lymphatic Drainage  stores glycogen, certain vitamins, and
minerals
 maintains normal blood sugar
 synthesizes plasma proteins, albumin,
clotting factors
 produces immune factors and removes
bacteria
 removes senescent red blood cells from the
circulation
 excretes bilirubin
SURFACES OF THE LIVER
 anterior surface
 diaphragmatic / superior surface
 posterior surface
 lymph drains into local nodal basin,  visceral/inferior surface
eventually reaching the celiac artery and LOBES OF THE LIVER
superior mesenteric artery major nodal
collections
 the lymphatics of the stomach form
anastomoses within the gastric wall
STOMACH: INNERVATION
 the stomach receives both parasympathetic
and sympathetic autonomic innervation
 the left and right vagus nerves
parasympathetic innervation
 left vagus —- anterior vagus
 right vagus —- posterior vagus

LIVER
o largest gland
o pyramidal-shaped
o 1/50 of body
weight
 1.0 -2.5 kg
 male 1.4- 1.8 kg
 female 1.2 - 1.4
kg

Porta hepatis=hilum of the liver

BASIC FUNCTIONS
o right & left hepatic ducts
 removes metabolic waste products,
o right & left branches of hepatic artery
hormones, drugs, & toxins
o portal vein
 produce bile to aid in digestion
o sympathetic/ parasympathetic fibers
 process nutrients absorbed from the
o few hepatic lymph nodes
digestive tract

Reference: PPT from HSB Department Page 3 of 16

BCA-Human Structural Biology- Abdominal Organs by: Dr. Catherine Lucas
DIVISIONS OF THE LIVER  70% portal vein: venous blood, deoxygenated
1. ANATOMICAL DIVISION (morphological) nutrient-rich
2. PHYSIOLOGICAL DIVISION (functional)

PHYSIOLOGICAL DIVISION
COUINAUD CLASSIFICATION
 Cantlie's line

BLOOD SUPPLY:
1. portal vein
2. hepatic artery
DRAINAGE- hepatic veins

LIGAMENTS OF THE LIVER

o Falciform ligament (ligamentum teres)
o Coronary ligament (left and right) LYMPHATIC DRAINAGE
o Left and Right triangular ligaments  1/3 to 1/2 of
o Lesser omentum all body
BLOOD SUPPLY lymph
 30% hepatic artery: oxygenated blood  celiac nodes
 posterior
mediastinal
nodes

Reference: PPT from HSB Department Page 4 of 16

BCA-Human Structural Biology- Abdominal Organs by: Dr. Catherine Lucas
NERVE SUPPLY  fundus
 sympathetic and  body
parasympathetic  infundibulum
nerves form the  neck
Celiac plexus  cystic duct
 anterior vagal  spiral valves of Heister
trunk gives rise to a
large hepatic trunk GALLBLADDER: BLOOD SUPPLY/DRAINAGE
passing directly to o Arterial blood supply : single cystic artery
the liver o majority (75%) of cases: cystic artery
originates from the proximal right hepatic
GALLBLADDER artery and immediately divides into 2
branches
o the superficial branch - runs along the
peritoneal surface of the gallbladder
o the deep branch – runs along the
gallbladder fossa between the gallbladder
and liver
o venous drainage: cystic vein

 hollow, piriform (pearshaped) organ

 length: 7-10 cm
 diameter: approx. 4 cm
 attached to the liver by loose connective tissue
 small veins and lymphatics course between the
CALOT’S TRIANGLE
gallbladder fossa and the gallbladder wall
 Boundaries:
 shared lymphovascular drainage
o liver
o common hepatic duct
o cystic duct
 CONTENTS: Located within this triangle are
some important structures:
o cystic artery
o right hepatic artery
o node of Calot
GALLBLADDER: Nerve Supply
 sympathetic and parasympathetic nervous
system innervate the gallbladder

Reference: PPT from HSB Department Page 5 of 16

BCA-Human Structural Biology- Abdominal Organs by: Dr. Catherine Lucas
CALCULOUS CHOLECYSTITIS
 Acute cholecystitis -
common
intraabdominal
infection
 when the cystic duct is
obstructed
 gallbladder becomes increasingly distended
 infection
o usually arises secondary to bile stasis
o represents proliferation of bacteria  FUNCTION: transports bile from the liver to
already present the small intestine
 PE  intrahepatic / extrahepatic
o RUQ peritoneal signs
o (+) Murphy’s sign COMMON BILE DUCT
o the patient is asked to inspire deeply
while the examiner palpates the area
of the gallbladder fossa just beneath
the liver edge.
 Clinical diagnosis
o UTZ findings
o CBC
o LFT
 Management
o parenteral antibiotics
o operative removal of the gallbladder
o percutaneous drainage of the  the common bile duct: from the confluence of
gallbladder the common hepatic and cystic ducts
CHOLYCYSTOENTERIC FISTULA  length: 5-17cm
 diameter: 3-8mm
 can be divided into 4 segments
o supraduodenal
o retroduodenal
o intrapancreatic
o intraduodenal
 generally lies anterolateral to the hepatic
artery and portal vein
 descends posterior to the first part of the
BILIARY TREE duodenum
 through the head of the pancreas
 within the medial wall of the second portion
of the duodenum
 forming a common channel with the main
pancreatic duct (ampulla of Vater)

• tubular system of ducts

Reference: PPT from HSB Department Page 6 of 16

BCA-Human Structural Biology- Abdominal Organs by: Dr. Catherine Lucas
DEFINITION OF TERMS

o Ampulla - "dilated portion" of a canal or duct

o Papilla – small nipplelike process/ projection/ CBD: Nerve Supply
protuberance  the nerve supply to the CBD is the same as
o Sphincter – a circular band of muscle that described for the GB
encircles an orifice
CHOLEDOCHOLITHIASIS
Sphincter of Oddi  stone/s within the common bile duct
o gallstones that have migrated into the
CBD via the cystic duct
o retained stones - stones that were left
in the CBD following biliary tract
surgery
o stones that originated within the
intra- or extrahepatic bile ducts
primarily

ARTERIAL SUPPLY OF BILIARY TREE

PANCREAS
• 60% gastroduodenal artery
• 30-40% hepatic artery

 Length: 15cm
 Weight: 120g

Reference: PPT from HSB Department Page 7 of 16

BCA-Human Structural Biology- Abdominal Organs by: Dr. Catherine Lucas
Parts: portions of the duodenum: celiac artery
 head branches
 uncinate process  left caudal portion of the pancreatic head,
 neck third and fourth portions of the
 body duodenum: SMA branches
 tail  body of pancreas: small branches of splenic
Head of the gland artery
 lies nestled in the C-loop of the 2nd part of  VENOUS DRAINAGE: portal vein, splenic
the duodenum vein, SMV
 lies anterior to the inferior vena cava  neck of the gland: no veins drain from the
Tail of the gland: extends obliquely into the hilum of neck of the gland to the anterior surface of
the spleen the portal vein

 Exocrine & endocrine gland

 Pancreatic ducts: SPLEEN
o Major (Wirsung)
o Minor Santorini  left upper
quadrant
PANCREAS: BLOOD SUPPLY
 beneath the 9th,
10th, and 11th
ribs
 multiple clefts
 weight: 150 -
250 g
 functions:
• filtration
• immunological
• reservoir

 The parietal surface of the spleen is related to

the diaphragm
 The visceral surface is related to the
o left colon
o left kidney
o tail of the pancreas
o stomach

The pancreas has a redundant blood supply

 head of the gland: paired (anterior and
posterior) pancreaticoduodenal arteries,
which course along the interface between the
duodenum and the head of the pancreas
 right cephalic portion of the pancreatic
head, region around the intrapancreatic
portion of the CBD, first and second

Reference: PPT from HSB Department Page 8 of 16

BCA-Human Structural Biology- Abdominal Organs by: Dr. Catherine Lucas
SMALL INTESTINE
FUNCTIONS:
o digestion
o absorption
o secretion
o endocrine function
o mucosal defense
Small bowel
• Length: 12 - 20 ft from pylorus to ileocecal
valve
DUODENUM

The spleen is held in place by a number of

ligaments
• splenogastric ligament
 First part of the small intestine
• splenocolic ligament
 10 in (25cm)
• splenorenal ligament
 joins the stomach to the jejunum
• splenophrenic ligament
• splenoomental ligament
• mostly
retroperitoneal
SPLEEN: BLOOD SUPPLY & VENOUS DRAINAGE
• wraps in a C-
shape around
the head of the
pancreas

• has 4 parts

 Blood supply: splenic artery

 splenic veins follow the arterial distribution
closely

Reference: PPT from HSB Department Page 9 of 16

BCA-Human Structural Biology- Abdominal Organs by: Dr. Catherine Lucas
Its first and second portions DUODENUM: VENOUS DRAINAGE
lie adjacent to the gallbladder 1. Superior PD vein —> portal vein
and liver 2. Inferior PD vein —> SMV

DUODENUM: LYMPHATIC DRAINAGE

 UPWARD: PD nodes—> GD nodes—> celiac
nodes
 DOWNWARD: PD nodes—> superior
mesenteric nodes

DUODENUM: BLOOD SUPPLY

1. upper half superior PD artery (GD artery)
2. lower half- inferior PD artery (SMA)

JEJUNUM
 the jejunum begins at the Ligament of Treitz

Reference: PPT from HSB Department Page 10 of 16

BCA-Human Structural Biology- Abdominal Organs by: Dr. Catherine Lucas
Jejunum/ Ileum (20ft/ 6 m long) SMALL INTESTINE: LYMPHATIC DRAINAGE
Upper 2/5- jejunum

 Peyer’s patches: antimesenteric border

along the distal ileum,
 lymphatic drainage of the intestine is
 wall abundant
 plicae circulares NERVE SUPPLY: JEJUNUM & ILEUM
 mesentery
 blood vessels
 fat
 Peyer’s patches
EXTERNAL & INTERNAL DIFFERENCES
SMALL INTESTINE: BLOOD SUPPLY

LARGE INTESTINE

 proximal duodenum: celiac axis

 remainder of the small intestine: SMA

SMALL INTESTINE: VENOUS DRAINAGE

 SMV

 cecum
 appendix
 ascending colon
 transverse colon
 descending colon
 sigmoid colon
 rectum
 anal canal

Reference: PPT from HSB Department Page 11 of 16

BCA-Human Structural Biology- Abdominal Organs by: Dr. Catherine Lucas
ILEOCECAL REGION APPENDIX
1. CECUM  in the adult,
2. TERMINAL average
ILEUM length: 9 cm
3. APPENDIX  outside
diameter: 3 -
8 mm
 luminal
diameter: 1 -
3 mm
 location of
the TIP of the
CECUM appendix
o 6cm (L), 7.5cm (W)  location of
o No mesentery the BASE of the appendix
o peritoneal
o widest lumen ; thinnest muscular wall
o Appendix : posteromedial surface
o 3 flat bands (taenia coli) converge on the base of
the appendix

vermiform appendix
MCBURNEY’S POINT

ileocecal valve
VERMIFORM APPENDIX
the posteromedial wall, just below the ileocecal  BLOOD SUPPLY: from appendicular branch
valve of the ileocolic artery
 LYMPHATIC DRAINAGE: flows into lymph
nodes that lie along the ileocolic artery
 INNERVATION: derived from sympathetic
elements contributed by the superior
mesenteric plexus (T10 - L1), afferents from
parasympathetic elements brought in via the
vagus nerve

Reference: PPT from HSB Department Page 12 of 16

BCA-Human Structural Biology- Abdominal Organs by: Dr. Catherine Lucas
ASCENDING COLON/HEPATIC FLEXURE SPLENIC FLEXURE/ LEFT COLIC FLEXURE
 Retroperitoneal (25% might have short  more superior, more acute and less mobile
mesentery) than right colonic flexure
DESCENDING COLON
(10 in/25 cm)
• Retroperitoneal organ
• extent

SMALL INTESTINE VS LARGE INTESTINE

o mobility
o caliber
o longitudinal muscle
o fatty tags
o wall

 From upper border of ileocecal region to

FEATURES OF COLON
hepatic flexure
1. Taenia Coli
2. Haustra Coli (sacculations)
3. Appendices Epiploicae

LARGE INTESTINE

TRANSVERSE COLON
(15 in/38 cm)

 the colon is one structural unit with 2

embryological origins
 cecum, right colon, midtransverse colon:
 of midgut origin
 and as such are supplied by the SMA

LARGE INTESTINE: BLOOD SUPPLY

 distal transverse colon, splenic flexure,
descending colon, and sigmoid colon
o of hindgut origin
o blood supply from IMA
• Largest & most mobile
• Peritoneal organ
• extent
• splenic flexure higher

Reference: PPT from HSB Department Page 13 of 16

BCA-Human Structural Biology- Abdominal Organs
LARGE INTESTINE: VENOUS DRAINAGE
 the venous drainage is through veins that
bear the same name as the arteries with
which they run except for the IMV that runs
above
LARGE INTESTINE: LYMPHATIC DRAINAGE
 the lymphatic drainage of the colon starts as a
network of vessels within the muscularis
mucosa than drain into the extramural
system
 the extramural lymphatic vessels follow along
the arteries to their origins at the superior
and inferior mesenteric vessels
LARGE INTESTINE: INNERVATION
 the colon is
innervated via the
sympathetic and
parasympathetic
nervous systems
 sympathetic
stimulation
inhibits peristalsis
 parasympathetic
system promotes
peristalsis
Reference: PPT from HSB Department
by: Dr. Catherine Lucas
 at least the lower six thoracic segments give
rise to fibers that join the paravertebral
ganglia
 the fibers leave these ganglia as the greater,
lesser, least, and lumbar splanchnic nerves
 they form the preaortic, celiac, and superior
mesenteric ganglia, the superior hypogastric
plexus, and eventually a pair of inferior
hypogastric plexuses
 parasympathetic innervation is from the
vagus nerve and the sacral outflow
ABDOMINAL AORTA
 The aorta is the main arterial trunk that delivers
oxygenated blood from the left ventricle of the
heart to the tissues of the body.
 It is divided for purposes of description into the
following parts:
o ascending aorta
o arch of the aorta
o descending thoracic aorta
o abdominal aorta
EMBOLIC BLOCKAGE OF AORTA
 bifurcation of the abdominal aorta
 Gradual occlusion of the bifurcation of the
abdominal aorta
 Blunt trauma to the aorta is most commonly
caused by head-on automobile crashes
Page 14 of 16
BCA-Human Structural Biology- Abdominal Organs
INFERIOR VENA CAVA
 caval opening
 T8 in the central tendon
 larger than the superior vena cava
 opens into the lower part of the right atrium
 most of the blood from the body below the
diaphragm
 union of the common iliac veins behind the
right common iliac artery at the level of L5
 it ascends on the right side of the aorta
 right sympathetic trunk lies behind its right
margin
 the right ureter lies close to its right border
Reference: PPT from HSB Department
by: Dr. Catherine Lucas
 The inferior vena cava has the following
tributaries
 Two anterior visceral tributaries: the
hepatic veins
 Three lateral visceral tributaries:
 the right suprarenal vein (the left vein
drains into the left renal vein),
 renal veins and
 right testicular or ovarian vein (the
left vein drains into the left renal
vein)
 Five lateral abdominal wall tributaries: the
inferior phrenic vein and four lumbar
veins
 Three veins of origin: two common iliac
veins and the median sacral vein
 The tributaries of the IVC correspond rather
closely to the branches of the abdominal
portion of the aorta.
Page 15 of 16
BCA-Human Structural Biology- Abdominal Organs by: Dr. Catherine Lucas

TRAUMA TO THE INFERIOR VENA CAVA

o commonly lethal
o Most patients have venous congestion
of the lower limbs.

COMPRESSION OF INFERIOR VENA CAVA

 later stages of pregnancy
 Malignant retroperitoneal tumors

END OF TRANS

Reference: PPT from HSB Department Page 16 of 16