SECTION VI
ABDOMEN III: ABDOMINAL VISCERA
The structures or organs located within the abdominal cavity is collectively
known as the abdominal viscera. The viscera play different roles and are part of different
systems such as the gastrointestinal system, genitourinary system and immune system.
Objectives:
1. Identify the abdominal visera and the parts of each. Review the function of each.
2. Identify the spaces and landmarks of the abdominal viscera.
3. Identify the blood supply of the abdominal viscera. Review its nerve supply.
THE ABDOMINAL VISCERA
Dissection Guide
1. At this point, the abdominal cavity should have been opened. If not, please refer to the
previous section (The abdominal wall and cavity) for instructions. Locate and identify the
following:
a. anatomic right lobe of liver e. greater omentum
b. anatomic left lobe of liver f. spleen
c. gallbladder g. small intestine
d. stomach h. large intestine
2. Identify the falciform ligament which divides the liver into the anatomical right and
left lobes. Identify the round ligament of the liver or ligamentum teres which is the
obliterated umbilical vein.
3. Lift the left lobe of the liver superiorly to identify the lesser omentum. This is the
anterior wall of the lesser peritoneal sac. Review the three peritoneal ligaments that form
the lesser omentum (hepatoesophageal, hepatogastric and hepatoduodenal). Review the
portal triad. Identify the foramen of Winslow which is posterior to the free margin of the
lesser omentum which is the hepatoduodenal ligament. Review its boundaries. Also
review the blood supply of the liver and its ligaments. Review the fissures on the visceral
surface (undersurface) of the liver that divide in into lobes. You may refer to a model or
atlas to visualize easily the caudate and quadrate lobe and see the impressions of the
organs that are closely related to the liver.
On the undersuface of the liver, you will see the gallbladder. Review the
function, parts of the gallbladder, its blood supply and relation to the
hepatobiliary tree. Follow the contour of the gallbladder proximally until you
feel a firm structure that is larger with one part going superiorly and deeper
into the liver while the other goes inferiorly towards the duodenum. This is the
common bile duct. Review the cystic duct. Posterior to the common bile duct
and a little to the left is the portal vein. Review the portal vein.
4. Identify the stomach and its parts. Identify the body, fundus, cardia, pyloric antrum,
pylorus, lesser curvature & greater curvature. Identify the greater omentum which is
attached to the greater curvature of the stomach and the transverse colon. Observe it for
its contents (gastroepiploic arteries). Review the gastrocolic ligament. Review the blood
supply of the stomach. Make an incision on the anterior surface of the stomach to
visualize the mucosal folds or rugae inside the stomach. Do not incise the posterior
surface of the stomach.
5. Reflect the greater omentum superiorly. Identify the cecum, ascending colon,
transverse colon, descending colon, sigmoid colon, jejunum and ileum.
6. Lift the stomach along the greater curvature and lift the middle of the transverse colon
with another hand. Another person can lift the free ends of the greater omentum keeping
it taut. Observe that by doing this you can visualize a space between them. Make an
incision there to enter the lesser peritoneal sac. Make the incision sufficient to enable you
to lift the stomach and reflect it superiorly. Review the boundaries of the lesser peritoneal
sac. Upon entering the sac, you should be able to see the pancreas. The most superior
portion of the sac is its superior recess where the caudate lobe of the liver projects into.
The splenic recess is in the left side of the sac where the splenic hilum can be located.
7. Lift the transverse colon and reflect it superiorly. Pay attention to the small intestine.
Locate the most proximal end of the small intestine which is the junction of the
duodenum and jejunum. The landmark is the ligament of Treitz. The delineation between
the jejunum and ileum is arbitrary although technically there are differences in the
mesentery that can be used to differentiate between the two. In general, the proximal 2/5
of the small intestine from the ligament of Treitz is the jejunum and the distal 3/5 is the
ileum. You may trace the small intestine from the ligament of Treitz to its connection to
the cecum by moving your hands along the intestines like you were holding a rope and
placing your hand in front of the other hand to get to the end. While doing so, observe the
mesentery as well. Note the blood vessels within it. You may shine a light on side to see
the shadow of these vessels on the other side if it is not readily visible. Identify the
superior mesenteric vessels. If not readily seen in your cadaver, you may refer to a model
or an atlas. Review its branches. Identify the abdominal aorta by reflecting the small
intestine superiorly and to the right. You can also observe its bifurcation into the iliac
vessels inferiorly. The inferior mesenteric artery can be seen anterior to the abdominal
aorta 2-3 vertebral level above the sacral promontory and will go to the left side of the
abdominal cavity to give off several branches. If you have forgotten the sacral
promontory please review it again and consult an atlas. Please review the branches of the
inferior mesenteric artery. The inferior mesenteric vein will accompany it. Review its
tributaries.
You may use a model or an atlas to review the parts of the duodenum and
its relationship with the pancreas, common bile duct, portal vein and inferior
vena cava. Review the duodenal papilla, ampulla of vater, sphincter of Oddi
and the pancreatic ducts.
You may use a model or an atlas to review the parts of the pancreas, its
blood supply and relation to the hepatobiliary tree and duodenum.
8. Identify the appendix which can be found attached to the cecum.
9. Identify the 3 major parts of the large intestine which is the cecum, colon and rectum.
Review the different parts of the colon (ascending, transverse, descending and sigmoid).
Observe the gross difference between the small and large intestine. Identify the hepatic
flexure or right colic flexure and the splenic flexure or the left colic flexure. Observe the
mesocolon or the mesentery of the colon. Observe the different taenia coli and epiploic
appendages along the large intestine. Identify the right paracolic gutter which is to the
right of the ascending colon and the left paracolic gutter which is to the left side of the
abdominal cavity. Identify the right paramesenteric gutter which is bordered by the
transverse mesocolon, cecum, ascending colon and root of the mesentery. Identifyt the
left paramesenteric gutter which is to the left of the mesentery of the small intestine and
is continuous with the pelvic cavity inferiorly.
10. Identify the right and left kidneys. These are retroperitoneal so you can palpate them
posterior to the right and left colonic flexures. Follow the curvature of the kidney going
to its hilum. Try to palpate the renal pelvis which is continuous to the ureters. Follow
this inferiorly towards the pelvic cavity to reach the urinary bladder which is posterior to
the symphysis. The exact entry of the ureter to the urinary bladder may be difficult to
identify so you can consult a model or an atlas for this. This will be encountered again in
the section of the pelvis and pelvic cavity. Remember that the urinary bladder is anterior
to the rectum.
GUIDE QUESTIONS:
1. Draw and label the parts of the 3 major salivary glands
2. Draw and label the Liver and its parts
3. Draw and label the Gallbladder and its parts
4. Draw and label the Pancreas and its parts
5. In tabulated form, list down the extrinsic muscles of the tongue (Origin,
Insertion, Action, and Nerve Supply)
Muscle Origin Insertion Innervation Action
Genioglossus Superior mental entire length of depresses and
spine of mandible dorsum of tongue, protrudes tongue
lingual (bilateral
aponeurosis, body contraction);
of hyoid bone hypoglossal deviates tongue
nerve (CN XII) contralaterally
(unilateral
contraction
Hypoglossus body and greater inferior/ventral depresses and
horn of hyoid bone parts of lateral retracts tongue
tongue
Styloglossus anterolateral blends with retracts and
aspect of styloid inferior elevates lateral
process (of longitudinal aspects of tongue
temporal bone), muscle
stylomandibular (longitudinal part);
ligament blends with
hyoglossus
muscle (oblique
part)
Palatoglossus palatine lateral margins of vagus nerve elevates root of
aponeurosis of soft tongue, blends (CN X) (via tongue, constricts
palate with intrinsic branches of isthmus of fauces
muscles of tongue pharyngeal
plexus)
