APOSTLEJOHN'

SSMARTANATOMYPREVI
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ABDOMEN
EXTERNALOBLI GUE
 Ar iseby8di gitations.
 Lower4sl i
psi nt erdi gitatewi t
hcost al fibr esofl atissimusdor si
.
 Upper4i nter digitat ewi thdi gitat ionsofser r
at usant eri
or.
 Haswi dei nser ti
onmostofwhi chi saponeur oti
c.
 Super fi
ci al l
ay ersofaponeur ot ici nser tionr unsobl iquelyupwar ds.
 Thoseofdeepl ay erar eatr i
ghtangl edownwar ds.
 Post er i
orbor deroft hemuscl ei sf ree, formsant eriorbor derofl umbart ri
angl e.
 Lowerbor derf ormsi nguinal l
igamentbet weenpubi ctuber cleandASI S.
 Fr om medi al endofi ngui nal ligament ,tr i
angul arl acunarl igamentent endshor izontall
ytopectineall
ineon
pubi s.
I
NTERNALOBLI GUE
 Ar isesf rom whol el engt hofl umbarf asci a,ant er i
or2/ 3ofI l
iaccrestandf r
ontofl ateral2/3ofingui
nal
l
igament .
 I t'
saponeur osi sf usewi thtransv ersusaponeur osi st oform conj oi
ntt endon.
 Hasf reel owerbor derwhi char chesov ersper mat iccor d
TRANSVERSUSABDOMI NI S
 Lowerf ibresofaponeur osiscur vewi tht hoseofi nternal obli
gueasconj ointtendon.
RECTUSABDOMI NI SANDPYRAMI DALI S
Rectusabdomi ni s
 Medi alheadi sf rom f rontofpubi csy mphy sis.
 Lat er al headf rom upperbor derofpubi ccr est .
 I nser tedt of rontof5- 7t hcost al car til
ages.
Pyramidalis
 Ar isesf rom pubi sandsy mphy sisbet weenr ectusabdomi nisandi t
'ssheat h.
 Li neaal bai sat tachedt oxi phoi dpr ocessabov eandpubi csy mphy sisbelow.
RECTUSSHEATH
 Ext er nal obliqueaponeur osisf or msant er i
orl ayer .
 Tr ansv er susabdomi nisaponeur osi sf or mspost eriorlayer.
 Aponeur osi sofI nt ernal andExt er nal obl igueandTr ansversusabdomi ni
sar ebi l
amina.
Contents
 Rect usandpy rami dal i
s, l
owersi xt hor aci cner ves,Lowersi xinter
cost alvessels,super i
orandinferi
or
epigast r icar teries.
I
ntercostalner ves
 Passt oabdomi nal wal lbetweenI nter nal Obl i
queandTr ansv ersusAbdomi nis.
 Pi ercepost eriorl ay erofI nter nal Obl iquet oent err ectussheat h.
 I nRect ussheat hT7ner ver unsupwar ds, T8r unst ransv erselyandot hersobl iguelydownwar ds.
Superi
orepi gast ricAr t
er y
 Suppl i
esr ect usmuscl e.
I
NGUI NALCANAL
 Tr ansmi tssper mat i
ccor dandi li
oi ngui nal ner vei nmal e
 Tr ansmi tsr oundl i
gamentofut er usandi lioingui nal nervei nfemal e
 Ant eriorwal lformedbyExt er nal obl igueaponeur osis.
 Lat er al wal l byi nter nal obligue.
 Fl oori sl oweredgeofi nguinal li
gament .

16
 APOSTLEJOHN'
SSMARTANATOMYPREVI
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 Medi allyi sl acunarl igament .

 Roofi sloweredgeofI nt er nal obl i
gueandTr ansv ersusmuscl e.
 Post eriorwal l isconj oi ntt endonandt ransv ersal i
sf asci a
 I nt egr i
tyofI ngui nal canal dependsonant eriorandpost eriorwal l.
 Conj ointt endonl i
espost er iort osuper ficial i
ngui nal ring.
Deepinguinal ri
ng
 I sanopeni ngi st ransv er sal i
sf asci a
Str
uctur
esdeept opost er iorwal l
 I nf eriorepi gast ricAr terycr ossespost eriorwal lmedi al l
y .
 Lat er allyDuct usdef er ensandr oundl igamentofut erusi nf emal eent ercanalbyhooki ngaround
inter fov eol arl igament .
 Atdeepr ing, inf er i
orepi gast ri
cAr terygi vesof fcr emast erbr anch.
 I ngui nal tri
angl ei sboundedl at eral l
ybyI nt ernal epi gast r
icar tery,medi al l
ybylat
eralborderofrectusmuscl
e,
bel owbyi ngui nal li
gament .
 I ndi recther niapassesl at er al toar tery( thr oughdeepr ing) .
 Di recther ni apassesmedi al toar tery( throughi ngui nal triangl e)
.
 Di recther ni aemer gest hr oughsuper ficial ri
ngandl iesabov eandmedi altopubi
ct ubercle.
 Neckoff emor al her ni ai sbel owandl ater altopubi ct uber cle.
SPERMATI CCORD
 I nt ernal sper mat icf asci ai sder ivedf rom Tr ansv er sal i
sf asciaatdeepr i
ng.
 Cr emast ermuscl eandf asci aar et hesecondl ay er.
 I n3r dl ayer , ext er nal sper mat i
cf asciai sacqui redf rom ext ernal obligueaponeur osis.
Content
s
 Duct usdef er ens.
 Ar teries-t est icul ar( lar gest ),ar ter ytoduct usandcr emast erartery.
 Vei ns-pampi nifor m pl exus.
 Ly mphat icandner ves( geni tal branchofgeni tofemor al ner ve)
 Pr ocessusv agi nal is.
TESTIS
 Epi didy mi si sat tachedt opost er olater al surface.
 Vasdef erensar isef rom l owerpol eofepi didymi sandr unsupmedi al t
oi t
.
 Test i
s, epi di dy mi sandt ur ni cav agi nalisl ieinscr ot um.
 Ri ghtandl ef tsi desar esepar atedbymedi anscr otal raphe.
 Appendi xt est isi sat tachedt oi tsupperpol ewi thint ur nicav aginalis.
Bl
oodsuppl y
 Test i
cul arar t erygi vesbr ancht oepi didy mi s.
 Ther e'sanast omosi sbet weent est i
cul ar, cremast erandduct alarteriesi nregi
onofepi didymis.
 Pampi nifor m pl exussur r oundst est i
cul arar tery .
 Pampi nifor m pl exussepar at esi nt of ourv einsi ni ngui nal canal .
 Thel ef ttv einj oinsr enal v einatr ightangl e.
 Ri ghtv eindr ai nsdi rect lyi nt oI VCatacut eangl e.
 Test i
cul arv ei nsusual l
yhav ev al ves.
 Var i
ocel eoccur smor eonl efttsi det hant her ight .
Lymphdr ainage
 Ly mphat icsr unwi tht est i
cul arar ter yt opar a-aorticnodesl y i
ngatL2l ev elj
ustaboveumbi l
i
cus( or
igi
nof
test i
cul arar t er y).
 Doesnotdr ai nt oi ngui nal nodes.
 Ov erlyingscr ot al skindr ainst oi ngui nal nodes.

17
 APOSTLEJOHN'
SSMARTANATOMYPREVI
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Nervesupply
 Celiacpl exusandl esserspl anchni cner ve
EPIDIDYMIS
 Attachedbehi ndt est is.
 Hasl ar geheadatupperendandpoi nt edt ail atlowerend.
 Headi sconnect edt oupperendbyv asaef ferent iaandt ailtol owerendbyl ooseconnect i
vetissue.
 Thebodyi ssepar at edf rom t est esbysi nusofepi didy mis.
VASDEFERENS
 Directcont inuat ionofcanal ofepi didy mis.
 Passesupmedi ally .
 Bloodsuppl ybybrf rom t est i
cul arar tery.
 Ner vebycel i
acgangl i
on.
ABDOMEN
 Stomachi sf ixedati ts2endsbutsuspendedbymesent eryel sewher e.
 Duodenum i spl ast eredt opost er i
orabdomi nal wal l
.
 Whol el engt hofsmal li
nt est i
neswi ngsf r
eel yi tsmesent ery.
 Ascendi nganddescendi ngcol onsar eadher entt opost eriorabdomi nal wal l.
 Transv er secol oni smobi lei ni tsmesent er ybet weencol icf lexures.
 Sigmoi dcol onswi ngsf reel yonamesent ery .
 Supr arenal s, kidney sandur eter s, aort a,I
VCl iebehi ndper itoneum.
Transpyl
ori
cpl ane
 Transpy l
or i
cpl ane( TP)i nsect sbodybet weenj ugul arnot chandpubi csy mphy si
s, midwaybet ween
xi
phist ernum andumbi l
i
cuswhi chcut scost al mar ginatt ipof9t hcost al car t
il
age.
 TPpl anepassest hroughl owerbor derofL1v ertebrawher espi nalcor dendsatconusmedul l
aris.
 TPpl anepassest hroughpy l
or us, alongheadnechandbodyofpancr eas, abov eat tachmentoft ransv er
se
mesocol on.
 Supr acol i
ccompar tmentl iesabov eTPpl anewhi l
ei nfr
acol iccompar tmentl i
ebel owi t.
 Super iormesent ericar ter y,spl enicv einjoinssuper i
ormesent eri
cv eint of or m por t
al vei
natlevel ofTPpl ane.
 Hilum ofki dneyl iesatt hispl ane.Ther i
ght tjustbel owandl eft tj
ustabov e.
PERITONEUM
 Cov ersant eriorandpost er iorabdomi nalwal ls.
 Consi stofsi ngl el ayeri sf lattenedcel ls.
 Doubl ef oldsuppor tingsmal lint estinei st hemesent ery.
Peri
tonealfoldsofant eriorabdomi nal wal l
 Raisedi nt o6f olds, 1abov eand5bel owumbi li
cus.
 Falcifor ml i
gamentconnect sl ivert osupr aumbi l
ical partofant er
iorabdomi nalwal landinfer
iorsur faceof
di
aphr agm.
 Belowumbi li
cus, cent ral foldi smedi anumbi l
ical foldcont ai ningmedi al umbi l
ical l
i
gament .
 Lateral tomedi anumbi l
ical fol di smedi al umbi li
cal foldcont ainingmedi al umbi l
ical l
igament.
 Fartherl ater allyisl ateral umbi l
ical foldcont ai ningi nferi
orepi gast r
icar teryanddoesnotr eachasf aras
umbilicus.
LESSERPERI TONEALSAC
 Opensi nt ogr eat ersact hr oughepi l
oi cforamen.
 Ant eriorwal l ofl essersaci sf ormedbypost eriorl ayerofl esseroment um.
 Post eriorwal lisant eriorof2post eriorlay ersofgr eateroment um.
 Cav it
yofl essersacdoesnotext endmuchbel owTr ansver secol onbecauseoff usionofi tsl
ay ers.
GREATEROMENTUM
 Formsf ourl ay erswhi chf usewi t heachot herbel owTr ansv ersecol on.

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 APOSTLEJOHN'
SSMARTANATOMYPREVI
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 I tenv elopsspl eenexceptf ort hehi lum ofspl een.

 Spl eni cv essel sl iei nspl enor enal ligament .
 Shor tgast ri
candl ef tgast roepi pl oicv essel sruni ngast r
ospl enicl i
gament .
EPIPLOICFORAMEN
 Upperboundar yi scaudat epr ocessofl iv er .
 Lowerboundar yi s1stpar tofduodenum.
 Post eriorboundar yi sIVC.
 Ant er iorboundar yisr ightf reemar gini flesseroment um.
PERITONEALCOMPARTMENT
 Tr ansv ersecol onandmesocol onar eadher entt opost er
iorsur faceofgr eateroment um.
 Lat er al l
imbofsi gmoi dmesocol onpassesal ongpel vi
cbr imt oi nguinall
igamentwhi lemedial
li
mbsl opes
downt ohol lowsacr um r eachi ngS3( commencementofr ectum) .
Nervesuppl y
 Di aphr agmat i
cPl eur a-phr enic( C4mai nl y)
 Restofpar i
etal per itoneum i sbyi ntercost al andl umbarner ves.
 Obt ur at orner vei st hechi efsour cei npel v is.
RETROPERI TONEALSPACE
 I ncludeaor ta,IVC, Cisternachy li,lymphnodesandv essels, nerves, ki
dney s,ur
eters,pancreas,
ascending
anddescendi ngcol ons, mostofduodenum andsupr arenal glands.
CELIACTRUNK
 I sar t eryoff oregut
 Ar isebet weencr ur aofdi aphr agm, belowmedi anar cuatel i
gamentatl ev
el ofT12body .
 Cel iacgangl ialieoneofeachsi de
 Di v i
desi nto3br anchesatupperbor derofpancr easbehi ndper itoneum.
Leftgastri
cAr tery
 Runsacr ossl ef tcr ust owar dsesophageal openi ng.
 Runst or ighti nl esseroment um al ongl essercur vat uretosuppl yst omach.
Splenicarter y
 Runsacr ossl ef tcr usandl eftpsoast ohi lum ofl ef tkidney .
 I tismai nsuppl yt ot hepancr eas.
 Maygi veofpost er i
orgast ricAr t eryf r
om i tsmi dpar ttost omach.
Commonhepat icar tery
 Passesov erupperbor derofpancr eas.
 Gi v esof fr i
ghtgast ricandgast roduodenal ar t
eries.
Leftgastri
cAr tery
 Leav escommonhepat i
c, r
unst ol ef talongl essercur vature, anat omosewi t
hleftgast r
icArt
ery.
Gastroduodenal artery
 Passesbehi nd1stpar tofduodenum.
 Di videsi nt o2atl owerbor derofduodenum.
Righttgastroepi ploicar ter y
 Passesbet ween1stpar tofduodenum andpancr eas, entranceofbi l
eductmar ksj uncti
onofforegutand
mi dgutandi st hemeet i
ngpoi ntofCoel iacandsuper iormesent er i
carteri
es.
SUPERI ORMESENTERI CARTERY( SMA)
 Suppl iesf rom ent ranceofbi l
eductt ospl eni cf i
ssur eofcol on.
 Ar iseacent i
met erbel owcoel iact runkatl ev elofl owerbor derofL1.
 Behi ndspl enicv einandbodyofpancr eas.
 Super i
ormesent er i
cv einoni tsr ightsi de.
 Li esant eriort ol eftr enal vein.

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 APOSTLEJOHN'
SSMARTANATOMYPREVI
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Infer
iorpancr eat i
coduodenal arter y
 1stbr anchofsuper i
ormesent ericar teryf rom t hepost er i
orsur f ace.
 Maycomeof fthef irstjejunal branch.
Jejunalandi ll
egal branches
 Ar isef rom l eftofmai nt runk.
 Passdownbet ween2l ay ersofmesent er y.
Il
eocolicar tery
 Ar isef rom r ightsi deofSMA.
 Descendst or i
ghti l
iacf ossa.
Rightcol i
car t ery
 Fr om r ightsi deofSMAi ncommonwi thi l
eocol i
car tery.
Middlecol icar tery
 Fr om r ightsi de, emer gesatl owerbor derofneckofpancr eas.
 Li est or ightofmi dline.
 Ri ghtbr anchanast omoseswi thascendi ngbr anchofr ightcol i
car t
ery
VENOUSDRAI NAGEOFMI DGUT
 Eachbr anchofSMAi saccompani edbyav ein.
Super i
ormesent er i
cv ei n( SMV)
 SMVl iest or ightofSMA.
 Cr osses3r dpar tofduodenum andunci natepr ocessofpancr eas.
 Joi nsspl eni cv einbehi ndneckofpancr east of orm por tal vein.
INFERIORMESENTERI CARTERY( IMA)
 Ar isef rom f rontofaor ta, behi ndi nferiorbor derof3r dpar tofduodenum, oppL3, atl
evelofumbil
icus,3or
4cm abov eaor ticbi furcat ion
Leftcolicar ter y
 Ascendi ngbr anchcr ossesl ef tpsoas, gonadal vessels, ureter, genitof
emor alner
veandquadratuslumborum
 Cr ossedant eri
or lybyi nfer i
ormesent ericv ein.
VENOUSDRAI NAGEOFHI NDGUT
Infer
iormesent ericv ein( IMV)
 Runst ol eftofI MA
 Li esonpsoasmuscl ei nf rontofgonadal vessel s,ureters, geni tofemoralnerve.
 Passbehi ndl owerbor derofbodyofpancr eas, infrontofr enal veinandjoi
nssplenicvei
n
LYMPHATI CDRAI NAGEOFGUT
 Coel iacgr oup-Ci st ernachy li
 Fi r
stf il
ter i
ngi sbyl ymphoi df oll
icles, notnumer ousi nesophagus, moreinstomach,becomespey er
's
patchesi nl oweri leum, aggr egat edi nappendi xasi nat onsi l
.
 Fi r
stgr oupsl i
esi nper i
toneum adj acentmar gi nofSmal lI
nt est ine.
 Secondgr oup-al ongmai nbl oodv essel sofsuppl y
 Thi rdgr oup-pr eaor ticnodesator igi
nofcel iac, SMAandI MA.
 l argei nt est i
nehasaddi ti
onal epipl oicnodes.
ESOPHAGUS
 1or2cm i nl engt h.
 Gr oov espost eriorsur faceofl efttlobeofl iver .
 Post er iorwal lisshor t
ert hanant eriorwal l
.
 Lef tI nf eriorphr eni cner vel i
esbehi ndesophagus.
STOMACH
 Rel at ivel yfixedatbot hends.
 Gast ro- esophageal j
unct ion( cardia)i st hemostf i
xedpar t, l
ies2. 5cm t
oleftofmidli
neatT10level.

20
 APOSTLEJOHN'
SSMARTANATOMYPREVI
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 Gast ro-duodenal junct ion( py lorus)isal itt

letor i
ghtofmi dlineatL1l ev el whenempt y.
 Py lor i
ccanal liesatheadandneckofpancr eas.
 St omachbedconsi stofl eftcr usanddomeofdi aphr agm, splenicar t
er y,bodyofpancr eas,Tr
ansverse
mesocol on, upperpar tofl ef tki dney ,leftsupr arenal gland, spl eenandl eftcol icflexure.
 Tor ightofl essercur vat urei nt hemi dlinel i
eAor t
aandCel i
at runk, celiacpl exusandgangl i
a,coel
i
acl y
mph
nodes.
Bloodsuppl y
 Gast ri
car ter iesmaybedoubl e.
 Fundusandupperl efttpar tr ecei veabout6shor tgast ricar t
er i
es.
 Ther i
ghtgast roepi ploicar ter y( GEA)i scl osert ogreat ercur v aturet hant hel efttGEA.
 Pr epy lori
cv eindr ai ni nt oright tgast r
icv ein.
Lymphaticdr ainage
 From upperl ef ttquadr ant-gast roepiploicnodes.
 From r estofgr eat etcur vatur e-nodesal ongr ightgast roepiploicv essel s.
 Py lor i
cpar t-hepat i
cnodes.
Nervesuppl y
 Ant er i
orv agal tr
unkl i
esi ncont actwi thant eri
oresophageal wal l
near eri tsr i
ghtmar gi
n
 Ant er i
orv agal tr
unki susual lydoubl eort ri
ple.
 Post eriorv agal tr
unkl iesi nl ooseconnect i
v eti
ssue( CT)al i
ttlebehi ndandt or i
ghtandnoti ncontactwit
h
post eriorsur faceofesophagus.
DUODENUM
 Liesi nf r
ontandt or ightofI VCandaor ta.
 First2. 5cm i sbet weenper i
t oneum ofl esserandgr eat eroment a.
 MakesC- shaper oundheadofpancr eas, oppositebodyofL2.
 1stpar tl
iesatl evel ofL1.
 2ndpar tliesonr ightsi deofL2.
 3r dpar tcrossesi nf rontofL3.
 4thpar tonl ef tofL2.
1stpart
 For msl owermostboundar yofopeni ngi ntol essersac.
 Liesi nf r
ontofgast r
o- duodenal artery,bileductandpor talvei nbehi ndwhi chl i
esI VC.
 Gal lbladderi santt oduodenal cap.
 Post eriorsur facei sbar eofper itoneum
2ndpart
 Cur v esdownwar dsov erhilum ofr ightki dney .
 Itsupperhal fl i
esi nsupr acol iccompar tmentt oleftofhepat orenal pouch.
 Lowerhal fl iesi nr ighti nfracol iccompar tmentmedi al toInferiorpol eofr ight tkidney.
 Liesal ongsi deheadofpancr easatl ev elofL2v ertebr a.

3r
dpar
t
 Curvesfrom rightparaver
tebralgutterov
ersl opeofr i
ghtPsoas.
 LiesoncommencementofI nferiormesentericarteryasit
sinfer
iorbor
dercr
ossesaor
ta.
 It
supperbor derhugsl owerborderofpancr eas.
 Liesinbothrightandl ef
tinf
racoliccompartment s.
 It
sant er
iorsurfaceisincontactwi t
hcoil
sofj ejunum.
4t
hpar
t
 Ascendst oleftofaorta
 Liesonleftofpsoasandl ef
tlumbarsy mpat heti
ct r
unk.

21
 APOSTLEJOHN'
SSMARTANATOMYPREVI
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 Reachesl owerbor derofbodyofpancr eas.

 Duodenoj ejunal flexurei sf i
xedt olef ttPsoas.
 Mout hoff ourpar aduodenal recessesorf ossaef acet owar dseachot her.
JEJUNUM ANDI LEUM
 Jej unum i swi der -boredandt hicker -wal ledt hani l
eum.
 Thi ckwal lofj ejunum f eel sdoubl e.
 Thi nwal l ofi leum f eelssi ngl e.
 Bot hl i
ei nf reemar ginoft hemesent ery .
 Jej unum consi st sof2/ 5oft hel engt h.
 I l
eum i s3/ 5oft ot al l
engt h.
 Occl usi onofst rai ghtar ter iesmakel eadt oinf arctionofpar tsuppl ied.
 Occl usi onofar cadev essel si susual l
ywi thoutef fect .
 I l
eal ar ter i
eshav el argerar cades-3t o5.
 Vagusgi vespar asy mpat het icsuppl ywhi char gument sper istalsis.
 Sy mpat het icsuppl yisf rom l athor nofT9- 10spi nal segment s.
CAECUM
 Usual lycompl et elycov eredbyper i
toneum.
 Lat er al wal lougr owsmedi al wal linadul ts.
 Appendi xl iesoni tspost eromedi al wal l i
nadul t
s.
 Li esi nper itoneal fl
oorofr ighti liacf ossaov eril
iacus.
 Lowerendl i
esatpel vicbr i
m.
 Post er iorcaecal arteryi sl argert hanant er i
or .
APPENDI X
 Opensatpost er omedi al wal l ofcaecum 2cm bel owi leocaecal valve( McBurney '
spoi nt
).
 McBur ney '
spoi ntl i
es1/ 3wayupt heobl i
guel i
nej oiningr ightASI Stoumbi li
cus.
 Mostcommonposi ti
oni sr etr ocaecal ,fol l
owedbypel vi
c.
 Ret r oileal si tei smostcommoni nabsenceofdi sease.
 Appendi cul arar ter yisanendar terywi thnocor respondi ngv eins.
COLON
 Tr ansv er seandsi gmoi dar esuspendedi nmesent eries.
 Ascendi nganddescendi ngcol onar epl ast eredt opost eriorabdomi nalwallsot hatthei
rpostwal l
sare
dev oidofper i
toneum.
Ascendingcol on
 Li esoni liacf asci aandantl ay erofl umbarf asci a.
 I ssaccul at edduet ot hreet aeni aebei ngt ooshor tf ort hebowel .
Transv
er secol on
 Hangsf reeonTr ansv ersemesocol onwhi chhangsbet weeni nfer i
orpol esofrightandl ef
ttkidneys.
 Spl eni cf l
exur el iesathi gherl ev el t
hanhepat i
cf l
exur e.
 Duet or otat ion, anteriort aeni aofascendi nganddescendi ngcol onsl ieposteriorl
ywhi l
eothert woli
e
anter ior l
yabov eandbel ow.
 Appendi cesepi ploicaear el argerandmor enumer oust hanonascendi ngcol on.
Descendingcol on
 Ext endsf rom spl enicf lexur et opel vicbr im.
 Pl ast er edt opost eriorabdomi nal wal l byper it
oneum.
 Mesent er yi spr esenti nabout20%ofadul ts
 Spl eni cf l
exur el iesonl ater al sur faceofl efttkidneybel ow.andi ncont actwitht ai
lofpancr easandthe
spleen.
 Phr eni cocol icl i
gamentat tachesspl eni cf l
exur et odi aphr agm at10t hand11t hriblevel
.

22
 APOSTLEJOHN'
SSMARTANATOMYPREVI
EW

 Li
esonl umbarf asci aandi li
acfascia.
 Endsinpel v
icbr im 5cm abov einguinalli
gament
 Taeniaecol ili
eoneant eriorandtwopost eri
or.
 Appendi cesepi ploicaear enumer ous.
Si
gmoi
dcolon
 Extendsf rom descendi ngcol onatpel vi
cbr i
mt ocommencementofr ect
um infrontof3r
dpieceofSacr
um.
 Compl etelyinvest edi nper it
oneum andhangsf reeonamesent er
y(Si
gmoidmesocol on)
.
 Taeniaecol iwidert hanelsewher e.
 Possesseswel l dev elopedappendi cesepi pl
oicae.
 There'
sanast omosi sbet weenpor talandsy stemicvenousdr
ainagewhereascendinganddescendi
ng
col
onsar eincont actwi thpostabdomi nalwall.
 Lymphchannel sf ol lowar teri
es.
 Sympat heticsuppl y-T10- 12.

LI
VER
 1500gandr ecieves1500mLofbl oodpermi nut e
 Occupi esmostofr ighthy pochondr ium andepi gast r
ium.
 Sur facei sconv ex.
 Shar pi nferiorbor dersepar at esr i
ghtandant er i
orsur facesfrom v i
sceralsurface.
 Mostv essel sent erandl eav eatpor t
ahepat isonv isceralsurface.
 Hepat icv ei nemer gesf rom post eriorsur face.
 Infer i
orbor deri sbot chedbyl i
gament um t eres.
 Por tahepat isl i
escent rallyint heHshapepat ter nofst r
uctures.
 Rightl i
mboft heH-I VCandgal l
bladder .
 Lef tlimboft heH-f issur ef orl igament um v enosusandl i
gament um teres.
 Triangul arbar ear eal i
est or ightofI VC( for mi ngi tsbase) .
 Caudat elobel iesbehi ndr ightpar tofl esseroment um.
 Caudat epr ocessext endsbet weenpor tahepat isandI VC.
Port
ahepatis
 Encl oser ight tandl ef thepat icduct s, r
ightandl ef tbranchesofhepat i
carteryandportal
vei
n.
 Sev er al l
ymphnodesandner vesofl iverar epr esenti nthepor ta.
 Gal lbladderl iesonv iscer al sur face.
 Cy sticductl iescl oset or i
ghtendofpor tahepat is.
 Itsnecki shi ghestandf undusl owest .
 Quadr at elobel iesbet weengal l
bladderandf issur ef orligament um teres.
 Bar ear eai si ncont actwi t
hdi aphr agm andr i
ghtsupr arenalgland.
 Esophagusmakesshal lowi mpr essiononpost eriorsur faceofl i
ver.
 Hepat icv ei nsar eent i
relyi ntrahepat ic.
 Viscer alsur facer est sonst omachandhepat icf l
exur eofcol on.
Surf
acemar kings
 Uppermar ginofl iv er-l ev el wit hxiphi ster nal j
oint .
 Itreaches5t hi nter cost al spaceont hel eft7- 8cm f rom mi dl
i
ne.
 Reaches5t hr i
bont her i
ght7- 11cm f r
om mi daxi l
laryl i
ne.
Lobes
 Lar gerr i
ghtandsmal lerlef tlobes.
 Caudat elobel iesbet weenI VCandf issur eforl igament um venosus.
 Quadr at elobel iesbet weengal l
bladderf ossaandf i
ssur eforli
gament um t er
es.
 Subdi visionsi snoti naccor dancewi thar rangementofv ascularandbi li
arychannels.

23
 APOSTLEJOHN'
SSMARTANATOMYPREVI
EW

Segments
 Caudat el obei sanaut onomoussegmenthav ingi ndependentv enousdr ai
nagei nt
oI VC.
 SegmentV-i nf er i
orsegmentofr i
ghtpost eriorsect or .
 SegmentVI-i nf eriorsegmentofr i
ghtant eriorsect or
 SegmentVI I-super iorsegmentofr i
ghtpost eriorsect or.
 SegmentVI II-super i
orsegmentofr ightant eriorsect or .
 Hepat icsegment sar ear rangedi nant iclockwi sedi r ect i
on.
 IVbsegmentcoi nci deswi t
hquadr atel obe.
Bloodsupply
 Rightbr anchofhepat icar ter ypassbehi ndcommonhepat icduct .
 Lef tbr anchdi videi nt omedi al andl ater al sect or al br anches.
 Commonhepat icar teryar isesf rom mesent ericar ter yoraor taandr unsbehindpor tal vei
n.
 Righthepat icar ter yar isesf rom SMA-15%
 Lef thepat icar teryar isesf rom l eftgast ricAr tery-20%
 Nocommuni cat ionbet weenr i
ght tandl ef tthal vesofl iver.
 Arter iesi neachhal far eendar teri
es.
 3mai nhepat icv ei nsdr aini ntoI VC.
 Lar gecent ral veinr unsbet weenr i
ghtandl ef tthal vesandr eciev esfrom both.
 Allt hev ei nshav enoext rahepat iccour se, ent erI VCj ustbel owcent ralt
endonofdi aphragm.
 Separ at ev einf rom caudat el obeent erI VC.
 Ther e'sanast omosi sbet weenpor talvenouschannel andazy gosv enouschannel acrossbar ear
eaofl
i
ver
.
 Hepat icbr anchofant er iorv agal trunkr eachpor tahepat i
sv i
al esseroment um.
BILI
ARYTRACT
 Rightandl efthepat i
cduct sf orm commonhepat icductnearr i
ghtendofpor tahepat is.
 Lef thepat icductmayr unal ongbaseofquadr atel obepr iortoi tsemer gencef rom li
v er.
 Cy sticductj oinscommonhepat i
cductatacut eangl et of orm bi leduct
GALLBLADDER
 50mLcapaci ty.
 Liesonv iscer al sur faceofl iveradj acentt oquadr atel obe
 Fundust ouchest i
pof9t hcost alcar til
age.
 Fundusl iesoncommencementofTcol ont ot hel ef tofhepat icf l
exure.
 Thebodyi sincont actwi th1stpar tofduodenum.
 Neckl iesathi gherl ev el thanf undusi nnor mal posi tion.
 Cy sticductj oinscommonhepat i
cducti nf r
ontofr i
ghthepat i
car teryanditscy sti
cbr anch.
 Fundusandbodyar eusual lyboundt oundersur faceofl i
ver.
 Smal l cy st i
cv einpassesf rom gal lbladdert ol iversubst ance.
 Gal lbladderoccasi onal lyhangsf reei nnar rowmesent eryf r
om l iverundersur f
ace.
 Gal lbladdermayr ar elybeembeddedi nl iver.
 Gal lbladdermayv er yr ar elybeabsent .
 Gal lbladdermayr ar elybedupl i
cat edwi thsi ngl eordoubl ecy sticduct s.
 Cy sticar ter ymaypassi nfr ontofcy sticandbi leduct s.
 Cy sticv einsdonotaccompanycy sticar ter i
es.
COMMONHEPATI CDUCT
 Rightandl eftthepat icduct sf orm commonhepat icductneari tsr i
ghtmar gininY-shapedmanner .
 Cy sticductj oinsi taf t
erabout3cm.
 Rightbrofhepat i
car t
er yPassbehi ndcommonhepat icduct .Mayal soruninfrontofi t
.
 Uni onofcy sticandcommonhepat icducti sonr i
ghtsi deofcommonhepat icduct .

24
 APOSTLEJOHN'
SSMARTANATOMYPREVI
EW

 Rar elyCy sticductmaybeabsentandgal lbl

adderdr ainsdirectl
yintocommonhepat icduct
.
BI
LEDUCT
 Uppert hirdl i
esi nf rontofpor talv einandt or ightofhepat i
car t
ery.
 Mi ddl et hi rdr unsbehi nd1stpar tofduodenum.
 I VCi sbehi ndt heduct .
 Lowert hi rdsl opesi ngr oov ebet weenbackofheadofpancr easand2ndpar tofduodenum andi nfrontof
renal vein.
 Joi nspancr eat icductat60°angl eathepat opancr eaticampul laofOddi.
 Ampul l
aopensi nt opost eromedi al wall of2ndpar tofduodenum atmaj orduodenal papi
ll
a10cm from
py l
or us.
 Recei vessmal l branchesf rom cy st i
candr i
ght thepat icar t
ery.
 Sy mpat het icf i
br es-T7- 9.
 Somef rom gal l
bl adderr unsi nrightphr enicner ve( C3- C5).
PORTALVEI N
 I t'
sSMVaf terr ecei vingspl endi dv einbehi ndneckofpancr eas.
 Li esi nf rontofI VC.
 Li esbehi ndpancr easand1stpar tofduodenum.
 Li esbehi ndbi leductandhepat i
car tery.
 Val veless( andi tst ribut aries).
 I npor tal hy per tensi on, 80%ofpor talbloodmay beshunt edintocollat
eralchannels,only20%reachesliver
.
Si
tesofpor tal/sy st emi canast omosi s
 Lowerendofesophagus.
 Upperendofanal canal .
 Bar ear eaofl i
v er.
 Per i
umbi lical regi on.
 Ret roper i
t oneal ar eas.
PANCREAS
 I tssur f
acei sl obul at ed.
 Headi sonr ight .
 Hasshor tneck.
 Bodycr ossesmi dl i
ne.
 Nar rowt ail i
sonl ef t.
 Headandnecki ncl inest owar dspar av ertebral gut t
ers.
 Neckandbodycur vescur v esov erI VCandaor tai nfrontofL1v ert
ebra.
 Neckl i
esont ranspy l
or i
cpl ane.
 Tr anspy lor i
cpl anepassesacr ossheadandbodyandbel owt hetai
l.
Head
 Li esov erI VCandr i
ghtandl eftrenal v
ei nsatL2l evel.
 Post eriorsur facei sindent edbyt er minal partofbi leduct .
 Ant er i
orsur facel iesi nbot hsupr acol i
candi nf racoli
ccompar tments.
 Tr ansv er secol oni sat tachedt oantsur face.
Unci
natepr ocessofhead
 Hook- shapedext ensi onofhead.
 Behi ndSMVandSMA.
 I nf rontofaor ta.
Neck
 Li esi nf rontofcommencementofpor talvein.
 SMVi sembr acedbt wnneckandunci nat epr ocessofhead.

25
 APOSTLEJOHN'
SSMARTANATOMYPREVI
EW

 Spl enicv einr unsbehi ndl ef tsi deoft heneckt oform por talvein.
 Tr ansv ersemesocol oni sat t achedt owar dl owerbor derofneck.
Body
 Sl opesupwar dsacr ossl ef ttr enal veinandaor ta,l
ef t
tcr usofdi aphr agm, l
efttpsoas,l
owerpartoflef
tt
supr ar enal glandt ohi l
um ofl ef tkidney .
 Super iorbor dercr ossesaor taator iginofcoel iactrunk.
 Spl enicar terypassest ol ef tal ongupperbor derofbodyandt ail
.
 I nferiorbor deral ongsi deneckcr ossesor iginofSMA.
 Spl enicv einl iesappl iedt opost er i
orsur face.
 I MVj oinsspl enicv einbehi ndbodyofpancr easi nfrontofl eftrenal v ei
n.
 Tr ansv ersemesocol oni sat t achedal ongant er i
orbor der .
 Li esbehi ndl essersacandf or mspar tofst omachbed.
Tai
l
 Passest olef tf r
om ant er i
orsur faceofl eftkidney .
 Accompani edbyspl eni car ter y ,v einandl ymphat i
c.
 Li eswi thin2l ayer sofspl enor enal ligament .
 Reacheshi lum ofspl een.
Pancreaticduct
 Cont i
nuoust ubef rom t ai ltohead.
 Joi nedat60°bybi leductathepat opancr eat icampul l
a.
 Dr ainsmostofpancr easEXCEPTunci nateandl owerpar tofhead( whichdr ainbyaccessorypancr
eati
cduct
(APD)ofSant orini).
 APDofSant or i
ni opensi nt oduodenum atmi norduodenal papilla.
Bl
oodsuppl y
 Spl enicar terysuppl i
esneck, bodyandt ail
.
 Headi ssuppl i
edbySuper iorandI nferiorpancr eati
coduodenal art
eries.
Nervesuppl y
 Par asy mpat het i
c-v agal trunk.
 Sy mpat heticv asoconst ri
ct ori mpul se-T6- 10spi nal ner ves.
SPLEEN
 Li esdeept ol ef t9t ht o11t hr ibs.
 Li est ol efttmar ginofl essersacbel owdi aphr agm.
 Hi lum l i
esinangl ebet weenst omachandl efttkidney .
 I tslongaxi sl iesal ongl i
neof10t hrib.
 Lowerpol edoesn' tpr oj ectf urtherf or wardt hanmi daxi l
laryline.
 Hi lum makescont actwi tht ai lofpancr easl yingwi thinspl enor enal l
igament .
 Spl eenmustdoubl eit snor mal si zef orantsur facet opassbey omdl efttcostalmargi
n.
 Behi ndhi l
um i sconcav er enal sur f
ace.
 Atl owerpol ei sthesmal l col ici mpr ession.
 Mayconsi stof2or3segment sbasedonv ascularar rangement .
Bl
oodsuppl y
 Spl eeni carter ypassesbet weenl ayersi sspl enorenal ligament .
 Spl eeni carter yhas2- 3mai nbr anchesand5ormor ebr anches.
Nervesuppl y
 Coel iacpl exus-sy mpat het icf ibresonl y.
POSTERI ORABDOMI NALWALL
 Mi dlinef orwar dpr oject ioni senhancedbyI VCandaor tal yi
ngi nf rontofv er
tebralbodi
es.
 Par av ertebral gut tersar ef loor edbyPsoasandquadr atusl umbor um andbel owi l
iaccrestbyi
li
acus.

26
 APOSTLEJOHN'
SSMARTANATOMYPREVI
EW

 Ki dneyl ieshi ghupi npar av er t

ebr algut ters.
 Lumbarv er tebr aear esepar atedbyt hi cki nt ervertebr aldisc
PSOASMAJOR
 Li esi ngut terbet weenbodi esandTr ansv ersepr ocessesofl umbarv er
tebrae.
 Ver tebr al at tachment-di scabov e5l umbar s, adjoi ningpar tsofbodyandmedi alendsofal ll
umbar
Transv er sepr ocesses.
 Ther e'sonecont inuousat tachmentf rom l owerbor derofT12t oupperbor derofL5.
 Passesbeneat hi ngui nal ligament .
 Tendoni sat tachedt olessert ronchant eroff emur .
 Lumbarpl exusi sembeddedwi thint hemuscl e.
 Par tofext er nal vertebral v enouspl exusi sbehi ndi t.
 Geni tof emor al ner veemer gef r om f rontofPsoasmuscl e.
 Ili
ohy pogast ric, ili
oingui nal ,lat eral femor al cutaneousandf emor al nervesemer gefr
om itslateralborder
.
 Obt ur at orner v eandl umbosacr al trunkf rom i tsmedi albor der.
 4l umbarar ter iesandv einsr unbehi ndt hemuscl e.
 Ret ainspusofPsoasabscess.
 Thi ckeni ngi nPsoasf asci acur v ingf rom bodyofL1orL2t oTransv erseprocessofL1i smedi anarcuate
l
igament( MAL) .
 Par tofPsoasabov eMALi sabov edi aphr agm ( int horax) .
 Sy mpat het ict runkpassesbeneat hMALf rom t hor axt oabdomen.
 Ner v esuppl y-L1- L3l umberner vesmai nlyL1.
 Act ioni sl atf l
exi onofv ert ebr al columnandassi st sinf lexionoft runk.
PSOASMI NOR
 Pr esenti n2outofev eryi ndi vidual .
 Li esonsur faceofPsoasmuscl e.
 Shor tbel lyar i
sef rom T12andL1.
 At tachedt oi liopubi cemi nence.
 Suppl iedbyL1ner ve.
 Aweakf l
exorofl umbarspi ne.
QUADRATUSLUMBORUM
 Li esedget oedgewi thPsoasmedi allyandTr ansv ersusabdomi nislateral
l
yi nParaver
tebralgutter.
 Li esi nant eriorcompar t mentofl umbarf asci a.
 Ar isesf rom Tr ansv er sepr ocessofL5.
 Ant er iorsur facei scov eredbyantl ay erofl umbarf ascia.
 Repr esent si nner mostl ay eroft he3muscul arlay er soft hebodywal l.
 Ner v esuppl y-T12, L1- L3( L4)l umbarner ves.
 Act ion-pr ev ent sdi aphr agm f rom el ev at i
ng12t hr ibdur i
ngi nspirati
on.
I
LIACUS
 Ar isef rom upper2/ 3ofi liacf ossa, innerl ipofi l
iaccr estandant eriorsacroil
iacli
gament .
 Inser tion-Psoast endont ol essert ronchant er.
 Cov eredbyst rongi liacf asci a.
 Ner v esuppl y-f emor alner ve.
 Act ion-wi thPsoasonhi pj oint .
FASCIAOFPOSTERI ORABDOMI NALWALL
 3f asci al lay er sencl ose2muscul arcompar tment s.
 Quadr at usl umbor um -ant erior
 Er ect orspi nae-post erior

27
 APOSTLEJOHN'
SSMARTANATOMYPREVI
EW

Vessel
sofpostabdomi nal wal l
 Vei nsl ieofr ightsi deofar t eries.
ABDOMI NALAORTA
 Passesbehi ndmedi anar cuat el igament
 Passesbet weent hecr uraofdi aphr agm onf rom ofT12body .
 I nclinessl i
ght l
yt ol eft
 Lef tsy mpat het ict runki sasi tsl ef tmar gi n.
 Di v i
dedi ntocommoni l
iacar ter iesonbodyofL4.
 Cr ossedbyspl eni cv ei nbet weenor i
gi nsofcoel iact runkandsuper iormesent ericarter
y.
 Bet weensuper iormesent er i
candi nf eriormesent ericar t
eri
esli
el ef trenal vein, uncinatepr
ocessand3r d
par tofduodenum.
 Sur facemar kingi s2. 5cm abov et r anspy l
or icpl anei nmi dli
netoapoi nt1or2cm bel ownor mal
lysit
uated
umbi li
cus( lev el wi thhi ghestpoi nt sofi l
iaccr est ).
 Medi ansacr al arter yl eavesaor taal i
t t
leabov ei tsbi furcat i
onandr unsi nmi dlineov ersacr
alpromontory
 Medi ansacr al arter yanat omoseswi thl at er al sacr al arteri
es
 1stbr anchofabdomi nal aor tai sI nfer i
orphr enicar teriesandmayar isemyacommonst em.
Phr eni car ter i
es
 Lef tphr eni car t
er ypassesbehi ndesophagus
 Ri ghtphr enicar ter ypassesbehi ndi nf er iorVenaCav a
 Phr eni car ter i
esgi v eofsmal lsupr ar enal branches
Supr ar enal
 Supr ar enal ar teriesar i
sebet weeni nfer iorphr eni candr enalbr
anches.
 Ri ghtsupr ar enal arter ypassesbehi ndi nf eriorVenaCav a
 Lef tsupr arenal ar terypassesbehi ndpost eriorwal lofl essersact or eachsupr ar enalgl
ands.
Renal ar teri
es
 Renal ar teri
esar i
seatr ightangl esf rom aor taatL2l ev el.
 Lef trenal arter yisshor tert hanr ight .
 Lef tcr ossesl ef tcr usandpsoasandi sbehi ndr enal vein(bothcov er edbyt ailofpancr easandspleni
c
vessel s) .
 Ri ghtcr ossesr ightcr usandpsoasbehi ndi nfer i
orVenaCav aandr ightr enal vein( t
heyseparat
ethear t
ery
from headofpancr easbi leductandsecondpar tofduodenum) .
 Eachgi vesof fsmal lsupr ar enal andur et ericbr anches.
 1or2accessor yr enal art
er iesf requent lyar isef rom aor t
abelowt hemai nar ter y
.
Gonadal arteries
 Ar i
sef rom nearf r ontofaor tabel owr enal ar teriesbutabov eoriginofi nferiormesent eri
c.
 St eepdownwar dsov erpsoasandgeni tof emor al ner ve.
 Ri ghtar teryf i
rstcr ossesI VC, ur et erandbei ngcr ossedbycol i
cv essel s.
 Ri ghtar teryi scr ossedby3r dpar tofduodenum.
 Thel eftar ter yiscr ossedbyi nf eriormesent er i
cv ein
 Test icul arar terypassesi nsper mat i
ccor dt ot est is
 Ov arianar ter yent erssuspensor yl igamentandpasst oov aryandut er i
net ube
Subcost alar teries
 Ar i
sef rom l owestpar toft hor aci caor ta
 Ent ersabdomenbeneat hl ater al ar cuat el igament
 Runsbet weensubcost alner v eandv ei nov erquadr atusl umborum behi ndki dney .
 Passesbet weeni nt er nalobl iqueandt ranv ersus( neur ov ascul
arpl ane) .

28
 APOSTLEJOHN'
SSMARTANATOMYPREVI
EW

Lumbarar teries
Ar e4i nnumber
Ar i
seopposi tebodi esofupper4v er tebr ae.
Theypassbehi ndl umbarsy mpat het ict runk
IVCov er l
iesl ower2andr ightcr ust heupper2ont her ightsi de.
Lef tcrusov erliesupper mostl ef tar tery.
Eachgi v espost er iorandspi nal br anchesandpassl at erallybehi ndquadr atusl umbor um.
4thpassesi nt oneur ov ascul arpl anei nf rontofl owerbor derofquadr atusl umbor um.
Ther e'sno5t hl umbarar ter y
Il
iolumbarar ter y
 Passesbehi ndobt ur atorner veandpsoasmuscl e.
Commoni li
acar ter i
es
 For medbyaor t i
cbi fur cat iononbodyofL4t ol eftofmi dline.
 Ri ghtar teryi sl ongert hant hel ef t.
 Ur eterliesi nf r ontofbi fur cat i
onorbegi nni ngofext er nal ili
ac.
 Lef tcommoni l
iaci scr ossedbyi nf er i
ormesent eric( super iorr ectal)v essel s.
 Sy mpat het i
ct r unkpassesbehi ndt hear ter y
 Eachi scr ossedbysy mpat het iccont r
ibut iont ohy pogast ricpl exus.
Ext ernal il
iacar ter y
 Passesbeneat hi ngui nal l
igamentt oent erf emor al sheat h
 I ts2br anchesar egi venof fabov et hel i
gament .
 Deepci rcumf lexi l
iacbr anchr unsabov ei ngui nal l
igament
 Bi fur cationofcommoni l
iacar ter iesi s3cm f rom mi dlinel ev el wi thtuber cleofi l
iaccr est
.
 Commoni li
acar ter i
escor respondt o1/ 3andext ernal il
iacar ter ies2/ 3ofl inef rom aor ti
cbif
urcat
iont
o
mi dpoi ntbet weenASI Sandpubi csy mphy si
s.
I
NFERI
ORVENACAVA
 Hasl ongercour set hanaor tainabdomen
 Begi nsopposi teL5v er tebr abehi ndr i
ghtcommoni li
acar tery .
 Runsupwar dsonr ightofaor t
a.
 Gr oov esbar ear eaofl iverandpi er cecent raltendonofdi aphr agm atT8l evel
 Li esonbodi esofl umbarv ertebr aeandr ightcr usofdi aphr agm.
 Cr ossesr ightr enal ,supr ar enal andi nferiorphr eni car teries.
 Par tl
yov erlapsr ightsupr ar enal gl andandcoel iacgangl i
on.
 Li esbehi ndper i
toneum ofpost er i
orabdomi nal wal lini nfracol iccompar tment
 Cr ossedbyr ootofmesent ery, rightgonadal arter yand3r dpar tofduodenum.
 I VCandi tst ribut arieshav enov al v esEXCEPTgonadal (especi all
ytest icular )art
er i
es.
 Sur facemar ki ngi s2. 5cm t or ightofmi dl inef rom i nt ertuber cul arplanet o6t hcost alcart
il
age.
 Hi ghestt r
ibut ar yi shepat icv ein.
Commoni li
acv ein
 For medi nf rontofsacr oiliacj oi ntbyuni onofi nter nal andext er nali
liacv eins.
 Femor al vei nent er sabdomenonmedi al sideofcor respondi ngar t
er y.
 The2commoni liacv einscont i
nueupwar dsmedi al tocor respondi ngar t
er i
es.
 Theyuni tebehi ndr i
ghtcommoni liacar ter y.
 Lef tcommoni l
iacv eini sl ongert hanr ight .
 Theyj oinal mostatr i
ghtangl eacr ossbodyofL5
Lumbarv eins
 Anast omoseant er ior l
ywi thepi gast ricv ei nsandpost eriorlywi t hvertebr alv einouspl exuses.
 The3r dand4t hempt yi nt oVenaCav a.

29
 APOSTLEJOHN'
SSMARTANATOMYPREVI
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 Thosef rom l ef tpassbehi ndaor taandbehi ndsy mpat hetictrunkbutoccasi onall

y1ormor emaybei nfr
ont.
 1stand2ndj oi nt heascendi ngl umbarv ein.
 Eachascendi ngl umbarv einj oinssubcost al veint of orm azy gosandhemi azygosv einsbef
ore3nteri
ng
thor ax.
Gonadal vei ns
 Eachi susual l
ypai red.
 The2comi tamt esuni teast heyr unuponPsoas.
 Ent er sVenaCav abel owr enal v einont her ight .
 Rightt est i
cul arv einmayoccasi onal lyjoi nt her enal vein.
 Leftgonadal veini nv ar i
abl yj oinsl ef trenal v ei
natr ightangl e.
 Test icul arv ei nshav ev alvesatt hei rter mi nat i
on.
 Valv esmaybepr esenti nt heov ar ianv eins.
Renal v eins
 Liei nf rontofr enal arter i
esandbehi ndpancr eas.
 JoinVenaCav aatr ightangl esatL2l ev el.
 LeftRVi s3t imesasl ongtasr ightRV( 7.5cm compar edt o2. 5cm)
 LeftRVcr ossesi nf rontofaor ta.
 LeftRVr eciev esl eftsupr ar enal ,lef tgonadal possi blyl efti
nfer i
orphrenicveins.
 RightRVusual l
ydr ainsonl yi tsownki dney .
Supr ar enal v eins
 LeftSupr ar enal Vei nr unsdownwar dsandmedi al l
yt ol eftRV.
 RightSupr ar enal Vei npasseshor izont allyt opost eriorofI VCbehi ndbareareaofl i
ver.
Infer i
orphr eni cv eins
 JoinVenaCav abel owt hel iver .
 Leftonemayj oi nl ef trenal orsupr arenal v einandmaybedoubl e.
ABDOMINALLYMPHNODESANDTRUNKS
 Preaor ticnodesar esi tuat edar oundor iginofcoel iac, superiorandi nfer
iormesent ericar
ter
ies.
 Par a- aor ticnodesl i
eal ongaor taator iginofpai redbr anchesofaor ta
 Commoni l
iacnodesdr ai nt opar a-aor ticnodes.
Cist er nachy li
 Situat edunder cov erofr i
ghtcr usi nf rontofbodi esofL1andL2.
 Liesbet weenaor taandazy gosv ein.
 Itsupperendi scont i
nuouswi tht hor aci cduct .
NERVES
SOMATICNERVES
 Emer gef rom i nt er ver tebr al for ami naanpassi ntosubst anceofPsoasmaj or
 Givesegment al br anchest osuppl yPsoasandquadr atuslumbor um.
Lumbarpl exus
 Iswi thint hesubst anceofPsoas.
 Mostoft hebr anchesar ef orl owerl i
mbsuppl y.
 T12andL1par tici pat ei nsuppl yofant eriorabdomi nal wall.
 L2t oL4gi vebr anchest opost er iorabdomi nal wal l(Psoasandquadr atuslumbor um)andpar ti
cipat
ein
format ionofner v est of lexorandext ensorcompar tment soft high.
 Apar tofL4andal l L5passdownasl umbosacr al t
runk.
 Ner v esf orsuppl yofant er iorabdomi nal wal lcr ossesant eri
orsur faceofquadr at
usl umborum (
i.
e.subcost
al,
il
iohy pogast ricandi l
ioingui nal ner ves) .
Subcost al ner ve
 Passbehi ndl at eral arcuat el igament .

30
 APOSTLEJOHN'
SSMARTANATOMYPREVI
EW

 Liesbel owsubcost alar teryandv ein

 Passest hrought ransv ersusabdomi nis
 Endsbysuppl yingl owerpar tofr ectusabdomi nis
 Lateral cut aneousbr anchpi ercesobl iguemuscl est osuppl yskinofant er
iorpartofbut t
ock( betweeni l
iac
crestandgr eat ert ronchant er)
Il
i
ohy pogast r i
candi l
ioingui nal ner ves
 Lieinf rontofquadr atusl umbor um atal llev els
 Bothar i
sef r
om ant eriorr amusofL1.
 Il
i
oingui nal repr esent scol lateral branchofi li
ohy pogast r i
c.
 Theyemer gef rom l ater albor derofPsoasmaj or
 Theypi erceant er iorlay erofl umbarf asciaast heysl opeacr ossquadr atuslumbor um behi ndki dney .
 Theypassi nf r
ontoft ransv ersusabdomi ni s.
Il
i
ohy pogast r i
cner ve
 Collateral branchpi erceobl iguemuscl estosuppl yski nofupperpar tofbut tocksbehi ndar easuppl iedby
subcost al.
 Piercei nt ernal obl iqueabov eASI S.
 Pierceext er nal obl i
que2. 5cm abov esuper ficial i
ngui nal ring.
 Endsbysuppl yingsupr abi cski n.
Il
i
oingui nal ner v e
 Entersi ngui nal canal andemer gest hr oughsuper fi
cial inguinal ri
ng.
 Piercesext er nal sper mat i
cf asciat obecomesubcut aneous.
 Suppl i
esant erior1/ 3ofscr otum ( monspubi sandl abiamaj us),rootofpeni s( cl
itoris)andupperandmedi al
partofgr oi n.
 Givesmot orbr anchest omuscl efibresofi nt ernal obliqueandt ransv ersus(insertedi nt oconjointtendon-
i
mpor tantmai nt ainingi ntegr i
tyofi ngui nal canal ).
Lateral femor al cut aneousner ve
 Formedbyuni onoff ibr esf rom post eriordi visionsofant eri
orrami ofL2andL3.
 Emer gef rom l at eral bor derofPsoasmaj or .
 Passesonsur faceofi liacusmuscl edeept oi l
iacf asci a, posteri
ort ocaecum onr ightanddescendi ngcol on
onlef t
.
 Perforat esi ngui nal li
gament1cm f rom ASI S.
 Suppl i
espar i
et al per i
t oneum ofi li
acf ossa.
Femor al ner v e
 Formedi nsubst anceofPsoasmaj orbyuni onofpost er i
ordi vi
sionsofant eriorrami ofL2t oL4.
 Emer gesf rom l at er albor derofPsoasi niliacf ossa.
 Givesbr anches( L2andL3)t oili
acus.
 Passesbeneat hi ngui nal l
igamentonl ateral sideoff emor alsheat h.
Geni t
of emor al ner v e
 Formedi nsubst anceofPsoasmaj orbyuni onofbr anchesf rom L1andL2.
 Emer gesf rom ant er i
orsur faceofPsoasmaj orandr unsdownont hemuscl edeept opsoasf ascia.
 Thel eftner v ei sov erlai dbyur eter,gonadal v essel s,ascendi ngbr anchesofl eftcol i
car teryandi nferior
mesent er icv ein.
 Rightner v ei sov er l
aidbyur eter ,gonadal v essel s,ileocol icar t
eryandr ootofmesent eryofsmal lintestine.
 Perforat espsoasf asci aabov ei ngui nal l
igamentanddi videintogeni tal andfemor albr anches.
 Femor al br anchi sL1andgeni tal branchi sL2.
 Geni t
al br anchsuppl iescr emast ermuscl es, sper mat i
cf ascia,tunicav aginalisofr etet esti
s,smal lareaof
skinofscr ot um andmonspubi sandl abiamaj us.
 Femor al br anchpassesdownbehi ndi ngui nal ligamentwi t
hf emor alartery,supplyski nov erupperpar tof

31
 APOSTLEJOHN'
SSMARTANATOMYPREVI
EW

femor al triangl e.
Obt urat orner ve.
 Emer gef rom medi al bor derofPsoaswi t
hl umbosacr altrunkt oent erpelv i
s.
AUTONOMI CNERVES
 Coel i
acpl exusi swhol lyv iscer al andsuppl iesabdomi nal or gansi ncl udinggonads.
 Gangl ionat edLumbart runksuppl iessomat icbr anchesf orl owerabdomi nal wal landl owerl imbs.I tsvisceral
branchsuppl yonl ypel v i
cor gans.
 Par asy mpat het icsuppl yi sbyv agusf rom abov eandpel vicspl anchni cner vesf rom bel ow( it
'swhol l
yvisceral
)
 Vagusbr ancht ocoel iacpl exusandpel vicspl anchni csj oi nt hei nf er i
orhy pogast r
icplexus.
SYMPATHETI CNERVES
 Lumbarpar tofsy mpat het ict runkr eci ev espr egangl ionicf i
bresf rom L1andL2ner ves.
 Sy mpat het ict runkpassesdownacr osspel vicbr i
m behi ndcommoni li
acv essel stobecomesacr alpartof
thet runk.
 Lumbarpar tent er sabdomenbypassi ngbehi ndmedi al arcuat el igamentonf rontofPsoasmaj orandr uns
downonmedi al mar ginofPsoasmuscl e.
 Itl i
esi nf rontofl umbarar t er i
esandv eins( segment al vessel s).
 Somel umbarv einsmaypassi nf r ontoft het runk.
 Lef tlumbart runkl iesbesi del ef tmar ginofaor ta,wi thpar a-aor ti
cnodesi nf r
ontofi t
.
 Ri ghtl umbart runkl i
esbehi ndI VC.
Lumbargangl ia
 Whi ter ami communi cat ef rom f i
r st2l umbarner vesjoint het runkandr elayinl umbarandsacr al gangli
a.
 Gr eyr ami communi cat ef rom l umbargangl iaaccompanyl umbarar teri
es.
 Vasoconst rictorf ibref orf emor al ar ter yandi tsbr anchest r
av elinf emor al nerve.
 Lumbarspl anchni cner vesar i
sef r om al llumbargangl i
a.
 Thosef rom t he1stand2ndgangl i
apasst opl exusesi nf rontoft heaor ta.
 Thosef rom 3r ddand4t hgangl iapassr espect ivelyinf rontandbehi ndcommoni li
acar teries.
Super iorhy pogast ricpl exus
 Li esant er iort ot heaor ti
cbi furcat ionandt hel ef tcommoni l
iacv eini nfr
ontofL5v ert
ebr aandsacr al
promont or y.
 Li esbehi ndt hepar ietal per itoneum.
 Itof tenl i
esal i
ttlet ot hel ef tofmi dl ine.
Coel i
acpl exus
 Li esar oundor iginofcoel i
act runkabov eupperbor deroft hepancr eas.
Great erandl esserspl anchni cner v es
 Pi ercecr ur aofdi aphr agm andent ercoel iacgangl ia.
 Coel i
acgangl ial i
ei nf rontoft hecr ur a, r
ightonebehi ndI VCandl ef tbehi ndspl eni carter y.
 Spl anchni cner vesar eal mostpr egangl i
oni candmanyr elayi ncoel iacgangl i
a.
 Leastspl anchni cr elay si nasmal renal gangl ionbehi ndr enal arter y .
 Renal plexusi sbehi ndr enal art ery .
 Test i
sandov aryar esuppl iedsy mpat het icpl exust hataccompanygonadal arter y
.
 Pr egangl ioni cf ibresf rom gr eat erspl anchni cner v
epasswi t
houtr el ayt ocel l
sofSupr ar enal medul la.
 Vasomot orsuppl yt oSupr ar enal gl andr eachespost gangl ionicf ibr eswhi chhav er elayedi ncoel iacgangl i
on.
PARASYMPATHETI CNERVE
 Wi t
hr elayt heyaccompanypost gangl i
oni csy mpat heticf ibres
Pelv i
cspl anchni cner ves
 Fr om cel l bodi esi nlat eral hor nofsacr al segment2t o3or4.
 Theyj oini nf er i
orhy pogast ri
cpl exusf ordi stribut i
ont opel v i
cv iscer a.
 Fi brespassi ngt ol ef tofsuper iorhy pogast ricpl exusar iseupoutofpel v
is.Theysuppl yt helargei ntest
ine.

32
 APOSTLEJOHN'
SSMARTANATOMYPREVI
EW

 Vagusi si nhi bitor yt opy loricsphi nct er .

 Vagusi smot orandsecr etomot ort ogut sandi t sgl andsdownt ot ransversecol on.Pel vicsplanchnictakes
overf rom spl eni cf l
exur e.
 Sensor yf ibr esar epr esenti nv agusandpel vicspl anchni cs.
KI
DNEYS
 Li
ebehi ndper itoneum l ar gelyunder cov erofcost al mar gin.
 Onl ythei rl owerpol escanbepal pat edi nnor mal individual .
 Eachl i
esobl i
quel ywi thi tslongaxi spar allelwi thl ater al bor derofPsoasmaj or.
 Measur es12x6x3cm
 Rightki dneyl iesj ustbel owandt hel ef tabov et het ranspy lor icpl ane5cm f rom t hemi dl i
ne.
 Thebul koft her i
ghtl obeofl i
v eraccount sf ort hel owerposi tionoft her i
ghtki dney .
 Upperpol eoft hel ef tkidneyov erliest he11t hr ib.
 Upperpol eoft hel ef tkidneyov erliest he12t hr ib.
 Eachki dneymov es2cm v er ti
cal lydur ingf ullinspi ration.
 Pelv i
semer gesf rom hi lum behi ndt hev essel s.
 Post eriorr elat i
onofbot hki dney sar edi aphr agm andquadr atusl umbor um, over lappi ngmedi al
lyonPsoas
andl at eral lyont ot ransv ersusabdomi nis.
 Upperpol esl ieonf ibr esofdi aphr agm ar isingf rom l ater al andmedi arcuat eligament s.
 Asmal ltr i
angul arpar tofCost odi aphr agmat icr ecessoft hepl eur ai satriski nl umbarappr oacht othekidney
.
 Subcost al vein, arter yandner veemer gingbeneat hlat eral ar cuat eligamentl iebehi ndt hekidneyasdo
i
li
ohy pogast ricandi lioingui nal ner v es.
 Hilum l iesov erPsoasandt heconv exi tyliesont heaponeur osi sofor i
ginoft ransv ersusabdomi ni
s.
 Supr arenal glandov er l
apasmal l par tofant er iorsur face.
 Restofupperhal vesofr estofeachki dneyl i
ei ncont actwi thper itoneum.Ont her ighti sperit
oneum of
hepat or enal pouchandonl efti sper itoneum ofl essersacmedi al l
yandgr eatersacl at eral
l
y .
 Hilum i ssepar at edf rom per it
oneum onr ightby2ndpar tofduodenum andonl ef tbybodyofpancr easand
spleni cv essel s.
 Lateral par tofl owerpol ei ssepar at edf rom per itoneum byhepat icandspl eni cf lexur es.
 Medi al par toft hel owerpol eoneachsi del i
ei ncont actwi thper itoneum separ at ingi tf r
om coilsofjejunum.
 Bet weenper itoneum andki dneyar eascendi ngbr anchesofr ightsandl eftcol icar teries.
 Renal fasci ar est rainsext ensi onofper inephr i
cabscess.
 Fasci al sept um separ ateski dneyandSupr arenal gl
and.
 Atl ateral renal bor dert heant er iorandpost eriorl ay ersf use.
 Renal fasci ai sat t
achedt or enal v essel sathi lum.
 Renal fasci af adesi ntoi nt oext raper itoneal tissuear oundur eter.
Renal pel v i
s
 Usual lyt hemostpost erioroft he3mai nst r
uct ur esi nt hehi lum.
 Capaci tyofav er agepel v isisl esst han5ml .
Bloodsuppl yandsegment s
 Renal ar teriesl eav eabdomi nal aor taatr i
ghtangl esandl i
ebehi ndt hepancr easandr enalveins.
 Eachki dneyposses5segment sbasedonbl oodsuppl y.
 Post eriordi v i
si onofRAsuppl i
espost eriorsegmentwhi leant eriorgi vebr anchest hatsuppl yapical,upper,
middl eandl owersegment s.
 Ther e'snocol lat eral ci r
cul ationbet weent hef ivesegment s.
 Abnor mal renal arter iesar enotusual lyaccompani edbyv ei ns.
Lymphdr ai nage
 Lymphat icsdr aint opar a-aor ti
cnodesatl ev el ofr enal arter iesor igin(L2)

33
 APOSTLEJOHN'
SSMARTANATOMYPREVI
EW

Ner vesuppl y
 Sy mpat het icpr egangl ioniccel l
sl ieinspi nal cor df rom T12t oL1segment .
 Af fer entfibr esi ncl udi ngt hosesubser v i
ngpai naccompanysy mpat het i
cner ves.
 Someaf ferent smaypossi blyrunwi thv agal .
URETERS
 Theur eteri s25cm l ong.
 Nar rowestpoi nti spel vi
ur etericjunct i
onwher ei tcr ossespel vi
cbr im.
 I tpassesdownonPsoasmaj ori nf rontofgeni tofemor al nervebei ngcr ossedant eri
orl
ybygonadal vessel
s.
 Onr i
ghtt heupperpar tisbehi nd3r dpar tofduodenum whi l
elowerdowni t
'scrossedant eriorl
ybyrightcol
ic
andi l
eocol icv essel sandr ootofmesent ery.
 Onl ef titi
sl ater al t oi nferiormesent eri
cv essel sandi scr ossedant eriorl
ybyl eftcoli
cv essels,andatpelvi
c
brim byapexofsi gmoi dmesocol on.
 Leav espsoasmuscl eatbi furcationofcommoni liacar ter yov ersacr oil
iacjoint.
 I tisawhi tishnonpul satilecor dwhi chshowsper istalt
icact i
v i
tywhengent l
ypi tched.
Sur facemar king
 Ti pof9t hcoast al car ti
laget obi f
ur cationofcommoni li
acar teryonant eri
orabdomi nalwall.
 I tli
esmedi al tot het ipsoft ransv ersepr ocessesoft hel umbarv ertebrae.
Bloodsuppl y
 Upperpar tissuppl i
edbyur etericbr anchofr enal ar t
ery
 Lowerendi sbybr anchesf rom i nfer i
orandsuper iorvesi cal andut erinear t
eries.
Lymphdr ainage
 Abdomi nal por ti
ondr ai nint opar a-aor ticnodes.
 Pel v icpor ti
ondr ainsi ntocommoni li
acandi nter nal il
iacnodes.
Ner vesuppl y
 Sy mpat het icfibr esi sf rom T10t oL1.Theyr eacht hecor dv iacoel iacandhy pogast r
icplexuses.
 Par asy mpat heticf ibresar ef rom pel vi
cspl anchni cner ves.
 Pai nf i
bresaccompanysy mpat heticner vessamewi thki dney .
SUPRARENALGLANDS
 Theyl i
eant erosuper iort oupperpar tofeachki dney .
RightSupr ar enal gl and
 Py r
ami dal i
nshape.
 Li esondi aphr agm andencr oachesonf rontoft her i
ghtki dney .
 Ant eriorsur facei sov erlappedmedi allybyI VC.
 Restofant er i
orsur facei si ncont actabov ewi thbar ear eaofl i
v er
.
LeftSupr arenal gl and
 Cr escent i
ci nshape.
 Dr apesov ermedi al bor derofl eftki dneyabov et hehi l
um.
 I tli
esonl ef tcr usofdi aphr agm andov er l
apst hef rontofl ef
tki dney .
 Upperpar tofant er i
orsur facei scov eredbyper itoneum ofpost eriorwal loflessersac
 Lowerpar tisi ncont actwi thbodyofpancr easandt hespl enicv essels.
Bloodsuppl y
 Ther e'susual l
yasi ngl ev ein.
 Thel
eftv
eini
slongerandent
ersl
eftr
enal
vei
n.

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