ANATOMY OF THE ABDOMEN

Prepared by: Kessy Innocent, MD

Contents
 Introduction
• The abdomen is the part of the trunk between the thorax and the pelvis.
• It is a flexible, dynamic container, housing most of the organs of the
alimentary system and part of the urogenital system.
• Containment of the abdominal organs and their contents is provided by
musculo-aponeurotic walls anterolaterally, lumber vertebra posteriorly, the
diaphragm superiorly, and the muscles of the pelvis inferiorly.
• Through voluntary or reflexive contraction of the abdomen, its muscular
roof, anterolateral walls, and floor can raise internal (intra-abdominal)
pressure to aid expulsion of air from the thoracic cavity (lungs and bronchi)
or of fluid (e.g., urine or vomitus), flatus, feces, or fetuses from the
abdominopelvic cavity
• There are about 7 layers of the anterolateral abdominal wall. These includes,
1. Skin (epidermis, dermis, subcutaneous tissue).
2. Superficial fascia [camper’s fascia + scarpa’s fascias).
3. Deep fascia Note: deep fascia are found in btn each muscle layer.
4. Muscles of abd wall (5 muscles)
3 lateral muscles: External oblique muscle, Internal oblique muscle, Transversus
abdominis muscle.
2 vertical muscles: Rectus abdominis muscle, Pyramidalis muscle [absent in 20% of
people]).
5. Rectus shealth: layer covering rectus abdominus and pyramidalis muscles. This layer
is formed by aponeurosis of 3 anterolateral muscles (external oblique, internal oblique and
transverse abdominis).
6. Extraperitoneal fascia/ endoabdominal fascia or fat.
7. Peritoneum (parietal peritoneum - visceral peritoneum).
External oblique muscle
• Its fibres run inferomedially and
become aponeurotic approximately
at midclavicular line.
• Aponeurosis of e.o.m contributes to
formation of rectus sheath
(anteriorly) and the Inguinal
ligament (inferiorly- folded
inferiorly to form inguinal ligament
+ inguinal rings i.e passage for
spermatic cord in males)
Internal oblique muscle
• Its fibres run superomedially &
become aponeurotic at
midclavicular line.
• Lies deep to external oblique
muscle.
• Its aponeurosis together with of
other 2 muscles forms the rectus
shealth anteriorly.
Transversus abdominis muscle
• This is a thin sheet of muscle
deep to internal oblique
• Its fibres runs horizontally and
end in aponeurosis which
contributes to the formation of
rectus sheath.
Rectus abdominis muscle
• T hi s i s a l ong st ra p m usc l e ,
broader above and narrow
inferiorly.
• It runs vertically and divided into
segments by 3 or more tendinous
intersections.
• It is enclosed between
aponeuroses of external oblique,
internal oblique and transversus
abdominis muscles (the, rectus
shealth).
Rectus sheath
• Fibrous sheath enclosing rectus abdominis Conjoint tendon
and pyramidalis muscles.
• Formed by decussation and interweaving
Conjoint tendon is formed by
of the aponeuroses of the 3 lateral lowest fibres of the internal
abdominal muscles. oblique & transversus
• The aponeuroses then interweave with abdominis muscles attached
their fellows of the opposite side, forming to pubic crest & pecten pubis.
a midline raphe (G. rhaphe, suture, seam),
the linea alba (L. white line), which
extends from the xiphoid process to the
pubic symphysis.
• Umbilical ring is the defect at the middle
of the linea alba through which fetal
umbilical vessels pass to & from
umbilical cord and placenta during fetal
period.
 FUNCTION OF ANTROLATERAL ABD WALL:
The muscles of the anterolateral abdominal wall:

• Form a strong expandable support for the anterolateral abdominal wall.

• Support the abdominal viscera and protect them from most injuries.

• Compress the abdominal contents to maintain or increase the intra-

abdominal pressure and, in so doing, oppose the diaphragm (increased
intra-abdominal pressure facilitates expulsion).

• Move the trunk and help to maintain posture.

 Blood supply of antlat. abdominal wall
Arterial supply
• Superior epigastric artery
• Inferior epigastric artery
• Deep circumflex iliac artery
• Lowest two posterior intercostal
arteries
• Four lumbar arteries
• Superficial circumflex iliac artery
• Superficial epigastric arteries
Venous drainage
• Superficial veins: Form a network
that radiates out from umbilicus ->
Drained above by lateral thoracic
vein into axillary vein, Drained
below by superficial epigastric vein
into femoral vein, Paraumbilical
veins connect umbilical veins to the
portal vein along the ligamentum
teres.
• Deep veins: Include superior and
inferior epigastric, posterior
intercostal and deep circumflex iliac
veins.
Lymph drainage
• Superficial lymph vessels above
the level of umbilicus drain into
axillary nodes.
• Superficial lymph vessels below
the level of umbilicus drain into
superficial inguinal nodes.
• Deep lymph vessels follow the
arteries and drain into internal
thoracic, external iliac, posterior
mediastinal and para-aortic
nodes.
• Dermatomes and nerve supply of
antlat abd wall
 QN (short answers)
01. The second layer of anterior abdominal wall is? .................
02. Mention 5 muscles of anterolateral abdominal wall.
.......................
.......................
.......................
.......................
.......................
03. Conjoint tendon is forms by tendons of which muscles?
04. Rectus shealth is the continuous of aponeurosis of which muscles?
• Abdominal cavity is contains most of abdominal visceras i.e digestive
organs, spleen, kidneys etc.
• Abdominal cavity is separated from thoracic cavity by the diaphragm and
is continuous inferiorly with pelvic cavity.
• The abdomen is divided into regions and quadrants for descriptions of
location of abdominal organs or pain in clinical practice.
• There are 4 quadrants and 9 regions.
QUADRANTS REGIONS
- Right upper quadrant (RUQ) • Right hypochrondriac region
- Left upper quadrant (LUQ) • Epigastric region
- Right lower quadrant (RLQ) • Left hypochondriac region
- Left lower quadrant (LLQ)
• Right lumbar region
• Umbilical region
• Left lumbar region

• Right iliac/ inguinal region

• Hypogastric region
• Left iliac/ inguinal region
 Abdominal quadrants
• Four abdominal
quadrants defined by
two planes( horizontal
or transumblical and
vertical or median
plane).
• QNS (home work)
01. MENTION ORGANS FOUND IN RUQ

02. MENTION ORGANS FOUND IN LUQ

03. MENTION ORGANS FOUND IN RLQ

04. MENTION ORGANS FOUND IN LLQ

 Abdominal regions
• Nine abdominal regions
divided by 2 horizontal
lines (subcostal and
transtubercular planes)
and 2 vertical lines
(midclavicular planes).
• Organ distribution in relation to 9 abdominal regions;
 Clinical anatomy
• ABDOMINAL DISTENSION
- Common causes of abdominal distension:
5F (feaces, flatus, fat, fluild, fetus).

• ABDOMINAL SURGICAL INCISIONS

• INGUINAL CANAL.

• ABDOMINAL HERNIAS (ventral

hernias): Inguinal hernia, Umbilical
hernia, Epigastric hernia, Incisional
hernia.

• HIATAL HERNIA.
• The abdominal cavity is contained in a fibrous membrane called
PERITONEUM.
• There are 2 types of peritoneal lining: Parietal peritoneum and Visceral
peritoneum separated by a space btn them called peritoneal cavity/ space
containing peritoneal fluid.
Parietal peritoneum: Deep lining/ internal surface of abdominopelvic wall.
Visceral peritoneum: Invests the viscera e.g. stomach & spleen
Intraperitoneal organs are
almost completely covered with
visceral peritoneum (e.g., the
stomach and spleen).
Intraperitoneal in this case does
not mean inside the peritoneal
cavity (although the term is used
clinically for substances injected
into this cavity).

Extraperitoneal [retroperitoneal,
and subperitoneal] organs are
also outside the peritoneal cavity/
external to the parietal
peritoneum and are only partially
covered with peritoneum (usually
on just one surface).
 OMENTUM
• Omentum is a double-layered extension or fold of peritoneum that passes from the
stomach and proximal part of the duodenum to adjacent organs in the abdominal cavity.
• It is divided into greater and lesser omentum.
NB- Omentum also plays a role in immunity to localize intraperitoneal infections and
prevent spread.

• The greater omentum is a prominent, four-layered peritoneal fold that hangs down like
an apron from the greater curvature of the stomach and the proximal part of the
duodenum. After descending, it folds back and attaches to the anterior surface of the
transverse colon and its mesentery.
• The lesser omentum is a much smaller, double-layered peritoneal fold that connects the
lesser curvature of the stomach and the proximal part of the duodenum to the liver. It
also connects the stomach to a triad of structures that run between the duodenum and
liver in the free edge of the lesser omentum.
 clinical anatomy

• PERITONITIS: Inflammation of peritoneum. It can be as the result of

infection or non infectious (chemical perionitis).

• ASCITIS: Excess fluid in the peritoneal cavity.

• PERITONEAL ADHESIONS: Fibrous tissue formation in btn the

peritoneal surface. Commonly occurs after abdominal surgeries ->
peritoneal healing by fibrosis.
• The viscera of the abdomen comprise the majority of the alimentary system
(terminal part of the esophagus, stomach, intestines), spleen, pancreas, liver,
gallbladder, kidneys, and suprarenal/ adrenal glands.
• When the abdominal cavity is opened to study these organs, it becomes
evident that;
01. the liver, stomach, and spleen almost fill the domes of the diaphragm.
Because they indent the thoracic cavity, they receive protection from the lower
thoracic cage.
02. the falciform ligament normally attaches along a continuous line to the
anterior abdominal wall as far inferiorly as the umbilicus. It divides the liver
superficially into right and left lobes.
03. The greater omentum, when in its typical position, conceals almost all of
the intestine.
04. The gallbladder projects inferior to the sharp border of the liver.
The alimentary canal (digestive system)
 EOSOPHAGUS (lower part)
• Majority of eosphagus is in the thoracic cavity, however the lower pary is in the abdominal cavity.
• It is also called food pipe.
• The esophagus is a muscular tube (approximately 25 cm long) with an average diameter of 2 cm
that conveys food from the pharynx to the stomach.
• Esophagus normally has three constrictions where adjacent structures produce impressions:
[a] Cervical constriction (upper esophageal sphincter): at its beginning at the pharyngoesophageal
junction, approximately 15 cm from the incisor teeth; caused by the cricopharyngeus muscle.
[b] Thoracic (broncho-aortic) constriction: a compound constriction where it is first crossed by the
arch of the aorta, 22.5 cm from the incisor teeth, and then where it is crossed by the left main
bronchus, 27.5 cm from the incisor teeth.
[c] Diaphragmatic constriction (lower eosophageal shincter): where it passes through the esophageal
hiatus of the diaphragm, approximately 40 cm from the incisor teeth.
• The esophagus:
- Just posterior to the trachea.
- Has two layers of muscle: circular muscle (inner muscle layer composed of
smooth muscles) and longitudinal muscles (outer muscle layer composed of
voluntary striated muscles).
- Food passes through the esophagus rapidly because of the peristaltic action of
its musculature, aided by but not dependent on gravity (one can still swallow if
inverted).
- It passes thru the esophageal hiatus in the diaphragm to connect with the
stomach.
- Is encircled by the esophageal nerve plexus distally.
• Arterial supply: The arterial supply of the abdominal part of the esophagus is
from the left gastric artery and the left inferior phrenic artery.
• Venous drainage: esophageal veins and left gastric vein.
• Lymphatic drainage: into the left gastric lymph nodes.
 STOMACH
• The stomach is the expanded part of the digestive tract between the
esophagus and small intestine.
• It is specialized for the accumulation of ingested food, which it chemically
and mechanically prepares for digestion and passage into the duodenum.
• The stomach acts as a food blender and reservoir; its chief function is
enzymatic digestion. The gastric juice gradually converts a mass of food into
a semiliquid mixture, chyme (G. juice), which passes fairly quickly into the
duodenum.
• An empty stomach is only of slightly larger caliber than the large intestine;
however, it is capable of considerable expansion and can hold 2–3 L of food.
• The stomach has 4 parts: cardia, fundus, body, pylorus part.
• It has 2 curvatures.
• Arterial supply: The rich arterial supply of the stomach arises from the
celiac trunk and its branches which forms anastomoses along the lesser
curvature [right and left gastric arteries, right and left gastroepiploic arteries,
posterior gastric arteries].
• Venous drainage: The veins of the stomach parallel the arteries in position
and course.
• Nerve supply: The parasympathetic nerve supply of the stomach is from the
anterior and posterior vagal trunks (vagus nerve) and their branches.
Sympathetic nerve supply of the stomach, from the T6 through T9 segments
of the spinal cord.
 SMALL INTESTINE

• The small intestine, consisting of 3

parts: duodenum, jejunum, and
ileum.
• It is the primary site for absorption
of nutrients (both macro and micro
nutrients) from ingested materials
and water.
• Small intestine is about 6 - 7meter
long and it extends from the pylorus
to the ileocecal junction where the
ileum joins the cecum.
• DUODENUM: The duodenum is the first and shortest (25 cm) part of the
small intestine, is also the widest and most fixed part. The duodenum
pursues a C- shaped course around the head of the pancreas. It begins at the
pylorus on the right side and ends at the duodenojejunal flexure (junction)
on the left side at level of L2. Duodenum has 4 parts [1st, 2nd, 3rd, 4th
parts].
• JEJUNUM: The second part of the small intestine which begins at the
duodenojejunal flexure. It is about 2/5 long of small intestine.
• ILEUM: third part of the small intestine which ends at the ileocecal junction,
the union of the terminal ileum and the cecum. It is about 3/5 long of small
intestine.
how to differentiate jejunum and ileum
• Arterial supply: major blood
supply of small intestine is from
SMA [superior mesenteric artery]
• Venous drainage: SMV
(superior mesenteric vein) →
hepatic portal vein
• Lymph drain: mesenteric LN.
• Nerve supply: The sympathetic-
superior mesenteric nerve plexus.
Parasympathetic- vagal trunks.
 LARGE INTESTINE
• The large intestine is responsible mainly for water absorption (water which
was not absorbed in small intestine i.e from the indigestible residues of the
liquid chyme) and conerting undigested foods into semisolid stool or feces
that is stored temporarily and allowed to accumulate until defecation occurs.
• The large intestine consists of 4 parts: the cecum & appendix, colon [ascending
colon, transverse colon, descending colon, and sigmoid colon], rectum, and anal canal.
• It is differentiated from small intestine by presence of;
- Omental appendices: small, fatty, omentum-like projections.
- Teniae coli: three distinct longitudinal muscular bands.
- Haustra: sacculations of the wall of the colon between the teniae.
- Also it has much greater caliber (internal diameter).
• Arterial supply: Caecum to transverse colon- SMA [Superior mesenteric
artery]. Descending colon to anal canal- IMA [Inferior mesenteric artery].
• Venous drainage: SMV + IMV + splenic vein → hepatic portal vein.

• RECTUM: Plays a role for temporary storage of feces until passed out during
defication. When it distends, the persons feel urge to deficate.

• ANAL CANAL and ANUS: Expells feces from rectum.

 Clinical anatomy (GI system)
• GI malignancies/ cancers (oesophagus - anal canal).
• Upper GI bleeding vs Lower GI bleeding.
• Peptic Ulcer Diseases (PUD).
• Acute abdomen: Appendicitis, Intestinal obstruction, Peritonitis, Bowel
perforation.
• Colostomy and Illeostomy.
• Diverticular (outpoaching of intestinal wall eg meckel diverticulum) and
Diverticulitis. “abd pain relieved by passing flatus”
• Endoscopic procedures: OGD/ EGD vs colonoscopy.
 SPLEEN
• The spleen is an ovoid, usually
purplish, pulpy mass about the
size and shape of one's fist.
• It is relatively delicate and
considered the most vulnerable
abdominal organ.
• The spleen is located in the
superolateral part of the left
upper quadrant (LUQ), or
hypochondrium of the abdomen,
where it enjoys protection of
the inferior thoracic cage.
 • Functions of spleen:

- It is the largest of the lymphatic organs, it participates in the body's defense system as a
site of lymphocyte (white blood cell) proliferation and of immune surveillance and
response ie clearing of encapsulated bacteria.
- Blood cell formation (hematopoiesis) in utero and early childhood.
- Clearance of old, abnormal blood cells and non functional blood cells from the
circulation.
- The spleen serves as a blood reservoir, storing RBCs and platelets, and, to a limited
degree, can provide a sort of “self-transfusion” as a response to the stress imposed by
hemorrhage.

NB:
01. In spite of its size and the many useful and important functions it provides, it is not a
vital organ (not necessary to sustain life).
02. When it is hardened and enlarged, it moves inferior to the left costal margin, and its
superior (notched) border lies inferomedially.
• Arterial supply: The arterial supply of the spleen is from the splenic artery,
the largest branch of the celiac trunk.
• Venous drainage from the spleen flows via the splenic vein, formed by
several tributaries that emerge from the hilum. It is joined by the IMV and
runs posterior to the body and tail of the pancreas throughout most of its
course. The splenic vein unites with the SMV posterior to the neck of the
pancreas to form the hepatic portal vein.
Clinical anatomy

• Splenic injury (laceration to shattered spleen).

• Splenomegally.

• Splenectomy.
 PANCREAS
• The pancreas is an elongated, accessory digestive gland that lies
retroperitoneally, overlying and transversely crossing the bodies of the L1
and L2 vertebra.
• It lies posterior to the stomach between the duodenum on the right and the
spleen on the left.
• Function of pancreas: Pancreas has both an endocrine and exocrine functions.
- Endocrine function; secretes insulin and glucagon via Inslet of langerhan
cells (plays role in glucose metabolism).
- Exocrine function; secretes digestive juices (lipase, amylase, protease etc)
via acinar cells.
• For descriptive purposes, the pancreas is divided into four parts: head, neck,
body, and tail.
• The main pancreatic duct begins in the tail of the pancreas and runs through
the parenchyma of the gland to the pancreatic head: here it turns inferiorly and
is closely related to the bile duct.
• The main pancreatic duct and bile duct usually unite to form the short, dilated
hepatopancreatic ampulla (ampulla of Vater), which opens into the descending
part of the duodenum. [sphincter in ampulla of vater = sphincter of Oddi]
• Arterial supply: The arterial supply of the pancreas is via pancreatic arteries
which are branches from tortuous splenic artery.
• Venous drainage: Venous drainage from the pancreas occurs via
corresponding pancreatic veins, tributaries of the splenic and superior
mesenteric parts of the hepatic portal vein; most empty into the splenic vein.
 LIVER
• The liver is the second largest organ in the body after the skin.
• It weighs approximately 1500 g and accounts for approximately 2.5% of adult
body weight. In a mature fetus when it serves as a hematopoietic organ, it is
proportionately twice as large (5% of body weight).
• Due to its many key functions, the liver is considered vital (necessary for life
and body functions).
• The liver lies mainly in the right upper quadrant of the abdomen, where it is
protected by the thoracic (rib) cage and the diaphragm. The normal liver lies
deep to ribs 7–11 on the right side and crosses the midline toward the left
nipple. The liver occupies most of the right hypochondrium and upper
epigastrium and extends into the left hypochondrium.
• The liver has 2 main lobes: right and
left lobes.

• It also has 4 ligaments which

provides attachment to the
diaphragm and peritoneum.

• Liver secretes bile, which is then

stored in the gallbladder before it is
poured into the intestines via biliary
tree.
• On the posterior surface, the liver
has portal triad (bile duct, hepatic
artery, and hepatic portal vein)
which enters the liver thru porta
hepatis.
 BLOOD SUPPLY TO THE LIVER:
• The liver has a dual blood supply: a dominant venous source and a lesser
arterial one.
1. The Portal vein brings 75– 80% of the blood to the liver. Portal blood,
contains about 40% more oxygen than blood returning to the heart from the
systemic circuit, sustains the liver parenchyma (liver cells or hepatocytes) +
The hepatic portal vein carries virtually all of the nutrients absorbed by the
alimentary tract to the sinusoids of the liver. The exception is lipids, which
are absorbed into and bypass the liver via the lymphatic system. [mesenteric
veins drains into portal system]
2. Arterial blood from the hepatic artery (a branch of celiac artery), accounting
for only 20–25% of blood received by the liver, is distributed initially to
non-parenchymal structures, particularly the intrahepatic bile ducts.
• Venous drainage: liver is drained
by the hepatic veins which later
drains into the IVC (Inferior Vena
Cava).
• Lymphatic drainage: hepatic LN ->
Celiac LN.
• Nerve supply: The nerves of the
liver are derived from the hepatic
plexus, the largest derivative of the
celiac plexus.
 GALLBLADDER & BILIARY DUCTS
• Bile is produced continuously by the liver and stored and concentrated in the
gallbladder, which releases it intermittently when fat enters the duodenum. Bile
emulsifies the fat so that it can be absorbed in the distal intestine.
• The biliary ducts convey bile from the liver to the duodenum.
• Liver → right and left hepatic ducts → common hepatic duct + cystic duct (duct to the
gallbladder) = common bile duct CBD → pour bile to the duodenum.
NB- CBD meets with the main pancreatic duct forming the ampulla of vater which both
pours their contents into the duodenum.
• The gallbladder (7–10 cm long) lies in the fossa for the gallbladder on the visceral
surface of the liver. This shallow fossa lies at the junction of the right and left lobes of
the liver. The pear-shaped gallbladder can hold up to 50 mL of bile.
• The arterial supply of the bile duct is from the: Cystic artery + Right hepatic
artery + Posterior superior pancreaticoduodenal artery and gastroduodenal
artery.
• The arterial supply of the gallbladder and cystic duct is from the cystic artery.
• The venous drainage from the neck of the gallbladder and cystic duct flows via
the cystic veins.
• The lymphatic drainage of the gallbladder is to the hepatic lymph nodes.
 HEPATIC PORTAL VEIN AND PORTAL–SYSTEMIC ANASTOMOSES

Splenic vein + mesenteric veins (SMV, IMV) → Portal vein.

NB- Hepatic portal vein system: portal vein → liver → hepatic vein → IVC.

• The hepatic portal vein collects blood with reduced oxygenation but rich in
nutrients from the abdominal part of the alimentary system, including the
gallbladder and pancreas, as well as the spleen, and carries it to the liver.
• Within the liver, its branches are distributed in a segmental pattern and end in
expanded capillaries, the venous sinusoids of the liver.
• Portal–systemic anastomoses, in which the portal venous system
communicates with the systemic venous system includes:
i. Veins in the submucosa of the inferior esophagus.
ii. Veins in the submucosa of the anal canal.
iii. Veins in the peri-umbilical region.
iv. Veins on the posterior aspects (bare areas) of secondarily retroperitoneal
viscera.
• When portal circulation through the liver is diminished or obstructed because
of liver disease or portal vein pathology, blood from the gastrointestinal tract
can still reach the right side of the heart through the IVC by way of these
collateral routes.
NB- These alternate routes are available because the hepatic portal vein and its
tributaries have no valves; hence blood can flow in a reverse direction to the
IVC. However, the volume of blood forced through the collateral routes may
be excessive, resulting in potentially fatal varices (abnormally dilated veins).
Clinical anatomy
• Hepatitis
• Chronic liver diseases and liver failure
• Hepatomegally
• Portal hypertension
• Gall stones: cholelithiasis [in gallbladder] vs choldocholithiasis [in
CBD]. Risks- 5F = fat, female, fertile, forty, fair.
• Cholecystitis: “+ve murphy sign”.
• Cholangitis: charcot’s triad.
• Obstructive jaundice.
 QN
• Elaborate blood supplies to the:
1. Small intestine
2. Large intestine
3. Liver
4. Spleen

• Mention 10 functions of liver:

 KIDNEYS, URETERS & SUPRA-RENAL GLANDS

• Supra-renal gland = Adrenal glands.

• The kidneys (right and left) produce urine that is conveyed by the ureters to
the urinary bladder.
• The superomedial aspect of each kidney normally contacts a suprarenal
gland. A weak fascial septum separates the glands from the kidneys; thus
they are not actually attached to each other. The suprarenal glands function
as part of the endocrine system, completely separate in function from the
kidneys.
NB- The superior urinary organs (kidneys and ureters), their vessels, and the
suprarenal glands are primary retroperitoneal structures on the posterior
abdominal wall that is, they were originally formed as and remain
retroperitoneal viscera.
KIDNEYS:
• Kidneys are bean shaped organs with several functions including:
a. Excretion of waste products eg urea, ammonia, drugs.
b. Water and salt/ electrolytes balance (via RAAS system).
c. EPO synthesis (erythropoietin 90% hormone responsible for RBC formation).
d. Activation of vitamin D (1,25- dihydrocalciferol).
e. Acid base balance.
• Kidneys are located one on each side of the vertebral column at the level of the
T12–L3 vertebrae.
• At the concave medial margin of each kidney is a vertical cleft, the renal hilum.
Structures that serve the kidneys (vessels, nerves, and structures that drain urine from
the kidney) enter and exit the renal sinus through the renal hilum.
• Posteriorly, the superior parts of the kidneys lie deep to the 11th and 12th ribs.
 Cross section anatomy of the kidney:
• The renal paranchyma has 3 main parts
1. Renal cortex
2. Renal medulla
3. Renal pelvis
• The kidneys are covered by an outer fibrous capsule (renal capsule).
URETERS
• The ureters are muscular ducts (25–30 cm long) that carry urine from the kidneys to
the urinary bladder.
• They run inferiorly from the apices of the renal pelves at the hila of the kidneys,
passing over the pelvic brim at the bifurcation of the common iliac arteries. They then
run along the lateral wall of the pelvis and enter the urinary bladder.
• The abdominal parts of the ureters adhere closely to the parietal peritoneum and are
retroperitoneal throughout their course.
• When examining the ureters radiographically using contrast medium, the ureters
normally demonstrate relative constrictions in three places:
(1) at the junction of the ureters and renal pelves
(2) where the ureters cross the brim of the pelvic inlet
(3) during their passage through the wall of the urinary bladder
NB- These constricted areas are potential sites of obstruction by ureteric stones
(calculi).
SUPRARENAL GLANDS (adrenal glands)
• The suprarenal (adrenal) glands, yellowish in living persons, are located
between the superomedial aspects of the kidneys and the diaphragm, where
they are surrounded by connective tissue containing considerable perinephric
fat.
• The suprarenal glands are enclosed by renal fascia by which they are
attached to the crura of the diaphragm.
• Although the name “suprarenal” implies that the kidneys are their primary
relationship, their major attachment is to the diaphragmatic crura.
• They are separated from the kidneys by a thin septum, a part of the renal
fascia.
• Function: Endocrine gland: plays role in sympathetic activities, water and
salt balance, cortisol production + production of androgens (less percent).
• Adrenal gland has 2 layers and it is covered by an adrenal capsule:

1. Adrenal cortex; adrenal cortex has 3 zones GFR

- zona glomerulosa which secretes minerocorticoid hormones regulating salt
and water balance.
- zona fasciculata which secretes glucocorticoid/ cortisol hormones
responsible for glucose maintainance and inflammatory suppressors.
- zona reticulata which secretes androgens/ sex hormones.

2. Adrenal medulla; have chromaffin cells which secretes catecholamines

(Adrenaline/ Epinephrine and Noradrenaline/ Norepinephrine) these plays a
role in sympathetic activations (activate the body to a flight-or-fight status in
response to traumatic stress).
• Arterial supply: kidneys - Renal
arteries, suprarenal glands -
suprarenal arteries (both branching
from abdominal aorta).
• Venous drainage: follows arterial
supply.
• Lymphatic drainage: drain into the
right and left lumbar (caval and
aortic) lymph nodes.
• Blood supply to the abdomen is mainly via the abdominal aorta.
• The abdominal aorta has 4 main branches:
1. Celiac trunk (with 3 sub-branches = common hepatic artery, splenic
artery and left gastric artery).
2. Superior mesenteric artery (SMA).
3. Renal arteries.
4. Inferior mesenteric artery (IMA).
• Other minor branches from abdominal aorta: Inferior phrenic
arteries, suprarenal/ adrenal arteries, testicular arteries and ovarian
arteries, lumbar arteries.
• Venous drainage: venous drainage follows arterial supply and
drains into the Inferior vena cava (IVC).
• Blood supply of abdominal viscera (branches of abdominal aorta)
 POSTERIOR ABDOMINAL WALL
• The posterior abdominal wall is mainly composed of the:
1. Five lumbar vertebrae (centrally).
2. Posterior abdominal wall muscles, including the psoas, quadratus
lumborum, iliacus, transversus abdominis, and oblique muscles (laterally).
3. Diaphragm, which contributes to the superior part of the posterior wall.
4. Fascia, including the thoracolumbar fascia.
5. Lumbar plexus, composed of the anterior rami of lumbar spinal nerves.
6. Fat, nerves, vessels (e.g., aorta and IVC), and lymph nodes.
• Muscles of posterior abdominal wall:
 The diaphragm
• The diaphragm is a double-domed, musculotendinous partition separating the
thoracic and abdominal cavities.
• Its mainly convex superior surface faces the thoracic cavity, and its concave
inferior surface faces the abdominal cavity.
• The diaphragm is the chief muscle of inspiration (actually, of respiration
altogether, because expiration is largely passive).
• Attachment: attaches to the inferior margin of the thoracic cage and the
superior lumbar vertebrae.
• The diaphragm has 3 openings which allows passage of some structures btn
thorax and abdomen. These are:
- Caval opening (vena cava hiatus)
- Aortic hiatus
- Eosophageal hiatus
- Nerve supply: phrenic nerve (c3-c5).
- Arterial supply: superior phrenic arteries (branches of thoracic aorta), inferior phrenic
arteries (branches of abdominal aorta).
- Venous drainage: follows arterial supply.
 QN 01
• Ashley was stabbed by a sharp wooden stick when he was fighting
in the streets. On examination, he has a bleeding wound below the
right coastal margin. Which organ is likely to be injured?
A. Adrenal gland
B. Spleen
C. Small intestines
D. Liver
E. Appendix
 QN 02

• Name the
structures labeled:
• Name the vessels labelled:
Thank you
(ahiJn)