Abdominal Cavity

The division of the abdominal cavity

The abdominal cavity is divided into the supracolic compartment and

infracolic compartment by the transverse colon and its mesocolon.

This figure is a median sagittal section of the abdominal cavity and

pelvic cavity. From it we can identify this is transverse colon, this is

transverse mesocolon. So here shows the supracolic compartment and

here shows infracolic compartment. This picture shows the transverse

colon and its mesocolon.

I. The supracolic compartment

The supracolic compartment lies between the transverse colon with its

mesocolon and diaphragm.

It includes abdominal part of esophagus, stomach, liver, extrahepatic bile

ducts, spleen and other viscera.

Stomach

1. Position and relations

Position: It is situated in the left hypochondriac region and the epigastric region.

Relations: Its anterior surface is behind the left lobe of the liver, the

diaphragm and the anterior abdominal wall. Its posterior surface is

separated by the omental bursa from a number of structures. These organs

lying posterior to stomach form the “stomach bed”. They are the spleen,

pancreas, left kidney, left suprarenal gland, transverse colon and its mesocolon.

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2. Blood Vessels of the Stomach

(1) Arteries

1) Left gastric artery and right gastric artery

The left gastric artery arises from the celiac trunk. The right gastric artery

arises from the proper hepatic artery.

They pass in the lesser omentum and supply the stomach wall at the side

of lesser curvature of stomach.

2) Left gastroepiploic artery and right gastroepiploic artery

The left gastroepiploic artery arises from the splenic artery. The right

gastroepiploic artery arises from the gastroduodenal artery.

They pass between the anterior two layers of the greater omentum and

supply both the stomach wall at the side of greater curvature of stomach

and the greater omentum.

3) Short gastric artery

The short gastric artery arises from the splenic artery. It passes in the

gastrosplenic ligament to the fundus of stomach.

4) Posterior gastric artery

It is found in about 60~80% of cases.

The posterior gastric artery arises from the splenic artery. It supplies the

posterior part of the fundus of stomach.

(2) Veins
The veins accompany the arteries and carry the blood back to the hepatic portal vein.

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(3) Lymphatic drainage
The lymph vessels of the stomach drain lymph from its surfaces toward its curvature,
where many of the lymph nodes are located. Efferent vessels from these lymph nodes
infuse the celiac lymph nodes.
(4) Nerves
The stomach receives both sympathetic nerve and parasympathetic nerve.
The parasympathetic nerve comes from the anterior vagal trunk and posterior vagal
trunk.

Duodenum

The duodenum is between stomach and jejunum.

1. Position

The duodenum lies on the posterior abdominal wall at the level of first

lumbar vertebra to third lumbar vertebra.

2. Divisions and relations

(1) Superior part

Anteriorly, its relations are Quadrate lobe of liver, Gallbladder

Posteriorly, its relations are Commom bile duct, Gastroduodenal a.,

Hepatic portal v., Inferior vena cava

Superioely, its relations are Omental foramen

Inferiorly, its relations are Head and neck of pancreas

(2) Descending part

Anteriorly, Liver, Transverse colon and its mesocolon, Loops of small intestine

Posteriorly, its relations are Right renal hilum and ureter, Right renal vessels

Medially, Head of pancreas, Common bile duct and pancreatic duct

Laterally, its relations are Right colic flexure

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(3) Horizontal part

Superiorly, its relations are Head of pancreas

Inferiorly, its relations are Loops of small intestine

Anteriorly, its relations are Radix of mesentery, Superior mesenteric a. and v.

Posteriorly, its relations are Right ureter, Inferior vena cava, Abdominal aorta

(4) Ascending part

Right side, its relations are Head of pancreas and abdominal aorta

Left side, its relations are Left kidney and ureter

3. Arteries of Duodenum
Superior pancreaticoduodenal artery- branch of the gastroduodenal artery
Inferior pancreaticoduodenal artery - branch of the superior mesenteric artery

Liver

1. Position

The liver occupies the right hypochondriac, epigastric and left

hypochondriac regions.

2. Relations

The great part of the liver lies under cover of the ribs and costal

cartilages, and it is contact with the diaphragm. Diaphragmatic surface

is separated by diaphragm from the right costodiaphragmatic recess, right

lung and cardiac base.

Relations of visceral surface, the great part of left lobe is related to the

stomach and abdominal part of esophagus, the right lobe is related to the

right colic flexure anteriorly, gallbladder and superior duodenal flexure

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medially, right kidney, superarenal gland posteriorly.

3. Ligaments
Lesser omentum (hepatogastric ligament, hepatoduodenal ligament)
(1) Falciform ligament
(2) Coronary ligament
(3) Left / right triangular ligament
The left / right junction of the upper and lower layers of the coronary ligament form
left / right triangular ligament.
Bare area of the liver is on the posterior aspect of the diaphragmatic surface. It is
limited by the upper and lower layers of the coronary ligament. Here, the liver was
adjacent to the diaphragm and not covered by peritoneum.

4. Porta hepatis
On the visceral surface of the liver an H-shaped set of fissures and fossae defines
four lobes, the right lobe, left lobe, caudate lobe, and quadrate lobe.

The ligamentum venosum and ligamentum teres occupy the left fissure

of the “H”. The gallbladder and inferior vena cava occupy the right

fossae of the “H”.

The cross-bar of the “H” is the porta hepatis, where the right and left

branches of hepatic portal vein, right and left branches of proper hepatic

artery, right and left hepatic ducts, lymphatics, and nerves enter or leave

the liver.

5. Hepatic pedicle

The structures enter or leave the porta hepatis form the hepatic pedicle.

These structures pass through the hepatoduodenal ligament.

Relations of hepatic pedicle

In the hepatoduodenal ligament the common bile duct lies anteriorly

and to the right, the proper hepatic artery lies anteriorly and to the left, the

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the hepatic portal vein lies behind them.

Close to the porta hepatic the right and left hepatic ducts lie anteriorly,

the right and left branches of proper hepatic artery lie in the middle, while

the right and left branches of the hepatic portal vein lie posteriorly.

6. Second porta hepatis

It is in the superior margin of the sulcus for vena cava on the

diaphragmatic surface of the liver, where the right, left and intermediate

hepatic veins leave the liver.

Subphrenic space
It lies between the transverse mesocolon and diaphragm. This space is divided into
suprahepatic space and infrahepatic space
1. Suprahepatic space lies between the diaphragm and liver －the falciform ligament
divides it into right and left suprahepatic space
(1) Left suprahepatic space is subdivided into left anterior suprahepatic space and
left posterior suprahepatic space by the left coronary ligament
(2) Right suprahepatic space
2. Infrahepatic space lies between the liver and transverse colon － the ligamentum
teres hepatic divides it into right and left infrahepatic space
(1) Right infrahepatic space (hepatorenal recess)
(2) Left infrahepatic space is subdivided into left anterior infrahepatic space and left
posterior infrahepatic space (omental bursa) by the lesser omentum and stomach.

3. Extraperitoneal space (Bare area of live)

Extrahepatic Bile Ducts

The extrahepatic bile ducts consist of the right and left

hepatic ducts, common hepatic duct, gallbladder, cystic

duct and common bile duct.

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 Gallbladder

1. Relations

The relations of the gallbladder include

Superiorly, the liver;

Inferiorly and posteriorly, the superior part of the duodenum and the

transverse colon;

Anteriorly, the anterior abdominal wall;

To the left, the pylorus;

To the right, the right colic flexure

2. Triangle of gallbladder / Triangle of Calot

It is formed by the cystic duct, common hepatic duct and the

inferior surface of the liver. The cystic artery is usually

found in this triangle.

Common bile duct

The common bile duct is formed by the union of the cystic duct and

common hepatic duct.

Divisions and relations

The common bile duct divided into four segments. That is supraduodenal
segment, retroduodenal segment, pancreatic segment and intraduodenal
segment.

1. Supraduodenal segment

From its beginning to the superior margin of the duodenum, it descends

along the right margin of hepatoduodenal ligment. On its left is the proper

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hepatic artery. On its posterior is the hepatic portal vein.

2. Retroduodenal segment

It lies behind the superior part of duodenum. It is anterior to the inferior

vena cava and to the right of the hepatic portal vein and the

gastroduodenal artery.

3. Pancreatic segment

It lies in a groove between posterior surface of head of pancreas and

duodenum. It is in front of the vena cava

4. Intraduodenal segment

It enters the wall of descending part of duodenum obliquely where jions

the pancreatic duct to form the hepatopancreatic ampulla which opens

at the major duodenal papilla.

Pancreas

1. Position

It lies in the epigastric region and left hypochondriac region, transversely

acrossing the anterior surface of 1st and 2nd lumbar vertebrae.

2. Divisions and relations

1) Head of pancreas

It is located in C-shapes curvature of doudenum

Anteriorly-- its relations are Transverse mesocolon

Posteriorly-- Common bile duct; Inferior vena cava; Right renal vessels

2) Neck of pancreas

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Anteriorly－its relations are pylorus

Posteriorly － commencement of hepatic portal vein. (formed by union of

splenic and superior mesenteric veins)

Superiorly- its relations are common bile duct

3) Body of pancreas

Anteriorly- it is separated from stomach by omental bursa

Posteriorly- its relations are Abdominal aorta; Left kidney; Left renal

vessels; Left suprarenal gland; Spleen vein.

Superiorly - its relations are Celiac trunk; Celiac plexus; Splenic atery.

Inferiorly- its relations are duodenojejunal flexure, some coils of jejunum

and the left colic flexure.

4) Tail of pancreeas

It runs in splenorenal ligament to reach hilum of spleen accompanying

with splenic vessels.

Inferiorly it is related to the left colic flexure, posteriorly it is related to

the left kidney and left suprarenal gland.

Spleen

1. Position

It lies in the left hypochondriac region (between stomach and diaphragm)

deep to the 9th rib to 11th ribs, its long axis corresponds roughly to the

10th rib.

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2. Relationships

Diaphragmatic surface－its relations is diaphragm.

Visceral surface Anteriorly－its relations is fundus of stomach

Posteriorly－its relations are left suprarenal gland and kidney

Inferiorly－its relations are tail of pancreas and left colic flexure

Hepatic portal vein

It is formed behind the neck of pancreas by the union of superior

mesenteric vein and splenic vein. It drains blood from gastrointestinal

tract from the lower end of esophagus to the upper end of anal canal,

pancreas, gall bladder, bile ducts and spleen.

Tributaries of Hepatic Portal Vein
Superior mesenteric v., Inferior mesenteric v., Splenic v., Left gastric v., Right gastric
v., Cystic v., Paraumbilical v.

Infracolic compartment

It lies between the transverse colon with its mesocolon and the superior

aperture of the lesser pelvis.

It contains the jejunum, ileum, cecum, vermiform appendix, colon and

other viscera.

Superior mesenteric artery

The superior mesenteric artery arises from the anterior surface of the

abdominal aorta approximately 1 cm inferior to the celiac trunk.

At its origin, the superior mesenteric artery lies posterior to the neck of

the pancreas. Then it passes anterior to the uncinate process, horizontal

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part of the duodenum, and left renal vein. After that the superior

mesenteric artery enters the mesentery. Within the mesentery the superior mesenteric
artery courses toward the terminal end of the ileum.

Branches of the superior mesenteric artery

1. Jejunum and ileum arteries – 12 to 18 arteries to the jejunum and the

ileum. Intestinal arteries end in straight terminal branches called vasa

recta. Arcades connect the intestinal arteries.

Only one or two arcades are found between proximal jejunum arteries,

resulting in relatively long vasa recta. Four or five arcades occur

between distal ileum arteries, resulting in relatively short vasa recta.

2. Ileocolic artery – supplies the cecum. The ileocolic artery gives rise to

the appendicular artery. The ileocolic artery anastomoses with intestinal

branches and with the right colic artery.

3. Right colic artery – supplies the ascending colon. The right colic

artery arises from the right side of the superior mesenteric artery and

passes to the right in a retroperitoneal position. It divides into a superior

branch and an inferior branch.

4. Middle colic artery – supplies the transverse colon. The middle colic

artery arises from the anterior surface of the superior mesenteric artery

and courses through the transverse mesocolon. It divides into a right

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branch and a left branch.

5. Inferior pancreaticoduodenal artery – the first branch of the superior

mesenteric artery.
Superior mesenteric vein
The superior mesenteric vein is formed by branches that correspond in name and
position to the branches of the superior mesenteric artery. The superior mesenteric
vein courses along the right side of the superior mesenteric artery. Posterior to the
pancreas, the superior mesenteric vein joins the splenic vein to form the hepatic portal
vein.
Superior mesenteric lymph nodes
The mesentery may contain up to 200 mesenteric lymph nodes. These lymph nodes
are along the branches of the superior mesenteric vessels. The superior mesenteric
lymph nodes are located near the origin of the superior mesenteric artery from the
abdominal aorta.

Inferior Mesenteric Artery

The inferior mesenteric artery arises from the anterior surface of the

abdominal aorta at the level of the intervertebral disk between vertebrae

L2 and L3.

Branches of the inferior mesenteric artery

1. Left colic artery – supplies the descending colon and the left half of

the transverse colon. The left colic artery anastomoses with the middle

colic branch of the superior mesenteric artery.

2. Sigmoid arteries – supply the sigmoid colon. Sigmoid arteries pass

through the sigmoid mesocolon.

3. Superior rectal artery – supplies the proximal part of the rectum.

Inferior mesenteric vein
The tributaries of the inferior mesenteric vein correspond to the branches of the
inferior mesenteric artery. The inferior mesenteric vein ascends on the left side of the
inferior mesenteric artery, passes posterior to the pancreas, and joins either the splenic
vein or (less frequently) the superior mesenteric vein.

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 Retroperitoneal space

The retroperitoneal space lies between the parietal peritoneum and the

endoabdominal fascia of the posterior abdominal wall.

The retroperitoneal space contains the kidneys, ureters, suprarenal glands,

aorta, inferior vena cava, lymph nodes and nerves etc.

Kidneys

Position

The kidneys lie in the paravertebral gutters against the posterior

abdominal wall.

Relationships of the kidneys

1. The suprarenal gland is superior to the kidney.

2. Anteriorly, through the peritoneum, the right kidney is in contact with

the visceral surface of the liver, the descending part of the duodenum, and

the right colic flexure.

3. Anteriorly, through the peritoneum, the left kidney is in contact with

the stomach, the spleen, the tail of the pancreas, the left colic flexure and

the coils of the jejunum.

4. Posteriorly, each kidney lies on muscles, i.e. (that is), the diaphragm

above, the psoas major, the quadratus lumborum and the transverses

abdominis below.

Renal pedicle

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The structures, which enter or leave the renal hilum, form the renal

pedicle.

It mainly contains the renal artery, renal vein and renal pelvis.

Arrangement, from anterior to posterior, they are the renal vein, renal

artery and renal pelvis; from above to downwards, they are the renal

artery, renal vein and renal pelvis.

Renal capsule
From outside to inwards, each kidney is enclosed, by the renal fascia, adipose capsule
and fibrous capsule.

Abdominal Aorta

The aorta passes through the aortic hiatus and continues as abdominal

aorta. At the level of L4, the abdominal aorta splits into the right and left

common iliac arteries. The abdominal aorta is on the left of the inferior

vena cava throughout its course.

Branches

Unpaired visceral branches

Celiac trunk

Superior mesenteric artery

Inferior mesenteric artery

Paired visceral branches

Renal arteries

Suprarenal arteries

Testicular or ovarian arteries

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Parietal branches

Lumbar and inferior phrenic arteries

Inferior vena cava

Tributaries

1. Common iliac veins

2. Renal veins

The left testicular (or ovarian) vein, the left suprarenal vein drains into

the left renal vein.

3. Hepatic veins

4. Right testicular (or ovarian) vein

5. Right suprarenal vein

6. Lumbar v.
7. Inferior phrenic v.

Nerves

1. Subcostal nerve is inferior to rib 12th

2. Iliohypogastric and ilioinguinal nerves descend across the anterior

surface of the quadratus lumborum muscle.

3. Lateral cutaneous nerve of the thigh

4. Femoral nerve lies on the lateral side of the psoas major muscle in the

groove between the psoas major and iliacus muscles.

5. Genitofemoral nerve is on the anterior surface of the psoas major muscle.

6. Obturator nerve lies on the medial side of the psoas major muscle
7. Lumbosacral trunk is formed by a contribution from the ventral primary ramus of L4 and all of the ventral
primary ramus of L5. The lumbosacral trunk passes into the pelvis to join the sacral plexus.

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8. Lumbar sympathetic trunk is located anterior to either side of the

vertebral column.

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