~ ~ ~ ABDOMEN ~ ~ ~ Ann Nguyen -- NYUCD 2008

Dr. Baker D1 Anatomy Notes -- Spring '05

TISSUE LAYERS SURFACE FEATURES

(1) superficial fascia • linea alba = jxn of the R & L aponeurosis of the 3 flat ab muscles
(2) deep fascia • linea semilunaris = represents the lateral limits of the rectus abdominis
(3) muscles + aponeurosis • tendinous insertion = runs horizontally bt linea semilunaris & linea alba
(4) transverse fascia • inguinal ligament = the crease where the elastic of your underwear lies
(5) extraperitoneal layer • iliac crest = the bony protruding part of your hip-bone
(6) peritoneum • umbilicus = belly-button

AB MUSCLES -- anterolateral wall

• External Oblique = superficial layer that runs diagonally from the lower ribs downward
• Internal Oblique = intermediate layer that runs diagonally from the iliac crest upward
• Transverse = deepest layer that runs from the iliac crest across to the midline
• Rectus Abdominus = runs vertically from the costal margin of the ribs down to the pubis bone
enclosed in a membranous sheath formed by the aponeurosis of the other three layers of muscle
tendinous insertions = the 3 horizontal lines dividing the 6-pack abs that you see in buff guys

○ Functions:
○ flexion & rotation of the trunk
○ compression of the anterior wall
- to tense up the abdominal wall for protection of the organs
- to increase intra-abdominal pressure for labored exhalation, coughing, sneezing, poo, pee, birth

DIAPHRAGM -- superior wall

- separates the abdominal cavity from the thoracic cavity

○ structures that pass through…

• aorta = passes thru the aortic hiatus located in the median arcuate ligament between the R & L crura
• thoracic duct = passes with the aorta
• esophagus = passes thru the esophageal hiatus formed by sphincter-like muscles in the (R) crus
• anterior & posterior vagal trunks = passes with the esophagus
• IVC = passes thru caval opening in the central tendon
• azygos vein = passes thru the (R) crus
• hemiazygos vein = passes thru the (L) crus
• splanchnic nerves = pass thru the R & L crura

○ Functions:
- respiration = via muscle contractions to pull down the central tendon to increase vertical dimension of the thorax
- esophageal constriction = to prevent gastric regurgitation
- aids flow of IVC back to the heart

○ Innervation = phrenic nerve arising from the anterior primary rami of spinal nerves C3, C4, C5

○ Arterial supply = pericardiophrenic + musculophrenic (from internal thoracic), intercostals + phrenic (from aorta)

PELVIC FLOOR -- inferior wall

• Levator Ani muscles

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PERITONEUM Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05
- inner layer of squamous cell mesothelium
- outer layer of nutritive connective tissue
• parietal peritoneum = lines the inner abdominal body walls
• visceral peritoneum = lines the organs
• peritoneal cavity = the space in between the 2 layers
• mesentery = double-layered fold of peritoneum that suspends various organs
mesentery is where the visceral peritoneum reflects off the parietal peritoneum of the posterior body wall
allows a certain degree of movement for the organs that have a mesentery
BV-N’s pass through here
• omentum = double-layered fold of peritoneum (like mesentery) that attaches 2 organs
• ligaments = are the specific names of the folds of peritoneum that are portions of mesentery or omenta
● Intraperitoneal organs = are completely surrounded by visceral peritoneum and are mobile b/c they posses a mesentery
○ jejunum
○ ileum
○ transverse colon
○ sigmoid colon
○ liver -- but doesn’t have a mesentery
○ stomach -- but doesn’t have a mesentery
● 2° Retroperitoneal organs = do not have a mesentery, lie within the extra-peritoneal space, attached to the abdominal wall
○ ¾ duodenum
○ ascending colon
○ descending colon
○ rectum
○ pancreas
● 1° Retroperitoneal organs = are not derived from the gut and do not develop in between folds of peritoneum
○ kidneys + ureters
○ suprarenal glands
○ abdominal aorta + IVC + sympathetic trunks

EMBRYOLOGY OF THE GUT

Arterial Supply Venous Drainage
• Foregut = Celiac Trunk • Foregut = Splenic Vein
• Midgut = Superior Mesenteric Artery • Midgut = Superior Mesenteric Vein
• Hindgut = Inferior Mesenteric Artery • Hindgut = Inferior Mesenteric Vein

Parasympathetic Innervation Sympathetic Innervation

• Foregut = Vagus Nerve • Foregut = Greater Splanchnic Nerve
• Midgut = Vagus Nerve • Midgut = Lesser Splanchnic Nerve
• Hindgut = Pelvic Splanchnic Nerve • Hindgut = Lumbar Splanchnic Nerve

Outgrowths of the gut

• liver = develops anteriorly in the primitive ventral mesentery
• pancreas = develops posteriorly in the primitive dorsal mesentery

Derivatives of the gut

○ Foregut
• liver
• pancreas
• stomach
• duodenum (proximal)
○ Midgut
• duodenum (distal)
• jejunum & ileum
• cecum & appendix
• ascending colon
2
• /3 transverse colon
○ Hingut
1
• /3 transverse colon
• descending colon
• sigmod colon Compiled for you by:
• rectum & anal canal
 Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05

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ESOPHAGUS Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05
• cricopharyngeus sphincter = at the proximal end where the pharynx becomes the esophagus
• cardiac sphincter = at the distal end where the esophagus becomes the stomach
• zig-zag “Z-line” = (at the vertebrae-T11 level) jxn of the esophageal and gastric mucosa
• esophageal hiatus = the hole in the (R) crus of the diaphragm where the esophagus pierces through (physiologic sphincter)
diaphragm contraction prevents gastric contents from being squeezed back into the esophagus

STOMACH -- food storage, digestion

- situated in upper left quadrant

- liver is located to the right
- spleen, pancreas, kidney are located posteriorly
- J-shaped, but size, shape, position depends on physiologic state & body build
- avg capacity = 1Liter

• zig-zag “Z-line” = jxn of the esophageal and gastric mucosa

• cardiac sphincter = in the beginning, where the esophagus enters the stomach
• pyloric sphincter = in the end, where the stomach enters the duodenum
• fundus = where the stomach bulges upward after the cardiac portion
• pyloric antrum = where the stomach begins to narrow before it enters the duodenum
• greater curvature of the body = the left inferior border
• lesser curvature of the body = the right superior border
• rugae = longitudinal folds of mucosa to allow distension and for increased surface area

- outer longitudinal muscle layer

- middle circular muscle layer
- inner oblique muscle layer (additional)

- mesentery is lost during development, but remains suspended via the omenta…
• lesser omentum
○ hepatogastric ligament = connects the liver to the stomach’s lesser curvature below
○ hepatoduodenal ligament = connects the liver to the duodenum below
• greater omentum = “fatty apron”
○ gastrocolic ligament = connects transverse colon to the greater curvature
○ gastrosplenic ligament = connects the spleen to the greater curvature
○ gastrophrenic ligament = connects the diaphragm to the greater curvature

● Arterial Supply = comes from all 3 branches of the Celiac Trunk that branched off the anterior aspect of the Aorta
● Venous Drainage = parallels the name and pathway of the arteries, but in opposite directions

 Descending Aorta
 Celiac Trunk
1) left gastric artery
2) splenic artery
 short gastric artery
 left gastro-omental artery
3) common hepatic artery
 hepatic artery
 right gastric artery
 cystic artery
 gastroduodenal artery
 superior pancreaticoduodenal artery
 right gastro-omental artery

Arteries in summary: Veins in summary:

• left gastric • left gastric  portal vein
• right gastric • right gastric  portal vein
• short gastric • short gastric  splenic vein  portal vein
• left gastro-omental • left gastro-omental  splenic vein  portal vein
• right gastro-omental • right gastro-omental  superior mesenteric vein  splenic  portal

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DUODENUM -- digestion Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05
- C-shaped, encircling the pancreas
- retroperitoneal = immobilized and fixed to the posterior body wall
- proximal end = stomach
- distal end = jejunum
• pyloric sphincter = where the distal end of the stomach opens into the duodenum
• plicae circulares = circular folds of mucosa (analogous to the stomach’s rugae) – except in the superior section
(1) superior section = runs posteriorly to the right; touches the liver and gall bladder
(2) descending section = runs vertical and parallel to IVC
○ major duodenal papilla = receives the common bile duct + pancreatic duct
○ minor duodenal papilla = receives accessory pancreatic duct
(3) horizontal section = turns to the left
(4) ascending section = turns abruptly upward; becomes the jejunem

● superior pancreaticoduodenal artery  gastroduoenal artery  common hepatic artery  celiac trunk  aorta
● inferior pancreaticoduodenal artery  superior mesenteric artery  aorta
● superior + inferior pancreaticoduodenal veins  superior mesenteric vein  portal vein

JEJUNUM & ILEUM -- absorption

JEJUNUM -- nutrient absorption ILEUM -- water absorption

2 3
- makes up /5 of the mobile small intestine - makes up /5 of the mobile small intestine
- larger diameter = more absorption - more mesenteric fat
- more plicae & villi = more absorption - more lymphoid tissue (Peyer’s Patches)
- thicker muscular wall = more peristalsis - more complex arterial configuration (arcades)
- both segments are framed superiorly by the large intestine
- both segments are covered anteriorly by the greater omentum / “fatty apron”
• plicae circulares = circular folds of mucosa (analogous to the stomach’s rugae)
• villi = fingerlike projections containing arteriole, venule, capillary bed, lacteals to absorb fats, crypts w/ enzymatic glands
• mesentery = the intimate double layers of visceral peritoneum that attaches to the body wall as parietal peritoneum
suspends the J & I from the body wall
measures only about 15 – 20 cm
runs from duodenal junction and ileocolic junction
BV-N’s travel to the J & I thru the mesentery

● arcades  vasa recti  mesentery  numerous intestinal branches  superior mesenteric artery  aorta
● small intestinal tributaries  superior mesenteric vein  portal vein

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COLON Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05
• teniae coli = longitudinal bands of smooth muscle
• haustra = sacculated pouches caused by contraction of the teniae coli
• appendices epiploicae = small outpouchings of peritoneum filled w/ fat

CECUM
- has a mesentery = moveable
- a blind pouch located inferior to the jxn of the ileum and colon
- because of its position, material can get trapped here
• ileocecal orifice w/ valve = where the ileum of the small intestine opens into the colon

APPENDIX
- has a mesentery (“mesoappendix”) = moveable
- a blind-ended diverticulum that branches off the cecum
- located inferior to the ileocecal orifice
- high concentration of lymphoid tissues  appendicitis  if it bursts  peritonitis

ASCENDING COLON -- water absorption

- retroperitoneal = immobilized and fixed to the posterior body wall
- ascends until the base of the liver
- this is the shortest portion of the large intestine
• hepatic flexure / right colic flexure = where the ascending colon turns sharply to the left to become the transverse colon

TRANSVERSE COLON -- water absorption

- has a mesentery (“transverse mesocolon”) = moveable
- runs transversely until the spleen
• splenic flexure / left colic flexure = where the transverse colon turns sharply downward to become the descending colon

DESCENDING COLON -- fecal transport

- retroperitoneal = immobilized and fixed to the posterior body wall
- turns medially at the level of the left iliac crest to become the sigmoid colon

SIGMOID COLON -- fecal storage

- has a mesentery (“sigmoid mesocolon”) = mobile
- follows an S-shaped path, then ends in the middle of the sacrum

RECTUM & ANAL CANAL -- fecal evacuation

- retroperitoneal = immobilized and fixed to the posterior body wall
- follows the curvature of the sacrum straight downward
- no teniae coli = no haustra
• internal sphincter ani = involuntary; under parasympathetic control
• external sphincter ani = voluntary control via the levator ani muscles

● ileal branch = distal ileum

● appendicular branch = appendix  ileocolic artery  superior mesenteric artery  aorta
● cecal branch = cecum
● colic branch = ascending colon
● right colic artery = ascending colon  superior mesenteric artery  aorta
● middle colic artery = transverse colon
● left colic artery = descending colon
● sigmoid arteries = sigmoid colon  inferior mesenteric artery  aorta
● rectal arteries = rectum & anus

● cecum, ascending, transverse = superior mesenteric vein  splenic vein  portal vein
● descending, sigmoid, rectum = inferior mesenteric vein  portal vein

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LIVER Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05
- located in the upper right quadrant, tucked under the diaphragm, protected by the lower right ribs
- covered w/ visceral peritoneum

• diaphragmatic surface = the superior, anterior, posterior aspects of the liver that touches the diaphragm
• visceral surface = the inferior aspect of the liver that takes the shape of and touches the other organs below…
- hepatic flexure of ascending colon, right kidney, gall bladder, duodenum, stomach

• lesser omentum / hepatogastric ligament = attaches the liver to the lesser curvature of the stomach below
• coronary ligament = where the liver’s peritoneum reflects posteriorly and attaches to the diaphragmatic peritoneum
• falciform ligament = divides R & L lobes as seen from an anterior view

Structures representing an “H” divides the 4 lobes as seen from a posterior view…
• ligamentum venosum = upper left bar -- this is the obliterated ductus venosus (fetal liver bypass)
• ligamentum teres = lower left bar -- this is a remnant of the umbilical vein
• inferior vena cava = upper right bar
• gall bladder = lower right bar
• porta hepatis = horizontal bar = entrance & exit for hepatic arteries + portal vein + common bile duct (“portal triad”)

(1) right lobe = larger lobe seen from the font

(2) left lobe = smaller lobe seen from the front
(3) caudate lobe = superior to the horizontal H-bar
(4) quadrate lobe = inferior to the horizontal H-bar

Functions:
- metabolizes products of digestion
- glycogen synthesis, storage, release
- bile synthesis (transported to gall bladder)
- synthesis of coagulation factors
- synthesis of lymph
- storage of ferritin, Vit-A, Vit-D, Vit-B12
- blood storage, filtration, phagocytosis
- fetal hemetopoiesis

● R & L hepatic ducts  common hepatic duct

● common hepatic duct + cystic duct of gall bladder  common bile duct
● common bile duct + pancreatic duct  into descending portion of duodenum

● R & L branches  hepatic artery  common hepatic artery  celiac trunk  aorta
● all GI tract blood  inferior mesenteric  splenic vein + superior mesenteric  portal vein  hepatic veins  IVC

PANCREAS
- retroperitoneal = immobilized and fixed to the transverse mesocolon
- lies transversely against the posterior body wall, between the duodenum + spleen
- exocrine function = secretes digestive enzymes into the duodenum
- endocrine function = clusters of cells in the “Islets of Langerhans” produce insulin for carbohydrate metabolism
• head = enveloped by the C-shaped duodenum; lies directly anterior to the aorta & IVC
• neck
• body
• tail = touches the spleen’s hilus
• main pancreatic duct + accessory pancreatic duct

SPLEEN
- lies in the upper left quadrant
- rests on the splenic flexure / left colic flexure of the descending colon
- covered w/ visceral peritoneum except at the hilum
• gastrosplenic ligament = connects the spleen to the stomach’s greater curvature (part of the greater omentum)
• splenorenal ligament = connects the spleen to the left kidney
• diaphragmatic surface = the superior and lateral aspects that touch the diaphragm
• visceral surface = the inferior and medial aspects that touch the stomach’s greater curvature, left kidney, splenic flexure
Functions:
- this is the largest lymphatic organ
- breaks down RBC’s (byproducts are used by the liver to make bile)
- storehouse for blood Compiled for you by:
- filters blood of debris