1. The Abdomen Stuart M Bunt Functional Anatomy 212
T290 Entire gut laid out
T318 barium meal/small intestines
T315 overall layout of gut
A1 Embryonic plate, gastrulation/streak
MF10 embryological devt of mesentaries
T13 gut rotation
T14 gut rotation cont.
T8 situs invertus
T39 omental bursa
T311 greater and lesser sac
MG6(?) fusion of trans mesocolon with omentum
T38 retroperitoneal attachments (post abd. wall)
T160 suspensory ligament of duodenum (of Treitz)
T37 duodenal pockets/folds
T43 ileocecal fold
(put volvulus etc here from next lecture slides?)
Functional Anatomy 212

2. Overview

3. Embryology Revision
Foregut, Midgut and Hindgut suspended by the dorsal mesentary, initially straight
Ventral mesentary connects stomach and ant. abd. wall, rest of gut free anteriorly
Mesentary supplies blood and nerves to gut between layers of peritoneum
Complex adult layout due to 270o rotation

4. Blood Supply to Abdominal Organs
Foregut
Celiac trunk
Midgut
Superior mesenteric artery
Hindgut
Inferior mesenteric artery
Rectum
Internal iliac artery (pudendal and rectal arteries)

5. Stomach Variable size and shape, distensible
J shaped related to body form
Lesser and greater curvature
gastroesophageal junction
fundus,cardiac part, body, pyloric part
pyloric antrum and sphincter
rugae and gastric pits

6. Blood Supply of Stomach

7. Superior Mesenteric Artery Territory

8. Inferior mesenteric artery territory

9. Venous system Portal Vein Hepatic Veins Inf. Vena Cava Splenic vein
inferior mesenteric vein
Superior mesenteric vein
Gastric veins
Hepatic Veins
Inf. Vena Cava

10. Anastomoses

11. Stomach rotates and distends
Front
Dorsal
Mesentary
Ventral
Mesentary
Back
Splenic
tissue
Omentum
Epiploic
Foramen

12. Omentum

13. Under the OMENTUM

14. The Peritoneal cavity is divided in two
Rotation of stomach forms the greater omentum
(allows stomach distension and infection control)
Omental bursa or Lesser sac is inside omentum
(a potential space)
Lesser omentum runs from stomach to liver
(note free lower border above epiploic foramen contains portal vein, hepatic artery and bile duct
Falciform ligament runs from liver to ant abd. wall

15. Mesenteries are important:-
Paracolic gutters channel fuid
Stop herniation due to bipedal posture
Supply blood/nerves
Sensitive to stretch
Contain infection
Useful in surgery

16. On return some gut fuses with posterior wall
Diaphragm 1 2
Duo.
Asc. Colon
Desc. Colon 3
1.lienorenal lig.
2.trans. mesocolon
3.mesentary proper
4.mes. of sig. colon 4
Rectum

17. Retro-peritoneal

18. Oesophagus 10 inches from pharynx to stomach narrow
at cricoid cartilage
where left bronchus crosses
oesophageal hiatus in diaphragm
mucous membrane folded (normally collapsed)
stratified squamous epithelium
striated above smooth below
trachea on right,
lower aorta on left
medial to L. lung, behind left atrium

19. Duodenum first 12 inches of gut four parts form C shape duodenal cap
radiologically identified, ulcers form here
mobile
descending part
pancreatic and bile ducts
horizontal part
crosses psoas, IVC and aorta
crossed by mesentery, sup mesen. art.
ascending part

20. Jejunum 2/5ths of small intestine gradual transition to ileum
many small villi
increasing numbers of lymph nodules
no submucosal glands
lacteals in each villus
columnar epithelium

21. Ileum distal 3/5ths of intestine
narrower, thinner, less vascular, slower,
more fat and arterial arcades in mesentery than jejunum.
Peyer’s patches of lymphoid tissue

22. Colon ascending colon retroperitoneal right colic or hepatic flexure
transverse colon (mesocolon)
droops towards pelvis?
left colic or splenic flexure
descending colon retroperitoneal
pelvic or sigmoid colon S shaped

23. Colonoscopy Barium enema outlines structures on X-rays

24. Appendix

25. The Liver Largest Gland (one of largest organs)
Right upper abdomen under diaphragm
Grows as outgrowth of gut plus mesoderm
Diaphragmatic surface
Visceral surface down and left
related to stomach, duodenum, r. kidney, r. colonic flexure
bears gall bladder

26. Biliary System R and L Hepatic ducts Common hepatic duct
Joined by cystic duct (to gall bladder)
Forms bile duct (common bile duct)
Gall Bladder
body and fundus, salts and water absorbed
store for bile, released in response to cholecystokinin

27. Pancreas

28. Pancreas Head in concavity of duodenum body across vertebrae
tail reaches the spleen
pancreatic duct (+ accessory?)
ampulla
duodenal papilla

29. Spleen

30. The Spleen
Lies in left hypochondriac region between gastric fundus and diaphragm at level of 9th-10th rib (not normally palpable)
Soft, friable, highly vascular, dark purple
Diaphragmatic surface
convex and smooth facing diaphragm
Visceral surface
gastric, renal, pancreatic and colic impressions
Slides
T74 pancreas from back (bile duct)
T75 annular pancreas formation
T83 annular pancreas
T82 ducts inside annular pancreas THESE SHOULD HAVE GONE IN LAST LECTURE?
T73 splenic artery
T86 splenic pedicle and accessory splenicules(Need slide of development?)
T87 splenic artery, short gastrics and left gastro-epiploic
T159 point of attachment of lienorenal ligament
T88 hilum of spleen
T89 many sorts of splenic hilum arteries
T197 Distribution of Vagus nerve in abdomen
T202 entrance points of splanchnic nerves into abdomen
T203 ceoliac plexus
T204 lumbar sympathetic ganglia
T206 hypogastric plexus
T207 general path of sympathetics to viscera (too complicated?)
(Need more/better autonomic slides next year?)

31. The Spleen (2)
Hilum of spleen long fissure through which vessels and nerves pass
Suspended from stomach by gastrolienal ligament (contains short gastric and left gastro-epiploic branches of spenic artery)
Suspended from posterior abdominal wall by lienorenal ligament
Covered by adherent peritoneum

32. Relationship to the Spleen

33. Kidneys In fat capsule Suprarenal glands superiorly
Direct Arterial and venous supply

34. Kidney Internal Structure
Renal pyramids between renal columns
Renal Cortex
Renal papillae drain into minor calix
Major calix join to form renal pelvis
Ureter as outlet

35. Kidneys External View
Artery - Vein - Ureter

36. Relationships of the Kidneys