REGIONAL ANATOMY

WENZHU YAN

Department of Anatomy,liaoning Medical College

Chapter 6 THE ABDOMEN

Section 1 Introduction

Theabdomenistheregionofthe

trunkbetweenthethoraxandthe
pelvis.

Itconsistsoftheabdominalwall,
theabdominalcavityandabdominal
viscera.

divition

Section 2 The Anterolateral Abdominal

Wall
Main Contents
.TheSuperficialStructures

1.TheskinTheskinofanterior
lateralabdominalwallcontained
moreelasticfibers.Surgeonsuse
theskinflapwithvesselsforplastic
surgery.

2.Thesuperficialfascia
Thesuperficialfasciaonlower
abdominalwalldifferentiates
usuallyintotwolayers.Between
themaresuperficialvessels,nerves
andlymphnodes.
Thesuperficiallayer Campers
fascia .
Thedeeplayer Scarpas
fascia

 1 Thesuperficial
bloodvessels
1 Thesuperficial
epigastricartery
2 Thesuperficialiliac
circumflexartery

3 Thesuperficialveins
thethoracoepigastricvein,
thelateralthoracicvein
thesuperficialepigastricvein
Theumbilicalvenousnetwork
theparaumbilicalvein

 2 ThecutaneousnervesTheabdominalwallis
suppliedsegmentallybyallthelowersixpairsofthe
intercostalsnervesandthefirstlumbarnerve.
The7thintercostalsnervedistributestheareaabout
thelevelofthexiphoidprocess.
The10thusuallyrunstotheleveloftheumbilicus.
Thefirstlumbarnervedistributestheareaabovethe
inguinalligamentandthepubicsymphysis.


3 Thelymphaticvessels
thelymphaticvesselsabovethelevelofthe
umbilicusflowintotheaxillarylymphnodes,the
vesselsbelowthelevelofumbilicusdrainintothe
superficialinguinallymphnodes.Theyalsoanastomose
withthelymphaticsoftheliverbythelymphvessels
withintheroundligamentofliver.

 TheDeepStructures
1.Themuscles
1 Therectus
abdominisanditssheath
TheRectusabdominisisa
longstriplikemuscles.
Thesheathofrectus
abdominisisenclosedby
aponeurosesoftheobliquus
andtransversemuscles.

Thesheathofrectusabdominis

 2 Theobliquusexternusabdominis

 3 Theobliquusinternus
abdominis
Theinguinalfalx conjoined
tendon isacommon
aponeurosisjoinedbythe
obliquusinternusabdominisand
transversusabdominis.
4 Thetransversesabdominis

2.Thetransversefascia
Itisathinlayerbetweenthe
extraperitonealfasciaand
transversesabdominis.
Intheinguinalregionitis
thick.
3.Theextraperitonealfascia
extraperitonealfattytissue
Thisisalooseconnective
tissuewithfatbetweenthe
transversefasciaandparietal
peritoneum.

Thisspaceextendstotheretroperitoneal
spaceandtheinferiorperitonealspaceofthe
pelvis.
4.TheparietalperitoneumItistheinner
mostlayeroftheanterolateralabdominalwall
andapartoftheperitoneumactually.

.ClinicalNotes
1.Thesuperficialepigastricveins
Thesuperficialepigastricvenousnetworkabove
theleveloftheumbilicusflowsintoaxillaryvein
viathelateralthoracicandthethoracoepigastric
veins,andbelowtheumbilicus,itflowsintothe
greatsaphenousvein.
Theveinsaroundtheumbilicusflowintothe
portalveinthroughtheparaumbilicalvein.
Thesevenousnetworksandveinsbelong
respectivelytothesuperior,inferiorvenaecavae
andtheportalsystem.

Ifvenousflowthroughtheliverisimpeded,the
portalhypertensiondilatestheveinsoftheportal
system,includingtheparaumbilicalveinwhichcan
causevaricositiesoftheabdominalwall thecaput
medusa .
2.Theabdominalincisions
1 ThemedianincisionItismadethroughthe
lineaalba.Itprovidesanalmostbloodlessoperation,
butincisionalherniaandgapingofwoundmayoccur.
2 TheparamedianincisionItisplaced2.5
4.0cmlateralandparalleltothemedianline.The
passinglayersare:skin,superficialfascia,the
anteriorlayerofthesheathofrectusabdominis,the
posteriorlayerofthesheathofrectusabdominis,


transversefascia,extraperitonealfasciaand
parietalperitoneum.Therectusabdominisisnot
incised,sothevessels,nervesandmusclesareless
damaged.
3 TherectusincisionTheincisedlayersare
thesameastheparamedianincisionbutwithan
additionalincisionofrectusabdominis.Theincision
hurtsmorevessels,nervesandmuscles.
4 TheMcBurneysincisionTheobliqueskin
incisioncenteredatMcBurneyspoint two-thirds
ofthewaylaterallyalongthelinefromtheumbilicus
totheanterioriliacspine .

theobliquusinternusabdominisandtransversus
abdominisarethensplitinthelineoftheirfibers,and
retreatedwithouttheirhavingtobedivided.On
closingtheincision,thesemusclessnaptogether
again,leavingavirtuallyundamagedabdominalwall.
Itisroutinelyusedtotheappendixoperation.
5 Thetransverseandobliqueincisions
Incisioncuttingthroughtheabdominalmusclesdonot
damagetheirrichlyanastomosingnervesupplyand
healwithoutweakness.Theyareusefulinexposing
sigmoidcolonorcecum,andbydisplacingthe
peritoneummediallytoexposetheextraperitoneal
structuressuchastheureter,sympathetictrunkand
theexternaliliacvessels.

Section 3 The Inguinal Region

.MainContents
TheLayersoftheInguinalRegion
The skin
The superficial fascia
The aponeurosis of the obliquus externus abdominis
Thesuperficialinguinalring
Thelateralcrus
Themedialcrus.
Theintercruralfibers
Theexternalspermaticfascia
Theinguinalligament
Thereflectedligament
Thelacunarligament

2.Theobliquusinternus
abdominisandtransversus
abdominis
Thesemuscleshavea
freelowerborder,which
archesoverthespermatic
cord.
Thecremasterwhich
surroundthespermatic
cordandthetestis
Theconjoinedtendonor
inguinalfalx.

3.Theiliohypogastricnerveandthe
ilioinguinalnerve
distributetotheskinofthescrotum
orlabiamajor.Thesetwonervesalso
havemuscularbranchestodistribute
tothisregionexceptthecutaneous
innervations
thegenitalbranchofthe
genitofemoralnerverunsalongthe
medialsideofthespermaticcordand
distributestothedartosmuscleand
thecremaster.

4.Thetransversefascia
thedeepinguinalring
theinternalspermaticfascia
5.Theextraperitonealfascia
theinferiorepigastric
thedeepcircumflexiliac
bloodvessels
1 Theinferiorepigastric
artery

 2 Thedeep
circumflexiliacartery
Itarisesfromthe
externaliliacarteryat
aboutthesamelevelof
theinferiorepigastric
artery.Thearteryruns
laterallyunderthe
inguinalligament.

6.Theinguinal
triangle Hesselbachs
trangle Theinferior
epigastricarterylaterally,
thelateralborderofthe
rectusabdominismedially
andthemedialhalfofthe
inguinalligamentinferiorly
boundanarea,knownas
Hesselbachstrangle.

7.Theparietalperitoneum
Themedianumbilicalfoldis
formedbytheremainsofthe
urachus
Thetwomedialumbilical
foldlieoneithersideofthe
medianumbilicalfold.These
foldsareformedbythe
obliterateddistalpartofthe
umbilicalartery.
Themostlateralfoldoneach
sideisthelateralumbilicalfold
whichcontainstheinferior
epigastricvessels.

Thelateralinguinalfossalies
laterallytothelateralumbilical
foldandcorrespondstothedeep
inguinalring.
Thefossabetweenthemedialand
lateralinguinalfoldsisknownas
themedialinguinalfossa.Its
inferomedialpartisoppositethe
superficialring.

 TheInguinalCanal
Itisaobliquepassage
about4cmlong,andhas
twoopeningsandfour
walls.
1.Thedeepinguinalring

Itistheentranceofthe
inguinalcanal.Itliesa
fingerbreadthabovethe
midpointoftheinguinal
ligament.

2.Thesuperficialinguinal
ringItisatriangulardefect
inshapeoftheaponeurosis
oftheobliquusexternus
abdominis.
Themedial
crus margin ofthering
attachestopubictowardsthe
medialendofthepubiccrest.
Thelateralcrusofthering
attachestothepubiccrest.

3.Thewallsoftheinguinalcanal
Anteriorwall:theaponeurosisof
obliquusexternusabdominis,and
laterallyisreinforcedbymuscle
fibersofobliquusinternusabdominis
Posteriorwall:thereflected
ligament,conjoined
tendon inguinalfalx and
transversefascia.
Superiorwall:archedfibersofthe
obliquusinternusabdominisand
transversesabdominis.
Inferiorwall:theinguinalligament.

4.Thecontentsofthe
inguinalcanal
thespermaticcordin
maleortheround
ligamentinfemaleand
ilioinguinalnerveinboth.

.Clinical Notes
1.Theanatomicalbasisoftheherniasandthe

hydrocele
1 Directandindirectinguinalhernias
Intheindirect oblique inguinalherniathe
abdominalcontentsenterthedeepringandtraversethe
inguinalcanaltoemergefromthesuperficialring,they
aresometimeseongenitaloracquired.
Butinadirectinguinalherniatheviscusprotrudes
immediatelyforwardtowardthesuperficialring.And
thereforetheneckofherniainvolvesthewallinthe
regionoftheHesselbachstriangle.

 2 ThehydroceleAdirctedorindirect
inguinalherniaisoftenconfusedwithahydroceleof
tunicavaginalisoftestisifitentersthescrotumand
alongwhichtheabdominalorgansdescend.
Thecommunicatinghydroceleoftestisoccurs
whentheupperpartofthevaginalprocessopensand
communicatesupwardstotheabdominalcavity,
sometimes,accompanyinganobliquehernia.Buta
commonhydroceleoftunicavaginalisoftestisdoes
notcommunicatewiththeabdominalcavity.

Section 4 The Peritoneum and

Peritoneal Cavity
.Introduction
Theperitoneum
Theparietalperitoneum
Thevisceralperitoneum.
Theperitonealcavity.
Thegreatersac,
Theomentalbursaorlessersac

theneckorcommunicationbetweenthegreatersac
andthelessersacistheomental epiploic foramen.
Basedonthecoveringoftheperitoneum,theviscerain
theabdominalandpelviccavitiescanbedividedinto
threekinds:
Theintraperitonealorgans:
thespleen,stomach,jejunum,ileum,cecum,transverse
colonandsigmoidcolon.
Themesoperitonealorgans:
gallbladder,liver,ascendingcolon,uterusandurinary
bladder.

Theextraperitonealorgans:Thevisceraare
coveredbyperitoneumonlyontheironeaspect,
suchaspancreas,ureter,kidney,suprarenal
gland,andthedescendingandtransversepartsof
theduodenum.Suchorganslieposteriortothe
peritoneum,knownasretroperitonealposition.

.Main Contents

Theomental epiploic foramen theforamenof

Winslow
Itsanteriorwallisformedbytherightmarginofthe
lesseromentum,whichcontainsbetweenitstwolayers
inthissituationthebileduct,thehepaticportalveinand
theproperhepaticartery.
Theinferiorvenacavaliesbehindtheomental
foramen.
Thecaudateprocessoftheliverformstheroofofthe
omentalforamen.
Theupperborderofthesuperiorpartoftheduodenum
istheinferiorwalloftheomentalforamen.

Section 5 The Supracolic compartment

Main Contents

TheStomach

1.Divisions
thecardiacpart
thefundusofstomach
thebodyofstomach
thepyloricpart.

2.Positionandrelation
Position
thelefthypochondriac
andtheepigastricregions.
Thecardiacorificelies
ontheleftsideofthe11th
thoracicvertebraandthe
pylorusontherightsideof
the1stlumbarvertebra


relation
Itsanteriorsurfaceis

behindtheleftlobeofthe
liver,thediaphragmandthe
anteriorabdominalwall.
Itsposteriorsurfaceis
separatedbytheomental
bursafromanumberof
structures.Theseform
thestomachbed.
Theyarethediaphragm,
spleen,pancreas,leftkidney,
leftsuprarenalgland,the
transversecolonandits
mesocolon.

3.Theligamentsofthe
stomach
thehepatogastric
ligament.
thegreateromentum
the
gastrosplenic gastrol
ienal ligamentthe
gastrophrenicligament

4.Thebloodvessels,lymphaticdrainageandnerves
1 ThearteriesThe
arteriesofthestomachare
derivedfromtheceliactrunk.
1 Theleftgastricartery
andrightgastricartery
Thepointbetweentheleft
firstbranchandsecond
branchoftheleftgastric
arteryofthestomachisa
landmarkofincisionofthe
stomachinthegastrectomy.

2 Therightandleft
gastroepiploicarteries
3 Theshortgastric
arteries

4 TheposteriorgastricarteryInrecentreports,
itisfoundinabout60 80 ofcases.
Itarisesfromthesplenicarteryandsuppliesthe
posteriorupperpartofthestomachwherethe
gastrophrenicligamentattaches.
Inoperation,itshouldbeprotectedfrom
damage.Thisarterygivesnutritiontotheremnant
ofthestomachaftersubtotalgastrectomy.

 2 Theveins
Therightandleft
gastric
therightgastroepiploic
vein.
Theleftgastroepiploic
andtheshortgastric
veins.

 3 Thelymphaticdrainage
1 Therightand
leftgastriclymphnodes
2 Thesuprapyloric
andsubpyloriclymph
nodes
3 Therightand
leftgastroepiploic
lymphnodes
4 Thesplenic
lymphnodes

 4 Thenerves

Thesympatheticnerve
comesfromtheceliac
gangliawhichgivesriseto
postganglionicfibersthat
accompanythearteriestothe
stomach.
Theparasympatheticnerve
isderivedfrombranchesof
theanteriorandposterior
vagaltrunks.

Theanteriorvagaltrunk,derivedmainlyfromthe
leftvagusnerve.itgivesoffhepaticandduodenal
branchesthatleavethestomachwithinthe
hepatoduodenalligament.
Therestofanteriorvagaltrunkcontinuesalong
thelessercurvatureofthestomach,givingriseto
anteriorgastricbranchessupplyingtheanterior
surfaceofthestomach.
crowsfoottosupplythepyloricantrumandthe
anteriorwallofthepyloriccanal.

Theposteriorvagal
trunk,derivedmainlyfrom
therightvagusnerve
Theposteriorvagaltrunk
givesoffaceliacbranch
Theposteriorgastric
branches
crowsfootwhich
supplythepyloricantrum
andtheposteriorwallof
thepyloriccanal.

 TheDuodenum

1.Positionandshape
Theduodenumis
continuousproximallywith
thepylorusofthestomach,
anddistallywiththe
duodenojejunaljunction.
Itisisrelatedtotheupper
threelumbarvertebraeand
theheadofthepancreas.

2.Divisionsandrelations
1 Thesuperiorpart
Itsrelationsare:
posteriorly,theinferiorvena
cava,commonbileduct,hepatic
portalveinandgastroduodenal
artery;
anteriorly,thequadratelobe
oftheliverandgallbladder;
superiorly,theneckofthe
gallbladderandlesseromentum;
inferiorly,thepancreas.

 2 Thedescendingpart
Thecommonbileductandpancreaticductpiercethe
posteromedialwallobliquelyjustbelowthemiddleofthe
descendingpart.
themajorduodenalpapilla,
theminorduodenalpapilla.
Itsrelationsinclude:posteriorly,therightkidney,right
renalvesselsandtherightureter;anteriorly,the
transversecolonanditsmesocolon;medially,the
pancreas,pancreaticductandcommonbileduct;laterally,
theascendingcolon.

 3 ThehorizontalpartItisabout10 12cm
longandpassestransverselytotheleftofthethird
lumbarvertebra..Itisretroperitioneal.
Itsrelationsare:posteriorly,theinferiorvenacava,
abdominalaortaandrightureter;anteriorlythesupeior
mesentericvesselsandtherootofthemesentery;
superiorly,theheadofthepancreas.Tightstretchingof
thesuperiormesentericarteryoverthispartof
duodenumisconsideredresponsibleforcertain
duodenalobstructions.

 4 Theascendingpart
Itrunsupwards,slightlytotheleftofthe
abdominalaortatothelevelofthesecond
lumbarvertebrawhereitterminatesby
bendingabruptlyforwardsandtotherightas
theduodenojejunalflexure,whichisfixedto
therightcrusofthediaphragmbythe
suspensoryligamentofduodenum.Itisthe
landmarkfortheoriginofthejejunumduring
operation.

3.Thebloodvessels,lymphaticdrainageandnerves

 1 ThearteriesTheprincipalbloodsupplyisfrom
thetwoarcadesformedbythesuperiorandinferior
pancreaticoduodenalarteries.

Thesuperiorpancreaticoduodenalartery.

Theinferiorpancreaticoduodenalartery.

 TheLiver
Position

Theportahepatisandhepaticpedicle

ThereareHshapeddeepgrooves
onthevisceralsurface:theleft
longitudinalgroovecontainsthe
ligamentumteres anteriorly and
theligamentum
venosum posteriorly ;theright
longitudinalgrooveisthefossafor
gallbladderandthesulcusforvenacava.
Thecross-baroftheHistheporta
hepatis orthefirstportahepatis

The second porta hepatis

Inthesuperiormarginofthesulcusfor
venacavaonthediaphragmaticsurfaceofthe
liverliesthe second porta hepatiswherethe
right,leftandintermediatehepaticveinsleave
theliverandentertheinferiorvenacava.

Thethird porta hepatis

Intheinferiorpartofthesulcusforvenacava
wheretheinferiorvenacavareceivesseveralsmall
veins theshorthepaticveins fromthevisceral
surfaceoftherighthalfandthecaudatelobeofthe
liveisthethird porta hepatis.

The hepatic pedicle

Thestructuresenteringorleavingthe
first portahepatisareboundedtogetherby
theconnectivetissueinthefreeborderofthe
hepatoduodenalligament,attheanteriormargin
oftheomentalforamen.Wherethesestructures
formthehepaticpedicle.

Atthislevelthecommonbileductliesanteriorlyandto
theright,whiletheproperhepaticarteryliesanteriorlyjust
totheleftofthecommonbileduct;thehepaticportalvein
liesbehindthem.
Closetothe first portahepatistheproperhepatic
artery,hepaticportalveinandcommonbileductareeach
representedbytwobranches,arightandaleft.

Therightandlefthepaticductslieanteriorly,the
rightandleftarterialbrancheslieinthemiddle,while
therightandleftbranchesofthehepaticportalveinlie
posteriorly.Therelationsofthesestructurestoeach
otherandtothecysticduct,andthevariationswhich
mayoccurhereareofgreatsurgicalimportance.

4.Thelobesandsegmentations
theliverisdividedintoarightlobe,a
quadratelobe,aleftlobeandacaudatelobeby
therightandleftlongitudinalgroovesandthe
portahepatis,thequadratelobeisanteriortothe
portahepatisandthecaudatelobeisposteriorto
theportahepatis.

ThesegmentsoftheliverThecommonhepaticduct,
hepaticportalveinandhepaticarterydivideintorightand
leftbranchestotherightandlefthalvesoftheliver.These
branchesfurthersplitintosmallerbranchestoformthe
Glissonssystem.

OnthebasisoftheGlissons
system,theliverisdividedinto
twohalves,fivelobesandeight
segments.
Twohalvesoftheliverarethe
rightandlefthalves.
Fivelobesare:therighthalf
includestherightanteriorlobe
andtherightposteriorlobe,the
lefthalfisconsistoftheleft
laterallobe,theleftmediallobe,
andthecaudatelobe.

Eightsegmentsare
thecaudatelobe ,thesuperiorandinferior
segmentsoftheleftlaterallobe and ,the
leftmediallobe ,thesuperiorandinferior
segmentsoftherightanteriorlobe and
,andthesuperiorandinferiorsegmentsofthe
rightposteriorlobe and .

theextrahepaticbileducts
)

) thepancreas

the spleen

section6theinfracoliccompartment

1.Verniformappendix

2.Thehepaticportalvein

Section7Theretroperitonealspace

1.kidney

relation

Renalcapsule

Theureter

Thank you

for your attention!

Department of Anatomy,liaoning Medical College