Abdominal anatomy

1. Abdomen Part 2(Organs)
Themba Hospital FCOG(SA) Part 1 Tutorials
By Dr N.E Manana

2. Abdominal oesophagus
• Its the short distal part of the oesophagus located in the abdomen
• Emerges via the right crus of the diaphragm, usually at T10
• Passing from the oesophagus hiatus to the cardial orifice of the stomach just left
to the midline
• The anterior and posterior vagal trunks are associated with the oesophagus as it
passes into the abdomen
• Arterial supply: esophageal branches from the left gastric artery (Celiac) and
esophageal branches from the left inferior phrenic artery (Aorta)

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4. Stomach
• Is the most dilated part of the GIT, its J-shaped
• In the epigastric, umbilical and hypochondrium regions
• Cardia: surrounds the opening of the oesophagus into the stomach
• Fundus: an area above the level of the cardinal orifice
• Body: largest region of the stomach
• Pyloric part: is divided into the antrum and canal, the pyloric orifice is
surrounded by circular muscles (Pyloric sphincter) at about L1
• Greater and Lesser curvature, Cardinal notch and Angular incisure

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6. Small intestine
• Largest part of the GIT, extending from the pyloric orifice to the
ileocecal fold
• It is approx. 6-7 m long, consisting of (A) duodenum, (B) jejunum and
(C) ileum
• (A) Duodenum its C shaped, adjacent to the head of the pancreas, 20-
25cm long, widest lumen of the small intestine
• it is retroperitoneal except for its beginning that is connected to the
liver via the hepatoduodenal ligament (part of the lesser omentum)
• It is divided into 4 parts: Superior, Descending, Inferior and Ascending
part

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8. Small intestine
(B) Jejunum
• It is mostly in the left upper quadrant of the abdomen
• Has a larger diameter, thicker wall and more mesenteric fat than the ileum
• Has less prominent arterial arcades and longer vasa recta
(C) Ileum
• Distal 3 fifths of the small intestine
• Its mostly in the right lower quadrant, it opens into the large intestine
where the cecum and ascending colon join together
• Two flaps (ileo-cecal folds) project into the lumen of the large intestine,
musculature from the ileum continues into each flap, forming a sphincter

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11. Large intestine
• It extends from the distal end of the ileum to anus, approx 1.5m
• It absorbs fluid and salts, forming feces
• Consists of the (A) Cecum, (B) Appendix, (C) Colon, (D) Rectum and (E}
Anal canal
(A) Cecum and Appendix
• The cecum is the 1st part of the large intestine, it is an intraperitoneal
structure because of its mobility
• It is continuous with the ascending colon at the entrance of the ileum

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13. Large intestine
(A) Cecum and (B) Appendix
• The appendix is attached to the posteromedial wall of the cecum, just
inferior to the end of the ileum
• The appendix is a narrow, hallow tube
• It has a large aggregations of lymphoid tissue in its wall and its
suspended from the terminal ileum by the mesoappendix
• The point of attachment to the cecum is consistent with the taenia
but the location of the rest of the appendix varies

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16. Large intestine
(C) Colon
• Extends superiorly from the cecum, consists of the ascending,
transverse, descending and sigmoid colon
• The transverse and the sigmoid are intraperitoneal
• The is the right colic flexure and a left colic flexure attached to the
phrenicocolic ligament
• Immediately lateral to the ascending and descending are the right and
left paracolic gutters
• The sigmoid begins above the pelvic inlet and extends to S3, it is S
shaped and mobile suspended by the sigmoid mesocolon

18. Rectum and anal canal
• Extending from the sigmoid colon is the rectum
• Rectosigmoid junction is usually at S3 or end of the sigmoid
mesocolon
• The anal canal is inferior to the rectum

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22. Liver
• It’s the largest visceral organ and its primarily in the right
hypochondrium and epigastric region, extending into the left
• It has 2 surfaces: Diaphragmatic surface and the visceral surface
Diaphragmatic surface
• Smooth and domed, lies against the inferior surface of the diaphragm
• It is associated with subphrenic and hepatorenal recesses which are
continues anterior
Visceral surface
• Its covered by visceral peritoneum except in the gallbladder fossa and
the porta hepatis

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25. Liver
Associated ligaments
• The liver is attached to the anterior abdominal wall by the falciform
ligament
• The are peritoneal folds that connects the liver to the stomach
(hepatogastric ligament), the duodenum(hepatoduodenal ligament), the
diaphragm (right and left triangular ligament) and anterior and posterior
coronary ligaments
Lobes
• Its divided into the right and left lobe by the fossae of the gallbladder and
IVC
• The caudate and quadrate lobes are part of the R lobe but functionally
distinct

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28. Gallbladder
• Its pear shaped sac lying on the visceral surface of the right lobe of
the liver, in the fossa between the right and the quadrate lobe
• It has:
• A fundus projecting from the inferior border of the liver,
• A body its major part which may be against the duodenum or
transverse colon
• and a narrow neck
• The gallbladder receives, concentrates and stores bile from the liver

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30. Pancreas
• It lies mostly posterior to the stomach, from the duodenum to the spleen
• It’s a secondarily retroperitoneal except for a small part of its tail, it
consists of:
• Head: lies within the c shaped cavity of the duodenum
• Uncinate process: Projecting from the lower part of the head, posterior to
the superior mesenteric vessels
• Neck: anterior to the superior mesenteric vessels, the portal vein forms
posterior to the neck
• Body
• Tail: ends as it passes between layers of the splenorenal ligament

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34. Spleen
• It develops as part of the vascular system in the dorsal mesentery of the
stomach
• It lies in the left hypochondrium and is against the diaphragm in an adult,
between Rib 9 -10
The spleen is connected :
• 1. The stomach by the gastrosplenic ligament which has the short gastric
and the gastro-omental vessels
• 2. The left kidney by the splenorenal ligament, which contains the splenic
vessels
• The spleen is surrounded by peritoneum except for its hilum, which is the
entry point for the splenic vessels and at times associated with the
pancreatic tail

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37. Thank you