This document provides an overview of the abdomen and pelvis. It begins by defining the abdomen and describing its anterior and posterior walls. It then discusses the contents of the abdomen, including the digestive system (esophagus, stomach, small intestine, large intestine), hepato-biliary apparatus (liver, gallbladder, bile ducts), and peritoneum. For each organ, it provides details on location, structure, arterial supply, venous drainage and lymph drainage. The small intestine is subdivided into duodenum, jejunum and ileum with specifics for each section.

1. ABDOMEN
& PELVIS
PRESENTED BY:-SARU GOSAIN
B.SC.MIT 2017
MODERATOR:- MR. RANJIT
KUMAR JHA
ASSISTANT

2. ABDOMEN
• Abdomen (also
called belly, tummy)
is the part of the
trunk below the
diaphragm and
above the pelvis at
the pelvic inlet.
• 2 parts:- anterior
abdominal wall and
posterior abdominal
wall.

3. ANTERIOR ABDOMINAL
WALL
• Extends from the
xiphoid process
to the pubic
symphysis
anteriorly and
thoracic cage to
the gluteal region
posteriorly.
• Consists of
various muscles,
peritoneal cavity
and abdominal
viscera

4. •Divided into 4 quadrants and 9
regions to describe the location of
abdominal viscera or structure.

8. CONTENTS OF ABDOMEN
PERITONEUM
• Large serous
membrane lining
the abdominal
cavity.
• It is divided into
Parietal
peritoneum
Visceral
peritoneum

9. CONTENTS OF ABDOMEN
1. Parietal peritoneum
lines the inner
surface of the
abdominal and
pelvic walls and the
lower surface of the
diaphragm.
2. Visceral peritoneum
lines the outer
surface of the
viscera

10. 1. Peritoneal folds connect
viscera to the abdominal
wall or to each other in
or outside the peritoneal
cavity.
2. Eg:- mesentery at small
intestine, mesocolon at
colon, omenta at
stomach and ligaments
which are the double-
layered folds of
peritoneum.
3. Viscera suspended in the
cavity are intra-
peritoneal whereas
suspended outside with
Retroperitoneal organs:- SAD PUCKER
S= Suprarenal gland
A= Aorta/IVC
D= Duodenum (2nd & 3rd)
P= Pancreas except tail
U= Ureters
C= Colon (ascending and descending
colon)
K= Kidney
E= Esophagus

11. CONTENTS OF ABDOMEN
1.DIGESTIVE SYSTEM
a) Oesophagus
b) Stomach
c) Small intestine
d) Large intestine

12. DIGESTIVE SYSTEM
OESOPHAGUS
• The abdominal part of
the esophagus is only
about 1.25cm long
which enters the
abdomen through the
esophageal opening of
the diaphragm situated
at the level of T10.

13. STOMACH
•Also called gaster,
(greek belly) or
venter
•Muscular bag
farming the widest
and most
distensible part of
the digestive tube.
•Intervenes between
oesophagus above

14. Situation
Occupies epigastric,
left hypochondriac
and umbilical
regions.
Capacity
• In new born= 30-
50ml
• In adult=1000-
1500ml
Shape
• In cadaver=sickle
shaped

15. Presenting parts
Two Orifices
The cardiac orifice is joined by lower end
of the oesophagus.
The pyloric orifice open into the
duodenum.
Two Curvature
The Lesser curvature and the greater
curvature.
Two surfaces
The anterior/anterosuperior surface
faces forward and upwards.
The posterior/posteroinferior surface
faces backward and downwards.
Two parts
1.Cardiac part;
Fundus and body
2.Pyloric part

16. • Posterior-inferior surface is
related to structures forming the
stomach bed.
• Structures upon which the stomach
rests;
-Left crus of diaphragm
-Left supra-renal gland
-Anterior surface of left kidney
-Tortuous splenic artery.
-Anterior surface of pancreas.
-Transverse mega colon.
-Gastric impression of
spleen(when distended stomach)
Stomach bed

17. ARTERIAL SUPPLY
• Left gastric
artery(principal
artery)
• Right gastric
• Short gastric
• Left gastro-epiploic
• Right gastroepiploic
• Posterior gastric
artery.

18. VENOUS DRAINAGE
• Right and left
gastric veins-into
the trunk of portal
vein
• Short gastric and
left gastro-epiploic
veins-into splenic
vein
• Right gastro-
epiploic vein-into

19. SMALL INTESTINE
Pylorus to
ileocaecal
junction
Length: 6 m
Duodenum = 25
cm
Jejunum = upper
2/5th

20. Duodenum:
fixed
-Retroperitoneal
organ (2nd & 3rd
part)
-elongated ‘C'
that lies between
the level of the
L1 to L3 in the 20
DUODENUM

21. Divided into 4
parts
• First or Upper
part:- 5 cm
• Second or vertical
part:- 7.5-8 cm
• Third or
horizontal part:-
10cm
• Fourth or
Ascending part:-

22.  Extends from pylorus to
superior duodenal flexure
 Length 5 cm
 In the radiograph taken
after giving a barium meal,
this part is seen as a
triangular shadow and is
referred to as duodenal
cap
 Relations
 In front covered by
peritoneum
 Related to quadrate
lobe of liver
 Neck of gall bladder

23. 2ND PART OF THE DUODENUM
• Begins from the
superior duodenal
flexure opposite L1
vertebra
• Passes vertically
downward to reach the
inferior duodenal
flexure opposite lower
boarder of L3

24. 3RD PART OF DUODENUM
Begins from inferior
duodenal flexure on the
right side of lower
border of 3rd lumbar
vertebra.
10 cm long
Extends across the
lower part of L3
Passes almost
horizontal and slightly
upwards in front of the
IVC and ends in
continuity with the
fourth part in front of
the abdominal aorta

25. 4TH PART OF DUODENUM
About 2.5 cm long
Extends to the duodeno-
jejunal flexure in front of
aorta
Relation
Peritoneal relation:
Most of the part is
retroperitoneal and fixed
Terminal part is
suspended by the
uppermost part of the
mesentery

26. ARTERIAL SUPPLY
• Up to the level of
opening of bile duct into
2nd part of the
duodenum, it is supplied
by superior
pancreaticoduodenal
artery and below it is
supplied by inferior
pancreaticoduodenal
artery.
• First part of duodenum
receives additional
supply from
1.Right gastric artery
2.Supraduodenal artery of
Wilkie, which is branch of
common hepatic artery
3.Retroduodenal branch of
gastroduodenal artery

27. VENOUS DRAINAGE:
• splenic veins
• Superior mesenteric veins
• portal veins
LYMPHATIC DRAINAGE:
• Pancreatoduodenal nodes
NERVE SUPPLY:
1. Sympathetic nerve: T9 & T10
2. parasympathetic nerve: Vagus nerve

28. JEJUNUM & ILEUM
Concerned with digestion &
absorption.
Hence, together known as
small intestine proper.
Extends from duodenojejunal
flexure to ileocaecal junction
-Upper 2/5th : jejunum
-Lower 3/5th : ileum
Are suspended from
posterior abdominal wall by
mesentery, hence mobile.

29. ARTERIAL SUPPLY:
•Jejunal and ileal branches of the
superior mesenteric artery.
•Vasa recta supplies to the glands
and villi.
LYMPHATIC DRAINAGE:
•Mesenteric lymph nodes
NERVE SUPPLY:
•Sympathetic T9 to T11

30. Feature Jejunum Ileum
Wall Thicker and more vascular Thinner and less
vascular
Lumen Wider and often empty Narrower and often
loaded
Mode of
blood
supply
Jujunal arteries form one or
two arterial arcades; the
vasa recta arising from it is
longer and fewer
Form three or more
arcades; vasa recta
are shorter and more
numerous
Mesentr
y
Fat is less abundant
therefore translucent
windows are found between
the vasa recta and the
window are rectangular
More abundant
therefore translucent
windows are usually
not observed. If
present they are
rectangular
Plicae
circulari
s
Larger and more closely set Smaller and widely
separated (fold are
absent in terminal 6
inch )
Solitary
lymphati
c follcles
absent present

31. Fig: plicae circulares of the jejunum(A) and
ileum(B).

32. LARGE INTESTINE
•Length: 1.5 m
•Extends from
caecum in right iliac
fossa to anus in
perineum.
•Apart from
transverse colon &
sigmoid colon, it is
more fixed in
position than small
32

33.  Four Parts
1. Cecum & Appendix
2. Colon
oAscending colon-
12.5 cm
oTransverse colon-
50cm
oDescending colon-
25cm
oSigmoid colon-
37.5cm
3. Rectum
4. Anal Canal 33

34. FEATURES OF LARGE GUT
1. TAENIAE COLI- three thick bands
produced by the aggregations of
the longitudinal muscles of the large
gut.
 Taenia libera – on anterior
surface
 Taenia mesocolica- on posterio-
medial surface
 Taenia omentalis- posterio

35. 2. SACCULATIONS
3. APPENDICES
EPIPLOICAE – are
peritoneal
pouches
containing fat
present in the
entire large gut
expect caecum,

36. CAECUM
• Large blind sac situated in
the right iliac fossa, above
the lateral half of inguinal
ligament.
• 6 cm long and 7.5 cm broad
VERMIFORM APPENDIX
• Worm like tubular
diverticulum arises from
postero- medial wall of the
caecum, 2cm below ileo-

37. Positions of appendix
11o clock – paracolic 2%
12 Clock - retrocolic
,commonest type
2 Clock - splenic type 1-2 %
3 CLOCK - promontoric rare
4 clock – pelvic 30% second
commonest
6 clock – mid inguinal

38. •ASCENDING COLON
extends from the
caecum to the right
colic flexure.
•TRANSVERSE
COLON extends from
the right colic flexure
to the left colic
flexure.
•DESCENDING
COLON extends from

39. ARTERIAL SUPPLY
• Marginal artery of Drummond
which is formed by colic
branches of superior and
inferior mesenteric arteries.
LYMPHATIC DRAINAGE
• Epicolic lymph nodes
• Paracolic nodes
• Intermediate nodes
• Terminal nodes
NERVE SUPPLY
• Sympathetic supply from
coeliac and superior
mesenteric ganglia (T11 to L1)
• Parasympathetic supply from
vagus

40. 2. HEPATO-BILIARY APPARATUS
a) Liver
b)Right and left
hepatic ducts
c) Common
hepatic duct
d)Gallbladder
e)Cystic duct
f) Bile duct

41. LIVER
Second largest organ of the
body and largest gland of
body. It consists of:
a) Exocrine part – secretes bile
and
b) Endocrine part– liberate
glucose from glycogen,
most of plasma protein and
heparin directly into blood.
Weight: 1200 to 1500 gm, or
4-5% of body weight.
Location: whole of the right
hypochondrium, the greater
part of epigastrium, and
extends into the left
hypochondrium

42. a)Five surfaces
1.Anterior
2.Posterior
3.Superior
4.Inferior &
5.Right lateral
b)1 prominent
Border: - inferior
c) 2 lobes

43. LOBES OF LIVER
• Anatomically liver is divided
into Rt and Lt lobe.
• Rt. Lobe is much larger than
left lobe and forms 5/6th of
liver and presents the
caudate and quadrate lobes.
• The left lobe is
smaller(1/6th) and ends in a
thin apex.

44. LIGAMENTS OF LIVER
5 peritoneal fold (false
ligaments):
a) Falciform lig
b) Coronary lig
c) Rt triangular lig
d) Lt triangular lig
e) Lesser omentum
2 developmental (true
ligaments);
Ligamentum teres hepatis
Ligamentum venosum

45. PORTA HEPATIS
• deep transverse fissure
(5cm long)
• gateway of liver
• present in inferior
surface of Rt lobe.
• The portal vein, hepatic
artery and hepatic nerve
plexus enters.
• The right and left
hepatic ducts and some
lymph vessels leaves.

46. PERITONEAL RELATIONS
• Liver is covered by
peritoneum
Except:
-bare area
-groove for IVC
-fossa for gall bladder
-coronary ligaments
-lesser omentum

47. ARTERIAL SUPPLY
Liver receive dual blood
supply:
1. 20% blood supply from
hepatic artery and
2. 80% through portal vein.
Before entering liver both
divide into Rt and Lt
branches  within liver it
divide into segmental vessels
interlobular vessels which
run along portal canals
further branch and open into
hepatic sinusoid central

48. VENOUS DRAINAGE
• Hepatic sinusoid  central vein interlobular
veins sublobular veins hepatic veins finally

49. • LYMPHATIC
DRAINAGE:
caval, hepatic,
paracardial and
coeliac nodes.
• NERVE SUPPLY:
from hepatic
plexus which
contain both
sympathetic
and
parasympatheti

50. RIGHT AND LEFT HEPATIC DUCTS
•Emerge at
porta
hepatis
from the
right and
left lobes
of the
liver.

51. COMMON HEPATIC DUCT
• Formed by
union of Rt
and Lt
hepatic
ducts.
• About 3 cm
long
• Joined at
right side by
cystic duct to

52. GALL BLADDER
• pear shaped reservoir of
bile.
• Situated in fossa on
inferior surface of Rt lobe
of liver.
Dimensions : 7-10cm long
and 3cm wide .
Capacity: 30-50ml.
Cystic artery, arising from
Rt hepatic artery supplies
GB, along with cystic duct,
hepatic ducts and upper

53. CYSTIC DUCT
BILE DUCT
 Formed by union of cystic and CHD
 It is 8cm long and 6mm in diameter.
 It comes in contact with pancreatic duct to form
hepatopancreatic ampulla or ampulla of Vater.
 Distal constricted end of ampulla open into summit
of major duodenal papilla. Sphincter of oddi
It is 3- 4cm long.
It begins at neck of gall
bladder and ends by joining
common hepatic duct to form
bile duct.

55. 3. LYMPHATIC SYSTEM
Lymphatic organ
connected to the
blood vascular
system
Location
• Left
hypochondrium,
and partly in the
epigastrium
Dimension
• 2.5cm thick, 7.5cm
broad, 12.5cm
long7 ounces in
weight, and is
related to 9th to
SPLEEN

56. EXTERNAL FEATURES
Two ends
• Anterior or lateral
• Posterior or medial
Three borders
• Superior
• Inferior
• Intermediate
Two surfaces
• Diaphragmatic
• visceral
Two angles
• Anterobasal
• Posterobasal
Ligaments
• Gastrosplenic
• Lienorenal
• Phrenicocolic
Impressions
• Gastric
• Renal
• Colic
• pancreatic

57. • ARTERIAL SUPPLY
Splenic artery,
branch of
coeliac artery
• VENOUS DRAINAGE
Splenic vein
• LYMPHATIC
DRAINAGE
Pancreaticospl
enic nodes
• NERVE SUPPLY
Sypathetic
fibres derived
from the celiac
plexus

58. PANCREAS
• Gland that is partly
exocrine and partly
endocrine.
• The exocrine part
secrets digestive
pancreatic juice and
the endocrine part
secretes hormones e.g.
insulin.
Location
• Posterior
abdominal wall, at
4. ENDOCRINE SYSTEM

59. Size
• 15-20 cm
long, 2.5-3.8
cm broad and
1.2-1.8 cm
thick and
weighs about
90g.
ARTERIAL
SUPPLY
Pancreatic
branches of the
splenic artery
Superior
pancreaticoduoden
al artery
Inferior

60. VENOUS DRAINAGE
Veins drain into splenic, superior
mesenteric and portal veins.
LYMPHATIC DRAINAGE
Pancreaticosplenic, coeliac and superior
mesenteric groups of lymph nodes
NERVE SUPPLY
Vagus or parasympathetic nerve
Splanchnic sympathetic nerve

61. ADRENAL GLAND
• Location: in the
epigastrium, on posterior
abdominal wall behind
peritoneum, at the upper
pole of kidney in 11th
intercostal space and 12th
rib.
• Size:5×3×1cm, 1/3rd size
of kidney at birth and
1/30th in adult.
• Weight: about 5g, 1/10th
formed by medulla
• Shape: Rt. triangular or
pyramidal and Lt.

62. ARTERIAL SUPPLY
There are usually three
arteries that supply each
adrenal gland:
1. The superior suprarenal
artery is provided by the
inferior phrenic artery
2.The middle suprarenal
artery is provided by the
abdominal aorta
3. The inferior suprarenal
artery is provided by the
renal artery.

63. VENOUS DRAINAGE
1. The right suprarenal vein drains into the
inferior vena cava
2.The left suprarenal vein drains into the
left renal vein
LYMPHATIC DRAINAGE
Lymphatics from the suprarenal gland
drain into the lateral aortic nodes
NERVE SUPPLY
Suprarenal medulla has a rich nerve supply
through preganglionic sympathetic fibers.

64. 5. URINARY SYSTEM
a)Kidney-
2
b)Ureter-
2
c)Urinary
bladder
d)Urethra

65. KIDNEY
Pair of excretory
organ situated on the
posterior abdominal
wall retroperitonally.
Occupy the
epigastric,
hypochondriac,
lumbar and umbilical
region.
Extends from T12-L3
Rt kidney is slightly

66. SIZE AND WEIGHT
11cm long, 6cm broad and 3cm thick
Weighs 150 gram in male and 135 gram in female.
Extent:- T12-L3
EXTERNAL FEATURES
• Two poles - upper pole
- lower pole
• Two surfaces –anterior
-posterior
• Two borders- lateral
-medial

67. RELATIONS OF KIDNEY
• Upper pole of each kidney is related to the corresponding
supranenal gland
• Medial border of each kidney is related to:-
a. The suprarenal gland , above the hilus, and
b. To the ureter below the hilus
• Posterior relations:- related to the following structures:-
a. Diaphragm
b. Medial and lateral arcuate ligaments
c. Psoas major
d. Quardratus lumborum
e. Transversus abdominis
f. Subcoatal vessels
g. Subcostal, iliohypogatric and ilioinguinal nerves

68. OTHER RELATIONS OF RIGHT
KIDNEY
1. 12th rib
2. Right suprarenal
gland
3. Liver
4. Second part of
duodenum
5. Hepatic flexure of
colon
6. Small intestine

69. OTHER RELATIONS OF LEFT
KIDNEY
1. 11th and 12th ribs
2. Left suprarenal gland
3. Spleen
4. Stomach
5. Pancreas
6. Splenic vessels
7. Splenic flexure and
descending colon
8. Jejunum

70. CAPSULES /COVERINGS OF
KIDNEY
1. The fibrous capsule
2. Perirenal or perinephric fat
3. Renal fascia
4. Pararenal or paranephric fat

72. LYMPHATIC DRAINAGE
Lymphatics of kidney drain into lateral
aortic node
NERVE SUPPLY
Kidney is supplied by renal plexus
It contains sympathetic T10-L1 fibers
which are chiefly vasomotor
The afferent nerves of kidney belong to
the segments T10-T12

73. URETER
• These are pair of
muscular tubes (25
cm) that are
continuous superiorly
with the renal pelvis.
• Consists of three
parts:-
Abdominal part
Pelvic part
Intramural part

74. DIMENSION
10 inch long of which upper half
5 inch lies in the abdomen and
lower half 5 inch in the pelvis
measures about 3mm in diameter
but it is slightly constricted at 5
places
1. At the pelviuretric junction
2. At the brim of lesser pelvis
3. Point of crossing of ureter by
ductus deference or broad
ligament of uterus.
4. Intravesical course and
5. At the trigone of urinary

75. BLOOD SUPPLY
• Upper part- renal
artery
• Middle part- from
aorta
• Pelvic part- vesical,
middle rectal or
uterine vessels
NERVE SUPPLY
Sympathetic- T10-
L1

76. POSTERIOR ABDOMINAL
WALL
• Includes following
1. Abdominal aorta
2. Inferior vena cava
3. Abdominal parts of the azygos and
hemiazygos veins
4. Lymph nodes of posterior abdominal wall
and cisterna chili
5. Muscles of the posterior abdominal wall and
thoracolumbar fascia
6. Nerves of the posterior abdominal wall
including lumbar plexus and the abdominal
part of autonomic nervous system

77. BONES IN RELATION TO
ABDOMEN
• Lumbar
vertebrae-5
• Sacrum-1
(formed by
fusion of 5
bones)
• Coccyx-1
(formed by
fusion of 4
bones)

78. LUMBAR VERTEBRAE
• There are 5 lumbar
vertebrae, of which the
first four are typical, and
the fifth is atypical
• Lumbar vertebrae is
identified by
1. Its large size
2. The absence of costal
facets on the body and
3. The absence of
foramen in transverse
process

79. TYPICAL FEATURES OF LUMBAR
VERTEBRAE
• The body is large, kidney-shaped
• The vertebral foramen is triangular in
shape, and is larger than in the
thoracic region but is smaller than in
cervical region
• The pedicles are short and strong
• The alminae are short, thick and
broad
• The spine forms a vertical
quadrilateral plate, directed almost
backwards and only slightly
downwards.
• The transverse process are thin and
tapering
• The superior articular processes lie

80. ATYPICAL FEATURES OF LUMBAR
VERTEBRAE
1. The transverse processes are thick,
short and pyramidal in shape.
2. The distance between the inferior
articular processes is equal to or
more than the distance between the
superior articular processes.
3. The spine is small, short and rounded
at the tip
4. The body is the largest of all the
lumbar vertebrae.
5. The pedicles are directed backwards
and laterally.
6. The superior articular facets look
more backwards than medially, and
the inferior articular facets look more
forwards than laterally, as compared
to other lumbar vertebrae

81. SACRUM
• Large, flattened, triangular bone formed from
the fusion of five sacral vertebrae
Male sacrum Female sacrum
Longer and narrower, i.e., the average
sacral index is 105
Shorter and wider, i.e., the average
sacral index is 115
The width of the body of the first
sacral vertebrae is greater than that of
each ala in the male
The two are equal
The dorsal concavity of auricular
surface is less marked in male
More marked
The concavity on the ventral aspect of
sacrum is more uniform, and is
shallower in males
The concavity is irregular especially
between S1 and S2 and between S3
and S4
The sacrovertebral angle and the size
of pelvic cavity is less
More

82. COCCYX
• Small
triangular
bone formed
by fusion of
four
rudimentary
coccygeal
vertebrae