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Abdomen 4

Abdomen 4

This presentation shows the 4th quarter of Anatomy of the Abdomen


Dr.Sherif Fahmy

August 15, 2019


  1. Spleen

  2. Site, Size

  3. Spleen Diaphragm Stomach

  4. Spleen Stomach Diaphragm 9th rib 10th rib 11th rib

  5. Surface Anatomy

  6. 1.5 inch Mid-axillary line

  7. Peritoneal Covering

  8. Spleen

  9. Spleen is completely covered with peritoneum except hilum that gives

    attachment to: -Gastrosplenic lig. -Lienorenal lig. Gastrosplenic lig. Lienorenal lig.
  10. Features of Spleen It has: 1- Two Ends: Anterior &

    Posterior. 2- Two Borders: Upper & Lower. 3- Two Surfaces: Diaphragmatic & Visceral.
  11. Posterior (medial) end Anterior (lateral) end Upper border Lower border

  12. Surfaces of the Spleen Visceral Surface Diaphragmatic Surface Hilum

  13. Relations A- Diaphragmatic surface. B- Visceral surface.

  14. Spleen Diaphragm 9th rib 10th rib 11th rib Diaphragmatic relations

  15. Hilum of Spleen Left colic flexure Tail of pancreas Stomach

    Visceral Relations Left kidney
  16. Gastric impression Renal impression for left kidney Colic impression for

    left colic flexure Impression of tail of pancreas
  17. Blood Supply

  18. Splenic artery Celiac trunk 4-5 Terminal branches

  19. Splenic vein Superior mesenteric vein Portal vein

  20. Lymph Drainage ➢Red bulbs of spleen has no lymphatics. ➢Few

    lymphatics from the capsule and trabeculae are drained to pancreatico- splenic nodes.
  21. Pancreatico-splenic lymph nodes Coeliac lymph nodes

  22. Factors supporting spleen in position 1- Peritoneal ligaments. 2- Intra-abdominal

    pressure. 3- Contact with surrounding organs.
  23. Functions of Spleen 1- Store of blood and iron. 2-

    Destruction of old red blood cells. 3- Formation of red blood cells during intra-uterine life till the 5th month of intrauterine life.
  24. Applied Anatomy 1- Common causes of splenic enlargement? 2- Spleen

    can be felt below costal margin after being enlarged 3 times its normal size. 3- Spleen enlarge downwards and to the right due to presence of phrenico-colic ligament.
  25. Pancreas

  26. Site of Pancreas 2nd part of duodenum Spleen

  27. Parts of Pancreas Head Uncinate process Neck Body Tail Dr.

    Sherif Fahmy
  28. Peritoneal Coverings

  29. Relations to peritoneum Transverse colon Transverse mesocolon

  30. Relations of Pancreas

  31. 1- Relations of Head

  32. Transverse colon Superior mesenteric vessels Dr. Sherif Fahmy

  33. IVC Common bile duct Right renal vein Deep surface of

  34. Head of panceas Duodenum Superior pancreatico- duodenal vessels Inferior pancreatico-

    duodenal vessels
  35. 2-Relations of Neck of Pancreas

  36. Pyloro-duodenal junction

  37. Portal vein Splenic vein Superior mesenteric vein Neck of pancreas

  38. 3- Relations of the Body The body of pancreas is

    triangular in cross section. It has 3 surfaces & 3 borders: Surfaces: - Anterior. - Posterior. - Inferior. Borders: - Anterior. - Upper. - Lower
  39. Posterior surface Inferior surface Upper border Anterior border Inferior border

  40. Omental tuberosity Transverse mesocolon Celiac trunk Celiac lymph nodes Splenic

    artery Pancreatico-splenic lymph nodes Duodeno-jujenal flexure Coils of jujenum Left colic flexure
  41. Abdominal aorta Superior mesenteric artery Splenic vein Left renal vein

    Left crus of diaphragm Left sympathetic chain Left psoas major muscle Left kidney Left suprarenal gland
  42. 4- Relations of the Tail

  43. Lieno-renal lig. Tail of pancreas Splenic vessels

  44. Pancreatic Duct

  45. Main pancreatic duct Common bile duct Ampulla of Vater Sphincter

    of Oddi in the major duodenal papilla Accessory pancreatic duct Minor duodenal papilla
  46. Blood Supply of Pancreas

  47. Celiac trunk Splenic artery Gastro-duodenal a. Superior mesenteric artery Inferior

    pancreatico- duodenal artery Superior pancreatico- duodenal artery
  48. Splenic vein Superior & inferior pancreatico- duodenal veins Superior mesenteric

    vein Portal vein
  49. Lymph Drainage

  50. Pancreatico-splenic lymph nodes Celiac lymph nodes Superior mesenteric lymph nodes

  51. Applied Anatomy Cancer head: may lead to obstruction of: 1-

    Common bile duct: leads to jaundice. 2- Inferior vena cava: Edema in lower limb. 3- Portal vein: Portal hypertension. 4- Pyloric end: leads to pyloric stenosis. 5- Duodenum: Duodenal obstruction. Pancreatic pain: Felt in epigastric region, referred to back. Relieved by leaning forward. Duodenal ulcer: May be complicated by erosion of pancreas.
  52. Arteries of the Gut

  53. Abdominal aorta Coeliac artery (upper border of L1) Superior mesenteric

    artery (lower border of L1) Inferior mesenteric artery (L3)
  54. 1- Coeliac Trunk (Page 139)

  55. Level & Relations of Coeliac Trunk

  56. Lesser omentum & lesser sac Coeliac trunk (at lower border

    of T12 or upper border of L1) Median arcuate ligament Anterior Relations Superior Relations
  57. Crura of diaphragm Coeliac ganglia Coeliac trunk Lateral Relations

  58. Coeliac ganglia Omental tuberosity of pancreas Lateral & Inferior Relations

  59. Branches of Coeliac Trunk 1- Celiac trunk. 2- Splenic artery.

    3- Hepatic artery.
  60. 1- Left Gastric Artery

  61. Coeliac trunk Left gastric artery Esophageal branch

  62. 2- Splenic Artery

  63. Coeliac trunk Splenic artery Pancreatic branches Arteria pancreatica magna

  64. Coeliac trunk Splenic artery 5 terminal splenic branches (end arteries)

    Short gastric arteries Left gastro-epiploic artery Posterior gastric 50 %
  65. 3- Hepatic Artery

  66. Coeliac trunk Common hepatic artery Right gastric artery Gastroduodenal artery

    Supraduodenal artery (50 %) Right gastro-epiploic a. Superior pancreatico- duodenal artery Hepatic artery proper
  67. Coeliac trunk Hepatic artery Hepatic artery proper Cystic artery Left

    & right divisions of hepatic artery proper
  68. Superior Mesenteric Artery (Page 146)

  69. Course & Relations

  70. Superior mesenteric a. Superior mesenteric vein 3rd part of duodenum

    Body of pancreas
  71. Splenic vein Left renal vein Head of pancreas (cut) Superior

    mesenteric a. 3rd part of duodenum Inferior vena cava
  72. Branches of Superior Mesentric Artery 1- Inferior pancreatico-duodenal. 2- Jujenal

    & ileal 3- Middle colic. 4- Right colic. 5- Ileocolic.
  73. Superior mesenteric a. Inferior pancreatico- duodenal a.

  74. Middle colic Right colic Ileocolic Superior mesenteric artery Jejunal arteries

    Ileal arteries
  75. None
  76. Inferior Mesenteric Artery (Page 152)

  77. Abdominal aorta Common iliac artery Coeliac artery Superior mesenteric artery

    Inferior mesenteric artery
  78. Inferior mesenteric a. Superior rectal a.

  79. Branches of inferior mesenteric artery: 1- Superior left colic. 2-

    Inferior left colic (sigmoidal). 3- Superior rectal artery.
  80. None
  81. Marginal Artery

  82. None
  83. Perineum (Page 104- pelvis book)

  84. Dr. Sherif Fahmy

  85. Dr. Sherif Fahmy

  86. Ischio-rectal Fossa (Page 112)

  87. Dr. Sherif Fahmy

  88. Dr. Sherif Fahmy

  89. Dr. Sherif Fahmy

  90. Internal Pudendal Artery & Pudendal Nerve (Page 115)

  91. None
  92. None
  93. Dr. Sherif Fahmy

  94. Deep Perineal Pouch (Page 124)

  95. Dr. Sherif Fahmy

  96. Dr. Sherif Fahmy

  97. Dr. Sherif Fahmy

  98. Superficial Perneal Pouch (Page 127)

  99. Dr. Sherif Fahmy

  100. Dr. Sherif Fahmy

  101. Female superficial pouch Dr. Sherif Fahmy


  103. Diaphragm (Page 233)

  104. Attachments of Diaphragm

  105. Origin of Diaphragm

  106. Xiphoid process Lower 6 ribs & costal cartilages Right crus

    of diaphragm Left crus of diaphragm Median arcuate ligament Medial arcuate ligament Lateral arcuate ligament Psoas major muscle Quadratus lumborum Central (trifoliate) tendon
  107. Insertion of Diaphragm & Defects in the Diaphragm

  108. Sternal origin Costal origin Vertebral origin Anterior defect (foramen of

    Morgagni) Posterior defect (foramen of Bockdalek – vertebrocostal triangle) Central tendon Median part (folium) of central tendon Lateral parts (folia) of central tendon
  109. Pericardium Pleura Peritoneal canal Pleuro-peritoneal membrane Pleuro-pericardial membrane Reason of

    formation of vertebro-costal defect
  110. Major Openings of Diaphragm

  111. Vena caval opening (1 inch to the right of midline

    at T8) IVC Right phrenic nerve Esophageal opening (1 inch to the left of midline at T10) Esophagus Anterior & posterior vagal trunks Aortic opening of diaphragm (midline at T12) Aorta Thoracic duct
  112. Minor openings of diaphragm ➢Superior epigastric and musculophrenic arteries. ➢Lower

    5 intercostal nerves and subcostal nerve. ➢Subcostal vessels. ➢Inferior hemiazygos vein. ➢Splanchnic nerves and sympathetic chain.
  113. Arterial supply of diaphragm ➢Superior phrenic artery from descending aorta.

    ➢Inferior phrenic artery from abdominal aorta. ➢Musculophrenic artery. ➢Lower posterior intercostal arteries. ➢Pericardiacophrenic artery.
  114. Applied anatomy Diaphragmatic hernia: A- Hiatus hernia: through esophageal opening.

    B- Hernia of Bockdalk: between vertebral and costal origin of diaphragm. C- Hernia of Morgagni: between sternal and costal origin of diaphragm.
  115. Psoas Major Muscle (Page 239)

  116. T12 Lumbar vertebrae & intervertebral discs Transverse processes of lumbar

  117. Iliac fossa of hip bone Lesser trochanter Ala of sacrum

    Inguinal lig.
  118. Psoas Major Muscle

  119. Psoas major m. T12 Lumbar vertebrae Ilio-psoas tendon to lesser

    trochanter & 1 inch below Inguinal lig.
  120. Lumbar arteries

  121. Relations of Psoas Major Muscle ➢Anterior. ➢Posterior. ➢Lateral. ➢Medial.

  122. Anterior Relations

  123. Right kidney 2nd part of duodenum 3rd part of duodenum

    Ureter Gonadal artery Genito-femoral nerve 4th part of duodenum
  124. Descending colon Root of mesentery of small intestine & superior

    mesenteric vessels
  125. Lateral & Posterior Relations

  126. Quadratus lumborum Ilio-hypogastric nerve Ilio-inguinal nerve Iliacus muscle Lateral cutaneous

    nerve of thigh Femoral nerve Quadratus lumborum muscle Iliac crest Iliacus muscle Lumbar plexus and transverse processes of lumbar vertebrae Posterior Relations Lateral Relations
  127. Medial Relations

  128. Inferior vena cava Abdominal aorta Common iliac arteries

  129. Diaphragm Transversus abdominis Quadratus lumborum Iliacus Psoas major Psoas minor

  130. Relations of Psoas Major in the Femoral Triangle

  131. Femoral nerve Psoas major Iliacus m. Femoral vessels inside femoral

    sheath Inguinal ligament Pectineus m.
  132. Quadratus Lumborum (Page 242)

  133. None
  134. None
  135. Quadratus lumborum

  136. Psoas Minor (Page 243)

  137. Psoas minor muscle


  139. None