Abdomen 3 - Speaker Deck

Slide 1

Slide 1 text

LIVER (Page 182)

Slide 2

Slide 2 text

Shape &Size

Slide 3

Slide 3 text

Site

Slide 4

Slide 4 text

Lobes of the liver: A- Anatomical: - Left lobe. - Right lobe. -Caudate lobe. -Quadrate lobe. By attachments of falciform ligament, fissure of ligamentum teres and fissure of ligamentum venosum.

Slide 5

Slide 5 text

Anatomical Divisions

Slide 6

Slide 6 text

Falciform lig. Containg

Slide 7

Slide 7 text

Fissure of lig. venosum Fissure of lig. teres Left lobe

Slide 8

Slide 8 text

Surgical & Physiological Divisions (Page 183)

Slide 9

Slide 9 text

Middle hepatic vein 1 2 3 4 5 6 7 8

Slide 10

Slide 10 text

Surfaces, Border & Relations (Page 187)

Slide 11

Slide 11 text

Anterior, Superior and Right Relations

Slide 12

Slide 12 text

No content

Slide 13

Slide 13 text

Posterior & Inferior Relations

Slide 14

Slide 14 text

Posterior Surface 1- Back of left lobe. 2- Fissure of ligamentum venosum. 3- Cudate lobe. 4- Fossa for inferior vena cava. 5- Back of right lobe.

Slide 15

Slide 15 text

No content

Slide 16

Slide 16 text

Groove for esophagus Fissure for lig. venosum Caudate lobe I.V.C. Upper layer of coronary lig. RT triangular lig. Lower layer of triangular lig. Gall bladder Quadrate lobe Fissure for lig. teres Omental tuberosity Gastric area Bare area Porta hepatis Papillary process Caudate process Inferior surface of RT lobe

Slide 17

Slide 17 text

No content

Slide 18

Slide 18 text

Inferior (Visceral) Surface

Slide 19

Slide 19 text

No content

Slide 20

Slide 20 text

Esophagus Stomach Lesser omentum Pyloro-duodenal junction Area for transverse colon Gall bladder 2nd part of duodenum Rt. Colic flexure Rt. kidney Rt. Suprarenal gland Dr. Sherif Fahmy

Slide 21

Slide 21 text

Peritoneal Relations (page 191)

Slide 22

Slide 22 text

Areas not covered with peritoneum: 1- Bare area of the liver. 2- Fossae for gall bladder & for IVC. 3- Porta hepatis. Peritoneal folds related to liver: 1- Falciform ligament. 2- Coronary ligament. 3- Triangular ligaments. 4- Lesser omentum (Page 82)

Slide 23

Slide 23 text

Falciform Ligament (Page 193)

Slide 24

Slide 24 text

Falciform ligament

Slide 25

Slide 25 text

Dr. Sherif Fahmy

Slide 26

Slide 26 text

Coronary Ligament (Page 195)

Slide 27

Slide 27 text

Dr. Sherif Fahmy

Slide 28

Slide 28 text

Dr. Sherif Fahmy

Slide 29

Slide 29 text

Triangular Ligaments (Page 195)

Slide 30

Slide 30 text

Dr. Sherif Fahmy

Slide 31

Slide 31 text

Lesser Omentum

Slide 32

Slide 32 text

Fissure of ligamentum venosum Lesser omentum Porta hepatis Dr. Sherif Fahmy

Slide 33

Slide 33 text

Lesser omentum Dr. Sherif Fahmy

Slide 34

Slide 34 text

Subphrenic Spaces (Page 86)

Slide 35

Slide 35 text

Falciform ligament

Slide 36

Slide 36 text

Dr. Sherif Fahmy

Slide 37

Slide 37 text

Dr. Sherif Fahmy

Slide 38

Slide 38 text

No content

Slide 39

Slide 39 text

Fissures of the Liver (Page 185) 1- Porta hepatis. 2- Fissure of ligamentum venosum. 3- Fissure of ligamentum teres.

Slide 40

Slide 40 text

No content

Slide 41

Slide 41 text

Ligaments of the Liver: (Page 186) A- Obliterated vascular ligaments: 1- Ligamentum teres. 2- Ligamentum venosum. B- Peritoneal ligaments: 1- Coronary ligament. 2- Right & left triangualr ligaments. 3- Lesser omentum. 4- Falciform ligament.

Slide 42

Slide 42 text

Surface Anatomy (Page 196)

Slide 43

Slide 43 text

5th intercostal space Xiphisternal junction Rt. 5th rib Rt. 7th rib 1 cm below the costal margin Rt 9th costal cartilage Transpyloric plane Left 8th costal cartilage

Slide 44

Slide 44 text

Blood Supply of Liver (Page 197)

Slide 45

Slide 45 text

Portal Vein

Slide 46

Slide 46 text

Hepatic artery Portal vein Liver sinusoid Central vein Liver cells

Slide 47

Slide 47 text

Hepatic Artery

Slide 48

Slide 48 text

No content

Slide 49

Slide 49 text

Lymphatic Drainage:(Page 197) A- Lymph vessels: Superficial & Deep. B- Lymph nodes: 1- Lateral diaphragmatic nodes. 2- Paracardial nodes. 3- Parasternal nodes. 4- Hepatic nodes. 5- Coeliac nodes.

Slide 50

Slide 50 text

No content

Slide 51

Slide 51 text

Factors supporting liver in position:(Page 198) 1- Hepatic veins. 2- Intra-abdominal pressure. 3- Tone of anterior abdominal muscles. 4- Peritoneal folds and ligaments.

Slide 52

Slide 52 text

Extra-hepatic Biliary Passage A. Duct system for transmission of bile. B. Gall bladder for storage of bile.

Slide 53

Slide 53 text

Hepatic & Cystic Ducts

Slide 54

Slide 54 text

Hepatic Artery Common Bile duct Common hepatic duct Gastro- duodenal art. Cystic duct

Slide 55

Slide 55 text

Common Bile Duct (Page 200)

Slide 56

Slide 56 text

Hepatic Artery Common Bile duct Common hepatic duct Gastro- duodenal art. Cystic duct

Slide 57

Slide 57 text

No content

Slide 58

Slide 58 text

No content

Slide 59

Slide 59 text

No content

Slide 60

Slide 60 text

Lesser omentum Common bile duct Hepatic artery Portal vein Opening of lesser sac

Slide 61

Slide 61 text

Main pancreatic duct Infra-duodenal common bile duct Ampulla of Vater Sphincter of Oddi in the major duodenal papilla Common hepatic duct Cystic duct Left hepatic duct Right hepatic duct Supraduodenal bile duct Retro-duodenal duct

Slide 62

Slide 62 text

Gall Bladder

Slide 63

Slide 63 text

Site, Shape and Size

Slide 64

Slide 64 text

Fundus of gall bladder

Slide 65

Slide 65 text

Gall bladder Neck of gall bladder Cystic duct

Slide 66

Slide 66 text

Surface Anatomy

Slide 67

Slide 67 text

Transpyloric plane Rt Linea semilunaris Murphy’s point

Slide 68

Slide 68 text

Functions of Gall Bladder 1- Concentration of bile. 2- Storage of bile.

Slide 69

Slide 69 text

Peritoneal Covering of Gall Bladder

Slide 70

Slide 70 text

Fundus of gall bladder

Slide 71

Slide 71 text

Parts & Relations of Gall Bladder

Slide 72

Slide 72 text

Fundus Body Hartman’s pouch of neck Cystic duct Neck

Slide 73

Slide 73 text

Fundus of gall bladder Transverse colon

Slide 74

Slide 74 text

Neck of gall bladder 2nd inch of 1st part of duodenum Cystic artery Hepatic artery Body of Gall bladder 2nd part of duodenum

Slide 75

Slide 75 text

Blood Supply of Gall Bladder

Slide 76

Slide 76 text

Neck of gall bladder Cystic duct 2nd inch of 1st part of duodenum Cystic artery Common hepatic duct Common bile duct Hepatic artery Gall bladder Calot’s triangle

Slide 77

Slide 77 text

Applied anatomy: Cholecystitis: pain in right hypochondrium and radiate to: ➢The tip of right shoulder because it receives sensory fibers from right phrenic (C3,4,5) while the right shoulder receives sensory fibers from lateral supraclavicular nerve (C3,4). ➢At the back below scapula because pain is transmitted through greater splanchnic nerve (T5 – 9). Stone in Hartman’s pouch: Can obstruct neck of the gall bladder or common hepatic duct leading to obstructive jaundice. Rare gall bladder gangrene: because it has arterial supply.

Slide 78

Slide 78 text

Portal Vein (Page 155)

Slide 79

Slide 79 text

Portal Circulation It is the venous drainage of stomach, spleen, pancreas and intestine. Portal vein Systemic veins Portal vein and tributaries. IVC & SVC and tributaries No valves May contain valves. Starts by tributaries and ends by divisions Starts by tributaries and ends by larger vein. Has 2 sets of capillaries One set of capillaries Blood contains absorbed food. Blood contains waste products. Blood is incompletely deoxygenated blood. Blood is completely deoxygenated blood. Blood pressure is higher. Blood pressure is lower.

Slide 80

Slide 80 text

Course of Portal Vein

Slide 81

Slide 81 text

Splenic vein Superior mesenteric vein Beginning of portal vein Ends in porta hepatis Neck of pancreas (cut) Portal vein (3 inches X 12 mms)

Slide 82

Slide 82 text

Relations

Slide 83

Slide 83 text

First part of duodenum Hepatic artery Bile duct Neck of pancreas Lesser omentum Anterior relations

Slide 84

Slide 84 text

Hepatic artery Common bile duct Free margin of lesser omentum Opening of lesser sac

Slide 85

Slide 85 text

Caudate process Inferior vena cava Deep (Posterior) relations

Slide 86

Slide 86 text

Inferior vena cava Portal vein

Slide 87

Slide 87 text

Tributaries

Slide 88

Slide 88 text

Splenic vein Superior mesenteric vein Left gastric vein Right gastric vein Cystic vein Paraumbilical vein

Slide 89

Slide 89 text

Porto-systemic Anastomosis

Slide 90

Slide 90 text

No content

Slide 91

Slide 91 text

No content

Slide 92

Slide 92 text

Splenic Vein (Page 158)

Slide 93

Slide 93 text

Superior mesenteric vein Splenic vein Beginning of portal vein Splenic veins Body of pancreas Neck of pancreas

Slide 94

Slide 94 text

Splenic vein Splenic veins Short gastric veins Left gastro-epipolic vein Pancreatic veins Inferior mesenteric vein

Slide 95

Slide 95 text

Superior Mesenteric Vein (Page 160)

Slide 96

Slide 96 text

Ileocolic vein Superior mesenteric artery Neck of pancreas Splenic vein Portal vein

Slide 97

Slide 97 text

Jejunal veins Ileal veins Ileocolic vein Right colic vein Middle colic vein Pancreatico-duodenal veins Right gastro-epiploic vein Superior mesenteric vein

Slide 98

Slide 98 text

Kidney

Slide 99

Slide 99 text

T12 L3 Site -It lies on the posterior abdominal wall from T12 to L3. -Left kidney reaches 11th rib while right kidney reaches 11th intercostal space.

Slide 100

Slide 100 text

Transpyloric plane (L1) Midline 2 inches 2 inches -Hilum is 2 inches away from midline at transpyloric plane -Upper end is 2 inches above hilum and 1 inch from midline. -Lower end is 2 inches below hilum and 3 inches from midline. -Long axis is directed downwards and laterally. Size: 4 X 2 X1 inches

Slide 101

Slide 101 text

External Features

Slide 102

Slide 102 text

Hilum External features: - Its shape is bean shape. - It has: -Two ends (upper & lower). -Two surfaces (anterior & posterior). -Two borders (lateral & medial). - Hilum -is concave and present in the middle of the medial border. -It contains renal vein, renal artery and pelvis of ureter ( from anterior to posterior) -Sinus is the space that lies inner to the hilum and deficient of renal tissue but contains segmental branches of renal artery and pelvis of ureter. -Transpyloric (L1) plane passes through upper part of right hilum and lower part of left hilum. - It is lined with fibrous capsule and perinephric fat.

Slide 103

Slide 103 text

Sinus of the kidney

Slide 104

Slide 104 text

Relations of Kidneys

Slide 105

Slide 105 text

Diaphragm Medial arcuate lig. Lateral arcuate lig. Psoas major m. Quadratus lumborum m. Transversus abdominis m. Subcostal vessels & nerve Ilio-hypogastric n. Ilio-inguinal n. Posterior Relations

Slide 106

Slide 106 text

No content

Slide 107

Slide 107 text

Anterior Relations

Slide 108

Slide 108 text

Anterior relations of left kidney Body of pancreas Splenic artery Left suprarenal gland Descending colon Ascending branch of superior left colic artery Coils of jejunum Area for spleen Area for stomach & lesser sac

Slide 109

Slide 109 text

Anterior relations of right kidney Right suprarenal gland 2nd part of duodenum Right colic flexure Ascending colon Ascending branch of right colic artery Coils of jejunum Area for Rt lobe of liver

Slide 110

Slide 110 text

Coverings of the Kidney

Slide 111

Slide 111 text

Anaterior Posterior LS Kidney & its coverings

Slide 112

Slide 112 text

Surface Anatomy

Slide 113

Slide 113 text

On the anterior abdominal wall

Slide 114

Slide 114 text

On the posterior abdominal wall

Slide 115

Slide 115 text

Stability of Kidney: 1- Its position in paravertebral gutter. 2- Coverings of the kidney. 3- Intra-abdominal pressure. 4- Apposition of surrounding organs. Applied Anatomy ➢ Renal pain is a result of stretch of renal capsule or spasm of smooth muscle of renal pelvis of the ureter. ➢ Renal pain is transmitted along sympathetic supply (T10 – T12), so pain is felt in the flanks and down to lower abdominal wall.

Slide 116

Slide 116 text

Dr. Sherif Fahmy

Slide 117

Slide 117 text

Blood Supply of Kidney (Page 216)

Slide 118

Slide 118 text

Arterial (Renal & Accessory Renal Arteries)

Slide 119

Slide 119 text

No content

Slide 120

Slide 120 text

No content

Slide 121

Slide 121 text

Venous Drainage

Slide 122

Slide 122 text

No content

Slide 123

Slide 123 text

Lymphatic Drainage

Slide 124

Slide 124 text

No content

Slide 125

Slide 125 text

Ureter (Page 219)

Slide 126

Slide 126 text

No content

Slide 127

Slide 127 text

No content

Slide 128

Slide 128 text

Relations of Ureter

Slide 129

Slide 129 text

A- Abdominal Part

Slide 130

Slide 130 text

No content

Slide 131

Slide 131 text

No content

Slide 132

Slide 132 text

No content

Slide 133

Slide 133 text

No content

Slide 134

Slide 134 text

B- Pelvic Part

Slide 135

Slide 135 text

No content

Slide 136

Slide 136 text

No content

Slide 137

Slide 137 text

No content

Slide 138

Slide 138 text

Constrictions of Ureter

Slide 139

Slide 139 text

No content

Slide 140

Slide 140 text

Blood Supply of Ureter

Slide 141

Slide 141 text

No content

Slide 142

Slide 142 text

Nerve Supply of Ureter

Slide 143

Slide 143 text

No content

Slide 144

Slide 144 text

Surface Anatomy of Ureter

Slide 145

Slide 145 text

No content

Slide 146

Slide 146 text

Applied Anatomy - Stone ureter is usually impacted at site of constrictions. - Ureteric pain from loin to groin (due to sympathetic supply comes from T11 – L2 Nerves). - Identification of stone ureter in X-ray.

Slide 147

Slide 147 text

X-Ray of Stone Ureter

Slide 148

Slide 148 text

No content

Slide 149

Slide 149 text

Suprarenal Gland

Slide 150

Slide 150 text

Rt. Suprarenal gland Left suprarenal gland

Slide 151

Slide 151 text

Relations of Suprarenal Glands

Slide 152

Slide 152 text

Anterior relations of left suprarenal

Slide 153

Slide 153 text

Anterior relations of right suprarenal gland

Slide 154

Slide 154 text

Posterior relations

Slide 155

Slide 155 text

Blood Supply

Slide 156

Slide 156 text

Superior suprarenal artery Middle suprarenal artery Inferior suprarenal artery Sprarenal vein

Slide 157

Slide 157 text

Vessels of Posterior Abdominal Wall

Slide 158

Slide 158 text

Abdominal Aorta (Page 223)

Slide 159

Slide 159 text

Course & Relations

Slide 160

Slide 160 text

Thoracic aorta Abdominal aorta

Slide 161

Slide 161 text

Abdominal aorta

Slide 162

Slide 162 text

Relations

Slide 163

Slide 163 text

Posterior Relations

Slide 164

Slide 164 text

Abdominal aorta Upper 4 lumbar vertebrae

Slide 165

Slide 165 text

Left 3rd & 4th lumbar veins Inf. Vena cava

Slide 166

Slide 166 text

Anterior Relations

Slide 167

Slide 167 text

No content

Slide 168

Slide 168 text

Abdominal Aorta Splenic vein Left renal vein Head of pancreas (cut) Superior mesenteric a. 3rd part of duodenum Inferior vena cava

Slide 169

Slide 169 text

No content

Slide 170

Slide 170 text

Side Relations

Slide 171

Slide 171 text

Crura of Diaphragm

Slide 172

Slide 172 text

Sympathetic chain

Slide 173

Slide 173 text

Inferior vena cava

Slide 174

Slide 174 text

Para-aortic lymph nodes Cisterna chyli

Slide 175

Slide 175 text

Branches

Slide 176

Slide 176 text

Coeliac artery Superior mesenteric artery Inferior mesenteric artery Common iliac artery Renal artery Middle suprarenal artery Inferior phrenic Gonadal artery Ventral single arteries Side paired branches

Slide 177

Slide 177 text

No content

Slide 178

Slide 178 text

No content

Slide 179

Slide 179 text

No content

Slide 180

Slide 180 text

Surface Anatomy

Slide 181

Slide 181 text

No content

Slide 182

Slide 182 text

Common Iliac Artery (page 224)

Slide 183

Slide 183 text

Common iliac artery External iliac artery Internal iliac artery Lumbosacral junction Begins opposite disc L4/5

Slide 184

Slide 184 text

Relations of Common Iliac artery

Slide 185

Slide 185 text

Sympathetic chains Body of L5 Sympathetic fibers from aortic plexus to superior hypogastric plexus Posterior Relations Anterior relations Inferior mesenteric artery crosses infront left common iliac artery

Slide 186

Slide 186 text

Inferior mesenteric artery Beginning of IVC is behind Rt common iliac artery

Slide 187

Slide 187 text

External Iliac Artery (Page 236)

Slide 188

Slide 188 text

Lumbosacral junction Deep to inguinal ligament at mid- inguinal point Femoral artery Course of Ext. Iliac Artery External iliac artery

Slide 189

Slide 189 text

Deep circumflex iliac artery Inferior epigastric artery Branches of Ext. Iliac Artery

Slide 190

Slide 190 text

External iliac artery Deep circumflex iliac artery Inferior epigastric artery Cremastric artery Pubic branch Obturator artery Pubic branch of obturator artery ASIS Branches of Inferior Epigastric Artery

Slide 191

Slide 191 text

External iliac a. Inferior epigastric a. Fascia transversalis Cremastric a. Pubic branch Obturator a. Pubic branch Course & beanches of Inferior epigastric artery Inner Aspect of Anterior Abdominal wall

Slide 192

Slide 192 text

4 Lumbar arteries Median sacral artery Branches from back of Aorta

Slide 193

Slide 193 text

Gonadal Arteries (Page 222)

Slide 194

Slide 194 text

Right gonadal a. Left gonadal a.

Slide 195

Slide 195 text

Inferior Vena Cava (Page 228)

Slide 196

Slide 196 text

Begins opposite L5 Opening in central tendon of diaphragm at T8 (1 inch to the Rt of midline)

Slide 197

Slide 197 text

Relations 1- Anterior. 2- Posterior. 3- Right. 4- left.

Slide 198

Slide 198 text

Anterior Relations

Slide 199

Slide 199 text

Rt common iliac artery Superior mesenteric vessels in the root of mesentery 3rd part of duodenum &right gonadal vs Head of pancreas & common bile duct 1st part of duodenum Portal vein

Slide 200

Slide 200 text

Common bile duct Hepatic artery Portal vein Opening of lesser sac Right lobe of liver

Slide 201

Slide 201 text

Posterior Relations

Slide 202

Slide 202 text

Rt. Renal artery Rt. Crus of diaphragm Middle suprarenal art. Rt, suprarenal gland Inferior phrenic artery Lower 3 lumbar vertebrae Rt. Psoas major muscle

Slide 203

Slide 203 text

Cisterna chyli Sympathetic chain Right margin of psoas major m. Lumbar arteries

Slide 204

Slide 204 text

Right and Left Relations

Slide 205

Slide 205 text

Rt. ureter Rt. Kidney 2nd part of duodenum Rt lobe of liver Right Relations

Slide 206

Slide 206 text

Abdominal aorta Left Relations Fibers from right crus of diaphragm

Slide 207

Slide 207 text

Tributaries

Slide 208

Slide 208 text

Common iliac vein Renal vein Rt. Gonadal vein Rt. Suprarenal vein Phrenic vein Hepatic veins

Slide 209

Slide 209 text

3rd & 4th lumbar veins Left gonadal vein Left suprarenal vein

Slide 210

Slide 210 text

Surface Anatomy

Slide 211

Slide 211 text

Inertubercular plane (L5), one inch to the right Rt 6th costal cartilage

Slide 212

Slide 212 text

Anastomosis Between Superior & Inferior Vena Cava (Page 230) A- At posterior abdominal wall: 1- Azygos vein. 2- Inferior hemiazygos vein. 3- Vertebral venous plexuses. B- At anterior abdominal wall: 1- Superior & inferior epigastric veins. 2- Thoraco-epigastric vein.

Slide 213

Slide 213 text

Lymph Drainage of Abdomen (Page 231)

Slide 214

Slide 214 text

Inferior mesenteric nodes Inferior mesenteric nodes Ext. iliac nodes Int. iliac nodes Common iliac nodes Para-aortic nodes Lumbar lymph trunk Intestinal lymph trunk Coeliac nodes Cisterna chyli

Slide 215

Slide 215 text

Cisterna Chyli Cisterna chyli 2 Lumbar lymph trunk Intestinal lymph trunk

Slide 216

Slide 216 text

Lumbar Plexus (Page 245)

Slide 217

Slide 217 text

Site of Lumbar Plexus

Slide 218

Slide 218 text

Dr. Sherif Fahmy Psoas major m. Lumbar plexus Roots of lumbar plexus: Anterior primary rami of upper 4 lumbar nerves

Slide 219

Slide 219 text

Formation of Lumbar Plexus

Slide 220

Slide 220 text

L1 L2 L3 L4 Ilio-hypogastric n. Ilio-inguinal n. Genito-femoral n. Lateral cutaneous nerve of thigh Femoral n. Accessory obturator n. Obturator n. Lumbo-sacral trunk L5 Dr. Sherif Fahmy Posterior (dorsal division) Anterior (ventral division)

Slide 221

Slide 221 text

Branches of Lumbar Plexus and its Relation to Psoas Major Muscle

Slide 222

Slide 222 text

Ilio-hypogastric n. Ilio-inguinal n. Lateral cutaneous nerve of thigh Femoral n. Genito-femoral n. Obturator n. Lumbo- sacral trunk Psoas major m. Iliacus Dr. Sherif Fahmy

Slide 223

Slide 223 text

Lumbar Part of Sympathetic Chain (Page 247)

Slide 224

Slide 224 text

Lumbar part of Sympathetic chain Medial arcuate ligament Common iliac artery Sacral part of sympathetic chain

Slide 225

Slide 225 text

Branches of Lumbar Sympathetic Chain Rami communicants: 1- White ramus communicant: from upper 2 ganglia. 2- Grey ramus communicants: from 4 ganglia. Splanchnic: 1- Upper 2 ganglia gives splanchnic branches to aortic plexus. 2- Lower 2 ganglia gives splanchnic branches to superior hypogastric plexus. Vascular: to abdominal aorta.

Slide 226

Slide 226 text

Autonomic Plexuses (Page 248)

Slide 227

Slide 227 text

Autonomic Plexus 1- Coeliac. 2- Aortic (Intermesenteric). 3- Superior hypogastric. 4- Inferior hypogastric (in the pelvic cavity).

Slide 228

Slide 228 text

Coeliac ganglia Coeliac plexus Aortic (intermesenteric) plexus Superior hypogastric plexus Inferior hypogastric plexus

Slide 229

Slide 229 text

Coeliac Aortic (Inter- mesenteric) Superior hypogastric Inferior hypogastric Site Sympathetic part Parasympathetic part Branches -Around coeliac trunk. - Infront abdominal aorta between origin of 2 mesenteric arteries -Below bifurcation of aorta infront L5 vertebra. - In pelvic cavity on both sides of rectum and urinary bladder -Greater and lesser splanchnic nerves relay in coeliac and aortico renal ganglia. -Postganglionic fibers join the coeliac plexus -From coeliac plexus. -Splanchnic nerves from L1 & L2 sympathetic ganglia. -From aortic plexus. -From splanchnic nerves of L3 & L4 ganglia. -From superior hypogastric plexus. -From splanchnic nerves S1 & S2 Vagus nerve Pelvic splanchnic nerve (S2,3,4) -Plexuses around branches of coeliac trunk. -Plexus around superior mesenteric artery. -Plexus around renal artery. -To aortic plexus. -Plexus around inferior mesenteric artery. -Gonadal plexus. -Iliac arteries plexus. -To superior hypogastric plexuses. -Gonadal plexus. -Iliac arteries plexus. -To inferior hypogastric plexuses. -Pelvic viscera plexuses (rectum, urinary bladder. Prostate and utero- vaginal.