266. The external oblique which runs infero-medially, originating on the
external posterior surface of ribs 5-12 (the lower 8 ribs, where its
originating fleshy digitations interlock with the digitations of the serratus
anterior and lattisimus dorsi
268. The internal oblique which runs supero-medially (at right angles to the
external oblique). It originates in the thoracolumbar fascia of the lower
back, the anterior 2/3 of the iliac crest and the lateral 2/3 of the inguinal
ligament. Its insertions are on the inferior borders of the 10th-12th ribs
and the linea alba
270. The transversus abdominus runs medially (horizontally) from the inner aspect of
the costal margin (just medial to the line formed by ribs 7-12), the lumbar fascia,
the anterior 2/3 of the iliac crest and the lateral third of the inguinal ligament. Its
insertion blends into the linea alba, with the lowest fibres inserted on the pubic
crest and the pectineal line (pelvic floor) along with the inferior part of the internal
oblique muscle
279. The rectus abdominus and the rectus sheath
The rectus abdominus is a long paired vertically running muscle that
extends the entire length of the abdominal wall (narrowing as they
descend), originating at the pubic crest + pubic symphysis and inserting
on the cartilages of ribs 5-7 and the xiphoid process of the sternum
The anterior surface of the muscle is interrupted by 3 transverse fibrous
bands of tissue called transverse tendinuous intersections (the linea alba also
bisects the muscle vertically - this divides the muscle into 6 segments – think
six pack)
Has a special role as powerful flexors of the lumbar spine
The aponeuroses of the 3 sheet-like muscles form the rectus sheaths,
which enclose the rectus abdominus and meet at the middle to form the
linea alba (a tough fibrous band that extends from the xiphoid process to
the pubic symphysis)
o The arrangement of the rectus sheath is different superiorly and inferiorly to
the arcuate line (line ½ way between the umbilicus + pubic symphysis)
283. Rectus Abdominis
Muscle
The muscle is divided into segments by
tendinous intersections, Which indicate
that the muscle arises from a number of
myotomes, fused together
1- Segmental nerve supply.
2- Hematoma of rectus m. is localized
2- In paramedian incision displace m.
laterally (n. supply comes from lateral)
Surgical Importance
285. Actions of Anterior Abdominal
Wall Muscles
They assist in raising the intra-bdominal pressure (so,
they help in vomiting, cough, delivery, etc….)
Keep the abdominal viscera in position.
Rectus abdominis flexes the trunk, while the 2 oblique
muscles bend the trunk laterally.
Act as accessory expiratory muscles.
Lower midline & paramedian incisions.
286.
287. The aponeuroses of the 3 sheet-like muscles form the rectus sheaths, which
enclose the rectus abdominus and meet at the middle to form the linea
alba (a tough fibrous band that extends from the xiphoid process to the
symphysis pubis)
o The arrangement of the rectus sheath is different superiorly and inferiorly to
the arcuate line (line ½ way between the umbilicus + pubic symphysis)
288. Superior to the arcuate line, the internal oblique aponeurosis splits to envelope the
rectus abdominus
o Inferior to the arcuate line, all 3 aponeuroses lie anterior to the rectus abdominus,
therefore the muscle lies purely on the transversalis fascia
At the lateral margin of the rectus abdominus, the aponeuroses also fuse to form the
linea semilunaris
290. Rectus Sheath
Falciform Ligament
External Oblique
Internal Oblique
Transversus Abdominis
Ant. Layer of Rectus Sheath
Post. Layer of Rectus Sheath
Rectus Abdominis
Above Arcuate Line
SKIN
Peritoneum
Transverslais Fascia
291. Rectus Sheath
External Oblique
Internal Oblique
Transversus Abdominis
Ant. Layer of Rectus Sheath
Rectus Abdominis
Below Arcuate Line
Urachus in Median Umbilical Fold
Medial Umbilical Ligament
Transverslais Fascia
SKIN
Peritoneum
292.
293.
294. Vessels and nerves
The rectus sheath contains arteries and veins lying posterior to
the muscle. These are the epigastric vessels
There is an anastomosis between the superior epigastric
arteries coming from the internal thoracic (branch of the
subclavian) and the inferior epigastric arteries that ascend
from the external iliac (by-pass of the abdominal aorta)
The nerve supply to all the antero-lateral muscles comes from
T6-L1
The intercostal nerves T6-T12 enter the abdominal wall at the
anterior ends of the intercostal spaces, passing deep to the costal
cartilages where these close the spaces
The main trunks of the nerves lie between the internal oblique
and transversus layers
295. Superior epigastric a.
Subcostal a.
Inferior epigastric a.
Deep circumflex iliac a.
- I -
Internal Mammary a.
- III -
External Iliac a.
- II -
Descending Aorta
10th, 11th intercostal a.
297. Important definitions
The inguinal region
The inguinal ligament is formed by the inferior folding-under of the external oblique,
and runs straight from the anterior superior iliac spine to the pubic tubercle .
The deep inguinal ring (internal) is an opening in the back wall of the inguinal canal,
which lies just superior and medial to the inguinal ligament. It marks the mid-point of the
length of the inguinal ligament, and provides an entry through which the canal’s contents
enter.
The superficial inguinal ring is a V-shaped slit in the external oblique aponeurosis
that allows the content of the canal to exit e.g. into the scrotum
E.g. the testicles develop from the back of the abdomen at the level of the kidneys,
and then descend through the deep ring into the inguinal canal and into the scrotum
The inguinal canal contains the ilioinguinal nerve in both males + females
In males it also contains the spermatic cord, which is covered in cremester muscle
(cremester reflex raises the testicles when cold) and 2 associated nerves
298. The borders of the inguinal canal:
o Floor – inguinal ligament
o Anterior – external oblique aponeurosis + internal oblique
o Roof – internal oblique arching over
o Posterior – transversalis fascia and the conjoint tendon medially
The inguinal region is an area of weakness in the abdominal wall, thus is often the site
of an inguinal hernia
299. The inguinal canal :-
The inguinal canal is approximately 4 cm long and is directed
obliquely inferomedially through the inferior part of the
anterolateral abdominal wall. The canal lies parallel and 2- 4 cm
superior to the medial half of the inguinal ligament .
The inguinal canal has openings at either end : –
The deep (internal) inguinal ring is the entrance to the inguinal
canal. It is the site of an outpouching of the transversalis fascia.
This is approximately 1.25 cm superior to the middle of the
inguinal ligament .
The superficial, or external inguinal ring is the exit from the
inguinal canal. It is a slit like opening between the diagonal fibres
of the aponeurosis of the external oblique
300. Inguinal canal
walls of The inguinal canal :-
The anterior wall is formed mainly by the aponeurosis of the external
Oblique along its whole length + internal oblique muscle along its
lateral 1/2
. The posterior wall is formed mainly by transversalis fascia along its
whole length + conjoint tendon along its medial 1/2
The roof is formed by the arching fibres of the internal oblique and
transverse abdominal muscles.
The floor is formed by the inguinal ligament. It is reinforced in its most
medial part by the lacunar ligament.
301.
302.
303.
304.
305.
306. Contents of inguinal canal :-
1. Spermatic cord ( round ligament of the uterus in
female )
The Cord Itself.—The contents of the spermatic cord are
(a) the ductus (vas) deferens and its artery .
(b) the testicular artery and venous (pampiniform)
plexus.
(c) the genital branch of the genitofemoral nerve.
(d) lymphatic vessels and sympathetic nerve fibers.
(e) fat and connective tissue surrounding the cord and
its coverings in various amounts
2. Ilioinguinal nerve .
3. Ilioinguinal lymph node .
307. • Obliterated processus
vaginalis
• Parietal layer of tunica
vaginalis
• Visceral layer of tunica
vaginalis
• Internal spermatic fascia
• Cremasteric fascia and
muscle
• External spermatic fascia
• Dartos fascia and muscle
• Superficial fascia
• Membranous
layer(Scarpa's)
• Fatty layer (Camper's)
• Skin
Peritoneum
Transversalis fascia
Transversus abdominis
m.
Internal oblique m.
External oblique m.
skin
Covering
308. The Hesselbach triangle
The inferior epigastric
vessels serve as its
superolateral border, the
rectus sheath as medial
border, and the inguinal
ligament as the inferior
border. Direct hernias occur
within the Hesselbach
triangle, whereas indirect
inguinal hernias arise lateral
to the triangle
311. Femoral Canal
The major feature of the femoral canal is the femoral sheath. This sheath is a
condensation of the deep fascia (fascia lata) of the thigh and contains, from
lateral to medial, the femoral artery, femoral vein, and femoral canal. The
femoral canal is a space medial to the vein that allows for venous expansion
and contains a lymph node (node of Cloquet). Other features of the femoral
triangle include the femoral nerve, which lies lateral to the sheath,
Wall of The Femoral canal
anterior is the inguinal ligament
posterior is the iliopsoas, pectineal, and long adductor muscles (floor).
Medial is lacunar ligament
Lateral is femoral vessle
A femoral hernia occurs through this space and is medial to the femoral
vessels
330. Liver
The liver is the largest gland in the body and has a wide variety of
functions
Weight: 1/50 of body weight in adult & 1/20 of body weight in infant
It is exocrine(bile) & endocrine organ(Albumen , prothrombin &
fibrinogen)
Function of the liver
Secretion of bile & bile salt
Metabolism of carbohydrate, fat and protein
Formation of heparin & anticoagulant substances
Detoxication
Storage of glycogen and vitamins
Activation of vita .D
335. Surface anatomy of the liver
-The greater part of
the liver is situated
under cover of the
right costal margin
- Diaphragm
separates it from the
pleura, lungs,
pericardium, and
heart.
336. Surfaces of the liver, their relations &
impressions
Postero - inferior surface= visceral
surface
Superior surface = Diaphragmatic
surface
Anterior surface
Posterior surface
Right surface
337. Ant. View of the liver
Right lobe
Cut edge of the Falciform ligament
left lobe
Diverging cut edges of the superior
part of the coronary ligament
Fundus of the gall bladder
338. Relations of the liver Anteriorly
Diaphragm
Rt & Lt pleura and lung
Costal cartilage
Xiphoid process
Ant. abdominal wall
339. Postero- infero surface= visceral surface
Relations
I.V.C
the esophagus
the stomach
the duodenum
the right colic flexure
the right kidney
Rt. Suprarenal gland
the gallbladder.
Porta hepatic( bile duct,H.a.H.V)
Fissure for lig. Venoosum & lesser omentum
Lig.teres
341. Sup. Surface of the liver
Right & left lobes
Cut edge of the Falciform ligament
The cut edges of the superior and inferior parts of the
coronary ligament
The left triangular ligament
The right triangular ligament
Bare area of the liver (where there is no peritoneum
covering the liver
Groove for the inferior vena cava and the hepatic veins
Caudate lobe of the liver more or less wrapping around
the groove of the inferior vena cava
Lig.teres
342. Relations of Sup. surface of liver
Diaphragm
Pleura & lung
Pericardium & heart
343. Posterior relation of the liver
Diaphragm
Rt. Kidney
Supra renal gland
T.colon(hepatic flexure
Duodenum
Gall bladder
I.V.C
Esophagus
Fundus of stomach
344. Lobes of the liver
Rt. Lobe
Lt .lobe
Quadrate lobe
Caudate lobe
346. Left Lobe
Varied in size
Lies in the epigastric and left
hypochondrial regions
Divided into lateral and
medial segments by the left
hepatic vein
347. Lobes of the liver…..cont
Rt. & Lt lobe separated by
Falciform ligament
Ligamentum Venosum
Ligamentum teres
348. Caudate Lobe
-present in the posterior surface
from the Rt. Lobe
Relations of caudate lobe
- Inf. the porta hepatis
- The right the fossa for
the inferior vena cava
- The left the fossa for
the lig.venosum.
349. Quadrate lobe
Present on the inferior surface
from the Rt. Lobe
Relation
- Ant. anterior margin of the
liver
- Sup. porta hepatis
- Rt. fossa for the gallbladder
- Lt by the fossa for lig.teres
356. Peritoneum of the liver
The liver is covered by
peritoneum
(intraperitoneal organ)
except at bare area.
Inferior surface covered
with peritoneum of greater
sac except porta hepatis,
G.B & Lig.teres fissure
Rt. Lateral surface
covered by peritoneum,
related to diaphragm
which separate it from Rt.
Pleura , lung and the Rt
Ribs (6-11)
358. 1- The Falciform ligament of liver
2- The Ligamentum teres hepatis
3- The coronary ligament
4- The right triangular ligament
5- The left triangular ligament
6- The Hepatogastric ligament
7- The hepatoduonedenal ligament
8- The Ligamentum Venoosum
1. The ligaments of the liver
359. Falciform ligament of liver
Consists of double
peritoneal layer
Sickle shape
Extends from anterior
abdominal wall (umbilicus)
to liver
Free border of the ligament
contains Ligamentum teres
(obliterated umbilical vein)
361. Liver anatomy
Historically, the liver was
divided into right and left
lobes by the external
marking of the falciform
ligament.
362. Segmental anatomy of the liver
Rt .& Lt. lobes anatomically no
morphological significance.
Separation by ligaments
(Falciform, lig. Venoosum &
Lig.teres)
True morphological and
physiological division by a line
extend from fossa of GB to fossa
of I.V.C each has its own arterial
blood supply, venous drainage
and biliary drainage
No anastomosis between
divisions
3 major hepatic veins Rt, Lt &
central
8 segments based on hepatic
and portal venous segments
364. Segmental anatomy of the liver
Liver segments are based on the portal and hepatic venous segments
365. Schematic diagram of the segmental anatomy of the liver.
Each segment receives
its own portal pedicle
(triad of portal vein,
hepatic artery, and bile
duct).
366. The Right Lobe The Left Lobe
VIII
V
IV
IV
III
II
VII
VI
I
368. Blood supply of the liver
Proper hepatic artery
The right and left hepatic
arteries enter the porta
hepatis.
The right hepatic artery
usually gives off the cystic
artery, which runs to the
neck of the gallbladder.
369. Blood Circulation through the Liver
The blood vessels conveying blood
to the liver are the hepatic artery
(30%) and portal vein (70%).
The hepatic artery brings
oxygenated blood to the liver, and the
portal vein brings venous blood rich
in the products of digestion, which
have been absorbed from the
gastrointestinal tract.
The arterial and venous blood is
conducted to the central vein of each
liver lobule by the liver sinusoids.
The central veins drain into the right
and left hepatic veins, and these
leave the posterior surface of the liver
and open directly into the inferior
vena cava.
370. Vein drainage of the liver
The portal vein divides
into right and left
terminal branches that
enter the porta hepatis
behind the arteries.
The hepatic veins (three
or more) emerge from
the posterior surface of
the liver and drain into
the inferior vena cava.
374. Lymphatic drainage of the liver
Liver produce large amount of lymph~ one third – one half of total body lymph
Lymph leave the liver and enters several lymph nod in porta hepatis efferent
vessels pass to celiac nods
A few vessels pass from the bare area of the liver through the diaphragm to the
posterior Mediastinal lymph nodes.
Nerve supply
Sympathetic hepatic plexus>>> celiac plexuses thoracic ganglion chain
T1-T12
Parasympathetic vagous nerve( anterior part)
Sympathetic and parasympathetic nerves form the celiac plexus.
The anterior vagal trunk gives rise to a large hepatic branch, which passes
directly to the liver
375. Porta hepatis
-It is the hilum of the liver
-It is found on the
posteroinferior surface
- lies between the
caudate and quadrate
lobes
-Lesser omentum attach
to its margin
Contents
- Hepatic ducts ant.
- Hepatic. Art + nerve+
lymphatic node
middle.
- Portal vein post.
378. Anatomical position of
GB
- Epigastric - Right hypochondrium
region
- At the tip of the 9th RT . C.C
- Green muscular organ
- Pear-shaped, hollow structure
- On inferior surface of liver
- Between quadrate and right lobes
- Has a short mesentery
- Capacity 40- 60 cc
- Body and neck
Directed toward porta hepatis
379. Structure of GB
Fundus
-Ant:ant.abdominal wall
- Post.inf: transverscolon
Body
sup: liver
post.inf: Tr.colon. End of 1st part of
doudenum , begins of 2nd part of doudenum
Neck
- Form the cystic duct, 4cm
Hartmann’s Pouch
1. Lies between body and neck of gallbladder
2. A normal variation
3. May obscure cystic duct
4. If very large, may see cystic duct arising from
pouch
381. Arterial Supply to the Gallbladder
Cystic artery
Right hepatic artery
Proper hepatic artery
Common hepatic artery
382. Blood supply of GB:
- Cystic artery branch of Rt.
Hepatic artery
- Cystic vein end in portal
vein
- Small branches ( arteries and
veins run between liver and gall
bladder
Common Hepatic
Artery
Proper Hepatic
Artery
Gastroduodenal
Artery
383. Lymphatic drainage of GB
1. Terminate @ celiac nodes
2. Cystic node at neck of GB
a. Actually a hepatic node
b. Lies at junction of cystic
& common hepatic ducts
3. Other lymph vessels also drain into hepatic
nodes
385. Extra hepatic biliary system
Rt. hepatic duct
+
Lt hepatic duct
↓
Common hepatic duct
+
Cystic duct
↓
Common bile duct
- 4cm
- Descend in free edge of
lesser omentum
- Supra duodenal part
Retro duodenal part
Retro pancreatic part
Common bile duct
386. Bile duct……. parts
and relations
-3 inc long
-1st part
-Located in right free margin of lesser omentum
- in front of the opening into the lesser sac
(Epiploic opening)
-Rt to hepatic artery and portal vein
- 2nd part
-Behind the 1st part of the duodenum
-Rt to the gastroduodenal artery
-3 rd part
-Posterior surface of the head of the pancreas
-Contact with main pancreatic duct
-Related with IVC, gastroduodenal artery, portal
vein
-End in the half second part of duodenum at
ampulla of Vater
396. Rt. hepatic duct Lt. hepatic duct
Common hepatic ductCystic duct
Common bile duct
397. Extra-hepatic biliary tract
The common bile duct is about 7.5 cm long and is
formed by the junction of the cystic and common
hepatic ducts. It is divided into four parts:
•the supraduodenal portion, about 2.5 cm long, running
in the free edge of the lesser omentum;
• the retroduodenal portion;
• the infraduodenal portion, which lies in a groove, but
at times in a tunnel, on the posterior surface of the
pancreas;
• the intraduodenal portion, which passes obliquely
through the wall of the second part of the duodenum,
where it is surrounded by the sphincter of Oddi, and
terminates by opening on the summit of the ampulla of
Vater.
403. Anatomy of the breast
Shape : hemispherical with its base applied to the anterior chest wall and its
apex at the nipple.
Extent of the breast :
2nd rib
6th rib
4th rib
The axillary tail of the breast is of surgical
importance. In some normal subjects it is
palpable and, in a few, it can be seen
premenstrually or during lactation. It
pierces the deep facsia to enter the axilla
404. Areas of the breast
upper medial,
lower medial,
upper lateral, lower
lateral, nipple and
arola and the
axillary tail of the
breast it is of
surgical
importance.
405. Deep relation of the breast
It lies on
Pectoralis major m. with its deep fascia
Serratus anterior m.
External abd. Oblique m.
The upper most part of rectus abd. And sheath
408. Pectoralis minor m. & fascia
Suspensory lig. of
axilla
Clavipectoral fascia
409. Architecture of the breast
The breast consists of :
1- the covering skin including the nipple and areola
2- the superficial fascia
3- the mammary gland ( modified sweat gland
ectodermal in origin).
The lobule is the basic structural unit of the
mammary gland (ducts and alveoli).
The number and size of the lobules vary
enormously: they are most numerous in young
women.
From 10 to over 100 lobules empty via ductules into
a lactiferous duct, of which there are 15–20
converging towards the nipple.
The lobules of the breast are separated by fibrous
septa ( coopers ligaments)
410. The ligaments of Cooper are hollow conical projections
of fibrous tissue filled with breast tissue; the apices of the
cones are attached firmly to the superficial fascia and
thereby to the skin overlying the breast to the deep
fascia . These ligaments account for the dimpling of the
skin overlying a carcinoma.
The areola contains involuntary muscle arranged in
concentric rings as well as radially in the subcutaneous
tissue. The areolar epithelium contains numerous sweat
glands and sebaceous glands, the latter of which enlarge
during pregnancy and serve to lubricate the nipple during
lactation (Montgomery’s tubercles).
The male breast differs from the female breast in being
rudimentary and its glandular tissue consists only of
ducts with no alveoli.
411.
412. Lobe of mammary gland
(breast fat)
Suspensory lig. of breast
414. Blood supply of the breast
Arterial supply:
1- pectoral branch of thoraco acromial artery supply the
upper part (axillary)
2- Perforating branches of internal thoracic artery: 2nd,
3rd, 4th, supplying the medial part of the breast.( 1st part
of subclavian ar.)
3- Branches of the lateral thoracic artery supplying the
lateral part (axillary)
4- Lateral branches of posterior intercostals arteries
supply the lower and lateral parts.
Venous drainage :
1- axillary vein. 2-Intarnal thoracic vein. 3-Intercostal
veins
422. Nerve supply of the breast
By the anterior and lateral branches of the 4th, 5th and 6th intercostals nerves
which supply
A- sensory fibers to the breast.
B- autonomic fibers to the smooth muscles and blood vessels.
423. Lymphatic drainage of the breast
The lymphatic vessels arranged in four plexuses:
1- subcutaneous plexus
2- subareoral plexus of sappy
3- interlobular plexus
4- submammary plexus
The regional lymph nodes draining the breast:
1- axillary lymph nodes
2- internal mammry lymph nodes
3- posterior intercostal subscapular and supraclavicular .
424. Lymphatic drainage of the breast
The lymphatics of the breast drain predominantly into the axillary and internal mammary lymph nodes.
The axillary nodes receive approximately 85% of the drainage and are arranged in the following groups:
• lateral, ,,,,,,along the axillary vein;
• anterior,,,,,,, along the lateral thoracic vessels;
• posterior,,,,,,,,, along the subscapular vessels;
• central,,,,,,,,,,, embedded in fat in the centre of the axilla;
• interpectoral, The apical nodes are also in continua few nodes lying between the pectoralis
major and minor muscles;
• apical, which lie above the level of the pectoralis minor tendon in continuity with the lateral nodes
and which receive the efferents of all the other groups.
The internal mammary nodes are fewer in number. They lie along the internal mammary vessels deep to
the plane of the costal cartilages, drain the posterior third of the breast and are not routinely dissected.
425. Lymphatic drainage of different parts of the breast:A- nipple and areola: drained by the subareolar plexus to pectoral and apical
groups
B- skin and subcutaneous tissue and parenchyma :
1- upper lat. Quadrant + upper ½ of breast : pectoral lymph nodes
2- lower lat. Quadrant : subscapular // //
3- upper medial // : internal mammary (both sides)
4- lower medial // : mediastinal L.ns then pass through the rectus sheath
to the falciform lig. Then spread to the liver , umbilicus and peritoneum.
426. Recently the axillary Lns are classified into 3 levels:
1- lymph nodes above the level of pectoralis minor ( medial) : apical
infraclavicular
2- lymph nodes deep to pectoralis minor: central
3- lymph nodes below the level of pectoralis minor ( lateral ) : the ant and post
and lateral
431. Major nervous structures in the axilla is required
to avoid their sacrifice during surgery
Coursing close to the chest wall on the medial side
of the axilla is the long thoracic nerve, or the
external respiratory nerve of Bell, which innervates
the serratus anterior muscle. Division may result in
the winging scapula deformity.
The second major nerve trunk encountered during
axillary dissection is the thoracodorsal nerve to the
latissimus dorsi muscle at the lateral border of the
axilla. Enters the axillary space under the axillary
vein, close to the entrance of the long thoracic
nerve. Its sacrifice leads to loss of latissimus
function and atrophy of the muscle.
433. Axilla
It is a 4 sided pyramidal shaped space
between the upper part of arm and the
upper part of the side of the thorax
Boundaries : it has apex, base, 4 wall
and content
Base : formed by the skin of the arm ,
superficial and deep fascia
435. Apex
Connects the axilla with the posterior triangle of the neck
Bounded by :
Medial : outer border of the 1st rib
Posterior: upper border of the scapula
Anterior: middle 1/3 of clavicle
437. Anterior wall of axilla
3ms + fascia
Superficial layer : pectoralis major ms
Deep layer : pectoralis minor and subclaivus ms
Claveipectoral fascia.
439. Pectoralis minor m.
& fascia
Suspensory lig. of
axilla
Clavipectoral fascia
Subclavius m. & fascia
440. Posterior & medial wall of axilla
Posterior : subscapularis , teres major and latissmus dorsi
Medial :
1- upper 4 or 5 ribs and intercostal ms
2- serratus anteroir ms
444. Contents of axilla
Axillary artery
Axillary vein
Cords and branches of the brachial plexus
Axillary lymph nodes , fat and axillary tail of the breast.
449. Company Logo
STERNO MASTOID
POSTERIOR BELLY OF DIGASTRIC
ANTERIOR BELLY OF DIGASTRIC
CLAVICLE
MANDIBLE
MID LINE
TRAPEZIUS
Posterior triangle
Superior belly of omohyoid
450. Company Logo
ANTERIOR BELLY OF DIGASTRIC
MANDIBLE
POSTERIOR BELLY OF DIGASTRIC
ANTERIOR BELLY OF DIGASTRIC
HYOID BONE
ANTERIOR BELLY OF DIGASTRIC
STERNOMASTOID
SUPERIOR BELLY OF OMOHYOID
MID LINE
STERNOMASTOID
SUPERIOR BELLY OF OMOHYOID
451. THYROID EMBRYOLOGY AND ANATOMY
The tissue bud that ultimately becomes the
thyroid gland arises initially as a midline
diverticulum in the floor of the pharynx.
The original attachment in the pharynx is in
the buccal cavity at the foramen cecum, and
this becomes the thyroglossal duct, which
after 6 weeks of age is usually absorbed. The
very distal end of this remnant may
occasionally be retained and mature as a
pyramidal lobe in the adult thyroid.(50%)
452.
453. Congenital malformations
A-These include the thyroglossal cyst, which
result from retained tissue along the thyroglossal
duct. These cysts are almost in the midline. They
usually occur as a cyst found in the midline on
physical examination moving up and down with
swallowing and protrusion of the tongue .
B- lingual thyroid .In most of these cases, this may be the only thyroid tissue that
remains.
457. The normally developed thyroid is a bilobed structure
that lies immediately next to the thyroid cartilage in a
position .
The two lateral lobes are joined at the midline by an
isthmus. The pyramidal lobe represents the most distal
portion of the thyroglossal duct and in the adult may be a
prominent structure.
A thin layer of connective tissue surrounds the thyroid is
part of the fascial layer, which invests the trachea. This
fascia is different from the thyroid capsule. This is why
thyroid gland moves up and down with digulitaion
This fascia coalesces with the thyroid capsule posteriorly
and laterally to form a suspensory ligament, known as
the ligament of Berry. The ligament of Berry is closely
attached to the cricoid cartilage and has important
surgical implications because of its relation to the
458. Right & left lobes
connected by an isthmus
• Occasional pyramidal
lobe
• Levator glandulae
thyroideae
• Slightly larger in women;
may enlarge during
menstruation &
pregnancy
• Extends from oblique
line on thyroid cartilage
down to 4th or 5th
tracheal ring
• Attaches to cricoid
thyroid lobes
isthmus
thyroid cartilage
common
carotid a.
462. The arterial supply to the thyroid gland is supplied by
four main arteries, two superior and two inferior. And
additional thyroid ema
Three pairs of venous systems drain the thyroid.
Superior venous drainage is immediately adjacent to
the superior arteries and joins the internal jugular vein
at the level of the carotid bifurcation.
The middle thyroid veins exist in more than half of
patients and course immediately laterally into the
internal jugular vein.
The inferior thyroid veins are usually two or three in
number and descend directly from the lower pole of
the gland into the innominate and brachiocephalic
464. The recurrent laryngeal nerves ascend on
either side of the trachea, and each lies
just lateral to the ligament of Berry as they
enter the larynx. There are a number of
important variations. Then disappearing
beneath the inferior border of the
cricothyroid muscle. The nerve can
usually be found immediately anterior or
posterior to a main arterial trunk of the
inferior thyroid artery at this level.
The motor function of the recurrent
laryngeal nerve is abduction of the vocal
465. Damage to a recurrent laryngeal nerve
results in paralysis of the vocal cord on the
side affected. Such damage might result in a
cord that remains in a medial position or just
lateral to the midline.
If the vocal cord remains paralyzed in an
abducted position and closure cannot occur,
a severely impaired voice and ineffective
cough can be the result.
If recurrent laryngeal nerves are damaged
bilaterally partialy , complete loss of voice
and airway obstruction requiring emergency
intubation and tracheostomy may be
474. The head
-It is disc shaped
- lies within the
concavity of the
duodenum
- A part of the head
extends to the left
behind the superior
mesenteric vessels
and is called the
Uncinate process.
475. The neck
- It is the
constricted portion
of the pancreas
- connects the
head to the body.
- It lies in front of
the
beginning of the
portal vein the
origin of the
superior
mesenteric artery
476. The body
-Runs upward
and to the left
across the
midline
- It is
somewhat
triangular in
cross section.
477. Body of pancreas…cont
-Three surfaces: anterior, posterior,
and inferior.
-Three borders: ant ,post & inf
The anterior surface
1- Covered by peritoneum of post. Wall
of lesser sac
2- Tuber omental :
where the ant. surface of pancreas join
the neck
478. Body of
pancreas…cont
The posterior surface
- devoid of peritoneum
- in contact with
1- the aorta
2- the splenic vein
3- the left kidney and its
vessels
4- the left suprarenal
gland
5- the origin of the
superior mesenteric
artery
6- and the crura of the
diaphragm.
479. Body of pancreas…cont
The inferior surface
- Narrow on the right but broader on the left
-Covered by peritoneum of greater omentum
- lies upon the duodenojejunal flexure
- Some coils of the jejunum
- its left extremity rests on the left colic
flexure
The superior border
-Blunt and flat to the right;
- Narrow and sharp to the left near the tail
It commences on the right in the omental
tuberosity
In relation with
1- The celiac artery
2- Hepatic artery
3- The splenic artery runs toward
the left in a groove along this border.
480. Body of pancreas…cont
The anterior border
separates the anterior surface from the inferior surface
along this border the two layers of the transverse mesocolon diverge from one
another; one passing upward over the anterior surface, the other backward
over the inferior surface.
481. Body of pancreas
The inferior border
separates the posterior from the inferior surface
the superior mesenteric vessels emerge under its
right extremity.
482. The Tail
- Passes forward in
the splenicorenal
ligament and
comes in contact
with the hilum of
the spleen
483. Pancreatic ducts
The main duct
-Begins in the tail and runs the length
of the gland
-Receiving numerous tributaries on the
way .
- It opens into the second part of the
duodenum at about its middle with the
bile duct on the major duodenal papilla
Accessory duct
- When present, drains the upper part of
the head
-Then opens into the duodenum a short
distance above the main duct on the minor
duodenal papilla .
- The accessory duct frequently
communicates with the main duct
484. Blood Supply of pancreas
Arteries
The splenic.a
The superior
pancreaticoduodenal .a
Inferior
pancreaticoduodenal
arteries.a
Veins
The corresponding veins
drain into the portal system.
485. Lymphatic drainage of pancreas
Lymph nodes are
situated along the
arteries that supply
the gland.
The efferent vessels
ultimately drain into
the celiac and
superior mesenteric
lymph nodes.
487. Congenital defects of
pancreas
Annular Pancreas (pancreas
encircles duodenum) (rare)
Ectopic Pancreas (very common)=
Outside the gastrointestinal tract
488. Clinical notes
Cancer head of pancreas Obstruction jaundices
Cancer body of pancreas pressure I.V.C & portal vein
Acute pancreatitis= inflammation of pancreas
502. The head
-It is disc shaped
- lies within the
concavity of the
duodenum
- A part of the head
extends to the left
behind the superior
mesenteric vessels
and is called the
Uncinate process.
503. The neck
- It is the
constricted portion
of the pancreas
- connects the
head to the body.
- It lies in front of
the
beginning of the
portal vein the
origin of the
superior
mesenteric artery
504. The body
-Runs upward
and to the left
across the
midline
- It is
somewhat
triangular in
cross section.
505. Body of pancreas…cont
-Three surfaces: anterior, posterior,
and inferior.
-Three borders: ant ,post & inf
The anterior surface
1- Covered by peritoneum of post. Wall
of lesser sac
2- Tuber omental :
where the ant. surface of pancreas join
the neck
506. Body of
pancreas…cont
The posterior surface
- devoid of peritoneum
- in contact with
1- the aorta
2- the splenic vein
3- the left kidney and its
vessels
4- the left suprarenal
gland
5- the origin of the
superior mesenteric
artery
6- and the crura of the
diaphragm.
507. Body of pancreas…cont
The inferior surface
- Narrow on the right but broader on the left
-Covered by peritoneum of greater omentum
- lies upon the duodenojejunal flexure
- Some coils of the jejunum
- its left extremity rests on the left colic
flexure
The superior border
-Blunt and flat to the right;
- Narrow and sharp to the left near the tail
It commences on the right in the omental
tuberosity
In relation with
1- The celiac artery
2- Hepatic artery
3- The splenic artery runs toward
the left in a groove along this border.
508. Body of pancreas…cont
The anterior border
separates the anterior surface from the inferior surface
along this border the two layers of the transverse mesocolon diverge from one
another; one passing upward over the anterior surface, the other backward
over the inferior surface.
509. Body of pancreas
The inferior border
separates the posterior from the inferior surface
the superior mesenteric vessels emerge under its
right extremity.
510. The Tail
- Passes forward in
the splenicorenal
ligament and
comes in contact
with the hilum of
the spleen
511. Pancreatic ducts
The main duct
-Begins in the tail and runs the length
of the gland
-Receiving numerous tributaries on the
way .
- It opens into the second part of the
duodenum at about its middle with the
bile duct on the major duodenal papilla
Accessory duct
- When present, drains the upper part of
the head
-Then opens into the duodenum a short
distance above the main duct on the minor
duodenal papilla .
- The accessory duct frequently
communicates with the main duct
512. Blood Supply of pancreas
Arteries
The splenic.a
The superior
pancreaticoduodenal .a
Inferior
pancreaticoduodenal
arteries.a
Veins
The corresponding veins
drain into the portal system.
513. Lymphatic drainage of pancreas
Lymph nodes are
situated along the
arteries that supply
the gland.
The efferent vessels
ultimately drain into
the celiac and
superior mesenteric
lymph nodes.
515. Congenital defects of
pancreas
Annular Pancreas (pancreas
encircles duodenum) (rare)
Ectopic Pancreas (very common)=
Outside the gastrointestinal tract
516. Clinical notes
Cancer head of pancreas Obstruction jaundices
Cancer body of pancreas pressure I.V.C & portal vein
Acute pancreatitis= inflammation of pancreas
528. Subclavian Artery
Right Subclavian Artery:
Arises from brachiocephalic artery
(Behind right sternoclavicular joint)
At outer border of 1st rib it becomes Axillary Artery
Left Subclavian Artery:
Arsis from Arch of Aorta in the thorax
Runs upwards to the root of the neck & arches
laterally
At outer border of 1st rib it becomes Axillary Artery
529. Subclavian Artery
Scalenus Anterior muscle passes anterior to the
artery on each side and divides it into 3 parts.
1. 1st part of subclavian artery
2. 2nd part of subclavian artery
3. 3rd part of subclavian artery
530. 1st part of Subclavian Artery
Extends from the origin of the subclavian artery to
the medial border of the Scalenus anterior muscle.
Branches:
1. Vertebral artery
2. Thyrocervical Trunk
3. Internal thoracic artery
531. 1st part of Subclavian Artery
Branches:
1. Vertebral artery
Spinal and muscular branches in neck
Branches in skull
533. 1st part of Subclavian Artery
Branches:
3. Internal thoracic artery
Superior epigastric artery
Musculophrenic artery
534. 2nd part of Subclavian Artery
Lies behind the Scalenus anterior muscle.
Branches:
1. Costocervical trunk
Superior intercostal artery
Deep cervical artery
535. 3rd part of Subclavian Artery
Extends from the lateral border of the Scalenus
anterior muscle to the lateral border of 1st rib.
It gives no Branches
536.
537.
538. Left is a branch of
the arch of the aorta
Right is a branch of
innominate artery
Subclavian Artery
Begins
548. Axillary Artery
Begins at inferior
border of first rib.
Divided into thirds by
pectoralis minor
muscle:
First part superior to
muscle.
Second part deep to
muscle.
Third part inferior to
muscle.
549. First Part of Axillary Artery
Superior thoracic
artery
550. Second Part of Axillary Artery
Thoracoacromial
artery (trunk)
562. Branches of Brachial Artery
Deep brachial (profunda
brachii):
Wraps around posterior
surface of humerus.
Runs in radial groove with
radial nerve.
Supplies posterior
compartment of brachium.
566. Brachial Artery
Runs medial to median
nerve in upper part of
arm.
Runs lateral to median
nerve in lower part of arm.
Passes deep to bicipital
aponeurosis lateral to
median nerve and medial
to bicipital tendon.
568. Radial Artery
Gives off radial recurrent
to radial collateral from
deep brachial.
Enters wrist and hand to
form deep palmar arch.
569. Ulnar Artery
Gives off common
interosseous artery (trunk)
near its origin.
Runs through
antebrachium with ulnar
nerve.
Enters wrist and hand to
form superficial palmar
arch.
570. Ulnar Artery
Common interosseous
artery gives off anterior
and posterior
interosseous arteries:
Run on either side of the
interosseous membrane in the
forarm
572. Femoral Artery
It is the continuation of the
external iliac artery at the
mid inguinal point
It descends in the femoral
triangle
Then, it continues in the
adductor canal
It reaches the adductor
hiatus where it becomes
the popliteal artery
It supplies all structures in
the thigh
573.
574. Femoral Artery
In the femoral triangle, it gives the
following branches:
Superficial circumflex iliac artery
Superficial epigastric artery
External pudendal artery
Deep artery of the thigh
Muscular branches
575. Deep Artery of the Thigh( profanda
femoris artery)
It is the main artery of the thigh
It gives the following branches
Medial circumflex femoral artery
Lateral circumflex femoral artery
which gives a descending branch
Perforating arteries
579. Femoral Artery
Ends
Passing through an opening in the
adductor magnus muscles
between its 2 insertions
entering Adductor canal
Becoming the popliteal artery
Vastus Medialis anterolateral
to it
583. Popliteal Artery
It is the continuation of the femoral
artery at the adductor hiatus
It runs through the popliteal fossa
It ends at the lower border of the
popliteus muscle by dividing into its
terminal branches
It gives the following branches:
Medial superior genicular artery
Lateral superior genicular artery
Medial inferior genicular artery
Lateral inferior genicular artery
Middle genicular artery
584. Popliteal Artery
At the lower end of the
popliteus muscle, it
divides into:
Anterior tibial artery
Posterior tibial artery
which gives the
peroneal artery
585. Anterior Tibial Artery
It is one of the two terminal
branches of the popliteal artery
It supplies all structures in the
anterior compartment of the leg
and perforating branches to
lateral compartment
It ends at the midpoint between
the malleoli
It continues as Drorsalis Pedis
Artery
It gives anterior medial and lateral
malleolar branches
586. Posterior Tibial Artery
It is one of the two terminal branches of the
popliteal artery
It supplies all structures in the posterior and
lateral compartment of the leg
It runs behind and inferior to lateral malleolus
It then divides into Medial and Lateral plantar
branches
It gives the following branches:
Peroneal artery which gives lateral malleolar
and calcaneal branches
587. Drorsalis Pedis Artery
It is the direct continuation of the
anterior tibial artery at the
midpoint between the malleoli
It gives the following branches:
Lateral tarsal
Medial tarsal
Arcuate
1st dorsal metatarsal
Deep plantar
588. Plantar Arteries
The posterior tibial artery divides
into:
Lateral plantar
Medial plantar artery which gives
the first plantar metatarsal artery
Deep plantar arch is formed by the
deep plantar branch of dorsalis
pedis artery and lateral plantar
artery
589. Veins of the Lower Limb
Deep veins accompany arteries of the
lower limb internal to the deep fascia
Superficial veins are not accompanied by
arteries in the subcutaneous tissue
Deep veins of the foot are drained to the
dorsal venous arch
Medial and lateral marginal veins emerge
from the sides of the arch
590. Veins of the Lower Limb Cont.,
The medial marginal vein continues
as great (large) saphenous vein
It ascends in front of the medial
malleolus to the leg and thigh
It passes through the
saphenous opening
to end in the femoral
vein
591. Tributaries of great saphenous vein:
Below knee:
1- anterior vein of leg
2- posterior arch vein
Above knee:
1- anterolateral vein of
thigh
2- postromedial vein of
thigh
At inguinal region:
1- superficial epigastric
2- superficial circumflex
iliac
3- Superficial external
pudendal
4- super ficial dorsal
vein of penis
Perforating veins.
592. Veins of the Lower Limb Cont.,
The lateral marginal vein
continues as lesser (small)
saphenous vein
It ascends on the posterior
aspect of the leg
It ends in the popliteal vein
Perforating veins connect the
lesser saphenous vein with
deep veins (One way valve)
595. ARCH OF AORTA
Branches of Arch
of Aorta
1. Left Subclavian artery.
2. Left Common Carotid
artery.
3. Brachiocephalic trunk.
-Right subclavian artery.
-Right common carotid
artery.
BLOOD SUPPLY TO HEAD AND NECK 595
596. COMMON CAROTID ARTERY
– The right common
carotid artery arises
from the
brachiocephalic
artery behind the
sternoclavicular
joint.
-- The left artery arises
directly from the arch
of aorta behind the
manubrium sternum.
BLOOD SUPPLY TO HEAD AND NECK 596
597. COMMON CAROTID
ARTERY
– In the neck, each CCA
extends upwards & laterally with
in the carotid sheath to the level
of upper border of lamina of
thyroid cartilage.
-- The bifurcation takes place in
carotid triangle opposite the disc
between c3 & c4 vertebra.
BLOOD SUPPLY TO HEAD AND NECK 597
598. BRANCHES OF COMMON CAROTID
ARTERY
External Carotid Artery
Internal Carotid Artery
BLOOD SUPPLY TO HEAD AND NECK 598
599. EXTERNAL CAROTID ARTERY
It lies anterior to ICA and is the chief arterial supply to structures in front of
neck and face. Under cover of anterior border of sternocleidomastoid
BLOOD SUPPLY TO HEAD AND NECK 599
600. Terminates in the
substance of the
parotid gland behind
the neck of mandible
by dividing into:
Superficial temporal
artery
Maxillary artery
BLOOD SUPPLY TO HEAD AND NECK 600
602. Internal Carotid Artery
Has no branches in the neck
and enters the cranial cavity.
Supplies structures inside skull.
Arises from the common
carotid at the level of the
superior border of the thyroid
cartilage
It is embedded in the carotid
sheath with internal jugular vein
and vagus nerve.
It Supplies:
◦ Brain
◦ Nose
◦ Scalp
◦ Eye
BLOOD SUPPLY TO HEAD AND NECK 602
603. APPLIED ANATOMY
CAROTID PULSE :
CCA may be
compressed against
the carotid tubercle of
transverse process of
C6 vertebra (
carotid tubercle) about
4cm above the
sternoclavicular joint.
•
605. Location
Aorta enters the abdomen through the aortic opening of the diaphragm
The opening lies in front of twelfth thoracic vertebra
It descends behind the peritoneum on the anterior surface of the bodies of the
lumbar vertebrae
606.
607. Location
On its right side lies the inferior vena cava, the cisterna chyli and beginning of
the azygos vein
On the left side lies the left sympathetic trunk
It divides into two common iliac arteries at the level of fourth lumbar vertebra
608.
609. Branches
Three anterior visceral branches: celiac artery (Upper border L1), superior (
lower border L1) and inferior mesenteric arteries (L3)
Three lateral visceral branches: Middle suprarenal artery L1 , renal artery L2 ,
testicular or ovarian arteryL3
610.
611. Branches
Five lateral abdominal wall branches: the inferior phrenic artery and four lumbar
arteries
Three terminal branches: two common iliac and the median sacral artery from
back of aorta at L4.
612. Common Iliac Arteries
Right and left common iliac arteries are the
terminal branches of the aorta
They arise at the level of fourth lumbar vertebra
Runs downward and laterally along the medial
border of the psoas muscle
Each artery divides into external and internal iliac
arteries in front of the sacroiliac joint
613.
614. External Iliac Artery
It runs along the medial border of psoas, following the pelvic brim
It gives off the inferior epigastric and deep circumflex iliac branches
The artery enters the thigh by passing under the inguinal ligament to become
the femoral artery
615. Inferior Epigastric Artery
The inferior epigastric artery arises just above the inguinal ligament
Passes upward and medially along the medial margin of the deep inguinal ring
Enters the rectus sheath behind the rectus abdominis muscle
616. Inferior Vena Cava
It conveys most of the blood from the body below
the diaphragm to the right atrium of the heart
It is formed by the union of common iliac veins
behind the right common iliac artery at the level of
fifth lumbar vertebra
It ascends on the right side of the aorta
Pierces the central tendon of the diaphragm at the
level of the eighth thoracic vertebra
617.
618. Inferior Vena Cava
It drains into the right atrium of the heart
Right sympathetic trunk lies behind its right margin
Right ureter lies close to its right border
619. Tributaries
Two anterior visceral tributaries: the hepatic veins
Three lateral visceral tributaries: the right
suprarenal vein, renal veins, right testicular or
ovarian vein
Lateral abdominal wall tributaries: inferior phrenic
vein and four lumbar veins
Three veins of origin: two common iliac veins and
the median sacral vein
622. Route of Lymph Flow
Lymphatic capillaries
Collecting vessels: course through many lymph nodes
Lymphatic trunks: drain major portions of body
Collecting ducts :
right lymphatic duct – receives lymph from R arm, R side of head and thorax;
empties into R subclavian vein
thoracic duct - larger and longer, begins as a prominent sac in abdomen called the
cisterna chyli, receives lymph from below diaphragm, left arm, left side of head, neck
and thorax; empties into L subclavian vein
627. Esophagus
A hollow muscular tube
About 25 cm (10 in.) long
and 2 cm (0.80 in.) wide
Conveys solid food and
liquids to the stomach
Begins posterior to cricoid
cartilage
Is innervated by fibers from
the esophageal plexus
A hollow muscular tube
About 25 cm (10 in.) long and 2
cm wide.
Conveys solid food and liquids
to the stomach.
Begins posterior to cricoid
cartilage
Is innervated by fibers from the
esophageal plexus.….
628. Starts at the level of:
Body of C6
Cricoid cartilage
Related to:
AnteriorlyPosteriorly
Trachea
Recurrent laryngeal n.
Vertebrae
641. Lt. crus of diaphragm
Left kidney
Left suprarenal gland
Spleen
Splenic artery
Body of pancreas
Transverse mesocolon
Transverse colon
Posterior (stomach bed)
642. Lt. crus of diaphragm
Left kidney
Left suprarenal gland
Spleen
Splenic artery
Body of pancreas
Transverse mesocolon
Transverse colon
Posterior (stomach bed)
643. pply
The rich arterial supply of the
stomach arises from the celiac
trunk and its branches
Most blood is supplied by
anastomoses formed along
the lesser curvature by the
right and left gastric
arteries, and along the
greater curvature by the right
and left gastro-omental
(gastroepiploic) arteries.
The fundus and upper body
receive blood from the short
and posterior gastric
arteries.
The veins of the stomach
parallel the arteries in position
and course
644. Arteries of stomach
Left and right gastric
arteries
Arise from celiac trunk and proper
hepatic artery, respectively.
These two vessels run in lesser
omentum along lesser curvature ,
and anastomose end-to-end.
645. Arteries of stomach
Right and left
gastroepiploic arteries
Arise from the gastroduodenal and
splenic artery, respectively.
These two vessels pass into the
greater omentum, run parallel to
the greater curvature, and
anastomose end-to-end.
646. Arteries of stomach
Short gastric arteries
Branches of splenic artery
Course through the gastrosplenic
ligament
Supply the fundus of stomach.
Posterior gastric artery (72%)
Arise from the splenic artery
Course through the gastrophrenic
ligament and supply the posterior wall
of fundus of stomach.
647. Venous drainage of stomach
Right and left gastric veins
empty directly into portal vein.
Left gastroepiploic and short
gastric veins drain into portal
vein via the splenic vein.
Right gastroepiploic vein drain
into superior mesenteric vein.
648. Lymph drainage of stomach
Right and left gastric ln. lie along
the same vessels and finally to the
celiac ln.
Right and left gastroomental ln.
lie along the same vessels, the
former drain into subpyloric ln., the
latter drain into splenic ln.
Suprapyloric and subpyloric ln.
receive lymphatics from pyloric
part and finally to the celiac ln.
Splenic ln. receive lymphatics
from fundus and left third of
stomach, and finally to the celiac
ln.
649. Nerve supply of stomach
Parasympathetic innervation
The anterior vagal trunk divides into
anterior gastric and hepatic branches
The posterior vagal trunk divides into
posterior gastric and celiac branches
The anterior and posterior gastric branches
descend on the anterior and posterior
surfaces of the stomach as a rule about 1
to 2 cm from the lesser curvature and
parallel to it in the lesser omentum as far as
the pyloric antrum to fan out into branches
called “crow’s foot” to supply the pyloric
part
Sympathetic innervation
Mainly from celiac ganglia
Afferent and efferent fibers derives from
thoracic segments (T5 －L1)
650. Short gastric
Lt. gastroepiploic
Rt. gastroepiploic
Rt. gastric
Lt. gastric
Prepyloric vein of Mayo
It is an intraoperative landmark of pylorus
653. Small Intestine
The Duodenum
The segment of small intestine closest to stomach
25 cm (10 in.) long
“Mixing bowl” that receives chyme from stomach and
digestive secretions from pancreas and liver
Functions of the duodenum
To receive chyme from stomach
To neutralize acids before they can damage the absorptive surfaces of
the small intestine
654. It forms a C - shaped curve around the head of the pancreas
655. It is fixed in the front surface of the structures of the posterior abdominal wall
Rt Kidney
Quadratus Lumborum
Vertebrae
665. 2nd Part:
The bile duct units with main pancreatic duct to form ampulla of Vater
Which open in the posteromedial aspect of 2nd part
C.B.D
Ampulla of Vater
Main pancreatic duct
674. 4th Part:
It is 1 inch longIt ends at the duodenojejunal flexureThe duodenojejunal flexure supported by ligament of Treitz from Rt. Crus of diaphragm
Rt. Crus of diaphragm
677. Small Intestine
The Jejunum
Is the middle segment of small intestine
2.5 meters (8.2 ft) long
Is the location of most
Chemical digestion
Nutrient absorption
Has few plicae circulares
Small villi
678. Small Intestine
The Ileum
The final segment of small intestine
3.5 meters (11.48 ft) long
Ends at the ileocecal valve, a sphincter that controls flow of material from the
ileum into the large intestine
684. Large Intestine
Is horseshoe shaped
Extends from end of ileum to anus
Lies inferior to stomach and liver
Frames the small intestine
Also called large bowel
Is about 1.5 meters (4.9 ft) long and 7.5 cm (3
in.) wide
695. Parts of Large Intestine
The Cecum
Is an expanded pouch
Receives material arriving from
the ileum
Appendix
Also called vermiform appendix
Is a slender, hollow appendage
about 9 cm (3.6 in.) long
Is dominated by lymphoid nodules (a
lymphoid organ)
705. Parts of Large Intestine
The Colon
Has a larger diameter and thinner wall than small intestine
The wall of the colon
Forms a series of pouches (haustrations)
Haustrations permit expansion and elongation of colon
706. Parts of Colon
Ascending Colon
Begins at superior border of cecum
Ascends along right lateral and posterior wall of peritoneal cavity
to inferior surface of the liver and bends at right colic flexure
(hepatic flexure)
Transverse Colon
Crosses abdomen from right to left; turns at left colic flexure
(splenic flexure)
Is supported by transverse mesocolon
Is separated from anterior abdominal wall by greater omentum
707. Parts of Colon
The Descending Colon
Proceeds inferiorly along left side to the iliac fossa (inner
surface of left ilium)
Is retroperitoneal, firmly attached to abdominal wall
The Sigmoid Colon
Is an S-shaped segment, about 15 cm (6 in.) long
Starts at sigmoid flexure
Lies posterior to urinary bladder
Is suspended from sigmoid mesocolon
Empties into rectum
709. Parts of Large Intestine
The Rectum
Forms last 15 cm (6 in.) of digestive tract
Is an expandable organ for temporary
storage of feces
Movement of fecal material into rectum
triggers urge to defecate
The anal canal is the last portion of the
rectum
Contains small longitudinal folds called anal
columns
Anus
Also called anal orifice
Is exit of the anal canal
Has keratinized epidermis like skin
710. Begins at S3
Ends 1 inch below & infront of coccyx
Length: 5 inches
716. Anterior
2-Female
Coils of ileum & sigmoid colon
Uterus & upper part of vagina(with
rectouterine pouch in between)
Lower part of vagina(no peritoneum in
between)
727. At the level of puborectalis the anorectal ring is formed of:
1- Internal sphincter
2- Deep external sphincter
3- puborectalis
728.
729. Esophagus
A hollow muscular tube
About 25 cm (10 in.) long
and 2 cm (0.80 in.) wide
Conveys solid food and
liquids to the stomach
Begins posterior to cricoid
cartilage
Is innervated by fibers from
the esophageal plexus
A hollow muscular tube
About 25 cm (10 in.) long and 2
cm wide.
Conveys solid food and liquids
to the stomach.
Begins posterior to cricoid
cartilage
Is innervated by fibers from the
esophageal plexus.….
730. Starts at the level of:
Body of C6
Cricoid cartilage
Related to:
AnteriorlyPosteriorly
Trachea
Recurrent laryngeal n.
Vertebrae
743. Lt. crus of diaphragm
Left kidney
Left suprarenal gland
Spleen
Splenic artery
Body of pancreas
Transverse mesocolon
Transverse colon
Posterior (stomach bed)
744. Lt. crus of diaphragm
Left kidney
Left suprarenal gland
Spleen
Splenic artery
Body of pancreas
Transverse mesocolon
Transverse colon
Posterior (stomach bed)
745. pply
The rich arterial supply of the
stomach arises from the celiac
trunk and its branches
Most blood is supplied by
anastomoses formed along
the lesser curvature by the
right and left gastric
arteries, and along the
greater curvature by the right
and left gastro-omental
(gastroepiploic) arteries.
The fundus and upper body
receive blood from the short
and posterior gastric
arteries.
The veins of the stomach
parallel the arteries in position
and course
746. Arteries of stomach
Left and right gastric
arteries
Arise from celiac trunk and proper
hepatic artery, respectively.
These two vessels run in lesser
omentum along lesser curvature ,
and anastomose end-to-end.
747. Arteries of stomach
Right and left
gastroepiploic arteries
Arise from the gastroduodenal and
splenic artery, respectively.
These two vessels pass into the
greater omentum, run parallel to
the greater curvature, and
anastomose end-to-end.
748. Arteries of stomach
Short gastric arteries
Branches of splenic artery
Course through the gastrosplenic
ligament
Supply the fundus of stomach.
Posterior gastric artery (72%)
Arise from the splenic artery
Course through the gastrophrenic
ligament and supply the posterior wall
of fundus of stomach.
749. Venous drainage of stomach
Right and left gastric veins
empty directly into portal vein.
Left gastroepiploic and short
gastric veins drain into portal
vein via the splenic vein.
Right gastroepiploic vein drain
into superior mesenteric vein.
750. Lymph drainage of stomach
Right and left gastric ln. lie along
the same vessels and finally to the
celiac ln.
Right and left gastroomental ln.
lie along the same vessels, the
former drain into subpyloric ln., the
latter drain into splenic ln.
Suprapyloric and subpyloric ln.
receive lymphatics from pyloric
part and finally to the celiac ln.
Splenic ln. receive lymphatics
from fundus and left third of
stomach, and finally to the celiac
ln.
751. Nerve supply of stomach
Parasympathetic innervation
The anterior vagal trunk divides into
anterior gastric and hepatic branches
The posterior vagal trunk divides into
posterior gastric and celiac branches
The anterior and posterior gastric branches
descend on the anterior and posterior
surfaces of the stomach as a rule about 1
to 2 cm from the lesser curvature and
parallel to it in the lesser omentum as far as
the pyloric antrum to fan out into branches
called “crow’s foot” to supply the pyloric
part
Sympathetic innervation
Mainly from celiac ganglia
Afferent and efferent fibers derives from
thoracic segments (T5 －L1)
752. Short gastric
Lt. gastroepiploic
Rt. gastroepiploic
Rt. gastric
Lt. gastric
Prepyloric vein of Mayo
It is an intraoperative landmark of pylorus
755. Small Intestine
The Duodenum
The segment of small intestine closest to stomach
25 cm (10 in.) long
“Mixing bowl” that receives chyme from stomach and
digestive secretions from pancreas and liver
Functions of the duodenum
To receive chyme from stomach
To neutralize acids before they can damage the absorptive surfaces of
the small intestine
756. It forms a C - shaped curve around the head of the pancreas
757. It is fixed in the front surface of the structures of the posterior abdominal wall
Rt Kidney
Quadratus Lumborum
Vertebrae
767. 2nd Part:
The bile duct units with main pancreatic duct to form ampulla of Vater
Which open in the posteromedial aspect of 2nd part
C.B.D
Ampulla of Vater
Main pancreatic duct
776. 4th Part:
It is 1 inch longIt ends at the duodenojejunal flexureThe duodenojejunal flexure supported by ligament of Treitz from Rt. Crus of diaphragm
Rt. Crus of diaphragm
779. Small Intestine
The Jejunum
Is the middle segment of small intestine
2.5 meters (8.2 ft) long
Is the location of most
Chemical digestion
Nutrient absorption
Has few plicae circulares
Small villi
780. Small Intestine
The Ileum
The final segment of small intestine
3.5 meters (11.48 ft) long
Ends at the ileocecal valve, a sphincter that controls flow of material from the
ileum into the large intestine
786. Large Intestine
Is horseshoe shaped
Extends from end of ileum to anus
Lies inferior to stomach and liver
Frames the small intestine
Also called large bowel
Is about 1.5 meters (4.9 ft) long and 7.5 cm (3
in.) wide
797. Parts of Large Intestine
The Cecum
Is an expanded pouch
Receives material arriving from
the ileum
Appendix
Also called vermiform appendix
Is a slender, hollow appendage
about 9 cm (3.6 in.) long
Is dominated by lymphoid nodules (a
lymphoid organ)
807. Parts of Large Intestine
The Colon
Has a larger diameter and thinner wall than small intestine
The wall of the colon
Forms a series of pouches (haustrations)
Haustrations permit expansion and elongation of colon
808. Parts of Colon
Ascending Colon
Begins at superior border of cecum
Ascends along right lateral and posterior wall of peritoneal cavity
to inferior surface of the liver and bends at right colic flexure
(hepatic flexure)
Transverse Colon
Crosses abdomen from right to left; turns at left colic flexure
(splenic flexure)
Is supported by transverse mesocolon
Is separated from anterior abdominal wall by greater omentum
809. Parts of Colon
The Descending Colon
Proceeds inferiorly along left side to the iliac fossa (inner
surface of left ilium)
Is retroperitoneal, firmly attached to abdominal wall
The Sigmoid Colon
Is an S-shaped segment, about 15 cm (6 in.) long
Starts at sigmoid flexure
Lies posterior to urinary bladder
Is suspended from sigmoid mesocolon
Empties into rectum
811. Parts of Large Intestine
The Rectum
Forms last 15 cm (6 in.) of digestive tract
Is an expandable organ for temporary
storage of feces
Movement of fecal material into rectum
triggers urge to defecate
The anal canal is the last portion of the
rectum
Contains small longitudinal folds called anal
columns
Anus
Also called anal orifice
Is exit of the anal canal
Has keratinized epidermis like skin
812. Begins at S3
Ends 1 inch below & infront of coccyx
Length: 5 inches
818. Anterior
2-Female
Coils of ileum & sigmoid colon
Uterus & upper part of vagina(with
rectouterine pouch in between)
Lower part of vagina(no peritoneum in
between)
