Lab 6

● Surface Anatomy
○ Xiphoid Process​: small cartilaginous process of lower sternum (ossified in adult)
○ Costal Margin
○ Iliac Crest
○ Anterior Superior Iliac Spine (ASIS)​: provides attachment for inguinal ligament
○ Inguinal Ligament
○ Pubic Crest
○ Umbilicus

● Layers of Abdominal Wall

1. Skin
2. Fatty Layer of Superficial Fascia (C ​ amper’s fascia​)​: fat ranging from several
centimeters thick to absent in emaciated bodies. Same fatty layer in rest of body
3. Membranous Layer of Superficial Fascia (S ​ carpa’s fascia)​: shiny, tough
membrane- compared to plastic wrap. Same deep fascia in rest of body
4. External Oblique muscle and aponeurosis:​ striations course from superolateral to
infero-medial, connects to aponeurosis = anterior tendinous membrane that
forms part of anterior lamina of rectus sheath. Innervated by T2-T12 anterior rami
5. Internal Oblique muscle and aponeurosis​: intermediate muscle layer deep to EO
and superficial to TA. striations course at right angles to EO in superomedial
direction. Aponeuroses blend anteriorly with linea alba at midline. Innervated by
T7-L1 anterior rami
6. Transversus Abdominis muscle and aponeurosis​: muscle layer deep to IO,
striations course (mostly) in transverse plane. Aponeuroses blend anteriorly with
linea alba at midline. Innervated by T7-L1 anterior rami
7. Transversalis Fascia​: thin continuous layer of fascia between TA and rectus
abdominis (RA) muscles superficially, and extraperitoneal fat deep.
8. Extraperitoneal Fat​: located between transversalis fascia and parietal peritoneum
9. Parietal Peritoneum​: serous lining on internal surface of abdominal wall
● Rectus Abdominis muscle​: long flat muscle that courses longitudinally from
sternum and costal margin to the pubis. Paired muscles separated by linea alba.
 Widens and thins as it ascends from pubic symphysis to costal cartilages.
Innervated by T7-T12 anterior rami
● Rectus sheath​: tendinous sheath formed by the aponeurosis of EO, IO, and TA.
This surrounds the rectus abdominis muscle
● Linea Alba​: dense aponeurotic band that forms strong tendinous seam between
the two rectus sheaths. Runs from xiphoid process to pubic symphysis
● Tendinous Intersections of rectus abdominis
● Inguinal Ligament
○ Superficial Inguinal Ring:​ triangular passage through EO aponeurosis traversed
by spermatic cord (males) or round ligament of uterus (female). Located at the
end of the inguinal canal, 2.5 cm superolateral to pubic tubercle
■ Medial crus:​ fibers of EO aponeurosis attached to pubic symphysis
■ Lateral crus:​ fibers of EO aponeurosis attached to pubic tubercle
■ Intercrural Fibers:​ intercrural (crossing) fibers in EO aponeurosis that hold
medial and lateral crura together. Prevents further widening of superficial
inguinal ring

○ Deep Inguinal Ring​: appears as oval defect on internal surface of abdominal wall,
located midway between anterior superior iliac spine and pubic symphysis,
superior to the inguinal ligament and lateral to inferior epigastric vessels
○ Spermatic Cord​: passes through superficial inguinal ring to reach perineum in
males
○ Ductus Deferens​: in males, courses from prostate gland in pelvic cavity, exits
abdominal cavity via deep inguinal ring (lateral to inferior epigastric vessels,
inguinal canal, and superficial inguinal ring). extends to scrotum to reach
posterior border of testis
○ Round Ligament of Uterus​: passes through superficial inguinal ring to reach
perineum in females, exits abdominal cavity via deep inguinal ring. Spreads into
fibrous strands within labia majora
○ Ilioinguinal Nerve:​ descends into inguinal canal, between internal and external
oblique muscles
■ Males: traverses inguinal canal, coursing along inferior aspect of
spermatic cord to superficial inguinal ring, where it contributes to
cutaneous innervation from upper thigh, scrotum and penis
■ Females: same course but supplies labia majora
**Inguinal canal contains blood and lymphatic vessels
● Vessels
○ Superficial Epigastric artery & vein​: ​arises from the front of the femoral artery about 1
cm below the ​inguinal ligament​, and, passing through the ​femoral sheath​ and the ​fascia
cribrosa​, turns upward in front of the inguinal ligament, and ascends between the two
layers of the ​superficial fascia​ of the ​abdominal wall​ nearly as far as the ​umbilicus
○ Superficial Circumflex Iliac artery & vein:​ ​smallest of the cutaneous branches of the
femoral artery​, arises close to the ​superficial epigastric artery​, and, piercing the ​fascia
lata​, runs lateralward, parallel with the ​inguinal ligament​, as far as the crest of the ​ilium​.
○ Superior Epigastric artery & vein:​ found on deep surface of rectus abdominis muscle.
Terminal branches of internal thoracic vessels, usually smaller than inferior epigastric
vessels
○ Inferior Epigastric artery & vein:​ arise from external iliac vessels superior to inguinal
ligament. Course superiorly in transversalis fascia to reach posterior surface of RA
muscle in vicinity of arcuate line (inferior edge of rectus sheath posterior layer). Course
deep to posterior layer of rectus sheath above arcuate line.
**Superior and inferior epigastric vessels anastomose on deep surface of rectus abdominis
muscle

● Folds and Ligaments

○ Median Umbilical Fold (ligament):​ unpaired fold in midsagittal plane, formed by
urachus and its peritoneal covering
■ Urachus​: fibrous remnant of allantois, a canal that drains the urinary
bladder of the fetus, running within the umbilical cord. Lies between
transversalis fascia anteriorly and peritoneum posteriorly
○ Medial Umbilical Folds (ligaments)​: paired folds lateral to median umbilical fold,
formed by inferior epigastric vessels and their peritoneal covering
 ■ Obliterated umbilical arteries:
○ Lateral Umbilical Folds (ligaments)​: paired folds lateral to medial umbilical folds,
formed by inferior epigastric vessels and their peritoneal covering
■ Inferior epigastric artery & vein:
○ Falciform Ligament:​ peritoneal fold that spans between umbilicus and liver
○ Ligamentum Teres​: ligamentous cord in free margin of falciform ligament, formed
by obliterated umbilical vein and its peritoneal covering
■ Obliterated Umbilical vein​: umbilical vein present during fetal development
that carries oxygenated blood from placenta to fetus. After birth, umbilical
vein is obliterated and replaced by fibrous cord (ligamentum teres).

SCROTUM / SPERMATIC CORD

ABDOMINAL WALL
 Skin Skin

Camper’s fascia Nothing

Scarpa’s fascia Dartos Muscle & fascia

External Oblique muscle/aponeurosis External Spermatic fascia

Internal Oblique muscle/aponeurosis Cremaster Muscle & fascia

Transversus Abdominus muscle Nothing

Transversalis fascia Internal Spermatic fascia

Extraperitoneal fat Areolar Connective Tissue

Peritoneum Tunica Vaginalis

Lab 7
● Organs of the Abdominal Cavity

○ Stomach​: left upper quadrant, inferior to left lobe of liver

■ Greater Omentum
■ Body:​ region between fundus and pylorus
■ Fundus:​ dilated, superior part of stomach related to left dome of
diaphragm
■ Cardia​: territory of cardiac sphincter, formed by right crus of diaphragm-
 region where esophagus enters the stomach
■ Pylorus​: funnel-shaped terminal region of stomach, surrounds pyloric
sphincter
■ Rugae​: longitudinal folds in stomach
■ Greater Curvature:​ inferior border of stomach
■ Lesser Curvature:​ superior border of stomach
○ Pyloric Sphincter​: thick band of smooth muscle separating stomach from
duodenum
○ Duodenum​: first segment of small intestine, most is retroperitoneal
■ Duodenojejunal Junction
■ Suspensory Ligament of Duodenum
○ Liver​: positioned in right upper quadrant
■ Diaphragmatic and Visceral Surfaces
■ Lobes (left, right, caudate, quadrate): caudate superior lobe between right
and left, quadrate inferior between right and left
■ Bare Area: large triangular surface of liver devoid of peritoneal covering,
attached to diaphragm by areolar tissue. between two layers of coronary
ligaments
■ Left and Right Hepatic Ducts
■ Common Hepatic Duct
■ Porta Hepatis: transverse fissure of liver extending under surface of left
portion of right lobe, nearer posterior surface
○ Gallbladder​: attached to inferior surface of
■ Cystic Duct
■ Common Bile Duct
○ Pancreas
■ Pancreatic Duct
○ Jejunum:​ second segment of small intestine
○ Ileum​: third segment of small intestine
○ Ileocecal Valve
○ Ascending Colon
■ Cecum​: right lower quadrant
● Appendix:​ right lower quadrant, on inferior border of cecum
○ Transverse Colon
■ Transverse Mesocolon
○ Descending Colon
○ Sigmoid Colon
○ Spleen:​ left upper quadrant, posterior and lateral to stomach. Touches diaphragm
and tail of pancreas

● Vessels of the Foregut

○ Celiac Trunk​: principal arterial supply to the foregut, and first major branch of the
abdominal aorta. ​Supplies oxygenated ​blood​ to the ​liver​, ​stomach​, abdominal
esophagus​,​spleen​ and the superior half of both the ​duodenum​ and the ​pancreas
■ Common Hepatic artery:​ short blood vessel responsible for supplying
blood to the liver. Arises from celiac trunk, branches into proper hepatic
artery, gastroduodenal artery, and right gastric artery.
● Proper Hepatic artery​: arises from common hepatic artery and
runs along hepatic portal vein and common bile duct to form the
porta hepatis
○ Left hepatic artery
○ Right hepatic artery
■ Cystic artery:​ supplies oxygenated blood to
gallbladder and cystic duct
● Right Gastric artery​: branch of common hepatic artery that
supplies lesser curvature of stomach (inferior), arising above
pylorus
● Gastroduodenal artery​: small blood vessel, ​ supplies blood directly to
the ​pylorus​ (distal part of the ​stomach​) and proximal part of the
duodenum
■ Superior Pancreaticoduodenal artery:​ ​an a ​ rtery​ that
supplies ​blood​ to the ​duodenum​ and ​pancreas​. It is a
branch of the ​gastroduodenal artery​, which most
commonly arises from the ​common hepatic artery​ of the
celiac trunk
■ Right gastro-omental artery:
■ Left Gastric artery:​ a
​ rises from the ​celiac artery​, and runs along the superior
portion of the ​lesser curvature​ of the ​stomach​. Branches also supply the lower
esophagus​. The ​left gastric artery ​anastomoses with the ​right gastric artery​,
which runs right to left
● Esophageal artery​: ​branches which supply the ​esophagu​s
■ Splenic artery:​ ​the b
​ lood vessel​ that supplies oxygenated ​blood​ to the s​ pleen​. It
branches from the ​celiac artery​, and follows a course ​superior​ to the p
​ ancreas​.
● Short gastric arteries​: ​five to seven small branches, which arise from
the end of the ​splenic artery​, and from its terminal divisions. They pass
from left to right, between the layers of the ​gastrolienal ligament​, and are
distributed to the ​greater curvature of the stomach​, anastomosing with
branches of the ​left gastric​ and ​left gastroepiploic​ arteries
● Left gastro-omental artery:​ l​argest branch of the ​splenic artery​, runs
from left to right about a finger’s breadth or more from the greater
curvature of the ​stomach​, between the layers of the ​greater omentum​,
and anastomoses with the ​right gastroepiploic
 ○ Hepatic Portal vein​: ​conducts blood from the ​gastrointestinal tract​ and ​spleen​ to the
liver​. The hepatic portal vein is usually formed by the confluence of the ​superior
mesenteric​ and s​ plenic veins​ and also receives blood from the ​inferior mesenteric​,
gastric​, and ​cystic veins

Lab 8
● Abdominal Organs
○ Duodenum
■ Circular Folds:​ invaginations of mucosal lining
■ Major Duodenal Papilla​: elevation where pancreatic duct and common
bile duct enter lumen
■ Pancreaticoduodenal Ampulla​: bulbous junction of common bile and
pancreatic ducts outside the second part of the duodenum- opens into
lumen of duodenum via major duodenal papilla
■ Main Pancreatic Duct

○ Jejunum
■ Circular Folds:​ increase surface area to accommodate passage of
digesting food, numerous in jejunum
 ○ Ileum
■ Circular Folds:​ decrease in number as ileum nears ileocecal junction

○ Large Intestine
■ Taenia Coli​: three longitudinal bands of smooth muscle on the outside of
the colon. Converge at the root of the vermiform appendix in the cecum
■ Haustra:​ small pouches of the colon, perform very slow contractions
(~1/25 min). Does not extend around entire circumference- separated by
taenia coli
■ Epiploic Appendices:​ small peritoneal pouches filled with fat, situated
along colon and upper part of rectum

■ Right and Left Colic Flexures​: sharp bend separating ascending and
transverse colon (right) and transverse and descending colon (left)
■ Rectum:​ final straight portion of large intestine
○ Left and Right Kidneys
■ Ureters:​ tubes of smooth muscle (one on each side) that propel urine from
the kidney to the urinary bladder
■ Adrenal Glands​: endocrine glands above the kidneys on each side.
Release hormones in response to stress through synthesis of
corticosteroids, and produce androgen.

● Vessels
○ Superior Mesenteric Artery​: arises from abdominal aorta just inferior to celiac
trunk. Supplies intestine from lower part of duodenum through ⅔ of transverse
colon, as well as pancreas
■ Right Colic Artery:​ supplies ascending colon. Branches from middle of
SMA concavity
■ Middle Colic Artery​: supplies transverse colon. Arises just below pancreas
■ Ileocolic Artery:​ supplies last part of ileum, cecum, and appendix. Lowest
branch from SMA concavity, splits into inferior and superior near the iliac
fossa
■ Jejunal Arteries​: branches of SMA supplying jejunum
● Arterial Arcades and Vasa Recta:​ arcades are looped arteries in
the mesentery, vasa recta are straight arteries branching off of the
arcades toward the intestines
■ Ileal Arteries:​ branches of SMA supplying ileum
● Arterial Arcades and Vasa Recta
○ Inferior Mesenteric Artery​: branch of the abdominal aorta below renal arteries,
supplies descending and sigmoid colons and part of rectum
■ Left Colic Artery​: supplies descending colon
■ Sigmoid Arteries​: run obliquely downward and to the left, behind the
peritoneum. supplies lower part of descending colon, sigmoid colon.
Anastomoses with left colic above
■ Superior Rectal Artery:​ terminal branch of the IMA
○ Marginal Artery​: aka artery of drummond. Connects the IMA and SMA
○ Abdominal Aorta: largest artery in abdomen. direct continuation of descending
aorta, beginning at the level of the diaphragm
■ Common Iliac Arteries:​ originate from abdominal aorta at fourth lumbar
level. Bifurcates into internal and external iliac arteries
● Internal Iliac Arteries​: main artery of pelvis- supplies buttocks,
viscera of pelvis, reproductive organs and medial portion of thigh
● External Iliac Arteries:​ proceed along psoas muscle, exit inferior to
inguinal ligament to become the femoral arteries
■ Renal Arteries:​ paired visceral arteries branching between L1 & L2
vertebral levels, supply the corresponding kidney
■ Suprarenal Arteries:​ paired visceral arteries branching from L1 vertebral
level, supply adrenal glands
■ Gonadal Arteries​: paired visceral arteries branching from L2 vertebral
level, ovarian artery in females and testicular artery in males
■ Lumbar Arteries:​ paired parietal arteries branching from L1-L4 vertebral
levels- four on each side that supply abdominal wall and spinal cord
■ Median Sacral Artery:​ parietal artery arising from L4 vertebral level-
comes from middle of aorta at lowest point
○ Inferior Vena Cava​: large vein carrying deoxygenated blood from lower half of
body to right atrium of heart
 ■ Common Iliac Veins​: left and right come together at L5 vertebral level to
form IVC
● Internal Iliac Veins​: corresponds with internal iliac arteries
● External Iliac Veins​: large veins connecting femoral and common
iliac
■ Renal Veins
■ Suprarenal Veins
■ Gonadal Veins
■ Lumbar Veins
○ Hepatic Portal Vein:​ conducts blood from GI tract and spleen to liver
■ Splenic Vein:​ drains blood from the spleen and joins with SMV to form
hepatic portal vein. Courses superior to pancreas along splenic artery
■ Superior Mesenteric Vein:​ drains blood from jejunum and ileum,
terminates behind neck of pancreas, lies to right of SMA
■ Inferior Mesenteric Vein:​ drains blood from large intestine, typically ends
in splenic vein
■ Right and Left Gastric Veins:​ left gastric runs right to left along lesser
curvature of stomach between layers of lesser omentum, turns backwards
and goes left to right. drains directly into portal vein. right gastric also
drains lesser omentum
■ Gastro-omental Veins​: left receives blood from posterior surface of
stomach and greater omentum. runs from right to left along greater
curvature and ends in splenic vein. right receives blood from
antero-superior and postero-inferior surfaces of stomach, runs from left to
right along greater curvature between layers of greater omentum
■ Superior Rectal Veins:​ inferior, rectal portion of IMV. originates in
hemorrhoidal plexus
○ Superior Mesenteric Lymph Nodes
○ Inferior Mesenteric Lymph Nodes

● Muscles
○ Diaphragm
■ Central Tendon​: thin aponeurosis inferior to fibrous pericardium, anterior
to vault formed by muscle
● Vena Caval Hiatus:​ hiatus in diaphragm through which the IVC
passes
■ Esophageal hiatus​: hole in diaphragm through which esophagus and right
phrenic nerve passes. located in right crus of diaphragm
■ Aortic hiatus​: lowest and most posterior of large apertures in diaphragm
■ Right crus​: crura are tendinous structures extending inferiorly from
diaphragm to attach to vertebral column. Right is larger and longer than
the left
■ Left crus
 ● Median Arcuate Ligament​: ligament under diaphragm connecting
right and left crura
■ Medial Arcuate Ligaments​: tendinous fascia arching over psoas major
muscle as it passes through diaphragm
■ Lateral Arcuate Ligaments​: ligament under diaphragm that arches across
upper part of quadratus lumborum
○ Psoas Major:​ long fusiform muscle on side of lumbar region of vertebral column
and brim of lesser pelvis. Joins iliacus to form iliopsoas. Innervated by lumbar
plexus, supplied by lumbar branch of iliolumbar artery. Inserts into lesser
trochanter of femur, originates at transverse processes of T12-L5
○ Psoas Minor:​ long skeletal muscle, present in ~50% of subjects. Located in front
of psoas major. Weak flexor of lumbar vertebral column
○ Quadratus Lumborum​: irregular, quadrilateral muscle on posterior wall, thicker
above than below. Responsible for lateral flexion of vertebral column, extension
of lumbar vertebral column, and elevation of ilium. Innervated by 12th thoracic
and 1-4th lumbar nerves
○ Iliacus​: flat triangular muscle which fills iliac fossa. Impt for lifting/flexing the leg
forward and moving trunk forward from lying position (ie situps). Innervated by
femoral nerve and direct branches from lumbar plexus. Inserts into lesser
trochanter of femur

● Nerves
○ Subcostal:​ large anterior division of twelfth thoracic nerve, runs along lower
border of twelfth rib and in front of quadratus lumborum
○ Iliohypogastric:​ superior branch of anterior ramus of spinal nerve L1 after
receiving fibers from subcostal. Also communicates with ilioinguinal nerve
○ Ilioinguinal​: branch of first lumbar nerve. emerges from lateral border of psoas
major inferior to iliohypogastric nerve. In males, accompanies spermatic cord
through superficial inguinal ring, fibers branch to root of penis and upper part of
scrotum. In females fibers distribute to anterior labial nerve
○ Genitofemoral:​ originates from upper part of lumbar plexus, roots are L1 and L2.
Responsible for efferent and afferent limbs of cremasteric reflex. emerges on
anterior surface of psoas major, and divides into two branches- femoral branch,
which supplies skin anterior to upper part of femoral triangle, and genital branch
which innervates cremaster muscle in males, skin of mons pubis and labia
majora in females
○ Lateral Cutaneous Nerve of thigh​: aka lateral cutaneous femoral nerve.
Innervates skin on lateral part of thigh. Arises from dorsal divisions of 2nd and
3rd lumbar nerves. Emerges from lateral border of psoas major around middle,
crosses iliacus obliquely towards ASIS.
○ Femoral​: largest branch of lumbar plexus, arises from dorsal divisions of ventral
rami of second, third and fourth lumbar nerves. Emerges from psoas major at
lateral edge of lower border, runs beneath inguinal ligament into the thigh
○ Obturator​: arises from ventral divisions of second, third and fourth lumbar nerves.
responsible for sensory innervation of skin on medial aspect of thigh
○ Lumbosacral Trunk:​ abdominal portion of sympathetic trunk with paravertebral
ganglia