INTEGRATED BASIC SCIENCES

MODULE 11 | ANATOMY [SNELL’S] – PART 2 MARCH | 2024

ABDOMINAL CAVITY PERITONEAL CAVITY
PERITONEUM • largest cavity in body and is divided into 2 parts
• thin serous membrane:
greater sac lesser sac
o line walls of abdominal and pelvic cavities
o clothes viscera main component smaller

extends from diaphragm

• can be regarded as a balloon against w/c organs behind stomach
down into pelvis
are pressed from outside

• greater and lesser sacs are in free communication

w/ one another through an oval window
o = opening of lesser sac, or epiploic foramen

• peritoneum secretes a small amount of serous fluid,

peritoneal fluid
o lubricates surfaces of peritoneum
o allows free movement between viscera

PERITONEAL LIGAMENTS
• 2-layered folds of peritoneum
o connect solid viscera to abdominal walls

• liver connects to diaphragm by:

✓ falciform ligament
✓ coronary ligament
✓ right and left triangular ligaments

OMENTA
• 2-layered folds of peritoneum
o connect stomach to another viscus

• greater omentum
GENERAL ARRANGEMENT o connects greater curvature of stomach to
• parietal peritoneum transverse colon
o lines walls of abdominopelvic cavity o hangs down like an apron in front of coils of SI
o folds back on itself to attach to transverse colon
• visceral peritoneum
o covers organs • lesser omentum
o suspends lesser curvature of stomach and
• peritoneal cavity proximal duodenum from fissure of ligamentum
o potential space between w/c is in effect inside venosum and porta hepatis on undersurface of
space of balloon liver

• males: this is a closed cavity • gastrosplenic omentum (ligament)

o connects stomach to hilum of spleen
• females: communication w/ exterior occurs in
females through: MESENTERIES
o uterine tubes • 2-layered folds of peritoneum
o uterus o connecting parts of intestines to posterior
o vagina abdominal wall

• layer of CT called extraperitoneal tissue • mesentery of SI, transverse mesocolon, and

o between parietal peritoneum and fascial lining
of abdominal and pelvic walls
area of kidneys:
o tissue contains a large amount of fat, w/c
supports kidneys
sigmoid mesocolon
peritoneal ligaments, omenta, and mesenteries
serve as bridges that permit blood, lymph vessels,
and nerves to reach viscera

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INTEGRATED BASIC SCIENCES
MODULE 11 | ANATOMY [SNELL’S] – PART 2 MARCH | 2024
LESSER SAC PARACOLIC GUTTERS
• behind stomach and lesser omentum • lateral and medial sides of ascending and
descending colons, respectively
extends:
• upward as far as diaphragm • subphrenic spaces and paracolic gutters are
• downward between layers of greater omentum clinically important
o may be sites for collection and movement of
• left margin of sac: infected peritoneal fluid
o spleen
o gastrosplenic omentum GASTROINTESTINAL TRACT
o splenorenal ligament ESOPHAGUS (ABDOMINAL PORTION)
• muscular, collapsible tube
• right margin • 10 in. (25 cm) long that joins pharynx to stomach
o opens into greater sac (main part of peritoneal • greater part lies w/in thorax
cavity) through epiploic foramen • enters abdomen through an opening in right crus of
diaphragm

BOUNDARIES OF EPIPLOIC FORAMEN

• after a course of 0.5 in. (1.25 cm):
➢ free border of lesser omentum o enters stomach on its right side
➢ bile duct
anterior
➢ hepatic artery RELATIONS
➢ portal vein
• anteriorly:
➢ o posterior surface of left lobe of liver

posterior ➢ inferior vena cava

• posteriorly:
➢ caudate process of caudate lobe of o left crus of diaphragm
superior
liver
• left and right vagi lie on its anterior and posterior
inferior ➢ 1st part of duodenum
surfaces, respectively

DUODENAL RECESSES BLOOD SUPPLY

• close to duodenojejunal junction
• 4 small pocket-like pouches of peritoneum: • branches from left gastric artery
✓ superior duodenal
✓ inferior duodenal • veins drain into left gastric vein
✓ paraduodenal o tributary of portal vein
✓ retroduodenal
LYMPH DRAINAGE
CECAL RECESSES • left gastric nodes
• folds of peritoneum close to cecum produce 3
peritoneal recesses: NERVE SUPPLY
✓ superior ileocecal • A & P gastric nerves (vagi)
✓ inferior ileocecal • sympathetic branches of thoracic part of
✓ retrocecal sympathetic trunk

INTERSIGMOID RECESS FUNCTION

• situated @ apex of inverted, V-shaped root of
sigmoid mesocolon
• mouth opens downward
SUBPHRENIC SPACES
• right and left anterior subphrenic spaces
o between diaphragm and liver
o on each side of falciform ligament
• right posterior subphrenic space
o between right lobe of liver, right kidney, and
right colic flexure
• right extraperitoneal space
o between layers of coronary ligament
o ‘.’ between liver and diaphragm
• conducts food from pharynx into stomach
• peristalsis
o wavelike contractions of muscular coat
o propel the food onward.
GASTROESOPHAGEAL SPHINCTER
• no anatomic sphincter @ lower end
• circular layer of smooth muscle in this region serves
as a physiologic sphincter [gastroesophageal]
as food descends through esophagus:
• relaxation of muscle occurs ahead of peristaltic wave
o = food enters stomach

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INTEGRATED BASIC SCIENCES
MODULE 11 | ANATOMY [SNELL’S] – PART 2 MARCH | 2024
• tonic contraction of sphincter DIVISION OF STOMACH
o = prevents stomach contents from
regurgitating into esophagus ➢ dome shaped
➢ projects upward and left of cardiac
fundus
orifice
• closure of sphincter
➢ usually full of gas
o under vagal control
o augmented by gastrin ➢ extends from level of cardiac orifice
o reduced in response to secretin, CCK, and to level of incisura angularis =
body
glucagon constant notch in lower part of
lesser curvature
STOMACH pyloric ➢ extends from incisura angularis to
• dilated portion of alimentary canal antrum pylorus

3 main functions: ➢ most tubular part

• stores food (in adult: capacity = 1500 mL) ➢ thick muscular wall = pyloric
pylorus
sphincter
➢ cavity = pyloric canal
• mixes food w/ gastric secretions
o form a semifluid chyme

• controls rate of delivery of chyme to SI

o = efficient digestion and absorption can take
place

LOCATION & DESCRIPTION

• upper part of abdomen
• extend from beneath left costal margin region
into epigastric and umbilical regions
• much lies under cover of lower ribs

• J-shaped
o w/ 2 openings:
▪ cardiac and pyloric orifices

o w/ 2 curvatures:
▪ greater and lesser curvatures

o 2 surfaces:
▪ anterior and posterior surface

• relatively fixed @ both ends but very mobile in • lesser curvature

between o forms right border
o extends from cardiac orifice to pylorus
• steerborn stomach o suspended from liver by lesser omentum
o high and transversely arranged in short, obese
person • greater curvature
o longer and extends from left of cardiac orifice
• J-shaped stomach ▪ over dome of fundus
o elongated vertically in tall, thin person ▪ along left border of stomach to pylorus

• shape undergoes variation in same person • gastrosplenic omentum (ligament)

depending on: o extends from upper part of greater curvature
✓ volume of its contents to spleen
✓ position of body
✓ phase of respiration • greater omentum
o extends from lower part of greater curvature to
transverse colon

• cardiac orifice
o where esophagus enters stomach

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INTEGRATED BASIC SCIENCES
MODULE 11 | ANATOMY [SNELL’S] – PART 2 MARCH | 2024
• pyloric canal forms pyloric orifice [1 in. long] ARTERIAL SUPPLY OF STOMACH
o circular muscle coat of stomach much thicker derived from branches of CELIAC ARTERY
here
➢ passes upward and to left to reach
o forms anatomic and physiologic pyloric
esophagus
sphincter
left gastric ➢ descends along lesser curvature
artery ➢ supplies lower 1/3 of
• pylorus lies on transpyloric plane
esophagus and upper right
o position recognized by slight constriction on stomach.
surface of stomach
➢ arises from hepatic artery @
PYLORIC SPHINCTER FUNCTION right gastric upper border of pylorus
artery ➢ runs to left along lesser curvature
• controls outflow of gastric contents into duodenum
➢ supplies lower right stomach
• motor fibers from sympathetic system
• inhibitory fibers from vagi ➢ arise from splenic artery @ hilum
of spleen
short gastric
• pylorus controlled by local nervous and hormonal ➢ pass forward in gastrosplenic
arteries
influences from stomach and duodenal walls omentum (ligament)
➢ supply fundus
o E.g. stretching of stomach because of filling will
stimulate myenteric nerve plexus in its wall ➢ arises from splenic artery @ hilum
▪ = reflex relaxation of sphincter of spleen
left
➢ passes forward in gastrosplenic
gastroepiploic
• mucous membrane artery
omentum (ligament)
o thick and vascular ➢ supply upper part of greater
o thrown into numerous folds, or rugae, mainly curvature
longitudinal in direction ➢ arises from gastroduodenal branch
▪ flatten out when stomach is distended right of hepatic artery
gastroepiploic ➢ passes to left
• muscular wall artery ➢ supplies stomach along lower
o contains longitudinal, circular, and oblique part of greater curvature
fibers
VEINS
• visceral peritoneum
• veins drain into portal circulation
o completely surrounds stomach
o leaves lesser curvature as lesser omentum
• left and right gastric veins
and greater curvature as gastrosplenic
o directly into portal vein
omentum and greater omentum

• short gastric veins and left gastroepiploic

RELATIONS OF STOMACH veins
➢ anterior abdominal wall o join splenic vein
➢ left costal margin
anteriorly ➢ left pleura and lung • right gastroepiploic vein
➢ diaphragm o joins superior mesenteric vein
➢ left lobe of liver
LYMPH DRAINAGE
➢ lesser sac
➢ diaphragm • left and right gastric, left and right gastroepiploic,
➢ spleen and short gastric nodes
➢ left suprarenal gland o all eventually passes to celiac nodes located
posteriorly ➢ upper part of left kidney around root of celiac artery on posterior
➢ splenic artery abdominal wall
➢ pancreas
➢ transverse mesocolon
➢ transverse colon

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INTEGRATED BASIC SCIENCES
MODULE 11 | ANATOMY [SNELL’S] – PART 2 MARCH | 2024
NERVE SUPPLY • situated in epigastric and umbilical regions
• sympathetic fibers from celiac plexus description
• parasympathetic fibers from right and left vagus
➢ begins @ pylorus
nerves
1st part ➢ runs upward and backward on
transpyloric plane @ level of L1
➢ formed in thorax mainly from left
➢ runs vertically downward in front of
vagus nerve
hilum of right kidney on right side of L2
➢ enters abdomen on anterior
& L3
surface of esophagus
➢ halfway down its medial border, bile
anterior ➢ may be single or multiple
duct and main pancreatic duct pierce
vagal trunk ➢ divides into branches that supply
2nd part duodenal wall = unite to form ampulla
anterior surface of stomach
that opens on summit of major
➢ large hepatic branch passes up to
duodenal
liver = from this, pyloric branch
➢ accessory pancreatic duct, if
passes down to pylorus
present, opens into duodenum a little
➢ formed in thorax mainly from right higher up on minor duodenal papilla
vagus nerve
➢ runs horizontally to left on subcostal
➢ enters abdomen on posterior
plane
surface of esophagus 3rd part
➢ pass in front of vertebral column
posterior ➢ divides into branches that supply
➢ follow lower margin of head of pancreas
vagal trunk posterior surface of stomach
➢ large branch passes to celiac and ➢ runs upward and to left to
superior mesenteric plexuses = duodenojejunal flexure held in
distributed to intestine as far as position by peritoneal fold, suspensory
splenic flexure and pancreas 4th part
ligament of duodenum (ligament of
Treitz), attached to right crus of
➢ carries a proportion of pain-
diaphragm
transmitting nerve fibers
➢ parasympathetic vagal fibers are
secretomotor to gastric glands
sympathetic
and motor to muscular wall of
innervation
stomach
➢ pyloric sphincter receives motor
fibers from sympathetic system
and inhibitory fibers from vagi

SMALL INTESTINE
• longest part of alimentary canal
• extends from pylorus to ileocecal junction
• greater part of digestion and food absorption takes
place in SI

1. DUODENUM
• C-shaped tube, 10 in. (25 cm) long
• joins stomach to jejunum
• receives openings of bile and pancreatic ducts
• curves around head of pancreas
• 1st inch (2.5 cm) resembles stomach
o covered on its A & P surfaces w/ peritoneum
o lesser omentum attached to upper border
o greater omentum attached to lower border
o lesser sac behind
• remainder is retroperitoneal
o only partially covered by peritoneum
MUCOUS MEMBRANE & DUODENAL PAPILLA
• mucous membrane mostly thick
o smooth in 1st part
o remainder: numerous circular folds, plicae
circulares
• major duodenal papilla
o small, rounded elevation
o located @ site where bile duct and main
pancreatic duct pierce medial wall of 2nd part

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INTEGRATED BASIC SCIENCES
MODULE 11 | ANATOMY [SNELL’S] – PART 2
BLOOD SUPPLY
• superior pancreaticoduodenal artery
o branch of gastroduodenal artery
o supplies upper half
• inferior pancreaticoduodenal artery
o branch of superior mesenteric artery
o supplies lower half
• superior pancreaticoduodenal vein
o drains into portal vein
• inferior vein
o joins superior mesenteric vein
LYMPH DRAINAGE
• upper duodenum drains upward
o via pancreaticoduodenal
gastroduodenal nodes
o then to celiac nodes
MARCH | 2024
mesenteric vessels form
receives numerous short
only ½ arcades, w/ long
terminal vasa recta that
and infrequent
arise from series of
branches (vasa recta)
arcades
passing to intestinal wall
jejunal end of mesentery: ileal end of mesentery:
fat is deposited near fat is deposited
root and scanty near throughout extending
intestinal wall from root to intestinal wall
aggregations of lymphoid
tissue (Peyer patches)
present in mucous
membrane of lower ileum
along antimesenteric
border
nodes to

• lower duodenum drains downward

o via pancreaticoduodenal nodes to superior
mesenteric nodes around origin of superior
mesenteric artery

NERVE SUPPLY
• celiac and superior mesenteric plexuses

2. JEJENUM & ILEUM

• jejunum = upper 2/5
o jejunum begins @ duodenojejunal flexure

• ileum ends @ ileocecal junction BLOOD SUPPLY

• branches of superior mesenteric artery
LOCATION & DESCRIPTION • intestinal branches
• coils of jejunum and ileum o from left side and run in mesentery to reach gut
o freely mobile o anastomose w/ one another to form series of
archlike arcades
o attached to posterior abdominal wall by a fan-
shaped fold of the peritoneum • Multiple straight vessels (vasa recta; arteriae
▪ = mesentery of SI rectae) branch off arcades
o run to wall of intestine
jejenum ileum
• ileocolic artery
lies coiled in upper part o also supplies lowest part of ileum
of peritoneal cavity below lower part
left side of transverse of cavity and in pelvis • veins drain into superior mesenteric vein
mesocolon

wider bored, thicker LYMPH DRAINAGE

walled, and redder • pass through intermediate mesenteric nodes and
reach superior mesenteric nodes
jejunal wall feels thicker
upper part: are smaller
because plicae circulares
and widely separated NERVE SUPPLY
are larger, more
lower part: absent
numerous, and closely set • superior mesenteric plexus

mesentery attached to
mesentery attached
posterior abdominal wall
below
above
and to right of aorta
and to left of aorta

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MODULE 11 | ANATOMY [SNELL’S] – PART 2 MARCH | 2024
LARGE INTESTINE RELATIONS OF CECUM
• extends from ileum to anus
➢ coils of SI
abdominal parts pelvic area
➢ sometimes part of greater omentum
anteriorly
➢ cecum ➢ anterior abdominal wall in right iliac
➢ appendix region
➢ lower sigmoid colon
➢ ascending colon
➢ rectum ➢ psoas and iliacus muscles
➢ transverse colon
➢ anal canal ➢ femoral nerve
➢ descending colon posteriorly
➢ lateral cutaneous nerve of thigh
➢ upper sigmoid colon
➢ appendix commonly found behind

• colon consists of cecum through sigmoid colon ➢ appendix arises from cecum on
medially
medial side
primary functions:
• absorption of water and electrolytes BLOOD SUPPLY
• storage of undigested material until it can be • A & P cecal arteries
expelled from body as feces o Branches of ileocolic artery, branch of
superior mesenteric artery
1. CECUM
• below level of junction of ileum with LI • veins drain into superior mesenteric vein
• blind-ended pouch situated in right iliac fossa
• 2.5 in. (6 cm) long LYMPH DRAINAGE
• completely covered w/ peritoneum • superior mesenteric nodes

• considerable amount of mobility NERVE SUPPLY

o does not have a mesentery • superior mesenteric plexus

• appendix
2. ILEOCECAL VALVE
o attached to its posteromedial surface
• rudimentary structure
• consists of 2 horizontal folds of mucous membrane
• presence of peritoneal folds creates recesses:
o project around orifice of ileum
o superior ileocecal
o inferior ileocecal
• plays little or no part in prevention of reflux of cecal
o retrocecal
contents into ileum
• longitudinal muscle
• circular muscle of lower end of ileum (ileocecal
o restricted to 3 flat bands = teniae coli
sphincter) serves as a sphincter
o ‘.’ controls flow of contents from ileum into
o converge on base of appendix
colon
▪ provide for it a complete longitudinal
muscle coat
• Smooth muscle tone is reflexly increased when
cecum is distended
• often distended w/ gas
o gastrin produced by stomach causes
• can palpated through anterior abdominal wall
relaxation of muscle tone
• terminal part of ileum enters large intestine @
junction of cecum w/ ascending colon
APPENDIX (VERMIFORM)
• opening is provided with 2 folds, or lips • narrow, muscular tube
o form ileocecal valve • large amount of lymphoid tissue
• varies in length from 3 to 5 in. (8 to 13 cm).
• appendix communicates w/ cavity of cecum
o through opening located below & behind • base attached to posteromedial surface of cecum
ileocecal opening 1 in below ileocecal junction
o remainder is free

• complete peritoneal covering

o attached to mesentery of SI by a short
mesentery of its own = mesoappendix
▪ contains appendicular vessels and nerves

• lies in right iliac fossa

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MODULE 11 | ANATOMY [SNELL’S] – PART 2 MARCH | 2024
in relation to anterior abdominal wall: 2. ASCENDING COLON
• base situated 1/3 of way up the line • 5 in. (13 cm) long
o joining right anterior superior iliac spine to • lies in RLQ
umbilicus (McBurney’s point)
• extends upward from cecum to inferior surface of
inside abdomen: right lobe of liver
• base easily found by identifying teniae coli of cecum o turns to left, forming right colic (hepatic)
and tracing them to base of appendix flexure
o where they converge to form a continuous o becomes continuous w/ transverse colon
longitudinal muscle coat
• peritoneum covers front and sides
COMMON POSITION OF APPENDIX TIP o binding it to posterior abdominal wall
most common sites:
✓ hanging down into pelvis against right pelvic wall RELATIONS OF ASCENDING COLON
✓ coiled up behind cecum
➢ coils of SI
anteriorly ➢ greater omentum
other sites:
➢ anterior abdominal wall
✓ projecting upward along lateral side of cecum
✓ in front of or behind terminal part of ileum ➢ iliacus
➢ iliac crest
BLOOD SUPPLY ➢ quadratus lumborum
➢ origin of transversus abdominis
• appendicular artery posteriorly
muscle
o branch of posterior cecal artery
➢ lower pole of right kidney
➢ iliohypogastric and the
• appendicular vein drains into posterior cecal vein
ilioinguinal nerves cross behind it

LYMPH DRAINAGE
BLOOD SUPPLY
• drain into 1 or 2 nodes lying in mesoappendix
o eventually into superior mesenteric nodes • ileocolic and right colic branches of superior
mesenteric artery
NERVE SUPPLY • veins drain into superior mesenteric vein

• superior mesenteric plexus

LYMPH DRAINAGE

• afferent nerve fibers
o conduction of visceral pain from appendix
o accompany sympathetic nerves
o enter spinal cord @ level of 10th thoracic
segment
• drain into lymph nodes lying along course of colic
blood vessels
o reach superior mesenteric nodes
NERVE SUPPLY
• superior mesenteric plexus

3. TRANSVERSE COLON
• extends across abdomen; occupy umbilical region

• begins @ right colic flexure below right lobe of

liver w/c hangs downward

• ascends to left colic (splenic) flexure below

spleen
o higher than right colic flexure
o suspended from diaphragm by phrenicocolic
ligament

• transverse mesocolon (mesentery)

o suspends transverse colon from anterior border
of pancreas
o attached to superior border of transverse colon
o posterior layers of greater omentum attached
to inferior border
o Because of its length: position of transverse
colon is extremely variable [sometimes reach
down as far as pelvis]

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INTEGRATED BASIC SCIENCES
MODULE 11 | ANATOMY [SNELL’S] – PART 2 MARCH | 2024
RELATIONS OF TRANSVERSE COLON BLOOD SUPPLY
• left colic and sigmoid branches of inferior
➢ greater omentum
mesenteric artery
anteriorly ➢ anterior abdominal wall (umbilical
• veins drain into inferior mesenteric vein
and hypogastric regions)

➢ 2nd part of duodenum LYMPH DRAINAGE

posteriorly ➢ head of pancreas
• colic lymph nodes and inferior mesenteric
➢ coils of jejunum and ileum
nodes around origin of inferior mesenteric artery.

BLOOD SUPPLY NERVE SUPPLY

• middle colic artery • sympathetic and parasympathetic pelvic
o branch of superior mesenteric artery splanchnic nerves through inferior mesenteric
o supplies proximal 2/3 plexus

• left colic artery

SI VS LI
o branch of inferior mesenteric artery
o supplies distal 1/3 external

SI LI
• veins drain into superior and inferior mesenteric
veins ascending and descending
mobile (exc. duodenum)
colon are fixed
LYMPH DRAINAGE caliber is smaller vs filled
--
• proximal 2/3 LI
o colic nodes > superior mesenteric nodes
mesentery that passes
downward across midline
• distal 1/3 --
into right iliac fossa (exc.
o colic nodes > inferior mesenteric nodes duodenum)

NERVE SUPPLY longitudinal muscle

longitudinal muscle forms
collected into 3 bands,
• proximal 2/3 a continuous layer
teniae coli (exc.
o sympathetic and vagal nerves through around gut
appendix)
superior mesenteric plexus
has fatty tags, omental
no fatty tags attached to
• distal 1/4 appendices (appendices
its wall
o sympathetic and parasympathetic pelvic epiploicae; epiploic
appendages)
splanchnic nerves through inferior
mesenteric plexus l sacculated in large folds
smooth walls
termed haustra
4. DESCENDING COLON
internal
• left upper and lower quadrants
• extends downward from left colic flexure, to pelvic SI LI
brim & becomes continuous w/ sigmoid colon mucous membrane has
permanent folds, absent
• peritoneum covers front and sides plicae circulares
o binds it to posterior abdominal wall
Peyer patches found in
absent
mucous membrane
RELATIONS OF DESCENDING COLON

➢ coils of SI GASTROINTESTINAL TRACT ARTERIAL SUPPLY

anteriorly ➢ greater omentum related to dev’t of different parts of gut
➢ anterior abdominal wall superior inferior
celiac
➢ lateral border of left kidney mesenteric mesenteric
➢ origin of transversus abdominis ➢ artery of ➢ artery of
muscle ➢ artery of midgut hindgut
➢ quadratus lumborum foregut ➢ mid of 2nd ➢ LI from
➢ iliac crest & iliacus ➢ lower 1/3 of part of distal1/3 of
posteriorly
➢ left psoas esophagus duodenum transverse
➢ iliohypogastric and ilioinguinal to mid of 2nd to distal 1/3 colon to
nerves part of transverse halfway
➢ lateral cutaneous nerve of thigh duodenum colon down anal
➢ femoral nerve canal

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MODULE 11 | ANATOMY [SNELL’S] – PART 2 MARCH | 2024
CELIAC ARTERY BRANCHES OF HEPATIC ARTERY
• very short
• arises from commencement of abdominal aorta @ ➢ from hepatic artery @ upper
level of T12 border of pylorus
• surrounded by celiac plexus ➢ runs to left in lesser omentum
right gastric
along lesser curvature
• behind lesser sac of peritoneum
➢ anastomoses with left gastric
artery
3 terminal branches: left gastric, splenic, and
hepatic arteries ➢ large branch that descends
behind 1st part of duodenum
LEFT GASTRIC ARTERY
divides into:
• small; runs to cardiac end of stomach
➢ right gastro-omental
o gives off few esophageal branches
(gastroepiploic) artery
o turns right along lesser curvature of stomach
= runs along greater
o anastomoses w/ right gastric artery
gastroduodenal curvature of stomach between
layers of greater omentum and
SPLENIC ARTERY
• large; runs to the left in a wavy course along upper ➢ superior
border of pancreas and behind stomach pancreaticoduodenal artery
= descends between 2nd part of
on reaching left kidney duodenum and head of
• enters splenorenal ligament pancreas
• runs to hilum of spleen ➢ enter porta hepatis
R & L hepatic ➢ right: gives off cystic artery
PRIMARY BRANCHES OF SPLENIC ARTERY = runs to neck of gallbladder

➢ 10 may branch off

pancreatic
➢ supply pancreas

➢ arises near hilum of spleen

➢ reaches greater curvature in
gastrosplenic omentum
left gastro-
➢ passes to right along greater
omental /
curvature between layers of
gastroepiploic
greater omentum
➢ anastomoses w/ right
gastroepiploic artery

➢ 5/6 arise from end of splenic

artery
➢ reach fundus of stomach in
short gastric
gastrosplenic omentum
➢ anastomose w/ left gastric and
left gastro-omental artery

HEPATIC ARTERY SUPERIOR MESENTERIC ARTERY

• medium-size; runs forward and to right • supplies midgut
o ascends between layers of lesser omentum ✓ distal part of duodenum
✓ jejunum
• lies in front of opening into lesser sac ✓ ileum
• left of bile duct ✓ cecum
• front of portal vein ✓ appendix
✓ ascending colon
@ porta hepatis: ✓ most transverse colon
• divides into R & L branches to supply corresponding
lobes of liver • from front of abdominal aorta below celiac artery
o runs downward and to right behind neck of
• sometimes divided into: pancreas
o common hepatic artery o front of 3rd part of duodenum
▪ from origin to gastroduodenal branch
• continues downward to right between layers of
o hepatic artery proper mesentery of SI
▪ remainder of artery • ends by anastomosing w/ ileal branch of its own
ileocolic branch

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MODULE 11 | ANATOMY [SNELL’S] – PART 2
BRANCHES OF SUPERIOR MESENTERIC ARTERY
❖ passes to right as a single
or double branch along
upper border of 3rd of
inferior duodenum and head of
pancreaticoduodenal pancreas
❖ supplies pancreas and
adjoining part of
duodenum
❖ runs forward in
transverse mesocolon
middle colic ❖ supply transverse colon
❖ divides into R & L
branches
❖ branch of ileocolic artery
❖ passes to right to supply
right colic ascending colon
❖ divides into ascending
and descending branches
❖ passes downward and to
right
gives rise to:
superior branch
❖ anastomoses w/ right
colic artery
inferior branch
ileocolic
❖ anastomoses w/ end of
superior mesenteric
artery
❖ gives rise to anterior and
posterior cecal arteries
appendicular artery
❖ branch of posterior cecal
artery
❖ 12 to 15 arise from left
side of superior
mesenteric artery
❖ each divide into 2 vessels,
w/c unite w/ adjacent
branches = series of
arcades
❖ branches from arcades
divide and unite to form
jejunal & ileal
2nd, 3rd, 4th series of
arcades
❖ fewer arcades supply
jejunum than supply
ileum
❖ from terminal arcades:
small straight vessels,
vasa recta, supply
intestine
MARCH | 2024
INFERIOR MESENTERIC ARTERY
• supplies hindgut
✓ distal 1/3 transverse colon
✓ left colic flexure
✓ descending colon
✓ sigmoid colon
✓ rectum
✓ upper half of anal canal
• arises from abdominal aorta, 1.5 in. (3.8 cm) above
its bifurcation
• runs downward and to left
• crosses left common iliac artery
o becomes superior rectal artery
BRANCHES OF SUPERIOR MESENTERIC ARTERY
❖ runs upward and to left
supplies
❖ distal 1/3 transverse colon
left colic ❖ left colic flexure
❖ upper part of descending colon
❖ divides into ascending and
descending branches
❖ 2/3 supply descending and
sigmoid
sigmoid colon
❖ continuation of inferior
mesenteric artery as it crosses
left common iliac artery
❖ descends into pelvis behind
rectum
superior rectal
supplies
❖ rectum
❖ upper half of anal canal
❖ anastomoses w/ middle rectal
and inferior rectal arteries
GASTROINTESTINAL TRACT VENOUS DRAINAGE
• venous blood from greater part of GI tract and its
accessory organs drains to the liver by portal
venous system
• portal circulation
o begins as a capillary plexus in organs it drains
o ends by emptying blood into sinusoids w/in
liver
• proximal tributaries
o drain directly into portal vein
• veins forming distal tributaries correspond to
branches of:
✓ celiac artery
✓ superior and inferior mesenteric arteries
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PORTAL VEIN (HEPATIC PORTAL) GASTROINTESTINAL TRACT ACCESSORY ORGANS
• drains blood from abdominal part of GI tract LIVER
o from lower 1/3 of esophagus • largest gland
o to halfway down anal canal
3 basic functions
• also drains: spleen, pancreas, and gallbladder • production and secretion of bile
• enters liver and breaks up into sinusoids, from w/c o passed into intestinal tract
blood passes into hepatic veins that join inferior
vena cava • involvement in metabolic activities related to
• forms behind neck of pancreas by union of superior carbohydrate, fat, and protein metabolism
mesenteric and splenic veins
• ascends to right, behind 1st part of duodenum • filtration of blood
• enters lesser omentum o removing bacteria and other foreign particles
that have gained entrance to blood from lumen
• runs upward in front of opening into lesser sac to of intestine
porta hepatis
o lies behind bile duct and hepatic artery • synthesizes heparin
o anticoagulant substance
• divides into R & L terminal branches o important detoxicating function

• produces bile pigments from hemoglobin of worn-

TRIBUTARIES OF PORTAL VEIN
out RBCs and secretes bile salts
❖ leaves hilum of spleen o conveyed to duodenum by biliary ducts
❖ passes to right in splenorenal
ligament LOCATION & DESCRIPTION
❖ unites w/ superior mesenteric
• soft, pliable, and highly vascular
vein behind neck of pancreas =
splenic • occupies upper part of abdominal cavity beneath
form portal vein
❖ receives short gastric, left diaphragm
gastro-omental, inferior
mesenteric, and pancreatic • greater part
veins. o situated under cover of right costal margin, and
right hemidiaphragm
❖ ascends on posterior abdominal
o separates it from pleura, lungs, pericardium,
wall
and heart
inferior ❖ joins splenic vein behind body
mesenteric of pancreas
❖ receives superior rectal, • extends to left to reach left hemidiaphragm
sigmoid, and left colic vein
• convex upper surface
❖ ascends in root of mesentery of o molded to undersurface of domes of diaphragm
SI
❖ passes in front of 3rd part of
• posteroinferior or visceral surface
duodenum
o molded to adjacent viscera ‘.’ irregular in shape
❖ joins splenic vein behind neck
superior o in contact w/:
of the pancreas
mesenteric ✓ abdominal part of esophagus
❖ receives jejunal, ileal,
ileocolic, right colic, middle ✓ stomach
colic, inferior ✓ duodenum
pancreaticoduodenal, and ✓ right colic flexure
right gastro-omental veins ✓ right kidney and suprarenal gland
✓ gallbladder
drains
❖ left portion of lesser
• may be divided into a large right lobe and a small
curvature of stomach
left gastric left lobe by attachment of peritoneum of falciform
❖ distal part of esophagus
ligament
❖ opens directly into portal vein
• right lobe further divided into: quadrate and
❖ drains right portion of lesser caudate lobe by presence of:
right gastric curvature of stomach ✓ gallbladder
❖ drains directly into portal vein ✓ fissure for ligamentum teres
❖ either drain gallbladder directly ✓ inferior vena cava
cystic
into liver or join portal vein ✓ fissure for ligamentum venosum

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• quadrate and caudate lobes are a functional part of PERITONEAL LIGAMENTS
left lobe of liver falciform ligament
o ‘.’ R & L branches of hepatic artery and portal • 2-layered fold of peritoneum
vein, and R & L hepatic ducts, are distributed • ascends from umbilicus to liver
to R & L left lobe
• sickle-shaped free margin
• 2 sides overlap very little o contains ligamentum teres, remains of
umbilical vein
• porta hepatis, or hilum of liver
o found on posteroinferior surface • passes on to anterior and then superior surfaces of
o between caudate and quadrate lobes liver and then splits into 2 layers

• upper part of free edge of lesser omentum • right layer

attached to its margins o forms upper layer of coronary ligament
o where the ff. structures lie:
✓ R & L hepatic ducts • left layer
✓ R & L branches of hepatic artery o forms upper layer of left triangular ligament
✓ portal vein
✓ sympathetic and parasympathetic nerve • right extremity of coronary ligament = right
fibers triangular ligament

✓ few hepatic lymph nodes • peritoneal layers forming coronary ligament are
• = drain liver and gallbladder widely separated,
• send efferent vessels to celiac o leaving an area of liver devoid of peritoneum
lymph nodes ▪ bare area of liver

• completely surrounded by a fibrous capsule • ligamentum teres

o only partially covered by peritoneum o passes into a fissure on visceral surface of liver
o joins left branch of portal vein in porta hepatis
• made up of liver lobules
• ligamentum venosum
• central vein of each lobule ✓ fibrous band
o tributary of hepatic veins ✓ remains of ductus venosus
✓ attached to left branch of portal vein
• spaces between lobules are portal canals ✓ ascends in a fissure on visceral surface of liver
o contain branches of hepatic artery, portal vein, to attach above to inferior vena cava
and a tributary of bile duct (portal triad)
in fetus
• arterial and venous blood passes between liver cells • oxygenated blood is brought to liver in umbilical vein
by means of sinusoids (ligamentum teres)
o drains into central vein
• greater proportion of blood bypasses liver in ductus
IMPORTANT RELATIONS venosus (ligamentum venosum)
o joins inferior vena cava
➢ diaphragm
➢ R & L costal margins
@ birth
➢ R & L pleura
anteriorly ➢ lower margins of both lungs • umbilical vein and ductus venosus = fibrous cords
➢ xiphoid process
➢ anterior abdominal wall in subcostal • lesser omentum arises from edges of porta hepatis
angle and fissure for ligamentum venosum
o passes down to lesser curvature of stomach
➢ diaphragm
➢ right kidney
BLOOD SUPPLY
➢ hepatic flexure of colon
➢ duodenum • hepatic artery [branch of celiac artery]
posteriorly o divides into R & L terminal branches that enter
➢ gallbladder
➢ inferior vena cava porta hepatis
➢ esophagus
➢ fundus of stomach • portal vein divides into R & L terminal branches
that enter porta hepatis behind arteries
• hepatic veins (3 or more) emerge from posterior
surface of liver and drain into inferior vena cava

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HEPATIC BLOOD CIRCULATION 1. HEPATIC DUCTS

hepatic artery (30%) portal vein (70%) • R & L hepatic ducts emerge from R & L lobes of liver
in porta hepatis
➢ brings venous blood
➢ brings O2 blood to rich in products of after a short course:
liver digestion absorbed
• hepatic ducts unite = common hepatic duct
from GI tract
o about 1.5 in. (4 cm) long
o descends w/in free margin of lesser omentum
• arterial and venous blood is conducted to central o joined on right side by cystic duct from
vein by liver sinusoids gallbladder = bile duct
o drain into R & L hepatic veins
o leave posterior surface of liver 2. BILE DUCT
o open directly into inferior vena cava
1st part of its course:
• lies in right free margin of lesser omentum in front
LYMPH DRAINAGE
of opening into lesser sac
• produces 1/3 to ½ of all body lymph o front of right margin of portal vein
• lymph vessels leave liver & enter several lymph o right of hepatic artery
nodes in porta hepatis
• efferent vessels pass to celiac nodes 2nd part:
• few vessels pass from bare area of liver through • behind 1st part of duodenum, right of
diaphragm to posterior mediastinal lymph gastroduodenal artery
nodes.
3rd part
NERVE SUPPLY • in a groove on posterior surface of head of pancreas
• sympathetic and parasympathetic nerves form
celiac plexus • bile duct comes into contact w/ main pancreatic duct
o ends below by piercing medial wall of 2nd part
• anterior vagal trunk of duodenum about halfway down its length
o gives rise to large hepatic branch = passes
directly to liver • main pancreatic duct usually joins bile duct
o together open into a small ampulla in duodenal
BILIARY TREE wall = hepatopancreatic ampulla (ampulla
• system of ducts that drain and store bile and deliver of Vater)
bile to SI
• ampulla opens into lumen of duodenum by major
• Bile is secreted by liver cells at a constant rate duodenal papilla
o = 40 mL per hour
• terminal parts of both ducts and ampulla
when digestion is not taking place: o surrounded by circular muscle, sphincter of
• bile is stored and concentrated in gallbladder hepatopancreatic ampulla (sphincter of Oddi)
o later, delivered to duodenum
• Occasionally, bile and pancreatic ducts open
• consists of: separately into duodenum
o R & L hepatic ducts
o common hepatic duct
o bile duct
o gallbladder
o cystic duct

• smallest interlobular tributaries of bile ducts

o situated in portal canals of liver
o receive bile canaliculi

• interlobular ducts join one another to form

progressively larger ducts eventually, at porta
hepatis = form R & L hepatic ducts

• right hepatic duct

o drains right lobe of liver

• left duct
o drains left, caudate, and quadrate lobe

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3. GALLBLADDER
• pear-shaped sac lying on undersurface of liver • smooth muscle around distal end of bile duct and
ampulla relaxes
• capacity: 30 to 50 mL and stores bile o = allow passage of concentrated bile into
o concentrates by absorbing water. duodenum

• divided into: fundus, body, and neck • bile salts

o emulsifying fat in intestine assisting w/
fundus body neck
digestion and absorption
➢ rounded and ➢ in contact ➢ becomes
projects w/ visceral continuous BLOOD SUPPLY
below surface of w/ cystic
• cystic artery [branch of right hepatic artery]
inferior liver duct
• cystic vein drains directly into portal vein
margin of ➢ directed
liver upward, ➢ turns into
LYMPH DRAINAGE
➢ comes in backward, lesser
contact w/ and to the omentum to • drains into a cystic lymph node near neck of
anterior left join gallbladder
abdominal common o lymph vessels pass to hepatic nodes along
wall at level hepatic duct course of hepatic artery, then to celiac nodes
of tip of 9th = bile duct
CC NERVE SUPPLY
• celiac plexus
• peritoneum completely surrounds fundus of
gallbladder 4. CYSTIC DUCT
o binds body and neck to visceral surface of liver
• connects neck of gallbladder to common hepatic
duct = bile duct
RELATIONS OF GALLBLADDER • S-shaped and descends in right free margin of
➢ anterior abdominal wall lesser omentum
anteriorly
➢ inferior surface of liver
• mucous membrane
➢ transverse colon o raised to form a spiral fold continuous w/
posteriorly
➢ 1st & 2nd parts of duodenum similar fold in neck of gallbladder

FUNCTION o commonly known as spiral valve

when digestion is not taking place ▪ = keep lumen constantly open
• sphincter of Oddi remains closed
5. PANCREAS
• bile accumulates in the gallbladder • both an exocrine and endocrine glands
✓ concentrates bile
✓ stores bile • exocrine portion
✓ selectively absorbs bile salts (keeping bile acid) o secretion contains enzymes capable of
✓ excretes cholesterol hydrolyzing proteins, fats, and
✓ secretes mucus carbohydrates

• mucous membrane is thrown into permanent folds • endocrine portion

that unite = surface w/ honeycombed o pancreatic islets (islets of Langerhans)
appearance o produces insulin and glucagon
• columnar cells lining surface have microvilli on ▪ key role in carbohydrate metabolism
their free surface
• elongated structure in epigastrium and LUQ
• Bile is delivered to duodenum • soft and lobulated
o result of contraction and partial emptying of • situated on posterior abdominal wall behind
gallbladder peritoneum
• crosses transpyloric plane
• entrance of fatty foods into duodenum initiates • divided into: head, neck, body, and tail
mechanism
o causes release of CCK from mucous membrane
of duodenum

• hormone then enters blood

o gallbladder contracts

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6. SPLEEN
• reddish and largest single mass of lymphoid tissue
• not a component of GI tract
• oval shaped and has notched anterior border
• lies just beneath left half of diaphragm close to 9th,
10th, and 11th ribs
• long axis lies along shaft of 10th rib

• lower pole extends forward as far as midaxillary line

o cannot be palpated on clinical examination

RELATIONS OF SPLEE

➢ stomach
➢ tail of pancreas
anteriorly
➢ left colic flexure
➢ left kidney lies along medial border

➢ diaphragm
➢ left pleura (left
RELATIONS OF PANCREAS
posteriorly costodiaphragmatic recess)
➢ transverse colon ➢ left lung
➢ attachment of transverse mesocolon ➢ 9th, 10th, and 11th ribs
anteriorly
➢ lesser sac
➢ stomach
• surrounded by peritoneum w/c passes from it at
➢ bile duct hilum as gastrosplenic omentum (ligament) to
➢ portal and splenic veins greater curvature of stomach
➢ inferior vena cava o carry short gastric and left gastroepiploic
➢ aorta vessels
posteriorly ➢ origin of superior mesenteric artery
➢ left psoas muscle • peritoneum also passes to left kidney as
➢ left suprarenal gland splenorenal ligament
➢ left kidney o carry splenic vessels and tail of pancreas
➢ hilum of spleen

PANCREATIC DUCTS
• main duct of pancreas
o begins in tail & runs length of gland
o opens into 2nd part of duodenum at about its
middle w/ bile duct on major duodenal papilla
o may drain separately into duodenum
• accessory duct of pancreas
o drains upper part of head
o opens into duodenum a short distance above
main duct on minor duodenal papilla
o frequently communicates w/ main duct.
BLOOD SUPPLY
• splenic and superior & inferior
pancreaticoduodenal arteries
• corresponding veins drain into portal system
LYMPH DRAINAGE
• Lymph nodes are situated along arteries that supply
gland
• efferent vessels drain into celiac and superior
mesenteric lymph nodes
BLOOD SUPPLY
• splenic artery [largest branch of celiac artery]
• has a tortuous course as it runs along upper border
of pancreas
• divides into 6 branches w/c enter spleen at hilum
• splenic vein leaves hilum
o runs behind tail and body of pancreas
o behind neck of pancreas:
▪ joins superior mesenteric vein = portal
vein.
LYMPH DRAINAGE
• lymph vessels emerge from hilum
• pass through a few lymph nodes along course of
splenic artery then drain into celiac nodes
NERVE SUPPLY
• nerves accompany splenic artery derived from
celiac plexus

NERVE SUPPLY
• sympathetic and parasympathetic (vagal) nerve
fibers

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RETROPERITONEAL SPACE COVERINGS
• on posterior abdominal wall behind parietal
peritoneum ➢ surrounds kidney
• extends from T12 and 12th rib to sacrum and iliac fibrous capsule ➢ closely applied to its outer
crests below surface

perirenal fat ➢ covers fibrous capsule

• floor (posterior wall)
➢ condensation of CT outside
o formed from medial to lateral by psoas and
perirenal fat
quadratus lumborum muscles and origin of the
➢ encloses kidneys and
transversus abdominis muscle renal fascia
suprarenal glands
➢ continuous laterally w/
• e/c muscle covered on anterior surface by a definite transversalis fascia
layer of fascia
➢ external to renal fascia
• front of fascial layers: ➢ often in large quantity
pararenal fat
o variable amount of fatty CT that forms bed for: ➢ forms part of
retroperitoneal fat
✓ suprarenal glands
✓ kidneys
✓ ascending and descending colon RENAL STRUCTURE
✓ duodenum • dark brown outer cortex and a light brown inner
medulla
• also contains ureters and renal and gonadal blood
vessels • medulla
o dozen renal pyramids
URINARY TRACT ▪ base oriented toward cortex
KIDNEYS ▪ apex, renal papilla, projecting medially
• 2 kidneys excrete most waste products of
metabolism
• cortex
o extends into medulla between adjacent
major role in:
pyramids as renal columns
✓ controlling water and electrolyte balance w/in body
✓ maintaining acid–base balance of blood
• medulla rays
o striations extending from bases of renal
• waste products leave kidneys as urine
pyramids into cortex
o passes down ureters to urinary bladder, located
within pelvis
• renal sinus
o leaves body in urethra
o space w/in hilum
o contains upper expanded end of ureter, renal
LOCATION & DESCRIPTION
pelvis
• reddish brown o divides into 2 or 3 major calyces
• behind peritoneum high up on posterior abdominal ▪ divides into 2 or 3 minor calyces
wall on either side of vertebral column
• largely under cover of costal margin • apex of renal pyramid, renal papilla
o indents e/c minor calyx
• right kidney slightly lower than left
o due large size of right lobe of liver

w/ contraction of diaphragm during respiration:

• both kidneys move downward in vertical direction

hilum
• vertical slit in medial concave border bounded by
thick lips of renal substance
• extends into a large cavity = renal sinus

• transmits, from front backward: (VAUA)

o renal vein
o 2 branches of renal artery
o ureter
o 3rd branch of renal artery

• lymph vessel & sympathetic fibers also pass through

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RELATIONS OF RIGHT KIDNEY
➢ suprarenal gland
➢ liver
anteriorly
➢ 2nd part of duodenum
➢ right colic flexure
➢ diaphragm
➢ costodiaphragmatic recess of pleura
➢ 12th rib
➢ Psoas
posteriorly ➢ quadratus lumborum
➢ transversus abdominis muscles
➢ subcostal (T12)
➢ iliohypogastric & ilioinguinal nerves
(L1) run downward and laterally
RELATIONS OF LEFT KIDNEY
➢ suprarenal gland
➢ spleen
➢ stomach
anteriorly
➢ pancreas
➢ left colic flexure
➢ coils of jejunum
➢ diaphragm
➢ costodiaphragmatic recess
➢ 11th and 12th ribs
➢ psoas, quadratus lumborum, and
posteriorly
transversus abdominis muscles
➢ subcostal (T12), iliohypogastric, and
ilioinguinal nerves (L1) run
downward and laterally
BLOOD SUPPLY
• renal artery arises from aorta at level L2
o each divide into 5 segmental arteries that
enter hilum
• distributed to different areas of kidney
• lobar arteries arise from each segmental artery
o one for e/c renal pyramid
before entering renal substance:
o e/c gives off 2 or 3 interlobar arteries
▪ run toward cortex on e/c side of renal
pyramid
@ junction of cortex and medulla:
• interlobar arteries give off arcuate arteries
o arch over bases of pyramids
o give off several interlobular arteries that
ascend in cortex
• afferent glomerular arterioles arise as branches
of interlobular arteries
• renal vein emerges from hilum in front of renal
artery
o drains into inferior vena cava.
MARCH | 2024
LYMPH DRAINAGE
• lateral aortic lymph nodes
NERVE SUPPLY
• renal sympathetic plexus
• afferent fibers that travel through renal plexus
o enter spinal cord in the 10th, 11th, and 12th
thoracic nerves
URETER
• 2 ureters = muscular tubes from kidneys to
posterior surface of urinary bladder
• urine is propelled along ureter by peristaltic
contractions of muscle coat
o assisted by filtration pressure of glomeruli
• resembles esophagus in having 3 constrictions along
its course, where:
o renal pelvis joins ureter
o it is kinked as it crosses pelvic brim
o it pierces bladder wall
• renal pelvis
o funnel-shaped expanded upper end of ureter.
o lies w/in hilum of kidney
o receives major calyces
• from hilum of kidney and vertically downward
behind parietal peritoneum on psoas muscle
o separates it from tips of transverse processes
of lumbar vertebrae
• enters pelvis by crossing bifurcation of common iliac
artery in front of sacroiliac joint
• then runs down lateral wall of pelvis to region of
ischial spine and turns forward to enter lateral angle
of bladder
RELATIONS OF RIGHT URETER
➢ duodenum
➢ terminal part of ileum
anteriorly ➢ right colic and ileocolic vessels
➢ right testicular or ovarian vessels
➢ root of mesentery of SI
➢ right psoas muscle, w/c separates it
from lumbar transverse processes
posteriorly
➢ bifurcation of right common iliac
artery
RELATIONS OF LEFT URETER
➢ sigmoid colon and mesocolon
anteriorly ➢ left colic vessels
➢ left testicular or ovarian vessels
➢ left psoas muscle, w/c separates it
from lumbar transverse processes
posteriorly
➢ bifurcation of left common iliac
artery
medially ➢ inferior mesenteric vein
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BLOOD SUPPLY LYMPH DRAINAGE
• arterial supply to the ureter is as follows: • lateral aortic nodes
o upper end: renal artery
o middle portion: testicular or ovarian artery NERVE SUPPLY
o pelvis: superior vesical artery • preganglionic sympathetic fibers derived from
splanchnic nerves; most end in medulla
LYMPH DRAINAGE
• lateral aortic and iliac nodes POSTERIOR ABDOMINAL WALL
POSTERIOR ABDOMINAL WALL ARTERIES
NERVE SUPPLY 1. AORTA

• renal & testicular (or ovarian) • enters abdomen through aortic opening (hiatus) of
• hypogastric plexuses (in pelvis) diaphragm in front of T12
• afferent fibers travel w/ sympathetic nerves • descends behind peritoneum on anterior surface of
• enter spinal cord in L1 & L2 segments bodies of lumbar vertebrae

SUPRARENAL GLANDS @ level of L4:

• 2 yellowish retroperitoneal organs on upper poles of • divides into 2 common iliac arteries
kidneys
• surrounded by renal fascia but are separated from • on right side:
kidneys by perirenal fat ✓ inferior vena cava
• yellow cortex and a dark brown medulla ✓ cisterna chyli
✓ beginning of azygos vein
• cortex secretes:
✓ mineral corticoids (control of fluid and • on its left side: left sympathetic trunk
electrolyte balance)
✓ glucocorticoids (control of carbohydrate COMMON ILIAC ARTERIES
metabolism) • R & L common iliac arteries
✓ fats, proteins, and small amounts of sex • arise @ level of L4
hormones (prepubertal development of sex • run downward and laterally along medial border of
organs) psoas muscle

• medulla secretes: • ends in front of sacroiliac joint by dividing into

✓ catecholamines external and internal iliac arteries
✓ epinephrine o e/c ureter crosses anterior side of common iliac
✓ norepinephrine artery at its bifurcation

LOCATION & DESCRIPTION EXTERNAL ILIAC ARTERY

• right suprarenal gland
✓ pyramid shaped
✓ caps upper pole of right kidney
✓ behind right lobe of liver
✓ extends medially behind inferior vena cava
✓ rests posteriorly on diaphragm
• left suprarenal gland
✓ crescentic in shape
✓ extends along medial border of left kidney from
upper pole to hilus
✓ behind pancreas, lesser sac, and stomach
✓ rests posteriorly on diaphragm
• runs along medial border of psoas, following pelvic
brim
• gives off inferior epigastric and deep circumflex iliac
branches
• enters thigh by passing under inguinal ligament to
become femoral artery
• inferior epigastric artery arises above inguinal
ligament
• passes upward and medially along medial margin of
deep inguinal ring
o enters rectus sheath behind rectus abdominis
muscle

BLOOD SUPPLY • deep circumflex iliac artery arises close to

inferior epigastric artery
3 typical vessels:
✓ superior suprarenal artery (branch of inferior
• ascends laterally to anterior superior iliac spine and
phrenic artery)
iliac crest
✓ middle suprarenal artery (branch of aorta)
o supply muscles of anterior abdominal wall
✓ inferior suprarenal artery (branch of renal artery)

INTERNAL ILIAC ARTERY

• single vein emerges from e/c hilum
• passes down into pelvis in front of sacroiliac joint
o right: drains into inferior vena cava
o left: renal vein

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POSTERIOR ABDOMINAL WALL VEINS tributaries of portal circulation:

1. INFERIOR VENA CAVA 2. INFERIOR MESENTERIC VEIN
• conveys most blood from body below diaphragm to • begins halfway down anal canal as superior rectal
right atrium vein
• formed by union of common iliac veins behind right • passes up posterior abdominal wall on left side of
common iliac artery @ level of L5 inferior mesenteric artery and duodenojejunal
• ascends on right side of aorta flexure
• pierces central tendon of diaphragm @ level T8. • joins splenic vein behind pancreas
• receives tributaries that correspond to branches of
• right sympathetic trunk artery.
o behind its right margin
3. SPLENIC VEIN
• right ureter • begins at hilum of spleen by union of several veins
o close to its right border • joined by short gastric and left gastro-omental veins
• passes to right w/in splenorenal ligament
• entrance into lesser sac separates inferior vena cava • runs behind the pancreas
from the portal vein • joins superior mesenteric vein behind neck of
pancreas = portal vein
• joined by veins from pancreas & inferior mesenteric

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4. SUPERIOR MESENTERIC
• begins at ileocecal junction
• runs upward on posterior abdominal wall w/in root
of mesentery of SI
• right side of superior mesenteric artery
• passes in front of 3rd part of duodenum

• behind neck of pancreas

o joins splenic vein to form portal vein

• tributaries correspond to branches of superior

mesenteric artery
• also receives inferior pancreaticoduodenal vein
and right gastroepiploic vein

5. PORTAL VEIN

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