1. GNK 288 (SA4 Anatomy dissection)
Abdomen 4
2.7 Duodenum and pancreas 2.8 Kidneys, suprarenal glands and ureters 2.9 Posterior abdominal wall and diaphragm
Albert van Schoor
GNK 288 (SA4 Anatomy dissection)

2. 2.7 Duodenum and pancreas 2.7.1 Surface anatomy 2.7.1 Structure
2.7.3 Blood supply, nerve supply
and lymph drainage

3. 2.7.1 Surface anatomy
Review the surface anatomy of the duodenum and pancreas
Name the vertebral heights of the various parts of the pancreas

4. 1st part Approx. 5 cm long Anterolateral of body of L1
2.7.1 Surface Anatomy
1st part
Approx. 5 cm long
Anterolateral of body of L1
On the transpyloric line

5. 2nd part Approx. 7-10 cm long Descends along the right sides of L1-L3
2.7.1 Surface Anatomy
2nd part
Approx cm long
Descends along the right sides of L1-L3

6. 3rd part Approx. 6-8 cm long Horisontal Crosses the body of L3
2.7.1 Surface Anatomy
3rd part
Approx. 6-8 cm long
Horisontal
Crosses the body of L3

7. 4th part Approx. 5cm cm long Begins at the left of L3
2.7.1 Surface Anatomy
4th part
Approx. 5cm cm long
Begins at the left of L3
Rises superior as far as the superior border of L2

8. 2.7.1 Surface Anatomy
T12 L1 L1 L2 L2 L3

9. 2.7.2 Structure
Identify and briefly describe the four parts of the duodenum and the structures opening into it

10. 1st 5cm from gastroduodenal junction
2.7.2 Structure
1st part
1st 5cm from gastroduodenal junction
Anterior:
Liver
Gallbladder
Posterior:
Ant. Border of omental foramen (gastroduodenal artery)

11. Curves around head of pancreas Anterior: Posterior:
2.7.2 Structure
2nd part
7-10cm long
Vertical
Curves around head of pancreas
Anterior:
Transverse colon
Posterior:
Right kidney and ureter
Posteromedial:
Major and minor duodenal papillae

12. 3rd part Horisontal 6-8cm Anterior: Posterior: Superior:
2.7.2 Structure
3rd part
Horisontal 6-8cm
Anterior:
Superior mesenteric artery
Mesentry of small intestines
Posterior:
IVC
Aorta L3
Superior:
Head of pancreas

13. Runs vertical for 2.5 - 5cm to duodenojejenal junction
2.7.2 Structure
4th part
Runs vertical for cm to duodenojejenal junction
Suspensory ligament of duodenum (Lig. of Treitz) extend from right crus of diaphragm
Suspends duedenojejenal junction

14. 2.7.2 Structure
Identify and schematically illustrate the different parts (regions) and duct system of the pancreas
Identify and list the general and peritoneal relations of the four parts of the duodenum
Identify and briefly discuss the relations of the pancreas to the spleen, duodenum, stomach and transverse colon and peritoneum
Identify the root of the transverse colon 

15. Accessory pancreatic duct of Santorini
2.7.2 Structure
Accessory pancreatic duct of Santorini
Major pancreatic duct of Wirsung

16. 2.7.2 Structure
Identify and briefly discuss the relations of the pancreas to the spleen, duodenum, stomach and transverse colon and peritoneum
Identify the root of the transverse colon 

17. Superior: Posterior: Anterior: Splenic artery Common hepatic artery
2.7.2 Structure
Superior:
Splenic artery
Common hepatic artery
Posterior:
IVC
Aorta
Sup. mesenteric vessels
Crurae of diaphragm
Coeliac plexus
Left kidney
Anterior:
Stomach
Transverse mesocolon
Omental bursa

18. 2.7.3 Blood supply and lymph drainage
Identify, trace and list the arterial supply and venous drainage of the duodenum and pancreas
Give a broad overview of the major lymph node groups into which the upper abdominal organs drain

19. 2.7.3 Blood & Lymph

20. Veins follows the arteries
2.7.3 Blood & Lymph
Veins follows the arteries
Drains into portal vein either directly or indirectly through:
Superior mesenteric vein
Splenic vein

21. 2.8 Kidneys, suprarenal glands and ureters
2.8.1 Surface anatomy
2.8.2 Structure
2.8.3 Blood supply, nerve supply
and lymph drainage
2.8.4 Radiographic anatomy

22. 2.8.1 Surface anatomy Review the surface anatomy of the kidneys
Identify the bony relations of the kidneys and ureters

23. Left: Right 5cm from median plane
2.8.1 Surface Anatomy
Left:
5cm from median plane
Transpyloric line through hilum of kidney
Right
Transpyloric line through superior pole of kidney
Inferior pole 2.5cm from ileac crest L1 L2

24. T11 T11 T12 T12 Psoas Major Quadratus Lumborum Transverse Abdominis
2.8.1 Surface Anatomy
T11
T11
T12
T12
Psoas Major
Quadratus Lumborum
Transverse Abdominis

25. 2.8.2 Structure
Annotate a coronal section of the kidneys as follows: hilus, pelvis, calices, pyramids and columns
Identify and name the general and peritoneal relationships of both kidneys
Identify and name the abdominal course and relationships of both ureters in both sexes

26. 2.8.2 Structure Identify both suprarenal glands
Compare the relative position of the two kidneys and suprarenal glands
Distinguish the three parts of the ureter and list where a kidney stone might obstruct it

27. 2.8.2 Structure

28. Urine moves by means of peristaltic movements 3 Components:
2.8.2 Structure
Approximately 25cm long
Urine moves by means of peristaltic movements
3 Components:
Abdominal: adjacent to transverse processes of lumbar vertebrae L2-L5
Pelvic: enters true pelvis, continues medial, over internal iliac artery, and anteromedial towards bladder
Intramural: short part between 2 layers of bladder wall. Serves as a mechanical valve to prevent reflux of urine

29. Potential constrictions:
2.8.2 Structure
Potential constrictions:
Renal pelvis
Where ureter crosses the internal iliac artery
Between the 2 muscle layers of the bladder wall

30. 2.8.3 Blood supply, nerve supply and lymph drainage
Trace, identify and compare the course and relations of both renal arteries and veins
Identify, trace and name the arterial supply and venous drainage of both suprarenal glands

31. 2.8.3 Blood & nerve supply, Lymph drainage

32. 2.8.4 Radiographic anatomy
Identify the following on a urogram (or IVP):
Kidneys
ureters,
bladder,
major and minor calyces,
pelvis of kidney, and
relation of the ureters to the transverse processes of the lumbar vertebrae 

33. 2.9 Posterior abdominal wall and diaphragm
2.9.1 Abdominal aorta
2.9.2 Abdominal inferior vena cava
2.9.3 Lymph drainage
2.9.4 Nerve structures
2.9.5 Fascia
2.9.6 Muscles
2.9.7 Diaphragm
2.9.8 Osteology

34. 2.9.1 Abdominal aorta
Identify the course, relationships and branches of the abdominal aorta

35. 3 unpaired to viscera (anterior)
2.9.1 Abdominal aorta
3 unpaired to viscera (anterior)
Coeliac trunk
Sup. mesenteric
Inf. mesenteric
3 paired to viscera (lateral)
Suprarenal
Renal
Gonadal
5 paired (lateral)
Inferior phrenic
4 pairs of lumbar
2 paired terminal branches
Common iliac
Median sacral

36. 2.9.2 Abdominal inferior vena cava
Briefly discuss and identify the course, relations and tributaries of the inferior vena cava
Identify the different drainage of the left and right gonadal veins

37. 2.9.3 Lymph drainage
Give a broad overview of the lymph drainage of the abdomen

38. 2.9.4 Nerve structures
Identify and briefly describe the sympathetic trunk and where possible the plexuses

39. 2.9.4 Nerve structures
2 parallel nerve cords
Extending on either side of the vertebral column from the base of the skull to the coccyx.
2 sympathetic trunks come together anterior to the coccyx to form the ganglion impar.

40. 2.9.4 Nerve structures
Identify and discuss the distribution and root values of the following nerves of the lumbar plexus:
Subcostal,
iliohypogastric,
ilioinguinal,
lateral cutaneous nerve of the thigh,
genitofemoral,
femoral and
obturator nerves
Give an overview of the autonomic nerve supply of the abdomen

41. Autonomic Sympathetic Paraympathetic Vagus nerve (X) ~ cranial outflow
2.9.4 Nerve structures
Autonomic
Sympathetic
Paraympathetic
Splanchnic nerves
Thoracic (Coeliac plexus)
Lumbar (Intermesenteric / aortic & superior hypogastric plexus)
Sacral (Inferior hypogastric plexus)
Pelvic* (Inferior hypogastric plexus)
* Both sympathetic and parasympathetic
Vagus nerve (X) ~ cranial outflow
Foregut & midgut
S2-S4 ~ abdominal outflow
Hindgut
Intermesenteric / aortic plexus
Superior & inferior mesenteric plexuses
Superior & inferior hypogastric plexuses

42. 2.9.5 Fascia Identify the layers of the thoracolumbar fascia
Identify the psoas and iliac fascia

43. 2.9.6 Muscles
Identify and briefly discuss the major attachments, relationships to organs and nerves, as well as the nerve supply of the following muscles:
psoas major,
iliacus and
quadratus lumborum

44. Psoas major Iliacus Quadratus Lumborum Muscle Origin Insertion
2.9.6 Muscles
Muscle
Origin
Insertion
Innervation
Psoas major
Lateral surface of bodies and intervertebral discs of T12 and L1 to L5, transverse processes of the lumbar vertebrae
Lesser trochanter of the femur
Anterior rami of L1 to L3
Quadratus Lumborum
Transverse process of L5, iliolumbar ligament, and iliac crest
Transverse processes of L1-L4 and inferior border of rib 12
Anterior rami of T12 and L1 to L4
Iliacus
Upper two-thirds of iliac fossa, anterior sacro-iliac and iliolumbar ligaments, and upper lateral surface of sacrum
Lesser trochanter of femur
Femoral nerve (L2 - L4)

45. 2.9.7 Diaphragm Review the surface anatomy of the diaphragm
Identify and name it's attachments, blood supply and nerve supply

46. 2.9.7 Diaphragm
1a) Vertebral ~ crura
Right Crus
L1-L3
Left Crus
L1-L2

47. 1b) Vertebral ~ fibrous arches Median arcuate lig
2.9.7 Diaphragm
1b) Vertebral ~ fibrous arches
Median arcuate lig
aorta
Medial arcuate lig
Psoas major
Lateral arcuate lig
Quadratus lumborum

48. 2 small attachments to xiphisternum
2.9.7 Diaphragm
2) Costal
Ribs 7-12
3) Sternal
2 small attachments to xiphisternum

49. Blood supply ~ superior
2.9.7 Diaphragm
Innervation
Motor supply ~ phrenic nerve
Blood supply ~ superior
Superior phrenic artery (thoracic aorta)
Musculophrenic and pericardiophrenic arteries(internal thoracic artery)
Blood supply ~ inferior
Inferior phrenic artery (abdominal aorta)

50. 2.9.7 Diaphragm
List it's superior and inferior relations on the left and right
Identify and name the orifices of the diaphragm with their vertebral heights and contents and the structures penetrating the diaphragm separately

51. 2.9.7 Diaphragm T8
T10
T12

52. 2.9.7 Diaphragm
Identify and name the arcuate ligaments of the diaphragm and the structures related posterior to them
Identify and name the crura of the diaphragm in relation to the oesophageal hiatus

53. 2.9.8 Osteology
Identify and briefly discuss the bony elements of the posterior abdominal wall