1. Supracolic Compartment 结肠上区
Regional anatomy
Supracolic Compartment 结肠上区
Ling Shucai

2. Relationships of abdominal viscera
First layer－live, gallbladder, stomach（肝、胆囊、胃）
Second layer－duodenum, pancreas, spleen
（十二指肠、胰、脾）
Third layer－suprarenal gland, kidney, ureter, inferior vena cava, abdominal aorta, nerves and lymphatics
（肾上腺、肾、输尿管、下腔静脉、腹主动脉等。）

3. Relationships of the stomach
Anterior:
Live (right part)
Diaphragm (left upper part)
Anterior abdominal wall (left lower part)
Posterior－separated by peritonum of lesser sac from the following (“stumach-bed”)
Pancreas
Left suprarenal gland
Left kidney
Spleen
Transverse colon and transvers mesoclon

4. Arteries of stomach
Left and right gastric arteries arise from celiac trunk and proper hepatic artery, repectively. These two vessels run in lesser omentum along lesser curvature , and anastomose end-to-end.

5. Right and left gastroepiploic arteries arise from the gastroduodenal and splenic artery, repectively.
Short gastric arteries, branches of splenic artery, course through the gastrosplenic ligament and 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.

6. Venous drainage of stomach
Right and left gastric veins empty directly into hepatic portal vein.
Left gastroepiploic and short gastric veins drain into hepatic portal vein via the splenic vein.
Right gastroepiploic vein join either superior mesenteric vein.

7. Lymphatics 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 splinic ln.
Supra- 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.

8. Innervation of stomach
Parasympathetic innervation by anterior (left) and posterior (right) vagal trunks
The anterior trunk divides into anterior gastric and hepatic branches
The posterior trunk divides into posterior gastric and celiac branches
“crow’s foot” to supply the pyloric part
Sympathetic innervation
Mainly from celiac ganglia
Affent and effent fibers derives from thoracic segments (T5 －L1)

9. Relationships of the the duodenum
Relationships of superior part
Anteriorly
Quadrate lobe of live
Gallbladder
Posteriorly
Commom bile duct
Gastroduodenal a.
Hepatic portal v.
Inferior vena cava
Superioely
Omental foramen
Inferiorly
Head of pancreas

10. Relationships of descending part
Anteriorly
Live
Transverse colon and mesocolon
Loops of small intestine
Posteriorly
Right renal hilum and ureter
Right renal vessels
Medially
Head of pancreas
Common bile duct and pancreatic duct
Laterally
Right colic flexure

11. Relationships of horizontal part
Superiorly
Head of pancreas
Inferiorly
Loops of small intestine
Anteriorly
Radix of mesentery
Superior mesenteric a. and v.
Posteriorly
Right ureter
Inferior vena cava
Abdominal aorta

12. Relationships of ascending part
Right
Head of pancreas and abdominal aorta
Left
Left kidney and ureter

13. Blood supply of duodenum
Arteries
Superior pancreaticoduodenal a.
Inferior pancreaticoduodenal a.
Veins
－follow arteries, draining directly into superior mesenteric and hepatic portal veins

14. Relationships of liver
Diaphragmatic surface
－separated by diaphragm from the following
Right costodiaphramatic recess and lung
Cardiac base
Visceral surface
Left lobe is related to the stomach and abdominal part of esophagus
Right lobe is related to the right colic flexure anteriorly, gallbladder and superior duodenal flexure medially, right kidney, superarenal gland posteriorly

15. The internal structure of the liver

18. Glisson system

19. For knowledge : Claude Couinaud :
A French surgeon & anatomist who made significant contribution in the field of hepatobiliary surgery ,he was the first to describe segmental anatomy of the liver (1954)

20. Prof Henri Bismuth :
A French surgeon who contributes much to the segmentation of the liver …
His classification is popular in the USA …while Couinauds’ classification is more popular in Asia & Europe…

21. Segments of liver 左半肝： 尾叶（段Ⅰ） 左外叶 上段（段Ⅱ） 下段（段Ⅲ） 左内叶（段Ⅳ） 右半肝： 右前叶
下段（段Ⅴ）
上段（段Ⅷ）
右后叶
下段（段Ⅵ）
上段（段Ⅶ） 21

23. Liver segment

25. Comparison between classical anatomy & modern functional segmentation of the liver…

26. Divisions and relations of common bile duct
1. Supraduodenal segment
Descends along the right margin of hepatoduodenal lig.
To the right of proper hepatic a.
Anterior to hepatic portal v.
2. Retroduodenal segment
Behind the superior part of duodenum
Anterior to the vena cava
To the right of the hepatic portal v.

27. 3. Pancreatic segment
Lies in a groove between posterior surface of head of pancreas and duodenum
4. Intraduodenal segment
Enters the wall of descending part of duodenum obliquely where jions the pancreatic duct to form the hepatopancreatic ampulla
Opens at the major duodenal papilla

28. Divisions and relations of pancreas
Head of pancreas
Located in C-shapes curvature of doudenum
Anteriorly
Transverse mesocolon
Posteriorly
Inferior vena cava
Right renal vessels
Common bile duct
Neck of pancreas
Anteriorly－pylorus
Posteriorly－commencement of hepatic portal v. (formed by union of splenic and superior mesenteric veins)

29. Body of pancreas
Anteriorly
Separated from stomach by omental bursa
Posteriorly
Abdominal aorta
Left suprarenal gland
Left kidney
Left renal vessels
Spleen vein
Superiorly
Celiac trunk
Celiac plexus
Splenic a.

30. Tail of pancreeas
Runs in splenicorenal ligament to reach hilum of spleen
Accompanies with splenic vessels

31. Relationships of spleen
Diaphragmatic surface－diaphragm
Visceral surface
Anteriorly－fundus of stomach
Posteriorly－left suprarenal gland and kidney
Inferiorly－tail of pancreas and left colic flexure

32. 思考题 何谓“胃床”？由哪些结构构成。胃后壁穿孔时，胃内含物可通过何结构到达何部位？ 试述胃的毗邻、血供和淋巴回流。
试述十二指肠的分段及各段毗邻。
熟悉肝的分段
试述胆总管的分段及胆汁的产生与排除的途径。
胰分为哪些部？各部分别与哪些结构毗邻？
试述胰头的位置和毗邻，患胰头癌时可压迫哪些结构，引起哪些症状？