1. Abdomen Forum 2012
1. Neuronal cell body for preganglionic sympathetic innervation to stomach. IML
2. Neuronal cell body for GVA from descending colon. Posterior root ganglion T10-L2
3. Layer not penetrated in peritoneocentesis in the right lower quadrant. Colle’s fascia
4. Organs of refer pain to body wall immediately inferior to xiphoid process. Duodenum
5. Kidney-lumbar lymph node

2. Surface Anatomy Guy:
Document where the following organs/structures can be palpated:
Liver Rib5-10 right
Spleen under 9th,10th, 11th ribs. Begins about midaxillary line. Posterior left
Gallbladder 9th rib, midclavicular right
Draw in:
Linea alba
Linea semilunaris
McBurney’s point
ASIS
Deep Inguinal ring
Superficial Inguinal ring 1 2 3
GB: 9th rib, midclavicular
Left: spleen, under 9th,10th, 11th ribs. Begins about midaxillary line. posterior
Kidney: 12th rib, posterior 4

3. Surface Anatomy Guy:
Draw in the 4 lines to create the “9-region pattern”
Name the 9 regions.
What organs are found in each?
RH: R liver, kidney, Asc colon, GB?
E: liver, kidney (R/L), GB, stomach, pancreas, Trans colon
LH: Stomach, spleen, kidney, tip of liver
RF: Asc colon, gutter,
U: SI, Colon
LF: Des colon, gutter, kidney
RG: Asc colon, ASIS, Ing Lig, appendix, cecum
P: appendix, cecum, SI, bladder, Genital organs, femoral vessels
LG: des colon, ASIS, Ing Lig, sigmoid colon. 1 2 3 4

4. Patient A – 42 year-old male presenting after trying to move his dishwasher
Compare and Contrast!
Left: direct inguinal hernia, older male moving heavy things. Hernia out of Hesselbach’s triangle (rectus abdominis, inguinal ligament, inferior epigastric vessels) through superficial inguinal ring. Medial to inferior epigastric vessels. Cover by parietal peritoneum & transversalis fascia with external spermatic fascia
Right: indirect inguinal hernia, most common, congenital, more in child and male. Lateral to inferior epigastric vessels via deep inguinal ring through entire inguinal canal. Same covering as spermatic cord. Enters the scrotum
Patient B – newborn male
Hydrocele, fluid from peritoneum, Space continuous with peritoneum.

5. What fascial layers are cut in this procedure?
Lymphatic drainage of the wound site?
Vasetomy
Skin
Darto’s fascia
ESF
Cremaster
ISF
Superficial inguinal node
Darto’s fascia
Superficial inguinal node

6. Identify! 1 What's my lymphatic drainage? 2 5 3 4 6
Liver (most-hepatic LN-celiac LN; bare area-phrenic LN-posterior mediastinal LN; Falciform lig-parasternal LN; round lig of liver-umbilicus & anterior ab wall)
Spleen, splenic artery
L. kidney (Lumbar LN), renal vein-IVC
Aorta
IVC
Ascending colon with contrast (Sup Men LN), cecum 2 5 3 4 6

7. Identify.
Black: portal vein; Green: IVC; Blue: Ab aorta; Pink: Inferior mesentery vein, Yellow: Psoas major
Yellow: SM vein; Green: intestinal vein *

8. CT scan from a 27-year-old male reveals the image to the left.
Zucchini in peritoneum, ruptured GI

9. 1 6 2 5 4 3 Identify; What’s wrong?
58-year-old male with abdominal pain. CT scans reveal: 1 6 2
1: liver, cirrohsis
2: spleen, enlarged due to liver cirohisis
3: bladder
4: Psoas major 5
1: liver,
2: spleen
3: bladder
4: Psoas major 4 3

10. 65-year-old female presents with the chief compliant of abdominal swelling and discomfort of two weeks duration. CT reveals:
Enlarged stomach, malrotation of small bowel on the right

11. 6 Identify! 1 3 2 5 7 4 8 9 GB Aorta IVC Gall stone L. kidney Liver
Spleen
R. Crus, diaphragm
Portal vein 1 4 8 9 3 6 2 5 7

12. 6 Identify! 5 4 1 3 2 1. Aorta; plexus abdominal
2. Erector spinae; extension
3. Right kidney; embryological origin?
4. Duodenum, annular pancreas
5. GB; proper hepatic, celiac
6. Liver; T6-T9, 5 6 4 1 3 2

13. Identify! 1 3 5 1. Pancreas; Celiac a. and splenic a.
2. Trav Colon; Middel colic a.?, SMA
3. Left renal vein.
4. SMA
5. Spleen; splenic vein to Portal vein? 2 1 4 3 5

14. Identify! 6 4 5 1 3 2 8 7 Aorta R. Kidney L. Kidney
(Duodenum) descending, celiac artery and portal vein, Celiac LN, T5-T9, vagus
IVC
Liver
Psoas M
Transverse colon 8 6 4 5 1 7 2 3

15. Identify! 4 2 1 3 5 6 7 L. common iliac R. common iliac IVC
Ascending colon or cecum
Psoas Major
External Oblique
Internal Oblique
Rectus abdominis 8 6 7 4 2 1 3 5

16. Imaging of a 75-year-old female with abdominal pain, weight loss and dysphagia reveals:3 2 1
1: aorta (white is plaques); 2 IVC, 3 portal vein, 4 GB, 5 pancrea, 6 left renal vein
Gas under diaphragm, Pneumoperitoneum is air or gas in the abdominal (peritoneal) cavity, The most common cause is a perforated abdominal viscus, generally a perforated peptic ulcer, although any part of the bowel may perforate from a benign ulcer, tumor or abdominal trauma. 4 5 6

17. Barium enema in a 1-year-old male with difficulty defecating reveals:
Hirschsprung disease (HD) is a disorder of the gut which is caused by the failure of the neural crest cells to migrate completely during fetal development of the intestine, eventually forming Auerbach's plexus. non contractile hindgut, back up of intestinal content.

18. SUPER BONUS! Identify! Celiac trunk (left) SMA
Renal artery next to SMA on the right.

19. Draw the celiac trunk, its major branches and anastomoses.
Cystic artery off of hepatic proper artery

20. Draw the IMA, its major branches and anastomoses.

21. CT scan of a 50-year-old male reveals:
Ascites!
Where is the fluid?
What layers must be traversed to drain this fluid? [Paracentesis] 1
Spleen
R. kidney
Fluid?
Arrow: liver or fluid? Paracolic gutter left.
Paracentesis: Skin, campers, scarpa’s, EO, IO, TA, Tran fascia, extraperinum fat, pariental peritonum
Bright around aorta is plaque. 3 2

22. Imaging from a 55-year-old female with a history of breast cancer reveals the images to the left.
Which breast?
How does this happen? 1 4 3
Right side, The liver's lymph system from the falciform ligament connects to the parasternal nodes where 25% of the lymph from the (right) breast comes from.
1: liver, 2 left kidney, 3 spleen (enlarged), 4 IVC 2

23. 74-year-old female with rectal bleeding.
Metastasis:
Lymphatic channels –
Venous channels – *
Rectal cancer, IMV to splenic vein to portal vein (spread to liver), IM Lymph node

24. Radiograph from a 73-year-old female with abdominal pain and elevated WBCs:
Right diaphragm is higher than the left. Infection based on high WBC. Infection of liver or peritoneal cavity pushing diaphragm up? Perforated bowel (ulcer)causing air leaked in between diaphragm and peritoneal cavity (pneumoperitoneum)
Hint:
Sitting: fluid drop and air goes up.

25. CT scan from a 30-year-old female with complaints of vomiting and weight loss:
Stomach
Duodenum
Portal vein
SMA
Strangulation of distal duodenum, SMA syndrome. Duodenum compressed by SMA or abdominal aorta 1 3 4 2

26. 3 5 1 2 4 6 Celiac trunk Splenic artery Left gastric Common hepatic
Hepatic proper
Gastroduodenal
pancreaticduodenal superior (ant.) 3 5 1 2 4 6 7

27. 1 3
SMA
Ileocolic artery
Right colic artery
Intestinal artery 4 2

28. SMV
IMV
Splenic vein
Portal vein 4 3 1 2

29. A 65-year-old female presents with her daughter who indicates her mother has a 2-year history of dementia, a recent seizure and a long history of alcoholism [she consumes only Natty Light]. Physical exam reveals the image to the left:
Varicose vein from liver damage. Paraumbilical vein backed up from portal vein blockage. Caput medusa.

30. 1 2 3 Super BONUS! 4 Common hepatic duct Cystic duct Common bile duct
Main Pancreatic duct
Super bonus:
pars interarticularis 1 2 3
Ampulla.
Super BONUS! 4

31. Draw the pattern of sympathetic innervation to the ________________.
Structure to be decided DURING the forum!
Include pre and postganglionic neurons and GVAs!

32. Referred Pain Guy:
A 30-year-old male presents with pain in the region indicated.
What organ is indicated?
What spinal cord levels are involved?
Cell bodies in what location are responsible for relay of pain from this organ?
Green: Liver, GB and duodenum contact with diaphragm (C3-5),
Yellow: Stomach, duodenum and head of pancreas, Dorsal (posterior) root ganglia T5-T9 (sympathetic)
Pink: Small intestine, appendix T10 dermatone; T9-T11 real; visceral pain, would turn to somatic pain. 1 2 3 4

33. Referred Pain Guy:
A 16-year-old female presents with a fever and pain in the region indicated.
Which organ is implicated?
What spinal cord level is involved?
Is this somatic or visceral pain? 1 2 3
Most likely appendix. Visceral pain interpreted as somatic. Will become somatic with rupture. T10 4

34. 1 2
Referred Pain Guy:
A 36-year-old female presents with pain in the region indicated.
Which organ is implicated? 3
Irritation of diaphragm (from liver, gallbladder, duodenum) 4