1. 2.3 Peritoneal cavity 2.4 Liver and gallbladder 2.5 Stomach and spleen
Abdomen 2
2.3 Peritoneal cavity 2.4 Liver and gallbladder 2.5 Stomach and spleen
Albert van Schoor
GNK 288 (SA4 Anatomy dissection)

2. 2.3 Peritoneal cavity and Disposition of abdominal organs
2.3.1 Peritoneum
2.3.2 Organs and relations
2.3.3 Peritoneal specialisation
2.3.4 Radiographic anatomy

3. 2.3.1 Peritoneum Define the terms:
Omentum and
Mesentery
Identify the parietal and visceral peritoneum
Identify and briefly discuss the attachments of the greater and lesser omentum

4. Intraperitoneal organs Retroperitoneal organs
2.3.1 Peritoneum
Serous membrane that lines the abdominopelvic cavity and invests the viscera
Parietal peritoneum
Visceral peritoneum
Intraperitoneal organs
Stomach, spleen
Retroperitoneal organs
Kidneys, ascending & descending colon

5. Mesentry of jejenum and ileum Transverse mesoclolon Sigmoid mesocolon
2.3.1 Peritoneum
Mesentry of jejenum and ileum
Transverse mesoclolon
Sigmoid mesocolon
Meso-appendix

6. 2.3.1 Peritoneum
Lesser Omentum
Greater Omentum

7. Central aspect, diaphragmatic peritoneum
Innervation
Central aspect, diaphragmatic peritoneum
Phrenic nerve (C3-5) (referred pain)
Peripheral aspect, diaphragmatic peritoneum
Inter- and subcostal nerves (T7-T12)
Parietal peritoneum
T7-T12 and L1 (pain at precise point of stimulation)
Visceral peritoneum
Insensitive to mechanical stimulation

8. 2.3.2 Organs and relations
Explain the functional anatomy of the mesentery, it’s position, vascular, lymphatic and neural contents
Explain how the abdomen is divided into a supracolic and infracolic compartment
Identify and briefly discuss the attachments of the mesentery of the small intestine to divide the infracolic compartment in two regions

9. Mesentry: double layer of peritoneum
2.3.2 Organs & relations
Mesentry:
double layer of peritoneum
serves as continuation of visceral and parietal peritoneum
provides a means for neurovascular communication between organ and body wall

10. Transverse Mesoclolon
2.3.2 Organs & relations
Transverse Mesoclolon
Mesentry of jejenum and ileum
Sigmoid mesocolon

11. 2.3.2 Organs & relations
Supracolic
Infracolic
Right
Left

12. 2.3.3 Peritoneal specialisation
Name and identify the peritoneal folds
Name and identify the peritoneal fossae
Name and identify the paracolic gutters

13. Inferior to the umbilicus
2.3.3 Peritoneal specialisation
Folds
Inferior to the umbilicus
Reflection of peritoneum
Raised from abdominal wall by underlying structure
Median umbilical fold
– urachus
Medial umbilical fold – obliterated umbilical artery
Lateral umbilical fold – inferior epigastric vessels

14. Superior to the umbilicus
2.3.3 Peritoneal specialisation
Folds
Superior to the umbilicus
Falciform ligament
Round ligament of the liver (obliterated foetal umbilical vein)

15. Fossae / Recess Duodenal recess Caecal recesses: Intersigmoid recess
2.3.3 Peritoneal specialisation
Fossae / Recess
Duodenal recess
Caecal recesses:
Superior ileocaecal
Inferior ileocaecal
Retrocaecal
Intersigmoid recess
Omental bursa

16. Duodenojejunal flexure Formed by superior and inferior duodenal folds
2.3.3 Peritoneal specialisation
Fossae / Recess
Duodenal recess
Duodenojejunal flexure
Formed by superior and inferior duodenal folds
Superior and inferior duodenal recesses
Paraduodenal recess

17. Fossae / Recess Caecal recesses: Formed by: Superior ileocaecal
2.3.3 Peritoneal specialisation
Fossae / Recess
Caecal recesses:
Superior ileocaecal
Inferior ileocaecal
Retrocaecal
Formed by:
Caecal fold
Ileocaecal fold
Vascular fold

18. Fossae / Recess Caecal recesses: Formed by: Superior ileocaecal
2.3.3 Peritoneal specialisation
Fossae / Recess
Caecal recesses:
Superior ileocaecal
Inferior ileocaecal
Retrocaecal
Formed by:
Caecal fold
Ileocaecal fold
Vascular fold

19. 2.3.3 Peritoneal specialisation
Fossae / Recess
Intersigmoid recess
Meso-sigmoid attached to posterior abdominal wall in relation where the left ureter crosses the left common iliac artery

20. Right paracolic gutter Left paracolic gutter
2.3.3 Peritoneal specialisation
Gutters
Right paracolic gutter
Left paracolic gutter
Right, between mesentry of jejenum and ileum and ascending colon (no exit)
Left, between mesentry of jejenum and ileum and descending colon (exit inferior)

21. 2.3.3 Peritoneal specialisation
Identify the following:
Gastrosplenic ligament,
Splenorenal ligament,
Transverse and sigmoid mesocolon,
Ileocoecal fold,
Meso-appendix and
The mesenterium of the small intestine

22. 2.3.3 Peritoneal specialisation
Identify and describe the omental bursa (lesser sac) in respect of its relations, borders and entrance - the omental foramen
Identify the structures forming the borders of the omental foramen
Name and identify the subphrenic spaces

23. (left subhepatic space)
2.3.3 Peritoneal specialisation
Omental bursa
(left subhepatic space)
Superior recess
Inferior recess
Splenic recess

24. Omental bursa Superior recess Anterior: Posterior: Right: Left:
2.3.3 Peritoneal specialisation
Omental bursa
Superior recess
Anterior:
Lesser omentum
Caudate process of liver
Posterior:
Diaphragm
Right:
IVC
Left:
Oesophagus

25. Omental bursa Inferior recess Anterior: Posterior: Stomach
2.3.3 Peritoneal specialisation
Omental bursa
Inferior recess
Anterior:
Stomach
Anterior 2 layers of greater omentum
Posterior:
Pancreas, transverse colon and mesocolon, poster 2 layers of greater omentum

26. Omental bursa Splenic recess Anterior: Posterior: Left:
2.3.3 Peritoneal specialisation
Omental bursa
Splenic recess
Anterior:
Gastrosplenic ligament
Posterior:
Splenorenal ligament
Left:
Hilum of the spleen

27. 2.3.3 Peritoneal specialisation
Omental foramen
Connects greater sac (peritoneal cavity) and lesser sac (omental bursa)

28. Free border of lesser omentum:
2.3.3 Peritoneal specialisation
Omental foramen
Anterior:
Free border of lesser omentum:
Common bile duct (right)
Proper hepatic artery (left)
Hepatic portal vein (posterior)

29. Omental foramen Posterior: Inferior vena cava
2.3.3 Peritoneal specialisation
Omental foramen
Posterior:
Inferior vena cava

30. Omental foramen Superior: Caudate lobe of liver
2.3.3 Peritoneal specialisation
Omental foramen
Superior:
Caudate lobe of liver

31. Omental foramen Inferior: 1st part of duodenum Common hepatic artery
2.3.3 Peritoneal specialisation
Omental foramen
Inferior:
1st part of duodenum
Common hepatic artery

32. 2.3.3 Peritoneal specialisation
Name and identify the subphrenic spaces

33. Right and left subphrenic spaces (separated by the falciform ligament)
2.3.3 Peritoneal specialisation
Spaces
Right and left subphrenic spaces (separated by the falciform ligament)
Right subhepatic space (Morison’s pouch)
Left subhepatic space (omental bursa)
Extraperitoneal subphrenic space

34. Right and left subphrenic spaces (separated by the falciform ligament)
2.3.3 Peritoneal specialisation
Right and left subphrenic spaces (separated by the falciform ligament)

35. Right subhepatic space (Morison’s pouch)
2.3.3 Peritoneal specialisation
Right subhepatic space (Morison’s pouch)

36. Extraperitoneal subphrenic space
2.3.3 Peritoneal specialisation
Extraperitoneal subphrenic space

37. 2.3.4 Radiographic anatomy
Identify the following structures on a plain erect abdominal X-ray:
ASIS,
lumbar vertebrae,
SI-joint,
large intestine,
diaphragm,
stomach with air in fundus of stomach,
liver,
psoas line

38. 2.4 Liver and gallbladder 2.4.1 Surface anatomy 2.4.2 Structure
2.4.3 Blood supply, nerve supply and lymph drainage

39. 2.4.1 Surface anatomy
Review the surface anatomy of the liver and gallbladder
Indicate where a liver biopsy should be done

40. Right, midaxillary line:
2.4.1 Surface anatomy
Liver
Right, midaxillary line:
7th rib almost to right iliac crest
Right, midclavicular plane:
5th rib cartilage to 9th costal cartilage
Left, midclavicular plane:
2.5cm short 5th intercostal space and left nipple

41. Inferior to 9th costal cartilage on right
2.4.1 Surface anatomy
Gallbladder
Inferior to 9th costal cartilage on right
Lateral to semilunar line (lateral border of rectus abdominis)
Approx. hands breadth from midline

42. 2.4.1 Surface anatomy

43. 2.4.2 Structure
Name and identify the borders and surfaces of the liver
Name and identify the lobes, segments, fissures with their contents Identify the subhepatic and subphrenic spaces, and their possible implication in the spread of infection

44. Diaphragmatic surface
2.4.2 Structure
Diaphragmatic surface
Visceral surface

45. 2.4.2 Structure
Left
Right

46. 2.4.2 Structure
Colon
Kidney
Duodenum
Stomach

47. 2.4.2 Structure Name and identify the following: Triangular ligaments,
Coronary ligaments,
Falciform ligament,
Lesser omentum,
Round ligament of the liver and
Ligamentum venosum

48. 2.4.2 Structure
Identify, schematically illustrate and discuss the extrahepatic bile ducts as follows:
Origin,
Course,
Outlet and
Relations to the pancreas head and duodenum
Name and identify the extrahepatic bile ducts on radiographs

49. Right and left hepatic ducts
2.4.2 Structure
Right and left hepatic ducts
Common hepatic duct
Cystic duct
(Common) bile duct
Main pancreatic duct of Wirsung
Ampulla of Vater with the sphincter of Oddi

50. ERCP Endoscopic retrograde cholangiopancreatography
2.4.2 Structure
ERCP Endoscopic retrograde cholangiopancreatography

51. 2.4.3 Blood supply
Discuss and identify the arterial blood supply and venous drainage of the liver and gallbladder
Take note of variations in the arterial blood supply of the liver and gallbladder

52. Left & right hepatic arteries Well-oxygenated blood
2.4.3 Blood supply
Left & right hepatic arteries
Well-oxygenated blood
Hepatic portal vein
Poorly oxygenated blood, nutrient-rich blood from GI tract

53. 2.5 Stomach and spleen 2.5.1 Surface anatomy 2.5.2 Structure
2.5.3 Blood supply, nerve supply and lymph drainage
2.5.4 Radiographic anatomy

54. 2.5.1 Surface anatomy
Review the surface anatomy of the stomach and spleen in relation to the anterior abdominal wall

55. Stomach Cardiac part: Pylorus: Fundus: Body:
2.5.1 Surface anatomy
Stomach
Cardiac part:
Deep to 7th costal cartilage, 2.5cm to the left of the midline
Pylorus:
On transpyloric plane, 2.5cm to the right of the midline
Vertebral height L1 / L2
Fundus:
Superior of a plane that extends horizontally from the cardia
Body:
Lies inferior of the above-mentioned plane

56. In relation to the 9th - 11th rib in the midaxillary line
2.5.1 Surface anatomy
Spleen
In relation to the 9th - 11th rib in the midaxillary line

57. 2.5.2 Structure
Name and identify the various regions, curvatures and surfaces of the stomach. Identify these also on radiographs
Identify and briefly describe the general and peritoneal relations of the stomach

58. Cardio-oesophageal orifice
2.5.2 Structure
Cariac zone
Fundus
Cardio-oesophageal orifice
Pylorus
Body
Gastric
and
fundic zones
Pyloric zone

59. Anterosuperior relations:
2.5.2 Structure
Anterosuperior relations:
Left lobe of liver
Diaphragm
Anterior abdominal wall
Left costal margin

60. Postero-inferior relations:
2.5.2 Structure
Postero-inferior relations:
Omental bursa with
Transverse colon and mesocolon
Pancreas
Spleen
Coeliac artery
Left kidney and suprarenal gland
Coeliac plexus
Coeliac ganglia
Diaphragm

61. 2.5.2 Structure
Identify and briefly discuss the structure and surfaces of the spleen
Identify and briefly discuss the relations of the spleen to: ribs, stomach, pancreas, kidney, transverse colon, suprarenal gland
Identify the possible routes of surgical access to the lesser sac: omental foramen, directly through the lesser omentum, posterior

62. 2.5.2 Structure

63. 2.5.2 Structure
Posterior
Anterior

64. 2.5.3 Blood supply, nerve supply and lymph drainage
Identify and briefly discuss the arterial supply and venous drainage of the stomach and spleen
Schematically illustrate the coeliac trunk and it's branches

65. Coeliac trunk Common hepatic artery Gastroduodenal artery
2.5.3 Blood & nerve supply, Lymph drainage
Coeliac trunk
Common hepatic artery
Gastroduodenal artery
Anterior superior pancreaticoduodenal artery
Right gastro-omental artery
Proper hepatic artery
Right gastric artery
Right hepatic artery
Cystic artery
Left hepatic artery

66. Splenic artery Coeliac trunk Left Gastro-omental artery
2.5.3 Blood & nerve supply, Lymph drainage
Coeliac trunk
Splenic artery
Left Gastro-omental artery
Short gastric artery

67. Left gastric artery Coeliac trunk
2.5.3 Blood & nerve supply, Lymph drainage
Coeliac trunk
Left gastric artery

68. 2.5.3 Blood supply, nerve supply and lymph drainage
Identify and briefly discuss the vagus nerve as follows:
Abdominal entrance (anterior and posterior vagus trunks),
Prominent plexuses and
Branches and extent of abdominal supply
Identify the intra-abdominal part of the oesophagus 

69. Enters abdomen at T10 together with oesophagus
2.5.3 Blood & nerve supply, Lymph drainage
Vagus nerve (X)
Enters abdomen at T10 together with oesophagus
Parasympathetic supply to GI tract as far as the left colic flexure
Contributions to
Cardiac plexus
Oesophageal plexus
Aortic plexus
Coeliac plexus
Branches:
Oesophageal
Gastric
Pancreatic
Branches to gallbladder
Branches to intestine as far as the left colic flexure

70. Left vagus nerve (X) – Ant. vagal trunk
2.5.3 Blood & nerve supply, Lymph drainage
Left vagus nerve (X) – Ant. vagal trunk
Branches:
Oesophageal branches
Gastric branches
Hepatic branches to hepatic portal vein
Pyloric branches

71. Right vagus nerve (X) – Post. vagal trunk
2.5.3 Blood & nerve supply, Lymph drainage
Right vagus nerve (X) – Post. vagal trunk
Branches:
Oesophageal branches
Gastric branches
Coeliac branches to coeliac plexus
Pyloric branches

72. 2.5.4 Radiographic anatomy
Identify the stomach and air in the fundus of the stomach on a plain erect abdominal X-ray
Identify the stomach on a barium meal