Abdomen

Abdominal wall





山东大学医学院 解剖教研室

李振华

Anterior wall

Layers ( from superficial to

deep)

 Skin



 Superficial fascia



 Anterolateral muscles



 Transversalis fascia

腹横筋膜

 Extraperitoneal fascia

腹膜下筋膜

 Parietal peritoneum

壁腹膜

Superficial fascia－

divisions below

umbilicus

 Superficial fatty layer

(Camper’s)

 Membranous layer

(Scarpa’s)

Muscles of abdomen



Anterolateral group

 Obliquus externus

absominis 腹外斜肌

 Oblequus enternus

abdominis腹内斜肌

 Transversus

abdominis腹横肌

 Rectus abdominis 腹

直肌

Posterior group

 Quadiatus lumborum 腰

方肌

 Psoas major 腰大肌

Obliquus externus absominis 腹外斜肌



General direction of fibers:

downward, forward and

medially (run down and

inward)

Structures

 Inguinal ligament

腹股沟韧带

 Lacunar ligament

腔隙韧带

 Superficial inguinal ring

腹股沟浅环 －triangular-

shaped defect in

aponeurosis of obliquus

externus abdominis above

pubic tubercle

Obliquus internus abdominis 腹内斜肌



 Deep to obliquus

externus abdominis

 General direction of

fibres: upwards,

forwards and medially

Transversels abdominis 腹横肌



 Deep to obliquus

internus

 Inguinal falx 腹股沟镰:

arch over spermatic

cord, inserted with

transverses abdominis

fiber into medial part of

pecten of pubis

 Cremaster 提睾肌:

around the spermatic

cord and testis

Rectus abdominis 腹直肌

 Position: lie on to either of

midline

 Origin: pubic crest and

symphysis

 Insertion: xiphoid and 5th-7th

costal cartilages

 Has 3-4 tendinous

intersections 腱划

 linea semiluaris 半月线

Similar functions for above four pairs of muscles





 Support and compress the abdominal viscera

 Increase intra-abdominal pressure, aid in expulsive

efforts-vomiting, coughing, sneezing, defecation,

urination and childbirth.

 Depress ribs, assist in (the act of force(4)expiration.

 Flex, lateral flex, and rotate vertebral column

Sheath of rectus abdominis 腹直肌鞘

Ant layer－formed by fusion of

aponeurosis of obliquus externus

abdominis and anterior leaf of

aponeurosis of obliquus internus

abdominis

Post layer

 Formed by fusion of posterion leaf

of aponeurosis of obliquus

internus abdominis and

aponeurosis of transverses

abdominis

 Absent in about 4-5cm below the

umbilicus, where aponeuroses of

all three muscles form anterior

layer the lower free border named

arcuate line

 Below this line rectus abdominis in

contact with transverse fascia

Linea alba 白线

－tendinous raphe between right and left recti from xiphoid to pubic symphysis.

Inguinal region 腹股沟区



Boundaries

 Inguinal ligament



 Lateral margin of

rectus abdominis

 A horizontal line

stretching from

anterior iliac spine to

laeral margin of

rectus abdominis

Descent of testes









Seven-week embryo showing the

testis before its descent from the

dorsal abdominal wall

Fetus at 28 week the testis passing

through the inguinal canal

Newborn

Inguinal canal 腹股沟管

Position: oblique passage, 4cm long, located 1.5cm

above medial half of inguinal lig.

Boundaries

 Ant wall

 Aponeurosis of

obliquus externus

abdominis

 Obliquus internus

abdominis (lateral

third of wall)

 Post wall

 Transverse fascia

 Inguinal flax medially

 Roof－arched lower

fibers of obliquus

internus and

transversua abdominis

 Floor－inguinal lig．

 Two openings

 Superficial inguinal ring 腹股

沟浅环

 Deep inguinal ring 腹股沟深环 －

defect in transverse fascia 1.5cm

above midpoint of inguinal

ligament

 Structures passing through the inguinal canal

 Spermatic cord 精索 and ilioinguinal nerve髂腹股沟神经 in males

 Round ligament of uterus 子宫圆韧带and ilioinguinal nerve髂腹股

沟神经 in females

Inguinal Triangle (of Hesselbach) 腹股沟三角





Boundaries

 Inguinal ligament

inferiorly

 Lateral border of

rectus abdominis

medially

 Inferior epigastric

artery laterally

Indirect inguinal heinia and direcet inguinal heinia

Superficial vessels and cutaneous nerves

 Arteries

 Superficial epigastric a.

 Superficial iliac circumflex a.

 Veins

 Thoracoepigastric v.

 Superficial epigastric v.

 Cutaneous nerves

 Anterior and lateral

cutaneous n. of lower six

thoracic

 Iliohypogastric n. (first lumb

nerves)

Deep vessels and nerves

Arteres

 Superior and inferior epigastric arteris

 Lower posterior intercostal a.

 Subcostal a.

 Four lumbar a.

Nerves

 Iliohypogastric n. 髂腹下神经

 Arises from lubar plexus

 Passes forward in the interval

between obliquus internus and

tranversus abdominis

 Pieces obliquus internus

abdominis 2.5 cm medial to

anterior superior iliac spine

 Pieces aponeurosis of obliquus

externus abdominisabout 2.5

cm above superficial inguinal

ring

 Ilioinguinal n. 髂腹股沟神经

 Runs parallel with

iliohypogastric n. at a lower

level

 Enters inguinal canal and

emerges through superficial

inguinal ring

 Genitofemoral n. 生殖股神经

Layer ?





Subcostal incision Median or midline incision







Muscle-splitting incision Left paramedian incision





Transverse incision

Suprapubic incision

Abdomen 2





山东大学医学院 解剖教研室

李振华

Abdominal aorta 腹主动脉



 Continuation of

thoracic aorta at aortic

hiatus of diaphragm in

front of T12

 Terminates at lower

border of L4 vertebra

by dividing into right

and left common iliac

arteries

Parietal branches

 Inferior phrenic a. 膈

下动脉(one pair)

 Lumbar a. 腰动脉(four

pairs of arteries that

supply the posterior

abdominal wall)

 Median sacral a. 骶

正中动脉

Visceral branches

 Paired branches

 Middle suprarenal

artery 肾上腺中动脉

 Renal artery 肾动脉

 Testicular (ovarian)

artery 睾丸（卵巢）动脉

 Unpaired branches

 Celiac trunk 腹腔干

－a short thick vessel that

arises from the front of

aorta, at the level of T12

 Superior mesenteric a.

肠系膜上动脉－arises from

the front of aorta, at the

level of L2

 Inferior mesenteric a. 肠

系膜下动脉 －arises from

the front of aorta, at level

of L3

Celiac trunk

Left branch Left gastric a.



Right branch Short gastric a.

Common

hepatic a.

Cystic a. Splenic a.

Right gastric a.



Proper hepatic a.



Gastroduodenal a.

Splemic branches





Left gastrioeploic a.

Right gastroepiploic a.

Superior pancreaticoduodenal a.

Celiac trunk

Middle colic a. Superior

Mesenteric v.





Inf. pancresticodudenal a.

Superior

mesenteric a.

Right colic a.





Ileocolic a. Jejunal and ileal a.









Appendicular a.

Inferior mesenteric v.









Inferior mesenteric a.

Left colic a.



Sigmoid a.





Superior rectal a.

Colic marginal artery

Relations of abdominal aorta

 Anteriorly (from above

downward)

 Pancreas

 Ascending part of

duodenum

 Radix of mesentery

 Posteriorly

 Upper four lumber

vertebrae

 On its right

 Inferior vena cava

 On its left

 Left sympathetic trunk

Veins of abdomen and pelvis



Internal iliac vein 髂内静脉

 Parietal tributaries: accompany with arteries

 Visceral tributaries



→superior rectal vein→inferior mesenteric v.

①Rectal venous plexus →inferior rectal vein→internal iliac v.

直肠静脉丛 →anal vein→internal pudendal v.

②Vesical venous plexus 膀胱静脉丛→vesical v.

③Uterine venous plexus 子宫静脉丛→uterine v.

 External iliac vein

髂外静脉– accompany

the artery

 Common iliac vein

髂总静脉– formed by

union of internal and

external iliac veins in

front of sacroiliac joint,

end upon L4~L5 by

uniting each other to

form inferior vena cava

Inferior vena cava 下腔静脉

 Formed by union of two

common iliac veins anterior

to and just to the right of

L4~L5

 Ascends on the right side of

aorta, pierces vena cava

foramen of diaphragm

opposite the T8 and drains

into the right atrium

 Conveys blood from the

whole body below the

diaphragm to the right

atrium

Chief tributaries

 Parietal

 Paired inferior phrenic v.

膈下静脉

 paired lumbar v. 腰静脉 (four)

 Visceral

 Right and left renal veins 左、

右肾静脉

 Right suprarenal vein

右肾上腺静脉 (left drain into

left renal vein)

 Right testicular or ovarian v

右睾丸（卵巢）静脉. (left

drain into left renal vein)

 Hepatic veins 肝静脉: right,

left and intermediate

Relations of inferior vena cava

 Anteriorly (cranially to caudally)

 Liver

 Head of pancreas

 Horizontal part of duodenum

 Right testicular (or ovarian) a.

 Radix of mesentery

 Posteriorly

 Right crus of diaphragm

 Upper four lumber vertebrae

 Left sympathetic trunk

 Parietal branches of abdominal aorta

 On its right

 Psoas major

 Right kidney

 Right suprarenal gland

 On its left

 Abdominal aorta

Hepatic portal vein 肝门静脉

General features

 Formed behind the neck of

pancreas by the union of

superior mesenteric vein and

splenic vein

 Ascends upwards and to the

right, posterior to the first part

of duodenum and then enters

the lesser omentum to the

porta hepatis, where it divides

into right and left branches

 There are no functioning

valves in hepatic portal system

 Drains blood from

gastrointestinal tract from the

lower end of oesophagus to

the upper end of anal canal,

pancreas, gall bladder, bile

ducts and spleen

Variation and anomalies

of hepatic portal vein

Tributaries of

hepatic portal

vein

1. Superior mesenteric v.

肠系膜上静脉

2. Inferior mesenteric v.

肠系膜下静脉

3.Splenic v. 脾静脉

4.Left gastric v. 胃左静脉

5.Right gastric v.胃右静脉

6.Cystic v. 胆囊静脉

7. Paraumbilical v.

附脐静脉

Portal-systemic anastomoses

1. At the lower end of the oesophagus

Hepatic portal vein → left gastric vein → esophageal

venous plexus → esophageal vein → azygos vein

→ superiorvena cava

2. At rectal venous plexus

Hepatic portal vein → splenic vein → inferior mesenteric

vein → superior rectal vein → rectal venous plexus →

inferior rectal and anal veins → internal iliac vein →

inferior vena cava

3. At periumbilical venous plexus

Hepatic portal vein→paraumbilical vein→periumbilical

venous plexus→

 thoracoepigastric and superior epigastric vein →

superiorvena cava

 superficial epigastric and inferior epigastric veins →

inferior vena cava

4. Portal-retroperitoneal anastomosis

Between the retroperitoneal branches of the colic

veins and the lumbar veins, pancreaticoduodenal

veins with the renal veins and the subcapsular

veins of the liver with the phrenic veins twigs of

colic veins (portal) anastomosing with systemic

retroperitoneal veins

The lymphatic drainage of abdomen



Lymphatic drainage of

abdominal wall

 To axillary lymph node from

region above umbilicus

 To superficial inguinal

lymph node from region

below umbilicus

 To lumbar lymph node from

post wall of abdomen

Lymphatic drainage of

abdominal viscera

 Lumbar lymph nodes

腰淋巴结

 Lie on posterior abdominal

wall, along the abdominal

aorta and inferior vena cava

 Receive lymph from kidneys,

suprarenal glands, testes,

ovarirs, fundus of uterus,

ovary, and common iliac

nodes

 Right and left lumbar trunks

formed by efferent vessel

 Paired viscera－drain to the

lumbar lymph nodes

 Celiac lymph nodes

腹腔淋巴结

－situated around the celiac

trunk

 Superior mesenteric lymph

node 肠系膜上淋巴结

－situated around superior

mesenteric a.

 Inferior mesenteric lymph

node 肠系膜下淋巴结

－situated around inferior

mesenteric a.

 Intestinal trunk 腹腔干

－formed by efferent vessel of

celiac, superior and inferior

lymph nodes

Thoracic duct 胸导管

 Begins in front of L1 as a dilated sac, the

cisterna chyli, which formed by joining of left

and right lumbar trunks and intestinal trunk

 Enter thoracic cavity by passing through the

aortic hiatus of the diaphragm and ascends

along on the front of the vertebral column,

between thoracic aorta and azygos vein

 Travels upward, veering to the left at the

level of T5

 At the roof of the neck, it turns laterally and

arches forwards and descends to enter the

left venous angle

 Just before termination, it receives the left

jugular, subclavian and bronchomediastinal

trunks

 Drains lymph from lower limbs, pelvic cavity,

abdominal cavity, left side of thorax, and left

side of the head, neck and left upper limb

Spleen 脾

Location: lies in the left

hypochondriac region

(between stomach and

diaphragm) deep to the

9th to 11th rib, its long

axis corresponds

roughly to the 10th rib

Shape－reddish in colour

Two surfaces

 Diaphragmatic: smooth, convex

 Visceral: concave, hilum of spleen

Two extremities

 Anterior－wider

 Posterior－rounder

Two border

 Superior－has 2-3 splenic notch 脾切迹,

which serve as a landmark on palpation

when it is enlarge; normally it is not palpable

 Inferior－rounder

Functions: the spleen is considered to be

important in:

 Formation of lymphocytes and monocyte

 Phagocytosis of bacteria, inert particles and

white blood cells and platelets

 Destroying effete or abnormal red blood cells

 Making antibodies

Ralationships 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

Nervers of abdomen

Lumbar plexus 腰丛

 Formation: formed by

anterior rami of L1-L3,

a part of anterior rami

of T12and L4

 Position: lies within

substance of psoas

major

Branches

 Iliohypogastric n. 髂腹下神经

Supplies lower part of

anterior abdominal wall

 Ilioinguinal n. 髂腹股沟神经

Passes through inguinal

canal to supply skin of the

groin and scrotum

 Lateral femoral cutaneous

股外侧皮神经

 Femoral n. 股神经

 Obturator n. 闭孔神经

 Genitofemoral n. 生殖股神经

Lumbar sympathetic trunk 腰交感干

 Made up of paired chains

with four to five lumbar

ganglia anterolateral to

vertebral column

 Enters abdomen via the

diaphragm and as a

continuation of he thoracic

part

 Passes inferiorly behind

common iliac vessels and

terminations by joining to

form unpaired ganglion

impar, anterior to sacrum

Abdomen 3





山东大学医学院 解剖教研室

李振华

Relationships of abdominal viscera



 First layer－live, gallbladder, stomach

 Second layer－duodenum, pancreas, spleen

 Third layer－suprarenal gland, kidney, ureter,

inferior vena cava, abdominal aorta, nerves

and lymphatics

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

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.

 Right and left gastroepiploic

arteries arise from the

gastroduodenal and splenic

artery, repectively. These two

vessels pass into the greater

omentum, run parallel to the

greater curvature, and

anastomose end-to-end.

 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.

Venous drainage

 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.

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.

Nerve supply

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

 The anterior and posterior gastric

branches descend on the anterior

and posterior surfaces of the

stomach as a rule about 1 to 2 cm

from the lesser curvature and

parallel to it in the lesser omentum

as far as thr pyloric antrum to fan

out into branches called “crow’s foot”

to supply the pyloric part

Sympathetic innervation

 Mainly from celiac ganglia

 Affent and effent fibers derives from

thoracic segments (T5 －L1

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

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

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

Relationships of ascending part

 Right

 Head of pancreas and abdominal aorta

 Left

 Left kidney and ureter

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 anteroly,

gallbladder and superior

duodenal flexure medially,

right kidney, superarenal gland

posteriorly

Blood supply

 Arteries

 Superior

pancreaticoduodenal a.

 Inferior

pancreaticoduodenal a.

 Veins－follow arteries,

draining directly into

superior mesenteric and

hepatic portal veins

Divisions and relations of common bile duct





Supraduodenal segment

 Descends along the right

margin of hepatoduodenal lig.

 To the right of proper hepatic a.



 Anterior to hepatic portal v.



Retroduodenal segment

 Behind the superior part of

duodenum

 Anterior to the vena cava



 To the right of the hepatic

portal v.

Pancreatic segment

 Lies in a groove between

posterior surface of head of

pancreas and duodenum

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

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 pf

hepatic portal v. (formed by union of

splenic and superior mesenteric

veins

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.

Tail of pancreeas

 Runs in spleicorenal

ligament to reach hilum

of spleen

 Accompanies with

splenic vessels

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

Celiac trunk

Left branch Left gastric a.



Right branch Short gastric a.

Common

hepatic a.

Cystic a. Splenic a.

Right gastric a.



Proper hepatic a.



Gastroduodenal a.

Splemic branches





Left gastrioeploic a.

Right gastroepiploic a.

Superior pancreaticoduodenal a.

Middle colic a. Superior

Mesenteric v.





Inf. pancresticodudenal a.

Superior

mesenteric a.

Right colic a.





Ileocolic a. Jejunal and ileal a.









Appendicular a.

Inferior mesenteric v.









Inferior mesenteric a.

Left colic a.



Sigmoid a.





Superior rectal a.