Gross 3- test 2

• between thoracic diaphragm and pelvic inlet
• lined by peritoneum (parietal and visceral with the peritoneal cavity between)
• viscera include digestive organs, spleen, kidneys, and ureters

• between thoracic diaphragm and pelvic diaphragm
• separated into abdominal and pelvic cavitys by a plane thru the superior pelvic aperature

• inferior to ribs 7-10 costal cartilages and xiphoid
• superior to inguinal ligament and pelvic bones

• superficial fatty layer (camper's fascia)
• superficial fascia just below dermis
• equal to hypodermis
• deep membranous layer (scarpa's fascia)
• thin layer of dense irregular CT
• separated from deep fascia by a layer of loose CT for separate movements of the two layers

• investing fascia
• dense irregular CT surrounding abdominal muscles
• equal to epimysium

• loose CT between muscles and parietal peritoneum
• provides a potential surgical dissection plane

removal of unwanted fat from superficial fatty layer

deep membranous (scarpa's) too add strength

• most superficial, fibers oriented inferoanteriorly
• O: ribs 5-12
• I: linea alba, pubic tubercle, anterior 1/2 of iliac crest
• N: T6-T11 thoracoabdominal N and Subcostal N
• A: compress abdominal viscera, flex and rotate trunk
• Aponeurosis: begins at Linea Semilunaris, decussates at linea alba. inferior margin thickens into inguinal ligament

• thickening of inferior external oblique aponerosis
• extends from ASIS to pubic tubercle
• attachement for fascia lata

• intermediate layer, fibers fan out anteromedially
• O: thoracolumbar fascia, anterior 2/3 of iliac crest and inguinal lig
• I: ribs 10-12, linea alba, and pectin pubis
• N: T6-T11 Thoracoabdominal N and Subcostal N
• A: compress abdominal viscera, flex and rotate trunk
• Aponeurosis: begins at linea semilunaris, join with fibers of transversus abdominis to form conjoint tendon

• attaches to pubic crest and pectin pubis
• fibers of transversus abdominis and internal oblique aponeurosis

• innermost layer, fibers run transversomedially
• O: thoracolumbar fascia, costal cartilages 7-12, iliac crest and inguinal lig
• I: linea alba, pubic crest, pectin pubis via conjoint tendon
• N: T6-T11 Thoracoabdominal N and Subcostal N
• A: compress and support abdominal viscera
• apponeurosis: starts at linea semilunaris, forms conjoint tendon

• vertical muscle in anterior wall
• O: puubic symphysis and pubic crest
• I: xiphoid process and costal cartilages 5-7
• N: T6-T11 Thoracoabdominal N and Subcostal N
• A: flex trunk, compress abdominal viscera
• Attached to anterior rectus sheath by 3 tendinous intersections

• small, triangular, overlapping inferior portion of Rectus Abdominis muscle
• between pubis and linea alba
• A: tense linea alba

• surrounds rectus abdominis muscle
• linea alba: midline
• umbilical ring: defect, all aponeuroses fuse here
• linea semilunaris: lateral edges
• arcuate line: structural change in posterior sheath, 1/4 up from pubic crest
• decussation: fibers intertwine at linea alba

external oblique aponeurosis and anterior portion of internal oblique aponeurosis

transversus abdominis aponeurosis, postior portion of internal oblique aponeurosis and endoabdominal fascia

external oblique, internal oblique, and transversus abdominis aponeurosis

endoabdominal fascia ONLY

• move trunk
• maintain posture
• protect abdominal viscera
• compress abdominal viscera

• food
• fluid
• feces
• flatus
• fat
• fetus
• -an everted umbilicus is a sign of increased intraabdominal pressure

stretch marks

due to incomplete aponeurotic fusion around umbilical ring

• more common in women and the obese
• occur as weakness in the anterior abdominal wall arises

• in midline between xiphoid process and umbilicus
• consist of peritoneal sac covered by skin and fatty tissue

• anterior branch of ventral rami T6-T11
• between internal oblique and transversus abdominis
• innervate lateral abdominal wall muscles and skin
• branch to lateral cutaneous N and terminate as anterior cutaneous N

• anterior ventral primary ramus of T12
• innervates lateral abdominal wall muscles and skin over ASIS and hip
• sensory for T12 dermatome via lateral and anterior cutaneous N

• superior terminal branch of ventral primary ramus of L1
• -anterior cutaneous pierces External Oblique aponeurosis
• innervates internal oblique and transversus abdominus muscle
• innervates hypogastric skin and skin over iliac crest

• inferior terminal branch of L1 ventral ramus
• -thru inguinal canal
• innervates internal obliqu and transversus abdominis muscle
• innervates skin of anterior scrotum/labia majora, mons pubis and medial thigh

• Posterior intercostal As
• Subcostal As
• Lumbar As
• supply lateral hypochondriac, flank, and lumbar regions

• from internal thoracic A in 6th intercostal space
• supplies hypochondriac region

• from internal thoracic A in 6th intercostal space
• between posterior rectus sheath and rectus abdominis muscle
• supplies rectus abdominis muscle and upper umbilical region
• anastomoses with inferior epigastric A

• from external iliac A
• in transversalis fascia, enters rectus sheath inferior to arcuate line
• supplies rectus abdominis muscle and lower umbilical region

• from external iliac A
• paralles inguinal lig toward ASIS
• supplies deep inguinal region

• from femoral A
• paralles inguinal lig toward ASIS
• supplies skin in inginal region

• from femoral A
• ascends in superficial fascia toward umbilicus
• supplies skin in pubic and lower umbilical regions

• lateral thoracic V to axillary V to subclavian V
• internal thoracic V to subclavian V

• inferor epigastric V to external iliac V
• superficial epigastric V to great saphenous V to femoral V to external iliac V

small superficial tributaries of hepatic portal V

between lateral thoracic V and superficial epigastric V

• superficial lymphatics into axillary nodes (some parasternal nodes)
• superficial below unbilicus to superficial inguinal nodes
• deep lymphatics to external iliac A nodes

• done in supine position with thicks and knees bent to relax the abdominal wall
• cold hands cause involunatary spasm called guarding
• guarding also occurs when an organ is inflamed

• between ASIS and pubic tubercle
• potential site for herniations

• parallel and just superior to inguinal lig
• connects extraperitoneal space of abdomen to scrotum/labia majora

• males- spermatic cord
• females- round lig of uterus
• blood vessels, lymphatics, linioinguinal N

• internal opening of the canal
• 1 cm superior to the middle portion of inguinal lig
• lateral to inferior epigastric A
• inferior to transversus abdominis muscle
• location of evaginated trasversalis fascia

• external opening
• in inferomedial portion of external oblique aponeurosis
• superolateral to pubic tubercle
• lateral margins are called CRURA

• lateral crus- to pecting tubercle
• medial crus- to pectin crest
• internal crural fibers- between two crura

• anterior wall- external oblique aponeurosis
• posterior wall- endoabdominal fascia and conjoint tendom
• roof- internal obluiq and transversus abdominis muscle/aponeuroses
• flool- inguinal lig

• testes develop in endoabdominal fascia on posterior abdominal wall
• attached to anterior abdominal wall at deep ring by gubernaculum
• -persists as scrotal lig
• -pulls testes thru the canal into the scrotal sac

• peritoneum transversing the inguinal canal
• carries things thru the canal and persists as fascia around the spermatic cord
• distal sacular portion persistas as the tunica vaginalis

• ovaries develop in endoabdominal fascia of posterior abdominal wall
• processus vaginalis protrudes into labia majora
• gubernaculum- connects ovaries and uterus to labia majora

• ovarian lig- between ovary and uterus, prevents ovaries from descending
• round lig of the uterus- between uterus and labia majora

• superolateral to pubic tubercle
• invaginate skin of upper scrotum, adjacent to spermatic cord with index finger
• turn your head a cough

• contains structures to/from the testis
• begins at deep inguinal ring, thru inguinal canal and superficial ring, ends at testis

• external spermatic fascia- evaginated external oblique aponeurosis and investing fascia
• cremasteric fascia- evaginated internal oblique investing fascia
• internal spermatic fascia- evaginated transversalis fascia

• evaginated internal oblique muscle
• raises/lowers testis in response to temperature
• innervated by genital branch of genitofemoral N (L1,2)

• contraction of muscle elicited by lightly stroking the skin of superomedial thigh (ilioinguinal N- L1)
• highly active reflexes simulate undescended testes

• muscular tube
• carries spermatozoa from tail of epidiymis to ejaculatory duct

• branches from abdominal aorta inferior to renal A
• retroperitoneal where it crosses the ureter and external iliac As
• enters inguinal canal at deep inguinal ring, exits at superficial inguinal ring
• supplies testis and epididymis

branched from inferior vesical A

from inferior epigastric A

• 8-12 veins surrounding testicular A
• anteror to ductus deferense
• thermoregulator
• converge to form testicular V
• -R drains to inferior vena cava
• -L drains to L renal V

• sypathetics (T10-11) to testicular A and ductus deferens
• -efferent and visceral afferent
• -contraction of ductus deferens during emission
• parasympathetics (Vagus) to ductus deferens
• -relaxes ductus deferens after emission

innervates cremaster muscle

• drain testis and epididymis to lumbar lymph nodes
• scrotum drainage goes to superficial inguinal nodes

• ductus deferens
• testicular A
• ductus deferens A
• cremaster A
• pampiniform venous plexus
• autonomic nerve fibers
• genital branch of genitofemoral N
• lymphatics

• skin- pigmented, hairless
• dartos fascia- continuation of scarpas fascia and colles fascia
• site for smooth muscle attachement
• -contracts when cold
• forms scrotal septum at scrotal raphe

• parietal and visceral layers
• parietal layer fuses to internal surface of internal spermatic fascia
• visceral layer fuses to external surface of testis and epididymis
• -posterior surface is uncovered
• mesorchium- from extensive tunica vaginalis, allows twisting of testis

• anterior scrotal A- off deep external pudendal A
• posterior scrotal A- off perineal A
• veins accompany As

• genital branch of genitofemoral N- (L1-2) to anterolateral surface of scrotum
• anterior scrotal N- from ilioinguinal N (L1) to anterior surface of the scrotum
• posterior scrotal N- from perineal N (S2-4) to posterior surface of the scrotum
• posterior femoral cutaneous N- (S2-3) to inferior surface of the scrotum

• tightly convoluted duct on posterior surface of testis
• covered by visceral tunica vaginalis
• head is superiorly, tail is inferiorly
• ductus deferens begins at the tail
• connected to the testis by efferent ductules
• function- storage/maturation of sperm

• ovoid organ suspended in scrotum by spermatic cord
• -L is usually lower
• tunica albuginea capsule covered by visceral tunica vaginalis

• undescended testis
• usually located in inguinal canal
• risk of malignancy is high if left uncorrected

• excess fluid in a processus vaginalis
• -indirect inguinal hernia
• excessive secretion by visceral tunica vaginalis
• adjacent to testis or in the spermatic cord

• blood between visceral/parietal tunica vaginalis
• caused by traumatic injury
• hematoma- accumulation of blood in any extravascular location

• tortuous dilation in pampiniform venous plexus
• valve insufficiency or venous return problems
• -more common on L becuase of testicular V drainage

• bilateral excision of ductus deferens thru superioranterior scrotum
• prevents sperm from passing
• doesnt affect secretions from accessory glands

• lining internal surface of abdominopelvic wall
• somatic sensory innervation via dermatome

• covering abdominopelvic viscera
• no somatic sensory innervation
• visceral afferent innervation causing refered pain
• same as serosa

• spave between parietal and visceral peritoneum
• thin fil of peritoneal fluid to lubricate surfaces and fight infection
• open to exterior in females via uterine tubes, uterus and vagina
• completely closed in males

• almost completely covered by visceral peritoneum
• NOT inside peritoneal cavity
• embryonically suspended by mesentery and remain suspended

• partiall covered by parietal peritoneum, external to peritoneal cavity
• primary retroperitoneal- embryonically behind peritoneun
• secondary retroperitoneal- become retroperitoneal due to return of gut

• painful, inflammation of peritoneum
• develop ascites (excess fluid)
• fluid flows along paracolic gutters and is reabsorbed in pelvis (best resprtion in thoracic diaphragm)
• commonly causes adhesions

• median umbilical fold- from apex of urinary bladder to umbilicus
• contains median umbilical lig
• medial umbilical fold- lateral to median fold
• contains medial umbilical lig
• lateral umbilical fold- lateral to medial fold
• contains inferiro epigastric A/V

• supravesical fossa- between median and medial folds
• location of parietal peritoneum reflection to urinary bladder
• medial inguinal fossa- between medial and lateral folds
• site of a direct hernia out superficial inguinal ring
• lateral inguinal fossa- lateral to lateral fold
• site of indirect inguinal hernia thru deep inguinal ring into the spermatic cord

• more common in females
• protrusion inferior to inguinal lig thru the femoral ring and canal
• extends into upper medial thigh

• double layer of peritoneum connecting intraperitoneal organ to posterior abdominal wall
• froms as intraperitoneal organ invaginates into peritoneal cavity
• contains nerves and vasculature to the organ

• double layer of peritoneum from lesser curvature of the stomach and proximal duodenum to the liver
• remnant of ventral mesentary

lesser omentum from liver to lesser curvature of the stomach

• thick right side of lesser omentum
• from liver to proximal duodenum and surrounds the portal triad

• aprom from greater curvature of sotmach and then folding back on itself to transverse colon
• remnant of dorsal mesentary
• prevents abdominal viscera from adhearing to anterolataeral wall, protection

• largest portion of greater omentum
• from greater curvature of stomach to transverse colon

from greater curvature of stomach to spleen

from greater curvature of stomach to thoracic diaphragm

• main, large portion
• supracolic compartment- anterosuperior to greater omentum and transverse colon (stomach, liver, spleen)
• infracolic compartment- posteroinferior to greater omentum and transverse colon, right and left sides (small intestine, up and down colon)
• paracolic gutters- grooves between lateral sides of up/down colon and posterolateral abdominal wall

• posterior to stomach and lesser omentum
• superiorly behind liver and up to diaphragm
• inferiorly between superior layers of gastrocolic lig

• communication between greater and lesser sacs
• posterior to hepatoduodenal lig

• muscular tube from pharynx to stomach
• follows curvature of vertebral column
• covered by adventitia above diaphragm, serosa below

crossed by cricopharyngeus muscle

passes thru diaphragm

• thru right crus of the diaphragm at T10
• phrenicoesophageal ligs- esophagus to diaphragm at hiatus, allow independent movement and seal off cavities

• left of midline at T11
• right border is continuous with lesser curvature of the stomach
• left border separated by cardiac notch
• cardiac sphincter prevents gastric reflux

• esophageal branch of L gastric A
• left inferior phrenic A

• superiorly thru esophageal Vs (to azygos veins)
• inferiorly thru L gastric Vs (to hepatic portal v)

primary nodes are LEFT GASTRIC LYMPH NODES

• from esophageal plexus
• parasympathetics via vagal trunks
• sympathetic via greater splanchnic N
• -presynaptic- ciliac ganglion
• -postsynaptic- periarterial plexus

• enlarged submucosal Vs with portal hypertension
• rupture is a potentially fatal condition
• associated with cirrhosis

• heartburn
• acid reflux thru cardiac sphincter

• intraperitoneal in uppermost left adbominal quadrant
• food blender, resorvoir, initiates digestion
• gastric juice begins digesting into chyme
• adult stomach holds 2-3 liters
• newborn stomach holds 30 mls

• cardai- T11, entrance of esophagus
• fundus- under left dome of diaphragm
• cardiac notch- between esophagus and fundus
• body
• pyloris- exit of stomach
• lesser curvature- right side
• angular incisure- indentation at junction of body and pyloris
• greater curvature- longer left side

• pyloric antrun- funnel- shapped extension of body
• pyloric canal- leading to sphincter
• pyloric sphincter- regulates exit

protrusion of stomach into mediastinum via esophageal hiatus

• esophagus, cardia and parts of fundus slide thru esophageal hiatus
• associated with acid reflux

• esophagus and cardia normal
• pouch of peritoneum extends thru hiatus
• acid reflux not an issue

• left gastric A- primary, along lesser curvature
• R gastric A- anastomoses with L gastric along lesser curvature
• R gastroepiploic A- greater curvature, in greater omentum
• L gastroepiploic A- anastomoses with R gastroepiploic A
• Short gastric As- 4-5, supplying fundus

• parallel arteries
• drain to liver
• L/R gastric Cs to hepatic portal V
• short gastric and gatroepiploic to splenic C
• r gastroepiploic to superior mesenteric V

• primary gastric nodes on lesser curvature
• gastroepiploic nodes on greater curvature
• ciliac nodes secondary

• parasymapthetic presynaptic- from vagal trunks. enter abdomen via esophageal hiatus, synapse on myenteric/submucosal ganglia
• sympathetic presynaptic- via greater splanchnic. synapse on postsynaptic neurons in ciliac ganglion. pass in tunica adventitia of arterial vessels into stomach

• if in body or pyloric part may be palpable
• evaluated by gastroscopy
• extensive lymphatic drainage and number of nodes creates surgical problems

• total is uncommon
• partial may be done
• extensive arterial anastomoses provides good vascular support

• 90% caused by infection with helicobater pylori and treatable by antibiotics
• -gastric mucous breaks down
• -if complete perforation occurs, peritonitis may be life threatening
• acid secretion by parasympathetic innervation
• vagotomy at esophageal hiatus is sometimes done for chronic ulces

• pylorus to duodenaljejunal junction
• -C shaped around head of pancreas
• mostly retroperitoneal

• ascends slightly from pylorus
• retroperitoneal
• attached to liver by hepatoduodenal lig

• curves around right side of head of pancreas
• major duodenal papilla- internal opening of common bild duct and main pancreatic duct at hepatopancreatic ampulla

• crosses to left side of body
• superior mesenteric A/V- anterior to this portion

• ends at duodenojejunal junction
• supported by suspensory muscle of duodenum, facilitates movement upon contraction

• superior pancreatioduodenal A- from gastroduodenal A. supplies proximal to major duodenal papilla
• inferior pancreaticoduodenal A- from superior mesenteric A. supplies distal to major duodenal papilla. anastomoses with ciliac trunk and superior mesenteric A

• supplies distal esophagus to major duodenal papilla
• artery of the foregut

• supplies major duodenal papilla to near left colic flexure
• arter of the midgut

hepatic portal v

• anteriorly: pancreaticoduodenal nodes to pyloric nodes
• posteriorly: superior mesenteric nodes
• secondary: celiac nodes

• parasympathetic- posterior vagal trunk
• sympathetic- greater and lesser splanchnic thru celiac and superior mesenteric plexuses

• largest gland
• upper right quadrant
• critical metabolic organ

• subphrenic recess- extension of greater sac between liver and diaphragm, separated by falciform lig
• hepatorenal recess- inferir extension of greater sac b/t liver and right kidney. bare area of the liver posteriorly
• coronary lig- anterior and posterior peritoneal reflections
• -triangular lig- right is anterior and posterior coronary ligs, left is falciform lig and lesser omentum

• posteriorinferior flat/concave aspect
• visceral peritoneum
• porta hepatis
• transverse fissure between caudate and quadrate lobes

• left lobe
• right lobe
• caudate lobe- between ligamentum venosum and IVC
• -caudate process- extension of caudate lobe connecting it to the right lobe
• quadrate lobe- b/t gall bladder fossa and ligamentum teres

• remnant of fetal umbilical V
• on free edge of falciform lig

• remnant of fetal ductus venosus
• on visceral surface between caudate lobe and left lobe

• hepatic portal v- 75% of blood to liver
• nutrient rich, bilirubin rich, pooly oxygenated
• confluence of superior mesenteric V and splenic V
• proper hepatic A- 25% of blood
• highly oxygenated
• off of common hepatic A, splits into right and left hepatic As

• right, middle, and left hepatic vs
• drain into IVC

• primary nodes= hepatic nodes
• secondary nodes= celiac nodes

• via celiac plexus
• sympathetics- greater splanchnic N, synapse in celiac ganglion
• parasympathetics- vagal trunk
• visceral afferents- T6-9 cord levels, via R greater splanchnic N

• loss of hepatocytes and their replacement with fibrous CT
• surface appears nodular
• seen in chronic alcoholics
• associated with hepatomegaly and portal hypertension

• produces bile continuously
• gall bladder stores and concentrates bile

bile canaliculi to bile ducts to R/L hepatic ducts to common hepatic duct. joins with cystic duct to form common bile duct

• in gallbladder fossa on visceral surface of liver
• at junction of R/L functional lobes
• on superior part of duodenum

• fundus- projecting from anteroinferior border of liver, just below tip of right 9th costal cartilage
• body- adjacent to visceral surface of liver
• neck- narrow, mucosa in this section spirals to form the spiral valve of the gallbladder
• cystic duct- neck of gallbladder to common hepatic duct

cystic A off of right hepatic A

cystic Vs to hepatic portal v

• primary nodes= cystic and hepatic nodes
• secondary nodes= celiac nodes

• via celiac plexus
• parasympathetics- vagal trunk
• sympathetics- greater splanchnic N, synapse in celiac ganglion
• visceral afferents- in splanchnic nerves back to T6-9

• cholesterol based
• small stones are most problematic because they get out of the gallbladder and get stuck somewhere
• cause jaundice and pancreatitis
• stones may be lodged in cystic duct causing liliary colic
• large stones usually asymptomatic

gallbladder removal

• largest lymphatic organ
• intraperitoneal
• filters blood
• not vital

from spleen to greater curvature of stomach

from spleen to posterior wall near kidney

• splenic A
• largest branch off celiac trunk

• splenic v
• joined by inferior mesenteric V to superior mesenteric V to form hepatic portal v

• primary nodes= pancreaticosplenic nodes
• secondary nodes= celiac or superior mesenteric nodes

• via celiac plexus
• sympathetics- greater splanchnic N (synapse in celiac ganglion)
• no parasymp innervation

• protected by ribs 9-12
• injured due to trauma or rib fracture
• if ruptured= hemorrhage= bad

• surgical repair of ruptured spleen is difficult
• some regeneratio possible if only partially removed
• functions taken over by liver and bone marrow

one or more usually present near hilum in 10%

• retroperitoneal
• exocrine function: digestive enzymes into duodenum
• endocrine function: insulin/glucagon secretion to blood

• head- right side, surrounded by duodenum.
• uncinate process- inferomedial extension of head
• Neck- short
• body- elongated left side
• tail- anterior to L kidney, near hilum of spleen

• main pancreatic duct- from tail to head of pancreas
• merges with common bile duct at hepatopancreatic ampula
• opens into duodenum at major duodenal papilla
• accessory pancreatic duct- may be pressent

• pancreatic As- along splenic A, supply body and tail
• anterior/posterior superior pancreaticoduodenal A- off gastroduodenal A, supplys superior head
• anterior/posterior inferior pancreatioduodenal A- off superior mesenteric, supplys inferior head

pancreatic veins- drain to plenic V and superior mesenteric V

• primary nodes= pancreaticoplenic nodes
• secondary nodes= celiac, superior mesenteric and hepatic nodes

• sympathetics- greater and lesser splanchnic N, synapse in celiac and superior mesenteric ganglia
• parasympathetic- vagal trunks and celiac and superior mesenteric plexuses
• -most secretions stimulated via hormones

• inflammation of pancreas/blockage of pancreatic duct
• pancreatectomy is performed
• -impossible to completely remove the head of the pancreas

• leads to obstructive jaundice
• causes duct obstruction

• beings at duodenojejunal flexure
• intraperitoneal

• ends at ileocecal junction
• suspended in mesentary
• absorption of food stuffs

• superior mesenteric A- off abdominal aorta, in mesentery
• -jejunal/ileal As- 15-18 brances off left side of superior mesenteric
• -unite to form arcades
• -branches off arcades are vasa recta

superior mesenteric V

• primary nodes= mesenteric nodes
• secondary nodes= superior mesenteric nodes

• perivascular nerve plexus to arteries
• sympathetics- greater lesser splanchnic N. synapse in celiac and superior mesenteric ganglia
• parasympathetic- vagal trunks, synapse in myenteric and submucosal plexuses
• visceral afferents to T8-10

• remnant of omphaloenteric duct
• fingerlike puch on anterior ileum

• completes absorption, compacts and stores feces
• tenia coli- 3 longitudinal strips of smooth muscle
• haustra- sacculations in wall of colon
• epiploic appendages- fatty projections on outside of large intestine

• beginning of large intesting
• pouch at inferior portion of scending
• at ileocecal junction
• intraperitoneal

• intestinal diverticulum on cecum
• contains large amounts of GALT
• mesoappendix- short triangular mesentery of appendix

• inflammation of appendix
• obstruction leads to swelling and pain
• rupture results in peritonitis, nausea, pain
• appendecomy to remove

• ileocolic A- terminal branch of superior mesenteric A
• -appendicular A- branch off ileocolic

ileocolic V- to superior mesenteric V

• primary nodes= ileocecal nodes
• secondary nodes= superior mesenteric nodes

• sympathetics- lesser splanchnic N, synapse of superior mesenteric ganglion
• parasympathetics- vagal trunks, synapse in myenteric and submucosal plexuses
• visceral afferents- to T10

• right colic flexure- bend into transverse colon
• retroperitoneal

• right colic A- from superior mesenteric A
• -marginal A- paralles inner length of colon
• ileocolic A- terminal branch of superior mesenteric A

ileocolic V and right colic V to superior mesenteric V

• primary nodes= paracolic, ileocolic, right colic nodes
• secondary nodes= superior mesenteric nodes

• sympathetics- lesser splanchnic N, synapse in superior mesenteric ganglion
• parasympathetics- vagal trunks, synapse in myenteric and submucosal plexuses
• visceral afferents- T10

• largest portion
• right colic flexure to left colic flexure
• suspended transverse mesocolon

middle colic A- branch from superior mesenteric, helps form marginal A

middle colic V drains to superior mesenteric V

• primary nodes= middle colic nodes
• secondary nodes= superior mesenteric nodes

• sympathetics- lesser splanchnic N and superior mesenteric plexus
• parasympathetics- vagal trunks and superior mesenteric plexus

from L colic flexure to left iliac fossa where it transitions to sigmoid colon

s shaped segment, transitions to rectum where mesentery dissapears

• L colic A- branches from inferior mesenteric A to descending colon. Marginal A connects to middle colic
• sigmoidal As- branch from inferior mesenteric A

inferior mesenteric V- to splenic V and then hepatic portal V

• primary nodes= paracolic or left colic nodes
• secondary nodes= inferior or superior mesenteric nodes

• sympathetic= least and lumbar splanchnic N, synapase in superior or inferior mesenteric ganglia
• parasympathetic= pelvic splanchnic N

• retroperitoneal, right lower than left
• removes salts and waste from blood
• maintains water balance in body
• creates urine

located inside renal fascia

• superomedially to each kidney in perirenal fat
• produce corticosteroids, androgens, epinephrine, and norepinephrine

located outside the renal fascia

• donor kidney might be removed
• suprarenal gland left in place
• transplanted kidney placed in iliac fossa

• hilum- on medial surface entry of renal V, renal A, ureter
• renal sinus- fat filled space housing renal pelvis
• renal pelvis- origin of ureter, collects urine from major calyces, minor calyces, medulla, renal pyramids, and renal columns

renal a- branches from abdominal aorta, right side longer, posterior to IVC, divides to anterior and posterior

• renal v- union of intrarenal veins.
• -L recieves left inferior phrenic v, left suprarenal v, and left gonadal v
• -on right these drain to IVC

primary drainage= lumbar lymph nodes

• sympathetic- renal plexus supplied by lesser and least splanchnic N, synapse in aorticorenal ganglion
• parasympathetics- renal plexus supplied by poserior vagal trunk

muscular duct from kidney to urinary bladder, retroperitoneal

renal A, gonadal A, abdominal A

renal v, gonadal v

primary nodes= lumbar or common iliac nodes

sympathetics- T11-L2

• stones in kidney, ureter, and urinary bladder
• cause fluid backup= hydornephrosis
• refered pain from T11-L2 dermatomes depending on location of stone
• lithotripsy- shockwaves that break up stones

duplication of induction process causing double

• inferior poles of the kidneys fuse together forming one horseshoe shaped kidney
• at L3-5 level

• kidney fails to ascend out of kidney
• may be injured during pregnancy
• blood from common iliac A

• between kidey and thoracid diaphragm
• enclosed by perirenal fat
• right- pyramidal shaped
• left- semilunar shaped

• secretes corticosteroids and androgens
• endocrine related activites

• secretes epinephrine and norepinephrine
• sympathetic activities
• regulated by sympathetic innervation
• presynaptic sympathetics innervate medullary cells directly

• superior suprarenal A- off inferior phrenic
• middle suprarenal A- off abdominal aorta
• inferior suprarenal A- off renal A

• suprarenal V
• R to IVC, L to L renal V

efferent only to lumbar nodes

• sympathetics- lesser and least splanchnic N and celiac plexus
• parasympathetic- posterior vagal trunk and celiac plexus

• b/t abdominal and throacic cavities
• primary muscle for inspiration
• parietal pericardium attaches to central part of diaphragm by pericardiacophrenic lig

• sternal part- 2 slips of muscle to posterior aspect of xiphoid process
• costal part- wide muscular slips to internal surface of inferior 6 costal cartilages, forms domes of diaphragm
• lumbar part- muscular crura

• right crus- larger and longer
• L1-3
• encircles seophageal hiatus, right side of aortic hiatus
• left crus- L1-2
• left side of aortic hiatus

• median arcuate lig- over anterior aspect of abdominal aorta, unites R and L crura
• medial arcuate lig- superior to psoas major, from L1 body to transverse process
• lateral arcuate lig- superior to quadratus lumborum muscle, L1- 12th rib

• caval opening- for IVC, in central tendon, T8/9 IVD, diaphragm facilitates venous return
• esophageal hiatus- in right crus, T10, forms lower esophageal sphincter
• aortic hiatus- posterior to diaphragm, T12

• contraction
• diaphragm descent compresses abdominal viscera, decreases intrathoracic pressure, air into lungs

• superior surface: pericardiacophrenic A, musculophrenic A, superior phrenic A
• inferior surface: inferior phrenic A

• inferior phrenic V
• -Right side drains to IVC
• -Left side drains to left suprerenal V

• abdominal surface main absorption for peritoneal fluid
• primary nodes= anterior/posterior diaphragmatic nodes
• secondary nodes= parasternal and posterior mediastinal nodes

• motor- phrenic N
• central sensory- phrenic N
• peripheral sensory- intercostal N and subcostal N

• due to injury of phrenic N
• permanent elevation and paradoxical movement
• -elevation of paralyzed diaphragm during contraction

• fusiform, lateral to lumbar vertebra
• O: TPs, bodies, IVDs of T12-L5
• I: lesser trochanter of femur with iliacus
• deep to inguinal lig
• A: flexes thigh, flexes trunk, balance trunk
• N: L1-L3

• triangular, lateral to inferior psoas major
• O: ala of sacrum, iliac fossa, saroiliac lig
• I: lesser trochanter
• A: flex thigh, stabalize hip
• N: femoral N

• O: R12, lumbar TPs
• I: iliolumbar lig, iliac crest
• A: depress/stabilize R12, laterally flex trunk
• N: T12-L4

• between parietal peritoneum and musculature
• continuous with transversalis fascia

• transparent in thoracic region
• stron in lujbar region
• spans from R12 to iliac crest

• iliopsoas muscle
• movement causes pain
• iliopsoas test
• patient lays on side, extends affected leg against resistance

• disease or infection may spread to psoas sheath
• fascia thickens and becomes taut
• pus spreads throughout compartment
• causes pain

• ventral rami T12
• to external oblique and T12 dermatome

• dorsal rami to back muscles
• ventral rami thru psoas major from lumbar plexus

• ventral rami L1-4
• postsynaptic from gray rami communicantes

• ventral rami T1
• innervate abdominal oblique muscles and L1 dermatome

• L2-3 ventral rami
• under inguinal lig
• sensory to anterolateral thigh

• L2-4 ventral rami
• to iliacus, hip flexors and knee extensors

• L1-2 ventral rami
• genital branch- thru deep inguinal ring
• sensory to anterolateral skin of scrotum/labia majora
• motor to cremaster muscle
• femoral branch- along external iliac A
• sensory over femoral triangle

• L2-L4 ventral rami
• innervates adductor thigh muscles

• L4-5
• joins wiht S1-4 to form sacral plexus of nerves

• 4 paravertebral ganglia
• presynaptic- lateral horn as low as L2-3
• postsynaptic- thru gray rami communicantes

• presynaptic sympathetics- T5-L2
• pass thru sympathetic trunk without synapsing

• from esophageal plexus thru esophageal hiatus
• presynaptic parasympathetics
• innervate lower esophagus to splenic flexure of colon and viscera

• ventral rami S2-4
• keep the feces off the floor

• via greater and lesser splanchnic N, posterior vagal trunk
• mainly to foregut

• lesser and least splanchnic, posterior vagal trunk
• mainly to midgut

• lumbar splanchnic, pelvic splanchnic
• mainly to hindgut

• lumbar splanchnic, pelvic splanchnic
• to ureteric and gonadal plexuses

• lumbar and pelvic splanchnic
• to pelvic viscera

enlargement of abdominal aorta