Abdomen

• Openings in diaphragm

  • At 12th thoracic vertebrae: Aorta, Thoracic duct, Azygous vein
  • At 10th thoracic vertebrae : Oesophagus, Gastric/vagus nerves, oesophageal branches of left gastric artery
  • At 8th thoracic vertebrae: Inferior vena cava, Branches of right phrenic nerve, lymphatics of liver
• Lesser sac or omental bursa

  Large recess of peritoneal cavity behind stomach, lesser omentum and caudate lobe of liver.

  Closed all around except in upper part of its right border where it communicates with greater sac through epiploic foramen
• Boundaries of lesser sac

  Anterior:

  1. peritoneum covering caudate lobe and caudate process of liver
  2. posterior layer of lesser omentum
  3. peritoneum covering posterior surface of stomach
  4. second layer of greater omentum
• Boundaries of lesser sac:

  Posterior:

  1. third layer of greater omentum
  2. peritoneum covering anterosuperior process of transverse colon
  3. upper layer of transverse mesocolon
  4. peritoneum covering anterior surface of body of pancreas, left suprarenal, left kidney, splenic vessels, diaphragm
• Boundaries of lesser sac:-

  • upper : reflection of peritoneum from diaphragm to liver
  • lower : right margin of greater omentum. reflection of peritoneum from neck of pancreas to 1st part of duodenum
  • right : epiploic foramen, peritoneal reflection from diaphragm to caudate lobe
  • left : left margin of greater omentum, inner layers of gastrosplenic and lienorenal ligament
• Downward and forward course of common hepatic artery: right gastropancreatic fold.

  Upward course of left gastric artery: left gastropancreatic fold.

  These folds divide lesser sac into superior and inferior recess
• Superior recess lies behind lesser omentum and liver.

  Inferior recess lies behind stomach and within greater omentum.

  Splenic recess lies between gastrosplenic and lienorenal ligament.
• Ureter lie deep to the peritoneum, closely applied to posterior abdominal wall in upper part, and to lateral pelvic wall in lower part.
• Ureter constrictions:

  1. at pelviureteric junction
  2. at brim of lesser pelvis
  3. point of crossing of uterus by ductus deferens or broad ligament
  4. during its oblique passage through bladder wall
  5. at its opening in lateral angle of trigone
• Lymphatic drainage of stomach:

  • Upper part of left 1/3rd drains into pancreaticosplenic nodes
  • Right 2/3rd drains into left gastric nodes
  • Lower part of left 1/3rd drains into right gastroepiploic nodes
  • Pyloric part drains into pyloric, hepatic and left gastric that drains into coeliac nodes
• Boundaries of inguinal canal:

  Anterior:

  1. In its whole extent: skin, superficial fascia, external oblique aponeurosis
  2. In lateral 1/3rd: fleshy fibers of internal oblique


  Posterior

  1. In its whole extent: fascia transversalis, extraperitoneal tissue, parietal peritoneum
  2. In its medial 2/3rd: conjoint tendon, reflected part of inguinal ligament
• Boundaries of inguinal canal:

  • Roof:- arched fibers of internal oblique and transversus abdominis
  • Floor:- grooved upper surface of inguinal ligament and medial end by lacunar ligament
• Contents of spermatic cord:

  1. Testicular artery
  2. Artery to ductus deferens
  3. Cremasteric artery
  4. Genital branch of genitofemoral nerve
  5. Ilioinguinal nerve
  6. Autonomic nerve
  7. Ductus deferens
  8. Pampiniform plexus
  9. Remains of processus vaginalis
• Relations of 3 borders of head of pancreas:

  1. Superior border: overlapped by 1st part of duodenum and related to superior pancreaticoduodenal artery
  2. Inferior border: 3rd part of duodenum and inferior pancreaticoduodenal artery
  3. Right lateral border: 2nd part of duodenum and terminal part of bile duct and anastomoses of both pancreaticoduodenal artery
• Relations of 2 surfaces of head of pancreas:

  Anterior surface:

  1. 1st part of duodenum
  2. transverse colon
  3. jejunum


  Posterior surface:

  1. inferior vena cava
  2. terminal parts of renal veins
  3. right crus of diaphragm
  4. bile duct
• Relation of uncinate process of head of pancreas:

  1. Anterior: superior mesenteric vessels
  2. Posteriorly: aorta
• Primary supports of uterus:-

  Muscular/active support:

  1. Pelvic diaphragm
  2. Perineal body
  3. Distal urethral sphincter mechanism


  Fibromuscular/mechanical support:

  1. Uterine axis
  2. Pubocervical ligaments
  3. Transverse cervical ligaments of mackenrodt
  4. Uterosacral ligaments
  5. Round ligaments of uterus
• Upper mucous part of interior of anal canal:

  15mm long.

  mucous membrane shows:

  1. 6 to 10 vertical ridge called anal columns of morgagni
  2. lower end of anal columns united by short transverse folds of mucous membrane called anal valves
  3. above each valve there is a depression called anal sinus
  4. anal valves together form transverse line called pectinate/dentate line
  5. occasionally valves show epithelial projections called anal papillae
  6. anal sinus contain anal glands
• Middle part of interior of anal canal:

  Also called transitional zone or pecten.

  15 mm long.

  Mucosa has bluish appearance because of dense venous plexus.

  Lower limit has whitish appearance also called white line of hilton.

  Hilton's line is situated at the level of interval between subcutaneous part of external anal sphincter and lower border of internal anal sphincter.

  It also marks stratifies squamous epithelium which is thin, pale and glossy and devoid of sweat glands
• Lower cutaneous part of interior of anal canal

  8 mm long.

  Lined by true skin containing sebaceous glands.
• Pudendal canal:

  fascial tunnel present in lateral wall of ischioanal fossa, just above sacrotuberous ligament.


  Canal extends from lesser sciatic notch to posterior border of perineal membrane.

  • Space between obturator fascia and lunate fascia.
  • Contents: 1) Pudendal nerve: gives off inferior rectal nerve in posterior part. 2) Internal pudendal artery: gives off inferior rectal artery in posterior part. divides into perineal artery and artery of penis in anterior part.