1st Part of Duodenum (Superior)
4-3-1-1 / 1) Neck of the Gall Bladder / 1) Neck of the Pancreas / 1) Gall Bladder
2) Peritoneum
3) Quadrate Lobe of the Liver / 1) Portal Vein
2) Common Bile Duct
3) Gastroduodenal Artery
4) Inferior Vena Cava
2nd Part of Duodenum (Descending)
4-3-3 / 1) Transverse Colon
2) Transverse Mesocolon
3) Some coils of the Small Intestine / 1) Hilus of the Right Kidney
2) Renal Vessels
3) Right Ureter
4) Right Psoas Major Muscle / 1) Head of the Pancreas
2) Pancreatic Duct
3) Common Bile Duct
3rd Part of Duodenum (Horizontal)
4-3-3 / 1) Head of the Pancreas
2) Superior Mesenteric Artery
3) Superior Mesenteric Vein / 1) Superior Mesenteric Artery
2) Superior Mesenteric Vein
3) Coils of the Small Intestine / 1) Abdominal Aorta
2) Inferior Vena Cava
3) Right Psoas Major Muscle
4) Right Ureter
4th Part of Duodenum (Ascending)
2-2-1-1 / 1) Body of the Pancreas / 1) Beginning of the root of the Mesentery
2) Coils of Jejunum / 1) Left Psoas Major Muscle
2) Left Margin of the Aorta / 1) Head of the Pancreas
Right Kidney
5-5 / 1) Suprarenal Gland
2) Liver
3) Hepatic Flexure of the Colon
4) 2nd part of the Duodenum
5) Small Intestine / 1) 12th Rib
2) Diaphragm
3) Aponeurosis of Transversus Abdominis
4) Quadratus Lumborum
5) Right Psoas Major
Left Kidney
6-6 / 1) Suprarenal Gland
2) Stomach
3) Spleen
4) Pancreas
5) Splenic Flexure of the Colon
6) Jejunum / 1) 11th rib
2) 12th rib
3) Diaphragm
4) Aponeurosis of Transversus Abdominis
5) Quadratus Lumborum
6) Left Psoas Major
Right Suprarenal Gland
2-1 / 1) Inferior Vena Cava
2) Right Lobe of the Liver / 1) Right Kidney
Left Suprarenal Gland
1-3 / 1) Body of the Pancreas / 1) Abdominal Aorta
2) Splenic Artery
3) Stomach
Right Upper Lobe of Lung / 1) First 4 ribs and their costal cartilages
Right Middle Lobe of Lung / 1) 4th and 5th ribs and their costal cartilages
Uncinate Process of Pancreas / 1) Superior Mesenteric Vessels
Head of Pancreas (including the Uncinate Process)
2-3 / 1) Superior Mesenteric Artery
2) Superior Mesenteric Vein / 1) Inferior Vena Cava
2) Bile Duct
3) Right Renal Vessels
Neck of Pancreas
2-3 / 1) Peritoneum
2) Pylorus of the Stomach / 1) Superior Mesenteric Artery
2) Superior Mesenteric Vein
3) Formation of Portal Vein
Body of the Pancreas
4-4 / 1) Splenic Artery / 1) Peritoneum
2) Bed of the Stomach
3) Provides attachment for the Transverse Mesocolon
4) Omental Bursa / 1) Aorta
2) Superior Mesenteric Artery
3) Left Suprarenal Gland
4) Left Kidney
Spleen / 1) Superior Pole of the Left Kidney
2) Left colic flexure (Splenic flexure)?? / 1) It contacts the diaphragm at the 9th to 11th ribs
Lesser Sac/Omental Bursa / 1) Posterior Part of the Coronary Ligament
2) Diaphragm / 1) Transverse Colon
2) Transverse Mesocolon
3) The Greater Omentum / 1) Posterior Wall of the Stomach
2) Lesser Omentum / 3) Posterior Abdominal Wall
4) Retroperitoneal structures: pancreas, left suprarenal gland and left kidney / Left Boundary:
1) Gastrophrenic Ligament
2) Splenorenal Ligament
3) Gastrosplenic ligament
Epiploic Foramen / 1) Caudate Lobe of the Liver / 1) First part of the duodenum / 1) Hepatoduodenal Ligament (portal vein, common bile duct and proper hepatic artery) / 1) The Inferior Vena Cava
2) Right Crus of the Diaphragm
Stomach / 1) Liver (mostly the left lobe) is superior to the body and pylorus / 1) Transverse Colon and Left Colic Flexure inferior/posterior to the body of the stomach / 1) Anterior Abdominal Wall / Bed of Stomach (formed by Posterior Wall of the Lesser Sac):
1) Retroperitoneal Structures: Pancreas, Left Kidney, Left Suprarenal Gland, Part of the Diaphragm, Celiac Artery and Proximal Branches, Splenic Artery and Splenic Vein, Terminal Part of the Superior Mesenteric Artery and Vein (9)
2) Peritoneal Structures: Transverse Colon and Spleen (2) / To the left of the body is the spleen
Bare Area of the Liver / 1) Hepatic Veins
2) Inferior Vena Cava
3) Right Suprarenal Gland
4) Part of Right Kidney
Left Lobe of the Liver / 1) Body and pylorus of the stomach
Diaphragm Passages:
1) Caval Opening: @ TV8 2-3 cm from the median plane
a. Inferior Vena Cava
2) Esophageal Hiatus: Formed by the Right Crus of the Diaphragm @ TV10
a. Esophagus
b. Anterior and Posterior Vagal Trunks
3) Aortic Hiatus: @TV12
a. Aorta
b. Azygos Vein
c. Thoracic Duct
Some Important Pathways
Ureters:
1) Transitions from the renal pelvis and descends as a retroperitoneal structure along the anterior surface of the psoas major muscle. It passes posterior to the testicular/ovarian vessels. The left ureter is also crossed by the inferior mesenteric artery and vein. Then, it courses anterior to the bifurcation of the common iliac artery. It makes a sharp bend over the pelvic brim and courses to the bladder in the floor of the pelvis.
Inferior Thyroid Vein:
1) Anterior to the trachea. Courses downward anterior to the brachiocephalic artery.
***The Transverse mesocolon attaches to the anterior margin of the pancreas. The pancreas lies posterior to the omental bursa (lesser sac).
Important Innervations
1) Kidney: Postganglionic SS Fibers from the Lesser and Least Splanchnic nerves (T10-12) (from aorticorenal ganglion)
2) Ureter: Postganglionic SS from the Lesser and Least and Lumbar and Sacral Splanchnic nerves, VA travel back with the Lesser and Least and Lumbar Splanchnic nerves (T10-L2)
3) Suprarenal Glands- Cortex: Postganglionic SS from Celiac Ganglion, driven by preganglionic fibers from the Greater Splanchnic nerve. (NO SENSORY AFFERENTS or VA)
4) Suprarenal Glands-Medulla: Receive Preganglionic SS Fibers from the Greater Splanchnic Nerve (T5-T9) (NO SENSORY AFFERENTS OR VA)
Right Upper Quadrant / rt. lobe of liver, gallbladder, pylorus, the first three parts of the duodenum, head of the pancreas, rt. suprarenal (adrenal) gland, rt. kidney, rt. colic (hepatic) flexure, sup. part of ascending colon, rt. half of transverse colonLeft Upper Quadrant / lt. lobe of liver, spleen, most of stomach, jejunum and proximal ileum, body and tail of pancreas, lt. suprarenal (adrenal) gland, lt. kidney, lt. colic (splenic) flexure, sup. part of descending colon, lt. half of transverse colon
Right Lower Quadrant / cecum, appendix, most of ileum, inf. part of ascending colon, rt. ovary, rt. uterine tube, rt. ureter, rt. spermatic cord
Left Lower Quadrant / sigmoid colon, inf. part of descending colon, lt. ovary, lt. uterine tube, lt. ureter, lt. spermatic cord
Organ / Innervation / Referred Pain
Parietal Pleura / Ventral Primary Rami/Intercostal nerves and phrenic nn. / Via Thoracic and Abdominal Nerves (cutaneous distribution of intercostal nn.)
Anterior Abdominal Wall / Thoracoabdominal nn. (T7-T11), subcostal n. (T12), iliohypogastric n. (L1) and ilioinguinal n. (L1) / T7- xiphoid process, T10- umbilicus, pubis (L1- via iliohypogastric n.)
Parietal Peritoneum
-Sensitive to touch, pain and temperature / Sensory: Intercostal, Lumbar and Sacral nn.
Sensory of Thoracic Diaphragm:
1) Intercostal nn. to costal margin (peripheral part) of the diaphragm (T5-T11) and subcostal n.
2) Phrenic n. (C3-5) to central diaphragm
Stomach / PS: Vagus n. (primarily the Anterior Vagal Trunk)
SS: Greater Splanchnic n. (T5-9) and postganglionics from the celiac ganglion
VA: pain via greater splanchnic n. / T5-9 (Left Epigastrium Quadrant) via Left Greater Splanchnic n.
Gall Bladder / PS: Vagus n.
SS: Greater Splanchnic n. (T5-9) and postganglionics from the celiac ganglion
VA: pain via greater splanchnic n. / T5-9 (Right Epigastrium Quadrant) via Right Greater Splanchnic n.
**If bile spreads to the inferior surface of the diaphragm, pain follows Right Phrenic n. (Right Shoulder C3-5)
Duodenum / PS: Vagus n.
SS: plexus on pancreaticoduodenal arteries
Pancreas / PS: Vagus n. (celiac and superior mesenteric plexuses)
SS: Splanchnic nn. (celiac and superior mesenteric plexuses)
VA: pain via splanchnic nn.
Spleen / Celiac Plexus
Small Intestine (Jejunum and Ileum) / Celiac and Superior Mesenteric Plexuses / Insensitive to most painful stimuli, including cutting and burning. But it is sensitive to distention.
Cecum and Appendix / Celiac and Superior Mesenteric Ganglia
Ascending Colon / Celiac and Superior Mesenteric Ganglia
Transverse Colon / Superior Mesenteric Plexus
Descending Colon / Lumbar part of the Sympathetic Trunk and the Superior Hypogastric Plexus
Sigmoid Colon / Superior Hypogastric Plexus and Pelvic Splanchnic nn.
Diaphragm / Motor: Phrenic n. (C3-5)
Sensory: Phrenic n. and peripheral areas via 6th and 7th intercostal nn. and the subcostal n. / Shoulder region (C4-C5 ventral rami)
Costal margin (via intercostal nn.)
Kidney / SS: Preganglionics from Lesser and Least Splanchnic nn. (T10-12) to aorticorenal ganglion (functioning to Increase renin secretion, which increases blood pressure)
PS: Vagus n.
VA: Least Splanchnic n. (T12) / Lower Quadrant (Subcostal) via Least Splanchnic n. (T12) (costal angle of the back)
Ureter / PS: Vagus and Pelvic Splanchnics (S2-4)
SS: Lesser and Least Splanchnics and Lumber and Sacral Splanchnics (Increase ureteric peristalsis)
VA: Lesser and Least Splanchnics and Lumbar Splanchnics (T10-L2) / T10-L2 as the stone passes through the ureter (along the posterior costal margin)
Distal portion of the ureter (L1-L2)
(suprapubic region, the genitals, medial thigh and leg)
Suprarenal Gland- Cortex / SS: Preganglionic fibers from Greater Splanchnic n. (T5-9) to the celiac ganglion, postganglionics go to blood vessels
NO VA! (NO SENSORY AFFERENTS) no PS
Suprarenal Gland- Medulla / SS: Direct input from preganglionic sympathetic fibers from the Greater Splanchnic n. (T5-9)
NO VA (NO SENSORY AFFERENTS) no PS / Chromaffin cells = postganglionic sympathetic neurons
Appendix / T10- umbilicus (via lesser splanchnic n.) as pain spreads it will go to L1-L2, the right lower quadrant (via the right lumbar splanchnic nn.)
Organ / Primary blood supply / Innervation / Function / Sup. contents / Inf. contents / Ant. contents / Post. contents / L contents / R contents
Esophagus / Sup./ascending esophageal, inf. thyroid / Esophageal plexus (vagus + SCG) / Transmits food / Oropharynx / Stomach / Larynx, L main bronchus, LA, diaphragm / Thoracic duct, hemiazygous v. post. intercostals, aorta / L lung / R lung
Stomach / L/R gastric, L/R gastroomental / Upper abdominal plexus / Mechanical & chemical digestion / Diaphragm, liver, and pancreas / Transverse colon / Diaphragm and body wall / Spleen, L kidney, lesser sac / Spleen / Pancreas, duodenum, liver, IVC, aorta
Duodenum - superior / Sup. pancreatico-duodenal / Upper abdominal plexus / Buffering of chyme, digestion, absorbtion of nutrients / Neck of gallbladder / Neck of pancreas / Peritoneum, gall bladder, quadrate lobe of liver / Bile duct, portal v., IVC, gastroduodenal a. / Stomach / R kidney, liver, R colic flexure
Duodenum - descending / Sup./inf. pancreatico-duodenal / Upper abdominal plexus / Digestion/absorbtion of nutrients / Sup. duodenum / Inf. duodenum / Transverse colon/mesocolon, small intestine / R kidney hilus, renal vessels, ureter, R psoas major m. / Pancreas head, pancreatic/bile ducts / R kidney, liver, R colic flexure
Duodenum - inferior / Sup./inf. pancreatico-duodenal / Upper abdominal plexus / Digestion/absorbtion of nutrients / Pancreas head/uncinate, sup. mesenteric a./v. / Inf. mesenteric a./v. / Sup. mesenteric a./v., small intestine / R psoas major m., IVC, aorta, R ureter / Ascending duodenum / Descending duodenum
Duodenum - ascending / Gastroomental / Upper abdominal plexus / Digestion/absorbtion of nutrients / Pancreas body / Jejunum / Mesentery roots, jejunum / L psoas major m., L. margin of aorta / Peritoneal recesses / Pancreatic head
Jejunum / Sup. mesenteric / Upper abdominal plexus / Absorbtion of nutrients / Transverse colon, duodenum / Sigmoid colon / Greater omentum / Mesentery/body wall, kidneys / Descending colon / Ascending colon, duodenum
Ileum / IMA, iliocolic / Upper abdominal plexus / Absorbtion of nutrients / Transverse colon, duodenum / Sigmoid colon / Greater omentum / Mesentery/body wall, kidneys / Descending colon / Ascending colon, duodenum
Organ / Primary blood supply / Innervation / Function / Sup. contents / Inf. contents / Ant. contents / Post. contents / L contents / R contents
Colon - cecum / Ileocolic, appendicular, ant./post. cecal / Upper abdominal plexus / Water/electrolyte absorbtion / Ascending colon / Appendix, iliacus m., iliac vessels, inguinal canal / Body wall / Iliac vessels / Ileum / R paracolic gutter
Colon - ascending / R colic / Upper abdominal plexus / Water/electrolyte absorbtion / R colic flexure / Cecum / Body wall / Lumbar plexus branches, transversus abdominis aponeurosis / Ileum/jejunum / R paracolic gutter
Colon - transverse / Middle colic / Upper abdominal plexus / Water/electrolyte absorbtion / Stomach, liver / Small intestine / Greater omentum / Duodenum, sup. mesenteric a./v. / L colic flexure / R colic flexure
Colon - descending / L colic (ascending and descending, IMA) / Upper/lower abdominal plexus, lumbar sympathetic trunk / Water/electrolyte absorbtion / L colic flexure, spleen, stomach / Sigmoid colon / Body wall / Lumbar plexus branches, transversus abdominis aponeurosis / L paracolic gutter / Ileum/jejunum
Colon - sigmoid / Sigmoid / Lower abdominal plexus, pelvic splanchnic nn. / Water/electrolyte absorbtion / Descending colon, small intestine / Rectum, L inguinal canal / Body wall / Iliacus m., external iliac a./v. / L paracolic gutter / Ileum/jejunum
Rectum / Sup./mid./inf. rectal / Lower abdominal plexus / Water/electrolyte absorbtion / Sigmoid colon, small intestine / Anal canal / Bladder, pubic symphysis / Middle sacral a. / L rectal aa. / R rectal aa.
Organ / Primary blood supply / Innervation / Function / Sup. contents / Inf. contents / Ant. contents / Post. contents / L contents / R contents
Heart / Coronoary / Cardiac plexus (SCG, vagus) / Pump blood / Great vessels / Diaphragm, fibrous pericardial attachment / Thymus, ribs, sternum / Aorta, esophagus, R/L main bronchus / L lung / R lung
Pancreas / Splenic, pancreatico-duodenal / Vagus, splanchnic (pain), upper abdominal plexus / Digestive exocrine, some endocrine / Celiac trunk, splenic a. / Inf./asc. duodenum, sup. mesenteric a./v. / Pylorus (head), stomach / IVC, renal a./v., bile duct (head), portal v. (neck), aorta, SMA, L adrenal g., L kidney (body) / Spleen / Sup./desc. duodenum