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Anatomy Notes ---- Abdomen

• LOCATION: Lies between the Thorax and the Pelvis.

• BOUNDRIES:
Anterolateral : Musculocutaneous Wall

Posterior: Lumbar vertebrae and intervertebral (IV) discs.

• CONTENTS:
Peritoneum : parietal & visceral (space between 2 layers is peritoneal cavity)
GIT and Parts of UGS (Urogenital system)

• SURFACE ANATOMY:
• Xiphoid process ../
• Costal margins./
• Pubic symphysis '­
• Pubic crest ~
• Pubic tubercle ~
• Inguinal ligaments Oo) b\'-ll
• Ant. Sup. Iliac Spine Ii
• Tubercle of iliac crest c/

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• ABDOMINAL CAVITY :
• Enclosed anterolaterally
by the dynamic musculo­
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aponeurotic abdominal
walls.
• Separated superiorly from the thoracic cavity by the
diaphragm.
• Undercover of the thoracic cage superiorly extending
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to the 4th intercostal space.
• Continuous inferiorly with the pelvic cavity.

Plane of superior
ThOlaaic cavity
=
= AbdominaJ cavrty
Grealer (false) pelvis
thoracic apenure
(thoracic Inlet)
_ ~ser (Irue) pelvis

= Perineum
• Lined with peritoneum, a

serous membrane.
V MuSCleso!
• The location of most of the
abdominal wa

digestive organs, the spleen,

the kidneys, and the ureters

Abdomino­

for most of their course. pelVIC cavity

AMedian section BCoronal section

 REGIONS:

------ Clinicians subdivide the abdominal cavity into nine

regions to locate abdominal organs or pain sites: right
bypo-chondriac. right lateral (lumbar). right inguinal
(groin), epigastric. umbilical. pubic (hypogastric). left
hypochondriac, left lateral (lumbar), and left inguinal
(groin). Four planes delineat the nine regions.

Two horizontal:
Subcostal plane, passing through the inferior border of
the 10th costal cartilage on each side.
Transtubercular plane, passing through the iliac
tubercles and

~
the body of the L5 vertebra. II'ldCiiIVl·:ulal " ,I
_ 'j / l ne~
• Two vertical: .' / V '. -1
Midclavicular planes, passing from the midpoints Righi hi ~ch(Jldriac ~ . ~
. tell h,rocht'l1crt c-­
'
- 1

II - -
of clavicles to the

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Midinguinal points, the midpoints of lines joining

the anterior superior iliac spines and the superior edge

of the pubic symphysis.

.ortal plamt
RI h: lun lJar~

TlBn~lubl! 'JI:J ,~_I-

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QUADRANTS: l!!lt IlQuin;]1

-------- For general clinical

~ __A _ J
descriptions, clinicians use
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four quadrants of the abdominal cavity: right opper, right
lower, left upper, and left lower. Two planes define the
four quadrants.

TransumbiHcal plane,
passing through the
umbilicus and IV disc
between the L3 and the L4
r~~~r'--I-- PUblC
vertebrae.
syrnpl\ysis
Median plane, passing 1m urnb /ica1
plane
longitudinally through the body, dividing it into right
RI~ht low r _rani ~-=-:--

and left halves.

 ANTEROLATERAL
ABDOMINAL WALL Investing (deep) f.a~ i a:
superticial, intetmecbatfl, deep
• The anterolateral abdominal
wall is bounded superiorly by Extemal
ob Iqul? m. ~~fMc¥-IN 1 --++- Superf ial 1a ty layer of
the cartilages of the 7th-10th
5ubcu1aneous tissue
ribs and the xiphoid process Inl<unill
obi quo m. ....;..:luN~;n ~Cam per fa sClIl)
of the sternum and inferiorly
by the inguinal ligament and
Tta Velse ( up ficia!
pelvic bones. abdominal • ~~I AJ" - Vi ins
• The wall consists of skin,
subcutaneous tissue
(superficial fascia) , muscles and I lrr~;.r ..- Oeep merntJranous layer
their aponeuroses, deep fascia , 01 subculaneous tissue
extraperitoneal fat, and {Scarpa'lISe ,
parietal peritoneum.
• The skin attaches loosely to the
subcutaneous tissue except at El<traperitoneal fat
the umbilicus, where it adheres
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Fascias of Abdomen: ANT to POST
• Superficial layer or the Camper fascia
o-r ,,",'0 cio~""'-
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• Deep layer or the Scarpa fascJa ""....... c.l u.
• Endoabdominal or transverse fascia
• Parietal Peritoneum: separated from the
transversalis fascia by a variable amount of
extraperitoneal fat.

Muscles of the Abdomen : ANT to POST

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• External Oblique MM
• Internal Oblique MM
• Transverse Abdominal MM

Superficial Veins of the Abdomen:

• Normally the blood from the lower limb is

carried back to the heart through the

Inferior Vena Cava (JVC).

• Sup. Epigastric Vein anastomosis with the

Lateral Thoracic Vein.

• Sup. Epigastric Vein anastomoSIS with

paraumbilical veins around the umbilicus.

I I
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- .
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CLINICAL CORELATTON: rl'

SPERFICIAL VEINS

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Caput medusa: radially arranged around the umbilicus dilated superficial veins in portal
hypertension
MUSCULOAPOEUROTIC LAYER:

Anterior Layer

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Above
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IlltermJ oblique
RECTUS SHEATH Aponeurosis of Int. Oblique
FORMATION: Ant. & Post. Laminae
linea alba
Aponeurosis of
• ABOVE THE Ext Oblique
ARCUATE LINE

--- Interior Oblique

aponeuroses divides

into anterior and

pCl-sterior lamina~.

• The ant. Laminae join

the external oblique

aponeurosis to form

the Ant. Rectus

Sheath.

• The post. Laminae join

the aponeurosis of the

transverse abd IS

to form the Post. Rectus Sheath.

13e.Q.l"cJ­
. ~THE Aponeurosis of Int. Obllqu
ARCUATE LINE
• All three Aponeuorosis

join anterior to

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Ant. & Post. Laminae
Aponeurosis of
Ext. Oblique
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Rectus abdominus

muscle with three

aponeurosis of the

opposite side in

midline (LNEA

ALBA)
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• No Post. Rectus sheath

below the arcuate

line

CLINICAL CORRELAnON: INCISIONAL HERNIA

• Linea Alba has a very poor blood su I - doesn't heal well after surgery.
Therefore this is a common site 0 Incisional Hernias. protrusion of Omentum
(fold of the peritoneum).
CLINICAL CORELATION : O rigin of rcc~ us -r-~~- C(Jslal c.artJiago
• An incision made on the a bdo minis 1rom -.;;;:;--~~ .~'-~DrE\p'h iI{l m
medial part would cut c ostal ca
through:
1. Skin ~r
~ 2. Superficial fascia (l~
3. De@ , iilEi0ia
4. Linea alba
5. Transverse fascia
6. Peritoneum P.aliOl a l
• An incision made to the pe,jtoneum
$ul)cul n ous
paramedian part above the bSSlJ~-~~
arcuate line: .. ~-n--Tr ans'\l rsail
'"scia
1. Skin Level ()'
2. Superficial fascia umbilicus - -il"
3.BHfJ iajeia
4. Ant. Rectus Sheath
5. Abdominus Rectus
Anterior layer of
6. Post. Rectus Sheath , OCI U& $"'~~l"

*
7. Transverse fascia of 8 11 th ree
8. Peritoneum BP<JneurQtic )lerS) ---"~~B
• An incision made to the
paramedian part below
the arcuate line:
1. Skin
2. Superficial fascia
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3 ,.J4 1 fe Reia .
4. Ant. Rectus Sheath (consisting of all three aponeurotic layers)
5. Abdominus Rectus.
6.Inf. Epigastric artery .
7. Transverse fascia
8. Peritoneum
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Q. A surgeon was doing a laproscopic trans abdominal tubal
ligation His resident observed that the tubal ligation. His
resident observed that the inferior epigastric vessels
disappeared behind the posterior rectus sheath. At what point
of the posterior rectus sheath do these vessels disappear?

a. Linea Alba

b.Anterior Rectus Sheath

c. Interior inguinal artery

d.Arcuate line

e. Deep inguinal ring

 Pectoralis maJor------;:'"";-

Serratus anterior -E"---+-',\~ '~--7th rib Contents of the re tus

sheath
Rectus abdominis
Rectus sheath

• Rectus abdominis ---

(anle rior layer) - --+-'.,...,...,.,----,,....- 11-- -1 01h rib
• Pyramidalis

muscles t.,..;"

External oblique --~ """"- - I nternaloblique • Anastomosing

Umbilicus ---ft-'o'""t--T......;.;~ superior and

inferior epigastric
Linea alba ---M,.--~-;------'ll arteries and veins,
• Lymphatic vessels ~
Intercrural fibers~_~~, • The distal portions

Ingliinai ligament of the anterior

Spermatic cord
rami of spinal
nery.es T7-T 12,
which supply the muscle and overlying skin.

• Rectus Abdominis : a long, broad, strap-like muscle that is mostly enclosed in the
rectus sheath.
• Pyramidalis : a small triangular muscle (absent in about 20% of people), lies in the
rectus sheath anterior to the inferior part of the rectus abdominis. It ends in the
linea Alba and tenses it. (Even if u are fat, you will have a linea alba line
superficially) Gp <>-.c.\L t, ,. .... ,C--, k.id..

CLINICAL SIGNIFICANCE OF FASCIA

AND FASCIAL SPACE OF THE

ABDOMINAL WALL:

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, \y APonetJrosls of external oblique
• When closing abdominal skin incisions,

surgeons include the membranous layer

. . Membranous (deep) layer of
subcutaneous tissue
of subcutaneous tissue when suturing

because of its strength. Between the

Spermatic cord
membranous layer and the deep fascia

covering the rectus abdominis and

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external oblique muscles is a potential

space whew flum-IDay accumulate

I .::.~ ':.~ -'.:,~

(e.g., urine from a ruptured urethra).

.~ Supenor ramus of pubis
/"
Although no barriers (other than gravity)

prevent fluid from spreading superiorly

from this space, it cannot spread f J

FaSCia lata of Ihlgh
f J
inferiorly into the thigh because the
membranous layer of subcutaneous tissue
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Fatty (superficial) layer of subcutaneous tissue

fuses with the deep fascia of the thigh

~ " Skin
(tascia lata) along a line inferior and
Sag ittal sectio n of anterior abdominal wall
parallel to the inguinal ligament
• The potential or fat-filled space between the Endoabdominal fascia and th~ietal
peritoneum provides a plane that can be opene"cl, enabling the surgeon to approach
structures on or III the antenor aspect 0 t -epOsterior abdominal wall (e.g.,
kidneys or lumbar vertebrae) without entering the membranous peritoneal sac
containing the abdominal viscera. Thus the risk of contamination is minimized.
 -.

Nerves of Anterolateral Abdominal Wall I I

The cutaneous nerve supply

• T7 - TIl - Thoracoabdominal Nerves

• A band of skin at the level of the umbilicus -TI 0

• Above umbilical level -- T7, T8, & T9.

• Below umbilical level -- TIl, TI2, and Ll.

• TI2 - subcostal nerve, superior to pubic symphysis

• L I - ilio inguinal and iliohypogastric nerves, skin overlying the pubic

symphysis ......
~

• Branches of the six nerves (T7 -T12) enter on the lateral side of the Rectus Sheath
and innervate the Rectus Abdominis MM.

Musculophrenic arlery

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------I--Anterior
cutaneoLls

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Superior epigastric arlery
branches

Posterior layer of reclus sheath

Thoracoabdomi al
nerves (T7- T11)
10th pOSlerior intercostal artGry

'1th posterior intercostal artery

LateraJ
cutaneous

branches
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Internal oblique _--"~ III #-- 4 - - - Lateral cutaneous branch of
Transverse abdominal-~-+-~-
subcostal nerve (T12)

Inferior epigasric a rlery'---+-p..-=-T:.......it"~ fI-P..+-I~- lliohypogastrjc nerve (L 1)

Deep Circumflex iliac artery'--~,...J..; -!,-I!---Anterior superior Ilac spine

Superficial epigastric artery'-~t-_~~==J

,,(L.-,L--~--lIio i ng u i nal nerve (L1)
Superficial circumflex iliac artery-----:~_ _....fll!i..~

Ext ernal iliac artery-~l--.-.:~~~~ ..-L-----+---Inguinal ligament

~I
~ "'-.....J1 1

Transversalis ~ascia

Femoral artery

Cremasteric artery

Anterior view
Vessels of Anterolateral Abdominal Wall

The blood vessels of the anterolateral abdominal wall are the:

• Superior epigastric vessels and branches of the musculophrenic vessels from

the internal thoracic vessels.
• Inferior epigastric and deep circumflex iliac vessels from the external iliac
vessels.
• Superficial circumflex iliac and superficial epigastric vessels from the femoral
artery and great saphenous vein.
• Posterior intercostal vessels in the 11 th intercostal space and anterior branches
of subcostal vessels.
• The supe..ior epigastric artery, the direct continuation of the internal thoracic
a~, enters the rectus sheath superiorly through its posterior layer, supplies the
upper part of the rectus abdominis, and anastomoses with the inferior
epigastric artery. The inferior epigastric artery arises from the external iliac
artery just superior to the inguinal ligament. It runs superiorly in the transversalis
-

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fascia to enter the rectus sheath inferior to the arcuate line. Its branches enter the
lower rectus abdominis and anastomose with those of the superior epigastric
artery.
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LYMPHATICS :

Superficial lymphatic vessels /'

• Superior to the umbilicus drain mainly to the axillary lymph nodes,
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• Inferior to drain to umbilicus the superficial inguinallympb nodes. V

Deep lymphatic vessels accompany the deep veins and drain to

• Vfhe external iliac 1/
• £ommon iliac '/
• J,:umbar (caval and aortic) lymph nodes.
CLINICAL CORRELATION :

ANTEROLATERAL ABDOMINAL WALL:

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The infraumbilical part DIilphragm --~

of the anterolateral abdominal

em
wall has several peritoneal

folds that contain remanants

of the vessels that carried

blood to and from the fetus.

Five ~itoneal folds - two

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on each Sloe and one othe

median plane - pass throught

the umbilicus.
La"'lll a.f~()ctiDnC--~ - _......--,.,.............­

• Median Umbilical

Fold (midline inferior

to the umbilicus).

CONTAINS : Urachus

(obliterated allantoic

duct).

• Medial Umbilical

Folds (lateral to the median umbilical fold). CONTAINS : Oblierated

Umbilical Aratery.

• Lateral Umbilical Folds (lateral to the medial umbilical fold). CONTAINS:

Inferior Epigastric artery and vein.
**** Lateral to the Lateral Umbilical Fold is the Deep Inguinal Ring.
**** Lateral Umbilical Fold is the only fold tbat contains strucures that function in
an adult
INGUICAL CANALILIGAMENTIHERNIAS

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In fetal life, the gonads descend from the posterior abdominal wall. in case of males
the testes must descend all the way outside the body , inorder to maintain optimal
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temperature for spermatogenesis to be maintained

What you m~ know about the inguinal region?????

Boundries:
• Ant: Ext Oblique Aponeurosis
• Post: Transversalis Fasci dJnl lig~ Uoin to form a conjoin tendon
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and attatch the Pubic Symphysis)
• Roof: Aponeurosis of the Int. Obli ue and Trans. Abd.
• Floor: In inal Li . r Lig.
• Extern~1 Ring: FOFined-b~xt. Oblique Aponeurosis.
• Internal Ring: For~ ed by ~n~<:JoD.

Layers: ~,d-u ~
• ~ spermatic fascia (EO muscle)
• Cremasteric fascia (10 muscle)
• ~ spermatic fascia (tram.'Versalis fascia)

1 '1 u f\oJ....

r\-
 Contents: Dunkin Donuts Tastes Awesome Please Sip a Caffeinated Grande Vanilla
latte

Inguinal canal:
• Deep inguinal rin
transversalis fascia
evaginaiton. ~

hah
• Superficial inguinal rin~: /
external oblique deriveV
nS
• The inguinal canal closes on
muscle contractions.

Contents of inguinal canal

Roha
Females:
Round ligament, ilioinguinal nerve (L 1)
External ~ arr ~-
inguinal
ring
Males:
Vas deferens Spermatic cord and ilioinguinal nerve (L 1)
Deferential Artery

Pampiniform Plexus
Spermatic cord consists of "\ 0 /
r()
Internal and external Spermatic fascial
'Y,- (covering of the spermatic cord)
Cremaster Muscle
• Cremasteric fasci a,..
~O
Contents: /
• Obliterated processus vaginalis
• Testicular artery v
• Pampiniform plexus of veins L..- '
• Vas deferens (ductus deferens) v
 I
DIRECT vs. INDIRECT HERNIAS: PROTRUSIONS OF PERlTONIUM
THROUGH AN OPENING

TYPE OF EXTRA THINGS TO

WHAT HAPPENS????
HERNIA KNOW

Goes through the deep IN uinal rin , superficial

INDIRECT

INguinal ring and into't he scrotum. Enters the Follows path of descent of

INGUINAL

inguinal ring lateral to the Inferior Epigastric artery. testes. Covered by all 3

HERNIA

Occurs in INfants owing to the failure of processus fascias

(congenital)

vqginalis to close. Much more common in males.

f rotruds through th~ InguiDal (Hasselbachs) MDs DONT LIE

DIRECT

triancl.f::i3Uldges diretly through the abdominal Medial to inferior epigastric

INGUINAL

HERNIA

w~ial to the Inferior Epigastri artery. Goes artery: Direct Hernia

through superfif ial inguinal ring only. Covered by Lateral to inferior pigastric

(aquired)

tranversalis fascia. Usually in older men artery: Indirect Hernia

f'er,l{)neum

TrnnS'w~aIis
I""Cla '
/ J re::1 ingu ~
hel1l ia
IlCirecl in
\ hem a
·ral

hah
nS
I _ __ """'-\- Deep
ing j nal ing
IngJlial canal
Pubic ­ SIt x.1:~iat
t~betde
II ingu· ill ring
Roha
,

**** Medial Inguinal Fossa

(hasselbach's triangle) : Common

;
site of Direct Inguinal
.
lkrnia

**** Lateral Inguina Fossa: Common site of Indirect Inguinal Hernia

1l) ~ h""~
Anterior supenor Iliac
spine
Inlono,........., JD".oun9u,"al Ingulnalligamenl

artery
Superficial Inguinal ring
ingUinal rlngJ ---.; ~~\ ~ Deep inguinal ring

Medial Inguinal ~- - Ii: I / }

""
los.... ~ ' I F ¥_____ -IngUinal canal
' -.,. ~ ~ , •• I '

D'-b ~·-~I · Super1lcl~1

Inguinal ligament oJ.

inguinal ring \
A
' -- /
Sope rf ,IClal
· /"

Pubic tubercle
I

II I
i1lJJ~
U Ingurnal nng

Anterior views
 Stuff you might need to know?????

CREMASTERIC REFLEX:
bt ' ../
~ AFFERENT: Inguinal Nerve ./
f1J EFFERENT: Gcnetal branch of genitofemoral nerve.

Lymphatic drainage:
• "" te L. follows blood supply through I back to
b o · ort to ...
0 1
testicular cancer --- LI

• Sc 0 y drain to e (just like all ectoderm ally

derived structures). ~~:.:.:.:~~==~~

Hesselbach's triangle:

Inferior
epigastric

hah Lateral Rectus

Abdominis
nS
Inguinal Ligament

Varicocele
Roha
Abnormal dilatation of the pampiniform plexus of veins
Abnormal Dll a Ion and
If it is bilateral -7 Results in infertility- TorSion of Veins
.--=

Inguinal ligament = external abdominal oblique aponeurosis

yC? • Inserts at anterior superior iliac spine to the pubic tubercle
~\ JP JP 0 Why important to know? -7 Visualizing this line allows us to properly
....i( ~tI diagnose a hernia. Below the inguinallig = femoral hernia
fjj Above the inguinal lig = inguinal hernia
? Also, to palpate the deep inguinal ring, you go about 1.25cm above the
mid-inguinal point!
• Modifications to ligament:
o Pectinate ligament
o Lacunar ligament -) cut this ligament to relieve strain in a strangulated
hernia =\/
-- w..cL.. ~ -L~ ~~{ oj (~
PERITONEUM AND PERITONEAL CAVITY:

Two continous layers

• Parietal peritoneum: The anterior abdominal wall found on the
anterior side of the the peritoneum
• Visceral Peritoneum: investing organs such as ~ and stomach
and the portal veins. Spl~.

Peritoneal Cavity: DIVISION '

• Greater Sac
• Ometal Bursa or the lesser sac
• Supra colic and infra colic compartments
• Paracolic gutters
• Pouches

PERITONEAL FORl"IATION ':

Mesentary: A two layer neurovascular communication

beteweasfen theb d'y' wa and an or an

hah
nS
I >-~_r.-- ~entery

~---\-40--+-- visceral pentoneum

/ I-J'--- periet~1 peritoneum

Roha
Paritoneal Ligament: Connencts one organ to another
or the abdominal wall.

Omental Formations:
A doub]e-Iayered extension of peritoneum passing
from the stomach and proximal part of the duodenum to
adjacent organs.
2 Omentums ....

1. Greater Omentum: 3 ligament ·

• Gastrophrenic ligament: Between greater

curvature and the diaphragm

• Gastrosplenic ligament: Between greater curvature and the s leg1

• Gastrocolic ligament: Between greater curvature and the transverse colon and its
mesentary
 Amerior
l esser omentlJmI
Hepatogastrlc I
I Portal triad in ITe paliC artery
hepatoduodenal Bile due!
ligament Portal ----t-­ . .
__
ligament Stomach
---J.;....._~
Visceral peritoneum (covering stomach)

~-r::~ ligame 11

Parietal peritoneum

imi--f-Spleen

Parietal peritoneum

Inferior view
Posterior

hah
2. Le ser Omentum : 2 ligaments that connects the Lesser curvature of the stomach and
the proximal part of the duodenum to the liver
nS
• Hepatogastric ligament
• Hepatoduodenalligament : includes the portal triad ... Portal vein, hepatic artery,
and bile duct.
Roha
Greater ..
omentl.ln
Otaphragm
 SUBDMSION OF PERITONEAL CAVITY:

Greater Sac:
• Main and larger part of the peritoneal cavity. A surgical incl$ion through the
anterolateral abdom' a1 wall enters the greater sac.

Omental Bursa or Lesser Sac:

• Lies posterior to the stomach
• Has a superior and inferior recess
• Communicates with the greater sac through the omental foramen and vice versa.
Bounderies :
• Anteriorly- the hepatoduodenalligament (free edge of lesser omentum)
containing the portal vein, hepatic artery, and bile duct.
• Posteriorly-lVC and right crus of diaphragm, covered with parietal peritoneum
(they are retroperitoneal)
• Superiorly- the liver, covered with visceral peritoneum.
• Inferiorly- superior or first part of the duodenum.
oare area 01 liver

Subphrenic space Ir~:eSiSI-...J

Visceral periloneum
Liver ~HfI--:....-

hah
l:f-.."'&::~=~
Aorta

Celiac tf nl(
nS
Lesser omentum -t1r:;~~~~~lJf.F~;;~~r7
Supracolic compartment of greater sac -+---+-
SlIper or recesS of om ntal bl fSa

Superior mesenteric ar~el'j

Inferior r~ess 01 omental bursa---j!---~~~~~.¥-7-==~~~)JL

Transverse mesocolon

IImVAIII1l7tl7tf;;;::::~~~llMesentery 01 small inlesline

Roha
Inlerior mesenteric artery
Greater omentum --\----':I"l ,.."ou "~'\.~~..J~>o;\Tr-1~ Pariewl perito neum

Infracolic compartment of greater sac

-u~_ . .r-Reclu m

Transl"vr:e mesocolon di"ide the abdominal cavity into 2 corn partmcnt ~

• Supracolic compartment: contains the spleen, stomach and liver

• Infracolic compartment: contains small intestine and ascending and descending
colon. Lies posterior to the greater omentum .
'TR CTURES OF THE HEPATODUODEI AL
LIGAMENT:
• Found anterior to the omental bursa or the lesser
sac.

3 structures found here

• The portal vein
• Hepatic artery
.B ~~ _______________
'Iepatrc

hah
nS
Roha
sc r~
OMENTAUEPIPLOIC rilOrlllUm
FORAMEN:

• Communicates omental bursa

and peritoneal cavity
• Anterior: Hepatoduodenal
Ligament
• Posterior: lVC
• Superior: Caudate lobe of the
liver
• Inferior: Duodenum 1st part

cft k1dn y
 CLINICAL CORRELA TlO

RECESSE OF THE PERITONEAL

CAVITY : Sare area

• Peritonitis (infection of the

peritoenum)... Collection of Pus in the

peritoneal cavity including the

Cnton a.ry or
recesses, pouches and gutters
hepa10renBl
'igan i lll
• Pus can collect in the
HEPATORENAL and

SUBPHRENIC recess.

• Subphrenic abcess can be drained by

an incision inferior to the 12th rib.

GlITTERC;; OF THE PERITONEUM

• Paracolic Gutters
• Supracolic and infracolic compartments

SUPRACOLIC
• Stomach
hah
nS
• Liver and
• Spleen

INFRACOLIC
• Small intestine
• Ascending Colon
• Descending Colon
Roha
VASCULATURE
• Parietal peritoneum: supplies the

body wall and the diaphragm lining it.

• Visceral peritoneum: supplies the

organs it covers ..

ABDOMINAL PA
• Visceral pain is localized in 3 areas of
the anterior abdominal wall depending on the embryological origin of the
diseased organ
• Visceral pain poorly localozed and is refered to the dermatome of spinal ganglia
providing sensory fibers and pain will therefore localzize:
1. EJ!igMtric area: for foregufpain
2. Periumbilical area: for midgut pain
3. S~prapubica=r;; : for hindgut pain
-
 BDOMINAL VI CERA

IJllp ar IlCILt
1Indt6 1i
stana:h '.II~j 3r II h.:I' L1',I(~r I
. ph. us

"

.1 J
.ell cc Ie
'lelU"b

fl c:; h~ COte
laxue ­

t;OII'1

I....--:~ Reclum

hah .......­ -RectuRl

nS
GUS:

• Muscular tube, extends from the pharanx to the stomach

• Passes through the elliptical esophageal hiatus in the muscular
Roha
0..0 ......

T",,111"1 right crus of the diaphragm, just to the left of the median plane
La,y'" at the level of the TIO vertebra.

~c~}
AbdDfr.:n~ pari
E
_ • Terminates at the esophagogastric junction, where ingested
matter enters the cardial orifice of the stomach is located to the
left of the midline at the level of the 7th left costal cartilage and
lNor the Tll vertebra; the esophagus is retroperitoneal during its
s_
""'­ short abdominal course.
PylOruS
-P.IlC,_ • The esophagogastric junction is marked internally by the
~m

Tcan.1II'II'N eaton
abrupt transition from esophageal to gastric mucosa, referred
- ,.",,, O dC~dlngcu\orl:
to clinically as the Z-line. Just superior to this junction, the
......,um diaphragmatic musculature forming the esophageal hiatus
IleUm
functions as a physiological inferior esophageal sphincter that
c"".....
contracts and relaxes. Radiological studies show that food or
liquid may be stopped here momentarily and that the
Antar10r OJ . .: medial vtew Of bIUelI<f heed
sphincter mechanism is normally efficient in preventing
reflux of gastric contents into the esophagus.
STOMACH:
Esopllagus ~
CaltHa ____
I
Card.iat notch

Fundus

TOMACH BED CONTENT .

Lesser CUf\'(l 'ure ~
------J''"-.---­. ~ , BodY

ANTERIOR: Diaphragm, left lobe of the liver and Anaular incisure ~

(nGtCh) '---­
the anterior abdominal waH
Duodenum
\
POSTERIOR: omental bursa and pancreas

• Left dome of the Doaphragm

• Spleen I curvature
• Left Kidney Pylorus
Plloric part
• Suprarenal gland
• Pancreas
• Transverse mesocolon and

colon.
Esop:l'i agogaslric;
junction (Z-line)
Interior of the stomach:
• Undergoes contraction

which his characterized by the

appearance of longitudinal

folds of mucous membrane,

the Rugae. The gastric canal,

a grooved channel along the

hah
nS
lesser curvature formed by the

rugae, directs fluids towards

B Anterior view
the pylorus.

• Produces HCL, which

destroys baceria in teh food and drink,
Roha
and a protein-digesting enzyme,
PEPSIN, in the fundus and the body.
• The pylorus divides in to Pyloric
Antrum and Pyloric Canal. It is
surrounded by the Pyloric Sphincter,
which controls the rate of discaharge of

the stomach.

Constricts: Sympathetic

Relaxes: parasympathetics

• Gastrin is produced in the Pyloric Antrum. VAGUS nerve stimulate gastric

secretions.
 Es!)ptJog::aJ o.
Sh)rt
gastrIc aa. VASCULATURE AIW
NERVE SUPPLY TO
THE 'TOMACH:

• Short gasteric arteries

have poor
ansatamoses if
splenic artery is
blocked.
\ Splenic • Strong anastamoses
a. occur between the
Left and Right
Left Qastro­ gastro epiploic
omen31a.
and
Left and Right
Gastrics
• The Cystic artery supplies the GALLBLADDER
• The Right and Left Hepatic arteries supply the right and left lobe of the Liver
respectively.
• The Superior pancreatico duodenal anastamosis with the inferior pancreatico

CL leAL CORRELATIO :
V
hah
duodenal coming from the Sup. Mesenteric Artery.
nS
Duodenal Atrasia: Do)Jle bubble effect.... air on an X-ray in the stomach and the

--
duodenum. PROJ cut VOMITING
- -.
Pyloric Stenosis: Sipgle Bubble .... ai~ in the stoma~

Splenic Infa. rction: Clot in the Splenic A. leads to obstruction of blood going into the
short gastric and the Left gastro epiploic. The tail of the..nancreas also suffers.
Roha
~ -

• The short gastric suffers the most because it has no other blood supply, thus
affectung the FUNDUS of the stomach.

Hepatic Poper A. CLOT: would not affect the liver because it still gets supply formt he
po ~ n which has 4QO!0-0x.-y. ~nat@d~blood in compared to 25% in the Hepatic Proper
J\rtery. -­
-
Ulcer in the lst part of the Duodenum: can cause massive bleeding in the
gastrocuodenal artery.
 VENOUS SUPPLY OF THE TOMACH:

• Gastric veins parallel the arteries AAnterior view Spll!l1'r. ""If'

i
in position and course. The left
and right gastric veins drain
directlx .- to the octal vein. The
short gastric veins and the left
gastro-omental veins drain into
the s lernc vein, which then
joins the sqp- ior mesenteric
vei ~) to form the-12.ortal
veiD-Th~ r~ght astro- ental
vei~ll em.Rti.etinto J he
SMV.

LYMPHATIC DRAINAGE OF THE B AnI.. ior view

STOMACH:

• Gastric lymphatic vessels that accompany the arteries along the greater and lesser
curvatures and drain lymph from its anterior and posterior surfaces toward its

hah
curvatures, where the gastric and gastro-omentallymph nodes are located. The
efferent vessels from these nodes via the pancreaticosplenic, pyloric, and
pancreaticoduodenal lymph nodes accompany the large arteries to the celiac
lymph nodes.
nS
An:er'o 1In(1 posterior I ~\

...agal 'Lnks 0...~ 'J

Thoraci.: sOl.anclmic nerves • Parasympathetic nerve

(g'eater, le~~r. lef.lljt:~' ; \ supply ---- anterio
c."" "Oh'" d ....... , , \ '
Pl v~al tr unk (mainly
Roha
from the left Vagus
Sy nerve) and osterior
vagal trunk (mainly
rom t e nght Va _us
nerve) and their
branches, which enter
Sup,ericv 'l1esent rIC the abdomen through the
03f'l liOn nd Ie_us esophageal hiatus.
oUC<lC1()j!ljU1al • Sympathetic nerve
lunch;,n supply ---- T - T9
segments of the spinal
cord, which passes to the
celiac plexus via the
o Anterior view greater s lanchnic nerves
~nd is distributed as
plexuses around the gastric and gastro-omental arteries.
 Inrerior vena cava

LIVER I"'~""~""";;"'-''-:::~I-Left t iaAgular

I ligament
I
• Largest Visceral organ
I
and the largest gland of

the body.

,
I
I
RI!IhlioH
JII---~-- Falc ~orm
ligamenl

• Surface anatomy Plan.) oJ separation oJ right I

Midclavicular line: ..:;,..
Mid axillary line: 7th ICS
Scapular line: 9th C .
• Plays an i mportant role
in:
o Production and
and lett portal lobes - -+- - - - - - i
5 th--=
I --­
'\.--;ClI- - Round ligament of liver
(Ligamen urn teres)
Fundu s of gallbladder
A Anteritlr view

secretion of bile

o Detoxification
o Storage or carbohydrate as glycogen and lipids as TRIGLYCERIDES
o Protein Synthesis

CatIlate lobe

o Production of HEPARIN and

For liQarne1tJm venosum . . . . BILE PIGMENTS
\
o Break down of Hemoglobin
o In fetus, it helps produce RBCs

RigtJt lobe

hah • SurrOlmded by the peritoneum and is

attached to the diaphragm by- coronary
and falciform ligaments
• Contains the Portal Triad
nS
1. Portal Vein
2. He atic Artery
3. Bile Duct ­
A • The lesser omentum, enclosing the
portal triad (portal vein, hepatic artery,
and bile duct), passes from the liver to the lesser curvature of the stomach and the
first 2 cm of the superior part of the duodenum. The thickened free edge of the
Roha
lesser omentum extending between the porta hepatis and the duodenum is the
hepatoduodenalligament.
• Liver blood supply is via the common hepatic artery (major branch of the celiac
trunk).
• The common hepatic becomes the proper
hepatic, gives off the R gastric A and the
Gastroduodenal A and then joins the common
bile duct and the portal vein in the portal
triad.
• Clinical - if a patient were bleeding from the
hepatic A, a surgeon can stick his fingers in
the epiploic foramen and squeeze the free
edge of the hepatoduodenal ligament in order
to stop bleeding to the area. Please note that
the hepatic a. branches into Rand L hepatic
A. The Right hepatic artery gives off the
cystic artery, which supplies the gallbladder.
 • Afferent venous supply is via the Portal vein, which is bringing nutrient rich blood

to the liver. After metabolism takes place, venous blood leaves the liver through

the hepatic veins into the lVe.

Le t hepatic arte ry and duct

Gallbladder -_~ Hepalic arter y

Cystic arle ry-_~.........

:ommon hepatic dUC' ~==~~~~~1

Gys6c dllct
Gastroduodenal ar tery
Bilc ducl ligament {c t edge)
Hepaloduodenal ligament
(cui ooge)

-"'i' -~------Pan creas

B
interior vieWg

CL C L CORRELA nON

Liver Biopsy

hah
Hepatic tissue may be obtained for diagnostic purposes by liver biopsy. The needle
puncture is commonly made through the right 10th intercostal space in the midaxillary
nS
line. Before the physician takes the biopsy, the person is asked to hold his or her breath in
full expiration to reduce the costodiaphragmatic recess and to lessen the possibility of
damaging the lung and contaminating the pteural cavity.

Rupture of Linr
Although less so than the spleen, the liver is vulnerable to rupture because it is large,
fixed in position, and friable. Often the liver is torn by a fractured rib that perforates the
Roha
diaphragm. Because of the liver's great vascularity and friability, liver lacerations often
cause considerable hemorrhage and right upper quadrant pain.

Cirrhosis of Liver
There is progressive destruction of hepatocytes in cirrhosis of the liver and replacement
of them by fibrous tissue. This tissue surrounds the intrahepatic blood vessels and biliary
ducts, making the Ever firm and impeding circulation of blood through it. Cirrhosis, the
most common of many causes of portal hypertension, frequently develops in chronic

-
alcoholics. - ­
GALLBLADDER:

• Pear shaped
• Location: Junction of 9th costal.cartila d
lateral border of abdominus rectus.
• It is In -confact wit the Duodenum and
Transverse Colon.
• Receive blood from the Celiac Artery, which
arises from the Hepatic Artery.
• Hepatic artery arises from the Cystohepatic
triangle.
• en'e suppJ) :
Parasympathetic:
• Vagus
Contracts gall bladder
Relaxes sphincter of oddi
Sympathetic:
• T7-TIO,
• Greater splanchnic nerves.
• Celiac plexus.

Contracts sphincter of oddi

Relaxes gall bladder

• Cystohepatic Triangle:

SUP. - Visceral 'ver

hah '---' 5, ",,«1"

_ P.f~~\AIl::
_ PI4I""".. (.)'~ aI
nS " ",;I PlIrUS)" 'P••ltIOIIC\

INF. - Cystic duct

MED. - Common Hepatic duct -

SPLEEN:

• Lymphatic organ that lays Intraperitoenaly.

• Entirely surrounded by the peritoneum except for the hilum. Hilum is in contact
Roha
with the tail of the pancreas and is the left boundary of the omental bursa.
• HILUM is where the splenic branches of the splenic artery and the vein leave.
• Posteriorly with the left 9th-11th ribs and separated from them by the diaphragm
and the costodiaphragmatic recess, the cleft-like extension of the pleural cavity
between the diaphragm and the lower part of the thoracic cage
• CLINICAL: IF the below the nih rib than its abnormal and the
pt has a SPLENOMEGALY.
• The greater curvature of the
stomach and the sleep attached
by the GASTROSPLENIC
LIGAMENT.
• Splenorenal Ligament connects it
to the left kidney.
 P NCREAS:
• Retroperitoneal organ
• Head lies within the C-shaped concavity of the Duodenum.
• CLINI AL: if the Bile flow at the head is obstructed the, it can cause
JAUNDICE. Bile pigments end up in the blood leading to yellow coloration of
the eyes and skin.
• The uncinate process, a projection

from the inferior part of the head,

extends medially to the left,

posterior to the SMA.

• The neck of the pancreas is short

and overli~s the superior

m~senteric vessels, which fonn a

groove in its posterior aspect.

• The body of the pancreas

continues from the neck and lies

to the left of the SMA and SMV.

• The tail of the pancreas is closely

related to the hilum of the spleen

and the left colic flexure . The tail

is relatively mobile and passes

hah
between the layers of the Splenorenalli ament with the splenic vessels.

• The bile duct (common bile duct) crosses the posterosuperior surface of the head of
the pancreas or is embedded in its substance. The pancreatic and bile ducts unite
to fonn a short, dilated hepatopancreatic ampulla.
nS
VASCULATURE OF THE PANCREAS
• P ancreatic arteries derive mainly from the branches of the splenic artery.
• The anterior and posterior superior pancreaticoduodenal arteries, branches of the
Gastroduodenal artery,
• The anterior and posterior inferior pancreaticoduodenal arteries, branches of the
SMA, supply the head. .
Roha
• The pancreatic
Right hepalic duct veins are
tributaries of the
splenic and
Gallbladder
supenor
mesenteric parts
of the portal vein;
Minor dt.-odensl papilla however, most of
Major duodenal papilla them empty into
the splenic vein.
• Pancreas is
"teriOl view inl1ervated by the
CELIAC
Left hepatic duct
PLEXUS.
Sphincter 01 Bile duct
b~EI duel (1) Right hepal\c duel
Oescencing
Hepatic ducl
parI of

duodenum f Bile duct

Major \ --.........'T" - ...
duodenal Main pancreatic duct
papilla
Ttub ..
Hcpatopancrealic
Duodenum
sphincler 13) in wall
01 heoalooancreatic
 t' (I •

O~'
DUODENUM c-
,1 /
\Y
(\,1 1 ,

\. ) r(
\()\I.f J
• Superior (1st) part: short
.
Q ' I )~.
i7 ~ .
0/W/

(approximately 5 cm), mostly

Kidney
horizontal, and lies anterolateral

Pancr ~
to the body of L 1 vertebra.

• Descending (2nd) part: longer Kidney

(7- 10 cm) and runs inferiorly
along the right sides of the L2 and
L3 vertebrae, curving around the
head of the pancreas; initially it
lies to the right and parallel to the IVe. The bile duct and main pancreatic ducts
via the
-=­
hepat02ancre~!£. amRull Q enter its posteromedial wall.
• Horizontal (3rd) part: 6--8 cm long and crosses anterior to the Ive and aorta

of th L3
. ­ rtebra7
and posterior to the superior mesenteric artery (SMA) and SMV at the level

hah
• Ascending (4th) part: short (approximately 5 cm) and begins at the left of the L3
vertebra and rises superiorly as far as the superior border of the L2 vertebra, 2-3
cm to the left of the midline. It passes on the left side of the aorta to reach the
nS
inferior border of the body of the pancreas. Here it curves anteriorly to join the
jejunum at the duodenojejunal junction, which takes the form of an acute
angle-the duodenojejunal flexure, which is supporte by the attachment of the
suspensory muscle of the duodeID!Jll (ligament of Treitz ' . th~only p~~of the
~:=:

Duodenum that is INTRAEERIT..oNEAL.

Roha
Blood Supply of the Duodenum
• The celiac trunk supplies the abdominal part of the alimentary tract, and the 1st
and 2nd parts of the duodenum are supplied via the g!!,.stroduodenal arte and
its branch, the s1;!perior pancreaticoduodenal artery.
• a major part of the alimentary canal (extending as far as the left colic flexure) is
supplied by the superior mesenteric artery (SMA), and its branch, the inferior

-
pancreaticoduodenal arte , sup lies the 3rd and 4th parts
- - - duodenum.
• The superior and inferior pancreaticoduodenal arteries form an anastomotic
loop between the celiac trunk and the SMA; consequently, there is potential for
collateral circulation here.
 JEJUNUM ILEUM
• Gross features:

• Large numerous palpable circular • Small and few circular folds

folds
• Terminal 2/5 of intestine
• Initial 3/5 of the intestine
• Short vasa recta
• Long vasa recta
• Prominent payers patches
• Thicker wall, more vascular and
redder than ileum in living • Site for B 12 absorption.
person

• Main site of absorption

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The arterial supply is from the SUPERIOR MESENSTERIC ARTERY.

t,., •.
 BLOOD SUPPLY TO THE ABDOMEN:
• The Celiac trunk supplies the Stomach,

spleen, the liver and the Pancreas

i esllculllr or OIIlItlan artllllcs (L

• CILlAC TRUNK --- Tl2
• The Celiac Trunk ends where the
a-!---'\\- lnlorior' lTlOS(]f')lCI'ic artery

Superior Pancreaticoduodenal branch

AbdICminal ll1)rlR
of the Celiac Trunk anastomoses with
~'urcalio n of abdOlTlinili aortll

the Inferior Pancreaticoduodenal

Branch of the SMA. Righi commQll ~1Ilt: III l ery@ Lill common ~,ac
Modil1l1 saaal al1ery
Brttlry

• SUPERIOR MESENTERl
Left Internal iliac iI !Wry
ARTRERY (SMA) --- L I
• SMA has it own branches and its supply.

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• The Middle, Right and Ileocolic branches anastomose with each other to form
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the " MARGINAL ARTERY" along the inner border of the colon.
• The Marginal Artery is completed by the branches of the left colic, which are
the branches of the
Inl~ri:: '
IMA.
• CLINILAL: Ligate
Appendiular artery,
which is a branch of
the Ileocolic artery to
operate on the
appendix.
 PORTAL VEIN FORMATION:

<':1$1 ' 1(1 - - - - ­-

( J .

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Blo d from the GIT, plee ,P ncre and G lIbl dder II drain in to th Liver tbe
PORTAL VEl
Ive TRIBUTARfES

PORTAL VEIN

TRIBUT ARIES
Midd e hepatic vein
Right hepatic vein
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Esoph V.

IcV. - - ­....

L 1 vein
Right renal vein

Ascendi g lumbar
vei

External
iliac v n
Superior m~enlenc vl!lin --~~----:!!

ParaLrllbillcal wlin - -- -..,

U mb.Ucus

Epiga stric veins ' -- ......

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PORTAL H ERTENSIO

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Retrop ritoneal Spa

LOCATION: Between ---­

• Posterior part of the parietal peritoneum
and
• Skeleton and muscles of posterior
abdominal wall.

CONTENTS:
• Kidneys V'

• Ureters ........

• Suprarenal Glands v
• Aorta .......

• Inferior Vena Cava -­

• Sympathetic Trunk ........

• Lymphatic Glands \",/"

Kidney in relation to the Retroperitoneal

Space:
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CLINICAL CORRELATIONS
• Periphrenic abscess: The
attachments of the renal fascia
determine the path of extension of a
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perinephric abscess. For example, the
fascia at the renal hilum firmly
attaches to the renal vessels and
ureter, usually preventing spread of
pus to the contralateral side.
However, pus from an abscess (or
blood from an injured kidney) may
force its way into the pelvis between
the loosely attached anterior and
posterior layers of the pelvic fascia.
 POSTERIOR ABDOMINAL WALL MUSCLES AND FASCIAS:

P t:I lUl ll UIiI

Inmrnol obhQu Q
E dorMl o!)I q~

A,,'critlr :q IJIl.!r ~Iw - .D j 10 .,"l lrMlII': f'o 0" fit

111m orlJln Imeta) IGl nsov'H.:1 bdotnl\al
L(ly OfC 01
1 Ol.:l to lu lXlt Jlidd e
/rscla
• Re nn l luti. <pm;.tanDi 1~'l=!n

Lalls!frml S dorsi

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PSOAS ABCESS: An abscess resulting from tuberculosis in the lumbar region tends to
spread from the vertebrae into the psoas sheath, where it produces a psoas abscess. As a
consequence, the psoas fascia thickens to form a strong stocking-like tube. Pus from the
psoas abscess passes inferiorly along the psoas within this fascial tube over the pelvic
brim and deep to the inguinal ligament. The pus usually surfaces in the superior part of
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the thigh. Pus can also reach the psoas sheath by passing from the posterior mediastinum
when the thoracic vertebrae are diseased.

REMOVING PUS:
 Posterior Abdominal Pain:
• The iliopsoas has extensive and clinically important relations to the kidneys,
ureters, cecum, appendix, sigmoid colon, pancreas, lumbar lymph nodes, and
nerves of the posterior abdominal wall.
• When any of these structures is diseased, movement of the iliopsoas usually
causes pain

ILIOPSOAS TEST:
( . . he person is asked to lie on the unaffected side and to extend the thigh on the
.0:
.~ ~js1 af~ected side a~ainst t~e. resistance the examiner's hand. Pain resulting from
9( ~ ~ thIs maneuver IS a p, slflve psoas sIgn
'-------~

Extraperitoneal Access:

1 Irwe51if'lg (deep) fastl.,·

superficial. inlcrmodiLllc. deep

• In order to reach the

retroperitoneal space you can

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n l[QLJe m -=¥.fI1'tft:o''Hfl,n

Imom;)1
obi Q.uo m.
Super! cial1att,laye,r 01
5U culancolJS tissue
lC<imper lase B)
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rrs vet e
enter between the
alJdcmM al m.
...
transversalis fascia and

parietal eritoneum.
Deep membranous layer
of subculllnOOlJS 1i sstJe
(ScnlJ)J '[lSCI i1 ~

DNEYS:
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• Retroperitoneal space
• T12 - L3
• Rightkidney lies at a slightly lower

level than the left kidney, due to the

presence of the liver.

• The kidneys are covered directly by a

fibrous capsule (renal or true

capsule).

Rena cortex
• The kidneys are further surrounded

by the perirenal fascia of Gerota

(false capsule), which is important in

staging renal cell carcinoma.

Reral paJiliae'
 • At the concave medial margin of each kidney is a vertical cleft, the renal hilum.
• The hilum is the entrance to the space within the kidney, the renal sinus, which is
occupied mostly by fat in which the renal pelvis, calices, vessels, and nerves are
embedded.
• In the renal hilum, the following anatomic structures are arranged in an anterior­
to-posterior direction:

Renal vein

Renal artery

Renal pelvis.

INTERNAL STRUCTURE:
• The outer cortex is located directly below the
~_ L AnlCri() t surfaco

renal capsule and extends between the renal Renal pi'" &-1 ~ ".... h',,"
pyramids as the renal columns (columns of
Urctar \
-­ L Medin mnrgin
Bertin). _____ -._
- !XI e
- lnle ~ io r

• The inner medulla is composed of 5-11 renal

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pyramids (pyramids of Malpighi), whose tips terminate as 5-11 renal papillae
• The collecting system of the kidney includes:
• 5-11 minor calyces, which are the cup-shaped structures that surround each renal
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papilla
• 2 or 3 major calyces, which are formed by the fusion of minor calyces
• The renal pelvis, which is the main urine collection chamber and is continuous with
the ureter at the ureteropelvic junction
• The renal artery branches into five segmental arteries.
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• Four anterior segmental arteries --- supply anterior segments of kidney
• One posterior segmental artery --- supplies the posterior segment.

POTERIOR ANTERIOR

[1'''('''''''''.'.

1' .... M.Vr .. ~ "'ocr.

0' "k"COIIO '"Villi ....
'fUn ....
CLINICAL CORRELATION:
• Horseshoe kidney occurs when the inferior poles of the

kidneys fuse during fetal development.

• The horseshoe kidney becomes trapped behind the

inferior mesenteric artery as the horseshoe kidney

attempts to ascend toward the normal adult location.

tTRETE S:
• The ureters begin at the ureteropelvic junction.
• Within the abdomen, the ureters descend

retroperitoneaUy and anterior to the psoas major muscle.

• They cross the pelvic inlet to enter the minor (true) pelvis.
• Within the minor pelvis, the ureters descend retroperitoneally and anterior to the
external iliac artery and vein
• The ureters end at the ureterovesical junction by traveling obliquely through the
wall of the urinary bladder (intramural portion of the ureter).

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• The intramural portion of the ureter functions as a check valve (ureterovesical
vlave of Sampson) to prevent urine reflux
• Normal constrictions of ureters
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1. Ureteropelvic junctiog...
2. Where the ureters cross the pelvic inley
3. Ureterovesical junction (entering in the bladder~
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