Arteries
|
| Artery |
Source |
Branches |
Supply |
Notes |
| aberrant hepatic (N305, TG5-25) |
left - l. gastric a.; right- SMA |
|
liver |
|
| celiac trunk |
abdominal aorta at level of T12-L1 intervertebral disc |
left gastric, splenic, common hepatic |
stomach, lower esophagus, liver, upper duodenum, pancreas, spleen |
(Greek, celiac = belly; the celiac artery supplies the principal organs of the belly) |
| cystic (TG5-24, TG5-25) |
right hepatic a. (or superior mesenteric a., proper hepatic a., left hepatic a., gastroduodenal a.) |
no named branches |
gall bladder |
cystic a. arises from the right hepatic a. in ~72% of cases; other possible origins are noted at left and are clinically relevant during gall bladder surgery (Greek, cystic/kystis = bladder or pouch) |
| gastroduodenal (TG5-27) |
common hepatic |
supraduodenal aa., retroduodenal aa., posterior superior pancreaticoduodenal a., anterior superior pancreaticoduodenal a., right gastro-omental a. |
upper duodenum, upper part of head of pancreas; greater curvature of stomach on right |
|
| gastro-omental, left (TG5-27) |
splenic |
gastric, omental |
mid-part of greater curvature of stomach; greater omentum |
anatomoses with right gastro-omental a.; also known as: left gastroepiploic a. |
| gastro-omental, right (TG5-27) |
gastroduodenal |
gastric, omental |
lower part of pyloric part of stomach, right part of greater curvature of stomach, greater omentum |
anastomoses with left gastro-omental; also known as: right gastroepiploic a. |
| hepatic, common (TG5-27) |
celiac trunk |
gastroduodenal & proper hepatic |
liver & parts of duodenum, pancreas & stomach |
|
| hepatic, proper (TG5-27) |
common hepatic |
right gastric, right & left hepatic |
liver, lesser curvature of stomach |
|
| hepatic, left (TG5-25) |
proper hepatic |
|
left & quadrate lobes of liver, part of caudate lobe |
left hepatic a. supports liver parenchyma and stroma |
| hepatic, right (TG5-25) |
proper hepatic |
cystic |
right lobe of liver, part of caudate lobe |
right hepatic a. supports liver parenchyma and stroma |
| splenic (TG5-27) |
celiac trunk |
dorsal pancreatic, pancreatic brs., pancreatica magna, caudal pancreatic, short gastric, left gastro-omental, splenic brs. |
pancreas, spleen, greater curvature of stomach |
|
| supraduodenal |
gastroduodenal |
|
1st part of duodenum superiorly |
|
| pancreatic, caudal (TG5-27) |
splenic |
|
tail of pancreas |
|
| pancreatic, dorsal (TG5-27) |
splenic |
right br., left br. |
pancreas near neck |
right br. anastomoses with anterior superior pancreaticoduodenal in prepancreatic arcade |
| pancreatic, inferior (TG5-27) |
dorsal pancreatic, left br. |
|
lower part of body of pancreas |
|
| pancreatic, superior (TG5-27) |
splenic (multiple small brs.) |
|
superior part of body of pancreas |
|
| pancreatica magna (great pancreatic) (TG5-27) |
splenic |
|
body of pancreas |
|
| pancreaticoduodenal, anterior inferior (TG5-27) |
inferior pancreaticoduodenal, from superior mesenteric |
pancreatic brs., duodenal brs. |
lower duodendum & head of pancreas |
anastomoses with anterior superior pancreaticoduodenal in anterior pancreatic arcade |
| pancreaticoduodenal, anterior superior (TG5-27) |
gastroduodenal |
pancreatic brs., duodenal brs. |
upper duodenum & head of pancreas |
anastomoses with anterior inferior pancreaticoduodenal in anterior pancreatic arcade |
| pancreaticoduodenal, inferior (TG5-27) |
superior mesenteric |
anterior & posterior inferior pancreaticoduodenal |
lower duodenum & head of pancreas |
|
| pancreaticoduodenal, posterior inferior (TG5-27) |
inferior pancreaticoduodenal, from superior mesenteric |
pancreatic brs., duodenal brs. |
lower duodendum & head of pancreas |
anastomoses with posterior superior pancreaticoduodenal in posterior pancreatic arcade |
| pancreaticoduodenal, posterior superior (TG5-27) |
gastroduodenal |
pancreatic brs., duodenal brs. |
upper duodenum & head of pancreas |
spiral around the bile duct; anastomoses with posterior inferior pancreaticoduodenal in posterior pancreatic arcade |
Veins
|
| Vein |
Tributaries |
Drains Into |
Region Drained |
Notes |
| esophageal (TG4-40) |
|
azygos and hemiazygos vv. |
esophagus |
connect with esophageal brs. of left gastric, forming potential portal-caval anastomosis (esophageal varices when enlarged) |
| portal (TG5-22, TG5-26) |
formed by union of superior mesenteric & splenic vv.; tributaries: posterior superior pancreaticoduodenal v., right & left gastric vv. |
right & left branches of portal v., into liver sinusoids |
|
connects with caval drainage at 1) esophagus, 2) rectum, 3) umbilicus, 4) retroperitoneal gut structures |
| hepatic, left (TG5-25) |
segmental vv. |
inferior vena cava |
lateral segment & superior portion of medial segment of left lobe of liver |
|
| hepatic, middle (TG5-25) |
segmental vv. |
inferior vena cava |
inferior portion of medial segment of left lobe of liver, & inferior part of anterior segment of right lobe |
|
| hepatic, right (TG5-25) |
segmental vv. |
inferior vena cava |
posterior segment & superior portion of anterior segment of right lobe of liver |
|
| gastric, left (TG5-28) |
esophageal vv. |
portal v. |
lesser curvature of stomach, lower esophagus |
connects with esophageal vv., forming portal-caval venous anastomosis (esophageal varices when enlarged); also known as: coronary v. |
| gastric, right (TG5-28) |
|
portal v. |
lesser curvature of stomach |
also known as: coronary v. |
| gastro-omental, left (TG5-28) |
gastric & omental brs. |
splenic v. |
greater curvature of stomach & greater omentum |
also known as: left gastroepiploic v. |
| gastro-omental, right (TG5-28) |
gastric & omental brs. |
superior mesenteric v. |
greater curvature of stomach & greater omentum |
also known as: right gastroepiploic v. |
| mesenteric, superior (TG5-26, TG5-27) |
pancreticoduodenal, jejunal, right and middle colic |
portal v. |
gut |
|
| pancreaticoduodenal, posterior superior |
|
portal v. |
posterior part of head of pancreas & 1st & 2nd part of duodenum posteriorly |
connects with posterior inferior pancreaticoduodenal |
| pancreaticoduodenal, inferior |
anterior & posterior inferior pancreaticoduodenal |
superior mesenteric v. |
lower part of duodenum & head of pancreas |
connects with anterior & posterior superior pancreaticoduodenal vv. |
| pancreaticoduodenal, anterior superior |
|
unites with right gastro-omental v. to drain to superior mesenteric |
upper duodendum & head of pancreas anteriorly |
connects with anterior inferior pancreaticoduodendal v. |
| paraumbilical (TG5-02) |
|
umbilical part of left branch of portal vein |
falciform ligament, round ligament of liver |
potential site of portal-caval anastomosis; blood may pass retrogradely into body wall veins near umbilicus, creating caput medusa sign |
| splenic (TG5-20) |
pancreatic brs. |
unites with SMV to form portal v. |
spleen |
|
| mesenteric, inferior (TG5-28) |
superior rectal, sigmoid, left colic vv. |
splenic v. (or superior mesenteric v.) |
gut from splenic flexure distally |
courses lateral to 4th part of duodenum |
Viscera
|
| Organ |
Location/Description |
Notes |
| duodenojejunal junction (TG5-17) |
suspended by suspensory muscle (ligament) of duodenum |
inferior mesenteric v. passes to left side |
| intestine, small (TG5-17) |
|
3 parts: duodenum (1 foot long, mostly retroperitoneal); jejunum (8 feet long); ileum (12 feet long) |
| duodenum (TG5-17) |
C-shaped proximal segment of small intestine |
4 parts: 1st or superior, 2nd or descending, 3rd or transverse, 4th or ascending (Latin, duodenum = 12, for it was estimated to be twelve finger-breadths long) |
| fusion fascia (TG5-29) |
a relatively avascular connective tissue plane formed behind secondarily retroperitoneal structures |
|
| greater duodenal papilla (TG5-26) |
an eminence on the posteromedial wall of the descending duodenum |
location of the opening of the hepatopancreatic duct (Latin, papilla = a nipple) |
| lesser duodenal papilla (TG5-26) |
located just superior to the greater duod. papilla |
location of the opening of the accessory pancreatic duct (Latin, papilla = a nipple) |
| pancreas (TG5-27) |
|
functions as digestive & endocrine gland; main pancreatic duct drains tail, body & lower head to greater duodenal papilla within 2nd part of duodenum; accessory pancreatic duct drains upper head to lesser duodenal papilla |
| pancreas, body of (TG5-27) |
stretches to left from neck; continuous with tail |
splenic a. lies on superior border, splenic v. lies posterior to body |
| pancreas, head of (TG5-27) |
right-most part |
lies within C-shaped curve of duodenum |
| pancreas, neck of (TG5-27) |
junction between head & body extending to left |
superior mesenteric a. arises posterior to neck |
| pancreas, tail of (TG5-27) |
left-most extent of pancreas, extending toward hilum of spleen within splenorenal ligament |
|
| pancreas, uncinate process of (TG5-27 |
lowest part of pancreas |
tip of uncinate process lies posterior to superior mesenteric vessels |
| pancreatic duct, accessory (TG5-26) |
drains upper head of pancreas |
opens onto lesser duodenal papilla |
| pancreatic duct, main (TG5-26) |
drains tail, body & lower head of pancreas |
unites with the bile duct at hepatopancreatic ampulla |
| liver (TG5-21A, TG5-21C, TG5-21D) |
consists of 4 anatomical lobes: left, right, quadrate & caudate |
lies inferior to the diaphragm as high as 5th rib on right |
| bare area of liver (TG5-21A, TG5-21D) |
lies between anterior & posterior laminae of coronary lig. |
in contact with diaphragm |
| porta hepatis (TG5-21) |
region of undersurface of liver where hepatic ducts, hepatic aa. & portal v. enter/leave |
|
| quadrate lobe (TG5-23) |
part of liver between bed of gall bladder & round ligament of liver |
functionally part of left lobe (Latin, quadrate = square) |
| ligamentum venosum (TG5-21) |
lies in attachment of hepatogastric lig. to liver, between caudate & left lobe |
remnant of obliterated ductus venosus |
| gallbladder (TG5-24A, TG5-24B) |
hangs below liver between right & quadrate lobes of liver |
connected to the bile duct via cystic duct |
| gallbladder, body of (TG5-24) |
lies in bed of gallbladder between right & quadrate lobes of liver |
|
| gallbladder, fundus of (TG5-24) |
expanded lower part; located near inner surface of anterior abdominal wall at junction of right 9th costal cartilage & right semilunar line |
|
| gallbladder, neck of (TG5-24) |
constricted upper part of gallbladder |
continuous with cystic duct |
| hepatic duct, common (N294, TG5-22A, TG5-24C) |
formed by union of right & left hepatic ducts |
unites with cystic duct to form bile duct |
| hepatic duct, left (N294, TG5-22A, TG5-24C) |
drains left lobe, quadrate lobe & part of caudate lobe of the liver |
unites with right hepatic duct to form common hepatic duct |
| hepatic duct, right (N294, TG5-22A, TG5-24C) |
drains right lobe & part of caudate lobe of the liver |
unites with left hepatic duct to form common hepatic duct |
| bile duct (N294, TG5-22A, TG5-24C) |
union of cystic & common hepatic ducts |
drains to hepatopancreatic ampulla & greater duodenal papilla with main pancreatic duct |
| cystic duct (N294, TG5-22A, TG5-24C) |
duct of the gallbladder; unites with common hepatic duct to form the bile duct |
both drains and fills gallbladder (Greek, cystic/kystis = bladder or pouch) |
Peritoneal Specializations and Associated Structures
|
| Specialization |
Location/Description |
Notes |
| circular folds of the pyloric sphincter (N279, TG5-26C) |
2nd part of the pyloric sphincter |
more like the duodenum than the stomach |
| hepatoduodenal ligament (TG5-18, TG5-19) |
part of lesser omentum connecting liver with 1st part of duodenum |
contains bile duct, proper hepatic a. & portal v. |
| hepatogastric ligament (TG5-18) |
part of lesser omentum connecting liver with lesser curvature of stomach |
|
| falciform ligament (N269 ,N287, TG5-21) |
sickle-shaped fold of peritoneum connecting liver to umbilicus |
contains round ligament of liver (ligament teres hepatis) (Latin and English combo, falciform = shaped like a scythe or sickle) |
| coronary ligament (N287, TG5-21) |
peritoneum connecting liver to undersurface of diaphragm |
area between anterior & posterior laminae is bare area of liver |
| pyloric sphincter (TG5-19) |
greatly thickened layer of the muscularis externa in the pylorus of the stomach |
normally closed except when excreting chyme |
| round ligament of the liver (TG5-21) |
|
also known as: ligamentum teres hepatis |
| triangular ligaments (TG5-21) |
left and right extremes of the coronary ligament |
formed by the fusion of anterior & posterior laminae of the coronary ligament |
| ligament of Treitz |
posterior to the pancreas and splenic vein and anterior to the left renal vein |
also known as the suspensory muscle of the duodenum |
| ligamentum teres hepatis (TG5-21) |
lies within falciform lig.; connects liver to umbilicus; remnant of umbilical v. |
also known as: round ligament of liver (Latin, teres = round) |
| transverse mesocolon (TG5-18) |
peritoneum connecting transverse colon to posterior abdominal wall |
|
| mesentery (TG5-29) |
peritoneum connecting jejunum & ileum to posterior abdominal wall |
also known as: mesentery of small intestine |
Clinical Terms
|
| Term |
Definition |
| portocaval anastomosis |
a common method for reducing portal hypertension by diverting blood
from the portal venous system to the systemic venous system by creating
a communication between the portal vein and the IVC. This usually leads
to hepatic encephalopathy as the toxins from the GI tract bypass the liver and
its processing of them. |
| pancreatitis |
acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic and which is due to autodigestion of pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis or uremia. |
| pancreatic cancer |
a malignant growth of the pancreas. More than 90% are ductal adenocarcinomas with islet cell carcinomas making up the difference. Symptoms include abdominal pain, abdominal swelling, jaundice, weight loss and anorexia. |
| gallstones |
a concretion in the gall bladder or a bile duct, composed chiefly of cholesterol crystals. |
| jaundice |
yellowing of the skin (and whites of eyes) by bilirubin, a bile pigment. Frequently because of a liver problem. (Latin, jaundice/jaune = yellow) |
| cholecystectomy |
the surgical removal of the gallbladder. This type of surgery may be performed with the traditional open incision or via a flexible fiberoptic scope (laparoscopic cholecystectomy). |
| cirrhosis |
liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. (Greek, kirrhos = yellow liver + -osis = condition) |
| portal hypertension |
any increase in the portal vein pressure due to anatomic or functional obstruction (for example alcoholic cirrhosis) to blood flow in the portal venous system. Indicators of portal hypertension are: esophageal varices, hemorrhoids, enlarged veins on the anterior abdominal wall (caput Medusae) and ascites (fluid within the abdominal cavity). |
| ascites |
an effusion and accumulation of serous fluid in the abdominal cavity. (Greek, askos = a bag) |
| Kocher manuever |
reflecting the duodenum and pancreas medially by cutting through the
fusion fascia along the right side of the descending part of the duodenum.
This maneuver is used to gain access behind the pancreas. |
| duodenal stenosis |
narrowing of the duodenum. May be congenital or the result of neoplastic growth. (Latin, stenosis = a narrowing) |
| duodenal atresia |
congenital duodenal atresia (blind end) of the duodenum, caused by a failure of recanalization of the duodenal lumen during development. It should be noted that 70% of patients with duodenal atresia also have other malformations including Down's Syndrome, cardiac or GI defects. (Greek, atresia = without hole) |
| cholecystojejunostomy |
surgical establishment of a communication between the gall bladder and the jejunum. |
| pruritis |
itching caused by drug reaction, food allergy, liver disease, cancers, parasites, aging or dry skin. (Latin, prurio = an itching) |
| bilirubin |
pigment found in bile. Mainly formed during heme catabolism- the breakdown of old red blood cells within the liver. (Latin, bilis = bile + ruber = red) |
| hepatomegaly |
enlargement of the liver |
| diuretics |
agents that promote the excretion of urine through their effects on the function of the kidney |
| endoscopic retrograde cholangiopancreatography |
fiberoptic endoscopy for duodenal observation and cannulation of the hepatopancreatic ampulla in order to visualize the pancreatic and biliary duct system by retrograde (against the usual direction of flow) injection of contrast media |
| hemangioma |
an anomaly that leads to a mass that resembles neoplastic tissue. (Greek, -oma = tumor) |
| caput medusae |
varicose veins radiating from the umbilicus. Ordinarily seen as a sign of cirrhosis of the liver and caused by portal hypertension. (Latin, caput medusae = medusa head) |
| cholecystitis |
acute or chronic inflammation of the gall bladder |
| laparoscopic cholecystectomy |
surgery to remove a diseased gallbladder through a fiberoptic scope that is inserted into a small incision near the navel. The patient is usually home 24 hours after the surgery. |
| hematemesis |
vomiting of blood. (Greek, hema = blood + -emesis = vomiting) |
| Pringle maneuver |
manually stopping the inflow to the liver by compressing the portal vein and
proper hepatic artery. This is utilized in cases when the liver is bleeding and the
bleeding must be stopped immediately (such as in trauma or surgical exploration) |
