Lieno-renal ligament F Attached to the posterior margin of the hilum & tail of pancreas & transmits the splenic vessels, nerves & lymphatics. F Difficult to be cut as it contains important structures. .^. Phrenico-colic ligament filf ) From splenic flexure of the colon to peritoneum over the kidney. tF F Spleen is in contact with it, but not attached to it. ) lt is a derivative of the dorsal mesogastrium.

 

Lower Bordery marked by a line joining

@ts: 1- A point on the Lt sth intercostal space at

the Lt. lateral vertical plane.

2- A point,on the lt. costal margin at the tip

of the 8'n costal cartilage.

3- Midway between xiphi-sternum & umbilicus.

4- Tip of right gth costal cartilage.

5- Following the costal margin to the mid-axillary line.

Right border: from 5ih rib to 7th and 11th rib in mid-axillary line.

Sha pe : Pyriform-shaped.

SiZe: 8 - 12 cm length x 3 cm width.

Site: fossa for gallbladder on the inferior surface of the Rt. lobe of the liver.

Capacitv: SeShr.ldil

3o-50 ml

Power of Concentration: 1o times

Pa rts:

A. Fundus:

Projects beyond the inferior border of the liver.

ls covered by peritoneum all around.

Related to:

- Anteriorly: anterior abdominal wall.

- Posteriorly: transverse colon.

Surface anatomy: at junction between Rt. linea semilunaris and Rt. costal margin

(tip of Rt. gth costal cartilage).

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I ABDOMEN

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In contact with gall bladder fossa of liver, to the right side of the quadrate lobe.

. lts inferior surface is covered by peritoneum.

. Related to: 1't part of the duodenum.

C. Neck:

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ABDOMEN I

Mucous Membrane:

- The mucous membrane of the bile duct secretes mucous at a higher pressure

than the pressure at which the liver cells can secrete bile.

- surgical lmportance: this causes white bile (mucous) ) bad prognosis.

Ar

- Cystic artery: a branch 'of Rt.

artery passing in the triangle of

(between the cystic duct & liver)

hepatic

Callot

- Accessory cystic A.: if present (from Rt.

or Lt. hepatic A. or common hepatic A.)

N.B: The Rt. hepatic artery passes behind

the common hepatic duct.

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Eu@firlVenous Drainaqe:

cystic veins ) Rt. branch of portal vein.

Lymphatic Drainaqe:

- Cystic LN of Lund at the junction of cystic duct & CHD ) to cellac LN

Triangle of Callot:

.Bounded by: liver, CHD & cystic duct .lt contains.'cystic artery & LN of Lund

Nerve Suoply:

o Autonomic:

- Parasympathetic: hepatic branch of anterior vagus.

- Sympathetic: from Tz-g (pain is reffered to inferior angle of Rt. scapula).

. Sensory: by the Rt. phrenic C3,4,5 (the same segments as the supra-clavicular

nerves ) so pain in gall bladder is referred to Rt. shoulder).

Rt. hepatic duct: union of

anterior & posterior segmental hepatic

ducts.

Lt, hepatic duct: union of medial

& lateral segmental hepatic ducts.

Common heoatic duct: union

of Rt. & Lt. hepatic ducts.

Diameter of the common hepatic duct

is 4 mm by U/S

Cystic duct;

Common Hepa$c Duc-l

.S-shaped ,2.5 cm, its mucosa

contains crypts of Luschka.

'Has a spiral valve in its interior of

Heister.

.Allows bile to flow to & from the

GB.

.Usually joins the common hepatic duct on its Rt. side.

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[@ fne Rt. hepatic duct rarely enters the gallbladder near its junction with the cystic

duct

The common bile duct: {[

. Formed by union of common hepblic duct & cystic duct.

. It is divided into 4 parts & its length is 3 - 4 inches.

. lts length inversely proportional to the length of the hepatic duct.

. Diameter by U/S ) CBD 6 mm (dilated if > 1 cm) & I mm by chr raphy.

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n+*opamerlic impurn {funpulla of vater}

A. Supra-duodenal Part

- lt is formed by union of cystic duct & common hepatic duct (Y-shaped).

- lt runs downwards in the free border of the lesser omentum.

- The portal vein lies behind it while the hepatic artery lies on its left side.

- lt is separated from IVC by foramen of Winslow.

- The wall of the supra-duodenal part has a venous plexus which can be seen

at operation.

B. Retro-duodenal Portion

- lt is behind the 1"t part of duodenum.

- On its left side lies the gastro-duodenal artery; and the portalvein behind them.

C. I nfra-duodenal Portion

- Behind the head of pancreas (cancer head of pancreas ) obstructive jaundice).

D. Termination of the CBD (lntra-duodenal portion)

a. Either unites with the main pancreatic duct to form hepato-pancreatic duct which

* ends in the ampulla of Vater (present in the postero-mediai part of the middle of * the 2nd part of the duodenum 10 cm beyond the pylorus).

b. Or common bile duct and main pancreatic duct open separately at ampulla of

Vater (it may terminate without ampulla).

The duodenal papillae permitpassage of dilator 3 mm in diameter.

ABDOMEN I

Anomalies of the Gall Bladder:

1) Congenital absence.

2) Septate.

3) Double gallbladder with single duct or double ducts.

4) Floating gall bladder.

5) lntra-hepatic gall bladder.

6) Sessile gallbladder (the surgeon may injure the CBD during cholecystectomy).

7) Phrygian cap.

8) Low insertion of the cystic duct.

9) Accessory cholecysto-hepaticduct.

10) Cystic duct joins the CBD on its left side.

Anomalies of the Blood Supplv

1)Cystic artery may pass in the front of the CBD.

2)Accessory cystic artery may arise from the Rt. or Lt. hepatic artery or other

branches of the celiac trunk.

3)The Rt. hepatic artery may be tortuous in front of the bile duct (Caterpillar turn or

Moynihan's hump deformity),

4)Accessory Rt. hepatic artery may arise from the superior mesenteric artery.

5) Cystic veins + open in the liver.

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I ABDOMEN

Cornmunicates l sser peritoneal sac_to gr"u,"fiGneal

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Greater peritoneal sac

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Left kidney

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Peritoneat

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Uiscaral

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Splenorenaf Iigament

Anterior: Free border of lesser om( ) portar vein: porterioLtum,

containinq:

) CBD: anterior & to the right. F Hepatic artery: anterior & to the left.

ABDO-MEN-

Surqical Importance

o Site of Porto-caval anastomosis.

o During cholecystegjoTy,. control of bleeding from cystic artery is achieved by Prinqles

maqguver ) pul the index finger of the Lt. hand in the foramen of Winslow & cornpress

the free border of lesser omentum against the thumb ) compression of hepatic artery.

o Site of exposure of supra-duodenal portion of CBD for removal of stones.

. A site for internal hernia (epiplocele) where the foramen represents the defect.

Embrvoloov

S&. The spleen arises from the left side of the dorsat mesogastrium.

'rF r lt is mesodermal in origin & later has its own lymphatic & vascular element.

, The spleen is rarely absent.

. The mesenchymal cells that fails to fuse becomes accesssory spleens.

. Sites of accessory spleens:

- Hilum of the spleen 50%.

- Splenic vessels and tail of pancreas 30%.

- Splenic ligaments & mesocolon.

. lf accessory spleens are left after spleenectomy )hyperplasia & recurrence.

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Suroical Anatomv

The odd numbers 1, 3, 5, 7,9 & 11 summarize certain statistical features of spleen.

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Site:

Size:1x3X5inches

Weioht: 7 ounces (150-200 gm)

.Lt. hypochondrium oppositetothe gth, lOth & 11th ribswith its long axis parallel to

1Oth rib.

.lt normally does not descend below the costal margin.

Afmlorrr

I ABDOMEN

Shape

It has 2 ends, 2 borders & 2 surfaces

o Ends: (LaMp)

o Lateral (anterior) end: broad, at mid-axillary line.

. Medial (posterior) end: tapering,4 cm from T10.

o Borders.

. gry1lgl@gglgtr sharp & usually has a notch.

. lnferior border: rounded & smooth.

o Surfaces:

1 . Diaphrusmatic= related to the diaphragm.

2. Viscerul: has 4 impressions & the hilum:

Gastric imoression:

) Between the hilum & the upper border.

) lt is related to the fundus of the stomach.

Pancreatic I mpre ssio n :

FJust below the hilum.

F lt is related to the tail of pancreas.

Renal lmpression:

) Between the hilum & lower border.

F lt is related to the front of the Lt. kidney.

Colic lmpression

) Close to the anterior end of the spleen.

F lt is related to Lt. colic flexure.

Peritoneal coverinqs:

- lt is completely covered with peritoneum.

Lioa ments

Gastro-splen ic I igament

) lt is attached to the anterior margin of the hilum & transmits short gastric

vessels and gastro-epiploic vessels.

) lt is a part of greater omentum.

> lt can be divided easily as it has no important contents.

Lieno-renal ligament

F Attached to the posterior margin of the hilum & tail of pancreas & transmits the

splenic vessels, nerves & lymphatics.

F Difficult to be cut as it contains important structures.

.^. Phrenico-colic ligament

filf ) From splenic flexure of the colon to peritoneum over the kidney. tF F Spleen is in contact with it, but not attached to it.

) lt is a derivative of the dorsal mesogastrium.

ABDOMEN I

ABDOMEN I

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Blood Supply