o Caudate lobe drains directly into the IVC by multiple small veins. Lymohatic drainaqe of liver: . Lymphatics of the posterior part of the liver follows the IVC to end in the diaphiagmatic LNs around the upper end of lVC. * Lymphatics of the remaining parts of the liver folllows the hepati,: aitery to en0 in the celiac LNs. Fahlo.m-lgEmsnl \ .-- F{b[orr|lbmfil L€lt I lttl€rht ccorniltgamerr I kntian$lrr ABDOMEN I Surface Anatomv Upoer Border: represented by a line

 

Site: in the Rt. iliac fossa above the taterat Tz of the inguinal ligament.

Relations:

o Anteriorly: anterior abdominal wall, greater omentum & loops of smatl intestine.

o Posteriorly: retro-caecal recess, Rt. psoas muscte, Rt. iliacus muscle, Rt.

femoral nerve, lateral cutaneous nerve of thigh, Rt. gonadal & external iliac

vessels.

PeritOnea I coverino: from front and sides.

Soecial features:

o lt has an ileo-caecal orifice opening in its medialwall.

o The appendix attached to its postero-medial aspect.

. lt possesses 3 taenia coli that converge on the appendix.

Adedrsil Foshrtr

cacd DrsldE8

iooscatnt8is

UDGaEi0Edo.dI

ilsmosel reces8

lloeNcilttr

l" l*aorutrn

bfarrll

Eolic sd6ry

0.lrrnnuor

ABD9MEN I

Embryoloqv:

o At first, it has the same caliber as the caecum but there is

excessive growth of Rt. side of the caecum.

o Rare sites are: the sub-hepatic type & situs inversus totalis.

Anatomy

#L. Rt. Iliac fossa (except in sub-hepatic type & situs inversus totalis). ,F. Attached to the postero-medial aspect of the caecum, l inch below the ileo-caecal

valve (at the meeting of 3 taenia coli).

-20 cm (average 10 cm) & about 0.5 cm wide

POSitiOn: lts tip points to one of the following positions:

ffi^ircr,

. Sub-caecal3.5o/o.

. Pre-ileal 1%.

. Post-ileal0.5%.

The appendix is completely covered by peritoneum

and has a mesoappendix which stops shortly at the

tip of appendix.

Blood Supplv: ffi, ,n"J*

. It runs along the free border of mesoappendix

& distally parallelto the appendix.

. lt is an end artery.

Size

2

Suroical Imoortance:

The inflammatory process causes thrombosis & gangrene of the appendix. lt

should be noticed that gangrene occurs at the tip because it is far from the

blood supply and the peritoneum is deficient over the tip of the appendix.

Annendicularlgiu

r Drains into superior mesenteric vein ) portal circulation.

o surqical rmoortance: Appendicitis can cause portal pyemia.

Nerve supply

- Tro supplies the peritoneal coverings of the appendix, so reffered

appendicular pain is felt at the umbilicus.

Lvmph Drainaoe ) llio-caecal ) superior mesenteric LNs.

Structu re

- The wall is composed of mucosa, submucosa,

musculosa & serosa.

- Submucosa & musculosa are rich in lymphoid tissue.

- Appendix is the tonsil of GIT and by aging, it atrophies.

Surgica! Importance: cancer caecum should be

suspected in any case of acute appendicitis in old age. (dd1ii IyryMd li!$.)

SUrfaCg anatOmyi The base of the appendix (McBurnev's point):

At the junction of lateral Ts & medialTs of a line extending from ASIS to the umbificus.

Spin6-

umbillcal

lins

M*Eurney

point

Points of Surqical Importance:

1) McBurney's point is the surface anatomy of the base of the appendix. Normally,

we open in front of the base & not the apex. This is because the base lies in a

fixed position while the apex has different positions.

^ 2)When performing appendicectomy through gridiron incision, you willencounter:

ftt, Scarpa's fasciasuperficial to external oblique aponeurosis. F b. External oblique muscle fibers parallel to the line of incision.

c. ffiiobliaue & transrersus abdominis lying almost in a transverse direction.

d. The transversalis fascia fused with the peritoneum.

flf,pl During appendicectomy, we use the anterior taenia coli on the caecum as a

T guide to the appendix.

4) Bleeding during muscle cutting occurs from deep circumflex iliac vessels.

ABDOMEN I

)

-

tutadian or midine lrclshn]1ag,, for€xptoraroqt

: Left paramed*n lnclsion J ipEritionst

r Gridircn (musde.splitlingf I

- ffi,#,- {ahdorninar} }':r'*m**,

-

Suprepr.rbic {Ffannendid} incislon {e.9., lar

iu;etareEtomyl

r Suhcoafial ind*hn {e.9., fur gallbhdder rcmonl}

LsttUlilUdarlgilllofit

falclhmtlgm.nt

turtrdlbffintrtltusl

$hgamontumtores|

Arnuratm

. The liver is divided into 2 livers by the principal plane (Cantlie's !ine).

o Cantlie's line passes from the gall bladder fossa to the left of the lVC.

o Each liver receives a branch from the hepatic artery, portalvein & bile duct.

o Rt. & Lt. hepatic veins divide the liver into 4 sectors.

o The 4 sectors are divided into 8 segments.

The Rioht Liver composed of

- Segments V & Vlll, anteriorly

- Segments Vl & Vll posteriorly

They are separated from each other by the right hepatic vein.

The Left Liver is composed of

- Segment I ) caudate lobe.

- Segment lV ) quadrate lobe.

- Segment !l & lll ) form the anterior part of the left lobe.

Suroical Imoortance:

Each segment has its own arterial, portal & hepatic duct branch ) can be removed

separately (i.e. segmentectomy).

I neo6Metl

lnlhrlrusmctri

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toflhqsUcCn

lnlsrsffie (mkldh) ho$i0c {dn

Sghtand bfitl"l huEtrrs

oltrpatc ut*y

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Heptc eruy F rorrar rno Ebfixt I

A. tntroryler

Morphologically divided into Rt. & Lt. lobes by:

1- Falciform lioament; at the anterior surface and superior surface.

2- Fissure of liqamentum teres: at inferior surface.

3- Fissure of liqamentum venosum: at posterior surface.

Rt. lobe shows 2 small lobes:

^^!) Caudate lobe: (on the posterior surface)

{S. ri.t o"t*".n groove of IVC & fissure for ligamentum venosum.

. The caudate process.' -F lt is the part of the caudate lobe extending between IVC & porta hepatis.

2) Ouadrate lobe: (on the inferior surface) ) it is bounded by.:

lfr.lb th. bft fissure for ligamentum teres. T .To the right: gallbladder fossa.

.Anteriorly: inferior border of the liver.

' Posteriorly: porta hepatis.

ABDOMEN I

Lsft lobe

LJgsm€rttm uanofltm

{ductus rremsus}

ftrund llgement

{umbill€l v6lnl

Blght lobe

PMdrhd:

enlers lv€r et

porla h€patls

C. ItsbrolnlEdor lrl6w

Shape & BOrderS: wedge-shaped with ill-defined borders except

irrferiorly.

Relations:

1. Superior surface: related to the diaphragm.

2. Anterior surface: related to diaphragm, xiphoid process & ant. abdominal wall.

3. Riqht lateral surface: related to the diaphragm, separating it from Rt. Iung, ffi

-^4. Inferior (visceral) surface: abdominal esophagus, stomach, duodenum, lesser

ylo'r|tr, nl ilriiflexure & Rt Kidney

thnguhrltgamofit

Lssssromeilfum ghptragmagcarg

Ewhagod arPa htsrlor vsna cava

Lolt lots

Ge6fic al8a Srpraranal area

Carfllato

Heflath arlery

corolary lignmsflt

Remlarua

Bh dus'l

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Hepe&pdalvdn

Fortr bopodi

ryhrE at8a loto

ouartralo lote

Duodanal ar€a

Gallb&dder

A h6'trolntorlduhtr

[- rrenaric )

I portal vetnz

I fepatc artery

l_.atte

prrrrg*t

(lo lossa tor gellbladden

. lt is a transverse fissure on the inferior surface of Rt. lobe of liver.

. Transmits (from anterior to posterior) hepatic ducts, hepatic artery, portal vein.

. Gives attachment to the lesser omentum.

I ABDOMEN

. The liver is conflDletely covered bv peritoneum except the followino areas:

ag. Bare area of the liver lies between superior & inferior layers of coronary

ff ligament.

2. Fossa for gall bladder.

3. Groove for lVC.

4. Porta hepatis.

Peritoneal Folds of the liver:

o Falciform ligament: to diaphragm & ant. abdominal wall.

. @to stomach & 1't inch of the duodenum.

. Rt. & Lt. triangular ligaments: to the diaphragm.

. Upper & lower coronary liqaments: to the diaphragm.

Bf OOd SUOply: 7Oo/o from portal vein & 30% from hepatic artery.

Venous Drainaqer

o Hepatic veins:

- 3 veins: Rt. hepatic vein drains into IVC while middle & left hepatic veins unite

and drain into lVC.

- Emerge from the back of the liver & drain into the lVC.

o Caudate lobe drains directly into the IVC by multiple small veins.

Lymohatic drainaqe of liver:

. Lymphatics of the posterior part of the liver follows the IVC to end in the

diaphiagmatic LNs around the upper end of lVC.

* Lymphatics of the remaining parts of the liver folllows the hepati,: aitery to en0

in the celiac LNs.

Fahlo.m-lgEmsnl \ .-- F{b[orr|lbmfil L€lt I lttl€rht ccorniltgamerr I kntian$lrr

ABDOMEN I

Surface Anatomv

Upoer Border: represented by a line

joining the following points:

1- Apex of the heart.

2- A point at the xiphi-sternum.

3- 5ll rib in right mid-clavicular line.

4- 7:i rib in the right mid-axillary line.

5- gth rib in right Scapular line.

-