Site: in the Rt. iliac fossa above the taterat Tz of the inguinal ligament.
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
PeritOnea I coverino: from front and sides.
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.
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.
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:
The appendix is completely covered by peritoneum
and has a mesoappendix which stops shortly at the
. It runs along the free border of mesoappendix
& distally parallelto the appendix.
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.
r Drains into superior mesenteric vein ) portal circulation.
o surqical rmoortance: Appendicitis can cause portal pyemia.
- Tro supplies the peritoneal coverings of the appendix, so reffered
appendicular pain is felt at the umbilicus.
Lvmph Drainaoe ) llio-caecal ) superior mesenteric LNs.
- The wall is composed of mucosa, submucosa,
- 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.
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:
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
4) Bleeding during muscle cutting occurs from deep circumflex iliac vessels.
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
r Suhcoafial ind*hn {e.9., fur gallbhdder rcmonl}
. 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.
- Segments V & Vlll, anteriorly
- Segments Vl & Vll posteriorly
They are separated from each other by the right hepatic vein.
- Segment !l & lll ) form the anterior part of the left lobe.
Each segment has its own arterial, portal & hepatic duct branch ) can be removed
separately (i.e. segmentectomy).
Heptc eruy F rorrar rno Ebfixt I
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.
^^!) 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.
Shape & BOrderS: wedge-shaped with ill-defined borders except
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
Ewhagod arPa htsrlor vsna cava
. 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.
. The liver is conflDletely covered bv peritoneum except the followino areas:
ag. Bare area of the liver lies between superior & inferior layers of coronary
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.
- 3 veins: Rt. hepatic vein drains into IVC while middle & left hepatic veins unite
- Emerge from the back of the liver & drain into the lVC.
o Caudate lobe drains directly into the IVC by multiple small veins.
. 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
Fahlo.m-lgEmsnl \ .-- F{b[orr|lbmfil L€lt I lttl€rht ccorniltgamerr I kntian$lrr
Upoer Border: represented by a line
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.
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