Laboratory Identifications and Relations - Abdominal Cavity and Vasculature

Structural Basis of Medical Practice -- Gross Anatomy

The Pennsylvania State University College of Medicine

Note: This guide is not exhaustive.  The relations are incomplete.  The intent is to highlight observation through dissection.
  1. Phrenicocolic ligament - supporting the left colic flexure, forming superior boundary of left paracolic gutter
  2. Transverse mesocolon - reflecting off the posterior wall as two layers of peritoneum extending to the tranverse colon, notice the two layers diverge to envelope most, but not all, of the circumference of transverse colon.  The transverse colon and, in fact, all intraperitoneal structures have a "bare area."
  3. Gastrocolic ligament - part of the greater omentum extending between the greater curvature of the stomach and the transverse colon, note that the posterior lamina forms, in part, an anterior boundary of the lesser sac (omental bursa)
  4. Greater omentum - extending off the greater curvature of the stomach, notice that the greater omentum does not attach to the ventrum (adhesions excepted), note that, to the left, the greater omentum is continous with the gastrosplenic ligament (dorsal mesentery)
  5. Leinorenal ligament - visceral ligament (two layers of peritoneum) securing the spleen to the posterior abdominal wall (dorsal mesentery)
  6. Right paracolic gutter - lateral to the ascending colon, unlike the left gutter, there is not a limiting structure at the superior (or inferior end), provides direct communication between the pelvic basin, hepatorenal recess, and lesser sac via the epiploic foramen
  7. Lesser omentum - connecting the liver to the lesser curvature of the stomach and to the region of the duodenal cap, has named parts (hepatogastric and hepatoduodenal ligaments) that are visceral ligaments (two layers of peritoneum), continuous with coronary ligament and falciform ligament, ventral mesentery
  8. Hepatogastric ligament - connecting the liver (ligamentum venosum) to the lesser curvature of the stomach, provides pathway for autonomics (e.g., hepatic branch of vagus), and vessels (e.g., right and left gastic) as do all visceral ligaments
  9. Hepatoduodenal ligament - connecting liver (porta hepatis) to the duodenal cap, envelopes the common bile duct, hepatic proper a., and the portal vein, forms inferior boundary of the epiploic foramen.
  10. Epiploic foramen - boundaries: anterior the hepatoduodenal ligament, posterior the inferior vena cava, superior the caudate lobe (liver), inferior the duodenal cap
  11. Coronary ligament - securing the liver to the diaphragm, continuous with the falciform ligament and the hepatogastric ligament
  12. Anterior lamina of right and left triangular ligaments - lateral extensions of coronary ligament, defining, in part, the subphrenic recesses
  13. Falciform ligament - securing the liver to the anterior abdominal wall, continous with the coronary ligament, contains the ligamentum teres and paraumbilical vv., inferior free edge represents the end of the ventral mesentery as does the inferior free edge of the lesser omentum at the epiploic foramen
  14. Duodenojejunal flexure - supported by the ligament of Treitz, marks end of duodenum and beginning of small intestine
  15. Root of intestinal mesentery - site of reflections of peritoneum off the posterior wall the extend to the small intestine, courses obliquely to the right starting from the duodenojejunal junction
  16. Ileocecal junction - lower right quadrant, location of ileocecal valve, beginning of large intestine
  17. Appendix - extending from cecum into pelvic basin
  18. Mesoappendix - visceral ligament (two layers of peritoneum) securing the appendix to the cecum
  19. Right colic flexure - transition from ascending to transverse colon, notice that this is lower than the left colic flexure (the liver is a bully)
  20. Left colic flexure - supported by the phrenicocolic ligament
  21. Coronary Ligament - continuous with falciform ligament and lesser omentum (ventral mesentery), attaching liver to diaphragm
  22. Left and right triangular ligaments - lateral extensions of the coronary
  23. Anterior lamina of coronary ligament - nick a small observation window to view the bare area
  24. Ligamentum teres - fibrous cord (remnant of left umbilical vein) extending anterioinferior near the free edge of the falciform lig.
  25. Bare area of the liver - boundaries defined by the coronary ligament, includes the IVC
  26. Ligamentum Venosum - fibrous cord between portal vein and left hapatic vein, site of attachment for the hepatogastric (not hepatoduodenal) ligament (watch out for Chung on this), remnant of ductus venosus
  27. Porta hepatis - site of entry into the liver for hepatic ducts, hepatic aa., and portal v., attachment of hepatoduodenal ligament
  28. Cystic duct - entering common hepatic duct ot form common bile duct
  29. Right hepatic a. - crossing posterior to common hepatic duct (typically not common bile duct as stated in Hollinshead)
  30. Celiac trunk - anterior border of trunk in contact with median arcuate ligament
  31. Celiac ganglia - posterior lateral to celiac trunk on sides of aorta
  32. Greater splanchnic n. - piercing crus of diaphragm to enter celiac trunk
  33. Celiac plexus - fibrous nervous tissue surrounding celiac trunk and arterial branches
  34. Splenic artery - branch of celiac trunk running transversely toward the spleen, retroperitoneal in floor of lesser sac, intraperitoneal in leinorenal ligament
  35. Dorsal pancreatic a. - entering superior medial aspect of pancreas, branch of either celiac trunk, splenic a., or aorta
  36. Chief (great) pancreatic a. - branch of splenic artery entering superior border of body of pancreas
  37. Short gastric aa. - branching from splenic a., travelling through gastroleino ligament to provide the fundus of the stomach
  38. Left gastroepiploic a. - branching from splenic artery within lienorenal ligament (commonly) and entering the greater omentum  to travel along greater curvature
  39. Left gastric a. - branching from the celiac trunk and traveling toward gastroesophageal junction, within hepatogastric ligament, lesser curvature
  40. Esophageal a.v. - branching from the left gastric a.v. near the gastroesophageal junction, ascending through esophageal hiatus, veins related to esophageal varices
  41. Right gastric a. - branching from the hepatic proper a., traveling through the hepatogastric ligament toward pyloric end of lesser curvature
  42. Gastroduodenal a. - terminal branch of common hepatic within lesser omentum
  43. Supraduodenal aa - branching from gastroduodenal before passing posterior to duodenal cap, supplying superior surface of duodenal cap
  44. Retroduodenal aa - branching from gastroduodenal as it passes posterior to the duodencap, supplying inferior surface of duodenal cap
  45. Superior posterior pancreaticoduodenal a. - coursing along the posterior surface of the head of the pancreas
  46. Superior anterior pancreaticoduodenal a. - along the anterior surface of the head of the pancreas, the anterior and posterior branches might arise from a common trunk
  47. Right gastroepiploic a. - terminal branch of the gastroduodenal a., entering the right border of the great omentum, following the greater curvature of stomach
  48. Proper hepatic a. - terminating in left and right hepatic aa.
  49. Portal vein - formed by union of splenic and superior mesenteric vv., most posterior of structures in hepatoduodenal ligament
  50. Left hepatic vein - draining directly into IVC, site of attachment for the ligamentum venosum
  51. Superior mesenteric a. -  left renal v. crossing the aorta immediately inferior, horizontal duodenum crossing aorta inferior to left renal v., "Nutcracker"
  52. Inferior anterior and posterior pancreaticoduodenal aa - anastomosing with counterparts from gastroduodenal, anastomosis between foregut and midgut, early branch(s) off supperior mesenteric a.
  53. Middle colic artery - traveling through transverse mesocolon, participates in anastomosis between midgut and hindgut (left colic a.)
  54. Intestinal artery - branch directly from superior mesenteric a., travelling through intestinal mesentery
  55. Arcades - anastomotic channels betwee intestinal aa., notice complexity increases according to distal extent of small intestine
  56. Vasa recta - end arteries branching from the arcades
  57. Iliocolic a. -  retroperitoneal and extending toward ileocecal junction, sends branch to the ilium, anterior and posterior cecal aa.
  58. Appendicular a. - running through the mesoappendix
  59. Ascending colic a. - retroperitoneal course toward proximal ascending colon
  60. Right colic a. - retroperitoneal course middle and distal ascending colon, forming anastomosis with middle colic a.
  61. Inferior mesenteric a. - retroperitoneal in left posterior wall
  62. Left colic a. - branching from inferior mesenteric a. and traveling superior lateral toward the left colic flexure, anastomosis with middle colic a.
  63. Sigmoidal aa. - branching from inferior mesenteric a., entering the sigmoid mesocolon
  64. Superior rectal a. - continuation of the inferior mesenteric a. into the pelvic basin, inferior mesenteric a. crosses the left common iliac
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