Anatomy l

Wajiha Nawabi MD

What is

Anatomy

 Macroscopic Anatomy
Gray anatomy

Microscopic Anatomy
Histology
Embryology
Regional, surface, systemic,
radiographic, endoscopic and clinical
anatomy

Language of Anatomy
International anatomical terminology
Latin
English

axillary fossa vs armpit

collarbone vs clavicle

Anatomic Position
One consistent
position
Standing upright
with:
head, gaze (eyes),
and toes directed
anteriorly (forward)
arms adjacent to the
sides with the palms
facing anteriorly,
lower limbs close
together with the
feet parallel.

Anatomical Planes
is a hypothetical plane used to
transect the human body, in order to
describe the location of structures or
the direction of movements.

1. Median plane
or sagittal plan

the vertical
plane passing
longitudinally
through the
body, divides the
body into right
and left halves.
Midline = the median
plane

2. Frontal (coronal) planes

are
vertical
planes
passing
through
the
body at right
angles to the
median
plane,
dividing
the
body
into
anterior
(front)
and
posterior
(back) parts.

3. Transverse planes

are
horizontal
planes
passing
through the body at
right angles to the
median and frontal
planes, dividing the
body into superior
(upper)
and
inferior
(lower)
parts.

Anatomical Planes

BREAK

Thanks

Body apparatus

Skin
Bones
Skeletal system
Muscle
Vessels
Lymph
Nerve

Integumentary system ( dermatology ) skin

Skeletal system ( osteology ) Bones & cartilage
Articular system ( arthrology ) joints
Muscular system ( myology ) muscles
Nervous system ( neurology ) CNS and PNS
Circulatory system ( angiology )
Cardiovascular and lymphatic system
Cardiovascular ( cardiology )

Alimentary or digestive system ( gastroenterology )

Respiratory system ( pulmonology )
Urinary system ( urology )
Genital ( reproductive ) system
Gynecology (female)
Andrology ( male )

Endocrine system ( endocrinology )

Integumentary System
The skin, the body's largest organ, consists of the
epidermis, a superficial cellular layer
dermis, a deep connective tissue layer

The epidermis is a keratinized epithelium that is, it has a tough, horny

superficial layer that provides a protective of deep or basal layer. The
epidermis has no blood vessels or lymphatics.
The dermis is supplied by arteries that enter its deep surface to form a
cutaneous plexus. The skin is also supplied with afferent nerve endings
that are sensitive to touch, irritation (pain), and temperature. Most
nerves are in the dermis, but a few penetrate the epidermis.
The dermis is a dense layer of interlacing collagen and elastic fibers.
These fibers provide skin tone and account for the strength and
toughness of skin.

Function of Skin
Protection of the body from environmental effects,
such as abrasions, fluid loss, harmful substances,
ultraviolet radiation, and invading microorganisms.

Heat regulation through the evaporation of sweat

and/or the dilation or constriction of superficial
blood vessels.
Sensation (e.g., pain) by way of superficial nerves
and their sensory endings.
Synthesis and storage of vitamin D.

Skeletal System
divided into two functional parts
1. The axial skeleton consists of the bones
of the head (cranium or skull), neck (hyoid
bone and cervical vertebrae), and trunk
(ribs, sternum, vertebrae, and sacrum).
2. The appendicular skeleton consists of
the bones of the limbs, including those
forming the pectoral (shoulder) and pelvic
girdles.

 The skeleton is composed of cartilages and

bones.
Cartilage is a resilient, semi rigid form of
connective tissue that forms parts of the
skeleton where more flexibility is required
ex: articulating surfaces
- articular cartilage

it is avascular NO BLOOD VESSELS; its

cells obtain oxygen and nutrients by
diffusion.

 Bones calcified connective tissue consisting of cells

(osteocytes) embedded in a matrix of ground substance
and collagen fibers, have a superficial thin layer of
compact bone around a central mass of spongy bone,
and contain internal soft tissue, the marrow - where
blood cells are formed.
support for the body or it is the supporting tissue of the
body.
protection for vital structures (e.g., the heart).
mechanical basis for movement .
storage for salts (e.g., calcium and phosphorus).
Cells for blood formation

Continues
Bones are classified based on their
shape

Long bones
Short bones
Flat bones
Irregular bones
Sesamoid Bones

Any
questio
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Thanks

A. Long Bones
Include the humerus, radius, ulna,
femur, tibia, fibula, metacarpals, and
phalanges.
Develop by replacement of hyaline
cartilage plate (endochondral
ossification).
Have a shaft (diaphysis) and two
ends (epiphyses). The metaphysis is
a part of the diaphysis adjacent to
the epiphyses.

1. Diaphysis
Forms the shaft (central region) and is composed of a thick tube
of
compact bone that encloses the marrow cavity.
2. Metaphysis
Is a part of the diaphysis, the growth zone between the diaphysis
and epiphysis during bone development.
3. Epiphyses
Are expanded articular ends, separated from the shaft by the
epiphyseal plate during bone growth and composed of a spongy
bone surrounded by a thin layer of compact bone.

Bone

B. Short Bones
Include the carpal and tarsal bones and are
approximately cuboid shaped. Are composed of
spongy bone and marrow surrounded by a thin outer
layer of compact bone.
C. Flat Bones
Include the ribs, sternum, scapulae, and bones in the
vault of the skull. Consist of two layers of compact
bone enclosing spongy bone and marrow space
(diplo).

D. Irregular Bones
Include bones of mixed shapes such as bones of the
skull, vertebrae, and coxa. Contain mostly spongy
bone enveloped by a thin outer layer of compact
bone.

E. Sesamoid Bones
as oval shape.
Are commonly found where tendons of muscles cross
the ends of long
bones in the limbs, as in the wrist and the knee
(i.e., patella).

Joints ( Articulations )
Joints (articulations) are unions or
junctions between two or more bones
or rigid parts of the skeleton

Synovial Joints
The articulating bones of synovial joints
are united by a joint capsule (composed
of an outer fibrous layer lined by a
serous synovial membrane).
The joint cavity of a synovial joint, like
the knee, that contains a small amount of
lubricating synovial fluid, secreted by
the synovial membrane.

Synovial joints

Muscle
Contractile cells which produces
movements of various parts of the
body.
Three types
Skeletal Muscle
Cardiac
Smooth

Skeletal Muscle
Voluntary and striated
40% of total body mass
Movement, posture
Origin more fixed, proximal attachment
Insertion movable, distal attachment
Endomysium (fiber )
Perimysium ( bundle )
epimysium ( whole )

Cardiac Muscle

Involuntary and striated

Myocardium Pericardium
Contractile force lesser than skeleton
muscles.

Smooth Muscle
Involuntary and no striated
Walls of many visceral organs
Rhythmic contractions peristalsis in GI,
Uterine tubes, ureters and etc.

Structures associated with muscles

Tendon fibrous band connects muscles to

bones.
Ligament fibrous bands connect bone to
bone.
Bursae A bursa is a flat, fluid-filled sac
found between a bone and a tendon or
muscle. to help the tendon or muscle slide
smoothly over the bone.

Thanks for watching

Thank
s

Thorax

Thorax
The thorax (or chest) is
the region of the body
between the neck and the
abdomen. It is flattened
in front and behind but
rounded at the sides.
The framework of the
walls of the thorax, which
is referred to as the
thoracic cage, is formed
by the vertebral column
behind, the ribs and
intercostal spaces on
either side, and the
sternum and costal
cartilages in front.

Thorax
Superiorly the thorax
communicates with the
neck, and inferiorly it is
separated from the
abdomen by the
diaphragm.
The thoracic cage
protects the lungs and
heart and affords
attachment for the
muscles of the thorax,
upper extremity,
abdomen, and back.

 The cavity of the thorax can

be divided into a median
partition, called the
mediastinum, and the laterally
placed pleurae and lungs.
The lungs are covered by a
thin membrane called the
visceral pleura, which passes
from each lung at its root (i.e.,
where the main air passages
and blood vessels enter) to the
inner surface of the chest wall,
where it is called the parietal
pleura.
In this manner, two
membranous sacs called the
pleural cavities are formed,
one on each side of the thorax,
between the lungs and the
thoracic walls.

 Structure of the Thoracic Wall:

The thoracic wall is covered
on the outside by skin and by
muscles attaching the
shoulder girdle to the trunk.
The thoracic wall is formed
posteriorly by the thoracic
part of the vertebral column;
anteriorly by the sternum and
costal cartilages, laterally by
the ribs and intercostal
spaces; superiorly by the
suprapleural membrane; and
inferiorly by the diaphragm,
which separates the thoracic
cavity from the abdominal
cavity.

Sternum

The sternum lies in the

midline of the anterior
chest wall.
It is a flat bone that can be
divided into three parts:
manubrium sterni, body of
the sternum, and xiphoid
process.
The manubrium is the
upper part of the sternum.
It articulates with the body
of the sternum at the
manubriosternal joint, and
it also articulates with the
clavicles and with the first
costal cartilage and the
upper part of the second
costal cartilages on each
side.

 The body of the sternum

articulates above with the
manubrium at the
manubriosternal joint and
below with the xiphoid
process at the xiphisternal
joint.
On each side it articulates
with the second to the
seventh costal cartilages.
The xiphoid process is a
thin plate of cartilage that
becomes ossified at its
proximal end during adult
life. No ribs or costal
cartilages are attached to
it.

RIBS
There are 12 pairs of ribs, all of
which are attached posteriorly to
the thoracic vertebrae.
The ribs are divided into three
categories:
True ribs: The upper seven pairs
are attached anteriorly to the
sternum by their costal cartilages.
False ribs: The 8th, 9th, and 10th
pairs of ribs are attached
anteriorly to each other and to the
7th rib by means of their costal
cartilages and small synovial
joints.
Floating ribs: The 11th and 12th
pairs have no anterior attachment.

 Typical Rib:
A typical rib is a
long, twisted, flat
bone having a
rounded, smooth
superior border and
a sharp, thin
inferior border.
The anterior end of
each rib is attached
to the
corresponding
costal cartilage.

 A rib has a head, neck, tubercle,

shaft, and angle.
The head has two facets for
articulation with the numerically
corresponding vertebral body
and that of the vertebra
immediately above.
The neck is a constricted portion
situated between the head and
the tubercle.
The tubercle is a prominence on
the outer surface of the rib at
the junction of the neck with the
shaft. It has a facet for
articulation with the transverse
process of the numerically
corresponding vertebra.
The shaft is thin and flattened
and twisted on its long axis. Its
inferior border has the costal
groove.
The angle is where the shaft of
the rib bends sharply forward.

 Atypical Rib:
The first rib is
important clinically
because of its close
relationship to the
lower nerves of the
brachial plexus and
the main vessels to
the arm, namely,
the subclavian
artery and vein.
This rib is small
and flattened from
above downward.

Costal Cartilages
Costal cartilages are
bars of cartilage
connecting the upper
seven ribs to the lateral
edge of the sternum and
the 8th, 9th, and 10th
ribs to the cartilage
immediately above. The
cartilages of the 11th
and 12th ribs end in the
abdominal musculature.
In old age, the costal
cartilages tend to lose
some of their flexibility
as the result of
superficial calcification.

Joints of the Chest Wall

Joints of the Sternum
The manubriosternal
joint is a cartilaginous
joint between the
manubrium and the
body of the sternum.
A small amount of
angular movement is
possible during
respiration.
The xiphisternal joint is
a cartilaginous joint
between the xiphoid
process (cartilage) and
the body of the
sternum.

Joints of the Ribs

Joints of the Heads of the
Ribs:
The first rib and the three
lowest ribs have a single
synovial joint with their
corresponding vertebral
body.
For the second to the ninth
ribs, the head articulates by
means of a synovial joint
with the corresponding
vertebral body and that of
the vertebra above it.
There is a strong
intraarticular ligament that
connects the head to the
intervertebral disc.

 Joints of the
Tubercles of the
Ribs:
The tubercle of a
rib articulates by
means of a synovial
joint with the
transverse process
of the
corresponding
vertebra. (This joint
is absent on the
11th and 12th ribs.)

THANK
YOU

Chest Cavity
The chest cavity is bounded
by the chest wall and below
by the diaphragm. It extends
upward into the root of the
neck and the clavicle on each
side.
The diaphragm, which is a
very thin muscle, is the only
structure (apart from the
pleura) that separates the
chest from the abdominal
viscera. The chest cavity can
be divided into a median
partition, called the
mediastinum, and the
laterally placed pleurae and
lungs.

Diaphragm
The diaphragm is a thin muscular
and tendinous septum that
separates the chest cavity above
from the abdominal cavity below. It
is pierced by the structures that
pass between the chest and the
abdomen.
The diaphragm is the most
important muscle of respiration. It is
dome shaped and consists of a
peripheral muscular part.
The origin of the diaphragm can be
divided into three parts:
A sternal part arising from the
posterior surface of the xiphoid
process.
A costal part arising from the deep
surfaces of the lower six ribs and
their costal cartilages.
A vertebral part arising by vertical
columns and from the arcuate
ligaments.

Functions of the Diaphragm

Muscle of inspiration: On
contraction, the diaphragm
pulls its central tendon down
and increases the vertical
diameter of the thorax. The
diaphragm is the most
important muscle used in
inspiration.
Muscle of abdominal straining:
The contraction of the
diaphragm assists the
contraction of the muscles of
the anterior abdominal wall in
raising the intra-abdominal
pressure for micturition,
defecation, and parturition. This
mechanism is further aided by
the person taking a deep breath
and closing the glottis of the
larynx.

Mediastinum
The mediastinum, is a
movable partition that
extends superiorly to the
thoracic outlet and the root
of the neck and inferiorly
to the diaphragm. It
extends anteriorly to the
sternum and posteriorly to
the vertebral column. It
contains the remains of the
thymus, the heart and
large blood vessels, the
trachea and esophagus,
the thoracic duct and
lymph nodes, the vagus
and phrenic nerves.

 The mediastinum is divided

into superior and inferior
mediastina by an imaginary
plane passing from the
sternal angle anteriorly to
the lower border of the
body of the fourth thoracic
vertebra posteriorly.
The inferior mediastinum is
further subdivided into the
middle mediastinum, which
consists of the pericardium
and heart; the anterior
mediastinum, which is a
space between the
pericardium and the
sternum; and the posterior
mediastinum, which lies
between the pericardium
and the vertebral column.

 Superior Mediastinum
(a) Thymus, (b) large veins,
(c) large arteries, (d)
trachea, (e) esophagus
The superior mediastinum is
bounded in front by the
manubrium sterni and
behind by the first four
thoracic vertebrae.
Inferior Mediastinum
(a) Thymus, (b) heart within
the pericardium with the
phrenic nerves on each
side, (c) esophagus and
thoracic duct.
The inferior mediastinum is
bounded in front by the
body of the sternum and
behind by the lower eight
thoracic vertebrae.

Pleurae
The pleurae and lungs lie on
either side of the
mediastinum within the chest
cavity.
Each pleura has two parts: a
parietal layer, which lines the
thoracic wall, covers the
thoracic surface of the
diaphragm and the lateral
aspect of the mediastinum,
and extends into the root of
the neck to line the
undersurface of the
suprapleural membrane at
the thoracic outlet; and a
visceral layer, which
completely covers the outer
surfaces of the lungs and
extends into the depths of
the interlobar fissures.

Trachea

The trachea is a mobile

cartilaginous and
membranous tube,
The trachea extends from
the lower border of the
cricoid cartilage (opposite
the body of the sixth
cervical vertebra) in the
neck to the level of the
sternal angle in the thorax
It commences in the midline
and ends just to the right of
the midline by dividing into
the right and left principal
bronchi. At the root of the
neck it may be palpated in
the midline in the
suprasternal notch.

 During expiration the

bifurcation rises by about
one vertebral level, and
during deep inspiration
may be lowered as far as
the sixth thoracic vertebra.
In adults the trachea is
about (11.25 cm) long and
(2.5 cm) in diameter.
The fibro elastic tube is
kept by the presence of Ushaped bars (rings) of
hyaline cartilage
embedded in its wall. The
posterior free ends of the
cartilage are connected by
smooth muscle, the
trachealis muscle.

The Bronchi
The trachea bifurcates
behind the arch of the
aorta into the right and
left principal bronchi.
The bronchi divide
dichotomously, giving
rise to several million
terminal bronchioles that
terminate in one or more
respiratory bronchioles.
Each respiratory
bronchiole divides into 2
to 11 alveolar ducts that
enter the alveolar sacs.

Lungs

During life, the right and left

lungs are soft and spongy and
very elastic. If the thoracic cavity
were opened, the lungs would
immediately shrink to one third
or less in volume. In the child,
they are pink, but with age, they
become dark and mottled
because of the inhalation of dust
particles that become trapped in
the phagocytes of the lung. This
is especially well seen in city
dwellers and coal miners. The
lungs are situated so that one
lies on each side of the
mediastinum. They are therefore
separated from each other by
the heart and great vessels and
other structures in the
mediastinum. Each lung is
conical, covered with visceral
pleura.

 Lobes and Fissures:

Right Lung
The right lung is slightly
larger than the left and is
divided by the oblique and
horizontal fissures into
three lobes: the upper,
middle, and lower lobes.
The oblique fissure runs
from the inferior border
upward and backward.
The horizontal fissure runs
horizontally.
The middle lobe is thus a
small triangular lobe
bounded by the horizontal
and oblique fissures.

 Left Lung
The left lung is
divided by a similar
oblique fissure into
two lobes: the
upper and lower
lobes. There is no
horizontal fissure in
the left lung.

Question?

Pericardium
The pericardium is a fibro
serous sac that encloses the
heart and the roots of the
great vessels.
Its function is to restrict
excessive movements of the
heart as a whole and to
serve as a lubricated
container in which the
different parts of the heart
can contract.
The pericardium lies within
the middle mediastinum
posterior to the body of the
sternum and the second to
the sixth costal cartilages
and anterior to the fifth to
the eighth thoracic
vertebrae.

Heart

The heart is a hollow

muscular organ that is
somewhat pyramid shaped
and lies within the
pericardium in the
mediastinum.
It is connected at its base to
the great blood vessels but
otherwise lies free within the
pericardium.
Surfaces of the Heart
The heart has three surfaces:
sternocostal (anterior),
diaphragmatic (inferior), and
a base (posterior). It also has
an apex, which is directed
downward, forward, and to
the left.
The sternocostal surface is
formed mainly by the right
atrium and the right ventricle,

 The right border is

formed by the right
atrium; the left border,
by the left ventricle.
The right ventricle is
separated from the left
ventricle by the
anterior
interventricular groove.
The diaphragmatic
surface of the heart is
formed mainly by the
right and left ventricles
separated by the
posterior
interventricular groove.

Borders of the Heart

The right border is formed by
the right atrium; the left
border, by the left ventricle.
The lower border is formed
mainly by the right ventricle
but also by the right atrium;
the apex is formed by the left
ventricle. These borders are
important to recognize when
examining a radiograph of
the heart.
The walls of the heart are
composed of cardiac muscle,
the myocardium; covered
externally, the epicardium;
and lined internally with a
layer of endothelium, the
endocardium.

Action of the Heart

The heart is a
muscular pump. The
series of changes that
take place within it as
it fills with blood and
empties is referred to
as the cardiac cycle.
The normal heart beats
70 to 90 times per
minute in the resting
adult and 130 to 150
times per minute in
the newborn child.

Surface Anatomy of the Heart Valves

The tricuspid valve lies
behind the right half of the
sternum opposite the fourth
intercostal space.
The mitral valve lies behind
the left half of the sternum
opposite the fourth costal
cartilage.
The pulmonary valve lies
behind the medial end of
the third left costal cartilage
and the adjoining part of
the sternum.
The aortic valve lies behind
the left half of the sternum
opposite the third
intercostal space.

Esophagus
The esophagus is a tubular
structure about 10 in. (25
cm) long that is continuous
above with the laryngeal
part of the pharynx
opposite the sixth cervical
vertebra. It passes through
the diaphragm at the level
of the 10th thoracic
vertebra to join the
stomach.
In the neck, the esophagus
lies in front of the vertebral
column; laterally, it is
related to the lobes of the
thyroid gland; and
anteriorly, it is in contact
with the trachea and the
laryngeal nerves.

Thymus
The thymus is a flattened,
bilobed structure lying
between the sternum and
the pericardium in the
anterior mediastinum.
In the newborn infant, it
reaches its largest size
relative to the size of the
body.
The thymus continues to
grow until puberty. It has
a pink, lobulated
appearance and is the site
for development of T
(thymic) lymphocytes.

THE END

THANK YOU

Layers of the Abdominal Wall

The layers of the
abdominal wall
consist of (external to
internal):
Skin.
Superficial fascia (or
subcutaneous tissue).
Muscles and
associated fascia.
Parietal peritoneum.

Muscles of the Anterior

Abdominal Wall
There are five muscles
in the abdominal wall.
They can be divided
into two groups:
Vertical muscles
There are two vertical
muscles, situated near
the mid-line of the
body.
Flat muscles There
are three flat muscles,
situated laterally.

 The Flat Muscles

There are three flat
muscles;
theexternal
oblique,internal
obliqueandtransv
ersus.
The Vertical
Muscles:
Rectus Abdominis
and Pyramidalis.

External oblique

Origin:
Lower eight ribs.
Insertion:
Xiphoid process, linea alba,
pubic crest, pubic tubercle,
iliac crest.
Nerve Supply:
Lower six thoracic nerves and
iliohypogastric and ilioinguinal
nerves (L1).
Action:
Supports abdominal contents;
compresses abdominal
contents; assists in flexing and
rotation of trunk; assists in
forced expiration, micturition,
defecation, parturition, and
vomiting.

Internal oblique

Origin:
Iliac crest.
Insertion:
Costal cartilages of 8 to
12 ribs, xiphoid process,
linea alba, symphysis
pubis.
Nerve supply:
Lower six thoracic
nerves and
iliohypogastric and
ilioinguinal nerves (L1).
Action:
As above.

Transversus

Origin:
Lower six costal
cartilages, iliac crest.
Insertion:
Xiphoid process, linea
alba, symphysis pubis &
aponeurosis of posterior.
Nerve supply:
Lower six thoracic
nerves and
iliohypogastric and
ilioinguinal nerves (L1).
Action:
Compresses abdominal
contents.

Rectus abdominis
Origin:
Symphysis pubis or pubic
crest.
Insertion:
Fifth, sixth, and seventh
costal cartilages and
xiphoid process.
Nerve supply:
Lower six thoracic nerves.
Action:
Compresses abdominal
contents and flexes
vertebral column;
accessory muscle of
expiration.

Pyramidalis
Origin:
Anterior surface of
pubis.
Insertion:
Linea alba.
Nerve supply:
12th thoracic nerve.
Action:
Tenses the linea
alba.

Function of the Anterior Abdominal Wall Muscles

The oblique muscles

laterally flex and
rotate the trunk.
The rectus
abdominis flexes the
trunk and stabilizes
the pelvis, and the
pyramidalis keeps
the linea alba taut
during the process.

Parietal Peritoneum
The walls of the
abdomen are lined
with parietal
peritoneum.
This is a thin
serous membrane
and is continuous
below with the
parietal
peritoneum lining
the pelvis.

Inguinal Canal
The inguinal canal is an
oblique passage through
the lower part of the
anterior abdominal wall.
In the males, it allows
structures to pass to and
from the testis to the
abdomen.
females it allows the
round ligament of the
uterus to pass from the
uterus to the labium
majus.
The canal is about 1.5 in.
(4 cm) long in the adult
and extends from the
deep inguinal ring.

Spermatic Cord
The spermatic cord is a collection
of structures that pass through
the inguinal canal to and from the
testis.
It begins at the deep inguinal ring
lateral to the inferior epigastric
artery and ends at the testis.
Structures of the Spermatic Cord:
The structures are as follows:
Vas deferens
Testicular artery
Testicular veins (pampiniform
plexus)
Testicular lymph vessels
Autonomic nerves
Remains of the processus
vaginalis
Genital branch of the
genitofemoral nerve, which
supplies the cremaster muscle

 Vas Deferens (Ductus

Deferens):
The vas deferens is a
cordlike structure that
can be palpated
between finger and
thumb in the upper part
of the scrotum. It is a
thick-walled muscular
duct that transports
spermatozoa from the
epididymis to the
urethra.
Testicular Artery:
It traverses the inguinal
canal and supplies the
testis and the
epididymis.

 Testicular Veins:
Lymph Vessels:

 Autonomic Nerves:
Run with the testicular
artery from the renal
or aortic sympathetic
plexuses.
Processus Vaginalis:
The remains of the
processus vaginalis
are present within the
cord.
Genital Branch of the
Genitofemoral Nerve:
This nerve supplies
the cremaster muscle.

Scrotum

The scrotum is an outpunching of

the lower part of the anterior
abdominal wall. It contains the
testes, the epididymides, and the
lower ends of the spermatic cords.
The wall of the scrotum has the
following layers:
Skin: The skin of the scrotum is
thin, wrinkled, and pigmented and
forms a single pouch. A slightly
raised ridge in the midline
indicates the line of fusion of the
two lateral labioscrotal swellings.
(In the female, the swellings
remain separate and form the
labia majora.)
Superficial fascia: This is
continuous with the fatty and
membranous layers of the anterior
abdominal wall; the fat is,
however, replaced by smooth
muscle called the dartos muscle.

 Spermatic fasciae: These

three layers lie beneath the
superficial fascia.
The external spermatic
fascia is derived from the
aponeurosis of the external
oblique muscle; the
cremasteric fascia is
derived from the internal
oblique muscle; and, finally,
the internal spermatic
fascia is derived from the
fascia transversalis.
The function of the
cremaster muscle is to raise
the testis and the scrotum
upward for warmth and for
protection against injury.

Testis
The testis is a firm, mobile
organ lying within the scrotum.
The left testis usually lies at a
lower level than the right.
Each testis is surrounded by a
tough fibrous capsule, the
tunica albuginea.
Extending from the inner
surface of the capsule is a
series of fibrous septa that
divide the interior of the organ
into lobules. Lying within each
lobule are one to three coiled
seminiferous tubules. The
tubules open into a network of
channels called the rete testis.
Small efferent ductules
connect the rete testis to the
upper end of the epididymis.

 Normal
spermatogenesis can
occur only if the testes
are at a temperature
lower than that of the
abdominal cavity.
The control of
testicular temperature
in the scrotum is not
fully understood, but
the surface area of the
scrotal skin can be
changed reflexly by
the contraction of the
dartos and cremaster
muscles.

Epididymis
The epididymis is a
firm structure lying
posterior to the
testis, with the vas
deferens lying on
its medial side.
It has an expanded
upper end, the
head, a body, and
a pointed tail
inferiorly.

Any
question?
Thanks

The Skeleton of Thoracic Wall

The osteocartilaginous thoracic cage

protects the thoracic viscera & some abdominal organs

Includes:
12 pairs of ribs and associated costal cartilages,
12 thoracic vertebrae and their intervertebral (IV) discs
the sternum

the ribs and costal cartilages form the largest part of the
thoracic cage; both are identified numerically, from the
most superior (1st rib or costal cartilage) to the most
inferior (12th).

 Typical Rib
A typical rib is a long, twisted, flat bone
having a rounded, smooth superior border
and a sharp, thin inferior border (Figs. 2-4
and 2-5). The inferior border overhangs
and forms the costal groove, which
accommodates the intercostal vessels and
nerve. The anterior end of each rib is
attached to the corresponding costal
cartilage

Ribs ( L.Costae )
1.Typical Ribs (3rd
9th)
Head
Wedge shaped , 2
facets

Neck
Tubercle , articulates
with Transverse Process

Shaft
Groove ( VAN structures
)

2.Atypical Ribs
Rib 1 : 1 facet and 2 grooves ( subclavian
vessels)
Groove Scalene tubercle Groove

Rib 2 : 2 facets & tuberosity for

- Surratus anterior muscle
Long Thoracic Nerve

Rib 10 : 1 Facet
Ribs 11 & 12 : one facet NO NECK/Tubercle

Articulatiions
Costotransverse
Tubercle and
Transverse Process
( costal facet )

Costovertebral
Head of Rib -> 2
verterbrae
Superior costal
facet of the
corresponding
vertebra
Inferior costal
facet of the
vertebrae above

Anteriorly
(Sternocostal)
STERNUM
Ribs 1 7 to

sternum
independently (true
ribs)
Ribs 8 , 9 and 10 to

costal cartilage
above (false ribs)
Ribs 11 12

nowhere

(floating

THORAX - General Features

The thorax extends from the top of the sternum to the diaphragm.
The thorax is bounded by the sternum, ribs, and thoracic vertebrae.
The entrance to the thorax (called the thoracic inlet) is small and
kidney-shaped.
The boundaries of the thoracic inlet are the manubrium anteriorly, rib 1
laterally, and the thoracic vertebrae posteriorly.
The outlet from the thorax (called the thoracic outlet) is large and is
separated from the abdomen by the diaphragm.
The boundaries of the thoracic outlet are the xiphoid process anteriorly,
costal cartilages 7 to 10 and rib 12 laterally, and T12 vertebra
posteriorly.

Thoracic Vertebrae
There are 12 thoracic vertebrae that
have facets on their bodies (costal
facets) for articulation with the heads
of ribs, facets on their transverse
processes for articulation with the
tubercles of rib 9
(except for ribs 11 and 12), and long
spinous processes.

Ribs
There are 12 pairs of ribs that articulate with the thoracic
vertebrae.
A rib consists of a head, neck, tubercle, and body.
The head articulates with the body of adjacent thoracic
vertebrae and the intervertebral disc at the costovertebral joint.
The tubercle articulates with the transverse process of a
thoracic vertebra at the costotransverse joint.
True (vertebrosternal) ribs are ribs 1 to 7, which articulate
individually with the sternum by their costal cartilages.
False (vertebrochondral) ribs are ribs 8 to 12. Ribs 8 to 10
articulate with more superior costal cartilage and form the
anterior costal margin.
Ribs 11 and 12 (often called floating ribs) articulate with
vertebral bodies but do not articulate with the sternum.

Sternum
The manubrium forms the jugular notch at its superior
margin; has a clavicular notch, which articulates with
the clavicle at the sternoclavicular joint; and
articulates with the costal cartilages of ribs 1 and 2.
The body articulates with the manubrium at the
sternal angle of Louis, articulates with the costal
cartilages of ribs 2 to 7, and articulates with the
xiphoid process at the xiphosternal joint.
The xiphoid process articulates with the body of the
sternum and attaches to the diaphragm and
abdominal musculature via the linea alba.

 The sternal angle of Louis marks

the junction between the manubrium
and body of the sternum at vertebral
level T4.
rib 2 articulates with the sternum
the aortic arch begins and ends
the trachea bifurcates
the superior mediastinum ends.

Diaphragm
The diaphragm is the most important muscle of inspiration.
The diaphragm elevates the ribs and increases the vertical,
transverse (bucket handle movement), and anteroposterior (pump
handle movement) diameters of the thorax.
The diaphragm is innervated by the phrenic nerves (ventral primary
rami of C3 to C5), which provide motor and sensory innervations.
Sensory innervation to the periphery of the diaphragm is provided by
the intercostal nerves.
A lesion of the phrenic nerve may result in paralysis and paradoxical
movement of the diaphragm.
The paralyzed dome of the diaphragm does not descend during
inspiration and is consequently forced upward due to increased
abdominal pressure.

Intercostal Muscles
The intercostal muscles are thin multiple layers of muscle that occupy the
intercostal spaces (1 to 11) and keep the intercostal space rigid during
inspiration or expiration.
The external intercostal muscles elevate the ribs and play a role in inspiration
during exercise or lung disease.
The internal intercostal muscles play a role in expiration during exercise or lung
disease.
The innermost intercostal muscles are presumed to act with the internal
intercostal muscles.
The intercostal vein, artery, and nerve run between the internal intercostal
muscles and innermost intercostal muscles.
The intercostal vein, artery, and nerve travel in the costal groove on the
inferior border of the ribs.

1.
2.

Internal intercostal
Transverse thoracis

C. Serratus Posterior Superior Muscle

D. Serratus Posterior Inferior Muscle
E. Levator Costarum Muscle
F. Transverse Thoracic Muscle
G. Sternocleidomastoid, Pectoralis Major and
Minor, and Scalene Muscles.
These muscles attach to the ribs and play a role in
inspiration during exercise or lung disease.

H. External Oblique, Internal Oblique,

Transverse Abdominal, and Rectus Abdominis
Muscles.
These abdominal muscles play a role in expiration
during exercise, lung disease, or the Valsalva
maneuver.

Joints of Thorax
1. Sternoclavicular Joint
bony attachment between the appendicular and axial skeletons.
2. Sternocostal (Sternochondral) Joints
articulation of the sternum with the fi rst seven cartilages.
3. Costochondral Joints
ribs articulate with their respective costal cartilages.
4. Manubriosternal Joint
Is symphysis between manubrium and body of the sternum.
5. Xiphisternal Joint
articulation between xiphoid process and body of the sternum.
6. Costovertebral Joints
joints of heads of ribs with corresponding and supraadjacent vertebral
bodies.
7. Costotransverse Joint
joint of tubercle of rib with transverse process of corresponding
vertebra.
8. Interchondral Joints
between 6th and 10th costal cartilages of ribs.

Surface Anatomy of Thorax

 In the body cavities, three double-wall serous

membranes cover the lungs (pleura ), heart
(pericardium), and abdominal viscera
(peritoneum).
These membranes provide a mechanism of
friction reduction so these viscera can move
freely without damage.
Each of these membranes is formed by an outer
layer (parietal) that is continuous with the inner
layer (visceral).
Between the two layers there is thin space that
contains a thin layer of serous fluid.

 The pleurae are the membranes that

surround the lungs.
They are found with the lungs in
each of the two lateral
compartments of the chest cavity.

Pleura
Is a thin serous membrane
1. Parietal Pleura - lines the inner surface of
the thoracic wall and the mediastinum (costal
diaphragmatic, mediastinal, and cervical parts.)
Very sensitive to PAIN
Intercostal nerves and phrenic nerves

2. Visceral Pleura covers the lungs and its all

surfaces
insensitive to pain but is sensitive to STRETCH
Vagus

Pleural Cavity
Is a potential space between the parietal
and visceral pleurae.
Represents a closed sac with no
communication between right and left parts.
Contains a film of fluid that lubricates the
surface of the pleurae and facilitates the
movement of the lungs.

 Pleural recesses
are narrow, potential spaces of the
pleural cavity that the lungs do not
completely descend into during quiet
respiration.

1. Costodiaphragmati
c Recesses

Are the pleural recesses

formed by the reflection
of the costal and
diaphragmatic pleurae.
Can accumulate fluid
when in the erect
position.
Allow the lungs to be
pulled in and expanded
during inspiration.

2.
Costomediastinal
Recesses
Are part of the
pleural cavity
where the costal
and mediastinal
pleurae meet.
On the left, the
lingula of the lung
fills this recess
during deep
inspiration.

 HOMEWORK

Pneumothorax
Pleurisy
Thoracentesis

Tracheobronchial Tree
The trachea is a tube composed of 16 to 20 U-shaped
hyaline cartilages and the trachealis muscle.
The trachea begins just inferior to the cricoid cartilage
(C6 vertebral level) and ends at the sternal angle (T4
vertebral level), where it bifurcates into the right
main bronchus and the left main bronchus.
At the bifurcation of the trachea, the last tracheal
cartilage forms the carina, which can be observed by
bronchoscopy as a raised ridge of tissue in the sagittal
plane.

The right main bronchus is shorter and wider and turns to

the right at a shallower angle than the left main bronchus.
The right main bronchus branches into 3 lobar bronchi
(upper, middle, and lower) and finally into 10 segmental
bronchi.
The left main bronchus branches into 2 lobar bronchi
(upper and lower) and finally into 8 to 10 segmental
bronchi.
The branching of segmental bronchi corresponds to the
bronchopulmonary segments of the lung

 Each main (primary) bronchus

secondary lobar bronchi, 2 left & 3 right,
each of which supplies a lobe of the lung.
Each lobar bronchus divides into several tertiary
segmental bronchi that supply the
bronchopulmonary segments
20 25 Conducting bronchioles (no
glands/alveoli)
Terminal bronchioles

Respiratory bronchioles ( alveoli ) = gas

exchange
2-11 alveolar ducts
5-6 alveolar sacs
8 years of age
300 million alveoli

The pulmonary alveolus is the basic

structural unit of gas exchange in
the lung

Lungs
The lungs are the
vital organs of
respiration.
Function is to
oxygenate the blood by
bringing inspired air
into close relation with
the venous blood in the
pulmonary capillaries.
Location pulmonary
cavities

 An apex, the blunt superior end of the lung, above

the level of the 1st rib into the root of the neck; the
apex is covered by cervical pleura.
A base, the concave inferior surface of the lung,
opposite the apex, resting on and accommodating
the ipsilateral dome of the diaphragm.
Two or three lobes, created by one or two fissures.
Three surfaces (costal, mediastinal, and
diaphragmatic).
Three borders (anterior, inferior, and posterior).

The hilum (doorway) is a wedge-shaped area on

the mediastinal surface of each lung through which
the structures forming the root of the lung pass to
enter or exit the lung.

The Right Lung

The right lung consists of
three lobes (upper,
middle, and lower)
separated by a horizontal
fissure and an oblique
fissure.
The horizontal fissure runs
at the level of costal
cartilage 4 and meets the
oblique fissure at the
midaxillary line.
The diaphragmatic surface
consists of the middle lobe
and lower lobe.

The Left Lung

consists of two lobes (upper
and lower) separated by an
oblique fissure.
The left upper lobe contains
the cardiac notch, where
the left ventricle and
pericardial sac abut the
lung.
The lingula (which is the
embryologic counterpart to
the right middle lobe) lies
just beneath the cardiac
notch.
The diaphragmatic surface
consists of the lower lobe.

Mediastinal surface ( left

lung )
This surface of the
left lung also
features a
prominent,
continuous groove
for:
the arch of the
aorta
the descending
aorta
smaller area for
the esophagus

Bronchopulmonary Segment
The largest subdivisions of a lobe.
Pyramidal-shaped segments of the lung, with their apices facing
the lung root and their bases at the pleural surface.
Separated from adjacent segments by connective tissue septa.
Supplied independently by a segmental bronchus and a tertiary
branch of the pulmonary artery.
Named according to the segmental bronchi supplying them.
Drained by intersegmental parts of the pulmonary veins that lie
in the connective tissue between and drain adjacent segments.
Usually 1820 in number (10 in the right lung; 810 in the left
lung, depending on the combining of segments).
Surgically resectable.

Right Lung
a. Upper lobe: Apical (no. 1), posterior (no. 2),*
anterior (no. 3).
b. Middle lobe: Lateral (no. 4), medial (no. 5).
c. Lower lobe: Superior (no. 6), medial basal (no. 7),
anterior basal (no. 8), lateral basal (no.9), posterior
basal (no. 10).
Left Lung
a. Upper lobe: Apical (no. 1), posterior (no. 2),
anterior (no. 3), superior lingular (no. 4), inferior
lingular (no. 5).
b. Lower lobe: Superior (no. 6), anterior basal (no.
8), lateral basal (no. 9), posterior basal (no.10);
note that no. 7 is absent.

Mediastinum
The central compartment of the thoracic
cavity
Is an interpleural space (area between
the pleural cavities)
laterally by the pleural cavities
anteriorly by the sternum and the transversus

thoracis muscles
posteriorly by the vertebral column

superior mediastinum above the

pericardium and the three lower divisions:
anterior, middle, and posterior.

superior mediastinum
anterior mediastinum
middle mediastinum
posterior mediastinum

The contents of the superior

mediastinum

trachea
esophagus
thymus
phrenic nerves
azygous vein
SVC
brachiocephalic artery and veins
aortic arch
left common carotid artery
Left subclavian artery
thoracic duct

The contents of the anterior

mediastinum

thymus
fat
lymph nodes
connective tissue

The contents of the middle

mediastinum

the heart
pericardium
phrenic nerves
Ascending aorta
SVC
coronary arteries and veins.

The contents of the posterior

mediastinum

the descending aorta

esophagus
thoracic duct,
azygous vein
splanchnic nerves
vagus nerves (cranial nerve X)

Pericardium

Is a fibroserous sac that encloses the heart and the

roots of the great vessels and occupies the middle
mediastinum.
Blood Supply from the pericardiophrenic, bronchial,
and esophageal arteries.
Nerve Supply vasomotor and sensory fibers from the
phrenic and vagus nerves and the sympathetic trunks.
A. Fibrous Pericardium
Is a strong, dense, fi brous layer that blends with the
adventitia of the roots of the great vessels and the
central tendon of the diaphragm.
B. Serous Pericardium
Consists of the parietal layer, which lines the inner
surface of the fi brous pericardium, and the visceral
layer, which

C. Pericardial Cavity
Is a potential space between the visceral
layer of the serous pericardium
(epicardium) and the parietal layer of the
serous pericardium lining the inner
surfaces of the fibrous pericardium.

The Heart

The Heart Surfaces

A. Posterior Surface (Base) consists mainly of the left atrium, which receives
the pulmonary veins and is related to vertebral bodies T6 to T9.
B. Apex consists of the inferior lateral portion of the left ventricle (LV) at
intercostal space 5 along the midclavicular line. The maximal pulsation of the
heart (apex beat) occurs at the apex.
C. Anterior Surface (Sternocostal Surface) consists mainly of the right
ventricle (RV).
D. Inferior Surface (Diaphragmatic Surface) consists mainly of the LV and
is related to the central tendon of the diaphragm.
E. Left Surface (Pulmonary Surface) consists mainly of the LV and occupies
the cardiac impression of the left lung.
F. Right Surface consists mainly of the right atrium located between the SVC
and IVC.

The Heart Borders

A. Right Border consists of the right atrium,
SVC, and IVC.
B. Left Border consists of the LV, left atrium,
PT, and aortic arch.
C. Inferior Border consists of the RV.
D. Superior Border consists of the right
atrium, left atrium, SVC, ascending aorta, and PT

Fibrous Skeleton of the

Heart
a dense framework of collagen within the
heart that keeps the orifices of the
atrioventricular (AV) valves and semilunar
valve patent, provides an attachment site
of the valve leaflets and cusps, serves as
the origin and insertion sites of cardiac
myocytes, and forms an electrical
barrier between the atria and ventricles
so that they contract independently.

The Valves of the Heart

A. Bicuspid (Mitral; Left

Atrioventricular) Valve
B. Tricuspid (Right Atrioventricular)
Valve
C. Pulmonary Semilunar Valve
(Pulmonic Valve)
D. Aortic Semilunar Valve

A. Bicuspid (Mitral; Left Atrioventricular) Valve

The bicuspid valve is located between

the left atrium and LV and is composed
of two leaflets(anterior and posterior),
both of which are tethered to papillary
muscles (anterolateral and
posteromedial) by chordae tendineae.
The auscultation site is at the cardiac
apex at left intercostal space 5.

B. Tricuspid (Right Atrioventricular) Valve

The tricuspid valve is located between

the right atrium and RV and is composed
of three leaflets (anterior, posterior, and
septal), all of which are tethered to
papillary muscles (anterior, posterior,and
septal) by chordae tendineae.
The auscultation site is over the sternum
at intercostal space 4.

C.

Pulmonary Semilunar Valve

(Pulmonic Valve)

The pulmonary semilunar valve is the outflow valve

of the RV and is composed of three cusps (anterior,
right, and left) that fit closely together when closed.
The orifice of the pulmonary semilunar valve is
directed to the left shoulder.
The auscultation site of the pulmonary valve area is
over the left upper sternal border at left intercostal
space 2.
The auscultation site of the secondary pulmonary
valve area is over the sternum at intercostal space 3.

D. Aortic Semilunar Valve

The aortic semilunar valve is the outflow
valve of the LV and is composed of three
cusps (posterior,right, and left) that fit
closely together when closed.
The orifice of the aortic semilunar valve is
directed to the right shoulder.
The auscultation site is over the right upper
sternal border at right intercostal space 2.

Heart Sounds
1. S1 heart sound (first sound; lub
sound) is caused by closure of the
tricuspid and bicuspid valves.
2. S2 heart sound (second sound;
dub sound) is caused by closure of
the pulmonary and aortic valves.

Arterial Supply of the

Heart
The right coronary artery and left
coronary artery supply oxygenated
arterial blood to the heart. The
coronary arteries fill with blood
during diastole.
The coronary arteries have maximal
blood flow during diastole and
minimal blood flow during systole.

Right Coronary Artery (RCA)

The RCA arises from the right aortic sinus (of Valsalva) of the
ascending aorta and courses in the coronary sulcus.
The blood supply of the heart is considered right-side dominant
(most common) if the posterior
interventricular (IV) artery arises from the RCA.

The RCA branches into the following:

Sinoatrial (SA) nodal artery
Conus branch
Right marginal artery
AV nodal artery
Posterior IV artery
Septal branches

B. Left Main Coronary Artery (LMCA

The LMCA arises from the left aortic
sinus (of Valsalva) of the ascending
aorta.
The blood supply of the heart is
considered left-side dominant (less
common) if the posterior IV artery
arises from the LMCA.

The LMCA branches into the following.

1. Left circumflex artery (LCx), which further
branches into the following.
Anterior marginal artery
Obtuse marginal artery
Atrial branches
Posterior marginal artery

2. Intermediate ramus (a variable branch)

3. Anterior IV artery (also called left anterior
descending artery [LAD]), which further
branches into the following.
Anterior diagonal artery
Septal branches

The Conduction System

A. Sinoatrial Node
The SA node is the pacemaker of the heart and
is located at the junction of the SVC and right
atrium just beneath the epicardium.
From the SA node, the impulse spreads
throughout the right atrium and to the AV node
via the anterior, middle, and posterior
internodal tracts and to the left atrium via the
Bachmann bundle.
If all SA node activity is destroyed, the AV node
will assume the pacemaker role.

B. Atrioventricular Node
The AV node is located on the right side of the
AV portion of the atrial septum near the ostium
of the coronary sinus in the subendocardial
space.
The AV septum corresponds to the triangle of
Koch, an important anatomical landmark
because it contains the AV node and the
proximal penetrated portion of the bundle of
His.

C. Bundle of His, Bundle Branches, and Purkinje

Myocytes

The bundle of His travels in the subendocardial

space on the right side of the IV septum and
divides into the right and left bundle branches.
The left bundle branch is thicker than the right
bundle branch.
A portion of the right bundle branch enters the
septomarginal trabecula (moderator band) to
supply the anterior papillary muscle.
The left bundle branch further divides into an
anterior segment and posterior segment.
The right and left bundle branches both terminate
in a complex network of intramural Purkinje
myocytes.

The Abdomen
Is divided topographically by two transverse and two
longitudinal planes into nine regions:
right and left hypochondriac, epigastric, right and left
lumbar, umbilical, right and left inguinal (iliac), and
hypogastric (pubic).
Is also divided by vertical and horizontal planes
through the umbilicus into four quadrants:
right and left upper quadrants and right and left
lower quadrants. The umbilicus lies at the level of the
intervertebral disk between the third and fourth
lumbar vertebrae. Its region is innervated by the
10th thoracic nerve.

FASCIAE AND LIGAMENTS OF THE

ANTERIOR
ABDOMINAL WALL
Are organized into superficial (tela
subcutanea) and deep layers. The
superficial layer has two layers
1. superficial fatty layer (Campers
fascia)
2. deep membranous layer
(Scarpas fascia)

A. Superficial Fascia
1. Superficial (Fatty) Layer of the
Superficial Fascia (Campers Fascia)
. Continues over the inguinal ligament to
merge with the superfi cial fascia of the
thigh
. Continues over the pubis and perineum
as the superficial layer of the superfi cial
perineal fascia

2. Deep (Membranous) Layer of the

Superficial Fascia (Scarpas Fascia)
Is attached to the fascia lata just below the
inguinal ligament.
Continues over the pubis and perineum as the
membranous layer (Colless fascia) of the
superficial perineal fascia.
Continues over the penis as the superfi cial
fascia of the penis and over the scrotum as the
tunica dartos, which contains smooth muscle.
May contain extravasated urine between this
fascia and the deep fascia of the abdomen,
resulting from rupture of the spongy urethra

B. Deep Fascia
Covers the muscles and continues
over the spermatic cord at the
superfi cial inguinal ring as the
external spermatic fascia.
Continues over the penis as the deep
fascia of the penis (Bucks fascia)
and over the pubis and perineum as
the deep perineal fascia.

C. Linea Alba
Is a tendinous median raphe between
the two rectus abdominis muscles,
formed by the fusion of the aponeuroses
of the external oblique, internal oblique,
and transverse abdominal muscles.
Extends from the xiphoid process to the
pubic symphysis and, in pregnancy, it
becomes a pigmented vertical

Peritoneal Cavity

is a potential space between the

visceral and parietal peritoneum.
It is divided into the lesser peritoneal
sac and greater peritoneal sac.

A. Lesser Peritoneal Sac (Omental Bursa)

is an irregular-shaped sac that communicates
with the greater peritoneal sac via the omental
(Winslow) foramen. The lesser peritoneal sac
forms due to the 90-degree clockwise rotation
of the stomach during embryologic
development. The boundaries of the lesser
peritoneal sac are as follows.
1. Anterior: The liver, stomach, and lesser
omentum
2. Posterior: The diaphragm
3. Right Side: Liver
4. Left Side: Gastrosplenic and splenorenal
ligaments

B. Greater Peritoneal Sac is the remainder of the peritoneal cavity

and extends from the diaphragm to the pelvis. The greater peritoneal
sac contains a number of pouches, recesses, and paracolic gutters
through which peritoneal fluid circulates.
1. Paracolic Gutters are channels that run along the ascending and
descending colon. Normally, peritoneal fluid flows upward through the
paracolic gutters to the subphrenic recess, where it enters the
lymphatics associated with the diaphragm.
2. Excess Peritoneal Fluid due to peritonitis or ascites flows downward
through the paracolic gutters to the rectovesical pouch (in males) or the
rectouterine pouch (in females) when the patient is in a sitting or
standing position.
3. Excess Peritoneal Fluid due to peritonitis or ascites flows upward
through the paracolic gutters to the subphrenic recess and the
hepatorenal recess when the patient is in the supine position.
The patient may complain of shoulder pain (referred pain) due to
irritation of the phrenic nerve (C3, C4, and C5 nerve roots). The
hepatorenal recess is the lowest part of the peritoneal cavity when the
patient is in the supine position.

Omental (Winslow) Foramen is the

opening (or connection) between the
lesser peritoneal sac and greater
peritoneal sac. If a surgeon places his
or her finger in the omental foramen,
the inferior vena cava (IVC) will lie
posterior and the portal vein will lie
anterior.

 Is a serous membrane lined by mesothelial cells.

Consists of the parietal peritoneum and the
visceral peritoneum.
A. Parietal Peritoneum
Lines the abdominal and pelvic walls and the
inferior surface of the diaphragm.
Is innervated by somatic nerves such as the
phrenic, lower intercostal, subcostal,
iliohypogastric, and ilioinguinal nerves.
B. Visceral Peritoneum
Covers the viscera, is innervated by visceral
nerves, and is insensitive to pain.

Omentum
Is a fold of peritoneum extending from
the stomach to adjacent abdominal
organs.

Lesser Omentum
Is a double layer of peritoneum extending from the
porta hepatis of the liver to the lesser curvature of
the stomach and the beginning of the duodenum.
Consists of the hepatogastric and hepatoduodenal
ligaments and forms the anterior wall of the lesser
sac of the peritoneal cavity.
Transmits the left and right gastric vessels, which run
between its two layers along the lesser curvature.
Has a right free margin that contains the proper
hepatic artery, bile duct, and portal vein.

Greater Omentum

Is derived from the embryonic dorsal mesentery.

Hangs down like an apron from the greater curvature of the stomach, covering the
transverse colon and other abdominal viscera.
Transmits the right and left gastroepiploic vessels along the greater curvature.
Plugs the neck of a hernial sac, preventing the entrance of coils of the small intestine.
Adheres to areas of infl ammation and wraps itself around the infl amed organs, thus
preventing serious diffuse peritonitis. Peritonitis is an infl ammation of the peritoneum,
characterized by an accumulation of peritoneal fl uid that contains fi brin and
leukocytes (pus).

Consists of the gastrolienal, lienorenal, gastrophrenic, and gastrocolic ligaments.

a. Gastrolienal (Gastrosplenic) Ligament - Extends from the left portion of the greater
curvature of the stomach to the hilus of the spleen and contains the short gastric and
left gastroepiploic vessels.
b. Lienorenal (Splenorenal) Ligament - Runs from the hilus of the spleen to the left
kidney and contains the splenic vessels and the tail of the pancreas.
c. Gastrophrenic Ligament- Runs from the upper part of the greater curvature of the
stomach to the diaphragm.
d. Gastrocolic Ligament- Runs from the greater curvature of the stomach to the
transverse colon.

Inguinal Canal

 Spermatic cord
scrotum

Esophagus and stomach

Duodenum

Small Intestine

Large intestine

Cecum and appendix

Liver

Gall Bladder

Pancrease

Spleen

Urinary System

Muscles of the abdomen

( backside )

 Iliac arteries
Sacral plexus

Sigmoid and rectum

Urinary bladder

Prostate

Uterus