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Abdominal visceral organs & their functions

The document provides a detailed overview of the abdominal visceral organs

Health & Medicine◦
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03/03/2026 1 Abdominal Viscera B.NSC 200L
Abdominal Viscera • The principal viscera of the abdomen are the terminal part of the esophagus and the stomach, intestines, spleen, pancreas, liver, gallbladder, kidneys, and suprarenal glands.
4 LIVER, GALL BLADDER, PANCREAS AND SPLEEN
5 • Liver is the largest gland in the body. It is wedge shaped & it weighs approximately 2.3kg in adult. • It accounts for 2.5% of adult body weight. • In the late foetus it serves as a haemopoietic organ & therefore is twice as large (5% of body weight) • The liver lies mainly in the right upper quadrant of the abdomen where it is hidden and protected by the thoracic cage and diaphragm. • The normal liver lies deep to ribs 7-11 on the right side and crosses the midline toward the left nipple liver
6 • It consists of both exocrine and endocrine parts. Exocrine part secretes bile which is conveyed by the biliary passages. • The endocrine part liberates some useful chemical substances such as glucose from glycogen, most of the plasma proteins (except immunoglobulins) and heparin directly into the blood stream. liver
7 liver • It occupies whole of the right hypochondrium, greater part of the epigastrium and extends into the left hypochondrium up to the left lateral line
Blood supply • The hepatic portal vein brings 75–80% of the blood to the liver. • The vein carries nutrients absorbed by the alimentary tract to the sinusoids of the liver with the exception of lipids, which are absorbed into the lymphatic system. • The vein is formed by the superior mesenteric and splenic veins posterior to the neck of the pancreas. It ascends anterior to the IVC as part of the portal triad in the hepatoduodenal ligament. • Arterial blood from the hepatic artery a branch of celiac trunk, accounting for only 20–25% of blood received by the liver.
12 • In the infrasternal angle the liver is readily accessible to examination on percussion though normally it is not palpable due to normal tone of the recti muscles and the softness of the liver. • A palpable left lobe in the epigastrium often indicates cirrhosis of the liver. APPLIED ANATOMY
13 • The liver receives a large amount of blood immediately before it enters the heart. Both the inferior vena Cava and hepatic veins lack valves. • Any rise in central venous pressure is directly transmitted to the liver, which enlarges as it becomes engorged with blood. • When massively enlarged, its inferior edge may be palpated below the right costal margin and may even reach the pelvic brim in the right lower quadrant of the abdomen. Hepatomegaly
14 • Is a condition in which liver hardens & shrinks due to progressive fibrosis. • The liver is the primary site for detoxification & so it is vulnerable to cellular damage & consequent scarring accompanied by regenerative nodules. • There is progressive destruction of hepatocytes in hepatic cirrhosis & replacement by fat & fibrous tissue. • Alcoholic cirrhosis is the most common cause of portal hypertension. CIRRHOSIS OF LIVER
15 • Hepatic tissue may be obtained for diagnostic purpose by liver biopsy. • Because the liver is located in the right hypochondrium where it receives protection from the overlying thoracic cage, the needle is commonly directed through the right 8th to10th intercostal space in the mid axillary line. LIVER BIOPSY
16 • With the patient holding his or her breath in full expiration —to reduce the size of the costodiaphragmatic recess and the likelihood of damage to the lung—a needle is inserted through the right eighth or ninth intercostal space in the midaxillary line. • The needle passes through the diaphragm into the liver, and a small specimen of liver tissue is removed for microscopic examination. LIVER BIOPSY
17 • The needle will pass through the following structures: • Skin → superficial fascia → external oblique muscle → intercostal muscles → costal parietal pleura→ costodiaphragmatic recess → diaphragmatic parietal pleura → diaphragm → peritoneum LIVER BIOPSY
18 • The liver is a soft and friable structure enclosed in a fibrous capsule. Its close relationship to the lower ribs is important. • Fractures of the lower ribs or penetrating wounds of the thorax or upper abdomen are common causes of liver injury. • Blunt traumatic injuries from automobile accidents are also common, and severe hemorrhage accompanies tears of this organ Liver Trauma
19 • A number of connections occur between the portal and systemic circulations. • When the direct pathway through the liver becomes congested (such as in cirrhosis) the pressure within the portal vein rises and under these circumstances the porto-systemic anastomoses form an alternative route for the blood to take. Porto-systemic anastomoses
PORTAL HYPERTENSION • It is defined as a state of increase in the hydrostatic pressure within the portal vein or its tributaries. • The normal portal venous pressure is 5- 10 mmHg.
Caval Obstruction • If the superior or inferior vena cava is obstructed, the venous blood causes distension of the veins running from the anterior chest wall to the thigh. The lateral thoracic vein anastomoses with the superficial epigastric vein, a tributary of the great saphenous vein of the leg. In these circumstances, a tortuous varicose vein may extend from the axilla to the lower abdomen
Portal Vein Obstruction and Caput Medusae • The superficial veins around the umbilicus and the paraumbilical veins become grossly distended. The distended subcutaneous veins radiate out from the umbilicus, producing Caput Medusae in severe cases.
Portal–systemic anastomoses • Portal–systemic anastomoses, in which the portal venous system communicates with the systemic venous system, • Are formed in the submucosa of the inferior esophagus, in the submucosa of the anal canal, in the paraumbilical region, and on the posterior aspects (bare areas) of secondarily retroperitoneal viscera, or the liver
• When portal circulation through the liver is diminished or obstructed because of liver disease or physical pressure from a tumor, • for example, blood from the digestive tract can still reach the right side of the heart through the IVC by way of these collateral routes. • These alternate routes are available because the hepatic portal vein and its tributaries have no valves; hence blood can flow in a reverse direction to the IVC. • However, the volume of blood forced through the collateral routes may be excessive, resulting in potentially fatal varices (abnormally dilated veins)
• Between the oesophageal branch of the left gastric vein and the oesophageal veins of the azygos system (these oesophageal varices are the cause of the severe haematemeses that may occur in portal hypertension); • Between the superior rectal branch of the inferior mesenteric vein and the inferior rectal veins draining into the internal iliac vein via its internal pudendal tributary; Portacaval Anastomoses
Porto-systemic anastomoses
Porto-systemic anastomoses
• Between the portal tributaries in the mesentery and mesocolon and retroperitoneal veins communicating with the renal, lumbar and phrenic veins; Porto-systemic anastomoses
• Between the portal branches in the liver and the veins of the abdominal wall via veins passing along the falciform ligament from the umbilicus(which may result in the formation of a cluster of dilated veins which radiate from the navel and which are called the caput Medusae); Porto-systemic anastomoses
Porto-systemic anastomoses • Between the portal branches in the liver and the veins of the diaphragm across the bare area of the liver.
31 GALLBLADDER AND EXTRAHEPATIC BILIARY SYSTEM • The gallbladder is a saclike, hollow organ measuring about 10 cm in length that lies in a fossa on the undersurface of the liver. • The gallbladder is attached to the liver by loose areolar tissue rich in small blood vessels and lymphatics. • The gallbladder has a fundus, body, infundibulum, and neck.
32 • Fundus the wide end of the organ, projects from the inferior border of the liver and is usually located at the tip of the right 9th costal cartilage in the MCL • Body contacts the visceral surface of the liver, the transverse colon, and the superior part of the duodenum. • neck narrow and tapered; directed toward the porta hepatic; it makes an S-shaped bend and joins the cystic duct. • The gall-bladder is supplied by the cystic artery (a branch usually of the right hepatic artery) Parts Gall bladder is divided into 3 parts:
33 • It stores and concentrates bile ten times more than liver bile. • It reduces the alkalinity of hepatic bile. • It equalizes ductal biliary pressure • Gallbladder is not indispensable, because its surgical removal is not associated with liver dysfunction. Functions of the gallbladder:
34 • Acute cholecystitis produces discomfort in the right upper quadrant or epigastrium. Inflammation of the gallbladder may cause irritation of the subdiaphragmatic parietal peritoneum, which is supplied in part by the phrenic nerve (C3, 4, and 5). • This may give rise to referred pain over the shoulder, because the skin in this area is supplied by the supraclavicular nerves (C3 and 4). APPLIED ANATOMY Acute Cholecystitis
35 • In diseased states of the gallbladder, a dilation or pouch appears at the junction of the neck of the gallbladder and the cystic duct. This pouch is called the infundibulum of the gallbladder (Hartmann pouch). • Gallstones commonly collect in the infundibulum. Infundibulum of the Gallbladder
36 • Obstruction of the biliary ducts with a gallstone or by compression by a tumor of the pancreas results in backup of bile in the ducts and development of jaundice. • The impaction of a stone in the ampulla of Vater may result in the passage of infected bile into the pancreatic duct, producing pancreatitis. APPLIED ANATOMY
37 Gallstones APPLIED ANATOMY • Gallstones are usually asymptomatic; however, they can give rise to gallstone colic or produce acute cholecystitis. • Gallstones have been known to ulcerate through the gallbladder wall into the transverse colon or the duodenum.
38 • Biliary Atresia Failure of the bile ducts to canalize during development causes atresia. Jaundice appears soon after birth; clay- colored stools and very dark colored urine are also present. • Absence of the Gallbladder : Occasionally, the outgrowth of cells from the hepatic bud fails to develop. In these cases, there is no gallbladder and no cystic duct. CONGENITAL ANOMALIES OF THE GALLBLADDER
39 • Double Gallbladder: Rarely, the outgrowth of cells from the hepatic bud bifurcates so that two gallbladders are formed. • Absence of the Cystic Duct: In absence of the cystic duct, the entire outgrowth of cells from the hepatic bud develops into the gallbladder and fails to leave the narrow stem that would normally form the cystic duct. • The gallbladder drains directly into the bile duct. CONGENITAL ANOMALIES OF THE GALLBLADDER
pancreas • The pancreas is an elongated, accessory digestive gland that lies retroperitoneally, overlying and transversely crossing the bodies of the L1 and L2 vertebra. • It lies posterior to the stomach between the duodenum on the right and the spleen on the left. • The transverse mesocolon attaches to its anterior margin.
42 • It is arbitrarily divided into a head with its uncinate process, a neck, a body, and a tail. • Bile and Pancreatic Ducts • The common bile duct passes posterior to the head of the pancreas on its way to the duodenum, and is partially or completely covered by the pancreas in over 70 percent of cases. PANCREAS
PANCREAS • an exocrine secretion (pancreatic juice from the acinar cells) that enters the duodenum through the main and accessory pancreatic ducts. • endocrine secretions (glucagon and insulin from the pancreatic islets [of Langerhans]) that enter the blood.
parts • For descriptive purposes, the pancreas is divided into four parts: head, neck, body, and tail. • The head of the pancreas is the expanded part of the gland that is embraced by the C-shaped curve of the duodenum to the right of the superior mesenteric vessels just inferior to the transpyloric plane. • The uncinate process, a projection from the inferior part of the pancreatic head, extends medially to the left, posterior to the SMA. • The pancreatic head rests posteriorly on the IVC, right renal artery and vein, and left renal vein. • The neck of the pancreas is short (1.5–2 cm) and overlies the superior mesenteric vessels, which form a groove in its posterior aspect.
• The body of the pancreas continues from the neck and lies to the left of the superior mesenteric vessels, passing over the aorta and L2 vertebra, continuing just above the transpyloric plane posterior to the omental bursa. • The anterior surface of the body of the pancreas is covered with peritoneum and lies in the floor of the omental bursa and forms part of the stomach bed. • The main pancreatic duct begins in the tail of the pancreas and runs through the parenchyma of the gland to the pancreatic head.
• The main pancreatic duct and bile duct usually unite to form the short, dilated hepatopancreatic ampulla (of Vater), which opens into the descending part of the duodenum at the summit of the major duodenal papilla. • The sphincter of the pancreatic duct (around the terminal part of the pancreatic duct), the sphincter of the bile duct (around the termination of the bile duct), and the hepatopancreatic sphincter (of Oddi)—around the hepatopancreatic ampulla—are smooth muscle sphincters that control the flow of bile and pancreatic juice into the ampulla and prevent reflux of duodenal content into the ampulla.
• The accessory pancreatic duct opens into the duodenum at the summit of the minor duodenal Papilla. • Usually, the accessory duct communicates with the main pancreatic duct. • In some cases, the main pancreatic duct is smaller than the accessory pancreatic duct and the two may not be connected. In such people, the accessory duct carries most of the pancreatic juice.
Arterial supply of the pancreas • mainly from the branches of the splenic artery. • Multiple pancreatic arteries form several arcades with pancreatic branches of the gastroduodenal and superior mesenteric arteries. • The anterior and posterior superior pancreaticoduodenal arteries, branches of the gastroduodenal artery, and the anterior and posterior inferior pancreaticoduodenal arteries, branches of the SMA, form anteriorly and posteriorly placed arcades that supply the head.
APPLIED ANATOMY • Note: from the posterior relations of the pancreas that a neoplasm of the head of the pancreas will produce obstructive jaundice by compressing the common bile duct
53 • The spleen is about the size of the cupped hand. If forms the left lateral extremity of the lesser sac. • Passing from it are the gastrosplenic ligament to the greater curvature of stomach (carrying the short gastric and left gastroepiploic vessels) and • the lienorenal ligament to the posterior abdominal wall (carrying the splenic vessels and tail of the pancreas). THE SPLEEN
spleen • The spleen is an ovoid, usually purplish, pulpy mass about the size and shape of one’s fist. It is relatively delicate and considered the most vulnerable abdominal organ. • The spleen is located in the superolateral part of the left upper quadrant (LUQ) or hypochondrium of the abdomen where it enjoys protection of the inferior thoracic cage. • As the largest of the lymphatic organs, it participates in the body’s defense system as a site of lymphocyte (white blood cell) proliferation and of immune surveillance and response.
• Prenatally, the spleen is a hematopoietic (blood-forming) organ, but after birth is involved primarily in identifying, removing, and destroying expended red blood cells (RBCs) and broken-down platelets, and in recycling iron and globin. • The spleen serves as a blood reservoir, storing RBCs and platelets, and, to a limited degree, can provide a sort of “self transfusion” as a response to the stress imposed by hemorrhage. • In spite of its size and the many useful and important functions it provides, it is not a vital organ (not necessary to sustain life).
Relations of the spleen • Anteriorly, the stomach. • Posteriorly, the left part of the diaphragm, which separates it from the pleura, lung, and ribs 9–11. • Inferiorly, the left colic flexure. • Medially, the left kidney. • The arterial supply of the spleen is from the splenic artery, the largest branch of the celiac trunk. • Venous drainage from the spleen flows via the splenic vein, formed by several tributaries that emerge from the hilum
• The thin fibrous capsule of the spleen is composed of dense, irregular, fibroelastic connective tissue that is thickened at the splenic hilum. • Internally the trabeculae (small fibrous bands), arising from the deep aspect of the capsule, carry blood vessels to and from the parenchyma or splenic pulp, the substance of the spleen. • The spleen contacts the posterior wall of the stomach and is connected to its greater curvature by the gastrosplenic ligament, and to the left kidney by the splenorenal ligament. • These ligaments, containing splenic vessels, are attached to the hilum of the spleen on its medial aspect.
59 • In performing a splenectomy, the close relation of the pancreatic tail to the hilum and splenic pedicle must be remembered. • Injuries to the left upper abdomen may damage the spleen; a stab wound of the posterior left chest may penetrate the diaphragm and tear the spleen. • The spleen, with its thin tense capsule, is the commonest intra-abdominal viscus to be ruptured by blunt trauma. APPLIED ANATOMY