 Hello. Good day everybody. My name is Dr. Sajju Sanya. This day this time I decided to create a different kind of video and call it the surgical anatomy of the abdominal viscera. I'm a professor of surgery and neuroscience and here's my video. What we did, we picked up a specimen from a cadaver and we extracted it and this is what you see in front of you, which I shall tell you in a little more detail as we go along. So to bring you up to speed, here we have sections of the cadaver here. So this is the cardia of the stomach, this is the diodenum, this is the stomach, this is the spleen, this is part of the ascending colon, transverse colon, the ascending colon, the greater omentum. In order to lift it out of the cadaver, we had to cut it in four different places. You can see they're marked by this small cross here. We had to cut it at the region of the cardia where the force is inserted. We had to cut it at the diodenum. We had to cut it at the terminal ilium and then we had to cut it at the junction of the descending colon with a sigmoid and then we lifted it out of the cadaver. So this is the specimen that we shall talk about in a little more detail as we go along. So let's start with the first structure that is the stomach. Let's take a quick look at what we can see here. So this is an enlarged view of the anterior surface of the stomach here. So this is the cardiac end of the stomach, the cardia where the force is inserted. This is the region of the fundus of the stomach, which is in relation to the left dome of the diaphragm. And just adjacent to the fundus and the greater curvature of the stomach, you can see this plane here. So this is the greater curvature of the stomach and this is the lesser curvature of the stomach. This is the body of the stomach, the anterior surface. Don't mind these creases and grooves here because these are all preservation artifacts. And the body of the stomach continues as the pyloric entrum and then it continues as the pylorus and into the diodenum, which has been removed from this specimen. The attached to the lesser curvature, we have the lesser momentum, which has been removed here. But we can see that attached to the greater curvature of the stomach, there is still a part of the momentum. And this is actually a part of the greater momentum, which I shall tell you a few slides later. This part of the greater momentum, which extends from the greater curvature of the stomach to the transverse colon, is referred to as the gastrocoleic ligament. So remember the word ligament here does not apply to the term ligament in the truest sense of the word. This is just a form of peritonium. What we can see is that within the greater gastrocoleic ligament, we do have multiple numerous blood vessels. These are the gastropeploid carterees. We have one gastropeploid carteree running from left to right. That's the left gastropeploid carteree. And when we have running from right to left, that is the right gastropeploid carteree. The left GERtree is a branch of the spleen carteree. The right one is a branch of the gastrodiodenal artery. And as they run along the force of the gastrocoleic ligament, they give off numerous gastric branches to the greater momentum and we can see all of them here. So this is about the stomach here. One more point. If we make a section of the gastrocoleic ligament here along the border of the greater curvature, and we lift up the greater curvature of the stomach, we will enter a space, a peritoneal space. And that is referred to as the lesser sac or the omental bursa. And this omental bursa is the one which separates the stomach from the contents of the bed of the stomach. One of which is the part of the spleen, part of the diaphragm, the left kidney, the transverse misal colon, and the pancreas. These are the structures which are in the bed of the stomach. Now let us take a look at the next part of the specimen, the colon. This portion that you can see which is black here. Don't mind this black portion. This is actually a postmortem artifact because of poor preservation. This is not an anti-mortem gangrene. So let us try to identify the parts of it. We can see that this is the terminal ilium here and this is the iliocecal junction. So therefore this is the cecum that we see here. The cecum is a unique part of the large intestine which is as long as it is wide, 7.5 centimeters in either direction. We could not trace the appendix, it may have been removed. And if we trace the cecum up, this is a part of the ascending colon here. And this ends in the hepatic flexure which is related to the visceral surface of the liver. And then it continues as the transverse colon. This transverse colon is the one which is running here. We can see part of it here under the greater omentum. Now in this particular specimen, the transverse colon happens to be quite redundant just to bring up to speed in a living person. If the person is very thin and small built, like an aesthetic individual, then the transverse colon tends to be redundant and long. On the other hand, if the individual is very stout and heavily built with a very short thorax, the hypersthetic individuals, then the transverse colon tends to be more transverse in nature. Continuing with this transverse colon, we have this clinic flexure here which is related to this colic area of the spleen on the visceral surface of the spleen, which I shall tell you just a little later. And then it curves down as the descending colon and ends in the sigmoid colon which has been removed here. Since this portion of the colon has been preserved, we can see a few structures here. For example, we can see the tinnia labora here. The tinnia labora is nothing but a thickened portion of the longitudinal muscle of the colon. And this one tinnia labora, the other two tinnia being the tinnia mesopolica and the tinnia omentalis. These tinnia are named according to their relationships with the omentum, greater omentum, and the mesocolon in the transverse colon. And they are the ones which are seen here. We can also see these fatty structures here. These are the appendices epiploic A. And there have been numerous mentions in the literature about inflammation of these and they are known as epiploic appendigitis. So this is about a few words about the transverse colon, cecum ascending colon. Before I get out of this slide, let me point out a few things here. This is the iliocecal junction, as I told you a little earlier. The ilium is intraperitoneal. As it enters the cecum, it raises two folds of peritoneum, one above and one below. We cannot see the one above the superior iliocecal fold, but we can see the inferior iliocecal fold. And this is a potential site of internal herniation. This inferior iliocecal fold is known as the bloodless fold of treves, because there are no blood vessels running along the margin of the iliocecal fold. And therefore, if an intestine gets incarcerated here, we can safely incise the iliocecal fold and extract that intestine. So that is about the colon. Now let's take a look at the next part of the specimen. And there's say a few words about the spleen here. The surface of the spleen that we see here, this is the costo diaphragmatic surface, the convex surface of the spleen. This is related to the left dome of the diaphragm and to the lower ribs, the 9th, 10th and 11th ribs. What is significant is that if we see any patient with injury to the 9th, 10th or 11th ribs or any fracture, we should always think of spleen injury, because spleen injury can produce severe hemorrhage and can be life-threatening condition, which may require emergency screenctomy. To continue, when we are palpating the abdomen for an enlarged spleen, and we recognize the spleen by its notched superior border. So this is the superior border and you can see there's a notch here. This is what enables us to recognize that this is the spleen. Correspondingly, there's an inferior border behind, which you cannot see, but it is way behind. And that is related to the left kidney. And this is the anterior border of the spleen, which is related to just behind this anterior border of the spleen, is the colic area, which is related to the splinic flexure of the colon. On the medial side of the spleen, the so-called visceral surface of the spleen, we have the hyalum of the spleen, which we cannot see, but that is a general location. And on the hyalum of the spleen, we have the splinic vessels entering and leaving. And there are two folds of petroleum. One is known as the gastro-splinic ligament, which contains the splinic artery and the splinic vein. And we have the lino-renal ligament, which contains the tail of the pancreas. And these branches that you see here, which we mentioned earlier, the gastro-left gastro-epipleyic artery, they are the branches of the splinic artery. So these are the parts of the spleen that we can see here in this specimen. Let's take a look at the next part of the specimen, and namely the greater omentum. This whole thing is a greater omentum here, the so-called abdominal policeman. The greater omentum is derived from the dorsal meso-, embryonic dorsal mesogastrium. During embryonic life, it has got four folds as the development progresses. The inner two folds, the fumes, and the omentum becomes double-layered. This portion of the greater omentum, which stretches between the greater curvature of the stomach and the transverse colon, is referred to as the gastro-polyclic ligament, which I had alluded to earlier. And the other portion of the greater omentum, which hangs down from the transverse colon down to the-, as an apron in front of the abdominal viscera, is referred to as the greater omentum proper. And we can see that the greater-, the gastro-epipleyic vessels, which were running on the greater curvature of the stomach, apart from giving out the gastric branches, they also give out multiple epipleyic branches, and these are the epipleyic branches that we can see, the greater omentum. So, what is the role of the greater omentum in nature, and what is the surgical use of the greater omentum? In nature, the greater omentum, it always tries to wall off any focus of infection. That's why we call it the abdominal policeman. For example, if there's a leaking appendix, or it tries to wall it off so that it does not become into a generalized retinitis. After surgery, if we are not sure about our intestinal anastomosis or any repair, we always take a patch of omentum and we try to cover it, especially after a juvenile perforation leak or something. This is to reinforce our intestinal anastomosis or a repair. So that is the surgical use, and there have been inventions in the literature where the greater omentum has been strangulated when it gets incarcerated inside an intestine-, inside a hernia, and then it becomes gangrenous. So that is-, these are the few words about the greater omentum. And finally, thank you very much for watching, and have a nice day. Thank you for letting the dead teach the living.