 Hello everyone, in this session we will be quickly revising the organs of abdomen and pelvis. We will be revising in a way that it is useful for practical examinations and at the end I will also show you the 3D models of the abdomen and pelvis which I have. So, let us begin. So, what all topics I will be covering in this particular session, I will be covering all the major organs which are asked in practical or the viva examinations. So, I will be covering these organs, stomach, duodenum, pancreas, spleen, intestine, liver, kidney, posterior abdominal wall, urinary bladder, uterus along with the associated structures called as adnexa and testis and the methalytal section of male pelvis as well as female pelvis. So, before beginning with the individual organs, let us have a brief overview of the location of these organs. To understand the locations of these organs, the quadrants of the abdomen are important. So, you all know how the 9 quadrants of the abdomen are divided. There are two vertical lines which are drawn at the level of the midpoint of the clavicle that is the midclavicular line and that two horizontal lines, one is at the transpiloric plane and other is the intertubericular plane. This is at the level of L1 vertebrae and this is at the level of L5 vertebrae. So, these two horizontal lines and these two vertical lines divide the abdominal quadrants into 9 regions. So, here are the regions, epigastric, hypochondriac are the right and the left, umlical, then right and the left, lumbar, hypochondriac, it is also referred to as suprapubic and right and the left, iliac. So, where will be the stomach located? It is located in the epigastric region as well as some part of hypochondriac and the umlical region. Duodenum also located here in the epigastric region and some part in the umlical region. Ancreas, umlical region then as well as some part in the epigastric and the hypochondriac region. So, location of these organs are very important because later on when a case presents with an abdominal pain, so one should know that which is the underlying organ in that particular region. So, spleen is there in the left hypochondriac region, liver is there in the right hypochondriac region as well as it extends into the epigastric and the left hypochondriac region. And uterus urinary bladder, this is present in the pelvis, ok, it is not directly palpable on the antirebdominal, what it is in the pelvic cavity and testis is in the perennial region. Apart from these nine regions, there is also a tenth region of the abdomen and pelvis that is referred to as the perennial region, ok, so the genital organs are located there, ok. So, with this basic idea, let us begin with the discussion of the individual organs. Let us begin with the stomach first, so here we can see the specimen of the stomach and for holding the stomach in anatomical position, it has to be held in left hand so that the palm goes on the posterior surface of the stomach, ok, the two surface of the stomach anterosuperior surface and posterior inferior surface, then the ends of the stomach, this is the cardiac end of the stomach, this is the pyloric end of the stomach, then the other parts here we can see this is the lesser curvature of the stomach, this is the greater curvature of the stomach and we have to divide the parts in the actual stomach, this is the fundus of the stomach and there is a small part here called as the cardiac part of the stomach and this is the body of the stomach and this entire region is referred to as the pyloric part. Pyloric part has further subdivisions. There is the pyloric anterum, then pyloric canal and there is a thick muscular fleshy part that is referred to as the pylorus. So, these are the parts of the stomach and you may be asked about the blood supply of the stomach. So, how is the blood supply of the stomach? There is a celiac trunk which is the artery of the fore gut. So, that gives a branch called as the left gastric artery. Then there is a tortuous branch that is the plenic artery. It actually goes behind the stomach and then goes towards the spleen which is on the left side and there is one branch called as common hepatic artery which gives a proper hepatic artery and from there a branch comes that is the right gastric artery and there is one branch from here descending down that is the gastrodoedinal artery and from there also there is a branch called as right gastroetyploid artery and from this plenic artery there is left gastroetyploid artery. So, all these are the blood vessels which supply the stomach and we should also know about the various peritoneal relations of the stomach. From the here there is the liver right from the liver there is a fold of peritoneum coming towards the stomach that is the lesser momentum and lesser momentum has got further parts. This is the hepatogastric ligament and hepatododinal ligament and along the greater curvature of the stomach majority of the part is by the greater momentum and in the upper part some part goes towards the spleen that is the gastro-plenic ligament and some part goes towards the diaphragm that is the gastro-plenic ligament. So, all these basic things we should be knowing with respect to the stomach and also the lymphatic drainage of stomach is important. So, to understand the lymphatic drainage you can remember in relation with the arterial supply like which arteries are present here for example, here is the left gastric artery. So, there is the left gastric lymph nodes and right gastric artery. So, here is the right gastric lymph nodes then here is the pancreatic or splenic lymph nodes. Then right gastro-ploid lymph nodes according to the location of the blood vessels and near the pylorus there is pyloric lymph nodes. From all these regions the lymphatics ultimately go into a group of lymph nodes called as celiac group of lymph nodes. Lymphatic drainage is very important because the cancers of the stomach like they are transmitted to different organs through the lymphatic drainage and this image shows the interior of the stomach. So, what all things in the interior we can appreciate there are certain poles here though these poles are referred to as rugae. Then there will be minute pits which are the openings of the gastric glands. So, gastric rugae, gastric pits and along the lesser curvature we can see a canal here. This canal is called as the gastric canal is also called as canal of Magen stress. So, three key features in the interior of the stomach are gastric rugae, gastric pits and gastric canal of Magen stress. And in the lesser curvature we can see an abrupt curvature here. The lesser curvature is bending here this angle is referred to as incisiora angularis. In applied anatomy of stomach we can remember gastric ulcers then gastric carcinoma is more common along the greater curvature ulcers are more common along the lesser curvature. And for gastric ulcers there is a surgical procedure is called as Begotomi. It is obsolete nowadays, but still as per theory we should know that there are different types of Begotomi which are performed for the gastric ulcers ok. Nowadays like with medicines itself gastric ulcers are treated. Now, let us move on to the next organ. In this specimen we can see the duodenum pancreas as well as spleen ok. So, duodenum as we can see it is a C shaped organ. So, it has got parts here is the first part of the duodenum then this vertical part is the second part and this horizontal part is the third part and there is some part extending beyond this also that is the fourth part of the duodenum ok. So, four parts of the duodenum we should know. And in the C shaped curvature of the duodenum the head of the pancreas is located ok head of the pancreas and there is small projection from the head that is the incinate process of the pancreas and this is the body of the pancreas and this is the tail of the pancreas ok. Tail of the pancreas is related with the spleen ok. This region of the spleen is referred to as the hilum of the spleen ok. So, the tail of the pancreas is related with the hilum of the spleen ok. So, so basically we should be able to identify this specimen usually when the specimen of pancreas is kept it is kept along with the duodenum ok. That is how easily you can remember spleen may not be there, but usually duodenum is present along with the pancreas ok. And little details about it the arterial supply the superior pancreatic or duodenal artery, inferior pancreatic or duodenal artery. Then for the pancreas the major branch is arteria pancreatica magna it is a branch from the splenic artery ok. And splenic artery as we notice a direct branch from the celiac trunk ok. So, this was about duodenum pancreas. Spleen we have a different specimen as well in that I will discuss the various relations of the spleen. Before that let us just look at the interior of the duodenum. Interior of the duodenum will show one characteristic opening that is the major duodenal papilla ok. There is a main pancreatic duct as well as accessory pancreatic duct. The main pancreatic duct opens into the major duodenal papilla ok. And the mucosal poles which are present in the interior of the duodenum. Then there is a fold above this major duodenal papilla that is called as called as plica semicircularis. And there is a fold called as plica longitudinal is a longitudinal fold just below this major duodenal papilla ok. So, these are certain key features you can remember for the interior of the duodenum ok. And this is the specimen of spleen. We are looking at the visceral surface of the spleen and while describing the spleen there is something called as Harris dictum which we should know. The dictum of odd numbers 1, 3, 5, 7 and 9 and 11 ok. These odd numbers we need to remember for description of the spleen. Spleen is 1 inches thick that is 3 inches in breadth, 5 inches in length, it is 7 ounces in weight, 7 ounces is approximately 200 grams and it lies between 9th and the 11th slit ok. So, this is called as the Harris dictum of odd numbers for the description of the spleen ok. And for the external features it has got an anterior end, posterior end and surfaces are the diaphragmatic surface visceral surface and borders. You can see this is a superior border and superior border continues as the intermediate border and here is the inferior border ok. So, there are 3 borders, 2 surfaces and 2 ends and we should note the relations of this visceral surface. Diaphragmatic surface is the name such as it is related with the diaphragm as well as the rips and the intercostal spaces. And visceral surface which all organs are related, the largest impression is of the stomach ok. So, stomach is related here, then this region is related with the left kidney ok. Stomach left kidney in this region is related with the flexure of the colon, the splenic flexure of the colon ok. And this region is the hilum of the spleen it is related with the tail of the pancreas ok. And the various peritoneal relations of the spleen we should know. There is a ligament from the stomach to the spleen that is called as the gastro splenic ligament. And from the spleen it is called as lino renal ligament and there is one ligament which is a fold of peritoneum which supports the spleen from the anterior aspect that is the pranicocolic ligament ok. And we should know the contents of these ligaments as well. Gastro splenic ligaments contain lenic artery as well as the tail of the pancreas ok. And lino renal ligament it contains the short gastric arteries ok. The relation of the tail of the pancreas with the hilum is very important surgically very important because whenever spleenectom is performed careful rejection has to be done in this region so that the tail of the pancreas is preserved ok. Because the tail of the pancreas consists of excess number of ilates of Langerhans ok. So, if it gets damaged it may lead to iotrogenic diabetes mellitus ok. And spleen is also one of the most common organ for rupture in blow of blow to the abdominal organs. Spleen is the most common organ to get ruptured and the blood oozes out and it may irritate the left sided diaphragm ok that is referred to as Kerr sign. K E H R Kerr sign because it is actually pain radiating towards the left shoulder because the left sided diaphragm is radiated which is supplied by the same final segment C 3 C 4 ok. Now, let us start with the small intestine here we can see the specimen of small intestine whenever a specimen of small intestine is kept it is only the Jejunum and Elium together ok. Duodenum is usually a separate specimen and Jejunum and Elium together are one specimen ok. Whenever a specimen and whenever this specimen is given you will be asked to differentiate Jejunum from Elium or else you will be asked to differentiate small intestine from the large intestine ok. So, basic differentiating points we should know first let us see the differences between Jejunum and Elium. So, to understand the differences we will have to lift the specimen of the small intestine and and view it in the region where there is light source ok. So, we will see this kind of image. So, here we can see this vertical running blood vessels these are referred to as Vasa Recti Vasa Recti straight blood vessels and these are referred to as arcades. So, in Jejunum arcades are less Vasa Recti are long and in Elium this arcades will be more in number and there will be short Vasa Recti ok. So, this is one of the most important difference to differentiate Jejunum from Elium there might be other differences as well the like the thickness of the wall then the Lumen, but with that it becomes difficult to differentiate this is the most important thing that you need to look for the arcades and the Vasa Recti ok. And also this this region between the Vasa Recti we can see transparent area that is referred to as the Peritonial Bindo that is seen more clearly in Jejunum because of less fat content here whereas in Elium fat content is more ok. Let us look at the specimen of Elium as well. So, here we can see the specimen of Elium just compare this this more number of arcades and short Vasa Recti ok. So, here we can see Arcade Arcade Arcade ok this region is the Vasa Recti which is short and also the fat content is more here in this mizantry ok. Lumen of this Elium it is smaller as compared to that of the Jejunum, but as I said other differences it is difficult to differentiate easily you can differentiate by looking at the arcades and the Vasa Recti ok. More arcades and short Vasa Recti means it is Elium and less arcades and long Vasa Recti means it is Jejunum ok. And this image shows the difference between the interior of Jejunum and interior of Elium. Here we can see the mucosal folds here these are referred to as walls of Kirkering these are also referred to as Pli K Circularis and in radiology these folds are referred to as Valvule Conumentus ok. So, this Jejunum we can see multiple small folds which are placed close to each other whereas in Elium they are placed wide apart and also it has got an aggregated lymphoid follicle that is a pair patch ok that may be seen in the Elium. So, there is one difference that we should know in the interior of Jejunum in Elium ok. Then how to differentiate the entire small intestine from the large intestine. So, when a specimen is kept. So, here we can see it has got a huge misentry along with the intestine whereas in large intestine you may not be able to look at the huge misentry because the ascending colon is retroperitoneal the descending colon is retroperitoneal only misentry is present in the transverse colon ok. So, that also most of the times get cut off when the specimen is removed. So, the specimen of large intestine looks like this it will be present along with this Ticum appendix and ascending colon transverse colon descending colon that will continue as the sigmoid colon that will further continue as the rectum ok and usually the part of the rectum is not there in the specimen rectum is most of the times left in the posterior abdominal ball itself ok. And what is the major difference? Major differences between small intestine and large intestine. So, there are some cardinal features of large intestine which will help you to differentiate with small intestine. One is tinnia coli. These are longitudinal bands of muscles ok those are referred to as tinnia coli there are three bands which are present then there is outpouching of this peritoneum that is referred to as the appendices epiploak ok. So, appendices epiploak then tinnia coli and there is third feature that is referred to as sacculations or hostrations ok those are holdings of this wall of the large intestine ok those are referred to as sacculations. So, these are the cardinal features of large intestine that helps us to differentiate between large intestine and small intestine ok. And if we see in microanatomy the small intestine has got villi which is absent in large intestine that is one of the important key microanatomical difference between small intestine and large intestine ok. So, here is a separate specimen of cecum and appendix this we can see this is the cecum and here this is the appendix ok this is the terminal part of the helium which is opening into the cecum in the eliocecal junction ok. And in appendix we should be aware of various positions of the appendix and one of the most common position is retrocecal. So, also referred to as the 12 o'clock position of the appendix while the appendix is behind the cecum and it is more towards the upper aspect that is referred to as the retrocecal appendix ok. Then arterials applied to the appendix is by the appendicular artery it is a branch from the heliocolic artery ok and heliocolic artery itself it is branch from the superior to the miscentric artery ok. Then cecum and in appendix there is a common clinical condition called as appendicitis the pain of which radiates on to the anterior abdominal wall the site on which there is maximum pain that is referred to as the mech bernice point it is at the junction of the medial two thirds and the lateral one thirds of the line joining the anterior superior EX spine to the umbilicus. So, for PDF handout y'all can WhatsApp me at this number and please do watch the other sessions of this YouTube channel ok.