 Welcome to the second part of the discussion of the abdominal viscera in the first part We had mentioned the portal structures this time. We are mentioning the viscera. Let's come back to the spleen So again, I have lifted up the spleen here With the pancreas attached to it that means it is in the spleen orenol ligament Remember the tail of the pancreas and the spinning vessels were in the spleen orenol ligament So the fact that it is attached I have freed it from the stomach here It was attached to the stomach by means of the gastro spleen ligament little bit of the gastro spleen ligament is visible here But most of it is attached to the tail of the pancreas. So let's look at the spleen It was stuck to the post to the side of the abdominal wall It was in relation to 9 10th and 11th ribs and I told you in class that the spleen has got a superior border And you can see the superior border very clearly here. Can you see a notch here? This is the classical notch of the superior border which helps us to palpate. So when we are palpating like this We recognize it by its superior border. This is the anterior border and This is the inferior border This is the diaphragmatic and the costal surface and this is the visceral surface and you can see the highlight of the spleen In fact, when we do a spleenectomy, we lift up the spleen and we clamp it and we remove it from here Okay, so the superior border just under the superior border. This portion is the gastric area So the stomach was related here. You see the stomach was related like this. So this is the gastric area This anterior border behind that is the colic area. We have removed the colon So this was a splinic flexure where it was located. Now, let me just turn to show you the inferior border This is the renal area and you can see that it is related to the left kidney Which is here, which I'm going to show you in the next section. So when it was located like this It was related to the left kidney. So that is the renal area So these are the important surfaces and the borders and the parts of the spleen now let's take a look at The stomach itself and in front of you I'm going to open the stomach and I'm going to show you the interior of the stomach I'm going to show you the pylorus Let's put back the stomach in its normal location where we started off if you remember this was the cut end of the Isophagus so this is the other cut end of the isophagus So this portion is the abdominal part of the isophagus and this isophagus is continuing This is the cardiac notch This is the fundus of the stomach this is the lesser curvature of the stomach This is the region of the instissura angularus the lowest most dependent part of the stomach when you see from the top and After that instissura angularus it becomes the pylorus and from the pylorus This diodina makes an upward curve, which is the superior part then the descending part Then the horizontal part then the ascending part and then the dj flexure from where the ligament of trides extends to the diaphragm Having said that now let me open out the stomach I've retained I've already shown you the left gastric artery and everything else I've shown you so now I'm going to open out the stomach To show you the rugal folds there These are the The rugae gastric rugae let me spray a little bit of water and then you'll be able to see much more clearly You can see You can see the gastric rugae This is how the interior of the stomach looks like I Okay You can see the rugal folds much more clearly Straight yes Surgeon is the only one who got straight with the curved scissors. They say you'll reach the pylorus. Okay slow down And here my I'm reaching an obstruction. That is the region of the pylorus. I am cut with a knife now And you'll see the thickness of the pylorus You see I'm having difficulty because it is thick There That is the region of the pylorus It is pyloric sphincter Hold the other end to me That's right There This is the pylorus And you can feel The thickness This is the pyloric sphincter Now I will put this instrument inside I put it inside now you cut on top of the instrument There we have crossed the pylorus Can you see the pylorus here? Can you see the thickness here? This portion here This is the thick portion. This is the pylorus portion. So we have crossed the pylorus. Now we have entered the diodenum And interior of the diodenum I have already opened out and you can see that there are transverse mucosal folds So this is the interior of the stomach interior of the diodenum Now I'm going to open This spleen I'm going to cut open the spleen just to show you the How the interior of the spleen looks like the spleen is composed of Mostly red And few white pulp Mostly it is red pulp red pulp contains spleenic sinusoids and I told you sinusoids means blood spaces without endothelium So even spleen has got sinusoids. So that is the red pulp Then what about the white pulp white pulp are those arteries which are surrounded by lymphoid follicles lymphoid tissue Those constitute white pulp and in between there are incomplete Trabiculate so that is the interior of the spleen and I told you the spleen acts as a reticulate endothelial organ And it acts as a temporary storage organ for RBCs in adults and in children in infants it is an organ of hematopoistus, but not in adults So this basically destroys all old and broken down RBC. So this is the interior of the spleen and finally Nothing much to show you inside the pancreas. I will open up one of these gallbladder to show you the interior Okay, cut it to here please for me Okay, let's go into the lumen It has already got some bile. That's why it is sticky and This is the interior of the gallbladder and you can see some of these This is the bile So this is a bifid gallbladder So and before I conclude for let me show you the last part though It is actually part of the abdominal wall since you're wearing gloves. You hold it for me, please This is the anterior abdominal wall the remnant is everybody with me This is the rectus sheath the anterior layer of the rectus sheath This other side anterior layer of the rectus sheath. Hold it stretch it out for me, please This is the linea alba. Can you see the linea alba in the middle? Where it fuses Now, what did I tell you in the class stretching out from the inner surface of the abdominal wall? We have a A ligament What was that ligament? This is the falsiform ligament. Can you see so this in is Margin of the falsiform ligament is the one which is attached to the abdominal wall clear The other end is attached to the liver. Can you see this is the liver? This is the left loop. This is the right loop And this is the free margin of the falsiform ligament which is going all the way to the umbilicus And this is the region of the umbilicus And this free margin if you feel you will feel the Round ligament of liver and you can feel the cord like structure And you can see that the falsiform ligament splits to form the anterior layer of the coronary ligament You can see this is the falsiform ligament here. And can you see it is splitting? It is attaching it is attached also to the part of the abdominal wall here And you can see the whole falsiform ligament completely here You can see it's splitting to form the right And the left leaf of the coronary ligament So this is the falsiform ligament which I wanted to show you And this is the one which divides the liver into an anatomical right lobe and an anatomical left lobe Which of course does not have any functional significance. This is the anatomical left lobe And this is the anatomical right lobe. This is the inferior margin of the liver. This is the posterior superior or the diaphragmatic surface of the liver And this is the visceral surface of the liver. And since we are on this In fact, this fluid is collected in the hepato-renal Morrison pouch by the way which came out Can you see this is the right kidney? Can you see this is the liver? So this is the Morrison pouch And just now you can see it's already the most dependent when I press down this fluid came out. So this is the Morrison pouch This is what I spent so much time telling you explaining to you Is is the most important most dependent space and the other most dependent space is the pelvis And you can see my hand is going deep down inside So the patient is lying down fluid tends to collect in the pelvis and it tends to collect in the Morrison pouch Clear. Thank you very much for watching ladies and gentlemen. Have a nice day. Dr. Sanjay Sanyal signing out I hope all of you have seen everything