 Good day ladies and gentlemen. Welcome to our next section of the abdomen. I am Dr. Sanjay Sanyal. I have dissected out the small intestine and the large intestine completely and this is the rest of the abdominal viscera except the retro-patternial structures. So what I have done, I have cut the esophagus and you can see this is the cut end of the esophagus here. This is the esophageal hiatus which I told you is at the level of T10. You can see this is the anterior vagus and behind that is the posterior vagus. Okay, so that is the cut end of the esophagus. So where is the other cut end of the esophagus? This is the other cut end of the esophagus. I have completely removed the petronium. So this is the other cut end. I have stripped off the petronium so the vagus has gone from here. So this is the cardia and you can see this is the cardia. This is the fundus of the stomach. This is the lesser curvature, a little bit of the lesser momentum I have retained here just so that you will get the orientation. Let's continue. So this is the stomach. This is the lesser curvature of the stomach. This is the greater curvature of the stomach. And as we trace the stomach, we find that the stomach at the pylorus, it makes the curve upwards and this is the superior part of the diodenum. The superior part of the diodenum then continues. This is the descending part of the diodenum. It was retro petronial. I removed it and I brought it forward. This is the horizontal part of the diodenum and you can see it is ascending slightly. This is the ascending part of the diodenum and this was the region of the DJF flexure where I have removed the small intestine. Let's continue further. This is the sea loop of the diodenum and what do we have within the sea loop of the diodenum? We can see the pancreas here. This is the head of the pancreas and below that is the unscenate process of the pancreas. This is enclosed within the sea loop of the diodenum here. This is the body of the pancreas and the tail of the pancreas is attached to the spleen here. The tail of the pancreas is within the spleen or renal ligament. I have lifted up the spleen or renal ligament with the tail of the pancreas here. This is the spleen with the tail of the pancreas. This is the broad overview. Now I am going to go a little deeper. For that I will start from a grand idea of structures which I have been talking about repeatedly. Let's pick up these three structures. Can anybody identify these three structures here? One, two, three. D, A, V. This is the common bile duct. This is the hepatic artery and under that is the portal vein because these are the three structures which we had lifted up which formed the epiploic foramen which was in the hepato-diodenal ligament and this is where we had performed the hogarth-pringle maneuver. We had compressed. Let me go further. So this is the common bile duct. This is the hepatic artery. This is the portal vein. I am going to trace each of them very minutely now. Let's take the hepatic artery. Let's keep tracing the hepatic artery. I am going to just gently turn all the contents and you can see that this is the hepatic artery. The hepatic artery is proper and you can see another artery here. This is the gastro-diodenal artery which is going behind the diodenum. Before that is the common hepatic artery. So common hepatic artery, gastro-diodenal artery, hepatic artery, proper going into the portahepatus. So this is the hepatic artery. It's the second largest artery of the celiac trunk. Let us continue further. I am going in the reverse direction so that it will be easy for you to understand. We have reached the celiac trunk here. Which is the largest branch of the hepatic of the celiac trunk? This is the splenic artery. So let us trace the splenic artery now. If I remember, I had told you the splenic artery is highly tortuous and it runs along the superior border of the pancreas. You can see the splenic artery is here and I am going to turn this and you will see that this is the same splenic artery. Can you see it is running in a tortuous fashion on the upper border of the pancreas here? Because this was the upper border, I turned it so this is the same splenic artery which you can see running here and it is running all the way to the hilum of the spleen. So this is that same splenic artery and if you look again, you see that it is starting from our starting position here. This is the splenic artery. Clear? So this was the hepatic artery again. This is the splenic artery and the smallest branch was the left gastric artery which you can see here. This is the left gastric artery which runs and it runs like this and it runs along the lesser curvature of the stomach and you can see the left gastric artery is running along the lesser curvature of the stomach. It runs within the attached margin of the lesser momentum which I have retained here. So we have seen the three major branches of the celiac trunk. You really get to see this minute way. Again, I will show you this is the hepatic artery. This is the splenic artery. This is the left gastric artery. Left gastric artery running along the lesser curvature. Hepatic artery running like this and then it making a bend upwards in the portal triad and this is the gastrodial branch. Clear? And this was the splenic artery which I showed you. Again, to show you let me turn this. You can see it running along the superior border in a very tortuous fashion. Along the superior, it is the largest branch which goes to and it also gives branches to the spleen, to the pancreas and to the posterior aspect of the stomach. Okay. So that is one thing we saw. That is the hepatic artery which is a part of the portal triad. Now let's come to the next structure. The what you have been waiting for. This is the portal vein. It is very friable therefore it takes a long time to dissect it out. So this is the portal vein. So naturally you would like to see how is the portal vein formed. So let's trace the portal vein. Let's trace the portal vein in and in. Let's go. What I have done I have reversed the dissection from the other side. This is the portal vein till here we are seeing. We would like to see where it is forming the portal vein. So I have removed this structure now. I have just turned the pancreas and you can see that this structure which you see here, this is the superior miscentric vein. The superior miscentric vein and this structure which you see coming here is this clinic vein. They unite and they form the portal vein and this is the portal vein that you see going inside. Are we clear? This is the portal vein. So superior miscentric vein, splinic vein uniting to form the portal vein. Again I am going to turn it and you can see the portal vein here. So this union has taken place behind the neck of the pancreas. So therefore I have to turn it several times to show you. This is the superior miscentric vein uniting with the splinic vein. I am going to trace the splinic vein just now. And it meets with the splinic vein to form the portal vein and the portal vein is here. It is running. So let me trace the splinic vein further. Here. There you see. Now you can see much more clearly. You can see that this is the superior miscentric vein. Can you see the splinic vein coming all the way? Can you see it is coming behind the pancreas? Because the superior, the splinic artery was above that. So it is coming behind. It is running behind the pancreas, running behind the pancreas. And it is meeting behind the neck of the pancreas. It is meeting the superior miscentric vein and it is forming the portal vein which again has become the portal vein here. Clear? I think everybody has seen that. So this is the portal vein. So now your next question in your mind is where is the inferior miscentric vein? And there you go. This is the inferior miscentric vein which is opening into the splinic vein. The inferior miscentric vein is running and it opens into the splinic vein. It can open as I told you either very close to the superior miscentric or it can open very far from the superior miscentric. So this is the other structure in the portal triad. So since I showed you the superior miscentric vein, just now I showed you the superior miscentric vein. This was the superior miscentric vein which was opening into the splinic vein to form the portal vein and you can see that. So naturally you would expect the superior miscentric artery to be right next to it. Yes, and these are the various divisions of the superior miscentric artery. And if you remember the superior miscentric vein and the superior miscentric artery, they cross the third part of the duode now. So they are crossing. Because we cut them when we remove the small intestine. So these are the branches of the superior miscentric artery you can see. And we did mention in the class that the superior miscentric artery crosses the left renal vein. I have not yet dissected it out but you can see that this is the left renal vein, this one. This structure is the left renal vein, this one. This is the left renal vein. I am going to dissect it out and then you will see much more clearly. This is the left renal vein. So it crosses the duodenum and the left renal vein and that is where you can get renal vein entrapment syndrome. Now let's take the third structure and these four and that is the common bile duct. So this is the common bile duct. As we know, the common bile duct is continuing up. It receives communication from the pancreatic duct which is inside. So if we trace the common bile duct, I have traced it right up to partially dissected out the pancreas from the duodenum to show you till where it goes. And if I tilt it around, this is the pancreatic duct. So both of them unite here to form the hepatopancreatic duct and they will open by means of a major duodenal papilla which you cannot see because it's a pinhole and especially in the preserved specimen like cadaver specimen with formalin and everything, it is difficult to identify but it opens here. So let's trace the common bile duct up. As we trace it up, you will see something very interesting which you see a bifid gallbladder. This gallbladder previously I had seen only this portion of the gallbladder. This one's not visible so I was thinking it's a single but then when I dissected further, I found that it was one of those rare congenital anomalies. This is a bifid gallbladder. So it is going and this is the region of the portahepatus. So this is the bifid gallbladder and this is the region of the portahepatus and this is where all the three structures. Incidentally, since we are in the portahepatus, I'm going to show you some more things and then I'm going to let's trace the portal vein which we mentioned just now. If you trace it right up to the portahepatus, you find that it is dividing into a right and a left division. You will see it is dividing into a right and the left. And similarly if I were to trace the hepatic artery, can you see it is dividing into a right and a left hepatic artery. It is also dividing and similarly you can see that the common bile duct is also dividing into a right and a left in the portahepatus. So all of these structures dividing to right and the left in the portahepatus. Thank you for watching stay tuned for the next video.