Anatomy of Ligaments in Abdominal Organs

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Peritoneal Ligaments and Folds

• Splenorenal ligament connects left kidney to spleen
• Gastrophrenic ligament connects stomach to diaphragm
• Gastrosplenic ligament connects stomach to spleen
• Gastrorenal ligament connects stomach to kidney
• Gastrocolic ligament connects stomach to transverse colon
• Falciform ligament connects liver to anterior abdominal wall
• Hepatogastric ligament connects stomach to liver
• Hepatoduodenal ligament connects duodenum to liver

Peritoneal Folds and Fossae

• Peritoneal fold: a reflection of peritoneum raised from the body wall by underlying blood vessels, ducts, and ligaments
• Peritoneal recess or fossa: a pouch of peritoneum formed by a peritoneal fold
• Examples: supravesical, medial and lateral inguinal fossae between the umbilical folds

Subdivisions of Peritoneal Cavity

• Greater sac: larger portion, further divided into two compartments by the mesentery of transverse colon
  • Supracolic: above the transverse mesocolon, contains stomach, liver, and spleen
  • Infracolic: below the transverse mesocolon, contains small intestine, ascending and descending colon
• Lesser sac: posterior to the stomach, liver, and lesser omentum, connected to the greater sac via the epiploic foramen

Innervation of Peritoneum

• Parietal peritoneum: similar to the anterior abdominal wall, except for some central parts that receive additional innervation from phrenic nerves where it relates to the diaphragm
• Visceral peritoneum: similar to the abdominal viscera, insensitive to pain except for the mesentery of small and large intestine, which is sensitive to mechanical stretching

Clinical Relevance

• Sampling of peritoneal fluid: culdocentesis (extraction of fluid from the rectouterine pouch) and paracentesis (draining fluid from the peritoneal cavity)
• Disorders of peritoneal cavity: ascites (accumulation of excess fluid) and peritonitis (infection and inflammation of the peritoneum)

Abdominal Viscera

• Include the majority of the alimentary system: esophagus, stomach, intestines, spleen, pancreas, liver, gallbladder, kidneys, and suprarenal glands

Division of Abdominal Viscera

• Foregut: lower part of esophagus, stomach, and first part of duodenum (plus liver and pancreas)
• Midgut: remainder of duodenum, jejunum, ileum, caecum, ascending and right two-thirds of transverse colon
• Hindgut: remainder of transverse colon, descending and sigmoid colon, rectum, and anal canal

Esophagus

• Abdominal part of esophagus: passes through the esophageal hiatus in the right crus of the diaphragm
• Relations: anteriorly to the left lobe of the liver, posteriorly to the aorta and left crus of the diaphragm

Stomach

• Divided into the cardia, fundus, body, and pyloric part
• Interior of stomach: smooth surface, gastric folds (rugae) that disappear when the stomach is distended
• Relationships: anteriorly to the liver, diaphragm, and anterior abdominal wall, posteriorly to the pancreas, left kidney, and suprarenal gland

Innervation and Blood Supply of Stomach

• Innervation: parasympathetic by the vagus nerve and sympathetic by the celiac ganglia
• Blood supply: rich arterial supply from the celiac trunk and its branches

Clinical Relevance of Stomach Disorders

• Barrett's esophagus: metaplasia of esophageal squamous epithelium to gastric columnar epithelium
• Esophageal carcinoma: dysphagia and weight loss
• Esophageal varices: abnormal dilated submucosal veins at the site of porto-systemic anastomosis

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Identify the connections between abdominal organs through different ligaments. Learn about the splenorenal, gastrophrenic, gastrosplenic, and more.