Bio335
BIO 335: Cross Sectional Anatomy
An unfortunate fact of the practice of modern medicine is that more hospitalized
patients die of medical mistakes than any other single cause. Accuracy is of the
utmost importance, especially in the communication of information and instructions.
For this reason, for
testing purposes,
bilateral parts must
be labeled right or
left. Parts of organs
must be fully identified.
The upper pole of
the left kidney can
not be called the
upper pole. The only
abbreviations allowed
are Rt or Lt for right
or left. A for artery, V
for vein, B for bone
and M for muscle.
Finally, spelling counts.
Unit 1
Unit 1
15 Transaxial CT Images of the Abdomen
On campus students must draw and identify the anatomy on the linedrawings on the next slide. Students in the degree completion course
should have an understanding of basic anatomy that makes testing on the
drawings unnecessary. But if you need a refresher try the drawings. The
ability to visualize is important to the study of cross sectional anatomy.
These images of the abdomen start just below the diaphragm. They
Continue in 1 cm increments through the abdominal cavity, ending just
above the pelvis.
First set of parenthesis, in bold, is page number for 3rd edition
Second set of parenthesis, not bold, is page number for 4rd edition
Biliiary & Portal
Drawings
Can you draw & label (or visualize) these anatomical structures:
An exercise in abdominal cross sectional anatomy recognition
Rt & Lt Hepatic ducts
Common hepatic duct
Cystic duct with spiral valves
Common bile duct
Pancreatic duct
Hepatopancreatic ampulla
(Ampulla of Vater)
Sphincter of hepatopancreatic ampulla
(Sphincter of Oddi) (287)
Major duodenal papilla
(Papilla of Vater)
See plate 299, 302 (309, 312)
See plate 285 (294)
Portal Circulation
Inferior mesenteric vein
Splenic vein
Superior mesenteric vein
Portal vein
Rt & Lt branch of the portal vein
Biliary Tree
Liver sinusoids (283, 284)
Hepatic veins (three)
Inferior vena cava
7
10
8
2
1
4
3
9
5
6
12
15
13
11
14
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Liver
Reference
Falciform ligament (279) (287)
Thoracic aorta
Abdominal essophagus* (267, 268) (275, 276)
Rt. lung
Lt. lung
Images 1 & 2
Lt. rib
Lt rib**
Azygos vein (234) (238)
Area Immediately below Lt. hemidiaphragm,
containing the fundus of the stomach anterior
to the spleen
11. Rt. lobe of liver
12. Lt. lobe of liver
13. Barium in haustra of splenic (Lt. colic)
flexure (276) (284)
14. Spleen
15. Body of stomach with barium (white) and air
(black)***
* Proximal to gastroesophageal (esophagogastric)
junction (faintly seen as it approaches the stomach)
** Ribs are difficult to identify by number on axial scans,
but when a rib is posterior to another it is also inferior:
the rib numbered 8 is inferior to the one numbered 7
***Typically the stomach is filled with barium, but this
patient was unable to tolerate the full dose.
Images 1-4
Reference
Images 3 & 4
All anatomy seen in images 1 & 2 is also visible
in 3 & 4, plus:
2
1
1. Branches of the Lt. branch of the portal vein*
(282) (290)
2. CT artifacts
3.
4.
5.
6.
7.
8.
9.
Transverse colon with air and barium contrast
Descending colon with air and barium contrast
Splenic vessel** (289) (299)
Rt. & Lt. crus of diaphragm (262) (270) bottom
Rt. & Lt. adrenal (suprarenal) glands
Lt. branch of the portal vein
Intrahepatic inferior vena cava*** (279) (287)
3
* On image 3 these branches of the portal vein have just
bifurcated off the left branch of the portal vein (#8).
Iodine contrast IV drip infused is increasing the density
of the blood as the scan progresses.
** Veins and arteries cannot be differentiated at the
highly vascularized hilum of the spleen. On later
images it will be possible to identify major splenic
vessels by their origins.
***The intrahepatic inferior vena cava has been in this
position since image #1. The concentration of iodine
contrast has just made it visible. Other white streaks
throughout the liver are either branches of the portal
vein or hepatic veins.
8
6
9
7
4
5
5
1
Images 5 & 6
1.
2.
3.
4.
5.
6.
Ligamentum teres (fissure for) (279) (287)
Lt. branch of the portal vein
Caudate lobe of the liver
Cystic duct of the gallbladder*
Gas in the body of the stomach
Rt adrenal (suprarenal gland) (322, 332 bottom)
(332, 342 bottom)
7. Lt. adrenal (suprarenal) gland
2
3
4
Reference
7
6
8. Rt. branch of the portal vein
9. Lt. branch of the portal vein**
10. Intrahepatic inferior vena cava***
11. Splenic vessels at the hilum of the spleen
12 Quadrate lobe of the liver (279) (287)
13. Upper pole of the Lt. kidney****
12
10
8
11
9
13
*
First appears in image 5, seen in 6, best seen in 7.
** This is the level of the bifurcation of the Lt. and Rt.
branches of the portal vein. They persist on image
7. Image 8 is portal vein.
*** At this level the vena cava is still intrahepatic, but
will soon be out of the liver.
****The Rt. is also seen
Images 5-8
Reference
Images 7 & 8
1. Neck of gallbladder
2. Hepatic artery proper in the porta hepatis* (290)
(300)
3. Quadrate lobe of liver (279) (287)
4. Caudate lobe of liver
2
3
1
4
5. Body of gallbladder
6. Portal vein
7. Inferior vena cava
8. Celiac axis (trunk) (290) (300)
9. Common hepatic artery
10. Splenic artery
11. Splenic vein
12. Atherosclerotic plaque in the abdominal aorta
13. Pyloric part of stomach** (267) (275)
14. Tail of pancreas
13
9
10
6
* From the common hepatic artery (#9). Also, note Netter’s
plate # 282 (290) which illustrates the portal triads, the
three structures that follow each other through the liver:
bile ducts, hepatic artery proper, and portal vein. All three
are seen in the porta hepatis (hilum of the liver) in this
section.
**As the body of the stomach crosses midline and heads
for the duodenum it becomes the pyloric antrum and
then the pyloric canal just before the sphincter.
5
11
14
7
8
12
Reference
1
4
6
7
2
1.
2.
Images 9 & 10
3.
4.
5.
6.
7.
8.
8
5
9. Superior mesenteric vein (289, 291,292)
(299, 301, deleted from 4th)
10. Superior mesenteric artery
11. Gas and barium in the transverse colon
12. Barium in the descending colon
3
11
12
9
10
Fundus of the gallbladder
Rt. Kidney*
Rt. pararenal fat capsule (332) (342)
First part of duodenum (cap, or bulb)
Celiac axis (trunk)**
Head of the pancreas
Splenic vein***
Body of the pancreas (288) (298)
* The kidneys, seen in images 6-18, are bright
(white) due to the IV iodine contrast saturating the
nephrons and collecting tubules.
** The celiac axis seen here is the origin off the
abdominal aorta. On image 8 (item 8) it continued
to the bifurcation of the splenic and common hepatic.
From this we conclude that on this patient the celiac
axis turns upward after it leaves the aorta.
***The splenic vein seen here is a continuation of #11
on image #8. It is heading toward the pancreatic
notch where it will anastomose with the superior
mesenteric vein (#9 on image 10)
Images 9-12
Reference
1.
2.
3.
4.
5.
6.
Hepatic (Rt. colic) flexure
Images 11 & 12
Lt. renal artery
Superior mesenteric vein
Superior mesenteric artery*
Uncinate process of pancreas (288) (298)
Lt. renal vein
1
6
2
7. Minor calicies (calyces) of Rt. kidney (321)
(334)
8. Major calyx of Rt. kidney
9. Rt. renal vein**
10. Rt. renal artery
11. Lt. renal artery
12. Third part (transverse) of duodenum***(271)
(280)
13
13. Rt. lobe of the liver
14. Transverse colon (with gas and barium)
14
12
* After the superior mesenteric artery and vein
emerge from the pancreatic notch, the pair
descends through the abdomen, diminishing in size.
** On image 10, the renal veins are first seen as
small points off the inferior vena cava. On image
12 both renal veins are seen running through the
inferior vena cava
***The second part of the duodenum (descending)
is seen with gas in it on image 11 & 12.
3 4
5
9
10
7
8
11
1 2
4
3
Images 13 & 14
Reference
1. Transversus abdominus muscle (245)
(253)
2. Lt. Internal abdominal oblique muscle
3. Lt. external abdominal oblique muscle
4. Lt. Renal pelvis* (321, 322) (334, 332)
5. Accessory Rt. renal vein** (324) (333)
5
6. Small bowel filled with barium
7. Inferior vena cava
8. Abdominal aorta
6
7 8
* Based on the size and position (emerging
from the hilum) clearly defines the renal
pelvis on both kidneys.
**Like the first renal vein identified it leads
to the inferior vena cava.
Images 13-16
Reference
1.
2.
3.
4.
5.
6.
4
Transverse colon
Ascending colon
Loops of small bowel without barium
Mesenteric vessels (arteries or veins)*
Psoas major muscles (255) (263)
Rt ureter (with iodine contrast)
* Seen throughout the abdominal cavity
Images 15 &16
1
3
2
6
5
Reference
1.
2.
3.
4.
1
Inferior mesenteric artery
Lt. ureter
Cecum of colon
Lower pole of the Lt. kidney
2
Images 17 & 18
1
3
4
Images 17 & 18