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Anatomy_Gray_800	Anatomy_Gray	How to find the superficial inguinal ring The superficial inguinal ring is an elongate triangular defect in the aponeurosis of the external oblique (Fig. 4.177). It lies in the lower medial aspect of the anterior abdominal wall and is the external opening of the inguinal canal. The inguinal canal and superficial ring are larger in men than in women: In men, structures that pass between the abdomen and the testis pass through the inguinal canal and superficial inguinal ring. In women, the round ligament of the uterus passes through the inguinal canal and superficial inguinal ring to merge with connective tissue of the labium majus. The superficial inguinal ring is superior to the pubic crest and tubercle and to the medial end of the inguinal ligament:	Anatomy_Gray. How to find the superficial inguinal ring The superficial inguinal ring is an elongate triangular defect in the aponeurosis of the external oblique (Fig. 4.177). It lies in the lower medial aspect of the anterior abdominal wall and is the external opening of the inguinal canal. The inguinal canal and superficial ring are larger in men than in women: In men, structures that pass between the abdomen and the testis pass through the inguinal canal and superficial inguinal ring. In women, the round ligament of the uterus passes through the inguinal canal and superficial inguinal ring to merge with connective tissue of the labium majus. The superficial inguinal ring is superior to the pubic crest and tubercle and to the medial end of the inguinal ligament:
Anatomy_Gray_801	Anatomy_Gray	The superficial inguinal ring is superior to the pubic crest and tubercle and to the medial end of the inguinal ligament: In men, the superficial inguinal ring can be easily located by following the spermatic cord superiorly to the lower abdominal wall—the external spermatic fascia of the spermatic cord is continuous with the margins of the superficial inguinal ring. In women, the pubic tubercle can be palpated and the ring is superior and lateral to it. The deep inguinal ring, which is the internal opening to the inguinal canal, lies superior to the inguinal ligament, midway between the anterior superior iliac spine and pubic symphysis. The pulse of the femoral artery can be felt in the same position but below the inguinal ligament. Because the superficial inguinal ring is the site where inguinal hernias appear, particularly in men, the ring and related parts of the inguinal canal are often evaluated during physical examination. How to determine lumbar vertebral levels	Anatomy_Gray. The superficial inguinal ring is superior to the pubic crest and tubercle and to the medial end of the inguinal ligament: In men, the superficial inguinal ring can be easily located by following the spermatic cord superiorly to the lower abdominal wall—the external spermatic fascia of the spermatic cord is continuous with the margins of the superficial inguinal ring. In women, the pubic tubercle can be palpated and the ring is superior and lateral to it. The deep inguinal ring, which is the internal opening to the inguinal canal, lies superior to the inguinal ligament, midway between the anterior superior iliac spine and pubic symphysis. The pulse of the femoral artery can be felt in the same position but below the inguinal ligament. Because the superficial inguinal ring is the site where inguinal hernias appear, particularly in men, the ring and related parts of the inguinal canal are often evaluated during physical examination. How to determine lumbar vertebral levels
Anatomy_Gray_802	Anatomy_Gray	How to determine lumbar vertebral levels Lumbar vertebral levels are useful for visualizing the positions of viscera and major blood vessels. The approximate positions of the lumbar vertebrae can be established using palpable or visible landmarks (Fig. 4.178): A horizontal plane passes through the medial ends of the ninth costal cartilages and the body of the LI vertebra—this transpyloric plane cuts through the body midway between the suprasternal (jugular) notch and the pubic symphysis. A horizontal plane passes through the lower edge of the costal margin (tenth costal cartilage) and the body of the LIII vertebra—the umbilicus is normally on a horizontal plane that passes through the disc between the LIII and LIV vertebrae. A horizontal plane (supracristal plane) through the highest point on the iliac crest passes through the spine and body of the LIV vertebra; A plane through the tubercles of the crest of the ilium passes through the body of the LV vertebra.	Anatomy_Gray. How to determine lumbar vertebral levels Lumbar vertebral levels are useful for visualizing the positions of viscera and major blood vessels. The approximate positions of the lumbar vertebrae can be established using palpable or visible landmarks (Fig. 4.178): A horizontal plane passes through the medial ends of the ninth costal cartilages and the body of the LI vertebra—this transpyloric plane cuts through the body midway between the suprasternal (jugular) notch and the pubic symphysis. A horizontal plane passes through the lower edge of the costal margin (tenth costal cartilage) and the body of the LIII vertebra—the umbilicus is normally on a horizontal plane that passes through the disc between the LIII and LIV vertebrae. A horizontal plane (supracristal plane) through the highest point on the iliac crest passes through the spine and body of the LIV vertebra; A plane through the tubercles of the crest of the ilium passes through the body of the LV vertebra.
Anatomy_Gray_803	Anatomy_Gray	A plane through the tubercles of the crest of the ilium passes through the body of the LV vertebra. Visualizing structures at the LI The LI vertebral level is marked by the transpyloric plane, which cuts transversely through the body midway between the jugular notch and pubic symphysis, and through the ends of the ninth costal cartilages (Fig. 4.179). At this level are: the beginning and upper limit of the end of the duodenum, the hila of the kidneys, the neck of the pancreas, and the origin of the superior mesenteric artery from the aorta. The left and right colic flexures also are close to this level. Visualizing the position of major Each of the vertebral levels in the abdomen is related to the origin of major blood vessels (Fig. 4.180): The celiac trunk originates from the aorta at the upper border of the LI vertebra. The superior mesenteric artery originates at the lower border of the LI vertebra. The renal arteries originate at approximately the LII vertebra.	Anatomy_Gray. A plane through the tubercles of the crest of the ilium passes through the body of the LV vertebra. Visualizing structures at the LI The LI vertebral level is marked by the transpyloric plane, which cuts transversely through the body midway between the jugular notch and pubic symphysis, and through the ends of the ninth costal cartilages (Fig. 4.179). At this level are: the beginning and upper limit of the end of the duodenum, the hila of the kidneys, the neck of the pancreas, and the origin of the superior mesenteric artery from the aorta. The left and right colic flexures also are close to this level. Visualizing the position of major Each of the vertebral levels in the abdomen is related to the origin of major blood vessels (Fig. 4.180): The celiac trunk originates from the aorta at the upper border of the LI vertebra. The superior mesenteric artery originates at the lower border of the LI vertebra. The renal arteries originate at approximately the LII vertebra.
Anatomy_Gray_804	Anatomy_Gray	The superior mesenteric artery originates at the lower border of the LI vertebra. The renal arteries originate at approximately the LII vertebra. The inferior mesenteric artery originates at the LIII vertebra. The aorta bifurcates into the right and left common iliac arteries at the level of the LIV vertebra. The left and right common iliac veins join to form the inferior vena cava at the LV vertebral level. Using abdominal quadrants to locate The abdomen can be divided into quadrants by a vertical median plane and a horizontal transumbilical plane, which passes through the umbilicus (Fig. 4.181): The liver and gallbladder are in the right upper quadrant. The stomach and spleen are in the left upper quadrant. The cecum and appendix are in the right lower quadrant. The end of the descending colon and sigmoid colon are in the left lower quadrant.	Anatomy_Gray. The superior mesenteric artery originates at the lower border of the LI vertebra. The renal arteries originate at approximately the LII vertebra. The inferior mesenteric artery originates at the LIII vertebra. The aorta bifurcates into the right and left common iliac arteries at the level of the LIV vertebra. The left and right common iliac veins join to form the inferior vena cava at the LV vertebral level. Using abdominal quadrants to locate The abdomen can be divided into quadrants by a vertical median plane and a horizontal transumbilical plane, which passes through the umbilicus (Fig. 4.181): The liver and gallbladder are in the right upper quadrant. The stomach and spleen are in the left upper quadrant. The cecum and appendix are in the right lower quadrant. The end of the descending colon and sigmoid colon are in the left lower quadrant.
Anatomy_Gray_805	Anatomy_Gray	The stomach and spleen are in the left upper quadrant. The cecum and appendix are in the right lower quadrant. The end of the descending colon and sigmoid colon are in the left lower quadrant. Most of the liver is under the right dome of the diaphragm and is deep to the lower thoracic wall. The inferior margin of the liver can be palpated descending below the right costal margin when a patient is asked to inhale deeply. On deep inspiration, the edge of the liver can be felt “slipping” under the palpating fingers placed under the costal margin. A common surface projection of the appendix is McBurney’s point, which is one-third of the way up along a line from the right anterior superior iliac spine to the umbilicus. Defining surface regions to which pain from the gut is referred	Anatomy_Gray. The stomach and spleen are in the left upper quadrant. The cecum and appendix are in the right lower quadrant. The end of the descending colon and sigmoid colon are in the left lower quadrant. Most of the liver is under the right dome of the diaphragm and is deep to the lower thoracic wall. The inferior margin of the liver can be palpated descending below the right costal margin when a patient is asked to inhale deeply. On deep inspiration, the edge of the liver can be felt “slipping” under the palpating fingers placed under the costal margin. A common surface projection of the appendix is McBurney’s point, which is one-third of the way up along a line from the right anterior superior iliac spine to the umbilicus. Defining surface regions to which pain from the gut is referred
Anatomy_Gray_806	Anatomy_Gray	McBurney’s point, which is one-third of the way up along a line from the right anterior superior iliac spine to the umbilicus. Defining surface regions to which pain from the gut is referred The abdomen can be divided into nine regions by a midclavicular sagittal plane on each side and by the subcostal and intertubercular planes, which pass through the body transversely (Fig. 4.182). These planes separate the abdomen into: three central regions (epigastric, umbilical, pubic), and three regions on each side (hypochondrium, flank, groin). Pain from the abdominal part of the foregut is referred to the epigastric region, pain from the midgut is referred to the umbilical region, and pain from the hindgut is referred to the pubic region. Where to find the kidneys The kidneys project onto the back on either side of the midline and are related to the lower ribs (Fig. 4.183): The left kidney is a little higher than the right and reaches as high as rib XI.	Anatomy_Gray. McBurney’s point, which is one-third of the way up along a line from the right anterior superior iliac spine to the umbilicus. Defining surface regions to which pain from the gut is referred The abdomen can be divided into nine regions by a midclavicular sagittal plane on each side and by the subcostal and intertubercular planes, which pass through the body transversely (Fig. 4.182). These planes separate the abdomen into: three central regions (epigastric, umbilical, pubic), and three regions on each side (hypochondrium, flank, groin). Pain from the abdominal part of the foregut is referred to the epigastric region, pain from the midgut is referred to the umbilical region, and pain from the hindgut is referred to the pubic region. Where to find the kidneys The kidneys project onto the back on either side of the midline and are related to the lower ribs (Fig. 4.183): The left kidney is a little higher than the right and reaches as high as rib XI.
Anatomy_Gray_807	Anatomy_Gray	The kidneys project onto the back on either side of the midline and are related to the lower ribs (Fig. 4.183): The left kidney is a little higher than the right and reaches as high as rib XI. The superior pole of the right kidney reaches only as high as rib XII. The lower poles of the kidneys occur around the level of the disc between the LIII and LIV vertebrae. The hila of the kidneys and the beginnings of the ureters are at approximately the LI vertebra. The ureters descend vertically anterior to the tips of the transverse processes of the lower lumbar vertebrae and enter the pelvis. Where to find the spleen The spleen projects onto the left side and back in the area of ribs IX to XI (Fig. 4.184). The spleen follows the contour of rib X and extends from the superior pole of the left kidney to just posterior to the midaxillary line. Fig. 4.1 Abdomen. A. Boundaries. B. Arrangement of abdominal contents. Inferior view.	Anatomy_Gray. The kidneys project onto the back on either side of the midline and are related to the lower ribs (Fig. 4.183): The left kidney is a little higher than the right and reaches as high as rib XI. The superior pole of the right kidney reaches only as high as rib XII. The lower poles of the kidneys occur around the level of the disc between the LIII and LIV vertebrae. The hila of the kidneys and the beginnings of the ureters are at approximately the LI vertebra. The ureters descend vertically anterior to the tips of the transverse processes of the lower lumbar vertebrae and enter the pelvis. Where to find the spleen The spleen projects onto the left side and back in the area of ribs IX to XI (Fig. 4.184). The spleen follows the contour of rib X and extends from the superior pole of the left kidney to just posterior to the midaxillary line. Fig. 4.1 Abdomen. A. Boundaries. B. Arrangement of abdominal contents. Inferior view.
Anatomy_Gray_808	Anatomy_Gray	Fig. 4.1 Abdomen. A. Boundaries. B. Arrangement of abdominal contents. Inferior view. Fig. 4.2 The abdomen contains and protects the abdominal viscera. Fig. 4.3 The abdomen assists in breathing. InspirationExpirationDiaphragmRelaxation of diaphragmContraction ofdiaphragmContraction of abdominal musclesRelaxation ofabdominalmuscles Fig. 4.4 Increasing intraabdominal pressure to assist in micturition, defecation, and childbirth. Laryngeal cavity closedAir retained in thoraxFixed diaphragmContraction of abdominal wallIncrease inintraabdominalpressureMicturitionChild birthDefecation Fig. 4.5 Abdominal wall. A. Skeletal elements. B. Muscles. Fig. 4.6 The gut tube is suspended by mesenteries. Branch of aortaGastrointestinal tractAortaDorsal mesenteryVentral mesenteryKidney—posterior toperitoneumVisceral peritoneumParietal peritoneum Fig. 4.7 A series showing the progression (A to C) from an intraperitoneal organ to a secondarily retroperitoneal organ.	Anatomy_Gray. Fig. 4.1 Abdomen. A. Boundaries. B. Arrangement of abdominal contents. Inferior view. Fig. 4.2 The abdomen contains and protects the abdominal viscera. Fig. 4.3 The abdomen assists in breathing. InspirationExpirationDiaphragmRelaxation of diaphragmContraction ofdiaphragmContraction of abdominal musclesRelaxation ofabdominalmuscles Fig. 4.4 Increasing intraabdominal pressure to assist in micturition, defecation, and childbirth. Laryngeal cavity closedAir retained in thoraxFixed diaphragmContraction of abdominal wallIncrease inintraabdominalpressureMicturitionChild birthDefecation Fig. 4.5 Abdominal wall. A. Skeletal elements. B. Muscles. Fig. 4.6 The gut tube is suspended by mesenteries. Branch of aortaGastrointestinal tractAortaDorsal mesenteryVentral mesenteryKidney—posterior toperitoneumVisceral peritoneumParietal peritoneum Fig. 4.7 A series showing the progression (A to C) from an intraperitoneal organ to a secondarily retroperitoneal organ.
Anatomy_Gray_809	Anatomy_Gray	Fig. 4.7 A series showing the progression (A to C) from an intraperitoneal organ to a secondarily retroperitoneal organ. MesenteryVisceral peritoneumGastrointestinal tractGastrointestinal tractGastrointestinal tractParietal peritoneumArtery to gastrointestinal tractRetroperitoneal structuresMesentery before fusion with wallIntraperitoneal part of gastrointestinal tractSecondary retroperitoneal part of gastrointestinal tract ABC Fig. 4.8 Inferior thoracic aperture and the diaphragm. Fig. 4.9 Pelvic inlet. Ala of sacrumS IL VPelvic inletInguinal ligamentPelvic bone Fig. 4.10 Orientation of abdominal and pelvic cavities. Thoracic wallAxis of abdominal cavityAbdominal cavityPelvic cavityPelvic inletAxis of pelvic cavity Fig. 4.11 The abdominal cavity is continuous with the pelvic cavity. RectumPeritoneumPelvic inletBladderUterusShadow of ureterShadow of internal iliac vessels Fig. 4.12 Structures passing between the abdomen and thigh.	Anatomy_Gray. Fig. 4.7 A series showing the progression (A to C) from an intraperitoneal organ to a secondarily retroperitoneal organ. MesenteryVisceral peritoneumGastrointestinal tractGastrointestinal tractGastrointestinal tractParietal peritoneumArtery to gastrointestinal tractRetroperitoneal structuresMesentery before fusion with wallIntraperitoneal part of gastrointestinal tractSecondary retroperitoneal part of gastrointestinal tract ABC Fig. 4.8 Inferior thoracic aperture and the diaphragm. Fig. 4.9 Pelvic inlet. Ala of sacrumS IL VPelvic inletInguinal ligamentPelvic bone Fig. 4.10 Orientation of abdominal and pelvic cavities. Thoracic wallAxis of abdominal cavityAbdominal cavityPelvic cavityPelvic inletAxis of pelvic cavity Fig. 4.11 The abdominal cavity is continuous with the pelvic cavity. RectumPeritoneumPelvic inletBladderUterusShadow of ureterShadow of internal iliac vessels Fig. 4.12 Structures passing between the abdomen and thigh.
Anatomy_Gray_810	Anatomy_Gray	RectumPeritoneumPelvic inletBladderUterusShadow of ureterShadow of internal iliac vessels Fig. 4.12 Structures passing between the abdomen and thigh. Fig. 4.13 A series (A to H) showing the development of the gut and mesenteries. Fig. 4.14 Innervation of the anterior abdominal wall. Fig. 4.15 Inguinal region. A. Development. B. In men. C. In women. Inferior vena cavaRight testicular arteryLeft testicular arteryRight testicular veinLeft testicular veinAortaPelvic brimLeft ductus deferensDuctus deferensInguinal canalSuperficial inguinal ringDeep inguinal ringSpermatic cordRemnant ofgubernaculumEpididymisTestisTunica vaginalisTesticularartery and veinBInferior vena cavaAortaLeft renal arteryLeft ovarian arteryLeft renal veinLeft ovarian veinPelvic inletUterine tubeRound ligament of uterus (remnantsof gubernaculum)UterusSuperficialinguinal ringC Fig. 4.16 Vertebral level LI.	Anatomy_Gray. RectumPeritoneumPelvic inletBladderUterusShadow of ureterShadow of internal iliac vessels Fig. 4.12 Structures passing between the abdomen and thigh. Fig. 4.13 A series (A to H) showing the development of the gut and mesenteries. Fig. 4.14 Innervation of the anterior abdominal wall. Fig. 4.15 Inguinal region. A. Development. B. In men. C. In women. Inferior vena cavaRight testicular arteryLeft testicular arteryRight testicular veinLeft testicular veinAortaPelvic brimLeft ductus deferensDuctus deferensInguinal canalSuperficial inguinal ringDeep inguinal ringSpermatic cordRemnant ofgubernaculumEpididymisTestisTunica vaginalisTesticularartery and veinBInferior vena cavaAortaLeft renal arteryLeft ovarian arteryLeft renal veinLeft ovarian veinPelvic inletUterine tubeRound ligament of uterus (remnantsof gubernaculum)UterusSuperficialinguinal ringC Fig. 4.16 Vertebral level LI.
Anatomy_Gray_811	Anatomy_Gray	Fig. 4.16 Vertebral level LI. Jugular notchRightkidneyLI (transpyloric)planePubic symphysisCostal marginPyloric orifice betweenstomach and duodenumPosition of umbilicus Fig. 4.17 Blood supply of the gut. A. Relationship of vessels to the gut and mesenteries. B. Anterior view. Fig. 4.18 Left-to-right venous shunts. Fig. 4.19 Hepatic portal system. Fig. 4.20 Prevertebral plexus. Sympathetic inputParasympathetic inputPrevertebral plexusLumbar splanchnicnerves (L1, L2)Pelvic splanchnic nerves (S2 to S4)Anterior and posterior vagus trunks (cranial)Greater, lesser, and least splanchnic nerves(T5 to T12) Fig. 4.21 Boundaries of the abdominal cavity. Fig. 4.22 Four-quadrant topographical pattern. Fig. 4.23 Nine-region organizational pattern. Fig. 4.24 Layers of the abdominal wall. Fig. 4.25 Superficial fascia.	Anatomy_Gray. Fig. 4.16 Vertebral level LI. Jugular notchRightkidneyLI (transpyloric)planePubic symphysisCostal marginPyloric orifice betweenstomach and duodenumPosition of umbilicus Fig. 4.17 Blood supply of the gut. A. Relationship of vessels to the gut and mesenteries. B. Anterior view. Fig. 4.18 Left-to-right venous shunts. Fig. 4.19 Hepatic portal system. Fig. 4.20 Prevertebral plexus. Sympathetic inputParasympathetic inputPrevertebral plexusLumbar splanchnicnerves (L1, L2)Pelvic splanchnic nerves (S2 to S4)Anterior and posterior vagus trunks (cranial)Greater, lesser, and least splanchnic nerves(T5 to T12) Fig. 4.21 Boundaries of the abdominal cavity. Fig. 4.22 Four-quadrant topographical pattern. Fig. 4.23 Nine-region organizational pattern. Fig. 4.24 Layers of the abdominal wall. Fig. 4.25 Superficial fascia.
Anatomy_Gray_812	Anatomy_Gray	Fig. 4.22 Four-quadrant topographical pattern. Fig. 4.23 Nine-region organizational pattern. Fig. 4.24 Layers of the abdominal wall. Fig. 4.25 Superficial fascia. Superficial fasciaFatty layer(Camper's fascia)Membranous layer(Scarpa's fascia)SkinPubic symphysisPenisDartos fasciaScrotumInguinal ligamentAponeurosis of external obliqueFascia lata of thigh Fig. 4.26 Continuity of membranous layer of superficial fascia into other areas. Continuity with superficialpenile fasciaContinuity withdartos fasciaExternal oblique muscleand aponeurosisMembranous layer ofsuperficial fascia (Scarpa's fascia)Attachment to fascia lataSuperficial perinealfascia (Colles' fascia)Attachment toischiopubic rami Fig. 4.27 External oblique muscle and its aponeurosis. Linea albaLatissimus dorsi muscleExternal oblique muscleAbdominal part ofpectoralis major muscleAponeurosis of external obliqueInguinal ligamentAnterior superior iliac spine Fig. 4.28 Ligaments formed from the external oblique aponeurosis.	Anatomy_Gray. Fig. 4.22 Four-quadrant topographical pattern. Fig. 4.23 Nine-region organizational pattern. Fig. 4.24 Layers of the abdominal wall. Fig. 4.25 Superficial fascia. Superficial fasciaFatty layer(Camper's fascia)Membranous layer(Scarpa's fascia)SkinPubic symphysisPenisDartos fasciaScrotumInguinal ligamentAponeurosis of external obliqueFascia lata of thigh Fig. 4.26 Continuity of membranous layer of superficial fascia into other areas. Continuity with superficialpenile fasciaContinuity withdartos fasciaExternal oblique muscleand aponeurosisMembranous layer ofsuperficial fascia (Scarpa's fascia)Attachment to fascia lataSuperficial perinealfascia (Colles' fascia)Attachment toischiopubic rami Fig. 4.27 External oblique muscle and its aponeurosis. Linea albaLatissimus dorsi muscleExternal oblique muscleAbdominal part ofpectoralis major muscleAponeurosis of external obliqueInguinal ligamentAnterior superior iliac spine Fig. 4.28 Ligaments formed from the external oblique aponeurosis.
Anatomy_Gray_813	Anatomy_Gray	Fig. 4.28 Ligaments formed from the external oblique aponeurosis. Fig. 4.29 Ligaments of the inguinal region. Fig. 4.30 Internal oblique muscle and its aponeurosis. External oblique muscleRib XInternal oblique muscleand aponeurosisLinea albaExternal oblique muscleAponeurosis of external obliqueAnterior superior iliac spine Fig. 4.31 Transversus abdominis muscle and its aponeurosis. External oblique muscleRib XTransversus abdominismuscle and aponeurosisLinea albaExternal oblique muscleAponeurosis of internal obliqueAponeurosis of external obliqueAnterior superior iliac spine Fig. 4.32 Rectus abdominis and pyramidalis muscles. External oblique musclePosterior wall of rectus sheathRectus abdominis muscleTendinous intersectionInternal oblique muscle Arcuate lineTransversalis fasciaLinea albaPyramidalis muscle	Anatomy_Gray. Fig. 4.28 Ligaments formed from the external oblique aponeurosis. Fig. 4.29 Ligaments of the inguinal region. Fig. 4.30 Internal oblique muscle and its aponeurosis. External oblique muscleRib XInternal oblique muscleand aponeurosisLinea albaExternal oblique muscleAponeurosis of external obliqueAnterior superior iliac spine Fig. 4.31 Transversus abdominis muscle and its aponeurosis. External oblique muscleRib XTransversus abdominismuscle and aponeurosisLinea albaExternal oblique muscleAponeurosis of internal obliqueAponeurosis of external obliqueAnterior superior iliac spine Fig. 4.32 Rectus abdominis and pyramidalis muscles. External oblique musclePosterior wall of rectus sheathRectus abdominis muscleTendinous intersectionInternal oblique muscle Arcuate lineTransversalis fasciaLinea albaPyramidalis muscle
Anatomy_Gray_814	Anatomy_Gray	External oblique musclePosterior wall of rectus sheathRectus abdominis muscleTendinous intersectionInternal oblique muscle Arcuate lineTransversalis fasciaLinea albaPyramidalis muscle Fig. 4.33 Organization of the rectus sheath. A. Transverse section through the upper three-quarters of the rectus sheath. B. Transverse section through the lower one-quarter of the rectus sheath. Fig. 4.34 Transverse section showing the layers of the abdominal wall. Fig. 4.35 Subdivisions of the extraperitoneal fascia. Fig. 4.36 Innervation of the anterolateral abdominal wall. External oblique muscleand aponeurosisIliohypogastric nerve (L1)Xiphoid processIlio-inguinal nerve (L1)Iliac crestAnterior cutaneousbranches T7 to T12Lateral cutaneousbranches T7 to T12 Fig. 4.37 Path taken by the nerves innervating the anterolateral abdominal wall. Fig. 4.38 Dermatomes of the anterolateral abdominal wall. Fig. 4.39 Arterial supply to the anterolateral abdominal wall.	Anatomy_Gray. External oblique musclePosterior wall of rectus sheathRectus abdominis muscleTendinous intersectionInternal oblique muscle Arcuate lineTransversalis fasciaLinea albaPyramidalis muscle Fig. 4.33 Organization of the rectus sheath. A. Transverse section through the upper three-quarters of the rectus sheath. B. Transverse section through the lower one-quarter of the rectus sheath. Fig. 4.34 Transverse section showing the layers of the abdominal wall. Fig. 4.35 Subdivisions of the extraperitoneal fascia. Fig. 4.36 Innervation of the anterolateral abdominal wall. External oblique muscleand aponeurosisIliohypogastric nerve (L1)Xiphoid processIlio-inguinal nerve (L1)Iliac crestAnterior cutaneousbranches T7 to T12Lateral cutaneousbranches T7 to T12 Fig. 4.37 Path taken by the nerves innervating the anterolateral abdominal wall. Fig. 4.38 Dermatomes of the anterolateral abdominal wall. Fig. 4.39 Arterial supply to the anterolateral abdominal wall.
Anatomy_Gray_815	Anatomy_Gray	Fig. 4.38 Dermatomes of the anterolateral abdominal wall. Fig. 4.39 Arterial supply to the anterolateral abdominal wall. Fig. 4.40 Superior and inferior epigastric arteries. Fig. 4.41 Descent of the testis from week 7 (postfertilization) to birth. Fig. 4.42 Inguinal canal. Linea albaSuperficialinguinal ringDeep inguinal ringExternal oblique muscleAponeurosis of external obliqueInguinal ligamentSpermatic cordAnterior superioriliac spine Fig. 4.43 Deep inguinal ring and the transversalis fascia. Fig. 4.44 Superficial inguinal ring and the aponeurosis of the external oblique. Inguinal ligamentFemoral artery and veinExternal oblique muscleAponeurosis of external oblique Spermatic cordSuperficial inguinal ringAnterior superior iliac spine Fig. 4.45 Internal oblique muscle and the inguinal canal. Inguinal ligamentFemoral artery and veinInternal oblique muscleAponeurosis of internal oblique Spermatic cordConjoint tendonAnterior superior iliac spine	Anatomy_Gray. Fig. 4.38 Dermatomes of the anterolateral abdominal wall. Fig. 4.39 Arterial supply to the anterolateral abdominal wall. Fig. 4.40 Superior and inferior epigastric arteries. Fig. 4.41 Descent of the testis from week 7 (postfertilization) to birth. Fig. 4.42 Inguinal canal. Linea albaSuperficialinguinal ringDeep inguinal ringExternal oblique muscleAponeurosis of external obliqueInguinal ligamentSpermatic cordAnterior superioriliac spine Fig. 4.43 Deep inguinal ring and the transversalis fascia. Fig. 4.44 Superficial inguinal ring and the aponeurosis of the external oblique. Inguinal ligamentFemoral artery and veinExternal oblique muscleAponeurosis of external oblique Spermatic cordSuperficial inguinal ringAnterior superior iliac spine Fig. 4.45 Internal oblique muscle and the inguinal canal. Inguinal ligamentFemoral artery and veinInternal oblique muscleAponeurosis of internal oblique Spermatic cordConjoint tendonAnterior superior iliac spine
Anatomy_Gray_816	Anatomy_Gray	Inguinal ligamentFemoral artery and veinInternal oblique muscleAponeurosis of internal oblique Spermatic cordConjoint tendonAnterior superior iliac spine Fig. 4.46 Transversus abdominis muscle and the inguinal canal. Fig. 4.47 A. Spermatic cord (men). B. Round ligament of uterus (women). Internal spermatic fasciaParietal layer of the tunica vaginalisAVisceral layer of the tunica vaginalisCavity of the tunica vaginalisExternal spermatic fasciaCremasteric fasciaDeep inguinal ringInternaloblique muscleSuperficial inguinal ringTesticular artery andpampiniform plexus of veinsParietal peritoneumArtery to ductus deferensCremasteric vesselsGenital branch of genitofemoral nerveInferior epigastric vesselsDuctus deferensExternal obliqueaponeurosisTransversusabdominis muscleConjoint tendonExternal obliqueaponeurosisTransversalisfasciaIlioinguinalnerveIlioinguinal nerveExtraperitoneal fascia	Anatomy_Gray. Inguinal ligamentFemoral artery and veinInternal oblique muscleAponeurosis of internal oblique Spermatic cordConjoint tendonAnterior superior iliac spine Fig. 4.46 Transversus abdominis muscle and the inguinal canal. Fig. 4.47 A. Spermatic cord (men). B. Round ligament of uterus (women). Internal spermatic fasciaParietal layer of the tunica vaginalisAVisceral layer of the tunica vaginalisCavity of the tunica vaginalisExternal spermatic fasciaCremasteric fasciaDeep inguinal ringInternaloblique muscleSuperficial inguinal ringTesticular artery andpampiniform plexus of veinsParietal peritoneumArtery to ductus deferensCremasteric vesselsGenital branch of genitofemoral nerveInferior epigastric vesselsDuctus deferensExternal obliqueaponeurosisTransversusabdominis muscleConjoint tendonExternal obliqueaponeurosisTransversalisfasciaIlioinguinalnerveIlioinguinal nerveExtraperitoneal fascia
Anatomy_Gray_817	Anatomy_Gray	Internaloblique muscleParietal peritoneumGenital branch ofgenitofemoral nerveGenital branch ofgenitofemoral nerveInferior epigastric vesselsRound ligament of uterusExternal obliqueaponeurosisTransversusabdominis muscleMembranous layerof superficial fasciaSuperficial fascia(fatty layers) Fine connectivetissue strandsBConjoint tendonExternal obliqueaponeurosisSkin of mons pubisIlioinguinalnerveIlioinguinal nerveExtraperitoneal fascia Fig. 4.48 Indirect inguinal hernia. Fig. 4.49 Direct inguinal hernia. Fig. 4.50 Right inguinal triangle. A. Internal view. B. Laparoscopic view showing the parietal peritoneum still covering the area. Inferior epigastricvesselsDirect herniaTesticular vesselsPosition of deepinguinal ringBLateralMedialExternal iliac vesselsDuctus deferens Fig. 4.51 Coronal CT shows a large inguinal hernia containing loops of large and small bowel (arrow) on the left side of a male patient.	Anatomy_Gray. Internaloblique muscleParietal peritoneumGenital branch ofgenitofemoral nerveGenital branch ofgenitofemoral nerveInferior epigastric vesselsRound ligament of uterusExternal obliqueaponeurosisTransversusabdominis muscleMembranous layerof superficial fasciaSuperficial fascia(fatty layers) Fine connectivetissue strandsBConjoint tendonExternal obliqueaponeurosisSkin of mons pubisIlioinguinalnerveIlioinguinal nerveExtraperitoneal fascia Fig. 4.48 Indirect inguinal hernia. Fig. 4.49 Direct inguinal hernia. Fig. 4.50 Right inguinal triangle. A. Internal view. B. Laparoscopic view showing the parietal peritoneum still covering the area. Inferior epigastricvesselsDirect herniaTesticular vesselsPosition of deepinguinal ringBLateralMedialExternal iliac vesselsDuctus deferens Fig. 4.51 Coronal CT shows a large inguinal hernia containing loops of large and small bowel (arrow) on the left side of a male patient.
Anatomy_Gray_818	Anatomy_Gray	Fig. 4.51 Coronal CT shows a large inguinal hernia containing loops of large and small bowel (arrow) on the left side of a male patient. Fig. 4.52 Right indirect inguinal hernia. T2, fat saturated, weighted magnetic resonance image in the coronal plane of a male groin. Fig. 4.53 A. Intraperitoneal. B. Retroperitoneal. Fig. 4.54 Greater and lesser sacs of the peritoneal cavity. Fig. 4.55 Transverse section illustrating the continuity between the greater and lesser sacs through the omental (epiploic) foramen. Fig. 4.56 Coronal CT shows ascites fluid in abdominal cavity. Fig. 4.57 Peritoneal metastasis on the surface of the liver. Computed tomogram in the axial plane of the upper abdomen. Peritoneal metastasison surface of liverAortaInferior vena cavaLiverSpleenLeft kidney Fig. 4.58 Radiograph of subdiaphragmatic gas. Fig. 4.59 Greater omentum. Fig. 4.60 Lesser omentum.	Anatomy_Gray. Fig. 4.51 Coronal CT shows a large inguinal hernia containing loops of large and small bowel (arrow) on the left side of a male patient. Fig. 4.52 Right indirect inguinal hernia. T2, fat saturated, weighted magnetic resonance image in the coronal plane of a male groin. Fig. 4.53 A. Intraperitoneal. B. Retroperitoneal. Fig. 4.54 Greater and lesser sacs of the peritoneal cavity. Fig. 4.55 Transverse section illustrating the continuity between the greater and lesser sacs through the omental (epiploic) foramen. Fig. 4.56 Coronal CT shows ascites fluid in abdominal cavity. Fig. 4.57 Peritoneal metastasis on the surface of the liver. Computed tomogram in the axial plane of the upper abdomen. Peritoneal metastasison surface of liverAortaInferior vena cavaLiverSpleenLeft kidney Fig. 4.58 Radiograph of subdiaphragmatic gas. Fig. 4.59 Greater omentum. Fig. 4.60 Lesser omentum.
Anatomy_Gray_819	Anatomy_Gray	Peritoneal metastasison surface of liverAortaInferior vena cavaLiverSpleenLeft kidney Fig. 4.58 Radiograph of subdiaphragmatic gas. Fig. 4.59 Greater omentum. Fig. 4.60 Lesser omentum. Liver (retracted )GallbladderStomachLesser omentumDuodenumDescending colonAscending colonOmental foramenLesser curvature of the stomachHepatogastric ligamentHepatoduodenal ligament Fig. 4.61 Peritoneal reflections, forming mesenteries, outlined on the posterior abdominal wall. Root of the transverse mesocolonRoot of the sigmoid mesocolonRoot of the mesentery Fig. 4.62 Abdominal esophagus. RightvagusnerveTracheaArch of aortaAortaThoracicesophagusAbdominal esophagusRight crus ofdiaphragmLeft vagus nerve Fig. 4.63 Arterial supply to the abdominal esophagus and stomach. Fig. 4.64 Stomach. Fig. 4.65 Radiograph, using barium, showing the stomach and duodenum. A. Double-contrast radiograph of the stomach. B. Double-contrast radiograph showing the duodenal cap.	Anatomy_Gray. Peritoneal metastasison surface of liverAortaInferior vena cavaLiverSpleenLeft kidney Fig. 4.58 Radiograph of subdiaphragmatic gas. Fig. 4.59 Greater omentum. Fig. 4.60 Lesser omentum. Liver (retracted )GallbladderStomachLesser omentumDuodenumDescending colonAscending colonOmental foramenLesser curvature of the stomachHepatogastric ligamentHepatoduodenal ligament Fig. 4.61 Peritoneal reflections, forming mesenteries, outlined on the posterior abdominal wall. Root of the transverse mesocolonRoot of the sigmoid mesocolonRoot of the mesentery Fig. 4.62 Abdominal esophagus. RightvagusnerveTracheaArch of aortaAortaThoracicesophagusAbdominal esophagusRight crus ofdiaphragmLeft vagus nerve Fig. 4.63 Arterial supply to the abdominal esophagus and stomach. Fig. 4.64 Stomach. Fig. 4.65 Radiograph, using barium, showing the stomach and duodenum. A. Double-contrast radiograph of the stomach. B. Double-contrast radiograph showing the duodenal cap.
Anatomy_Gray_820	Anatomy_Gray	Fig. 4.64 Stomach. Fig. 4.65 Radiograph, using barium, showing the stomach and duodenum. A. Double-contrast radiograph of the stomach. B. Double-contrast radiograph showing the duodenal cap. Fundus of stomachPyloric orificeSuperior part of duodenumABPyloric antrumEsophagusNormal duodenal capPyloric antrum of stomachInferior duodenumDuodenal jejunal flexureBody of stomachDescending part of duodenumPyloric canalPyloric sphincter Fig. 4.66 Duodenum. PancreasDuodenum—superior partDuodenum—descending partDuodenum —ascending partDuodenum—inferior partDescending colonAscending colonSpleenAbdominal aortaEsophagusL1L2L3Bile ductRight suprarenal glandRight kidneyGallbladderPosition of majorduodenal papillaPosition of minorduodenal papillaLeft kidneySuperior mesenteric vein and arteryPortal veinInferior vena cava Fig. 4.67 Arterial supply to the duodenum. Fig. 4.68 Radiograph, using barium, showing the jejunum and ileum.	Anatomy_Gray. Fig. 4.64 Stomach. Fig. 4.65 Radiograph, using barium, showing the stomach and duodenum. A. Double-contrast radiograph of the stomach. B. Double-contrast radiograph showing the duodenal cap. Fundus of stomachPyloric orificeSuperior part of duodenumABPyloric antrumEsophagusNormal duodenal capPyloric antrum of stomachInferior duodenumDuodenal jejunal flexureBody of stomachDescending part of duodenumPyloric canalPyloric sphincter Fig. 4.66 Duodenum. PancreasDuodenum—superior partDuodenum—descending partDuodenum —ascending partDuodenum—inferior partDescending colonAscending colonSpleenAbdominal aortaEsophagusL1L2L3Bile ductRight suprarenal glandRight kidneyGallbladderPosition of majorduodenal papillaPosition of minorduodenal papillaLeft kidneySuperior mesenteric vein and arteryPortal veinInferior vena cava Fig. 4.67 Arterial supply to the duodenum. Fig. 4.68 Radiograph, using barium, showing the jejunum and ileum.
Anatomy_Gray_821	Anatomy_Gray	Fig. 4.67 Arterial supply to the duodenum. Fig. 4.68 Radiograph, using barium, showing the jejunum and ileum. Fig. 4.69 Differences in the arterial supply to the small intestine. A. Jejunum. B. Ileum. Fig. 4.70 Ileocecal junction. A. Radiograph showing ileocecal junction. B. Illustration showing ileocecal junction and the ileocecal fold. C. Endoscopic image of the ileocecal fold. Fig. 4.71 Arterial supply to the ileum. Fig. 4.72 The endoscope is a flexible plastic tube that can be controlled from the proximal end. Through a side portal various devices can be inserted, which run through the endoscope and can be used to obtain biopsies and to perform minor endoluminal surgical procedures (e.g., excision of polyps). Fig. 4.73 Endoscopic images of the gastroesophageal junction. A. Normal. B. Esophageal cancer at esophageal junction. Fig. 4.74 Endoscopic image of the pyloric antrum of the stomach looking toward the pylorus.	Anatomy_Gray. Fig. 4.67 Arterial supply to the duodenum. Fig. 4.68 Radiograph, using barium, showing the jejunum and ileum. Fig. 4.69 Differences in the arterial supply to the small intestine. A. Jejunum. B. Ileum. Fig. 4.70 Ileocecal junction. A. Radiograph showing ileocecal junction. B. Illustration showing ileocecal junction and the ileocecal fold. C. Endoscopic image of the ileocecal fold. Fig. 4.71 Arterial supply to the ileum. Fig. 4.72 The endoscope is a flexible plastic tube that can be controlled from the proximal end. Through a side portal various devices can be inserted, which run through the endoscope and can be used to obtain biopsies and to perform minor endoluminal surgical procedures (e.g., excision of polyps). Fig. 4.73 Endoscopic images of the gastroesophageal junction. A. Normal. B. Esophageal cancer at esophageal junction. Fig. 4.74 Endoscopic image of the pyloric antrum of the stomach looking toward the pylorus.
Anatomy_Gray_822	Anatomy_Gray	Fig. 4.74 Endoscopic image of the pyloric antrum of the stomach looking toward the pylorus. Fig. 4.75 Endoscopic image showing normal appearance of the second part of the duodenum. Fig. 4.76 Small bowel visualization using MRI in coronal plane. Fig. 4.77 Axial CT shows sigmoid colon wall thickening caused by tumor. Fig. 4.78 Vasculature associated with a Meckel’s diverticulum. A. Surgical image of Meckel’s diverticulum. B. Digital subtraction angiography. Fig. 4.79 Large intestine. Transverse colonSigmoid colonAscending colonRight colic flexureAppendixCecumHaustra of colonOmental appendicesLeft colic flexureAnal canalRectumIleumTaeniae coli Fig. 4.80 Radiograph, using barium, showing the large intestine. Fig. 4.81 Position of the large intestine in the nine-region organizational pattern. Fig. 4.82 Cecum and appendix. Fig. 4.83 Mesoappendix and appendicular vessels. Fig. 4.84 Positions of the appendix. Fig. 4.85 Arterial supply to the cecum and appendix.	Anatomy_Gray. Fig. 4.74 Endoscopic image of the pyloric antrum of the stomach looking toward the pylorus. Fig. 4.75 Endoscopic image showing normal appearance of the second part of the duodenum. Fig. 4.76 Small bowel visualization using MRI in coronal plane. Fig. 4.77 Axial CT shows sigmoid colon wall thickening caused by tumor. Fig. 4.78 Vasculature associated with a Meckel’s diverticulum. A. Surgical image of Meckel’s diverticulum. B. Digital subtraction angiography. Fig. 4.79 Large intestine. Transverse colonSigmoid colonAscending colonRight colic flexureAppendixCecumHaustra of colonOmental appendicesLeft colic flexureAnal canalRectumIleumTaeniae coli Fig. 4.80 Radiograph, using barium, showing the large intestine. Fig. 4.81 Position of the large intestine in the nine-region organizational pattern. Fig. 4.82 Cecum and appendix. Fig. 4.83 Mesoappendix and appendicular vessels. Fig. 4.84 Positions of the appendix. Fig. 4.85 Arterial supply to the cecum and appendix.
Anatomy_Gray_823	Anatomy_Gray	Fig. 4.82 Cecum and appendix. Fig. 4.83 Mesoappendix and appendicular vessels. Fig. 4.84 Positions of the appendix. Fig. 4.85 Arterial supply to the cecum and appendix. Fig. 4.86 Inflamed appendix. Ultrasound scan. Fig. 4.87 Axial CT shows inflamed appendix. Fig. 4.88 Colon. Fig. 4.89 Right and left colic flexures. Fig. 4.90 Arterial supply to the colon. Fig. 4.91 Rectum and anal canal. Fig. 4.92 Arterial supply to the rectum and anal canal. Posterior view. Fig. 4.93 Small bowel malrotation and volvulus. Radiograph of stomach, duodenum, and upper jejunum using barium. Fig. 4.94 Small bowel malrotation. Radiograph of stomach, duodenum, and jejunum using barium.	Anatomy_Gray. Fig. 4.82 Cecum and appendix. Fig. 4.83 Mesoappendix and appendicular vessels. Fig. 4.84 Positions of the appendix. Fig. 4.85 Arterial supply to the cecum and appendix. Fig. 4.86 Inflamed appendix. Ultrasound scan. Fig. 4.87 Axial CT shows inflamed appendix. Fig. 4.88 Colon. Fig. 4.89 Right and left colic flexures. Fig. 4.90 Arterial supply to the colon. Fig. 4.91 Rectum and anal canal. Fig. 4.92 Arterial supply to the rectum and anal canal. Posterior view. Fig. 4.93 Small bowel malrotation and volvulus. Radiograph of stomach, duodenum, and upper jejunum using barium. Fig. 4.94 Small bowel malrotation. Radiograph of stomach, duodenum, and jejunum using barium.
Anatomy_Gray_824	Anatomy_Gray	Fig. 4.94 Small bowel malrotation. Radiograph of stomach, duodenum, and jejunum using barium. Fig. 4.95 This radiograph of the abdomen, anteroposterior view, demonstrates a number of dilated loops of small bowel. Small bowel can be identified by the plicae circulares that pass from wall to wall as indicated. The large bowel is not dilated. The cause of the small bowel dilatation is an adhesion after pelvic surgery. Dilation of small bowelPlicae circulares Fig. 4.96 Coronal CT demonstrates dilated and fluid-filled loops of small bowel in patient with small bowel obstruction. Dilated and fluid-filledloops of small bowel Fig. 4.97 Coronal CT of abdomen shows fluid-filled and dilated ascending and transverse colon in patient with large bowel obstruction. Fig. 4.98 This oblique radiograph demonstrates contrast passing through a colonic stent that has been placed to relieve bowel obstruction prior to surgery.	Anatomy_Gray. Fig. 4.94 Small bowel malrotation. Radiograph of stomach, duodenum, and jejunum using barium. Fig. 4.95 This radiograph of the abdomen, anteroposterior view, demonstrates a number of dilated loops of small bowel. Small bowel can be identified by the plicae circulares that pass from wall to wall as indicated. The large bowel is not dilated. The cause of the small bowel dilatation is an adhesion after pelvic surgery. Dilation of small bowelPlicae circulares Fig. 4.96 Coronal CT demonstrates dilated and fluid-filled loops of small bowel in patient with small bowel obstruction. Dilated and fluid-filledloops of small bowel Fig. 4.97 Coronal CT of abdomen shows fluid-filled and dilated ascending and transverse colon in patient with large bowel obstruction. Fig. 4.98 This oblique radiograph demonstrates contrast passing through a colonic stent that has been placed to relieve bowel obstruction prior to surgery.
Anatomy_Gray_825	Anatomy_Gray	Fig. 4.98 This oblique radiograph demonstrates contrast passing through a colonic stent that has been placed to relieve bowel obstruction prior to surgery. Fig. 4.99 This double-contrast barium enema demonstrates numerous small outpouchings throughout the distal large bowel predominantly within the descending colon and the sigmoid colon. These small outpouchings are diverticula and in most instances remain quiescent. Fig. 4.100 Axial CT of inflamed sigmoid colon in patient with diverticulitis. Fig. 4.101 Position of the liver in the abdomen. Fig. 4.102 Surfaces of the liver and recesses associated with the liver. Fig. 4.103 Diaphragmatic surface of the liver. Fig. 4.104 Visceral surface of the liver. A. Illustration. B. Abdominal computed tomogram, with contrast, in the axial plane.	Anatomy_Gray. Fig. 4.98 This oblique radiograph demonstrates contrast passing through a colonic stent that has been placed to relieve bowel obstruction prior to surgery. Fig. 4.99 This double-contrast barium enema demonstrates numerous small outpouchings throughout the distal large bowel predominantly within the descending colon and the sigmoid colon. These small outpouchings are diverticula and in most instances remain quiescent. Fig. 4.100 Axial CT of inflamed sigmoid colon in patient with diverticulitis. Fig. 4.101 Position of the liver in the abdomen. Fig. 4.102 Surfaces of the liver and recesses associated with the liver. Fig. 4.103 Diaphragmatic surface of the liver. Fig. 4.104 Visceral surface of the liver. A. Illustration. B. Abdominal computed tomogram, with contrast, in the axial plane.
Anatomy_Gray_826	Anatomy_Gray	Fig. 4.103 Diaphragmatic surface of the liver. Fig. 4.104 Visceral surface of the liver. A. Illustration. B. Abdominal computed tomogram, with contrast, in the axial plane. Left lobe of liverLeft lobe of liverRight lobeof liverCaudate lobeRight lobe of liverQuadrate lobeQuadrate lobeGallbladderAnteriorPosteriorFundusBodyNeckCystic ductPorta hepatisPortal veinFissure for ligamentum teresFissure for ligamentumvenosumHepatic artery properHepatic ductsBile ductABGallbladderPortal veinInferior vena cavaStomachNeck of pancreasSpleenLeft kidneyAortaRight crusLeft crus Fig. 4.105 Posterior view of the bare area of the liver and associated ligaments. Inferior vena cavaSuprarenal impressionLeft lobe of liverRight lobe of liver Renal impressionCaudate lobeGastric impressionEsophageal impressionColic impressionQuadrate lobeFalciform ligamentGallbladderPorta hepatisAnterior coronary ligamentPosterior coronary ligamentRight triangularligamentLeft triangular ligamentBare areaFundusBodyNeck	Anatomy_Gray. Fig. 4.103 Diaphragmatic surface of the liver. Fig. 4.104 Visceral surface of the liver. A. Illustration. B. Abdominal computed tomogram, with contrast, in the axial plane. Left lobe of liverLeft lobe of liverRight lobeof liverCaudate lobeRight lobe of liverQuadrate lobeQuadrate lobeGallbladderAnteriorPosteriorFundusBodyNeckCystic ductPorta hepatisPortal veinFissure for ligamentum teresFissure for ligamentumvenosumHepatic artery properHepatic ductsBile ductABGallbladderPortal veinInferior vena cavaStomachNeck of pancreasSpleenLeft kidneyAortaRight crusLeft crus Fig. 4.105 Posterior view of the bare area of the liver and associated ligaments. Inferior vena cavaSuprarenal impressionLeft lobe of liverRight lobe of liver Renal impressionCaudate lobeGastric impressionEsophageal impressionColic impressionQuadrate lobeFalciform ligamentGallbladderPorta hepatisAnterior coronary ligamentPosterior coronary ligamentRight triangularligamentLeft triangular ligamentBare areaFundusBodyNeck
Anatomy_Gray_827	Anatomy_Gray	Fig. 4.106 Arterial supply to the liver and gallbladder. A. Schematic. B. Laparoscopic surgical view of cystic duct and cystic artery. Fig. 4.107 Pancreas. Fig. 4.108 Abdominal images. A. Abdominal computed tomogram, with contrast, in the axial plane. B. Abdominal ultrasound scan. GallbladderPancreasPortal veinSplenic veinStomachLeft colonic flexureSpleenLeft kidneyAortaInferior vena cavaRight lobe of liverRight crusALeft crus Left lobe of liverBSplenic arterySuperior mesenteric arteryPancreasLeft renal veinAortaInferior vena cavaVertebra Fig. 4.109 Pancreatic duct system. Fig. 4.110 Arterial supply to the pancreas. Posterior view. Fig. 4.111 Bile drainage. A. Duct system for passage of bile. B. Percutaneous transhepatic cholangiogram demonstrating the bile duct system. GallbladderCystic ductBile ductBile ductRight hepatic ductLeft hepatic ductCommon hepatic ductCystic ductNeedleCommonhepatic ductMain pancreatic ductDescending part of duodenumDescending part of duodenumAB	Anatomy_Gray. Fig. 4.106 Arterial supply to the liver and gallbladder. A. Schematic. B. Laparoscopic surgical view of cystic duct and cystic artery. Fig. 4.107 Pancreas. Fig. 4.108 Abdominal images. A. Abdominal computed tomogram, with contrast, in the axial plane. B. Abdominal ultrasound scan. GallbladderPancreasPortal veinSplenic veinStomachLeft colonic flexureSpleenLeft kidneyAortaInferior vena cavaRight lobe of liverRight crusALeft crus Left lobe of liverBSplenic arterySuperior mesenteric arteryPancreasLeft renal veinAortaInferior vena cavaVertebra Fig. 4.109 Pancreatic duct system. Fig. 4.110 Arterial supply to the pancreas. Posterior view. Fig. 4.111 Bile drainage. A. Duct system for passage of bile. B. Percutaneous transhepatic cholangiogram demonstrating the bile duct system. GallbladderCystic ductBile ductBile ductRight hepatic ductLeft hepatic ductCommon hepatic ductCystic ductNeedleCommonhepatic ductMain pancreatic ductDescending part of duodenumDescending part of duodenumAB
Anatomy_Gray_828	Anatomy_Gray	Fig. 4.112 Spleen. Fig. 4.113 Splenic ligaments and related vasculature. Fig. 4.114 Surfaces and hilum of the spleen. Fig. 4.115 Arterial supply to the spleen. Fig. 4.116 Division of the liver into segments based upon the distributions of the bile ducts and hepatic vessels (Couinaud’s segments). Fig. 4.117 Gallbladder containing multiple stones. Ultrasound scan. Fig. 4.118 Magnetic resonance cholangiopancreatography (MRCP) in the coronal plane. Fig. 4.119 Endoscopic retrograde cholangiopancreatography (ERCP) of biliary system. Endoscope with side-viewing optic mechanismStent in common bile duct Fig. 4.120 Coronal CT of the abdomen containing a massively enlarged spleen (splenomegaly). Fig. 4.121 Anterior branches of the abdominal aorta. Fig. 4.122 Divisions of the gastrointestinal tract into foregut, midgut, and hindgut, summarizing the primary arterial supply to each segment.	Anatomy_Gray. Fig. 4.112 Spleen. Fig. 4.113 Splenic ligaments and related vasculature. Fig. 4.114 Surfaces and hilum of the spleen. Fig. 4.115 Arterial supply to the spleen. Fig. 4.116 Division of the liver into segments based upon the distributions of the bile ducts and hepatic vessels (Couinaud’s segments). Fig. 4.117 Gallbladder containing multiple stones. Ultrasound scan. Fig. 4.118 Magnetic resonance cholangiopancreatography (MRCP) in the coronal plane. Fig. 4.119 Endoscopic retrograde cholangiopancreatography (ERCP) of biliary system. Endoscope with side-viewing optic mechanismStent in common bile duct Fig. 4.120 Coronal CT of the abdomen containing a massively enlarged spleen (splenomegaly). Fig. 4.121 Anterior branches of the abdominal aorta. Fig. 4.122 Divisions of the gastrointestinal tract into foregut, midgut, and hindgut, summarizing the primary arterial supply to each segment.
Anatomy_Gray_829	Anatomy_Gray	Fig. 4.121 Anterior branches of the abdominal aorta. Fig. 4.122 Divisions of the gastrointestinal tract into foregut, midgut, and hindgut, summarizing the primary arterial supply to each segment. Fig. 4.123 Celiac trunk. A. Distribution of the celiac trunk. B. Digital subtraction angiography of the celiac trunk and its branches. Fig. 4.124 Arterial supply to the pancreas. Fig. 4.125 Distribution of the common hepatic artery. Fig. 4.126 Initial branching and relationships of the superior mesenteric artery. Fig. 4.127 Superior mesenteric artery. A. Distribution of the superior mesenteric artery. B. Digital subtraction angiography of the superior mesenteric artery and its branches. Fig. 4.128 Inferior mesenteric artery. A. Distribution of the inferior mesenteric artery. B. Digital subtraction angiography of the inferior mesenteric artery and its branches. Fig. 4.129 Arterial supply to the abdominal parts of the gastrointestinal system and to the spleen.	Anatomy_Gray. Fig. 4.121 Anterior branches of the abdominal aorta. Fig. 4.122 Divisions of the gastrointestinal tract into foregut, midgut, and hindgut, summarizing the primary arterial supply to each segment. Fig. 4.123 Celiac trunk. A. Distribution of the celiac trunk. B. Digital subtraction angiography of the celiac trunk and its branches. Fig. 4.124 Arterial supply to the pancreas. Fig. 4.125 Distribution of the common hepatic artery. Fig. 4.126 Initial branching and relationships of the superior mesenteric artery. Fig. 4.127 Superior mesenteric artery. A. Distribution of the superior mesenteric artery. B. Digital subtraction angiography of the superior mesenteric artery and its branches. Fig. 4.128 Inferior mesenteric artery. A. Distribution of the inferior mesenteric artery. B. Digital subtraction angiography of the inferior mesenteric artery and its branches. Fig. 4.129 Arterial supply to the abdominal parts of the gastrointestinal system and to the spleen.
Anatomy_Gray_830	Anatomy_Gray	Fig. 4.129 Arterial supply to the abdominal parts of the gastrointestinal system and to the spleen. Fig. 4.130 Enlarged marginal artery connecting the superior and inferior mesenteric arteries. Digital subtraction angiogram. Fig. 4.131 Portal vein. Fig. 4.132 Venous drainage of the abdominal portion of the gastrointestinal tract. Fig. 4.133 Portosystemic anastomoses. LiverSpleenSplenic veinSuperior mesenteric veinSuperior rectal veinInferior rectal veinsInferior vena cavaInferior mesenteric veinLeft gastric veinPortal veinRectumStomachTributaries to azygos veinSuperficial veinson abdominal wallExternal iliac veinInternal iliac veinCommon iliac veinPara-umbilical veinsthat accompany theligamentum teres Fig. 4.134 Lymphatic drainage of the abdominal portion of the gastrointestinal tract. Fig. 4.135 Sympathetic trunks. Fig. 4.136 Splanchnic nerves. Fig. 4.137 Abdominal prevertebral plexus and ganglia.	Anatomy_Gray. Fig. 4.129 Arterial supply to the abdominal parts of the gastrointestinal system and to the spleen. Fig. 4.130 Enlarged marginal artery connecting the superior and inferior mesenteric arteries. Digital subtraction angiogram. Fig. 4.131 Portal vein. Fig. 4.132 Venous drainage of the abdominal portion of the gastrointestinal tract. Fig. 4.133 Portosystemic anastomoses. LiverSpleenSplenic veinSuperior mesenteric veinSuperior rectal veinInferior rectal veinsInferior vena cavaInferior mesenteric veinLeft gastric veinPortal veinRectumStomachTributaries to azygos veinSuperficial veinson abdominal wallExternal iliac veinInternal iliac veinCommon iliac veinPara-umbilical veinsthat accompany theligamentum teres Fig. 4.134 Lymphatic drainage of the abdominal portion of the gastrointestinal tract. Fig. 4.135 Sympathetic trunks. Fig. 4.136 Splanchnic nerves. Fig. 4.137 Abdominal prevertebral plexus and ganglia.
Anatomy_Gray_831	Anatomy_Gray	Fig. 4.135 Sympathetic trunks. Fig. 4.136 Splanchnic nerves. Fig. 4.137 Abdominal prevertebral plexus and ganglia. Fig. 4.138 Parasympathetic innervation of the abdominal portion of the gastrointestinal tract. Fig. 4.139 The enteric system. Fig. 4.140 Posterior abdominal region. Fig. 4.141 Osteology of the posterior abdominal wall. Fig. 4.142 Muscles of the posterior abdominal wall. Fig. 4.143 Diaphragm. Left phrenic nerveRight phrenic nerveInferior phrenicarteryAortaThoracic ductEsophagus with anteriorand posterior vagal trunksLIVLIIILIILISuperior epigastric arteryCentral tendonInferior vena cavaHemi-azygos veinGreater splanchnic nerveLesser splanchnic nerveLeast splanchnic nerveLeft crusSympathetic trunkRight crus Fig. 4.144 Crura of the diaphragm. Fig. 4.145 Right and left domes of the diaphragm. Chest radiograph. Fig. 4.146 Fetal diaphragmatic hernia in utero. T2-weighted MR image. Fetus in coronal plane, mother in sagittal plane.	Anatomy_Gray. Fig. 4.135 Sympathetic trunks. Fig. 4.136 Splanchnic nerves. Fig. 4.137 Abdominal prevertebral plexus and ganglia. Fig. 4.138 Parasympathetic innervation of the abdominal portion of the gastrointestinal tract. Fig. 4.139 The enteric system. Fig. 4.140 Posterior abdominal region. Fig. 4.141 Osteology of the posterior abdominal wall. Fig. 4.142 Muscles of the posterior abdominal wall. Fig. 4.143 Diaphragm. Left phrenic nerveRight phrenic nerveInferior phrenicarteryAortaThoracic ductEsophagus with anteriorand posterior vagal trunksLIVLIIILIILISuperior epigastric arteryCentral tendonInferior vena cavaHemi-azygos veinGreater splanchnic nerveLesser splanchnic nerveLeast splanchnic nerveLeft crusSympathetic trunkRight crus Fig. 4.144 Crura of the diaphragm. Fig. 4.145 Right and left domes of the diaphragm. Chest radiograph. Fig. 4.146 Fetal diaphragmatic hernia in utero. T2-weighted MR image. Fetus in coronal plane, mother in sagittal plane.
Anatomy_Gray_832	Anatomy_Gray	Fig. 4.145 Right and left domes of the diaphragm. Chest radiograph. Fig. 4.146 Fetal diaphragmatic hernia in utero. T2-weighted MR image. Fetus in coronal plane, mother in sagittal plane. Fetal vertebralcolumnFetal abdominalcontents (fluid-filledloops of intestine)in left side ofthoracic cavityFetal headNormal fetal lung development on rightside of thoracic cavityFetal diaphragmdeveloped onright sideMaternal lumbarvertebra Fig. 4.147 Lower esophagus and upper stomach showing a hiatal hernia. Radiograph using barium. Fig. 4.148 Coronal CT of hiatal hernia. Fig. 4.149 Retroperitoneal position of the kidneys in the posterior abdominal region. Inferior vena cavaDiaphragmRight suprarenal glandLeft suprarenal glandRight kidneyLeft kidneyCut edges of peritoneumAbdominal aortaEsophagus Fig. 4.150 Structures related to the anterior surface of each kidney.	Anatomy_Gray. Fig. 4.145 Right and left domes of the diaphragm. Chest radiograph. Fig. 4.146 Fetal diaphragmatic hernia in utero. T2-weighted MR image. Fetus in coronal plane, mother in sagittal plane. Fetal vertebralcolumnFetal abdominalcontents (fluid-filledloops of intestine)in left side ofthoracic cavityFetal headNormal fetal lung development on rightside of thoracic cavityFetal diaphragmdeveloped onright sideMaternal lumbarvertebra Fig. 4.147 Lower esophagus and upper stomach showing a hiatal hernia. Radiograph using barium. Fig. 4.148 Coronal CT of hiatal hernia. Fig. 4.149 Retroperitoneal position of the kidneys in the posterior abdominal region. Inferior vena cavaDiaphragmRight suprarenal glandLeft suprarenal glandRight kidneyLeft kidneyCut edges of peritoneumAbdominal aortaEsophagus Fig. 4.150 Structures related to the anterior surface of each kidney.
Anatomy_Gray_833	Anatomy_Gray	Fig. 4.150 Structures related to the anterior surface of each kidney. StomachLiverPancreasDescending colonSmall intestineSpleenJejunumRight colic flexureLeft colic flexureDescending part of duodenumRight suprarenal glandLeft suprarenal gland Fig. 4.151 Structures related to the posterior surface of each kidney. Fig. 4.152 Organization of fat and fascia surrounding the kidney. Fig. 4.153 Internal structure of the kidney. Renal arteryRenal veinPyramid in renal medullaRenal sinusMinor calyxRenal cortexRenal papillaRenal columnRenal pelvisMajor calyxUreterHilum of kidney Fig. 4.154 A. Renal vasculature. B. CT image showing long left renal vein crossing the midline. Fig. 4.155 Ureters. Internal iliac arteryExternal iliac arteryCommon iliac arteryGonadal arteriesLeft kidneyLeft renal arteryRight renal arteryRight kidneyAbdominal aortaBladderUreterThird constriction—entrance to bladderSecond constriction—pelvic inletFirst constriction—ureteropelvic junctionUreter	Anatomy_Gray. Fig. 4.150 Structures related to the anterior surface of each kidney. StomachLiverPancreasDescending colonSmall intestineSpleenJejunumRight colic flexureLeft colic flexureDescending part of duodenumRight suprarenal glandLeft suprarenal gland Fig. 4.151 Structures related to the posterior surface of each kidney. Fig. 4.152 Organization of fat and fascia surrounding the kidney. Fig. 4.153 Internal structure of the kidney. Renal arteryRenal veinPyramid in renal medullaRenal sinusMinor calyxRenal cortexRenal papillaRenal columnRenal pelvisMajor calyxUreterHilum of kidney Fig. 4.154 A. Renal vasculature. B. CT image showing long left renal vein crossing the midline. Fig. 4.155 Ureters. Internal iliac arteryExternal iliac arteryCommon iliac arteryGonadal arteriesLeft kidneyLeft renal arteryRight renal arteryRight kidneyAbdominal aortaBladderUreterThird constriction—entrance to bladderSecond constriction—pelvic inletFirst constriction—ureteropelvic junctionUreter
Anatomy_Gray_834	Anatomy_Gray	Fig. 4.156 Low-dose axial CT of urinary tract (CT KUB) displays stone in left renal pelvis. Fig. 4.157 Tumor in the right kidney growing toward, and possibly invading, the duodenum. Computed tomogram in the axial plane. Fig. 4.158 Tumor in the right kidney spreading into the right renal vein. Computed tomogram in the axial plane. Fig. 4.159 Transitional cell carcinoma in the pelvis of the right kidney. Coronal computed tomogram reconstruction. Fig. 4.160 This radiograph demonstrates a double-J stent (anteroposterior view). The superior aspect of the double-J stent is situated within the renal pelvis. The stent passes through the ureter, describing the path of the ureter, and the tip of the double-J stent is projected over the bladder, which appears as a slightly dense area on the radiograph.	Anatomy_Gray. Fig. 4.156 Low-dose axial CT of urinary tract (CT KUB) displays stone in left renal pelvis. Fig. 4.157 Tumor in the right kidney growing toward, and possibly invading, the duodenum. Computed tomogram in the axial plane. Fig. 4.158 Tumor in the right kidney spreading into the right renal vein. Computed tomogram in the axial plane. Fig. 4.159 Transitional cell carcinoma in the pelvis of the right kidney. Coronal computed tomogram reconstruction. Fig. 4.160 This radiograph demonstrates a double-J stent (anteroposterior view). The superior aspect of the double-J stent is situated within the renal pelvis. The stent passes through the ureter, describing the path of the ureter, and the tip of the double-J stent is projected over the bladder, which appears as a slightly dense area on the radiograph.
Anatomy_Gray_835	Anatomy_Gray	Fig. 4.161 Kidney transplant. A. This image demonstrates an MR angiogram of the bifurcation of the aorta. Attaching to the left external iliac artery is the donor artery for a kidney that has been transplanted into the left iliac fossa. B. Abdominal computed tomogram, in the axial plane, showing the transplanted kidney in the left iliac fossa. AAbdominal aortaCommon iliac arteryExternal iliacarteryInternal iliacarteryThe left external iliac arteryhas been used to connectto the donor kidneyTransplant kidneyin the left iliacfossa Fig. 4.162 Coronal view of 3-D urogram using multidetector computed tomography. Fig. 4.163 Arterial supply to the suprarenal glands. Fig. 4.164 Abdominal aorta.	Anatomy_Gray. Fig. 4.161 Kidney transplant. A. This image demonstrates an MR angiogram of the bifurcation of the aorta. Attaching to the left external iliac artery is the donor artery for a kidney that has been transplanted into the left iliac fossa. B. Abdominal computed tomogram, in the axial plane, showing the transplanted kidney in the left iliac fossa. AAbdominal aortaCommon iliac arteryExternal iliacarteryInternal iliacarteryThe left external iliac arteryhas been used to connectto the donor kidneyTransplant kidneyin the left iliacfossa Fig. 4.162 Coronal view of 3-D urogram using multidetector computed tomography. Fig. 4.163 Arterial supply to the suprarenal glands. Fig. 4.164 Abdominal aorta.
Anatomy_Gray_836	Anatomy_Gray	Fig. 4.162 Coronal view of 3-D urogram using multidetector computed tomography. Fig. 4.163 Arterial supply to the suprarenal glands. Fig. 4.164 Abdominal aorta. Fig. 4.165 Volume-rendered reconstruction using multidetector computed tomography of patient with an infrarenal abdominal aortic aneurysm before (A) and after (B) endovascular aneurysm repair. Note the image only demonstrates the intraluminal contrast and not the entire vessel. White patches in the aorta represent intramural calcium. Fig. 4.166 Inferior vena cava. Fig. 4.167 Lumbar veins. Fig. 4.168 Abdominal lymphatics. Inferior vena cavaIntestinal trunkRight lumbar trunk with lateral aortic (lumbar) nodesLeft lumbar trunk withlateral aortic (lumbar) nodesExternal iliac nodesExternal iliac nodesInternal iliac nodesCommon iliac nodesCeliac nodesSuperior mesenteric nodesInferior mesenteric nodesCisterna chyliPre-aortic nodes Fig. 4.169 Sympathetic trunks passing through the posterior abdominal region.	Anatomy_Gray. Fig. 4.162 Coronal view of 3-D urogram using multidetector computed tomography. Fig. 4.163 Arterial supply to the suprarenal glands. Fig. 4.164 Abdominal aorta. Fig. 4.165 Volume-rendered reconstruction using multidetector computed tomography of patient with an infrarenal abdominal aortic aneurysm before (A) and after (B) endovascular aneurysm repair. Note the image only demonstrates the intraluminal contrast and not the entire vessel. White patches in the aorta represent intramural calcium. Fig. 4.166 Inferior vena cava. Fig. 4.167 Lumbar veins. Fig. 4.168 Abdominal lymphatics. Inferior vena cavaIntestinal trunkRight lumbar trunk with lateral aortic (lumbar) nodesLeft lumbar trunk withlateral aortic (lumbar) nodesExternal iliac nodesExternal iliac nodesInternal iliac nodesCommon iliac nodesCeliac nodesSuperior mesenteric nodesInferior mesenteric nodesCisterna chyliPre-aortic nodes Fig. 4.169 Sympathetic trunks passing through the posterior abdominal region.
Anatomy_Gray_837	Anatomy_Gray	Fig. 4.169 Sympathetic trunks passing through the posterior abdominal region. Fig. 4.170 Prevertebral plexus and ganglia in the posterior abdominal region. Fig. 4.171 Nerve fibers passing through the abdominal prevertebral plexus and ganglia. Fig. 4.172 Prevertebral ganglia associated with the prevertebral plexus. Fig. 4.173 Lumbar plexus. T12L1L2L3L4To lumbosacral trunkObturator nerveFemoralnerveTo iliacusmuscleLateral cutaneousnerve of thighGenitofemoralnerveIlio-inguinal nerveIliohypogastricnerve Fig. 4.174 Lumbar plexus in the posterior abdominal region. Subcostal nerveIliohypogastric nerveIlio-inguinal nerveLateral cutaneous nerve of thighFemoral nerveGenitofemoral nerveObturator nerveSubcostal nerve (T12)Iliohypogastric nerve (L1)Psoas major muscleIlio-inguinal nerve (L1)Lateral cutaneous nerve of thigh (L2,L3)Femoral nerve (L2 to L4)Genitofemoral nerve (L1,L2)Iliacus muscleObturator nerve (L2 to L4)Lumbosacral trunks(L4,L5)	Anatomy_Gray. Fig. 4.169 Sympathetic trunks passing through the posterior abdominal region. Fig. 4.170 Prevertebral plexus and ganglia in the posterior abdominal region. Fig. 4.171 Nerve fibers passing through the abdominal prevertebral plexus and ganglia. Fig. 4.172 Prevertebral ganglia associated with the prevertebral plexus. Fig. 4.173 Lumbar plexus. T12L1L2L3L4To lumbosacral trunkObturator nerveFemoralnerveTo iliacusmuscleLateral cutaneousnerve of thighGenitofemoralnerveIlio-inguinal nerveIliohypogastricnerve Fig. 4.174 Lumbar plexus in the posterior abdominal region. Subcostal nerveIliohypogastric nerveIlio-inguinal nerveLateral cutaneous nerve of thighFemoral nerveGenitofemoral nerveObturator nerveSubcostal nerve (T12)Iliohypogastric nerve (L1)Psoas major muscleIlio-inguinal nerve (L1)Lateral cutaneous nerve of thigh (L2,L3)Femoral nerve (L2 to L4)Genitofemoral nerve (L1,L2)Iliacus muscleObturator nerve (L2 to L4)Lumbosacral trunks(L4,L5)
Anatomy_Gray_838	Anatomy_Gray	Fig. 4.175 Cutaneous distribution of the nerves from the lumbar plexus. L1T12T12T12T11T11T10T10Ilio-inguinal nerve (L1)Ilio-inguinal nerve (L1)Genitofemoral nerve (L1,L2)Lateral cutaneous nerve of thigh (L2,L3)Obturator nerve (L2 to L4)Cutaneous branch of obturator nerve (L2 to L4)Femoral nerve (L2 to L4)Lateral cutaneous branchof iliohypogastric nerve (L1)Anterior cutaneous branchof iliohypogastric nerve (L1)Femoral branch of genitofemoral nerve (L1,L2)Lateral cutaneous nerve of thigh (L2,L3)Intermediate cutaneous from femoral nerveMedial cutaneous fromfemoral nerveSaphenous nerve from femoral nerve Fig. 4.176 Interior view of the abdominal region of a man. Palpable bony landmarks, the inguinal ligament, and the position of the diaphragm are indicated. Fig. 4.177 Groin. A. In a man. B. In a woman. C. Examination of the superficial inguinal ring and related regions of the inguinal canal in a man.	Anatomy_Gray. Fig. 4.175 Cutaneous distribution of the nerves from the lumbar plexus. L1T12T12T12T11T11T10T10Ilio-inguinal nerve (L1)Ilio-inguinal nerve (L1)Genitofemoral nerve (L1,L2)Lateral cutaneous nerve of thigh (L2,L3)Obturator nerve (L2 to L4)Cutaneous branch of obturator nerve (L2 to L4)Femoral nerve (L2 to L4)Lateral cutaneous branchof iliohypogastric nerve (L1)Anterior cutaneous branchof iliohypogastric nerve (L1)Femoral branch of genitofemoral nerve (L1,L2)Lateral cutaneous nerve of thigh (L2,L3)Intermediate cutaneous from femoral nerveMedial cutaneous fromfemoral nerveSaphenous nerve from femoral nerve Fig. 4.176 Interior view of the abdominal region of a man. Palpable bony landmarks, the inguinal ligament, and the position of the diaphragm are indicated. Fig. 4.177 Groin. A. In a man. B. In a woman. C. Examination of the superficial inguinal ring and related regions of the inguinal canal in a man.
Anatomy_Gray_839	Anatomy_Gray	Fig. 4.177 Groin. A. In a man. B. In a woman. C. Examination of the superficial inguinal ring and related regions of the inguinal canal in a man. Deep inguinal ringAponeurosis of external obliqueAponeurosis of external obliqueSuperficial inguinal ringPosition of pubic symphysisABCAnterior superior iliac spineSpermatic cordInguinal ligamentFemoral arteryDeep inguinal ringSuperficial inguinal ringPosition of pubic symphysisAnterior superior iliac spineRound ligament of uterusInguinal ligamentFemoral artery Fig. 4.178 Landmarks used for establishing the positions of lumbar vertebrae are indicated. Anterior view of the abdominal region of a man. End of ninth costal cartilageLower edge of tenthcostal cartilageHighest point on iliac crestLILIILIIILIVLVPubic symphysisTubercle of crest of iliumJugular notchTranspyloric planeSubcostal planeSupracristal planeIntertubercular planeUmbilicus910	Anatomy_Gray. Fig. 4.177 Groin. A. In a man. B. In a woman. C. Examination of the superficial inguinal ring and related regions of the inguinal canal in a man. Deep inguinal ringAponeurosis of external obliqueAponeurosis of external obliqueSuperficial inguinal ringPosition of pubic symphysisABCAnterior superior iliac spineSpermatic cordInguinal ligamentFemoral arteryDeep inguinal ringSuperficial inguinal ringPosition of pubic symphysisAnterior superior iliac spineRound ligament of uterusInguinal ligamentFemoral artery Fig. 4.178 Landmarks used for establishing the positions of lumbar vertebrae are indicated. Anterior view of the abdominal region of a man. End of ninth costal cartilageLower edge of tenthcostal cartilageHighest point on iliac crestLILIILIIILIVLVPubic symphysisTubercle of crest of iliumJugular notchTranspyloric planeSubcostal planeSupracristal planeIntertubercular planeUmbilicus910