! " #$$"" $ $%&'()'(*'+,)&*" front.card2.4.qxd 12/5/06 2:28 PM Page 1 Abdomen 2.4 Drainage of the Anterior Abdominal Wall 1 2 3 Transumbilical plane 4 5 6 Lymphatic Venous drainage drainage COA back.card2.4.qxd 12/4/06 3:16 PM Page 1 Drainage of the Anterior Abdominal Wall 1. axillary lymph nodes 2. axillary vein 3. thoracoepigastric vein 4. superficial inguinal lymph nodes 5. superficial epigastric vein 6. femoral vein Lymph superior to the transumbilical plane drains to the axil- lary lymph nodes, while lymph inferior to the plane drains to the superficial inguinal lymph nodes. When flow in the supe- rior or inferior vena cava is blocked, anastomoses between their tributaries, that is, the thoracoepi- gastric vein, may pro- vide collateral circula- tion, allowing the ob- struction to be bypassed. Thoracoepigastric vein COA © 2008 Lippincott Williams & Wilkins front.card2.36.qxd 12/5/06 1:20 PM Page 1 Abdomen 2.36 Portal System 1 3 4 2 6 5 7 Grant’s back.card2.36.qxd 12/4/06 3:28 PM Page 1 Portal System 1. inferior vena cava 2. hepatic portal vein 3. right gastric vein 4. splenic vein 5. superior mesenteric vein 6. inferior mesenteric vein 7. superior rectal veins Caput Medusae When scarring and fibrosis from cir- rhosis obstruct the portal vein, pres- sure in the portal vein rises and pro- duces portal hypertension. The blood then flows to into the systemic system at places of portal-systemic anastomo- sis, producing varicose veins. Caput medusae is caused by the veins of the anterior abdominal wall becoming dilated from portal hypertension. A common method for reducing portal hypertension is to divert blood from COA the portal system to the systemic venous system by creating a communication between the portal vein and the inferior vena cava. © 2008 Lippincott Williams & Wilkins front.card2.37.qxd 12/5/06 1:22 PM Page 1 Abdomen 2.37 Viscera of Posterior Abdominal Wall 1 2 3 4 5 6 7 8 Grant’s back.card2.37.qxd 12/4/06 3:28 PM Page 1 Viscera of Posterior Abdominal Wall 1. celiac ganglion 2. celiac trunk 3. spleen 4. right suprarenal gland 5. right kidney 6. right testicular artery and vein 7. right ureter 8. right external iliac artery and vein Nephroptosis (dropped kidney) is the result of an abnormally mobile kidney. In nephroptosis, when a person is standing, the ureter, which is of normal length (unlike in ectopic kid- ney) may become coiled and/or kinked. Renal transplantation is a well-established operation to re- place failing kidneys. The transplanted kidney is placed in the iliac fossa for support. © 2008 Lippincott Williams & Wilkins.