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Anatomy: Abdomen

Bowel

COLON AND ANUS

Transverse colon

Hepatic flexure

Ascending colon

Cecum

Appendix

Rectum

Urinary bladder

Prostate

External anal sphincter

Taenia coli

Splenic flexure

Superior mesenteric artery

Descending colon

Inferior mesenteric artery

Sigmoid

Rectum

Muscularis propria of rectum

Internal anal sphincter

Anal canal

(Top) Graphic shows the colon in situ. The transverse colon has been retracted upward to demonstrate the arterial supply of the colon from the superior and inferior mesenteric arteries. The SMA supplies the colon from the appendix through the splenic flexure, and the inferior mesenteric artery (IMA) supplies the descending colon through the rectum. Note the band of smooth muscle (taenia coli) running along the length of the intestine, which terminates in the vermiform appendix; these result in sacculations/haustrations along the colon, giving it a segmented appearance. (Bottom) Graphic shows the longitudinal section of a male pelvis. The anus is the external opening of the rectum and terminal end of the GI tract. The internal anal sphincter (IAS) is a thin involuntary muscle deep to the submucosa. The external anal sphincter is thicker, encircles the IAS, and is under voluntary control.

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Bowel

Abdominal wall

Left hepatic vein

Gastro esophageal junction

Vertebral body

Abdominal wall

Left lobe of liver

Aorta

Vertebral body

Subcutaneous adipose tissue

Rectus muscle

STOMACH

Left lobe of liver

Stomach fundus

Collapsed body of stomach

Tail of pancreas

Anterior wall of stomach

Rugae

Posterior wall of stomach

(Top) Transverse oblique ultrasound at the epigastric region shows the gastroesophageal (GE) junction, which can be traced to the fundus of the stomach. Note the relationship to the adjacent structures. (Middle) Transverse oblique ultrasound through the left upper quadrant shows the collapsed stomach body with the rugal folds. Echogenic gas is seen between the rugae. The tail of the pancreas is seen posterior to the stomach, and the left lobe of the liver is anterior to the stomach. (Bottom) High-resolution transverse ultrasound through the epigastric region shows the gastric body tapering to the gastric antrum. Note the gastric folds (rugae). The stomach wall shows the gut signature.

Abdomen Anatomy:

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Anatomy: Abdomen

Bowel

GASTRODUODENAL REGION/DUODENUM

Subcutaneous adipose tissue

Left lobe of liver

Inferior vena cava

Abdominal wall

Superior mesenteric vein

Uncinate process of pancreas

D3

D2/D3 junction

Inferior vena cava

3rd part of duodenum (D3)

Inferior vena cava

Abdominal wall musculature

Pylorus

Duodenal bulb (D1)

Pancreas

Aorta

Gastric antrum

Superior mesenteric artery

D3/D4 junction

Aorta

Abdominal wall

Inferior mesenteric artery origin

Aorta

(Top) Transverse oblique ultrasound through the epigastric region shows the pylorus with the hypoechoic prominent muscular wall leading to the duodenal bulb. (Middle) Transverse ultrasound through the upper abdomen shows the gastric antrum anteriorly compressed by the curvilinear probe and collapsed 3rd part of the duodenum (D3) posteriorly. The SMA and the superior mesenteric vein (SMV) are seen in the plane in between. The inferior vena cava (IVC) and aorta are seen posterior to the D3. (Bottom) Axial midline high-resolution ultrasound through the upper abdomen shows fluid distended in the D3 located across, in the upper retroperitoneum. Note the aorta and IVC posterior to the D3. Gut signature is seen in the wall of the D3.

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Bowel

SMALL BOWEL

Rectus muscle

Jejunal loops

Valvulae conniventes

Rectus muscle

Ileum

Jejunum with valvulae conniventes

Right rectus muscle

Anterior bowel wall

Ileal segment

Posterior bowel wall

Psoas muscle

(Top) Transverse oblique ultrasound through the left flank shows jejunal loops with mucosal folds, valvulae conniventes. (Middle) Transverse ultrasound through the lower abdomen close to midline shows jejunal ileal transition from a segment with folds to a segment with no folds. (Bottom) Sagittal oblique ultrasound through the right lower quadrant (RLQ) shows a normal ileal segment. Note the lack of folds and a normal gut signature in the wall.

Abdomen Anatomy:

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Anatomy: Abdomen

Bowel

SMALL BOWEL AND LARGE BOWEL

Cecum

Terminal ileum

Right iliopsoas complex

Cecum anterior wall

Ileocecal junction

Cecum posterior wall

Jejunal loops

Psoas muscle

Right common iliac artery

Right common iliac vein

Terminal ileum

Abdominal wall musculature

Descending colon

(Top) Transverse oblique ultrasound through the right iliac fossa (RIF) with graded compression shows a compressed, normal terminal ileum (between the abdominal wall musculature anteriorly and psoas muscle posteriorly) leading to the cecum. (Middle) Transverse high-resolution ultrasound through the RIF in the same patient shows the ileocecal junction and the ileocecal valve. (Bottom) Transverse ultrasound through the left iliac fossa (LIF) shows a short-axis view of the descending colon with gut signature. Medial to the descending colon, normal jejunal loops can be seen with valvulae conniventes.

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Abdominal wall musculature

Cecum

Iliacus muscle

Abdominal wall musculature

Posterior lip of ileocecal junction

Bowel

ILEOCECAL JUNCTION

Terminal ileum

Psoas muscle

Iliac blade

Anterior lip of leocecal junction

Ileocecal junction

Ileocecal valve en face

Abdomen Anatomy:

(Top) Transverse ultrasound through the RIF shows the cecum, which is represented by curvicurvilinear echogenicity with posterior reverberation. Note the terminal ileum compressed by the curvicurvilinear probe between the abdominal wall musculature and the iliopsoas complex posteriorly. (Middle) High-resolution transverse ultrasound through the RIF shows echogenic (fatty) lips of a normal ileocecal valve. (Bottom) Oblique right sagittal ultrasound through the RIF in the same patient shows the ileocecal junction end on.

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Anatomy: Abdomen

Bowel

APPENDIX

Subcutaneous adipose tissue

Abdominal wall musculature

Appendix

Tip of appendix

Psoas muscle

Abdominal wall

Tip of appendix

Appendix

Short axis of normal appendix

(Top) Coronal oblique ultrasound through the RIF shows a long-axis normal appendix with a stratified mural appearance. Note the absence of peri appendicular inflammatory changes. (Middle) Transverse oblique ultrasound through the RIF shows a blind-ending tubular structure with a gut signature representing the long-axis view of a normal appendix. (Courtesy A. Law, MD.) (Bottom)

Transverse oblique ultrasound through the RIF shows the short-axis view of a normal appendix with preservation of gut signature. Note the normal appearance of peri appendicular fat. (Courtesy A. Law, MD.)

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Bowel

LARGE BOWEL

Abdominal wall musculature

Haustra of ascending colon

Abdominal wall

Transverse colon

Posterior reverberation artefact from gas in transverse colon

Abdominal wall musculature

Outer muscular layer of colon

Descending colon

Posterior reverberation artefact

(Top) Right sagittal ultrasound shows a normal ascending colon with curvicurvilinear arcs of echogenicity from luminal gas/feces reflecting the normal haustra pattern. (Middle) Transverse ultrasound through the epigastric region close to the midline shows the normal haustral pattern of intraluminal gas/feces within the horizontally lying transverse colon. Note the posterior reverberation artifact from a gas-filled colon. (Bottom) Left sagittal ultrasound through the left side of the abdomen shows the descending colon represented by arcs of echogenicity with posterior reverberation artifacts due to gaseous contents of the colon. Note the normal haustral pattern. Images obtained with curvilinear probe or linear probe with virtual convex are better for orientation of anatomy within the peritoneal cavity.

Abdomen Anatomy:

81

Anatomy: Abdomen

Bowel

LARGE BOWEL

Abdominal wall musculature

Abdominal wall

Compressed lumen

Psoas muscle

Loops of pelvic loops of small bowel

Muscularis propria layer

Long-axis view of collapsed descending colon

Muscularis propria layer

Submucosal layer

Muscularis mucosa

Compressed lumen

Muscularis propria layer

Sigmoid colon

Iliacus muscle in pelvic wall

(Top) Left sagittal ultrasound shows the normal descending colon in a collapsed state and compressed by the ultrasound probe. Note the gut signature. This is an alternative appearance to the descending colon when it is collapsed and empty. (Middle) High-resolution left sagittal ultrasound obtained with a higher frequency linear probe from the same patient shows the collapsed descending colon with gut signature. The hypoechoic outer layer represents the muscularis propria layer. (Bottom) Transvaginal ultrasound shows the sigmoid colon and pelvic loops of small bowel. Note the hypertrophied outer muscularis propria layer of the sigmoid colon, seen in patients with irritable bowel syndrome and early diverticular disease.

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Bowel

RECTOSIGMOID REGION

Urinary bladder

Prostate gland

Anterior wall of rectosigmoid

Bladder

Seminal vesicles

Anterior wall of rectum

Bladder

Base of prostate gland

Lower rectum

Puborectalis

(Top) Midline sagittal ultrasound in a male patient shows the anterior wall of the rectosigmoid region and its relationship to the prostate gland anteriorly. (Middle) Transverse ultrasound through the pelvis in the same patient (with cystic fibrosis) shows the anterior wall of the rectosigmoid region and its relationship to the seminal vesicles anteriorly (note the small seminal vesicles seen here). (Bottom) Transverse ultrasound at a lower level in the same patient shows the lower rectum, pelvic floor, and anterior relationship to the prostate gland.

Abdomen Anatomy:

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