Visceral Manipulation 1: Dissection & Anatomy Companion Course (3 CE/HR)

 The materials for this course are divided into sections, each containing videos, study guides, review quizzes, and other learning materials. For planning purposes, the video durations are noted (HH:MM:SS).

Review quiz times are estimated based on completing one multiple choice question per minute. Reading is estimated at the rate of 150 words/minute.

Abdominal Wall Orientation: King - 4:03

In this video, Gil tours the general abdominal wall to orient you to the major structures and their relationships. Note the relationships and connections of the following structures:

• Pyramidalis
• Rectus abdominis
• External obliques
• Internal obliques
• Transversus abdominis
• Anterior and posterior rectus sheath
• Arcuate line
• Linea alba
• Transversalis fascia
• Peritoneum
• Review Quiz (2:00)

Peritoneum, Medial & Median Umbilical Ligaments, Round Ligament, Greater Omentum (King) - 15:46

In this video, Gil will look at King's peritoneum, the lateral, median and medial umbilicus, the round ligament of the liver, and explore addressing adhesions.

• 1:45: Reveal and dissection of peritoneum from posterior rectus sheath
• 4:30: Umbilical ligaments exploration
• 7:00: Round ligament and adhesions
• 11:00: Greater omentum
• 11:30: Reveal of transverse colon
• 12:20: Liver adhesions revealed
• Review Quiz - 4:00

Omentum: Greater and Lesser; Hepatoduodenal and Hepatogastric Ligaments (King) - 12:18

In this video, Gil continues his abdominal tour of King, exploring the greater omentum, the transverse colon, the spleen, the lesser omentum, the lesser omental bursa, and the epiploic foramen.

• 00:15: Greater omentum, defined
• 3:14: Adhesion of greater omentum to liver..or is it the hepatogastric ligament?
• 4:06: Reveal of spleen 
• 4:30: The mystery of King's stomach
• 5:35: Splenic flexure and the phrenicocolic ligament
• 8:10: Reveal of gallbladder
• 8:48: Hepatogastric ligament
• 8:35: Epiploic foramen of the lesser omental bursa
• Review Quiz - 3:00

Mesentery Tour (King) - 11:24

In this video, Gil explores the key structures of the mesentery, including the transverse mesocolon, the mesocolon, and the mesentery. Along the way, discover the superior mesenteric artery, the appendix, tributaries of the portal vein, and the root of the mesentery.

• 00:40: Transverse mesocolon
• 1:10: Mesocolon
• 2:00: Mesentery
• 3:08: Backlighting the superior mesenteric artery
• 4:10: Reveal of vermiform appendix
• 4:25: “Running the bowel”
• 5:00: Tributaries of the portal vein
• 5:30: The stomach mystery continues! A great exploration of why everyone is not always as it seems!
• 6:50: Jejunum
• 7:50: Root of the mesentery and the intestinal bouquet
• 8:30: Mesocolon and mesentery
• 9:05: Reveal of duodenum
• 9:30: Vascular vs. fascial root of the mesentery
• Review Quiz - 5:00

Liver Ligaments: King - 12:09

In this video, we continue our exploration of King and focus on the ligaments of the liver, including the right, left, coronary, triangular, and hepatocolic.

• 00:54: Round ligament
• 2:20: Falciform ligament
• 2:40: Glisson's capsule," aka the visceral peritoneum or the ""skin" of the liver
• 3:13: Diaphragm
• 4:00: Coronary ligament
• 5:20: Right triangular ligament
• 5:50: Left triangular ligament
• 7:20: Hepatogastric ligament
• 9:00: Epiploic foramen of lesser omental bursa
• 9:20: Hepatorenal ligament (introduced, will be discussed more later)
• 10:00: Hepatocolic ligament
• 10:30: Summary of ligaments
• Review Quiz - 5:00

Stomach and Related Tissues (Maestro) - 5:44

In this video, we explore our donor form Maestro's stomach and note the fundus, curves, pylorus, bursae and gastrophrenic ligament. We also have the rare opportunity to witness the impact of a pyloric bypass surgery. 

• 00:15: Overview
• 00:35: Greater omentum
• 00:47: Transverse colon, transverse mesocolon
• 1:05: Stomach, greater curvature of stomach and relationship to greater omentum
• 1:40: Gastrocolic ligament
• 2:10: Lesser curvature of the stomach
• 2:20: Lesser omentum and the hepatogastric ligament
• 3:30: Fundus, cardiac, and pyloric portions of the stomach
• 4:18: Introduction to the duodenum
• 4:45: The Maestro mystery!
• Review Quiz - 3:00

Pyloric Bypass: Learning from Stomach Surgery (King) - 6:47

In this video, we have the unique opportunity to witness the effects of a pyloric bypass surgery from our donor form, King. King's unique presentation provided Gil with quite a mystery for a day or two! In this video, Gil unravels the mystery and shares his findings. Along the way, Gil will landmark the cardiac portion of the stomach.

• 00:40: Orientation to form
• 1:05: Running of the bowel
• 1:45: Intestinal scar and jejunum
• 2:48: Fundus of stomach
• 2:55: Esophageal hiatus of diaphragm and esophagus
• 3:40: The missing pylorus
• 4:50: Superior mesenteric artery and portal vein
• Review Quiz - 1:00

Pancreas, Duodenum, Portal Vein, Superior Mesenteric Artery (King) - 6:51

In this video, we will identify the head and tail of King's pancreas, duodenum, portal vein, spleen, sphincter of Oddi, and superior mesenteric artery. 

• 00:13: Orientation to pancreas
• 00:20: Liver
• 00:45: Vascular root of the mesentery
• 1:00: Superior mesenteric artery and the portal vein
• 1:20: Pancreas, identified
• 1:37: Relationship of head of pancreas to duodenum
• 2:20: Head of the pancreas
• 2:50: The sphincter of Oddi
• 3:08: Tail of the pancreas
• 3:54: Spleen
• 4:45: Superior mesenteric artery and the portal vein
• 5:07: Non-standard issue duodenum journey
• 5:54: Review
• Review Quiz - 5:00

Stomach, Duodenum, Pancreas, Spleen: In-Situ Overview; Hiatal Hernia and Ligament of Treitz (A) - 15:47

In this video, we visit our wonderful donor form Anna to see another presentation of the stomach, duodenum, pancreas and spleen.  We will also see Anna's remarkable hiatal hernia and identify the Ligament of Treitz and the celiac plexus. At this point in the dissection, the small intestine, large intestine and liver have been removed, offering a rare view of these structures.

• 00:50: Duodenum and its sections, mesenteric arteries
• 1:30: Pancreas (head and tail) and relationship to spleen; splenic artery
• 4:05: Sections of the stomach (pylorus, fundus, curves
• 5:15: Artifact of a hiatal hernia (Gil figures it out at 5:50!)
• 6:02: Demonstration of hiatal hernia
• 10:52: Tour recap
• 11:15: Ligament of Treitz
• 14:20: Nerves of the celiac plexus
• Review Quiz - 3:00

Exposing Duodenum: Dissection & Ligament/Muscle of Treitz (Z) (9:35)

In this video, we will visit our donor Z. Z's small and large intestines have been removed, giving us a good view of the duodenum and the Ligament of Treitz. Z has an interestingly thickened peritoneum, which Gil dissects on camera to reveal the duodenum.

• 00:20: Peritoneum remnant
• 1:05: Stomach and duodenum
• 2:10: Exposure of loop of duodenum and vascular root of the mesentery (mesenteric artery and portal system)
• 6:00: Duodenum revealed
• 6:30: Ligament of Treitz (also called Muscle of Treitz)
• 8:00: Path demonstrated: stomach to pyloric sphincter to duodenum
• Review Quiz - 2:00

Gallbladder, Hepatoduodenal Ligament; Cystic, Common Bile and Hepatic Ducts, Portal Vein, Hepatic Artery, Hepatic Plexus (King) - 16:07

In this tour of King, we identify the gallbladder and the hepatoduodenal ligament. Gil dissects the hepatoduodenal ligament to reveal the portal vein, hepatic artery, common bile duct and hepatic plexus. We also have the opportunity to note gallbladder stones as well as the cystic and hepatic ducts.

• 00:30: Liver
• 00:45: Gallbladder position and stones
• 2:45: Epiploic foramen of lesser omental bursa and the hepatoduodenal ligament with its included viscera and nerves
• 4:20: Dissection of hepatoduodenal ligament to reveal its contents: hepatic artery, hepatic plexus, common bile duct, cystic duct
• 7:18: Fundus of gallbladder and cystic duct
• 11:45: Reveal of cystic duct and common bile duct, reference of sphincter of Oddi
• 12:50:Reveal of right and left hepatic duct
• 13:41:Reveal of hepatic artery
• 14:19: Reveal of portal vein
• 14:50: Review of revealed structures
• Review Quiz - 3:00

Adhesions of Loops of Small Intestine (Maestro) - 3:06

In this short video of our donor form Maestro, Gil demonstrates and de-adheres loops of the small intestine, demonstrating unexpected (but not uncommon) relationships in the small intestine and mesentery that may impede mobility in the viscera.

• 00:00: Reveal of adhesions
• 2:38: Reveal of arcades of vasculature, lymphatics, and nervous tissue in the small intestine and mesentery

(No review quiz for this video.)

Adhesions of Small to Large Intestines (Maestro) - 2:38

In this short video of our donor form Maestro, Gil demonstrates and de-adheres loops of the small to large intestine, demonstrating unexpected (but not uncommon) relationships that may impede mobility in the viscera.

• 00:43: Reveal of adhesions
• 2:38: Reveal of arcades of vasculature, lymphatics, and nervous tissue in the small intestine and mesentery

(No review quiz for this video)

Colon Tour (King) - 10:44

In this video, we tour King's colon to landmark its features: cecum, ileocecal valve, ascending, transverse and descending sections, sigmoid colon, hepatic and splenic flexures, appendix, and rectum. King has a particularly extensive colon and provides a unique viewpoint on the diversity of this structure.

• 00:00: Overview of colon
• 00:26: Cecum
• 00:40: Iliocecal valve
• 1:10: Appendix
• 1:53: Cecum and gallbladder, compared
• 2:50: Ascending colon
• 3:00: Hepatic flexure at liver
• 3:30: Transverse colon
• 4:05: Splenic flexure
• 4:25: Descending colon
• 5:05: Sigmoid colon and its remarkable length (in King) to the rectum
• 7:17: Rectum (note bladder)
• 7:25: Running the colon in reverse: rectum, sigmoid colon, descending colon, splenic flexure, transverse colon, hepatic flexure, ascending colon, cecum, appendix, ileocecal valve
• 9:10: Details on ileocecal valve compared to pyloric valve
• Review Quiz - 2:00

High Cecum & Variability (Maestro) - 2:06

In this short video, we tour the high cecum of Maestro and compare his presentation of the cecum with the typical location for the cecum as noted in anatomy books. 

While the cecum is usually described as lying midway between the ASIS and the navel, in Maestro we find the cecum all the way up under his right ribs! Maestro is a reminder that human anatomy is unique to the individual and we must look to each body for its own individual expression.

Surprise Visceral Orientations (Maestro) - 5:34

In this short video, we compare Maestro's presentation of the liver, transverse colon and cecum with the typical location for the cecum as noted in anatomy books. 

Maestro is a reminder that human anatomy is unique to the individual and we must look to each body for its own individual expression. 

• 00:30: Orientation to Maestro
• 1:05: Surprise position of the cecum
• 2:10: Ileocecal junction
• 2:40: Surprise position of the transverse colon
• 4:10: Liver
• Review Quiz - 2:00

Recommended Supplemental Resources

Not counted towards course time.

• The Integral Anatomy Series: Vols. 3 and 4
• The Integral Anatomy Intensive: Video 6
• Dissection Series: Margaret Day 4: Abdominal Viscera, from 22:40, through 1:28:42.
• Dissection Series: Jerry, Day 4: Abdominal Visceral Tour, from 00:00 through 1:14:17.
• For an even deeper dive into the viscera, explore the entirety of Course 14, Anatomy from A-Z: Abdominal Viscera (15.5 hrs)