Dissecting Viscera

The aspect of the small intestine that is inside the peritoneal sac that we saw over the top originally is basically everything from the ileocecal valve here where the ileum transitions into the cecum, which is a geographical name change and a shape change. And we go through all the loops, which are all tied into the root of the mesentery here and the other end of the intestine that's inside the bag starts here at the duodenal jejunal junction, it's called the DJ junction. This swirling here, this is the peritoneum tunneling down, is this the end of the road here? Not at all. It continues on to the stomach of course, but the stomach will remember disappeared here as well.

We got to the pyloric valve here and all of a sudden we couldn't really see the small intestine anymore. So the small intestine starts after the pyloric valve and then the jejunum is over here. The jejunum is here. What's in between? It's behind the bag.

What's in between is the duodenum and the duodenum is behind the bag. Here's one aspect of it. So look, I've got the DJ junction right here. The transition point from the duodenum to the jejunum, the transition point from retroperitoneal to intraperitoneal. Inside the bag, behind the bag, inside the bag, all this.

Inside the bag, the bag of the peritoneum, the bag of the parietal peritoneum. Inside the bag, behind the mesocolon here, we have this tunnel, the DJ junction. This tunnel. I've got the transverse colon here. This is the only thing that's really intervening at this point.

If we peek here, look, I've got my transverse colon, I've scootched it out of the way and we can see simultaneously the DJ junction here and I just scootch my transverse colon over and I'm looking at the pylorus here. The pylorus and the DJ junction with the transverse colon running in between them. So if I were to peel away the peritoneum here, we'd see two things. We'd see our duodenum and the head of the pancreas. In the following sequence, I've jumped ahead a bit in the dissection process in order to complete the account of the path of the gut through the abdomen.

I've peeled back the peritoneum from the posterior abdominal space to reveal the path of the duodenal portion of the small intestine as well as the pancreas. We've gone on through, we've broken on through to the other side to this retroperitoneal space which started right here, go from the pyloric part of the stomach and we trace our duodenum. I'm tracing the duodenum here and here, it's like a C at this point. Can you see the duodenum? It's the first loop of the small intestine and I'm fluffing the duodenum now, just tearing away all the peritoneum from the duodenum and now you can see the duodenum having its edge fluffed up here, sort of peeling up the duodenum off of the spine here.

We've got our transverse colon and our stomach, stomach to the pyloric part of the stomach to the pylorus across the border of the peritoneum which has been torn away into the duodenum. The duodenum is here, circumambulating, it's walking around the head of the pancreas which is here and we can follow our pancreas from here where it's seated in the arcing C curve of the duodenum and we can follow it, follow it all the way down to the spleen. You can see our spleen peeking through the window here, there, see that, pancreas to the spleen, there's the spleen and the pancreas stretches all the way over to it. I'm going to pull these tissues away and you can see the border of the pancreas a little better. It's not a very wide organ but golly if it isn't eight inches long here, if I push my intestines out of the way again, I'm in the DJ junction here and I'm in the retroperitoneal side of the duodenum here, head of the pancreas, I can slide my finger across the borderland here and link up now across the border end.

What's overlying, I'm noticing, what's overlying this transition point is the superior mesenteric artery, see? The superior mesenteric artery here on the portal vein here, the two of them together, it's a busy place and we see then that this root of the mesentery, this vascular root of the mesentery, like a twisting point, I can just get my finger through here, I've got the vascular root of the whole bouquet, the vascular root of the bouquet immediately overlies the duodenogeminal junction where the intestines from their retroperitoneal place, we get to around the duodenum here and we get to the end of the duodenum and then we slide under these vascular roots of the mesentery and there we are out on the duodenum, which we can follow forever, right? So the large intestine essentially starts at determinants of the small intestine, which from an internal point of view is just more of the same tube, we have our ileocecal valve here, this transition point between the smaller tube, the smaller part of the Z plant and the larger part of the Z plant, the secum, this giant dehydrator bag, so as the chyme travels through the small intestine, it's going to basically travel next into the secum where the body will retrieve water, we retrieve our water, we're an incredible water conservation device between the gallbladder over here and the secum over here, we have two magnificent water retrieval systems because we're constantly producing bile and pancreatic juices and digestive juices and we use more fluid than we consume, so we have to recycle our water, so when the watery chyme comes into the secum here, this is a grand dehydrator bag and it draws the water off and concentrates the material inside until it becomes what we refer to as feces. So we come from our secum and once we pass out of the bulbous quality of this dehydrator bag here and we go up, we just ascend for a little bit, we ascend, we go northward towards the liver here, we go headward towards the liver, the ascending colon but then the colon, see it's quite wide, it's a wide bag here, it's wide and floppy and it's having a joint with the liver and where it bends here, at the liver we call it the hepatic flexure, so we have the secum, the ascending colon, this is the ascending portion, then the ascending colon transitions to the transverse colon, we call that the hepatic flexure, the bend at the liver, hepatic flexure means nothing more than the bend at the liver, so the intestine bends at the liver, the large intestine and we come across the body, secum, ascending colon, hepatic flexure, transverse colon, we follow the transverse colon here and there's all these little bitty tabs coming off of here and these little bitty tabs, these little fat tabs are on everybody, we come across the transverse colon here, we're working our way along the greater omentum of course which we pull up or greater omentum and then we see the skin, the visceral peritoneum of the transverse colon arising into the greater omentum here or descending it depending upon which way you hold it, so our transverse colon comes across and it's a continuous, we're going to pull our small intestines out of our view here now, we're following the transverse colon across and it bends again, it bends right here, it takes a little turn and starts going down, now where does it bend? It bends at the spleen, at the splenic flexure, we have the splenocalic ligament where it ties in together, the spleen and the colon and we can just see this grand pathway from the transverse colon sweeping down past the spleen, at which point we're no longer ascending, now we're descending, so we have our descending colon here, the descending colon and I've got the peritoneum here and that had been previously here, so the descending colon, we keep going, we get to the brim of the pelvis now and we take a turn and it changes name again, this is called the sigmoid colon and of course this is the part of the colon is like a sigma or an S form as it sort of swirls past the anterior superior spine and into the deep pelvis, so they call that, it's like an S form going down and then up and around, so the sigmoid colon from the descending, all these different names, cecum, ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, sigmoid colon, rectum, these are all just geographical points along a common pathway of the large intestine which is nothing more than the larger part of the tube which is the tube from the mouth to the anus, now we're headed towards the anus, so I'll scoop my small intestines out here a bit and we can see all these little tabbities, these little flibbity tabs of fat along here and right at this point we sort of disappear here, we disappear here but I know that the rectum is in here somewhere, so if I scoop my hand down here I can pull up and I see that there's another little loop in here, so the rectum isn't particularly rect meaning straight in this case, because it comes down here as deep to the peritoneum now and I can slide my hand in here and I see we have just another loop, it's doubled back on itself right here before it goes straight out to anus, so that's the path. Having taken our time learning the basic pathway of the gut within the abdominal space, we turn to the new female form and the rich colors and textures evident in the unpreserved tissue, creating the dense transverse mesocoland and mesocoland, we note the relative wealth of metabolic reserve in the form of fatty deposition as compared to the male form, though the external morphology of their abdomens appeared so similar when the superficial fascia was removed.

The loops of the small intestine, like a liquid river, meander through the abdominal space, tethered by the mesentery and sliding with relative freedom over the mesocoland, scooping up these loops we see the breadth of this mesocolic fascia lining the posterior wall of the abdominal space, on either side of the root of the mesentery. When paired off and considered in relationship with the apron-like sheet of the greater omentum, I see them together as a protective and communicative resonance sphere surrounding the abdominal organs, much as the superficial fascia envelops the whole body. The unpreserved tissue reveals the particularly fluid quality of the alimentary pathway, as the muscle tissue is flaccid. I always make a point to palpate along the entire length of the gut of every body that I dissect, both to appreciate its continuity and, to note, its relationships. This particular form had endured numerous surgical interventions, the upshot of which were numerous adhesions, both intentional and accidental.

By relieving those adhesions, I restore the normal relations and range of motion of the tissues, and in doing so, learn what those normal relations are. Lots of practice learning those normal tissue relationships allow the abnormal ones to appear much more obvious. It is extremely common among the donor body population to find many examples of surgical intervention. The intestines and mesentery should slide over themselves. When they don't, I try to figure out whether I'm looking at a normal anatomical variation, an existing but uncorrected pathology or surgical intervention, as is the case here.

Having finally sorted out and undone the various adhesions of the small intestines, we can now see the transition point from the small to large intestines at the ileocecal valve, the internal transit from the ileum to the cecum. Unlike the pyloric valve, which has a substantial thickness to its muscle wall, the ileocecal valve is a more simple and less dense configuration. Gathering up the loops of the small intestines at their root, the intestines never fail to impress me as both a form of nature as well as an incredible repository of intelligence. God intelligence, at a physical level, coordinates myriad physiological events in our inner world. At an emotional level, God intelligence indicates our relationship to events in our outer world.

Tracing the path of the colon, we can anticipate now its somewhat predictable circuit around the abdominal space. Even though the quality of the tissue is very fluid, not to mention its contents, the normal structural orientations are maintained. That orientation is a function of completed development in relationship to the surrounding tissues. The peritoneal ligamentous relationships in the colon enable us generally to predict its position. Here while the position is normal, I find an adhesion of the descending colon to the parietal peritoneum.

This adhesion, while it does represent something of a fixation of the tissue, has no profound bearing upon the normal position of the organ itself. That having been said, there are numerous known positional variations, some with developmental origins. One being that the cecum is undescended and so found noticeably higher in the abdomen, as in this example, the cecum is visible at the thumb of the white gloved hand as the costal margin is reflected. One consequence of this variation is that the ileocecal valve is closer to where one would normally find the hepatic flexure. This example of that variation has an exceptionally long vermiform appendix as well, visible at center frame as a thin prolongation of tissue from the bottom edge of the cecum and wandering along the posterior abdominal wall to the tip of the right blue glove.

The contingencies of every particular form should serve as an important reminder to anyone who does visceral work. One should avoid being overly committed to one's mental projection of where things should be in the body. Variety is the spice of life, and actual bodies always trump textbook generalizations. The drawings in the books are averaged over thousands of bodies, and therefore actually portray no one individual. The averaged images point us towards the general idea, but every body brings to the table its own version of the truth.

Now, many people expect to see a kidney bean lying in the body cavity here. Do we see that? No. What we see is peritoneum. See this peritoneum?

Look, I'm getting my hand behind the peritoneum, because the kidney is retroperitoneal, and this is the proof of it. Here's the peritoneum, and the kidney's down here, but where is the kidney bean? It is always embedded in what's called subserosal fascia. Okay, what's the serosal? The serosal is the serous membrane that I'm pulling away, so we can say two words, retroperitoneal or subserosal, meaning about the same thing, right, under the serosal membrane, the peritoneum.

So I pull the peritoneum away, I expose a mass of tissue, oh, what could it be, this mass of tissue? We call it subserosal fascia, and you say, but that's not fascia, fascia's white and shiny, and I'm telling you that this is a loose, areolar fascia with fatty deposition, just like the superficial fascia that surrounds the whole body. We can think of the kidney as a homunculus. It's a little man or a little woman inside of our body, and just like the greater man or a greater woman, it's surrounded with a fatty body around it, and that's the subserosal fascia. I think it's best friends with the superficial fascia.

So if I get my hands now underneath the whole mass of the kidney here, look at that, it's a big organ when we include the fascia around it, and if I look right here, I see, well, the liver, which has its sliding surface with the kidney, I reflect the liver, and I go looking, say, oh, I don't see a kidney bean, and I don't see a little hat on top of it either. Where's the little hat that's always drawn in those textbooks on top of the kidney? The adrenal gland. The adrenal gland also has a sliding surface with the liver, but the fact is the adrenal gland is actually embedded here in the subserosal fascia, and it doesn't actually sit on top of the kidney bean itself. It sits on top of the fascia.

Now if I intrude into this space with my finger, I can open up the space where that famous shape is hiding, here, see, look, you peel it back, and the kidney is encapsulated within another fascia, the renal capsule, as I push away the subserosal fascia here to create a window into the more famous tissue. I don't think we can rank the importance of the tissues of our body as we have become accustomed to. I think that all the tissues work together. I want to go and find that adrenal friend, and there is the tip of it, right there. You see that little brown color there?

That's not the kidney. Kidney's over here. But look, there's a little brown tip here. I can scratch away here a little bit, and sure enough, what am I on now? As I scratch with my probe, many small threads of relationship are evident linking the adrenal gland to the surrounding subserosal fascia in which it is embedded, and I cannot help but imagine that there is a resonance between the superficial fascia and the subserosal fascia, which is conveyed to the adrenal glands and on to the rest of the body.

This is a pet theory of mine, for which I have no particular justification beyond my conviction that common textures co-vibrate. My understanding that vibration is information, and the fact that our bodies are spectacular instruments for interpreting the web of information in which we live. The kidney, I see it has this gossamer fabric around it, the skin of the kidney, the renal capsule. Like all the other organs, we have a skin on this organ, and as I work my way around it, I can feel that skin, and I see there's a, it doesn't seem to be related in the same way to the subserosal fascia that the adrenal gland is, does it? I don't see, if I go this way, I don't get strings coming off of it, right?

I have this very nice, tidy capsule that I just broke there, but then when I go back to the adrenal gland itself, here, we have this corona of vasculature that relates the adrenal gland to the surrounding fascia. As I peel, we might as well have a peek at this. Yeah, thank you. Let's have a peek at this, and we'll see right here a great vessel, an incredible vessel, the inferior vena cava. I'm looking for that blonde organ.

Let's see if it's interred. Oh, there we go, yeah, yeah, the inferior vena cava, and here's the aorta here. So the aorta is whiter, right, so that makes sense. So that's our renal vein, here, going over, draining the kidney, kidney to renal vein, and then up here, that vena cava is going to pass behind the liver, so we don't see it anymore here, going to have a, see right here, that's the vein, the adrenal vein. Coming directly into the vena cava, there, and here's the kidney being scooped out now in its entirety, from the renal capsule, see, oh well, kidney vein, that's the famous kidney.

Sweet little organ. I want to see the other kidney, I'm going to break through the mesocolla, now there are vessels in there, of course, and, just remember, the kidney is retroperitoneal, so now that's easy. I break through the mesocolla, and what am I on? I break through a fatty layer, and I encounter a fatty layer, I break through the peritoneal fatty layer, that is the mesocolla, and reveal the fatty layer that is the subserosal fascia surrounding the kidney on the left side, but I'm getting my hand underneath the subserosal fascia, I'm fluffing up from behind. Now one thing I've also learned about the peritoneum is that it wraps around the kidney, so that the kidney is under it, but it's also above it in the back, yeah, it's in it in some sense, it's deep to it, but it's circumambulated by it, as I peel, look, I'm peeling peritoneum, so here's what we learned about those vessels.

The vessels are in the peritoneum, but the peritoneum itself is highly vascular, look at that beautiful, is that something, peritoneum, yeah, the fatty layer, and the fibrous layer, or the serous, membranous layer, that's pretty cool, I'm going to break those connections so we can get the bigger picture, oh look, here we have a little window through the subserosal fascia onto the kidney itself, you can see these beautiful vessels, I'll have to look over here, at the right, we have to look for our left adrenal gland, I've just peeled away the peritoneum now, and I can see this change of color, and I'm free to completely adrenal gland, kidney inside of its subserosal fascia body, and then we work our way into the, well we open the subserosal fascia to find the capsule, and then we can open the capsule, I'm pushing the subserosal fascia away from the kidney, pushing, pushing, pushing, and as I do so, I'm conscious that I have the adrenal gland in my hand up here attached to the subserosal fascia, see, our adrenal gland is over here, and its best friend seems to be the subserosal fascia, and then its cousin is the kidney, see how I'm peeling the capsule here, the capsule is over my thumb, I'm pulling at it, and I expose then the parent kind of the kidney, the kidney tissue itself, and there's that incredible little organ so important to our life, and we see then the capsule here, and if we come close to it, you see many little beautiful blood vessels spotting and dotting their way through here. I don't find her subserosal fascia to be inordinately large for her body size, it's important to have fat around her kidney for protection structure, but also I'm suggesting for communication. This capsule, see, is still adhering to the subserosal fascia, they're built into each other, so you have to peel the capsule away from the subserosal fascia, and you have to peel the kidney away from the capsule. Well, a little different, because the heart, say let's pretend this were the heart, the heart is sliding within the parietal pericardium, the visceral pericardium slides against the parietal pericardium, but the kidney tissue does not slide in its capsule, and the capsule doesn't slide in the subserosal fascia, so it is a slightly different arrangement, because you have a heart that's capable of writhing within this two-layered bag of the fibrous and parietal pericardium, so there's a slice there, but the kidney doesn't ride inside of its capsule, or ride in the subserosal fascia, rather the whole group of them together slide up and down with the breath. The uterus and associated structures are viscera-specific to the female form.

In this example, we reflect first the greater omentum and the transverse colon to reveal the underlying array of the small intestines, and upon reflecting the small intestines themselves, we clear the view into the deep pelvic structures. Not every form presents the female generative organs so perfectly, and it is with deep appreciation that I came upon these when in need of a clear and instructive example. With the sigmoid colon reflected as well, the uterine tubes, ovaries, and the uterus itself are all in plain view, with the fimbre of the uterine tubes marking the lateral breadth of the generative organs. Here with the left ovary uterine tube and its fimbre at the center screen, we can appreciate the close positional and ligamentous relationships of these tissues. The preserved ovaries of this elderly woman are perfectly intact.

The uterine tubes have several inches of length extending laterally from the fundus of the uterus, which is draped in the spanning peritoneal covering. Each uterine tube has a frilly top, in the living these fimbre dynamically palpate the ovary to draw the emergent egg through the small opening at their center, thus bringing the egg from the abdominal space in which the ovaries lie into the pelvic space and the uterine interior. The uterus itself demonstrated here is relatively small in the elderly, it's more parasized in the younger woman, the transition of hormonal expression results in the shrinkage of the tissue. Dropping to a deeper dissection of the same form, we can see how her left ovary and fimbre directly overlie the lower abdominal portion of her psoas muscle. The psoas is a famous favorite target for the attention of massage therapists and structural integrators who would do well to be aware that in addition to having the ovarian or testicular veins and the ureter draped across it, there may well be an ovary perched there as well, all of which cry out for caution to the overzealous hand.

You wouldn't want to pin those tissues, it would be to your client's detriment. The ligaments of the ovary like most visceral ligaments are folds or spanning of the peritoneum. The salpingo ovarian ligament is the peritoneal tissue here relating the ovary to the uterine tube. The uterus is positioned between two other pelvic organs, the urinary bladder and the rectum. The urinary bladder lies deflated and buried within its peritoneal and loose areolar coverings between the pubic bones and the uterus.

The rectum curls neatly within the deep pelvic space posterior to the uterus. Not only was this form completely intact in terms of the organic structures, there were also no presenting adhesions. All the tissues were free and mobile relative to each other. The tiny oss of the uterine tube testifies to the near miraculous passage each one of us has undergone to blossom into the fullness and perfection of our human form. Having enjoyed the clarity of shape afforded by the preserved tissues we've just observed, we can have a look at the uterus of the unpreserved tissue to demonstrate some of the sequelae of surgical intervention, adhesion and pathology in pelvic space.

If I scratch around here a bit we'll learn more about the configuration of tissues of this particular body. So I'm going to scratch through here and we see this tautness as I pull right here. See that tautness? Well, we're going to call that the round ligament of the uterus, isn't that nice? The round ligament of the uterus, so it's within the peritoneum.

The uterus is subperitoneal or in the pelvic space so as we create tension on the round ligament it pops up for us. And interestingly if there were a pregnancy here and the uterus became very large then the round ligament would stretch and stretch and stretch on either side like a giant slingshot. Good. So we have the ovary here, ovary is an abdominal organ, the uterus is a pelvic organ and the communication between them happens through the oss of the uterine tube. Now where is that uterine tube and where are those fimbre?

I'm not so sure. The uterine tubes have in fact been surgically removed on both sides and what remains is a bit of scar tissue. With some scratching of my probe I'm able to differentiate the adherent surfaces of the rectum and the body of the uterus which normally have free sliding surfaces as we saw in the preserved form. Having restored the normal relationships here I can demonstrate the so called pouch of Douglas or retro uterine pouch. When I pull back on the uterus the round ligament goes all the way to the labia major.

So I'm going to hook under the round ligament on its side and follow the trajectory of pull as it draws the inguinal canal here. And also yes see I'm tugging you over here the round ligament on this side and this pathway and the round ligament here on this side going through the inguinal canal much like the spermatic cord and grounding into the labia major. So if I scratch through the broad ligament here some more we'll work our way into pelvic space. So I use my probe and draw back the tissues and now I can palpate and feel the cervix the neck of the uterus down this way and the fundus and the body and the neck of the uterus and from behind now we've freed it up quite completely and get a real clear sense of the uterus. Here I'm tractioning the colon and it's pulling up the uterus so we see how these pelvic organs are working together the bladder, the uterus, and the rectum.

So I'm going to pull a little I see a little bit of adhesion here between the ovary and the epiploea like a little brain see it's sulcus and gyri it reminds me of the intestines as well. So what arises from the ovary the egg the pleuropotential cell that's incredible. Wow that's just fantastic what a treat if I palpate I don't feel the texture of an ovary I feel this bubble and perhaps the bubble is the ovary and the tissues have dissolved into it but I also don't see the fimbri or the uterine tubes I'll see the fundus and body of the uterus the round ligament on the left the round ligament on the right a cyst on the right an ovary on the left what an incredible array of tissues. Continuing our own journey here we will now enter layer by layer into thoracic space. The visceral pleura is adhering to the parietal pleura is that true or is that just the arching portion it doesn't seem to have a free talk does it see so I'm going to have to do a little tugging there we see there is a normal continuity but this seemed to be adhering and I'm going to have to peel it away peeling away the long from the pleura so now it's free see the difference you see how there was material connecting the parietal pleura and the visceral pleura and that will make for a limitation on the movement of the lung this long is very free now here's a little adhesion see there's a little adhesion of the lung see if I that should be a free sliding aspect right so I have to it's got some strength to it huh there we go now it's a free so that one is free and meanwhile I'm going to differentiate the lung because it's completely adhered on this left side so I don't know how long it's been like that I'm going to guess a while but see how I can release them and we're releasing this is the medius stinal pleura see it's running up the middle and here's the visceral pleura the lung so I'm differentiating these two aspects of the pleura which are normally sliding surfaces but they become stuck together this entire surface would normally be sliding here it's stuck visceral pleura medius stinal pleura and I'm separating them because they're adherent in this form although they're normally sliding surfaces and when I do that and I sort of slowly release the lung from the central structures and look it's also adherent down here to the diaphragm this whole lung is adhered in all sorts of ways and I'm freeing up these adhesions with my hands call this blunt dissection as I just you run my finger through here to create freedom where there wouldn't normally be freedom so now we see the top of the diaphragm on this side having moved the lung out of the way and then the top of the diaphragm on this side so look now we have a clear sense of all the abdominal contents and how high up they come now what's this it seems like a fatty body in the central portion of the thorax and people often say at this point where's the thymus and I indicate these lobular fatty bodies right here and say well that's the remnant of the thymus right here these lobules where fatty substance has displaced over time the thymic tissue which was at its largest when she was about five years old so where's the heart we have our lungs we're in the thorax we're above the diaphragm it must be deep to some of this loose aerial or fascia that's surrounding it and I can use my fingers and open that loose fascia I'll reveal the fibrous wrappings of the heart it's incredible huh so soft and we all have a little fatty deposition around our heart we remember she was large in her abdomen but this isn't very much fat here just a little filmy fascia a little fatty filmy fascia and now we see this organ inside my gosh the fibrous pericardium is translucent we can see right through it is that incredible holy cow when they're in the embalmed tissue you normally can't see right you can't see through there it's it's opaque and it's dried but here it's translucent and I can see the heart and imagine its motion this fibrous pericardium the wrapping here around the heart is continuous with the diaphragm and at this point they are a common fabric look I'm pulling on the diaphragm I'm pulling on the fibrous pericardium every beat of your heart and every motion of the diaphragm constitute a common motion my colleagues and I were overwhelmed by the sheer beauty of seeing the breath fill the lungs as we created these images having freed the presenting adhesions the air induces the spiraling motions native to the living organs even without the action of the diaphragm in play the heart is lifted upon the inflating pillows of the lungs because the breath is introduced from without and the lung movements are not contained as they normally are by the bony ribbasket the internal massage of the heart induced by a full inhalation would involve a contact even more thoroughgoing than we are now witnessing not to mention the downward motion induced by the added action of the diaphragm seeing these movements bring me to a level of heightened awareness with respect to the movements within me even in this moment and I hope they do the same for you some 20,000 times a day we breathe and are so moved the quality of the motion induced by the breath is dependent upon a host of factors not least of which is one's emotional state to the extent that we hold our breath through chronic posturing of body and personality and in so doing brace ourselves against the natural movement of life within us we limit every advantage freely afforded us by our ever-present breath and the cascades of physiological benefit which come to us as a result of healthy inspiration our health is built one breath at a time here we see the direct effect of the inflation of the lungs as they gently displaced the liver as with the heart the normal motion of the liver occurs both through the shortening of the fibers of the respiratory diaphragm as well as through the simultaneous filling of the lungs whose expansion naturally displaces the surrounding tissues the liver cannot help but move and then its movements are as a matter of course translated further through every tissue proximate to it so we've seen our incredible gorgeous motion of the lungs the breath and as we reflect them backwards we'll expose our mediastinal structures in the heart space so gently bring our lungs back and see this intimate relationship of heart and liver of lungs and heart and then we tease back this covering this loose aerial or fascia and see this sack this is a double layered sack it's the fibrous pericardium on the outer surface and then on the inner surface it's the parietal pericardium so I'm going to open up this space and expose the surface of the heart see how I introduced air in there opening up the fibrous pericardium it's very thin double sack fibrous pericardium and the serous layer the parietal pericardium and we'll create a window into the heart space beautiful it's an incredible place the heart space oh my gosh it's so beautiful I'm gonna go up a little higher here now we see a beautiful center of motion the heart arriving within our chest soft it's a supple organ it's incredibly soft and tender and we see windows on the heart musculature through the visceral pericardium the skin of the heart which has fat embedded in it the fat surrounding the cardiac arteries as they wind their way to the heart musculature so this inner surface of the sack around the heart would be the parietal pericardium and then this surface is the visceral pericardium and we see some of these immediate features the oracle on the right side the heart's orientation as it is in the chest here we have the right atrium the right ventricle is centrally oriented and the left ventricle is on the left side so where's the left atrium it's in the back so that the vessels from the lungs are feeding the heart from behind like this and if we just place the heart upwards we can see that pathway of the venous return and here we have the venous return coming from low down from the liver we have the vena cava vena cava right here vena cava draining the lower part of the body and then we'll have that's the inferior vena cava and then we'll have the superior vena cava right here superior vena cava from above and the inferior vena cava from below draining the blood into the right atrium to the right ventricle out the pulmonary trunk to the lungs back to the venous drainage of the lungs bringing the oxygenated blood into the left atrium and down to the left ventricle and out the aorta so where is the aorta it's in the middle right here the aorta is this large vessel here it's deflated it's very large if I disrupt the tissue a little bit I can actually get my finger around it and you see the breadth of the aorta coming and arcing out of the top of the heart here in this great crazy straw of motion that is this central place where the blood spins itself yeah look at that aorta it's tremendous huh it's broad and of course it's deflated now but it's a cylindrical shape it's bigger than my garden hose and here we can follow isn't this interesting you can follow the the bag across underneath here as it comes out over to this side and we have this the space that we've opened so now we can tuck that away and see the lungs in relationship to the heart out of its sack and see how every motion of breath implies itself into the heart space and every motion of the heart generates an impact a percussive motion on the liver beating through the hollow space of the stomach and echoing its waves reiterating into the very form of the rib cage they're like waves in a puddle echoing out from this heart space my fingers are the ribs the wave forms leaving this heart space and communicating into the space around us our very feelings pulmonary trunk the aorta and the superior vena column these three major major vessels the heart itself very beautiful on the inside and on the outside look at these incredible vessels here those branches have we seen that somewhere else sure just look out the window a plane and you'll see the rivers and streams down below as you pass over where you see the very shape of the mountains you see the mountain ridge and then the ridge is coming off the mountains the mountains themselves are like rivers on our planet so incredible because the water runs from the top down the bottom and carves up the mountains and leaves these very identical impressions as these vessels in our bodies which are nothing more than the life of water on our planet moving through us and here they're feeding the heart now when we see the heart so soft and supple I hope it intrudes a little bit upon our descriptions of the heart as a pump when have you ever seen a pump that had this quality it just adds to my my appreciation of the incredible dynamic spiraling motion of the blood when I see how flexible a central place it moves through right so there's no rigidity here in the nature of the form if there's rigidity it's from the way we hold ourselves but the nature of the form itself is completely motion capable fluid thank you fluid that's it this is a place of fluid motion and I get it I can feel it in my hands what a fantastic place for fluid to move through it's just never felt anything like it is with deepest respect and appreciation for my hosts my mentors the donors and their families that I bring this tour of the viscera and their fascia to a close the somanaut exploring integral anatomy will find no end to the journey once begun it is as deep as the universe is wide and no less profound thank you for joining me and do let me know where it brings you