Principles of abdominal anatomy
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Lecture given on 12 Oct 2010 by Dr Vooght and Dr Banigo to Surgical Scousers.
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Principles of abdominal anatomy
- 1. Anatomy of Abdomen- GI tract Adonye Banigo & Abigail Vooght, Oct 2010
- 6. Surface Markings Linea Alba Linea semilunaris Tendinous intersections (3)
- 7. Landmarks Xiphisternum T9 Iliac crest Costal Margin Umbilicus L3/4
- 8. 9 regions Midclavicular line
- 9. 9 regions Midclavicular line Transpyloric plane (L1) Transtubercular plane (L4/5)
- 10. 9 regions Umbilical Suprapubic Epigastric
- 11. 9 regions Lumbar Iliac Fossae Hypochondrium
- 15. Abdo wall- Layers Medially Costal Margin Arcuate line (of Douglas)
- 17. 1) External oblique aponeurosis, 2) Internal oblique muscle, 3) Transversus abdominis muscle, 4) Endo abdominal fascia, 5) Internal inguinal ring, 6) Iliopubic tract, 7) Inguinal ligament, 8) Pubic symphisis, 9) Spermatic cord, 10) Interparietal connective tissue (cremasteric fascia), 11) cremasteric muscle, 12) Aponeurotic layer of posterior inguinal wall, 13) Fascial layer of posterior inguinal wall
- 18. Inguinal Canal- conceptual- from above Extenal Oblique Aponeurosis Transversalis fascia ASIS Pubic Tubercle Posterior Anterior Conjoint Tendon Internal Oblique
- 24. Abdo wall nerve supply 7 8 9 10 11 12-s/c L1-i/h L1-i/i
- 25. Abdo Wall Arterial Supply
- 27. Abdominal Incisions- access vs healing Midline Paramedian Pfannenstiel Subcostal (Kochers) Gridiron Muscle split
- 28. The Abdominal Cavity Viscera + peritoneum Peritoneal Cavity
- 32. Whistlestop tour of gut
- 33. Stomach
- 34. Duodenum
- 35. Jejenum
- 36. Ileum
- 37. Caecum
- 38. Large Bowel
- 39. Rectum & Anus
- 40. Embryology of gut- 6/40 Midgut Foregut Hindgut Posterior abdo wall Mesentery (ventral) Mesentery (dorsal)
- 42. Rotation of foregut Midgut Foregut Hindgut Mesentery (ventral) Mesentery (dorsal) liver Spleen
- 43. Foregut rotation 2 Greater sac Lesser sac
- 45. Midgut rotation 6-10/40 Rotation occurs around the axis of the SMA on a single mesentery, “the mesentery”
- 47. Peritoneal Attachments Bare area of liver Lesser sac Epiploic foramen Greater sac
- 49. Any Questions? ?
Editor's Notes
- II nerve enters canal from the side (pierces internal oblique), leaves through superficial ring, supplies skin over inguinal region, upper part of thigh, root of penis, anterior third of scrotum
- Midline- linea alba, bloodless plane, good for rapid access. ?weak since less vascular Paramedian 1 inch from midline. Rectus sheath opened, rectus displaced laterally, posterios sheath and peritoneum incised. On closing, peritoneal sutures covered by rectus muscle, strengthens peritoneal scar.It can be extended upwards into 8 th /9 th incostal space (thoracoabdominal incision), thereby extensive access to upper abdomen & thorax Transrectus-same as paramedian but rectus not reflected, instead cut. Laterally-derived blood and nerve supply disrupted. Kochers- R side biliary surgery, L side spleen. 8 th intercostal nerve sacrificed, 9 th preserved Transverse muscle-split incision (starts 1inch above ASIS) preferred generally, in line with skin creases, adequate access with muscles split not cut Pfallenstiel- used for pelvic access
- Mobility and Stability required for propelling large volumes of food, fluid, gas Alternate segments lost their mesentery and became secured for stability, thereby secondary retro peritoneal, therefore lying directly on top of primary retroperitoneal structures. Other sections are mobile to distend and alter their relative position (mobility).
- Serous membrane- single layer flat cells, secrete fluid to minimise friction
- Abdo cavity consists of abdo viscera (with peritoneum) and peritoneal cavity Both of utmost importance to surgeon, the cavity to plan safe planes of dissection. Entire GI tract develops on dorsal mesentery. Foregut also has a ventral mesentery, attaching it to anterior abdo wall
- Abdo cavity consists of abdo viscera (with peritoneum) and peritoneal cavity Both of utmost importance to surgeon, the cavity to plan safe planes of dissection. Entire GI tract develops on dorsal mesentery. Foregut also has a ventral mesentery, attaching it to anterior abdo wall