Ant.

Abdominal wall 9 regions of antero-lateral wall

5 muscles `describe the location of abdominal organs and pains

`flat

`ext. oblique

`int. oblique

`transverse abdominal

(end anteriorly in RECTUS SHEATH [strong sheath like

aponeurosis])

`vertical

`rectus abdominis

`pyramidalis

4 planes

Horizontal

`Sub-costal (10th)

`Trans tubercules (L5)

Vertical

`both midclavicular

Physical examination

Position: crook lying

Give?

`inspection

Nerve supply (sensory + motor) `palpations

`thoracoabdominal nerve (inf. Intercostal [T7-11]) `percussion

`sub-costal nerve (T12) `auscultation

`ilio-hypogastric & ilioinguinal nerves (L1) Functions

`form strong expandable support

Blood supply `protect abdominal viscera from injury

`compress abdominal content

`help maintain or increase intraabdominal pressure

`move trunk and help to maintain posture

Protuberance of abdomen common causes

5F

`fat

`faeces
`fetus Posterior abdominal wall

`flatus 胀气 Composition

`fluid `5 Lumbar vert. and IV discs

Abdominal hernia `Post abdominal wall muscles (psoas, iliacus,

quadratus lumborum, transverse abdominis, ext.
`inguinal (might go into scrotum)
oblique, int. oblique.

`Lumbar plexus (ventral rami of lumbar spinal nerves)

`fascia (thoracolumbar fascia)

`diaphragm (superior part of the wall)

`fat, nerves, vessel (IVC, aorta) and lymph nodes

Main muscles

Psoas major, iliacus, quadratus lumborum

Nerves

`umbilical Somatic

`subcostal

`lumbar

` lumbar plexus

`obturator (L2-4)

`femoral (L2-4)

`ilioinguinal (L1)

`iliohypogastic (L1)

`genitofemoral (L1-2)

`lateral femoral cutaneous (L2-3)

Autonomic

`consist of one cranial nerve ( vagus)

`epigastric
`and several different splanchnic nerves that deliver
presynaptic sympathizer and parasympathetic fibers
to the plexus and sympathetic ganglia.

Arteries

Abdominal aorta and branches

Veins

`Triturates of IVC
Anatomy of abdominal incision

Definition `vertical abdominal

Incision is a cut made with knife for surgical purposes. `transverse abdominal

Type `oblique abdominal

`abdominothoracic

Cardiothoracic incision

1. Median sternotomy
`Open heart surgery (valve replacement,
CABG, cardiac transplantation)

2. Pacemaker incision (horizontal, oblique and

deltopectoral)
`Utilised in pacemaker insertion, 4-5cm in left
infraclavicular region

Thoracotomy
Use to access the pleural space. 3 subtypes

3. Posterolateral incision
Gold standard, mainly for pulmonary
resection (pneumonectomy, lobectomy),
chest wall resection, oesophageal surgery

4. Anterolateral incision
Can use in cardiac, pulmonary and
oesophageal pathology

5. Axillary incision
Muscle sparing approach to thoracic cavity,
used for pneumonectomy or pneumothorax
operations.
Applied anatomy Anatomy of abdominal hernia orifices

`abdominal cavity can be approached through Definition

numerous incisions (only correct diagnosis enables
Protrusion of an organ through its containing wall.
the surgeon to choose correct incision)
Causes
`pre-operative diagnosis is reasonably certain the
incision may be chosen with confidence Weakness in the wall
当诊断确认 选 incision 就可以很自信 ` normal weakness found in everyone and related to
anatomy of the area e.g., place where vessel or
` laparotomy for undiagnosed abdominal disease is
viscus enters or leaves the abdomen.
most usefully approached through vertical incision
equidistant above and below the umbilicus and once ` abnormal weakness caused by congenital
the diagnosis confirmed. The incision may be abnormality or acquired as result of trauma or
enlarged in an upward or downward direction diseases.
Factor for choice of incision Common site of abdominal hernia
`organs to be investigated `inguinal
`type of surgery to be preformed `umbilical
`Whether speed is an essential consideration `femoral
`build of the patient `incisional
`degree of obesity LESS COMMON
`presence of previous abdominal incisions `epigastric

`recurrent
Closure of abdominal incision (no ideal method)

should be free from complications

`Burst abdomen

`Incisional hernia

`Persistent sinuses

`Should be comfortable to the patient

`Should leave reasonably good scar

Incisional Hernia
`Protrusion of omentum or organ through
surgical incision.

`When muscles and aponeurotic layers of the

abdomen doesn’t heal properly an incisional
hernia can result. Features
`Infection, bowel obstruction and obesity are `occur at weak spot
predisposing factors to incisional hernia
`reduce on lying down or with direct pressure

`expansile cough impulse