ANATOMY PRACTICAL SESSION 13

GROSS ANATOMY VIRTUAL TABLE CONFERENCE

STUDENT-CENTRED INTERACTIVE STUDY ON THE
DIGESTIVE SYSTEM
Please read through these QUESTIONS carefully and write all your answers on the
worksheets. Please use your atlases, videos, text books, and lecture notes. This
is a good opportunity for interactive learning - Confer with your neighbours/colleagues!
Please maintain your small groups of 10/9/8/7/6/5. At the end of the table conference,
write your names individually and sign against your names on the last page. Please
photocopy your worksheets and submit the original copy to the Instructor/Demonstrator.
Please sign the submission book when you submit your work.

Learning objectives
• Comprehend the divisions of the abdominopelvic cavity
• Identify the surface landmarks of the anterior abdominal wall
• Comprehend the layers and general features of anterior-lateral abdominal
wall.
• Comprehend the general features of the superficial fascia (subcutaneous
layer)
• Comprehend the Rectus sheath and its contents
• Define the innervation, blood supply, and lymphatic drainage of the anterior
abdominal wall.
• Understand the anatomical basis of abdominal incisions. Describe the tissue
layers through which the incision is made.
• Identify the anatomical landmarks on the deep surface of the anterior
abdominal wall and their relationships to the types of inguinal hernias
• Describe the muscles of the posterior abdominal wall
• Comprehend the peritoneal cavity and its various
compartments
(subdivisions).
• Relate peritoneal recesses, folds and fossae to collection and spread of fluid in
the peritoneal cavity.
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• ANTERIOR ABDOMINAL WALL
1. Identify the following regions of the abdomen in specimen I:

Specimen I

2. What is the clinical significance of the division of the abdomen

into regions?

3. Which planes are used for the 9 regions division?

4. List the organs/structures that are crossed by the transpyloric

plane.

5. Identify the layers of the anterior abdominal wall in specimen II:

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 a
d

Specimen II

6. Identify the labels in specimen III

Specimen III
d c b
The Scarpa (membranous layer) fascia:
a) continues over the pubis and perineum as the Colles’ fascia (Superficial
perineal fascia)

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 b) continues over the penis as the superficial fascia of the
penis and over the scrotum as the dartos muscle

7. What is the surgical importance of the two layers of

subcutaneous tissue of the anterior abdominal wall?

8. State the origin and insertion of each of the anterior-lateral

abdominal wall muscles

9. Describe the orientation of the muscular and aponeurotic part of

each of the anterior-lateral abdominal wall muscles

10. Identify the labels in specimens IV - VIII

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 c
d
a
e

Specimen IV

a
b
c
d

f
c

Specimen V Specimen VI
b
a

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 a

Specimen VII

Specimen VIII

11. What is the name and the content of the triangle in specimen
VIII above?

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 12. Discuss the advantage and disadvantage of making each of
these abdominal incision a. Midline incision
b. Paramedian incision
c. Lanz incision, Gridiron incision, McBurney's
incision
d. Right Subcostal Incision (Kocher's) incision
i. Chevron / Rooftop (double Kocker's) incision ii.
Mercedes Benz incision
e. Pfannenstiel incision
f. Transverse muscle-splitting incision
g. Oblique muscle-cutting (Rutherford Morrison's)
incision
h. Battle incision
i. Maylard Transverse Muscle cutting Incision
j. Lumbar incision

Note that the specific surgical incision will depend on the underlying pathology, site, patient
factors, and the surgeon 's preference and experience. The key principles of making surgical
incisions are (1) Incisions should try to follow Langer's lines where possible —for maximal
wound strength with minimal scarring. (2) Muscles should be split and not cut (where
possible).

• Anatomical basis of Direct and Indirect Inguinal hernia.

13. How are the two hernias related to the inferior epigastric vessels?

14. Which type of inguinal hernia

i. is congenital and which is acquired? ii.
passes through the inguinal triangle? iii.
often enters the scrotum?
iv. passes through the deep inguinal ring v.
is commonest

15. What is the embryological origin of the median umbilical ligament?

16. What is the embryological origin of the medial umbilical ligament?

17. What is the content of lateral umbilical fold?

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 18. What are the relationships of the medial inguinal fossa and lateral
inguinal fossa to the inguinal triangle and the deep inguinal ring?

Posterior abdominal wall

1. Identify the muscles of the posterior abdominal wall in specimen IX

iii

i iv
v

ii

Specimen IX

• Peritoneal Cavity

A potential space between the visceral and parietal peritoneum.

19. What is the difference between the innervations of the
visceral and parietal peritoneum?

Note that the peritoneal cavity is closed in males but open in females .
20. List some examples of intraperitoneal and retroperitoneal
organs.

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 21. What are primary and secondary retroperitoneal organs?
Give an
example each.

The subdivisions of the Peritoneal Cavity.

The peritoneal cavity is divided into greater sac and lesser sac. The two communicates via epiploic
(omental) foramen (of Winslow). The greater sac is divided into supra- and infracolic compartments by
the transverse colon and mesocolon.

22. Describe the boundaries of the omental foramen?

The root of the mesentery of the small intestine divides the infracolic/inframesocolic compartment into
right infracolic compartment and the left infracolic compartment.

23. Which compartment communicates with the pelvic cavity?

24. The left paracolic gutter is limited above by a small

transverse fold of peritoneum, called…………………….
a. Lesser sac (omental bursa) – The lesser sac or omental bursa is a subsection or a
diverticulum of the greater sac behind the stomach.
25. Describe the boundaries of the lesser sac.

26. List the structures located on the floor of the stomach bed

27. Surgically, how can one enter the lesser sac?

28. What is the significance of the right subhepatic

space/hepatorenal pouch (of Morrison)?

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 Modifications Of The Peritoneum
1. Ligaments:
29. (a) Which ligaments support the liver
(b) What is the embryological origin of the round ligament of
the liver?

30. What are the contents of gastrosplenic (gastrolienal) and

splenorenal (lienorenal)?

2. Mesentery and mesocolon: mesentery of small intestines, transverse mesocolon,

sigmoid mesocolon, mesoappendix. Note the vessels contained in the two-fold
peritoneum.

3. Omentum: greater omentum (gastrocolic, gastrosplenic, splenorenal and

gastrophrenic) and lesser omentum (Hepatogastric and hepatoduodenal
ligaments).

31. List the structures contained in the hepatoduodenal

ligament. Note their relations.

4. Recess/fossae: superior and inferior duodenal recesses, superior and inferior

iliocaecal recesses, intersigmoid recess, rectovesical pouch (in males),
vesicouterine pouch and rectouterine pouches (of Douglas) in females.

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 32. Identify the labels in specimens X and XI

Specimen X

Specimen XI

Clinical Correlations
Briefly define the following
a. Spread of infections
b. Abdominal paracentesis
c. Pringle manoeuvre
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d. Peritoneovenous shunt (PVS) (Denver Shunt)
e. Ventriculoperitoneal shunt
f. Subphrenic abscesses
g. Ascites
h. Peritonitis

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