ANATOMY important points from ABDOMEN

By
DR NAVEED AHMED PANHWAR
• Posterior border of external oblique is free while that of IO and transverses
abdom en is attached to vertebra by lum ber fascia
• Conjoined tendon has lateral free m arg in
• Rectus sheath: contents are 2 m uscles, lower 6 thoracic nerves, sup and inf
epig atric vessels, lym phatics. Above the costal m arg in the anterior wall of rectus
sheath is form ed by apponeurosis of EXTERNAL OBLIQUE and The posterior wall is
form ed by thoracic wall.
• Anterior wall of rectus sheath is firm ly attached to rectus abdom inis by tendinous
sheath but posterior wall is not attached to the m uscle.
• Hem atom a of rectus sheath occurs m ost frequently on Rig ht side and from inf
epig astric vein
• Dartos m uscle is sm ooth m uscle
• In the newborn the ing uinal canal is shorter(not absent)
• Pam piniform venous plexus becom es sing le vein at the level of deep ring
• Testes take their final position in the scrotum by the end of 8th m onth
• Abdom inal vessels lie within the fascial lining of abdom inal wall while m ain
nerves lie outside the fascial lining .fem oral sheath is extension of this adom inal
lining so fascial nerve lies outside it.
• Strang ulation is com m on problem in these hernias
a. Indirect ing uinal,
b. Fem oral
c. Paraum blical
d. Spig elion hernia
e. Internal hernia
• Others abdom inal hernia have less chances of strang ulation
• Spig elian hernia: hernia of linea sem iluneris. It occurs thru apponeurosis of
transverses abdom inis just lateral to lateral edg e of rectus abdom inis
• Transpyloric plane: (L1) pyloris of stom ach, duodenojejunal junction, neck of
pancrease, hila of kidney, fundus of g all blader, first part o duodenum
• Rig ht kidney can be palpated but not the left one
• Structures that can easily be palpated
a. Rig ht kidney
b. Ascending and descending colon
c. Cecum
d. Aorta
• Spleen lies along the long axis of left 10th rib
• Peritoneal fluid is produced by peritoneum and is absorbed by subperitoneal
lym phatics
• Whatever the position of body the peritoneal fluid m oves towards diaphrag m
above in norm al persons. Inflam ed fluid follows the g ravity
• Inferior m esenteric vein lies at anterior wall of paraduodinal recess
• In Partial g astrectom y the g astrin bearing ANTRUM is rem oved
• Anterior wall ulcers of stom ach: perforation g oes to g reater sacrig ht lateral
paracolic g utter rig ht iliac fossa and it adheres to liver
• Posterior wall ulcers of stom ach erode splenic artery
• Sm all bowel contents have norm al pH and produce little or no irritation of
peritoneum
• Cecum is com pletely covered by peritoneum but has no m esentry
• Most com m on intussuption are iliocolic
• Lig am ent of treitz is fibrom uscular structure and is rem nant of dorsal m esentry
• Rig ht and left g astric vein and cystic vein drain directly to portal vein
• Paraum blical vein connects the LEFT branch of portal vein to veins of anterior
abdom inal veins
• Rig ht lobe of liver receives blood m ostly form intestine. Left lobe, caudate and
quadrate lobe receive blood from stom ach and spleen. This explains the
distribution of secondry m alig nant deposits in liver
• Left vag us g ives a direct branch to liver which donot pass thru celiac plexus
• Liver Is m ainly supported by hepatic veins.. peritoneal lig am ents and tone of
abdom inal wall play a m inor role
• Gang rene of g all blader is a rare phenom enon coz instead of cystic artery it also
receives blood from vessels from the surface of liver
• Structures having direct contact to kidneys without peritoneum : Left side
duodenum , colon, suprarenal. Rig ht side pancrease, suprarenal, colon
• Renal transplant: iliac fossa in the posterior abdom inal wall is the site. Renal
artery is anastom osed end to end to internal iliac and renal vein is anatom osed
end to side with external iliac.
• Rig ht suprarenal is pyram idal and left is cresenteric
Credit Goes to Dr Usm an Siddique....