Anterior Abdominal Wall, Diaphragm, Peritoneal Cavity

Question 0

Layers of AAW

Answer 0

Skin
Superficial fascia - Camper’s, Scarpa’s (recognizable in hernia and appendix operations)
Deep fascia
Muscles
Transversalis fascia
Extraperitoneal fat
Peritoneum (once transversed, already in the abdominal cavity)

Question 1

Planes and Regions of AAW

Know the regions!

Answer 1

Subcostal plane L3

Transtubercular plane L5

Question 2

Muscles of AAW

Answer 2

External oblique: most superficial muscle; inferomedial, covers rectus abdominis (aponeurotic)
, forms anterior sheath only
Internal oblique: Superomedial, forms anterior and posterior sheath
Transverse abdominis: horizontal direction, forms posterior and anterior rectus sheath

Question 3

Rectus abdominis

Answer 3

Vertical direction
Medial - linea alba
Lateral - line semilunaris
There is a rectus sheath

Question 4

Rectus sheath

Answer 4

Aponeurosis of 3 muscles
Incomplete compartment
Posterior wall: inferiorly ends as arcuate line or linea semicircularis

Question 5

Innervation

Answer 5

Ventral rami: T5-T12

Ventral ramus of L1: iliohypogastric, ilioinguinal

Question 6

Blood supply

Answer 6

Superior epigastric
Inferior epigastric
Deep circumflex iliac
Musculophrenic
Posterior intercostal
Subcostal
Lumbar

Question 7

Inguinal region

Answer 7

Inherent weakness
Inferior part of AAW
Inguinal trigone: between internal and external rings is the inguinal canal (4cm diagonal canal), transversalis fascia
Site of hernias

Question 8

Hernias of infants

How do they have?

Answer 8

Nahihila ang peritoneum towards the inguinal region
What is this called? (Procesus vaginalis?)
Effect: intestines and omentum can go to the scrotum

Question 9

Spermatic cord

Answer 9

Spermatic cord coverings
Internal spermatic fascia
Cremaster muscle
External spermatic fascia

Question 10

Indirect vs direct hernias

Answer 10

Adult hernias: usually direct, diretso ang pag-protrude

Infant hernias: indirect, pass through internal ring to canal to scrotum

Question 11

Diaphragm: has apertures

Answer 11

IVC foramen: right phrenic nerve pierces it directly
Esophageal hiatus: T10, esophagus, vagal trunks
Aortic hiatus: T12, thoracic duct, lymph trunks, azygos vein
Sternocostal hiatus

Question 12

Innervation

Answer 12

Phrenic nerve : C3, 4, 5

Question 13

Peritoneal Cavity

Answer 13

Lined by peritoneum-parietal & visceral
Obliterated by organs-potential space
Intraperitoneal vs retroperitoneal organs
Retroperitoneal in the GT: duodenum and pancreas
Mesentery=mobility (appendix and small intestines)
Divisions-greater sac and lesser sac (insert index finger near hepatoinguinal ligament, gallbladder)

Question 14

Upper GIT (supracolic compartment)

Answer 14

Stomach
Liver
Spleen
Duodenum

Question 15

Morrison’s pouch

Answer 15

Hepatorenal recess

Question 16

Pouch of Douglas

Answer 16

Rectouterine pouch

Where excess fluid accumulates (e.g. ectopic pregnancy)

Question 17

Peritoneum

Answer 17

Mesentery
Mesocolon
Lessr omentum : primitive ventral mesentery
Greater omentum: know 3 parts
Ligaments
Peritoneal folds

Question 18

Pringle’s maneuver

Answer 18

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