SA Approach to the Abdomen

Question 1

linea alba

Answer 1

the convergence of the fibers of the tendinous aponeurosis of 3 muscles at midline

best visualized at the umbilicus

Question 2

what muscle tendons make up the linea alba

Answer 2

• external abdominal obliques
• internal abdominal obliques
• transverse abdominis

Question 3

rectus abdominis

Answer 3

most external muscle of the abdominal wall

NOT part of the linea alba
- located slightly off midline
- will cut into this muscle if incision strays off midline

Question 4

falciform ligament

Answer 4

fatty ligament that is attached to the linea internally

use scissors to detach from the body wall during explore

Question 5

what are the landmarks for abdominal exploration incision

Answer 5

cranial: xiphoid process
caudal: pelvic inlet

Question 6

what are the two techniques to make the midline incision

Answer 6

• stab incision: poking through the linea
• paint stokes: cut using multiple strokes along the linea until you pop into the abdomen

Question 7

male vs female midline incision

Answer 7

female: straight down midline for entire incision

male: incise to the right of midline once you reach the prepuce –> cut through the preputialis muscle –> undermine the tissue deep to the preputialis to return to midline

Question 8

what type of retractor is best for holding apart the body wall

Answer 8

self retaining retractors (Balfour)

Question 9

what are the layers of closure after an abdominal explore

Answer 9

3-4 layers

1. linea alba
2. subcutaneous tissue
3. skin

Question 10

what is the holding layer of the midline incision

Answer 10

ventral sheath of the linea alba

MUST include in closure

Question 11

what type of suture should be used to close the midline incision

Answer 11

monofilament
absorbable
continuous or interrupted

Question 12

what order should abdominal organs be evaluated

Answer 12

1. diaphragm
2. liver
3. gallbladder
4. omentum
5. GIT (oral –> aboral)
6. urinary tract
7. reproductive tract
8. spleen