04-11-12 Abdominopelvic cavity_ peritoneum_ stomach_ spleen and by linzhengnd


									04-11-12 Abdominopelvic cavity, peritoneum, stomach, spleen and surgical correlations

   •   Falciform ligament
   •   Round ligament of liver (ligamentum teres)
   •   Inferior epigastric artery and vein lead up to umbilicus
   •   Round ligament (ligamentum teres) comes from umbilicus
   •   Falciform ligament attaches to ligamentum teres and separates the left and right lobes of
       the liver
   •   Greater omentum = apron of fat
   •   Things to know about abdominal organs
           o Name
           o Size
           o Weight
           o Source of nutrients
                       Blood supply and venous drainage
           o Embriology
           o Vulnerability to disease
           o Neighboring structures
                       Helps in knowing what would be vulnerable to carcinoma
           o Intraperitoneal organ
                       Include: check email from Dr. Davies
                       Located in peritoneal cavity
                       Surrounded by visceral peritoneal surrounding
                       Connected to body wall by mesentery
                           • Is a generic term (also called ‘omentum’)
                                   o Also refers specifically to that surrounding the small
                           • = two layers of mesothelium surrounding blood supply and
                               drainage, lymph drainage, and autonomic nerves
           o Retroperitoneal organ
                       Includes: check email from Dr. Davies
                       Not up on mesentery
                       Have blood supply, lymph drainage, innervation comes from underneath
   •   Sagittal section
           o Small intestine are all suspended from wall by mesentery of small intestine
           o Lesser omentum suspends the stomach from the liver
   •   N336
           o Lowest level of diaphragm attachment = T12
           o Liver on right
           o Falciform ligament holding liver to body wall
           o Spleen attached to stomach by gastrosplenic ligament
                       Attached to left kidney by splenrenal ligament
   •   N 261
           o Greater omentum
           o Attached to greater curvature of the stomach (the lower curve)
   •   N 263
          o   Ileum empties into colon
          o   Colon attached to vermiform appendix
          o   Assending colon become retroperitoneal
          o   Right colic flexure = hepatic flexure
          o   Left colic flexure = splenic flexure
          o   Characteristics
                     Tenia coli = Longitudinal muscles
   •   N 267
           o Stomach
                       Learn terminology of various areas
                       Fundus is at top of body
                       Esophagus enters at T10
           o Gall bladder
                       Underneath liver
                       Has fundus
           o Stomach goes to duodenum
                       Is intraperitoneal
                       At T11
   •   N 264
           o Find lesser peritoneal sac
                       Is underneath stomach
   •   N 280
           o Omental foramen (
   •   Spleen
           o Has diaphragmatic surface
           o Hilar side is opposite
           o Has renal impression, gastric impression, splenic flexor of the colon
   •   Transversalis fascia
           o Endoabdominal fat
   •   Peritoneum
   •   Greater omentum
   •   Greater peritoneal sac
   •   Male vs. female
           o In male = peritoneal cavity is completely enclosed
           o In female = infections can spread up from pelvic region
   •   Cut costal cartilages
   •   Falciform ligament
   •   Adhesions
           o After surgery
           o Inflammation
           o Cancer

Dr. Jensen’s part
    • Insiscional hernia
           o Abdominal wall defect thru with something comes
           o Occurs frequently when surgical incision along linea alba doesn’t heal properly
       o Fix
                  Define space between peritoneum and muscles – insert a mesh
                      • Muscles grow into mesh and is infection resistant
                      • Sutures go thru the rectus abdominus
•   Blunt trauma to the back
       o Common splenic injury
•   Puncture trauma to abdomen
       o Most commonly injured is the small intestine
       o Most common solid organ injured is the liver

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