[SURG 2] M.06 Abdominal wall, Omentum, and Mesentery (copy)

Abdominal Wall Function

Provides protection of intra-abdominal retroperitoneal organs and assists in torso movement and raising intra-abdominal pressure.

Intraperitoneal

Inside the peritoneum.

Retroperitoneal

Outside the peritoneum, usually at the back.

Embryology

The study of the development of an organism from fertilization to birth.

Anatomy

The study of the structure of organisms and their parts.

Mesodermal

Originating from the mesoderm, one of the three primary germ layers in embryonic development.

Rectus Abdominis

Longitudinally oriented muscles in the anterior abdominal wall.

Linea Alba

The midline fusion of the rectus abdominis muscles.

External Oblique Muscle (EOM)

Muscle that runs inferiorly and medially, originating from the latissimus dorsi, serratus anterior, and iliac crest.

Internal Oblique Muscle (IOM)

Muscle that lies deep to the EOM and arises from the lateral aspect of the inguinal ligament, iliac crest, and thoracolumbar fascia.

Transversus Abdominis

The deepest of the three lateral muscles, running transversely from the lowest six ribs, lumbosacral fascia, and iliac crest to the lateral border of the rectus abdominis.

Arcuate Line/Semicircular Line of Douglas

A line that lies roughly at the level of the anterior iliac spine.

Fascia

A sheet of connective tissue that surrounds and supports muscles and organs.

Fascia Transversalis

The fascia located between the transversus abdominis muscle and the peritoneum.

Extraperitoneal Fascia

The fascia located outside the peritoneum.

Parietal Peritoneum

The layer of the peritoneum that lines the abdominal wall.

Blood Supply

Supplied by branches of the superior and inferior epigastric arteries, as well as intercostal, lumbar, and deep circumflex iliac arteries.

Venous Drainage

Consists of upper and lower parts, with anastomosis through the thoracoepigastric vein and communication through paraumbilical veins.

Lymphatic Drainage

Divided into supraumbilical and infraumbilical lymph vessels that drain into pectoral and superficial inguinal lymph glands, respectively.

Innervation

Segmental innervation to the anterior abdominal wall, with motor nerves running from the T6-T12 levels and sensory innervation provided by afferent branches of the T4-L1 nerve roots.

Abdominal Surgical Incisions

Longitudinal or vertical, transverse/oblique incisions made for open abdominal surgery.

Closure

The process of suturing or closing the incision made during abdominal surgery.

Midline incision

A longitudinal incision made down the linea alba to provide access to the abdomen with minimal injury to skeletal muscles, nerves, and vessels.

Paramedian incision

A longitudinal incision made lateral to the midline to the rectus sheath in the pararectus location, restricting access to the contralateral abdomen and pelvis and posing a risk of damage to the muscles and vessels.

Subcostal/Kocher incision

An incision used to access the upper abdomen, commonly used for gallbladder and spleen operations.

Bilateral subcostal incision

A chevron-shaped incision used to access organs of the upper abdomen, such as the gastric, liver, spleen, esophagus, and diaphragm.

Rocky-Davis incision

A transverse incision on the right lower quadrant area, used for appendectomies as a counterpart to McBurney's incision.

McBurney's incision

An oblique incision in the right lower quadrant area, commonly used for appendectomies.

Transverse incision

A horizontal incision made across the midline, used in various procedures such as appendectomies and pelvic surgeries.

Pfannenstiel or Pubic incision

A transverse suprapubic skin incision used for gynecologic or urologic procedures, such as cesarean sections or hysterectomies.

Hasson Technique

The most common port site placement in laparoscopy to access the peritoneum, typically using a 1 cm or 10 mm incision at the umbilicus for the main port and a 5 mm incision for the dissecting port.

Laparoscopic Appendectomy

A surgical procedure where access ports are typically placed at the umbilicus, left lower quadrant, and lower midline to remove the appendix using laparoscopic techniques.

Embryology

The study of the development of an organism from fertilization to birth. In the context of abdominal wall abnormalities, it refers to the stages of development where defects can occur.

Omphalocele

A congenital abnormality where the midgut fails to re-enter the abdomen, leading to a defect in the abdominal wall. The contents of the defect protrude through the open umbilicus and are covered by an amniotic fluid or peritoneal membrane.

Gastroschisis

A congenital abnormality resulting from a malformation or disruption of the abdominal wall. It presents as protruding viscera through a defect lateral to the umbilicus, usually along the right side, without the amniotic sac covering.

Omphalocele vs Gastroschisis

A comparison between the two congenital abnormalities, including their incidence, location of the defect, covering sac, description of the protruding contents, associated anomalies, prognosis, and mortality rates.

Omphalomesenteric Fistula and Cyst

Abnormalities that can occur when there is a failure of the vitelline duct to regress during development. This can result in a persistent connection between the intestine and the umbilicus, causing drainage of intestinal contents (fistula) or a partially closed duct (cyst).

Meckel's Diverticulum

A congenital abnormality where a remnant of the vitelline duct persists at the ileal border. It is characterized by a diverticulum located about 2 feet from the ileocecal valve, measuring about 2 inches in length, and may contain heterotrophic mucosa (pancreatic/gastric tissue).

Urinary Fistula or Cyst

A condition where the vitelline duct persists as a fibrous attachment of the intestine to the abdominal wall, predisposing the patient to bowel obstruction. Surgical resection is required to remove fistulas, cysts, and fibrous attachments.

Urachus

The median umbilical ligament of the abdominal wall that fails to close properly, resulting in a urinary fistula or cyst. Treatment involves urachal excision and closure of the bladder defect.

Abdominal Wall Hernia

A protrusion or bulge of abdominal contents through the abdominal wall muscle or fascia. It can be congenital or acquired and may present as asymptomatic bulges that increase with abdominal pressure.

Valsalva maneuver

A technique where a person tries to exhale forcefully while keeping their mouth and nose closed, leading to increased pressure in the chest and abdomen.

Non-incisional hernia

A type of hernia that occurs without a previous abdominal incision.

Epigastric hernias

Defects in the abdominal wall located between the umbilicus and the xiphoid process (midline), which rarely contain bowel and usually contain a portion of the omentum or falciform ligament.

Umbilical hernias

Hernias that occur at the umbilicus, which can be congenital or acquired and may require repair if there is incarceration, symptoms, failure to decrease in size, or if the defect fails to close by the age of 5 years.

Spigelian hernias

Hernias that occur along the arcuate line, which is a weak area of the abdominal wall below the umbilicus.

Incisional hernia

Hernias that develop at sites of previous abdominal incisions, with a higher risk in vertical incisions and upper abdominal incisions.

Mesh repair

The use of a mesh to repair hernias, which has become the gold standard for elective management of most incisional hernias and can be placed in different locations such as above the midline fascia, bridged above/across the defect, underneath the fascia, within the abdominal cavity, or as an intraperitoneal mesh.

Rectus abdominis diastasis

An acquired abnormality characterized by an abnormal separation of the rectus muscles and laxity at the linea alba, which may not require surgery but can be repaired for functional disability or cosmesis.

Rectus sheath hematoma

A hematoma that occurs within the rectus sheath due to bleeding from the epigastric vessels, often caused by shearing forces on the muscle or disruption of the vessels, commonly occurring around the arcuate line.

Anticoagulants

Medications that prevent blood clotting.

Rectus sheath hematoma

A collection of blood within the rectus sheath, usually caused by trauma or bleeding disorders.

Ultrasound

A diagnostic imaging technique that uses sound waves to create images of the internal structures of the body.

CT scan

A diagnostic imaging technique that uses X-rays and computer technology to create detailed cross-sectional images of the body.

IV contrast

A substance injected into the bloodstream to enhance the visibility of blood vessels and organs during imaging tests.

Soft tissue tumor

Abnormal growth of cells in the soft tissues of the body, such as muscles, tendons, or fat.

Fothergill's Sign

A physical examination maneuver used to diagnose rectus sheath hematoma, where a mass in the area of the rectus muscle does not change when the muscle is contracted.

Hemodynamic stability

The ability of the cardiovascular system to maintain adequate blood flow and pressure.

Angiographic intervention

A medical procedure that uses imaging guidance to treat blood vessel abnormalities, such as blocking the source of bleeding.

Chemoembolization

A procedure that combines chemotherapy drugs with embolization to treat tumors by blocking their blood supply.

Surgical treatment

Medical intervention that involves operative evacuation of the hematoma and ligation of bleeding vessels.

Hernia recurrence

The return of a hernia after surgical repair.

Wound-related complications

Problems that can occur after surgery, such as infection, poor wound healing, or tissue damage.

Abdominal wall defects

Abnormal openings or weaknesses in the abdominal wall, which can lead to hernias.

Umbilicus

The navel or belly button.

Xiphoid process

The small, cartilaginous extension at the lower end of the sternum.

AOG

Age of gestation, referring to the number of weeks since conception.

Vitelline or omphalomesenteric duct

A structure in the developing embryo that connects the yolk sac to the midgut.

Urachus

A remnant of the embryonic urinary bladder that connects to the umbilicus.

Abdominal ligament

A band of connective tissue that supports and stabilizes abdominal organs.

Pelvic procedures

Surgical interventions performed in the pelvic region.

Cesarean section

A surgical procedure to deliver a baby through an incision in the mother's abdomen and uterus.

Subcostal area

The region below the ribs.

Cosmesis

The aesthetic appearance or outcome of a surgical procedure.

Disruption of one of the branches of inferior epigastric artery

One of the possible causes of rectus sheath hematoma.

Arcuate line

A curved line on the abdominal wall where the rectus sheath changes its composition.

Hemoglobin

A protein in red blood cells that carries oxygen.

Serial hemoglobin levels

Repeated measurements of hemoglobin concentration over time to monitor changes.

Compression of the hematoma

Applying pressure to the hematoma to reduce bleeding and promote healing.

Bedrest

Resting in bed to allow the body to recover and heal.

Omentum

a fibrous adipose tissue (apron) providing support and protection of the intraabdominal organ

Embryology

Originates from the dorsal mesogastrium

Greater omentum

Peritoneal defense organ formed during the 4th week AOG, double-layered sheet of visceral fibroadipose tissue descending from the greater curvature of the stomach, covering the small intestines

Lesser omentum

Forms the anterior boundary of the lesser sac, extends between the liver and the lesser curvature of the stomach