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Where is the Transpyloric plane located, and what structures does it pass?
- Located @ L1. It is half way b/w jugular notch and pubic symphysis. It is half way b/w the xiphoid process and umbillicus.
- Passes through; Tip of 9 costal cartilage, fundus of gall bladder, hilus of kidney, SMA, Pylorus, D-J junction, Neck of the Pancreas, formation of the Portal vein, transcolon SC/IC,
What is McBurney's point? Why is it important?
- Junction of the outer 1/3 and middle 1/3 of an imaginary line b/w the umbilicus and ASIS.
- It marks the site of root of vermiform appendix. Its also the site of max pain and tenderness in acute appendicitis.
What are the layers of the anterior abdominal wall?
- SUPERFICIAL FASCIA: superficial fatty layer: Camper’s fascia and deep membranous layer: Scarpa’s fascia
- DEEP FASCIA
- MUSCLES; external oblique, internal oblique, transversus abdominis, rectus abdominis, pyramidalis
- TRANSVERSALIS FASCIA
- EXTRAPERITONEAL FAT
- PARIETAL PERITONEUM
Injury to the 11th or 12th rib would compromise what structure?
Areas of abdomen more prone to hernias,
difference in areas 1,2,3
- Areas: 3, 1, 2
- Area 3 is more prone to hernia’s because its
- Posterior rectal sheet only has Fascia Transversalis (FT) layer. Area 2 has FT and costal cartilage, Area 1 has Internal Oblique (IO), Transversus Abdominal Muscle (TAM), and FT
The kidney's are located at what level? At what level is the hilum?
How would you prevent another hernia from occurring?
After repairing a hernia it is important to add a mesh made of prolene, to help prevent another hernia. This mesh allows fibrous tissue to grow through it and in between to add stability. It should be placed on the internal ring, in the area of the FT.
Incisions of Abdomen (adults and children). Possible damage sites
- Adult incisions should be vertical, Children can be cut horizontal because their abdominal muscle haven’t developed yet.
- Incisional hernia: Post-Op incisional hernia is most likely to occur in patients in whom it was necessary to cut one of the segmental nerves supplying the muscles of the anteriror abdominal wall; post op wound infection with death of the abdomijnal muscularture is also common. The neck of the sac is usually large, and adhesion and strangulation of its contents are rare complications. In obese patients the extent of the abdominal wall weakness is often difficult to assess.
Timeline of the descent of the testes.
- 5th month: testes are at the level of the 5th rib and begin to descend.
- 6th month: testes are at the level between the 5th rib and umbilicus.
- 7th month: enter the deep/internal ring of the inguinal canal
- 8th month: and midway through the inguinal canal
- 9th month: exit the superficial/external ring of the inguinal canal.
- 10th month: descend into the scrotum
Layers of the testes (superficial to deep layer)
- Scrotal skin layer
- Dartos muscle
- External oblique
- Cremaster muscle and fasia
- Internal spermatic fascia
- Parietal layer
- Visceral layer
Tunica Vaginalis hydrocele; cause, tx, prevention
- Description: Fluid b/w visceral and parietal layer, common in tropical countries, especially where vaccination doesn’t occur
- Cause: Increased secretions: tumor or inflammation. Mumps: virus that attacks the epidymesis and testes. Or could be due to decreased absorption
- Tx: Aspiration
- Prevention: For increased secreation prevention MMR vaccine
What are the percentages for undescended testes for; Right, Right & Left, and Left
- Right testes: 70%
- Right & Left testes: 20%
- Left testes: 10%
Lymphatics of the testes
pass up over to the posterior abdominal wall to drain in the lumbar paraaortic nodes. (BRS) Has lymph vessels that ascend with the testicular vessels and drain into the lumbar (aortic) nodes: Lympahtic vessels in the scrotum drain into the superficial inguinal nodes.
Pain for a young boy around the umbilicus or
midgut is due to what nerve?
The testes develop at T-10. A tumor in the testes can lead to pain around the umbilicus or midgut. Testes is supplied by sympathetic coming from T-10.
Embryo of the GI tract
The yolk sac is mesodermal in origin. The mesoderm gives rise to the splanchopleure, which gives rise to the tube of the GI tube, foregut, midgut and hindgut. Paraxial, intermediate and lateral plates are near the neural tube and are parts of the mesoderm. The Paraxial intermediate gives rise to somites, limbs start growing from a lateral plate and the intermediate plate gives rise to the urogenital system.