This is an oblique intermuscular passage in the lower part of the anterior abdominal wall ,
Situated just above the medial half of the inguinal ligament
This is an oblique intermuscular passage in the lower part of the anterior abdominal wall ,
Situated just above the medial half of the inguinal ligament
Anatomy of the breast for medical/dental students. This presentation also contains MCQs to test your knowledge as well as clinical scenario to apply your knowledge.
Anatomy of the breast for medical/dental students. This presentation also contains MCQs to test your knowledge as well as clinical scenario to apply your knowledge.
boundaries of perianal region or perirecatal region, division of perineum, contents of the division, anal region, urogenital region and their contents, perineal body, ischioanal fossa or ischio rectal fossa,boundaries of ischio anal fossa, contents of ischio rectal fossa, dimension of ischio anal fossa, recessess, anterior recesses, posterior recesses, spaces and canals, perianal space, ischioanal spaces, pudendal canal, superficial fascia, deep fascia. cutaneous innervation of urogenital region,
Abdominal anatomical and symptoms and symptoms and Marasmus of the fetus first and symptoms to the signs on a verification dsujŝkkkllllllllljnvvvhĵjbvvghhjjĵkķkkkkkkkkkkkllķ
This is a clinically oriented maternal anatomy, prepared by Dr Gebresilassie Andualem
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Anatomy of the anterior abdominal wall and incisions
1. ANATOMY OF THE ANTERIOR
ABDOMINAL WALL AND INCISIONS
BY
DR GEORGE OWUSU
2. OUTLINE
• Introduction
• Embryology of the anterior abdominal wall
• Divisions of the anterior abdominal wall
• Components of the anterior abdominal wall
• Parietal peritoneum and posterior part of the
anterior abdominal wall
• Applied anatomy
• Abdominal Incisions
• Principles of making abdominal incisions
• Types of abdominal incisions
• Complications
• conclusion
3. INTRODUCTION
• The abdomen houses several viscera responsible
for different bodily functions.
• The anterior abdominal wall is well crafted to
keep these viscera in place and protected from
the external environment.
• However with aberrations involving the intra-
abdominal contents, the anterior abdominal wall
serves as a gateway to the abdomen, where
several important and life saving incisions could
be made to access the impaired viscera.
4. EMBRYOLOGY OF THE ANTERIOR
ABDOMINAL WALL
• By the end of the 5th week,
somites derived from the para-
axial mesoderm differentiate
into two groups of prospective
muscle cells.
• Hypomeres derived from the
dorsolateral part and epimeres
from its dorsomedial part.
• The hypomeres in the abdominal
region splits to give rise to the
external oblique, internal
oblique and transversus
abdominis muscle.
5. EMBRYOLOGY OF THE ANTERIOR
ABDOMINAL WALL
• A ventral longitudinal
column from the
hypomeric tip gives rise
to the Rectus
abdominis.
• Nerves innervating
segmental muscles also
divide with ventral rami
innervating the
hypomere derivatives
6. DIVISIONS OF THE ANTERIOR
ABDOMINAL WALL
• Divided into nine regions by
two paramedian vertical and
horizontal lines.
• Paramedian line, lies in a
plane joining the
midclavicular line to the mid-
inguinal line bilaterally.
• The upper transverse line lies
in the transpyloric plane.
• Lower transverse line lies in
the intertubercular plane.
7. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• Composed of four
major layers:
– Skin
– Subcutaneous layer
– Muscular layer
– Parietal peritoneal layer
• Their accompanying
neurovascular bundle
and lymphatics.
8. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• SKIN:
• Continuous from the chest
wall with termination of
the rib cage.
• Thinner in texture than the
back.
• Of surgical importance are
the Langers tension line
arranged transversely.
• Incisions made in their
direction gives
cosmetically better scars.
9. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• Skin:
• Blood supply: from
cutaneous branches of;
– lumbar artery,
– superior and inferior
epigastric arteries
• Venous drainage:
– Great saphenous vein from
areas below the umbilicus
– Lateral thoracic vein from
areas above the umbilicus.
10. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• Skin:
• Nerve supply:
– Anterior and lateral
cutaneous branches of
ventral rami T7-L1 spinal
nerves segmentally.
• Lymph drainage:
– Above the umbilicus to the
pectoral group of axillary
nodes
– Below the umbilicus to the
medial group of superficial
inguinal lymph nodes
11. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• SUBCUTANEOUS FASCIAL
LAYER:
• Made up of two parts:
– Fatty superficial layer of
campers
– Membranous layer of scarpa
• The membranous layer
allows the fatty layer to
slide freely over the
underlying structures.
• Extends over the penis and
scrotum as the superficial
fascia of bucks.
• And perineum as the colle’s
fascia
12. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• MUSCULAR LAYER:
• Three flat muscles:
– External oblique muscle
– Internal oblique muscle
– Transversus abdominis
• Two vertical muscles
– Rectus abdominis
– pyramidalis
13. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• EXTERNAL OBLIQUE MUSCLE:
• Made up of fleshy and aponeurotic
parts.
• origin: external surfaces of 5th-12th
ribs
• INSERTIONS:
– Anterior half of the iliac crest
– The pubic tubercle
– Linea alba
• Nerve supply: ventral rami of T7- T12
• Blood supply: superior and inferior
epigastric arteries
• Action: compress and supports
abdominal viscera
• Flexes and rotates the trunk
14. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• Ligaments and reflections
of the external oblique
aponeurosis:
– Inguinal ligament (of
Poupart)
– Lacunar ligament (of
Gimbernat)
– Pectineal ligament (of
Astley cooper)
– Reflected part of the
inguinal ligament
15. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• INTERNAL OBLIQUE MUSCLE:
• Origin:
– Thoracolumbar fascia
– iliac crest
– inguinal ligament
• Insertion:
– Linea alba
– Pubis via conjoint tendon
• Blood supply:
– Superior and inferior epigastric
– Deep circumflex iliac artery
• Nerve supply: ventral rami of
T7 – L1
• ACTION
– Compresses and supports
abdominal viscera
– Flexes and rotates the trunk
16. COMPONENTS OF THE ANTERIOR ABDOMINAL
WALL• TRANSVERSUS ABDOMINIS:
• Origin:
– Internal surfaces costal
cartilage of 7th-12th ribs
– Thoracolumbar fascia
– iliac crest
– inguinal ligament
• Insertion:
– Linea alba
– Pubis via conjoint tendon
• Blood supply:
– Superior and inferior epigastric
– Deep circumflex iliac artery
• Nerve supply: ventral rami of
T7 – L1
• ACTION
– Compresses and supports
abdominal viscera
– Flexes and rotates the trunk
17. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• RECTUS ABDOMINIS
• Origin:
– Pubic symphysis (medial lip)
– Pubic crest (lateral lip)
• Insertion:
– Xyphoid process
– Costal cartilage of T5 – T7
• Blood supply:
– Superior and inferior
epigastric
• Nerve supply: ventral rami
of T7 – L1
• Action:
– Major flexor of the trunk
– Compresses and supports
abdominal viscera
18. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• PYRAMIDALIS:
• Origin:
– Body of pubis
• Insertion:
– Linea alba
• Blood supply:
– Inferior epigastric artery
• Nerve supply: ventral
rami of T12
• ACTION
– Tenses the linea alba
19. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• RECTUS SHEATH:
• Encloses the vertical
muscles.
• Formed by splitting and
fusion of the flat muscle
aponeurosis
• Splitting of the internal
oblique aponeurosis
forms a shallow groovy
curve ‘semi-lunar line’.
20. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• INGUINAL CANAL:
• Oblique intramuscular slit,
about 4cm long, above
medial half of the inguinal
ligament.
• Extends from the deep ring
to the superficial ring.
• Boundaries:
• Roof: lower edges of the
internal oblique and
transversus abdominis
muscles.
21. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• INGUINAL CANAL:
• Floor: inguinal ligament
(reinforced medially by the
lacunar ligament)
• Anterior wall: external
oblique aponeurosis
(reinforced laterally by
internal oblique muscle
• Posterior wall:
transversalies fascia
(reinforced medially by the
conjoint tendon)
• Contents:
– Spermatic cord and
ilioinguinal nerve in males;
round ligament and
ilioinguinal nerve in females.
22. COMPONENTS OF THE ANTERIOR
ABDOMINAL WALL
• Parietal peritoneum and
posterior surface:
• Contains five folds in the
infraumbilical region:
– Median umbilical fold
– Two medial umbilical fold
– Two lateral umbilical fold
• Falciform ligament in the
in the supraumbilical
region
24. INCISIONS
• Incisions are surgical wounds made on the skin and
deepened to gain access to an internal structure or
organ.
• PRINCIPLES OF ABDOMINAL INCISIONS:
– It should provide adequate exposure of the organ or
organs to be dealt with.
– It should be capable of extension
– minimal damage to neurovascular bundles and muscles
– Secured closure should be achievable
– Provide a cosmetically acceptable scar
– Peritoneal drainage tubes should be inserted through a
separate incision
– Wound should be closed in layers
26. MIDLINE INCISION
• Vertical incision made in
the midline.
• Could be supraumbilical
or subumblical or a
combination of both.
• It divides through the
skin, linea alba and
peritoneum
• It is almost bloodless
• Nerves are spared
27. MIDLINE INCISION
• It is quick and easy to
close.
• No muscles divided
• Supraumbilical midline
incisions provides quick
access to the stomach
and duodenum, spleen,
liver especially left lobe.
• The subumbilical –
intestines, appendix,
pelvic viscera
28. PARAMEDIAN INCISION (UPPER OR
LOWER, RIGHT OR LEFT)
• Incision is made 2-5cm
lateral to the midline.
• Skin and subcutaneous
tissue incised – anterior
layer of rectus sheath
opened and stripped off
muscle – rectus muscle
reflected laterally and
posterior layer of sheath
and peritoneum opened.
29. PARAMEDIAN INCISION (UPPER OR
LOWER, RIGHT OR LEFT)
• Has the advantage of offsetting the vertical incision to
the right or left with access to lateral structures such as
the spleen and kidneys.
• Closure is theoretically more secure.
• PARAMEDIAN MUSCLE SPLITTING INCISION:
• Could be done instead of lateral retraction of the
rectus abdominis
• Muscle splitted in line of incision
• Disadvantage: atrophy of medial part and risk of
herniation.
30. KOCHERS (SUBCOSTAL) INCISION:
• Started at midline about 2cm
below the xyphoid process,
extending outwards and
parallel to the costal margin.
• Right incisions affords good
access to the gall bladder and
billiary tract.
• Left incisions affords access to
the spleen.
• N/B Mini-lap cholecystectomy -
A small 5-10 cm incision could
be done in the right subcostal
area for cholecystectomy
31. MODIFICATIONS OF KOCHERS
INCISION
• CHEVRON (ROOFTOP):
• Incision continued
across midline as
double kochers incision.
• Useful in carrying out
gastrectomy,
renovascular surgeries,
liver transplantation,
bilateral adrenalectomy.
32. MODIFICATIONS OF KOCHERS
INCISION
• MERCEDES BENZ
INCISION:
• Consist of bilateral low
kochers incision and a
midline incision up to
the xiphisternum.
• Gives access to the
upper abdominal
viscera especially the
diaphragmatic hiatuses.
33. Mc Burney’s grid iron or muscle split
incision:
• Oblique incision made at
Mc Burney’s point on the
skin and subcutaneous
tissues.
• External oblique
aponeurosis is divided in
direction of its fibers –
underlying internal oblique
is opened by splitting along
the line of its fibers.
• Used for appendicectomy
and on the left for drainage
of diverticular abscess.
34. Lanz incision
• A modification of the
MC Burney’s incision,
made with a transverse
skin incision .
• Gives a better cosmetic
outcome.
35. RUTHERFORD MORRISON INCISION
(OBLIQUE MUSCLE CUTTING INCISION)
• Similar to the grid iron’s
incision, however cuts
through the underlying
muscles.
• Used for appendicectomy
• Useful in right and left
sided colonic resections,
caecostomy or sigmoid
colostomy
36. TRANSVERSE MUSCLE DIVIDING
INCISION
• This is done at a level
above the umbilicus.
• Following a transverse
skin and subcutaneous
tissue dissection, the
rectus sheath and
muscles are divided
transversely and
peritoneum afterwards.
• It is preferred in
newborns and infants,
because more abdominal
exposure will be gained.
37. PFANNENSTIEL INSCISION
• Used frequently by gynecologist
and urologist to access pelvic
organs.
• Transverse curvilinear skin
incision made about 12cm long
on skin fold, about 5cm above
the pubic symphysis.
• Deepened through the
subcutaneous tissue with
anterior rectus sheath divided
along length of incision and
separated from muscle.
• The rectus muscles are retracted
laterally and peritoneum opened
vertically in midline.
38. MAYLARD(TRANVERSE MUSCLE
CUTTING) INCISION
• Transverse incision placed a
little higher than the
Pfannenstiel.
• It differs from the
Pfannenstiel incision by
transverse division of the
rectus sheath and rectus
muscle, which could be
extended to the flat muscles.
• Gives wider exposure to
pelvic structures
39. COMPLICATIONS OF INCISIONS
• Nerve injury
• Hematoma formation
• Surgical site infection
• Wound dehiscence and burst abdomen
• Incisional hernia
40. PRINCIPLE OF WOUND CLOSURE
• GOAL: To approximate and not strangulate
• Proper choice of suture materials and
technique.
• Elimination of dead space
• Closing with sufficient tension (tight enough
to seal wound but not strangulate)
• Proper immobilisation of wound
41. CONCLUSION
• The anterior abdominal wall is well crafted to
give support and protection to the intra
abdominal viscera.
• However defects in its wall could lead to
protrusions of such viscera.
• Valuable incisions when well placed on the
abdomen, gives life saving access to the intra-
abdominal organs, avoiding complications and
cosmetically acceptable scars.
43. REFERENCES
• Chummy sinnatamby. Last’s anatomy 12th edition
2011.
• Keith Moore et al. clinically oriented anatomy 6th
edition 2010.
• Frank Netter. Atlas of human anatomy 6th edition
2014
• Badoe E.A et al. Principles and practice of surgery
including pathology in the tropics.3rd edition
2000:
• Siram Bhat M. SRBs manual of surgery. 3rd edition
2009: