ABDOMEN

Introduction
The anterior abdominal wall is firm and elastic. Firmness allows protection of viscera & elasticity allows expansion of viscera. Part of pelvis below the pelvic diaphragm is perineum. The pelvic and urogenital diaphragms forming the inferior boundary of pelvic cavity support the pelvic viscera and regulate the act of defecation, micturtion, and parturition. All the abdominal viscera are intra-abdominal but extra peritoneal except ovaries in female The peritoneal cavity is a closed sac in the male and in female it is open and communicates to the exterior through the openings of the uterine tubes. The upper part of abdominal cavity is overlapped by the lower thoracic region, lower part by the gluteal region therefore penetration wounds of these region frequently involve abdominal viscera also. The upper abdominal contents such as liver, spleen fill the concavity of the diaphragm. Therefore it is easy to reach these organs thro thorax and diaphragm/thro anterior abdominal wall. The mobile diaphragm forms the upper limit of the abdominal cavity; the contents descend with it on deep inspiration. This is made use of in clinical examination of certain organs like liver &enlarged spleen, which can be palpated thro ant abdominal wall, inferior to coastal margin on deep inspiration, though hidden in thoracic cage in quiet respiration. Disorders of abdomen: 1. Hernia: protrusion of an organ thro the wall, which contains/retains it. Common ones are inguinal, umbilical, femoral, insicional; the order reflecting their frequency. 2. Abdominal pain:2 important features of an abdominal pain ar site & nature Upper abd pain_ gall bladder, stomach, duodenum, pancreas Central abd pain_ small bowel, kidneys Lower abd pain_ urinary bladder, uterus, rectum, caecum, sigmoid colon. 3. Abdominal mass: common causes-hepatomegaly, splenomegaly, hydronephrosis, pseudocyst of pancreas, mesenteric cysts, carcinoma of stomach, enlargement of gall bladder, accumulation of faeces, retention of urine in blabber, ovarian cyst, pregnant uterus, uterine fibroids, appendicular mass. 4. Abdominal distension: 6 common causes- Fetus, Flatus, Feces, Fat, Fluid (ascites), Fibrinoids. The distension is normal in front and young children due to: GIT contains considerable amount of air The liver is relatively large in size. Their abd muscles are relatively less toned. Fawcetts rule for identification of individual lumbar vertebrae Sacralisation of L5 vertebrae: fusion of L5 with the sacrum. Spina Bifida: on fusion of 2 halves of vertebral arch. Here, the spinal cord & meninges are exposed and may herniated out in the midline in the gap. Spondylolisthesis: Forward slipping of L5 over the sacrum. clinical cond-backache , pain radiating along sciatic nerve.(sciatica)

Osteology

Cauda Equina Syndrome: Due to compression of Cauda equine. Clinically- 1.Flaccid paraplegia 2.saddleshaped anesthesia 3. Late bladder & bowel involvement leading to incontinence of urine & faeces. 4. Impotence 5. Absence of knee & ankle jerks. In an articulated skeleton, the sacrum is placed obliquely like a wedge b/w the 2hip bones. Owing to its oblique site, it forms an angle-Lumbosacral angle.149 in males, 135 in females. Sacralisation:fusion of L 5 or C1 with sacrum Lumbarisation: S1 is separated from sacrum and fuse with L5. Sacral Index: Ratio b/w length &breadth of sacrum[Breadth * 100/Length] 116 infemale, 112 in male Coccydynia: pain in coccygeal region due to separation of coccyx from sacrum. Sacred Bone:Sacrum Tail Bone: coccyx Deep Fascia absent in ant abdominal wall, penis, scrotum & perineum. Congenital anoamalies of umbilicus: 1. Faecal fistula: Failure of vitello-intestinal duct to obliterate=faecal fistula 2. Urinary Fistula: Failure of urachus to obliterate 3. Exomphalos/Omphalocele: failure of midgut loop to return back to abd cavity. 4. Congenital umbilical hernia: intestine protrudes thro umbilicus,covered by peritoneum. ~~Therefore Umblicus is considered as Hot Bed Of Embryology. The line of attachment of Scarp

Anterior Abdominal Wall