Surgical Anatomy 2023 PDF
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Keele University
2023
Professor Robert Kirby
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Summary
Keele University School of Medicine's Surgical Anatomy notes from September 2023, covering topics like abdominal wall and hernias, the UGI tract, breast anatomy, vascular systems, and surgical incisions. Diagrams help visualize the structures discussed.
Full Transcript
SURGICAL ANATOMY Updated September 2023 Professor Robert Kirby Thanks to Dr Iles, Dr Cathcart & Dr Thursby (Former Teaching Fellows) Learning Objectives REVISION - You should know most of this already! ABDOMEN – Abdominal Wall and Hernias – UGI Tract,...
SURGICAL ANATOMY Updated September 2023 Professor Robert Kirby Thanks to Dr Iles, Dr Cathcart & Dr Thursby (Former Teaching Fellows) Learning Objectives REVISION - You should know most of this already! ABDOMEN – Abdominal Wall and Hernias – UGI Tract, stomach, biliary tree, small bowel, appendix, large bowel BREAST – Anatomy, lymphatics, arterial supply, venous drainage VASCULAR – Abdominal aorta, lower limb arteries, venous drainage Layers of Abdominal Wall Upper Abdomen Layers of Abdominal Wall Skin Superficial fascia – Camper’s fascia (Subcutaneous fat) – Scarpa’s fascia External oblique / Aponeurosis Internal Oblique Transversus Abdominus Transversalis fascia Extraperitoneal fat Peritoneum Peritoneal contents Upper Abdomen Layers of Abdominal Wall Skin Superficial fascia – Camper’s fascia (Subcutaneous fat) – Scarpa’s fascia External oblique / Aponeurosis Internal Oblique Transversus Abdominus Transversalis fascia Extraperitoneal fat Peritoneum Peritoneal contents Lower Abdomen Layers of Abdominal Wall Skin Superficial fascia – Camper’s fascia (Subcutaneous fat) – Scarpa’s fascia External oblique / Aponeurosis Internal Oblique Transversus Abdominus Transversalis fascia Extraperitoneal fat Peritoneum Peritoneal contents Layers of Abdominal Wall Reminder: The anatomy can be well hidden! Surgical Incisions Mercedes-Benz Kocher Rooftop Upper midline Midline Laparotomy Laparoscopy Para-median Rutherford-Morrison Gridiron Lanz Lower midline Pfannensteil Inguinal Lanz or Gridiron incisions for Appendicectomy Centred over McBurney’s Point Opening in layers No cutting of Muscle Fibres Hernias Definition: ‘A hernia is a protrusion through a congenital or acquired defect in the muscular and fascial structures of the abdominal wall. ’ Reducible Contents can be manually manipulated/reduced Irreducible/ Contents can not be reduced Incarcerated Obstructed Hernia causing bowel lumen obstruction Strangulated Hernia causing compression of blood supply and venous drainage ; causing ischaemia Hernias Epigastric Divarication of Recti Swelling of midline on straining Divarication of Recti Hernias Para Umbilical Hernias Umbilical Hernias Indirect Inguinal (Through Internal Ring) Presents External Ring Hernias Indirect Inguinal Direct Inguinal (Through Transversalis Fascia defect) Presents External Ring Hernias Femoral Hernias Lumbar (rare) Hernias Incisional Groin Hernias Direct Indirect Femoral Inguinal Inguinal Hernia Hernia Hernia Relationship to Above and Above and Below and Pubic Tubercle medial medial lateral Stays reduced NO YES NO with pressure over deep ring? Anatomical Through a Through deep Through Course weakness in the ring femoral canal abdominal wall (Transversalis fascia) Inguinal Canal Inguinal Canal Inguinal Canal Inguinal Canal Inguinal Canal Abdominal Contents UGI Tract, Stomach, Biliary tree, Small bowel, Appendix, Large bowel / colon + rectum Calot’s Triangle Right hepatic Artery (most commonly) Colon Appendix Blood Supply of Colon Blood Supply of Colon Blood Supply of Colon BREAST VASCULAR Summary ABDOMEN – Abdominal Wall and Hernias – UGI Tract, stomach, biliary tree, small bowel, appendix, large bowel BREAST – Anatomy, lymphatics, arterial supply, venous drainage VASCULAR – Abdominal aorta, lower limb arteries, venous drainage Any Questions?