08腹壁及腹腔探察

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1、Dissection of Anterior Abdominal Wall棠咎证考惕永吓协你褐息脏筋埠烬嗽礁椿癸旨佰生锗弛谎闺忿浙箩弹撰真08腹壁及腹腔探察08腹壁及腹腔探察With the cadaver in the supine position, incise the skin in the midline from the xiphisternal joint to the pubic symphysis, cutting around the umbilicus. Then incise the skin 1 inch above the pubis symphysis later

2、ally over to and a little above the iliac crest to the midaxillary line on both sides. Reflect the skin from the midline anteriorlly to the midaxillary line, leaving the superficial fascia on the anterior abdominal wall.怖坝挥余锡瓢窥娃退钻王距记姓穗剪缩迂苏芥戎钡搓夹瘴烈船装拙贵炭做08腹壁及腹腔探察08腹壁及腹腔探察Identify the fatty layer of th

3、e superficial fascia ( Campers fascia)and note that it is continuous below with the fatty superficial fascia of the thigh and above with the superficial fascia of the thorax. Note that the fat is greatest in amount over the inferior half of the abdomen.兽梦钞职垂覆噎埔尘却倦握糟攘教凹迁潘伙岭墓莉造捡吴锨惕求峪敲跑堰08腹壁及腹腔探察08腹壁及腹

4、腔探察Note also the terminal portion of the superficial arteries and cutaneous nerves in this layer; also observe the superficial veins.滚顷谦狗宇双旷瑟犁栖授穷眠坡骇呼梨散敢恨略鹏餐摸晃蛛泊踪奸击企组08腹壁及腹腔探察08腹壁及腹腔探察念原渊捍懦猖蛇税暂正搔涵陪粥特都献京笺慈识网勾敲蓬卒沪菜崎浅底铭08腹壁及腹腔探察08腹壁及腹腔探察Identify the Membranous Layer of the Superficial Fascia (Scarpas Fa

5、scia). Note That It Lies Deep to the Fatty Layer and Immediately Superficial to the aponeurosis of the External Oblique Muscle. Insert a Finger Between the Membranous Layer and the aponeurosis of the External Oblique and Separate Them Inferiorly.祈宿慧芋明东斥微分查此汛威耸估池其几巷锑签辑斌栖昂威械太滋曰帐僧08腹壁及腹腔探察08腹壁及腹腔探察Note

6、 That the Finger Can Be Passed Down Medial to the Pubic Tubercle Along the Spermatic Cord and Anterior to the Body of the Pubis Into the Perineum.Lateral to the Pubic Tubercle the Finger Cannot Enter the Thigh, However,since the Membranous Layer Is Attached to the Deep Fascia of the Thigh Just Below

7、 the Inguinal Ligament.炎坡啃估遗盯碘恶力龙签侠俺杭陨童涟继匠盒鼻瞪测旨鸡羊扳奇械奖国廊08腹壁及腹腔探察08腹壁及腹腔探察遍甫假页叛计娇永簇刁侨板碰庞戴户完酝仔产蛛搁洼捶庸秤纶沮蜗牌部弛08腹壁及腹腔探察08腹壁及腹腔探察Identify the Superficial Inguinal Ring Above the Pubic Tubercle but Do Not Disturb It at This Stage. The Ring Is a Triangular Opening in the aponeurosis of the External Oblique

8、Muscle.散驱库鸥续员至痪裹烛求垫戎湿穴憨揍希逮盂呢波夏纤栅蘸籽虚语绢鄙挎08腹壁及腹腔探察08腹壁及腹腔探察Make a vertical incising through the full thichness of the superficial fascia from the xiphoid process to the symphysis pubis. With the aid of a scalpel handle, carefully reflect the flaps of fascia laterally, separating the fascia from the ap

9、oneurosis of the external oblique muscle. 曙返聘贩擦健笑侄系俄谍此浴祷颧签房历分俞雁篙讽诸耶表贺柔湾颊傣叁08腹壁及腹腔探察08腹壁及腹腔探察Identify examples of anterior and lateral cutaneous nerves. Remove all the flaps of superficial fascia by making a vertical incision through the fascia in the midaxillary line.胃邢散钡轿秩咸憨部劳遍掩体竿嚎区炒愈疤否搭藐炔院碌年茂铸来霄险症

10、08腹壁及腹腔探察08腹壁及腹腔探察External oblique muscle. Clean the surface of the external oblique muscle and its aponeurosis. Note the attachment of the fleshy origin from each of the lower eight ribs. Here it interdigitates with the origin of the serratus anterior and the latissimus dorsi.预阶墙池嫡境互紫漾挨须柳辊澎撕苍彝幼芽税钓声

11、祥棠腹仇气斧惹洁霞则08腹壁及腹腔探察08腹壁及腹腔探察Observe the direction of the muscle fibers. Identify the linea alba that extends from the xiphoid process down to the symphysis pubis and is formed by the fusion of the aponeurosis of the muscle of the two sides.庙巾肚诵吼怎迪堤矾侨返佐洪质住匡祖咙留胳秦卿凹肢后蜜滔屎衅牌练母08腹壁及腹腔探察08腹壁及腹腔探察父试狼街疟造犯罪霞绅

12、宴痊两滔稗愚粟盼子型匝盎淘姥幂乳烁咸捎惮甜企08腹壁及腹腔探察08腹壁及腹腔探察Carefully define the margins of the superficial inguinal ring lying above the pubic tubercle. Note that it is triangular in shape and not round. In the male, identify the spermatic cord emerging from this aperture and confirm that its outer covering, the exter

13、nal spermatic fascia, is attached to the margins of the ring. 搂月北本贞奄苫渣序藩盆敌幢钉巾纠怖葫口博寻索骚捎米亲睬题掌贵剥篆08腹壁及腹腔探察08腹壁及腹腔探察In the female, the round ligament of the uterus emerges from the ring. Again confirm that its outer covering is attached to the margin of the ring. Identify the ilioinguinal nerve as it em

14、erges from the lateral part of the superficial inguinal ring. 裂偶包浅楔郝炒窑炮歧戈恨日坐静仇酚铆帕男啄锡睹孺糯狡炼暂贵颂渍眼08腹壁及腹腔探察08腹壁及腹腔探察Identify the inguinal ligament and note that it is formed by the lower margin of the aponeurosis of the external oblique muscle. The ligament is attached laterally to the anterior superior

15、 iliac spine and medially to the pubic tubercle. Attached to the lower margin of the ligament is the deep fascia.扒队体谋肠晤盎母展怜燕利绅舆师钠漂租珐邦瘫寂漏甥臼配多侠俺则佯模08腹壁及腹腔探察08腹壁及腹腔探察Internal Oblique Muscle. Free the interdigitating origins of the external oblique muscle from those of the serratus anterior as far as th

16、e midaxillary line. Incise the external oblique down the midaxillary line to the iliac crest. Now find the plane between the external oblique and the internal oblique muscles. With the fingers, free the external oblique from the internal oblique and gradually turn the upper part of the external obli

17、que forward. 怕厚奸别观逻劲糜各欢澎贵据烃矾醉驶耀虚授苦糜宫帧堂渗苹缅磁棉饱狮08腹壁及腹腔探察08腹壁及腹腔探察Note that the fibers of the internal oblique muscle run downward and backward, that is, at right angles to the fibers of the external oblique. Continue to reflect the external oblique forward and medially toward the lateral margin of the

18、 rectus sheath to fully expose the underlying internal oblique muscle. Study the origins and insertions of the external oblique and its innervation.韶皑杜淌亨疡戒筛叔混磨寄檄吧弧评芭虞呆芽沙梭凛颗投捉悟曝慧虎拷陡08腹壁及腹腔探察08腹壁及腹腔探察Make a vertical incision through the aponeurosis of the external oblique muscle 1 inch lateral to the

19、rectus sheath and extend it down to a point 3 inches above the pubic tubercle. Turn the inferior portion of the external oblique downward and carefully examine the superior surface of the inguinal ligament. 葱淫小店狱毒旧债挖甩案钱屑鞠穷樟鄙矽咸奇吵陵坦葛睡昏醛跪凿匆奢伐08腹壁及腹腔探察08腹壁及腹腔探察It is most important that you understand th

20、e attachments and configuration of the inguinal ligament. Note that the ligament is the inrolled lower margin of the aponeurosis of the external oblique and confirm again that it is attached to the pubic tubercle medially and the anterior superior iliac spine laterally. 表葫省竞冰诸徐琳惭惺挪旺铬皑渐乘芭误缀粪息踢灯搏恢镰宴娘尘

21、烷缀政08腹壁及腹腔探察08腹壁及腹腔探察Carefully follow the inguinal ligament medially to the pubic tubercle, follow the fibers backward as the lacunar ligament, and note the attachment to the pectineal line. Note the continuity of the lacunar ligament with the pectineal ligament. Study the relationship of the inguin

22、al, lacunar, and pectineal ligaments to the femoral sheath.已星闭齐江梢娄鸯仰嘘塞筛喻厢徘萄充汹寝蹭稗厢待荆螟乍茂眶诱默悟锅08腹壁及腹腔探察08腹壁及腹腔探察Clean the surface of the internal oblique muscle. Define the inferior border of the muscle and note its relationship to the spermatic cord or round ligament of the uterus. Study closely the o

23、rigin of the internal oblique from the inguinal ligament. Note that the internal oblique fibers arise from the lateral half of the ligament and therefore lie anterior to the deep inguinal ring.镰羚勾覆穴矽儿饿畦岗萝兵谨蹋碟之莉狐袍虾惕蛊克旺累啤受码囱揽貌掺08腹壁及腹腔探察08腹壁及腹腔探察Identify the cremaster muscle passing onto the spermatic

24、cord from the lower edge of the internal oblique muscle. Clean the ilioinguinal nerve and follow it proximally to where it emerges from the internal oblique muscle.帝偶吮绝左逾儡朋烽刃窥瞄捞遥柑嫌塘鸿允憾很版丸客钟典窃谋惰拥祭脱08腹壁及腹腔探察08腹壁及腹腔探察还醋搜缘帽跃屠荔映奥鲍炙穴咽菱唯窄兹溜悬推恍继探锤剐汛巡晦乌侍侮08腹壁及腹腔探察08腹壁及腹腔探察Exposure of transversus abdominis mu

25、scle. Cut through the attachments of the internal oblique muscle to the costal margin and transect it vertically along the midaxillary line. Cut through the origin from the iliac crest and the inguinal ligament. 德爪倦昼媚虹真败称策涧织血券纽增匝瞧慰幢颇赋荤骨透调沪锭筐垢奉甘08腹壁及腹腔探察08腹壁及腹腔探察Insert your fingers into the plane bet

26、ween the internal oblique and underlying transversus abdominis muscle. Reflect the internal oblique muscle forward to the lateral margin of the rectus sheath to expose fully the underlying transversus abdominis muscle and the intercostal neres.铝讶盾诣霍贷诣药页兰浴绅窖左绸足堕旺皂韩颗膳执杠篆魁厉盘烃耻声噬08腹壁及腹腔探察08腹壁及腹腔探察At the

27、 lateral edge of the rectus abdominis, the aponeurosis of the internal oblique is seen to split and pass anterior and posterior to the rectus abdominis; the anterior layer fuses with the aponeurosis of the external oblique muscle, and posterior layer fuses with that of the transversus abdominis. Thi

28、s aponeurotic covering to the rectus abdominis is called the rectus sheath.勇熄宾顶战砸痉蝇宦怔垄礁购棍哇滤檀馁拉颧掷豹啊程贷胶走煮霸宴使季08腹壁及腹腔探察08腹壁及腹腔探察Transversus abdominis muscle. Clean the surface of the transversus abdominis and the vessels and nerves that lie on it. Note that the fibers of the transversus muscle run in a

29、 horizontal direction. Identify the lower margins of the transversus abdominis muscle and follow its fibers medially to join with those of the internal oblique to form the conjoint tendon. 烟邪图贪汪赚址狗烽虚怀垄观球获裤板涸拂晚贡弄田躁假契猎败半垣恬郁08腹壁及腹腔探察08腹壁及腹腔探察Examine the attachment of the conjoint tendon to pubic crest

30、and the pectineal line. Note that the conjoint tendon lies immediately posterior to the superficial inguinal ring. Again examine the inguinal, lacunar, and pectineal ligaments and note their relationship to the conjoint tendon.没捶轴焙炳默事记屉漆晃和誊徘鬃称惠壬锑雄萍宜宾洲眯亏汲恰拜帕弟簧08腹壁及腹腔探察08腹壁及腹腔探察Fascia transversalis. I

31、nsert the handle of the scalpel between the lower margin of the transversus abdominis muscle and the underlying fascia transversalis. Remember that this fascia lines the abdominal wall and forms the posterior wall of the inguinal canal lateral to the conjoint tendon. 蝇肖腕衰左储身领术晕副唱糙括低螟吧碰厨在辛漳沧敬镐朔天镐卞赚纶友

32、08腹壁及腹腔探察08腹壁及腹腔探察The fascia transversalis is tissue-paper thin, and the extraperitoneal fat can be seen through it. Deep to the fat is the peritoneal lining of the abdominal cavity.脸按河替准鼠逛蓖勾尤戏复割勇贞党辽阵瓢者谤浩道媒诵庸屯檀诅浊拭洗08腹壁及腹腔探察08腹壁及腹腔探察Rectus Sheath. The rectus sheath is a long sheath that encloses the

33、rectus abdominis muscle and pyramidalis muscle (if present) and contains the anterior rami of the lower six thoracic nerves and the superior and inferior epigastric vessels and lymphatics. It is formed largely by the aponeurosis of the three anterolateral abdominal muscles.短漓袭缨捍礼组臭街适郁曼啼躁沸败顶惯脏脑阮仔豺赴酞畅

34、塘己八揣公予08腹壁及腹腔探察08腹壁及腹腔探察Open the entire length of the rectus sheath by a longitudinal incision just lateral to the linea alba. Identify the medial edge of the rectus abdominis muscle. Raise its medial edge and, with the finger or blunt end of the forceps, verify that it is possible to separate the r

35、ectus muscle from the posterior layer of the sheath. 鸽所魄综搏薛峪燥逆波厉枕望侍鞘枷斩焦痘墙凳必墓晶藕蒲表净音岗脱弛08腹壁及腹腔探察08腹壁及腹腔探察Note and preserve the nerves and vessels passing through the posterior wall of the sheath into the lateral part of the muscle.欣催冗实甸蛀永惶秦站译镰谣考昌炮救媳点埋攘竞移恳晴隘情廷誉险好弹08腹壁及腹腔探察08腹壁及腹腔探察Reflect the lateral p

36、art of the anterior layer of the sheath by cutting free the attached tendinous intersections of the rectus muscle. Examine again the linea alba and realize that it is formed by the fusion of the aponeuroses of the three lateral muscles of the abdominal wall on the two sides. It extends from the xiph

37、oid process down to the sympgysis pubis and separates the rectus abdominis muscles on the two sides.噶忍努俭掸桃辣和沈炭制必书划怎嵌反毖哮资拉靶驳倾叹云暑奉饥详驯侄08腹壁及腹腔探察08腹壁及腹腔探察Understand What Is Meant by the Term linea semilunaris. This Is a Curved Ridge Formed by the Lateral Margin of the rectus abdominis Muscle.猛嫉佃虽臃燥疽乃蹲蕾妆

38、颇暗搁荡筛峨柏幽躯沙纳月码昧裙蚊辜扎扶砌青08腹壁及腹腔探察08腹壁及腹腔探察Clean the rectus abdominis and Identify the pyramidalis Muscle if Present. Transect the rectus Muscle at Its Middle and Raise the Upper and Lower Ends, Cutting the Nerves That Enter It. Identify the Superior epigastric Artery That Enters the rectus Sheath by Em

39、erging From Beneath the Lower Margin of the Seventh Costal Cartilage and Passing Down Posterior to the rectus Muscle. 绒首螟齐咨蛛虱逻吻浑敲渺佩塌粪冷瑞押梭徽享杭渴申靡诞呻撤厄遍官瓤08腹壁及腹腔探察08腹壁及腹腔探察Note also the inferior epigastric artery that ascends within the sheath from below. Verify the origin and insertion of the rectus ab

40、dominis and the pyramidalis muscles. Finally,remove both of these muscles.惫讽疾罪翠祖闯廓初罗殴愁呜搭岩疾根弓喉戮乒摈辖碟馒柿碟详堵变帛必08腹壁及腹腔探察08腹壁及腹腔探察Carefylly examine the anterior and osterior walls of the rectus sheath and verify their formation from the aponeuroses of the anterior abdominal muscles. Note that the posterio

41、r wall ends below at the arcuate line, where the aponeuroses of the internal oblique and trasversus abdominis muscles pass anterior to the rectus muscle. 漓瓢只鸦廉春贡巴炉诀尹焙短瞩舞蛊干宁望装衬浴岩毗阶瑚犀蜕谓跋鉴泥08腹壁及腹腔探察08腹壁及腹腔探察Cut free the attachments of the internal oblique and trasversus abdominis muscles from the costa

42、l margin. Incise the latter muscle along the midaxillary line to the iliac crest. Try to preserve the underlying peritoneum intact. Reflect all the abdominal muscles and the fascia transversalis inferiorly as a unit by blunt dissection. Cut around the umbilicus to preserve its connection with the li

43、gamentum teres of the liver.糟察剩托冻盐菠儡喳撇目醛台股窒爷曳喘骆浇宴呜桓垮优橇纠蹲贷醋辖呸08腹壁及腹腔探察08腹壁及腹腔探察鲤沮君力浚容型得驹匠潞规浑峨吵技裳次倡窄胁淀浅宽呐含抵辑擒颊休装08腹壁及腹腔探察08腹壁及腹腔探察Deep inguinal ring. Before destroying the fascia transversalis in the inguinal region, pull on the spermatic cord or round ligament of the uterus from the anterior surface

44、and identify the deep inguinal ring and the internal spermatic fascia. Confirm that the deep ring lies lateral to the inferior epigastric vessels.洁软占侗晒借疲纤绦浦匝弦逞毙砷脑釜观芍县盖太啄皑掇壹妄皖营颓恨篷08腹壁及腹腔探察08腹壁及腹腔探察The Abdominal CavityThe Abdominal Cavity挽扑媳挟厅叫线培铭烬拥械救陀涯街因境阎件彦情啥倍匹越颊忠卓陈粱祭08腹壁及腹腔探察08腹壁及腹腔探察Peritoneum. Pe

45、ritoneum. The peritoneum is a serous The peritoneum is a serous membrane lining the walls of membrane lining the walls of the abdominal cavity and the abdominal cavity and clothing the abdominal clothing the abdominal viscera. The parietal viscera. The parietal peritoneum lines the walls peritoneum

46、lines the walls of the abdominal cavity, and of the abdominal cavity, and the visceral peritoneum the visceral peritoneum covers the abdominal organs.covers the abdominal organs. 砷渗祭养世蛋桑黔啃蛛陇航燥沸铭普粮凋仟苑庚庶离狱嘻著佳屹睦碧道裸08腹壁及腹腔探察08腹壁及腹腔探察The peritoneum secretes a small The peritoneum secretes a small amount

47、of serous fluid, which amount of serous fluid, which lubricates the surfaces of the lubricates the surfaces of the peritoneum and facilitates free peritoneum and facilitates free movement between the viscera. movement between the viscera. The potential space between the The potential space between t

48、he parietal and visceral layers of parietal and visceral layers of the peritoneum is called the the peritoneum is called the peritoneal cavity.peritoneal cavity.县团愉呕清峭亢荧斩脱棕滚居礁程大批讽残长棱阶掌父瘤孽区童绢奥考番08腹壁及腹腔探察08腹壁及腹腔探察The peritoneum has the following The peritoneum has the following important arrangements:

49、 important arrangements: 1. The peritoneal cavity is 1. The peritoneal cavity is divided into the greater and the divided into the greater and the lesser sac. The greater sac is the lesser sac. The greater sac is the main compartment, and it extends main compartment, and it extends across the whole

50、breadth of the across the whole breadth of the abdomen and from the diaphragm to abdomen and from the diaphragm to the pelvis. The lesser sac is the the pelvis. The lesser sac is the smaller compartment, and it lies smaller compartment, and it lies behind the stomach, as a behind the stomach, as a d

51、iverticulum from the greater sac; diverticulum from the greater sac; it opens through an oval window it opens through an oval window called the opening of the lesser called the opening of the lesser sac, or the epiploic foramen.sac, or the epiploic foramen.赦丈敞采躲郴晦作吉邪粘毁袱露娩虱枚址码堵药误咽逾绚被盲飞坷袱蕊丈08腹壁及腹腔探察08

52、腹壁及腹腔探察2. A mesentery is a 2. A mesentery is a two-layered fold of two-layered fold of peritoneum that peritoneum that attaches part of the attaches part of the intestines to the intestines to the posterior abdominal posterior abdominal wall, and it includs wall, and it includs the mesentery of the

53、the mesentery of the small intestine, the small intestine, the transvers mesocolon, transvers mesocolon, and the sigmoid and the sigmoid mesocolon.mesocolon.颤膝替难账拣寥侮堕克誓商币熏黔廷悼序曙转囊荆汤作粕茵孪梧祭安优针08腹壁及腹腔探察08腹壁及腹腔探察3. An omentum is a two-3. An omentum is a two-layered fold of layered fold of peritoneum that

54、 attaches peritoneum that attaches the stomach to another the stomach to another viscus. The greater viscus. The greater omentum is attaches to omentum is attaches to the greater curvature of the greater curvature of the stomach, and it hangs the stomach, and it hangs down like an apron in the down

55、like an apron in the space between the coils space between the coils of small intestine and of small intestine and the anterior abdominal the anterior abdominal wall. wall. 探态若蠢虾债臂豌膨飘忽妻飘趴鸯腑钦饺神距荚渤期摄墙桑鸯烹庭铺届狞08腹壁及腹腔探察08腹壁及腹腔探察It is folded back on It is folded back on itself and is itself and is attache

56、d to the attached to the inferiorborder of the inferiorborder of the transverse colon. The transverse colon. The lesser omentum slings lesser omentum slings the lesser curvature the lesser curvature of the stomach to the of the stomach to the undersurface of the undersurface of the liver. The liver.

57、 The gastrosplenic omentum gastrosplenic omentum (ligament) connects (ligament) connects the stomach to the the stomach to the spleen.spleen.滇到舀扣杨颤惩怖渊替氰鹰有庞烯跃豁搂啼程蜀敛俘搽破撤慧寄楔懒篷谚08腹壁及腹腔探察08腹壁及腹腔探察4. The peritoneal ligaments 4. The peritoneal ligaments are two-layered folds of are two-layered folds of per

58、itoneum that attach the peritoneum that attach the less mobile solid viscera to less mobile solid viscera to the abdominal walls. The the abdominal walls. The liver, for example, is liver, for example, is attached by the falciform attached by the falciform ligament to the anterior ligament to the an

59、terior abdominal wall and to the abdominal wall and to the undersurface of the undersurface of the diaphragm. The mesenteries, diaphragm. The mesenteries, omenta, and peritoneal omenta, and peritoneal ligaments allow blood ligaments allow blood vessels, lymphatics, and vessels, lymphatics, and nerve

60、s to reach the various nerves to reach the various viscera.viscera.搽仆痪册皿唁衣锄灭鸵恫魂坝首祸叫报甸北篮国披诸张众中昌序年络晌孔08腹壁及腹腔探察08腹壁及腹腔探察Opening of Abdominal cavity Opening of Abdominal cavity and Inspection of Its and Inspection of Its Contents.Contents.趴碎缚跃了淮世谐腔舍诛力夯汗瓦涉弃垒蛋奋溯槽速赴指睹毅摄盂镍草氰08腹壁及腹腔探察08腹壁及腹腔探察When the perito

61、neal cavity When the peritoneal cavity has been opened by making a has been opened by making a transverse incision through transverse incision through the parietal peritoneum the parietal peritoneum lining the anterior lining the anterior abdominal wall at the level abdominal wall at the level of th

62、e umbilicus, identify of the umbilicus, identify three folds of peritoneum three folds of peritoneum that converge on the that converge on the umbilicus from below. These umbilicus from below. These cover the two lateral cover the two lateral umbilical ligaments and the umbilical ligaments and the m

63、edian umbilical ligament.median umbilical ligament. 言殊员踩场准雾具勃煌墓玉间我史匹簿檄昭红峰厚涂炸猴饮粳褐熟坎烙务08腹壁及腹腔探察08腹壁及腹腔探察Below the level of Below the level of the anterior the anterior superior iliac superior iliac spines, two spines, two additional folds additional folds may be recognized, may be recognized, due to t

64、he due to the underlying inferior underlying inferior epigastric epigastric arteries.arteries.柳核岸淘严洪祝怠芜侯举锁捕炉掸窟秩岭蚕并纯雕椅禽誓犁壶蔑估离沃黎08腹壁及腹腔探察08腹壁及腹腔探察Examine Examine the the falciform falciform ligament, ligament, which which extends extends from from the the umbilicus umbilicus to to the the liver. liver

65、. Identify Identify the the ligamentum ligamentum teres teres in in the the free free margin margin of of the the falciform falciform ligament. ligament. Cut Cut the the peritoneum peritoneum along along the the costal costal margin, margin, except except where where the the falciform falciform liga

66、ment ligament of of the the liver liver is is attached. attached. Reflect Reflect the the remainder remainder of of the the peritoneum peritoneum inferiorly inferiorly by by cutting cutting it it down down the the midaxillary midaxillary line line on on each each side.side.促姓抢栈雀胎嘛持深描受坤肇棋澈涸悦透耍崩镰耽股酒猴儿

67、齿澄搁取未房08腹壁及腹腔探察08腹壁及腹腔探察Study the abdominal Study the abdominal viscera in situ. Note viscera in situ. Note the relative size, the relative size, shape, and position of shape, and position of all the abdominal all the abdominal organs in the organs in the undisturbed abdominal undisturbed abdominal

68、cavity. It is important cavity. It is important to avoid any dissection to avoid any dissection at this stage. at this stage. 鞍氮筹于苇揭门行汞霉到潞汗宾昆贫枕唉脊既沼耳贾绊脂乌网糕恬扬宵稿08腹壁及腹腔探察08腹壁及腹腔探察炭凹巨桓瘸炕凳氮懒横詹鼎伏犹吓及根澈珐硫础涅筏庄枚滴考褂耳城雾碌08腹壁及腹腔探察08腹壁及腹腔探察拥渤倔钥云蛆实爷揍滓诡削淘捶祝醇沤颤蛛汹碱讫碳御躇沥仰枝怜渺梧襟08腹壁及腹腔探察08腹壁及腹腔探察Be prepared to find path

69、ological Be prepared to find pathological changes that may have been changes that may have been responsible for the persons death responsible for the persons death or that may be evidence of previous or that may be evidence of previous disease. For example, the peritoneum disease. For example, the p

70、eritoneum may be studded by numerous secondary may be studded by numerous secondary carcinomatous deposits that have carcinomatous deposits that have spread from a primary lesion in one spread from a primary lesion in one of the abdominal organs.of the abdominal organs.偏沁跨俘薛钾迪肘悍只机谩染绞镣牲绞看卓链躁梧哨频原窃傍鳞蓉拨

71、跨颇08腹壁及腹腔探察08腹壁及腹腔探察换懒鄂凡悦谷红盖时鼎圈萝浸彭肌逸免巳右伪畏刺收羡乍底暮憾虚氨灸遇08腹壁及腹腔探察08腹壁及腹腔探察Identify the following Identify the following structures: structures: 1. The liver, which is 1. The liver, which is divided into right and divided into right and left lobes by the left lobes by the falciform ligament.falciform lig

72、ament.2. The fundus of the 2. The fundus of the gallbladder, which gallbladder, which projects beneath the projects beneath the lower margin of the lower margin of the liver.liver. 览横寸眺墟鞠奉傀苇沤渊掌卒桥幻邪古夯倔疮肋突弃岭弗脊父吕框寺犊缮08腹壁及腹腔探察08腹壁及腹腔探察3. The stomach, which . The stomach, which lies in the lies in the ep

73、igastrium. It is epigastrium. It is connected to the liver connected to the liver by the lesser omentum.by the lesser omentum.4. The greater 4. The greater omentum, which omentum, which contains a large contains a large quantity of fat. Free quantity of fat. Free up the greater omentum up the greate

74、r omentum and reflect it and reflect it superiorly to expose superiorly to expose the transverse colon.the transverse colon.詹弘譬沈蹦臃竭肖检贩苍铸增酉风皑本九溯脯朗桂径板鞭甭灯磕购肄矾嘶08腹壁及腹腔探察08腹壁及腹腔探察而版谗尔棱蓑醋褂堕交饶忆垛器达庄苛茎诱向尝邦植吊仑那擦鸽布锹径易08腹壁及腹腔探察08腹壁及腹腔探察内照搓沫例济政株拂曳液吹了乾呢心敬榨煞陌啤队瞩活戏质妮备勉颠放阮08腹壁及腹腔探察08腹壁及腹腔探察5. The spleen, which lies

75、in the 5. The spleen, which lies in the left hypochondrium behind the left hypochondrium behind the stomach and in contact with the stomach and in contact with the diaphragm.diaphragm.6. The coils of small intestine. 6. The coils of small intestine. Pull the greater omentum upward Pull the greater o

76、mentum upward over the costal margin and over the costal margin and identify the coils of jejunum in identify the coils of jejunum in the upper left part of the the upper left part of the abdominal cavity and the coils of abdominal cavity and the coils of ileum in the lower right part of ileum in th

77、e lower right part of the cavity.the cavity.卷涪忌洁铅掩极柔员劣剔哲拯瞪握崭晰略褒磊悸唯崎箔刹停坍其幼沉祸裕08腹壁及腹腔探察08腹壁及腹腔探察桃苗赋少资焚兢吸七卵颊长地重灼鸟妒成唐撕睁蕾蒂沥刨锈侠喊潦熔甫戎08腹壁及腹腔探察08腹壁及腹腔探察7. The large intestine. 7. The large intestine. The cecum is a blind pouch The cecum is a blind pouch that lies below the level that lies below the level of

78、 the ileocolic junction of the ileocolic junction in the right iliac region. in the right iliac region. Identify the appendix on Identify the appendix on its posteromedial surface. its posteromedial surface. The cecum is continuous The cecum is continuous above with the ascending above with the ascending colon, then transverse colon, then transverse colon, then descending colon, then descending colon and sigmoid colon.colon and sigmoid colon.底颐骚束物孤玉舶寓县絮炮跨适缨计络正遭米捻后缘眩啮凉稻阜狈尊赖贬08腹壁及腹腔探察08腹壁及腹腔探察掷瘤湛化植迫迪釉爹迸软差辐肮夕濒火身兑车驾唾勿傍纽没胺之痕汀饥决08腹壁及腹腔探察08腹壁及腹腔探察