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  <head>
    <title>078-01 Abdominal wall, inguinal region, peritoneum, mesenteries, and spaces</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Abdominal wall, peritoneum, and spaces">
      <outline text="Anterior wall and landmarks">
        <outline text="Costal margin to iliac crests, inguinal ligaments, symphysis"/>
        <outline text="Layers: skin to parietal peritoneum"/>
        <outline text="Camper fatty and Scarpa membranous fascia">
          <outline text="Membranous fascia continues into perineum"/>
          <outline text="Directs spread of urine or blood"/>
          <outline text="Thigh fascia attachment limits descent into limb"/>
        </outline>
        <outline text="Oblique and transverse muscle fibre directions">
          <outline text="Aponeuroses form rectus sheath and linea alba"/>
        </outline>
        <outline text="Arcuate line changes rectus sheath">
          <outline text="Below it all aponeuroses pass anteriorly"/>
          <outline text="Only transversalis fascia remains posterior"/>
        </outline>
      </outline>
      <outline text="Wall nerves, vessels, lymph, and incisions">
        <outline text="Thoracoabdominal nerves between internal oblique and transversus">
          <outline text="Incisions can denervate the wall"/>
        </outline>
        <outline text="Superior and inferior epigastric anastomosis">
          <outline text="Collateral flow subclavian to external iliac"/>
        </outline>
        <outline text="Paraumbilical veins link portal and systemic channels"/>
        <outline text="Lymph above umbilicus to axillary nodes"/>
        <outline text="Lymph below umbilicus to superficial inguinal nodes"/>
        <outline text="Midline linea alba: avascular, needs durable closure"/>
        <outline text="Transverse incision may cross segmental paths"/>
      </outline>
      <outline text="Posterior wall">
        <outline text="Vertebrae, psoas, quadratus lumborum, iliacus, diaphragm"/>
        <outline text="Lumbar plexus forms within psoas"/>
        <outline text="Retroperitoneal blood or pus irritates psoas">
          <outline text="Hip-flexion posture"/>
          <outline text="Femoral neuropathy"/>
        </outline>
      </outline>
      <outline text="Wall mechanics and hernias">
        <outline text="Muscles raise pressure with diaphragm and pelvic floor"/>
        <outline text="Pressure alone does not cause every hernia">
          <outline text="Fascial weakness, collagen, age, surgery, loading"/>
        </outline>
        <outline text="Umbilicus is a former fetal conduit"/>
        <outline text="Epigastric, umbilical, incisional, Spigelian, parastomal"/>
        <outline text="Sac, contents, neck, coverings"/>
        <outline text="Reducibility and strangulation describe risk, not type"/>
        <outline text="Rectus diastasis: no fascial defect, not a hernia"/>
      </outline>
      <outline text="Inguinal canal and groin hernias">
        <outline text="Deep ring to superficial ring, oblique course"/>
        <outline text="Anterior wall external oblique, internal oblique laterally"/>
        <outline text="Posterior wall transversalis fascia, conjoint tendon medially"/>
        <outline text="Spermatic cord or round ligament with ilioinguinal nerve">
          <outline text="Ilioinguinal enters laterally, not via deep ring"/>
        </outline>
        <outline text="Inferior epigastric vessels separate hernia types">
          <outline text="Indirect: lateral, via deep ring toward scrotum"/>
          <outline text="Direct: medial, through Hesselbach triangle"/>
        </outline>
        <outline text="Femoral hernia below ligament, medial to vein">
          <outline text="Narrow rigid neck, high strangulation risk"/>
        </outline>
      </outline>
      <outline text="Peritoneal layers and organ positions">
        <outline text="Parietal peritoneum: somatic, sharp localised pain"/>
        <outline text="Visceral peritoneum: autonomic, diffuse pain"/>
        <outline text="Intraperitoneal organs suspended by mesentery"/>
        <outline text="Primarily retroperitoneal: kidneys, adrenals, aorta, cava"/>
        <outline text="Secondarily retroperitoneal organs fused to back wall">
          <outline text="Duodenum, pancreas except tail, ascending, descending colon"/>
          <outline text="Fusion fascia gives avascular surgical planes"/>
        </outline>
      </outline>
      <outline text="Sacs, omenta, and mesenteries">
        <outline text="Lesser sac behind stomach and lesser omentum">
          <outline text="Pancreatic fluid can collect here"/>
        </outline>
        <outline text="Epiploic foramen links lesser and greater sacs">
          <outline text="Hepatoduodenal ligament anterior, cava posterior"/>
          <outline text="Portal triad with portal vein posterior"/>
        </outline>
        <outline text="Greater omentum fuses with transverse colon">
          <outline text="Adheres to inflammation"/>
        </outline>
        <outline text="Mesentery root runs duodenojejunal to ileocaecal">
          <outline text="Crosses duodenum, aorta, cava, right ureter"/>
        </outline>
        <outline text="Sigmoid mesocolon crosses left ureter"/>
        <outline text="Peritoneal ligaments are double layers, not strong">
          <outline text="Falciform ligament contains ligamentum teres"/>
        </outline>
      </outline>
      <outline text="Spaces, gutters, and fluid spread">
        <outline text="Supracolic: liver, stomach, spleen"/>
        <outline text="Hepatorenal recess dependent when supine"/>
        <outline text="Right gutter opens to hepatorenal, subphrenic spaces"/>
        <outline text="Left gutter limited by phrenicocolic ligament"/>
        <outline text="Pelvic recesses lowest when upright">
          <outline text="Rectovesical pouch in males"/>
          <outline text="Rectouterine pouch usually lowest in females"/>
        </outline>
      </outline>
      <outline text="Pain by embryological territory">
        <outline text="Foregut epigastric, midgut periumbilical"/>
        <outline text="Hindgut lower abdominal or suprapubic"/>
        <outline text="Appendicitis: periumbilical then right lower quadrant">
          <outline text="Parietal peritoneum involvement localises pain"/>
        </outline>
        <outline text="Diaphragmatic peritoneum refers to shoulder"/>
        <outline text="Posterior structures cause back pain without peritonism"/>
      </outline>
    </outline>
  </body>
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