Fig. 4.181 Abdominal quadrants and the positions of major viscera. Anterior view of a man.
Fig. 4.182 The nine regions of the abdomen. Anterior view of a woman.
Fig. 4.183 Surface projection of the kidneys and ureters. Posterior view of the abdominal region of a woman.
Fig. 4.184 Surface projection of the spleen. Posterior view of a man.
eFig. 4.187 Transjugular liver biopsy needle in the right hepatic vein. Radiograph.
eFig. 4.188 Subphrenic collection of pus and gas. Computed tomogram in the axial plane.
Subphrenic collection of pus and gas eFig. 4.189 Position of a transjugular intrahepatic portosystemic shunt stent. Radiograph.
eFig. 4.190 Functioning transjugular intrahepatic portosystemic shunt. Venogram.
Fig. 4.185 Tumor in the head of the pancreas. Computed tomogram in the axial plane.
eFig. 4.191 A computed tomogram, in the axial plane, of the pelvis demonstrates a loop of sigmoid colon with numerous diverticula and a large abscess in the pelvic cavity.
Fig. 4.186 This postcontrast computed tomogram, in the axial plane, demonstrates two metastases situated within the right lobe of the liver. The left lobe of the liver is clear. The larger of the two metastases is situated to the right of the middle hepatic vein, which lies in the principal plane of the liver dividing the left and right sides of the liver.
Table 4.1 Abdominal wall muscles
Table 4.2 Posterior abdominal wall muscles
Table 4.3 Branches of the abdominal aorta
Table 4.4 Lymphatic drainage
Table 4.5 Referred pain pathways (visceral afferents)
Table 4.6 Branches of the lumbar plexus
In the clinic
Access to the abdomen and its contents is usually obtained through incisions in the anterior abdominal wall. Traditionally, incisions have been placed at and around the region of surgical interest. The size of these incisions was usually large to allow good access and optimal visualization of the abdominal cavity. As anesthesia has developed and muscle-relaxing drugs have become widely used, the abdominal incisions have become smaller.
Currently, the most commonly used large abdominal incision is a central craniocaudad incision from the xiphoid process to the symphysis pubis, which provides wide access to the whole of the abdominal contents and allows an exploratory procedure to be performed (laparotomy).
In the clinic
Laparoscopic surgery, also known as minimally invasive or keyhole surgery, is performed by operating through a series of small incisions no more than 1 to 2 cm in length. As the incisions are much smaller than those used in traditional abdominal surgery, patients experience less postoperative pain and have shorter recovery times. There is also a favorable cosmetic outcome with smaller scars. Several surgical procedures such as appendectomy, cholecystectomy, and hernia repair, as well as numerous orthopaedic, urological, and gynecological procedures, are now commonly performed laparoscopically.
During the operation, a camera known as a laparoscope is used to transmit live, magnified images of the surgical field to a monitor viewed by the surgeon. The camera is inserted into the abdominal cavity through a small incision, called a port-site, usually at the umbilicus. In order to create enough space to operate, the abdominal wall is elevated by inflating the cavity with gas, typically carbon dioxide. Other long, thin surgical instruments are then introduced through additional port-sites, which can be used by the surgeon to operate. The placement of these port-sites is carefully planned to allow optimal access to the surgical field.