S2M2 anat

• - passes thru tip of 9th cc
• - transects pylorus when patient is recumbant
• - often used with interspinous plane
• - GB(fundus), origin of SMA, pylorus of stomach, duodenojejunal junction, pancreas(neck), kidneys(hilum) are all located on this plane

• - passes horizontally across both ASIS
• - pairs with transpyloric plane

• - passes through lower border of 10th cc
• - at level of L3
• - pairs with intertubercular plane

• - passes horizontally thru tubercles of iliac crest (~4-5 cm behind ASIS)
• - transects body of L5
• -pairs with subcostal plane

• 1- skin
• 2- superficial fascia (s- campers fat, d- scarpas)
• 3- deep fascia
• 4- muscular layer
• 5- tranversalis fascia
• 6- extraperitoneal fat
• 7- parietal peritoneum

• - outermost muscle
• - hand in pocket fiber orientation
• - T7-T11 spinal nerves and subcostal nerve

• - middle muscle
• - hand on chest fiber orientation
• - T6-L1

• - inferior aponeurotic fibers of internal oblique and transversus abdominis join to form this tendon
• - inserts into pubic tubercle

• - deep muscle
• - horizontal fiber orientation
• - T6-L1

• - ab muscles
• - T6-L1

• -a curved line along the lateral border of each rectus abdominis muscle and rectus shealth, marking the meeting of the aponeuroses of the internal oblique and transverse abdominal muscles(conjoint tendon)
• - money maker line
• - weak point-> spigelian hernia

• -tough fibrous sheath a top rectus abdominis made of aponeurosis of obliques and transversus abdominis
• - semilunar line is lateral border
• - contents: rectus abdominis, pyramidalis, sup and inf epigastric vessels and lymphatics, ventral primary rami of T7-T12

• - aka linea semicircularis
• - demarcates lower limit of posterior layer of rectus sheath

- internal thoracic-> superior epigastric and musculophrenic

- external iliac-> inferior epigastric and deep circumflex iliac

- femoral-> superficial epigastric and superficial circumflex iliac

• - SADPUCKER
• -suprarenal glands, aorta/IVC, duodenum(2,3,4), pancreas(except tail), ureters, colon(A & D), kidneys, esophagus, rectum
• -1,1 2,2 1,2 1,1,1

• - communication between greater and lesses sac
• - aka foramen of Winslow

• -supports flexure of 4th part of duodenum attach to pyloric antrum
• - anatomical cut off for GI bleeding
• - below=lower GI= red blood stools
• - above= upper GI= black blood stools

-lienogastric(gastrosplenic)- contains short gastric vessels and L gastroepiploic vessels

- lienorenal(splenorenal)- contains splenic vessels and tail of pancreas

• -performed at right 10th intercostal space in midaxillary line-
• - have pt hold there breath in full expiration to lessen possiblilty of damaging lung and contaminating pleural cavity

• - forms behind the NECK of the pancreas by the anastamosis of the SPLENIC v and SMv
• (IMv joins splenic v)

• 1- b/t esophageal veins (esophageal varisces)
• 2- b/t rectal veins (hemorrhoids, rectal bleeding)
• 3- paraumbilical veins (and small epigastric veins of anterior abdominal wall)
• 4- twings of colic veins (portal & retroperitoneal veins)

• - lies in gallbladder fossa of liver
• - body in contact with TC and first part of duodenum (possible locations for stone jumping)
• - fundus lies at tip of 9th ICC

• - cystohepatic triangle
• - sup- liver, lat- cytic duct, med- common hepatic duct
• - cystic artery(from right hepatic artery) runs thru center of triangle

• - thoracic splanchnic nerves (T5-T9)
• - carry pain sensation to DRG

• - pelvic splanchnic (S2-S4)
• - NOT vagus

- foregut- epigastric region

- midgut- periumbilical

- hindgut- pelvic region

• - LUQ
• - deep red
• - long vasa recta and few large arcades
• - large, tall and tightly packed circular folds

• - RLQ
• - pale pink
• - short vasa recta and many short arcades
• - low and sparse circular folds
• - many peyers patches
• - abundant mesenteric fat

• -S4 (via pudendal n. to inferior rectal n)
• - nerve to levator ani (S3-S4)

• - SMA
• - portal vein
• - internal iliac LN
• - visceral innervation

• - internal iliac artery
• - caval venous plexus
• - superficial inguinal LN
• - pudendal nerve (somatic)

-SNS- greater splanchnic nerve (T5-T10) which synapses at celiac and SMA ganglion, accompany SMA periarterial branches

- PNS- vagus posterior trunk

- SNS- lesser(T10-T11) and least(T12) splanchnic nerves, synapse at SMA ganglion

PNS- vagus postrior trunk

- SNS- Lumbar splanchnic nerves (L1-L2/3) thru inferior mesenteric plexus

-PNS- pelvic splanchnic (S2-S4) thru inferior hypogastric plexus

- SNS- lumbar splanchnic nerves

-PNS- pelvic splanchnic nerves (S2-S4)

• - seen in portal HTN
• - extreme dilation of thoracic epigastric and superficial epigastric veins