ABDOMINAL WALL, HERNIA AND UMBILICUS

Abdominal wall
A complex structure: musle, bone, fascia.

Functions:
Major: protect enclosed organs of GIT and UGT
Secondary: mobility- flex, extend, rotate and vary capacity. N.B: this flexibility needs elasticity and
stretch compromises abd. Wall strength

BOUDARIES:

Roof: diaphragm
Floor: Bony pelvis
Lateral: 3 thin muscle layers
Anterior: 2 rectus abdominus
Posterior: posterior triangles, vertebral column, ribs and pelvis

SPECIAL THINGS REGARDING THE BOUNDARIES.

The diaphragm that separates the thorax and abdomen also separates the pressures of these
two regions, i.e, the negative pressure of the thorax and positive pressure of the abdomen.
Therefore, diaphragm weakness bowel drawn into chest (down the pressure gradient)
The perineum (floor)- can weaken rectum, bladder and gynae organs prolapsing.
The muscles posteriorly are supported by the vert. column, ribs and pelvis.
The post. Triangles are areas of weakness and can lumbar hernias.
The fibres of the lateral 3 thin mm layers criss-cross strength and flexibility.
Various surgical techniques can be employed to make use of these layers eg: making releasing
incisions, separating layers and sliding one layer on another to increase girth and allow closure
of defects in centre of abdomen Ramirez slide (used in large incisional hernia repair)

Hernia thru the rectus abdominus mm dont occur naturally, but the linea alba is a point of
weakness epigastric and paraumbilical herniation.
Another condition is DIVERIFICATION OF RECTI: the linea alba stretches laterally as the two
rectus mm separate. This occurs in upper abd of middle aged, overweight men and also from
birth trauma in females, but in them it occurs below umbilicus.

ABD. PRESSURE:
Rem: its positive pressure. This can be used to allow drainage tru drains: blood, pus, bile, bowel
content, urine flow outwards DOWN the pressure gradient.
BUT the positive pressure can also hernias via defects in the mm. wall.