Abdominal wall

“ We distinguish the segment dorsad of the stomach as the dorsal mesogastrium, directly continuous with the remaining segments of the common primitive dorsal mesentery, while the portion ventrad of the stomach forms the ventral mesogastrium in which the liver develops. The segment of the ventral mesogastrium between liver and stomach becomes the lesser or gastro-hepatic omentum, while that between liver and ventral abdominal wall forms the falciform or suspensory ligament. ”

“ The anterior wall may be cut midway between the greater and lesser curvatures, or the cut may follow the greater curvature, extending through the cardia into the œsophagus. As the stomach is opened its contents are inspected and removed. They should not be allowed to escape into the abdominal cavity. When the organs are removed en masse the stomach may be opened from the cardiac end. The organ may also be opened by an incision through its posterior wall or along its lesser curvature, as occasion may demand. ”

“ Stabs of the abdomen are serious if they have penetrated the abdominal wall, as, at the time of injury, septic germs may have been introduced, or the bowel may have been wounded. In either case a fatal inflammation of the peritoneum may be set up. It is inadvisable to probe a wound in order to find out if the belly-cavity has been penetrated, as the probe itself might carry inwards septic germs. ”

“ When the large intestine is full, palpation through the abdominal wall demonstrates that the material in the lower descending colon and in the sigmoid flexure is usually composed of hard, incompressible lumps, while that in the ascending and transverse colon and the cæcum is soft, permitting the walls of the gut to be easily pushed together. ”

“ The original ventral surface looks cephalad, as well as ventrad, forming the convex surface which in the adult rests in contact with the abdominal wall and diaphragmatic vault, while the surface originally directed dorsad toward the stomach finally in large part has an inclination caudad forming the “inferior” surface of human anatomy. ”

“ The abdominal and pelvic organs are cushioned or held in place somewhat by the network of fatty tissue that surrounds them, and the rectum is no exception to the rule. The outer or serous wall is surrounded by an abundance of loose areolar tissue, which is divided into cellular spaces. ”

“ The greatest amount of dulness would be over the tenth and eleventh ribs; above this the thin edge of the lung would intervene between the spleen and the abdominal wall. If, therefore, the spleen can be distinctly felt below the ribs, it must be enlarged. In proportion to its enlargement, so can its lower rounded border be detected below the tenth and eleventh ribs, especially when forced downwards by a deep inspiration. [5]
82. Pancreas.—The pancreas lies transversely behind the stomach, and crosses the aorta and the spine about the junction of the first and second lumbar vertebræ. ”

“ A great variety is observed in the arrangement of the biliary ducts, through which, at the period of intestinal digestion, bile passes from the liver and gall-bladder into the intestine, while in the intervals of digestion the secretion is only carried from the liver to the bladder. The following main types of the biliary duct system may be recognized:
1. The hepatic duct joins the cystic to form the common bile-duct, entering the duodenum by passing obliquely through the intestinal wall (Fig. 242) . This form is encountered in man and in most mammals. ”

“ It must then become apparent that the entire serous surface which in the adult human subject we regard as “parietal peritoneum of the lesser sac” lining the dorsal wall of the retrogastric space is derived from what originally was the right layer of the primitive sagittal dorsal mesogastrium. ”

“ The adhesion and fixation of the dorsal wall of the intestine seems to afford an advantage to the dorsal vessel, whereas the greater mobility and the alternating conditions of distension and contraction, with variations of intracæcal pressure, depending upon the contents of the pouch, appear to operate unfavorably upon the development of the ventral vessel. ”

“ Suppose we make a rubber duplicate of the abdominal walls of the average man, and place therein rubber duplicates of all the internal vital organs—pelvic and abdominal. To hold the stomach, bowels, and other organs in place, we fasten them with elastic bands here and there, and make a generous use of cotton to support the various parts, which are all connected with many little circulating tubes, with strings for the greater nerves, etc. ”

“ But the damage is not done to the heart and lungs alone. The liver is crowded out of place until it sometimes reaches clear across the abdomen and is creased with ruts from the pressure of the ribs upon it. The stomach is also pressed out of place. It belongs close up under the diaphragm, but it is crowded by the pressure down until it lies in the abdominal cavity, as low down, sometimes, as the umbilicus, six or eight inches below where it belongs. ”

“ Now the liver, stomach, and all the intestines below the diaphragm, have no support from above, and so the question is, what sustains these organs, weighing from six to twelve pounds, so that they do not sink down on to the delicate pelvic organs below? The answer is, they are held up chiefly by abdominal breathing, as above explained. For at every rise of the diaphragm a vacuum is made above the abdominal viscera, lifting them upward, and this is done at every breath, and we breathe about twenty times each minute. ”

“ The space between the thorax and the pelvis, bounded above by the lumbar vertebræ and shut in below and on the sides by the skin and muscular walls of the belly (abdomen) , is called the abdominal cavity. This cavity opens directly into the pelvic cavity, and contains the stomach, intestines, liver, spleen, pancreas, kidneys, and a part of the generative organs. The thoracic and abdominal cavities are separated by a muscular partition, the diaphragm.
The bones of the limbs may be likened to columns, upon which the body rests ”

“ Foreign bodies left in the abdomen. Every writer on ovariotomy and kindred operations insists on the importance of exercising the utmost personal vigilance in counting instruments and dabs before, and immediately after, an abdominal operation in order to avert the dangers which ensue when instruments, dabs, gauze, or drainage tubes are accidentally left in the abdominal cavity. Before the era of antiseptic surgery nearly all the patients in whom foreign bodies were left in the abdominal cavity died. ”

“ The patient lies on the back with the knees drawn up so as to relax the abdominal muscles; the breathing becomes rapid and shallow, and is performed by movements of the chest only, the abdominal muscles remaining quiescent—unlike what takes place in healthy respiration. The abdomen becomes swollen by flatulent distension of the intestines, which increases the distress. ”

“ The mechanical principle upon which the abdominal chamber is constructed, enables it to adjust its capacity to such exigence or pressing necessity as its own visceral organs impose on it, from time to time; and the relation which the abdominal cavity bears to the thoracic chamber, enables it also to be compensatory to this latter. When the inspiratory thorax gains space from the abdomen, or when space is demanded for the increasing bulk of the alimentary canal, or for the enlarging pregnant uterus ”

“ It is only in an occasional flabby abdomen that pressure has been low with a wide gaping opening, but in such instances the mobile abdominal contents have been subjected to a considerable range of displacement upward or downward, so that the rule is not vitiated that reads "the wider the gap the greater the tension." ”

“ The only difference which I can discover between the regions called thorax and abdomen, in the osseous skeleton, (considering this body morphologically,) results, simply, from the circumstance that the ribs, which enclose thoracic space, have no osseous counterparts in the abdomen enclosing abdominal space, and this difference is merely histological. In man and the mammalia the costal arches hold relation with the pulmonary organs, and these costae fail at that region where the ventral organs are located. ”

“ After opening the abdominal cavity of the human adult, elevating the liver and depressing the stomach, the hepatic attachment of the lesser omentum can be traced as already described. It will then be observed that the gastric attachment of the membrane lies in one plane following the lesser curvature while the hepatic attachment forms a broken line, with the angle situated at the left extremity of the transverse fissure. ”

“ That portion of the trunk which in man commences beneath, and in mammalia behind, the diaphragm, and terminates at the extremity of the pelvis. The abdominal cavity is the largest in the human body. It is lined with a serous membrane, called the peritoneum. ”

“ If, after removing all pressure, and giving those wonderful organs in the abdominal cavity full opportunity to perform their vital functions, the mischievous effects of the long continued pressure do not at once disappear, you may percuss and knead the abdomen a few minutes, morning and evening. Weak digestion, torpid liver and constipation are, by this simple means, frequently cured, and invariably relieved. ”

“ The analogy between the systems with black blood, the abdominal and general, supposes them the same in properties, sympathies, affections, &c. I have often irritated the mesenteric veins, upon which it is extremely easy to act, by drawing through a small wound of the abdomen a portion of the intestinal canal; the results have always been the same as in the preceding system. Only when we inject air, the animal does not struggle, does not appear to suffer, and the experiment is not fatal ”