In this video you will be a bit of surgeon. We will show you what you would encounter if you would open the abdomen and explore it from the front to the back. We incise the skin Just below the skin is a layer of fascia that may contain little or much fat called compressed fascia. In persons with a, let's say rounder belly, this subcutaneous fat layer is one of the places where the fat is located. The other major place is between the intestines, more precisely within the mezentries. Deep in the fatty layer is a membraneous layer called scarpua fascia. Then we encounter the muscular layer. This consists of the abdominal muscles that we can see clearly in a muscular, slim person. Centrally, at both sides of the midline, is the rectus abdominus muscle. At the lateral sides of the abdomen are three muscle layers. The muscles are all ensheathed in fascia. A slim layer of fascia covers the muscles outer and inner side. You see the outer layer of this fascia being opened here, giving a view on the muscle tissue itself. In the zone between the rectus abdominis and the lateral muscles, the fascia layers unite to form a thick band of connective tissue named aponeuroses. We now cut the muscle layer and we'll also open the muscle's inner fascia layer. That has been done here. And this brings us to the parietal peritoneum that is adhered to the inner side of the abdominal wall. The abdominal wall has now been completely removed, leaving the parietal peritoneum in place as a sac. To demonstrate the peritoneum more clearly, air is drawn inside this peritoneal sac and released again. By opening the peritoneum we enter the peritoneal cavity. The first thing we see is the greater omentum. A fat filled apron of peritoneum that covers all the structures in the middle and lower abdomen. The greater omentum is a protective layer and it can also maneuver itself to places in the abdomen where there is an inflammation. Covering the inflamed structures in an attempt to prevent the spread of that inflammation. That might have been the case here as the omentum lies folded upward here. We know unfold it to its full size. The parietal peritoneum of the front abdominal wall has now been cut away completely to allow us a good view. In the upper abdomen, at the right side, we can see the liver protruding under the rib cage. The felsi form ligament, can be seen extending from the liver to the front abdominal wall. This is a double layer of peritoneum, that contains, at its inferior border, the remnant of the umbilical vein. When this person was still a fetus in her mother's womb, she received all the oxygenated blood from her mother via this vein. In the midline, and to the left, we can see a brim of the stomach protruding below the liver. And the greater omentum hangs downward from the greater curvature of the stomach. So far we saw the structures we can see directly after opening the abdomen. Now we'll lift obstructions to find what's behind them, to the left of the stomach we can find the spleen. It lies hidden behind the stomach and the back, safely covered by the rib cage. If we lift up the liver, we see the gallbladder. It's fundus my protrude slightly below the livers inferior edge. The gallbladder usually rest on the duodenum. The small first part of the duodenum can be seen. The rest of the duodenum dives out of site into the depth. Between the liver and the stomach is the lesser omentum. Once again, this is a double layer of peritoneum. It can be divided into hepatoduodenal ligament and the hepatogastric ligament. The hepatoduodenal ligament is the part that extends from the liver, or hepar in Latin, to the duodenum. It is a thick part of the lesser omentum. It contains the vessels and ducts to and from the liver, for instance, the portal vein that transports all the blood coming from the intestines, loaded with the nutrients rebsorbed from the intestines. Also, the bile duct is here, that transports the bile from the liver to the duodenum. The hepatogastric ligament is the part of the lesser omentum that extends between the liver and the stomach, or gastro in Latin. It's only a very thin membrane, one can look through it. The difference between the thick hepatoduodenal ligament and the thin hepatogastric ligament can be clearly shown by hooking a finger around the hepatoduodenal ligament. And we see our finger showing through the hepatogastric ligament. One can appreciate how thin it is. Now we shift our attention to the lower abdomen. If we lift up the great romantum we also lift of the transverse colon that's adhered to the great romantum. Beneath the great romantum we find the small intestines lying in a heap. To be precise, these are only two of the three parts of the small bowel, the duodenum, and the ileum. We can lift them up and move them around freely. They are so mobile because they're attached to mesentery, a stretch of double layer peritoneum that connects the intestines with the back wall. The mesentery can also hold a significant amount of fat. Beside the subcutaneous fat that I mentioned earlier, this is another main place of fat store. The multiple layers of fat reside in-between the intestines also contribute to the rounded belly in an obese person. To the lateral side we find the ascending and descending colon attached to the back wall. It's somewhat imbedded in the fat here. We move our exploration downwards to the pelvis. We see the uterus, and to it's side, fallopian tubes, and ovaries. Pritoneum is draped over and around them. At the front side of the body lies the bladder. We cannot see it, as it's outside the peritoneal cavity and inferior to it. To indicate the bladder's place, I move my fingers on its roof. You can see the roof undulating. To the back lies the rectum. It disappears into the depth of the pelvis. We repeat with a short overview of the pelvis from front to back, bladder, uterus, and rectum. So far we saw all the structures that can be reached after opening the abdomen and simply lifting structures that cover other structures. You might realize that we didn't yet find all abdominal structures. We didn't get to see the pancreas, nor the kidneys, and aorta or the inferior vena cava, to reach those structures we must go deeper and dissect. First lets go to the upper abdomen. We have now separated the greater omentum from the transverse colon and major colon, that allows us to lift up the stomach. And it gives us a view in the cavity behind the stomach, the omental bursa. We can now completely see the pancreas from its head, that's embedded in the C shaped duodenum, to its tail that lies at the hilum of the spleen. Going through the lower abdomen now, we look at the back wall of the peritoneal cavity. The parietal peritoneum. The aorta and inferior vena cava are behind the peritoneum here. Also, the kidneys are hidden behind the back wall here. When I move a kidney slightly, you only see the abdominal back wall that covers it move up and down a bit. To reach these structures, we must open the parietal peritoneum of the back wall. Here this is done. All the intestines and the back opening of the perinatal cavity have been removed. We are now in the retro perinatal area. We might call this the cellar of the abdomen. Here lie the the large vessels, the inferior vena cava and the aorta. The aorta is hidden behind nervous tissue and fatty connective tissue. Also you see the kidneys. This brought us to the end of our tour showing the abdomen from its front to its back. I hope you enjoyed it, and got a good impression of all that's behind your belly wall.
