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By Raftery, Delbridge, Douglas

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Extensive and complex lymphatic drainage of stomach creates problems in dealing with gastric cancer—involvement of nodes around coeliac axis may render growth incurable. l l l l Structure of the gastric mucosa (Fig. 19) l l Nerve supply l l l Anterior and posterior vagus nerves enter the abdomen through the oesophageal hiatus. Anterior vagus nerve lies close to wall of oesophagus but posterior nerve is at a little distance from the wall of the oesophagus. Anterior vagus gives off hepatic branch and pyloric branch to the pyloric sphincter.

L l The testis may fail to descend and may be found anywhere along its course either intra-abdominally, within the inguinal canal or at the external ring. Processus vaginalis may fail to obliterate or may become partially obliterated, resulting in a variety of hydroceles (Fig. 6). Abdominal wall muscles (Fig. 7) l l l Abdominal wall consists of three sheets of muscle. Fleshy laterally and aponeurotic in front and behind. As aponeuroses pass forward they ensheath the rectus abdominis muscle. Rectus abdominis ANTERIOR ABDOMINAL WALL l l Superficial fascia of abdominal wall l l l l l l Only superficial fascia on abdominal wall.

Applied to front and sides of upper third of rectum. Applied to the front of the middle third of the rectum. In male, reflected onto base and upper part of bladder. In female, reflected onto upper part of posterior vaginal wall and over posterior, upper and anterior surface of uterus onto bladder. Between uterus and rectum is rectouterine pouch (of Douglas). Peritoneum passes off lateral margins of uterus to pelvic wall, forming broad ligaments with fallopian tubes in upper border. Falciform ligament passes upwards from umbilicus and slightly to right of midline to liver (containing the ligamentum teres in its free edge).

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Basic Science for the MRCS. A revision guide for surgical trainees by Raftery, Delbridge, Douglas

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