Identifying the Abdominal Wall

It is important to know the relation of the stomach to the abdominal wall, particularly during the placement of a feeding tube (Figs. 2.48-2.50).

Table 2.6 Relations of the stomach

Anterior wall

Posterior wall

Cardia

Fundus

Fundus

Body

Lesser curvature

Angulus

Pylorus

Inferior surface

Diaphragm

Spleen

Pancreas

of liver

Chest wall

Diaphragm

Duodenum

Abdominal wall

Heart

Orientation requires knowing the axis of the endoscope shaft. This forms the basis for identifying the lesser and greater curvatures of the stomach and the anterior and posterior walls (Fig. 2.51). The anterior wall can be positively identified by indenting the external abdomen with the finger and looking for the bulge (Fig. 2.49).

Fig. 2.48 Relation of the stomach to the abdominal wall. Conventional anatomical

Fig. 2.48 Relation of the stomach to the abdominal wall. Conventional anatomical

Fig. 2.49 View of the anterior wall of the distended body of the stomach. The indentation at the 8-o'clock position is caused by digital pressure on the external abdominal wall

Fig. 2.50 Ultrasound views of the stomach. The distended stomach is broadly apposed to the abdominal wall a Longitudinal scan

Transverse scan s = stomach b

Fig. 2.50 Ultrasound views of the stomach. The distended stomach is broadly apposed to the abdominal wall a Longitudinal scan

Transverse scan s = stomach

Fig. 2.51 Topography in the endoscopic image. Straight-ahead view of the stomach and abdominal wall db = duodenal bulb

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