3-Anterior Abdominal Wall
Terms
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copy deck
- What is the osteological and soft tissue superior boundary of the abdomen?
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costal margin ribs 10-12 & xiphoid
resp diaphragm - What is the osteological and soft tissue posterior boundary of the abdomen?
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lumbar vertebrae
posterior muscles - What is the osteological and soft tissue anterolateral boundary of the abdomen?
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no osteologic
4 muscles (External & Internal Abdominal Obliques, transversus & rectus abdominis - What is the osteological and soft tissue inferior boundary of the abdomen?
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pelvic brim
pelvic diaphragm - The inferior edge of the costal margin is associated with which plane? What organs lie at this plane?
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subcostal plane
liver & spleen - What is the umbilicus? Which plane is it associated with? Which vertabrae level is it aligned with?
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tissue remnant of umbilical cord
transumbilical plane
L3-4 - What is the name of the midline plane of the abdomen? What does it mark?
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linea alba
junction of L&R aponeuroses of anterior wall muscles - What is the linea semilunaris?
- paramedian furrow at lateral edge of L&R rectus muscles
- What is the name of the transverse borders of the rectus muscles that give a washboard appearance?
- tendinous intersections
- What is the superior margin of the iliac bone?
- iliac crest
- What is the distal attachment point for the inguinal ligament? medial?
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ASIS
pubic tubercle - Which nerve is associated with the location of the ASIS? What else is associated w/ this area?
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iliohypogastric nerve
appendectomy incision - Which plane are the iliac tubercles associated with?
- transtubercular plane
- What are the R&L pubic bones separated by?
- symphysis pubis
- What helps approximate the midsagittal plane?
- linea alba
- Which planes divide the abdomen into quadrants?
- midsagittal and transumbilical
- Which transverse planes help divide the abdomen into 9 regions?
- transpyloric and transtubercular
- Which vertical planes divide the abdomen into 9 regions?
- midclavicular/midinguinal
- Name the medial regions (of the 9) from superior to inferior. From which gut derivative does each come?
- epigastric (foregut), umbilical (midgut), hypogastric (hindgut)
- Name the lateral regions (of the 9) from superior to inferior).
- hypochondriac, lumbar, inguinal
- Discuss the location of primary blood vessels in the abdomen.
- localized in defined areas and relatively void in other areas
- Name the 7 layers of the abdominal wall.
- skin, superficial fascia, deep fascia, muscles, transversalis fascia, subserous fascia, peritoneum
- What are the natural lines of folding in skin due to orientation of collagen fibers?
- langer lines
- What are the two layers of the superficial fascia?
- hypodermis, subcutaneous tissue
- What are the 2 layers of subcutaneous CT (2 names for each)?
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superficial fatty layer or Camper's fascia
superficial membranous layer or Scarpa's layer - Which type of subcutaneous CT is only found in the lower 1/3 of the abdominal wall?
- Scarpa's layer
- What are the 3 different parts of the Scarpa's layer?
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false suspensory (or fundiform) ligament
Dartos Fascia and Colles fascia - What does the false susensory ligament cover?
- penis/clitoris
- What does the Dartos FAscia cover?
- scrotum of males, labia majora of female
- What does the Colles fascia attach to?
- posterior edge of the urogenital diaphragm
- What type of injury is it when the urethra is torn below the urogenital diaphragm?
- Straddle Injury
- Which layer of the abdominal wall encloses the muscles?
- deep fascia
- Where is the transversalis fascia?
- posterior surface of transverse abdominis muscle
- What is the deepest layer of the abdominal wall?
- peritoneum
- Name the 3 flat muscles of the abdominal wall.
- external and internal abdominal obliques and transversus abdominis
- What nerves innervate the external and internal abdominal obliques and the transversus abdominis?
- T7-12 and L1
- What is the action of the external & internal abdominal obliques?
- compress, flex, rotate torso and protect internal organs
- What is the action of the transversus abdominis?
- compress abdomen and protect internal organs
- What does the aponeurosis of the external abdominal obliques form?
- inguinal ligament
- The common insertion area of the internal oblique and transversus is triangulated between the pecten pubis and the linea alba. What is this called?
- Conjoint Tendon (Falx Inguinalis)
- What is the origin and insertion of the external abdominal obliques?
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o-outer surface ribs 5-12
i-iliac & pubic crests; linea alba - What is the origin and insertion of the internal abdominal oblique?
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o-iliac crest & posterior fascia & inguinal ligament
i-edge of ribs 7-12, linea alba, pubic crests - What is the origin and insertion of the transversus abdominis?
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o-inner surface of ribs 7-12; iliac crest & posterior fascia; inguinal ligament
i-linea alba & pubic crests - What is the origin and insertion of the rectus abdominis muscles?
- o-costal cartilage ribs 5-8 & xiphoid process
- What is the innervation of the rectus abdominis muscle?
- thoracic spinal nerves 7-12
- What is the action of the rectus abdominis?
- compress and protect abdomen; weak flexors of vertebral column
- What forms the washboard abs of the rectus abdominis?
- tendinous intersections (3)
- What is the vertical skin furrow createdc by the lateral edge of the rectus abdominis?
- linea semilunaris
- What forms the rectus sheath?
- aponeuroses of the 3 'flat' muscles extending medially to surround the recti muscles
- Which part of the rectus sheath is incomplete? Is it incomplete on the anterior or posterior side?
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lower 1/4
posterior - Where are the superior epigastric vessels located?
- within the sheath on the posterior surface of the recti
- What is the line between the complete rectus sheath and incomplete sheath?
- arcuate line
- What is the name of the posterior sheath of the abdomen?
- transversalis fascia
- Where are the inferior epigastric vessels located?
- on posterior surface of recti
- What determines the dermatomes of the abdomen? (Specifically which nerves)
- peripheral distribution of spinal nerves T7-L1
- What is the reason for hypoplasia?
- dermatomes overlap, so w/ ablation of one nerve there is reduced senasation rather than anesthesia
- Which nerve(s) supply the epigastric region?
- T7-9
- Which nerve(s)supply the umbilical region?
- T10
- Which nerve(s) supply the upper hypogastric region?
- T11
- Which nerve(s) supply the middle hypogastric region? What is another name for the nerve at this level?
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T12
subcostal nerve - Which nerves come from L1?
- iliohypogastric and ilioinguinal nerves
- What does the iliohypogastric nerve supply? Is it deep or superficial?
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lower hypogastric region
becomes superficial when it pierces EOM - Where is the iliohypogastric N located w/ respect to the superficial inguinal ring?
- superior
- Which nerve emerges from the inguinal canal? What does it supply?
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ilioinguinal N
anteriomedial upper thigh, anterior scrotal wall and root of penis (or labia majora and clitoris in females) - What does the superior epigastric artery stem from? Where is it located?
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from internal thoracic A
posterior to rectus abdominis - What does the inferior epigastric A stem from? Where is it located?
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from External iliac
posterior to rectus - What is the superfical epigastric artery stem from? What does it branch toward?
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femoral A
toward umbilicus - What do the circumflex iliacs supply?
- inguinal regions
- What vein(s) drain the lumbar and hypochondriac regions?
- posterior intercostals
- What does the superior epigastric vein drain? What does it drain to?
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posterior surface of recti muscles
internal thoracic - What is the connecting channel between the epigastric veins and lateral thoracic veins?
- thoracoepigastric
- Which vein(s) are in the falciform ligament of the liver?
- paraumbilical veins
- What do the paraumbilical veins link?
- superficial veins to the left branch of the portal vein
- Where does the blood from the lower quadrants of the abdomen drain?
- great saphenous
- Which veins empty blood from the abdomen into the great saphenous?
- superficial external pudendal, superficial circumflex iliac, superficial epigastric and inferior epigastric
- What are 5 normal protrusions of the abdomen?
- fat, flatus, feces, fluid, fetus
- What does the inguinal canal contain?
- spermatic cord or round ligament of the uterus, ilioinguinal nerve, genitofemoral nerve, fascia and CT, vascular & lymphatic vessels
- What is the extension of the aponeurosis of the external abdominal oblique that covers the spermatic cord?
- external spermatic fascia
- What is the superficial (external) inguinal ring?
- natural 'defect' in the EAO aponeurosis
- What are the borders of the inguinal ring called?
- medial and lateral crura
- What are the aponeurotic fibers that reinforce the superior margin of the ring? How does this attach to the crura?
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intercrural fibers
perpendicular to the crura - What forms the 'roof' of the inguinal canal? What does it attach to?
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aponeurosis of internal abdominal oblique and aponeurosis of transversus abdominis
both attach medially to pubic tubercle, laterally to inguinal ligament - The aponeurosis of internal abdominal oblique and the aponeurosis of transversus abdominis blend medially to form what?
- conjoined tendon
- What is the lateral inferior edge of the aponeurosis of transversus abdominis a border for?
- deep (internal) inguinal ring
- What is the deep inguinal ring filled with? What does this inner part extend over?
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transversalis fascia
internal spermatic fascia - What forms the posterior wall of the inguinal canal?
- transversalis fascia and conjoint tendon
- What distinguishes inguinal hernias?
- their relationship to the inferior epigastric artery and their presence or absence within the inguinal canal
- What type of inguinal hernia is medial to the inferior epigastric artery? Does this type of hernia go through the inguinal triangle?
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direct
yes - What binds the inguinal (Hesselbach's) triangle?
- inguinal ligament, lateral margin of rectus muscle and inferior epigastric artery
- What type of inguinal hernia is lateral to the inferior epigastric artery? Where does this type of hernia pass?
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indirect
goes into the passageway of the inguinal canal - Which type of inguinal hernia is congenital? acquired?
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congenital-indirect
acquired-direct