Abdominal wall (262-269)

Question 1

Describe the musculature of the anterior abdominal wall;

Answer 1

Flat muscles- External oblique, internal oblique, transversus abdominis. Vertical muscles- rectus abdominis, pyramidalis.

Question 2

Describe the arterial supply of the abdominal wall

Answer 2

• Superior epigastric (branch of internal thoracic artery),
• Inferior epigastric (branch of external iliac artery),
• Deep circumflex (branch of external iliac),
• Superficial epigastric (branch of femoral artery),
• Musculophrenic artery (branch of internal thoracic artery),
• Lateral cutaneous branches of intercoastal arteries

Question 3

What nerve supply the anterior abdominal wall;

Answer 3

Thoraco-abdominal nerves (T7-T11) [innervates external, internal oblique, transversus abdominis & rectus abdominis.
Subcoastal nerve (T12) [Innverates Pyramidalis plus contributes to external, internal oblique and transversus abdominis].
Iliohypogastric nerve (L1).
Ilioinguinal nerve (L1).

Question 4

How are the anterior and the posterior rectus sheaths formed?;

Answer 4

ABOVE ARCUATE LINE- Anterior wall rectus sheath- aponeuroses of the external oblique, and of half of the internal oblique. Posterior wall rectus sheath- aponeuroses of half the internal oblique and of the transversus abdominis.
BELOW ARCUATE LINE- all the aponeuroses move to the anterior wall of the rectus sheath. No posterior wall to the sheath; the rectus abdominis is in direct contact with the transversalis fascia

Question 5

Name the layers of the abdominal wall that you would go through if performing a midline laparotomy;

Answer 5

Skin, subcutaneous fat, campers fascia, scarpas fascia (first 4 layers in all abdo surgery). Linea alba. Transversalis fascia, preperitoneal fat, peritoneum (Last 3 layers in all abdo surgery).

Question 6

Name the layers of the abdominal wall you would go through if performing an open appendicetomy;

Answer 6

Skin, subcutaneous fat, campers fascia, scarpas fascia (first 4 layers in all abdo surgery). External oblique, Internal oblique, transversalis abdominis. Transversalis fascia, preperitoneal fat, peritoneum (Last 3 layers in all abdo surgery).

Question 7

Name the layers of the abdominal wall you would go through if performing an open cholecystectomy/whipples;

Answer 7

Skin, subcutaneous fat, campers fascia, scarpas fascia (first 4 layers in all abdo surgery). External oblique, Internal oblique, transversalis abdominis. Transversalis fascia, preperitoneal fat, peritoneum (Last 3 layers in all abdo surgery).

Question 8

Name the boundaries of the Hesselbach’s triangle. What is its significance?;

Answer 8

Medial- lateral border of the rectus abdominis muscle. Lateral- inferior epigastric vessels. Inferior- inguinal ligament.

Doesn’t contain any particular structures of clinical importance but demarcates an area of potential weakness in the abdominal wall – through which herniation of the abdominal contents can occur