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MD3002 > abdominal wall > Flashcards

abdominal wall Flashcards

1
Q

what structures can be found in the right upper quadrant

A

liver and gall bladder

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2
Q

what can be found in the left upper quadrant

A

jejunum

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3
Q

what can be found in the left lower quadrant

A

sigmoid colon

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4
Q

what can be found in the right lower quadrant

A

ileum, caecum and appendix

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5
Q

what lines divide the abdomen into quadrants

A

the transumbilical line at L3/4 and the median plane

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6
Q

what lines divide the abdomen into 9 regions

A

the midclavicular lines

the subcostal plane just below the costal margin at L3

the trans tubercular plane between the iliac crests at L4/5

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7
Q

what name is given to the top corners of the abdomen

A

left and right hypochondrium

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8
Q

what name is given to the top centre quadrant of the abdomen

A

epigastric region

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9
Q

what name is given to the centre of the abdomen

A

the umbilical region

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10
Q

what name is given to the centre sides of the abdomen

A

lumbar/ flank/ loin / lateral region

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11
Q

what name is given to the bottom left and right regions

A

groin/ inguinal region/ iliac fossa

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12
Q

what name is given to the bottom centre of the abdomen

A

pubic region/ supra pubic/ hypogastric

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13
Q

what is the superficial fatty layer of superficial fascia called

A

Camper’s fascia

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14
Q

what is the deep membranous layer of superficial fascia called

A

Scarpa’s

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15
Q

why is skin loosely attached to underlying structures

A

to allow movement and distension

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16
Q

if bruising is trapped under scarpa’s fascia what will be the appearance

A

blue swimming trunks anteriorly

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17
Q

what is camper’s fascia replaced by in the scrotum

A

dartos fascia

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18
Q

what is scarper’s fascia in the penis and scrotum known as

A

Buck’s and Colles’

it fuses with the fascia lata of the thigh and perineal body

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19
Q

where is the transversalis and extraperitoneal fascia

A

deep to the muscle layer
transversalis lines the inside of transversus abdominus

extra peritoneal fascia is between the transversalis fascia and the parietal peritoneum

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20
Q

where is the thoraco lumbar fascia

A

iliac crest to the 12th rib and is in 3 layers -ant, mid and post. they surround the back muscles and fuse together and give origin to transversus abdominis and internal oblique.
It is thicker and almost aponeurotic

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21
Q

what is the reason for lumbar hernias

A

external oblique is not attached to the thoracolumbar fascia

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22
Q

in what direction does external oblique go

A

downwards and medially

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23
Q

what are the functions of the abdominal muscles

A

supports abdom contents
raise intra abdo pressure
support vertebral column and create movement
respiration

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24
Q

which parts of the pelvis are on the same coronal plane

A

ASIS and pubic tubercle

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25
Q

what are the attachments of external oblique

A

lower 8 ribs, lateral lip of iliac crest, aponeurosis to linea alba via rectus sheath, forms inguinal ligament

there is a free edge posteriorly

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26
Q

what is the nerve supply to external oblique

A

T7-12

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27
Q

where is the inguinal ligament

A

ASIS to pubic tubercle

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28
Q

what does the inguinal ligament continue as

A

lacunar and pectineal ligaments

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29
Q

what is the superficial ring

A

triangular opening in external oblique aponeurosis with a base at the pubic crest

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30
Q

what are the attachments of internal oblique

A

thoraco lumbar fascia, iliac crest, lateral 2/3rds of inguinal ligament, lower 3/4 ribs and costal cartilages, aponeurosis to linea alba via rectus sheath, pubic crest behind the superficial inguinal ring via conjoint tendon

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31
Q

what is the nerve supply to internal oblique

A

T7 to 12 plus L1 via the iliohypogastric nerve to the fibres that form the conjoint tendon

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32
Q

what may predispose to inguinal hernias

A

injury to the iliohypogastric nerve which may weaken the conjoint tendon

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33
Q

what is the attachment of transversus abdominus

A

Attachments: thoracolumbar fascia; iliac crest (inside int obl); lateral 1/3rd or half of inguinal ligament; lower 6 ribs and costal cartilages; aponeurosis to linea alba (xiphoid to pubic symphysis) via rectus sheath; pubic crest behind the superficial inguinal ring via conjoint tendon (with internal oblique)

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34
Q

in what direction do the transvesus abdominis fibres pass

A

transversely

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35
Q

what is the nerve supply to trans. abdo

A

lower intercostal nerves (thoracoabdominal, nerve roots T7-T11), as well as the iliohypogastric nerve and the ilioinguinal nerve.

same as internal oblique

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36
Q

what makes up the conjoint tendon

A

formed from the aponeurosis of internal oblique and trans. abdom

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37
Q

what does the conjoint tendon attach to

A

the pubic crest and pectineal line behind the superficial inguinal ring, thereby supporting the ring

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38
Q

what are the attachments of rectus abdominis

A

costal cartilages ribs 5-7, xiphoid, pubic symphysis, pubic crest and pectineal line

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39
Q

what is the nerve supply of rectus abdominis

A

t7-12

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40
Q

where is pyramidalis

A

anterior to RA, from pubic crest to linea alba

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41
Q

which aponeurosis encloses RA

A

external oblique, int obl and trans abdom which form the rectus sheath

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42
Q

what is the linea alba

A

midline fusion of the rectus sheath

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43
Q

what happens at the arcuate line

A

all the aponeuroses pass anteriorly and the posterior sheath ends

demarcates the lower limit of the rectus sheath

the inferior epigastric vessels enter the sheath, behind rectus abdominis

Superior to the arcuate line, the internal oblique aponeurosis splits to envelop the rectus abdominis muscle.

Inferior to the arcuate line, the internal oblique and transversus abdominis aponeuroses merge and pass superficial (i.e. anteriorly) to the rectus muscle.

the arcuate line is well below the umbilicus

44
Q

how long is the inguinal canal

A

4-6 cms

45
Q

what does the inguinal canal contain

A

vas, testicular blood vesses, ilioinguinal nerve and genital branch of genitofemoral nerve

46
Q

where is the superficial inguinal ring

A

in external oblique with its base on the pubic crest

it is supported from behind by the conjoint tendon

47
Q

where is the deep inguinal ring

A

evagination of the transversalis fascia
overlain by internal and external oblique

Lies lateral to the inferior epigastric vessels, about 1 cm above the mid-point of the inguinal ligament – half way between the ASIS and the Pubic Tubercle

48
Q

what does the deep inguinal ring transmit

A

vas and gonadal vessels

49
Q

what is a hernia

A

a protrusion of a viscus through the wall of its containing cavity
may also be fat

50
Q

where is an inguinal hernia found

A

above and medial to the pubic tubercle

51
Q

where is a femoral hernia found

A

below and lateral to the pubic tubercle

it passes through the femoral canal

52
Q

how might inguinal hernias present

A

a lump in the groin or testicle

53
Q

describe the course of a direct inguinal hernia

A

through the posterior wall of the inguinal canal medial to the inferior epigastric vessels

usually a mature adult male

will pass through Hesselbach’s triangle
the viscera is covered by parietal peritoneum and pushes against a weakened conjoint tendon

will not be covered by spermatic fascia

54
Q

describe the course of an indirect inguinal hernia

A

through the deep inguinal ring lateral to the inferior epigastric vessels

usually congenital or pre adolescent but can be any age

is within the spermatic cord

55
Q

what are the boundaries of Hesselbach’s inguinal triangle

A

lateral: rectus abdominis muscle and inf epigastric vessels
inferior: inguinal ligament

56
Q

what are the signs of a hernia

A

increases in size on coughing or straining
reduces in size when supine
may be painful if obstruction, also emesis and distension

strangulation: red and tender

57
Q

what is the posterior abdominal wall made of

A

Quadratus lumborum
psoas major and minor overlying
iliacus
diaphragm superiorly

58
Q

what is the function of QL

A

stabilises rib 12 for diaphragmatic movement in respiration and may weakly laterally flex the trunk

59
Q

what is the insertion of iliopsoas

A

lesser trochanter

it is a hip flexor

60
Q

where is the iliolumbar ligament

A

transverse process of L5 to the post sup iliac spine and iliac crest

61
Q

what is the attachment of quadratus lumborum

A

iliac crest, iliolumbar ligament, L5 transverse process, 12th rib and L1 to L4 TPs

62
Q

what is the nerve supply to quadratus lumborum

A

T12-L4

63
Q

what is the attachment of psoas major

A

TP, bodies and IV discs of t12- L5

64
Q

what is the nerve supply of psoas major

A

L1-3

65
Q

what is the attachment of psoas minor

A

t12-L1 vertebral bodies to pectineal line and pectineal eminence on pelvic bone

66
Q

what is the nerve supply of psoas minor

A

L1

67
Q

what is the attachment of iliacus

A

iliac fossa

68
Q

what is the nerve supply of iliacus

A

L2,3,4 via the femoral nerve

69
Q

what does the femoral sheath surround

A

the femoral artery, vein and canal which transmits lymphatic and may be the site of a femoral hernia

the nerve is just outside the sheath

70
Q

what is the femoral sheath made of

A

an extension of the abdominal transversalis fascia

71
Q

what nodes does the femoral canal contain

A

Cloquet’s lymph nodes that receive directly from the glans

72
Q

what is the medial boundary of the femoral canal

A

lacunar ligament

73
Q

what is the proximal boundary of the femoral canal

A

femoral ring

74
Q

what is the lateral boundary of the femoral canal

A

femoral vein

75
Q

what is the posterior boundary of the femoral canal

A

pectineus or pectineal ligament

76
Q

what is the anterior boundary of the femoral canal

A

inguinal ligament

77
Q

what does the sup epigastric artery branch from

A

internal thoracic

78
Q

describe the route of the sup epigastric artery

A

enters the upper part of the rectus sheath between the sternal and costal origins of the diaphragm

it descends behind the rectus muscle, supplying the upper central part of the anterior abdominal wall and anastomoses with the inferior epigastric artery

79
Q

what artery supplies the upper lateral abdo wall

A

branches from the musculophrenic artery which is a branch of internal thoracic

80
Q

what artery does inferior epigastric branch from

A

external iliac

81
Q

describe the course of the inferior epigastric artery

A

it runs upwards and medially along the medial side of the deep inguinal ring and pierces the transversalis fascia to enter the rectus sheath anterior to the arcuate line

it ascends behind the rectus muscle, supplying the lower central part of the anterior abdominal wall, and anastomoses with the superior epigastric artery

82
Q

what is the deep circumflex artery a branch of

A

external iliac just above the inguinal ligament

83
Q

describe the course of the deep circumflex iliac

A

runs upwards and laterally towards the anterior iliac spine and then continues along the iliac crest

84
Q

what does the deep circumflex iliac supply

A

lower lateral part of the abdominal wall

85
Q

where are the superficial circumflex iliac and superficial epigastric arteries

A

they arise from the femoral just below the inguinal ligament

they supply the lower abdominal wall

86
Q

what do the posterior intercostals and four lumbar arteries arise from

A

descending aorta

they pass forward between the muscle layers and supply the lateral part of the abdominal wall

87
Q

where do the superficial circumflex iliac and superficial epigastric veins drain to

A

the proximal end of the great saphenous vein along with superficial and deep external pudendal veins

this is important in varicose surgery

88
Q

in which direction do veins travel around the umbilicus (skin and fascia deep only)

A

they radiate away from it

they eventually drain into the femoral and external iliac inferiorly and axillary superiorly

89
Q

how do para umbilical veins connect the system

A

they go to the portal veins of the liver forming a porto systemic anastomosis

90
Q

what might result from obstruction of the portal vein

A

venous back pressure into the veins of the abdominal wall resulting in caput medusae

91
Q

describe superficial lymph drainage of the anterior abdo wall

A

above umbilicus to the axillary nodes

below umbilicus to the superficial inguinal nodes

92
Q

describe superficial lymph drainage of the posterior abdo wall

A

above the iliac crests to axillary nodes and below the iliac crests to the superficial inguinal nodes

93
Q

which axillary nodes does the posterior superficial wall above iliac crests drain to

A

posterior or subscapular group

94
Q

which axillary nodes does the anterior superficial wall above umbilicus drain to

A

anterior or pectoral group

95
Q

where do axillary nodes empty into

A

subclavian lymph trunk

96
Q

where is the T shaped superficial lymph node group

A

below the inguinal ligament and extending inferiorly along the great saphenous vein

97
Q

what does the T group drain

A

anterior and posterior lower superficial abdo wall below umbilicus and iliac crest

98
Q

where do the superficial nodes drain

A

deep inguinal nodes in the femoral canal which drain to external iliac and the para aortic nodes

99
Q

where does deeper abdominal wall lymph drain

A

in parallel with epigastrics

inferiorly to the external iliac and then para aortic nodes
superiorly to the parasternal nodes alongside the thoracic artery and mediastinal nodes

100
Q

what is the function of iliopsoas

A

pass to the lesser trochanter and are powerful hip flexors

101
Q

what is the iliohypogastric nerve

A

originates from the lumbar plexus that supplies sensation to skin over the lateral gluteal region and motor to the internal and transverse abdominal muscles.
skin of L1 dermatome
L1

102
Q

what is the ilioinguinal nerve

A

supplies internal oblique, spermatic cord, skin over penis and scrotum, skin covering mons pubis and labia majora
skin of L1 dermatome
L1

103
Q

what nerves make up the lumbar plexus

A 
iliohypogastric
ilioinguinal
genitofemoral
lateral femoral cutaneous
obturator
femoral

plexus is in psoas major

104
Q

what nerve is at risk if an incision is extended laterally during appendicecetomy

A

iliohypogastric

105
Q

which arteries may form a collateral circulation in an obstructed aorta

A

inferior and superior epigastrics

106
Q

is the deep inguinal ring medial or lateral to the inferior epigastrics

A

lateral

107
Q

what is the nerve supply of the anterior abdominal wall

A

T7-12 and L1

MD3002 (56 decks)

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