2 - Anterior Abdominal Wall and Peritoneum Flashcards

1
Q

What are the boundaries of the abdomen? (broadly)

A

Superior = Diaphragm and inferior thoracic aperture
Inferior = Iliac crest, Inguinal Ligament and the Pelvic Inlet (continuous) (superior lower limb)
Posterior = The lumbar vertebrae, Psoas Major, Iliacus and Quadratus Lumborum
Lateral and Anterior = the abdominal wall muscles

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2
Q

What is peritoneum?

A

A single layer of epithelial like cells (mesothelium) with a supportive CT layer that lines the abdominal cavity

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3
Q

The viscera of the abdomen are …

A

suspended in the peritoneal cavity by mesentery or are between the cavity and the body/muscular body wall

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4
Q

Parietal and visceral peritoneum?

A

P = Lines abdominal wall
V = Lines/covers suspended viscera
Are continuous

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5
Q

Intra/Retroperitoneal?

A
Intraperitoneal = Suspended by mesenteries from the abdominal wall
Retroperitoneal = Organ lies between the parietal peritoneum and abdominal wall
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6
Q

How do neurovascular structures reach the intraperitoneal structures?

A

Travel in mesenteries

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7
Q

Abdominal and pelvic cavities are continuous and structures pass between the 2… give an example of a process

A

Birth

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8
Q

Identify the layers of the abdominal wall from the skin to peritoneum

A

Skin l Camper’s Fascia l Scarper’s Fascia l External Oblique l Internal Oblique l Transversus Abdominis l Transversalis Fascia l Extraperitoneal Fascia l Parietal Peritoneum

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9
Q

What nerves, broadly, supply the abdominal wall and parietal peritoneum?

A

The anterior rami of spinal nerves T7 > T12 as well as L1 (iliohypogastric). These then split into anterior and lateral cutaneous branches

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10
Q

What nerves are intercostal and which are subcostal?

A

T7 > T11 are intercostal. T12 and L1 are SUBcostal

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11
Q

Where do the nerves run?

A

In between the abdominal muscles internal oblique and transversus abdominis

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12
Q

The peritoneal cavity is split into the … and …

A

Greater sac and lesser sac (omental bursa)

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13
Q

The lesser omentum can be divided into the …

A

Hepatoduodenal and hepatogastric ligaments

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14
Q

What is the greater omentum?

A

Is a large apron-like fold of VISCERAL peritoneum that hangs down form the stomach and anterior transverse colon. It is a double fold that connects the stomach to the posterior abdominal wall. It is derived from dorsal mesogastrium

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15
Q

What is omentum?

A

Double layer of peritoneum that attaches the stomach to another organ. Greater = greater curvature of stomach. Lesser = lesser curvature of the stomach

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16
Q

What is the lesser omentum?

A

A double fold of peritoneum that extends from the liver to the lesser curvature of the stomach and the duodenum

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17
Q

What do the lesser and greater omentum arse from?

A
Greater = dorsal mesogastrium
Lesser = Ventral mesogastrium
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18
Q

Peritoneal folds from…

A

Mesentery, ligaments and omentum. They contain vessels and maintain the position of the viscera

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19
Q

What are the 2 divisions of extra peritoneal fascia?

A

Retro and preperitoneal fascia

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20
Q

What are the 4 divisons of the abdomen?

A

Right upper … quadrant

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21
Q

What are the 9 divisions of the abdomen?

A
Right and left hypochondrium (below the cartilage of the ribs)
Epigastric
Right and left flank 
Umbilical
Right and left groin
Pubic/Suprapubic
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22
Q

What are the planes that form the 9 divisions of the abdomen?

A

2x Midclavicular Plane
1x Subcostal Plance
1x Intertubercular Plane

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23
Q

What side is the stomach and liver on?

A
Stomach = left upper quadrant
Liver = right upper quadrant
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24
Q

Where does the superficial fascia divide into Camper’s and Scarper’s?

A

Below the umbilicus. Camper’s fascia is superficial and fatty. Scarper’s is deep and membranous

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25
Q

Why are there muscles protecting the abdomen rather than bones like in the thoracic region?

A

Because we want flexibility and movement as the viscera are always moving when we eat and breathe etc. The only bones in this region are the lumbar vertebra and the lower thoracic aperture/ribs (outlet)

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26
Q

Describe Rectus Abdominis

A

O= Pubic symphisis, crest and tubercle
I = Costal cartilages of ribs 5-7 AND xiphoid process
> flex trunk, support and compresses abdominal wall, can force air out
> anterior rami of thoracic spinal nerves
> most superficial (linea alba is underneath)

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27
Q

External Oblique?

A

O = Lower ribs (5-12)
I = Iliac crest and linea alba via aponeurosis
Aponeurosis runs from xiphoid process to pubic symphysis where its lower border forms the inguinal ligament
> flex trunk, turn to OPPOSITE side and bend trunk to same side
> O and I can swap to pull lges up and to side
> anterior rami of thoracic spinal nerves
> fibres infero-medial

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28
Q

Internal Oblique?

A

O = Fascia of the back (thoracolumbar) inguinal ligament and iliac crest
I = Ribs 9-12, linea alba and pubis symphysis
> flex trunk, bend and turn trunk to SAME side (works with ext oblique of opposite side)
> Anterior Rami of thoracic spinal nerves AND some L1
> Supero-medial fibres

29
Q

As well as the anterior rami of the thoracic spinal nerves, which muscle also receives innervation from L1?

A

The internal obliques and transversus abdominis

30
Q

Transversus Abdominis?

A

O: Thoracolumbar fascia, iliac crest, inguinal ligament, costal CARTILAGES of ribs 7-12
I: Linea alba, pubic crest via conjoint tendon, pectineal line
> Supports abdominal wall
> Anterior rami of thoracic nerves and some L1
> transverse fibres

31
Q

At the upper 3/4 of the abdomen the aponeurosis from which muscle splits?

A

The internal oblique. External oblique runs anterior and transversus abdominis posterior

32
Q

What happens at the inferior 1/4 of the abdomen?

A

All 3 muscles course round the anterior of rectus to form the rectus sheath.

33
Q

What is behind rectus abd. at the lower 1/4?

A

Only transversalis fascia, extraperitoneal fascia and pariteal peritoneum

34
Q

What is the arcuate line and where is it found?

A

Line where the posterior rectus sheath ends. Half way umbilicus > pubis. From here only see transversalis fascia. Continues whole way anteriorly/infront of rectus

35
Q

What arteries supply the abdominal wall, where do they come from and where do they run?

A
Sup Epigastric (from internal thoracic)
Inferior Epigastric (ext iliac)
> run under rectus, on top of transversalis fascia and within the rectus sheath on the TOP of the posterior rectus sheath. They anastomose but the inferior is larger and more important
36
Q

What is the significance and purpose of the arcuate line?

A

If the posterior rectus sheath continued then the inferior epigastric artery would have to penetrate through the aponeurotic sheath as it comes from deep/inferior to more superficial/superior. This is unyielding and would clamp off the artery if you sat in a particular position for too long. This way the artery only has to go through the softer transversalis fascia and then lie under the rectus abdominis muscle on top of the transversalis fascia and within the rectus sheath

37
Q

Thoracoepigastric veins (superior) drain to …

A

Axillary Vein

38
Q

Superficial Epigastric Veins (inferior) drain to …

A

Femoral Vein

39
Q

Nervous supply?

A

Anterior Rami of spinal nerves 7-12 and L1 (iliohypogastric and ilioinguinal). These branch into the lateral and anterior cutaneous branches. Lateral has L1 anterior doesn’t.

40
Q

Where do the nerves travel?

A

In a fascial/neurovascular plain between the internal oblique and transversus abdominis

41
Q

Dermatomes?

A

> The skin, muscle AND PARIETAL peritoneum are supplied by anterior rami of spinal nerves T7-T12 (intercostal) and L1 (iliohypogastric/ilioinguinal)
run in the neurovascular plane before piercing the muscular wall to reach the skin

42
Q

Describe the lymphatic drainage

A

Follows the superficial layers drainage pattern so follows the veins.
Superior from umbilicus > anterior axillary
Inferior > superficial inguinal
Posterior > Posterior Axillary

43
Q

Purpose of peritoneum?

A

Peritoneal cavity contains a small amount of serous fluid to reduce the friction of movement and avoid inflammation

44
Q

Sensation in the parietal peritoneum?

A

Is ALSO innervated by the somatic nerves to the body wall T7-T12 and L1, as well as the phrenic nerve (diaphragm) and obturator nerve (down in the pelvis)
> this means it is sensitive to pain, touch, temperature, and pain

45
Q

Sensation in visceral peritoneum and mesenteries?

A

Not innervated by T7-T12. Is instead innervated by ANS afferent fibres which are sensitive to stretch/distention i.e. when you eat too much

46
Q

Mesenteries formed by..

A

The visceral peritoneum comes back around itself to form a mesentery anchoring the viscera to the posterior body wall

47
Q

GI tract is suspended by…

A

mesenteries

48
Q

Midgut and Hindgut are suspended by…

A

Only DORSAL mesentery

49
Q

Foregut is suspended by…

A

BOTH ventral and dorsal mesenteries. Means the foregut is attached to the body wall both anteriorly and posteriorly by peritoneal folds.

50
Q

Where is infraperitoneal?

A

Pelvic.

51
Q

What organs are intra-peritoneal?

A
Completely contained in peritoneum and suspended by a mesentery
> stomach
> liver
> gall bladder
> spleen
> proximal duodenum
> SI
> appendix
> transverse colon
> sigmoid colon
52
Q

What organs are retro-peritoneal?

A
Covered one 1 side/between peritoneum and body wall.
> kidneys 
> pancreas
> distal duodenum
> ascending and descending colon
> upper 2/3 of rectum
53
Q

Greater Sac?

A

Peritoneal Cavity Proper

54
Q

Lesser Sac?

A

Also called the omental bursa. Behind the lesser omentum and stomach. Is more clinically relevant as is a blind ended pouch

55
Q

How is the lesser omentum formed?

A

Created due to the rotation of the foregut structures which drags the lesser omentum round to create a ‘pocket’

56
Q

What is in the lesser and greater sacs?

A

Serous flui/peritoneal space

57
Q

What is the free edge of the omental bursa called?

A

omental foramen (of Winslow)

58
Q

What does the lesser omentum attach to and what does it consist of?

A

Attaches from the liver to the stomach and proximal duodenum

Consists of the hepatoduodenal ligament and hepatogastric ligament

59
Q

The anterior of the omental foramen is bounded by the … which contains the …

A

Lesser omentum which contains the portal triad

60
Q

The posterior of the omental foramen is bounded by the …

A

Inferior Vena Cava

61
Q

The inferior 1/3 of the rectum is…

A

infra-peritoneal

62
Q

Peritoneal fold containing the jejunum to terminal ileum

A

mesentery

63
Q

peritoneal fold containing transverse colon?

A

Transverse mesocolon

64
Q

Sigmoid colon mesentery?

A

Sigmoid Mesocolon

65
Q

What and where are the paracolic gutters?

A

They are peritoneal sulci/reflections lateral to the ascending and descending colon

66
Q

What do they paracolic gutters do?

A

They create a pathway for peritoneal fluid OR pus/bile/blood to migrate around the abdomen

67
Q

Which paracolic gutter is more clinically relevant and why?

A

It is larger in size and the left side is usually limited by the phrenico-colic ligament. The right side peritoneum is continuous with the peritoneum of the of the hepatic recess and lesser sac

68
Q

What is the clinical significance of paracolic gutters?

A

The migration of fluid can cause pain to present in sites DISTANT from the affected organ/pathology. I.e. if sitting fluid will migrate down and present as appendicitis, if supine will migrate to the lesser sac which is a blind ended pouch, collect and form an abscess
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