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COM: GI (Midterm) COPY > Lecture 2: Anterior Abdominal Wall > Flashcards

Lecture 2: Anterior Abdominal Wall Flashcards

1
Q

Describe the division of the abdominal wall into 9 regions

A

The 9 regions are delineated by 4 planes… 2 sagittal: usually MCL planes and 2 transverse planes: either subcostal plane and transtubular plane or transpyloric plane and interspinous plane

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2
Q

Where is the xiphisternal junction located?

A

7th costal cartilage at the level of T9

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3
Q

What is the midway mark across the rectus abdominis?

A

Tip of 8th costal cartilage at the level of T11

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4
Q

What does the transpyloric plane traverse?

A

Tip of 9th costal cartilage at the level of L1

  • This is the junction of linea semilunaris and costal margin and hallway from sternal notch to symphysis pubis
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5
Q

What does the subcostal plane traverse?

A

10th costal cartilage (just above the umbilicus) at the level of L3

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6
Q

What is the landmark for the supracristal plane?

A

Crest of the ilium at the level of L4

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7
Q

What is the landmark for the transtubercular plane?

A

Iliac tubercle at the level of L5

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8
Q

What is the landmark for the interspinous plane?

A

ASIS at the level of S2

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9
Q

Where is the suprapubic plane?

A

Below the vertebral column

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10
Q

What are the 9 quadrants of the abdominal wall when divided into 9 regions?

A

Top row: Right hypochondrium, Epigastric, Left hypochondrium
Middle row: Right flank, umbilical, left flank
Bottom row: Right inguinal, pubic, left inguinal

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11
Q

What are the planes used to divide the abdomen into 4 quadrants?

A 
Median plane (sagittal cut straight down the middle)
Transumbilical plane (Transverse cut across umbilicus)
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12
Q

What organs 2 organs are unique to the RUQ?

A

Gallbladder

Superior ascending colon

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13
Q

What 5 organs are found bilaterally in the RUQ and LUQ?

A 
Liver (R and L lobes)
Stomach (pylorus in RUQ and the rest in LUQ)
Pancreas (head in RUQ and rest in LUQ)
Kidneys
Transverse colon
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14
Q

What 4 organs are unique to the LUQ?

A

Spleen
Proximal ileum
Jejunum
Superior descending colon

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15
Q

What 4 organs are unique to the RLQ?

A

Cecum
Appendix
Ileum
Inferior ascending colon

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16
Q

What 5 organs are found bilaterally in the RLQ and LLQ?

A 
Ovaries and uterine tubes
Ureters
Spermatic cords
Uterus if enlarged
Bladder if full
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17
Q

What 2 organs are unique to the LLQ?

A

Sigmoid colon

Inferior descending colon

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18
Q

Identify the boundaries of the abdomen

A

Superior border = xiphisternum diaphragm
Lateral borders = erector spinae muscles
Inferior borders = pelvic floor -> inguinal ligaments from iliac crests to pubic tubercle

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19
Q

List in order the layers of the anterior abdominal wall

A
  • Skin
  • Superficial fatty layer: campers
  • Deep membranous layer: Scarpa’s… superficial -> external oblique m. -> intermediate -> internal oblique m. -> deep -> transversus abdominis m.
  • Transversalis fascia
  • Extraperitoneal fat
  • Parietal peritoneum
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20
Q

What muscle is found in layer 1 of the abdominal wall and what is its origin and insertion?

A

External oblique m

  • Origin = 5th - 12th ribs
  • Insertion = linea alba, pubic tubercle, anterior 1/2 of iliac crest
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21
Q

What is the innervation of the external oblique m?

A

Thoracic-abdominal nerves (T7-T11) and subcostal n.

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22
Q

What is the action of the external oblique muscle?

A

Compress and support abdominal viscera, flex and rotate trunk

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23
Q

What muscle is found in the 2nd layer of the abdominal wall and what are its origin and insertion?

A

Internal oblique m

  • Origin = thoracolumbar fascia, anterior 2/3 iliac crest, and CT deep to lateral 1/3 inguinal ligament
  • Insertion = inferior borders of 10th-12th ribs, linea alba, and pecten pubis via conjoint tendon
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24
Q

What is the innervation of the internal oblique m?

A

Thoracoabdominal nerves (T6-T12) and 1st lumbar nerves

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25
Q

What are the actions of the internal oblique muscles?

A

Compress and support abdominal viscera, flex and rotate trunk

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26
Q

What muscle is found in the third layer of the abdominal wall and what is its origin and insertion?

A

Transversus abdominis

  • Origin = 7th-12th costal artilages, thoracolumbar fascia, iliac crest and CT deep to lateral 1/3 of inguinal ligament
  • Insertion = linea alba with aponeurosis of internal oblique, pubic crest and pecten pubis via conjoint tendon
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27
Q

What is the innervation of the transversus abdominis muscle?

A

Thoracoabdominal nerves (T6-T12) and 1st lumbar nerves

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28
Q

What is the action of the transversus abdominis muscle?

A

Compress and support abdominal viscera

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29
Q

What is the main anterior abdominal wall muscle and what are its origin and insertion?

A

Rectus abdominis

  • Origin = pubic symphysis and pubic crest
  • Insertion = xiphoid process and 5th-7th costal cartilages
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30
Q

What is the innervation of the rectus abdominis?

A

Thoracoabdominal nerves (T6-T12

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31
Q

What are the actions of the rectus abdominis muscles?

A

Flexes trunk (lumbar vertebrae) and compresses abdominal viscera, stabilizes and controls tilt of pelvis (antilordosis)

32
Q

What is the name of the random small, insignificant triangular muscle in the abdominal wall?

A

Pyramidalis

Absent in 20% of pts

33
Q

Where do you find the pyramidalis muscle?

A

Lies anterior to the inferior part of the rectus abdominis and attaches to the anterior surface of the pubis and anterior pubic ligament

34
Q

What are the actions of the pyramidalis muscles?

A

Tenses linea alba

Surgeons use the attachment of the pyramidalis to the linea alba as a landmark for median abdominal incisions

35
Q

What 2 muscles in the abdominal wall are enclosed in the rectus sheath?

A

Rectus abdominis and pyramidalis

36
Q

What is the role of the erector spinae muscles in respiration?

A

Antagonist of anterior abdominal muscles so assists in active expiration

37
Q

What is the role of the intercostal muscles in respiration?

A

External intercostal muscles are the most significant and assist in inhalation

38
Q

What is the role of the diaphragm in respiration?

A

Contracts during inhalation to expand the thoracic cavity and relaxes during exhalation pushing air out

39
Q

What does the arcuate line demarcate?

A

The transition between the aponeurotic posterior wall of the sheath covering the superior 3/4 of the rectus and the transversalis fascia covering the inferior 1/4

40
Q

Above the arcuate line, what structures make up the rectus sheath?

A

Aponeuroses of the internal oblique, external oblique and transversus abdominis, plus the transversalis fascia

This is the anterior rectus sheath

41
Q

Below the arcuate line, what structures make up the rectus sheath?

A

Just the transversalis fascia

This makes up the posterior rectus sheath

42
Q

What arteries are found above the arcuate line?

A

Subcostal a.
Intercostal arteries
Superior epigastric a

43
Q

What arteries are found below the arcuate line?

A

Inferior epigastric a
Superficial circumflex iliac a.
External iliac a
Femoral a

44
Q

What nerves are found above the arcuate artery?

A

Thoracoabdominal (T7-T10)

45
Q

What nerves are found below the arcuate line?

A

Thoracoabdominal (T11)
Subcostal
Iliohypogastric
Ilioinguinal

46
Q

What is teh function of the thoracoabdominal nerves (T7-T11)?

A

Muscles of anterolateral abdominal wall and overlying skin

**These are former inferior intercostal nerves

47
Q

What is the function of the 7th-9th lateral cutaneous branches?

A

Skin of right and left hypochondriac regions

48
Q

What is the function of the subcostal nerve (anterior ramus of T12)?

A

Muscles of anterolateral abdominal wall and overlying skin, superior to iliac crest and inferior to umbilicus

49
Q

What is the role of the iliohypogastric nerve (L1)?

A

Skin overlying iliac crest, upper inguinal and hypogastric regions; internal oblique and transversus abdominis muscles

50
Q

What is the role of the ilioinguinal nerve (L1)?

A

Skin of lower inguinal region, mons pubis, anterior scrotum or labium majus and adjacent medial thigh, inferiormost internal oblique and transversus abdominis

51
Q

Justify a midline incision

A

From Xihoid process to pubic symphysis done for rapid access or exploratory surgeries

  • Tension = somewhat strong (similar to paramedian)
  • Blood supply = no major vessels but possible slow healing
  • Innervation = no large nerves
52
Q

Justify a paramedian incision

A

From costal margin to iliac crest alon linea semilunaris made in sagittal plane

  • Tension = relatively strong but its an aponeurosis so you can put strong sutures along linea semilunaris
  • Blood supply = no major vessels so possible poor healing
  • Innervation = thoracoabdominal nerves and lateral cutaneous nerves cut completely deinnervating the rectus abdominis muscles

Usually only used for major surgeries such as transplants because one this incision is made the rectus abdominis muscles are going to atrophy and be gone

53
Q

Justify a gridiron (muscle sparing) incision

A

Used for appendectomy -> the oblique incision is made at the McBurney pt 2.5 cm superomedial to the ASIS on the spinoumbilical line; have to be careful not to injur th eiliohypogastric nerve running deep to the internal oblique

54
Q

Justify a suprapubic (Pfannenstiel) incision

A

Made at the pubic hairline and used for most gynecological operations

  • Tension = good bc it goes in similar directions as muscle fibers
  • Blood supply = inferior epigastric artery
  • Innervation = iliohypogastric and ilioingual but iliohypogastric is in the most danger
55
Q

Justify a transverse incision

A

Through anterior layer of rectus sheath and rectus abdominis; want to avoid tendinous intersections bc cutaneous nerves and branches of the superior epigastric vessels pierce these regions

56
Q

Justify a subcostal incision

A

Parallel to but 2.5cm inferior to costal margin

  • Tension = only slight pull
  • Blood supply = watch for superior epigastric artery
  • Innervation = will lose some cutaneous nerves and possibly some innervation to the top of the rectus abdominis muscle but not a huge deal
57
Q

What incision provides access to the gallbladder and biliary ducts on right and spleen on left?

A

Subcostal incision

58
Q

What 2 incisions are considered high risk and why?

A

Pararectus = along lateral border of rectus sheath; may cut nerve supply to rectus abdominis

Inguinal = for repairing hernias; may injur the ilioinguinal n.

59
Q

How would cancer superior to the transumbilical plane spread?

A

Mainly drain into axillary LNs but a few drain to the parasternal LNs

60
Q

How would cancer inferior to the transumbilical plane spread?

A

Mainly drain into the superficial inguinal LNs

61
Q

How does cancer in the deep lymphatic vessels spread?

A

Drain deep veins of abdominal wall and drain into the external iliac, common iliac, and right and left lumbar LNs

62
Q

What is the medial umbilical fold a remnant of?

A

Obliterated urachus

63
Q

What are the medial umbilical folds remnants of?

A

Obliterated umbilical arteries

64
Q

What does the lateral umbilical fold contain?

A

Inferior epigastric artery and vein

65
Q

Where is the medial inguinal fossae located?

A

In inguinal triangle (where direct inguinal hernias happen)

66
Q

Where are lateral inguinal fossae located?

A

Lateral to the inferior epigastric artery (where indirect inguinal hernias happen)

67
Q

What are the 3 main features that characterize prune belly syndrome?

A
  • Anterior abdominal wall muscles deficient or absent -> paraxial mesoderm specifically hypomere responsible for this
  • Urinary tract anomalies (such as very large bladder)
  • Bilateral cryptorchidism (2 undescended testes)
68
Q

When closing the incisions made during liposuction, what layers of the abdominal wall do surgeons include?

A

The membranous layer of subcutaneous tissue bc of its strength

Between this layer and the deep fascia covering the rectus abdominis and external oblique muscles is a potential space where fluid may accumulate. There are no barriers to prevent the fluid from spreading superiorly but it CANT spread inferiorly bc of the deep membranous layer of subcutaneous tissue that fuses with the fascia lata of the thigh

69
Q

Why is protuberance of the abdomen normal in infants and young children?

A

Bc their GI tracts contain a lot of air and their relatively large liver accounts for some of the bulging as well

70
Q

What are the 6 common causes of abdominal protrusion?

A 
Food 
Fluid
Fat
Feces
Flatus
Fetus
71
Q

What migh eversion of the umbilicus be a sign of?

A

Increased intra-abdominal pressure, usually resulting from ascites or a large mass

72
Q

Most hernias occur in what 3 regions?

A

Inguinal
Umbilical
Epigastric

73
Q

In what pts are umbilical hernias common in?

A

Neonates an can be acquired in women and obese pts

74
Q

Where do epigastric hernias occur?

A

In the midline between the xihoid process and the umbilicus

75
Q

Where do spigelian hernias occur?

A

Along the semilunar lines -> these tend to occur in pts older than 40 & are usually associated with obesity

76
Q

When palpating the anterolateral abdominal wall, what is intense guarding, board-like reflexive muscular rigidity that cant be willingly supppressed indicative of?

A

Inflamed organ and is a sign of acute abdomen

77
Q

The abdominal wall will react if an organ is diseased or injured. How does it react?

A

Any injury to the abdominal skin results in rapid reflex contraction of the abdominal muscles

COM: GI (Midterm) COPY (7 decks)

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