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Abdominal Wall And Inguinal Region Flashcards

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1
Q

Abdominal wall boundaries

A

. Sup: costal margin

. Inf: iliac crests, inguinal ligament, and pubis

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2
Q

Umbilicus

A

. Midline at L3-4 intervertebral disc

. Innervated by T10 dermatome

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3
Q

Linea alba

A

. Tendinous midline raphe extending from process xiphoid to pubic symphysis
. Formed by interdigitating fibers of aponeuroses of abdominal wall muscles
. Located at depression btw rectus abdominis mm.

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4
Q

Linea semilunaris

A

. Curved line formed by lat. margin of rectus abdominis

. Runs from costal margin to pubic symphysis bilaterally

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5
Q

Inguinal groove

A

. Boundary btw abdomen and thigh

. Location of inguinal ligament

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6
Q

Subcostal plane

A

Through 10th costal cartilages

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7
Q

Transumbilical plane

A

Umbilicus and L3-4 vertebral disc

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8
Q

Transtubercular plane

A

Through iliac tubercles

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9
Q

Midclavicular plane

A

. Connecting midpoints of clavicle and inguinal ligament

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10
Q

How are abdominal quadrants created?

A

Transumbilical and median planes intersect

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11
Q

Abdominal regions

A 
. Sub cost, transtubercular, and R/L midclavicular planes intersect 
. R/L hypochondriac
. R/L lateral
. R/L inguinal
. epigastric 
. Umbilical 
. Hypogastric (pubic)
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12
Q

Lateral abdominal wall layers from superficial to deep

A

. Skin
. Superficial fascia
. Deep fascia (assoc. w/ abdominal wall muscles)
. Muscles
. Transversalis fascia
. Extraperitoneal fat
. Parietal peritoneum (serous membrane lining cavity)

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13
Q

Superficial fascia layers

A

. Superficial fatty (Camper) fascia: contains nerve, blood vessels, and variable subQ fat
. Deep membranous (Scarpa) fascia: abdominal wall inf. To umbilicus attached to iliac crest, inguinal ligament and pubis, continous w/ perianal fascia

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14
Q

Transversalis fascia

A

. Anterolateral portion of the endoabdominal fascia that lines deep surfaces of abdominal wall muscles

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15
Q

Muscles of anterolateral abdominal wall innervated by ____

A

. T7-L1 ventral rami

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16
Q

External abdominal oblique m. OIA and fiber orientation

A

O: external surface of ribs 5-12
I: linea alba, pubic tubercle, iliac crest
A: flex and rotate torso
Fibers: inferomedial

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17
Q

Inguinal ligament

A

. Thickened inf. Margin of external abdominal oblique aponeurosis btw pubic tubercle medially and the ASIS laterally
. Inf. Margin rolls inward forming gutter
. Bridges muscles, nerves, and vessels running btw abdomen and thigh

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18
Q

Internal abdominal oblique m. OIA and fiber orientation

A

O: thoracolumbar fascia, iliac crest
. I: inf. Border ribs 10-12, linea alba, pubis via conjoint tendon
A: flex and rotate torso
Fiber: superomedial

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19
Q

Transversum abdominis OIA and fiber orientation

A

O: internal surface costal cartilages 7-12, thoracolumbar fascia, iliac crest
I: inf. Border ribs 10-12, linea alba, pubic crest, pecten pubis via conjoint tendon
A: support and compress abdominal contents
Fiber: horizontal

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20
Q

Conjoint tendon

A

. Falx inguinalis
. Formed by fused aponeuroses of internal abdominal oblique and transversum abdominis where they insert on pubic crest and pectineal line

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21
Q

Rectus abdominis OIA and fiber orientation

A

O: pubic symphysis and crest
I: xiphoid process, costal cartilages 7-12
A: flex torso and stabilize pelvis
fibers: vertical

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22
Q

Pyramidalis OIA and fiber orientation

A

O: pubic symphysis
I: linea alba
A: tenses linea alba
Fibers: superomedial

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23
Q

Functions of all anterolateral abdominal wall muscles

A

. Compress and support abdominal viscera
. Depress sternum and lower ribs to aid expiration
. Inc. intra-abdominal pressure to aid in micturition, defecation and parturition

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24
Q

Rectus sheath

A

. Formed by aponeuroses of lat. abdominal wall muscles

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25
Rectus sheath boundaries
. Xiphoid process to pubic symphysis | . Linea alba to linea semilunaris
26
Rectus sheath composition sup. To umbilicus
. Ant. Layer: aponeuroses of external and internal abdominal obliques . Post. Layer: aponeuroses of internal abdominal oblique and transversum abdominis
27
Rectus sheath composition inf. To umbilicus
. Post. Rectus sheath absent and all 3 aponeuroses contribute to ant. Rectus sheath . Arcuate line marks point where post. Layer ends . Inf. To arcuate line, the post. Surface of rectus abdominis rests directly on the transversalis fascia
28
Tendinous intersections of rectus sheath
. Horizontal tendinous bands that subdivide each rectus abdominis muscle and attach it to ant. Rectus sheath
29
Diastasis recti
. Abnormal separation of rectus abdominis muscle accompanied by stretching of linea alba . Pregnancy and obesity most common cause in adults
30
Internal surface of anterolateral abdominal wall
. Inf to umbilicus, ligaments and vessels on interior surface of abdominal wall create folds in parietal peritoneum
31
Median umbilical ligament/fold
. Formed by obliterated remnant of embryonic duct (urachus) connecting urinary bladder to umbilicus
32
Medial umbilical ligaments/folds
. Formed by obliterated distal segments of embryonic umbilical arteries
33
Lateral umbilical folds
. Formed by inf. Epigastric vessels
34
Ventral rami course in anterolateral abdominal wall
. Anteroinferiorly in plane btw internal abdominal oblique and transversum abdominis muscles . Enter rectus sheath laterally
35
Lat. and ant. Cutaneous branches in anterolateral abdominal wall
. T7-9: sup. To umbilicus . T10: level of umbilicus . T11-12: inf. To umbilicus . L1: iliohypogastric n. (Inguinal and hypogastric region) and ilioinguinal n. (Scrotum/labium majus, mons pubis, and superomedial thigh)
36
Blood supply to upper abdominal wall
. Internal thoracic a.branches int musculophrenic a. (To diaphragm and hypochondriac region) and sup. Epigastric a. (Post. Layer of rectus sheath tp supply rectus abdominis and epigastric region) . Post. Intercostal and subcostal aa. To upper abdominal wall
37
Blood supply to lower abdominal wall
. External iliac a. Branches into inf. Epigastric and deep circumflex aa. . Superficial fascia and skin below umbilicus supplied by superficial circumflex iliac and superficial epigastric (from femoral)aa.
38
Inf. Epigastric a.
. From external iliac . Ascends deeps to rectus abdominis . Enters rectus sheath . Anastomoses w/ sup. Epigastric a.
39
Deep circumflex iliac a.
. Muscles of inguinal region
40
Thoracoepigastric v.
. Located in superficial fascia of lat. thoracoabdominal wall . Connects superficial epigastric v. To lateral thoracic v. Creating indirect communication btw femoral and axillary vv. . Communicates w. Paraumbilical vv. In central abdominal wall
41
Lymphatic drainage in anterolateral abdominal wall
Follows venous return to axillary and superficial inguinal lymph nodes
42
Thoracoepigastric vv. Role when iliac veins or inf. Vena cava are obstructed
. Provides collateral route for venous return from lower body
43
Inguinal region
. Portion of lower abdominal wall sup. To inguinal groove . Boundary btw abdomen and thigh . Most common site of abdominal hernias
44
Iliopubic tract
. Thickening of transversalis fascia | . Reinforces inguinal ligament post.
45
Lacunar ligament
. Fibers of inguinal ligament pass lat. from pubic tubercle and attach to sup. Pubic ramus . Forms sickle-shaped structure
46
Pectineal ligament of Cooper
. Inguinal ligament fibers run post. Attaching to pecten pubis
47
Inguinal canal
. Oblique 4 cm long passage in lower abdominal wall parallel and just sup. To medial half of inguinal ligament
48
Inguinal canal openings
. Deep inguinal ring: evagination of transversalis fascia sup. To middle of inguinal ligament and lat. to inf. Epigastric vessels . Superficial inguinal ring: opening in external oblique aponeurosis superolat. To pubic, has crura margins
49
Superficial inguinal ring crura
. Lat. crus: fibers attaching to pubic tubercle . Med. crus: fibers attaching to pubic body . Intercrural fibers: run perpendicular to crura to reinforce apex of ring
50
Inguinal canal boundaries
. Ant. Wall: aponeurosis of external abdominal oblique reinforced lat. by internal oblique m. . Post. Wall: transversalis fascia reinforced med. by conjoint tendon . Floor: iliopubic tract, inguinal ligament, and lacunar ligament (lat to med order) . Roof: transversalis fascia (at deep ring), arching fibers from transversum abdominis m., internal oblique m., and external oblique aponeurosis at superficial inguinal ring (lat. to med. order)
51
Inguinal canal development
. Formed during descent of fetal testis from original site in. Post. Abdominal wall to scrotum
52
testis development
. Scrotum is Outpouching of abdominal wall lined by peritoneum (processus vaginalis) . Gubernaculum (fibrous cord) guides testis external to peritoneal lining of abdominal cavity and processus vaginalis . Testis drags ducts, nerves, vessels, and lymph behind creating permanent inguinal canal . Wrapped by spermatic fascia corresponding to abdominal wall layers forming spermatic cord
53
Inguinal canal in females
. Round ligament of uterus (gubernaculum derivative) follows same course as testis to reach labium majus(scrotum homolog) . Canal is smaller . Fascial coverings of round ligament indistinct
54
Spermatic cords
. Composed of structures running to/from testis . Starts at deep inguinal ring, transits inguinal canal, exits superficial inguinal ring . Terminate post. To testis w/in scrotum
55
Spermatic fasciae
. External spermatic fascia: from external oblique aponeurosis . Cremasteric fascia: from internal oblique m. . Internal spermatic fascia: from transversalis fascia
56
Cremaster muscle
. Cremasteric fascia has loops of skeletal muscle innervated by genital branch of genitofemoral n. (L1-2) . Contraction of cremaster muscle elevates testis to inc. temp
57
Cremasteric reflex
Rapid elevation of testicle by stroking ipsilateral upper med. thigh by ilioinguinal n. (L1)
58
Spermatic cord contents
. Ductus vas deferens: muscle tube that conveys sperm from Estes to ejaculatory duct . Testicular a./vv. . Lymph vessels . Genital branch of genitofemoral n. . Autonomic nerve fibers (supply smooth upscale of ductus deferens and arteries)
59
Testicular torsion
. Interrupts blood flow to testicle . Causes sudden, intense pain . Requires immediate intervention to preserve affected testis . Common in adolescents
60
Round ligament of uterus
. Gubernaculum remnant composed of fibrous CT, smooth muscle, and blood vessels . Attaches uterine body to fatty CT w/in labium majus
61
Common inguinal canal contents (all genders)
. Ilioinguinal n. . Genital branch of genitofemoral n. (Motor to cremaster, sensory to skin of lat. scrotum and labium majus) . Small blood and lymph vessels following course of spermatic cord/round ligament
62
Ilioinguinal n.
. L1 . Pierces internal oblique to enter inguinal canal . Exits at superficial ring w/ spermatic cord/round ligament . Supplies skin of med. thigh and ant. Scrotum/labium majus
63
Scrotum structure
. Pendulous cutaneous sac . Skin: darkly pigmented w/ hair . Raphe: line of fusion of fetal R/L genital swellings, continuous internally w/ scrotal septum . Septum: divides scrotum into R/L parts . Dartos fascia: membranous layer continous w/ Scarpa’s fascia, contains dartos muscle . Scrotal ligament: gubernaculum remnant that anchors mature testis
64
Dartos muscle
. Smooth muscle fibers attaching to scrotal skin . Innervated by sympathetic nerve fibers . Wrinkles skin of scrotum dec. surface area and drawing it closer to body . Reduces heat loss
65
Scrotum blood supply
. Ant. And post. Scrotal branches of external and internal pudendal aa.
66
Scrotum innervation
. Sensory vi genitofemoral n. (Lat. surface), ilioinguinal n. (Ant. Surface), and pudendal and post. Femoral cutaneous nn. (Post. Surface) . Postsynaptic sympathetic fibers from nerves supply dartos mm. And cutaneous glands of scrotum
67
Lymph drainage of scrotum
. Superficial inguinal lymph nodes
68
Optimal temperature for spermatogenesis
34 degrees, 3 degrees lower than normal body temp
69
Testis and components
. Male gonad, source of spermatozoa and testosterone . Tunica albuginea: tough CT forming outer tunic of testis . Septa: continous w/ tunica albuginea, divides testis into lobules . Seminiferous tubules: densely coiled ducts (site of spermatogenesis) open to rete testis . Efferent ductules: connect rete testis and epididymis
70
Epididymis
. Densely coiled duct of epididymis . Site of sperm storage and maturation . Post. To testis . Head: attached to testis by efferent ductules . Body: separated from testis by sinus of epididymis . Tail: continous inf. W/ ductus deferens
71
Ductus (vas) deferens
Muscular tube that moves sperm from epididymis to ejaculatory duct via inguinal canal and deep inguinal ring
72
No scalpel (keyhole) vasectomy
. Permanent method of male sterilization . Single scrotal puncture to isolate and ligament the vasa deferential . Performed w/ local anesthetic . Does not require scrotal sutures
73
Tunica vaginalis
. Closed peritoneal sac surrounding testis and epididymis | . Remnant of fetal processus vaginalis
74
Tunica vaginalis layers
. Visceral layer: surface of testis and epididymis . Parietal: adjacent to internal spermatic fascia . Cavity: closed peritoneal space btw visceral and parietal layers, contains small amt of serous fluid (no testis here) . Bare area of testis: post. Region not covered by tunica vaginalis (site where vessels enter/leave testis)
75
Testicular hydrocele
. Accumulation of excess serous fluid in tunica vaginalis cavity . If it’s blood it’s a hematochezia . Distinguished from other masses by transillumination of scrotum
76
Testicular a.
. From abdominal aorta at L2 vertebral level | . Supplies testis, epididymis, and vas deferens
77
Pampiniform plexus
. Complex network of anastomoses veins surrounding testicular a. . Coalesce to form testicular veins that drain to inf. Vena cava (right) or left renal v. (Left) . Provides counter-current heat exchange to help regulate testis temp.
78
Varicocele
. Marked enlargement of pampniform plexus resembling bag of worms on palpation . Caused by incompetent valves . Reduce when patient lies down (hydroceles don’t)
79
Lymph drainage of testis
. Follows blood supply | . Goes to lumbar lymph nodes w/in abdomen
80
Testis innervation
. Testicular plexus follows testicular a. . Plexus contains post-synaptic sympathetic fibers and visceral afferent fibers from T10 spinal level and vagal parasympathetic fibers
81
Testicular cancer
. Most common cancer in males btw 15-35 | . Tumor cells metastasize via lumbar lymph nodes
82
Primary scrotal cancers
Metastasize via superficial inguinal lymph nodes
83
Hernia
. Protrusion of anatomical structure into abnormal location
84
Abdominal hernia
. Occurs when structural defects allow abdominal contents to protrude through abdominal wall . Umbilicus, surgical incision sites, and inguinal region are common sites
85
Abdominal wall hernia
. Covered by peritoneum forming hernia sac | . Neck of sac marks site of herniation
86
Inguinal hernia
. Protrusion of abdominal contents through abdominal wall at superficial inguinal ring . More common in males bc canal is larger . Distinguished by etiology and site
87
Indirect (congenital) inguinal hernia
. 2/3s of inguinal hernia . Caused by persistence of patent processus vaginalis . Protrudes through deep inguinal ring and transits entire canal . Neck is lat. to inf. Epigastric vessels . Covered by peritoneum and fascia of spermatic cord . Passes from superficial ring to scrotum/labium majus
88
Canal of Nuck
. Persistence of processus vaginalis in females . May cause cysts in canal or labia . Lead to indirect inguinal hernia
89
Direct (acquired) inguinal hernia
. Caused by weakness of abdominal wall post. To superficial inguinal ring . Protrudes through inguinal (Hesselbach) triangle . Neck is med. to inf. Epigastric vessels . Covered by peritoneum and transversalis fasica only . Exits superficial ring lat. to spermatic cord . Doesn’t usually enter scrotum/labium majus
90
Hesselbach triangle
Inguinal trianglel | . Bound by inguinal ligament, lat. rectus abdominis, and inf. Epigastric vessels
91
Structural features that mitigate inguinal hernia risk
. Oblique course of canal . Ant. Reinforcement of deep inguinal ring via internal oblique m. . Post. Reinforcement of inguinal triangle via conjoint tendon . Approximation of ant. And post. Walls in response to inc. intra-abdominal pressure
92
Femoral hernia
. Protrusion of abdominal contents inf. To inguinal ligament and into upper thigh . More common in females bc longer pubic rami . Sac covered by peritoneum and transversalis fascia . Neck lat. to lacunar ligament

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