Abdominal Wall and Peritoneum Flashcards
(99 cards)
1
Q
What are the contents of the abdominal region?
A
- peritoneal cavity
- gastrointestinal tract and associated glands and digestive organs
- nerves, lymphatics, and blood vessels
- renal system
2
Q
What is the pelvic inlet?
A
- a line (also called linea terminalis) that separates the true pelvis from the false pelvis.
- superior to the linea terminalis -> abdomen or false pelvis
- inferior to the linea terminalis -> pelvis or true pelvis
3
Q
What is the pelvic inlet formed from?
A
-
Pectin pubis
- pubic bone
-
Arcuate line
- ilium
-
Sacral promontory
- sacrum
4
Q
Is the Camper’s fascia deep or superficial to Scarpa’s fascia and what is it continuos with?
A
- Fatty Layer (more superficial than Scarpa’s)
- continuous with the superficial fatty layers in the thorax, thigh and perineus
- NOTE: superficial blood vessels run in the fatty layer of superficial fascia
5
Q
What is Scarpa’s fascia continuous with?
A
- Membranous layer (deep to Camper’s fascia)
- continuous with the fascia lata in the thigh and with the deep layer of superficial perineal fascia (continuous over the penis and scrotum)
6
Q
What is clinically important about deep fascia of the abdominal wall?
A
Holds Sutures
7
Q
True or False:
There is a potential space between the membranous layer of superficial fascia and the deep fascia of the external abdominal oblique muscle.
A
True
** fluid can leak into this potential space between the membranous layer of superficial fascia and the deep fascia of the external abdominal oblique muscle **
8
Q
What is the transpyloric plane?
A
Transverse plane midway between the superior borders of the pubic symphysis and the manubrium.
9
Q
What is the subcostal plane?
A
Plane at the lowest level of the costal margin (the inferior margin of the tenth costal cartilage).
10
Q
What is the supracrestal plane?
A
Plane passing through the summits of the iliac crests. (through belly button)
11
Q
What is the transtubercular plane?
A
Plane at the level of the iliac tubercles (the iliac tubercle lies - 5 cm posterolateral to the anterior superior iliac spine).
12
Q
What is the interspinous plane?
A
Plane at the level of the anterior superior iliac spine.
13
Q
Which 4 pairs of muscles, located anteriorly and laterally, collectively compress and hold the abdominal organs in place?
A
- external oblique
- internal oblique
- transversus abdominis
- rectus abdominis
** work together to FLEX and STABILIZE the vertebral column **
14
Q
What happens when the external oblique, internal oblique, transversus abdominis, and rectus abdominis unilaterally contract?
A
Laterally flex the vertebral column.
15
Q
What other muscles, located posteriorly, flex the spine and lower limb?
A
- iliacus
- psoas major
- psoas minor
- quadratus lumborum
16
Q
Fill in the Blank:
The three “flat” muscles of the anterior/lateral abdominal wall end anteriorly in a strong sheet of aponeurosis called the _______ ________.
A
Rectus sheath
17
Q
What is the midline of the rectus sheath called?
A
linea alba
18
Q
What is the arcuate line?
A
- The line where the arrangement of the layers of fascia and aponeuroses of the muscles forming the rectus sheath are arranged differently in the upper abdominal wall than they are in the lower wall.
- Located 1/2 way between umbilicus and pubic symphysis.
19
Q
What is going on above the arcuate line?
A
The aponeurosis from the internal oblique splits to surround rectus abdominis and the aponeurosis from transversus abdominus runs posterior to rectus abdominis.
20
Q
What is goin on below the arcuate line?
A
Rectus abdominis muscle lies directly on transversalis fascia.
21
Q
Which muscle forms the inguinal ligament?
A
external oblique
22
Q
Where do the superficial system of arteries of the anterior abdominal wall run?
A
- Run in the superficial fascial layer
- superficial circumflex iliac artery
- superficial epigastric artery
- external pudendal artery
- superficial branch
- deep branch
23
Q
Where do deep anterior abdominal wall veins drain to?
A
- Deep Drainage (right)
- within abdominal wall muscles (like the deep arteries)
- to subclavian vv.
- to external iliac vv.
- to lumbar and intercostal vv.
24
Q
Where do the anterior abdominal wall veins run within?
A
within Camper’s fascia
25
Where do the anterior abdominal walls veins drain into (superficial drainage)?
* thoracoepigastric vv.
* lateral thoracic vv.
* superficial epigastric vv.
26
What is the innervation of the anterior abdominal wall?
* Dermatomes (sensory)
* T7-L1
* T7 is xiphoid region (tip)
* T10 is umbilical region
* L1 is inguinal fold region
* Innervate muscles (motor)
* intercostal nn., T7-T11
* subcostal nerve, T12
* lumbar nn., L1-L4
27
Between which two muscle layers do the cutaneous branches of ventral rami, intercostal nn, lie between?
* Lie between internal abdomnial oblique and transversus abdominis
* Pierce the rectus sheath to innervate the rectus abdominis muscles
* Supply skin, muscles, and parietal peritoneum
* Angle inferiomedially
28
Which nerve of the anterior abdominal wall nerves supplies the supra pubic region?
* Iliohypogastric nerve
* L1 (sometimes + T12)
* lateral cutaneous branch
* anterior cutaneous branch
29
Which nerve of the anterior abdominal wall nerves enters the inguinal canal and emerges through the superficial inguinal ring to supply the groin and scrotum/labium major?
Ilioinguinal nerve
30
Where does the genital branch of the genitofemoral nerve exit and what does it innervate?
* exits the inguinal canal through the superficial inguinal ring
* innervates the cremaster muscle or is cutaneous to the labium majus
31
What is the superficial lymphatic drainage of the anterior abdomin?
* superficial lymphatic drainage
* drains superiorly from umbilical region to anterior axillary and sternal nodes
* drains inferiorly from umbilical region to superficial inguinal nodes
* deep lymphatic drainage:
* along posterior intercostal and lumbar vessels to deep abdominal nodes
* from testes to deep abdominal nodes
32
What is the definition of a hernia?
A portion of the viscera protrudes through a weakened point of the muscular wall of the abdominopelvic cavity.
33
What is a strangulated intestinal hernia?
Blood flow to the trapped segment may diminish, causing that portion of the intestine to die. Very painful and can be life-threatening.
34
Which hernia type is the most common?
inguinal hernia
35
Which region of the abdominal wall is the weakest, thus leading to the most common type of hernia, inguinal hernia?
Inguinal region
36
Between male and female, which is more likely to develop an inguinal hernia?
Males
37
What are the two types of inguinal hernias?
* **Direct inguinal hernia -\>** the loop of small intestine protrudes directly through the superficial inguinal ring, but not down the entire length of the inguinal canal, and creates a bulge in the lower anterior abdominal wall.
* **Indirect inguinal hernia -\>** herniation travels down the entire inguinal canal and may even extend all the way into the scrotum.
38
Which type of hernia travels the entire inguinal canal and can even exten into the scrotum?
indirect inguinal hernia
39
In an indirect inguinal hernia, where does the herniation pass, and what does it follow?
* Herniation passes _lateral to inferior epigastric vessels_ to enter deep inguinal ring.
* Follows path of spermatic cord.
40
Which kind of inguinal hernia passes medial to inferior epigastric vessels punching through peritoneum and transversalis fascia?
Direct inguinal hernia
* usually acquired; females too
* punches through peritoneum and transversalis fascia
41
Where does the femoral hernia occur?
* **In the upper thigh, just inferior to the inguinal ligament, originating in the femoral triangle.**
* Medial part of the femoral trangle is relatively weak and prone to stress injury, allowing a loop of small intestine to protrude.
* Women more commonly develop femoral hernias because of the greater width of their femoral triangle.
42
Does men or women commonly develop femoral hernias? Why?
Women more commonly develop femoral hernias because of the greater width of their femoral triangle.
43
When does an umbilical hernia occur?
Occur when a portion of intestine pushes through abdominal wall musculature in the periumbilical or umbilical region.
44
In who are umbilical hernias more common?
Most common in infants, but can occur in adults, as well.
45
What organs make up the foregut and what branch off the abdominal aorta does their arterial supply come from?
* Foregut:
* esophagus
* stomach
* duodenum
* liver
* gallbladder
* spleen
* pancreas
* Celiac Trunk
46
What organs make up the midgut and what branch off the abdominal aorta does their arterial supply come from?
* Midgut:
* duodenum
* jejunum
* ileum
* cecum and appendix
* ascending colon
* 2/3 of tranverse colon
* Superior mesenteric artery
47
What organs make up the hindgut and what branch off the abdominal aorta does their arterial supply come from?
* Hindgut:
* 1/3 transverse colon
* descending colon
* sigmoid colon
* rectum and anal canal
* Inferior mesenteric artery
48
Does the visceral layer (serosa) of the peritoneum have pain fibers?
NO
49
Which layer lines the body wall of the body wall?
parietal layer
50
Does the parietal layer of the peritoneum have pain fibers?
Yes - abundant pain fibers via nerves from the body wall.
51
What suspends the intraperitoneal organs from the body wall?
Mesentery
52
What are retroperitoneal organs covered by?
Covered by _parietal peritoneum on one side only_.
\*\* lie deep to the parietal peritoneum \*\*
53
Which nerves supply the parietal peritoneum?
Nerves from the adjacent body wall.
Supply pain and vasomotor fibers.
54
Of the retroperitoneal organs, which are primarily retroperitoneal?
* kidneys
* ureters
* adrenals
* gonads
* aorta and inferior vena cava
55
Of the retroperitoneal organs, which are secondarily retroperitoneal (became retroperitoneal during development)?
* duodenum (some of it)
* pancreas
* ascending colon
* descending colon
56
What is a mesentery?
2-layered fold of peritoneum.
* The mesentery
* attaches the "free" small intestine to the posterior body wall.
* jejunum
* ileum
57
What is the tranverse mesocolon?
Mesentery of the transverse colon.
58
What does the transverse mesocolon hold?
Holds the transverse colon to the posterior body wall.
59
What does the transverse mesocolon fuse with?
Fuses with posterior layer of greater omentum.
60
What is the sigmoid mesocolon and what does it hold?
* mesentery of sigmoid colon
* holds sigmoid colon to posterior body wall
61
What is the mesoappendix?
Mesentery of the vermiform appendix.
62
True or False:
The mesenteries of the duodenum, ascending colon, descending colon, and cecum are usually lost during development. Since they are no longer suspended by a mesentery, these organs are primarily retroperitoneal.
False
* The mesenteries of the duodenum, ascending colon, descending colon, and cecum are usually lost during development. Since they are no longer suspended by a mesentery, these organs are **secondarily** retroperitoneal.
63
List the characteristics of peritoneal folds and "ligaments".
* Peritoneal ligaments:
* may be subdivisions of a larger structure
* usually transmit nerves and vessels
* usually lack connective tissue and are NOT the same as ligaments that join bones
* gastrosplenic ligament
* splenorenal (lienorenal) ligament
64
What is an omentum?
Broad, 2-4 layered sheet of peritoneum that attaches the stomach to other viscera.
65
What is the lesser omentum develped from and what are its subdivisions?
* Develops from the ventral mesogastrium (mesentery)
* Subdivided into parts:
* hepatogastric ligament (stomach to liver)
* hepatoduodenal ligament (liver to duodenum)
66
What does the greater omentum develop from?
dorsal mesogastrium
67
What does the gastrocolic ligament attach?
Stomach to transverse colon.
68
What does the gastrophrenic ligament attach?
Stomach to diaphragm.
\* continuous with phrenicosplenic ligament \*
69
What is the gastrophrenic ligament continuous with?
phrenicosplenic ligament
70
What does the gastrosplenic ligament attach?
stomach to spleen
71
What are the peritoneal ligaments associated with the liver?
* coronary ligament
* right and left triangular ligament
* falciform ligament
* ligamentum teres hepatis
72
What is a "minor" fold?
Folds: ridge or elevation in peritoneum produced by underlying vessels.
\*\* fold is formed by _inferior mesenteric vein posterior to peritoneum_ \*\*
73
What are "minor" fossae?
* Fossae (fossa) or recesses -\> depressions between folds.
* superior duodenal fold and fossa (recess)
* paraduodenal fossa
* inferior duodenal fold and fossa
* retroduodenal fossa
* fold is formed by inferior mesennteric vein posterior to pertoneum
74
What is a fold and fossa fo the internal aspect of the abdominal wall?
* structures coursing through the extraperiotneal tissue form elevations on the interior abdominal wall called peritoneal (umbilical) folds
* median umbilical fold
* urachus
* midline from bladder
75
What forms the medial umbilical folds?
* medial umbilical ligaments
* obliterated umbilical aa.
76
What forms the lateral umbilical folds?
* inferior epigastric vessels
* functional aa. and vv.
77
What is the falciform ligament?
* curved remnant of the ventral mesogastrium
* ligamentum teres hepatis (round ligament of the liver) in its lower free border
* obliterated umbilical vein
78
What is the lower free border of the falciform ligament?
ligamentum teres hepatis (round ligament of the liver)
79
What is the falciform ligament from?
obliterated umbilical vein
80
What rare occurrence can happen in the supravesical fossa?
site for supravesical hernia
81
Where is the supravesical fossa located?
Between the median and medial umbilical folds
82
Where is the medial inguinal fossa located?
between the medial and lateral umbilical folds
83
What is the medial inguinal fossa (also called inguinal triangle) the site for?
direct inguinal hernias
84
Where is the lateral inguinal fossa located?
lateral to the lateral umbilical folds
85
What is the lateral ingunial fossa a site for?
indirect ingunial hernias
86
What is the greater sac of the peritoneal cavity?
* Most of the "potential" space within the abdomen.
* Can be subdivided into supracolic and infracolic regions by the colon and transverse meocolon.
* supramesocolic (supracolic) region
* superior and anterior to the liver an stomach
* includes hepatorenal and subphrenic spaces and fossae of the anterior wall
87
What is the peritoneal cavity?
Is a "closed" potential space between parietal and visceral layers of peritoneum.
88
What are the recesses and fossae of the peritoneal cavity?
* subphrenic recess
* subhepatic/hepatorenal recess
* rectovesical/rectouterine recess
89
Why is the greater sac of the peritoneal cavity clinically important?
Because abscesses may develop and excess fluid (ascites) will pool here.
90
What are the characteristics of the inframesocolic (infracolic) region? (which is a subdivision of the greater sac of the peritoneal cavity).
* inferior and posterior part of greater sac
* subidivided by mesenteries and "ligaments"
* right and left paracolic gutters are lateral to the ascending and descending colon
* upper and lower parts are divided by the mesentery into right and left infracolic spaces
* clinically important spaces where intraperitoneal infections spread
* the phrenicocolic ligament limits the spread of fluid superiorly
91
What is the lesser sac of the peritoneal cavity?
* Lesser sac (omental bursa) develops as a part of the greater sac.
* lesser sac is posterior and inferior to the stomach
* **greater and lesser peritoneal sacs communicate through the epiploic foramen (of Winslow)**
92
How do the greater and lesser peritoneal sacs communicate?
Through the epiploic foramen (of Winslow).
93
What are the 3 recesses of the lesser sac?
* superior recess
* inferior recess
* splenic recess
94
Where is the superior recess of the lesser sac located with respect to the liver?
posterior to the liver
95
What is the inferior recess of the lesser sac?
potential space between the 2 layers of the gastrocolic ligament
96
Where is the splenic recess of the lesser sac located with respect to the stomach?
posterior to and left of the stomach
97
What organs does the lesser sac of the peritoneal cavity have a clinically important relationship with?
* liver
* pancreas
* stomach
* spleen
98
What is the epiploic foramen (of Winslow)?
* opening between the greater and lesser sacs
* anterior:
* hepatoduodenal ligament with the portal vein, hepatic artery, and bile duct
* posterior:
* IVC, diaphragm
* superior:
* liver, caudate lobe
* inferior:
* duodenum, 1st part
99
