Abdominal Wall Structure

Question 1

What are the superior and inferior borders of the abdominal wall?

Answer 1

Superior - xiphoid process, costal cartilages ribs 7-10

Inferior - Iliac crest, Inguinal ligament, Pubic bone

Question 2

What spinal nerve innervates the skin around the umbilicus?

Answer 2

T10

Question 3

What are the linea alba, semilunares, and transversae?

Answer 3

Linea alba - linear endinous raphe extending along the midline; medial border of two rectus abdominis muscles

Linea semilunares - Connective tissue along alteral borders of rectus abdominis

Linea transversai - fibrous connective tissue bands within rectus abdominis muscles

Question 4

What planes divide the abdomen into regions?

Answer 4

Two longitudinal - right and left midclavicular

Two horizontal - subcostal plane and transturbercular plane

Question 5

What is McBurney’s point?

Answer 5

One-third of the way up a line between right anterior superior iliac spine and umbilicus

Point of maximum tenderness during acute appendicitis

Question 6

What surface region does acute diverticulitis refer to?

Answer 6

Left lower quadrant

Question 7

What surface region does acute pancreatitis refer to?

Answer 7

Epigastric

Question 8

What surface region does acute cholecystitis refer to?

Answer 8

Right hypochondrial

Question 9

What are the layers of Anterior Abdominal Wall superficial to deep??

Answer 9

Skin

Superficial Fascia (Fatty/Campers -> Membrane/Scarpa’s)

Deep fascia covering muscles

Transversalis fascia (endoabdominal)

Extraperitoneal fat

Parietal Peritoneum

Question 10

What is camper’s fascia?

Answer 10

Fatty layer of superficial fascia

Contains superficial epigastric vessels

Continues as superficial fascia of thigh

Question 11

What is Scarpa’s fascia?

Answer 11

Membranous layer of superficial fascia

Fused with deep fascia of thigh (fascia lata)

Question 12

What is the difference between the midline and lateral approach to penetrating the abdominal wall?

Answer 12

Midline - pass through the linea alba after the superficial fascia

Lateral - pass through muscles layers after the superficial fascia

Question 13

What is the rectus sheath?

Answer 13

Incomplete connective tissue envelope that surrounds each rectus abdominis muscle; formed by aponeuroses of the anterolateral muscles

Question 14

What does the rectus sheath contain?

Answer 14

Rectus abdominis and pyramidalis muscles

Superior and inferior epigastric vessels

Terminal ends of T7-12 nerves

Question 15

What is the arcuate line?

Answer 15

Marks the change in fascia contributing to the anterior and posterior layers of the rectus sheath; occurs below umbilicus at a point midway between umbilicus and pubis

Question 16

What is the difference between the area superior to the arcuate line and inferior to the arcuate line?

Answer 16

Superior -rectus abdominis is completely enclosed by aponeuroses of the anterolateral abdominal wall muscles

Inferior - the aponeuroses of all three muscles pass anterior to the rectus abdominis muscle

Question 17

Describe the innervation to muscles and skin of the anterior abdominal wall

Answer 17

T7-L1

Thoracoabdominal nerves (T7-T11)

Subcostal nerve (T12)

Iliohypogastric nerve (L1)

Ilioinguinal nerve (L1)

Question 18

What are the four major vessels that provide blood supply to the abdomen?

Answer 18

Internal thoracic - superior epigastric/musculophrenic

Aorta - posterior intercostal/subcostal

External Iliac - inferior epigastric (can also give rise to obturator and deep circumflex iliac

Femoral Artery - Superficial epigastric/superficial circumflex iliac

Question 19

What arteries anastomose within the rectus sheath?

Answer 19

Superior epigastric and Inferior epigastric

Form major connection between subclavian and external iliac

Important if aorta becomes obstructed

Question 20

What are the umbilical folds?

Answer 20

Coverings of the peritoneum on the ifnerior half of the abdominal wall taht cours toward the umbilicus

Five total: One along the midline and two on either side (medial and lateral folds)

Question 21

What are the peritoneal fossa?

Answer 21

Depressions lateral to the umbilical folds which are potential sites for hernias

Question 22

What is Caput Medusae?

Answer 22

Condition in which veins of anterior abdominal wall are swollen and dilated due to blockage

Can be caused by cirrhosis of the liver, chronic hepatitis, or portal hypertension

Question 23

What is aortic coarctation?

Answer 23

Narrowing of the aorta that can occur at the site of the ductus arteriosus

Collateral circulation is provided by the superior and inferior epigastric arteries

Question 24

What are the three parts of a hernia?

Answer 24

The sac

Contents of the sac

Coveriong of the sac

Question 25

What is an umbilical hernia?

Answer 25

Herniation of intestinal loops through the umbilical rings Common in newborns

Question 26

What are congenital umbilical hernias?

Answer 26

Have an embryological basis and are present at birth

Question 27

What is an acquired infantile hernia?

Answer 27

Small hernia that often occurs in infants and children, occurs through defect in linea alba and protrudes during crying, straining or coughing Usually resolves by 3-5 w/o treatment

Question 28

What is an acqured adult umbilical hernias?

Answer 28

Called a paraumbilical hernia when the hernia sac does not protrude through the umbilical scar, but instead through the linea alba in the region of the umbilicus

Question 29

What is an epigastric hernia?

Answer 29

Occurs through linea alba above umbilicus in the epigastric region

Question 30

What is a spigelian hernia?

Answer 30

Occurs along the linea semilunares Occurs at or below the arcuate line where the rectus abdominis is in direct contact with the transveralis fascia