Anterior abdominal wall Flashcards
(92 cards)
1
Q
Make up of linea terminalis
Border between what?
A
Pectin pubis, arcuate line, sacral promontory
True (below) and false (above) pelvis
2
Q
Vertical defining lines of abdomen
A
Linea alba - center
Linea semilunaris (lateral borders of rectus abdominis on each side)
3
Q
Subcostal plane
A
10th costal cartilage
Superior border of L3
4
Q
Transtubercular plane
A
Tubercles of iliac crests
L5
5
Q
Transumbilical plane
A
L3-L4
6
Q
Transpyloric line
A
T12-L1
1/2 way between suprasternal notch and pubic symphysis
7
Q
Midclavicular plane
A
Through middle of clavicle down to middle of inguinal ligament
8
Q
Midsagittal plane
A
Down linea alba from xiphoid to pubic symphysis
9
Q
Planes used to make abdominal quadrants
A
Transumbilical
Median sagittal
10
Q
Organs in RUQ
A
GB, duodenum, R. pleura, R lobe of liver, R kidney
11
Q
Organs in LUQ
A
Spleen, stomach, left pleura, tail of pancreas, L kidney
12
Q
What are the R and L pleura in the RUQ and LUQ?
Border what?
Clinical significance?
A
Lies over liver
Space between L and R = costodiaphragmatic recess
A stab wound to the liver could also collapse a lung
13
Q
Organs in RLQ
A
R ureter, cecum, ileal diverticulum, ascending colon, appendix
14
Q
Organs in LLQ
A
L ureter, descending colon
15
Q
Lines that make up the 9 regions
A
Midclavicular (x2)
Subcostal (L3 sup. border)
Transtubercular (L5 body)
16
Q
Names of top 3 regions
A
R and L hypochondriac
Epigastric
17
Q
Names of middle 3 regions
A
R and L lumbar/lateral
Umbilical
18
Q
Names of lower 3 regions
A
R and L inguinal/iliac
Hypogastric/pubic
19
Q
functions of anterolateral superficial abdominal muscles
A
Flex, rotate, side-bend trunk
20
Q
A good longitudinal incision to avoid any major vessels or nerves, but undergo necrosis after incision is what?
A
Median/midline incision (linea alba)
21
Q
A longitudinal incision made just lateral to the linea alba is called what?
A
Paramedian incision
22
Q
Generally when making incisions in the anterior abdominal wall, how should cuts be made in relation to the muscles?
A
Parallel to the muscle fibers
23
Q
About how far is McBurney’s Point from the ASIS?
A
2.5 cm superomedially towards the umbilicus (1/3 of the way)
24
Q
What nerve must be found and preserved when cutting at McBurney’s Point?
A
Iliohypogastric n.
25
Which incision is used for a C-section and other OB/GYN procedures?
Which nerves must be found and saved here?
Suprapubic (just above hairline)
Iliohypogastric and Ilioinguinal
26
Is rectus abdominis m. transected along tendinous intersections?
Why or why not?
NO
Cutaneous nerves and branches of superior epigastric vessels pierce through those
27
How are the gallblader, bile ducts, and spleen reached surgically?
What nerves must be avoided here?
Subcostal incisions
7th and 8th thoracic spinal nerves
28
What forms the linea alba?
Fusion of R and L abdominal aponeuroses, especially external abdominal oblique
29
At which point does external abdominal oblique m. become aponeurotic?
Midclavicular line
30
What forms the inguinal ligament?
From where to where?
What opening is right above it?
Lower border of external abdominal oblique aponeurosis
Pubic tubercle to ASIS
Superficial inguinal ring
31
Clinical relevance of edges of superficial inguinal ring?
Names?
Strong and suture-able
Medial crus, lateral crus, intercrural fibers
32
2 ligaments of importance below the inguinal ligament
Lacunar ligament
Pectineal ligament
33
Lacunar ligament
Shape?
Borders?
Extension of inguinal ligament inferomedial to femoral canal
Triangular
```
Apex = pubic tubercle
Base = empty space w/ lymph (of femoral canal region)
```
34
Pectineal ligament
Clinical significance
Extension laterally from the apex of the lacunal ligament
Can constrict a femoral hernia
35
Muscle that borders lateral edge of femoral canal
Iliopsoas
36
What muscle surrounds the spermatic cord?
What is it an extension of?
Cremaster m.
Internal abdominal oblique m.
37
What is formed inferiorly by the aponeuroses of IAO m. and TA m.?
Clinical significance?
Conjoint tendon
Protects weak part in abdominal wall, helps prevent direct inguinal hernias
38
Purpose of tendinous intersections in rectus abdominis m.?
Shorter muscle fibers = stronger force of contraction
39
Rectus abdominis m. is enclosed in what?
Rectus sheath
40
Muscle that functions to tense the linea alba
Pyramidalis m.
41
The anterior abdominal wall muscles also aid in what visceral-initiated actions?
How? (3)
Respiration, coughing, sneezing, urination, defecation, vomiting
Pushes up on diaphragm for breathing
Pushes in on abdominal contents for coughing, etc.
Pushes down on pelvic diaphragm for urination, etc.
42
2 layers of superficial fascia in the abdominal wall:
Fatty layer just deep to the skin in the abdomen
Membranous layer just deep to ^^^
Camper's fascia/fat
Scarpa's fascia
43
Camper's fascia is continuous with what?
Superficial fatty layers in the thigh
44
Scarpa's fascia is continuous with what?
Also continuous over what pelvic stuff?
Fascia lata and deep perineal fascia
Pubic bone, scrotum, penis
45
What is deep perineal fascia?
Continuous with what?
Fascia over genitalia
Scarpa's fascia
46
Function of deep fascial layers around muscles
Allow muscles to move past each other w/o much friction
47
Where can fluid sometimes leak within the fascial layers of the abdomen?
Stopped by what?
Between Scarpa's fascia and the deep fascia of the EAO m. - superficial to the inguinal ligament
Scarpa's fascia as it wraps around under spermatic cord and over pubic bone
48
Where do the layerings of the rectus sheath change?
How?
Arcuate line of the rectus sheath
Above: 3-4 fascial layers on each side of rectus abdominis
Below: All 6 layers in front of rectus abdominis, only transversalis fascia behind it
49
Superficial arterial system of the anterior abdomen runs in where?
Includes what arteries?
Superficial (Camper's) fascia
Superficial circumflex iliac a.
Superior epigastric a.
External pudendal a.
50
Artery that runs laterally along costal margin
Arteries that run along anterior side of rectus abdominis
Artery that runs parallel to inguinal ligament DEEP to it from femoral a.
Musculophrenic
Sup/Inf. epigastrics
Deep circumflex iliac a.
51
Artery that runs parallel to inguinal ligament SUPERFICIAL to it from femoral a.
Artery that runs up abdominal wall from femoral a.
Superficial circumflex iliac a. (both)
52
Deep venous drainage of anterolateral abdominal wall drain into what veins?
Contained where?
Subclavian vv.
External iliac vv.
Lumbar and intercostal vv.
W/in abdominal wall muscles w/ arteries
53
Superficial abdominal wall venous drainage is contained where?
Use what veins?
Clinical relevance?
W/in camper's fascia
Thoracoepigastric vv.
Superficial epigastric v.
Femoral --> axillary bypass mechanism if necessary
54
Sensory dermatomes of:
Xiphoid
Umbilicus
Inguinal fold
T7
T10
L1
55
Intercostal mm. innervated by what spinal nerves?
Subcostal m. innervated by what spinal n.?
Lumbar muscles innervated by what spinal n.?
T7-11
T12
L1-4
56
Nerves that supply the skin, muscles, and parietal peritoneum of ant. abd. wall
Cutaneous branches of ventral rami
57
Nerve roots of Iliohypogastric n.
Runs where?
T12/L1
Btwn QL and Psoas m. --> between ant. wall muscles --> cutaneous in hypogastric region
58
Nerve root of ilioinguinal n.
Runs where?
L1
Enters inguinal canal from between ant. wall muscles --> superficial inguinal ring --> groin, thigh, scrotum/labia
59
Nerve roots of genitofemoral n.
Runs where?
L1-2
Pierces psoas major --> deep inguinal ring (genital branch) OR below inguinal ligament to cutaneous femoral triangle (femoral branch)
60
Superficial lymphatic drainage to what 2 lymph node sets?
Up from umbilicus --> ant. axillary sternal nodes
Down from umbilicus --> superficial inguinal nodes
61
Deep lymphatic drainage goes to what lymph nodes?
Along post. intercostal aa. and lumbar vessels to deep abdominal nodes
62
Lymph from testes/scrotum drains to where?
Deep abdominal nodes (part of deep drainage system)
63
Cause of infant's umbilical hernia
Cure?
Umbilical scar doesn't heal
Heals on its own
64
.
Cause of adult umbilical hernia
Most often where exactly, and in what gender?
Cure?
Weak abdominal muscles around umbilicus + increased abdominal pressure
Superior to umbilicus (more in women)
Surgical repair
65
Hernia type more common in men
Cause?
Epigastric hernia
Increased intra-abdominal pressure
66
Spigelian hernia
Hernia through linea semilunaris, below the arcuate line
67
3 structures that form the inguinal canal
EAO aponeurosis
IAO muscle
TA muscle
68
Clinical significance of "turn your head and cough"
IAO and TA muscles can contract and push down on inguinal canal contents, causing herniation through the canal
69
Floor of inguinal canal
Roof
Anterior to it
Posterior to it
Inguinal and lacunar ligaments
IAO muscle
EAO muscle
Transversalis fascia + conjoint tendon
70
Inguinal canal contents must pierce through ___ at the deep inguinal ring
Transversalis fascia
71
What vessels become the femoral a. and v.?
Where?
Important branches from them?
External iliac aa. and vv.
Past the inguinal ligament
Inferior epigastric, cremasteric
72
Testes start at what vertebral level? Where?
Why is this significant?
L1, retroperitoneal
Blood supply and lymph come to/from L1 level, NOT lower down
73
Testes are pulled down via what?
Name of peritoneal pouch that encases them as they pull through the peritoneum
Gubernaculum
Processus vaginalis
74
At what time are the testes at the deep inguinal ring?
At what time are they pulled through the inguinal canal?
7 mo.
9 mo.
75
Cryptorchidism
Clinical significance?
Undescended testes
High risk of testicular cancer due to higher temperatures inside the body
76
Hydroceles
Cause?
Fluid build-up in tunica vaginalis
The peritoneum it originated from has cells that make fluid
77
Hematocele
Blood between tunica vaginalis and testicle
78
4 fascial layers around testes and spermatic cord (w/ origins)
Internal spermatic fascia (transversalis fascia)
Cremaster m./fascia (IAO)
External spermatic fascia (EAO)
Tunica vaginalis (peritoneum)
79
Which muscle or fascia from anterior abdominal wall does NOT contribute to the spermatic cord or testes?
Why?
Transversus abdominis
Too high up, does not border the start of these structures
80
The gubernaculum is attached inferiorly to what?
Labiosacral fold
81
Why don't ovaries descend down all the way like testes do?
Get caught on developing uterus
82
What can cause pain in the labia?
Pulling of gubernaculum remnant since ovaries get caught on uterus
83
.
| Instead of the spermatic cord, what is contained in the inguinal canal of a female?
Round ligament of the uterus
84
3 layers of scrotal wall
Skin
Dartos fascia
Dartos m.
85
The line on the external side of the scrotum between the 2 testes is called what?
Associated with what?
Scrotal raphe
Scrotal septum (inside)
86
What forms the inner layers of the scrotum and the septum?
Fundiform ligament
87
How does the tunica vaginalis cover the testis?
Covers ONLY one half (not posterior side)
88
How does sperm get from testis to epididymis?
Through efferent ductules
89
Direct vs. indirect inguinal hernias are distinguished based on which side of ___ they protrude through
Always superior to what?
Inferior epigastric vessels
Inguinal ligament
90
Direct inguinal hernia protrudes through what?
More common in whom?
Hesselbach's triangle (weak conjoint tendon)
Older males
91
What is hesselbach's triangle?
Space between inguinal ligament, lateral border of rectus abdominis, and inferior epigastric vessels
92
Indirect inguinal hernias protrude through what?
Common cause?
Deep and superficial inguinal rings
Incomplete closure of processus vaginalis as it's pinched off when testis descends through canal
