Anterior Abdominal Wall

Question 1

Superior borders of anterolateral abdominal wall

Answer 1

Costal margin and xiphoid process

Question 2

Inferior borders of the anterolateral abdominal wall

Answer 2

Inguinal ligament, Pelvic girdle (iliac crests, ASIS, pubic tubercle, pubic symphysis)

Question 3

What are the components of the pelvic girdle?

Answer 3

iliac crests, ASIS, pubic tubercle, pubic symphysis

Question 4

What are the three planes used to create the 9 abdominal regions and where does each run?

Answer 4

Midclavicular lines, Subcostal plane (through inf border of 10th CC), and Transtubercular plane (through iliac tubercles and body of L5)

Question 5

What are the two planes used to create the four abdominal quadrants and at what vertebral level is the horizontal plane?

Answer 5

Median plane and transumbilical plane. The transumbilical plane is at the level of the IV disc between L3 and L4

Question 6

Give the contents of the anterolateral abdominal wall in order from superficial to deep

Answer 6

Skin, Camper subcutaneous tissue, Scarpa subcutaneous tissue, Deep fascia, Muscles and their aponeur, Transversalis Fascia, Extraperitoneal Fat, Parietal Peritoneum

Question 7

What is the difference between camper and scarpa subcutaneous tissue?

Answer 7

Camper is more fatty, Scarpa is more membranous

Question 8

What are the functions of Camper and Scarpa subcutaneous tissues respectively?

Answer 8

Camper - Fat storage, Scarpa - Compartmentalize fluids (also good for suturing)

Question 9

How many layers of investing (deep) fascia overly the anterolateral abdominal muscles and their aponeuroses?

Answer 9

3 layers, superficial, intermediate, and deep

Question 10

Give the bilaterally paired muscles of the anterolateral abdomen and which type each muscles is

Answer 10

External oblique (flat), Internal oblique (flat), Transversus abdominus (flat), Rectus abdominus (vertical), Pyramidalis (vertical)

Question 11

What is the conjoint tendon comprised of?

Answer 11

Arching fibers of the 1) Internal oblique muscle, and 2) Transversus abdominus muscles

Question 12

How is the endoabdominal fascia named?

Answer 12

According to the muscle it is lining (e.g. transversalis fascia)

Question 13

What separates the endoabdominal fascia from the parietal peritoneum?

Answer 13

Extraperitoneal fat (amount depending on person)

Question 14

What establishes space allowing surgeons anterior access to retroperitoneal structures without entering the peritoneal cavity?

Answer 14

The extraperitoneal fat between the endoabdominal fascia and parietal peritoneum

Question 15

What can happen in individuals with poorly developed rectus abdominus muscles and what does this look like?

Answer 15

Distended abdomen, may look like a hernia

Question 16

What is the rectus sheath?

Answer 16

An incomplete fibrous compartment of the rectus abdominis

Question 17

What is the rectus sheath formed from?

Answer 17

Interweaving of the aponeuroses of the abdominal muscles

Question 18

Approximately where is the arcuate line located?

Answer 18

1/3 of distance from umbilicus to pubic crest

Question 19

What does the arcuate line mark the transition between?

Answer 19

Aponeurotic posterior wall of the superior 3/4 of rectus sheath and transversalis fascia covering the inferior 1/4 of the rectus sheath

Question 20

What is the linea alba?

Answer 20

A midline raphe of all the aponeuroses from both sides interweaving. This white ridge is an optimal place for surgical incisions because it creates minimal bleeding

Question 21

What dermatome includes the umbilicus?

Answer 21

T10

Question 22

What dermatome includes the inguinal fold?

Answer 22

L1

Question 23

What dermatome includes the nipple?

Answer 23

T4

Question 24

The thoracoabdominal nerves run between what two muscles?

Answer 24

Internal Obliques and Transversus Abdominus muscles

Question 25

What artery can provide collateral circulation to make up for a compromised superior epigastric artery?

Answer 25

The inferior epigastric artery

Question 26

What artery is the inferior epigastric artery derived from and where?

Answer 26

External iliac artery, superior to the inguinal ligament

Question 27

In the anterior abdominal there is venous anastomosis between what two superficial vessels, and in what situation might this come into play?

Answer 27

Lateral thoracic vein and internal thoracic vein. Useful if one of the vena cavae is blocked

Question 28

In the anterior abdomen there is venous anastomosis between what two deep vessels, and in what situation might this come into play?

Answer 28

Inferior epigastric vein and superior epigastric vein. Useful if either vena cava is blocked

Question 29

What superficial veins drain the abdominal wall into the SVC and IVC respectively?

Answer 29

Lateral thoracic vein (SVC), Superficial epigastric vein (IVC)

Question 30

What deep veins drain the abdominal wall into the SVC and IVC respectively?

Answer 30

Superior epigastric vein (SVC), and Inferior epigastric vein (IVC)

Question 31

What is portocaval circulation?

Answer 31

An abnormal connection between portal and systemic circulation caused by portal hypertension

Question 32

What is an obvious sign of portocaval circulation?

Answer 32

Caput medusae - Dilation of veins appearing as a worm like venous congestion in the abdomen

Question 33

List the umbilical folds from most lateral to most medial, name which have patent blood vessels running with them, and name the blood vessels with each

Answer 33

Lateral umbilical fold (inferior epigastric vessels run with it), Medial umbilical fold (no patent vessels with it, only obliterated umbilical arteries), and Median umbilical fold (no patent vessels with it, only remnant of urachus)