Flashcards in Anterior Abdominal Wall Deck (77):
Layers of Anterior Abdominal Wall. (Lateral)
2. Camper’s fascia
3. Scarpa’s fascia
4. External oblique muscle
5. Internal oblique muscle
6. Transverse abdominis muscle
7. Fascia transversalis
Layers of anterior abdominal wall (Medial)
2. Campers fascia
3. Scarpa’s fascia
4. Anterior wall of rectus sheath
5. Rectus abdominis muscle
6. Posterior wall of rectus sheath
Are there any deep fascia in the anterior abdominal wall?
Why aren’t there any deep fascia in the anterior abdominal wall?
To allow free movement in respiration and distention after meals
The extent of the camper’s fascia?
-Descends to the thigh with its corresponding layer (SC fat)
- reflects backwards as the superficial layer of perineum
Where does the camper’s fascia end?
- In Males: it is continuous over the penis and becomes dartos fascia in the scrotum
- In Females: it is continuous from the abdomen to the labia majora
What is the clinical importance of loosing the fat of campers fascia in the penis and perineum?
It may lead to lipoma but doesn’t effect penis, scrotum and labia majora
Beginning of scarpa’s fascia ?
Midway between the umbilicus and the symphysis pubis
Superior attachments of scarpa’s fascia ?
Fades away midway between the pubis and umbilicus above and in the lumber region at the sides
Inferior attachments of scarpa’s fascia ?
Just below the external ring the name changes to Colle’s fascia
Lateral attachments of scarpa’s fascia ?
Attached to fascia lata just below (2 finger breadth) the inguinal ligament at the groin crease
Clinical importance of attachment of scarpa’s fascia to fascia lata ?
1. Prevents descend of femoral hernia
2. Rupture urethra will lead to urine collection under it
3. Knee flexion during abdominal examination
Another name for colle’s fascia ?
Superficial perineal fascia
Another name for superfician perineal fascia ?
What is colle’s fascia ?
Continuation of scarpa’s fascia below the superficial inguinal ring
Extent of colle’s fascia ?
- The penis and scrotum giving a fascial covering
- The muscles in the superficial part of perineum
Muscles of the anterior abdominal wall?
1. External oblique
2. Internal oblique
3. Transversus abdominis
4. Rectus abdominis
5. Pyramidalis muscle
6. Cremasteric muscle
Origin of External oblique?
Fleshy digitations from the lower 8 ribs
(the upper 5 slips interdigitate with the serratus anterior )
Insertion of external oblique?
Fleshy fibers: ant ½ of outer lip of the iliac crest
Aponeurosis: Medial part inserted to linea alba from xiphoid process to symphasis pubis and lateral part forms the inguinal ligament
What is inguinal ligament?
It is the lateral part of the external oblique aponeurosis folded upwards and backwards upon itself from ASIS to pubic tubercle
Direction of external oblique?
Downward forward and medially
Direction of internal oblique?
Upward forward and medially
Direction of transverse abdominus ?
Nerve supply of external oblique?
Lower 6 thoracic nerves ( intercostal nerves t7 to t11 and subcostal nerve t12)
Nerve supply of internal oblique?
T7 to t12 (lower 6 thoracic) and ilio hypogastric and ilio inguinal nerves(L1) same as nerve supply of transversus abdominis
What muscle shares in forming both anterior and posterior rectus sheaths ?
Relation of internal oblique to the inguinal canal?
Triple relations ( anterior superior and posterior )
Origin of internal oblique?
3 .. lateral 2/3 of the upper surface of the inguinal ligament, anterior 2/3 of intermediate area of iliac crest and lumber fascia
Insertion of internal oblique?
Fleshy part to lower 3 ribs and aponeurotic part to xiphoid process, linea alba, pubic crest and pectineal line
Origin of tranversus abdominis ?
Deep surface of lower 6 ribs , anterior 2/3 of inner lip of iliac crest, lateral 1/3 of upper surface of inguinal ligament and lumber fascia
Insertion of transversus abdominis ?
Xiphoid process , linea alba, pubic crest and pectineal line
Nerve supply of transversus abdominis?
T7 to t12 (lower 6 thoracic) and ilio hypogastric and ilio inguinal nerves(L1) same as nerve supply of internal oblique
Nerve supply of conjoint tendon ?
Ilio inguinal nerve
Mention 3 surgical importance of conjoint tendon?
1. Its weakening predispose to direct inguinal hernia
2. Ilioinguinal n injury during appendectomy direct inguinal hernia paralytic type
3. Conjoint tendon prevents direct hernia from descending to scrotum
(if decended funicular type)
Origin of rectus abdominis muscle ?
From the pubis crest and the symphasis pubis
Insertion of rectus abdominis muscle ?
Xiphoid process and 5 6 7 costal cartilages
Nerve supply of rectus abdominis?
as external oblique from lower 6 thoracic nerves ( t7 to t12)
clinical value of mig inguinal point ?
surface anatomy of external iliac artery
surgical importance of rectus abdominis muscle?
1. In kocher incision it is divided
2. In paramedian it is displaced laterally cause it receives nerve supply from lateral side
3. Embryologically it arise from a number of myotomes so
a. Ms has segmental n supply
b. Divided into 4 segments by 3 tendinios intersections
c. Hematoma of rectus abdominis is localized because of tendinious intersections
Actions of ant abdominal wall?
1. Assist in raisin IBP (help vomiting, coughin, delivery)
2. Keep abdominal viscera in place
3. Rectus abdominis flexes the trunk
4. 2 oblique ms bend the trunk laterally
5. Act as accessory expiratory ms
What is fascia transversalis and its importance?
1. Lines the inner surface of transversus abdominis ms
2. Form post wall of rectus sheath below arcuate like ( a lil above pubic tubercle)
3. Extend as ant wall of femoral sheath
4. Prolonged as internal spermatic fascia
5. Contain deep inguinal ring
What is extraperitoneal fat?
Layer of areolar fatty tissue (loose CT) between fascia transversalis and parietal peritoneum
What is rectus sheath?
It is an envelop like sheath for rectus ms
Site of rectus sheath?
Between linea alba (medially) and linea semilunaris (laterally)
Formation of rectus sheath is divided into 3 parts what are they?
1. Above costal margin
2. From costal margin to midway between umbilicus and SP
3. Below the level midway between umbilicus and SP
Ant and post wall formation of rectus sheath above costal margin?
Anterior wall (external oblique)
Posterior wall (5 6 7 CC)
Ant and post wall formation of rectus sheath from costal margin to midway between umbilicus and SP?
Anterior wall ( ext oblique, ant layer of internal oblique)
Posterior wall ( post layer of internal oblique, transversus abd (its lower border is the arcuate line)
Ant and post wall formation of rectus sheath below level midway between umbilicus and SP?
Anterior wall ( external oblique, internal oblique and transversus abd)
Posterior wall ( abscent and is replaced by fascia transversalis)
Contents of rectus sheath?
2 muscles inside rectus sheath?
1. Rectus abdominis
4 vessels inside rectus sheath?
Sup epigastric vessels
Inf epigastric vessels
6 nerves inside rectus sheath?
Lower 5 intercostal nerves (t7 to t11)
Subcostal nerve (t12)
What is arcuate line?
A crescentic line that is situated between upper ¾ and lower ¼ of posterior wall of rectus sheath
Sup and inferior epigastric a anastomosis occurs?
In the posterior wall of rectus sheath above the level of umbilicus
What is linea semilunaris?
Lateral border of rectus sheath extending from pubic tubercle below to the tip of the 9th CC
What do u know about linea alba?
1. It is a white line in the midline of the abdomen
2. Formed by decussation of apaneurosis of EO ms, IO ms and transversus abdominis ms
3. Extend from xiphoid process to SP (not attached to pubic tubercle)
5. Broad in its supra umbilical part ( surgical imp epigastric hernia)
What is fascia iliaca?
Continuation of fascia transversalis posteriorly below iliac crest over the iliacus ms
Descends forming the post wall of femoral sheath behind femoral vessels
All intra abdominal organ can herniate?
No . all except pancrease cause it is guarded posteriorly by aorta IVC and vertebrae
What is the arterial supply of ant abd wall?
1. Internal mammary artery
2. External iliac artery
3. Descending aorta
4. Femoral Artery
How internal mammary A supply ant abd wall?
Though its 2 terminal br
1. sup epigastric A
2. musculophrenic A
how Ext iliac A supply Ant Abd Wall?
Through its 2 terminal br
1. inf epigastric A
2. deep circumflex A
how descending aorta supply Ant Abd Wall?
1. 10th 11th post intercostal A
2. subcostal A
3. All 4 lumber A
How femoral A supply Ant Abd Wall?
1. Superficial epigastric A
2. Superficial circumflex A
Lymphatic drainage of Ant Abd Wall?
Above umbilicus to axillary LN
Below umbilicus to inguinal LN
Clinical note on inf epigastric a?
When the pubic br of inf epigastric a is large its called abnormal obturator A. maybe injured while cutting lacunar ligament during femoral hernia operation resulting in life threatening he
Skin around umbilicus supplied by ?
Neurovascular plane of ant abd wall lies between?
Internal oblique and transversus abdominis ms
Lateral thoracic vein anastomose with?
Superficial epigastric vein
Inflammation of umbilicus spread to which LN?
Bilaterally to both axillary and inguinal LN cause umbilicus is the lymphatic water shed area
Nerves that supply the ant abd wall?
1. T7 to t11
2. Subcostal n
Supply of iliohypogastric n?
Supplies skin above the pubis and skin of gluteal region
Supply of ilioinguinal n?
Pierces the internal abdominis muscle and enters the inguinal canal comes out from the sup ring and supplies skin of upper part of medial thigh, root of penis and upper part of scrotum + CONJOINT TENDON
Umbilicus fold are present ?
In the post rectus sheath
How many umbilicus fold are there?
Three folds but 2 ligaments . inf epigastric a raises a fold of peritoneum but its not a ligament
What are the 3 umbilicus folds?
1. One median umbilical fold (median umbilical ligament) contain urachus
2. Two medial umbilical folds (occluded umbilical artery)
3. 2 lateral umbilical folds (inf epigastric vessels)
What is water shed area?
Zones of overlap where lymph may drain more than one direction
1. Vertical (midline, along line of fusion durin development)
a. Cervical- axillary
b. Axillary inguinal