Anterior Abdominal Wall

Question 1

What are the 4 transverse planes of the anterior abdominal wall?

Answer 1

Transpyloric plane

Subcostal plane

Transtubercle plane

Interspinous plane

Question 2

Which of the following is found at L1?

A. Subcostal plane
B. Transpyloric plane
C. Transtubercle plane
D. Interspinous plane

Answer 2

B. Transpyloric plane

Question 3

The transpyloric plane at L1 is used as a reference point for the location of what organs?

Answer 3

Gallbladder fundus
Pylorus
Pancreatic neck
SMA origin
Hepatic portal vein
Root of transverse mesocolon
Hila of kidneys

Question 4

Where is the subcostal plane located?

Answer 4

Passes inferior border of 10th costal cartilage

Level of L3

Question 5

The subcostal plane is an important landmark for what organ?

Answer 5

Transverse colon

Question 6

Where is the transtubercle plane located

Answer 6

Between iliac tubercles at the level of iliocecal junction

Level of L5

Question 7

Where is the interspinous plane located

Answer 7

Between ASIS

Level of S2

Question 8

The interspinous plane is an important landmark for what 2 organs?

Answer 8

Appendix

Sigmoid colon

Question 9

The abdominopelvic cavities include the abdomen and pelvis, existing between thoracic diaphragm and pelvic diaphragm; it can extend as high as the ____ intercostal space. The abdomen is separated from the pelvis by the imaginary border of the pelvic ______, above which is the ____ pelvis

Answer 9

4th
Inlet
Greater

Question 10

The abdominopelvic cavity walls are mostly bone, muscle, and CT, lined by _______

Answer 10

Peritoneum

Question 11

The anteriolateral abdominal wall is mostly made up of what 2 components?

Answer 11

Muscle

Aponeurosis

Question 12

What are the boundaries of the anteriorlateral abdominal wall?

Answer 12

Upper 7-10 costal cartilages

Lower inguinal ligament and pelvic bones

Question 13

Components of outer layer of anteriolateral abdominal wall

Answer 13

Skin
Camper’s fascia
Scarpa’s fascia
Aponeurosis (rectus sheath)

Question 14

Differentiate between Camper’s and Scarpa’s fascia

Answer 14

Both are integument

Camper’s = fatty layer of superficial fascia

Scarpa’s = membranous underlying CT layer of superficial fascia; continuous with Colle’s fascia of perineum but fused with fascia lata of lower limb

Question 15

What is the significance of Scarpa’s fascia in terms of fluid flow?

Answer 15

Fluid cannot go from abdominal wall into leg but could flow into or out of superficial perineum

Question 16

The serratus anterior m. interdigitates with what abdominal muscle?

Answer 16

External oblique m.

Question 17

Origin of external oblique m.

Answer 17

Lower 6 ribs

Question 18

Insertion of external oblique m.

Answer 18

Aponeurosis and linea alba, anterior iliac crest and pubic tubercle

Question 19

The inguinal ligament is formed by what structures? What are its attachment points?

Answer 19

The lower portion of the external oblique m. rolls under to form the inguinal ligament attached to ASIS and pubic tubercle

Question 20

The lower portion of the external oblique m. rolls under to form the inguinal ligament which forms the opening of the __________, as well as a reflection beneath that forms the _______ ligament

Answer 20

Superficial inguinal canal; lacunar

Question 21

Innervation of external oblique m.

Answer 21

Ventral rami of T7-12 of intercostal nn.

Question 22

Action of external oblique m.

Answer 22

Compresses abdomen and increases intra abdominal pressure; moves trunk and retains posture

Question 23

Origin of internal oblique m.

Answer 23

Iliac crest and some of thoracolumbar fascia

Question 24

Insertion of internal oblique m.

Answer 24

Lower 10-12 ribs, aponeurosis, linea alba, and pubic crest; lower part makes part of conjoint tendon (falx inguinalis)

Question 25

Some fibers of the internal oblique m. follow the spermatic cord to make the ______ muscle

Answer 25

Cremasteric

Question 26

The upper 3/4s of the internal oblique aponeurosis splits to encompass what muscle

Answer 26

Rectus abdominis m.

Question 27

Innervation of internal oblique m.

Answer 27

T7-12 and L1

Question 28

Action of internal oblique m.

Answer 28

Compresses and supports viscera, laterally flexes and rotates

Question 29

The _____ ______ m. runs transversomedially except for some running toward the pubic crest to contribute to the _____ tendon

Answer 29

Transversus abdominis Conjoint

Question 30

Origin of transversus abdominis m.

Answer 30

Lower 7-12 costal cartilages, thoracolumbar fascia, iliac crest, outer third of upper inguinal ligament

Question 31

Insertion of transversus abdominis m.

Answer 31

Linea alba Pecten pubis Pubic crest

Question 32

T/F: the aponeurosis of the transversus abdominis m. contributes to the rectus sheath

Answer 32

True

Question 33

Innervation of transversus abdominis m.

Answer 33

T7-L1

Question 34

Action of transversus abdominis m.

Answer 34

Compresses and supports viscera

Question 35

Origin of rectus abdominis m.

Answer 35

Pubic symphysis and pubic crest

Question 36

Insertion of rectus abdominis m.

Answer 36

Xiphoid process and outer surface of 5-7th intercostal cartilages

Question 37

Tendinous intersections of rectus abdominis muscle form part of rectus sheath at what 3 approximate locations?

Answer 37

Umbilical, xiphoid, and midway levels

Question 38

Innervation of rectus abdominis m.

Answer 38

Ventral rami of T7-12

Question 39

Action of rectus abdominis m.

Answer 39

Flexes abdomen and compresses it

Question 40

What forms the lateral border of the rectus abdominis m.?

Answer 40

Linea semilunaris

Question 41

What muscle, missing in 20% of the population, may be found at the inferior region of the rectus abdominis m., near the pubic crest?

Answer 41

Pyramidalis m.

Question 42

How do the aponeuroses of EO, IO, and TA muscles contribute to the rectus sheath?

Answer 42

EO aponeurosis is always anterior IO aponeurosis splits in upper 3/4 but is all anterior in lower 1/4 TA aponeurosis is posterior except in lower 1/4

Question 43

______ = sharp transition where all EO, IO, and TA aponeuroses become anterior to rectus abdominis m.

Answer 43

Arcuate line

Question 44

Below the arcuate line, the rectus abdominis is in contact with _______ ______

Answer 44

Transversalis fascia

Question 45

Nerves of anterior abdominal wall

Answer 45

Thoracoabdominal n. Subcostal n. Iliohypogastric n. Ilioinguinal n.

Question 46

Thoracoabdominal n. (T7-T11) form as continuation of _____ nn. Motor or sensory?

Answer 46

Intercostal Both motor and sensory

Question 47

The nerves of the anterior abdominal wall run between what 2 muscles?

Answer 47

Transversus abdominis m. | Internal oblique m.

Question 48

Location of subcostal n. Is it motor or sensory?

Answer 48

Subcostal n. = T12, runs along inferior 12th rib Motor; sensory is superior to iliac crest

Question 49

Location of iliohypogastric n. Motor or sensory?

Answer 49

Iliohypogastric n. = L1, runs between 2nd and 3rd muscle layers Motor to IO and TA; sensory to upper inguinal and hypogastric region

Question 50

Location of ilioinguinal n. Motor or sensory?

Answer 50

Ilioinguinal n. = L1 Motor to lower IO and TA; sensory to lower inguinal, anterior scrotum/labia, near medial thigh

Question 51

Arteries of anterior abdominal wall exist as continuation of _____ arteries. Lumbar arteries branch from the _______ _______

Answer 51

Intercostal; abdominal aorta

Question 52

Major arteries of anterior abdominal wall

Answer 52

``` Superficial epigastric a. Superficial circumflex iliac a. Deep circumflex iliac a. Inferior epigastric a. Superior epigastric a. ```

Question 53

The superficial epigastric a. branches from what a.?

Answer 53

Femoral a.

Question 54

Superficial circumflex iliac a. branches from what a.? What anatomical landmark does it run along?

Answer 54

Femoral a. | Runs along inguinal ligament

Question 55

Deep circumflex iliac a. branches from what a.? What anatomical landmark does it run along?

Answer 55

External iliac a. | Runs deep along inguinal ligament

Question 56

Inferior epigastric a. branches from what a.? What anatomical landmark does it run along and what does it anastomose with?

Answer 56

External iliac a. Runs posterior to rectus abdominis m. Anastomosis with superiro epigastric a.

Question 57

The superior epigastric a. is a terminal branch of what a.?

Answer 57

Internal thoracic a.

Question 58

What a. runs anterior to the posterior layer of the rectus sheath?

Answer 58

Inferior epigastric a.

Question 59

What fold exists on the interior surface of the anterior abdominal wall due to obliterated urachus?

Answer 59

Median umbilical fold

Question 60

What fold exists on the interior surface of the anterior abdominal wall due to obliterated umbilical aa.?

Answer 60

Medial umbilical fold

Question 61

What fold exists on the interior surface of the anterior abdominal wall due to inferior epigastric a.?

Answer 61

Lateral umbilical fold

Question 62

What fossa exists on the interior surface of the anterior abdominal wall as a gutter on either side of the upper bladder?

Answer 62

Supravesicular fossa

Question 63

What fossa exists on the interior surface of the anterior abdominal wall as a gutter lateral to medial umbilical folds?

Answer 63

Medial inguinal fossa

Question 64

What fossa exists on the interior surface of the anterior abdominal wall as a gutter lateral to lateral umbilical folds?

Answer 64

Lateral inguinal fossa

Question 65

What important anatomical landmark delineates the path of lymph drainage in the abdomen?

Answer 65

Transumbilical plane

Question 66

Superficial vessels superior to the umbilicus (transumbilical plane) drain into ______ nodes, with a few going to the ______ nodes Superficial vessels below the umbilicus (transumbilical plane) drain to ________ nodes

Answer 66

Axillary; parasternal Superficial inguinal

Question 67

T/F: deep lymph vessels accompany the deep veins of the abdominal wall like the external and internal iliac veins

Answer 67

True

Question 68

Where would you make a subcostal incision? What organs could you access here?

Answer 68

2.5 cm inferior from margin; access to gallbladder and biliary tract and spleen

Question 69

What type of incision can be made rapidly d/t few blood vessels or nerves?

Answer 69

Midline incision

Question 70

How would you make a paramedian incision?

Answer 70

Open anterior sheath, push rectus m. aside laterally and enter peritoneum

Question 71

What type of incision is typical of appendectomy?

Answer 71

Gridline (McBurney’s point) - muscle splitting

Question 72

What type of incision is used in most non-laparascopic gynecological/obstetrical surgeries?

Answer 72

Suprapubic

Question 73

Origin; insertion; innervation; action of: External oblique m.

Answer 73

Origin: lower 6 ribs Insertion: aponeurosis and linea alba, anterior iliac crest and pubic tubercle Innervation: ventral rami of T7-12 of intercostal n. Action: compress abdomen and increase intraabdominal pressure; move trunk; retain posture

Question 74

Origin; insertion; innervation; action of: Internal oblique m.

Answer 74

Origin: iliac crest and some of thoracolumbar fascia Insertion: lower 10-12 ribs, aponeurosis, linea alba, and pubic crest, lower part makes part of conjoint tendon (falx inguinalis) Innervation: T7-L1 Action: compresses and supports viscera, laterally flexes and rotates

Question 75

Origin; insertion; innervation; action of: Transversus abdominis m.

Answer 75

Origin: lower 7-12 costal cartilages, thoracolumbar fascia, iliac crest, and outer third of inguinal ligament Insertion: linea alba, pecten pubis, and pubic crest Innervated by T7-L1 Action: compresses and supports viscera

Question 76

Origin; insertion; innervation; action of: Rectus abdominis m.

Answer 76

Origin: pubic symphysis and pubic crest Insertion: xiphoid process and outer surface of 5-7th intercostal cartilages Innervation: ventral rami of T7-12 Action: flexes abdomen and compresses it

Question 77

Organs found in RUQ

Answer 77

``` Liver (R lobe) Gallbladder Stomach (pylorus) Duodenum (parts 1-3) Head of pancreas R suprarenal gland Right kidney Right colic flexure Ascending colon: superior part Transverse colon: right half ```

Question 78

Organs found in LUQ

Answer 78

``` Liver (L lobe) Spleen Stomach Jejunum and proximal ilium Pancreas: body and tail L kidney L suprarenal gland L colic flexure Transverse colon: left half Descending colon: superior part ```

Question 79

Organs found in RLQ

Answer 79

``` Cecum Appendix Most of ileum Ascending colon: inferior part R ovary R uterine tube R ureter: abdominal part R spermatic cord: abd part Uterus (if enlarged) Urinary bladder (if full) ```

Question 80

Organs found in LLQ

Answer 80

``` Sigmoid colon Descending colon: inferior part L ovary L uterine tube L ureter: abdominal part L spermatic cord: abd part Uterus (if enlarged) Urinary bladder (if full) ```

Question 81

How might muscles of the anterior abdominal wall contribute to respiration?

Answer 81

Anterior abdominal mm. that increase intraabdominal pressure act to oppose the diaphragm and thus facilitate expulsion of air from the lungs [forced exhalation]

Question 82

Actions of external, internal, and innermost intercostals for respiration

Answer 82

External = elevate ribs during forced inspiration Internal = depression of ribs Innermost = depression of ribs

Question 83

When would erector spinae be used for respiration?

Answer 83

Forced inhalation