Anterior Abdominal Wall

Question 1

• What are the 9 quadrants in the 9 quadrant system?

Answer 1

• Left side (top to bottom)
  
  • Right hypochondrium
  • Right Flank (Lateral region)
  • Right inguinal region
• Middle (top to bottom)
  
  • Epigastric
  • Umbilical
  • Pubic
• Right side (top to bottom)
  
  • Left hypochondrium
  • Left flank (lateral)
  • Left Inguinal

Question 2

• What are the 4 quadrants in the 4 quadrant system?

Answer 2

• Right Upper Quadrant
• Right Lower Quadrant
• Left Upper Quadrant
• Left Lower Quadrant

Question 3

• Contents of the RUQ

Answer 3

• Liver: Right Lobe
• Gallbladder
• Pylorus of stomach
• Duodenum: parts 1-3
• Head of the Pancreas
• Right Suprarenal gland
• Right kidney
• Right colic (hepatic) flexure
• Superior ascending colon
• Transverse colon (right half)

Question 4

• Contents of the RLQ

Answer 4

• Cecum
• Appendix
• Ileum
• Inferior Ascending Colon
• Right ovary
• Right uterine tube
• Right ureter
• Right spermatic cord
• Bladder (if full)
• Uterus (if enlarged)

Question 5

• Contents of the LUQ

Answer 5

• Liver: Left Lobe
• Spleen
• Stomach
• Jejunum and Proximal Ilieum
• Pancreas (body and tail)
• Left kidney
• Left suprarenal gland
• Left colic flexire
• Transverse colon (Left half)
• Descending colon (superior part)

Question 6

• Contents of the LLQ

Answer 6

• Sigmoid Colon
• Descending Colon: Inferior Part
• Left Ovary
• Left Uterine Tube
• Left ureter
• Left spermatic cord (abdominal part)
• Uterus
• Urinary bladder

Question 7

• Name the Following Planes

Answer 7

• Top to Bottom
• T9=Xiphisternal
• T11-no name
• L1=Transpyloric
• L3=Subcostal
• L4=Supracrystal
• L5=Transtubercular (widest part of hips)
• S2=Interspinous

Question 8

• Identify the layers of the anterior abdominal wall

Answer 8

1. Skin
2. Camper’s Fascia
3. Scarpa’s Fascia
4. External Oblique M.
5. Internal Oblique M.
6. Transversus Abdominis M.
7. Transversalis Fascia

Question 9

• _ is the superficial fatty layer of the anterior abdomen
• _ is the deep membranous layer of the anterior abdomen

Answer 9

• Camper’s
• Scarpa’s

Question 10

• _ is the layer of fascia targeted in liposuction

Answer 10

Camper’s

Question 11

• Name the layers of the anterior abdominal musculature

Answer 11

• External Oblique
• Internal Oblique
• Transversus Abdominis

Layers including fascia:

• Skin
• Camper’s fascia
• Scarpa;s fascia
• External oblique
• Deep fascia
• Internal oblique
• Deep fascia
• Transversus abdominis
• Endoabdominal/Transversalis fascia
• Parietal peritoneum

Question 12

• Which direction do the fibers of external oblique muscles

Answer 12

• Hands in pockets
• Inferomedially

Question 13

• Fiber direction of internal oblique muscle
• Together with external obliques, these two muscles (on opposite sides) are called _ muscles

Answer 13

• Superolaterally
• Strat

Question 14

• What muscles contribute to the formation of the linea alba

Answer 14

• External oblique
• Internal oblique
• Transversus Abdominis

Question 15

• Where is the arcuate line located anatomically?

Answer 15

• 1/3 of the way between umbilicus and pubic tubercle

Question 16

• What forms the rectus sheath above the arcuate line?

Answer 16

• Anteriorly
  
  • ​External Oblique
  • Internal Oblique
• Posteriorly
  
  • ​Internal Oblique
  • Transversus Abdominis
  • Transversalis fascia

Question 17

• What forms the rectus sheath below the arcuate line?

Answer 17

• Anteriorly
  
  • _​_External oblique m.
  • Internal oblique m.
  • Transversus abdominis m.
• Posteriorly
  
  • _​_Transvesalis Fascia

Question 18

• Identify the following structures

Answer 18

1. Investing (deep) fascia
2. Superficial fatty layer
3. Transversus abdominis m.
4. Internal oblique m.
5. External oblique m.
6. Parietal peritoneum
7. Extraperitoneal fat
8. Transversalis fascia
9. Aponeurosis of transversus abdominis

Question 19

• The internal thoracic artery branches into what two arteries?

Answer 19

• Superior epigastric a. (located between rectus abdominus and posterior rectus sheath)
• Musculophrenic a.

Question 20

• What dermatome is at the level of the umbilicus?

Answer 20

T10

Question 21

• Nerve roots of L1

Answer 21

• Iliohypogastric nerve
• Ilio-inguinal nerve ​

Question 22

• Through what two muscles do neurovascular bundles (thoracoabdominal nerves) in the anterior abdomen travel?
• What nerve roots are these?

Answer 22

• Internal oblique m.
• Transversus abdominis m.
• Anterior rami of T7-T11

Question 23

• Function of the iliohypogastric nerve (L1)

Answer 23

• Supplies cutaneous sensation to upper inguinal region and superior hypogastric region

Question 24

• Function of the ilioinguinal n. (L1)

Answer 24

• Sensation to inguinal canal
• Sensation to anterior scrotum/anterior labia majora
• Sensation to medial thigh

Question 25

* What two structures does the superior epigastric artery run through?

Answer 25

* Posterior to the rectus abdominus m and anterior to the posterior rectus sheath

Question 26

* The inferior epigastric a. is a branch of the _ artery * This artery anastamoses w/ _ at the umbilicus

Answer 26

* External iliac * Superior epigastric

Question 27

* Midline incision

Answer 27

From xiphoid process to pubic symphysis * Tension: * Good for sutures * Bad because muscle tension will want to pull apart * Neurovascularly: * Slow to heal-limited blood supply

Question 28

* Subcostal incision

Answer 28

* Parallel to, but 2.5 cm inferior of costal margin * Tension: * OK * Neurovascular: * Nerve risk * Blood supply OK (watch for superior epigastric a.)

Question 29

* Suprapubic incision

Answer 29

* At pubic hair line, horizontal with slight convexity * Tension: * Not bad * Neurovascular: * Watch for L1 (iliohypogastric and ilioinguinal nerves) * Watch for inferior epigastric a.

Question 30

* Paramedian incision

Answer 30

* From costal margin to iliac crest along linea semilunaris * Tension: * OK * Neurovascular: * De-innervating rectus abdominus * Cutting posterior intercostals and subcostal arteries * **DO NOT DO THIS INCISION UNLESS ABSOLUTELY NECESSARY**

Question 31

* Name the incisions

Answer 31

1. Subcostal 2. Midline 3. Suprapubic 4. Paramedian

Question 32

* Name that hernia

Answer 32

1. Epigastric 2. Umbilical 3. Incisional 4. Inguinal 5. Spigelian 6. Femoral

Question 33

* Umbilical hernias common in _ population * Epigastric hernias are located in _ superior to the \_ * Spigelian hernias are located in _ and are RARE

Answer 33

* Newborn * Linea alba, umbilicus * Linea semilunaris

Question 34

* What compromises the superficial lymphatics of the anterior abdomen?

Answer 34

* Superficial inguinal lymph * to * Parasternal lymph * to * Axillary lymph

Question 35

* Deep lymphatics of the anterior abdomen

Answer 35

* External iliac * to * Common Iliac * to Lumbar (caval or aortic nodes)

Question 36

* Identify the structures of the internal surface of the anterior abdomen

Answer 36

1. Medial inguinal fossa 2. Supravesicular fossa 3. Arcuate line 4. Medial umbilical fold 5. Median umbilical fold

Question 37

* The median umbilical fold is a remnant of what embryological structure?

Answer 37

* Urachus (which was the allantois)

Question 38

* The medial umbilical fold is the remnant of what embryological structure?

Answer 38

* Umbilical arteries

Question 39

* Function of the lateral umbilical fold

Answer 39

* Covers inferior epigastric vessels

Question 40

* Medial inguinal fossae involved in _ hernias * Lateral inguinal fossae involved in _ hernias

Answer 40

* Direct * Indirect