Lecture 1 And 2 PPT Ant. Abd. Wall Flashcards
1
Q
Pelvic inlet (linea terminalis)
A
Separates the true pelvis from the false pelvis
- Superior to the linea terminalis is the abdomen/false pelvis
- Inferior to the linea terminalis is the true pelvis
2
Q
Pelvic inlet is formed by?
A
- Pectin pubis (pubic bone)
- Arcuate line (ilium)
- Sacral promontory (sacrum)
3
Q
Linea semilunaris
A
- Lateral border of the rectus abdominis muscle
- Aponeurosis
4
Q
Linea alba
A
- Midline
- Aponeurosis
5
Q
4 horizontal abdominal planes?
A
- Subcostal
- Transtubercular
- Transumbilical
- Transpyloric
6
Q
Subcostal plane
A
- 10th costal cartilage
- Superior border of LV3
7
Q
Transtubercular plane
A
- Tubercles of the iliac crests
- Body of LV5
8
Q
Transumbilical plane
A
- LV3-4
- Similar to supracristal plane
9
Q
2 vertical planes
A
Midclavicular and midsagittal
10
Q
Midclavicular
A
Midpoint of clavicle and midinguinal point
11
Q
Midsagittal (median)
A
- Linea alba
- Passes though umbilicus
12
Q
Contents of abdominal quadrants
-Right Upper Quadrant (RUQ)
A
Gallbladder, duodenum, right pleura, liver (right lobe) and right kidney
13
Q
Left Upper Quadrant
-Contents?
A
Spleen, stomach, left pleura, tail of the pancreas, left kidney
14
Q
Right lower quadrant
-Contents?
A
Right ureter, cecum, ileal diverticulum, vermiform appendix
15
Q
Left lower quadrant
-Contents?
A
Left ureter, descending and sigmoid colon
16
Q
9 abdominal regions
A
See slide 19/20
17
Q
Muscles and aponeuroses
-Organized into three groups-Anterior?
A
Rectus abdominis and pyramidalis
18
Q
Anterolateral?
A
EO, IO, and transversus abdominis
19
Q
Posterior?
A
Iliacus, psoas major/minor, and quadratus lumborum
20
Q
McBurney’s point
- Where is it located?
- Used for what common surgery?
A
- 1/3 of the way between the ASIS and the umbilicus (going lateral to medial)
- Used for appendectomies
21
Q
External abdominal oblique
-Which way do the fibers run?
A
Inferomedially (hands in pockets)
22
Q
External abdominal oblique
-Characteristics of the aponeurosis?
A
- Wide
- Begins at midclavicular lines
- Goes to midline
23
Q
External abdominal oblique
-Aponeurosis goes to midline to meet aponeurosis of the other side-forming?
A
Linea alba
24
Q
External abdominal oblique
-Inguinal ligament
A
Specialized part of the lower free margin of the aponeurosis
25
Where does the inguinal ligament attach?
The ASIS and the pubic tubercle
26
Superficial inguinal ring
A triangular opening in the EO aponeurosis between the pubic tubercle and the pubic symphysis
27
Superficial inguinal ring
| -Formed by?
- Medial crus
- Lateral crus
- Intercrural fibers
28
Lacunar ligament
- How is it formed?
- Where is the apex?
An "extension" of the inguinal ligament
- triangular in shape
- apex at pubic tubercle
- base is concave, lateral and sharp
29
The lacunar ligament is important for what type of hernia? How?
Femoral hernia
| -Its sharp free edge cuts into the femoral canal which enlarges with a femoral hernia
30
Pectineal ligament
The lateral-posterior extension of the lacunar ligament that runs along the pectineal line
-Can also form a sharp border that can constrict a femoral hernia
31
Internal abdominal oblique
| -Which way do the fibers run?
Superomedially
32
* *Cremaster muscle is from which layer?**
| - surrounds?
the internal oblique layer
| -Surrounds the spermatic cord
33
The internal oblique helps to form the?
Conjoint tendon
34
Transversus abdominis muscle
- Location relative to the other layers?
- Aponeurosis-where does it begin?
- Innermost of the three layers
| - Wide aponeurosis begins at the semilunaris
35
Transversus abdominis muscle
| -Which way do the fibers run?
Horizontally
36
Conjoint tendon
| -formed by?
Transversus abdominis (medially) and internal oblique
37
**Where do nerves and vessels run?**
Between internal oblique and transversus abdominis
38
Rectus abdominis
| -characteristics?
Strap muscles
| broad superiorly and narrow inferiorly
39
Rectus abdominis
| -Tendinous intersections-position relative to fibers?
Perpendicular to fibers
40
Rectus abdominis
| -Enclosed by?
Rectus sheath
41
Pyramidalis
- Attaches to?
- Action?
- Often absent
- Attaches to the pubic crest
- Tenses linea alba
42
Rectus abdominis
| -Function?
- Fixes abdomen-contracts to maintain stability
| - Flexes (brings thoracic cage closer to thighs)
43
External oblique
| -Function?
-Unilaterally-lateral bending and twisting toward midline
44
Internal oblique
| -Function?
-Lateral bending and twisting toward ilium
45
Transversus abdominis
| -Function?
- Primarily a girdle (supporting abdomen)
| - Important for Valsalva manuever, defecation, parturition (anything where you are contracting)
46
Camper's fascia
- More superficial
| - Fatty layer
47
Camper's fascia
| -Continuous with?
Continuous with the superficial fatty layers in the thorax, thigh and perineum
48
Scarpa's fascia
- Deep to Camper's
| - Membranous layer
49
Scarpa's fascia
| -Continuous with?
Continuous with the fascia lata in the thigh and the deep perineal fascia (penis/scrotum)
50
Deep fascia of the abdominal wall
- Compared to the membranous layer of superficial fascia?
- Why is it clinically important?
Investing fascia of the muscles
- Does not follow the same pattern as the membranous layer of superficial fascia
- Clinically important, holds sutures
51
Potential space between Scarpa's fascia and the deep fascia of the EO musle
-Why is this significant?
Fluid can leak into this space
52
Rectus sheath-formed by?
Formed by the fusion of the abdominal muscles and their associated facias (EO, IO and transversus abdominis)
53
Rectus sheath encloses?
the rectus abdominis muscle and pyramidalis muscle (if present)
54
Internal thoracic artery splits into?
Musculophrenic and superior epigastric arteries
55
Deep system of arteries
Musculophrenic, superior and inferior epigastric, intercostal, subcostal, lumbar, deep circumflex iliac
56
Inferior epigastric artery
| -If a hernia is medial to this artery, what type of hernia is it?
Direct inguinal hernia
| If hernia is Lateral to inferior epigastric artery, it is an indirect inguinal hernia
57
Superficial system of arteries
Superficial circumflex iliac, superficial epigastric, and external pudendal (superficial and deep branch)
58
Anterior abdominal wall veins
| -Deep drainage-where are the veins located?
Within abdominal wall muscles along with arteries
59
Anterior abdominal wall veins
| -Deep drainage-What veins do they drain to?
-to subclavian vein, external iliac, lumbar, and intercostal veins
60
Anterior abdominal wall veins
| -Superficial drainage-Where are the veins located?
Within Camper's fascia
61
Anterior abdominal wall veins
| -Superficial drainage-3 main veins?
THORACOEPIGASTRIC, lateral thoracic, and superficial epigastric
62
Thoracoabdominal intercostal nerves
- Lateral cutaneous branches
- where do they emerge?
- Bifurcate into?
Emerge anterior axillary region
| Bifurcate into anterior and posterior branches
63
Thoracoabdominal intercostal nerves
| -Anterior cutaneous branches end with?
medial and lateral branches
64
Anterior abdominal wall nerves
| -Sensory dermatomes
T7-L1
65
T7-region?
Xiphoid region (tip)
66
T10-region?
Umbilical
67
L1-region?
Inguinal fold region
68
Intercostal nerves
T7-T11
69
Subcostal nerve?
T12
70
Lumbar nerves?
L1-L4
71
Anterior abdominal wall nerves
- Branches of?
- Lie between what muscles?
- Branches of ventral rami and intercostal nerves
| - Lie between IO and tranversus abdominis
72
Anterior abdominal wall nerves
| -Pierce the rectus sheath to innervate what muscle?
Rectus abdominis
73
Anterior abdominal wall nerves
| -**Supply?**
Skin, muscles, and **parietal peritoneum**
74
Iliohypogastric n
L1 (and T12 sometimes)
75
Ilioinguinal n
L1
76
Genitofemoral n
L1 and L2
77
Iliohypogastric n
| -Where does it run?
- Exits the posterior abdominal wall between the quadratus lumborum and psoas muscles
- Enters the anterolateral abdominal wall and runs between muscles
- Exits to become cutaneous (lateral and anterior cutaneous branches)
78
Iliohypogastric n
| -What region does it supply?
Suprapubic region
79
Ilioinguinal nerve
| -Where does it run?
- Exits the posterior abdominal wall between quadratus lumborum and psoas muscles
- Enters the anterolateral wall between muscles
- Enters the inguinal canal and emerges through the superficial inguinal ring
80
Ilioinguinal nerve
| -What does it supply?
Supplies groin, thigh, and scrotum/labium majus
81
Genitofemoral nerve
| -**Where does it run?**
Exits posterior abdominal wall **through psoas muscle**
| -Runs between the peritoneum and psoas muscle
82
Genitofemoral n
| -Genital branch-where does it run?
-Enters the inguinal canal through the deep inguinal ring and exits the inguinal canal through the superficial inguinal ring
83
Genitofemoral n
| -Genital branch-what does it innervate?
Innervates the cremaster muscle or is cutaneous to the labium majus
84
Genitofemoral n
| -Femoral branch-where does it exit?
Exits inferior to the inguinal ligament
85
Genitofemoral n
| -**Where is it located relative to the femoral triangle?**
Cutaneous to the femoral triangle area
86
Anterior abdominal wall lymphatics
- Superficial lymphatic drainage
- Superiorly?
Drains superiorly from umbilical region to anterior axillary and sternal nodes
87
Anterior abdominal wall lymphatics
- Superficial lymphatic drainage
- Inferiorly?
Drains inferiorly from umbilical region to superficial inguinal nodes
88
Anterior abdominal wall lymphatics
| -Deep lymphatic drainage
- Along posterior intercostal and lumbar vessels to deep abdominal nodes
- From testes to deep abdominal nodes
89
Umbilical hernias-in infants
- Involve the umbilicus
- Scar of umbilicus did not heal completely
- Usually small and wider transversely
- Usually heal spontaneously
90
Umbilical hernias-in adults
- result from?
- Where are they usually located?
- more common in what gender?
- Result from weakened abdominal wall around umbilicus
- Usually superior to umbilical scar
- More common in women
- Require surgical repair
91
Epigastric hernias
- Protrudes through?
- Where are they located usually?
- More common in what gender?
- Do not involve the umbilicus
- Protrudes through the linea alba
- Are usually superior to the umbilicus
- More common in men
92
Inguinal canal
| -Floor?
Inguinal and lacunar ligaments
93
Inguinal canal
| -Roof?
Internal abdominal oblique fibers
94
Inguinal canal
| -Anterior wall?
External abdominal oblique
95
Inguinal canal
| -Posterior wall?
Transversalis fascia and conjoint tendon
96
Where does the inguinal canal start?
Deep inguinal ring
97
Where does the inguinal canal end?
Superficial inguinal ring
98
Hesselbach's triangle is only covered by?
Transversalis fascia
99
Rectus sheath-above the arcuate line
| -Order (from outside to inside)?
- Skin
- Camper's
- Scarpa's
- Aponeurosis of EO fascia (2 layers)
- 1 layer of IO aponeurosis
- Rectus abdominis muscle
- Arcuate line
- 1 layer of IO aponeurosis
- Aponeurosis of transversus abdominis (2 layers)
- Transversalis fascia
- Extraperitoneal tissue
- Parietal peritoneum
100
Rectus sheath-Below the arcuate line
| -Order (from outside to inside)?
- Skin
- Camper's
- Scarpa's
- EO aponeurosis (2 layers)
- IO aponeurosis (2 layers)
- Transversus abdominis aponeurosis (2 layers)
- Rectus abdominis muscle
- Arcuate line
- Transversalis fascia
- Extraperitoneal tissue
- Parietal peritoneum
101
The deep system of arteries
| -originate superiorly from?
the subclavian artery to the internal thoracic
102
The deep system of arteries
| -originate inferiorly from?
the external iliac artery
103
The deep system of arteries
| -branches in the mid-abdomen come from?
the abdominal aorta
104
The superficial system of arteries
| -originate superiorly from?
Perforating branches
105
The superficial system of arteries
| -Originate inferiorly from branches of the?
femoral artery
106
Where does the ductus deferens (round ligament) exit the abdomen?
- Posterior to the peritoneal cavity
| - As the ductus emerges and goes through the anterior wall, it picks up layers as it goes through them
107
External iliac artery and vein are posterior to peritoneal cavity
-Once they cross the inguinal ligament, they become?
Femoral artery and vein
108
Main branches of the femoral artery/vein?
- Inferior epigastric artery/vein
| - Cremasteric arteries
109
Where does the spermatic cord enter the canal?
Deep inguinal ring
110
Descent of the testes
| -Testes develop?
- Testes develop retroperitoneally from the urogenital ridge of mesoderm in the upper lumbar/lower thoracic region
- migrate inferiorly
111
Testes are attached to the?
| -What is its function?
- Gubernaculum which is attached inferiorly to the labial-scrotal fold
- It guides the migration
112
Descent of the testes-process
- By the 7th month?
- Meanwhile?
- The testes have reached the deep inguinal ring
| - Meanwhile, a pouch of peritoneum, processus vaginalis develops and pushes into labial-scrotal swelling
113
Descent of the testes-process cont
| -As the testes go through?
- As the testes go through the inguinal canal, they carry layers of anterior abdominal wall muscles and fasciae with them
- The gubernaculum "shortens" and pulls the testes into the developing scrotum
- The processus vaginalis continues to develop within the labial-scrotal fold
114
Descent of the testes-process
- Testes are now within the scrotum (around the time of birth)
- Where do they slide in?
posterior to the processus vaginalis (should close)
115
What do the testes pull down with them?
Epididymus, ductus deferens, testicular vessels, nerves, and lymphatics
116
The processus vaginalis (normally) closes off and becomes an isolated pocket of peritoneum called the?
Tunica vaginalis
117
Cryptorchidism
- Undescended testes
- Unilateral or bilateral
- Associated with a higher incidence of testicular cancer
118
Hydrocele/Hematocele
water (?) or blood in the tunica vaginalis
119
As the testes descends through inguinal canal, it "acquires" what fascial layers?
- Internal spermatic fascia
- Cremaster fascia and muscle
- External spermatic fascia
- Tunica vaginalis (partially covers testes)
120
Descent of the ovaries
| -Primative ovaries are also attached to a?
Gubernaculum which is attached to the labioscrotal fold
121
Descent of the ovaries
| -process?
- Ovaries descend into the pelvis and attach to the developing uterus
- The gubernaculum becomes attached to the posterior area of the developing uterus
122
Descent of the ovaries
| -The gubernaculum forms?
the round ligaments of the ovary (ovarian ligaments) and the round ligaments of the uterus
123
Female inguinal canal contents?
- Round ligament of the uterus
- Ilioinguinal n
- Genital branch of genitofemoral n
124
Where does the round ligament enter the inguinal canal?
Deep inguinal ring
125
Where does the round ligament exit the inguinal canal?
Superficial inguinal ring through the EO muscle
126
Male inguinal canal contents?
- Ductus deferens,
- Ductus deferens artery
- Ilioinguinal n
- Genital branch of genitofemoral n
- Testicular artery
- Pampiniform plexus of veins
- Lymphatics
127
Where does the spermatic cord exit the inguinal canal?
Superficial inguinal ring through the EO muscle
128
Coverings of the spermatic cord?
- External spermatic fascia
- Cremasteric fascia and muscle with genital branch of genitofemoral n
- Internal spermatic fascia
129
All contents of the inguinal canal (male) are surrounded by?
Internal spermatic fascia
130
The testis and epididymis are partially covered by?
the tunica vaginalis (2 layers-parietal and visceral)
131
Testes is held to scrotum by?
gubernaculum
132
Function of efferent ductules?
Carry sperm from testes to head of epididymis
133
Ductus deferens is continuous with?
Tail of epididymis
134
Ductus deferens continues through spermatic cord into?
Abdomen
135
**Tunica albuginea**
Connective tissue capsule of the testis
136
Rete testis
?
137
Sinus epididymis
A space of visceral layer of tunica vaginalis
138
Femoral hernias exit the abdomen through the?
femoral canal, INFERIOR TO THE INGUINAL LIGAMENT
139
Direct inguinal hernia-location relative to the inferior epigastric artery?
***neck of the hernial sac is MEDIAL***
140
Direct inguinal hernia
- How does it happen?
- Usually due to?
- Pushes "directly" through the anterior abdominal wall through a "weak" abdominal triangle
- Usually due to a weak conjoint tendon
141
- Which type of hernia is more often bilateral-direct or indirect?
- More common in?
- Direct inguinal hernias are more often bilateral than indirect
- More common in older males
142
Indirect inguinal hernia-location relative to the inferior epigastric artery?
Neck of the hernial sac lies LATERAL to the inferior epigastric artery
143
Indirect inguinal hernia
- How does it happen?
- Often due to?
- Pushes through the deep inguinal ring, through the deep inguinal ring, and exits through the superficial inguinal ring
- Often due to incomplete closure of the processus vaginalis
144
Indirect inguinal hernias
| -common in?
Common in young males
145
Most inguinal hernias are which type?
Indirect
146
Only layer that is lost when talking about spermatic is the?
Transversus abdominis
147
2 muscles that draw the testes closer to the body when it needs to be warmed?
Cremaster and dartos muscles
148
Layers of the anterior abdominal wall and the layers of the scrotum that are derived from them:
-***What is derived from Scarpa's fascia?***
***Dartos muscle/fascia***
149
What is derived from the EO muscle?
External spermatic fascia
150
***What is derived from IO muscle?***
Cremaster muscle
151
What is derived from the fascia of both superficial and deep surfaces of the IO muscle?
Cremasteric fascia
152
What is derived from the transversalis fascia?
Internal spermatic fascia
153
What is derived from peritoneum?
Processus vaginalis and tunica vaginalis
