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Flashcards in Lecture 2 Deck (71):
1

What forms the superior boundary of the abdomen?

Diaphragm, inferior thoracic aperture

2

What forms the inferior boundary of the abdomen?

Iliac crest, inguinal ligament, pelvic inlet

3

What forms the posterior boundary of the abdomen?

Lumbar vertebral column, psoas major, quadratus lumborum, (abdominal wall muscles)

4

What forms the lateral and anterior boundaries of the abdomen?

Abdominal wall muscles

5

List the layers of the abdominal wall from the most superficial to most deep.

Skin
Camper's Fascia
Scarpa's Fascia
External Oblique
Internal Oblique
Transversus Abdominis
Transversalis Fascia
(Extraperitoneal Fascia)
Parietal Peritoneum

6

What are the two layers of the superficial fascia?

Camper's Fascia and Scarpa's Fascia

7

In the abdomen, where is the superficial fascia similar to that found elsewhere in the body?

Above the umbilicus

8

What happens to the superficial fascia below the umbilicus?

It divides into 2 layers: Camper's fascia and Scarpa's fascia

9

Describe the two layers of the superficial fascia. Which layer is more deep?

Camper's: thick, yellow, fatty layer all over the abdomen
Scarpa's: thinner, orange, membranous layer continuous with various other fascia (deep)

10

What are the functions of the muscles of the abdominal wall? What other feature aids the ability to move?

Provide stability and allow abdominal viscera to move. No bony structures between ribs and pelvis also allows movement.

11

What are the muscles of the abdominal wall?

Rectus Abdominis
External Oblique
Internal Oblique
Transversus Abdominis

12

What is the origin of Rectus Abdominis?

Pubic Tubercle, Crest, and Symphysis

13

What is the insertion of Rectus Abdominis?

Costal cartilages of ribs 5-7 and xiphoid process

14

What are the actions of Rectus Abdominis?

- Flex trunk
- Support/compress abdominal wall (Secondary respiratory muscles for forcing expiration)

15

What is the nerve supply of the Rectus Abdominis?

Anterior rami of thoracic spinal nerves

16

What is the origin of the external oblique muscle?

Ribs 5-12

17

What is the insertion of the external oblique muscle?

Iliac crest and linea alba via aponeurosis

18

Where does the aponeurosis of the external oblique stretch from and to?

From xiphoid process to pubic symphysis

19

What does the lower border of external oblique form?

Inguinal ligament

20

What are the actions of external oblique?

- Flex trunk (both)
- Turn to opposite side/bend trunk to same side (single)

21

What is the nerve supply of external oblique?

Anterior rami of thoracic spinal nerve

22

What is the fibre direction of external oblique?

Infero-medial

23

What is the origin of internal oblique?

Thoracolumbar fascia, inguinal ligament and iliac crest

24

What is the insertion of internal oblique?

Ribs 9-12

25

What are the actions of the internal oblique muscles?

- Flex trunk (both)
- Bend and turn trunk to same side (single)

26

What is the nerve supply of internal oblique?

Anterior rami of thoracic spinal nerves (some L1)

27

What is the fibre direction of internal oblique muscles?

Supero-medial

28

What is the origin of transversus abdominis?

Thoracolumbar fascia, iliac crest, inguinal ligament, costal cartilage of ribs 7-12

29

What is the insertion of transversus abdominis?

Linea alba, pubic crest, pectineal line

30

What is the action of the transversus abdominis?

Supports abdominal wall

31

What is the nerve supply of transversus abdominis?

Anterior rami of thoracic spinal nerves (some L1)

32

What is the fibre direction of transversus abdominis?

Transverse

33

Describe the upper 3/4 of the rectus sheath

All 3 abdominal wall muscles surround rectus abdominis. Internal oblique splits around rectus abdominis. External oblique stays above and transversus abdominis stays below.

34

Describe the lower 1/4 of the rectus sheath. What does this allow?

Rectus sheath over front of rectus abdominis only. Behind = transversalis fascia and parietal peritoneum. Allows vessels to pass through.

35

Where is the lower 1/4 of the rectus sheath found?

Below the arcuate line

36

Where is the arcuate line?

Roughly halfway along line from umbilicus to pubic bone

37

What are the main arteries that supply the abdomen? Which is larger?

Superior epigastric (from internal thoracic)
Inferior epigastric (from external iliac) Larger

38

What is the pathway of the arterial supply to the abdomen?

Both arteries run underneath Rectus Abdominis (on top of transversalis fascia and within the rectus sheath) and anastamose together.

39

What are the other arteries that surround the abdomen region?

Deep circumflex iliac
Musculophrenic branches
Intercostal
Lumbar
Iliolumbar

40

What are the two types of veins that drain the abdomen? Where do they drain to?

- Thoracoepigastric veins drain to axillary
- Superficial epigastric veins drain to femoral

41

What are the types of nerves that drain the abdomen?

- Lateral cutaneous branches 7-12 intercostal nerves and iliohypogastric nerve (L1)
- Anterior cutaneous branches of 7-12 intercostal nerves

42

What is the pathway of the nerves that drain the abdomen?

Travel in neurovascular plane between internal oblique and transversus abdominis before piercing the muscular wall to reach the skin

43

What is the skin, muscle, and parietal peritoneum of the abdomen suppled by?

T7-12 (intercostal) and L1 (iliohypogastric/ilioinguinal) spinal nerves

44

What exists between the two layers of the peritoneum? What is its purpose?

A small amount of serous fluid. Reduces friction.

45

Describe the mesentery.

Visceral peritoneum comes back around on itself to form a mesentery anchoring the viscera to the posterior body wall.

46

What is the parietal peritoneum sensitive to?

Pain, touch, temperature, pressure

47

What is the nervous supply of the parietal peritoneum?

- Somatic nerves to body wall (thoracic and lumbar nerves)
- Phrenic nerve (up by diaphragm)
- Obturator nerve (down in pelvis)

48

What are the visceral peritoneum and mesenteries sensitive to?

Stretching and distension e.g. when you've eaten too much

49

What fibres of which nervous system are supplied by the visceral peritoneum and mesenteries?

Afferent nerve fibres of autonomic nervous system (ANS)

50

What is the GI tract suspended by?

Mesenteries

51

The midgut and hindgut are only suspended ____ __________

One mesentery (dorsal)

52

What is the foregut suspended by?

Both a ventral and dorsal mesentery

53

What is meant by intraperitoneal?

Completely contained in visceral peritoneum and suspended by a mesentery.

54

Identify the intraperitoneal structures of the abdomen

Stomach, liver, gall bladder, spleen, proximal duodenum, smal intestine, appendix, transverse colon, sigmoid colon

55

What is meant by retroperitoneal?

Lays between peritoneum and body wall

56

What is the inguinal ligament formed by?

The external oblique rolling in on itself to create a gap for femoral vessels to pass underneath

57

Describe the linea alba

Midline, where the aponeuroses of the muscles meet

58

What issue can occur below the arcuate line?

Weak so can end up with hernia

59

Identify the retroperitoneal structures of the abdomen

Kidneys, pancreas, distal duodenum, ascending and descending colon, upper 2/3 of rectum

60

What is the greater sac?

Peritoneal cavity proper: everything that is not the lesser sac

61

Where is the lesser sac found?

Behind lesser omentum and stomach. It spans from liver to stomach.

62

What is the lesser sac created due to?

Rotation of the foregut structures - drags lesser omentum around to create a pocket

63

What are two other names for omental foramen?

Epiploic foramen or Foramen of Winslow

64

What is the omental foramen bounded by anteriorly and posteriorly?

A: Free edge of lesser omentum
P: IVC

65

What does the free edge of the lesser omentum contain?

Portal triad

66

What are paracolic gutters?

Peritoneal sulci lateral to the ascending/descending colons

67

What do paracolic gutters create a pathway for?

Peritoneal fluid (or pus, blood, bile etc) to migrate around the abdomen

68

The paracolic gutter on which side is more clinically significant? Why?

Right hand side
- Larger
- Left side limited
- Right side peritoneum is continuous with peritoneum of hepatic recess and lesser sac

69

What is the left paracolic gutter limited by?

The phreno-colic ligament, which blocks a bit of the passageway so fluid doesn't move as freely.

70

Describe how migration of fluid can present as acute appendicitis

When sitting, fluid moves down the paracolic gutters due to gravity. Pressure build-up leads to pain in lower right quadrant. Presents like appendicitis, but may originate from the liver.

71

Describe what happens to fluid in the paracolic gutters when we are supine.

Fluid will enter lesser sac. When standing, it will have nowhere to go, so will collect there. If pus and bile are occupying space that they are not meant to, can form abscesses, which can be very distant from the site of pathology.