Lectures 1 And 2- Anterior Abdominal Wall Outline Cont.

Question 1

Actions of abdominal muscles

-Flexion of trunk and pelvis?

Answer 1

-Contraction of EO, IO, and RA muscles bilaterally

Question 2

Abduction (lateral flexion) of trunk?

Answer 2

Contraction of EO and IO together on one side

Question 3

Rotation of trunk?

Answer 3

Contraction of EO on one side and contraction of IO on the opposite side (fibers of EO on one side run in same direction as those of IO on other side)

Question 4

Respiration?

Answer 4

Assist in forced expiration by compressing abdominal contents, forcing viscera up against diaphragm

Question 5

Fixation of abdominal wall

Answer 5

Contraction of abdominal and thoracic muscles together, with glottis closed, raises thoracoabdominal pressure (Valsalva maneuver)

Question 6

Abdominal wall muscles also act in?

Answer 6

Coughing, sneezing, urination, defecation, emesis, parturition

Question 7

Fascia of the anterior abdominal wall

-Superficial (subcutaneous)-2 layers?

Answer 7

• Camper’s fascia

- Scarpa’s fascia

Question 8

Camper’s fascia

• Type of fascia?
• Continuous with?

Answer 8

• Fatty superficial layer

- Continuous with superficial fatty fascia of thorax, thigh, and perineal fascia

Question 9

Scarpa’s fascia

-Continuous with?

Answer 9

-Continuous with fascia lata of thigh, deep layer of superficial perineal fascia (Colles’ fascia), and fibrous fascial sheath of penis/clitoris

Question 10

Scarpa’s fascia

-Fuses with?

Answer 10

Deep fascia of abdomen

Question 11

Layer that holds sutures?

Answer 11

Scarpa’s fascia

Question 12

Deep fascia of abdominal wall (investing fascia of abdominal muscles)

Answer 12

-Thin, tough investing fascia of muscles and aponeuroses

Question 13

Deep fascia of abdominal wall (investing fascia of abdominal muscles)
-Where does it stop?

Answer 13

-“Stops” at the thigh as it fuses with fascia lata

Question 14

Deep fascia of abdominal wall (investing fascia of abdominal muscles)
-Continues over Spermatic cord as?

Answer 14

-Continues over spermatic cord as external spermatic fascia

Question 15

Deep fascia of abdominal wall (investing fascia of abdominal muscles)
-Continues over pubis and perineal muscles as?

Answer 15

Deep perineal fascia

Question 16

Deep fascia of abdominal wall (investing fascia of abdominal muscles)
-Continues over penis/clitoris as?

Answer 16

Deep penile/clitoral fascia

Question 17

Deep fascia of abdominal wall (investing fascia of abdominal muscles)

• Thoracolumbar fascia of lumbar region of back and anterolateral wall
  
  • Origin for?

Answer 17

Origin for internal oblique and transversus abdominis muscles

Question 18

Deep fascia of abdominal wall (investing fascia of abdominal muscles)

• Thoracolumbar fascia of lumbar region of back and anterolateral wall
  
  • Splits into?

Answer 18

-Splits into 3 laminae that enclose deep back muscles and quadratus lumborum muscle of posterior abdominal wall

Question 19

Fascial layers associated with anterior abdominal wall muscles
-Rectus sheath-Encloses?

Answer 19

Encloses rectus abdominis (and pyramidalis if present)

Question 20

Fascial layers associated with anterior abdominal wall muscles
-Rectus sheath-Contains what nerves?

Answer 20

Contains anterior rami of lower 6 thoracic nerves, superior and inferior Epigastric vessels and lymphatics

Question 21

Fascial layers associated with anterior abdominal wall muscles
-Rectus sheath-Formed by fusion of?

Answer 21

Formed by fusion of the EO, IO, and transversus abdominis aponeuroses

Question 22

Fascial layers associated with anterior abdominal wall muscles
-Rectus sheath-What happens to the IO aponeurosis above the arcuate line?

Answer 22

IO aponeurosis splits into two layers-anterior and posterior layers

Question 23

IO aponeurosis-above arcuate line-splits into two layers

-Anterior layer?

Answer 23

-The anterior layer of sheath is formed by fusion of EO aponeurosis and anterior portion of the split IO aponeurosis

Question 24

IO aponeurosis-above arcuate line-splits into two layers

-posterior layer?

Answer 24

The posterior layer is formed by fusion of the posterior layer of the split IO aponeurosis and the transversus abdominis aponeurosis

Question 25

Fascial layers associated with anterior abdominal wall muscles -Rectus sheath-What happens to the IO aponeurosis below the arcuate line?

Answer 25

- There is an anterior layer ONLY | - Rectus abdominis lies directly on transversalis fascia

Question 26

IO aponeurosis-below arcuate line | -Anterior layer is formed by?

Answer 26

Fusion of all 3 muscles: EO, IO, and transversus abdominis

Question 27

Arcuate line

Answer 27

- Inferior free edge of the posterior part of the rectus sheath - Located about midway between umbilicus and pubic crest (or symphysis)

Question 28

Transversalis fascia | -What is it?

Answer 28

-Thin, rather transparent membrane

Question 29

Transversalis fascia | -Location relative to transversus abdominis?

Answer 29

-Lies on the deep surface of transversus abdominis m and aponeurosis

Question 30

Transversalis fascia | -Specialized regions (named according to structures it is associated with)?

Answer 30

- Diaphragm - Iliacus muscle - psoas muscle - femoral artery

Question 31

Transversalis fascia | -Separated from peritoneal membrane (lining of abdominal cavity) in some areas by?

Answer 31

A layer of extra-peritoneal fat

Question 32

``` Linea alba ("white line") -What is it? ```

Answer 32

Anterior midline where aponeurotic fibers of the rectus sheath interlace to form a tough raphe

Question 33

Layers of abdominal wall at level of umbilicus, just lateral to midline, through the rectus sheath are?

Answer 33

- Skin - Superficial fascia - Camper's layer - Scarpa's layer - Anterior layer of rectus sheath - Rectus abdominis muscle - Posterior layer of rectus sheath - Transversalis fascia - Extraperitoneal CT and fat - Peritoneum

Question 33

Arterial supply of the anterior abdominal wall - General considerations-Arterial supply to abdominal wall is derived from several sources, providing opportunities for collateral circulation via anastomoses between the sources - 2 main sources?

Answer 33

- Superficial vessels | - Deep vessels

Question 34

Arterial supply of anterior abdominal wall | -Deep vessels run their course in what layer?

Answer 34

Deep vessels run their course within the muscular layer

Question 35

Arterial supply of anterior abdominal wall | -Deep vessels have 3 possible origins?

Answer 35

- Originate superiorly from subclavian artery - Originate in mid-abdomen from aorta - Originate inferiorly from external iliac artery

Question 36

Arterial supply of anterior abdominal wall | -Superficial vessels run their course in what layer?

Answer 36

Superficial vessels run their course in the subcutaneous connective tissue

Question 37

Arterial supply of anterior abdominal wall | -Superficial vessels have 2 possible origins?

Answer 37

- Originate from perforating branches of deeper vessels located within muscular layer - Originate from branches of the femoral artery

Question 38

Deep vascular system - Superior epigastric artery - Arises from?

Answer 38

- Arises from internal thoracic artery (a branch of subclavian) - Internal thoracic artery branches into musculophrenic and superior epigastric

Question 39

Deep vascular system - Superior epigastric artery - Where does it enter the rectus sheath?

Answer 39

Beneath the costal margin

Question 40

Deep vascular system - Superior epigastric artery - Anastomoses with? Where do they anastomose?

Answer 40

Anastomoses with inferior epigastric artery within rectus abdominis muscle

Question 41

Deep vascular system - Superior epigastric artery - Supplies?

Answer 41

Upper central part of anterior abdominal wall

Question 42

Deep vascular system - Inferior epigastric artery - Arises from?

Answer 42

Arises from external iliac artery just above inguinal ligament

Question 43

Deep vascular system - Inferior epigastric artery - Where does it run?

Answer 43

- Runs superomedially along medial side of deep inguinal ring - Courses toward umbilicus in extraperitoneal (subserous) CT, raising along with its accompanying vein the lateral umbilical fold on the internal aspect of the anterior abdominal wall

Question 44

Deep vascular system - Inferior epigastric artery - Where does it enter the rectus sheath?

Answer 44

Pierces transversalis fascia at level of arcuate line to enter rectus sheath

Question 45

Deep vascular system - Inferior epigastric artery - Anastomoses with? Where?

Answer 45

Anastomoses with superior epigastric artery within rectus abdominis muscle

Question 46

Clinical relevance of the epigastric arterial anastomosis?

Answer 46

- Epigastric arterial anastomosis can provide collateral circulation to lower part of body when the aorta is occluded - Pulsations of epigastric arteries in such a case can erode the adjacent ribs, producing a radiographically observable "notched rib" sign

Question 47

Other major (deep) anterior abdominal arteries - Musculophrenic artery - Arises from?

Answer 47

Bifurcation of internal thoracic artery (internal thoracic splits into superior epigastric and musculophrenic)

Question 48

Other major (deep) anterior abdominal arteries - Musculophrenic artery - where does it run its course?

Answer 48

Runs along the costal margin

Question 49

Other major (deep) anterior abdominal arteries - Musculophrenic artery - Supplies?

Answer 49

Supplies branches to abdominal wall and diaphragm

Question 50

Posterior intercostal arteries 10/11 and subcostal artery | -Arise from?

Answer 50

-Arise from thoracic aorta and extend ventromedially beyond costal margin onto abdominal wall, lying between transversus abdominis and internal oblique

Question 51

Posterior intercostal arteries 10/11 and subcostal artery | -Where do they enter the rectus sheath?

Answer 51

Enter rectus sheath laterally to anastomose with epigastric arteries

Question 52

Lumbar arteries - Abdominal counterparts of? - How many are there?

Answer 52

- Abdominal counterparts of posterior intercostal arteries | - Four on each side

Question 53

Lumbar arteries - Arise from? - Where do they run?

Answer 53

- Abdominal aorta at level of lumbar vertebra 1-4 | - Course laterally to provide branches to posterior and posterolateral abdominal wall muscles

Question 54

Deep circumflex iliac artery | -Arises from?

Answer 54

Arises from external iliac artery

Question 55

Deep circumflex iliac artery | -Where does it run?

Answer 55

-Runs deep to inguinal ligament toward ASIS, then along iliac crest

Question 56

Deep circumflex iliac artery | -Supplies?

Answer 56

Supplies deep inguinal region of lower lateral part of abdominal wall

Question 57

Deep circumflex iliac artery | -Anastomoses with?

Answer 57

Anastomoses with lower intercostal arteries by an ascending branch

Question 58

The superficial arteries arise from what artery? Run in what fascia?

Answer 58

Femoral artery and run in the superficial fascia

Question 59

Superficial arteries - Superficial circumflex iliac artery - Goes to what region?

Answer 59

Iliac region

Question 60

Superficial arteries - Superficial epigastric artery - Goes to what region?

Answer 60

Umbilical region

Question 61

Superficial arteries - External pudendal artery - Goes to what regions?

Answer 61

Suprapubic, pubic, and genital regions

Question 62

Superficial arteries | -Anastomose with?

Answer 62

Perforating branches of deep arteries

Question 63

Venous drainage of the anterior abdominal wall | General considerations?

Answer 63

Superficial and deep veins tend to run with arteries of the same name

Question 64

``` Superficial drainage (of skin and subcutaneous tissue) -Main drainage pathway? ```

Answer 64

Drain superiorly to axillary vein via thoracic and thoracoepigastric veins

Question 65

Superficial drainage (of skin and subcutaneous tissue) - Variably developed connections between? - What do each of these drain into?

Answer 65

-Variably developed connections between lateral thoracic veins (axillary vein tributaries) and superficial epigastric vein (femoral vein tributaries)

Question 66

Superficial drainage -Variably developed connections between lateral thoracic veins (axillary vein tributaries) and superficial epigastric vein (femoral vein tributaries)

Answer 66

One of these is a system of veins that follows the former umbilical artery (paraumbilical veins) and connect to the superficial veins within the fatty layer of the anterior abdominal wall

Question 67

Superficial veins - Variably developed connections between lateral thoracic veins (axillary vein tributaries) and superficial epigastric vein (femoral vein tributaries) - When these veins are enlarged they form?

Answer 67

A "caput medusae"

Question 68

Superficial veins | -This superficial system of veins drains inferiorly to the?

Answer 68

femoral vein via superficial tributaries that empty through saphenous opening in femoral triangle

Question 69

Superficial veins - This superficial system of veins drains inferiorly to the femoral vein via superficial tributaries that empty through saphenous opening in femoral triangle - 4 veins?

Answer 69

- Superficial epigastric, superficial circumflex iliac, superficial external, pudendal - May empty independently into femoral vein

Question 70

Deep drainage of (muscular wall) via veins that accompany deep arteries of same name -Tributaries to subclavian vein?

Answer 70

Superior epigastric and musculophrenic

Question 71

Tributaries to external iliac vein?

Answer 71

Inferior epigastric and deep circumflex iliac

Question 72

Tributaries to inferior vena cava?

Answer 72

Lumbar veins

Question 73

Tributaries to azygous system? | -Ultimately goes to?

Answer 73

- Posterior intercostal veins 10/11 and subcostal vein | - Ultimately goes to superior vena cava

Question 74

Veins of abdominal wall - Clinical note about veins of the abdominal wall? - If IVC is obstructed?

Answer 74

- Veins of the abdominal wall anastomose to a high degree - If IVC is obstructed, blood may flow from inferior epigastric to superior epigastric via anastomoses the to subclavian vein to SVC

Question 75

Lymphatic of anterior abdominal wall | -Subcutaneous lymphatics usually drain to?

Answer 75

Subcutaneous lymphatics usually drain to superficial lymph nodes located in the subcutaneous tissue of thigh and thorax (axilla)

Question 76

Lymphatic of anterior abdominal wall | -Lymphatics of the muscular abdominal wall and testes drain to?

Answer 76

Internal nodes of the abdomen and thorax

Question 77

``` Superficial layers (skin, subcutaneous CT) of abdomen, perineum, and external genitalia drain as follows: -Above the umbilicus? ```

Answer 77

Cutaneous and subcutaneous lymphatics drain toward sternal and axillary LNs

Question 78

``` Superficial layers (skin, subcutaneous CT) of abdomen, perineum, and external genitalia drain as follows: -Below the umbilicus? ```

Answer 78

Cutaneous and subcutaneous lymphatics drain toward superficial inguinal nodes -(superficial inguinal nodes are arranged in a "T" located just inferior to the inguinal ligament. They receive drainage from the lower abdomen, perineum and genitalia, and lower limb)

Question 79

Lymphatic drainage of the muscular layers of the abdominal wall parallels the major vascular supplies -Four main groups?

Answer 79

- Along the inferior epigastric vessels to the external iliac nodes - Along the deep circumflex iliac vessels to the external iliac nodes - Along the lumbar vessels to the lumbar nodes - Along the superior epigastric vessels to the sternal nodes

Question 80

Lymphatic drainage of the muscular layers of the abdominal wall parallels the major vascular supplies - Along the inferior epigastric vessels to the external iliac nodes - Found along the?

Answer 80

Found along the external iliac artery

Question 81

Lymphatic drainage of the muscular layers of the abdominal wall parallels the major vascular supplies - Along the lumbar vessels to the lumbar node - Found along the?

Answer 81

Lumbar part of the aorta and IVC

Question 82

Lymphatic drainage of the muscular layers of the abdominal wall parallels the major vascular supplies - Along the superior epigastric vessels to the sternal nodes - Found along the?

Answer 82

Internal thoracic vessels

Question 83

Nerves of the anterior abdominal wall | -Dermatomes of abdominal wall are supplied by?

Answer 83

Cutaneous sensory branches of ventral rami of spinal nerves T7-L1

Question 84

Muscles of abdominal wall | -Innervated by?

Answer 84

Ventral rami of of spinal nerves T7-L4

Question 85

Muscles of abdominal wall | -abdominal branches of T7-T11 arise from what nerves?

Answer 85

Intercostal nerves

Question 86

Muscles of abdominal wall | -Abdominal branches of T12 arise from what nerves?

Answer 86

Subcostal nerves

Question 87

Muscles of abdominal wall | -Abdominal branches of ventral rami of L1-L4 originate within the?

Answer 87

Lumbar plexus

Question 88

Thoracoabdominal intercostal nerves (T7-T12) - Where are they located? - Run in between what muscles? - Run in what plane?

Answer 88

- Continue beyond costal margin onto abdominal wall - Lie between internal oblique and transversus abdominis muscles - Run in neurovascular plane - Run with arteries and veins

Question 89

Thoracoabdominal intercostal nerves (T7-T12) | -Pierce the rectus sheath to innervate what muscle?

Answer 89

Rectus abdominis

Question 90

Thoracoabdominal intercostal nerves (T7-T12) | -Supply?

Answer 90

Supply skin, muscles, and parietal peritoneum

Question 91

Thoracoabdominal intercostal nerves (T7-T12) | -Branch to form?

Answer 91

Branch to form lateral cutaneous branches and anterior cutaneous branches

Question 92

Thoracoabdominal intercostal nerves (T7-T12) - Lateral cutaneous branches - Where do they arise? - Pierce abdominal muscles to reach? - Bifurcate into?

Answer 92

- Arise at about anterior axillary line - Pierce abdominal muscles to reach dermis - Bifurcate into anterior and posterior branches

Question 93

Thoracoabdominal intercostal nerves (T7-T12) - Anterior cutaneous branches - Arise as? - How do they get to the dermis? - Bifurcate into?

Answer 93

- Arise as terminal branches of the ventral rami - Enter rectus sheath laterally and exit from it anteriorly to reach the dermis - Bifurcate into medial and lateral branches

Question 94

Lumbar nerves 1 and 2 - Are part of lumbar plexus - Formed by? - 2 divisions?

Answer 94

- Lumbar plexus is formed by ventral primary rami of T12 through L4 nerves - Plexus has anterior and posterior divisions

Question 95

Iliohypogastric and ilioinguinal nerves supply?

Answer 95

Iliohypogastric and ilioinguinal nerves supply cutaneous sensation to the hypogastric, inguinal, anterior perineal, and superomedial thigh regions

Question 96

Iliohypogastric (L1, sometimes with contribution from L2 and/or T12) - Where does it Pierce IO? - Where does it run?

Answer 96

Superomedial to ASIS and runs inferomedially between IO and EO muscles

Question 97

Iliohypogastric | -Sends a lateral branch to the?

Answer 97

Skin of the gluteal region

Question 98

Iliohypogastric | -Innervates?

Answer 98

Innervates anterolateral abdominal muscles

Question 99

Iliohypogastric | -Communicates with?

Answer 99

Ilioinguinal nerve

Question 100

Iliohypogastric | -terminates as?

Answer 100

Terminates as anterior cutaneous branches to hypogastric (suprapubic) regions

Question 101

Ilioinguinal (L1) - Where is it located? - Enters? - Where does it run? - Emerges through?

Answer 101

- Lies parallel and slightly inferior to iliohypogastric nerve - Enters inguinal canal - Runs on surface of spermatic cord or round ligament of uterus - Emerges through superficial inguinal ring

Question 102

Ilioinguinal | -Supplies skin of?

Answer 102

Supplies skin of groin and scrotum/labium majus

Question 103

``` Genitofemoral n (L1, L2) -Exits the? Runs through? ```

Answer 103

-Exits the intervertebral foramen and runs through the psoas muscle

Question 104

Genitofemoral n (L1, L2) - Divides into what 2 branches? - What do the branches run In between?

Answer 104

- Divides into a genital branch and a femoral branch and a femoral branch either within the muscle or after emerging from the muscle - The branches run in between the muscle and the overlying peritoneum

Question 105

Genitofemoral n | -Genital branch enters? Passes through? Emerges through?

Answer 105

Genital branch enters the deep inguinal ring, passes through the inguinal canal and emerges through the superficial inguinal ring

Question 106

Genitofemoral n - Genital branch supplies - in males? - in females?

Answer 106

- In males the genital branch supplies the cremaster muscle and skin of the scrotum - In females the genital branch supplies the skin of the labium majora

Question 107

Genitofemoral n - Femoral branch - Where does it exit the abdomen?

Answer 107

The femoral branch exits the abdomen inferior to the inguinal ligament (sometimes through the femoral sheath)

Question 108

Genitofemoral n - Femoral branch - Supplies?

Answer 108

Supplies the skin of the thigh over the femoral triangle

Question 109

Hernias of the upper abdominal wall | -What is a hernia?

Answer 109

Protrusion of any of the abdominal contents outside of the abdominal cavity -includes herniations through the diaphragm, umbilicus, or any other weak spots in abdominal wall

Question 110

Umbilical hernias in infants

Answer 110

- The 'scar' of the umbilicus doesn't heal completely | - Will usually heal with time

Question 111

Umbilical hernias in adults - Result from? - How are they fixed? - More common in which gender?

Answer 111

- Result from a weakened abdominal wall around the umbilicus - Require surgical repair - More common in females

Question 112

Umbilical hernias in adults | -Where are they usually located?

Answer 112

Usually superior to umbilical scar

Question 113

Epigastric hernias - compare to umbilical hernias? - protrude through? - How are they fixed?

Answer 113

- Do not involve the umbilicus - Herniations that protrude through the linea alba - Repaired surgically if large or symptomatic

Question 114

Epigastric hernias | -Where are they usually located?

Answer 114

-Usually superior to the umbilicus

Question 115

Incisional hernias | -Where do they occur?

Answer 115

Can occur at surgical/laparotomy sites

Question 116

Spigelian hernias | -Where are they located?

Answer 116

Hernias located at the semilunar line of the anterior rectus sheath