01-22: Abdominal Wall Flashcards
1
Q
What are the 4 main contents of the Abdominal region?
A
- Peritoneal cavity
- GI tract (and associated glands and digestive organs)
- Nerves, lymphatics, blood vessels
- Renal system
2
Q
What are the 4 major bony landmarks on the Anterior Abdominal Wall?
A
- Xiphoid process
- Costal margins
- Ilium
- Pubis
3
Q
What are the 3 bony landmarks on the ilium?
A
- Iliac crest
- ASIS
- Tubercle of iliac crest (widest part of pelvis)
4
Q
What are the 3 bony landmarks on the Pubis?
A
- Pubic tubercle
- Pubic symphysis
- Pubic crest
5
Q
What is the pelvic inlet also called?
A
Linea Terminalis
** Defines true pelvis from false pelvis
6
Q
What does the pelvic inlet separate?
A
True pelvis from False pelvis
7
Q
What is SUPERIOR to the linea terminalis?
A
Abdomen or False pelvis
8
Q
What is INFERIOR to the linea terminalis?
A
Pelvis or True pelvis
9
Q
What 3 things form the pelvic inlet Linea Terminalis?
A
- Pectin pubis/Pectinate line (Pubic bone)
- Arcuate line (Ilium)
- Sacral promontory (Sacrum)
10
Q
What is the order of the Superficial Fascia from outside to inside?
A
- Skin
- Fatty layer (Camper’s)
- Membranous layer (Scarpa’s)
11
Q
What is the Fatty/Camper’s layer continuous with?
A
Superficial fatty layers in the:
- Thorax
- Thigh
- Perineum
12
Q
What is the Membranous/Scarpa’s layer continuous with?
A
- Fascia lata in the thigh
- The deep layer of superficial perineal fascia
- Continuous over the penis and scrotum
13
Q
What layer of the superficial fascia do the superficial blood vessels run in?
A
Fatty/Camper’s layer
14
Q
What fascia of the abdominal wall is clinically important because it holds sutures?
A
Deep fascia (Investing fascia of the muscles)
-It does not follow the same pattern as the membranous layer of the superficial fascia
15
Q
Where is there a potential space in the Deep Fasica where fluid can leak?
A
Between:
- Membranous layer of superficial fascia
- Deep fascia of the external abdominal oblique muscle
16
Q
What line is the lateral border of the rectus abdomens muscle?
A
Linea Semilunaris (Semilunar line)
**6-pack
17
Q
What line is the abdominal midline?
A
Linea Alba (white line)
18
Q
What are the 5 planes of the Anterior Abdominal Wall surface?
A
From Superior > Inferior:
1) Transpyloric plane
2) Subcostal plane
3) Supracrestal plane
4) Transtubercular plane
5) Interspinous plane
19
Q
Which abdominal plane is midway between the superior borders of the pubic symphysis and the manubrium?
A
Transpyloric plane (goes through the stomach)
20
Q
Which abdominal plane is at the lowest level of the costal margin (the inferior margin of the 10th costal cartilage)?
A
Subcostal plane
21
Q
Which abdominal plane passes through the summits of the iliac crests (L4)?
A
Supracrestal plane
22
Q
Which abdominal plane is at the level of the iliac tubercles?
A
Transtubercular plane
23
Q
Which abdominal plane is at the level of the anterior superior iliac spine (ASIS)?
A
Interspinous plane
24
Q
What 3 regions are between the two midclavicular lines?
A
Superior > Inferior
- Epigastric region
- Umbilical region
- Pubic/Suprapubic/Hypogastric region
25
What 3 regions lie on the Right side of the abdomen?
Superior > Inferior
- Right Hypochondriac region
- Right Lateral (Lumbar) region
- Right Inguinal region
26
What 3 regions lie on the Left side of the abdomen?
Superior > Inferior
- Left Hypochondriac region
- Left Lateral (Lumbar) region
- Left Inguinal region
27
What are the contents of the RUQ Anterior to Posterior?
- Liver
- Duodenum
- Gallbladder
- Kidneys
- Suprarenal glands
28
What are the contents of the LUQ Anterior to Posterior?
- Transverse colon
- Stomach
- Spleen
- Pancreas
- Kindeys
- Suprarenal glands
- Abdominal aorta
29
What are the contents of the RLQ Anterior to Posterior?
- Small intestine (jejunum and ileum)
- Ascending colon with cecum and vermiform appendix
- Ureters
- Urinary bladder
30
What are the contents of the LLQ Anterior to Posterior?
- Small intestine (jejunum and ileum)
- Descending colon
- Ureters
- Urinary bladder
31
What are the 4 pairs of muscles (located Anteriorly and Laterally) that collectively compress and hold the abdominal organs in place, flex and stabilize the vertebral?
- External abdominal obliques
- Internal abdominal obliques
- Transversus abdominis
- Rectus abdominis
**Laterally flex the vertebral column when they unilaterally contract
**TIER
32
What are the 4 muscles (located posteriorly) that flex the spine and lower limb?
**flexors of trunk and/or hip
- iliacus
- psoas major
- psoas minor
- quadratus lumborum
**QIPP
33
What is the rectus sheath?
the 3 flat muscles of the anterior/lateral abdominal wall end anteriorly in a strong sheet of aponeurosis
34
What does the rectus sheath enclose?
the rectus abdominis
35
What is the midline of the rectus sheath?
linea alba
36
What is the arcuate line?
-the line where the arrangement of layers of fascia and aponeuroses of the muscles forming the recuts sheath changes going from upper to lower abdominal wall
37
Where is the arcuate line located?
half way between:
- umbilicus
- public symphysis
**Now all layers are ANTERIOR to rectus abdominis
38
What are the layers of the rectus sheath in order going from Anterior to Posterior ABOVE the arcuate line?
* *[SF ME IR]
* *[I TA TEP]
- Skin
- Fatty later of superficial fascia
- Membranous layer of superficial fascia
- Aponeurosis of external abdominal oblique fascia (2 layers)
- 1 layer of internal abdominal oblique aponeurosis
- Rectus abdominis muscle
-----------------------------------------------
- 1 layer of internal abdominal oblique aponeurosis
- Aponeurosis of transverse abdominis (2 layers)
- Transverse fascia [saran wrap]
- Extraperitoneal tissue
- Parietal peritoneum
39
What are the layers of the rectus sheath in order going from Anterior to Posterior BELOW the arcuate line?
* *[SF ME IT]
* *[R TEP]
- Skin
- Fatty later of superficial fascia
- Membranous layer of superficial fascia
- Aponeurosis of external abdominal oblique fascia (2 layers)
- Aponeurosis of internal abdominal oblique (2 layers)
- Aponeurosis of transverse abdominis (2 layers)
------------------------------------------------
- Rectus abdominis muscle
- Transverse fascia [saran wrap]
- Extraperitoneal tissue
- Parietal peritoneum
40
Do any BV cross the linea alba?
NO
41
What do the external obliques form by folding over?
inguinal ligament
42
Which posterior abdominal muscle is posterior to the inguinal ligament and attaches to the LESSER TROCHANTER?
Iliacus
43
Where do the deep system of abdominal wall arteries originate?
- superiorly = subclavian artery
| - inferiorly = external iliac artery
44
Where do the deep system of abdominal wall arteries branch from in the mid-abdomen?
abdominal aorta
45
Where do the superficial system of abdominal wall arteries originate?
- superiorly = perforating branches
| - inferiorly = branches of femoral artery
46
What 7 arteries does the deep system of abdominal wall arteries include?
- musculophrenic aa.
- superior epigastric
- inferior epigastric
- intercostal aa.
- subcostal aa.
- lumbar aa.
- deep circumflex iliac aa.
**MSII SLD
47
Where do the arteries of the superficial system of arteries run?
in the superficial fascial layer
48
What 3 arteries does the superficial system of abdominal wall arteries include?
- superficial circumflex iliac a.
- superficial epigastric a.
- external pudendal a. (superficial and deep branch)
**SSE
49
Where does the superficial circumflex iliac artery sit?
on membranous fascia through the Camper's fascia
50
What are the 4 Anterior Abdominal wall veins for Deep Drainage within the abdominal wall muscles along with arteries?
- subclavian vv.
- external iliac vv.
- lumbar vv.
- intercostal vv.
**SELI
51
What are the 3 Anterior Abdominal wall veins for Superficial Drainage within the Camper's fascia?
- thoracoepigastric vv.
- lateral thoracic vv.
- superficial epigastric vv.
**TLS
52
From the thoracoabdominal intercostal nerve, the Lateral cutaneous branches emerge anterior to the axillary region and bifurcate into ______ and _______ branches
anterior and posterior cutaneous branches
53
What do the anterior cutaneous branches of the thoracoabdominal intercostal nerve end with?
medial and lateral anterior cutaneous branches
54
What sensory dermatomes do the nerves in the Anterior Abdominal wall innervate?
T7-L1
55
Where is the T7 sensory dermatome located?
xiphoid region (tip)
56
Where is the T10 sensory dermatome located?
umbilical region
57
Where is the L1 sensory dermatome located?
inguinal fold region
58
What are the 3 nerves that innervate muscles in the Anterior Abdominal wall?
- intercostal nn.
- subcostal nerve
- lumbar nn.
59
What sensory dermatomes does the intercostal nn. innervate in the Anterior Abdominal wall?
T7-T11
60
What sensory dermatomes does the subcostal nerve innervate in the Anterior Abdominal wall?
T12
61
What sensory dermatomes does the lumbar nn. innervate in the Anterior Abdominal wall?
L1-L4
62
Where do the cutaneous branches of ventral rami of the intercostal nn. lie in the Anterior Abdominal wall?
between internal abdominal oblique and transversus abdominis
63
Where do the cutaneous branches of ventral rami of the intercostal nn. pierce in the Anterior Abdominal wall?
the rectus sheath to innervate the rectus abdominis muscles
64
What do the cutaneous branches of ventral rami of the intercostal nn. supply in the Anterior Abdominal wall?
- skin
- muscles
- parietal peritoneum
65
What is the angle of the cutaneous branches of ventral rami of the intercostal nn. in the Anterior Abdominal wall?
angle inferiomedially
66
Which nerves are part of the lumbar plexus?
L1
| L2
67
What is the superior aspect of the abdomen-pelvic cavity?
thoracic diaphragm at T12
68
What are the 3 foramina that go through the diaphragm?
- esophagus
- aorta
- IVC
69
Which rib is the last to attach singly to the sternum?
rib 6
70
What is the opening in the external abdominal oblique muscle for the spermatic cord/uterus?
superficial inguinal ring
71
What 2 muscle layers do intercostal arteries and nerves run through?
- Innermost
- Internal
**In abdomen >> between Internal Abdominal Oblique and Transversus abdominis
72
What nerves make up the Iliohypogastric nerve?
L1
| Sometimes T12
73
What branches make up the Iliohypogastric nerve?
- Lateral cutaneous branch
| - Anterior cutaneous branch
74
What does the Iliohypogastric nerve supply?
Suprapubic region
75
What nerve makes up the Ilioinguinal nerve?
L1
76
What does the Ilioinguinal nerve enter?
inguinal canal
77
What does the ilioinguinal nerve emerge through?
superficial inguinal ring
78
What does the Ilioinguinal nerve supply?
- Groin
| - Scrotum/Labium Majus
79
What nerves make up the Genitofemoral nerve?
L1
| L2
80
What are the 2 branches of the Genitofemoral nerve?
- Genital branch
| - Femoral branch
81
What does the genital branch of the Genitofemoral nerve exit through?
superficial inguinal ring of the inguinal canal
82
What does the genital branch of the Genitofemoral nerve innervate?
- Cremaster muscle
| - Cutaneous to Labium Majus
83
What does the femoral branch of the Genitofemoral nerve innervate?
cutaneous to the femoral triangle area
84
Where does the superficial lymphatic drainage of the anterior abdomen drain SUPERIORLY from?
From Umbilical region >> Anterior Axillary and Sternal Nodes
85
Where does the superficial lymphatic drainage of the anterior abdomen drain INFERIORLY from?
From Umbilical region >> Superficial Inguinal Nodes
86
Where does the Deep Lymphatic drainage of the anterior abdomen drain along?
Along Posterior intercostal & Lumbar vessels >> Deep Abdominal Nodes
87
Where does the Deep Lymphatic drainage of the anterior abdomen drain from?
From Testes >> Deep Abdominal Nodes
88
What is a hernia?
A portion of the viscera that protrudes through a weakened point of the muscular wall of the abdominopelivic cavity
89
When do hernias become a significant medical problem?
if the herniated portion of the intestine swells and becomes trapped
**Strangulated intestina hernia
90
What are the 3 types of hernias?
- Inguinal hernias
- Femoral hernias
- Umbilical hernias
91
What is the most common type of hernia that requires treatment?
inguinal hernia
92
What region of the abdominal wall is one of the weakest?
inguinal region
93
Are males or females more likely to develop inguinal hernias?
males
94
What provides the force to push a segment of the small intestine into the canal?
the rising pressure in the abdominal cavity
95
What are the 2 types of inguinal hernias?
- Direct inguinal hernia
| - Indirect inguinal hernia
96
What is a direct inguinal hernia?
- Loop of small intestine protrudes directly through the superficial inguinal ring
- NOT down the entire length of the inguinal canal
- Creates = a bulge in lower anterior abd wall
97
What is an indirect inguinal hernia?
- Herniation travels down the ENTIRE inguinal canal
| - May extend to scrotum
98
Which inguinal hernias are seen commonly in younger males and can be congenital?
indirect inguinal hernias
99
Which inguinal hernias are usually acquired?
Direct inguinal hernias
100
Which inguinal hernias have the herniation pass lateral to Inferior Epigastric vessels to enter the Deep Inguinal Ring?
Indirect inguinal hernias
101
Which inguinal hernias have the herniation pass medial to Inferior Epigastric vessels punching trough the peritoneum and transversalis fascia?
Direct inguinal hernias
102
Where does a femoral hernia occur?
- Upper thigh
- Just inferior to inguinal ligament
- In femoral triangle
103
Which part of the femoral triangle is relatively weak and prone to stress injury?
medial part of femoral triangle
**Allows a loop of small intestine to protrude
104
Do males or females more commonly develop femoral hernias?
females
**Their femoral triangle has a greater width
105
What is an umbilical hernia?
portion of the intestine pushes through the abdominal wall musculature in the:
- Periumbilical region
- Umbilical region
106
Are umbilical hernias more common in adults or infants?
infants
