1 - Abdominal Wall

Question 1

Objectives: Define borders, quadrants, and regions of anterior abdominal wall

Borders

Answer 1

• Superior
  
  • Xiphoid Process
  • Costal Cartilages Ribs 7-10
• Inferior
  
  • Iliac Crest
  • Inguinal Ligament
  • Pubic Bone

Question 2

Objectives: Define borders, quadrants, and regions of anterior abdominal wall

Quadrants

Answer 2

• Quadrants: Divided by
  
  • L-R: Midline Plane (Linea Alba)
  • U-L: Umbilicus

Question 3

Objectives: Define borders, quadrants, and regions of anterior abdominal wall

Regions

Answer 3

• Upper: R. Hypochondrial / Epigastric / L. Hypochondrial
• Middle: R. Flank / Umbilical / L. Flank
• Lower: R. Groin / Pubic / L. Groin

Question 4

Objectives: Explain the layers of the anterior abdominal wall

Answer 4

1. Skin
2. Superficial Fascia
   
   1. Camper’s Fascia (Fatty)
   2. Scarpa’s Fascia (Membranous)
3. Deep Fascia Covering Muscles
   
   1. External Oblique
   2. Internal Oblique
   3. Transversus Abdominis
4. Transversalis Fascia (or endoabdominal fascia)
5. Extraperitoneal Fat
6. Parietal Peritoneum

Question 5

Objectives: Identify the muscles of the abdominal wall

What are the actions of the anterior and lateral muscles?

Answer 5

• Flat Muscles
  
  • External Oblique (“hands in pocket”)
  • Internal Oblique (“hands in gloves”)
  • Transversus Abdominis (often fused w/Int Obl)
• Strap-Like Vertical Muscle
  
  • Rectus Abdominis (6-pack)
• Small Vertical Muscle
  
  • Pyramidalis (tenses linea alba)
• Action:
  
  • Flex Trunk
  • Rotate Trunk (flat muscles)
  • Compress / Support Viscera

Question 6

Objectives: Explain the muscle-fascia relationships of the rectus sheath

What is the rectus sheath?

What does this contain?

What is the arcuate line?

Answer 6

• Rectus Sheath: Incomplete connective tissue envelope that surrounds each rectus abdominis muscles; formed by aponeuroses of three anterolateral muscles
  
  • Rectus Abdominis Mm.
  • Pyramidalis Mm. (if present)
  • Sup. / Inf. Epigastric Vessel
  • Terminal Ends of T7 - T12 nerves
• Arcuate Line: Arch of Fibers marking change in fascia contributing to Anterior and Posterior Layers of rectus sheath; midway between pubis and umbilicus; Lower limit of Posterior wall of rectus sheath!

Question 7

Objectives: Identify nerves, vessels, and arterial anastomoses

Superior Epigastric + Inferior Epigastric

Study Tables on page 9,10/12

Answer 7

• Superior Epigastric + Inferior Epigastric
  
  • Connects Subclavian + External iliac Artery
  • Blood flow for coarctation of aorta
    *

Question 8

Clinical: McBurney’s Point

Location

Importance

Answer 8

1/3 up on line from ASIS to Umbilicus

Site of maximum tenderness in acute appendicitis

Question 9

Structures Deep to Abdominal Quadrants

Answer 9

• Right Upper
  
  • Stomach, pylorus, Ascending colon, hepatic flexure, transverse colon, right half, right liver lobe, gallbladder, pancreas (head), right kidney, adrenal gland
• Left Upper
  
  • Stomach, jejunum, ileum, transverse colon, left liver lobe, spleen, pancreas (body, tail), left kidney, adrenal gland
• Right Lower
  
  • Ileum, cecum, appendix, ureter, spermatic cord
• Left Lower
  
  • Descending colon, sigmoid colon, ureter, spermatic cord

Question 10

Where is the first site of referred pain with an enlarged appendix?

Answer 10

T10 dermatome around umbilicus

(Later felt in lower right quadrant)

Question 11

What is the clinical importance of the tranversalis Fascia and Extraperitoneal Fat layers?

Answer 11

Provides access to retroperitoneal structures without entering peritoneal cavity (where organs are housed)

Question 12

What are the primary differences between Camper’s Fascia and Scarpa’s Fascia?

Answer 12

• Camper’s = Fatty Layer
  
  • ​Superficial Epigastric vessels
  • Fat extends into female labia majora
  • Dartos muscle in scrotum
• Scarpa’s = Membranous Layer
  
  • ​Deeper layer
  • Colle’s Fascia in perineum/scrotum

Question 13

Explain the difference in penetration layers from a midline and lateral puncture

Answer 13

• Midline:
  
  • Skin
  • Superficial Fascia
    
    • Camper
    • Scarpa
  • Linea Alba
  • Transersalis Fascia
  • Extraperitoneal Fat
  • Parietal Peritoneum
• Lateral
  
  • Skin
  • Superficial Fascia
    
    • Camper
    • Scarpa
  • External Oblique
  • Internal Oblique
  • Transversus Adominis
  • Transersalis Fascia
  • Extraperitoneal Fat
  • Parietal Peritoneum

Question 14

What is the Conjoint Tendon?

Answer 14

Common insertion of Transversus Abdominis and Internal Oblique Muscle on the pubis