1. Anterior Abdominal Wall Flashcards by Andrew Niemann

The abdomen can be split into 9 regions. Vertically divided via the midclavicular line and horizontally divided via the transtubercular plane and the ?

transpyloric plane

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What are the upper 3 quadrants from left to right?

left hypochondrium (LH)
Epigastric (E)
right hypochondrium (RH)

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What are the 3 middle quadrants from left to right?

Left flank (LL)
Umbilical (U)
Right flank (RL)

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What are the 3 lower quadrants from left to right?

Left inguinal (LI)
Pubic (P) (aka hypogastric)
Right inguinal (RI)

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What are the four quadrants and how are they divided (2) ?

RUQ: right upper quadrant
LUQ: left upper quadrant
RLQ: right lower quadrant
LLQ: left lower quadrant
Divided vertically by the median plane and horizontally via the transumbilical plane

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Along with the gallbladder, right kidney and right suprarenal gland, what else is in the RUQ? (7)

right lobe of liver
pylorus of stomach
Duodenum parts 1-3
Head of the pancreas
Right colic (hepatic) flexure
Ascending colon: superior part
Transverse colon: right half

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Along with the spleen, stomach, left kidney, and left suprarenal gland, what else is in the LUQ? (6)

Left lobe of liver
jejunum and proximal ileum
body and tail of pancreas
left colic (splenic) flexure
transverse colon: left half
Descending colon: superior part

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Along with the cecum, appendix, ileum and right ovary, what else is in the RLQ? (6)

Ascending colon: inferior part
right uterine tube
right ureter: abdominal part
right spermatic cord: abdominal part
Uterus (if enlarged)
Urinary bladder (if very full)

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Along with the sigmoid colon, left ovary, left uterine tube and left ureter, what else is in the LLQ? (4)

Descending colonL inferior part
Left spermatic cord abdominal part
Uterus if enlarged
Urinary bladder if very full

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The xiphisternal plane is at the 7th rib and goes to?

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The transpyloric plane at the costal margin, which has many organs at this level, goes from 9th rib to?

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The subcostal plane is under the ribs and goes from what to what?

10th rib to L3

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There is a plane at L4 which is called?

the Supracristal plane which lies on the iliac crests

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From superficial to deep in the anterior abdominal wall, the first layer is skin followed by a superficial fatty layer of tissue known as?

Campers fascia

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Deep to the campers fascia, one will find deep membranous layer of subcutaneous tissue also known as?

Scarpas Fascia, which is white looking and becomes the scrotum

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After Scarpa’s fascia, comes the external oblique M, then internal oblique M, and transversus abdominis. What are the final three layers?

transversalis fascia
extraperitoneal fat
parietal peritoneum

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Liposuction takes the fat from which layer of the abdomem?

Campers fascia, or the superficial fatty layer

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How does liposuction become bothced?

The device goes into the membranous layer, scarpo’s fascia and causes adhesions

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The external oblique muscle becomes aponeurotic at the linea semilunares (mid clavicular line). Originates from 5th-12th ribs and inserts on the linea alba, pubic tubercle and anterior iliac crest. What are the actions and innvervation?

Compress/Support abdominal viscera and rotate trunk

Thoracoabdominal and subcostal N.

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The internal oblique muscles becomes aponeurotic at the linea semilunares. From the anterior iliac crest and lateral inguinal ligament to the 10-12th ribs and linea alba. What are the actions and innervation?

Abdominal compression/ Rotate

Ilioinguinal, thoracoabdominal, subcostal, and iliohypogastric N.

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The transversus abdominus M. becomes aponeurotic at linea semilunares. Orginiates at internal 7-10 costal cartilages and inserts on linea alba. What are its actions and innervation?

Compress and support abdominal viscera

ilioinguinal, thoracoabdominal, subcostal and iliohypogastric Ns.

Rectus abdominis M is anchored to the rectus sheath and has 3 tendinous intersections (forms 6 pack). Origin at pubic symphysis and crest, inserts on xiphoid process and 5-7th costal cartilages. What are its action and innervation?

Flex trunk and compress viscera

Thoracoabdominal and subcostal Ns.

Which of the abdominal muscles does not take part in forming the linea alba in the median of the abdomen?

rectus abdominis

The pyramidalis M is absent in about 20% of people. What is its function?

it is insignificant!

The arcuate line which can be found 1/3 of the way between the umbilicus and the pubic tubercle is made up of different fascias. What is the rectus sheath above the arcuate line made of anteriorly and posteriorly? (2,3)

Anteriorly above the arcuate line: External/Internal Oblique | Post above the arcuate line: Internal oblique, transversus abdominis, and trasnversalis fascia

What is the anterior and posterior fascia made up of below the arcuate line? (3,1)

Anterior: External, internal oblique and transversus abdominis Posterior: Transversalis fascia

What is the highest point in the body that the abdomino-pelvic cavity stretches?

goes up to the 4th intercostal space

What can be found at the transpyloric plane (L1)? (7)

``` Level of gall bladder fundus pylorus pancreatic neck SMA origin hepatic portal vein root of transverse mesocolon hila of kidneys ```

What can be found at the subcostal plane below the 10th costal cartilage? L3

Transverse colon

What can be found at the transtubercle plane between iliac tubercles? L5

iliocecal junction

What can be found at the interspinous plane between ASISs? S2

Appendix and sigmoid colon

What are the boundaries to the anterior abdominal wall? (5)

``` Xiphisternum/Costal margin (7-10) Erector Spinae Iliac crest, tuburcle and spine Inguinal Ligament Pubic tuburcle and crest ```

Where does the Neurovasculature of the abdomen lie?

between the internal oblique muscle and the transversus abdominis

Thoracoabdominal nerves innervate T7-T11 which is a continuation of intercostal N., while subcostal N is under rib 12. What is another name for these nerves?

Anterior rami

L1 is split into two different nerves. The first is iliohypogastric N and the second is?

Ilioinguinal N which goes into the inguinal canal to scrotum/labia and medial thigh for cutaneous innervation

From the internal thoracic A, splits into two which are?

the musculophrenic and superior epigastric As.

The superior epigastric which is posterior to rectus abdominis, will anastamose with what at the belly button?

inferior epigastric A which is a branch off of the external iliac A.

What are the two abdominal wall arteries that come off the femoral A?

Superficial epigastric and superficial circumflex iliac A

Above the arcuate line is whiter while below the arcuate line is considered?

transparent

A midline incision from the xiphoid process to the pubic symphysis is good or bad?

Okay, there are no nerves or blood supply, however will take a long time to heal

Subcostal incision is made 2.5cm inferior of the costal margin to access gall bladder/spleen. Suprapubic incision is at pubic hair line. Are these incisions good or bad?

Subcostal: not bad but near superior epigastric Suprapubic: Okay but near inferior epigastric

What is an incision that you should never use unless you have to save someones life?

Paramedian from costal margin to iliac crest along linea semilunaris

What are the ventral hernias? (3)

umbilical, epigastric, and spigelian

In the groin, there can be femoral or inguinal. What are the other two types of hernias?

Pelvic through the sciatic foramen and flank hernias through back muscles

For lymph above the transumbilical plane, what are the two main places the lymph will drain to?

``` Axillary LN Parasternal LN (more to axillary) ```

The deep lymphatics includ external iliac, common iliac, and lumbar (caval/aortic) nodes. Where would superficial lymph under the umbilicus drain to?

Superficial inguinal LN

The median umbilical fold is made via obliterated urachus. On either side are the?

supravesical fossa

The medial umbilcal fold is derived from obliterated umbilical arteries. On either side of these folds are?

Medial inguinal fossa

The lateral umbilical fold is a fold due to inferior epigastric A which run anterior to posterior layer of rectus sheath. What is on either side (laterally) of the lateral umbilical folds?

lateral inguinal fossa

What can cause prune belly?

Failure of hypomere to migrate and form the abdominal muscles OR a paramedial incision which cuts nevers