10.9-10 Flashcards by Hamish T

Layers of abdominal wall:

Skin.
Superficial fascia.
Three layers of muscle.
Deep fascia - transversalis fascia.
Extraperitoneal fat.
Peritoneum.

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Attachments of muscles of abdominal walls (like boundaries of abdomen):

Costal margin
Superior aspect of pelvis: anteriorly = pubic crest (pubic tubercle is lateral bump of bone of pubic crest), and posterior = iliac crest (ASIS is anterior bump of bone on iliac crest).

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How do 3 layers of abdominal muscles attach to costal margin?

Over, edge to edge, and under!

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The 3 muscles layers of the anterior abdominal wall are fleshy ___ and aponeurotic ___.

Laterally

Medially

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Abdominal muscles - there are 2 aponeurotic extensions from left and right that join in ___ in a vertical raphe called ___ ___.

In midline to form linea alba.

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The abdominal muscles extend posteriorly as far as the ___ ___.

Thoracolumbar fascia.

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Muscles of abdominal wall:
Outer layer = ___
Middle layer = ___
Inner layer = ___

External oblique.
Internal oblique.
Transversus abdominus.

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Fibres of external oblique run in “___ ___” direction.

Front pocket (like external intercostals!).

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External oblique overlaps the ___ ___ and up to and edge-to-edge with ___ ___ and ___ ___.

Thoracic cage.

Up to and edge-to-edge with pectoralis major and serratus anterior.

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External oblique attaches to the ___ half of the ___ ___, then jumps and attaches to the ___ ___ and ___ ___

Attaches to the anterior half of iliac crest, jumps and attaches to pubic tubercle and pubic crest.

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There is a free inferior edge to the ___ ___ called the ___ ___.

External oblique.

Free edge is called the inguinal ligament.

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The inguinal ligament extends form the ___ to ___ to form a ___ opening.

ASIS to pubic tubercle to form a triangular opening.

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The ___ ___ is thickened and turns under self.

Inguinal ligament.

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Fibres of internal oblique run in “___ ___” direction.

“Back pocket” direction (like inter intercostals!).

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The internal oblique muscle attaches to the ___ ___ (edge-to-edge) and joins the other internal oblique muscle at the ___ ___ in the midline.

Costal margin.

Linea alba.

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Internal oblique attaches to the ___ half of the ___ ___ and the ___.

Anterior half of iliac crest and the ASIS.

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Some fibres of internal oblique originate beyond the ASIS from the ___ / of the inguinal ligament.

Lowermost fibres of internal oblique originate from the lateral 2/3 of the inguinal ligament.

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The lowermost fibres of internal oblique do not go up to the linea alba, but arch up, over and down to insert into the ___ ___ independently.

Pubic crest.

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The inner layer of abdominal wall muscles is the ___ ___.

Transversus abdominus.

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Fibres of transversus abdominus run in a ___ direction.

Horizontal i.e. transverse!

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The transversus abdominus muscle attaches ___ the costal margin, in the same plane as the ___.

Under, in the same plane as the diaphragm.

Fibres of transversus abdominus come from the ___ half of the ___ ___, AND the lowermost fibres come from the ___ / (to /) of the inguinal ligament.

Anterior half of the iliac crest.

Lowermost fibres from the lateral 1/3 (to 1/2) of the inguinal ligament.

The lowermost fibres of the transversus abdominus muscle do not join at the ___ ___, but arch up, over and down to insert into ___ ___, like the ___ ___ muscle.

Do not join at the linea alba.

Arch up, over and down to insert into pubic crest, like the internal oblique muscle.

Internal oblique and transversus abdominus attach to the pubic crest by a ___ ___.

Conjoined tendon.

The rectus abdominis muscle originates inferiorly from the ___ ___.

Pubic crest, and fibres diverge as the ascend (wider as up).

Rectus abdominis crosses anterior to the costal margin and attaches to costal cartilages ___, ___ and ___.

5, 6, 7 (edge-to-edge with pectoralis major!).

There are ___ tendinous intersections of rectus abdominis.

The levels of the 3 tendinous intersections of rectus abdominis:

Level of umbilicus. Level of xiphisternum. Level halfway between two.

The arcuate line is approx. 1 inch ___ the ___.

Under the umbilicus.

Above the arcuate line - relationship of aponeuroses to rectus abdominis.

External oblique aponeurosis anterior (forming front of rectus sheath), transversus abdominus aponeurosis posterior (forming back of rectus sheath). Internal oblique aponeurosis splits – half in front (anterior leaf) and half in back (posterior leaf)!

Below the arcuate line - relationship of aponeuroses to rectus abdominis.

All aponeuroses in front of rectus abdominis (forming anterior rectus sheath). Therefore, NO posterior rectus sheath. Rectus abdominis is directly on transversalis fascia/extraperitoneal fat/parietal peritoneum.

The neurovascular plane in the anterior abdominal wall is between the ___ and ___ layers.

Intermediate and deep i.e. between internal oblique and transversus abdominus.

There is segmental innervation of the anterior abdominal wall: ___ = umbilicus, and ___ = groin (spinal nerves).

``` T10 = umblilicus. L1 = groin. ``` Therefore, T7/8/9 = anterior abdominal wall above umbilicus. Therefore, T11/12 = between umbilicus and groin.

There is a crescentic extension of inguinal ligament to the pectineal line of the pubic bone - called the ___ ___.

Lacunar ligament.

There is a linear extension from the lacunar ligament called the ___ ___.

Pectineal ligament.

The testes develop in ___ __ on the ___ abdominal wall and descend to scrotum.

Extraperitoneal fat on posterior abdominal wall.

The testes pass ___ ___, ___ ___, ___ ___ and ___ ___ to descend to scrotum.

Transversalis fascia. Transversus abdominis. Internal oblique. External oblique.

The testes first pass through the ___ ___, by creating a deficiency in it.

Fascia transversalis.

The deficiency in fascia transversalis for the testes occurs halfway between ___ and ___ ___, a fingers breadth above the inguinal ligament.

ASIS and pubic tubercle.

The deficiency in fascia transversalis is called the ___ or ___ ___ ___.

Deep or internal inguinal ring.

Remember - there is a hole in ___ ___ at the inguinal ligament (triangular opening), called the ___ or ___ ___ ___.

External oblique, called the superficial or external inguinal ring.

Remember - the lowermost fibres of ___ ___ and ___ ___ originate from the ___ part of the ___ ___, and arch up, over and down to insert into ___ ___ by a ___ ___.

Internal oblique and transversus abdominus originate from lateral part of the inguinal ligament, insert into pubic crest by a conjoined tendon.

The testes pass through deep/internal inguinal ring, move ___ and pass under the arching fibres of ___ and ___, before passing through the superficial/external inguinal ring.

Medially and pass under the arching fibres of transversus abdominus and internal oblique.

As testes descend, they take ___, ___, ___, ___ and the ___ ___ (duct).

Nerves, arteries, veins, lymphatics and vas deferens (duct).

As testes pass each layer of anterior abdominal wall, they gain a cover for protection: after deep/internal inguinal ring, they gain ___ ___ ___, after passing under the arching fibres of transversus abdominis and internal oblique they gain ___ ___, and after exiting the superficial/external inguinal ring, they gain ___ ___ ___.

Internal spermatic fascia (from transversalis fascia). Cremasteric fascia. External spermatic fascia (from external oblique).

The cremasteric fascia has some associated ___ fibres, important in ___ retraction.

Muscles fibres - cremaster muscle. | For testicular retraction!

Abdominal hernia:

Abnormal protrusion of abdominal contents through abdominal wall!

Inguinal hernias - can be bilateral ___ or ___.

Direct or indirect.

Bilateral indirect inguinal hernia is a protrusion through the ___ ___, into the inguinal canal.

Deep ring, i.e. following path of the testes!

Bilateral direct inguinal hernia does NOT enter the ___ ___, and not in scrotum.

DO NOT enter the inguinal canal, and not the scrotum!

The ___ ___ is the weakest point of the anterior abdominal wall, between the ___ ___ artery and ___ ___.

Inguinal TRIANGLE | Between the inferior epigastric artery and rectus abdominis.

___ ___ is superolateral in the paravertebral gutter, and ___ is inferolateral in the paravertebral gutter.

Quadratus lumborum Iliacus Both next to psoas major