ABDOMEN Flashcards
Paracentesis
MIDLINE APPROACH
Skin
Superficial fascia (Camper & Scarpa)
LINEA ALBA
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum
Paracentesis
FRANK APPROACH
Skin
Superficial fascia (Camper & Scarpa)
EXTERNAL OBLIQUE MUSCLE
INTERNAL OBLIQUE MUSCLE
TRANSVERSE ABDOMINIS
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum
Level of umbilicus
L3-L4
Level of subcostal plane
10th rib; L3
Level of transtubercular
Iliac tubercle; L5
The dermatome level of umbilicus
T10
Guide of DERMATOMES
C2 - back of head C5 - tip of shoulder C6- thumb C7 - middle finger C8 - small finger T4 - nipple T10 - umbilicus L1 - inguinal L4 or L5 - big tor S1 - small toe S5 - perianal region
Muscles of the abdomen
External oblique
Internal oblique
Transversus abdominis
Rectus abdominis
Pyramidalis
EXTERNAL OBLIQUE
Most superficial
Free inferior margin = inguinal ligament
Interdigitate with serratus anterior and latissimus dorsi
OBLIQUELY DOWNWARD AND MEDIALLY
From aponeurosis
INTERNAL OBLIQUE
Deep to external oblique
UPWARD AND MEDIAL
Aponeurotic fibers of internal oblique and transvershs abdominis = CONJOINT TENDON
From aponeurosis which splits to form rectus sheath
TRANSVERSUS ABDOMINIS
Innermost
Flat
Ends in aponeurosis
Contribute to conjoint tendon
RECTUS ABDOMINIS
On either side of linea alba
Segmented = tendinous intersections
Lateral border convex = LINEA SEMILUNARIS
PYRAMIDALIS
Not always present
Tenses linea alba
At the level below the anterior superior iliac spines, the posterior wall of the rectus sheath is formed by
TRANSVERSALIS FASCIA
Cresenteric border on the posterior wall
Midway between umbilicus and pubic crest
Arcuate line
Contents of RECTUS SHEATH
Rectus abdominis
Pyramidalis
Superior epigastric vessels
Inferior epigastric vessels
Lower 5 intercostals and subcostal vessels and nerves
Blood supply of rectus sheath
Superior epigastric - from internal thoracic (1st part of subclavian)
Inferior epigastric - from external iliac
Deep circumflex iliac - from external iliac
Venous drainage of rectus sheath
Superior epigastric - to internal thoracic
Inferior epigastric - to external iliac
Deep circumflex iliac - to external iliac
Nerve supply rectus sheath
Ventral rami of the lower sicpx thoracic nerves and first lumbar nerve
Hesselbach’s triangle
Inferior epigastric artery - superior and lateral inguinal ligament/POUPART’s ligament
Inferior and lateral rectus abdominis
Medial
Inguinal canal
Anterior - EOM APONEUROSIS
Posterior - TRANSVERSALIS FASCIA AND CONJOINT TENDON
Superior - INTERNAL OBLIQUE AND TRANSVERSALIS ABDOMINIS
Inferior - INGUINAL LIGAMENT
Males - SPERMATIC CORD
Females - ROUND LIGAMENT
Common structure - ILIOINGUINAL NERVE (L1)
Abnormal cysts in the spermatic cord
HYDROCELE - accumulation of serous fluid
HEMATOCELE - accumulation of blood, results from rupture of testicular blood vessels after trauma
SPERMATOCELE - cysts containing sperm that develops in th epididymis
VARICOCELE - results from dilatations of tributaries of testicular vein
INDIRECT INGUINAL HERNIA
Passes LATERAL to inferior epigastric vessels
Congenital type; processus vaginalis
Children and young adults
Neck of hernial sac is narrow
Enters the scrotum
DIRECT INGUINAL HERNIA
Acquired type
Elderly
Neck of hernial sac is wide
MEDIAL to inferior epigastric vessels
Never enters the scrotum
Are either direct or indirect
Both types may emerge through the superficial inguinal rings and pass superficial to the inguinal ligament
INGUINAL HERNIAS
Protrude through the anterior abdominal wall lateral to inferior epigastric vessels
Enter the deep inguinal ring and appear at the superficial ring
COVERED BY PERITONEUM AND LAYERS OF SPERMATIC CORD
INDIRECT INGUINAL HERNIA
Protrude through the posterior wall and medial to inferior epigastric vessels
COVERED ONLY BY EXTERNAL SPERMATIC FASCIA
DIRECT INGUINAL HERNIA
Cremaster muscle is derived from what layer of the abd wall
INTERNAL OBLIQUE
Layers of the ABDOMINAL WALL
Skin Superficial fascia (Campers and Scarpas) Deep fascia Muscles Transversalis fascia Extraperitoneal fat Parietal peritoneum
Derivatives of the abdominal layers
Skin = SKIN Superficial fascia = DARTOS MUSCLES External oblique = EXTERNAL SPERMATIC FASCIA Internal oblique = CREMASTER MUSCLE Transversalis abdominis = none Transversalis fascia = INTERNAL SPERMATOC FASCIA Extraperitoneal fat = none Peritoneum = TUNICA VAGINALIS
Utilizes sensory and motor fibers in the ventral ramus of the L1 SPINAL NERVE
Stroking the skin of the superior and medial thigh stimulates sensory fibers of the ILIOINGUINAL NERVE
Motor fibers from the GENITAL BRANCH OF THE GENITOFEMORAL cause the cremaster muscle to contract, elevating the testis
CREMASTERIC REFLEX
9 Abdominal regions
R hypochondriac
R lumbar
R inguinal
Epigastric
Umbilical
Hypogastric
L hypochondriac
L lumbar
L inguinal
