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Z Year 1 Anatomy > Abdomen and Pelvis 1 > Flashcards

Abdomen and Pelvis 1 Flashcards

1
Q

What does the abdomen do?

A
  1. protects the contents of the abdominal cavity and maintains the position of the viscera, particularly the intestine.
  2. Its flexibility allows movement to the trunk.
  3. It provides a major route of surgical access to the abdominal and pelvic contents, and palpation of the abdomen can provide important clinical information.
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2
Q

What is the abdomen bound by superiorly and posteriorly and laterally and anteriorly?

A
  • diaphragm superiorly
  • the lumbar vertebrae and posterior wall muscles posteriorly
  • the muscles of the anterior wall laterally and anteriorly.
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3
Q

What is the abdominal cavity continuous with?

A

Pelvis inferiorly

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4
Q

What is lining the deep surface?

A
  • Lining the deep surface, the abdominal wall is a strong layer of fascia together with some fat.
  • The posterior abdominal wall muscles lie deep to the muscles of the back.
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5
Q

What comprises medially to laterally on either side? What are these muscles important for?

A
  • psoas major and minor
  • quadratus lumborum
  • iliacus
  • These muscles are important in flexing the lumbar spine, flexing the thigh at the hip, and in breathing.
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6
Q

Where does the anterior abdominal wall extend from?

A

The anterior abdominal wall extends from the rib cage and costal margin to the pelvis, where it is attached to the iliac crest laterally, and the superior surface of the body of the pubis and the pubic symphysis medially.

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7
Q

What is the pace between the anterior superior iliac spine and the public tubercle bridged by?

A

inguinal ligament

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8
Q

What can you regard the flank as?

A

Part of the anterior abdominal wall

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9
Q

What does the flank muscle comprise of from superficial to deep?

A
  1. External oblique
  2. Internal oblique
  3. Transversus abdominis msucles on either side
    - Anteriorly, the rectus abdonomis muscles on either side of the midline
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10
Q

What does the flak muscles give rise to?

A

-to flat sheets of tendon known as aponeuroses, which extend medially to envelope the rectus abdominis muscles as the rectus sheath, meeting in the midline as the linea alba.

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11
Q

What is the. nerve supply to the abdominal wall?

A
  • Segmental

- Arising from spinal segments T7 to L1

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12
Q

How do the nerves run?

A
  1. anteriorly in the plane between transversus abdominis and internal oblique
  2. They then pierce the rectus sheath to run deep to rectus abdominis. T7 supplies the skin in the xiphisternal region, T10 supplies the umbilical region, and T12 supplies the suprapubic region
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13
Q

What is the inguinal canal?

A
  • There is a canal through the inferior anterior abdominal wall, just superior to the medial half of the inguinal ligament on either side, and it is known as the inguinal canal
  • This canal transmits structures that you will learn about later in the course.
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14
Q

What does the inguinal canal do in the male and female?

A
  1. In the male it allows the descent of the testes into the scrotum and transmits the spermatic cord.
  2. And in the female it transmits the round ligament of the uterus to the labia majora.
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15
Q

Why is the canal important clinically?

A

-This canal and the abdominal wall adjacent to it are important clinically because, particularly in males, they are sites of a common condition know as inguinal hernia, in which abdominal contents breach the abdominal wall

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16
Q

Why are the anterior abdominal wall muscles important?

A
  1. flexing and rotating the trunk
  2. Particularly transversus abdominis important for compressing the abdominopelvic cavity to generate high pressure within it
    - This occurs whenever expulsive efforts are made, such as coughing, sneezing, defecation, micturition, and parturition.
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17
Q

Why is the action of the transverses abdominis muscles also important?

A
  1. for stabilizing the lumbar spine in activities such as lifting a heavy weight.
    - However, it is important to understand the action of transversus abdominis alone, is not sufficient to raise abdominopelvic pressure.
    - The thoracic diaphragm and larynx that you have already studied, and the pelvic diaphragm that you will meet later on in the course, are also involved in raising abdominopelvic pressure.
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18
Q

Does the abdominal wall cover all of the abdominal cavity?

A

No

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19
Q

Where is the abdominal wall?

A
  1. a muscular tendinous structure which lies underneath the costal margin
  2. So inferior to the costal margin and superior to the crest of the ileum and the pubic bones.
    3So it is rather narrow at either side and from xiphisternum to the pubic symphysis quite a considerable distance.
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20
Q

What are the regions of the abdominal wall?

A
  • We can mark the surface of the anterior lateral abdominal wall into a grid which gives nine regions.
  • These regions are important descriptively so that you can map the surface projections of the abdominal pelvic organs and can use them to investigate referred pain in this region.
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21
Q

What are the nine regions?

A
  • On right side:
    1. Right hypochondriac
    2. Right lumbar
    3. Right iliac regions
  • Mirrored left regions
  • In center:
    1. The epigastric region
    2. The umbilical region
    3. The hypogastric region
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22
Q

What does the anterior wall comprise of?

A
  1. Rectus abdominis

2. Rectus Shesth

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23
Q

What is the lateral wall on either side formed of?

A
  • three muscles from external to internal, 1. 1. external oblique
    2. internal oblique
    3. Transversus abdominis
24
Q

What does the posterior abdominal wall comprise of?

A
  • Posteriorly, the abdominal wall comprises muscles that are lying anterior to the spinal column.
  • We have here the large muscle that is so as major and lateral to it quadratus lumborum
25
Q

What muscle is further down into the false pelvis?

A

-Further down into the false pelvis lining the walls of the iliac bones, we have another muscle which is described as being part of the posterior wall and that is iliacus

26
Q

What are the three lateral or flank muscles that are sheet-like muscles?

A
  1. External Oblique
  2. Internal oblique
  3. Transversus abdominis
27
Q

What are these muscles replaced anteriorly by?

A

Aponeurosis

28
Q

What is an aponeurosis?

A

-An aponeurosis is a flat tendon sheet and indeed to a lesser extent, they are replaced posteriorly as well by aponeurosis.

29
Q

What do these muscles do?

A
  1. These muscles raise intra-abdominal pressure and they are important for all expulsive activities and indeed breathing out.
  2. They assist flexion of the trunk and guard or protect the viscera contained within the abdominal and pelvic cavities
30
Q

Where are the attachments of the external oblique?

A
  1. Lower either ribs the outer surface of lower ribs
  2. Free posterior border ( immediately as you can see the muscle changes to a tendon)
  3. Aponeurosis contributes medially to rectus sheath
31
Q

Where does the external oblique arise?

A

-Inferiorly it arises from the anterior half of the crest of the ileum, and the lower border forms the inguinal ligament.
–This inguinal ligament has a deficiency in it which is the external opening of the inguinal canal, this opening is known as the superficial inguinal ring.
(forms superficial inguinal ring)

32
Q

What are the lateral attachments of the internal oblique?

A
  • arises in a continuous line from a dense area fascia.
  • Continuous line from he thoracolumbar fascia from the anterior two thirds of the iliac crest and the lateral half of the inguinal ligament (that you have already seen being formed by the most inferior part of the aponeurosis of external oblique_
33
Q

What are the medial attachments of the internal oblique?

A
  1. The medial attachments are costal cartilages 7-12.
  2. The aponeurosis passes to the midline and forms part of a structure known as the rectus sheath.
  3. Most medially and inferiorly through the conjoint tendon to the iliopectineal line on the pubis and ileum.
34
Q

What are the fibres like in the external oblique?

A

-If you look at the direction of the fibers within this muscle parsing downwards and medially, you’ll be able to work out what the action of this muscle is unilaterally, and if the external oblique of both sides contract together.

35
Q

What are the fibres like in the internal oblique?

A
  1. If we look at the direction of these fibers again, you will be able to work out what the action of the muscle is unilaterally and bilaterally
  2. -But in addition to the major action of the muscle, it’s important to understand that not all of the fibers pass superhero medially.
  3. If we look at this diagram, you can see that the majority of the fibers pass superior medially, but the most inferior ones arch downwards towards the pubis.
  4. This downward arching of these most inferior fibers is important for an understanding of the inguinal canal which we will meet later on.
36
Q

What are the fibres like in the transverses abdominis?

A
  • Deepest of three muscle

- Fibres pass horizontally

37
Q

What are the lateral attachments of the transverses abdominis?

A
  1. Continuous line from lower inner surface 6 costal cartilages
  2. The thoracolumbar fascia
  3. The iliac crest
  4. The lateral third of the inguinal ligament.
38
Q

What are the medial attachment of the transverses abdominis?

A
  1. it’s aponeurosis passes towards the midline and contributes to the rectus sheath
  2. The most inferior fibers form the conjoint tendon with the aponeurosis of internal oblique
    - So it is the conjoin tendon of internal oblique and transversus abdominis.
39
Q

How does the transverses abdomens work?

A
  1. This muscle is not going to move the trunk.
  2. It’s acting like a belt or a corset, and it is the most important muscle for raising intra-abdominal pressure for explosive episodes deep to transversus abdominis or of the cavity of the abdomen and pelvis is lined by a fascia known as transversalis fascia.
40
Q

What happens to the flank muscles medially?

A
  1. We have already seen that medially, the flank muscles become upper neurotic, and they meet in the mid line.
  2. These flat tendons of external oblique, and internal oblique, and trans-versus abdominis meet at the mid line and form a depression
    - This depression when we remove the skin is white.
    - Therefore, this line is known as the linea alba.
41
Q

Where else does the aponeurosis come together and fuse?

A
  • They also fuse at the edge of the muscles that form the six-pack.
  • This line because of its shape, is known as the linea semilunaris.
  • You will all be aware of this important landmark, the umbilicus.
42
Q

What forms the rectus abdominis?

A
  1. Two blocks either side of the lines alba

2. these two blocks have superior attachments, medially to the xiphoidprocesses

43
Q

What are the superior attachment of the rectus abdominis?

A
  1. 5/6/7 costal cartilages

2. Xiphoid cartilages

44
Q

What are the inferior attachments of the rectus abdominis?

A
  1. Pubic crest
  2. Pubic symphysis
    - You will see that the muscles do not run directly from their superior attachments to the inferior attachments
45
Q

What are the blocks of muscle?

A
  1. There are typically four blocks of muscle, four pairs of blocks of muscles
    - Normally, this group of muscles is referred to as a six-pack. But in reality it is four pairs of blocks of muscle. So it is an eight-pack.
46
Q

What are the blocks separated by?

A

Tendious intersections

47
Q

What do the blocks allow?

A
  • These blocks allows segmental contraction of this muscle

- That means greater control of the major activity of this muscle, which is flexion of the trunk.

48
Q

Describe the rectus muscle

A
  • The rectus muscle itself is enclosed by the aponeurosis of the flank muscles.
  • So the aponeurosis of external, internal oblique and transversus abdominis enclose the rectus muscle on either side.
  • -Then the two aponeusets of aponeurosis meet in the middle line, at the linea alba
49
Q

When else do they fuse?

A

-they also fuse laterally at the linea semilunaris forming more or less a tubular sheath to enclose the rectus abdominis muscles on either side

50
Q

What is the formation of the rectus sheath like?

A
  • Now the formation of the rectus sheath is not uniform throughout the entire length of the rectus muscles.
  • For all, but the most inferior part of the sheath, external oblique aponeurosis passes anterior to the rectus abdominis.
  • Internal oblique splits to pass anterior and posteriorly around rectus abdominis.
  • Transverses oponeurosis passes posterior to rectus abdominis.
51
Q

Where does the external aponeurosis pass?

A

-Anterior to rectus abdominis

52
Q

What does the internal oblique aponeurosis pass?

A

-Splits around rectus abdominis

53
Q

What does the transverses abdominis aponeurosis pass?

A

-Posterior to rectus abdominis

54
Q

What are the transversus abdominis, internal oblique or external oblique covered by?

A
  • The muscle fibers themselves are covered by a layer of deep fascia on either side. It is these two layers of fascia that come together to form the aponeurosis of each of the three flight muscles.
  • Understanding that makes it much easier to understand how and why the aponeurosis of internal oblique, can split around the rectus muscle. Interestingly, the direction of the collagen fibers in the two parts of each aponeurosis at right angles to each other, and that gives a lot more strength to the rectus sheath.
55
Q

What is the arcuate line?

A

-Arcuate line midway between the umbilicus and pubic symphysis - below this all the aponeurosis pass anterior to rectus abdomens so her posterior rectus sheath consists of the tranverassis fascia only

56
Q

What happens halfway between the umbilicus and the pubic symphysis?

A
  • Pattern changes
  • Here, we are looking at the posterior part of the lower rectus sheath.
  • You will see that the most inferior part of the lowest block of rectus abdominis muscles appears to be bare of the sheath. In fact, it is just covered by the transversalis fascia.
  • Because at this point here, which is known as the arcuate line, all of the aponeurosis of the flag muscles pass anterior to the rectus abdominis. So the posterior rectus sheath consists only of transversalis fascia.

Z Year 1 Anatomy (16 decks)

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