Abdominal Flashcards
queations
answer
The region between the thorax superiorly and the pelvis inferiorly
abdomen
This region is composed of skeletal muscles, visceral structures, and cavities that aid in movement, and function in protection and contraction
abdomen
Key surface features of the anterolateral wall
rectus abdominis muscles (6-pack ABS)
Linea Alba (white line)
Semilunar line (Spigelian line)
Tendinous intersection
Umbilicus
Iliac crest
Inguinal ligament (both side)
runs through the pubic symphysis and crests to the xiphoid process and 5th to 7th costal cartilages
rectus sheath
where the fascial aponeuroses of the rectus sheath from each side interdigitate in the midline
linea alba
avascular; midline subcutaneous band of fibrous tissue
linea alba
the lateral border of the rectus abdominis muscle in the rectus sheath
semilunar line
transverse skin grooves that demarcate transverse fibrous attachment points of the rectus sheath to the underlying rectus abdominis muscle
tendinous intersection
dermatome of umbilicus
T10
umbilicus lies at what vertebral level
intervertebral disc between L3 and L4
iliac crest lies at what vertebral level
L4
composed of the aponeurotic fibers of the external abdominal oblique muscle
inguinal ligament
which lies deep to a skin crease that marks the division between the lower abdominal wall and thigh of the lower limb
inguinal ligament
regions of the anterolateral abdominal wall
*Top Row
Right Hypochondriac Region
Epigastric Region
Left Hypochondriac Region
*Middle Row
Right Flank/Lumbar Region
Umbilical Region
Left Flank/Lumbar Region
*Bottom Row
Right Iliac (Inguinal) Region
Hypogastric (Pubic) Region
Left Iliac (Inguinal) Region
the 2 sagittal planes of the anterolateral abdominal wall lies along the
midclavicular line
the 2 transverse planes of the anterolateral abdominal wall lies along the
Subcostal plane
Intertubercular plane
what can you find in the right upper quadrant
right lobe of the liver
gallbladder
stomach: pylorus
Duodenum: part 1-3
pancreas: head
right suprarenal gland
right kidney
right colic (hepatic) flexure
Ascending colon: superior part
Transverse colon: right half
what can you find in the left upper quadrant
Left lobe of the liver
spleen
stomach
Jejunum and proximal ileum
pancreas: body and tail
left suprarenal gland
left kidney
left colic (splenic) flexure
Descending colon: superior part
Transverse colon: left half
what can you find in the right lower quadrant
Cecum
appendix
most of the ileum
ascending colon: inferior part
right ovary
R uterine tube
R ureter: abdominal part
R spermatic cord: abdominal part
uterus (if enlarged)
urinary bladder (if very rull)
what can you find in the left lower quadrant
sigmoid colon
descending colon: inferior part
L ovary
L uterine tube
L ureter: abdominal part
L spermatic cord: abdominal part
uterus (if enlarged)
urinary bladder (if very rull)
inferior to the umbilicus, the subcutaneous tissue is consistent with that found in most regions.
false
it’s superior
inferior to the umbilicus, the deepest part of the subcutaneous tissue is reinforced by many elastic and collagen fibers, so it has two layers
True or false
true
abdominal wall layers
skin
camper’s fascia (fatty layer)
scarpa’s fascia (deep membranous layer)
superficial investing fascia
external oblique
intermediate investing fascia
internal oblique
deep investing fascia
transversus abdominis
transversalis fascia
extraperitoneal fat
parietal peritoneum
continues INF into the perineal region as the membranous layer of subcutaneous tissue of perineum (superficial perineal or Colles fascia), but not into the thighs
scarpa’s fascia
what do you call the fatty accumulation in the lower anterior abdominal wall; common in males
panniculus adiposus
3 flat muscles
External abdominal oblique muscle
Internal abdominal oblique muscle
Transversus abdominis muscle
2 vertical muscles
Rectus abdominis muscle
Pyramidalis muscle - inconsistent
pyramidalis muscles is absent to what percent of the population
20
the portion lining the deep surface of the transversus abdominis muscle and its aponeuroses
transversalis fascia
glistening lining of the abdominal cavity; single layer of epithelial cells and supporting connective tissue; internal to the transversalis fascia and is separated from it by a variable amount of extraperitoneal fat
parietal peritoneum
innervation of the external oblique
thoraco-abdominal nerves T7-T11
subcostal nerves
innervation of the internal oblique
thoraco-abdominal nerves T6-T12
L1 nerves
innervation of the transversus abdominis
thoraco-abdominal nerves T6-T12
L1 nerves
innervation of the rectus abdominis
thoraco-abdominal nerves T6-T12
Compresses and supports abdominal visceral and flexes and rotates trunk
external and internal oblique
Compresses and supports abdominal visceral
trasversus abdominis
direction of external oblique
inferomedially
direction of internal oblique
superomedially
its lowermost fibers, which arise from the lateral half of the inguinal ligament, runs inferomedially
internal abdominal oblique muscle
transversus abdominis muscle
external oblique
aponeurosis that extends from the xiphoid process to the pubic symphysis
linea alba
Small, insignificant triangular muscle
pyramidalis muscles
Lies anterior to the inferior part of the rectus abdominis and attaches to the anterior surface of the pubis and the anterior pubic ligament
pyramidalis muscles
landmark of the median abdominal incision
pyramidalis muscles
Strong, incomplete fibrous compartment of the rectus abdominis and pyramidalis muscles
rectus sheath
above the arcuate line:
The external oblique aponeurosis contributes to the anterior wall of the sheath throughout its length
The superior two thirds of the internal oblique aponeurosis splits into two; one lamina passing anterior to the muscle and the other passing posterior to it
rectus sheath
below the arcuate line: _____ of the rectus sheath is absent
posterior wall
demarcates the transition between the aponeurotic posterior wall of the sheath covering the superior three quarters of the rectus and the transversalis fascia covering the inferior quarter
arcuate line
a defect in the linea alba through which the fetal umbilical vessels pass to and from the umbilical cord and placenta
umbilical ring
All layers of the anterolateral abdominal wall fuse at the umbilicus
t
the skin around the unbilical ring depresses after the umbilical cord falls off (7-14 days after birth)
false
skin raises as fat accumulates
Drains into the femoral vein
Superficial epigastric
Drains into the femoral vein and parallels inguinal ligament
Superficial circumflex iliac
Drains into the external iliac vein
Inferior epigastric
Drains into the internal thoracic vein
Superior epigastric
Anastomoses between superficial epigastric and lateral thoracic
Thoracoepigastric
Drains into axillary vein
Lateral thoracic
In cases of increased pressure brought about by portal hypertension, your venous drainage system becomes engorged, and patient develops _______
caput medusae
arteries of the anterolateral abdominal wall
Musculophrenic
superior epigastric
10th and 11th posterior intercostal arteries
subcostal
inferior epigastric
deep circumflex iliac
superficial circumflex iliac
superficial epigastric
arteries of the anterolateral abdominal wall branching from internal thoracic artery
Musculophrenic
superior epigastric
arteries of the anterolateral abdominal wall branching from aorta
10th and 11th posterior intercostal arteries
subcostal
arteries of the anterolateral abdominal wall branching from external iliac artery
inferior epigastric
deep circumflex iliac
arteries of the anterolateral abdominal wall branching from femoral artery
superficial circumflex iliac
superficial epigastric
arteries that descend between internal oblique and transversus
10th and 11th posterior intercostal arteries
subcostal
artery that is parallel to the inguinal ligament
deep circumflex iliac artery
arteries inside the rectus sheath
superior epigastric artery
inferior epigatsric artery
Runs in subcutaneous tissue along the inguinal ligament
Superficial circumflex iliac
Runs in subcutaneous tissue toward the umbilicus
Superficial epigastric
lymphatic drainage of the anterolateral abdominal wall (superficial)
axillary lymph nodes
parasternal lymph nodes
superficial inguinal lymph nodes
Superior to the transumbilical plane drain mainly to _____
parasternal lymph nodes
Superficial lymphatic vessels inferior to the transumbilical plane drain to _____
superficial inguinal lymph nodes
superficial lymphatic vessels accompany the subcutaneous veins while the deep lymphatic vessels accompany the deep veins of the abdominal wall
t
drainages of the deep lymphatic vessels of the abdominal wall
External iliac
Common iliac
Right and left lumbar (caval and aortic) lymph nodes
what dermatome is the inguinal ligament
L1
The nerves supplying the muscles of the anterolateral abdominal wall are located in the plane between the transversus abdominis and internal oblique muscles.
t
the nerves of the anterior abdominal wall originate from where in the vertebra?
T7-L1
The skin and muscles of the anterolateral abdominal wall are mainly supplied by:
Thoracic Spinal Nerves (T7–T9 or T10)
Subcostal Nerve (T12)
Iliohypogastric and Ilio-inguinal Nerves (L1)
Terminal branches of the anterior ramus of spinal nerve L1.
Iliohypogastric and Ilio-inguinal Nerves (L1)
Large anterior ramus of spinal nerve T12.
subcostal nerve T12
What nerve has significant importance on the inguinal region rather than on the lateral abdominal wall
Iliohypogastric and Ilio-inguinal Nerves (L1)
Are the distal parts of the anterior rami of T7–T11 and the first lumbar spinal nerve (L1).
clue:nerve
thoraco-abdominal nerves
Enter the subcutaneous tissue along the anterior axillary line
clue: nerve
lateral cutaneous branch
Pierce the rectus sheath to enter the subcutaneous tissue near the median plane.
clue: nerve
Anterior Abdominal Cutaneous Branches
innervation in Skin superior to the umbilicus is supplied by_____
T7-T9
innervation in Skin around umbilicus is supplied by_____
T10
innervation in Skin inferior to the umbilicus is supplied by_____
T11-L1
T11, T12 (subcostal), iliohypogastric, and ilio-inguinal (L1)
The main nerves of the lumbar plexus relevant to the anterior abdominal wall are:
Iliohypogastric Nerve
Ilioinguinal Nerve
Genitofemoral Nerve (including the genital branch)
Lateral Femoral Cutaneous Nerve
NERVES OF ANTEROLATERAL ABDOMINAL WALL:
Thoraco-abdominal (T7–T11)
7th–9th lateral cutaneous branches
Subcostal (anterior ramus of T12)
Iliohypogastric (L1)
Ilio-inguinal (L1)
The internal (posterior) surface of the anterolateral abdominal wall is covered with transversalis fascia, a variable amount of extraperitoneal fat, and parietal peritoneum
t
how many umbilical peritoneal folds
5
the most important peritoneal fold that comes from the urachus
median umbilical cord
Extends from the apex of the urinary bladder to the umbilicus and covers the median umbilical ligament, a fibrous remnant of the urachus that joined the apex of the fetal bladder to the umbilicus
urachus
Lateral to the median umbilical fold, cover the medial umbilical ligaments, formed by occluded parts of the umbilical arteries. (what fold)
medial umbilical cord
Lateral to the medial umbilical folds, cover the inferior epigastric vessels and therefore bleed if cut. (what fold)
lateral umbilical cord
The depressions lateral to the umbilical folds, each of which is a potential site for a hernia. The location of a hernia in one of these fossae determines how the hernia is classified.
peritoneal fossa
what peritoneal fossa:
Between the median and medial umbilical folds, formed as the peritoneum reflects from the anterior abdominal wall onto the bladder.
Supravesical fossae
what peritoneal fossa:
Between the medial and lateral umbilical folds, areas also commonly called inguinal triangles (Hesselbach triangles), which are potential sites for the less common direct inguinal hernias.
Medial inguinal fossae
What peritoneal fossa:
include the deep inguinal rings and are potential sites for the most common type of hernia in the lower abdominal wall, the indirect inguinal hernia
Lateral inguinal fossae
The level of the supravesical fossae rises and falls with filling and emptying of the bladder.
t
what are the peritoneal fossae
Supravesical fossae
medial inguinal fossae
lateral inguinal fossae
sagittally oriented peritoneal reflection in the supraumbilical part of the internal surface of the anterior abdominal wall that extends between the superior anterior abdominal wall and the liver
falciform ligament
round ligament corresponds to what vein
umbilical vein
encloses the round ligament of the liver (ligamentum teres hepatis) and paraumbilical veins in its inferior free edge
falciform ligament
fibrous remnant of the umbilical vein, which passed from the umbilicus to the liver prenatally
round ligament
region that extends between the ASIS (anterior superior iliac spine) and the pubic tubercle
inguinal region or groin
other name for inguinal ligament
poupart’s ligament
dense band constituting the inferior most part of the external oblique aponeurosis
inguinal ligament
Some of the deeper fibers of the inguinal ligament pass posteriorly to attach to the superior pubic ramus, lateral to the pubic tubercle, forming the ____
lacunar ligament
lacunar ligament other name
gimbernat’s ligament
medial boundary of the subinguinal space
lacunar ligament
The most lateral of the inguinal ligament fibers continue to run along the pecten pubis as the ____
Pectineal ligament (of Cooper)
Some of the more superior inguinal ligament fibers fan upward, bypassing the pubic tubercle and crossing the linea alba to blend with the lower fibers of the contralateral external oblique aponeurosis. These fibers form the _____
Reflected inguinal ligament
oblique passage through the lower part of the anterior abdominal wall
inguinal canal
what passes through the inguinal canal in females
round ligament of uterus
what passes through the inguinal canal in males
structures from the testis (spermatic cord)
provide central strength to the area of innate weakness in the body
The inguinal ligament and Iliopubic tract
area of innate weakness in the body
area of myopectineal orifice
______ an opening in the fascia transversalis, 1.3 cm above the inguinal ligament. The margins of the ring give attachment to internal spermatic fascia (or internal covering of the round ligament of the uterus
deep inguinal ring
______ triangular-shaped defect in aponeurosis of external oblique and lies above and medial to pubic tubercle. The margins of the ring (sometimes called crura) give attachment to external spermatic fascia
superficial inguinal ring
The deep ring is the entrance of the inguinal canal.
Superficial or external ring – this is the exit.
t
what inguinal ring is superior to the middle of the inguinal ligament and is lateral to inferior epigastric artery
deep ring
______ a region of weakness where abdominal contents might herniate. Herniation from here contributes to a direct inguinal hernia
hesselbach’s traingle
borders of the hesselbach’s triangle
Inferior border- Inguinal ligament
Medial border - Rectus abdominis muscle
Lateral border- Inferior epigastric vessels
The inguinal canal is naturally collapsed posteriorly
false
anteroposteriorly
what is the posterior wall of the inguinal canal on the lateral 3rd
transversalis
what is the posterior wall of the inguinal canal on the medial 3rd
inguinal falx or conjoint tendon
failure in the growth or descent of the testis
cryptorchidism
layers of the scrotum
Skin
Superficial fascia
External spermatic fascia - comes from the external oblique
Cremasteric fascia - comes from the internal oblique
Internal spermatic fascia
Transversalis fascia
Tunica vaginalis
in your scrotum:
There is no delineation between the fatty and membranous layer. It is continuous and becomes one
t
approximately 45 cm long and conveys sperm from the epididymis to the ejaculatory duct
vas/ductus deferens
Artery of the ductus deferens arising from?
inferior vesical artery
Artery of the cremasteric artery arising from?
inferior epigastric artery
Artery of the testicular artery arising from?
aorta
around 12 veins, and the veins of each plexus converge superiorly as the right or left testicular veins
Pampiniform venous plexus
innervation of the cremaster muscle
Genital branch of the genitofemoral nerve
failure of the obliteration of your processus vaginalis
Processus vaginalis vestige
Processus vaginalis vestige leads to indirect inguinal hernia
t
Outpouching of the anterior abdominal wall and contains the testes, epididymis and lower end of the spermatic cords.
scrotum
Paired gonad responsible for the production of spermatozoa and testosterone
testes
Normal spermatogenesis occurs only at the temperature lower than that of the abdominal cavity, that’s why the testes ascends into the pubic region
false
decsend into the scrotum
the outer fibrous capsule of the testes
tunica albuginea
lymphatic drainage for testes and epididymis
Paraaortic lymph nodes
artery for testes and epididymis
testicular artery
innervates the base of the penis and upper scrotum
ilioinguinal nerves
innervates mon pubis and the labia majora
ilioinguinal nerves
innervation of the scrotum
4 answer
ilioinguinal nerves
iliohypogastric nerves
genitofemoral nerves
lateral femoral cutaneous nerves
nerves of the scrotum that Courses along the anterior surface of the psoas muscle
genitofemoral nerves
which branch of the genitofemoral nerve passes posterior to the inguinal ligament, sensory nerve that supplies skin of the upper anterior thigh
femoral
which branch of the genitofemoral nerve passes through the deep inguinal ring to enter the inguinal canal and exits at the superficial ring
genital branch of the genitofemoral nerve
innervates cremaster muscle and terminates at the skin of the upper anterior scrotum
genitofemoral nerves
which nerves in females that accompanies the round ligament
genitofemoral nerves
STRUCTURES TO AVOID DURING SURGERY OF INGUINAL HERNIAS
triangle of doom
triangle of pain
circle of death
this area to be avoided during surgery contains:
External iliac vessels
Deep circumflex iliac vein
Femoral nerve
Genital branch of the femoral nerve
triangle of doom
lateral border of the triangle of doom
spermatic cord
medial border of the triangle of doom
vas deferens
this area to be avoided during surgery contains:
Lateral femoral cutaneous nerve
Femoral branch of the genitofemoral nerve
Femoral nerve
triangle of pain
Vascular continuation formed by:
Common iliac artery
Internal iliac artery
External iliac artery
Obturator artery
Aberrant obturator artery
Inferior epigastric artery
circle of death
borders of the triangle of pain
iliopubic tract and gonadal vessels
Rectus abdominis can be transected because its muscle fibers run short distances between tendinous intersections and segmental nerves supplying it enter the lateral part of the rectus sheath
t
In surgery, muscles and viscera are retracted away from their neurovascular supply.
false
toward
In abdominal surgery, because of overlapping areas of innervation between nerves, one or two small branches of nerves may usually be cut without a noticeable loss of motor supply to the muscles or loss of sensation to the skin
t
what incision:
Useful for open cholecystectomy
R subcostal incision
RUQ
~3 cm below and parallel to the costal margin
kocher incision
Useful for liver transplantation, duodenal surgeries, and adrenalectomy
Extension of the Kocher incision to cross the midline, thereby involving the other side of the abdomen
Chevron (Rooftop) incision
Useful for liver transplantation
Combination of Chevron and sternotomy
mercedez benz incision
Most common access to the abdomen
Sometimes:
Supraumbilical
Infraumbilical
Midline Laparotomy incision (Intra-Abdominal Access)
~2–3 cm left or right of midline
Sometimes used in cases wherein there is previous abdominal surgery
Paramedian incision (Intra-Abdominal Access)
incision laterla to rectus abdominis
pararectus incision
Useful for Stoma Closure/Formation:
Colostomy
Ileostomy
A portion of bowel is externalized
transverse incision
Useful for open appendectomy
Gridiron incision
Lanz incision
Along with Gridiron and Lanz incisions, they are variations of transverse incision
Pfannenstiel incision (Bikini Cut)
Caused by a weakening of the abdominal muscles; protrudes to the Hesslebach’s triangle
direct inguinal hernia
Caused by the incomplete closure of the processus vaginalis, an outpouching of the peritoneum
indirect inguinal hernia
Most common type of hernia for both genders but femoral Hernia is more common in females than in males
indirect inguinal hernia
unilateral hernia
indirect inguinal hernia
oval hernia
indirect inguinal hernia
hernia common in young
indirect inguinal hernia
hernia that can reach the scrotum
indirect inguinal hernia
hernia that is downwards, forwards, medially
indirect inguinal hernia
hernia that is lateral to the inferior epigastric artery
indirect inguinal hernia
hernia that will cause an impulse on the tip of the finger during superficial inguinal ring test
indirect inguinal hernia
hernia common in old
direct inguinal hernia
hernia usually bilateral
direct inguinal hernia
hemispherical hernia
direct inguinal hernia
hernia that never reaches the scrotum
direct inguinal hernia
hernia that is forwards
direct inguinal hernia
hernia that the reduction is backward
direct inguinal hernia
hernia that is medial to the inferior epigastric artery
direct inguinal hernia
hernia that will cause an impulse on the side of the finger during superficial inguinal ring test
direct inguinal hernia
different phases of hernia
reducible
incarcerated
strangulated
which phase:
Hernia that can be pushed back into the abdominal cavity when pressure is applied
reducible
which phase:
When tissue becomes trapped in a hernia and can’t be pushed back into place
incarcerated
which phase:
Occurs when tissue from the abdomen becomes trapped in a hernia and its blood supply is cut off; Surgical Emergency
strangulated
origin of the femoral hernia
femoral ring
Femoral hernias are more common in females, largely due to
their wider pelves and smaller inguinal canals and rings
The femoral hernia is bounded laterally by _____and medially by _____
femoral vein; lacunar ligament
why is strangulated hernia an emergency
can cause necrosis
where is the femoral hernia located in relation to the inguinal area
inferior
pregnancy increases risk of femoral hernia
t
