Abdominal Organization : Part I Flashcards
umbilicus level
LV3/Lv4
xiphoid process
TV10
What are the 9 quadrants? what lines divide them?
subcostal plane: LV3
Transtubercal plane LV5
MCL’s
R/Lt hypochondrium, epigastric
R/L flank/lateral region, umbilical
R/L inguial/groin, pubic
how do you divide the quadrants?
midsagittal plane
transumbilical plane (LV3/4)
organs located in RUQ
right love of liver
gallbladder
pylorus of stomach
duodenuma: parts 1-3
head of pancreas
rt. kidney
superior portion of ascending colon
organs locate din LUQ
left lobe of liver
spleen
stomach
jejunum and proximal ileum
body and tail of pancreasleft kidney
left half of transverse colon
descending colon superior portion
RLQ
- cecum
- appendix
- most of ileum
- ascending colon: inferior part
- right ovary
- right uterine tube
- right ureter
- right spermatic cord
- uterus
- urinary bladder if very full
LLQ
- sigmoid colon
- descending colon: inferior part
- left ovary
- left uterine tube
- left ureter: abdominal part
- lefts spermatic cord
- uterus if enlarged
- urinary bladder if very full
transpyloric plane
LV1
through stomach
subcoastal plane
under ribs
LV3
transumbilical plane
LV3/4
supracristal
LV4
highest point of illiac crest: stay below for lumbar punctures
transtubercular plane
LV5
through tubercles of iliac crest
interspinous plane
SV1
through ASIS
layers of anterolateral abominal wall
- skin
- superficial fatty fascia layer (camper’s fascia)
- deep memmbranous fascial layer (Scarpa’s fascia)
- external oblique
- internal oblique
- transverse abdominus muscle
- transversalis fascia
- extraperitoneal fat (subserous fascia)
- parietal peritoneum
superficial fascia of abdominal wall
- Campers fascia
- Scarpa’s fascia
- continous with Colle’s and Dartos fascia of perineum
- attaches to iliac crest, fascia lata below inguinal ligmaent and pubic tubercle
- the fundiform ligament is a specialization of Scarpa’s Fascia (a sling for the penis, from the pubic bone)
Deeper fascias of abdominal wall
- Transversalis fascia: lines all of abdominoplevic cavity; deep to muscle layer
- subserous fascia: loose, fatty CT between transversalis fascia and peritoneum
- parietal peritoneum: serous membrane which lines the abdonimopelvic cavity
external abdominal oblique muscle
Origin: Outer surfaces of ribs 5-12
I: anterior iliac crest; via external abdominal oblique aponeurosis attaches to linea alba from xiphoid process to pubic symphysis
A: flexion of vertebral column and pelvis; compression and support of abdominal viscera; one side acting alone causes lateral flexion of trunk, and rotation to opposite side (torsional mvmt of trunk)
N: intercostal, subcostal, iliohypogastric nn.
internal abdominal oblique. what do inferior fibers compose?
O: thoracolumbar fascia; anterior iliac crest; lateral inguinal ligament
I: inferior borders of ribs 9-12; via internal abdonominal oblique aponeurosis to linea alba from xiphoid process to pubic symphysis
A: flexion of vertebral column and pelvis; compression and support of abdominal viscera; one side acting alone causes lateral flexion and rotation of same side (torsional movment of trunk)
N: intercostal, subcostal, iliohypogastric, ilioinguinal nn.
NOTE: inferior fibers of IAO give rise to the cremaster muscle which plays an important role in temperature regulation of testes
Transversus abdominus muscle
O: inner surface of ribs 7-12; thoracolumbar fascia; anterior iliac crest; lateral inguinal ligament
I: via aponeurosis to linea alba
A: compression and support of abdominal viscera
N: intercostal, subcostal, iliohypogastric, ilioinguinal nn
Rectus abdominus muscle
O: pubic symphysis and pubic crest
I: costal cartilages 5-7, xiphoid process
A: flexion of vertebral column and pelvis
N: ventral rami T6-12 (intercostal, subcostal nn)
NOTE: tendinous intersections: 3-4: attachments of rectus abdominis to rectus sheath
Pyrimidalis:
O: pubic bone, anterior to rectus abdominis
I: linea alba
A: tenses linea alba
N: subcostal n.
Rectus Sheath: arcuate line, linea alba, linea semilunaris
- fascia surrounding rectus abdominis and pyramidalis; formed from decussation of external/internal abdominal oblique and transversus abdominis aponeurosis
- composition changes midway between umbilicus and pubic symphysis at the arcuate line
- above arcuate line: anterior layer: is external/internal abdominial oblique aponeuroses, posterior layer is transversus abdominus aponeurosis
- below arcuate line: all 3 layers pass anterior to rectus abdominis
- linea alba: midline site of attachment of aponeuroses: runs from xiphoid process to pubic symphisis
- linea semilunaris: lateral, fused border of rectus sheath
5 folds/ligaments?
- Median umbilical fold: runs from apex of bladder to umbilicus (median umbilical ligament/urachus found here)
2/3. Medial umbilical folds: run towards umbilicus: medial umbilical ligaments (occluded portion of umbilical aa. found within the folds)
4/5. lateral umbilical folds: contain the inferior epigastric aa.
anterolateral abdomina wall hernias
“ventral hernias” due to weakness in rectus sheath
- umbilical hernia
- linea alba hernia
- linea semilunaris hernia
- incisional hernia
dermatomes
(T7-11) = abdomen
T6: xiphoid process
T10: umbilicus
L1: inguinal region; anterior scrotum, labia (iliac crest, ASIS, inguinal region)
- iliohypogastric n, ilioninguinal n.
Fossae of abdominal wall
- supravesical fossa: betwen median and medial umbilical folds
* site of supravesical hernias - medial inguinal fossa: between medial and lateral folds
* direct inguinal hernias - lateral inguinal fossa: area lateral to lateral umbilical fold
* indirect inguinal hernia
superficial abdominal wall innervation?
intercostal nn. (anterior and lateral branches) T7-11
subcostal n. T12
iliohypogastric n L1
ilioinguinal n L1
where are nerves located?
- nerves course between transversus abdominis and internal oblique
- thoracoabdominal and subcostal nn provide lateral cutaneous branches and terminate anteriorly as cutaneous branches
iliohypogastric and ilioinguinal nn pierce internal oblique near the ASIS, run between the internal and external oblique, then terminate as anterior branches
superficial aa. of abdominal wall
- mostly perforating branches of deeper arteries
- superficial epigastric a, and superficial circumflex iliac a. (branches from femoral a.)
deep arteries
- musculophrenic a. (terminal branch of internal thoracic a.)
- superior epigastric a. (terminal branche of internal thoracic a.)
- runs between rectus abdominis and posterior layer of rectus sheath
- anastomoses with inferior epigastric a. in region of umbilicus
- inferior epigastric a. (branch of external iliac a. given off medial to deep inguinal ring)
- ascneds along anterior body wall, inside lateral umbilical fold
- pierces posterior layer of rectus sheath to anastamose with superior epigastric a.
4/5: posterior intercostal and subcostal aa. (b/w internal abdominal and transversus abdominus muscles)
- lumbar a.
- deep circumflex iliac. a.
Where do superficial veins drain?
lateral thoracic vein –> axillary vein
musculophrenic/superior epigastric vv. –> internal thoracic v.
superficial epigastric and superficial circumflex iliac v –> femoral v.
where do deep veins drain?
musculophrenic/superior epigastric v –> internal thoracic v.
inferior epigastric/deep circumflex iliac vv –> external iliac v.
lumbar vv –> IVC
posterior intercostal/subcostal vv. –> azygos vein
Where do superficial lymphatics drain?
superior to transumbilical plane –> axillary nodes
inferior to transumbilical plane –> superfiical inguinal lymph nodes
What are ligaments of inguinal region? what do they reinforce?
- inguinal ligament, iliopubic tract
- these ligaments reinforce the myopectineal orifice: an area of weakness, where three most common hernias occur
inguinal ligament? three specializations?
inferior, “rolled under” portion of external oblique aponeurosis
Specializations:
- lacunar ligament: medial fibers of inguinal ligament which attach lateral to pubic tubercle; crescent-shaped ligament which forms medial border of femoral canal
- pectineal ligament: lateral continuation of lacunar ligament attaching to pectineal line of superior pubic ramus
- reflected ligament: continuation of superiomedial fibers of inguinal ligament which atach to linea alba
how does inguinal canal form?
- during gonadal descent from abdomen to scrotum (or labia)
- gubernaculum = thick ligament attaching testes to anterior body wall at furutre site of deep inguinal ring
deep inguinal ring
- site of indirect hernias
- entrance to inguinal canal from abdominal cavity
- formed as an evagination of transversalis fascia
- located lateral to inferior epigastric aa.
superficial inguinal ring
- site of direct inguinal hernias
- exit from inguinal canal into scrotum or labia majora
- formed from split in fibers of the external abdominal oblique aponeurosis
- lateral crus: attaches to pubic tubercle
- medial crus: attaches to pubic crest
- intercrural fibers: artch between medial/lateral crus
boundaries of inguinal canal/
anterior: external oblique aponeurosis
floor: inguinal ligament
roof: internal oblique and transversus abdominus muscles
posterior: transversalis fascia laterally; reinforced medially by conjoint tendone
Conjoint tendon
- medial reinforcement of posterior part of inguinal canal- composed of the inferior-most fibers of the internal and transversus abdominis muscles
- attaches to the pubic bone posterior to the superficial inguinal opening
- aka “inguinal falx” tendon
what does external abdominal oblique aponeurosis go to form?
external spermatic fascia
what does internal abdominal oblique go to form?
cremaster muscle
contents of inguinal canal?
Male: spermatic cord, ilioinguinal n, genital branch of genitofemoral n.
- contains: ductus deferens, testicular a, artery of ductus deferens, pampiniform plexus of veins, autonomic and lymphatics of testes
female: - round ligament of utuerus, ilioinguinal n. genital branch of genitofemoral n.
what covers the testes/spermatic cord?
skin
dartos fascia: superficial fascia of abdominal wall
external spermatic fascia = external oblique aponeurosis
cremaster muscle/fascia = internal abdominal oblique muscle
internal spermatic fascia = transversalis fascia
tunica vaginalis = evagination of peritoneum (processus vaginalis) - forms around serous cavity of testes
indirect hernia
*** through superficial ring****
2/3 of all inguinal hernias: more common in males on rt. side
- congenital, caused by failure of proximal processus vaginalis to close
- occur in lateral inguinal fossa; lateral to inferior epigastric vessels
Direct Hernia
*** superficial inguinal ring***
- more common in males: 1/3 of cases
aquired; caused by a weakness in atnerior body wal posterior to superficial inguinal ring
- conjoint tendon provides a natural protection against direct hernias
occurs in medial inguinal fossa (Hesselbach’s triangle); medial to inferior epigastric vessles
