Abdominal planes, regions and walls Flashcards
Transpyloric plane
L1
Subcostal plane
10th costal cartilage
Transumbilical plane
L3/4
Interspinous plane
Line of iliac spines
Supra-cristal plane
L4
Trans-tuberculae plane
L5
Transpyloric plane
- Midway between superior borders of manubrium of sternum and pubic symphysis at L1 vertebra - hands width below xiphisternum
- Commonly transects pylorus, fundus of gallbladder, pancreatic neck, origins of superior mesenteric artery and hepatic portal vein, root of transverse colon, duodenojejunal junction and hila of kidneys
Tissue layers of abdominal wall
- Skin
- Subcutaneous tissue - Camper’s fascia (loose superficial fatty fascial layer) and Scarpa’s fascia (deep membranous fascial layer)
- Deep fascia
- External oblique and aponeurosis
- Internal oblique and aponeurosis
- Transverse abdominis and aponeurosis
- Endoabdominal (transversalis) fascia
- Extraperitoneal fat
- Parietal peritoneum
Why do muscles run in different directions?
Strength and support
What is the tendinous intersection
Where muscles split into sections - rectus abdomens
Linea alba
Aponeurosis wraps around muscle and meets in midline
Above umbilicus
- Rectus abdominis
- Rectus sheath
- Skin
- Internal oblique + aponeurosis
- External oblique aponeurosis
- Subcutaneous tissue
- External oblique
- Internal oblique
- Transversalis abdominis
- Transversalis fascia
- Parietalo peritoneum
- Aponeurosis of transversus abdominis
Below umbilicus
- Parietal peritoneum
- Extraperitoneal fat
- Transversalis fascia
- Membranous layer
- Fatty layer
- Rectus sheath
- Linea alba
Neurovascular contents
- Superior and inferior epigastric vessels
- Rectus sheath = neurovascular + fascias
- External aponeurosis is free - from iliac spine to pubic tubercle
- Aponeurosis from AIIS to pubic tuberlce is inguinal ligament
- Inguinal hernia in inguinal ligament
- Cutting open anterolateral abdominal wall = peritoneal folds - covers inferior epigastric vessels
Rectus sheath
Neurovascular bundle + fibres
Falciform ligament
from umbilicus to liver, encloses round ligament, remnant of umbilical vein and paraumbilical veins
Umbilical peritoneal folds
- Median umbilical fold: covers medial umbilical ligament (remnant of urachus)
- Two medial umbilical folds: cover medial umbilical ligament which are occluded parts of umbilical arteries
- Two lateral umbilical folds: covers inferior epigastric vessels
Peritoneal fossa
- Supravesical fossae: between median and medial umbilical folds
- Lateral inguinal fossae: lateral to lateral umbilical folds, contain deep inguinal rings (common site for indirect hernia)
- Medial inguinal fossa: bounded laterally by inferior epigastric vessels (lateral umbilical fold), medially by lateral edge of rectus abdominis and inferiorly by inguinal ligament
Nerve supply of abdominal wall
- Cutaneous from lower thoracic spinal nerves (T7-11)
- Subcostal nerve from anterior ramus of T12
- Terminal branches of anterior ramus of lumbar spinal nerve (L1): iliohypogastric and ilio-inguinal nerves
Undescended testes
cryptorchidism and is normally unilateral, undescended testis is in inguinal canal
External supravesical hernia
medial to site for direct inguinal hernia - iliohypogastric nerve is in danger of injury during repair
Inguinal hernia
direct = acquired and indirect = congenital
Pain in right hypochondriac region
Liver, gallbladder, r kidney, small intestine
Pain in epigastric region
Stomach, liver, pancreas, duodenum, spleen, adrenal glands
