Abdominal Wall Flashcards
Superior: diaphragm
Posterior: lumbar vertebrae and muscles
Lateral and anterior: abdominal muscles
Inferior: pelvic inlet - form sacral promontory to pubic symphysis along the pectineal line
Structures Between Thorax and Pelvis
What is the vertebral level of the renal artery, L diaphragm crus attachment (renal artery can be higher)
L2
Which plane is located on the L3 vertebral level?
a) . subcostal plane - 12th rib, inferior mesenteric arteries
b) . transpyloric plane- 1st part of the duodenum, 8thh intercostal space, superior mesenteric artery
c) . supracristal plane- umbilicus, abdominal aorta divides into R/L common illiac arteries
d) . intertubercular plane- IVC formed by R/L common veins
Name the 4 quadrants of the abdominal wall?
R Upper quadrant: liver duodenum
L Upper quadrant: stomach
R Lower quadrant: cecum and ascending colon **Mcburney’s point- appendix referral pain
L Lower quadrant: descending and sigmoid colon
What region is medial to the R and L lumbar/flank region?
a) .umbilic
b) .epigastric
c) .hypogastric/pubic
What is the nerve innervation of the posterior abdominal wall?
dorsal rami of spinal nerves
What is the nerve innervation of the lateral abdominal wall?
intercostal nerve- lateral cutaneous branch T6/T7 lateral cutaneous branch impingement by serratus anterior 2/2 shoulder problems.
What is the nerve innervation of the anterior wall of the abdomen?
intercostal nerve- anterior cutaneous branch
If a patient was injured and served T9 spinal nerves what vertebral level would lose sensation or have numbness and tingling?
a) . L3
b) . L2
c) . L1
T9 spinal root is at what vertebral level?
L3
What is the blood supply for the lateral wall of the abdomen?
posterior intercostal vessels
Superior and inferior epigastric vessels deep and superficial circumflex iliac artery is blood supply for the ________ abdominal wall
Clincial importance:
portal hypertension: caput-medusae
Anterior
Skin Fatty Layer (Camper's) Membranous layer (Scarpa's) External Oblique Internal Oblique Transversus abdomonis Transversalais fascia Extraperitoneal fascia Parietal peritoneum
The 9 layers of the anterolateral abdominal wall
Clinical importance: testis descending, and herniation will ______ through the anterolateral abdominal layers of structures
push
External surface of 5th-12th ribs
Attaches to the iliac crest, linea alba, pubic tubercle, folds to form inguinal ligament
Function: compression of the abdominal cavity, stabilization of the pelvis ipsilateral SB, contralateral RT (L/R), trunk FLX (B)
Innervation: Intercostal nerves (T7-T12 )
a) .Internal oblique
b) .Transverse abdominis
c) .External oblique
d) .Rectus abdominis
The inferior border of 10th-12th ribs, thoracolumbar fascia
Attaches to the linea alba, anterior 2/3 iliac crest
Function: Core to support abdominal contents, and stabilize pelvis; ipsilateral SB and RT (L/R), trunk FLX elevates testes
Intercostal nerves T7-T12 and 2 branches of L1
iliohypogastric: internal oblique ilioinguinal: cremaster part
like the pair of external and internal intercostal
a) .Internal oblique
b) .Transverse abdominis
c) .External oblique
d) .Rectus abdominis
Core muscles
intercostal nerves running between transverses abdominis and internal oblique
a) .Internal oblique
b) .Transverse abdominis
c) .External oblique
d) .Rectus abdominis
6 pack muscles
Distal attachment narrows down and forms a weak point on the anterior abdominal wall
a) .Internal oblique
b) .Transverse abdominis
c) .External oblique
d) .Rectus abdominis
A fusion of the aponeurosis creates the ______ and happens at the_______
rectus sheath and linea alba
internal/external oblique + transverse abdominis
All 3 abdominal muscles of aponeurosis are superficial to the rectus abdominis. Does this occur below or above the arcuate line?
Below
trans
subs
super
intratarbercula
The supracristal plane lies at the ________
iliac crest, umbilicus, abdominal aorta divides into R/L common iliac arteries
L4 vertebral level
The midline of the aponeurosis fiber exchange
Linea alba
Intermuscular exchange from superficial to deep
Between opposite external and internal oblique
landmark of development, completed in 3rd week of gestation
nutrients and oxygen exchange with mother’s blood
Placenta
Within the foramen ovale _______ may not fully close
fossa ovalis
What happens when there is an issue with the epigastric veins to IVC or SVC if IVC has problems too?
a) . portal hypertension; caput-medusae
b) . esophageal varices
c) . internal hemorrhoids
External oblique aponeurosis: as a scaffold, distal part forms a superficial inguinal ring
Internal oblique muscle slip: cover inner structures cremaster muscles
Transverse abdominis: deep inguinal rings (spermatic/duct vessels in males, ligament teres in females)
Layers of of inguinal canal
Most common abdominal hernia (3/4)
Abdominal contents enter the scrotum in males and the groin in females
occurs at deep inguinal ring
Indirect inguinal hernia
weakness of the abdominal wall at Hesselbach’s (inguinal) triangle
Abdominal contents never enter the scrotum
can sometimes be predisposed
direct inguinal hernia
Internal organs push outward when intra-abdominal pressure increases but return after
worsens with increasing intra-abdominal pressure
Diastasis recti
Anterior layer: internal oblique
Middle layer: quadrates lumborum
Posterior layer: erector spinae/extrinsic back muscles
Anterior layer: internal oblique
Middle layer: quadrates lumborum
Posterior layer: erector spinae/extrinsic back muscles
Thoracolumbar fascia
What are the posterior core muscles?
Multifdi psaos major (possible)
Too much: hyperlordosis results in over stretch of the _______________, resulting in weakness
transverse abdominis
What is McBureny’s point and what quadrant is it in?
appendix pain; R lower quadrant
