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DPT Anatomy > Abdominal wall > Flashcards

Abdominal wall Flashcards

1
Q

What are the boundaries of the abdomen?

A

between thorax and pelvis

superior: diaphragm
posterior: lumbar vertebrae and muscles
lateral and anterior: abdominal muscles
inferior: pelvic inlet - from sacral promontory to pubic symphysis along pectineal line

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2
Q

What internal structure correlates with T8?

A

inferior vena cava opening

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3
Q

What internal structure correlates with T10?

A

esophageal hiatus

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4
Q

What internal structure correlates with T12?

A

aortic hiatus - abdominal aorta and celiac trunk

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5
Q

What internal structure correlates with L1?

A

transphyloric plane: 1st part of duodenum, 8th intercostal space, superior mesenteric artery

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6
Q

What internal structure correlates with L2?

A

renal artery (sometimes found at L1) and L diaphragm crus attachment

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7
Q

What internal structure correlates with L3?

A

subcostal plane: 12th rib, inferior mesenteric arteries

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8
Q

What internal structure correlates with L4?

A

supracristal plane, umbilicus, abdominal aorta divides into R/L common iliac arteries

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9
Q

What internal structure correlates with L5?

A

intertubercular plane, IVC formed by R/L common iliac veins

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10
Q

which two planes make up the borders of the quadrants?

A

median sagittal plane: xiphoid process and pubic symphysis
(vertical)

transumbilical plane
(horizontal across belly button)

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11
Q

which structures are found in the right upper quadrant?

A

liver

duodenum

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12
Q

which structure is found in the left upper quadrant?

A

stomach

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13
Q

which structures are found in the right lower quadrant?

A

cecum
ascending colon
appendix

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14
Q

which structures are found in the left lower quadrant?

A

descending colon

sigmoid colon

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15
Q

what is McBurney’s point?

A

appendix referral pain

aka appendicitis

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16
Q

which planes make up the 9 abdominal regions?

A

mid-clavicular plane (x2): mid clavicle and mid inguinal ligament
(two vertical planes)

subcostal (L3) or transpyloric (L1) plane
(top horizontal plane)

intertubercular plane (L5)
(lower horizontal plane)
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17
Q

what are the 9 abdominal regions?

A 
right hypochondrium
epigastric
left hypochondrium
right lumbar/flank
umbilical
left lumbar/flank
right inguinal/groin
pubic
left inguinal/groin
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18
Q

what are the posterior, lateral, and anterior innervations of the abdominal wall?

A

posterior: dorsal rami of spinal nerves
lateral: intercostal nerve & lateral cutaneous branch
anterior: intercostal nerve & anterior cutaneous branch

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19
Q

which muscle causes T6/T7 lateral cutaneous branch impingement and what happens because of it?

A

serratus anterior

causes shoulder problems

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20
Q

which landmark is at T6 dermatome?

A

xiphoid process

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21
Q

which landmark is at T10 dermatome?

A

umbilicus

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22
Q

which landmark is at T12 dermatome?

A

ASIS

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23
Q

What is the relationship between innervation and the spinal nerve in the abdomen dermatome?

A

the innervation does not correlate with the spinal nerve exiting level from spinal cord in the lower part due to the spinal cord stopping at T12-L2.

Example: T9 spinal nerve is innervated at the L3 vertebral level

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24
Q

What is the lateral blood supply for the anterolateral abdominal wall?

A

posterior intercostal vessels

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25
Q

what is the anterior blood supply for the anterolateral abdominal wall?

A

superior and inferior epigastric vessels

deep and superficial circumflex iliac artery

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26
Q

when there is an abdominal aorta malfunction, where do the lower extremities get blood supply from?

A

superior epigastric artery

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27
Q

when there is an inferior vena cava malfunction, where do lower extremities get their blood supply from?

A

blood can drain back to the superior vena cava

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28
Q

what is caput medusae?

A

portal hypertension
a cluster of swollen veins in your abdomen that stem from around the belly button.
this indicates a circulatory problem usually associated with liver disease

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29
Q

what are the 9 layers of the anterolateral abdominal wall? superficial to deep

A 
skin
superficial fascia:
- fatty layer (Camper's)
- membranous layer (scarpa's)
external oblique muscle
internal oblique muscle
transversus abdominis muscle
transversalis fascia
extraperitoneal fascia
parietal peritoneum
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30
Q

what is the clinical importance of the layers of the abdominal wall?

A

testis descending and herniation will push through different layers of structures

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31
Q

what direction do the external oblique muscles run?

A

superolateral to medio-inferior

“hands in pockets”

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32
Q

what direction does the internal oblique muscles run?

A

opposite of external oblique muscle

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33
Q

what are the two branches of L1 nerve and their parts?

A

iliohypogastric: internal oblique
ilioinguinal: cremaster part

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34
Q

what kind of muscle is the transversus abdominis?

A

a core muscle

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35
Q

between which muscle layers do the intercostal nerves run?

A

between transversus abdominis and internal oblique

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36
Q

what distal attachment narrows down and forms a weak point on the anterior abdominal wall?

A

pyramidalis

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37
Q

what is the function of the rectus sheath?

A

it protects and keeps together the rectus abdominis and pyramidalis.
the rectus abdominis is wrapped by aponeurosis of the 3 abdominal muscles

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38
Q

where is the arcuate line located?

A

~1/3 distance of umbilicus to pubic symphysis of posterior rectus abdominis

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39
Q

what structures are above the arcuate line?

A

superficial to rectus: aponeurosis of external oblique
half aponeurosis of internal oblique

deep to rectus: half aponeurosis of internal oblique
aponeurosis of transversus abdominis

40
Q

what are the structures below the arcuate line?

A

superficial to rectus: all aponeurosis of 3 layers of muscles

deep to rectus: none - weakness of abdominal wall

41
Q

what is aponeurosis fiber crossing and what is its function?

A

weaving of superficial and deep layers of same aponeurosis

function: improves strength and functions

42
Q

what happens between two of the same layer obliques crossing?

A

intramuscular exchange, from superficial to deep

43
Q

what happens between opposite external and internal oblique fiber crossing?

A

intermuscular exchange, from superficial to deep

the two different layers intertwine

44
Q

what is the linea alba in relation to fiber crossing?

A

the midline of the aponeurosis fiber exchange

45
Q

what are the umbilical folds/ligaments in order of lateral to medial?

A

lateral: inferior epigastric vessels
medial: remnant umbilical artery
median: remnant allantois (urachus), from umbilicus to suspend urinary bladder

46
Q

what are the borders of Hesselbach’s triangle (inguinal triangle)?

A

lateral: medial of lateral umbilical fold
inferior: inguinal ligament
medial: lateral rectus abdominis

47
Q

what is the placenta?

A

landmark of development completed in the 3rd week of gestation
- nutrients and oxygen exchange with mother’s blood occurs here

48
Q

Do the placenta and embryo have direct contact?

A

No!

embryo does not have direct contact with the placenta of the mother

49
Q

does the fetus always have the same blood type as mother?

A

No!

because there is no direct contact, the fetus can have a different blood type

50
Q

how is the fetus and placenta connected if there is no direct contact?

A

through the umbilical cord

  • blood vessels/urachus
  • remnant structures after birth
51
Q

what do the umbilical arteries turn into after birth?

A

2 medial umbilical ligaments/folds –> not fully remnant (with 2 branches)

52
Q

where do the umbilical arteries run to?

A

2 internal iliac arteries to placenta

53
Q

what does the umbilical vein turn into after birth?

A

ligament teres and ligamentum venosum

54
Q

where does the umbilical vein run to?

A

to liver and continue to inferior vena cava (ductus venosus)

55
Q

what does the allantois turn into after birth?

A

median umbilical ligament/fold

56
Q

what is the function of the allantois?

A

fetal urine drainage

57
Q

what does the foramen ovale turn into after birth?

A

fossa ovalis

58
Q

where is the foramen ovale located?

A

opening between right and left atrium

59
Q

what does the ductus arteriosus turn into after birth?

A

ligamentum arteriosum

60
Q

what does the ductus arteriosus bridge?

A

bridging blood vessel between aorta and pulmonary trunk

61
Q

what is internal hemorrhoids?

A

anastomosis with rectal vein to IVC

painless

62
Q

what is esophageal varices?

A

anastomosis of portal vein branches to esophageal veins to SVC

63
Q

what is caput medusae?

A

anastomosis with epigastric veins to IVC or SVC if IVC has problems

64
Q

what happens after birth in caput medusae?

A

paraumbilical veins are close after birth.

this re-opens in portal hypertension

65
Q

what is the inguinal ligament formed by?

A

external oblique aponeurosis
ASIS
pubic tubercle

66
Q

what are the layers of inguinal canal?

A

external oblique aponeurosis as scaffold
internal oblique muscle slip
transversus abdominis

67
Q

what part of the inguinal canal is the external oblique aponeurosis?

A

distal part forming superficial inguinal ring

68
Q

what does the internal oblique muscle slip do?

A

cover inner structures

cremaster muscle

69
Q

what structure comes out of he transversus abdominis?

A

deep inguinal ring (spermatic duct/vessels in males, ligament teres in females)

70
Q

what is the sensory innervation for the inguinal canal?

A

ilioinguinal nerve

71
Q

what is the motor innervation for the inguinal canal?

A

genital branch of genitofemoral nerve

72
Q

where does an indirect hernia happen?

A

at the deep inguinal ring

73
Q

where does a direct inguinal hernia happen?

A

superficial inguinal ring

74
Q

does the abdominal contents enter the scrotum in indirect inguinal hernia?

A

yes, abdominal contents enter the scrotum in the males and into groin in females

75
Q

does abdominal contents enter the scrotum in direct inguinal hernia?

A

no, abdominal contents never enter the scrotum

76
Q

what is the most common abdominal hernia?

A

indirect inguinal hernia (75%)

77
Q

how does on get an indirect inguinal hernia?

A

can be congenital or acquired

78
Q

how does one get a direct inguinal hernia?

A

all acquired but can be predisposed

79
Q

where does a direct hernia have weakness?

A

weakness of abdominal wall at Hesselbach’s (inguinal) triangle

80
Q

what is an umbilical hernia?

A

abnormal closure after birth

81
Q

what is a post-surgical/incisional hernia?

A

happens mainly after laparotomy/laparoscopy

artificially weakened anterior abdominal wall

82
Q

what is a diastasis recti?

A

separation of linea alba

generally not a hernia but internal organs can push outward when intra-abdominal pressure increases

83
Q

who does diastasis recti normally happen to?

A

happens equally in both genders

can happen to pregnant women

84
Q

what worsens diastasis recti?

A

increasing intra-abdominal pressure

85
Q

what are the layers of the thoracolumbar fascia?

A

anterior layer: internal oblique, transversus abdominis
middle layer: quadratus lumborum
posterior layer: erector spinae/extrinsic back muscles

86
Q

how are the arcuate ligaments formed?

A

by tendinous structures of diaphragm, wrapping muscles and aorta

87
Q

where is the median arcuate ligament located?

A

aortic hiatus - abdominal aorta

88
Q

what is median arcuate ligament syndrome?

A

compression of aorta

which causes pain around stomach and leads to being afraid of eating

89
Q

where is the medial arcuate ligament located?

A

psoas major

90
Q

where is the lateral arcuate ligament located?

A

quadratus lumborum

91
Q

what are the three arcuate ligaments?

A

median, medial, lateral

– compare to abdominal folds in anterior wall

92
Q

where do the ventral rami L1-L4 exit?

A

between quadratus lumborum and psoas major

93
Q

what is the anterior core muscle?

A

transversus abdominis - active all the time without activity specificity

94
Q

what is the posterior core muscle?

A

multifidi - possible contribution of psoas major

95
Q

what does proximal stability mean?

A

if your core is stable, movement in your distal joints are better. Thus, if you have good stability, you’re less likely to be injured

96
Q

what is hyperlordosis?

A

too much lumbar lordosis

- over stretch transversus abdominis, resulting in weakness

97
Q

what is flat back?

A

too little lumbar lordosis

- compromised shock absorption through the back

DPT Anatomy (8 decks)

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