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Anatomy > Abdominal Wall > Flashcards

Abdominal Wall Flashcards

1
Q

What are the 9 layers of the anterior abdominal wall (not accounting for sheaths & aponeuroses)?

A

1 = Skin
2 = Camper’s fascia (Superficial fascia - fatty layer)
3 = Scarpa’s fascia (Superficial fascia - membranous layer)
4 = External oblique muscle
5 = Internal oblique muscle
6 = Transversus abdominus muscle
7 = Transversalis fascia
8 = Peritoneal fat
9 = Peritoneum

Rectus abdominus with tendinous intersections = enclosed by rectus sheath (also around pyramidalis muscles) = so has posterior (behind) & anterior (front) aspects

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2
Q

What is the camper’s fascia made of?

A

Adipose tissue (fatty tissue) - continuous with thigh fascia
-M = continues to penis & scrotum
-F = part of labia majora

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3
Q

What is the Scarpa’s fascia?

A

Membranous - continuous w/ dartos muscle of
scrotum

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4
Q

Label rectus abdominus & internal & external oblique muscles.

A
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5
Q

Role of the abdominal muscles?

A

Mobility & expansion
–> pregnancy, movement (rotation), structure, posture, coughing, protection/support (of abdominal viscera), eaten big meal, expiration, vomiting
- Inc. abdominal pressure for birth, defecation, urination

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6
Q

How is intraabdominal pressure changed by the anterolateral muscles?

A

Compress abdominal viscera

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7
Q

How do abdominal muscles assist with expiration, coughing & vomiting?

A

Both forced & quiet –> push viscera up = push relaxed diaphragm further into thoracic cavity

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8
Q

What is rectus abdominus?

A

6 pack muscles - formed also from tenderness intersections which subdivides

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9
Q

Direction of external oblique muscle fibres?

A

Inferomedial
- down & in (hands in front pockets)

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10
Q

Direction of internal oblique muscle fibres?

A

Superomedial
- down & out (hands in back pockets)
(90 degrees to ext)

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11
Q

Direction of transversus abdominus muscle fibres?

A

-Horizontal
–> 90 degrees to rectus abdominus

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12
Q

Label transversus abdominus.

A
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13
Q

What is aponeurosis?

A

= thin sheath of connective tissue - helps connect muscles to bones

-Extensions of (external oblique, internal oblique, & transversus abdominis muscles) - continues medially = aponeurosis of these flat muscles
—> external oblique aponeurosis extends down center of abdomen from bottom of ribs to pelvis - & connects external oblique to other muscles in abdomen e.g., rectus abdominis

  • Flat muscle aponeurosis encloses vertical muscles - (rectus abdominus & pyramidalis muscles)
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14
Q

What is the rectus sheath & what is it made of?

A

= made of aponeurosis of ext oblique, Int oblique, transversus abdominis
*Has ant wall = formed by aponeurosis of ext oblique & half of int oblique
*Has ant wall = formed by aponeurosis of half int oblique & transversus abdominis
—> @ actuate line = all aponeuroses move to ant wall if rectus. sheath - so is no post wall —> so rectus sheath is in direct contact w/ transversales fascia

-Tendinous sheath enclosing rectus abdominus (& pyramidalis muscles)
= white colour = tendons from ext. oblique, int. oblique & transversus abdominus (i.e., their aponeuroses)
-Has posterior & anterior parts (as encapsulates rectus abdominus)

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15
Q

What is the rectus sheath like above the umbilicus/actuate line?

A

*Anterior wall = formed by aponeuroses of ext oblique & half of int oblique

*Posterior wall = formed by aponeuroses of half int oblique & of transversus abdominis

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16
Q

What is the rectus sheath like below the umbilicus?

A

The aponeuroses for all x3 muscles (ext oblique, int oblique, transverses abdominis) go anterior to the rectus abdominus (i.e., none posterior) —> rectus abdominis is in direct contact w/ transversalis fascia
-There is NO post wall to rectus sheath (as this is made by the aponeuroses of these 3 muscles)

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17
Q

What marks the change from above to below the umbilicus & the corresponding change in fascia positioning & of rectus abdominus muscle?

A

Arcuate line

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18
Q

What does aponeurosis join to/form medially?

A

Linea alba

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19
Q

Location of Linea alba?

A

-Medial
-From xiphoid process –> to pubic symphysis

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20
Q

What does aponeurosis join to superiorly?

A

Costal cartilage

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21
Q

What are the 2 points of attachment of the inguinal ligament?

A

The anterior most part of the anterior superior iliac crest and the pubic tubercle

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22
Q

5 muscles of anterolateral abdominal wall?

A

-External oblique
-Internal oblique
-Transversus abdominis
-Rectus abdominis
-Pyramidalis muscles

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23
Q

What does the aponeurosis of the flat muscles form?

A

-Linea alba (medially)
-Inguinal ligaments (inferior) - @ junction between trunk & upper thigh (groin) = allows structures to enter & exit testes in males (less important in females)

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24
Q

How do the muscular fibres of ext, int oblique & transversus abdominus start & go?

A

Start posterolaterally & pass anteriorly

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25
Q

Describe how aponeurosis forms from 3 flat muscles.

A

-Transversus abdominus, int oblique, ext oblique fibres have extensions = aponeuroses - wrap around medially & anteriorly to connect to blend into Linea alba

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26
Q

Where is the pyramidalis muscle?

A
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27
Q

Where is the neurovascular plane?

A

Thoracoabdominal nerves travel in neurovascular plane between transversus abdominis & internal oblique muscles before pierce post rectus sheath

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28
Q

What nerves innervate the skin & muscles of the anterolateral abdominal wall (x3)?

A

*Transversus abdominis = Thoracoabdominal nerves (T7-T11), subcostal nerve (T12) & branches of the lumbar plexus
*Rectus abdominis = Thoracoabdominal nerves (T7-T11)
*Pyramidalis muscle = Subcostal nerve (T12)
*Ext. oblique = Thoracoabdominal nerves (T7-T11) and subcostal nerve (T12)
*Int. oblique = Thoracoabdominal nerves (T7-T11), subcostal nerve (T12) and branches of the lumbar plexus

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29
Q

What arteries/veins (vasculature/vessels) supplies the anterolateral abdominal wall?

A

-Superior epigastric
-Inferior epigastric
-Superficial epigastric

–> inf. epigastric vessels = arise from external iliac vessels - descend anterior abdominal wall
-not in rectus sheath until at umbilical level (as must pass anteriorly to arcuate line)
-will anastomose w/ sup. epigastric vessels (branch of internal thoracic artery)

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30
Q

What are the lymphatics which are involved in draining the abdomen?

A

-Axillary LNs (above umbilicus - drains upwards)
-Superficial inguinal LNs (below umbilicus - drains downwards)

31
Q

Which arteries supply the supero-medial aspect of the anterior abdominal wall?

A

Superior epigastric arteries

32
Q

What are the 4 abdominal quadrants?

A
33
Q

What lines are drawn to create quadrants, & in what planes?

A

-Vertically = sagittal - down from xiphoid process through umbilicus to pubic symphysis (anterior midsternal line) = median plane
-Horizontally = transverse - from one side abdomen to other through umbilicus = transumbilical plane

34
Q

What organs are found in the right upper quadrant?

A

Liver (right lobe - majority)
Upper portion of pancreas
Gall bladder
Asc colon
Right colonic/hepatic flexure
Trans colon
Duodenum of SI

35
Q

What organs are found in the right lower quadrant?

A

Cecum
Appendix
Asc colon
Ileocolonic junction

36
Q

What organs are found in the left upper quadrant?

A

Liver (some of left lobe)
Stomach (majority)
Left colonic flexure
Spleen
Trans colon
SI (some)

37
Q

What organs are found in the left lower quadrant?

A

Desc colon
Sig colon
Ileum
Duodenum
Rectum

38
Q

Where are the left & right midclavicular lines?

A
39
Q

Where is the subcostal plane?

A

T12/L1–L3 (usually L2)

40
Q

Where is the transtubercular plane?

A

L5

41
Q

Where is the jugular notch?

A

T2

42
Q

Which vertebral level is sternal angle at?

A

T4/5

43
Q

Where is the transpyloric plane?

A

Midpoint between the jugular notch & pubic bone (L1)

44
Q

Where is the anterior midsternal line?

A

Bisects umbilicus

45
Q

What lines/planes x3 are used to divide abdomen into 9 segments?

A
46
Q

How do you palpate to feel where anterior midsternal line is?

A

Feel for xiphoid process (bottom of sternum)

47
Q

How do you palpate to feel where subcostal plane is?

A

palpating the inferior most aspects of the ribs on either side (not ribs 11 & 12) - this gives rib 10 - then work directly posterior from here (note: not following the bone of rib) - will end up on spinous process of L3

48
Q

How do you palpate to feel where transtubercular plane is?

A

Feel for ASIS (anterior superior iliac spine) or pubic tubercle (more intimate)

49
Q

How do you palpate for midclavicular line?

A

Middle of clavicle can be felt

50
Q

What are the names of the 9 regions of the abdomen?

A
51
Q

How to palpate for midaxillary line?

A

The ASIS meets

52
Q

What would an ultrasound of the abdomen in the midline between the xiphoid process and umbilicus look like?

A
53
Q

What would an ultrasound of the abdomen midway between the xiphoid process and umbilicus, and lateral to the Linea semilunaris look like?

A
54
Q

Where would local anaesthetic be injected to anaesthetise one side of the abdominal wall & why here?

A

Between transversus abdominus & internal oblique
–> as will reach thoracoabdominal nerves from spinal nerves T7-L1 (found in the neurovascular plane)

55
Q

Where is the inguinal ligament found?

A

At the junction between the trunk and upper thigh (groin).
In M&F but in M = structures pass though in/out testes

56
Q

What movements are the obliques responsible for?

A

Trunk rotation in opposite directions (as their muscle fibres = @ 90 degrees to each other)

57
Q

What direction does external oblique rotate to?

A

To contralateral side

58
Q

What direction does internal oblique rotate to?

A

To ipsilateral side (i & i)

59
Q

Label muscles of anterolateral abdominal wall, what plane is this image @ L5 below umbilicus?

A

Transverse cross-section

60
Q

Label the relevant surface anatomy of the anterior abdominal wall.

A

1 = Costal Margin
2 = Iliac Crest
3 = Anterior Superior Iliac Spine
4 = Inguinal Ligament
5 = Pubic Tubercle

61
Q

Label the cadaveric image showing rectus abdominis (purple)

A

1 = Linea Alba
2 = Tendinous intersections
3 = Linea Semilunaris
4 = Umbilicus

62
Q

What features of the Linea alba make it suitable for a midline incision for abdominal surgery?

A

Fibrous = so is poorly vascularised - meaning little blood loss (so long as cut around umbilicus)

63
Q

What is A?

A

Inferior Epigastric Artery

64
Q

What is A a branch of?

A

External Iliac Artery

65
Q

What does Structure A anastomose with?

A

Superior Epigastric Artery, from the Internal Thoracic Artery, from the Subclavian Artery

66
Q

Structure A is used as a landmark to classify hernias. What type of hernia emerges medial to Structure A?

A

-Direct hernias are MEDIAL to the Inferior Epigastric Artery.
-Indirect hernias are LATERAL to it.

67
Q

Which dermatome supplies the skin around the umbilicus?

A

T10

68
Q

Function of external oblique?

A

-Contralateral rotation of torso

-Bilateral contraction = Trunk flexion, compresses abdominal viscera, expiration
-Unilateral contraction
= trunk lateral flexion (ipsilateral) & contralateral trunk rotation

69
Q

Function of internal oblique?

A

-Bilateral contraction = trunk flexion, compresses abdominal viscera, expiration
-Unilateral contraction = trunk rotation (ipsilateral), trunk lateral flexion (ipsilateral)

70
Q

Function of transversus abdominis?

A

-Bilateral contraction - Compresses abdominal viscera, Expiration
-Unilateral contraction - Trunk rotation (ipsilateral)

71
Q

Function of rectus abdominis?

A

-Assists flat muscles in compressing abdominal viscera
-Stabilises pelvis when walking & depresses ribs
-Trunk flexion
-Expiration

72
Q

Function of pyramidalis muscle?

A

Tenses linea alba

73
Q

Define flat muscles of abdominal wall & name them.

A

3 muscles - situated laterally either side of abdomen
-Ext oblique
-Int oblique
-Transversus abdominis

74
Q

Define vertical muscles of abdominal wall & name these.

A

2 muscles - situated near mid-line of body
-Rectus abdominis
-Pyramidalis muscle

Anatomy (21 decks)

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