Abdominal Wall Flashcards
Fascia
Above umbilicus single layer
Below superficial fatty (camper)
Deep membranous (scarpa)
3 layers investing fascia around muscles
Below muscles endoabdominal fascia
External oblique
T7-11 + SC nerves
Becomes inguinal ligament
From ext 5-12 rubs
To linea alba, pubic tubercle, and ant half iliac crest
Internal oblique
T6-12+L1
From thoracolumbar region, ant 2/3 iliac crest, CT deep to lat 1/3 inguinal lig
To 10-12th ribs, linea alba and pecton pubis via conjoint tendon
Transversus abdominus
T6-12+L1
Neurovascular plane lies superior to it
From int 7-12th ribs, thoracolumbar fascia, iliac crest + ct deep to lat 3rd inguinal lig (same as int oblique)
To linea alba, aponeurosis internal oblique, pubic crest, pecton pubis via conjoint tendon
becomes iliopubic tract
Rectus abdominus
T6-12 ant rami
From pubic symphysis and crest
To xiphoid process and 5-7th costal cartilages
Pyramidalis absent 20% people
Rectus sheath
Contains sup and inf epigastric arteries and veins, lymph vessels and distally nerves T7-12
Sup 2/3 post to obliques
Inf post to obliques and transverse
Thoracoabdominal nerves
T7-11
Continuation intercostals distal to costal margin
Between int oblique and transversus abdominus
Distal muscles and skin
Lateral cutaneous branches thoracic
T7-9 anterior rami
Skin R+L hypochindrium
Subcostal nerve
T12
Largest anterior ramus of t12
Between int oblique and transversus
Skin sup to iliac crest and inf to umbilicus
Iliohypogastric
L1
Sup terminal branch anterior ramus
Pierces transversus then between that and int oblique
Skin over iliac crest, upper inguinal and hypogastrium
Muscles int oblique and trans abdo
Ilioinguinal nerve
L1
Inferior terminal branch ant ramus
Normal route thn traverses inguinal canal NOT DEEP RING
Skin lower inguinal, mons pubis, ant scrotum, adjacent medial thigh
Muscle lower in oblique and transversus abdominus
Superficial veins ant abdo drainage
Sup medial internal thoracic
Sup lateral lat thoracic
Inf
Superficial epigastric to femoral
Inferior epigastric to external iliac
Superficial abdo arteries from internal thoracic
Musculophrenic - follows costal margin, supplies hypochondrium and ant lat diaphragm
Superior epigastric - in rectus sheath deep to rectus abdominus, supplies epigastric and supra umbilical plus rectus abdominus
Superficial abdo arteries from aorta
10+11 IC + subcostal
Supply lumbar and flank
Superficial abdo arteries from external iliac
Inferior epigastric - deep to rectus abdominus, supplies deep wall pubic and infra umbilical and rectus abdominus
Deep circumflex iliac - deep wal parallel to inguinal ligament, supplies deep wall inguinal + iliac fossa + iliacus muscle
Superficial abdo arteries from femoral
Superficial epigastric - in subcut tissue to umbilicus, supplies sup wall pubic and inf umbilical
Superficial circumflex iliac - subcut tissue along ing ligament, supplies superficial wall inguinal and adjacent ant thigh
Lymph drainage ant wall
Superficial sup umbilicus to axillary
Inf to umbilicus superficial inguinal
Deep - follow vessels to iliac and lumbar
Infra umbilical peritoneal folds
1x median, apex bladder to umbilicus, covers median umbilical lig
2x medial umbilicus, cover medial umb ligs (old umb arteries)
2x lateral, cover inferior epigastric vessels
Infra umbilical fossae
med to lat
supravesicular - bladder
medial inguinal - direct hernia, hesselbachs triangle
lat inguinal - indirect (most common)
Hesselbachs triangle
Base ing lig
lat inferior epigastric
Med rectus sheath (linea semilunaris)
DIRECT HERNIA
Inguinal canal
formed by reocation testes, 4cm
parallel and SUP the inguinal lig
Contains: spermatic cord/ round ligament, , blood, lymph, ilioninguinal nerve L1, genital branch genitofemoral nerve L1+2
Walls inguinal canal
MALT
2Muscles ROOF - tranversalis and in oblique
2Aponeurosis ANT - in and ext oblique
2Ligaments LOWER - inguinal and lacunar
2T POST - Transversalis fascia and conjoint Tendon
Spermatic cord fascia
Internal spermatic - transversalis
Cremasteric - int oblique
External spermatic - ext oblique
Spermatic cord contents
3 arteries - cremasteric, testicular and ductus deferens
Venous pampiform plexus
Ductus deferens
Symp nerves on arteries and ductus deferens
Genital branch genitofemoral (for cremasteric)
Lymph vessels (drain lumbar)
Scrotal arteries
Post from int pudendal
Int scrotal from external pudendal
Cremaseric from inferior epigastric
Lymph drainage scrotum and testes
Scrotum to superficial inguinal
Testes to lumbar and preaortic
Testicular arteries and veins
Art - from aorta L2 - ant to ureters ->through ing canal
Veins - 8-12 veins, pampiform plexus -> testicular veins, R to aorta, left to renal vain
Hernias
Direct medial to epigstric, 25%, weakness wall, preitoneum and transversalis fascia
Indirect due to processus vaginalis still present, can go to testes, through ing canal
Processus vaginalis
Continuation of peritoneum
Absent in adults other than tunica vaginalis at end of testes
Posterior abdominal wall fascia
Endoabdominal - continuous with transversalis
Psoas - from L ver and pelivis, sup med arcuate, lat quad lumborum and thoracolumbar, inf iliac
Thoracolumbar - 3 layers, post and middle deep back muscles, ant encloses quadratus laborum
Psoas major
L1-3 ant rami
TP L, T12-L5 lat bodies to lesser trochanter
Flex trunk and thigh with iliacus
Vert column lat
Iliacus
L2-4 innervation
From ant 2/3 iliac fossa to lesser trochanter and psoas tendon
Flex thigh and stabilise hip
Quadratus lumborum
T12 -L4
12th rib and TPs l spine to int lip iliac crest and iliolumbar lig
Extention and lat flexion vertebral column, fixes 12th rib insp
Subcostal nerve
Post to lat arcuate
Inf on quad lumborum
Supplies ext oblique and skin lat abdo wall
Lumbar spinal nerves
Post rami back muscles and overlying skin
Ant rami rest
L1+2 lumbar splanchnic
Lumbar plexus
Femoral l2-4
Obturator l2-4
Lumbrosacral l4-5
Ilioinguinal and hypogastric l1
Genitofemoral l1+2
Latcut thigh l2+3
Femoral nerve
Lat border psoas major deep to ing lig to ant thigh
Hip flexors, extention knee, iliacus
Obturator nerve
L2-4
Medial psoas major through obturator foramen
Adductor muscles
