Abdominal Wall Flashcards
Which part of the abdominal wall is more mobile?
Anterolateral
Posterior is more stable
What 3 structures make up the superior margin of the abdominal wall?
Xyphoid
Costal margin
Ribs 11 and 12
What makes up the posterior margin of the Ab wall?
Lumbar vertebrae
What makes up the inferior margin of the Ab wall?
Superior part of the bony pelvis
What makes up the anterior margin of the Ab wall?
Epidermis
What is the linea terminalis?
Imaginary line dividing abdominal and pelvic cavities
What 3 structures make up the linea terminalis?
Pubic crest
Pectineal line on pubis
Arcuate line on ilium
What 3 bones make up the pelvis?
Ilium
Ischium
Pubis
What 6 structures comprise the pelvic inlet?
Sacral promontory (most superior) Ala (wings) of sacrum Arcuate line (most lateral) Pectineal line Pubic crest Pubic symphysis (most inferior)
The umbilicus is located at which vertebral level?
L3-L4
Which dermatome corresponds to the umbilicus?
T10
What is the medial plane?
Separates quadrants into right and left
What is the transumbilical plane?
Separates quadrants into upper and lower
What region does epigastric refer to?
Anything above the umbilicus
What region does suprapubic refer to?
Anything between pubic bone and umbilicus
What region does periumbilical refer to?
Anything around the umbilicus
Where is McBurney’s Point?
2/3 from umbilicus to ASIS
What 2 structures can be palpated at McBurney’s Point?
Cecum
Appendix
What forms the medial border of the rectus sheath?
Linea alba
What forms the lateral border of the rectus sheath?
Semilunar line
What forms the horizontal indentations in a six pack?
Tendinuous intersections
What forms the middle longitudinal line in a six pack?
Linea alba
What forms the side longitudinal lines in a six pack?
Semilunar lines
What form the penis lines in a six pack?
Inguinal ligaments
What forms the boundary between the Ab wall and thigh?
Inguinal ligaments
True or false. The abdominal fascia is consistent throughout the entire Ab wall.
False. It is different between the upper and lower abdomen
What are the layers of the fascia in the upper ab wall?
Skin
Superficial fascia
Deep fascia
Muscle
What are the layers of the fascia in the lower abdomen?
Skin Camper's fascia Scarpa's fascia Deep fascia Muscle
What is the superficial fascia divided into in the lower abdomen?
Camper’s fascia- fatty
Scarpa’s fascia- membranous
Both the fatty and membranous layers of the superficial fascia of the lower abdomen extend inferiorly into which 2 regions?
Pubic
Perineal
The pubic and perineal regions contain which layers of the superficial fascia of the lower abdomen?
BOTH fatty and membranous
True or False. Both fatty and membranous superficial fascia layers in the lower abdomen descend inferiorly into the thighs.
False. Fatty layer DOES descend into thighs but membranous layer STOPS and fuses with fascia lata of thigh.
What comprises the fascia lata?
Membranous Scarpa’s fascia of the lower abdomen
If blood or fluid accumulates below Scarpa’s fascia, would you expect it to accumulate in the pelvic, perineal or thigh regions?
Pelvic and perineal only
Scarpa’s fascia stops and becomes fascia lata in the thigh
What are the 4 major ab muscles?
External oblique
Internal oblique
Transversus abdominis
Rectus abdominis
Which ab muscles are considered flank muscles?
Ext. Ob
Int. Ob
Trans abdominis
Which ab muscle is most medial?
Rectus ab
Which ab muscles form aponeuroses?
Ext ob
Int ob
Trans ab
What is the rectus ab sheathed by?
Aponeuroses of Ext, Int and Trans
The external oblique is a continuation of which muscle?
External intercostal
What are the orientation of the fibers of ext ob?
Hands in pockets ////////
Where does the ext ob start forming aponeurosis?
Semilunar line
What is the most lateral and medial border of the ext ob aponeurosis?
Lateral- semilunar line
Medial- linea alba
What comprises the inguinal ligament? What 2 structures does it attach to?
Inferior edge of the rectus sheath which folds in on itself and attaches to ASIS and pubic tubercle
What is the orientation of int ob fibers?
90* to ext ob fibers \\\\
Where does the int ob originate from?
Lateral 2/3 of inguinal ligament
What is the orientation of trans ab fibers?
Horizontal =
Where does the trans ab originate?
Lateral 1/3 of inguinal ligament
There is a larger gap between the inguinal ligament and which muscle?
Trans ab
What is the orientation of the rectus ab fibers?
Vertical |||||
What surrounds the rectus ab?
Rectus sheath
How does the rectus sheath connect to the rectus ab?
Tendinuous intersections
What comprises the rectus sheath?
Aponeuroses of ext ob, int ob, trans ab
True or False. The rectus sheath is NOT continuous.
True! It is separated into upper and lower parts by the arcuate line
What is the arcuate line?
Separation of the rectus sheath into upper and lower halves
What comprises the rectus sheath anterior to the rectus ab and superior to arcuate line?
External oblique
1/2 internal oblique
What comprises the rectus sheath posterior to the rectus ab and superior to arcuate line?
1/2 internal oblique
Trans ab
What comprises the rectus sheath anterior to the rectus ab and inferior to arcuate line?
All 3 aponeuroses: ext ob, int ob, trans ab
What comprises the rectus sheath posterior to the rectus ab and inferior to arcuate line?
NO aponeuroses
Just transversalis fascia
What are the 3 layers of fascia BELOW the rectus ab inferior to the arcuate line?
Transversalis fascia
Extraperitoneal fascia
Parietal peritoneum
What 2 regions does the extraperitoneal fascia divide into?
Preperitoneal- anterior
Retroperitoneal- posterior
What 4 nerves innervate the ab wall?
Lower intercostals
Subcostal
Iliohypogastric
Ilioinguinal
All 4 ab wall nerves are:
Ventral rami
Lower intercostal nerves originate where?
T7-T11
Subcostal nerve originates where?
T12
Iliohypogastric nerve originates where?
L1
Ilioinguinal nerve originates where?
L1
True or false. The iliohypogastric and ilioinguinal nerves originate from the same location and are branches of the same nerve.
True! Both originate at L1 and are branches of the same ventral ramus
What dermatome marks the region inferior to xyphoid and above umbilicus?
T7
What dermatome marks the umbilicus region?
T10
What dermatome marks the suprapubic region?
T12
What dermatome marks the upper medial thigh and genitalia region?
L1
What are the 2 important artery pathways that supply the ab wall?
Descending aorta
Epigastric
What 4 arteries branch from abdominal descending aorta?
Posterior intercostal
Subcostal
2 common iliacs
Posterior intercostal arteries travel where?
Between ribs
Subcostal arteries travel where?
Below the 12th rib
What arteries travel between int ob and trans ab?
Posterior intercostal
Subcostal
What arteries supply the flank muscles? (E, I, T)
Posterior intercostal
Subcostal
True or False. The posterior intercostal and subcostal arteries travel together to supply the same muscles.
False. They travel separately (between ribs or below 12th rib) but within the same region (between int ob and trans ab).
There are how many branches of the common iliac?
2
Common iliac branches into which arteries?
External iliac
Internal iliac
The femoral artery comes from which artery?
External iliac
The femoral artery supplies the?
Thigh
The internal iliac arteries supply the?
Pelvis
The internal thoracic artery splits into which 2 arteries?
Musculophrenic
Superior epigastric
True or false. The superior epigastric artery enters the rectus sheath.
True! It enters rectus sheath superiorly on the ab wall
What arteries supply the rectus ab muscles?
Superior epigastric
Inferior epigastric
What arteries supply the int ob?
Subcostal and posterior intercostal
What arteries supply the ext ob?
Subcostal and posterior intercostal
What arteries supply the trans ab?
Subcostal and posterior intercostal
Where does the inferior epigastric artery enter the rectus sheath?
Enters inferiorly on ab wall
Where does the inferior epigastric artery branch from?
External iliac artery
What are the 2 sets of veins draining the ab wall?
Superficial
Deep
The superficial veins are also known as the?
Thoracoepigastric veins
What do the thoracoepigastric veins drain?
Superficial fascia
Where do the thoracoepigastric veins drain superiorly?
Axilla veins
Where do the thoracoepigastric veins drain inferiorly?
Groin veins
Where do the thoracoepigastric veins drain medially?
Umbilicus veins
What are the deep veins also called?
Same names as the arteries
What do the deep veins drain?
Muscle
Deep tissue
Where do the deep veins drain superiorly?
Subclavian vein
Where do the deep veins drain inferiorly?
External iliac veins
Femoral veins
Where do deep veins drain posteriorly?
IVC
Azygos vein
What are the 2 divisions of the lymphatic vessels?
Superficial
Deep
Where do the superficial lymphatic vessels travel?
With veins superiorly and inferiorly
Where do the superficial lymph vessels drain superiorly?
Axilla nodes
Where do the superficial lymph vessels drain inferiorly?
Groin nodes
Where do deep lymph nodes drain?
To nodes along major vessels –> cisterna chyli –> thoracic duct
What carries oxygenated blood to fetus?
Umbilical vein
What is the falciform ligament?
Fold of parietal peritoneum over the umbilical vein
What carries deoxygenated blood from fetus?
Umbilical arteries
Where do umbilical arteries branch from?
Internal iliac arteries
What does the umbilical vein form when it closes?
Ligamentum teres hepatis
What is the ligamentum teres hepatis made of?
Fibrous remnant of umbilical vein
Fold of peritoneum
What do the umbilical arteries form after they close?
Medial umbilical folds
What does the allantois form?
Urachus
Where does the urachus run?
Bladder to umbilicus
What does the urachus form?
Median umbilical fold
Where do medial umbilical folds come from?
Umbilical arteries
Where does median umbilical fold come from?
Urachus
What two folds are found in the peritoneum?
Medial umbilical folds
Lateral umbilical folds
Where do lateral umbilical folds come from?
Inferior epigastric vessels
Where do inferior epigastric vessels travel between?
Transversalis fascia and peritoneum
Where do the inferior epigastric vessels pierce through rectus sheath at?
Inferiorly at deep surface of rectus abdominis
What 2 parts is the abdominal wall divided into?
Anterolateral
Posterior
A pain within the skin of the abdominal wall is sensed by which nerves?
Intercostals
Subcostal
Iliohypgastric
After a car accident, a patient presents with abdominal pain and internal bleeding within the peritoneal cavity. Which nerves could be sensing this pain?
Nerves sensing parietal peritoneum:
Intercostals
Subcostal
Iliohypogastric
Which nerves provide motor function to the anterior abdominal wall?
Intercostals
Subcostal
Iliohypogastric
Ilioinguinal
A gash to the medial thigh causes pain that would be sensed by which nerve?
Ilioinguinal
A swift kick to the scrotum would cause pain that might travel via which two nerves?
Ilioinguinal
Genitofemoral
If the temperature drops outside and a man gets cold, his testes will rise upward toward his body to conserve heat. This action is controlled by which nerve?
Genitofemoral
What are the two sympathetic nerves that sense abdominal pain in organs?
Thoracic splanchnics- greater, lesser, least
Lumbar splanchnics
Which sympathetic nerves provide motor innervation to organs and blood vessels in the foregut and midgut?
Thoracic splanchnics- greater, lesser, least
Which sympathetic nerves provide motor innervation to the organs and abdominal blood vessels in the hindgut?
Lumbar splanchnics
What two parasympathetic nerves carry sensory information from abdominal viscera?
Vagus
Pelvic splanchnics
Which nerve carries parasympathetic innervation to foregut and midgut organs?
Vagus
Which nerve carries parasympathetic innervation to the hindgut and pelvic organs?
Pelvic splanchnics
Where does the rectus abdominis originate?
Pubic symphysis and crest
Where does the rectus abdominis insert?
Costal margin and ribs
Xyphoid process
What innervates the rectus abdominis?
Intercostals
Subcostal
Ilioinguinal
Iliohypogastric
What two functions does the rectus abdominis have?
Flexes trunk
Supports abdominal contents
Where does the external oblique originate?
Lower Ribs
Where does the external oblique insert?
Iliac crest
Linea alba
Pubic tubercle
What innervates the external oblique?
Intercostals
Subcostal
Ilioinguinal
Iliohypogastric
What 3 functions does the external oblique have?
Flexes trunk
Rotates trunk to the opposite side
Compresses abdominal contents
What muscles would help rotate the trunk to the right?
Left external oblique
Right internal oblique
What muscles would help the trunk rotate to the left?
Right external oblique
Left internal oblique
Where does the internal oblique originate?
Thoracolumbar fascia
Iliac crest
Inguinal ligament
Where does the internal oblique insert?
Lower ribs
Linea alba
Pubic crest
What innervates the internal oblique?
Intercostals
Subcostal
Ilioinguinal
Iliohypogastric
What 3 actions does the internal oblique have?
Flexes trunk
Rotates trunk to same side
Compresses abdominal contents
Where does the transversus abdominis originate?
Thoracolumbar fascia
Iliac crest
Inguinal ligament
Where does the transversus abdominis insert?
Linea alba
Pubic crest
What innervates the transversus abdominis?
Intercostals
Subcostal
Ilioinguinal
Iliohypogastric
What does the transversus abdominis do?
Compresses abdominal contents
Where does the cremaster muscle originate?
Internal oblique
Where does the cremaster muscle insert?
Surrounds testes
What innervates the cremaster muscle?
Genitofemoral nerve
What does the cremaster muscle do?
Raises testes
