Abdominal Wall Flashcards by Alex Stein

Superior Boundary

R and L costal margins

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Inferior Boundary

Line connecting ASIS to pubic symphysis

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Lateral Boundary

Vertical line through ASIS

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Umbilicus

Lies at level of L3 and L4 vertebrae

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Linea Alba

Site where aponeruosis of three flat abdominal muscles interact

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Vasalva Maneuver

Coordinated increase of abdominal pressure, partially due to contraction of wall

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Linea Semilunaris

Lateral border of rectus abdominis

9th costal cartilage to pubic tubercle

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Quadrant Pattern

Median and Transumbilical Plane at L3/L4 level
R Upper and Lower
L Upper and Lower

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9 Region Pattern

Horizontal Subcostal (L3) and Transtubercular Plane (L5) Vertical right and left midclavicular lines
R and L Hypochondrium (epigastric in middle)
R and L Lumbar (umbilical in middle)
R and L Iliac (hypogastric in middle)

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Superficial Fascial Layers

Campers Fascia = more superficial - fat

Scarpas Fascia = Membranous portion

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Campers Fascia

Contains superficial epigastric A and V

Continuous with superficial fascia of lower limb and labia majora

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Scarpas Fascia

Fuses medially with linea alba and with fascia lata below inguinal ligament
Continuous with superficial fascia of perineum, dartos fascia of scrotum, and superficial penile fascia

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Innervation - ventral rami of…

T7 to T11 = intercostal nerves (thoracoabdominal nerves)
T12 = subcostal
L1 = ilioinguinal and iliohypogastric

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Nerves run between

Transversus abdominis and internal oblique

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Dermatomes

T7 to L1 again

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Herpes Zoster

Shingles - often follows dermatomes on anterior-lateral thoracic and/or abdominal walls

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All nerves provide ___ branches

Lateral cutaneous and anterior cutaneous branches

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Arterial Supply - Superior anterior wall

Internal thoracic Branches

Posterior/Thoracic Aorta Branches

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Arterial Supply - Inferior anterior wall

External Iliac Branches

Femoral Artery Branches

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Superior anterior wall

Internal Thoracic
- Superior Epigastric
- Musculophrenic 
Thoracic Aorta
- Posterior intercostal and subcostal arteries

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Inferior anterior wall

Femoral Artery
- Superficial circumflex iliac 
- Superfcial Epigastric
External Iliac
- Deep circumflex iliac
- Inferior Epigastric

Venous drainage…

Follows arteries

Venous Drainage of Superior Wall

Posterior intercostal veins and subcostal drain into azygos system
Superior epigastric and musculophrenic drain into internal thoracic vein

Venous Drainage of Inferior Wall

Inferior epigastric and deep circumplex drain to external iliac
Superficial epigastric and superficial circumflex drain into great saphenous and then to femoral vein

Muscular Basket

Muscle and collagen fibers within and btw abdominal area | Distensible but rigid

Benefits to muscular basket | Benefits to corset training

Function in protection, posture Protect organs Skinny - acts like external gastric bypass Helps with posture

Risks

Abdominal muscles will atrophy because the corset is doing the work for them

Abdominal Guarding

Patients with internal abdominal problems often present with abdominal guarding - tense and twitchy muscles

External Abdominal Oblique - O

Ribs 5 to 12

External Abdominal Oblique - I

Linea alba, pubic tubercle, and iliac crest | Hands in pockets

External Abdominal Oblique - Innervation

Ventral Rami of T7-T12

External Abdominal Oblique - Action

Compress and support abdominal viscera Laterally flex to the same side Rotate to the opposite side

Internal Abdominal Oblique - O

Thoracolumbar Fascia | Iliac Crest

Internal Abdominal Oblique - I

Rubs 10-12 Linea alba Pecten Pubis via conjoint tendon (aponeurosis of transvers abdominis and internal oblique)

Internal Abdominal Oblique - Innervation

Central Rami of T7-T12

Internal Abdominal Oblique Action

Compress and support abdominal viscera Laterally flex to same side Rotate to same side

Transversus Abdominis Origin

Costal cartilages of ribs 7-12 Thoracolumbar fascia Iliac Crest

Transversus Abdominis Insertion

Linea Alba Pubic Crest Pecten pubis via conjoint tendon

Transversus Abdominis Innervation

L1 - ilioinguinal and iliohypogastric

Transverus Abdominis Action

Compress and support abdominal viscera

Rectus Abdominis Origin

Pubic symphysis and pubic crest

Rectus Abdominis Inerstion

Xiphoid process and costal cartilages of ribs 5-7

Rectus Abdominis Innervation

Ventral Rami of T7-T12

Rectus Abdominis Action

Compres and suport abdominal viscera | Flexion of trunk

Rotate to left you are using...

Left internal obluqie | Right external oblique

Rectus Sheath

Aponeurosis of the three flat abdomnal muscles (EO, IO, TA) | Completely encloses the rectus abdominis muscle above the arcuate line

Arcuate Line

Located midway between the umblicus and pubic crest Inferior to arcuate line, all aponeurotic fibers run anterior to rectus abdominis So rectus sheath is absent here

Conjoint Tendon

Internal Oblique and Transversus abdominis tendons | At point ant to rectus abdominis muscle

Patient with swelling in epigastric region - What is it?

``` Epigastric Hernia (or ventral) Coming through linea alba ```

Diastasis Recti

Separation of rectus abdominis at linea alba Occasionally occurs in older patients and those with weakened abdominal muscles Normal in pregnant women - muscles move with pregnancy Bulge when raise head - vasalva Avoid crunches!!! - just stand there and squeeze abdominal muscles