Abdominal Wall Flashcards by Chance Lee Cauble

What are the 4 surfaces of the abdominal cavity?

) Superior- diaphragm which is domed to the 4th intercostal space
) Inferior- superior pelvic aperture (pelvic inlet)
) Anterolateral- muscular wall
) Posterior- lumbar vertebrae

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Layers of the peritonium?

Parietal peritoneum- serous membrane lining cavity
Visceral peritoneum- serous membrane lining abdominal organs
Peritoneal cavity- fluid filled space
Mesentery- continuation of visceral and parietal peritoneum that attaches intestine to body wall

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What is the retroperitoneal?

Organs located posterior to the peritoneum
Includes:
-Kidney
-Pancreas
-Duodenum
-Colon

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What is the transumbilical plane?

Goes through the umbilicus and L3/4; divides the cavity into superior and inferior halves

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What is the median plane?

Divides cavity into L and R

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What are the quadrants and what are in each quadrant?

RUQ:
-Liver, gallbladder
RLQ:
-Appendix, cecum
LUQ:
-Stomach, spleen
LLQ:
-Sigmoid Colon

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What are the peripheral attachments of the respiratory diaphragm?

) anterior: xiphoid process
) lateral: costal cartilage and ribs 5-10
) posterior: L1-3 lumbar vertebrae and floating ribs
- right and left crus

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What is the deep attachment of the diaphragm?

central tendon

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What are the major organs superior to the diaphragm?

Pericardium (heart) attached to central tendon

- R and L pleura (lungs)

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What organs are inferior to the diaphragm?

Liver (anterior right side)
Stomach and Spleen (anterior left side)
Kidneys (posterior)

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What muscles pass through the diaphragm?

paired psoas major under medial arcuate ligaments

- paired quadrates lumborum under lateral arcuate ligaments (rib to hip)

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Blood and Lymph vessels passing through the diaphragm

Descending aorta:
-via aortic hiatus formed by left and right crus
Inferior vena cava:
-via caval opening in central tendon
Superior epigastric a. and v. :
-via sternocostal triangle
Azygous and hemiazygous veins:
-via aortic hiatus
Thoracic duct: (junction between L jugular and subclavian)
-via aortic hiatus

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Does the esophagus pass through the diaphragm?

Yes, through the esophageal hiatus

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Nerves passing across the diaphragm

sympathetic trunks at level of vertebral column

- anterior and posterior vagi via esophageal hiatus

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What nerve innervates the diaphragm?

Phrenic nerve

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Vasculature of the diaphragm

) Superior surface
- thoracic aorta→ superior phrenic a.’s
- internal thoracic→ musculophrenic and pericardiophrenic a.’s
- veins named for arteries drain into IVC and internal thoracic
)Inferior surface
- abdominal aorta→ inferior phrenic a.’s
- veins named for arteries drain into IVC

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Actions of the diaphragm

inhale when it contracts

2. exhale when it relaxes

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Anteriolateral muscular wall layers

superficial to deep

skin
subcutaneous layer= hypodermis: fat layer held together by CT fibers
- camper fascia- superficial layer of CT below naval
- scarpa fascia- deep layer of CT below naval
muscles and aponeurosis
deep fascia of transverse abdominis
extraperitoneal fat
parietal peritoneum

What are the muscles of the anterolateral abdominal wall?

External oblique
Internal oblique
Transverse abdominis
Rectus abdominis

External Oblique:
Origin-
Insertion-
Innervation-
Action-

Origin- ribs 5-12
Insertion-rectus sheath
Innervation-spinal nerves T7-12 (ventral rami)
Action-
-Bilateral- flex at trunk
-Unilateral- ab/adduct; rotate
-Respiration- pull rib cage down and compress abdomen to exhale

Internal Oblique:
Origin-
Insertion-
Innervation-
Action-

Origin- vertebral column via thoracolumbar fascia; hips
Insertion- lower ribs; rectus sheath
Innervation- T6-12 (ventral rami)
Action-
-Bilateral- flex at trunk
-Unilateral- ab/adduct; rotate
-Respiration- pull rib cage down & compress abdomen to exhale

Transverse abdominis
Origin-
Insertion-
Innervation-
Action-

Origin- lower ribs; vertebral column via thoracolumbar fascia; hips
Insertion- rectus sheath
Innervation T7-12 (ventral rami)
Action-
Unilateral- ab/adduct; rotate
Respiration- compress abdomen to exhale

Rectus abdominis
Origin-
Insertion-
Innervation-
Action-

Origin- pubic symphysis
Insertion- lower ribs; xiphoid
Innervation- T6-12 (ventral rami)
Action-
Bilateral- flex at trunk
Respiration- pull rib cage down &amp; compress abdomen to exhale

Function to regulate abdominal pressure

contract to increase intra-abdominal pressure
- forced exhale
- defecation
- micturition
- vomiting
- parturition
- stabilize vertebral column for heavy lifting
relax in decrease intra-abdominal pressure when inhale

What does the rectus sheath surround and what forms it?

Surrounds rectus abdominis and superior and inferior epigastric blood vessels Formed by aponeuroses of lateral wall muscles: external oblique, internal oblique, and transverse abdominis

The rectus sheath is divided into what components?

Superior Sheath components: - anterior formed from external oblique and anterior internal oblique aponeurosis - posterior formed from posterior internal oblique and transverse abdominis aponeurosis Inferior Sheath components: - anterior formed from external oblique, internal oblique, and transverses aponeurosis - posterior- no aponeurosis

What line seperates the sheath compartments and where is it located?

arcuate line, located below umbilicus 1/3 of distance to pelvis

What is the linea alba?

Connective tissue strip running down the mid line, connecting the 2 halves of the rectus /rectal sheath

Sensory innervation (dermatomes)

1. ) above umbilicus - T7-T9 2. ) umbilicus - T10 3. ) below umbilicus - T11-L1

Sensory innervation (nerves) of the anteriolateral abdominal wall

1. ) thoracoabdominal m.'s 2. ) lateral cutaneous branches of intercostals n.'s 3. ) Subcostal n. 4. ) Iliohypogastric n. 5. )Ilioinguinal n.

Blood vessels of the anteriolateral wall

1. ) internal thoracic arteries - musculophrenic→ anterolateral diaphragm and abdominal wall near diaphragm - superior epigastric→ anterior abdominal wall 2. ) descending abdominal aorta - lower intercostals a.'s→ lateral superior abdominal wall - subcostal a 3. ) external iliac a.'s - inferior epigastric→ anterior inferoir abdominal wall - deep circumflex→ inguinal region 4. ) femoral a.'s - superior circumflex→ inguinal region - superficial epigastric

The inguinal region is also known as the what?

groin

What is the location of the inguinal region?

Anterior superior iliac spine (attachment of ilioinguinal ligament) to pubic tubercle at pubic symphysis

What is the inguinal canal?

Tubular passage about 4cm long, through the inferior anterior abdominal wall

Inguinal canal crosses:

- peritoneum - retroinguinal space of Bogros - transversalis fascia forms covering of the canal contents - transversus abdominal muscle - internal oblique - external oblique

What are the contents of the inguinal canal?

``` Males= spermatic cord Females= round ligament ```

What is the deep internal inguinal ring? | What goes through this ring?

- Forms an opening in the peritoneum and transversalis | - Spermatic cord or round ligament in females

Anterior and posterior walls:

roof and floor of the inguinal canal are formed by the layers that the tube crosses

What is the superficial inguinal ring? | What goes through this ring?

- Forms the openings in the external oblique aponeurosis into the subcutaneous tissue of the medial pelvis - Ilioinguinal n., genitofemoral n., spermatic cord or round ligament in females

What does the inguinal canal run parallel to?

- inguinal ligament | - iliopubic tract

What does the posterior abdominal wall consist of?

1. ) 5 lumbar vertebrae 2. )abdominal wall and leg muscles - psoas major and minor - quadratus lumborum - iliacus - transversus abdominis - in/external obliques 3. )respiratory diaphragm 4. )thoracolumbar fascia 5. )lumbar nerve plexus 6. )fat muscles, vessels, and lymph nodes 7. )fascia 8. )peritoneum

Blood vessels of the post abdominal wall?

1. ) abdominal aorta parietal branches - subcostal a. - lumbar a.'s - median sacral a. (unpaired) 2. )inferior vena cava- recieves blood from veins named for posterior abdominal wall arteries 3. ) azygous and hemiazygous veins- also drain lumbar and subcostal veins

Nerves of post abdominal wall

- subcostal nerves - lumbar plexus nerves (L1-5) - sympathetic trunks