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MRCEM Primary > Abdominal wall anatomy > Flashcards

Abdominal wall anatomy Flashcards

1
Q

At what vertebral Lebel is the transpyloric plane of the abdomen?

A

L1

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2
Q

Name the main structures that the transpyloric plane passes through.

A

Fundus of GB
Hila of kidneys
First part of duodenum
Neck of the pancreas
Origin of SMA
Origin of portal vein
Pylorus of stomach
Hilum of spleen

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3
Q

At which vertebral level does the trans tubercular plane cross through?

A

L4

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4
Q

Where do the vertical lines of the abdominal regions pass between?

A

A point halfway between the pubic tubercle and the associated ASIS.

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5
Q

What marks the lower margin of the thorax and start of abdomen?

A

Costal margin

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6
Q

What structures form the costal margin?

A

Costal cartilages anteriorly
Ribs 7-10 laterally
Ribs 11-12 posteriorly

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7
Q

What is the linea alba?

A

A fibrous structure that runs down the midline of the abdomen in the median plane.

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8
Q

Where does the linea alba run between?

A

Xiphoid process and pubic symphysis.

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9
Q

What is the linea alba formed by?

A

The fusion of the aponeurosis of the muscles of the anterior abdominal wall.

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10
Q

What is the pubic symphysis?

A

The midline cartilaginous structure that unites the superior rami of the left and right pubic bones.

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11
Q

What are the layers of the anterior abdominal wall from external to internal?

A

Skin
Superficial fascia
Muscles and associated fascia
Parietal peritoneum

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12
Q

What are the 3 ‘flat’ muscles of the anterior abdominal wall?

A

External obliques
Internal obliques
Transverse abdominis

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13
Q

What are the 2 ‘vertical’ muscles of the anterior abdominal wall?

A

Rectus abdominis
Pyramidalis

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14
Q

Where are the flat muscles of the abdominal wall located?

A

Laterally.

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15
Q

How do the flat muscles strengthen the anterior abdominal wall and reduce the risk of hernias?

A

By running in different directions and the fibres ‘crossing’ each other.

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16
Q

In the anteromedial aspect of the abdominal wall, each flat muscle forms what?

A

An aponeurosis.

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17
Q

What is an aponeurosis?

A

A broad, flat tendon

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18
Q

What do the aponeuroses of the anterior abdominal Wal, cover?

A

The rectus abdomens muscle.

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19
Q

The aponeurosis of the flat muscles of the anterior abdominal wall become entwined in the midline and form what?

A

The linea alba.

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20
Q

What is the order of the flat muscles of the abdomen from external to internal?

A

External obliques
Internal obliques
Transversus abdominis

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21
Q

In which direction do the fibres of the external obliques run?

A

Inferomedially

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22
Q

What is the innervation of the external obliques?

A

Thoracoabdominal nerves (T7-T10)
Subcostal nerve (T12)

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23
Q

What are the actions of the external obliques?

A

Contralateral rotation of the torso

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24
Q

What is the origin of the external obliques?

A

Ribs 5 - 12

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25
Q

What is the attachment of the external obliques?

A

Iliac crest + pubic tubercle

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26
Q

In what direction do the fibres of the internal obliques run?

A

Superomedially

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27
Q

What is the innervation of the internal obliques?

A

Thoracoabdominal nerves (T7-T11)
Subcostal nerve (T12)
Branches of lumbar plexus

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28
Q

What are the functions of the internal obliques?

A

Bilateral contraction compresses abdomen
Unilateral contraction ipsilaterally rotates torso

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29
Q

What is the origin of the internal obqliues?

A

Inguinal ligament
Iliac crest
Lumbodorsal fascia

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30
Q

What is the attachment of the internal obliques?

A

Ribs 10-12

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31
Q

In what direction do the fibres of the transversus abdominis run?

A

Transversely

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32
Q

What is found deep to the transverse abdominis?

A

Transversals fascia

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33
Q

What is the innervation of the transverse abdominis?

A

Thoracoabdominal nerves (T7-T11)
Subcostal nerve (T12)
Branches of lumbar plexus

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34
Q

What is the function of the transverse abdominis?

A

Compression of abdominal contents

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35
Q

What is the origin of the transverse abdominis?

A

Inguinal ligament
Costal cartilages 7-12
Iliac crest
Thoracolumbar fascia

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36
Q

What is the attachment of the transverse abdominis?

A

Conjoint tendon
Xiphoid process
Linea alba
Pubic crest

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37
Q

Where is the rectus abdominis found?

A

Either side of the midline in the abdominal wall.

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38
Q

What splits the rectus abdominis into 2?

A

Linea alba

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39
Q

What do the lateral borders of the rectus abdominis create?

A

Linea semilunari (surface marking)

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40
Q

What structures transversely intersect the rectus abdominis?

A

Tendinous intersections (fibrous strips)

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41
Q

What is the innervation of the rectus abdominis?

A

Thoracoabdominal nerves (T7-T11)

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42
Q

What are the functions of the rectus abdominis?

A

Depresses the ribs
Stabilises the pelvis during walking
Assists flat muscles in compressing abdominal viscera

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43
Q

What is the origin of the rectus abdominis?

A

Crest of pubic bone

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44
Q

What are the attachments of the rectus abdominis?

A

Xiphoid process
Costal cartilage of ribs 5-7

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45
Q

What is the rectus sheath formed by?

A

The aponeuroses of the 3 flat muscles.

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46
Q

What does the rectus sheath enclose?

A

The rectus abdominis and pyramidalis muscles
Posterior intercostal nerves
Superior epigastric artery
Inferior epigastric artery

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47
Q

What is the arcuate line?

A

The demarcation point where the posterior layer of the rectus sheath ends.

Below the arcuate line, the rectus abdominis comes into direct contact with the transversals fascia.

48
Q

The vertical planes of the abdomen line up with which other hypothetical line?

A

Mid-clavicular lines.

49
Q

The fibres of the rectus abdominis have what orientation?

A

Run vertically.

50
Q

At what level does the thoracic aorta become the abdominal aorta?

A

T12

51
Q

In which space does the abdominal aorta descend in?

A

Retroperitoneal space, anterior and to the left of the lumbar vertebrae and IVC.

52
Q

Where does the abdominal aorta end?

A

At the L4 level, slightly to the left of the midline.

53
Q

What does the abdominal aorta bifurcate into?

A

Right and left common iliac arteries.

54
Q

What are the 3 main groups of branches of the abdominal aorta?

A

Single ventral gut arteries
Paired visceral arteries
Pairs wall arteries

55
Q

Which 3 vessels are single ventral gut arteries?

A

Coeliac artery
SMA
IMA

56
Q

At what level does the coeliac artery arise from?

A

T12

57
Q

At what level does the superior mesenteric artery arise from?

A

L1

58
Q

At what level does the inferior mesenteric artery arise from?

A

L3

59
Q

Which 3 vessels are classed as paired visceral vessels?

A

Middle adrenal arteries
Renal arteries
Gonadal arteries

60
Q

Which level do the middle adrenal arteries arise from?

A

L1

61
Q

Which level do the renal arteries arise from?

A

L2

62
Q

When the abdominal aorta is healthy, in what direction should it move when palpated?

A

Upwards in a pulsatile motion.

63
Q

What direction will the abdominal aorta move in upon palpation if there is an abdominal aortic aneurysm?

A

Outwards

64
Q

Define abdominal aortic aneurysm.

A

An enlargement of the aorta at least 1.5 times its normal diameter or >3cm in total.

65
Q

At what size can AAAs become prone to rupture?

A

> 6cm

66
Q

Where does the IVC arise from?

A
67
Q

At what vertebral level does the IVC arise?

A
68
Q

At what location does the IVC ascend?

A
69
Q

At what vertebral level does the IVC pierce the diaphragm?

A
70
Q

Name the veins which drain into the IVC.

A

Common iliac
Lumbar
Right gonadal
Renal
Hepatic

There are more but RCEM doesn’t require knowledge of them.

71
Q

Which areas are drained by the common iliac veins?

A

Lower limbs and gluteal regions

72
Q

Which areas are drained by the lumber veins?

A

Posterior abdominal wall

73
Q

Which areas are drained by the right gonadal vein?

A

Right testis/ ovary

74
Q

Which areas are drained by the renal veins?

A

Kidneys
Left adrenal
Left testis/ovary

75
Q

Which areas are drained by the left, right and middle hepatic veins?

A

Liver

76
Q

What are the 2 groups of abdominal lymph nodes?

A

Pre-aortic
Para-aortic

77
Q

Where do the pre-aortic lynph nodes lie?

A

Anterior to the aorta, around origins of visceral arteries.

78
Q

Which areas do the pre-aortic lymph nodes drain?

A

GI tract
Liver
Spleen
Pancreas

79
Q

The pre-aortic lymph nodes can be divided into which 3 further groups?

A

Coeliac lymph nodes
Superior mesenteric lymph nodes
Inferior mesenteric lymph nodes

80
Q

Where do the efferent lymphatics of the pre-aortic nodes drain into?

A

Intestinal trunk.

81
Q

Where do the para-aortic lymph nodes lie?

A

Laterally on either side of the aorta

82
Q

Which areas are drained by the para-aortic lymph nodes?

A

Kidneys
Upper parts of ureters
Gonads
Fallopian tubes
Uterus

83
Q

Where do the efferent lymphatics from the para-aortic lymph nodes drain into?

A

Lumbar trunk.

84
Q

What are the 5 muscles which form the posterior abdominal wall?

A

Iliacus
Psoas major
Psoas minor
Quadratus lumborum
Diaphragm

85
Q

Where is the quadrtus lumborum in relation to the posts major?

A

Superficial to it

86
Q

What is the innervation of the quadratus lumborum?

A

Anterior rami or T12 - L4

87
Q

What are the functions of the quadratus lumborum?

A

Extension and lateral flexion of the vertebral column

**Also fixes 12th rib during inspiration so that contraction of diaphragm is more efficient.

88
Q

What is the innervation of posts major?

A

Anterior rami of L1-L3

89
Q

What is the function of posts major?

A

Flexion of the thigh at the hip
Lateral flexion of the vertebral column.

90
Q

What is the innervation of iliacus?

A

Femoral nerve (L2-L4)

91
Q

What is the function of iliacus?

A

Flexion and lateral rotation of the thigh at the hip

92
Q

What is the posts sign?

A

Performed by flexing the thigh at the hip. Positive if this causes lower abdominal pain.

93
Q

What does the posts sign suggest?

A

Appendicitis.

94
Q

Where is the lumbar plexus located?

A

Within the psoas major, anterior to the transverse processes of the lumbar vertebrae.

95
Q

What is the lumbar plexus formed by?

A

The anterior rami (divisions) of the lumbar spinal nerves L1-L4.

96
Q

What are the 6 branches of the lumbar plexus?

A

Iliohypogastric nerve
Ilioinguinal nerve
Genitofemoral nerve
Lateral cutaneous nerve
Femoral nerve
Obturator nerve

97
Q

Which roots form the iliohypogastric nerve?

A

L1 (+ some T12)

98
Q

Which roots form the ilioinguinal nerve?

A

L1

99
Q

Which roots form the genitofemoral nerve?

A

L1 + L2.

100
Q

Which nerve roots form the lateral cutaneous nerve?

A

L2, L3

101
Q

Which nerve roots form the femoral nerve?

A

L2 - L4

102
Q

Which nerve roots form the obturator nerve?

A

L2 - L4

103
Q

Which muscles are supplied by the iliohypogastric nerve?

A

Internal obliques
Transversus abdominis

104
Q

Which cutaneous areas are supplied by the iliohypogastric nerve?

A

Posterolateral gluteal skin.

105
Q

Which muscles are innervated by the ilioinguinal nerve?

A

Internal obliques and transverse abdominis

106
Q

Which cutaneous areas are supplied by the ilioinguinal nerve?

A

Superior antero-medial thigh

Skin over root of penis and anterior scrotum

OR

Skin over mons pubis + labia majora

107
Q

Which muscles are supplied by the genitofemoral nerve?

A

Cremasteric muscle (genital branch)

108
Q

Which cutaneous areas are supplied by the genitofemoral nerve?

A

Genital = anterior scrotum/ mons pubis + labora majora.

Femoral = skin on upper anterior thigh

109
Q

What is the motor function of the lateral cutaneous nerve?

A

None.

110
Q

What cutaneous areas are supplied by the lateral cutaneous nerve?

A

Anterior and lateral thigh down to the knee.

111
Q

Which muscles are supplied by the obturator nerve?

A

Medial thigh muscles:

Obturator externes
Adductor longus
Adductor brevis
Adductor magnus
Gracilis

112
Q

What cutaneous areas are supplied by the obturator nerve?

A

Skin over medial thigh

113
Q

Which muscles are supplied by the femoral nerve?

A

Anterior thigh muscles:

Iliacus
Pectineus
Sartorius
Quadriceps femoris

114
Q

Which cutaneous areas are supplied by the femoral nerve?

A

Skin on anterior thigh and medial leg

115
Q
A

MRCEM Primary (39 decks)

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