Abdominal Wall Anatomy

Question 1

Abdominal communication with the thoracic and pecliv cavity

Answer 1

Thoracic connection to abdominal cavity- holes in the diaphragm

Communication to pelvis- open communication

Question 2

Extent of the abdominal cavity superiorly and inferiorly and posterior

Answer 2

Superior- diaphragm, coastal margin, xiphoid

inferior- lilac crest, anterior superior iliac spine, inguinal ligament, pubic symphysis

posterior-lumbar vertebrae, muscle and fascia

Question 3

Rectus abdominus is?

Answer 3

The msucle that connects the ribs to the pelvis (six pack)

Question 4

Tendinous insertions?

Answer 4

Interruptions in the rectus abdominus that allows you to control each rectus abdominus muscle

Question 5

What is the linea alba

Answer 5

white line in cadavers where the aponeurosis of the lateral muscles come over and meet. Nothing there expect muscle so makes a good point of incision because there are no blood vessels or nerves.

Right in line with the umbilicus

Question 6

Linea semilunaris line

Answer 6

The lateral edge of the rectus abdominus. Good point of surgurical access and you avoid structures that you should incise through

Question 7

Umblicus is

Answer 7

The entrance of the umbilical cord. Usually at the 10th thoracic level

Question 8

What is in the right upper quadrant?

Answer 8

Most anteriorly- liver, small part of stomach, tranverse colon, small intestine

Middle- gallbladder,top portion of ascending colong, duodenum, pancrease

posteriorly- right kidney and suprarenal gland

Question 9

What is in the right lower quadran

Answer 9

Anterior- small intestine

Middle Ascending colon and appendix

Posteriorly ureters and half of urinary bladder

Question 10

What is in the left upper quad

Answer 10

Anterior- Stomach, transverse colon, and SI (jejunum and ileum)

Middle- Spleen, pancreas, top of descending colon, small bit of duodenum

Posterior- Left kidney, suprarenal and abdominal aorta

Question 11

What is in the left lower quadrant

Answer 11

Anterior- jejunum and ileum

Middle- descending colon

Posterio- half of urinary bladder, left ureters

Question 12

How to divide into the 9 quad system

Answer 12

Vertical- Line at the midclavicular line

Two horizontal lines- one under the costal margin and one extending between the iliac crest

Question 13

Name the nine zones

Answer 13

1. Right hypochondrium, 2. epigastric,
2. left hypochondrium
3. right flank, umblical region, left flank, right groin, pubic (hypogastric) region, left groin

Question 14

Match the three regions to foregut, midgut and hindgut pain

Answer 14

Foregut- epigastric
MId- umbilical
Hind- pubic (hypogastric) region

The pain associated with these areas can compartmentalize it so this one is useful

Question 15

What structures are by the transpyloric plane and where is it?

Answer 15

Half way between the jugular notch and the pubic symphsis

Pylorus of the stomach, fundus of the gallbladder, neck and body of the pancreas, hila of the kidneys, 1st part of duodenum, and the origin of the superior mesenteric artery

Question 16

Structures in the foregut

Answer 16

Artery- celiac

esophagus, stomach, duodenum, liver, pancrease, biliary appartus, gallbladder

Question 17

Structures in the midgut (umblical region

Answer 17

Atery- superio mesenteric

Duodenum (2-4th part), jejunum, ileum, cecum, appendix, ascending colon, transverse colon

Question 18

Structures in the hind gut (hypogastric/pubic region)

Answer 18

Artery- inferior mesenteric

transverse colon
Descending colon
sigmoid colon
rectum
anal canal

Question 19

What thoracic nevce is the umblical associated with

Answer 19

T10- important neural landmark especially when determing spinal injury

Question 20

What innervates the thoracic wall

Answer 20

The intercostal thoracic nerves from T7-T12

Question 21

Explain blood supply to abdominal wall

Answer 21

Main the superior epigastric artery which is a continuation to the internal thoracic artery

The Superior epigastric anastomoses with the inferior epigastric which is a branch of the external iliac artery

Other blood supplies- lower posterior intercostal arteries
Lumbar arteries
Branches of the femoral artery

Veins follow the artery

Question 22

Explain the layers of superficial fascia of the abdominal cavity

Answer 22

It’s uniform in thickness around the umblicus

Camper- outer fatty
Scarpas- deeper fibrous (tough) layer- always there

The scarpas extends to the inguinal ligament and adheres to the fascia lata of the thigh

Question 23

Layers of the deep fascia

Answer 23

Rectus muscle with its aponeurosis and below that is the transversalis fascia (can’t be dissected out)

Question 24

Scarpas fascia range

Answer 24

Stops at the inguinal ligament and in a male contiunes covers the scrotum over the penis and stops before the head of penis and

Female covers clit and covers the labia majora

So injecting bacteria under the scapas fascia can infiltrate the entire area

Urine would flow into the space contained by the scapas fascia if the pelvis is crushed and the ureter is cut, so swelling would begin

Question 25

Muscles of the abdominal cavity

Answer 25

``` Outer Layer Rectus abdomnius External oblique Internal oblique Transversus abdominus ```

Question 26

Rectus Sheath difference below the ___ line

Answer 26

Arcuate line Anterior rectus above is the external and internal oblique Posterio-- rectus sheath above the arcuate line is the internal and transversus Below the line all three layers are anterior

Question 27

Expalin how the layers work around the rectus abdominus

Answer 27

External is always superficial to the rectus abdominus The deepest layer always stay deep to the rectus abdominus The middle layer splits to enclose the rectus At the arcuate line all three sheaths are anterior so that they don't miss the pubic smpyhsis

Question 28

Inferior epigastric artery | Location

Answer 28

Lie within the lateral umbliical folds and associated with the arcuiate line.

Question 29

Structures inside the abdominal wall 3 folds and what lies in them? Know this!

Answer 29

Median umbliical fold that relates to the urchus which is part of the developing urinary bladder Medial umbilical fold contains obliterated umbilical artery Laterl umblical fold- inferior epigastric artery

Question 30

Inguinal region Where? Shape? male vs female

Answer 30

Where- Under the inguinal ligament; two creases between the abdomen and the thigh Shaped like- oblique tubes Two rings- the deep (opening to pelvic cavity) and superficial (proximal opening to scrotum or labia majora)

Question 31

Contents of inguinal canal in males and femal

Answer 31

Females- through the canal is the round ligmanet exteds from uterus and inserts onto the labia majora and the illioinguinal nerve (off L1) Males- through the inguinal canal is the spermatic cord that extend to the scrotum and the illioinguinal nerve Illioinguinal nerve is lateral to the other parts

Question 32

Content of the spermatic cord (5)

Answer 32

1. Testicular artery 2. Pampiniform venous plexus 3. Vas deferens and its artery 4. Autonomic nerves 5. Lymphatic

Question 33

Parts of the inguinal ligament Where does it extend from?

Answer 33

Lateral crus fibers Medical Crus fibers Intercrural fibers Anterior superior iliac spine to the pubic tubercle

Question 34

Fascia covering the spermatic cord and where do they come from?

Answer 34

External spermatic fascia from external oblique Cremasteric fascia from internal oblique Internal spermatic fascia from transversalis fascia

Question 35

What layer of spermatic cord fascia is most important? Why

Answer 35

The cremasteric fascia (from the internal oblique) and it has skeletal muscle. So stroking the inside of the thigh will cause the testes to go up. Good assessment for neural activity.

Question 36

Explain the descend of testis

Answer 36

They start in the abdominal cavitiy in utero and are guided down into the scrotum as you grow by the gubernaculum. Important because of the path

Question 37

key factor of direct and indirect inguinal hernias

Answer 37

Lateral is the deep inguinal ring (indirect-- often due to defect in descent of testis) Medical is the anterior abdominal wall (direct)

Question 38

Hydrocele

Answer 38

abnormal accumulation of fluid in the cavity of the tunica vaginalis

Question 39

Vasectomy

Answer 39

Cutting the vas deferens so disconneting the testis from the penis