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LSS_Abdomen > Abdominal wall - ANATOMY > Flashcards

Abdominal wall - ANATOMY Flashcards

1
Q

How is the abdominal wall separated?

A

Into 9 regions, divided by the mid-clavicular, subcostal and intertubular planes

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2
Q

Name the 9 regions of the abdomen

A

Epigastric
Left hypochondriac
Right hypochondriac

Umbilical
Left and right lumbar

Suprapubic
Left and right iliac

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3
Q

How else can the abdomen be separated?

A

Into 4 quadrants

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4
Q

What are the 4 quadrants of the abdomen?

A

Left and right upper and lower quadrants

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5
Q

What separates these quadrants?

A

Line down the centre and one horizontal at the belly button

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6
Q

On the antero-lateral abdominal wall, what are some surface landmarks?

A

Linea alba - midline

Umbilicus - belly button

Costal margin - ribcage as it slopes

Xiphoid process

Iliac crest - lateral protrusion of hip bone

ASIS - Anterior protusion of hip bone

Pubic symphysis - pubic bone middle

Pubic tubercle - on both sides of the pubic symphysis

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7
Q

How many layers of muscle are there on the lateral abdominal wall?

A 
Three
Oblique
- external
- internal
- transversus abdominal
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8
Q

What are the muscles on the anterior wall?

A

Paired vertical rectus abdominis - abs

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9
Q

What are the muscles on the posterior wall?

A

Post-vertebral
- erector spinae

Psoas
Quadratus lumborum
Iliacus

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10
Q

Where and what are the flank sheet muscles?

A

Muscles covering the lateral abdominal wall - which are?

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11
Q

What is the function of the flank sheet muscles?

A

Compress the abdomen and increase intra-abdominal pressure -

Supports viscera - guard intestines

Flexes and rotates trunk

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12
Q

What is the external oblique muscle attached to?

A

External surface of lower 8 ribs
- ORIGIN

HAS A FREE POSTERIOR BORDER

Attaches to - INSERTION

  • xiphoid process
  • linea alba
  • pubic crest + tubercle
  • anterior half of iliac crest

Muscle fibres are directed down and forward

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13
Q

What is aponeurosis?

A

A sheet of white fibrous tissue that take the place of tendon in flat muscle, with a wide point of attachment.

The aponeuroses form the rectus sheath

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14
Q

What is the internal oblique attached to?

A

Lateral
Thoracolumbar fascia
Iliac crest
Inguinal ligament

Medial
Lower 3 ribs
Xiphoid process
Rectus sheath

Fibres are downward and backward

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15
Q

What is the transversus abdominis attached to?

A

Lateral

  • Lower 6 costal cartilages
  • Thoracolumbar fascia
  • Iliac crest - anterior 3rd
  • Inguinal ligament - lateral 3rd

Medial

  • Xiphoid process
  • Linea alba
  • Symphysis pubis
  • Conjoint tendon

Fibres are horizontal

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16
Q

What is the rectus abdominis attached to?

A

Superior

  • 5-7 costal cartilages
  • Xiphoid process

Inferior

  • Symphysis pubis
  • Pubic crest

Fibres run longitudinally

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17
Q

What forms the rectus sheath? What does it do?

A

Aponeurosis of 3 muscles. Covers rectus abdominis

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18
Q

How is the rectus sheath divided?

A

Above umbilicus

  • Internal oblique aponeuorsis ENCLOSES rectus abdominis
  • External oblique is anterior to abdominis
  • Internal is POSTERIOR

Below umbilicus
- All three aponeurotic layers sit anterior to the rectus muscle

Posterior rectus sheath ends at ARCUATE Line before umbilicus, after this it joins the transversalis fascia, anterior to the rectus abdominis

19
Q

What are the posterior abdominal wall muscles?

A

Psoas major

  • hip and trunk flexor
  • joins to the 5 lumbar vertebra

Quadratus lumborum
- stabilises 12th rib and lateral trunk flexor

Iliacus muscle
- hip joint flexor

20
Q

Nerve supply of the posterior abdominal wall

A

Subcostal

Iliohypogastric

Ilio-linguinal

21
Q

What is the nerve supply of the abdominal wall?

A 
Segmental
 - External oblique
    - T7-11
 - Internal oblique and 
   transverse
    - T7-12 and L1
 - Rectus
    - T7-12

Dermatomes at

  • T7 - epigastrium
  • T10 - umbilicus
  • L1 - inguinal ligament
22
Q

What is the inguinal region?

A

Junction between abdominal wall and thigh

23
Q

Lymphatic drainage of the abdominal wall

A

None on the abdominal wall

Superficial
- go to the axiliiary lymph node

Deep
- mediastinal and external

24
Q

WHy is this area weak?

A

Muscles not directly attached to any structure

25
Q

What are the landmarks of inguinal region?

A

ASIS (anterior superior iliac spine) and pubic tubercle

26
Q

Why is this area weak?

A

Muscles not directly attached to any structure - ligament fills - thus weak

27
Q

What is the clinical and anatomical importance of this region?

A

C: Site of potential herniation
- femoral or inguinal

A: Site of structure entry and exit

28
Q

What is the inguinal canal used for?

A

The inguinal canal has an inherent weakness, allowing hernia formation

M

  • testis and spermatic cord descend from abdomen into the scrotum via the canal
  • ilioingual nerve
  • genito-femoral nerve

F

  • uterine ligament descends
  • ilion ingual nerve
  • genito-femoral nerve
29
Q

What is a hernia?

A

Where part of, or a whole organ/ tissue abnormally protudes through the wall of the structure containing the organ.

Occurs if the deep inguinal ring is large enough for part of organ to ‘pop’ through

30
Q

Describe a hernia

A

Protrusion of peritoneum through defective abdominal wall, forming hernial sac

Some organ is contained in the peritoneum

Covered by skin - lump-like

Requires

  • wall weaknesss
  • hernial sac
  • contents
31
Q

What is the structure of the inguinal canal?

A

Oblique passageway in the lwoer anterior abdominal wall

4cm long

32
Q

What are some facts about herniae in the groin

A

Inguinal > femoral

In femoral, female > male
- larger pelvis and hence space for herniation

Most inguinal herniae are congenital

33
Q

What is the structure of the inguinal canal?

A

Oblique passageway in the lower anterior abdominal wall

4cm long, above medial half of inguinal ligament

Deep ring 1.5cm above midpoint

Superficial ring right above and medial to tubercle

34
Q

How many walls are there of the inguinal canal and what are they made of?

A

Anterior

  • external oblique aponeurosis
  • internal oblique for reinforcement - lateral 3rd

Floor
- rolled inferior edge of ext oblique - inguinal ligament

Roof
- arching fibres of both internal and external oblique muscles

Posterior

  • transversalis fascia
  • medially conjoint tendon

Made from the various muscles and ligament

35
Q

What is an inguinal hernia?

Compare the types

A

Direct - ACQUIRED

  • goes through Hesselbach’s triangle - inguinal - posterior to superficial ring
  • always medial to inferior epigastric vessels
  • just goes through superficial ring
  • associated with chronic straining
  • doesn’t go into scrotum

Indirect - CONGENITAL

  • internal ring is LATERAL to inferior epigastric vessels
  • goes through deep ring THEN superficial
  • through to scrotum as it takes path that testes would
  • defective DEEP ring - dilation
36
Q

What are the layers of fat along the abdominal wall, superficial to deep?

A

Camper’s fascia

Scarpa’s fascia

Preparietal fat

37
Q

What happens if the abdominal aorta is blocked?

A

The superior and inferior epigastric arteries can anastomose, forming a bypass.

38
Q

How are the parietal and visceral peritoneum innervated?

A

Parietal - same as anterior abdominal wall

Visceral - no innervation

39
Q

What is the femoral canal?

A

Canal beneath inguinal ligament containing lymph vessel, the femoral vein and artery pass lateral to it

Vessels + canal = femoral sheath

40
Q

What is a conjoint tendon?

A

Lowest fibres of the internal oblique aponeurosis and transversus abdominis aponeurosis join, forming this tendon.

Attaches medially to linea alba

41
Q

What is a femoral hernia?

A

Hernia via femoral canal
Not as common as inguinal
More common in women and elderly
High incidence of obstruction and strangulation

42
Q

Where is the femoral canal located?

A

In relation to it:

Superior - inguinal ligament
Inferior - pectineus fascia
Medial - lacunar (Gimbernat) ligament
Lateral - femoral vein

43
Q

How are femoral herniae characterised?

A

Irreducible

Hot and painful if strangulated

Distinguishable from inguinal as below and lateral to pubic tubercle

44
Q

Where are inguinal hernias positioned?

A

Above and medial to pubic tubercle

LSS_Abdomen (16 decks)

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