Abdominal wall and inguinal region Flashcards
Fascias of abdominal wall
- Superficial fascia:
- Camper’s fascia
- Membranous fascia of Scarpa - Deep fascia
Layers of abdominal wall
- skin
- subcutaneous fatty tissue
- superficial fascia
- external oblique + aponeurosis
- internal oblique + aponeurosis
- transversus abdominis + aponeurosis
- transversalis fascia
- preperitoneal fatty tissue
- parietal peritoneum
External oblique
O: rib 5-12
I: iliac crest, inguinal ligament, rectus sheath
I: intercostal nerves (T8-T11), subcostal nerves (T12), ilioinguinal nerve, iliohypogastric nerve
F: flex vertebral column, bend laterally + rotation
Internal oblique
O: iliac crest, thoracolumbar fascia, ASIS, inguinal ligament
I: ribs 10-12, linea alba, pubic tubercle
I: T6-T12 IC nerves, iliohypogastric + ilioingunal
F: rotation, bending laterally, flexes lumbar vertebral column
Transversus abdominis
O: 7-12 ribs, thoracolumbar fascia, iliac crest, inguinal ligament
I: xiphoid cartilage, linea alba, pubic tubercle, pectin pubis
I: lower 6 thoracic IC nerves, ilioinguinal + iliohypogastric
F: contraction + expansion of abdominal wall, rotation , flexion of trunk
Rectus abdominis
O: 5-7 ribs, xiphoid process
I: pubic tubercle
I: T7-T12 IC nerves
F: flexes vertebral column, tenses abdominal wall
Pyramidalis
O: pubic crest
I: linea alba
I: intercostal nerves
F: tenses linea alba
Rectus Sheath
Anterior layer:
- above arcuate line: external + internal oblique
- below arcuate line: external + internal oblique + transversus abdominis
Posterior layer:
- above: internal oblique + transverses abdminis
- below: rectus abdominis, transversalis fascia
Nerves of anterolateral abdominal wall
- thoracoabdominal nerves
- thoracic spinal nerves
- subcostal nerve
- iliohypogastric nerve
- ilioinguinal nerve
Vessels of anterolateral abdominal wall
- superior epigastric vessels (internal thoracic)
- inferior epigastric vessels (external iliac)
- superficial circumflex iliac vessels (femoral artery, ⇒ greater saphenous vein)
- deep circumflex iliac vessels (external iliac artery)
- superficial epigastric vessels (demoral artery, ⇒ greater saphenous vein)
Cutaneous veins: - paraumbilical veins
- thoracoepigastric veins
- inferior/superior epigastric veins
Inguinal region
BORDERS: sup: horizontal line from ASIS to midline med: linea alba inf.lat.: inguinal ligament CONTENT: 5 umbilical folds inguinal canal
Inguinal ligament of Poupart
fibrous band formed by the thickened inferior border of the aponeurosis of the external oblique
from ASIS to pubic tubercle
bridging muscular and vascular lacunae
Inguinal canal
BORDERS:
sup: internal oblique, transverses abdominis
ant: aponeurosis of external + internal oblique
post: transversalis fascia + conjoint tendon
inf: inguinal ligament
CONTENT:
- in males: spermatic cord + ilioinguinal nerve
- in females: round ligament + ilioinguinal nerve
Peritoneum
- serous sac of mesothelium
- the peritoneal sac + omental bursa
- parietal + visceral peritoneum
Intraperitoneal organs
- stomach
- duodenum
- liver
- spleen
- jejunum
- ileum
- cecum + appendix
- transverse colon
- sigmoid colon
- oviduct
- uterus
Semi-intraperitoneal organs
- cecum
- ascending colon
- descending colon
- rectum
- urinary bladder
- posterior fornix of vagina
Retroperitoneal organs
- kidney
- adrenal gland
- ureter
- rectum (middle1/3)
- duodenum
- pancreas
also:
- abdominal aorta
- IVC + common iliac veins
- lymphatics: lumbar trunks, intestinal trunk, cisterna chyli
- nerves: lumbar + sciatic plexus, sympathtic trunk, para- and prevertebral ganglia
Infraperitoneal organs
- urinary bladder
- rectum (lower1/3)
- prostate
- seminal vesicle
- vas deference
- cervix of uterus
- anterior fornix of vagina
- urethra
- vagina
also:
- common iliac arteries, external iliac a., internal iliac a
- pelvic venous plexus
- lymphatics: lumbar trunk, pelvic lymph nodes
- nerves: pudendohaemorrhoidal plexus-
Preperitoneal space
- between anterior parietal peritoneum and transversalis fascia
1. Median umbilical fold: - apex of urinary bladder ⇒ umbilicus
- covers median umbilical ligament, remnant of urachus
⇒ FSV: supravesical fossa
2. Medial umbilical folds: - lateral to medial umbilical fold
- covers medial umbilical ligament⇒ remnant of umbilical arteries
⇒ FIM: medial inguinal fossa
3. Lateral umbilical folds: - covers inferior eoigastric vessels
⇒ FIL: lateral inguinal fossa
Omental bursa
- 3 recesses: superior, inferior splenic
- parts:
⇒ epiploic foramen: communication with greater sac
⇒ vestibule: between epiploic foramen + gastropancreatic fold
⇒ gastropancreatic fold
⇒ cavity proper
Borders of Epiploic foramen
ant: Hepatoduodenal ligament
post: Hepatorenal ligament + IVC
sup: Liver (caudate lobe)
inf: Duodenum (1st part) + Duodenorenal ligament
Borders of Cavity proper of Omental bursa
ant: Hepatogastric ligament, stomach, gastrocolic ligament
inf: Transverse colon + Transverse mesocolon
post: Posterior parietal peritoneum + pancreas
Surgical entrace to Omental bursa
⇒ via lesser omentum
⇒ via greater omentum
⇒ via transverse mesocolon
Recesses of Greater sac
- Subphrenic recess
- Subhepatic recess
- Paracolic recess
- Rectovesical puch- in males
- Rectouterine pouch- in female
- Vesicouterine puch - in female
- Duodenojejunal, sup + inf
Lesser omentum
- connects lesser curvature of stomach + duodenum with liver
- consists of: Hepatogastric + Hepatoduodenal ligament
Greater omentum
- hangs down from greater curvature of stomach + duodenum⇒ attaches to transverse colon + mesocolon
- consists of: Gastrosplenic + splenorenal + gastrophrenic + gastrocolic ligaments
Peritoneal ligaments
- Phrenicocolic
- Falciform
- Teres ligament of liver
- Coronary ligament of liver
- Ligamentum venosum
- Hepatoduodenal
- Hepatogastric
- Gastrosplenic
- Splenorenal
- Gastrophrenic
- Gastrocolic
- Root of mesentery
Monro-Richter line
line passing from umbilicus to ASIS
McBurney point
located on lateral 1/3 of Monro-Richter line, marks approximate location of base of appendix
Monro point
located on interspinal line of Lanz, vertically below McBurney point, also for location of appendix
Right upper quadrant
- Liver
- Gall bladder
- stomach: pylorus
- duodenum: parts 1-3
- pancreas: head
- right suprarenal gland
- right kidney
- right colic flexure
- ascending colon
- transverse colon
Right lower quadrant
- cecum
- vermiform appendix
- ileum
- ascending colon
- right ovary
- right uterine tube
- right ureter
- right spermatic cord
- uterus
- urinary bladder
Left upper quadrant
- liver
- spleen
- stomach: fundus
- jejunum + ileum
- pancreas: body + tail
- left kidney
- left suprarenal gland
- left colic flexure
- transverse colon
- descending colon
Left lower quadrant
- sigmoid colon
- descending colon
- left ovary
- left uterine tube
- left ureter
- left spermatic cord
- uterus
- urinary bladder
Hernias
- Abdominal hernias
- umbilical
- epigastric
- spigelian
- incusional
- lumbocostal
- lumbar
- femoral
- hiatal - Inguinal hernias
- indirect
- direct
Corona mortis
- anatomical variant
- anastomosis between the obturator and the external iliac or inferior epigastric arteries or veins
- location: behind the superior pubic ramus
- importance: hemorrhage may occur if accidentally cut and it is difficult to achieve subsequent hemostasis, e.g. during hernia operation
