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Anatomy > Abdominal Wall And Inguinal Region > Flashcards

Abdominal Wall And Inguinal Region Flashcards

1
Q

Abdominal wall boundaries

A

. Sup: costal margin

. Inf: iliac crests, inguinal ligament, and pubis

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2
Q

Umbilicus

A

. Midline at L3-4 intervertebral disc

. Innervated by T10 dermatome

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3
Q

Linea alba

A

. Tendinous midline raphe extending from process xiphoid to pubic symphysis
. Formed by interdigitating fibers of aponeuroses of abdominal wall muscles
. Located at depression btw rectus abdominis mm.

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4
Q

Linea semilunaris

A

. Curved line formed by lat. margin of rectus abdominis

. Runs from costal margin to pubic symphysis bilaterally

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5
Q

Inguinal groove

A

. Boundary btw abdomen and thigh

. Location of inguinal ligament

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6
Q

Subcostal plane

A

Through 10th costal cartilages

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7
Q

Transumbilical plane

A

Umbilicus and L3-4 vertebral disc

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8
Q

Transtubercular plane

A

Through iliac tubercles

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9
Q

Midclavicular plane

A

. Connecting midpoints of clavicle and inguinal ligament

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10
Q

How are abdominal quadrants created?

A

Transumbilical and median planes intersect

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11
Q

Abdominal regions

A 
. Sub cost, transtubercular, and R/L midclavicular planes intersect 
. R/L hypochondriac
. R/L lateral
. R/L inguinal
. epigastric 
. Umbilical 
. Hypogastric (pubic)
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12
Q

Lateral abdominal wall layers from superficial to deep

A

. Skin
. Superficial fascia
. Deep fascia (assoc. w/ abdominal wall muscles)
. Muscles
. Transversalis fascia
. Extraperitoneal fat
. Parietal peritoneum (serous membrane lining cavity)

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13
Q

Superficial fascia layers

A

. Superficial fatty (Camper) fascia: contains nerve, blood vessels, and variable subQ fat
. Deep membranous (Scarpa) fascia: abdominal wall inf. To umbilicus attached to iliac crest, inguinal ligament and pubis, continous w/ perianal fascia

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14
Q

Transversalis fascia

A

. Anterolateral portion of the endoabdominal fascia that lines deep surfaces of abdominal wall muscles

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15
Q

Muscles of anterolateral abdominal wall innervated by ____

A

. T7-L1 ventral rami

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16
Q

External abdominal oblique m. OIA and fiber orientation

A

O: external surface of ribs 5-12
I: linea alba, pubic tubercle, iliac crest
A: flex and rotate torso
Fibers: inferomedial

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17
Q

Inguinal ligament

A

. Thickened inf. Margin of external abdominal oblique aponeurosis btw pubic tubercle medially and the ASIS laterally
. Inf. Margin rolls inward forming gutter
. Bridges muscles, nerves, and vessels running btw abdomen and thigh

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18
Q

Internal abdominal oblique m. OIA and fiber orientation

A

O: thoracolumbar fascia, iliac crest
. I: inf. Border ribs 10-12, linea alba, pubis via conjoint tendon
A: flex and rotate torso
Fiber: superomedial

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19
Q

Transversum abdominis OIA and fiber orientation

A

O: internal surface costal cartilages 7-12, thoracolumbar fascia, iliac crest
I: inf. Border ribs 10-12, linea alba, pubic crest, pecten pubis via conjoint tendon
A: support and compress abdominal contents
Fiber: horizontal

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20
Q

Conjoint tendon

A

. Falx inguinalis
. Formed by fused aponeuroses of internal abdominal oblique and transversum abdominis where they insert on pubic crest and pectineal line

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21
Q

Rectus abdominis OIA and fiber orientation

A

O: pubic symphysis and crest
I: xiphoid process, costal cartilages 7-12
A: flex torso and stabilize pelvis
fibers: vertical

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22
Q

Pyramidalis OIA and fiber orientation

A

O: pubic symphysis
I: linea alba
A: tenses linea alba
Fibers: superomedial

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23
Q

Functions of all anterolateral abdominal wall muscles

A

. Compress and support abdominal viscera
. Depress sternum and lower ribs to aid expiration
. Inc. intra-abdominal pressure to aid in micturition, defecation and parturition

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24
Q

Rectus sheath

A

. Formed by aponeuroses of lat. abdominal wall muscles

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25
Q

Rectus sheath boundaries

A

. Xiphoid process to pubic symphysis

. Linea alba to linea semilunaris

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26
Q

Rectus sheath composition sup. To umbilicus

A

. Ant. Layer: aponeuroses of external and internal abdominal obliques
. Post. Layer: aponeuroses of internal abdominal oblique and transversum abdominis

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27
Q

Rectus sheath composition inf. To umbilicus

A

. Post. Rectus sheath absent and all 3 aponeuroses contribute to ant. Rectus sheath
. Arcuate line marks point where post. Layer ends
. Inf. To arcuate line, the post. Surface of rectus abdominis rests directly on the transversalis fascia

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28
Q

Tendinous intersections of rectus sheath

A

. Horizontal tendinous bands that subdivide each rectus abdominis muscle and attach it to ant. Rectus sheath

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29
Q

Diastasis recti

A

. Abnormal separation of rectus abdominis muscle accompanied by stretching of linea alba
. Pregnancy and obesity most common cause in adults

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30
Q

Internal surface of anterolateral abdominal wall

A

. Inf to umbilicus, ligaments and vessels on interior surface of abdominal wall create folds in parietal peritoneum

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31
Q

Median umbilical ligament/fold

A

. Formed by obliterated remnant of embryonic duct (urachus) connecting urinary bladder to umbilicus

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32
Q

Medial umbilical ligaments/folds

A

. Formed by obliterated distal segments of embryonic umbilical arteries

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33
Q

Lateral umbilical folds

A

. Formed by inf. Epigastric vessels

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34
Q

Ventral rami course in anterolateral abdominal wall

A

. Anteroinferiorly in plane btw internal abdominal oblique and transversum abdominis muscles
. Enter rectus sheath laterally

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35
Q

Lat. and ant. Cutaneous branches in anterolateral abdominal wall

A

. T7-9: sup. To umbilicus
. T10: level of umbilicus
. T11-12: inf. To umbilicus
. L1: iliohypogastric n. (Inguinal and hypogastric region) and ilioinguinal n. (Scrotum/labium majus, mons pubis, and superomedial thigh)

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36
Q

Blood supply to upper abdominal wall

A

. Internal thoracic a.branches int musculophrenic a. (To diaphragm and hypochondriac region) and sup. Epigastric a. (Post. Layer of rectus sheath tp supply rectus abdominis and epigastric region)
. Post. Intercostal and subcostal aa. To upper abdominal wall

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37
Q

Blood supply to lower abdominal wall

A

. External iliac a. Branches into inf. Epigastric and deep circumflex aa.
. Superficial fascia and skin below umbilicus supplied by superficial circumflex iliac and superficial epigastric (from femoral)aa.

38
Q

Inf. Epigastric a.

A

. From external iliac
. Ascends deeps to rectus abdominis
. Enters rectus sheath
. Anastomoses w/ sup. Epigastric a.

39
Q

Deep circumflex iliac a.

A

. Muscles of inguinal region

40
Q

Thoracoepigastric v.

A

. Located in superficial fascia of lat. thoracoabdominal wall
. Connects superficial epigastric v. To lateral thoracic v. Creating indirect communication btw femoral and axillary vv.
. Communicates w. Paraumbilical vv. In central abdominal wall

41
Q

Lymphatic drainage in anterolateral abdominal wall

A

Follows venous return to axillary and superficial inguinal lymph nodes

42
Q

Thoracoepigastric vv. Role when iliac veins or inf. Vena cava are obstructed

A

. Provides collateral route for venous return from lower body

43
Q

Inguinal region

A

. Portion of lower abdominal wall sup. To inguinal groove
. Boundary btw abdomen and thigh
. Most common site of abdominal hernias

44
Q

Iliopubic tract

A

. Thickening of transversalis fascia

. Reinforces inguinal ligament post.

45
Q

Lacunar ligament

A

. Fibers of inguinal ligament pass lat. from pubic tubercle and attach to sup. Pubic ramus
. Forms sickle-shaped structure

46
Q

Pectineal ligament of Cooper

A

. Inguinal ligament fibers run post. Attaching to pecten pubis

47
Q

Inguinal canal

A

. Oblique 4 cm long passage in lower abdominal wall parallel and just sup. To medial half of inguinal ligament

48
Q

Inguinal canal openings

A

. Deep inguinal ring: evagination of transversalis fascia sup. To middle of inguinal ligament and lat. to inf. Epigastric vessels
. Superficial inguinal ring: opening in external oblique aponeurosis superolat. To pubic, has crura margins

49
Q

Superficial inguinal ring crura

A

. Lat. crus: fibers attaching to pubic tubercle
. Med. crus: fibers attaching to pubic body
. Intercrural fibers: run perpendicular to crura to reinforce apex of ring

50
Q

Inguinal canal boundaries

A

. Ant. Wall: aponeurosis of external abdominal oblique reinforced lat. by internal oblique m.
. Post. Wall: transversalis fascia reinforced med. by conjoint tendon
. Floor: iliopubic tract, inguinal ligament, and lacunar ligament (lat to med order)
. Roof: transversalis fascia (at deep ring), arching fibers from transversum abdominis m., internal oblique m., and external oblique aponeurosis at superficial inguinal ring (lat. to med. order)

51
Q

Inguinal canal development

A

. Formed during descent of fetal testis from original site in. Post. Abdominal wall to scrotum

52
Q

testis development

A

. Scrotum is Outpouching of abdominal wall lined by peritoneum (processus vaginalis)
. Gubernaculum (fibrous cord) guides testis external to peritoneal lining of abdominal cavity and processus vaginalis
. Testis drags ducts, nerves, vessels, and lymph behind creating permanent inguinal canal
. Wrapped by spermatic fascia corresponding to abdominal wall layers forming spermatic cord

53
Q

Inguinal canal in females

A

. Round ligament of uterus (gubernaculum derivative) follows same course as testis to reach labium majus(scrotum homolog)
. Canal is smaller
. Fascial coverings of round ligament indistinct

54
Q

Spermatic cords

A

. Composed of structures running to/from testis
. Starts at deep inguinal ring, transits inguinal canal, exits superficial inguinal ring
. Terminate post. To testis w/in scrotum

55
Q

Spermatic fasciae

A

. External spermatic fascia: from external oblique aponeurosis
. Cremasteric fascia: from internal oblique m.
. Internal spermatic fascia: from transversalis fascia

56
Q

Cremaster muscle

A

. Cremasteric fascia has loops of skeletal muscle innervated by genital branch of genitofemoral n. (L1-2)
. Contraction of cremaster muscle elevates testis to inc. temp

57
Q

Cremasteric reflex

A

Rapid elevation of testicle by stroking ipsilateral upper med. thigh by ilioinguinal n. (L1)

58
Q

Spermatic cord contents

A

. Ductus vas deferens: muscle tube that conveys sperm from Estes to ejaculatory duct
. Testicular a./vv.
. Lymph vessels
. Genital branch of genitofemoral n.
. Autonomic nerve fibers (supply smooth upscale of ductus deferens and arteries)

59
Q

Testicular torsion

A

. Interrupts blood flow to testicle
. Causes sudden, intense pain
. Requires immediate intervention to preserve affected testis
. Common in adolescents

60
Q

Round ligament of uterus

A

. Gubernaculum remnant composed of fibrous CT, smooth muscle, and blood vessels
. Attaches uterine body to fatty CT w/in labium majus

61
Q

Common inguinal canal contents (all genders)

A

. Ilioinguinal n.
. Genital branch of genitofemoral n. (Motor to cremaster, sensory to skin of lat. scrotum and labium majus)
. Small blood and lymph vessels following course of spermatic cord/round ligament

62
Q

Ilioinguinal n.

A

. L1
. Pierces internal oblique to enter inguinal canal
. Exits at superficial ring w/ spermatic cord/round ligament
. Supplies skin of med. thigh and ant. Scrotum/labium majus

63
Q

Scrotum structure

A

. Pendulous cutaneous sac
. Skin: darkly pigmented w/ hair
. Raphe: line of fusion of fetal R/L genital swellings, continuous internally w/ scrotal septum
. Septum: divides scrotum into R/L parts
. Dartos fascia: membranous layer continous w/ Scarpa’s fascia, contains dartos muscle
. Scrotal ligament: gubernaculum remnant that anchors mature testis

64
Q

Dartos muscle

A

. Smooth muscle fibers attaching to scrotal skin
. Innervated by sympathetic nerve fibers
. Wrinkles skin of scrotum dec. surface area and drawing it closer to body
. Reduces heat loss

65
Q

Scrotum blood supply

A

. Ant. And post. Scrotal branches of external and internal pudendal aa.

66
Q

Scrotum innervation

A

. Sensory vi genitofemoral n. (Lat. surface), ilioinguinal n. (Ant. Surface), and pudendal and post. Femoral cutaneous nn. (Post. Surface)
. Postsynaptic sympathetic fibers from nerves supply dartos mm. And cutaneous glands of scrotum

67
Q

Lymph drainage of scrotum

A

. Superficial inguinal lymph nodes

68
Q

Optimal temperature for spermatogenesis

A

34 degrees, 3 degrees lower than normal body temp

69
Q

Testis and components

A

. Male gonad, source of spermatozoa and testosterone
. Tunica albuginea: tough CT forming outer tunic of testis
. Septa: continous w/ tunica albuginea, divides testis into lobules
. Seminiferous tubules: densely coiled ducts (site of spermatogenesis) open to rete testis
. Efferent ductules: connect rete testis and epididymis

70
Q

Epididymis

A

. Densely coiled duct of epididymis
. Site of sperm storage and maturation
. Post. To testis
. Head: attached to testis by efferent ductules
. Body: separated from testis by sinus of epididymis
. Tail: continous inf. W/ ductus deferens

71
Q

Ductus (vas) deferens

A

Muscular tube that moves sperm from epididymis to ejaculatory duct via inguinal canal and deep inguinal ring

72
Q

No scalpel (keyhole) vasectomy

A

. Permanent method of male sterilization
. Single scrotal puncture to isolate and ligament the vasa deferential
. Performed w/ local anesthetic
. Does not require scrotal sutures

73
Q

Tunica vaginalis

A

. Closed peritoneal sac surrounding testis and epididymis

. Remnant of fetal processus vaginalis

74
Q

Tunica vaginalis layers

A

. Visceral layer: surface of testis and epididymis
. Parietal: adjacent to internal spermatic fascia
. Cavity: closed peritoneal space btw visceral and parietal layers, contains small amt of serous fluid (no testis here)
. Bare area of testis: post. Region not covered by tunica vaginalis (site where vessels enter/leave testis)

75
Q

Testicular hydrocele

A

. Accumulation of excess serous fluid in tunica vaginalis cavity
. If it’s blood it’s a hematochezia
. Distinguished from other masses by transillumination of scrotum

76
Q

Testicular a.

A

. From abdominal aorta at L2 vertebral level

. Supplies testis, epididymis, and vas deferens

77
Q

Pampiniform plexus

A

. Complex network of anastomoses veins surrounding testicular a.
. Coalesce to form testicular veins that drain to inf. Vena cava (right) or left renal v. (Left)
. Provides counter-current heat exchange to help regulate testis temp.

78
Q

Varicocele

A

. Marked enlargement of pampniform plexus resembling bag of worms on palpation
. Caused by incompetent valves
. Reduce when patient lies down (hydroceles don’t)

79
Q

Lymph drainage of testis

A

. Follows blood supply

. Goes to lumbar lymph nodes w/in abdomen

80
Q

Testis innervation

A

. Testicular plexus follows testicular a.
. Plexus contains post-synaptic sympathetic fibers and visceral afferent fibers from T10 spinal level and vagal parasympathetic fibers

81
Q

Testicular cancer

A

. Most common cancer in males btw 15-35

. Tumor cells metastasize via lumbar lymph nodes

82
Q

Primary scrotal cancers

A

Metastasize via superficial inguinal lymph nodes

83
Q

Hernia

A

. Protrusion of anatomical structure into abnormal location

84
Q

Abdominal hernia

A

. Occurs when structural defects allow abdominal contents to protrude through abdominal wall
. Umbilicus, surgical incision sites, and inguinal region are common sites

85
Q

Abdominal wall hernia

A

. Covered by peritoneum forming hernia sac

. Neck of sac marks site of herniation

86
Q

Inguinal hernia

A

. Protrusion of abdominal contents through abdominal wall at superficial inguinal ring
. More common in males bc canal is larger
. Distinguished by etiology and site

87
Q

Indirect (congenital) inguinal hernia

A

. 2/3s of inguinal hernia
. Caused by persistence of patent processus vaginalis
. Protrudes through deep inguinal ring and transits entire canal
. Neck is lat. to inf. Epigastric vessels
. Covered by peritoneum and fascia of spermatic cord
. Passes from superficial ring to scrotum/labium majus

88
Q

Canal of Nuck

A

. Persistence of processus vaginalis in females
. May cause cysts in canal or labia
. Lead to indirect inguinal hernia

89
Q

Direct (acquired) inguinal hernia

A

. Caused by weakness of abdominal wall post. To superficial inguinal ring
. Protrudes through inguinal (Hesselbach) triangle
. Neck is med. to inf. Epigastric vessels
. Covered by peritoneum and transversalis fasica only
. Exits superficial ring lat. to spermatic cord
. Doesn’t usually enter scrotum/labium majus

90
Q

Hesselbach triangle

A

Inguinal trianglel

. Bound by inguinal ligament, lat. rectus abdominis, and inf. Epigastric vessels

91
Q

Structural features that mitigate inguinal hernia risk

A

. Oblique course of canal
. Ant. Reinforcement of deep inguinal ring via internal oblique m.
. Post. Reinforcement of inguinal triangle via conjoint tendon
. Approximation of ant. And post. Walls in response to inc. intra-abdominal pressure

92
Q

Femoral hernia

A

. Protrusion of abdominal contents inf. To inguinal ligament and into upper thigh
. More common in females bc longer pubic rami
. Sac covered by peritoneum and transversalis fascia
. Neck lat. to lacunar ligament

Anatomy (49 decks)

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