Abdominal Wall And Peritoneum Flashcards
What are the four major bony landmarks of the anterior abdominal wall?
The xiphoid process
Cotsal margins
Ilium (crest, ASIS, iliac crest)
Pubis
Ribs 6 & 7
What is the linea terminalis/pelvic inlet?
A line that separates the true pelvis from the false pelvis.
What is found superior to the linea terminalis?
The abdomen or false pelvis
What is found inferior to the linea terminalis?
Pelvis or true pelvis
What is the pelvic inlet formed from?
Pectin pubis (pubic bone)
Arcuate line (ilium)
Sacral promontory (sacrum)
Where is the deep inguinal ring found?
At the transversalis facia.
What are fascial layers of the abdomen continuous with?
The fascia of the thigm
What is the difference between the perineum and the periotneum?
The perineum are exteral reproductive structures.
The peritoneum is the outer layer fascial covering.
What is the superficial layer of the abdominal cavity? What is it continuous with?
Camper’s fascia (fatty layer)
It is continuous with the superficial fatty layers in the thorax, thigh and perineum.
What is the deeper layer of the abdominal cavity? What is it continuous with?
Scarpas layer (membranous layer)
It is continuous with the fascia lata in the thigh and with the deep layer of the superificial perineal fascia.
What three ligaments oconnect the fascia to the pubic bone?
Pectineal ligament
Lacunar ligament
Illioinguinal ligament
True or false: superficia blood vessels run in the fatty layer of the superficial fascia.
True
What does Scarpa’s fascia fuse with?
The fascia lata.
It is continuous over the penis and scrotum
Why is fascia thicker in the lower limb and abdomen?
Because more weight is present in the lower limb and abdomen, and a greater fascia is needed to support it.
What are the contents of the abdominal region?
Peritoneal cavity
GI tract (with associated glands and digestive organs)
Nerves (ANS and parasympathetics), lymphatics, vessels
Renal system
Why can fluid leak into the potential space between the membranous layer of superfiical fascia and the deep fascia of the external abdominal oblique muscle?
Because there are weak areas in the fascia into which fluid can leak.
What is the transverse plane midway between the superior borders of the pubic syphysis and the manubrium?
Transpyloric plane
What is the plane at the lowest level of the costal margin?
Subcostal plane
What is the plane passing through the summits of the iliac crests?
Supracrestal plane
What is the plane at the level of the iliac tubercles?
Transtubercular plane
What is the plane at the level of the ASIS?
Interspinous plane
What organs are found in the most anterior/superficial layer of the abdominal wall?
Liver
Stomach
Transverse colon
Small intestine
What organs are found in the middle layer of the abdominal wall?
Spleen
Pancreas
Duodenum
Descending colon
What organs are found in the most posterior/deep region of the abdominal wall?
Kidneys
Abdominal aorta
Ureters
Urinary bladder
In what quadrant is the liver found?
Right upper quadrant
In what quadrant is most of the stomach found?
Left upper quadrant
In what quadrants is most of the small intestine found?
Right and left lower quadrants
In what quadrant is the gall bladder found?
Right upper quadrant
In what quadrant is the spleen and pancreas found?
Left upper quadrant
In what quadrants is the descending colon found?
Right and left lower quadrants.
In what quadrants are the kidneys found?
Right and left upper quadrants
What are the four pairs of muscles found in the anterior and lateral portions of the abdominal wall?
External obliques
Internal obliques
Transversus abdominis
Rectus abdominis
The external obliques, internal obliques, transversus abdominis and rectus abdominis are found in the anterior and lateral portions of the abdominal wall. What are their functions?
They collectively compress and hold the abdominal organs in place.
They also flex and stabilize the vertebral column and laterally flex it.
What are the four muscles located in the posterior portion of the abdominal wall?
Iliacus
Psoas major
Psoas minor
Quadratus lumborum
The iliacus, psoas major, psoas minor and quadratus lumborum are located in the posterior region of the abdominal wall. What are the functions of these muscles?
They flex the spine and lower limb.
What is the rectus sheath?
An aponeurosis formed by three muscles of the anterior/lateral abdominal wall. (External obliques, internal obliques, transversus abdominis, rectus abdominis)
What does the rectus sheath enclose?
The rectus abdominis
What is the term for the midline of the rectus sheath?
Linea alba
True or false: the layers of fascia and aponeuroses of the muscles forming the rectus sheath are arranged differently in the upper abdominal wall than they are in the lower wall.
True
The layers of fascia and aponeuroses of the muscles forming the recturs sheath are arranged differently in the upper abdominal wall than they are in the lower wall. What is the line where this arrangement changes?
The arcuate line is the line where this arrangment changes.
What is found above the arcuate line?
Skin
Fatty layer of superficial fascia
Aponeurosis of external abdominal oblique fascia
1 layer of internal abdominal oblique aponeurosis
Rectus abdominis muscle
Skin, fatty layer of superficial fascia, aponeurosis of external abdominal oblique, abdominal oblique aponeurosis and rectus abdominis muscle are found above the arcuate line of the rectus sheath. What is also found above the arcuate line?
1 layer of internal oblique aponeurosis
Aponeurosis of transversus abdominus
Transversalis fascia
Extraperitoneal tissue
Parietal peritoneum
What is found below the arcuate line?
Skin
Fatty layer of superficial fascia
Membranous layer of superficial fascia
Aponeurosis of external abdominal oblique
Aponeurosis of internal abdominal oblique
Aponeurosis of transversus abdominis
The skin, fatty layer of superficial fascia, membranous layer of superficial fascia, aponeurosis of external abdominal oblique and aponeurosis of transversus abdominus are found below the arcuate line. What are some other things that are found below the arcuate line?
Rectus abdominis muscle
Transversalis fascia
Extraperitoneal tissue
Parietal peritoneum
How does the aponeurosis surround muscles above the arcuate line?
Above the arcuate line, the aponeurosis from the internal oblique splits to surround the rectus abdominis.
The aponeurosis from transversus abdominus runs posterior to rectus abdominus.
Where does the rectus abdominis directly lie?
It lies directly on the transversalis fascia.
What is the most superficial muscle of the abdominal wall?
External obliques
What is the most posterior/deep muscle of the abdominal wall?
Transversus abdominus
What muscles are found, from superficial to deep, in the anterior and lateral abdominal wall?
External obliques
Internal obliques
Rectus abdominus
Transversus abdominus
What muscle in the anterior/later abdominal wall forms the inguinal ligament?
External oblique
What is the primary function of the posterior muscles of the abdominal wall (iliacus, psoas major, psoas minor, quadratus lumborum)?
Flexors of the trunk and/or hip
Where do the deep system of arteries originate?
Superiorly from the subclavian artery.
Where does the deep system of the arteries branch?
In the mid-abdomen are from the abdominal aorta.
Where does the deep system of arteries originate?
Inferiorly from the external iliac artery.
Where does the superifical system of arteries originate?
They originate superiorly from perforating branches.
Where does the superficial system or arteries originate?
Inferiorly from branches of the femoral artery
The deep system of arteries includes … ?
Musculophrenic
Superior epigastric
Inferior epigastric
Intercostal
Subcostal
Lumbar
Deep circumflex
Iliac
Where does the superficial system of arteries run?
In the superficial fascial layer.
What are the major anterior abdominal wall veins?
Subclavian
External iliac
Lumbar and intercostal
What is the superficial drainage of the abdominal wall?
Thoracoepigastric veins
Lateral thoracic veins
Superficial epigastric veins
What is the innervation of the abdominal cavity?
Thoracoabdominal intercostal.
Lateral cutaneous branches emerge anterior axillary region, bifurcate into anterior and posterior branches.
Anterior cutaneous branches end with medial and lateral branches.
True or false: nerves in the anterior abdominal wall are ventral rami.
True
The inguinal fold is innervated by what intercostal nerves?
T7 - L1
The xiphoid region is innervated by what intercostal nerve?
T7
The umbilical region is innervated by what intercostal nerve?
T10
The inguinal fold region is innervated by what intercostal nerve?
L1
What are the vertebrae from which the intercostal nerve emerges?
T7 - T11
What are the vertebrae from which the subcostal nerve emerges?
T12
What are the vertebrae from which the lumbar nerve arises?
L1 - L4
What innervates the anterior abdominal wall nerves?
Cutaneous branches of ventral rami, intercostal nerves.
Where do the cutaneous branches of ventral rami and the intercostal nerves lie between?
The internal abdominal oblique and transversus abdominis.
They also pierce the recus sheath and innervate the rectus abdominis muscles.
What does the anterior abdominal wall nerves supply?
The skin, muscle and parietal peritoneum.
What does the iliohypograstric nerve supply?
The suprapubic region.
Where does the ilioinguinal nerve enter the pubic region?
Through the inguinal canal.
It emerges through the superficial inguinal region.
What does the ilioinguinal nerve supply?
The groin and scrotum/labium majus
What are the two branches of the genitofemoral nerve?
Genital branch
Femoral branch
Where does the genital branch exit the inguinal canal?
Through the superficial inguinal ring.
What does the genital branch innervate?
The cremaster muscle
It may also be cutaneous to the labium majus
Where is the femoral branch of the genitofemoral nerve cutaneous to?
The femoral triangle area.
Where does the anterior abdomen drain superiorly from?
The umbilical region to anterior axillary and sternal nodes.
Where does the superficial lymphatic drainage drain inferiorly from?
The umbilical region to superficial inguinal nodes.
Where does the deep lymphatic drainage drain?
Along posterior intercostal and lumbar vessels to deep abdominal nodres from testes to deep abdominal nodes.
What is a hernia?
A hernia is when a portion of the viscera protrudes through a weakened point of the muscular wall of the abdominopelvic cavity.
Why is a hernia a significant medical problem?
Blood flow to the trapped segment may diminish, causing that portion of the intestine to die.
It is called a strangulated intestinal hernia.
What are the two types of hernias?
Inguinal
Femoral
What is the most common type of hernias?
Inguinal
It occurs because the inguinal region is one of the weakest areas of the abdominal wall.
True or false: females are more likey to develop inguinal hernias than males.
False. Males are more likely to develop inguinal hernias than males.
What provides the force to push a segment of the small intestine into the canal?
Rising pressure in the abdominal cavity.
What are the two types of inguinal hernia?
Direct inguinal hernia
Indirect inguinal hernia
What is a direct inguinal hernia?
When a loop of small intestine protrudes directly through the superficial inguinal ring, but not down the entire length of the inguinal canal, and creates a bulge in the lower abdominal wall.
What is an indirect inguinal hernia?
When a herniation travels down the entire inguinal canal and may even extend al lthe way into the scrotum.
What occurs in an indirect inguinal hernia?
A herniation passes lateral to inferior epigastric vessels to enter deep inguinal ring.
What occurs during a direct inguinal hernia?
Herniation passes medial to inferior epigastric vessels punching through peritoneum and transversalis fascia.
Where does a femoral hernia occur?
In the upper thigh, just inferior to the inguinal ligament, originating in the femoral triangle.
The medial part of the femoral triangle is relatively weak and prone to sress injury, allowing a loop of small intestine to protrude.
Why do women more commonly develop femoral hernias?
Because of the greater width of their femoral triangle.
What occurs in an umbilical hernia?
It is when a portion of the intestine pushes through the abdominal wall musculature in the periumbillical or umbilical region.
It is most common in infants
What organs comprise the foregut?
Esophagus
Somtach
Duodenum
Liver
Gallbladder
Spleen
Pancreas
What organs comprise the midgut?
Duodenum
Jejunum
Ileum
Cecum & appendix
Ascending colon
2/3 of transverse colon
What organs comprise the hindgut?
1/3 transverse
Descending and sigmoid colon
Rectum
Anal canal
What are the subdivisions of the peritoneum?
Parietal layer
Visceral layer
What layer of the peritoneum contains pain fibers?
The parietal layer
What layer of the peritoneum lines the body wall?
Parietal layer
What is the intraperitoneal region covered on most sides by?
The visceral peritoneum.
It is susupended by the mesentery from the body wall.
What do the retroperitoneal organs lie deep to?
The parietal peritoneum.
It is covered by parietal peritoneum on one side only.
What is the nerve supply to the peritoneum?
Nerves from the adjacent body wall supply parietal peritoneum.
They supply pain and vasomotor fibers.
What are the retroperitoneal organs?
Kidneys
Ureters
Adrenals
Gonads
Aorta and inferior vena cava
What are the secondary retroperitoneal organs?
Duodenum
Pancreas
Ascending and descending colon
What are the mesenteries?
2 layered fold of the peritoneum.
It attaches free small intestine to the posterior body wall.
It also includes the jejunum and ileum.
What is the function of the transverse mesocolon?
It holds the transverse colon to the posterior body wall. It also fuses with the posterior layer of the greater omentum.
What is the function of the sigmoid mesocolon?
It holds the sigmoid colon to the posterior body wall.
What is the mesoappendix?
The mesentery of the vermiform appendix
The mesenteries of the duodenum, ascending colon, descending colon and cecum are usually lost during development. Since they are no long susupended by a mesentery, what are they held by?
Secondary retropritoneal.
What are features of peritonea ligaments?
They usually transmit nerves and vessels
They usually lack connective tissue and are not the same as ligaments that join bones.
They may be subdivisions of a larger structure.
What are two examples of peritoneal ligaments?
Gastrosplenic ligament
Splenorenal ligament
What is the omentum (epiploon)?
A broad, 2-4 layered sheet of peritoneum that attaches the stomach to other viscera.
What does the lesser omentum develop from?
The ventral mesograstrium (mesentery).
It is divided into the hepatogastric ligament (stomach to liver) and the heptaduodenal ligament (liver to duodenum)
What are peritoneal ligaments associated with the liver?
Coronary ligaments
Right and left triangular ligaments
Falciform ligament
Ligamentum teres hepatis
What is a fold?
A ridge or elevation in the peritoneum produced by underlying vessels.
What are fossae?
Depressions between folds.
What are exapmles of some folds and fossae?
Superior duodenal fold and fossa
Paraduodenal fossa
Inferior duodenal fold and fossa
Retroduodenal fossa
Fold is formed by inferior mesenteric vein posterior to peritoneum.
What are the structures coursing through the extraperitoneal tissue that form elevations on the interior abdominal wall called?
Peritonal folds
Where is the median umbilical fold found?
Midline from the bladder
What folds are found in the internal aspect of the abdominal wall?
Medial umbilical folds
Lateral umbilical folds
What is a supraumbilical structure located on the internal aspect of the anterior abdominal wall?
The falciform ligament.
It is a curved remnant of the ventral mesograstrium.
What fossa is the site for supravesical hernias?
The supravescial fossa.
It is located between the median and medial umbilical folds.
What is the site for direct inguinal hernias?
Medial inguinal fossa.
It is between the medial and lateral umbilical folds.
What is another term for the medial inguinal fossa?
The inguinal triangle
What is a site for indirect inguinal hernias?
Lateral inguinal fossa.
It is lateral to umbilical folds.
What forms most of the “potential” space within the abdomen?
The greater sac
What can the greater sac be subdivided into?
The supracolic and infracolic regions by the colon and transverse mesocolon.
What is the supramesocolic (supracolic region)?
A region superior and anterior to the liver and stomach.
It includes the hepatorenal and subphrenic spaces and fossae of the anterior wall.
What is the peritoneal cavity?
A closed potential space between the parietal and visceral layers of peritoneum.
What are three recesses and fossae of the peritoneal cavity?
Subphrenic recess
Subhepative/hepatorenal recess
Rectovesical/rectouterine recess.
Why is the greater sac of clinical importance?
It is important because abscesses may develop and excess fluid (ascites) will pool here.
What is the inframesocolic (infracolic) region?
The inferior and posterior part of the greater sac. It is subdivided by mesenteries and ligaments.
Where are the right and left pracolic gutters located?
Lateral to the ascending and descending colon.
What are the upper and lower parts of the inframesocolic region dividd by?
The right and left infracolic spaces
Why is the inframesocolic region clinically important?
Because it is where intraperitoneal infections spread.
What in the inframesocolic region limits the spread of fluid superiorly?
The phrenicocolic ligament.
True or false: the lesser sac (omental bursa) develops as a part of the greater sac
True
Where is the lesser sac located (in terms of the stomach)?
Posterior and inferior to the stomach.
How do the greater and lesser peritoneal sacs communicate?
Through the epiploic foramen (of Winslow)
What are the three recesses of the lesser sac
Superior recess (posterior to the liver)
Inferior recess (potential space between the 2 layers of the gastrocolic ligament)
Splenic recess (posterior to and left of the stomach)
What is the clinical importance of the lesser sac?
It has a clinically important relationship to the liver, pancreas, stomach and spleen.
What is the epiploic foramen?
The opening between the greater and lesser sacs.
What is found in the anterior region of the epiploic foramen?
Hepatoduodenal ligament with portal vein, hepatic artery and bile duct.
What is found in the posterior region of the epiploic foramen of winslow?
IVC, diaphragm
What is found in the superior region of the foramen of Winslow?
Liver, caudate lobe
What is found in the inferior part of the epiploic foramen of WInslow?
Duodenum
