Abdominal Wall And Peritoneum Flashcards
The pelvic inlet is formed from
- Pectin pubis (pubic bone)
- Arcuate line (ilium)
- Sacral promontory (sacrum)
Continuous with the superficial fatty layers in the thorax, thick and perineum
Fatty layer (Camper’s fascia)
Continuous with the fascia Lata in the thigh and with the deep layer of superficial perineal fascia
Scarpa’s fascia (membranous layer)
The membranous layer (scarpa fascia) is just deep to what
Fatty layer (Camper Fascia)
Superficial blood vessels run in the ____ layer of superficial fascia
Fatty layer (Camper fascia)
The membranous (Scarpa’s fascia) fuses with the ______ and is continuous over the ___ and __-
Fascia Lata, and is continuous over the pets and scrotum
Does the deep fascia of the abdominal wall follow the same pattern as the membranous layer of superficial fascia
No
There is a potential space between the the membranous layer of superficial fascia (Scarpa fascia) and the ______ of the external abdominal oblique muscle
Deep fascia ( note that fluid can leak into this potential space between the membranous layer of superficial fascia and the deep fascia of the external abdominal oblique muscle)
Abdominal midline
Linda Alba
Lateral border of rectus abdominus muscle
Linea semilunar is (semilunar line)
Transverse plane midway between the superior borders of the pubic symphysis and the manubrium
Transpyloric plane
Plane at the lowest level of the costal margin (the inferior margin of the tenth costal cartilage)
Subcostal plane
Plane passing through the summits of the iliac crests
Supracrestal plane
Plane at the level of the iliac tubercles (the iliac tubercle lies-5cm posterolateral to the nation superior iliac spine)
Transtubercular plane
Plane at the level of the anterior superior iliac spine
Interspinous plane
Contents of the RUQ (most superficial to deepest)
Liver, Gallbladder, Suprarenal glands and kidneys
Contents of the LUQ most superficial to deepest
Stomach and transverse colon, then Spleen, pancreas, and duodenum, Then kidneys, Suprarenal glands, and the abdominal aorta (this is slightly left of midline
The ascending colony with cecum and vermiform appendix is in what quadrant
RLQ
The descending colon is in what quadrant
LLQ
____ pairs of muscles, located anteriorly and laterally collectively compress and hold the abdominal organs in place. What are they.
- 4
- External obliques
- Internal obliques
- Transversus abdominis
- rectus abdominis
- note that these work together to flex and stabilize the vertebral column
- When they unilaterally contract they laterally flex the vertebral column
_____ pairs located in the posterior abdominal wall flex the spin and lower limb. What are they
- Iliacus
- Psoas major
- Psoas minor
- Quadratus lumborum
The three “flat” muscles of the anterior/lateral abdominal wall end anteriorly in a strong sheet of aponeurosis called the _____-
Rectus sheath
The rectus sheath encloses the _____-
Rectus abdominis
The midline of the rectus sheath is the ____
Linea Alba
Are the layers of fascia and aponeurosis of the muscles forming the rectus sheath are arranged differently in the upper abdominal wall than they are in the lower wall
Yes
The ___ is the line where the layers of fascia and aponeurosis of the muscles forming the rectus sheath are arranged differently in the upper and lower abdominal wall
Arcuate line
The Arcuate line is located
About half way between the umbilicus and pubic symphysis
Above the Arcuate line, the aponeurosis from the _______ splits to surround ______ and the aponeurosis from the __________ runs posterior to ________
Above the Arcuate line, the aponeurosis from the internal oblique splits to surround rectus abdominis and the aponeurosis from Transversus abdominus runs posterior to rectus abdominis
Below the Arcuate line, the rectus abdominis muscle lies
Directly on transversal is fascia
What muscle has fibers that project inferomedially to form the inguinal ligament
External oblique
Bony landmarks of anterior abdominal wall
- Xiphoid process
- Costal margins
- Ilium
- Pubis
Muscles of the posterior abdominal wall
Iliacus, Psoas major, Psoas minor, Quadratus lumborum
Superficial arteries of Abdominal Wall
- Superficial circumflex iliac artery
- superficial epigastric artery
- external pudendal artery (superficial branch, and deep branch)
The deep drainage of the anterior abdominal wall veins go to the
Subclavian vein, eternal iliac vein, lumbar, and intercostal veins
Anterior abdominal wall veins are within the ____ fascia and are what veins
Campers fascia, thoracoepigastric veins, lateral thoracic veins, and superficial epigastric veins
What are the dermatomes. Of the anterior abdominal wall
T7-L1
What dermatomes is at the Xiphoid region (tip)
T7
What is the dermatomes at the umbilical region
T10
What is the dermatomes at the inguinal fold
L1
What are the nerves of the anterior abdominal wall
- sensory : Dermatomes (T7-L1)
- Innervated muscles (motor): Intercostal nerves (T7-T11), sub costal nerve (T12) , Lumbar nerve (L1-L4)
The cutaneous branches of ventral rami, intercostal nerves (T7-T11) of the anterior abdominal wall lie between _____ and ______. They pierce the _____ to innervate the rectus abdominis muscles. They supply ____. ____ and ______. and are angled _____
The cutaneous branches of ventral rami, intercostal nerves (T7-T11) of the anterior abdominal wall lie between internal abdominal oblique and transverse abdominis. They Pierce the rectus sheath to innervate the rectus abdomens muscles. They supply skin, muscles and parietal peritoneum. They are angled inferiomedially
The ilioinguinal nerve (L1) enter the ____ canal and merges through the ____. Supplies ___ and ____
enters the inguinal canal and emerges through the superficial inguinal ring. Supplies groin and scrotum/labium majus
Iliohypogastic nerve arises form the ventral rami of Nerve ____ and branches into the ____ and ____ which supplies ______ region
L1 (sometimes plus T12), lateral cutaneous branch and anterior cutaneous branch, supra pubic region
The genitofemoral nerve is a branch of ___ and ___
L1 and L2
The genital branch of genitofemoral nerve exits the ____ and innervates the
exits the inguinal canal through the superficial inguinal ring. Innervates the cremaster muscle or is cutaneous to the labium majus
The femoral branches of the genitofemoral nerve (L1, L2) is cutaneous to the
femoral triangle area
Superficial lymphatic drainage of the anterior abdomen drains superiorly from ____ to _____ and drains inferiorly form _____ to ___
- Drains superiorly from umbilical region to anterior axillary and sternal nodes
- inferiorly from umbilical region to superficial inguinal nodes
Deep lymphatic drainage of anterior abdomen
- along posterior intercostal and lumbar vessels to deep abdominal nodes
- from testes to deep abdominal nodes
Portion of the viscera protrudes through a weakened point of the muscular wall of the abdominal cavity
hernia
What is a strangulated intestinal hernia
When herniated portion of the intestine swells thus becoming trapped and the blood flow to the trapped segment diminishes causing that portion of the intestine to die
What are the two types of hernias
- Inguinal hernias
- Femoral hernias
An _____ hernia is the most common type of hernia to require treatment
Inguinal hernia
The inguinal region is one of the ____ areas of the abdominal wall
weakest
Are males more likely to develop inguinal hernias than females
yes
What causes an inguinal hernia
Rising pressure in the abdominal cavity provides the force to push a segment of the small intestine into the canal
what are the two types of inguinal hernias
- Direct inguinal hernia
- indirect inguinal hernia
What is a direct inguinal hernia
the 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 anterior abdominal wall
what is an indirect inguinal hernia
herniation travels down the entire inguinal canal and may even extend all the way into the scrotum
Indirect inguinal hernias are more common in
younger males and may be congenital
indirect inguinal hernias pass _____ to epigastric vessels to _____ to enter _____ and follows the path of
lateral to inferior epigastric vessels to enter deep inguinal ring, follows path of spermatic cord
What type of hernia is usually acquired an happens in females as well
Direct inguinal hernias
In direct inguinal hernias herniation passes ___ to inferior epigastic vessels punching though ___ and ____
medial to inferior epigastric vessels punching through peritoneum and transversalis fascia
Femoral hernia occurs in the _____
upper thigh, just inferior to he inguinal ligmanet, originating in the femoral triangle
The ___ part of the femoral triangle is relatively weak and prone to stress injury, allowing a loop of small intestine to protrude
medial
Women more commonly develop femoral hernias because of the
greater width of their femoral triangle
_____occur when a portion of intestine pushes through abdominal wall musculature in the periumbilical or umbilical region
umbilical hernia
Umbilical hernias are most common in ___ but can occur in ___ as well
infant, adults
Derivatives of foregut (celiac trunk)
- Esophagus, stomach, duodenum, liver, gallbladder, spleen, and pancreas
Derivatives of midgut (superior mesenteric artery)
Duodenum, jejunum, ileum, cecum and appendix, ascending colon, 2/3 of transverse colon
Derivatives of hindgut (inferior mesenteric artery)
1/3 transverse, descending and sigmoid colon, rectum and anal canal
serous membrane of the abdomen
peritoneum
What are the subdivisions of the peritoneum
- Parietal layer (lines the body wall)
- Viscer alyer (serosa)- covers viscera
Which of the peritoneum layers has abundant pain fibers
Parietal layer has abundant pain fibers via nerves form the body wall. The visceral layer lacks pain fibers
These organs have a mesentery and are completely covered by the peritoneum
Intraperitoneal organs
what are the abdominal cavity intraperitoneal organs
- Stomach
- Small intestine (jejunum, ileum, some of the superior part of the duodenum)
- Spleen
- Liver
- Gallbladder
- Cecum with vermiform appendix (portions of variable size may be retroperitoneal)
- Large intestine (transverse and sigmoid colons)
What are the pelvic cavity intraperitoneal organs
- Uterus (fundus and body)
- Ovaries
- Uterine tubes
These organs either have no mesentery or lost it during development
Extraperitoneal organs
Primarily retroperitoneal organs
- kidneys
- suprarenal glands
- Uterine cervix
- ureters
- adrenals
- gonads
- aorta and inferior vena cava
Secondarily retroperitoneal organs (became retroperitoneal during development)
- duodenum (descending, horizontal, and ascending)
- ascending and descending colon
- pancreas
- rectum (upper 2/3)
What are the infra peritoneal/subperitoneal organs
- urinary bladder
- distal ureters
- prostate
- Seminal vesicle
- uterine cervix
- Vagina
- Rectum (lower 1/3)
Intraperitoneal organs are covered on most sides by ______ and suspended by ____ form the body wall
visceral peritoneum, suspended by mesentery from the body wall
Retroperitoneal organs lie deep to the _____ and are covered by ___ on one side only
parietal peritoneum, parietal peritoneum
what part(s) of the small intestine are retroperitoneal
- duodenum (descending, horizontal, and ascending) note that the jejunum, ileum, and superior part of the duodenum are intraperitoneal organs
2-layered fold of peritoneum
the mesenteries
“The mesentery” attaches _____ to the posterior body wall
free small intestine (jejunum and ileum)
Transverse mesocolon
- mesentery of the transverse colon
- holds the transverse colon to the posterior body wall
- fuses with the posterior layer of the greater omentum
The transverse mesocolon fuses with the posterior layer of the ______
greater omentum
Sigmoid mesocolon
- mesentery of the sigmoid colon
- holds the sigmoid colon to the posterior body wall
Mesoappendix
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 longer suspended by a mesentery, these organs are _____
secondarily retroperitoneal
peritoneal ligaments may be subdivisions of a ____ structure
larger
Peritoneal ligament usually transmit ___ and ____
nerves and vessels
Peritoneal ligaments usually lack ____ and are not the same as ligaments that join bones
Connective tissue
Examples of peritoneal ligaments
Gastrosplenic ligament, splenorenal (lienorenal) ligament
Broad, 2-4 layered sheet of peritoneum that attaches the stomach to other viscera
Omentum (epiploon)
The lesser omentum develops from the ________
Ventral mesogastrium (mesentery)
The lesser omentum is subdivided into two parts
- hepatogastric ligament (stomach to liver)
- Hepatoduodenal ligament (liver to duodenum)
Peritoneal reflections (adult)
- Greater Omentum
- Gastrocolic ligament
- Gastrophrenic ligament
- Gastrosplenic ligament
The greater omentum develops form the
dorsal mesogastrium
The Gastrocolic ligament attaches the
stomach to transverse colon
The Gastrophrenic ligament attaches the
stomach to diaphragm (is continous with phrenicosplenic ligament)
The Gastrosplenic ligament attaches the
stomach to the spleen
What are the peritoneal ligaments that are associated with the liver
- Coronary ligaments
- Right and left triangular ligaments
- Falciform ligaments
- Ligamentum teres hepatis
a ridge or elevation in the peritoneum produced by underlying vessels
Folds
The fossae (fossa) or recesses are
depressions between folds
Examples of abdominal fossa or recesses
- superior duodenal fold and fossa (recess)
- Paraduodenal fossa
- inferior deuodenal fold and fossa
- retroduodenal fossa
- Fold is formed by inferior mesenteric vein posterior to peritoneum
Structures coursing through the exztraperitoneal tissue form elevations on the interior abdominal wall called _____
peritoneal (umbilical) folds
Median umbilical fold
- Urachus
- midline from bladder
Medial umbilical folds
- 2
- medial umbilical ligaments
- obliterated umbilical aa.
Lateral umbilical fold
- 2
- inferior epigastric vessels
- Functional aa. and vv.
supraumnbilical structures located on the internal aspect of the anterior abdominal wall
- falciform ligament
Falciform ligament
- curved remnant of the ventral mesogastrium
- ligamentum teres hepatis (round ligament of the liver) in tis lower free border
- Obliterated umbilical vein
The Supravesical fossa is between the ___ and ____ umbilical folds
median and medial
The supravesical fossa is the site for ______
supravesical hernias (rare)
The medial inguinal fossa is between the ____ and _______
medial and lateral umbilical folds
The medial inguinal fossa is the site for
direct inguinal hernias
The medial inguinal fossa is also called the
inguinal triangle
The lateral inguinal fossa is lateral to the
lateral umbilical folds
The lateral inguinal fossa is the site for
indirect inguinal hernias
The _____ is most of the potential space within the abdomen
Greater sac
The greater sac can be subdivided into
supracolic an infracolic regions by the colon and transverse mesocolon
The supramesocolic (supracolic) region of the greater sac is superior and anterior to the ___ and the ___ and includes
liver and the stomach and includes hepatorenal and subphrenic spaces and fossa of the anterior wall
The peritoneal cavity is a ____ potential space between parietal and visceral layers of peritoneum
closed
recesses and fossa of the peritoneal cavity
- Subphrenic recess
- subhepatic/hepatorenal recess
- rectovesical/rectouterine recess
Why are the recesses and fossa of the peritoneal cavity of clinical importance
Because abscesses may develop and excess fluid (ascites) will pool here
inferior and posterior part of the greater sac
- Inframesocolic (infracolic) region of the greater sac of the peritoneal cavity
The inframesocolic region of the greater sac is subdivided by
mesenteries and ligaments
the upper and lower parts of the inframesocloic (infra colic) region of the greater sac is divided by _______ into right and left infra colic spaces
The mesentery
What limits the spread of fluid superiorly in the inframesocolic region
phrenicocolic ligament
The lesser sac (omental bursa) develops as a part of the
greater sac
The lesser sac is _____ and ____ to the stomach
posterior and inferior
Greater and lesser peritoneal sacs communicate through the
Epiploic foramen (of Winslow)
Recesses of the lesser sac
- Superior recess (posterior to the liver)
- Inferior process (potential space between the 2 layers of the gastrocolic ligament)
- Splenic recess (posterior to and left of the stomach)
The lesser sac has a clinically important relationship to the
liver, pancreas, stomach, and spleen.
Epiploic forament (of Winslow) (omental foramen)
- opening between the greater and lesser sacs
- anterior: hepatoduodenal ligament with the portal vein, hepatic artery and bile duct
- posterior: IVC, diaphragm
- Superior: liver, caudate lobe
- Inferior: duodenum, 1st part
