Abdominal Wall and Peritoneum

Question 1

What is the superior border of the abdominal wall?

Answer 1

Diaphragm; Inferior thoracic aperture

Question 2

What is the inferior border of the abdominal wall?

Answer 2

Iliac crest; Inguinal ligament; pelvic inlet

Question 3

What is the posterior border of the abdominal wall?

Answer 3

Lumbar spine; QL + PM muscles

Question 4

What are the arteries involved with the abdominal muscles?

Answer 4

Superior epigastric ( from int thoracic)
Inferior epigastric (from ext iliac)

Question 5

Where do these arteries run?

Answer 5

Beneath rectus abdominis (withitn the sheath) and above the transversalis fascia and they anastamose.

Question 6

What are the two main sources of venous drainage?

Answer 6

thoracoepigastric-to axillary

superficial epigastric- to femoral

Question 7

What is the nerve supply to ant and lat abdomen?

Where do they run?

Answer 7

Lower 6 intercostal nerves and iliohypogastric (L1)

They run between int olbique and transversus abdominis

Question 8

What do these abdominal nerves supply? And what spinal levels do they come from?

Answer 8

T7-T12 pls L1
They supply skin, muscle and parietal peritoneum
NB umbilicus T10

Question 9

What is different about parietal and visceral peritoneum nerve supply?

Answer 9

Parietal: Has somatic nerves supplying it as well as the phrenic and obturator nerve. Can sense pain, temp touch and pressure.
Visceral: ANS supply (sensitive to stretch etc)

Question 10

What is different about the foregut mesentery?

Answer 10

It is suspended by dorsal and ventral mesentery. Unlike midgut and hind gut which is suspended by dorsal mesentery only.

Question 11

What is intra-peritoneal?

Answer 11

Anything entirely encased by visceral peritoneum

Question 12

What is retro-peritoneal? (eg)

Answer 12

Lays between peritoneum and body wall. (fat or muscle may lay behind).
Examples- kidneys, pancreas, distal duodenum, etc

Question 13

Where is the lesser sac?

Answer 13

Behind the lesser omentum.

Question 14

`What are the boundaries of the omental foramen (of the lesser/omental sac) ?

Answer 14

Anteriorly by free edge of lesser omentum ( bile duct; hepatic artery proper; portal vein)
Posteriorly by IVC

Question 15

What are the paracolic gutters?

Answer 15

Peritoneal sulci lateral to the ascending and descending colon.
Fluid can migrate through these gutters eg pus

Question 16

Which paracolic gutter is more significant?

Answer 16

Right side as continuous with hepatic recess and lesser sac. If sitting fluid will migrate down and will present as appendicitis but no. If supine can collect in lesser sac

NB left side stopped by phrenico- colic lig.