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M1 Gross Anatomy > Abdominal Wall & Cavity > Flashcards

Abdominal Wall & Cavity Flashcards

1
Q

Camper’s fascia

A

Fatty layer camping out on top serving as an insulator

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2
Q

Scarpa’s fascia

A

Membranous layer loosely attaching skin to body wall; continuous with other regional fasciae

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3
Q

External abdominal oblique muscle

A

The largest and most superficial of the three flat muscles

Fibers run inferomedially (hands in pockets) on anterior wall

Attached to ribs 5-12 -> iliac crest, pubic tubercle and linea alba

Forms the inguinal ligament at the most inferior aspect of the EAO aponeurosis as it rolls down to its inferior attachements

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4
Q

IAO

A

Internal abdominal oblique muscle

Thin muscular sheet just deep to EAO

Fibers run perpendicular to those of EAO and aponeurosis (superiorly and anteriorly)

Attachements:

Origin - to inferior borders of ribs 10-12 and th elinea alba at midline

Insertion - to thoracolumbar fascia posteriorly, and the lateral third of inguinal ligament and anterior 2/3 iliac crest anteriorly

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5
Q

Transversus Abdominis muscle

A

Innermost of three (deep to EAO and IAO muscles)

Fibers run transversally at superior exten; run parallel to those of the IAO muscle more inferiorly

Fibers originate from the lateral 1/3 of the inguinal ligament, iliac crest, thoracolumbar fascia, and internal surface of 7th-12th costal cartilages -> linea alba with aponeuorses of IAO and EAO

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6
Q

Aponeurosis

A

An aponeurosis is a thin sheath of connective tissue that helps connect your muscles to your bones. Aponeuroses are similar to tendons. They support your muscles and give your body strength and stability. Aponeuroses absorb energy when your muscles move. You have aponeuroses all over your body

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7
Q

What are the three flat muscles of the abdomen?

A

From superficial to deep:

EAO
IAO
Transversus abdominis

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8
Q

Vertical muscles of the anterior abdomen wall

A

Rectus abdominis muscle

Pyramidalis muscle

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9
Q

Rectus abdominus

A

Paired muscle that are divided into segments (“6 pack”) - tendinous intersections anchor the muscle to the rectus

Paired muscles are separated in the midline by linea alba

Muscle fibers run vertically and are enclosed in the rectus sheath (sheath is formed by the convergin aponeuroses of the three flat muscles)

Attached to pubic symphysis and pubic crest - xiphoid process and costal cartilages of ribs 5-7

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10
Q

What nerves innervate the anterior abdominal wall?

A

Thoracoabdominal nerve (T7-T11)

Distal, abdominal parts of the ventral rami of intercostal nn. T7-T11

Subcostal (T12), iliohypogastric (L1), and ilioinguinal (L1-L2) nerves supply the rest of the skin and muscles inferior to umbilicos

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11
Q

L1 dermatome

A

The groin region

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12
Q

Arteries of the anterior abdominal wall

A

Internal thoracic artery-> superior epigastric and musculophrenic arteries

Aorta -> 10th and 11th posterior intercostal arteries and subcostal artery

External iliac artery -> inferior epigastric and deep cirumflex iliac arteries

Femoral artery -> superificial circumflex iliac and superficial epigastric arteries

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13
Q

What do intercostal T7-11 and the subcostal arteries supply?

A

The lateral aspect of the anterior abdominal wall in a segmental fashing (three flat muscles and overlying skin)

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14
Q

What do the superior and inferior epigastric arteries supply?

A

The rectus abdominis muscles (muscles only blood supply)

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15
Q

What do the superficial epigastric arteries supply?

A

The skin in the midline overlying the rectus muscles

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16
Q

Veins of the anterior abdominal wall

A

Deeper veins bare the same name and course as the arteries

Superficial veins are located in the superficial fascia (Camper’s)
-Thoracoepigastric veins - direct anastomotic channel between lateral thoracic veins and paraumbilical veins, superficial epigastric and circumflex iliac veins connecting the axillary and femoral veins

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17
Q

What does the rectus sheath enclose?

A

Vertical muscles (rectus abdominins and pyramdialis)

Superior and inferior epigastric vessels

Sheath is pierced by distal portions of thoracoabdominal nerves to supply the rectus abdominis muscle (supplying bessels are vertical, while the nerves path is horizontal inside the rectus sheath)

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18
Q

Where do the superior and inferior epigastric vessels anastomose?

A

Near the umbilicus

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19
Q

Where does the superficial epigastric vessels lie?

A

In the skin above the rectus sheath, not inside the sheath

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20
Q

Where do all areas of the abdominal wall fuse?

A

At the umbilicus

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21
Q

What makes the linea alba difficult to heal?

A

It is almost avascular because it does not transmit small vessels and nerves to the skin

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22
Q

What is always the most anterior layer of the rectus sheath?

A

EAO aponeurosis

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23
Q

What is always the most posterior layer of the rectus sheat?

A

The trasversalis fascia

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24
Q

Above arcuate line

A

IAO aponeurosis splits to contribute to both the anterior & posterior layers of the sheath

  • Internal oblique aponeurosis splits into 2 layers— anterior & posterior laminae of the internal oblique

– one passing anterior & the other passing posterior to the rectus abdominis m.

  • The anterior lamina of the IAO joins the aponeurosis of the EAO to form the anterior layer of the
    rectus sheath (2 contributors to this layer)
  • The posterior lamina of the IAO aponeurosis joins the aponeurosis of the transversus abdominis and the transversalis fascia to form the posterior layer of the rectus sheath (3 contributors to this layer)
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25
Q

Below arcuate line

A

contributions from the 3 flat mm. all contribute to the anterior layer of the rectus sheath
* The aponeuroses of all 3 flat muscles pass anterior to rectus abdominis m. to form the anterior rectus sheath, and thin transversalis fascia is the only component of the posterior rectus sheath The internal lining of the abdominal wall is parietal peritoneum – this lining drapes over structures to form 5 peritoneal folds that run inferiorly from the umbilicus (infra umbilical folds) & one that runs superiorly (supraumbilical)

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26
Q

Falciform ligament

A

The only supraumbilical peritoneal fold

Reflects off the liver to run and join the parietal peritoneum on the internal surface of anterior abdominal wall just above the umbilicus

Round ligament of the liver is found in the falciform ligaments inferior, free edge and contains 2 structures - ligamentum teres hepatis (remnant of the umbilical vein) and paraumbilical veins

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27
Q

Median umbilical fold

A

1 - unpaired

Run inferiorly from the umbilicus to the urinary bladder

Formed as peritoneum covers the median umbilical ligament

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28
Q

Medial umbilical folds

A

2 - paired

Found lateral to the median umbilical fold

Formed as peritoneum covers the medial umbilical ligaments

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29
Q

Lateral umbilical folds

A

2- paired

Infraumbilical folds found lateral to the medial umbilical folds

Formed as peritoneum covers the inferior epigastric artery and accompanying veins

Contains a patent functional artery (bleeds if cut)

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30
Q

All medial fibers of inguinal ligament insert on pubic tubercle except _______ ?

A

Lacunar (Gimbernat’s) ligament - deep fibers attaching to superior pubic ramus to roll under spermatic coord

Pectineal (Cooper’s) ligament - most lateral fibers of lacunar ligament running along the pectin pubis

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31
Q

Contents traversing the inguinal canal and rings

A
  1. Spermatic cord or round ligament of uterus
  2. Iloinguinal nerve - sensory to skin on anterior scrotum/ mons pubis and labia majora via anterior scrotal/labial branches
  3. Genitofemoral nerve - sensory to skin of upper anterior thigh
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32
Q

Stomach

A

Intraperitoneal organ

Lesser curvature faces liver, greater curvature is convex border

Folds when stomach contracts - rugae (direct food toward pyloric part)

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33
Q

Small intestines

A

Doudenum
Jejunum
Ileum

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34
Q

Duodenum

A

oC-shaped around pancreatic head, and about 12” long
oSubdivide the duodenum into four parts:
■ 1st - continuous with pylorus; also called duodenal bulb
- Intraperitoneal at LV1 and connects to the liver via the hepatoduodenal ligament (only portion
that is intraperitoneal)
- Common site for duodenal ulcers
■ 2nd / descending
- Secondarily retroperitoneal at LV2
- Pancreatic and biliary ducts open into the lumen
■ 3rd / horizontal – secondarily retroperitoneal at LV3
■ 4th / ascending - ascends to LV2,
- Secondarily retroperitoneal
- Continuous with the jejunum where it becomes intraperitoneal

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35
Q

Jejunum

A

oIntraperitoneal, suspended by the mesentery proper and the root of the mesentery
oContinuous with the ileum

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36
Q

Ileum

A

oDistal 3/5 of the small intestine that terminates at ileocecal junction
oIntraperitoneal, suspended by the mesentery proper and the root of the mesentery
oSite of Meckel’s diverticulum
oSmaller diameter than the jejunum and increased fat deposition in the mesentery proper

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37
Q

Large intestines

A

Cecum
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum

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38
Q

Spleen

A

Intraperitoneal organ in the left upper quadrant of the abdominal cavity

  • Found lateral & posterior to the stomach, tucked under the left dome of the diaphragm just superior to the left colic flexure
  • Protected by ribs 9-11 (putting the spleen at risk when these ribs are broken)
  • Splenic injury can often occur with abdominal trauma
    oInjury is usually caused by blunt trauma, but can be penetrating injuries that tear the capsule
    o Rupture occurs when there is a break in the capsule disrupting the underlying parenchyma.
    oHighly vascular organ so rupture can cause profuse bleeding into the peritoneal cavity & lead to hemodynamic instability
    oPain is often referred to the left shoulder (Kehr’s sign) due to its intimate relationship with the
    diaphragm
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39
Q

A 25-year-old male presents with a sharp pain in his lower abdomen after lifting a heavy object.
Physical examination reveals a bulge in the groin area. The bulge is reducible and lies medial to the inferior
epigastric artery. Which layer is most likely involved in the formation of this hernia?

A

The external oblique aponeurosis

40
Q

A 30-year-old female presents with abdominal pain localized around the umbilicus. She recalls
that the pain started after she was struck in the abdomen. Which dermatome is likely involved based on the
location of her pain?

A

T10 dermatome

41
Q

During a surgical procedure, the surgeon needs to access the rectus abdominis muscle.

Which of the following structures will the surgeon encounter immediately anterior to this muscle?

A

External oblique aponeurosis

42
Q

List the tissue layers of the external abdominal wall (superficial to deep)

A
  1. Skin
  2. Superifical fascia
    Camper’s
    Scarpa’s
  3. Muscles of anterior wall: EAO, IAO, transversis abdominis, rectus abdominis, pyramidalis
  4. Transversalis fascia
  5. Extraperitoneal fat
  6. Parietal peritoneum
43
Q

A 40-year-old male is diagnosed with an inguinal hernia that is lateral to the inferior epigastric vessels. Which type of hernia does he have?

A

Indirect inguinal hernia

44
Q

A patient with a history of abdominal surgery presents with a bulge at the surgical site. On examination, the bulge is located just lateral to the rectus abdominis muscle. Which structure is likely involved?

A

Linea semilunaris

45
Q

A medical student is asked to identify the layer of the anterior abdominal wall that is continuous with the superficial fascia of the thigh. Which layer should the student identify?

A

Scarpa’s fascia

46
Q

A patient presents with pain in the lower abdomen and groin. Imaging reveals a structure
passing through the superficial inguinal ring but not the deep inguinal ring. Which muscle’s aponeurosis
forms this superficial ring?

A

The external oblique abdominal muscle’s fascia forms the inguinal ring

47
Q

A 28-year-old woman presents with pain and a palpable mass just below her umbilicus. Upon surgical exploration, it is found that the mass is composed of extraperitoneal fat. Between which layers of the anterior abdominal wall is this fat located?

A

Extraperitoneal fat is found between the transversalis fascia and parietal peritoneum

48
Q

During a physical examination, a physician palpates a firm structure extending from the pubic tubercle to the anterior superior iliac spine. This structure forms the inferior border of which muscle?

A

External oblique abdominal muscle

49
Q

A previously healthy 20-year-old man comes to the physician because of a 6-month history of a painless mass in his left groin that has been gradually increasing in size. Physical examination shows a 3x3-cm oval, nontender left inguinal mass and a fluctuant, painless left scrotal swelling that increases in size with coughing. Which of the following is the most likely cause of this patient’s symptoms?

A

Failure of process vaginalis to close

50
Q
A

A - runs over linea alba

H - nerves and arteries that run here

51
Q

A 37-year-old woman comes to the physician because of right-sided lower abdominal pain for the past 8 weeks. During this period, the patient has had increased pain during activities such as walking and standing. There is a nonpulsatile, palpable groin protrusion above the inguinal ligament on the right side. The protrusion is palpable lateral to the location of the right inferior epigastric artery. Bulging is felt during the Valsalva maneuver. Which of the following apply to this type of abdominal hernia?

A

Indirect hernia

52
Q

EAO origin and insertion

A

Origin - external surface of ribs 5-12

Insertion - linea alba, pubic tubercle, and anterior half of iliac crest

53
Q

EAO origin and insertion

A

Origin - external surface of ribs 5-12

Insertion - linea alba, pubic tubercle, and anterior half of iliac crest

54
Q

IAO origin and insertion

A

Origin - thoracolumbar fascia, anterior 2/3 of iliac crest, and connective tissue deep to inguinal ligament

Insertion - Inferiro borders of 10th-12th rubs, línea alba, and pubis via conjoint tendon

55
Q

IAO origin and insertion

A

Origin - thoracolumbar fascia, anterior 2/3 of iliac crest, and connective tissue deep to inguinal ligament

Insertion - Inferiro borders of 10th-12th rubs, línea alba, and pubis via conjoint tendon

56
Q

Transversus andominis origin and insertion

A

Origin - Internal surfaces of 7th-12th costal cartilages, thoracolumbar fascia, iliac crest, and connective tissue deep to inguinal ligament

Insertion - linea alba with aponeurosis of internal oblique, pubic crest, and pubis via conjoint tendon

57
Q

Rectus abdominis origin and insertion

A

Origin - Pubic symphysis and pubic crest

Insertion - xiphoid process and and 5-7th costal cartilages

58
Q

Rectus abdominis origin and insertion

A

Origin - Pubic symphysis and pubic crest

Insertion - xiphoid process and and 5-7th costal cartilages

59
Q

EAO innervation

A

Thoracoabdominal and subcostal nerves (T7-12 anterior rami)

60
Q

IAO innervation

A

Thoracoabdominal nerves (T7-11 anterior rami), subcostal and first lumbar nerve

61
Q

Rectos andominis innervation

A

Thoracoabdominal and subcostal nerves (T7-12 anterior rami)

62
Q

Action of EAO/IAO

A

Compress and support abdominal visceral, flex and rotate trunk

63
Q

Median umbilical fold

A

Holds median umbilical ligament (embryological remains of urachus)

64
Q

What covers the posterior surface of the inferior epigastric arteries?

A

The two lateral umbilical folds

65
Q

What layer of fascia contains the obliterated umbilical arteries?

A

The two medial folds of the internal anterior abdominal wall

66
Q

Lobes of the liver

A
67
Q

Remnant of the umbilical vein

A

Round ligament of the liver

68
Q

Falciform ligament

A

Separates the right and left lobes, and attaches the liver to the front of the body wall

(contains round ligament)

69
Q
A
70
Q

What holds the liver to the diaphragm?

A

The coronary ligament

71
Q

Blood supply to the lesser curvature of the stomach

A

The left and right gastric arteries (gastric is a less word than gastromental - less words)

72
Q

Blood supply to the greater curvature of the stomach

A

The left and right gastromental arteries

73
Q

When disrupted, which stomach valve causes stomach burn?

A

The cardiac sphincter

74
Q

Parasympathetic innervation of stomach

A

From celiac plexus, relaxes pyloric sphincter to allow chyme to flow into duodenum

75
Q

Sympathetic innervation of stomach

A

Constricts the pyloric sphincter to prevent chyme from flowing into duodenum

76
Q

What is the blood supply to the pyloric sphincter?

A

The gastroduodenal artery

77
Q

What prevents the parietal and visceral peritoneum from adhering to each other?

A

The greater omentum

78
Q

Function of greater omentum

A

Able to adhere to inflammed organs

79
Q

Parasympathetic innervation of gallbladder

A

Vagus nerve = contracts the gallbladder to release bile

80
Q

Sympathetic innervation of the gallbladder

A

Celiac plexus - inhibition of contraction to increase bile storage, also carries visceral sensory information

81
Q

Blood supply to the gallbladder

A

The cystic artery

82
Q

Blood supply and innervation of spleen

A

Blood - splenic artery

Parasympathetic and sympathetic innervation - celiac and splenic plexus

Immunosurveilance

83
Q

What connects the spleen and stomach?

A

The gastrosplenic ligament, contains short gastric aa./vv and left gastroepipoic a and v

84
Q

Duodenum function, innervation, and blood supply

A

Fx - mix chyme with digestive enzymes from pancrease and liver

Parsympathetic - celiac plexus increases motility

Sympathetic - celiac functions decreases motility

Blood - gastroduodenal

85
Q

Parts of the duodenum

A
86
Q

Innervation and blood supply to jejunum and ileum

A

Parasymp - superior mesenteric plexus from vagus n

Symp - superior mesenteric plexus from greater and less splanchnic nn

Blood - intestinal branches from superior mesenteric a.

87
Q

Funtion of jejunum

A

Absorb sugars, amino acids, and fatty acids

88
Q

Function of ileum

A

Absorbs nutrients: vitamins, minerals, carbohydrates, fats, and proteins

Also absorbs water

89
Q

Cecum

A

Fx = bacterial breakdown of cellulose and remaining contents

Parasympathetic - superior mesenter plexus from vagus

Symp - Superior mesenteric plexus from greater and less splanchnic nerve

Blood - Ileocecal a.

Same innervation as ascending and transverse colons

90
Q

Ascending colon

A

Fx - water absorbtion

Parasympathetic - superior mesenter plexus from vagus

Symp - Superior mesenteric plexus from greater and less splanchnic nerve

Blood - right colic a.

Same as transverse colon

91
Q

Transverse colon

A

Fx - water absorbtion

Parasympathetic - superior mesenter plexus from vagus

Symp - Superior mesenteric plexus from greater and less splanchnic nerve

Blood - middle colic a.

Same as ascending colon

91
Q

Descending colon

A

Fx - water absorbtion

Parasymp - inferior mesenteric plexus from pelvic splanchnic nn

symp - inferior mesenteric plexus from lumbar splanchnic nn

Blood - left colic a. of the inferior mesenteric a.

92
Q

Sigmoid colon

A

Fx - water absorbtion

Parasymp - inferior mesenteric plexus from pelvic splanchnic nn

symp - inferior mesenteric plexus from lumbar splanchnic nn

Blood - sigmoidal a

93
Q

Rectum

A

Fx - water absorbtion and stool concentration

Parasymp - inferior mesenteric plexus from pelvic splanchnic nn

symp - inferior mesenteric plexus from lumbar splanchnic nn

Blood - Superior, middle, and inferior rectal aa.

94
Q

What attaches the intestines to posterior abdominal wall?

A

The root of the mesentery (located between the duodenojejenual flexure and vertebral column)

95
Q

Intraperitoneal vs. retroperitoneal organs

A

Intraperitoneal - organs covered by visceral peritoneum

Retroperitoneum - organs covered on anterior surface by parietal peritoneum

96
Q

Retroperitoneal organs

List the organs of the abdominal cavity

A

S - Suprarenal gland
A - Aorta/IVC
D - Duodenum

P - Pancrease
U - Ureters
C - Colon (ascending and descending)
K - Kidneys
E - Esophagus
R -Rectum

M1 Gross Anatomy (16 decks)

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