abdominal wall, inguinal region Flashcards
the importance of abdominal wall
- protection and stabilization of abdominal contents
-surgical access to abdominal contents - trunk rotation and flexion (anterior and lateral)
- maintain and control intra abdominal pressure for parturition and defecation
- respiration: opposes diaphragm
muscles that makes up the posterior abdominal wall
quadrates lumborum muscle
psoas major muscle
iliacus muscle
boundaries of the anterolateral abdominal wall
from: costal cartilage or ribs 7-10 and xyphoid process
to: inguinal ligament, anterior superior iliac spine, and pubic tubercle
abdominal wall divisions
- 4 quadrants and 9 regions
- internal anatomy of the quadrants is important to know for physical examinations
- RUQ - LUQ - RLQ - LLQ
foregut pain
epigastric
midgut pain
umbilical
hindgut pain
hypogastric
layers of anterior abdominal wall
- skin
- subcutaneous fascia layers
- three overlapping muscular sheets with aponeurotic tendinous fascia
-transversalis fascia - peritoneum
1st layer of the anterior abdominal wall
skin
2nd layer of the abdominal wall (2 of them)
campers fascia (fatty)
scrapas fascia (membraneous)
third layer of abdominal wall
external oblique muscle
4th layer of abdominal wall
internal oblique muscle
5th layer of abdominal wall
transverse abdominal muscle
the layer below the transverse abdominal muscle is
transversalis fascia
layer below transversalis fascia
endoabdominal (extraperiotneal) fat
layer below endoabdominal fat
parietal peritoneum
campers fascia
adipose (fatty) layer coursing with cutaneous nerves and blood vessels
scrapas fascia
membranous fascial layer deep to the camper’s fascia (inferior to umbilicus)
- fuses with fascia lata of the thigh
clinical importance of “potential space”
- between: membranous scarpa’s fascia and aponeurosis of eternal oblique
- fluid can accumulate in the potential space (a ruptured urethra)
- no barriers to prevent superior spreading of the fluid
- deep fascia of the thigh prevents inferior spreading
muscles of the abdominal wall
rectus abdominis
external oblique
internal oblique
transversus abdominis
actions of the abdominal muscles
flex the trunk
rotate the trunk
compress the abdominal viscera
the primary muscle that compresses abdominal viscera and the deepest
transversus abdominis
external oblique origin and insertion
O: external surfaces of ribs 5-12
I: linea alba, pubic tubercle and anterior half of iliac crest
(CONTRIBUTES TO THE INGUINAL LIGAMENT)
internal oblique origin and insertion
O: thoracolumbar fascia, anterior two thirds of iliac crest, and lateral half o inguinal ligament
I: inferior borders of ribs 10-12, lines alba
rectus abdominis origin and insertion
O: pubic symphysis (medial) and pubic crest (lateral)
I: typhoid process and costal cartilage form ribs 5-7
transversus abdominis origin and insertion
O: internal surfaces of costal cartilage of ribs 7-12, thoracolumbar fascia, iliac crest, and iliopsoas fascia
I: Linea alba with aponeurosis of internal oblique and pubic crest
contribution of abdominal muscles to the rectus sheath
Above arcuate line
EO
IO
TA
TF
Below arcuate line
EO
IO
TA
arterial supply of the abdominal wall
internal thoracic artery
aorta
external iliac artery
what supplies the superior and epigastric arteries and musculophrenic arteries
internal thoracic artery
what supplies the lower posterior intercostals/subcostal and lumbar arteries
aorta
what supplies the inferior epigastric arteries
external iliac artery
innervation of the abdominal wall
intercostal nerves:
lateral cutaneous branch
anterior cutaneous branch
thorax-abdominal nerves
subcostal nerve
iliohypogastric nerve
ilioinguinal nerve
genitofemoral nerve
intercostal nerve of abdominal wall is
ventral rami wrapping around body wall between the inner most and internal intercostals (neuromuscular plane)
anterior cutaneous nerve entrapment
cause of chronic abdominal wall pain
Carnett’s sign
- positive: abdominal wall/somatic pain
- negative: abdominal viscera/visceral pain
if increase pain during flexed abdomen which are you most likely going to have? negative or positive carnett’s sign?
positive carnett’s sign
thorax-abdominal nerves of abdominal wall
from intercostals
- innervation of abdominal muscles and cutaneous innervation of body wall (T7-T11)
nerves in neurovascular layer between internal oblique and transversus abdominus
thorax-abdominal nerves
subcostal nerve
iliohypogastric nerve
ilioinguinal nerve
lateral and anterior cutaneous branch of subcostal nerve
T12
lateral and anterior cutaneous branches of iliohypogastric nerve
L1
anterior scrotal branch of ilioinguinal nerve
L1
Genital and femoral branches of genitor femoral nerve
L1-L2 (sensory inguinal region)
inguinal canal
- deep inguinal ring - entrance
- transversals fascia forms innermost layer of coverings
- superficial inguinal ring - exit
what comes out of the inguinal anal?
spermatic cord with cremaster muscle
what covers the inguinal canal?
transversalis fascia
what makes up the superficial inguinal ring
lateral crus
intercrural fibers
medial crus
the layers around the inguinal canal
- external abdominal oblique aponeurosis
- internal oblique muscle
- transversals fascia
- parietal peritoneum
- inguinal ligament
supravescial fossa
between the median and medial umbilical folds
(site of supravescial hernias (rare)
median inguinal fossa
between the medial and lateral umbilical folds
(site of direct inguinal hernias)
lateral inguinal fossa
lateral to the lateral umbilical folds
(site of indirect inguinal hernias)
