Abdominal Wall, Inguinal Region, Hernias Flashcards
What are the bony landmarks of the Abdomen
Sternum and Xiphoid Process
Costal Margin, costal cartilages, ribs
Iliac crest, iliac fossa, ASIS,
Public Symphysis, pubic tubercle, pubic ramus,
Thoracic and lumbar vertebrae, Sacrum, and pelvic bones
What visceral structures are found in the abdomen
Stomach, duodenum, small intestines, liver, pancreas, spleen, kidneys, ureters, urinary bladder, reproductive organs, abdominal vessels
What are the 9 regions that the abdomen can be divided into
Right Hypochondriac, epigastric, left hypochondriac,
Right lumbar, umbilical, left lumbar,
Right Iliac, Hypogastric, Left Iliac
What are the two fascia found immediately below the skin and what are their characteristics
Camper’s fascia: fatty fascia
Scarpa’s fascia: membranous layer
What muscles make up the posterior wall of the abdomen
Quadrates lumbers, posts major, iliac muscles
Post-vertebral muscles
What muscles make up the lateral wall of the abdomen
External Oblique
Internal Oblique
Transversalis Abdominis
What muscles make up the anterior wall of the abdomen
The paired vertical rectus abdominal muscles within the rectus sheath.
What is an aponeurosis
Thin but strong fibrous sheet of tissue that replaces a tendon in muscles that are flat and sheet-like and have a wide area of attachment.
What are some functions of the three sheet-like muscles
Compresses the abdomen and increases intra-abdominal pressure to aid expiration and evacuation of feces, urine, and parturition
What are the attachments of external oblique
Bottom 8 ribs, free posterior border, xiphoid prices, linea alba, pubic crest and tubercle, anterior 1/2 of iliac crest
What is the direction of the external oblique muscle fibers
Infero-medially
How is the inguinal ligament made and where does it attach
Formed by the rolling inwards of the lower aponeurotic border of the external oblique. It extends from the ASIS to the pubic tubercle.
What are the attachments of the internal oblique; lateral and medial
Laterally: Thoracolumbar fascia, anterior 2/3 of iliac crest, lateral 1/2 of inguinal ligament
Medially: lower 3 ribs and costal cartilages, xiphoid process, rectus sheath and conjoint tendon
State the direction of the internal oblique
Infero-laterally
What are the attachments of the transverse abdominus
Laterally: bottom 6 costal cartilages, anterior 2/3 iliac crest, lateral 1/2 of inguinal ligament
Medially: Xiphoid process, linea alba, pubic symphysis, conjoint tendon
Direction of transverses abdominis
Horizontally
Where does the neurovascular bundle lie
Between internal oblique and transverses abdominis
What are the points of attachment of rectus abdominis
5-7 costal cartilages, xiphoidprocess, pubic symphysis and pubic crest
What structure divides the rectus abdominis into segments`
Transverse tendinous intersections
What is the rectus sheath formed by
Aponeurosis of three flat muscles
What is the function of rectus abdominis
Flexor of the vertebral column
Points of attachment of quadrates lumborum
Lower border of 12th rib
Transverse process of L5
Iliac crest
Points of attachment for psoas major
All 5 lumbar vertebra
Lesser trochanter
What plane carries the nervous and blood supply to abdominal wall
Neuromuscular plane - found between internal oblique and transverses abdominis
Describe blood supply to rectus sheath
Superiorly: Blood supply comes from superior epigastric artery which is a branch of the internal thoracic
Inferiorly: Blood comes from inferior epigastric after which comes from External iliac artery.
Two arteries anastomose creating collateral circulation of abdominal aorta
Which vessels supply flank muscles
Intercostal arteries 7-11
Subcostal artery
Lumbar arteries
Deep circumflex
Which nerves supply abdominal wall
T7-L1
What nerves supply abdominal muscles
EO: T7-L1
IO: T7-L1
TA: T7-L1
What nerves supply rectus abdominis
T7-T12
What is the difference in the innervation of the visceral and parietal peritoneum
The parietal peritoneum has the same segmental somatic sensory innervation as the abdominal wall
Visceral peritoneum has NO somatic sensory innervation
Which three nerves innervate the anterolateral abdominal wall
Subcostal nerves(T12), ilioinguinal nerve (L1) Iliohypogastric (L1)
Which nerves provide motor supply to quadrates lumborum, psoas major, and iliacus
Quadratus Lumborum: T12-L4
Psoas: L2-L4
Iliacus: L2-L4
Where is the lumbar plexus formed
L1-L4
Which line defines the border between the lymphatic drainage to different groups of lymph nodes?
Transumbilical plane
Where does the inguinal ligament attach to the pelvis
ASIS and Pubic tubercle
How long is the inguinal canal
4cm
Are hernias more common in males or females
Males
What are the contents of the Inguinal Canal
Males: Spermatic cord(Artery of ductus deferent, cremasteric artery, testicular artery, genital branch of genitofemoral nerve, cremasteric nerve, autonomic nerve, Ductus dererens, pampiniform plexus, lymphatics) + Ilioinguinal Nerve
Female: Round ligament + Ilioinguinal Nerve
At what stage do the testes usually enter the inguinal canal and drop into the scrotum
Testicular decent starts at week 7. Enters inguinal canal at week 28. Enters scrotum at week 32-36.
What facts increase the risk of hernias in women
Age and pregnancies
Where are the superficial and deep inguinal rings positioned
Superficial: Immediately above and medial to pubic tubercle
Deep: 1.5 cm above midpoint of inguinal ligament
The superficial and deep inguinal rings are holes in which fascia/muscle
Superficial: EO
Deep: TF
What is the conjoint tendon
The lowest fibers of IO and TA come together to form the Conjoint Tendon. Attached medially to the pubic crest
What makes up the four walls of the Inguinal canal
Anterior: EO(the whole way) + IO(lateral third)
Posterior: TF + Conjoint tendon(medially)
Superior: IO + TF + Conjoint tendon(medially)
Inferior: Inguinal Ligament
What region do direct hernias occur
Hesselbach’s Triangle - medial to the inferior epigastric vessels
Where is the defect in indirect inguinal hernias positioned
Dilatation of the deep inguinal ring - lateral to inferior epigastric vessel
What types of patients have direct hernias
Older patients - associated wth chronic straining and weak musculature.
What types of patients have indirect hernias
Young adults and children
