Abdominal Wall Review

Question 1

Sections of the abdomen

Answer 1

Question 2

4 main abdominal muscles

Answer 2

1. External Oblique
2. Internal Oblique
3. Rectus Abdominis
4. Transverse Abdominis

Superficial to deep

Question 3

External Oblique runs?

Answer 3

lower ribs to pelvis

hands in pockets direction

Question 4

Internal Oblique runs

Answer 4

Opposite to External Oblique muscle

Question 5

Rectus Abdominis

Answer 5

the 6 pack or abs muscle

connected by the linea alba

Question 6

Transverse Abdominis

Answer 6

Wraps around spine for stability

Question 7

TAP

Answer 7

Transverse abdominis plane
fascial plane superficial to the transverse abdominis

Question 8

Rectus Sheath

Answer 8

Rectus muscle is encircled by fascia which then extends to the external oblique, internal oblique, and transverse abdominis

Question 9

Inguinal Muscles

Answer 9

Psoas Major
Psoas Minor
Iliacus
Iliopsoas

Question 10

Psoas Major

Answer 10

Originates: T12-L4
Inserts: lesser trochanter

Question 11

Psoas Minor

Answer 11

Originates: T12-L1

Missing in 40-70% of all people

Question 12

Iliacus

Answer 12

Originates: Illiac fossa
Inserts: with psoas major at lesser trochanter

Question 13

Iliopsoas

Answer 13

Iliacus and Psoas Major unifty to form this muscle

Descends below the inguinal ligament with the femoral nerve

Question 14

Abdominal Nerves

Answer 14

T7-T11 = intercostal
T12 = subcostal
L1-L2 = iliohypogastric and ilioinguinal

Question 15

Nerves within the TAP plane?

I know it says plane plane but I wanted to show the block nerves are different from the nerves just chilling in the plane itself

Answer 15

T7-L2

Question 16

TAP space?

Answer 16

Inbetween the transversus abdominis and interal oblique

Question 17

Downside to a TAP block?

How many injections?

Answer 17

Have to block both sides if you want a complete block

Question 18

Describe the TAP block “pops”

Answer 18

Two pops are felt.

The 2nd pop is the transverse abdominis plane and where we inject the local

Question 19

Rectus Sheath Block

Answer 19

Between the rectus muscle and posterior rectus sheath

covers the midline of the abdomen

Question 20

Ilioinguinial Nerve

Answer 20

L1

Question 21

Iliohypogastric Nerve

Answer 21

T12-L1

Question 22

Lateral cutaneous nerve of the thigh

Answer 22

L2-L3

Question 23

Genitofemoral Nerve

Answer 23

L1-L2

Question 24

4 Abdominal blocks

Answer 24

1. TAP
2. Rectus Sheath
3. Quadratus Lumborum (QL)
4. Ilioinguinal/Iliohypogastric

Question 25

What nerves does the TAP block hit?

Answer 25

T10-L1

lower abdomen only

Question 26

TAP block provides what but not what coverage?

Answer 26

Somatic

Visceral

Question 27

QL block coverage

Answer 27

T7-L1

Entire abdomen coverage, also a bilateral block like the TAP

Question 28

Rectus Sheath Block in regards to QL and TAP

Answer 28

The TAP and QL block does not provide coverage for the midline, therefore this block is needed for midline surgeries

Question 29

Ilioinguinal/Iliohypogastic Block

Answer 29

L1-L3

good for inguinal hernia, hydrocele and varicocele

hypogastric, inguinal crease and upper medial thigh coverage

Question 30

QL Block Anatomy

Technically the deepest abdominal muscle but commonly referred to as a back muscle

Answer 30

• Latissimus Dorsi
• Erector Spinae
• Quadratus Lumborum
• Psoas major

Looking at the pt posteriorly, superficial to deep

Question 31

Laterally what muscle comes in contact with the Latissimus Dorsi during ultrasound?

Answer 31

External Oblique

Question 32

QL Block Landmarks

Answer 32