Adominal Wall Flashcards
What makes up the:
Superior Border of Abdominal Wall
Xiphoid process Costal Margin (costal cartilages of ribs 7-10)
Inferior Border of Abdominal Wall
Iliac Crest
Inguinal Ligament
Pubic Bone
Innervation to skin around Umbilicus come from..
spinal nerve T-10
Linea Alba (what is it, where does it go, how was it formed, what does it mark)
linear tendinous raphe
from xiphoid process to pubic symphysis
formed by fusion of insertions of anterolateral abdominal muscles
marks medial border of rectus abdomens muscles
Linea Semilunaris (what is it, where does it go, how was it formed, what does it mark)
connective tissue
from 9th costal cartilage to pubic tubercle
formed by fusion of aponeurosis of anterolateral abdominal wall muscles
marks lateral border of rectus abdominis muscles
Linea Transversae
fibrous connective tissue bands within rectus abdominis muscles
usually 3 above umbilicus (rare- one below)
produce “washboard stomach” appearance
What produce “washboard stomach” appearance
Linea Transversae
name the 4 quadrants of the anterior abdominal wall
Right Upper
Right Lower
Left Upper
Left Lower
4 Quadrants of Anterior Abdominal Wall are defined by
a midline (longitudinal or midsagittal) plane a transumbilical (horizontal or transverse) plane
How many regions are there in the anterior abdominal wall and what defines them
9 regions
defined by:
two longitudinal (sagittal) planes
right and left midclavicular
two horizontal planes
transpyloric (subcostal) plane- inferior border of L1
trans(inter)tubercular plane- connecting tubercles of iliac crest
Name the regions of the anterior abdominal wall
Right hypochondrial Epigastric Left hypochondrial Right flank Umbilical Left flank Right groin Pubic Left groin
Site of Maximum Tenderness during Acute Appendicitis (name, region, quadrant)
McBurney’s Point
Region- umbilical
Quadrant- right lower
McBurney’s Point
1/3 of the way up the line b/w the right anterior superior iliac spine and the umbilicus
site of maximum tenderness during acute appendicitis
Structures Found Deep to Right Upper Quadrant
Stomach- pylorus Duodenum Ascending Colon- superior part Right Colic (hepatic) Flexure Transverse Colon- right half Liver- right lobe Gallbladder Kidney-right Adrenal Gland- right
Structures Found Deep to Right Lower Quadrant
Ileum- major part Cecum Appendix Ascending Colon- inferior part Ureter- right Spermatic Cord- right
Structures Found Deep to Left Upper Quadrant
Stomach Jejunum Ileum- proximal part Transverse Colon- left half Left Colic (Splenic) Flexure Descending Colon- superior part Liver- left lobe Spleen Pancreas- body and tail Kidney- left Adrenal Gland- left
Structures Found Deep to Left Lower Quadrant
Descending Colon
Sigmoid Colon
Ureter- left
Spermatic Cord- left
Location of Pain in Acute Diverticulitis
Quadrant- lower left
Location of Pain in Pancreatitis
Region- epigastric
Location of Pain in Cholecystitis
Region- right hypochondrial
Pain from Enlarged Appendix is first referred where?
T10 dermatome around umbilicus (later felt in lower right quadrant when inflammation involves peritoneum)
The Liver, GB, and Duodenum all have visceral surface projections of pain where and why
right shoulder
from diaphragm irritation
Surface Projections of Visceral Stomach Pain
Epigastric Region
Surface Projections of Visceral Head of Pancreas Pain
Epigastric Region
Surface Projections of Visceral Gallbladder Pain
Upper Right Quadrant (right hypochonrial region)
Surface Projections of Visceral Liver Pain
Upper Right Quadrant (lower right quadrant posteriorly)
Surface Projections of Visceral Spleen Pain
Upper Left Quadrant (left hypochdrial region)
Surface Projections of Visceral Small Bowel Pain
Umbilical Region
Surface Projections of Visceral Cecum and Colon Pain
Pubic Region
Surface Projections of Visceral Kidney and Ureter Pain
Lower Left Quadrant (left groin region)
Name the Layers of the Anterior Abdominal Wall
- Skin
- Superficial Fascia
2a. Fatty layer = Camper’s Fascia
2b. Membranous later - Scarpa’s Fascia - Deep (investing) facia- covering muscles
- Transversalis Fascia (Endoabdominal Fascia)
- Extraperitoneal Fat
- Parietal Peritoneum
Name the Layer of the Anterior Abdominal Wall
- Skin
- Superficial Fascia
2a. Fatty layer = Camper’s Fascia
2b. Membranous later - Scarpa’s Fascia - Deep (investing) facia- covering muscles
- Transversalis Fascia (Endoabdominal Fascia)
- Extraperitoneal Fat
- Parietal Peritoneum
What layers make up the space to access retroperitoneal structures with our entering peritoneal cavity (where organs are housed)
Transversalis Fascia and Extraperitoneal Fat
Camper’s Fascia
fatty layer of superficial fascia
contains superficial epigastric vessels
continues as superficial fascia of thigh
fat extends as labia major in females
Labia Majora in Females is an extension of what?
fat from camper’s fascia of the superficial fascia in the abdominal wall
Dartos Fascia
in males
camper’s fascia continuation over penis (loses fat) and fuses to scrapa’s fascia
Scarpa’s Fascia
membranous layer of superficial fascia
fused with deep fascia of thigh (facia late)
continues in perineum and scrotum as Colle’s Fascia (females and males)
forms superficial fascia and fundiform ligament of penis in males
What forms fundiform ligament in the penis of males
scarpa’s fascia
Colle’s Fascia
membranous layer of superficial perineal fascia
continuation of Scarpa’s Fascia in perineum and scrotum (both males and females)
The Deep Investing Fascia continues as what in males?
suspensory ligament and deep fascia of the penis
What layers are passed through during Midline Approach of abdominal wall penetration
Skin
Superficial Fascia
Camper's Fascia
Scarpa's Fascia
LINEA ALBA
Transversalis Fascia
Extraperitoneal Fat
Parietal PeritoneumWhat layers are passed through during Lateral Approach of abdominal wall penetration
Skin
Superficial Fascia
Camper's Fascia
Scarpa's Fascia
Deep Fascia
External Oblique
Internal Oblique
Transversus Abdominis
Transversalis Fascia
Extraperitoneal Fat
Parietal PeritoneumName the Muscles of the Anterolateral Abdominal Wall
External Oblique Internal Oblique Transversus Abdominis Rectus Abdominis Pyramidalis (may be absent)
External Oblique (origin, insertion, action, innervation)
O: ribs 5-12
I: linea alba, pubic tubercle, and anterior half of iliac crest
A: flex and rotate trunk, compress and support abdominal viscera
N: T7-T11 (throacoabdominal nerves)
T12 (subcostal)
Internal Oblique (origin, insertion, action, innervation)
O: thoracolumbar facia, iliac crest, inguinal ligament
I: ribs 10-12, linea alba, and pubis (via conjoint tendon)
A: flex and rotate trunk, compress and support abdominal viscera
N: T7-T11 (thoracoabdominal nerves)
T12 (subcostal)
L1 (iliohypogastric and ilioinguinal)
Transversus Abdominis (origin, insertion, action, innervation)
O: ribs 7-12, throacolumbar fascia, iliac crest, inguinal ligament
I: linea alba, pubic crest (via conjoint tendon)
A: flex and rotate trunk, compress and support abdominal viscera
N: T7-T11 (thoracoabdominal nerves)
T12 (subcostal)
L1 (iliohypogastric and ilioinguinal)
Rectus Abdominis (origin, insertion, action, innervation)
O: pubic symphysis and crest
I: xiphoid process, ribs 5-7 (costal cartilages)
A: flex trunk, compress abdominal viscera
N: T7-T11 (thoracoabdominal nerves)
Pyramidalis (origin, insertion, action, innervation)
O: anterior pubis
I: linea alba below umbilicus
A: tenses linea alba
N: T12 subcostal or L1
Inguinal Ligament is formed by what
Inferior border of external oblique
What gives rise to cremaster muscle
internal oblique
Creamster Muscle (origin, insertion, action, innervation)
O: inguinal ligament as continuation of internal oblique
I: tubercle and crest of pubis
A: elevates testis
N: L1 and L2 via genital branch of genitofemoral nerve
What is Caput Medusae
a condition in which the superficial epigastric vein (in Camper’s Fascia) are swollen and dilated (varicose)
Conjoint Tendon
common insertion of transverses abdominis and internal oblique muscles on the pubis
Tendinous Intersection of Rectus Abdominis Muscle (function)
function as mini-tendons to control degree of forward flexion
What is the Rectus Sheath and what is it formed of
incomplete connective tissue that envelope that surrounds each rectus abdomens muscle
formed by aponeuroses of the three anterolateral muscles
What are the contents of the rectus sheath
rectus abdominis muscle
pyrimidalis muscle (if present)
superior and inferior epigastric vessels
terminal ends of T7-T12 nerves
Arcuate Line (what and where is it)
marks the change in facia contributing to the anterior and posterior laters of the rectus sheath
occurs below umbilicus at a point between umbilicus and pubis
Rectus Sheath Superior to Arcuate Line (what makes up anterior and posterior walls of sheath)
rectus abdominis is completely enclosed by aponeurosis of the anterolateral abdominal wall muscles
anterior wall of sheath- aponeuroses of external oblique and 1/2 of internal oblique
posterior wall of sheath- aponeuroses of the other 1/2 of internal oblique and transverses abdomens
Rectus Sheath Inferior to Arcuate Line (what makes up anterior and posterior walls of sheath)
no posterior wall of sheath- rectus abdominis is in direct contact with transversals fascia
aponeuroses of all 3 anterolateral abdominal muscles pass anterior to the rectus abdomen muscle and make up the anterior wall of the sheath
What designates the lower limit of the posterior wall of the rectus sheath
arcuate line
Nerve supply to muscles and skin of anterior abdominal wall comes from?
ventral (anterior) rami of spinal nerves T7-L1
What 4 major vessels supply the anterior wall of the abdomen
Internal Thoracic Artery
Aorta
External Iliac Artery
Femoral Artery
What branches of the Internal Thoracic Artery supply the anterior wall of the abdomen
superior epigastric artery
musculophrenic artery
What branches of the Aorta supply the anterior wall of the abdomen
posterior intercostal arteries
subcostal artery
What branches of the External Iliac Artery supply the anterior wall of the abdomen
inferior epigastric artery
deep circumflex iliac artery
What branches of the Femoral Artery supply the anterior wall of the abdomen
superficial epigastric artery
superficial circumflex iliac artery
What two arteries anastomose within the rectus sheath
superior epigastric artery and inferior epigastric artery
forms a major connection b/w subclavian and external iliac- good if aorta obstructed
what in the abdomen is helpful during aortic coarctation
anastomoses of superior epigastric artery and inferior epigastric artery
Thoracoabdominal Nerve (source, branches, motor, sensory, notes)
Source: ventral rami of spinal nerve T7-T11
Branches: lateral and anterior cutaneous branches
Motor: abdominal wall muscles
Sensory: skin of anterolateral abdomen
Notes: continuation of intercostal nerves (travel below posterior intercostal artery in intercostal groove)
Subcostal Nerve (source, branches, motor, sensory, notes)
Source: ventral rams of T12
Branches: lateral and anterior cutaneous branches
Motor:muscles of abdominal wall
Sensory: skin of anterolateral abdomen
Notes: equivalent to a posterior intercostal nerve found at higher thoracic levels
Iliohypogastric Nerve (source, branches, motor, sensory, notes)
Source: lumbar plexus (ventral ramus L1)
Branches: lateral and anterior cutaneous branches
Motor: muscles of lower abdominal wall
Sensory: skin of lower abdominal wall, upper hip, upper thigh
Notes: receives a contribution from T12 in approx 50% of cases
Ilioinguinal Nerve (source, branches, motor, sensory, notes)
Source: lumbar plexus (ventral ramus L1)
Branches: anterior cutaneous branches (anterior labial/scrotal nerves)
Motor: muscles of lower abdominal wall
Sensory: skin of lower abdominal wall and anterior scrotum/labium majus
Notes: courses through the inguinal canal and superficial inguinal ring
What nerve is equivalent to a posterior intercostal nerve found at higher thoracic levels
Subcostal
What nerves are a continuation of intercostal nerves (travel below posterior intercostal artery in intercostal groove)
Thoracoabdominal Nerves
What nerve courses through the inguinal canal and superficial inguinal ring
ilioinguinal nerve
Superior Epigastric Artery (source, branches, supply to, notes)
Source: internal thoracic artery
Branches: no named
Supply to: upper rectus abdominis muscle, upper abdominal wall
Notes: direct continuation of internal thoracic artery
Musculophrenic Artery (source, branches, supply to, notes)
Source: internal thoracic artery
Branches: anterior intercostal arteries
Supply to: anterior diaphragm, anterior aspects of intercostal spaces 7-11
Notes: supplies muscles that develop in the septum transversum
Posterior Intercostal Artery (source, branches, supply to, notes)
Source: descending thoracic aorta (3-11 intercostal spaces)
Branches: posterior, spinal, anterior, collateral, and lateral cutaneous branches
Supply to: intercostal muscles, spinal cord, vertebral column, deep muscles to back, superficial fascial overlying intercostal spaces
Notes: supply lateral and posterior portions of the intercostal space
Superficial Epigastric Artery (source, branches, supply to)
Source: femoral artery
Branches: cutaneous branches
Supply to: superficial facial and skin of the abdominal lower wall
Superficial Circumflex Iliac (source, branches, supply to, notes)
Source: femoral artery
Branches: unnamed muscular branches
Supply to: superficial fascia of lower abdomen and thigh
Notes: crosses the paper thigh parallel to the inguinal ligament
Deep Circumflex Iliac Artery (source, branches, supply to, notes)
Source: external iliac artery
Branches: unnamed muscular branches
Supply to: iliacus muscle and the lower abdominal wall
Notes: courses along the iliac crest on the inner surface of the adbominal wall
Inferior Epigastric Artert (source, branches, supply to, notes)
Source: external iliac artery
Branches: cremasteric artery
Supply to: lower rectus abdomens muscle, lower abdominal wall
Notes: gives rise to obturator artery in oppress 20% of cases
Cremasteric Artery (source, branches, supply to, notes)
Source: inferior epigastric artery
Branches: no named branches
Supply to: cremaster muscles, coverings of the spermatic cord
Notes: anastomoses with testicular artery distally
Name the three superficial arteries that arise from the femoral artery
superficial epigastric, superficial circumflex iliac, and superficial external pudendal arteries
What gives rise to obturator artery in approximately 20% of cases
inferior epigastric artery
Features on internal surface of abdominal wall that are potential hernia sites
umbilical folds
peritoneal fossa
Umbilical Folds (what are they and how many are there)
coverings of peritoneum on lower abdominal wall that cause toward the umbilicus
there are 5 of them
Medial Umbilical Fold (location and contents)
along the midline and connects anterior abdominal wall to bladder
contains: obliterated urachus/allonic duct
Median Umbilical Folds (location and contents)
occur on each side of the midline from the internal iliac artery to umbilicus
contains: obliterated umbilical arteries
Lateral Umbilical Folds (location and contents)
not embryonic rudiments
cover the inferior epigastric vessels and will bleed if cut
Peritoneal Fossa (what is it)
depressions lateral to the umbilical folds
each one is a potential site for hernia
3 parts to a hernia
sac
contents of sac
covering of sc
Aortic Coarctation (what is it)
narrowing of the aorta that can occur at the site of ductus arteriosus
circulation provided by superior epigastric and inferior epigastric can provide important channel of blood to lower body in case of obstruction
Umbilical Hernia
common in newborns
herniation of intestinal loops through umbilical ring
occurs from increased intra-abdominal pressure in area of weakness of the umbilical scar
Congenital umbilical hernias
have an embryological basis
(omphalocele, or failure of part of
midgut to return to abdominal cavity
during fetal development) and are present at birth
Acquired infantile umbilical hernia
small hernia that often occurs in infants and children; hernia occurs through defect in linea alba and protrudes during crying, straining or coughing. Usually resolves by 3-5 yrs without treatment
Acquired adult umbilical hernias
common in females, obesity, pregnancy, or ascites (fluid accumulation), along with a weakened abdominal wall
Epigastric hernia
occurs through linea alba above umbilicus in the epigastric region
Spigelian Hernia
occurs along the linea semilunares – usually in obese people > 40 years of age. Usually occurs at or below the arcuate line where the rectus abdominis is in direct contact with the transversalis fascia (where there is no posterior wall of the rectus sheath from the anterolateral abdominal muscles).
paraumbilical hernia
acquired adult umbilical hernia when the hernia sac does not protrude through the umbilical scar, but instead through the linea alba in the region of the umbilicus
