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SF4 Exam I > Adominal Wall > Flashcards

Adominal Wall Flashcards

1
Q

What makes up the:

Superior Border of Abdominal Wall

A 
Xiphoid process
Costal Margin (costal cartilages of ribs 7-10)
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2
Q

Inferior Border of Abdominal Wall

A

Iliac Crest
Inguinal Ligament
Pubic Bone

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3
Q

Innervation to skin around Umbilicus come from..

A

spinal nerve T-10

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4
Q

Linea Alba (what is it, where does it go, how was it formed, what does it mark)

A

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

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5
Q

Linea Semilunaris (what is it, where does it go, how was it formed, what does it mark)

A

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

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6
Q

Linea Transversae

A

fibrous connective tissue bands within rectus abdominis muscles
usually 3 above umbilicus (rare- one below)
produce “washboard stomach” appearance

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7
Q

What produce “washboard stomach” appearance

A

Linea Transversae

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8
Q

name the 4 quadrants of the anterior abdominal wall

A

Right Upper
Right Lower
Left Upper
Left Lower

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9
Q

4 Quadrants of Anterior Abdominal Wall are defined by

A 
a midline (longitudinal or midsagittal) plane
a transumbilical (horizontal or transverse) plane
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10
Q

How many regions are there in the anterior abdominal wall and what defines them

A

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

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11
Q

Name the regions of the anterior abdominal wall

A 
Right hypochondrial
Epigastric 
Left hypochondrial
Right flank 
Umbilical
Left flank 
Right groin
Pubic 
Left groin
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12
Q

Site of Maximum Tenderness during Acute Appendicitis (name, region, quadrant)

A

McBurney’s Point
Region- umbilical
Quadrant- right lower

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13
Q

McBurney’s Point

A

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

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14
Q

Structures Found Deep to Right Upper Quadrant

A 
Stomach- pylorus
Duodenum
Ascending Colon- superior part
Right Colic (hepatic) Flexure
Transverse Colon- right half
Liver- right lobe
Gallbladder
Kidney-right
Adrenal Gland- right
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15
Q

Structures Found Deep to Right Lower Quadrant

A 
Ileum- major part
Cecum
Appendix
Ascending Colon- inferior part
Ureter- right
Spermatic Cord- right
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16
Q

Structures Found Deep to Left Upper Quadrant

A 
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
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17
Q

Structures Found Deep to Left Lower Quadrant

A

Descending Colon
Sigmoid Colon
Ureter- left
Spermatic Cord- left

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18
Q

Location of Pain in Acute Diverticulitis

A

Quadrant- lower left

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19
Q

Location of Pain in Pancreatitis

A

Region- epigastric

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20
Q

Location of Pain in Cholecystitis

A

Region- right hypochondrial

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21
Q

Pain from Enlarged Appendix is first referred where?

A

T10 dermatome around umbilicus (later felt in lower right quadrant when inflammation involves peritoneum)

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22
Q

The Liver, GB, and Duodenum all have visceral surface projections of pain where and why

A

right shoulder

from diaphragm irritation

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23
Q

Surface Projections of Visceral Stomach Pain

A

Epigastric Region

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24
Q

Surface Projections of Visceral Head of Pancreas Pain

A

Epigastric Region

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25
Surface Projections of Visceral Gallbladder Pain
Upper Right Quadrant (right hypochonrial region)
26
Surface Projections of Visceral Liver Pain
Upper Right Quadrant (lower right quadrant posteriorly)
27
Surface Projections of Visceral Spleen Pain
Upper Left Quadrant (left hypochdrial region)
28
Surface Projections of Visceral Small Bowel Pain
Umbilical Region
29
Surface Projections of Visceral Cecum and Colon Pain
Pubic Region
30
Surface Projections of Visceral Kidney and Ureter Pain
Lower Left Quadrant (left groin region)
31
Name the Layers of the Anterior Abdominal Wall
1. Skin 2. Superficial Fascia 2a. Fatty layer = Camper's Fascia 2b. Membranous later - Scarpa's Fascia 3. Deep (investing) facia- covering muscles 4. Transversalis Fascia (Endoabdominal Fascia) 5. Extraperitoneal Fat 6. Parietal Peritoneum
32
Name the Layer of the Anterior Abdominal Wall
1. Skin 2. Superficial Fascia 2a. Fatty layer = Camper's Fascia 2b. Membranous later - Scarpa's Fascia 3. Deep (investing) facia- covering muscles 4. Transversalis Fascia (Endoabdominal Fascia) 5. Extraperitoneal Fat 6. Parietal Peritoneum
33
What layers make up the space to access retroperitoneal structures with our entering peritoneal cavity (where organs are housed)
Transversalis Fascia and Extraperitoneal Fat
34
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
35
Labia Majora in Females is an extension of what?
fat from camper's fascia of the superficial fascia in the abdominal wall
36
Dartos Fascia
in males | camper's fascia continuation over penis (loses fat) and fuses to scrapa's fascia
37
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
38
What forms fundiform ligament in the penis of males
scarpa's fascia
39
Colle's Fascia
membranous layer of superficial perineal fascia | continuation of Scarpa's Fascia in perineum and scrotum (both males and females)
40
The Deep Investing Fascia continues as what in males?
suspensory ligament and deep fascia of the penis
41
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 Peritoneum ```
42
What 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 Peritoneum ```
43
Name the Muscles of the Anterolateral Abdominal Wall
``` External Oblique Internal Oblique Transversus Abdominis Rectus Abdominis Pyramidalis (may be absent) ```
44
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)
45
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)
46
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)
47
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)
48
Pyramidalis (origin, insertion, action, innervation)
O: anterior pubis I: linea alba below umbilicus A: tenses linea alba N: T12 subcostal or L1
49
Inguinal Ligament is formed by what
Inferior border of external oblique
50
What gives rise to cremaster muscle
internal oblique
51
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
52
What is Caput Medusae
a condition in which the superficial epigastric vein (in Camper's Fascia) are swollen and dilated (varicose)
53
Conjoint Tendon
common insertion of transverses abdominis and internal oblique muscles on the pubis
54
Tendinous Intersection of Rectus Abdominis Muscle (function)
function as mini-tendons to control degree of forward flexion
55
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
56
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
57
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
58
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
59
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
60
What designates the lower limit of the posterior wall of the rectus sheath
arcuate line
61
Nerve supply to muscles and skin of anterior abdominal wall comes from?
ventral (anterior) rami of spinal nerves T7-L1
62
What 4 major vessels supply the anterior wall of the abdomen
Internal Thoracic Artery Aorta External Iliac Artery Femoral Artery
63
What branches of the Internal Thoracic Artery supply the anterior wall of the abdomen
superior epigastric artery | musculophrenic artery
64
What branches of the Aorta supply the anterior wall of the abdomen
posterior intercostal arteries | subcostal artery
65
What branches of the External Iliac Artery supply the anterior wall of the abdomen
inferior epigastric artery | deep circumflex iliac artery
66
What branches of the Femoral Artery supply the anterior wall of the abdomen
superficial epigastric artery | superficial circumflex iliac artery
67
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
68
what in the abdomen is helpful during aortic coarctation
anastomoses of superior epigastric artery and inferior epigastric artery
69
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)
70
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
71
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
72
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
73
What nerve is equivalent to a posterior intercostal nerve found at higher thoracic levels
Subcostal
74
What nerves are a continuation of intercostal nerves (travel below posterior intercostal artery in intercostal groove)
Thoracoabdominal Nerves
75
What nerve courses through the inguinal canal and superficial inguinal ring
ilioinguinal nerve
76
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
77
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
78
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
79
Superficial Epigastric Artery (source, branches, supply to)
Source: femoral artery Branches: cutaneous branches Supply to: superficial facial and skin of the abdominal lower wall
80
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
81
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
82
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
83
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
84
Name the three superficial arteries that arise from the femoral artery
superficial epigastric, superficial circumflex iliac, and superficial external pudendal arteries
85
What gives rise to obturator artery in approximately 20% of cases
inferior epigastric artery
86
Features on internal surface of abdominal wall that are potential hernia sites
umbilical folds | peritoneal fossa
87
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
88
Medial Umbilical Fold (location and contents)
along the midline and connects anterior abdominal wall to bladder contains: obliterated urachus/allonic duct
89
Median Umbilical Folds (location and contents)
occur on each side of the midline from the internal iliac artery to umbilicus contains: obliterated umbilical arteries
90
Lateral Umbilical Folds (location and contents)
not embryonic rudiments | cover the inferior epigastric vessels and will bleed if cut
91
Peritoneal Fossa (what is it)
depressions lateral to the umbilical folds | each one is a potential site for hernia
92
3 parts to a hernia
sac contents of sac covering of sc
93
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
94
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
95
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
96
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
97
Acquired adult umbilical hernias
common in females, obesity, pregnancy, or ascites (fluid accumulation), along with a weakened abdominal wall
98
Epigastric hernia
occurs through linea alba above umbilicus in the epigastric region
99
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).
100
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

SF4 Exam I (16 decks)

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