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Block 3; Week 1 > Anatomy; Anterior Abdominal Wall > Flashcards

Anatomy; Anterior Abdominal Wall Flashcards

1
Q

What are the superior, inferior, & lateral boundaries of the anterior abdominal wall?

A

Superior: right & left costal margin 7-10th ribs & the xiphoid
Inferior: inguinal ligament & superior margins of the pelvic girdle
Lateral: lateral abdominal wall…

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2
Q

T/F The origins & insertions of all of the muscles & tissues of the abdominal wall are found w/i the superior, inferior & lateral boundaries.

A

FALSE

the tissues of the ant ab wall have extensive origins & insertions…

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3
Q

What divides up the 4 quadrants of the anterior abdominal wall & what is each quadrant called?

A 
midline & horizontal line thru the umbilicus
Right Upper
Left Upper
Right Lower
Left Lower
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4
Q

What are the 5 layers of the abdominal wall?

A 
Skin
Superficial Fascia
Muscle w/ investing fascia
transversalis fascia
Parietal Peritoneum
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5
Q

Parietal Peritoneum…

What is the synonymous structure in the thoracic cavity?

A

Parietal Pleura

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6
Q

What is the role of the transversals fascia? Is this also present in other areas of the body?

A

A version of it is present in the thoracic & pelvic cavities…
This binds the peritoneum to the inside of the abdominal wall. It is a thin layer of CT.

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7
Q

What are the 2 layers of the superficial fascia in the anterior abdominal wall?

A

Camper’s Layer: superficial fatty (expands during obesity)

Scarpa’s Layer: deeper & membranous

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8
Q

What’s the deal with a space & Scarpa’s fascia & where does that extend?

A

There is a space underneath the Scarpa’s fascia before the investing fascia of the external oblique muscle.
This space extends down until you hit near the thigh where the Scarpa’s fascia fuses w/ the fascia lata of the thigh @ the inguinal ligament.

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9
Q

What are the 4 muscle layers of the abdominal wall?

A

External Oblique
Internal Oblique
Transversus Abdominis
Rectus Abdominis

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10
Q

What is another name for the midline of the abdominal wall?

A

linea alba

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11
Q

What directions do each of the anterior abdominal wall muscles run?

A 
External oblique...run downward @ an angle (hands in the pocket--pointing toward the exit). 
Internal Oblique...run upward @ a 90 degree angle from external (where the stuff goes in your mouth)
Transversus Abdominis (run horizontally)
Rectus Abdominis (run vertically)
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12
Q

What are the thoracic structures that are synonymous to the internal & external oblique muscles?

A

The external & internal intercostals…

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13
Q

What is the origin of the external oblique muscle? What are 2 insertions?

A

Origin: Surface of ribs 5-12
Insertions: linea alba
anterior iliac crest & pubic tubercle

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14
Q

What is the significance of the inferior border of the external oblique muscle?

A

It reflects on itself to create the inguinal ligament. This is a border of the inguinal canal.

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15
Q

Where does the innervation of the external oblique muscle come from?

A

T7-T12 (intercostals & subcostals)

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16
Q

What is the weak spot associated w/ the external oblique muscle?

A

@ the opening of the superficial ring, associated w/ the inguinal canal…Ahhh hernia.

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17
Q

What is the action of the external oblique muscle?

A

rotate the trunk to the opposite side & raise the intrabdominal pressure & assist w/ flexion against resistance.

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18
Q

What is a tendon?

A

the attachment from a muscle to a bone or another fixed point

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19
Q

What is an aponeuroses?

A

A flat tendon of a flat muscle

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20
Q

Where does the external oblique muscle turn into an aponeuroses?

A

at the anteriomedial line

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21
Q

What is the superficial inguinal ring? What forms it?

A

It is formed by an extension of the external oblique muscle.
It is an opening to the inguinal canal & a point where a hernia can happen…I think…
And this is where the descent of the testes happens & where the spermatic cord enters…

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22
Q

Where does the internal oblique muscle arise posteriorly & inferiorly?

A

Posteriorly: lateral part of the thoracolumbar fascia
Inferiorly: iliac crest & lateral half to the inguinal ligament

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23
Q

What is the course of the internal oblique muscle & its final place of insertion?

A

superomedial course at a 90 degree angle to the external obliques
Inserts at the linea alba & the lower ribs
Inserts into the pecten pubis & pubic crest via the conjoint tendon (w/ the transversus)

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24
Q

The internal oblique arises posteriorly from the thoracolumbar aponeuroses. What other abdominal wall muscle also arises from this? What is the significance of this? WHat is the thoracolumbar aponeuroses?

A

Thoracolumbar aponeuroses is a flat tendon that arises from the latissimus dorsi muscle in the back.
The internal oblique muscle & the transversus abdominis both arise from this & are thus important muscles for protecting the back.

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25
Q

What is the action of the internal oblique muscle?

A

rotate the trunk to the same side…compress it w/ pressure against resistance…

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26
Q

What is the innervation of the internal oblique muscle?

A

ventral rami of T6-L1 spinal nerves

specifically: T6-T11 intercostal nerves, subcostal, & L1 spinal nerve

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27
Q

So…what’s the deal w/ the cremaster muscle & the cremasteric reflex?

A

The cremaster muscle is over the scrotum & contains little bits of various muscles that are low enough on the inguinal ligament to be dragged down during the descent of the testis.
This muscle is made up of striated skeletal muscle & is therefore voluntary.
The reflex is that when you stroke the inner thigh you see the testicles elevate.

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28
Q

Are there smooth muscle fibers on the scrotal sac too?

A

Yes…so, they are affected by temperature & a part of an autonomic response. Involuntary.

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29
Q

What is an important abdominal muscle that is NOT a part of the cremaster muscle?

A

the transversus abdominis…it isn’t low enough on the inguinal ligament to become a part of it.

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30
Q

What does the transversus abdominis arise from posteriorly & inferiorly?

A

Posteriorly: lateral part of the thoracolumbar fascia
7-12 costal cartilages
Inferiorly: iliac crest & lateral third of the inguinal ligament

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31
Q

What is the course of the transversus abdominis?

A

horizontal & inserts into the linea alba via the rectus sheath
also inserts into pecten pubis & pubic crest via the conjoin tendon…

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32
Q

What is the innervation of the transversus abdominis muscle?

A

T6-T11 intercostal nerves, subcostal, L1 spinal nerve

like most of the abdominal muscles

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33
Q

What is the action of the transversus abdominis muscle?

A

compresses the abdomen in bearing down actions

also supports the back b/c attached to the thoracolumbar aponeuroses

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34
Q

What are the 3 layers of the anterior & posterior rectus sheath (near the linea alba)?

A

External aponeuroses
Internal aponeuroses
Transversus abdominis aponeuroses

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35
Q

Where does the rectus abdominis arise from inferiorly & superiorly?

A

Inferiorly: pubic symphysis & cret
Superiorly: xiphoid process & 5-7th costal cartilages

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36
Q

What is the innervation of the rectus abdominis?

A

T6-T11 intercostal nerves

subcostal

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37
Q

What is the action of the rectus abdominis?

A

flex the trunk against resistance

stabilize the tilt of the pelvis

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38
Q

What sheathes the rectus abdominis muscles?

A

Rectus Sheath (contributions from 3 abdominal muscles

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39
Q

Describe the structure of the rectus abdominis.

A

So it is sorta composed of 2 sets of muscles…mirrored across the linea alba & broken up into 4 compartments by tendinous intersections with the anterior wall of the sheath

40
Q

What composes the linea alba?

A

an interdigitation of all aponeurotic fibers @ the midline

41
Q

Where is the arcuate line & what is its significance w/ respect to the rectus sheath?

A

Arcuate line is located halfway b/w the umbilicus & the pubic symphysis…
Above this line the fibers of the abdominal wall muscles are split traveling behind or in front of the rectus abdominis.
Below this line all the fibers of the abdominal wall muscle travel in front of the rectus.

42
Q

Once you are below the arcuate line…what runs posteriorly to the rectus abdominis muscles?

A

just transversalis fascia & peritoneum

43
Q

What are the pros & cons to cutting along the linea alba during abdominal surgery?

A

Pro: you wouldn’t be cutting thru any nerves, blood vessels or muscles & you would be able to get a good large view of the abdominal cavity.
Cons: it would be difficult for this to heal b/c of the lack of blood vessels…it’s just dense CT there…

44
Q

There is a TON of collateral flow in the anterior abdominal wall…why is this so important? What are the main sources of blood flow?

A

Really important so that if one gets blocked…you can still supply blood to that region. Also, the internal thoracic artery is used for bypass sometimes…important to know the the collateral flow of the area will take care of those regions of the patient.
T10, T11 intercostal arteries
musculophrenic arteries (off the diaphragm–branches from the internal thoracic)
subcostal artery
1st lumbar artery
superior epigastric (off the internal thoracic)
inferior epigastric (off the external iliac & deep circumflex iliac)

45
Q

Once again, what do the superior epigastric & inferior epigastric arteries branch from? Remember, they have an important anastomotic connection. Where can they both be found?

A

They can both be found running in the posterior region of the rectus sheath.
The superior epigastric branches off of the internal thoracic artery. The internal thoracic artery branched from the subclavian artery
The inferior epigastric artery branches off of the external iliac artery.

46
Q

What is something funky about the venous drainage of the abdominal wall that is unlike the arterial supply to the abdominal wall?

A

there are numbers par umbilical vein tributaries that contributed to the umbilical vein of the itty bitty babies…but as adults…you don’t want that! If you have severe portal hypertension…they can open up & you can see dilation around your umbilicus due to the enlargement of the paraumbilical veins.

47
Q

What is the transversalis fascia? Where can it be found? What are other names it can go by?

A

This is the CT connector of the peritoneum to the abdominal wall.
It is found deep to the transversus abdominis muscle & rectus muscle etc.
Found all over the abdominal wall…
Could also be known as diaphragmatic fascia or pelvic fascia etc. depending on position…

48
Q

T/F The parietal peritoneum is fused to absolutely all the organs in the abdomen.

A

False.
It is only partially fused to retroperitoneal structures. Ex: it is only found on the anterior portion of the kidneys, which are retroperitoneal structures.

49
Q

T/F There may be fat found b/w the peritoneum & transversalis fascia.

A

TRUE.

50
Q

What is the innervation of the skin & muscles of the anterior abdominal wall?

A

almost entirely supplied by T6-T11 intercostal nerves & subcostal nerve (T12)

51
Q

What is the innervation of the inferior aspect of the abdominal wall?

A

supplied by the L1 nerve via iliohypogastric & ilioinguinal nerves…

52
Q

Where can the iliohypogastric nerve be found?

A

in the area underneath the umbilicus, suprapubic region

53
Q

Where can the ilioinguinal nerve be found? What does it supply?

A

in the inguinal canal w/ the spermatic cord in males…

supplies the anterior wall of the scrotum in males & the anterior aspect of the labia majora in females

54
Q

Where do all of these nerves run?

A

They run in b/w the 2 deepest layers of the wall

They give off lateral & anterior cutaneous branches along the way…

55
Q

The following cutaneous nerves give sensation to which areas?
T6
T10
T12/L1

A

T6–>subxiphoid area
T10–>umbilical area
T12/L1–>suprapubic area

56
Q

In the abdomen & thorax w/ the nerves we have been talking about…what happens to the dorsal & ventral rami?

A

Dorsal Rami: go back to the back structures

Ventral Rami: it travels around towards the front giving off lateral & anterior cutaneous branches…

57
Q

What’s the deal with the innervation of body wall structures?

A

They all synapse in the sympathetic chain ganglion & travel to their targets as postganglionics.

58
Q

What forms the inguinal canal in males? Females?

A

Males: descent of the testis
Females: round ligament of the uterus

59
Q

T/F Females can’t get inguinal hernias b/c they don’t have processus vaginalis or the descent of the testis.

A

False. These things make inguinal hernias less common in females, but they can still happen.

60
Q

Where do the testis & ovaries begin? Where do they move? What controls this movement?

A

posterior abdominal wall…they are retroperitoneal…sitting in transversalis fascia
descend downwards in their migration
gubernaculum controls this movement

61
Q

What is the gubernaculum attached to on each side? What is its role?

A

on one side attached to the ovary or testis & on the other side attached to the scrotal sac of the male & the labia majora of the female
it shortens during the descent…moderates the movement…

62
Q

What happens to the gubernaculum in the male & female?

A

Male: you get descent of the testis all the way into the scrotal sac…
Female: you get descent of the ovary to the point of the uterine wall…
Gubernaculum that attaches the ovary to the uterine wall is called the round ligament of the ovary. The gub that is connected from the uterine wall to the labia majora is called the round ligament of the uterus.

63
Q

What is the processus vaginalis? Why is this more common in males? What is the clinical significance?

A

This is an invagination of the coelomic cavity during the descent of the testis. It is more common in males b/c it is formed by this journey.
This is an opportunity for an inguinal hernia if the processus vaginalis is patent.

64
Q

How many coelomic sacs are in males v. females?

A

Males: 6
Females: 4

65
Q

When the processus vaginalis in a male closes up…what is left? Where is this found?

A

tunic vaginalis…this is an extension that covers the testes.

66
Q

Where is the level of the deep ring?

A

roughly around the transversalis fascia

67
Q

Where is the level of the superficial ring?

A

around the external oblique…formed by the pulling apart of the muscle…

68
Q

What all gets pulled down during the descent of the testis?

A

The peritoneum & transversalis fascia get pulled down.
The transversus abdominis DOES NOT.
The internal oblique gets pulled down.
The fascia of the external oblique gets pulled down.

69
Q

What does the transversalis fascia that gets pulled down become known as?
How about the internal oblique muscle?
How about the external oblique fascia?

A

Transversalis Fascia: internal spermatic fascia
Internal Oblique Muscle: Cremaster Muscle
External Oblique Fascia: external spermatic fascia

70
Q

When the hernia is made through a course that follows the descent of the testis…what is this called?

A

An indirect inguinal hernia

71
Q

What is the deepest layer of the spermatic cord?

A

processus vaginalis

72
Q

Which ring is more medial…the deep or the superficial?

A

The superficial

73
Q

What are the 2 most superficial layers that surround the spermatic cord?

A

Most superifical: skin

Then: Scarpa’s fascia

74
Q

What is the coelom away from home?

A

the tunica vaginalis

75
Q

At what point is the spermatic cord considered the spermatic cord?

A

Not until it comes out of the superficial inguinal ring

76
Q

What are some random necessary things that are dragged down into the spermatic cord & sit next to the processus vaginalis?

A

blood vessels
nerves
lymph
vas deferens

77
Q

What is the conjoint tendon composed of? What is another name for its arc? Why is this an important spot clinically?

A

internat oblique, transversus abdominis
Inguinal Falx
This forms part of the triangle that is vulnerable to direct hernias.

78
Q

The spermatic cord pierces through what making it the superficial inguinal ring?

A

the external oblique

79
Q

Why is the inferior epigastric artery an important landmark?

A

It divides the inguinal triangle medially from the deep inguinal ring laterally…

80
Q

T/F The internal wall of the abdominal cavity is formed by 3 folds from the same embryological origin…

A

FALSE

NO! They all have distinct embryological origins.

81
Q

What are the names of the 3 folds found on the internal wall of the abdominal cavity & what forms them?

A

Lateral Umbilical Fold: deep inferior epigastric vessels
Medial Umbilical Fold: obliterated umbilical arteries
Median Umbilical Fold: obliterated urachus

82
Q

Review: What is the urachus?

A

connection of the primitive bladder to the umbilicus

83
Q

Concerning the Hasselbach’s triangle or the inguinal triangle…what is the tendon that arches over it? What is this tendon composed of?
What is anterior to this structure?
What are the medial, lateral, & inferior borders of this triangle?

A 
Conjoint tendon: composed of the transversus abdominis & internal oblique
Anterior to this: superficial ring
Medial: Rectus Abdominis
Lateral: deep inferior epigastric artery
Inferior: inguinal ligament
84
Q

What is the inguinal triangle a site for?

A

a direct hernia

85
Q

In a direct hernia…what layers of muscle are grabbed to cover it?

A

only the fascia of the external oblique muscle

86
Q

What is it about the conjoint tendon that contributes to the weakness of the inguinal triangle?

A

the high arch of the conjoint tendon…

87
Q

What is the path of the direct inguinal hernia?

A

medial to the inguinal canal
medial to inferior epigastric artery
this is thru the Hesselbach’s triangle…

88
Q

What is the path of the indirect inguinal hernia?

A

lateral to the inguinal canal
thru the patent processus vaginalis
could end up in the tunica vaginalis
follows the course of the descent of the testis

89
Q

Where do femoral hernias occur?

A

in the femoral canal

inferior to the inguinal ligament

90
Q 
What are the follow boundaries of the femoral canal?
Anterosuperior?
Medial?
Posteroinferior?
Lateral?
A

Anterosuperior: inguinal ligament
Medial: lacunar ligament
Posterioinferior: pectineal ligament
Lateral: femoral vein & artery

91
Q

What does the femoral sheath surround? What is it made of? Which of the things in the sheath is found in the canal?

A

surrounds the artery, vein, & lymphatics
made of transversalis fascia
Lymphatics found in the femoral canal

92
Q

T/F The femoral nerve is NOT found in the femoral canal.

A

true

93
Q

What is the opening to the femoral canal? What are other important characteristics of the canal?

A

Femoral Ring
Short canal
rigid canal (means that anything that is in there is subject to strangulation)

94
Q

Once the femoral sheath gets to the thigh…what happens?

A

The femoral sheath blends w/ the fascia of the thigh…

94
Q

Once the femoral sheath gets to the thigh…what happens?

A

The femoral sheath blends w/ the fascia of the thigh…

Block 3; Week 1 (11 decks)

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