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Anatomy of the abdomen and pelvis > Anatomy of the Abdominal Wall, Inguinal Region and Hernias > Flashcards

Anatomy of the Abdominal Wall, Inguinal Region and Hernias Flashcards

1
Q

What are the bony landmarks of the abdomen?

A

Sternum and xiphoid process

Costal margin, costal cartilages and ribs

Iliac crest, iliac fossa and anterior superior iliac spine (ASIS)

Pubic symphysis, pubic tubercle and pubic ramus

Thoracic and lumbar vertebrae, sacrum and pelvic bones

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2
Q

What visceral structures are found in the abdomen?

A

Stomach, duodenum and small intestines

Liver, pancreas and spleen

Kidneys, ureters and urinary bladder

Reproductive organs

Abdominal vessels

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3
Q

What are the 9 regions that the abdomen can be divided into (from top right to bottom left)?

A

Right hypochondriac, epigastric, left hypochondriac

Right lumbar, umbilical, left lumbar

Right iliac, hypogastric/suprapubic, left iliac

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4
Q

What are the two fascia found immediately below the skin and what are their characteristics?

A

Camper’s Fascia - fatty fascia

Scarpa’s Fascia - membranous layer

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5
Q

What muscles make up the posterior wall of the abdomen?

A

Quadratus lumborum, psoas major and iliacus muscles

Post-vertebral muscles (erector spinae group)

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6
Q

What muscles make up the lateral wall of the abdomen?

A

External oblique

Internal oblique

Transversus abdominis

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7
Q

What muscles make up the anterior wall of the abdomen?

A

The paired vertical rectus abdominal muscles within the rectus sheath.

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8
Q

What is an aponeurosis?

A

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.

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9
Q

What are some functions of the three sheet-like muscles?

A

Compresses the abdomen and increases intra-abdominal pressure to aid expiration and evacuation of faeces, urine and parturition, heavy lifting.

Supports viscera - guards the intestines

Flex and rotate the trunk

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10
Q

What are the attachments of the external oblique?

A

External surfaces of the bottom 8 ribs

Free posterior border

Xiphoid process, linea alba, pubic crest and tubercle, anterior 1/2 of the iliac crest

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11
Q

State the direction of the external oblique muscle fibres.

A

Infero-medially (hands in pocket)

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12
Q

How is the inguinal ligament made and where does it attach?

A

Formed by the rolling inwards of the lower aponeurotic border of the external oblique. It extends from the anterior superior iliac spine (ASIS) to the pubic tubercle

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13
Q

What are the attachments of the internal oblique?

A

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

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14
Q

State the direction of the muscle fibres of the internal oblique.

A

Infero-laterally (reverse hand in pokcets)

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15
Q

What are the attachments of the transversus abdominis?

A

Laterally: bottom 6 costal cartilages, thoracolumbar fascia, anterior 2/3 of the iliac crest, lateral 1/3 of the inguinal ligament

Medially: xiphoid process, linea alba, pubic symphysis, conjoint tendon

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16
Q

State the direction of the muscle fibres of the transversus abdominis.

A

Horizontally

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17
Q

Where does the neurovascular layer lie?

A

Between the internal oblique and the transversus abdominis

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18
Q

What are the points of attachment of the rectus abdominis?

A

5-7 costal cartilages, xiphoid process

Pubic symphysis, pubic crest

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19
Q

What structures divide the rectus abdominis into segments?

A

Transverse tendinous intersections

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20
Q

What is the rectus sheath formed by?

A

The aponeuroses of the three flat muscles.

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21
Q

Describe the arrangement of the rectus sheath above and below the arcuate line.

A

Above the arcuate line - the internal oblique splits to encase the rectus abdominis. The external oblique is anterior to the rectus sheath and the transversus abdominis is posterior to the rectus abdominis.

Below the arcuate line - all three sheet muscles are anterior to the rectus abdominis. The posterior surface of rectus abdominis is in contact with the transversalis fascia.

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22
Q

What is the function of the rectus abdominis?

A

It is a powerful flexor of the vertebral column.

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23
Q

What are the points of attachment of quadratus lumborum?

A

Lower border of the 12th rib

Transverse process of lumbar vertebra 5

Adjacent iliac crest

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24
Q

What are the points of attachment of psoas major?

A

Bodies of all five lumbar vertebra

Lesser trochanter of the femur

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25
Q

What plane carries the nervous and blood supply to the abdominal wall?

A

Neurovascular plane - found in between the internal oblique and the transversus abdominis

26
Q

Describe the blood supply to the rectus sheath.

A

Superiorly, blood supply comes from the superior epigastric artery, which is the terminal branch of the internal thoracic artery.

Inferiorly, blood supply comes from the inferior epigastric artery, which is a branch of the external iliac artery.

The two vessels anastomose providing a potential by-pass of the abdominal aorta.

27
Q

Which vessels supply the flank muscles?

A

Intercostal arteries 7-11

Subcostal artery

Lumbar arteries

Deep circumflex iliac artery

28
Q

What nerves supply the abdominal wall?

A

T7-L1

29
Q

What nerves supply the external oblique, internal oblique and transversus abdominis?

A

External Oblique - T7-T11

Internal Oblique - T7-L1

Transversus Abdominis - T7-L1

30
Q

What nerves supply the rectus abdominis?

A

T7-T12

31
Q

Describe the difference in the innervation of the visceral and parietal peritoneum.

A

The parietal peritoneum has the same segmental somatic sensory innervation as the abdominal wall.

The visceral peritoneum has NO somatic sensory innervation

32
Q

Which three nerves supply the antero-lateral abdominal wall?

A

Subcostal nerve (T12), Ilioinguinal nerve (L1), Iliohypochondriac nerve (L1)

33
Q

Which nerves provide the motor supply for quadratus lumborum, psoas major and iliacus?

A

Quadratus Lumborum - T12-L4

Psoas Major - L2-L4

Iliacus - L2-L4

34
Q

Where is the lumbar plexus located?

A

L1-L4

35
Q

Which line defines a border between the lymphatic drainage to different groups of lymph nodes?

A

Transumbilical plane

36
Q

Where do the superficial lymphatics above and below the transumbilical line drain to?

A

Above - pectoral group of axillary lymph nodes

Below - superficial inguinal lymph nodes

37
Q

Where do the deep lymphatics above and below the transumbilical line drain to?

A

Above - mediastinal lymph nodes

Below - external iliac and para-aortic lymph nodes

38
Q

Where does the inguinal ligament attach to the pelvis?

A

Anterior superior iliac spine and the pubic tubercle

39
Q

Why is the inguinal region clinically important?

A

It is an area of inherent weakness where most abdominal hernias occur.

40
Q

What defines the ends of the inguinal canal?

A

The superficial and deep inguinal rings

41
Q

How long is a normal inguinal canal?

A

4cm

42
Q

Are hernias more common in males or females?

A

males

43
Q

What are the contents of the inguinal canal in males and females?

A

Males - spermatic cord + ilioinguinal nerve

Females - round ligament of the uterus + ilioinguinal nerve

44
Q

At what stage in intrauterine life do the testes usually enter the inguinal canal and drop into the scrotum?

A

Testicular descent starts at 7 weeks IUL. They enter the inguinal canal around 28 weeks IUL and enter the scrotum around 32-36 weeks IUL

45
Q

What passes through the femoral canal?

A

Efferent lymphatics and a lymph node

NOTE: the femoral artery and vein do NOT go through the femoral canal (the femoral vein, in fact, is the lateral wall of the femoral canal)

46
Q

Define hernia.

A

Protrusion of part or a whole of an organ or tissue through the walls of the structure that contain it.

47
Q

What are the three main parts of a hernia?

A

Weakness/hole, hernial sac, contents of the hernial sac

48
Q

What are some clinical symptoms and signs of a hernia? What symptoms indicate that the hernia should be treated as an emergency situation?

A

Swelling or protrusion in the groin area

Pain/lack of pain and discomfort

May be intermittent or presenting all the time

May be reducible or irreducible

Strangulation may occur leading to tissue death causing symptoms such as vomiting, constipation and intestinal obstruction - this is considered an emergency

49
Q

What factors increase the risk of femoral hernia in women?

A

Age and number of pregnancies

50
Q

Where are the superficial and deep inguinal rings positioned?

A

Superficial inguinal ring is located immediately above and medial to the pubic tubercle

Deep inguinal ring is 1.5 cm above the midpoint of the inguinal ligament

51
Q

The superficial and deep inguinal rings are holes in which muscles/fascia?

A

Superficial inguinal ring is a hole in the external oblique

Deep inguinal ring is a hole in the transversalis fascia

52
Q

What is the conjoint tendon?

A

The lowest fibres of the internal oblique and the transversus abdominis come together to form the conjoint tendon, which attaches medially to the pubic crest .

53
Q

What makes up the four walls of the inguinal canal?

A

Anterior - external oblique (the whole way) + internal oblique (lateral 1/3)

Posterior - transversalis fascia + conjoint tendon medially

Superior - arching over fibres of the internal oblique and transversus abdominis and the conjoint tendon medially

Inferior - inguinal ligament (folding inwards of the lower border of the external oblique aponeurosis)

54
Q

What region do direct inguinal hernias occur through and where is this region positioned?

A

Hesselbach’s Triangle - medial to the inferior epigastric vessels

55
Q

Where is the defect in indirect inguinal hernias positioned?

A

Dilation of the deep inguinal ring - lateral to the inferior epigastric vessels

56
Q

What type of patients tend to have direct inguinal hernias and what behaviours and defects are direct inguinal hernias associated with?

A

Older patients - it is associated with chronic straining and weak musculature

It is caused by a defect in the posterior abdominal wall.

57
Q

What type of patients tend to have indirect inguinal hernias?

A

Young adults and children

58
Q

What type of patients are more likely to get femoral hernias?

A

Women and the elderly

59
Q

What makes up the walls of the femoral canal?

A

Superior - inguinal ligament

Inferior - pectineus fascia

Medial - lacunar ligament

Lateral - femoral vein

60
Q

Where is a femoral hernia usually seen on the surface?

A

Below and lateral to the pubic tubercle

61
Q

Where is an inguinal hernia usually seen on the surface?

A

Above and medial to the pubic tubercle

Anatomy of the abdomen and pelvis (9 decks)

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