Anterior Abd wall and Neurovascular Supply

Question 1

Explain the function of the abdomen and its boundaries

Answer 1

A flexible container for the abdominal organs
Boundaries: posterior=spinal column, anterior=abdominal wall, Lateral=Tra, obliques, superior=diaphragm, inferior=pelvic inlet

Question 2

Explain the functions of the anterior abdominal wall

Answer 2

Regulate intra abdominal pressures. Support the trunk. Support the abdominal viscera. Move the trunk and maintain posture.

Question 3

Describe the organization of the peritoneal ‘ligaments’

Answer 3

Gastrophrenic ligament (diaphragm to greater curvature of the stomach), Gastrosplenic (spleen to gr. curvature of the stomach), Gastrocolic (around the small intestine), Hepatogastric, hepatoduodenal. Falciform lig. Round lig of liver.

Question 4

Describe the organization of the mesenteries

Answer 4

a. Mesentery proper- surrounds branches of the superior mesenteric vessels
b. Sigmoid mesocolon- surrounds branches of the inferior mesenteric vessels
c. Transverse mesocolon- surrounds branches of the middle colic vessels

Question 5

Draw the layers of the rectus sheath including the arcuate line

Answer 5

Draw

Question 6

Why is the arcuate line significant?

Answer 6

Demarcates the transition between the aponeurotic posterior rectus sheath and the transversalis fascia. Where the inferior epigastric vessels perforate the rectus abdominis.

Question 7

Describe the anatomy of the inguinal canal including its contents in both males and females

Answer 7

About 4cm long and runs parallel to the inguinal ligament. Has deep and superficial rings.

Boundaries: Floor=inguinal lig, reinforced medially by lacunnar lig. Ant wall=external oblique aponeurosis reinforced laterally by internal oblique. Post wall=transversalis fascia reinforced by conjoint tendon

Male: spermatic cord (A annd V of ductus deferens, ilioinguinal n., genital br of genitofemoral n., testicular a, cremasteric a and v., pampiniform plexus, testicular plexus nn.)
Female: round ligament

Question 8

List the layers of the anterior abdominal wall from superficial to deep

Answer 8

Skin, Camper’s fascia, scarpas fascia, rectus femoris sheath, RF, posterior rectus sheath. Laterally, external oblique, internal oblique, TrA, transversalis fascia, extraperitonneal adipose, parietal peritoneum.

Question 9

Describe the innervation of the skin of the abdomen via T7-T12 spinal nerves

Answer 9

Innervate via the lateral cutaneous brr and anterior cutaneous brr of the T7-12 costal nn.

Question 10

Distinguish between direct and indirect inguinal hernias

Answer 10

Direct inguinal hernias press directly through the abdominal wall, medial to the inferior epigastric vessels and potentially through the superficial inguinal ring

Indirect hernias the bowel passes lateral to the inferior epigastric vessels, through the deep and potentially superficial inguinal rings. Most common >66%

Question 11

Name the composition of the portal triad

Answer 11

The common bile duct, the hepatic portal vein, and the hepatic artery proper. The omental foramen runs directly posterior to this.

Question 12

Draw the abdominal aortic brr

Answer 12

Draw!

Question 13

Draw the celiac trunk and brr

Answer 13

Drraw!

Question 14

Draw the SMA and brrr

Answer 14

Draw ✍️

Question 15

Draw the IMA and brr

Answer 15

✍️

Question 16

Draw the sympathetic innervation

Answer 16

✍️

Question 17

Draw the parasympathetic innervation

Answer 17

✍️

Question 18

Draw the brr of the biliary tree

Answer 18

✍️

Question 19

Describe the caval and portal venous drainage of the abdomen from peripheral veins to the right atrium

Answer 19

Hepatic portal vein drains into liver > Sinusoid v > central v. > hepatic vv. (3) > IVC

Question 20

Draw the portal venous system

Answer 20

✍️

Question 21

Explain the venous pathways involved in each of the four primary portal hypertension scenarios

Answer 21

A: blockage at L gastric
B: blockage at superior rectal
C: blockage at superficial epigastric or inferior epigastric
D: Blockage at L colic

Question 22

Name the groups of lymph nodes that drain the abdomen including the territory they drain and their pattern of drainage

Answer 22

Deep inguinal > external iliac + Internal iliac&raquo_space; common iliac > lateral aortic via the lumbar trunk to the cisterna chyli @ L2

Preaortic and retroaortic&raquo_space;cisterna chyli

Question 23

Structures of the foregut

Answer 23

liver, spleen, stomach, duodenum, pancreas, gall bladder

Question 24

Structures of the midgut

Answer 24

cecum, small intestine, appendix, ascending and transverse colon

Question 25

Structures of the hindgut

Answer 25

Descending, transverse, sigmoid colon and rectum