Anterior Abdominal Wall Flashcards
4 quadrants of anterior abdominal wall
RUQ
LUQ
RLQ
LLQ
Subcostal plane connects/goes through which structures? lies at the level of which vertebral body?
horizontal plane that connects lowest points of right and left costal margins (lower margins of 10th costal cartilages)
• lies at the level of body of L3, near its upper border
Intertubercular (transtubercular) plane is a what type of plane that connects what structures? lies at which vertebral body?
- horizontal plane connecting tubercles of right and left iliac crests
- lies at the level of body of L5, near its upper border
Midclavicular plane is what oriented plane that passes through what?
- vertical plane that passes through midpoint of clavicle
* intersects halfway between anterior superior iliac spine (ASIS) and pubic tubercle
the transpyloric plane is what oriented plane (horizontal or vertical)? Passes through what vertebrae? Located midway between which structures? It crosses the costal margin at roughly which costal cartilage? It passes through the opening of which organ? the body of which organ? and the hila of?
• horizontal plane that passes through lower part of body of L1
• located about midway between jugular notch of sternum and pubic symphysis
• crosses costal margin on each side at roughly the 9th costal cartilage
• passes through opening of stomach into duodenum (pyloric orifice), body of pancreas
and hila of kidneys
the 2 midclavicular planes and 2 horizontal planes (subcostal and intertubercular)
are used to divide anterior abdominal wall into (how many) regions? the upper part is above which plane and consists of which regions?
- upper part which is above subcostal plane creates the
- epigastric region or epigastrium (center) region
- right hypochondriac region
- left hypochondriac region
the middle part of the anterior abdominal wall is between/formed by which planes and consists of which regions?
(between subcostal and intertubercular planes):
- umbilical region (center)
- Right lumbar regions (lateral region or flank (R))
- Left lumbar regions (lateral region or flank (L))
the lower part of the anterior abdominal wall is between/formed by which planes and forms which regions?
lower part (below intertubercular plane):
- pubic, hypogastric region or hypogastrium (center)
- right inguinal (right iliac) region
- left inguinal (left iliac) region
Layers of the Anterior Abdominal Wall (Superficial to Deep)
- skin
- superficial fascia
- muscles with their deep (investing) fasciae
- transversalis fascia
- extraperitoneal fascia
- parietal peritoneum
the superficial fascia of lower anterior abdominal wall is composed of how many layers? what are they?
2,
Camper’s fascia and Scarpa’s fascia
Camper’s fascia is the (superficial/deep) layer of lower anterior abdominal wall and is the (fatty/membranous layer), can it be thick?
superficial, fatty layer
continuous with superficial fat over rest of body
• may be extremely thick
3 broad and thin muscles on side of anterior abdominal wall
external oblique
internal oblique
transversus abdominis
On each side of the ______ there is a (long/short?) (vertical/horizontal?) muscle called the ?
anterior midline, the rectus abdominis
A small muscle anterior to lower part of rectus abdominis is called? and is absent in about 10%/20%/30%/50% of people?
pyramidalis (absent in
about 20% of people)
the (#?) flat abdominal muscles are muscular (fleshy) (laterally or medially) and aponeurotic/fibrous (?laterally/medially?)
3 flat abdominal muscles are (fleshy) laterally and aponeurotic (fibrous) mediall
aponeuroses of 3 flat muscles pass (laterally or medially) and enclose which muscle? (and also encloses this muscle, if present)? this enclosure forms the ?
aponeuroses of 3 flat muscles pass medially and enclose rectus abdominis (and
pyramidalis, if present) to form rectus sheath
in midline of anterior abdominal wall, aponeuroses of 3 right flat muscles join aponeuroses of 3 left flat muscles form fibrous band called the ______ that extends from
linea alba, that extends from xiphoid process to pubic symphysis
origin and insertion of external oblique
Origin: outer surface of lower 8 ribs
insertion: on an anterior view, fibers run inferiorly and medially (similar to external • intercostals) → lower fibers insert into iliac crest → remaining fibers become continuous
with an aponeurosis which inserts into xiphoid process, linea alba and pubic bone
the inguinal ligament is an extension of the _____ border of the ________ aponeurosis that extends from ____ to pubic tubercle
lower border of external oblique aponeurosis that extends from ASIS to pubic tubercle
it is folded backward on itself forming a trough structure called inguinal ligament forms boundary
between abdomen and thigh
the lacunar ligament is what shape? located where? fibers run which direction and where does it attach?
crescent-shaped expansion at medial end of inguinal ligament
its fibers pass posteriorly to attach to pectineal line, on superior ramus of pubis
the fascia lata (deep fascia of thigh) attaches
superiorly to the inguinal ligament
superficial inguinal ring is an opening in?
the external oblique aponeurosis located immediately to the pubic tubercle
the superficial inguinal ring is the anterior/superficial opening of?
the inguinal canal
the internal oblique is located
immediately deep to external oblique
internal oblique origin and insertion
Origin: thoracolumbar fascia, iliac crest and lateral ⅔ of inguinal ligament
• Insertion: on an anterior view, upper fibers run superiorly and medially (similar to
internal and innermost intercostals) while lower fibers are more horizontal
upper fibers insert into inferior border of lower 3 or 4 ribs and their costal
cartilages
• remaining fibers become continuous with an aponeurosis which inserts into
xiphoid process, linea alba and pubic bone
• has a lower free border that arches over contents of inguinal canal • its lowest tendinous fibers join lowest tendinous fibers of transversus abdominis to
form conjoint tendon which attaches to pubic crest and pectineal line
the transversus abdominis lies deep to
the internal oblique
origin and insertion of transversus abdominis
• Origin: deep surface of lower 6 costal cartilages, thoracolumbar
fascia, iliac crest and lateral ⅓ of inguinal ligament
• Insertion: fibers run horizontally forward and become continuous
with an aponeurosis which inserts into xiphoid process, linea alba and
pubic bone
has a lower free border that arches over contents of inguinal canal • its lowest tendinous fibers join lowest tendinous fibers of internal
oblique to form conjoint tendon which attaches to pubic crest and
pectineal line.
the rectus abdominis is a (describe muscle) that extends the long strap muscle that extends along whole length of anterior abdominal wall • It is narrower and thicker below, broader and thinner above • it is separated from its fellow by linea alba • Origin: pubic symphysis and pubic crest • Insertion: 5th, 6th and 7th costal cartilages and xiphoid process • divided into segments by 3 transverse fibrous bands (tendinous intersections
or inscriptions)
abdominis muscle
• more prominent in thin, muscular individuals when muscle contracts
• extends from tip of 9th costal cartilage to pubic tubercle
• superior tendinous intersection is just inferior to xiphoid process • inferior one is at the level of umbilicus • middle one is half-way between the other two
• semilunar line: hallow skin groove that indicates lateral border of rectus
• long strap muscle that extends along whole length of anterior abdominal wall
the rectus abdominis is ____ and_____ below and ______ and above
It is narrower and thicker below, broader and thinner above
the two rectus abdominis is separated by what
linea alba
origin and insertion of rectus abdominis
Origin: pubic symphysis and pubic crest
• Insertion: 5th, 6th and 7th costal cartilages and xiphoid process • divided into segments by 3 transverse fibrous bands (tendinous intersections
or inscriptions)
abdominis muscle
- more prominent in thin, muscular individuals when muscle contracts
- extends from tip of 9th costal cartilage to pubic tubercle
the rectus abdominis is divided into how many segments? by what type of band? what are they?
divided into segments by 3 transverse fibrous bands (tendinous intersections
or inscriptions)
- superior tendinous intersection is just inferior to xiphoid process
- inferior one is at the level of umbilicus
- middle one is half-way between the other two
the semilunar line is a _____ skin groove that indicates?
semilunar line: hallow skin groove that indicates lateral border of rectus abdominis muscle
more prominent in thin, muscular individuals when muscle contracts
extends from tip of 9th costal cartilage to pubic tubercle
the pyramidalis is a small triangular muscle located ____, within_____may be absent on one or both sides
anterior to lower part of rectus abdominis within rectus sheath
origin, insertion, and action of pyramidalis
Origin: anterior surface of body of pubis
- Insertion: linea alba
- Action: tensor of linea alba
the rectus sheath is formed by
aponeurosis of 3 flat abdominal muscles
what are the contents of the rectus sheath
- rectus abdominis
- pyramidalis (if present)
- terminal parts of lower 5 (7th to 11th) intercostal nerves and subcostal nerve
- superior and inferior epigastric vessels
5, penises, SIR
T12 is also called the
subcostal nerve
T7-T11 spinal nerves (7th-11th intercostal nerves) and the subcostal nerves course
these nerves run forward between internal
oblique and transversus abdominis, 7th to 11th intercostal nerves and subcostal nerve enter rectus sheath and
supply rectus abdominis
the subcostal nerve innervates pyramidalis
ventral ramus of L1 spinal nerve give rise to which nerves?
iliohypogastric and ilioinguinal nerves
does the iliohypogastric and ilioinguinal nerves pierce the rectus sheath?
no, just the 7th to 11th intercostal nerves and subcostal nerve enter rectus sheath and
supply rectus abdominis and pyramidalis (supplied by subcostal nerve only)
T7-T11 and 7th to 11th intercostal nerves terminate by?
terminate by piercing anterior wall of rectus sheath to supply skin of anterior abdominal wall (anterior cutaneous branches)
iliohypogastric and ilioinguinal nerves pierce what and what are its course?
• anteriorly, they pierce internal oblique and run between this muscle and external oblique aponeurosis
terminal part of iliohypogastric nerve pierces ________above
superficial inguinal ring to supply _____
terminal part of iliohypogastric nerve pierces external oblique aponeurosis above superficial inguinal ring to supply suprapubic skin
terminal part of ilioinguinal nerve emerges through ______ to
supply skin _____ and _______
terminal part of ilioinguinal nerve emerges through superficial inguinal ring to
supply skin of superomedial thigh and external genitali
nerves of anterolateral abdominal wall provide sensory innervation _______ and _______ that line the outer and inner surfaces, respectively, of anterior
abdominal wall and provide motor innervation to muscles of anterior abdominal
wall
nerves of anterolateral abdominal wall provide sensory innervation to skin and
parietal peritoneum that line the outer and inner surfaces, respectively, of anterior
abdominal wall and provide motor innervation to muscles of anterior abdominal
wall
T7 → just inferior to tip of xiphoid process • T10 → level of umbilicus • L1 → pubic symphysis and area immediately
superior to it
T7 → just inferior to tip of xiphoid process • T10 → level of umbilicus • L1 → pubic symphysis and area immediately
superior to it
dermatome T7 location
T7 → just inferior to tip of xiphoid process • T10 → level of umbilicus • L1 → pubic symphysis and area immediately
superior to it
dermatome T7 location
T7 → just inferior to tip of xiphoid process
dermatome of L1 location
pubic symphysis and area immediately
superior to it
superficial venous drainage of anterior abdominal wall?
network of veins from umbilicus draining superiorly into the axillary vein via the the thoracoepigastric/lateral thoracic vein and draining inferiorly into the femoral vein by superficial epigastric vein
in the anterior abdominal wall, the IVC is bypassed which vein, providing collateral drainage
the thoracoepigastric vein links from femoral vein to axillary vein, bypassing the IVC
the deep veins of abdominal wall follow which arteries?
superior epigastric artery (vein), inferior epigastric arterty (vein), deep circumflex artery (vein), lower posterior and intercostal arteries (veins), lumbar arteries (veins)
superficial lymph drainage above and below level of what? describe it?
above level of umbilicus, lymph drains upwards toward the anterior axillary lymph nodes
below level of umbilicus, lymph drains downward toward superficial inguinal lymph nodes
the super epigastric vein drains into the
internal thoracic vein
the inferior epigastric vein and deep circumflex iliac veins drains into
external iliac vein
the lower posterior intercostal and subcostal veins drain into
azygos vein on the right side and the hemiazygos veins on the left side
the lumbar veins drain into
the inferior vena cava
deep lymph drainage consists of/follow what course
lymph vessels follow arteries and deep veins and drain into internal thoracic (parasternal), external iliac, posterior mediastinal, and lumbar (para-aortic) lymph nodes
what is the inguinal canal?
oblique passage about 4 cm in length, through lower part of anterior abdominal wall
the inguinal canal lies parallel and immediately (above/below?) the (medial/lateral?) part of inguinal ligament
parallel immediately above medial part of inguinal ligament
contents of inguinal canal in both male and females?
males->spermatic cord (including genital branch of genitofemoral nerve) and ilioinguinal nerve
females-> round ligament of uterus (fibrous cord that extends from uterus to labium majus), genital branch of genitofemoral nerve and ilioinguinal nerve
the deep inguinal ring is an opening of the inguinal canal made by which components? where is it at? what vessels pass deep to the ring and where?
- opening in transversalis fascia
- located about 1/2 inch above inguinal ligament, halfway between ASIS and pubic tubercle
- inferior epigastric vessels pass medial to deep inguinal ring
the superficial inguinal ring is an opening of the inguinal canal made of what? located where?
opening in aponeurosis of external oblique
located immediately superior to pubic tubercle
anterior wall of inguinal canal
aponeurosis of external oblique (reinforced laterally by fibers of internal oblique that originates from inguinal ligament)
posterior wall of inguinal canal
transversalis fascia (reinforced medially by conjoint tendon)
inferior wall of inguinal canal
inguinal ligament and lacunar ligament (forms medial end of floor)
superior wall of inguinal canal
lower borders of internal oblique and transversus abdominis
abdominal hernia is what and made up of which 3 parts?
protrusion of abdominal contents beyond normal confines of abdominal wall
3 parts
- hernial sac
- contents of sac
- coverings of sac
the hernial sac is
a pouch (diverticulum) of parietal peritoneum
the contents of sac may consist of?
any structure found within abdominal cavity (piece of omentum, loop of small intestine) etc
the coverings of sac formed by?
layers of abdominal wall through which hernial sac passes
types of abdominal hernias? where do most occur? these type occur (more or less) in males/females
inguinal, femoral, umbilical, incisional , etc
75% of abdominal hernias occur in inguinal region (most common type)
inguinal hernias occur more in males than in females
types of inguinal hernia
indirect inguinal hernia vs direct inguinal hernia
indirect inguinal hernia are the (most or least common) type of inguinal hernia? origin? what age type are these more common?
most common, 2/3 to 3/4 hernias are indirect
congenital in origin
more common in children and young adults
in an inguinal hernia, the ______ leaves abdominal cavity lateral to _______ vessels, through the ____ inguinal ring. The neck of the sac is ____
the hernial sac leaves abdominal cavity lateral to inferior epigastric vessels,
through deep inguinal ring. Neck of hernial sac is narrow
an indirect inguinal hernia results from persistent _______ (outpouching of peritoneum that the fetus is respobsible for formation of ______)
results from a persistent processus vaginalis (outpouching of peritoneum
that in the fetus is responsible for formation of inguinal canal)
in a direct inguinal hernia, the hernial sac leaves abdominal cavity (lateral or medial) to the ______ vessels. The hernial sac protrudes through an area of relative weakness in _____ wall of inguinal canal
hernial sac leaves abdominal cavity medial to inferior epigastric vessels • hernial sac protrudes through an area of relative weakness in posterior wall of inguinal canal
the inguinal triangle aka Hesselbach’s triangle is bounded laterally by? medially by? inferiorly by?
- inferior epigastric vessels (laterally)
- rectus abdominis (medially)
- inguinal ligament (inferiorly)
the hernial sac in a direct inguinal hernia is (narrow or wide)?
wide
direct inguinal hernias are more common in which type of people because of what? the origin is then what?
more common in older men with weak abdominal muscles (considered to be
acquired in origin)
the spermatic cord is a
collection of structures running between testis and abdominopelvic cavity
the spermatic cord begins at ? and passes through? exits? it descends to?
- begins at deep inguinal ring
- passes through inguinal canal
- exits inguinal canal via superficial inguinal ring
- descends within scrotum and ends posterior to testis and epididymis
the components of spermatic cord?
- ductus (vas) deferens
- testicular artery and veins (pampiniform venous plexus)
- artery of the ductus deferens
- cremasteric artery
- lymph vessels
- autonomic nerves
- genital branch of genitofemoral nerve
Dicks Taste Like Gouda Cheese After Anal
the ductus deferens is a ___ walled tube that is about ___ cm long?
thick walled tube, 45 cm long
function of ductus deferens?
carries mature sperm from epididymis to ejaculatory duct
the ductus deferens path- it begins at? ascends within? passes through? at the ____ ring it separates from? descends posterior to? the terminal part is ____ called the ____ of ductus deferens). it then (narrows or widens) and joins ____ to form ejaculatory duct
-ascends within scrotum toward superficial inguinal ring as part of spermatic cord
- passes through inguinal canal (also as part of spermatic cord)
- at deep inguinal ring it separates from testicular vessels and passes inferiorly into
pelvis
-descends posterior to base (fundus) of urinary bladder
-its terminal part is dilated (ampulla of ductus deferens)
- it then narrows and joins seminal vesicle to form ejaculatory duct
the testicular arteries are _____ branches of the _____ aorta
paired visceral branches of abdominal aorta
the testicular arteries originate where, descend on? and pass through? to supply what?
-originates from abdominal aorta just below renal arteries (site of
embryological origin of testes)
-descend on posterior abdominal wall (behind peritoneum)
-pass through inguinal canal and descend in scrotum as part of spermatic cord
-supply testis and epididymis
the testicular veins form a ___ around the testicular ____ called the ____ plexus? it ascends, the plexus becomes ____ in size and eventually a ____ testicular vein is formed on each side. They then run up the ____ abdominal wall (behind what)?
form a plexus around testicular artery (pampiniform plexus) • as it ascends, plexus becomes reduced in size and eventually a single
testicular vein is formed on each side. • runs up on posterior abdominal wall (behind peritoneum)
the right testicular vein drains into and the left testicular drains into?
- right testicular vein drains into IVC
* left testicular vein drains into left renal vein
• testicular lymph vessels run with _____ to ____ inguinal ring. They ascend on______ wall (behind peritoneum) to reach______ lymph nodes
• testicular lymph vessels run with spermatic cord to deep inguinal ring • ascend on posterior abdominal wall(behind peritoneum) to reach lumbar (lateral aortic) lymph nodes
lymph from scrotum drains into
superficial inguinal lymph nodes
the cremasteric artery is a
branch of _____ it supplies coverings of _____ Anastomoses with ______
A branch of inferior epigastric artery
- Supplies coverings of spermatic cord
- Anastomoses with the testicular artery
the artery of vas deferens
accompanies the ______ from pelvis. It originates from _____ .
Anastomoses with ______
artery of vas deferens accompanies the vas deferens from pelvis
Originates from superior vesical artery
Anastomoses with the testicular artery
Genital branch of genitofemoral nerve
is a branch of ____ contains fibers from _____ .
divides into ____ and ___ branches
• genital branch supplies what muscle and skin of ___ or____ and
and skin of scrotum or mons pubis and
labium majus
the femoral branch supplies skin over _____
Genital branch of genitofemoral nerve is a branch of lumbar plexus, contains fibers from ventral rami of L1 and L2 spinal nerves
• divides into genital and femoral branches
• genital branch supplies cremaster muscle and skin of scrotum or mons pubis and
labium majus
• femoral branch supplies skin over upper part of femoral triangle
