Anterior Abdominal Wall Flashcards
What level is the xiphisternal joint?
T9
What level is the xiphisternal process?
T10
What is the lateral limit of rectus abdominis?
Linea semilunaris/ semilunar line
Segment rectus abdominis and connect to anterior wall of aponeurotic coverings to prevent bowstringing
Tendinous intersections
a midline tendinous line from xiphisternum to pubic symphysis where the aponeuroses of the abdominal muscles meet?
Linea alba “white line”
All layers of the wall fuse at this level (L3-L4)
Umbilicus
what are the vertical lines in abdomen?
Midline, midclavicular line
What are the horizontal planes in abdomen?
Transpyloric Planes
Subcostal plane
Intercristal plane
Intertubercular plane
Where does transpyloric plane passes?
tips of 9th costal cartilages on both sides
Where does transpyloric plane lie?
L1 vertebra pylorus of the stomach duodenojejunal function neck of pancreas hila of kidneys
Joins lowest point of costal margin on both sides that is the 10th costal cartilage
Subcostal Plane
What level is the Subcostal Plane?
L3 vertebra
Passes across highest points on iliac crests
Intercristal Plane
At what level is the Intercristal Plane?
L4 vertebra
What procedure is commonly done at the level of L4?
Lumbar spine tap
Joins tubercles on iliac crests
Intertubercular Plane
What level is the Intertubercular Plane?
L5 vertebra
Divided topographically by two transverse and two longitudinal planes into nine regions
Abdomen
Also divided by vertical and horizontal planes through the umbilicus into four quadrants
Abdomen
What are the 9 regions of abdomen?
1: right hypochondriac/ hypochondrium
2: epigastrium
3: left hypochondriac/ hypochondrium
4: right lumbar/ flank
5: umbilical
6: left lumbar/ flank
7: right inguinal (iliac)/ groin
8: hypogastric (pubic)
9: left inguinal (iliac)/ groin
What are the 4 regions of abdomen?
right and left upper quadrants and right and left lower quadrants
What level is the umbilicus?
at the level of the intervertebral disk between L3-L4 vertebrae
what innervates umbilicus?
10th thoracic nerve
May occur due to failure of the midgut to return to the abdomen early in fetal life, and it occurs as a protrusion of intestines through a defect at the umbilicus.
Umbilical hernia
A persistence of the herniation of abdominal contents, which remain outside the abdominal cavity and are covered only by the amniotic membrane; thus, immediate surgical repair is required.
Omphalocele
A protrusion of the abdominal viscera through a defect in the abdominal wall without involving the umbilical card on the right side of the umbilicus.
Gastroschisis
What are the common actions of external oblique, internal oblique, transverse, and rectus abdominis muscles?
Flexes trunk
Compresses abdomen
What is the exercise to reduce abdomen area?
sit-ups
What muscles are involved in forceful expiration?
Internal oblique muscle
Transverse muscle
How many percent have an absent or unpaired pyramidalis muscle?
10-20% of cases
Continues over the inguinal ligament to merge with the superficial fascia of the thigh.
Superficial (Fatty) Layer of the Superficial Fascia (Camper Fascia)
Continues over the pubis and perineum as the superficial layer of the superficial perineal fascia
Superficial (Fatty) Layer of the Superficial Fascia (Camper Fascia)
Attached to the fascia lata just below the inguinal ligament.
Deep (Membranous) Layer of the Superficial Fascia (Scarpa Fascia)
Scarpa Fascia continues over the pubis and perineum as the membranous layer of the superficial perineal fascia.
Colles fascia
Scarpa Fascia continues over the penis as the superficial fascia of the penis and over the scrotum as the ____, which contains smooth muscle.
tunica dartos
Covers the muscles and continues over the spermatic cord at the superficial inguinal ring as the external spermatic fascia.
Deep Fascia
Continues over the penis as the deep fascia of the penis __ and over the pubis and perineum as the deep perineal fascia.
Buck fascia
Is a tendinous median raphe between the two rectus abdominis muscles, formed by the fusion of the aponeuroses of the external oblique, internal oblique, and transverse abdominal muscles.
Linea Alba
Linea Alba becomes the __ in pregnancy , probably due to hormone stimulation to produce more melanin.
linea nigra
Is a curved line along the lateral border of the rectus abdominis.
Linea Semilunaris
Is a crescent-shaped line marking the inferior limit of the posterior layer of the rectus sheath just below the level of the iliac crest.
Linea Semicircularis (Arcuate Line)
Represents the medial triangular expansion of the inguinal ligament to the pectineal line of the pubis.
Lacunar Ligament (Gimbernat Ligament)
Forms the medial border of the femoral ring and the floor of the inguinal canal.
Lacunar Ligament (Gimbernat Ligament)
May contain extravasated urine between this fascia and the deep fascia of the abdomen, resulting from rupture of the spongy urethra.
Deep (Membranous) Layer of the Superficial Fascia (Scarpa Fascia)
Extends from the xiphoid process to the pubic symphysis
Linea Alba
Is a strong fibrous band that extends laterally from the lacunar ligament along the pectineal line of the pubis.
Pectineal (Cooper) Ligament
Is the folded lower border of the aponeurosis of the external oblique muscle, extending between the anterior superior iliac spine and the pubic tubercle.
Inguinal Ligament (Poupart Ligament)
Forms the floor (inferior wall) of the inguinal canal.
Inguinal Ligament (Poupart Ligament)
Is a fascial partition that separates the muscular [(lateral) and vascular (medial) lacunae deep to the inguinal ligament.
Iliopectineal Arcus or Ligament
It transmits the iliopsoas muscle.
muscular lacuna
It transmits the femoral sheath and its contents, including the femoral vessels, a femoral branch of the genitofemoral nerve, and the femoral canal.
vascular lacuna
Is formed by fibers derived from the medial portion of the inguinal ligament and lacunar ligament and runs upward over the conjoint tendon to end at the linea alba.
Reflected Inguinal Ligament
Is formed by the aponeuroses of the internal oblique and transverse muscles of the abdomen and is inserted into the pubic tubercle and crest.
Falx Inguinalis (Conjoint Tendon)
Strengthens the posterior wall of the medial half of the inguinal canal.
Falx Inguinalis (Conjoint Tendon)
Is formed by fusion of the aponeuroses of the external oblique, internal oblique, and transverse muscles of the abdomen.
Rectus Sheath
What are the contents of Rectus Sheath?
rectus abdominis pyramidal muscle superior epigastric vessel inferior epigastric vessel lower 5 intercostal nerves subcostal nerve
What forms the rectus sheath?
aponeuroses of:
external oblique
internal oblique
transverse muscles
In the Anterior Layer of the Rectus Sheath, what are above the arcuate line?
aponeuroses of the external and internal oblique muscles
In the Anterior Layer of the Rectus Sheath, what are below the arcuate line?
aponeuroses of the external oblique, internal oblique, and transverse muscles
In the Posterior Layer of the Rectus Sheath, what are above the arcuate line?
aponeuroses of the internal oblique and transverse muscles
In the Posterior Layer of the Rectus Sheath, what are below the arcuate line?
rectus abdominis is in contact with the transversalis fascia
It is a thin layer of fascia that lines the transversus abdominis muscle and is continuous with a similar layer lining the diaphragm and the iliacus muscle
Fascia Transversalis
It is a thin layer of connective tissue that contains fat and lies between the fascia transversalis and the parietal peritoneum
Extraperitoneal Fat (Tissue)
It is a serous membrane that lines the walls of the abdomen and is continuous below with the parietal peritoneum lining the pelvis
Parietal Peritoneum
Is bounded medially by the linea semilunaris (lateral edge of the rectus abdominis), laterally by the inferior epigastric vessels, and inferiorly by the inguinal ligament.
Inguinal (Hesselbach) Triangle
Inguinal (Hesselbach) Triangle is an area of potential weakness and hence is a common site of?
direct inguinal hernia
Is a triangular opening in the aponeurosis of the external oblique muscle that lies just lateral to the pubic tubercle
Superficial Inguinal Ring
Lies in the transversalis fascia, just lateral to the inferior epigastric vessels.
Inguinal Ring
Borders of Hesselbach Triangle
Medially: linea semilunaris
Laterally: inferior epigastric vessels
Inferiorly: inguinal ligament
Begins at the deep inguinal ring and terminates at the superficial ring.
Inguinal Canal
What does Inguinal Canal transmit?
spermatic cord or the round ligament of the uterus
genital branch of the genitofemoral nerve
What clinical correlate passes through the Inguinal Canal?
indirect inguinal hernia
Where does ilioinguinal nerve run?
inguinal canal and the superficial inguinal ring
Where does ilioinguinal nerve don’t pass?
deep inguinal ring
What are the contents of inguinal canal?
genital branch of the genitofemoral nerve
ilioinguinal nerve
spermatic cord or the round ligament of the uterus
What are the borders of the inguinal canal?
Anterior wall: aponeuroses of the external oblique and internal oblique muscles. Posterior wall: aponeurosis of the transverse abdominal muscle and transversalis fascia. Superior wall (roof): arching fibers of the internal oblique and transverse muscles. Inferior wall (floor): inguinal and lacunar ligaments.
Arises when a portion of intestine protrudes through a weak spot in the inguinal canal or in the inguinal triangle.
Inguinal hernia
A hernia in which the contents of the hernial sac can be returned to their normal position.
Reducible hernia
An irreducible hernia in which the contents of the hernial sac are entrapped or stuck in the groin.
Incarcerated hernia
An irreducible hernia in which the intestine becomes tightly trapped or twisted; thus, the circulation is arrested, and gangrene (death of tissue) occurs unless relief is prompt.
Strangulated hernia
Passes through the deep inguinal ring, inguinal canal, and superficial inguinal ring and descends into the scrotum.
Indirect inguinal hernia
Where does Indirect inguinal hernia lie?
lateral to the inferior epigastric vessels
Which kind of hernia is congenital and which is acquired?
Congenital: Indirect inguinal hernia
Acquired: Direct inguinal hernia
Occurs in the inguinal triangle directly through the abdominal wall muscles (posterior wall of the inguinal canal), lateral to the edge of the conjoint tendon (falx inguinalis), and rarely descends into the scrotum.
Direct inguinal hernia
The hernia lies medial to the inferior epigastric vessels and protrudes forward (but rarely through) the superficial inguinal ring.
Direct inguinal hernia
What composes spermatic cord?
ductus deferens testicular, cremasteric, and deferential arteries pampiniform plexus of testicular veins genital branch of the genitofemoral cremasteric nerves testicular sympathetic plexus
derived from the aponeurosis of the external oblique muscle.
External spermatic fascia
originating in the internal oblique muscle.
Cremasteric fascia
derived from the transversalis fascia.
Internal spermatic fascia
Is a peritoneal diverticulum in the fetus that evaginates into a developing scrotum and forms the visceral and parietal layers of the tunica vaginalis testis.
Processus Vaginalis Testis
Normally closes before birth or shortly thereafter and loses its connection with the peritoneal cavity.
Processus Vaginalis Testis
What may result if Processus Vaginalis Testis persists?
congenital indirect inguinal hernia
What may Processus Vaginalis Testis cause if it is occluded?
fluid accumulation (hydrocele processus vaginalis)
Is a double serous membrane, a peritoneal sac that covers the front and sides of the testis and epididymis.
Tunica Vaginalis
Tunica Vaginalis is derived from the abdominal peritoneum and forms the?
innermost layer of the scrotum
Is the fetal ligament that connects the bottom of the fetal testis to the developing scrotum.
Gubernaculum Testis
Appears to be important in testicular descent (pulls the testis down as it migrates)
Gubernaculum Testis
Is homologous to the ovarian ligament and the round ligament of the uterus.
Gubernaculum Testis
Consists of a thin pigmented skin and dartos fascia, a layer of smooth muscle fibers; when contracted, it wrinkles to regulate the temperature.
Scrotum
What innervates scrotum?
genital branch of the genitofemoral
anterior scrotal branch of the ilioinguinal
posterior scrotal branch of the perineal
perineal branch of the posterior femoral cutaneous nerves
Where does scrotum receive blood?
anterior scrotal branches of the external pudendal artery
posterior scrotal branches of the internal pudendal artery
Where does scrotum drain lymph?
superficial inguinal nodes
Are surrounded by the tunica vaginalis in the scrotum and produce sperm in the seminiferous tubules and testosterone by interstitial (Leydig) cells.
Testes
What innervates the testes?
autonomic nerves
Where does testes drain lymph?
deep inguinal nodes
Where does testes receive blood?
testicular arteries arising from the aorta
Where does testes drain venous blood?
Right: IVC
Left: renal vein
Is a depression on the anterior abdominal wall between the median and medial umbilical folds of the peritoneum.
Supravesical Fossa
Is a depression on the anterior abdominal wall between the medial and lateral umbilical folds of the peritoneum. It lies lateral to the supravesical fossa.
Medial Inguinal Fossa
fossa where most direct inguinal hernias occur
Medial Inguinal Fossa
Is a depression on the anterior abdominal wall, lateral to the lateral umbilical fold of the peritoneum.
Lateral Inguinal Fossa
Is a fibrous cord, the remnant of the obliterated urachus,
Median Umbilical Ligament or Fold
Lies between the transversalis fascia and the peritoneum and extends from the apex of the bladder to the umbilicus.
Median Umbilical Ligament or Fold
Is a fibrous cord, the remnant of the obliterated umbilical artery, which forms a medial umbilical fold and extends from the side of the bladder to the umbilicus.
Medial Umbilical Ligament or Fold
Is a fold of the peritoneum that covers inferior epigastric vessels and extends from the medial side of the deep inguinal ring to the arcuate line.
Lateral Umbilical Fold
Is the lining fascia of the entire abdominopelvic cavity between the parietal peritoneum and the inner surface of the abdominal muscles.
Transversalis Fascia
Forms the deep inguinal ring and gives rise to the femoral sheath and the internal spermatic fascia.
Transversalis Fascia
Is directly in contact with the rectus abdominis below the arcuate line.
Transversalis Fascia
Continues with the diaphragmatic, psoas, iliac, pelvic, and quadratus lumborum fasciae.
Transversalis Fascia
Is the ventral ramus of the 12th thoracic nerve and innervates the muscles of the anterior abdominal wall.
Subcostal Nerve
Has a lateral cutaneous branch that innervates the skin of the side of the hip.
Subcostal Nerve
Arises from the first lumbar nerve and innervates the internal oblique ad transverse muscles of the abdomen.
Iliohypogastric Nerve
Divides into a lateral cutaneous branch to supply the skin of the lateral side of the buttocks and an anterior cutaneous branch to supply the skin above the pubis.
Iliohypogastric Nerve
Arises from the first lumbar nerve, pierces the internal oblique muscle near the deep inguinal ring, and accompanies the spermatic cord through the inguinal canal and then through the superficial inguinal ring.
Ilioinguinal Nerve
Innervates the internal oblique and transverse muscles
Ilioinguinal Nerve
Gives rise to a femoral branch, which innervates the upper and medial parts of the anterior thigh. and the anterior scrotal nerve, which innervates the skin of the root of the penis (or the skin of the mons pubis) and the anterior part of the scrotum for the labium majus)
Ilioinguinal Nerve
A drawing up of the testis by contraction of the cremaster muscle when the skin on the upper medial side of of the thigh is stroked
Cremasteric reflex
What is the efferent limb of cremasteric reflex arc?
genital branch of the genitofemoral nerve
What is the afferent limb of cremasteric reflex arc?
femoral branch of the genitofemoral nerve
ilioinguinal nerve
Drain into the axillary lymph nodes.
Lymphatics in the Region above the Umbilicus
Drain into the superficial inguinal nodes.
Lymphatics in the Region below the Umbilicus
Receive lymph from the lower abdominal wall, buttocks, penis, scrotum, labium majus, and the lower parts of the vagina and anal canal. Their efferent vessels primarily enter the external iliac nodes and, ultimately, the lumbar (aortic) nodes.
Superficial Inguinal Lymph Nodes
Arises from the internal thoracic artery, enters the rectus sheath, and descends on the posterior surface of the rectus abdominis
Superior Epigastric Artery
Anastomoses with the inferior epigastric artery within the rectus abdominis.
Superior Epigastric Artery
Arises from the external iliac artery above the inguinal ligament, enters the rectus sheath, and ascends between the rectus abdominis and the posterior layer of the rectus sheath.
Inferior Epigastric Artery
Anastomoses with the superior epigastric artery, providing collateral circulation between the subclavian and external iliac arteries.
Inferior Epigastric Artery
Gives rise to the cremasteric artery, which accompanies the spermatic cord.
Inferior Epigastric Artery
Arises from the external iliac artery and runs laterally along the inguinal ligament and the iliac crest between the transverse and internal oblique muscles.
Deep Circumflex Iliac Artery
Forms an ascending branch that anastomoses with the musculophrenic artery.
Deep Circumflex Iliac Artery
Arise from the femoral artery and run superiorly toward the umbilicus over the inguinal ligament. Anastomose with branches of the inferior epigastric artery.
Superficial Epigastric Arteries
Arises from the femoral artery and runs laterally upward, parallel to the inguinal ligament. Anastomoses with the deep circumflex iliac and lateral femoral circumflex arteries.
Superficial Circumflex Iliac Artery
Arise from the femoral artery, pierce the cribriform fascia, and run medially to supply the skin above the pubis.
Superficial (External) Pudendal Arteries
- Are longitudinal venous connections between the lateral thoracic vein and the superficial epigastric vein.
- Provide a collateral route for venous return if a caval or portal obstruction occurs.
Thoracoepigastric Veins
