Anterior Abdominal Wall Flashcards
INTRODUCTION
The anterior abdominal wall forms the anterior limit of the ———
Runs superiorly from the ——and costal cartilages of the —-, —-, —- and —- ribs to the —-, ——, ——, ——, —— and ——— inferiorly
INTRODUCTION
The anterior abdominal wall forms the anterior limit of the abdominal viscera
Runs superiorly from the xiphoid process and costal cartilages of the 7th, 8th, 9th and 10th ribs to the iliac crest, inguinal ligament, anterior superior iliac spine, pubic tubercle, pubic crest and pubic symphysis inferiorly
BORDERS
Superior: ———.
Inferior:.
Umbilicus: Level of IV disc L— to L—
BORDERS
Superior: Costal cartilages 7-12.
▪ Xiphoid process: Level of 10th cartilage =
L3
Inferior: Pubic bone and iliac crest: Level of L4.
Umbilicus: Level of IV disc L3-4
BORDERS
Superior: Costal cartilages— to —.
▪ Xiphoid process: Level of —th cartilage =L—
Inferior: Pubic bone and iliac crest: Level of L—.
Umbilicus: Level of IV disc L3-4
BORDERS
Superior: Costal cartilages 7-12.
▪ Xiphoid process: Level of 10th cartilage =
L3
Inferior: Pubic bone and iliac crest: Level of L4.
Umbilicus: Level of IV disc L3-4
ABDOMINAL REGIONS
Divided into 9 regions by two pairs of planes:
▪ —— Planes: Left and right lateral planes (also called —— planes)
▪ —— Planes: Transpyloric plane: Midway between ——and—— (between ——- and ——-).
▪ Intertubercular plane: Through ———
ABDOMINAL REGIONS
Divided into 9 regions by two pairs of planes:
▪ Vertical Planes: Left and right lateral planes (midclavicular planes)
▪ Horizontal Planes: Transpyloric plane: Midway between jugular notch and pubic symphysis (between xiphoid and umbilicus).
▪ Intertubercular plane: Through tubercles of iliac crests.
ABDOMINAL REGIONS CONT’D
Right and left hypochondriac: Contain ——
Epigastric: Contains: ——-
Right and left lateral (lumbar): ——
Umbilical: Contains ———
Right and left inguinal: ———
Hypogastric: Contains ———-.
ABDOMINAL REGIONS CONT’D
Right and left hypochondriac: Contain liver
Epigastric: Contains: liver, stomach,
pancreas
Right and left lateral (lumbar): Right contains ascending colon, Left contains descending colon.
(Kenhub, 2019)
ABDOMINAL REGIONS CONT’D
Umbilical: Contains small intestine and transverse colon.
Right and left inguinal: Right contains ileocecal junction and appendix, Left contains sigmoid colon.
Hypogastric: Contains small intestine, urinary bladder (full), pregnant uterus.
LINES ON AAW
——: Located along the midline and separates right and left rectus abdominis.
——: Along each lateral border of rectus abdominis.
——: Tendinous bands of rectus abdominis.
LINES ON AAW
Linea alba: Located along the midline and separates right and left rectus abdominis.
Linea semilunaris: Along each lateral border of rectus abdominis.
Linea transversa: Tendinous bands of rectus abdominis.
STRUCTURE OF AAW
The anterior abdominal wall consists of four main layers: ——-
STRUCTURE OF AAW
The anterior abdominal wall consists of four main layers: Skin, superficial fascia, muscles and associated fascia,
parietal peritoneum.
SKIN
The skin is the most superficial layer and shows creases which represent lines of orientation of collagen fibers in the dermis of the skin. These lines are referred to as ——— lines
These lines are referred to as langer’s lines
SUPERFICIAL FASCIA
A connective tissue and its composition depends on location:
▪ ———: single sheet of connective tissue and continuous with the superficial fascia in the other regions of the body.
▪ ————: divided into two layers
SUPERFICIAL FASCIA
A connective tissue and its composition depends on location:
▪ Above the umbilicus: single sheet of connective tissue and continuous with the superficial fascia in the other regions of the body.
(Jones, 2019)
SUPERFICIAL CONT’D
▪ Below the umbilicus: divided into two layers
Below the umbilicus: divided into two layers; the ———layer (also called —— fascia) and ——— layer (also called —— fascia)
Runs inferiorly into lower limbs where it changes name to the ——of the thigh and also continuous with superficial perineal fascia called ——-fascia and also with the fascia which invests the scrotum and penis in males called the ——- fascia
The —— and ——- run between these two layers of fascia
Below the umbilicus: divided into two layers; the fatty superficial layer (camper’s fascia) and membranous deep layer (scarpa’s fascia)
(Jones, 2019)
Figure 6: Superficial fascia
(Oluwadiya, 2015)
SUPERFICIAL CONT’D
Runs inferiorly into lower limbs where it changes name to the fascia lata of the thigh and also continuous with superficial perineal fascia called colles’ fascia and also with the fascia which invests the scrotum and penis in males called the dartos fascia
The superficial vessels and nerves run between these two layers of fascia
MUSCLES OF AAW
General Characteristics:
▪ how many bilaterally paired muscles
▪ how many large flat sheets connecting rib cage to hip bone.
▪ how many vertical muscles
▪ Muscular ——— and ——-.
▪ Aponeurotic —— and ——
MUSCLES OF AAW
General Characteristics:
▪ Five bilaterally paired muscles
▪ Three large flat sheets connecting rib cage to hip bone.
▪ Two vertical muscles
▪ Muscular posteriorly and laterally.
▪ Aponeurotic anteriorly and medially
EXTERNAL OBLIQUE MUSCLE.
Its fibres run in what direction .
Originates from ribs — to ——, and inserts into the —— and——.
Helps in —— of the torso.
Innervation:——-
EXTERNAL OBLIQUE MUSCLE
Largest and most superficial.
Its fibres run inferomedially.
Originates from ribs 5-12, and inserts into the iliac crest and pubic tubercle.
Helps in contralateral rotation of the torso.
Innervation: Thoracoabdominal nerves
(T7-T11) and subcostal nerve (T12).
(Jo
INTERNAL OBLIQUE MUSCLE
Lies deep to the ———
Its fibres run in what direction
Originates from the ——,——,—-, and inserts into ——-
Innervation:——
INTERNAL OBLIQUE MUSCLE
Lies deep to the external oblique
Smaller and thinner in structure
Its fibres run superomedially
Originates from the inguinal ligament, iliac crest and lumbodorsal fascia, and inserts into ribs 10-12
Innervation: thoracoabdominal nerves (T7-T11), subcostal nerve (T12) and
branches of the lumbar plexus.
TRANSVERSUS ABDOMINIS
Deep to it is a well-formed layer of fascia known as ———
Originates from the ———-
Inserts into the ———
Helps in ————
Innervation:——
TRANSVERSUS ABDOMINIS
Deepest of the flat muscles with transversely running fibres
Deep to it is a well-formed layer of fascia known as transversalis fascia.
Originates from the inguinal ligament, costal cartilages 7-12, iliac crest and thoracolumbar fascia.
(Jones, 2019)
TRANSVERSUS CONT’D
Inserts into the conjoint tendon, xiphoid process, linea alba and the pubic crest
Helps in compression of abdominal contents.
Innervation: Thoracoabdominal nerves (T7-T11), subcostal nerve (T12) and branches of the lumbar plexus.
RECTUS ABDOMINIS
Long, paired muscle found either side of the midline in the abdominal wall
Split into two by ———
Lateral borders of this muscle create a surface marking known as ———
At several places, the muscle is intersected by fibrous strips, known as ————.
Originates from ——— before inserting into the ——- and ——
function of the Rectus abdominis
Innervation: ——-
RECTUS CONT’D
(T7-T11).
RECTUS ABDOMINIS
Long, paired muscle found either side of the midline in the abdominal wall
Split into two by linea alba
(Jones, 2019)
Figure 11: Anterior abdominal wall muscles (Jones, 2019)
RECTUS CONT’D
Lateral borders of this muscle create a surface marking known as linea semilunaris
At several places, the muscle is intersected by fibrous strips, known as tendinous intersections.
Tendinous intersection and linea alba give rise to the “six packs” seen in individuals with a well developed rectus abdominis.
(Jones, 2019)
Originates from crest of the pubis, before inserting into the xiphoid process of the sternum and the costal cartilage of ribs 5-7.
Stabilizes pelvis during walking and depresses the ribs.
Innervation: Thoracoabdominal nerves
RECTUS CONT’D
(T7-T11).
PYRAMIDALIS
shape? Is it superficially or deep to Rectus abdominis?
Located inferiorly with its base on the —— and apex of the triangle attached to the ——-.
Originates from the —— and —— before inserting into the ——
It acts to ——-
Innervation: ——-
PYRAMIDALIS
Small triangular muscle superficial to rectus abdominis
Located inferiorly with its base on the pubis bone and apex of the triangle attached to the linea alba.
Originates from the pubic crest and pubic symphysis before inserting into the linea alba.
It acts to tense the linea alba
Innervation: Subcostal nerve (T12)
RECTUS SHEATH
Formed by aponeuroses of the —— muscles.
▪ Anterior wall: formed by
▪ Posterior wall:formed by
RECTUS SHEATH
Strong, incomplete fibrous compartment of the rectus abdominis and pyramidalis muscles.
Formed by aponeuroses of the three flat muscles
Has an anterior and posterior wall for most of its
length.
▪ Anterior wall: formed by aponeuroses of external
oblique and half of the internal oblique
▪ Posterior wall: aponeuroses of half the internal oblique and transversus abdominis
RECTUS SHEATH CONT’D
Also found in the rectus sheath are;
.
RECTUS SHEATH CONT’D
Also found in the rectus sheath are;
▪ Superior and inferior epigastric arteries and
veins
▪ lymphatic vessels, and
▪ distal portions of the thoracoabdominal nerves (abdominal portions of the anterior rami of spinal nerves T7—T12).
FUNCTIONS of the Rectus sheath
FUNCTIONS
Forms a strong expandable support.
Protects the abdominal viscera from injury
such as low below in boxing.
Compresses the abdominal content.
Helps to maintain or increase the intraabdominal pressure.
Moves the trunk and help to maintain posture.
ARTERIES OF AAW
ARTERIES OF AAW
Superior epigastric:
▪ Terminal branch of
internal thoracic.
▪ Descends in rectus sheath posterior to muscle.
▪ Anastomoses with inferior epigastric.
Inferior epigastric:
▪ Arises from external
iliac artery.
▪ Enters rectus sheath at arcuate line.
▪ Branches: Cremasteric artery, Pubic branch
Deep circumflex iliac artery: Branch of external iliac.
Superficial epigastric artery: Arises from femoral artery.
Superficial circumflex iliac artery: Arises from femoral artery.
Superficial external pudendal artery: Arises from femoral
artery.
Superior epigastric:
▪ Terminal branch of
——-.
▪ Descends in rectus sheath (posterior/anterior?) to muscle.
▪ Anastomoses with ———
Superior epigastric:
▪ Terminal branch of
internal thoracic.
▪ Descends in rectus sheath posterior to muscle.
▪ Anastomoses with inferior epigastric
Inferior epigastric:
▪ Arises from ———
▪ Enters rectus sheath at ——-.
▪ Branches: ——-
Inferior epigastric:
▪ Arises from external
iliac artery.
▪ Enters rectus sheath at arcuate line.
▪ Branches: Cremasteric artery, Pubic branch
VEINS OF AAW
External iliac vein: Receives from —— and ——— veins.
Femoral vein: Receives ——-, —-, ——
Superior epigastric vein: Drains to —— vein
VEINS OF AAW
External iliac vein: Receives from epigastric and deep circumflex iliac veins.
Femoral vein: Receives superficial circumflex iliac vein, Superficial epigastric vein, Superficial external pudendal vein.
Superior epigastric vein: Drains to brachiocephalic vein
CLINICAL CORELLATION
———: peripheral nerve block used to do anaesthetize the nerves in the AAW.
Tap block
CLINICAL CORELLATION
. Tap block means ———block; it is performed by injecting anaesthesia on the fascia between the ———and ——muscles.
Tap block means transverse abdominis plane block; it is performed by injecting anaesthesia on the fascia between the transverse abdominis and internal oblique muscles.
CLINICAL CORELLATION
The ——— space: space between the parietal peritoneum and the transversalis fascia. It can be used for putting a prosthesis when treating an inguinal hernia
———: abnormal protrusion in the abdominal wall, can be umbilical, inguinal, and/or epigastric hernias
CLINICAL CORELLATION
The retroinguinal space: space between the parietal peritoneum and the transversalis fascia. It can be used for putting a prosthesis when treating an inguinal hernia
Hernias: abnormal protrusion in the abdominal wall, can be umbilical, inguinal, and/or epigastric hernias
CLINICAL CORELLATION
Abdominal incisions: incisions depend on the type of surgery T or F.
CLINICAL CORELLATION
Abdominal incisions: incisions depend on the type of surgery
Nerve injury to the AAW: nerves such as the ilioinguinal, iliohypogastric and inferior thoracic nerves are prone to the injury because they are spread across the AAW. Injury to these nerves results in muscle weakness of the AAW
