Anterior Abdominal Wall

Question 1

The anterior abdominal wall forms the —— limit of the abdominal viscera

Answer 1

Anterior

Question 2

On each side,AAW is separated from the posterior abdominal wall by

Answer 2

The midaxilliary line

Question 3

Another name for transpyloric plane is

Answer 3

Addison’s plane

Question 4

———is a point at the junction of medial 2/3rd and lateral 1/3rd of the line extending from the umbilicus to the anterior superior iliac spine (spinoumbilical line). The base of appendix lies deep to this point.

Answer 4

McBurney’s point

Question 5

McBurney’s point is a point at the junction of medial —rd and lateral —rd of the line extending from the —— to the ———. The —— lies deep to this point.

Answer 5

is a point at the junction of medial 2/3rd and lateral 1/3rd of the line extending from the umbilicus to the anterior superior iliac spine (spinoumbilical line). The base of appendix lies deep to this point.

Question 6

Murphy’s Point
It is a point where ——— meets the ———. It corresponds to the tip of the — costal cartilage. The ——lies deep to this point.

Answer 6

Murphy’s Point
It is a point where linea semilunaris meets the right subcostal margin. It corresponds to the tip of the 9th costal cartilage. The fundus of gall bladder lies deep to this point.

Question 7

———It is a point where linea semilunaris meets the right subcostal margin. It corresponds to the tip of the 9th costal cartilage. The fundus of gall bladder lies deep to this point.

Answer 7

Murphy’s Point

Question 8

Transpyloric plane passed through the tip of — costal cartilage and the lower border of the body of L— vertebrae

Answer 8

9th
L1

Question 9

Subcostal Plane
It is an imaginary horizontal plane, which passes immediately below the costal margins. It passes anteriorly through the lowest borders of costal cartilages of the — rib, and posteriorly through the body of L—vertebra.

Answer 9

10th
L3

Question 10

Transumbilical Plane
It is a transverse plane that passes through the umbilicus (or navel) and lies at the level of intervertebral disc between the
L—and L— vertebrae.

Answer 10

L3 and L4

Question 11

Intertubercular Plane
It is an imaginary horizontal plane which joins the tubercles of the iliac crests. It is palpable — cm posterior to the ——— and passes through the upper part of the body of L— vertebra.

Answer 11

5 cm
ASIS
L5

Question 12

Right and Left Vertical Planes (also called ——— Planes)
They pass from the midpoint of the —— superiorly to the point midway between the —— and the ——, i.e., —— point.

Answer 12

Right and Left Vertical Planes (also called Midclavicular Planes)
They pass from the midpoint of the clavicle superiorly to the point midway between the anterior superior iliac spine and the pubic symphysis inferiorly, i.e., midinguinal point.

Question 13

LAYERS OF THE ANTERIOR ABDOMINAL WALL
The anterior abdominal wall is firm and elastic. It consists of eight layers. From superficial to deep, these are:.

Answer 13

LAYERS OF THE ANTERIOR ABDOMINAL WALL
The anterior abdominal wall is firm and elastic. It consists of eight layers. From superficial to deep, these are:
1. Skin.
2. Superficial fascia.
3. External oblique muscle.
4. Internal oblique muscle.
5. Transversus abdominis muscle.
6. Fascia transversalis.
7. Extraperitoneal tissue.
8. Parietal layer of peritoneum.

Question 14

Is deep fascia present in the anterior abdominal wall

Answer 14

The deep fascia is absent in the anterior abdominal wall to allow the bulging/distension of the abdominal wall as after taking meals, during pregnancy, etc. It is also absent in the penis, scrotum, and perineum.

Question 15

———: It is a semilunar line with concavity facing upward, seen mostly in females on the anterior abdominal wall between the umbilicus and pubic symphysis.
In the multiparous women, the lower part of the anterior abdominal wall presents a number of irregularly branched white lines
called ——.

Answer 15

Line of Venus: It is a semilunar line with concavity facing upward, seen mostly in females on the anterior abdominal wall between the umbilicus and pubic symphysis.
Linea gravidarum: In the multiparous women, the lower part of the anterior abdominal wall presents a number of irregularly branched white lines
called striae
gravidarum.

Question 16

The cleavage lines (called —— lines) in the anterior abdominal all run horizontally.

Answer 16

cleavage lines (Langer’s lines) in the anterior abdominal all run horizontally.

Question 17

Position of umbilicus, in adult, it lies at the level of intervertebral disc between — and — vertebrae.

Answer 17

adult, it lies at the level of intervertebral disc between L3 and L4 vertebrae.

Question 18

skin around the umbilicus is supplied by the —- spinal segment.

Answer 18

10th

Question 19

BORDERS
􏰀 Superior: Costal cartilages— to —.
▪ Xiphoid process: Level of — cartilage =L—
􏰀 Inferior: —///
􏰀 Umbilicus: Level of IV disc L— to L—
(

Answer 19

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
(

Question 20

BORDERS
􏰀 Superior: Costal cartilages 7-12.
􏰀 Inferior: Pubic bone and iliac crest: Level of L—
(

Answer 20

L4

Question 21

ABDOMINAL QUADRANTS
􏰀 Formed by two
• intersecting lines: Intersect at ——-.
Quadrants include:

Answer 21

ABDOMINAL QUADRANTS
􏰀 Formed by two • intersecting lines: Intersect at umbilicus.
Quadrants: Upper left, Upper right, Lower left, Lower right.

Question 22

Lines of the Anterior Abdominal Wall
●———:
Located along the midline.
●———:
Along each lateral border of rectus abdominis.
●———:
Tendinous bands of rectus abdominis.

Answer 22

Lines of the Anterior Abdominal Wall
●Linea alba:
Located along the midline.
= connective tissue raphe.
●Linea semilunaris:
Along each lateral border of rectus abdominis.
●Linea transversa:
Tendinous bands of rectus abdominis.

Question 23

Lines of the Anterior Abdominal Wall
●Linea alba:
Located along the ———.
= connective tissue raphe.
●Linea semilunaris:
Along each —— border of rectus abdominis.
●Linea transversa:
Tendinous bands of ——-

Answer 23

Lines of the Anterior Abdominal Wall
●Linea alba:
Located along the midline.
= connective tissue raphe.
●Linea semilunaris:
Along each lateral border of rectus abdominis.
●Linea transversa:
Tendinous bands of rectus abdominis.

Question 24

ABDOMINAL REGIONS
􏰀 Divided into 9 regions by two pairs of planes:
▪ Vertical Planes: —————
▪ Horizontal Planes:
1.—— plane: Midway between ——- and —— (between —— and ——).
2.—— plane: Through ——-

Answer 24

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.

Question 25

ABDOMINAL REGIONS CONT’D
􏰀 Right and left hypochondriac: Contain ——-
􏰀 Epigastric: Contains——-
􏰀 Right and left lateral (lumbar): Right contains———, Left contains ——-
Umbilical: Contains ———
􏰀 Right and left inguinal: Right contains ———, Left contains ——-/.
􏰀 Hypogastric: Contains ———-

Answer 25

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.

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.

Question 26

STRUCTURE OF AAW
􏰀 The anterior abdominal wall consists of four main layers:.

Answer 26

STRUCTURE OF AAW
􏰀 The anterior abdominal wall consists of four main layers: Skin, superficial fascia, muscles and associated fascia,
parietal peritoneum.

Question 27

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 ———

Answer 27

Langer’s line

Question 28

SUPERFICIAL FASCIA
􏰀 A connective tissue and its composition depends on location:
▪ Above the umbilicus: ———

▪ Below the umbilicus: ———

Answer 28

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.

▪ Below the umbilicus: divided into two layers; the fatty superficial layer (camper’s fascia) and membranous deep layer (scarpa’s fascia)

Question 29

SUPERFICIAL FASCIA
􏰀 Runs inferiorly into lower limbs where it changes name to the ——— and also continuous with superficial perineal fascia called —— and also with the fascia which invests the scrotum and penis in males called——
􏰀 The ——— and ——run between these two layers of fascia

Answer 29

UPERFICIAL 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 dartos fascia
􏰀 The superficial vessels and nerves run between these two layers of fascia

Question 30

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 ——

Answer 30

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

Question 31

EXTERNAL OBLIQUE MUSCLE
􏰀 Largest and most superficial.
􏰀 Its fibres run in what direction?.
􏰀 Originates from——, and inserts into the ———
􏰀 function:
􏰀 Innervation: ———

Answer 31

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).

Question 32

INTERNAL OBLIQUE MUSCLE
􏰀 Lies deep to the —— muscle
􏰀 Smaller and thinner in structure
􏰀 Its fibres run in what direction
􏰀 Originates from the ———, and inserts into——
􏰀 Innervation: ———

Answer 32

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.

Question 33

TRANSVERSUS ABDOMINIS
􏰀 Deep to it is a well-formed layer of fascia known as ——fascia.
􏰀 Originates from the ————
􏰀 Inserts into the ———
􏰀 function:——
􏰀 Innervation: ———

Answer 33

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.

􏰀 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.

Question 34

RECTUS ABDOMINIS
􏰀 Long, paired muscle found either side of the —— 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 ———.
􏰀 function:.
􏰀 Innervation: ——/

Answer 34

RECTUS ABDOMINIS
􏰀 Long, paired muscle found either side of the midline in the abdominal wall
􏰀 Split into two by linea alba
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.

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 (T7-T11).

Question 35

PYRAMIDALIS
􏰀 Small —— shaped muscle superficial to who muscle?
􏰀 Located inferiorly with its base on the ——and apex of the triangle attached to the ——-
􏰀 Originates from the ——— before inserting into the——.
􏰀 function:
􏰀 Innervation:——

Answer 35

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)

Question 36

RECTUS SHEATH
􏰀 Strong, (incomplete/complete ?) fibrous compartment of the —— and ——muscles.
􏰀 Formed by ———
􏰀 Has an anterior and posterior wall for most of its ——-
▪ Anterior wall: formed by ———
▪ Posterior wall: formed by———

Answer 36

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

Question 37

RECTUS SHEATH CONT’D
􏰀 Also found in the rectus sheath are;
————.

Answer 37

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).
(Rich

Question 38

FUNCTIONS OF THE RECTUS SHEATH

Answer 38

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.

Question 39

ARTERIES OF AAW
􏰀 Superior epigastric:
▪ Terminal branch of———.
▪ Descends in posterior to——muscle.
▪ Anastomoses with ——-.
􏰀 Inferior epigastric:
▪ Arises from ____ artery.
▪ Enters rectus sheath at ———.
▪ Branches: ——-———

Answer 39

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

Question 40

ARTERIES OF AAW CONT’D
􏰀 Deep circumflex iliac artery: Branch of ———.
􏰀 Superficial epigastric artery: Arises from ——.
􏰀 Superficial circumflex iliac artery: Arises from ——.
􏰀 Superficial external pudendal artery: Arises from ——-

Answer 40

ARTERIES OF AAW CONT’D
􏰀 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.

Question 41

List the 6 arteries of th AAW

Answer 41

Superior epigastric
Inferior epigastric
Deep circumflex iliac
Superficial epigastric
Superficial circumflex iliac
Superficial external pudendal

Question 42

VEINS OF AAW
􏰀 ——— vein: Receives from epigastric and deep circumflex iliac veins.
􏰀 —— vein: Receives superficial circumflex iliac vein, Superficial epigastric vein, Superficial external pudendal vein.
Superior epigastric vein: Drains to —— vein

Answer 42

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

Question 43

VEINS OF AAW
􏰀 External iliac vein: Receives from —— veins.
􏰀 Femoral vein: Receives ——-veins.
——— vein: Drains to brachiocephalic vein

Answer 43

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

Question 44

CLINICAL CORELLATION
􏰀 Tap block: peripheral nerve block used to do anaesthetize the nerves in the AAW. Tap block means ——— block; it is performed by injecting anaesthesia on the fascia between the ——— and ——— muscles.

Answer 44

CLINICAL CORELLATION
􏰀 Tap block: peripheral nerve block used to do anaesthetize the nerves in the AAW. Tap block means transverse abdominis plane block; it is performed by injecting anaesthesia on the fascia between the transverse abdominis and internal oblique muscles.

Question 45

􏰀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

Answer 45

􏰀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
K

Question 46

􏰀The retroinguinal space: space between the ——— and the ———. It can be used for putting a prosthesis when treating an ———

Answer 46

􏰀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

Question 47

CLINICAL CORELLATION
􏰀 Nerve injury to the AAW: nerves such as the ———, ——— and ———nerves are prone to the injury because they are spread across the AAW. Injury to these nerves results in muscle weakness of the AAW

Answer 47

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

Question 48

Cutaneous Nerves
●Derived from ventral rami of — through —.
●Pass inferiorly and medially in plane between —— and —— muscles.
●Motor innervation:
To ——.
●Cutaneous innervation:
——— branches.
——— branches:
Penetrate ——

Answer 48

Cutaneous Nerves
●Derived from ventral rami of T7 through L1.
●Pass inferiorly and medially in plane between transverse and internal oblique muscles.
●Motor innervation:
To abdominal muscles.
●Cutaneous innervation:
Lateral cutaneous branches.
Anterior cutaneous branches:
Penetrate rectus sheath.

Question 49

Cutaneous Nerves
●Ventral rami of — through —:
= called——- nerves.
T— to dermatome over xiphoid process.
T— at level of umbilicus.
●Subcostal nerve
●Ventral ramus of L1:
Gives rise to:
——— nerve.
——— nerve.

Answer 49

Cutaneous Nerves
●Ventral rami of T7 through T11:
= thoracoabdominal nerves.
T7 to dermatome over xiphoid process.
T10 at level of umbilicus.
●Subcostal nerve
●Ventral ramus of L1:
Gives rise to:
iliohypogastric nerve.
ilioinguinal nerve.

Question 50

Venous Drainage
●Superficial veins are paired with arteries.
●Above the umbilicus:
Drain into the —— venous system or —— vein and eventually into ——
●Below the umbilicus:
Drain into the —— system (via ——)

Answer 50

Venous Drainage
●Superficial veins are paired with arteries.
●Above the umbilicus:
Drain into the azygos venous system or axillary vein and eventually into SVC
●Below the umbilicus:
Drain into the femoral system (via great saphenous).

Question 51

Lymphatic Drainage
●Above the umbilicus:
Drain into the —— and —— nodes.
●Below the umbilicus:
Drain into the ———nodes.

Answer 51

Lymphatic Drainage
●Above the umbilicus:
Drain into the axillary and sternal nodes.
●Below the umbilicus:
Drain into the superficial inguinal nodes.