Anterior Abdominal Wall Flashcards
The anterior abdominal wall forms the —— limit of the abdominal viscera
Anterior
On each side,AAW is separated from the posterior abdominal wall by
The midaxilliary line
Another name for transpyloric plane is
Addison’s plane
———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.
McBurney’s point
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.
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.
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.
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.
———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.
Murphy’s Point
Transpyloric plane passed through the tip of — costal cartilage and the lower border of the body of L— vertebrae
9th
L1
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.
10th
L3
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.
L3 and L4
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.
5 cm
ASIS
L5
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.
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.
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:.
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.
Is deep fascia present in the anterior abdominal wall
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.
———: 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 ——.
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.
The cleavage lines (called —— lines) in the anterior abdominal all run horizontally.
cleavage lines (Langer’s lines) in the anterior abdominal all run horizontally.
Position of umbilicus, in adult, it lies at the level of intervertebral disc between — and — vertebrae.
adult, it lies at the level of intervertebral disc between L3 and L4 vertebrae.
skin around the umbilicus is supplied by the —- spinal segment.
10th
BORDERS
Superior: Costal cartilages— to —.
▪ Xiphoid process: Level of — cartilage =L—
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 7-12.
Inferior: Pubic bone and iliac crest: Level of L—
(
L4
ABDOMINAL QUADRANTS
Formed by two
• intersecting lines: Intersect at ——-.
Quadrants include:
ABDOMINAL QUADRANTS
Formed by two • intersecting lines: Intersect at umbilicus.
Quadrants: Upper left, Upper right, Lower left, Lower right.
Lines of the Anterior Abdominal Wall
●———:
Located along the midline.
●———:
Along each lateral border of rectus abdominis.
●———:
Tendinous bands of rectus abdominis.
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.
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 ——-
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.
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 ——-
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): Right contains———, Left contains ——-
Umbilical: Contains ———
Right and left inguinal: Right contains ———, Left contains ——-/.
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.
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.
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 ———
Langer’s line
SUPERFICIAL FASCIA
A connective tissue and its composition depends on location:
▪ Above the umbilicus: ———
▪ Below the umbilicus: ———
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)
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
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
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
Largest and most superficial.
Its fibres run in what direction?.
Originates from——, and inserts into the ———
function:
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).
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: ———
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 ——fascia.
Originates from the ————
Inserts into the ———
function:——
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.
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 —— 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: ——/
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).
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:——
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
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———
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).
(Rich
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
Superior epigastric:
▪ Terminal branch of———.
▪ Descends in posterior to——muscle.
▪ Anastomoses with ——-.
Inferior epigastric:
▪ Arises from ____ artery.
▪ Enters rectus sheath at ———.
▪ Branches: ——-———
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
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 ——-
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.
List the 6 arteries of th AAW
Superior epigastric
Inferior epigastric
Deep circumflex iliac
Superficial epigastric
Superficial circumflex iliac
Superficial external pudendal
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
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
VEINS OF AAW
External iliac vein: Receives from —— veins.
Femoral vein: Receives ——-veins.
——— vein: Drains to brachiocephalic 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
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.
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.
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
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
The retroinguinal space: space between the ——— and the ———. It can be used for putting a prosthesis when treating an ———
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
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
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
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 ——
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.
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.
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.
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 ——)
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).
Lymphatic Drainage
●Above the umbilicus:
Drain into the —— and —— nodes.
●Below the umbilicus:
Drain into the ———nodes.
Lymphatic Drainage
●Above the umbilicus:
Drain into the axillary and sternal nodes.
●Below the umbilicus:
Drain into the superficial inguinal nodes.
