Anterior Abdominal Wall Flashcards

1
Q

Boundaries of the abdominal wall

A

Superior- right, and left costal margins, xiphisternal joint
Inferior- a line on either side, connecting that ASIS to the pubic symphysis
Lateral- vertical lines, ascending from the ASIS on each side
Posterior- lumbar paravertebral musculature

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2
Q

How was the abdomen divided?

A

Four planes and nine regions

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3
Q

Subcostal plane

A

Line through the most inferior points of the coastal cartilage, 10th coastal cartilage
the line passes through the body of L3 vertebrae

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4
Q

Transtubercular plane

A

Line passes through the iliac tubercles at the level of the L5 vertebrae

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5
Q

Sagittal plane

A

Clavicular lines extends inferior from the mid clavicle to the mid inguinal point

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6
Q

Transpyloric plane

A

Addisons plane

Imaginary horizontal plane located halfway between the suprasternal notch of the manubrium and the upper border of the pubic symphysis

Usually cuts through the pylorus of the stomach and the tips of the costal cartilages and the lower border of L5 vertebrae

It lies, roughly a hands breath between the sternum for midway between the zippy sternum and the umbilicus

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7
Q

Transpyloric plane transects…

A

Fundus of the gallbladder
Neck of the pancreas
Origins of the superior mesenteric artery
Hepatic portal vein
Root of a transverse Mesocolon
Duodenal Jejunum Junction
Highlight of the kidneys

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8
Q

Upper region

A

R hypochondriac
Epigastric
L hypochondriac

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9
Q

Middle region

A

R lumbar
Umbilical
L lumbar

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10
Q

Lower region

A

R inguinal
Hypogastric
L inguinal

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11
Q

Transumbilical plane

A

Left to right
Makes 4 quadrants with median plane

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12
Q

Median plane

A

Superior to inferior
Making 4 quadrants with transumbilical plane

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13
Q

Right upper quadrant

A

Liver
Gallbladder
Right suprarenal gland
Right kidney
Ascending colon superior part

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14
Q

Left upper quadrant

A

Spleen
Stomach
Pancreas body and tail
Left kidney
Transverse colon left half
Descending colon superior part

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15
Q

Right lower quadrant

A

Cecum
Vermiform appendix
Right ovary
Right ureter
Most of ileum

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16
Q

Left lower quadrant

A

Sigmoid colon
Descending colon inferior part
Left ovary
Left ureter
Left spermatic cord

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17
Q

External abdominal oblique

A

O- external surface of the 5th to 12th ribs
I- linea alba, pubic crest, iliac crest, pubic symphysis
N-inferior, five thoracic nerves and subcostal nerve T12 and iliohypogastric nerve
A- flex and rotate trunk, laterally rotate the trunk compress abdominal contents

Fibers travel medially and inferiorly

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18
Q

Internal abdominal oblique

A

O- thoracolumbar fascia anterior iliac crest lateral half of inguinal ligament
I- linea alba pubic crest ribs 10 to 12 inferior surface .
N- lower five thoracic nerves, subcostal, iliohypogastric nerve
A- flex and rotate the trunk, laterally rotate the trunk compress abdominal contents

Fibers run medially and superiorly

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19
Q

Transversus abdominis

A

O- thoracolumbar fascia (lateral Raphae), iliac crest, lateral 1/3 of the inguinal ligament, internal surface of the coastal cartilage is seven to 12
I- linea alba pubic crest pubic synthesis
N- lower, five thoracic nerves, subcostal, and Illiohypogastric nerves
A- compress and support abdominal viscera
(Pull on lateral raphae and cinch down or tighten up two layers of thoracolumbar fascia to compress the spinal muscles and provide this hydraulic amplifier effect)

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20
Q

Rectus abdominis

A

O- pubic symphysis pubis crest
I- xiphoid process fifth and seventh costal cartilages
N- lower, five thoracic nerves, subcostal, and Illiohypogastric nerves
A- flexes trunk and tenses anterior abdominal wall

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21
Q

Rectus sheath

A

Dense, fibrous sheath enclosing the rectus abdominous muscle
Formed by fusion of aponeuroses of the abdominal muscles

22
Q

Rectus sheath Above the level of the umbilicus

A

Anteriorly- external abdominal oblique aponeurosis, and half of internal abdominal oblique aponeurosis

Posteriorly - half of internal abdominal oblique I’m gonna roses and aponeurosis of transversus abdominis

The anterior and posterior walls meet and fuse in the anterior median line called the linea alba

23
Q

Rectus sheath Below the level of the umbilicus

A

Anteriorly- aponeuroses of all three muscles now passing anteriorly over the rectus abdominous with no facia from the muscles passing posteriorly

Posteriorly - thin, fascial film remains posteriorly that protects the rectus abdominous from rubbing against the abdominal contents

The point of transition were all three upper neuroses pass entirely, is marked by the arcuate line

24
Q

Innervation of the anterior abdominal wall

A

Ventral primary rami of thoracic spinal nerves of T6 to T11
Ventral primary ramus of T12 subcostal nerve
Illiohypogastric and Ilioinguinal nerves from ventral primary ramus of L1

25
Landmarks for innervation for the anterior abdominal wall
T10 umbilical region T7 xiphoid region L2 pubic region
26
Superior epigastric
Branch of the internal thoracic artery
27
Inferior epigastric
A branch of the external iliac artery
28
Where does the superior epigastric and inferior epigastric enter?
They enter the rectus sheath posterior to the rectus abdominis and anastomoses with the rectus muscle
29
Posterior intercostal arteries that accompany the intercostal nerves
Also contribute to the arterial supply of the anterior abdominal wall
30
Additional arterial supply for anterior abdominal wall come from where
Direct branches of the abdominal aorta and lumber arteries
31
Inguinal canal
Passage from the abdominal cavity through the anterior abdominal wall Formed by folds of the external oblique aponeurosis Superficial and deep inguinal rings
32
Inguinal ligament
Fibrous band, extending from the anterior superior iliac spine to the pubic tubercle
33
Contents of the inguinal canal
Spermatic cord in males Round ligament of the uterus in females Inguinal nerve Blood and lymphatic vessels
34
Interspinous plane
Horizontal plane that Passes through the ASIS on each side
35
Which planes lowers the nine regions inferiorly
Interspinous and Transpyloric plane It can account for the sag of the viscera at the pull of gravity when the patient is standing
36
The Planes create the four quadrants
Transumbilical plane Median plane
37
Abdominal facia
Skin superficial fascia fatty layer campers facia Superficial fascia membranous layer Scarpas facia
38
Panniculi
Sagging folds in the abdomen Apron
39
Below the umbilicus
The deepest part of the subcutaneous tissue is reinforce by many elastic and collagen fibers
40
Colles fascia
Continues inferiorly to the peritoneum region as a member, this layer of tissue of the peritoneum Doesn’t extend into the thighs
41
Superficial to deep abdominal wall
Skin Camper facia Scarpas facia Abdominal muscles (with epimyosin) -external oblique -Internal oblique -Transversus abdominis Endoabdominal transversalis fascia Extraperitoneal fat Parietal peritoneum
42
Arcuate line
Where all three sheaths of abdominal aponeuroses go anterior to rectus abdominis
43
Posterior rectus sheath above arcuate line
Made up of half of the internal abdominal oblique aponeurosis and the transversus abdominis aponeurosis
44
Anterior sheath above arcuate line
Half of the internal abdominal oblique aponeurosis, and all of the external abdominal oblique aponeurosis
45
Superior epigastric artery
Continuation of internal thoracic artery In coronary artery bypass surgery, can be detached from the anterior thoracic wall and connected to the left anterior descending coronary artery (LAD) because if this is blocked, it usually leads to a massive ischemic attack Which leaves the inferior epigastric artery to supply the anterior abdominal wall
46
Thoracoepigastric vein
Helps drain the anterior abdominal wall superficial vein that is not accompanied by an artery Sometimes there are issues with this vein- caput medusae
47
caput medusae
also known as the palm tree sign The appearance of these distended engorged superficial epigastric veins Which seems to be radiating from the umbilicus of the abdomen Common in portal, hypertension Can be caused by the dilation of the paraumbilical veins which carry oxygenated blood to the mother to the fetus in utero and normally close within a week of birth And sometimes these can be re-catalyzed because of portal hypertension caused by liver failure
48
hesselbachs triangle
medial inguinal fossa region in the anterior abdominal wall The boundaries Medial border- lateral margin of the rectus sheath (linear semilunaris) supralateral border- inferior epigastric artery and vein Inferior border - inguinal ligament (pouparts ligament) RIP Contains depression, referred to, as the medial inguinal fossa, through which a direct inguinal hernia can protrude from the abdominal wall
49
Direct hernias
Acquired Results in a weakness in the floor of the inguinal canal it is more likely to develop and men over the age of 40 The floor of the inguinal canal is located just below the deep or internal inguinal ring and a weakness in the floor allows for a piece of small intestine or bowel to loop through and come through the deep end superficial inguinal rings to poke out words
50
indirect hernia
congenital Natural weakness of the internal inguinal ring congenital - closely adhered to the vas deferens aquired- anatomically separate from the vas deferens segments of the intestine prolapsed through the defect in the anterior abdominal wall they cause a separate sequestration of fluid within the tube of the herniated bowel