Anterior Abdominal Wall Flashcards
Boundaries of the abdominal wall
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
How was the abdomen divided?
Four planes and nine regions
Subcostal plane
Line through the most inferior points of the coastal cartilage, 10th coastal cartilage
the line passes through the body of L3 vertebrae
Transtubercular plane
Line passes through the iliac tubercles at the level of the L5 vertebrae
Sagittal plane
Clavicular lines extends inferior from the mid clavicle to the mid inguinal point
Transpyloric plane
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
Transpyloric plane transects…
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
Upper region
R hypochondriac
Epigastric
L hypochondriac
Middle region
R lumbar
Umbilical
L lumbar
Lower region
R inguinal
Hypogastric
L inguinal
Transumbilical plane
Left to right
Makes 4 quadrants with median plane
Median plane
Superior to inferior
Making 4 quadrants with transumbilical plane
Right upper quadrant
Liver
Gallbladder
Right suprarenal gland
Right kidney
Ascending colon superior part
Left upper quadrant
Spleen
Stomach
Pancreas body and tail
Left kidney
Transverse colon left half
Descending colon superior part
Right lower quadrant
Cecum
Vermiform appendix
Right ovary
Right ureter
Most of ileum
Left lower quadrant
Sigmoid colon
Descending colon inferior part
Left ovary
Left ureter
Left spermatic cord
External abdominal oblique
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
Internal abdominal oblique
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
Transversus abdominis
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)
Rectus abdominis
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
Rectus sheath
Dense, fibrous sheath enclosing the rectus abdominous muscle
Formed by fusion of aponeuroses of the abdominal muscles
Rectus sheath Above the level of the umbilicus
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
Rectus sheath Below the level of the umbilicus
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
Innervation of the anterior abdominal wall
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
Landmarks for innervation for the anterior abdominal wall
T10 umbilical region
T7 xiphoid region
L2 pubic region
Superior epigastric
Branch of the internal thoracic artery
Inferior epigastric
A branch of the external iliac artery
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
Posterior intercostal arteries that accompany the intercostal nerves
Also contribute to the arterial supply of the anterior abdominal wall
Additional arterial supply for anterior abdominal wall come from where
Direct branches of the abdominal aorta and lumber arteries
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
Inguinal ligament
Fibrous band, extending from the anterior superior iliac spine to the pubic tubercle
Contents of the inguinal canal
Spermatic cord in males
Round ligament of the uterus in females
Inguinal nerve
Blood and lymphatic vessels
Interspinous plane
Horizontal plane that Passes through the ASIS on each side
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
The Planes create the four quadrants
Transumbilical plane
Median plane
Abdominal facia
Skin
superficial fascia fatty layer campers facia
Superficial fascia membranous layer Scarpas facia
Panniculi
Sagging folds in the abdomen
Apron
Below the umbilicus
The deepest part of the subcutaneous tissue is reinforce by many elastic and collagen fibers
Colles fascia
Continues inferiorly to the peritoneum region as a member, this layer of tissue of the peritoneum
Doesn’t extend into the thighs
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
Arcuate line
Where all three sheaths of abdominal aponeuroses go anterior to rectus abdominis
Posterior rectus sheath above arcuate line
Made up of half of the internal abdominal oblique aponeurosis
and the transversus abdominis aponeurosis
Anterior sheath above arcuate line
Half of the internal abdominal oblique aponeurosis, and all of the external abdominal oblique aponeurosis
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
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
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
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
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
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
