Anterior Abdominal Wall 2 Flashcards
Where is thoracic cavity?
Deep to rib cage, above diaphragm
Where is the abdominal cavity?
From diaphragm to pelvic inlet
Where is the pelvic cavity ?
Under/dep to pelvic inlet
L to R, Top to Bottom, what are the 9 areas of the Abdomen?
1) Right hypochondrium
2) epigastric region
3) Left hypochondrium
4) Right flank
5) Umbilical region
6) Left flank
7) Right groin
8) Pubic region
9) Left groin
What are the layers of the abdominal wall?
Skin, Superficial (camper’s) fascia - fatty layer, Superficial (scarpa’s) fascia - membranous layer, muscular layer, transversalis fascia, extraperitonial fascia, parietal peritoneum
What are the Superficial Muscles of the Abdominal Wall?
External oblique (has an aponeurosis)
What are the Deep Muscles of the Abdominal Wall?
Rectus abdominis muscle, internal oblique
Other muscle?
Transversus abdominis muscles
True or false, all 3 muscles have midline aponeurosis running into line alba.
True
What is the rectus sheath?
An Aponeurotic (tendinous) sheath that Envelops rectus abdominus & pyramidalis mm. It Consists of anterior & posterior layers.
*Structure of the sheath is relative to the arcuate line. (midway between umbilicus & pubic symphysis)
What is layering organization Superior to Arcuate line?
Anterior layer – formed by aponeuroses of EO & ½ IO
Posterior layer – formed by aponeuroses of ½ IO & TA, & transversalis fascia
What is layering organization Posterior to Arcuate line?
Anterior layer – formed by aponeuroses of EO, IO, TA
Posterior layer – formed by transversalis fascia
What are the Infraumbilical peritoneal folds?
median umbilical fold
medial umbilical folds (2)
lateral umbilical folds (2)
Where is the median umbilical fold?
from urinary bladder to umbilicus
covers median umbilical ligament
Where are the medial umbilical folds?
covers medial umbilical ligaments
occuded portions of umbilical aa.
Where are the lateral umbilical folds?
covers inferior epigastric vessels
What are the superficial vessels?
Circumflex Iliac a.
br. of femoral a.
supplies region of inguinal ligament
Epigastric a.
br. of femoral a.
supplies abdomen infr. to umbilicus.
Circumflex Iliac v.
drains to femoral v.
drains region of inguinal ligament
Epigastric v.
drains to femoral v.
drains abdomen infr. to umbilicus.
*All vessels run in superficial fat & fascia
What are the Deep Circumflex Iliac vessels?
Br. of External Iliac
Runs between IO & TA
Supplies inferior lateral abdominal mm.
*All veins are similarly placed and drain to Ext. Iliac v.
What are the Inferior Epigastric vessels?
Br. of External Iliac
Enters posterior rectus sheath at arcuate line
Supplies lower rectus abdominus mm.
anastomoses with Sup. Epigastric
*All veins are similarly placed and drain to Ext. Iliac v.
What are the Superior Epigastric vessels?
Br. of Internal Thoracic (Mammary)
Enters posterior rectus sheath lat. to sternum
Supplies upper rectus abdominus mm.
Anastomoses with Inf. Epigastric
*All veins are similarly placed and drain to internal thoracic v.
What are the Musculophrenic vessels?
Br. of Internal Thoracic (Mammary)
Runs along costal cartilages
Supplies upper abdominal mm. & diaphragm
*All veins are similarly placed and drain to internal thoracic v.
What are the nerves of the abdominal wall?
- Ventral rami of T7-L1 spinal nn.
- T7, T8 & T9 – supply region above umbilicus
- T10 – supplies umbilical region
- T11, T12 & L1 – supply region below umbilicus
- Run between IO and TA mm.
- Injury to last 3 nn. weakens mm in inguinal region
- Predisposes to developing direct inguinal hernias
Where is the inguinal region?
-Inferior lateral abdominal region
- superior to thigh
- medial to ilium
- lateral to pubic bone
- {Area extends between the anterior superior iliac spine (ASIS) and the pubic tubercle.}
- Inguinal ligament, canal (male & female), superficial and deep rings of the inguinal canal, walls of the canal
What is the inguinal ligament?
- Folded inferior border of the EO aponeurosis
- Extends from ASIS to pubic tubercle
What is the inguinal canal?
- Obliquely set tunnel 3 to 5 cm long
- Traverses ant. abdominal wall
- Runs parallel & superior to inguinal ligament
What is in the male inguinal canal?
- Contains spermatic cord & its contents
- (vas deferens, testicular nn & vessels, cremasteric m & fascia) & Ilioinguinal n. (L1)
What is in the female inguinal canal?
- Contains round ligament of uterus (corresponds to spermatic cord in males)
- Ilioinguinal n. (L1)
What are the Inguinal Canal Rings?
Superficial Ring = opening in EO aponeurosis
obvious triangular opening lateral to pubic tubercle
Deep Ring = opening in transversalis fascia
subtle piercing just lateral to inferior epigastric vessels
NOTE: Canal extends between superficial and deep rings
What are the walls of the inguinal canal?
Anterior wall = EO aponeurosis
Posterior wall = transversalis fascia & conjoint tendon
fusion of IO, TA aponeuroses medially
Roof = IO & TA muscles (superior)
Floor = inguinal ligament (inferior)
What is the conjoint tendon of the Inguinal Canal Wall?
Anterior = EO apon. Posterior = transversalis fascia & conjoint tendon fusion of IO, TA aponeuroses medially Roof = IO & TA muscles Floor = inguinal ligament
What is an Abdominal Hernia?
Outpouching of abdominal viscera within a sac
Hernial sac composed of 3 layers
peritoneum, extraperitoneal fat & transversalis fascia
~90% of hernias occur in inguinal region
What is an Indirect Inguinal Hernia?
-extends thru entire inguinal canal
-lateral to inferior epigastric vessels
-commonly enters scrotum or labia majora
-most common type of hernia (more in ♂ than ♀)
-usually from persistent processus vaginalis in ♂
(connects peritoneum with descended testis)
-referred to as canal of Nuck in ♀
What is a Direct Inguinal Hernia?
-thru inguinal triangle (Hesselbach’s)
inferior epigastric a., rectus abdominus m. & inguinal ligament
-emerges thru conjoint tendon by or at superficial ring
-medial to inferior epigastric vessels
-usually does not enter scrotum or labia majora
-more common in ♂ than ♀
-usually associated with weakened abdominal wall
Femoral hernia
- thru femoral ring & canal
- = medial compartment of sheath
- more common in ♀than ♂ (femoral ring is wider in♀)
- Note: most common type in ♀ = indirect inguinal
Umbilical hernia
- thru umbilical ring
- most common in newborns
- more common in ♀ & obese individuals
Epigastric hernia
- thru linea alba
- most common in over 40
- usually assoc. with obesity
