Anterior Abdominal Wall Flashcards
Innervation
Ventral Rami T5-L1, Thoracoabdominal nerves (T7-T11), Lateral (Thoracic) cutaneous branches ( T7-T9 or T10), Subcostal nerve T12, Iliohypogastric (sup) and Ilioinguinal (inferior)
Blood Supply
Superior epigastric Inferior epigastric Deep circumflex iliac Musculophrenic Post. intercostal Subcostal Lumbar
Branch of internal thoracic/ mammary artery and supplies superior part of rectus abdominis
Superior epigastric
Arises from the external iliac artery and supplies inferior part of rectus abdominis
Inferior epigastric
Venous drainage is via
accompanying veins
Where does the superficial epigastric vein and lateral thoracic vein anastomoses?
Thoraco-epigastric vein
Superficial and deep anastomoses are important for
collateral circulation
What veins end in the greater saphenous vein of the lower limb?
Three superficial inguinal vens
Lymphatic system
Superior:
above umbilicus: axillary or cervical nodes
below umbilicus: superficial inguinal nodes
Deep:
drain to external iliac nodes, common iliac nodes, lumbar (para-aortic) nodes..reaches the cisterna chylii and thoracic duct
Area of inherent weakness
inguinal area
common site of herniation
inguinal area
Inguinal trigone and its borders
Hesselbach’s Triangle
Superior: inferior epigastric artery
Medial: lateral border of rectus abdominis
Inferior: inguinal ligament
Usually opened when performing operations involving hernias
inguinal canal
Borders of inguinal canal
Anterior: external oblique aponeurosis
Posterior: transversalis fascia
Roof: internal oblique and transversus abdominis
Floor: inguinal ligament
Contents of inguinal canal
spermatic cord (part of which is vas deferens)
round lig of uterus
ilioinguinal nerve from L1 ventral ramus
Congenital Hernia
Indirect Hernia
due to presence of serous processus vaginalis
laterla to internal epigastric
CIL
Acquired Hernia
Direct Hernia
due chronic cough and prostatic problems and to weaking of the muscles of the inguinal canal
Medial to internal epigatric
DAM
Remnant of the urachus (what is urachus)
Median umbilical fold
Urachus is the communication between the urinary bladder and the amniotic sac
Remnant of the umbilical artery
Medial umbilical fold
UA is the path of poorly O2 blood from fetus to placenta
Remnant of the umbilical vein
Falciform ligament, covers the ligamentum teres hepatis
assists the anterior abdominal muscles in raising intraabdominal pressure
diaphragm
Innervations of the Diaphragm
Anterior rami of C345, sensory and motor
Diaphragmatic apertures
I8 10eggs At12
Migration of structures outside their normal anatomical location
hernia
T/F peritoneal cavity/ abdominal cavity contains no organs but thin film of peritoneal cavity
True
Sensitive to pressure, pain, heat and cold, and laceration. Pain is well localized
Parietal peritoneum
Insensitive to pressure, pain, heat and cold, and laceration
Visceral peritoneum
Visceral organs almost completely covered by the visceral peritonuem
Intraperitoneal Organs:
stomach, first part of the duodenum, jejunum, ileum, transverse colon, sigmoid colon, superior rectrum, liver, gallbladder and spleen
Organs exterior to the peritoneal cavity and posterior to the peritonuem
Retroperitoneal organs:
kidneys, ureters, aorta, inferior vena cava, GIT (posterior): part of duodenum part of pancreas
connects visceral organs to the body wall
mesentery
Provides mobility to organs attached
mesentery
Greater omentum hangs from
Greater curvature of the stomach and proximal parts of the duodenum
Parts of the greater omentum
Gastrophrenic
Gastrosplenic
Gastrocolic
Lesser omentum connects
the lesser curavature and proximal part of the duodenum to the liver
Parts of the lesser omentum
Hepatogastric/gastrohepatic
Hepatoduodenal
Greater Sac is made up of
Transverse mesocolon
Supracolic compartments
upper GIT, above transverse mesocolon: stomach, duodenum, pancreas, liver and spleen
Spaces in the peritoneal cavity
subphrenic recess
subhepatic- hepatorenal recess/morrison’s pouch
Area more commonly looked for by radiologists when conducting ultrasounds or CT scans for abscess or fluid accumulation
Hepatorenal recess of Morrison’s pouch
Hepatorenal recess of Morrison’s pouch located where
bounded by right lobe of the liver, inferiorly by right kidney and duodenum
Infracolic compartments
Lower GIT, below transverse mesocolon
jejunum, ileum, large intestine, sigmoid colon and rectum
Important spaces in the infracolic compartment
Rectouterine pouch or pouch of Douglas - between uterus and rectum
REctovesical pouch - between bladder and rectum
Lesser Sac
omental bursa
Spaces of the lesser sac
superior and inferior recess
Communication between greater and lesser sac
Forman of Winslow (Omental foramen)
Boundaries of foramen of winslow
anterior: portal triad
posterior: IVC
superior: caudate lobe of the liver
inferior: superior part of the duodenum
Surgical maneuver in which the hepatoduodenal ligament is clamped and is only a temporary procedure
Pringle’s maneuver
