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Anatomy Exam 2 > Anterior Abdominal Wall > Flashcards

Anterior Abdominal Wall Flashcards

0
Q

What muscles comprise the anterior wall?

A

Superficial: external oblique (EO), (aponeurosis of EO)

Deep: rectus abdominus, internal oblique

Other: transversus abdominus (linea alba)

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1
Q

Describe the 4 quadrant pattern

A

4 quadrants

  1. right upper
  2. left upper
  3. right lower
  4. left lower

left/right separated by median plan

upper/lower separated by transumbilical plane

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2
Q

What are the aponeurotic divisions of the anterior abdominal wall

A

rectus sheath

linea alba

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3
Q

Describe the layers of the anterior abdominal wall

A

from superficial to deep

  1. Skin
  2. Camper’s fascia (superficial fatty layer of subcutaneous tissue)
  3. Scarpa’s fascia (deep membraneous layer of subcutaneous tissue)
  4. External oblique m (surrounded by investing (deep) fasicia)
  5. Internal oblique m (deep fasicia underneath)
  6. Transversus abdominis m
  7. Endo-abdominal (transversalis) fasicia
  8. Extraperitoneal fat
  9. Parietal peritoneum
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4
Q

Describe the rectus sheath

A
  • aponeurotic (tendinous) sheath envelops rectus abdominus and pyramidalis mm
  • consists of anterior and posterior layers
    • anterior layer is in front of rectus abdominis m, posterior is behind rectus abdominis
  • superior and inferior portions are relative to arcuate line
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5
Q

How does the composition of the rectus sheath differ above the arcuate line vs. below the arcuate line?

A

Above the arcuate line: the anterior layer of sheath is formed by aponeuroses of EO and 1/2 of IO. The posterior layer of the sheath is formed by aponeuroses of 1/2 of IO, all of transersus abdominis and transversalis fascia

Remeber the anterior layer is in front of rectus abdominis m while the posterior layer is behind rectus abdominis m.

Below the arcuate line: The anterior layer of the sheath is formed by aponeuroses of EO, IO and transersus abdominis. The posterior layer of the sheath is formed by transversalis fascia

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6
Q

Describe the neurovascular supply of the anterior abdominal wall

A
  • superficial vessels
  • deep circumflex iliac vessels
  • inferior epigastric vessels
  • superior epigastric vessels
  • musculophrenic vessels
  • nerves: ventral rami of T7-L1 spinal nn
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7
Q

Describe the inguinal region

A

inferior lateral abdominal region

  • superior to thigh
  • medial to ilium
  • lateral to pubic bone

area extends between anterior superior iliac spine (ASIS) and pubic tubercle

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8
Q

Describe the gender distinctions for the inguinal canal

A

They contain different contents based on reproductive organs and genitalia

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9
Q

Describe the rings of the inguinal canal

A
  • 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

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10
Q

Describe the difference between an indirect and direct inguinal hernia

A

Indirect inguinal hernias extend thru the _inguinal cana_l while direct inguinal hernias extend thru the inguinal triangle and are associated with weakened abdominal wall. *Indirect *inguinal hernias are lateral to inferior epigastric vessels while direct inguinal hernias are medial to inferior epigastric vessels.

indirect inguinal hernias are the most common type

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11
Q

What are the other common types of abdominal hernias

A
  • Femoral hernia
  • Umbilical hernia
  • Epigastric hernia

Note: most common type in ♀ : indirect inguinal

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12
Q

Describe an abdominal hernia

A
  • 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
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13
Q

Define the arcuate line

A
  • Midway between the umbilicus and pubic symphysis.
  • Structure of the rectus sheath changes relative to it.
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14
Q

Rectus sheath superior to arcuate line

A

Anterior layer: formed by aponeuroses of EO and 1/2 IO

Posterior layer: formed by aponeuroses of 1/2 IO & TA and transversalis fascia

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15
Q

Rectus sheath inferior to arcuate line

A

anterior layer: formed by aponeuroses of EO, IO and TA

posterior layer: formed by transversalis fascia

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16
Q

Describe the 9 quadrant pattern

A
  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

2 midclavicular planes (vertical)

subcostal plane (superior horizontal)

intertubercular plane (inferior horizontal)

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17
Q

Describe the infraumbilical peritoneal folds

A
  • median umbilical fold
  • 2 medial umbilical folds
  • 2 lateral umbilical folds
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18
Q

Median umbilical fold

A
  • from urinary bladder to umbilicus
  • covers median umbilical ligament
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19
Q

Medial umbilical folds

A
  • 2 of them
  • covers medial umbilical ligaments
  • occluded portions umbilical aa
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20
Q

Lateral umbilical folds

A
  • 2 of them
  • covers inferior epigastric vessels
21
Q

Superficial vessels

A
  • superficial circumflex Iliac a.
  • superficial circumflex Iliac v.
  • superficial epigastric a.
  • superficial epigastric v.

Note: run in superficial fat and fascia

22
Q

Superficial circumflex Iliac a.

A
  • branch of femoral a.
  • supplies region of inguinal ligament
23
Q

Superficial circumflex Iliac v.

A
  • drains to femoral v.
  • drains region of inguinal ligament
24
Q

Superficial epigastric a.

A
  • branch of femoral a.
  • supplies abdomen inferior to umbilicus
25
Q

Superficial epigastric v.

A
  • drains to femoral v.
  • drains abdomen inferior to umbilicus
26
Q

Deep Circumflex Iliac a.

A
  • branch of external Iliac a.
  • runs between inferior oblique m and transversus abdominis m.
  • supplies inferior lateral abdominal mm.
27
Q

Deep circumflex Iliac v.

A
  • drains to external iliac v.
  • runs between inferior oblique and tranversus abdominis mm.
  • drains inferior lateral abdominal mm.
28
Q

Inferior epigastric a

A
  • branch of external Iliac
  • enters posterior rectus sheath at arcuate line
  • supplies lower rectus abdominis mm
  • anastomoses with superior epigastric a.
29
Q

Inferior epigastric v.

A
  • drains to external Iliac v
  • enters posterior rectus sheath at arcuate line
  • drains lower rectus abdominis mm
30
Q

Superior epigastric a

A
  • branch of internal thoracic a. (mammary)
  • enters posterior rectus sheath lateral to sternum
  • supplies upper rectus abdominis mm
  • anastomoses with inferior epigastric
31
Q

Superior epigastric v

A
  • drains to internal thoracic v
  • enters posterior rectus sheath lateral to sternum
  • drains upper rectus abdominis muscles
32
Q

Musculophrenic a.

A
  • branch of internal thoracic (mammary)
  • runs along costal cartilages
  • supplies upper abdominal mm and diaphragm
33
Q

Musculophrenic v.

A

drains to internal thoracic v runs along costal cartilages drains upper abdominal mm and diaphragm

34
Q

Nerves of Abdominal Wall

A
  • ventral rami of T7-L1 spinal nn
  • run between IO and TA mm
35
Q

Nerve(s) that supply region above the umbilicus

A
  • T7
  • T8
  • T9
36
Q

Nerve(s) that supply umbilical region

A
  • T10
37
Q

Nerve(s) that supply region below umbilicus

A
  • T11
  • T12
  • L1
38
Q

Injury to what 3 nerves weakens mm in inguinal region, leading to a predisposition to developing direct inguinal hernias?

A
  • T11, T12 and L1
39
Q

Describe the inguinal ligament

A
  • Folded inferior border of the EO aponeurosis
  • Extends from ASIS to pubic tubercle
40
Q

Inguinal canal

A
  • Obliquely set tunnel 3 to 5 cm long
  • Traverses antertior abdominal wall
  • Runs parallel & superior to inguinal ligament
41
Q

Describe the Male Inguinal Canal

A
  • Contains spermatic cord & its contents
    • (vas deferens, testicular nn & vessels, cremasteric m & fascia
  • Ilioinguinal n. (L1)
42
Q

Describe the female Inguinal Canal

A
  • Contains round ligament of uterus
    • corresponds to spermatic cord in males
  • Ilioinguinal n. (L1)
43
Q

Describe the walls of the inguinal canal

A
  • 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)
44
Q

Describe the inguinal triangle

A
  • also known as Hesselbach’s triangle
  • contains
    • inferior epigastric a.
    • rectus abdominus m.
    • inguinal ligament
45
Q

Describe an indirect inguinal hernia

A
  • 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 ♀
46
Q

Describe a direct inguinal hernia

A
  • 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
47
Q

Describe a femoral hernia

A
  • thru femoral ring & canal
  • medial compartment of sheath
  • _more common in ♀_than ♂
    • femoral ring is wider in♀
48
Q

Describe an umbilical hernia

A
  • thru umbilical ring
  • most common in newborns
  • more common in ♀ & obese individuals
49
Q

Describe an epigastric hernia

A
  • thru linea alba
  • most common in over 40
  • usually assoc. with obesity

Anatomy Exam 2 (13 decks)

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