Anterior Abdominal Wall Flashcards
What are the types of organization of the abdomen?
4- quardrants
9-regions
What are the planes in the 4-quadrant organization of the abdomen?
Midline plane
Transumbilical plane - horizontal at the belly button
What are the quadrants in the 4-quadrant organization of the abdomen?
Upper Right
Upper Left
Lower Right
Lower Right
What are the vertical planes in the 9-region organization of the abdomen?
Midclavicular planes - parasagittal
What are the horizontal planes in the 9-region organization of the abdomen?
Subcostal - just below the last rib
Intertubercular - runs between the ilium tubercles
What are the superior regions of the 9-region organization from the abdomen?
Right Hypochondrium
Epigastric
Left Hypochondrium
What are the middle regions of the 9-region organization of the abdomen?
Right Flank
Umbilical
Left Flank
What are the inferior regions of the R-region organization of the abdomen?
Right Groin
Pubic
Left Groin
What are the layers of the anterior abdominal wall (from sup. to deep)
Skin Superficial fascia ) Camper's fascia External Oblique m Internal Oblique m Rectus abdominus m Extraperitoneal fat Peritoneum
What layer of the anterior abdominal wall does the vasculature run through?
Superficial fascia (Camper’s fascia)
What direction do the fibers of the External Oblique muscle run?
The same direction as the fingers when hands are in our pockets
Aponeurosis of external oblique
Medial extension of the External Oblique muscle that connects it to the linea alba
Internal Oblique muscle
Deep to the ext oblique m
Fibers run perpendicular to the external oblique
Also has a medial aponeurotic extension
Rectus abdominus muscle
“6-pack muscles”
Fibers run vertically
Has tendonous intersections perpendicular to the muscle that connect it to the linea alba
Transverse Abdominus muscle
Deep to the rectus abdominus m
Fibers are parallel to the external oblique
Linea alba
A tendonous fiber that runs vertically down the midline of the anterior abdominal wall
Both obliques and rectus muscles have tendons that connect them to the linea alba
What is the Rectus Sheath?
Aponeurotic (tendonous) sheath that envelops the rectus abdominus and pyramidalis muscles
Has anterior and posterior layers
What makes up the Anterior layer of the Rectus Sheath superior to the arcuate line?
Aponeuroses of the external oblique and
Half of the internal oblique aponeurosis
What makes up the Posterior layer of the Rectus Sheath superior to the arcuate line?
Aponeuroses of half of the internal oblique
Transverse abdominus aponeurosis
Transversalis fascia
What makes up the Anterior layer of the Rectus Sheath inferior to the arcuate line?
Aponeurosis of External oblique m
Aponeurosis of Internal oblique m
Aponeurosis of Transverse abdominus m
What makes up the Posterior layer of the Rectus Sheath inferior to the arcuate line?
Transversalis fascia
What are the different Infraumbilical Peritoneal folds?
Median Umbilical Fold (most medial)
Medial Umbilical Folds
Lateral Umbilical Folds
Median Umbilical Fold
At the midline from the urinary bladder to the umbilicus and Urachus
Covers the medial umbilical ligament
Medial Umbilical folds
Lateral to the Median Umbilical Fold (R and L)
Covers medial umbilical ligaments and occluded portions of the umbilical arteries
Lateral Umbilical Folds
Covers the inferior epigastric vessels
What are the superficial vessels of the anterior abdominal wall?
Circumflex Iliac a and v
Epigastric a and v
Circumflex Iliac artery
Branch of femoral artery
Supplies the region of the inguinal ligament
Epigastric artery
Branch of femoral artery
Supplies the abdomen inferior to the umbilicus
Circumflex Iliac vein
Drains to the femoral vein
Drains the region of the inguinal ligament
Epigastric vein
Drains to the femoral vein
Drains the abdomen inferior to the umbilicus
What are the deep vessels of the anterior abdominal wall?
Deep Circumflex Iliac vessels
Inferior Epigastric vessels
Superior Epigastric vessels
Musculophrenic vessels
Deep Circumflex Iliac artery
Branch of External Iliac artery
runs between the Internal Oblique and Transverse Abdominus
Supplies the inferior lateral abdominal muscles
Deep Circumflex Iliac vein
Drains the inferior lateral abdominal muscles
Runs between the internal oblique and transverse abdominus
Drains to the External Iliac vein
Inferior Epigastric artery
Branch of external Iliac artery
Enters the posterior rectus sheath at the arcuate line
Supplies the lower rectus abdominus muscle
Anastomoses with Superior Epigastric artery
Inferior Epigastric vein
Drains the lower rectus abdominus muscle
Drains to External Iliac vein
Superior Epigastric artery
Branch of Internal Thoracic artery
Enters posterior rectus sheath lateral to the sternum
Supplies upper rectus abdominus m
Anastamoses with Inf. Epigastric artery
Superior Epigastric vein
Drains the upper recuts abdominus muscle
Drains to the Internal Thoracic vein
Musculophrenic artery
Branch of Internal Thoracic artery
Runs along costal cartilage
Supplies upper abdominal muscles and diaphragm
Musculophrenic vein
Drains upper abdominal muscles and diapharagm
Drains to Internal Thoracic vein
What nerves cover the anterior abdominal wall?
Ventral rami of T7-L1 spinal levels
What nerves cover the anterior abdominal wall superior to the umbilicus?
T7-T9
What nerve covers the anterior abdominal wall at the umbilicus?
T10
What nerve covers the anterior abdominal wall inferior to the umbilicus?
T11-L1
Where is the Inguinal Region?
Inferior to Lateral abdomen region Superior to thigh Medial to the ilium Lateral to the pubic bone Between the anterior superior iliac spine (ASIS) and pubic tubercle
Contents of the Inguinal Region
Inguinal Ligament
Deep ring of the inguinal canal
Walls of the inguinal canal
Inguinal Ligament
Folded inferior border of external oblique aponeurosis
Goes from ASIS to the the pubic tubercle
Inguinal canal
Obliquely set tunnel 3-5 cm long
Traverses the anterior abdominal wall
Runs parallel and superior to the inguinal ligaement
What’s the difference in the Inguinal Canal between males and females?
Males - contains spermatic cord, its contents, and Ilioinguinal n (L1)
Females - contains the round ligament of the uterus and the Ilioingunial n (L1)
What are the contents of the spermatic cord?
Vas deferens
Testicular nerves and vessels
Cremasteric m
Fascia
Superficial ring of the Inguinal canal
Opening of the external oblique aponeurosis
Obvious opening lateral to the pubic tubercle
Deep ring of the Inguinal canal
Opening of the transverse fascia
Subtle piercing just lateral to the inferior epigastric vessels
Anterior Wall of the Inguinal canal
External Oblique Aponeurosis
Posterior wall of the Inguinal canal
Transversalis fascia and conjouint tendon
Roof of the Inguinal canal
Internal oblique and transverse abdominus muscles
Floor
Inguinal Ligament
Abdominal Hernia
Outpouching of abdominal viscera within a sac
Composed of 3 layers - peritoneum, extraperitoneal fat, and transversalis fascia
About 90% of abdominal hernias occur in the inguinal region
Indirect Inguinal Hernia
Extends through the entire inguinal canal
Commonly enters the scrotum or labia majora
Most common type of hernia and most common in males
Direct Inguinal Hernia
Through inguinal triangle (Hesselbach’s triangle)
Usually does not enter scrotum or labia majora
Usually associated with weakened abdominal wall
Inguinal triangle contents
Inferior epigastric artery
Rectus abdominus muscle
Inguinal ligament
Femoral hernia
Through femoral ring and canal
More common in females because of wider femoral ring
Umbilical hernia
Through umbilical ring
Most common in newborns
In adults, it is most common in females and obese people
Epigastric hernia
Through linea alba
Most common in people over 40
Usually associated with obesity