Anterior Abdominal Wall Flashcards
Where does the abdominal cavity span from?
Just under the diaphragm superiorly to the pelvic inlet inferiorly
What are the nine regions of the abdominal cavity?
R and L Hypochondrium, R and L Flank, R and L Groin, Epigastric, Umbilical, and Pubic
What is the chondrium?
The cartilage inferior to the thorax
What are the nine layers of the anterolateral wall of the abdomen?
Skin, Camper’s fascia, Scarpa’s fascia, external oblique muscle, internal oblique muscle, transversus abdominis muscle, transversalis fascia, extraperitoneal fat, parietal peritoneum
What is Camper’s fascia also called?
Superficial fascia
What is Scarpa’s fascia also called?
Deep fascia
What are six pack abs muscles called?
Rectus abdominis muscle
What is the linea alba?
This is the medial most part of the abdominal wall
What direction do the external oblique and aponeurosis of the external oblique fibers run?
lateral superiorly to medial inferiorly, or at a rough 45 degree angle
What direction do the internal oblique and aponeurosis of the internal oblique fibers run?
Mostly medially
The rectus abdominis muscle has breaks in it that create the six pack abs, what are the breaks called?
Intramuscular attachments or tendenous intersections
These are the three muscles of the anterior abdominal wall that have aponeurosis that insert into the linea alba…
External oblique, internal oblique, and transversus abdominis
Medially the rectus abdominis muscle is surrounded by three layers of aponeurosis called what?
Rectus sheath
What direction does the rectus abdominis muscle run?
Completely horizontal
What two muscles are in the rectus sheath?
Rectus abdominis and pyramidalis muscles
What is the arcuate line?
A line that is midway between the umbilicus and pubic symphysis
Superior to the arcuate line the anterior layer of the rectus sheath is formed by what?
Aponeurosis of EO and 1/2 of IO
Superior to the arcuate line the posterior layer of the rectus sheath is formed by what?
Aponeurosis of 1/2 IO and TA, and transversalis fascia
Inferior to the arcuate line the anterior layer of the rectus sheath is formed by what?
Aponeurosis of EO, IO, and TA
Inferior to the arcuate line the posterior layer of the rectus sheath is formed by what?
Transversalis fascia
What are the five infraumbilical peritoneal folds?
Median umbilical fold, 2 medial umbilical folds, and 2 lateral umbilical folds
Where does the one median umbilical fold run from?
Urinary bladder to umbilicus
What does the one median umbilical fold cover?
Median umbilical ligament
What do the two medial umbilical folds cover?
Medial umbilical ligaments, and occluded portions of the umbilical arteries
What do the lateral umbilical folds cover?
Inferior epigastric vessels
What are the two superficial vessels of the anterior abdominal wall?
Circumflex iliac a. and v. and the epigastric a. and v.
What does the circumflex iliac vein drain?
Drains region of inguinal ligament to the femoral v.
What does the epigastric v. drain?
Drains abdomen inferior to umbilicus and that drains to the femoral v.
The circumflex iliac and epigastric aa. and vv. are in what tissues?
Superficial fat and fascia
The circumflex iliac a. originates from what and supplies what?
Branch of femoral a. and supplies region of inguinal ligament
The epigastric a. originates from what and supplies what?
Branch of femoral a. and supplies abdomen inferior to umbilicus
The deep circumflex iliac vessels are branch of what?
External iliac vessels
The deep circumflex iliac vessels run between what?
IO and TA
What do the deep circumflex iliac vessels supply?
Inferior lateral abdominal mm.
The inferior epigastric vessels are a branch of what?
External iliac vessels
Where do the inferior epigastric vessels enter the posterior rectus sheath?
At the arcuate line
What do the inferior epigastric vessels supply?
Lower rectus abdominus mm.
The inferior epigastric vessels anastomose with what?
Superior epigastric
Superior epigastric vessels are a branch of what?
Branch of internal thoracic (mammary)
The superior epigastric vessels enter the rectus sheath where?
Lateral to the sternum
What do the superior epigastric vessels supply?
Upper rectus abdominus mm.
The superior epigastric vessels anastomose with what?
Inferior epigastric vessels
Any time the word “phrenic” is used what should you think of?
Diaphragm
The musculophrenic vessels are a branch of what?
Internal thoracic (mammary)
The musculophrenic vessels run along what?
Costal cartilages
The musculophrenic vessels supply what?
Upper abdominal mm. and diaphragm
What generally innervates the anterior wall of the abdomen?
Ventral rami of T7-L1
T7, T8, and T9 innervate what?
Supply region above umbilicus
T10 innervates what?
Umbilical region
T11, T12, and L1 innervate what?
Supply region below umbilicus
Injury to T11, T12, and L1 nerves cause what?
Weakens the muscles in the inguinal region
Rami comes from what?
Spinal nerves
Where is the inguinal region?
Inferior lateral abdominal region, superior to thigh, medial to ilium, and lateral to pubic bone
What are the four major things in the inguinal region?
Inguinal ligament, canal (male and female), superficial and deep rings of the inguinal canal, walls of the canal
The inguinal ligament extends between what two structures?
Extends from ASIS to pubic tubercle
What is the inguinal ligament made up of?
Folded inferior border of the EO aponeurosis
How long is the inguinal canal?
3 to 5 cm
What does the inguinal canal run along?
Runs parallel and superior to inguinal ligament
What does the inguinal canal transverse?
Anterior abdominal wall
What runs through a male inguinal canal?
Contains spermatic cord (vas defrens, testicular nn. and vessels, cremasteric muscle and fascia) and ilioinguinal n. (L1)
What is contained in a female inguinal canal?
Round ligament of the uterus (corresponds to spermatic cord in male) and ilioinguinal n. (L1)
What and where is the superficial ring of the inguinal canal?
An opening in EO aponeurosis. Obvious triangular opening lateral to pubic tubercle
What and where is the inferior ring of the inguinal canal?
Opening in transversalis fascia. Subtle piercing just lateral to inferior epigastric vessels
Which ring is more cranially located?
The deep ring
What makes up the anterior wall of the inguinal canal?
EO aponeurosis
What makes up the posterior wall of the inguinal canal?
Transversalis fascia and conjoint tendon. Fusion of IO, TA aponeurosis medially
What makes up the roof of the inguinal canal?
IO and TA muscles (superior)
What makes up the floor of the inguinal canal?
Inguinal ligament (inferior)
What is the definition of an abdominal hernia?
An outpouching of abdominal viscera within a sac
Hernial sac is composed of what three layers?
Peritoneum, peritoneal fat, and transversalis fascia
Where does an indirect inguinal hernia extend?
Extends through entire inguinal canal
What does the indirect inguinal hernia commonly enter?
Scrotum or labia majora
What is the most common type of hernia?
Indirect inguinal hernia (more common in males than females)
What is a direct inguinal hernia?
One that goes through the inguinal triangle (Hesselbach’s)
What does the direct inguinal hernia emerge through?
Emerges through conjoint tendon by or at superficial ring
What is a direct inguinal hernia usually associated with?
Weakened abdominal muscles
Are direct inguinal hernias more common in males or females?
Males
Are indirect inguinal hernias medial or lateral to the inferior epigastric muscles?
Lateral
Are direct inguinal hernias medial or lateral to the inferior epigastric vessels?
Medial
What is a femoral hernia?
One that passes through the femoral ring and canal
Are femoral hernias more common in males or females?
Females
What is an umbilical hernia?
One that passes through the umbilical ring
Who do umbilical hernias happen commonly with?
Most common in new borns and common in females and extremely common in obese
What is an epigastric hernia?
One that passes through the lina alba
Who is commonly affected by epigastric hernias?
Those over 40 and obese
