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GI Midterm > Anterior Abdominal Wall > Flashcards

Anterior Abdominal Wall Flashcards

1
Q

Bony Landmarks of the Anterior Abdominal Wall (8)

A

1) Ribs and Costal Cartilages
2) Transverse processes
3) Ilium and Iliac Crest
4) Pubic Symphysis and Rami
5) Pubic Tubercle
6) Pecten Pubis
7) Anterior superior/inferior iliac spines
8) Greater and Lesser pelvis (lesser below pelvic inlet)

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2
Q

9 Regions of Abdominal Wall

A

1) Right hypochondrium
2) Right Flank (lateral region)
3) Right Inguinal (groin)
4) Epigastric
5) Umbilical
6) Pubic
7) Left hypochondriac
8) Left Flank (lateral region)
9) Left inguinal (groin)

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3
Q

4 Quadrants of the Abdominal Wall

A

1) Right Upper Quadrant
2) Left Upper Quadrant
3) Right Lower Quadrant
4) Left Lower Quadrant

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4
Q

Organs in Right Upper Quadrant (10)

A

1) Liver: right lobe
2) Gallbladder
3) Stomach: pylorus
4) Duodenum: parts 1-3
5) Pancreatic head
6) Right Suprarenal gland
7) Right Kidney
8) Right Colic (hepatic) flexure
9) Ascending Colon: superior part
10) Transverse Colon: right half

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5
Q

Organs in Left Upper Quadrant (10)

A

1) Liver: left lobe
2) Spleen
3) Stomach
4) Jejunum and proximal ileum
5) Pancreas: body and tail
6) Left Kidney
7) Left Suprarenal gland
8) Left Colic (splenic)
9) Transverse colon: left half
10) Descending Colon: superior part

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6
Q

Organs in Right Lower Quadrant (9)

A

1) Cecum
2) Appendix
3) Most of ileum
4) Ascending Colon: inferior part
5) Right Ovary
6) Right Uterine Tube
7) Right Ureter: abdominal part
8) Uterus
9) Urinary Bladder

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7
Q

Organs in Left Lower Quadrant (8)

A

1) Sigmoid Colon
2) Descending Colon: inferior part
3) Left ovary
4) Left Uterine tube
5) Left Ureter: abdominal part
6) Left spermatic cord: abdominal part
7) Uterus
8) Urinary Bladder

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8
Q

Transverse planes/ Organs (4)

A

1) Transpyloric Plane
2) Subcostal Plane
3) Transtubercle Plane
4) Interspinous Plane

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9
Q

Transpyloric Plane

A
  • L1 Level
  • level of gall bladder fundus, pylorus, pancreatic neck, SMA origin, hepatic portal vein, root of transverse mesocolon, hila of kidneys
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10
Q

Subcostal Plane

A
  • passes inferior border 10th costal cartilage

- level of transverse colon

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11
Q

Transtubercle Plane

A
  • between iliac tubercles

- level of iliocecal junction

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12
Q

Interspinous Plane

A
  • between ASIS

- level of appendix, sigmoid colon

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13
Q

Abdominopelvic Cavities

  • location
  • lining
A
  • abdomen and pelvis
    • between thoracic and diaphragm and pelvic diaphragm
    • 4th intercostal space
    • abdomen separate from pelvis by imaginary border of pelvic inlet
    • greater pelvis (above pelvic inlet)
  • walls mostly bone, muscle, and CT
  • Lined by peritoneum
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14
Q

Anteriolateral Abdominal Wall

  • boundaries
  • Outer layer
A
  • mostly muscle and aponeurosis
  • boundaries
    • Upper 7-10 Costal cartilage
    • lower inguinal ligament and pelvic bones

Outer Layer

  • skin, camper’s fascia, scarpa’s fascia
  • aponeurosis- tough, thick bc of several layers ( rectus sheath)
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15
Q

Camper’s and Scarpa’s Fascia

A
  • integument
  • Camper’s Fascia: fatty layer of superficial fascia
  • Scarpa’s Fascia: membranous underlying CT layer of superficial fascia
    • continuous with Colle’s fascia of perineum but fused with fascia lata of lower limb
    • fluid cannot go from abdominal wall into leg but could flow into or out of superficial perineum
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16
Q

External Oblique Muscle

  • location
  • direction
  • OIAN
A
  • runs in downward medial direction (inferiormedially)
  • interdigitates with serratus anterior

Origin: outer surface of lower 6 ribs

Insertion- aponeurosis and linea alba, anterior iliac crest and pubic tubercle
- makes opening of superficial inguinal canal

Innervation: Ventral Rami of T7-12 of intercostal nerves

Action: compress abdomen and increase intra-abdominal pressure; move trunk and retain posture

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17
Q

Internal Oblique Muscle

  • direction
  • OIAN
A
  • Runs 90 degrees from external oblique muscle (superomedially and horizontally)

Origin: iliac crest, thoracolumbar fascia

Insertion: lower 10-12 ribs, aponeurosis, linea alba and pubic crest, inguinal falx

  • some fibers follow spermatic cord and make cremasteric muscle
    - aponeurosis splits to encompass rectus muscle

Innervation: T7-T12 and L1

Action: compresses and supports viscera, lateral flexes and rotates

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18
Q

Transversus Abdominus Muscle

  • direction
  • OIAN
A
  • Runs tranverso-medially except for some running toward pubic crest ( contribute to conjoint tendon)
  • innermost of the 3 layers

Origin: lower 7-12 costal cartilages, thoracolumbar fascia, iliac crest, upper inguinal ligament

Insertion: linea alba, pecten pubis, pubic crest
- aponeurosis contributes to rectus sheath

Innervation: T7-L1

Action: compresses and supports visceral

19
Q

Rectus Abdominus Muscle

  • OIAN
  • two muscles
A
  • paired muscle of anterior abdominal wall; wider at top than bottom

Origin: pubic symphysis and pubic crest

Insertion: xiphoid process and outer surface of 5-7th intercostal cartilage
-tendinous insertions form part of rectus sheath at umbilical, xiphoid, and midway levels

Innervation: ventral rami of T7-T12

Action: flexes abdomen and compresses it

Linea semilunaris- lateral border of rectus abdominis m.

Pyramidis m- missing in 20%

20
Q

Rectus Sheath

  • content
  • Description of EO, IO, TA
  • arcuate line definition
A
  • made of fascia and aponeurosis of muscles encompassing RA
  • EO aponeurosis is always anterior
  • IO aponeurosis splits in upper 3/4s but all anterior in lower 1/2
  • TA aponeurosis is posterior except in lower 1/4

Arcuate line

  • sharp transition where all EO, IO, TA aponeuroses become anterior to RA m.
    • so below line, the rectus abdominis is in contact with transversalis fascia
21
Q

Thoraco-abdominal Nerve

A 
T7-T11
continuation of intercostal n
- sensory and motor innervation
- run between TA and IO m.
- lateral thoracic cutaneous branches of thoracic spinal nerve T7-T9 or 10
22
Q

Subcostal Nerve

A

T12
run along inferior 12th rib
- motor
- sensory is superior to iliac crest

23
Q

Iliohypogastic Nerve

A

L1
runs between 2nd and 3rd layer
- motor to IO and TA
- sensory bifurcate to upper inguinal and hypogastric region

24
Q

Ilioinguinal Nerve

A

L1

  • motor lower IO and TA
  • sensory to lower inguinal
  • anterior scotum/labia, near medial thigh
25
Q

Abdominal Wall Arteries (6)

- where they come off off

A
  • continuation of intercostal arteries

1) Lumbar arteries
- off abdominal aorta

2) Superficial epigastric a.
- off femoral artery
- anastomose with inferior epigastric a.

3) Superifical circumflex iliac a.
- off femoral artery
- runs along inguinal ligament

4) Deep circumflex iliac a
- off external iliac artery
- runs deeps along inguinal ligament

5) Inferior epigastric a.
- off external iliac a.
- runs posterior to rectus abdominis m.
- anastomosis with superior epigastric a

6) Superior epigastric artery
- a terminal branch of internal thoracic a.

26
Q

Anterior Wall- Interior Surface

  • artery
  • fold (3)
  • fossa (3)
A

Inferior epigastric a. runs anterior to posterior layer of rectus sheath

1) Median umbilical fold- due to obliterated urachus
2) Medial umbilical fold- fold due to umbilical arteries
3) Lateral umbilical fold- fold due to inferior epigastric a.

1) Supravesicular fossa- gutter on either side of upper bladder
2) Medial inguinal fossa- gutter lateral to medial umbilical folds
3) Lateral inguinal fossa- gutter lateral to lateral umbilical folds

27
Q

Lymph Drainage

  • superficial (2)
  • deep
A

Superficial vessels SUPERIOR to umbilicus drain into axillary nodes with a few going to parasternal nodes

Superficial vessels below umbilicus drain to superficial inguinal nodes

Deep lymph vessels accompany deep veins of abdominal wall (exm external, common, internal iliac veins, lumbar (caval or aortic nodes) )

28
Q

Abdominal Wall Incision (5)

A

1) Subcostal- 2.5 cm inferior from costal margin; access to gall bladder and biliary tract and spleen

2) Midline - can be made rapidly ( few BVs or nerves)
- from xiphoid process to pubic symphysis

3) Paramedian- open anterior sheath, push rectus muscle aside laterally and enter peritoneum
- from costal margin to iliac crest along linea semilunaris

4) Gridline (McBurney’s point) - muscle splitting; typical appendectomy

5) Suprapubic- used most in gynecological/ obsterical surgeries
- at pubic hair line
- horizontal with sight convexity

29
Q

Boundaries of Anterior Abdominal Wall (5)

A

1) Xiphisternum, costal margin
2) Erector Spinae- lateral margin
3) Iliac Crest, Tubercle, Spine
4) Inguinal Ligament
5) Pubic Tubercle and Crest

30
Q

Xiphisternal Junction

A

T9 Vertebral Level

7th Cartilage

31
Q

T11 Vertebral Level

A

Tip of 8th costal cartilage- midway across rectus abdominis

32
Q

L1 Vertebral Level

A

Tip of 9th costal cartilage

Transpyloric plane

junction of linea semilunaris and costal margin

halfway from sternal notch to symphysis pubis

33
Q

L3 Vertebral Level

A

Subcostal plane
- just above umbilicus
10th Costal Cartilage

34
Q

L4 Vertebral Level

A

Supracristal plane

crest of ilium

35
Q

L5 Vertebral Level

A

Transtubercular plan

iliac tubercle

36
Q

S2 Vertebral Level

A

Interspinous plane

anterior Superior iliac spines

37
Q

Suprapubic plane

A

below vertebral column

38
Q

Layers of Anterior Abdominal Wall:

Superficial to Deep

A
  • Superficial fatty layer: Campers
  • Deep membranous layer: Scarpa’s
  • External Oblique
  • Internal Oblique
  • Transversus abdominis
  • transversalis fascia
  • extraperitoneal fat
  • parietal peritoneum
39
Q

Liposuction

A

surgical procedure that uses a suction technique to remove fat from subcutaneous layer in abdomen

40
Q

Rectus Sheath: above arcuate line

  • anterior
  • posterior
A

Anterior

  • external oblique
  • internal oblique

Posterior

  • internal oblique
  • transversus abdominis
  • transversalis fascia
41
Q

Rectus Sheath: below arcuate line

  • Anterior
  • Posterior
A

Anterior

  • external oblique
  • internal oblique
  • transversus abdominis

Posterior
- transversalis fascia

42
Q

Rectus Sheath: below arcuate line

  • Anterior
  • Posterior
A

Anterior

  • external oblique
  • internal oblique
  • transversus abdominis

Posterior
- transversalis fascia

43
Q

Abdominal Hernias (4)

A

1) Ventral
- umbilical
- epigastric
- Spigelian

2) Groin
- inguinal
- femoral

3) Pelvic
- protrude through the pelvic foramina, as with sciatic and obturator hernis, or through pelvic floow as perineal hernias

4) Flank: protrude through weakened areas of back musculature and include the superior and inferior lumbar triangle hernia

44
Q

Prune Belly Syndrome

A

anterior abdominal wall muscles deficient or absent

  • urinary tract anomalies ( very large bladder)
  • bilateral cryptorchidism (two undescended testicles)

GI Midterm (10 decks)

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