Anterior Abdominal Wall Flashcards
9 regions of abdomen
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
layers of anterolateral abdominal wall
Skin.
Superficial fascia (Camper’s/fatty/Scarpa’s/membranous).
Deep fascia (connective tissue sheaths, transversalis fascia).
Extraperitoneal fat.
Parietal peritoneum.
flat muscles of anterolateral abdominal wall
external oblique
internal oblique
transversus abdominus
2 vertical muscles of anterolateral abdominal wall
rectus abdominis
pyramidalis
innervation of external oblique
intercostal nerves T7-T11,
subcostal nerve T12
origin/insertion of external oblique
O: 5th -12th ribs
I: linea alba, pubic tubercle, anterior iliac crest
innervation of internal oblique
intercostal nerves T7-12, iliohypogastric n. ilioinguinal n (L1)
origin/insertion of internal oblique
O: thoracolumbar fascia, iliac crest, ASIS, iliopsoas fascia
I: 10th-12th ribs, linea alba
innervation of transversus abdominis
intercostal nerves T7-12, iliohypogastric n. ilioinguinal n (L1)
transversus abdominis origin/insertion
O: 7th-12th costal cartilages, thoracolumbar fascia, iliac crest, ASIS, iliopsoas fascia
I: linea alba, pubic crest
rectus abdominis O,I,N
O: pubis
I: 5th-7th intercostal cartilages, xiphoid process
N: intercostal nn (T5-12)
pyramidalis OIN
O: pubis
I: linea alba
N: subcostal T12
semilunar line
Lateral sides of rectus abdominis
arcuate line
lower line of the “six pack”
shift from 1.5 anterior/posterior to all 3 anterior (layers of the rectus sheath)
nerves of anterolateral abdominal wall
above umbilicus: T7-T9
umbilicus = T10
below umbilicus: T11-L1
arteries of anterolateral abdominal wall
superior epigastric (from internal thoracic) anastamoses with inferior epigastric (external iliac)
deep
veins of anterolateral abdominal wall
1) superior epigastric v
2) inferior epigastric v
3) paraumbilical vv in round ligament of liver
infraumbilical peritoneal folds
Median fold (1) [urachus]
Medial umbilical folds (2) [umbilical arteries]
Lateral umbilical folds (2) [inferior epigastric vessels]
counterpart from fetal circulation: ligamentum teres of liver
paraumbilical veins
counterpart from fetal circulation: medial umbilical ligament
umbilical arteries
counterpart from fetal circulation: median fold
urachus
inguinal ligament
Inferior border of external oblique aponeurosis (folded over).
From ASIS to pubic tubercle.
inguinal canal
Transmits spermatic cord (male) or round ligament (female)
Made of deep inguinal ring and superificial inguinal ring
superficial inguinal ring
medial crus + lateral crus + intercrural fibers
relocation of testes
Start in extraperitoneal CT.
Gubernaculum pulls testes inferior, pulling surrounding tissue with it.
scrotum equivalent of abdominal superficial fascia (fatty and membranous)
dartos muscle and fascia
scrotum equivalent of abdominal external oblique
external spermatic fascia
scrotum equivalent of abdominal internal oblique
cremaster muscle
scrotum equivalent of abdominal fascia transversalis
internal spermatic fascia
scrotum equivalent of abdominal extraperitoneal fatty tissue
areolar tissue with localizwed collections of fat
scrotum equivalent of abdominal peritoneum
tunica vaginalis
iliohypogastric nerve
L1
Skin above inguinal ligament.
ilioinguinal nerve
L1
Skin of anterior scrotum and adjacent thigh.
Runs parallel and inferior to iliohypogastric n.
Emerges from superficial inguinal ring.
genitofemoral nerve
L1, L2
Skin below inguinal ligament.
Motor to cremaster.
spermatic cord contents
Ductus deferens. Artery of ductus deferens. Testicular artery. Pampiniform vein plexus. Cremaster muscle. Nerve fibers.
round ligament contents
Artery/vein of round ligament.
Nerve fibers.
CT cord.
common places for hernias
Of linea alba.
Umbilical.
Incisional.
At semilunaris (Spigelian)
inguinal hernia
Indirect hernia (also: congenital, acquired) Inside spermatic cord
indirect hernia
Loop of bowel inside the spermatic cord.
Travels through canal, taking an indirect route.
LATERAL to inferior epigastric artery.
direct hernia
Does NOT go through canal.
Loop of bowel parallels spermatic cord.
MEDIAL to inferior epigastric artery
strangulated hernia
blood supply is lost
Necrosis occurs
diastasis recti linea alba
large herniation between muscles of rectus abdominus
direct inguinal hernia
MEDIAL to deep epigastric vessels.
ABOVE inguinal ligament.
In HASSELBACK’s TRIANGLE.
femoral hernia
Neck of hernia is below inguinal ligament.
Passes thru femoral ring into femoral canal
lumbar hernia
Occurs thru lumbar triangle. (superior to middle iliac crest, covered only by transversus abdominis muscle and internal oblique., AKA Petit’s triangle)
spigelian hernia
Lateral ventral hernia thru semilunar line
