Anterior Abdominal Wall

Question 1

What are the planes that divide the abdominal wall into 9 regions?

Answer 1

mid-clavicular lines
10th rib
iliac spine

Question 2

What are the 9 regions of the abdominal wall?

Answer 2

right hypochondriac, epigastric, left hypochondriac
right flank, umbilical, left flank
right inguinal, pubic, left inguinal

Question 3

What structures lie within the right upper quadrant?

Answer 3

liver (right lobe), gallbladder, pylorus, duodenum, head of pancreas, right kidney and suprarenal gland, right (hepatic) colic flexure, ascending colon (superior part), transverse colon (right half)

Question 4

What structures lie within the left upper quadrant?

Answer 4

liver (left lobe), spleen, stomach, jejunum, proximal ileum, body and tail of pancreas, left kidney and suprarenal gland, left colic (splenic) flexure, transverse colon (left half), descending colon (superior part)

Question 5

What structures lie within the lower right quadrant?

Answer 5

cecum, appendix, most of the ileum, ascending colon (inferior part), right ovary and uterine tube, right ureter (abdominal part), right spermatic cord (abdominal part), uterus and bladder (right portions, if enlarged or full)

Question 6

What structures lie within the left lower quadrant?

Answer 6

descending colon (inferior part), sigmoid colon, left ovary and uterine tube, ureter (left abdominal part), left spermatic cord (abdominal part), uterus and bladder (left portions, if enlarged or full)

Question 7

What are the boundaries of the abdominal cavity?

Answer 7

superior = thoracic diaphragm
inferior = superior pelvic aperture (pelvic inlet)
-lined by peritoneum
-walls are mostly bone, muscle, and CT

Question 8

At what vertebral level is the transpyloric plane?

Answer 8

• L1

- around the 8th rib

Question 9

What structure(s) lie in the transpyloric plane?

Answer 9

-gallbladder fundus, pylorus, pancreatic neck, superior mesenteric A. origin, hepatic portal V., root of transverse mesocolon, hila of the kidneys

Question 10

At what vertebral level is the subcostal plane?

Answer 10

• L3

- around the 10th costal cartilage

Question 11

What structure(s) lie in the subcostal plane?

Answer 11

transverse colon

Question 12

At what vertebral level is the transtubercular plane?

Answer 12

• L5

- b/w iliac tubercles

Question 13

What structures lie in the transtubercular plane?

Answer 13

-ileocecal junction

Question 14

At what vertebral level is the interspinous plane?

Answer 14

• S2

- b/w ASIS’s

Question 15

What structures lie in the interspinous plane?

Answer 15

appendix

sigmoid colon

Question 16

What are the layers of the anterior abdominal wall, superficial to deep?

Answer 16

skin, Camper’s fascia, Scarpa’s fascia, aponeurosis and muscles (external oblique, internal oblique, transversus abdominis), rectus abdominus within rectus sheath, transversalis fascia, peritoneum

Question 17

What are the nerves of the anterior abdominal wall?

Answer 17

• thoracoabdominal nn. (T7-T11)
• subcostal N. (T12)
• iliohypogastric N. (L1)
• ilioinguinal N. (L1)

Question 18

What are the characteristics of the thoracoabdominal nn. (T7-T11)?

Answer 18

• continuations of intercostal nn.
• both motor and sensory
• runs b/w IOand transversus abdominis

Question 19

What are the characteristics of the subcostal N. (T12)?

Answer 19

• runs along inferior border of the 12th rib
• motor
• sensory superior to iliac crest

Question 20

What are the characteristics of the iliohypogastric N. (L1)?

Answer 20

• runs b/w IO and transversus abdominis
• motor to IO and transversus abdominis
• sensory to upper inguinal and hypogastric areas

Question 21

What are the characteristics of the ilioinguinal N. (L1)?

Answer 21

• motor to lower IO and transversus abdominis

- sensory to lower inguinal, anterior scrotum or labia, and proximal medial thigh

Question 22

What are the arterial components of the anterior abdominal wall?

Answer 22

• lumbar aa. and continuations of intercostal aa.
• superficial epigastric A.
• superficial and deep circumflex iliac aa.
• inferior epigastric A.
• superior epigastric A.

Question 23

What are types of common abdominal incisions?

Answer 23

• subcostal
• midline
• paramedian
• gridiron
• suprapubic

Question 24

What are the characteristics of a subcostal incision?

Answer 24

• approx. 2.5 cm inferior to costal margin

- access to gallbladder, biliary tract, and spleen

Question 25

What are the characteristics of a midline incision?

Answer 25

• can be made rapidly
• few blood vessels and nerves
• a lot of CT

Question 26

What are the characteristics of a paramedian incision?

Answer 26

• open anterior sheath
• push rectus abdominis aside
• enter peritoneum

Question 27

What are the characteristics of a gridiron incision?

Answer 27

• muscle-splitting (in the direction of fibers)

- typical of an appendectomy

Question 28

What are the characteristics of a suprapubic incision?

Answer 28

-used in most OBGYN surgeries

Question 29

To which lymph nodes do abdominal superficial lymph vessels that are superior to the umbilicus drain?

Answer 29

• mostly axillary lymph nodes

- some drain to parasternal lymph nodes

Question 30

To which lymph nodes do abdominal superficial lymph vessels that are inferior to the umbilicus drain?

Answer 30

-superficial inguinal lymph nodes

Question 31

What are the folds and fossae of the anterior abdominal wall, medial to lateral?

Answer 31

median umbilical fold - supravesical fossa
medial umbilical fold - medial inguinal fossa
lateral umbilical fold - lateral inguinal fossa

Question 32

What are the folds of the anterior abdominal wall and from what are they derived?

Answer 32

median umbilical fold - remnant of urachus
medial umbilical fold - remnant of umbilical aa.
lateral umbilical fold - d/t inferior epigastric bv’s