Anterior Abdominal Wall Flashcards

1
Q

Describe anterolateral abdominal wall from superficial to deep

A
  1. Skin 2. Subcutaneous tissue (fatty) 3. Muscle layers 4. Peritoneum
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2
Q

What are the 3 paired muscles form the anterolateral abdominal wall?

A
  1. External oblique 2. Internal oblique 3. Transversus abdominus
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3
Q

How do the external oblique muscles run?

A

Forward and downwards

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4
Q

How do the internal oblique muscles run?

A

Opposite to external

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5
Q

What is the peritoneum?

A

Membrane lining abdominal cavity and encompassing some organs - Parietal peritoneum (around body wall) - Visceral peritoneum (around organs)

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6
Q

As right and left external obliques come towards midline, what does it form?

A

A flat tendinous sheet –> aponeurosis In midline, there is thickened aponeurosis (N.B. this happens for all 3 layers, so there is an aponeurosis for internal and transverses abdominus too)

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7
Q

What is an aponeurosis?

A

A flat tendinous sheet

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8
Q

What is the linea alba?

A

Thickened aponeurosis in midline of abdomen (where muscle fibres join)

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9
Q

Where is the rectus abdominis muscle?

A

Muscle in midline

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10
Q

What is a ‘6 pack’?

A

Muscle bellies of rectus abdominis separated by tendinous intersections in midline (attached from costal margin down to pelvis)

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11
Q

What is a 6-pack covered by?

A

Subcutaneous fat

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12
Q

What are rectus abdominis covered by?

A

Aponeurosis from anterolateral muscles (pearly white)

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13
Q

What are the 3 paired muscles supported anteriorly and posterioly by?

A
  1. Rectus abdominis
  2. Quadratus lumborum
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14
Q

What 2 main groups can the muscles of the anterolateral abdominal wall be divided into?

A
  1. Flat muscles - three flat muscles, situated laterally on either side of the abdomen.
  2. Vertical muscles – two vertical muscles, situated near the mid-line of the body
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15
Q

In the anteromedial aspect of the abdominal wall, what does each flat muscle form?

A

An aponeuorisis (a broad, flat tendon) which covers the vertical rectus abdominis muscle

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16
Q

The aponeuroses of all the flat muscles become entwined in the midline to form what?

A

The linea alba (a fibrous structure that extends from the xiphoid process of the sternum to the pubic symphysis)

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17
Q

What are the 3 flat muscles?

A
  1. External oblique
  2. Internal oblique
  3. Transversus abdominis
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18
Q

Describe the external oblique

A

The largest and most superficial flat muscle in the abdominal wall. Its fibres run inferomedially.

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19
Q

Where do the external obliques originate from?

A

Ribs 5-12 and inserts into the iliac crest and pubic tubercle

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20
Q

What is function of external obliques?

A
  • Flexion of torso (pulls chest down to compress abdominal cavity)
  • Contralateral rotation of torso
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21
Q

What are external obliques innervated by?

A

Thoracoabdominal nerves (T7-T11) and subcostal nerve (T12)

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22
Q

Describe the internal obliques

A

Lie deep to the external oblique. It is smaller and thinner in structure, with its fibres running superomedially (perpendicular to the fibres of the external oblique).

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23
Q

Where do the internal obliques originate from?

A

The inguinal ligament, iliac crest and lumbodorsal fascia, and inserts into ribs 10-12.

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24
Q

What is the function of the internal obliques?

A

Bilateral contraction compresses the abdomen, while unilateral contraction ipsilaterally rotates the torso.

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25
Q

What are the internal obliques innervated by?

A

Thoracoabdominal nerves (T7-T11), subcostal nerve (T12) and branches of the lumbar plexus.

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26
Q

Image of muscles

A
27
Q

Describe the transversus abdominis

A

The transversus abdominis is the deepest of the flat muscles, with transversely running fibres. Deep to this muscle is a well-formed layer of fascia, known as the transversalis fascia.

28
Q

Where do the transversus abdominis originate from?

A

The inguinal ligament, costal cartilages 7-12, the iliac crest and thoracolumbar fascia. Inserts into the conjoint tendon, xiphoid process, linea alba and the pubic crest.

29
Q

What is the function of the transversus abdominis?

A

Compression of abdominal contents.

30
Q

What are the transversus abdominis innervated by?

A
  1. Thoracoabdominal nerves (T7-T11)
  2. Subcostal nerve (T12)
  3. Branches of the lumbar plexus: iliohypogastric nerve (L1), ilioinguinal nerve (L1)
31
Q

What are the 2 vertical muscules located in the midline of the anterolateral abdominal wall?

A
  1. Rectus abdominis
  2. Pyramidalis
32
Q

Describe the rectus abdominis

A

Long, paired muscle, found either side of the midline in the abdominal wall

33
Q

What is the rectus abdominis split into 2 by?

A

The linea alba

34
Q

What are the lateral borders of the muscles create a surface marking known as?

A

The linea semilunaris

35
Q

At several places, the rectus abdominis is intersected by fibrous strips known as what?

A

Tendinous intersections

36
Q

What do the tendinous intersections and the linea alba give rise to?

A

A 6-pack in individuals with a well-developed rectus abdominis

37
Q

Where does the rectus abdominis originate from?

A

Originates from the crest of the pubis, before inserting into the xiphoid process of the sternum and the costal cartilage of ribs 5-7

38
Q

What is the function of the rectus abdominis?

A

As well as assisting the flat muscles in compressing the abdominal viscera, the rectus abdominis also stabilises the pelvis during walking, and depresses the ribs.

39
Q

What is the rectus abdominis innervated by?

A

Thoracoabdominal nerves (T7-T11)

40
Q

What is the rectus sheath?

A

Formed by the aponeuroses of the three flat muscles and encloses the rectus abdominis and pyramidalis muscles. It has an anterior and posterior wall for most of its length

41
Q

What is the anterior wall of the rectus sheath formed by?

A

the aponeuroses of the external oblique, and of half of the internal oblique

42
Q

What is the posterior wall of the rectus sheath formed by?

A

the aponeuroses of half the internal oblique and of the transversus abdominis.

43
Q

At what point is there no posterior wall to the rectus sheath?

A

Approximately midway between the umbilicus and the pubic symphysis, all the aponeuroses move to the anterior wall of the rectus sheath. At this point, there is no posterior wall to the sheath; the rectus abdominis is in direct contact with the transversalis fascia.

44
Q

What vessel sits either side of the sternum and continues downwards?

A

Internal thoracic - gives off some anterior intercostal arteries

45
Q

What level does the internal thoracic artery split?

A

Around 6th costal cartilage it bifurcates

46
Q

What does the internal thoracic artery bifurcate into?

A

Musculophrenic artery (laterally) and superior epigastric artery (inferiorly)

47
Q

What level does the adominal aorta bifurcate? What does it bifurcate into?

A

L4 –> 2 common iliac arteries

48
Q

Describe rectus sheath above umbilicus

A
  • Anterior = external oblique aponeurosis, anterior layer of internal oblique aponeurosis
  • Posterior = posterior layer of internal oblique aponeurosis, transversus abdominis and peritoneum

(above umbilicus, aponeuorisis for internal oblique splits around rectus abdominis)

49
Q

Describe rectus sheath below umbilicus

A
  • Anterior = external oblique aponeurosis, internal oblique aponeurosis and transversus abdominis
  • Posterior = fascia, peritoneum

(all 3 layers are now anterior to rectus abdominus)

50
Q

Describe fascia above the umbilicus

A

A single sheet of connective tissue that is continuous with the superficial fascia in other regions of the body

51
Q

What is a hernia?

A

Increase in intraabdominal pressure causes contents to protrude through weakenings in abdominal wall

52
Q

Sagittal view of rectus sheath

A
53
Q

When are all the aponeuroses anterior to the rectus abdominis?

A

Below the umbilicus

54
Q

What is the only thing posterior to the rectus abdominus below the umbilicus?

A

Layer of fascia and peritoneum

55
Q

What is the arcuate line?

A

Where the posterior wall ends (change in formation of rectus sheath)

Below –> where all aponeuroses pass anterior to rectus abdominis

56
Q

What is the inguinal triangle of Hesselbach?

A

A region in the anterior abdominal wall. It is alternatively known as the medial inguinal fossa.

57
Q

What are the 3 borders of the inguinal triangle?

A

Medial – lateral border of the rectus abdominis muscle.

Lateral – inferior epigastric vessels.

Inferior – inguinal ligament.

58
Q

Why do hernias often occur through inguinal triangle?

A

The triangle does demarcate an area of potential weakness in the abdominal wall – through which herniation of the abdominal contents can occur

59
Q

What is the inguinal region?

A

An area of the adominal wall that extends from the ASIS to the pubic tubercle.

60
Q

Where is the inguinal canal found?

A

In the inguinal region

61
Q

What does the inguinal canal contain?

A

The spermatic cord in the male and the round ligament of the uterus in the female

62
Q

How is the inguinal ligament formed?

A

External oblique muscle (free edge) folds back on itself to form inguinal ligament

63
Q

Describe the origin of the thoracoabdominal nerves

A

Five pairs of thoracoabdominal nerves continue from the 7th through 11th intercostal nerves.