Anterior Abdominal Wall And Inguinal-1/4/16 Flashcards
Identify the TRANSTUBERCULAR PLANE
- Tubercles of iliac crests
- Body of LV5
Identify the TRANSUMBILICAL PLANE
- LV3-4
- Similar to supracrestal plane
Identify the SUBCOSTAL PLANE
- 10th costal cartilages
- Superior border LV3
Identify the TRANSPYLORIC PLANE
- T12-LV1
- Halfway between jugular notch and pubic symphysis
- Goes through pyloric part of stomach which is “fixed”
Identify the MIDCLAVICULAR PLANE
- Midpoint of clavicle
- Midinguinal point
Identify the MIDSAGITTAL PLANE
- Linea Alba
- Passes through umbilicus
List contents of the RUQ
Gallbladder duodenum Right pleura Liver (right lobe) Right kidney
List contents of LUQ
Spleen Stomach Left pleura Pancreas tail Left kidney
List contents of RLQ
Right ureter
Cecum
Iliad diverticulitis
Vermiform appendix
List contents of LLQ
Left ureter
Descending and sigmoid colon
List the regions of the upper abdomen
R and L hypochondriac
Epi gastric
List the regions of the mid-abdomen
R and L lumbar (lateral)
Umbilical
List the regions of the lower abdomen
R and L inguinal (iliac) Hypo gastric (pubic)
List the anterior abdominal wall muscles
Rectus abdominis and sometimes pyramidalis
List the anterolateral abdominal muscles
External oblique
Internal oblique
Transversospinalis abdominis
List the Posterior abdominal muscles
Iliacus
Psoas major and minor
QUADRATUS lumborum
The _____ ligament is an “extension” of the inguinal l. And is important in FEMORAL HERNIAS
Lacunar
The cremaster muscle is from which abdominal muscle layer?
Internal oblique
What are the functions of the anterior abdominal wall muscles?
1) Flex trunk (anteriorly)
2) Laterally flex trunk
3) Rotate the trunk
4) assist in respiration
5) important in valsalva maneuver
6) also act during coughing, sneezing, urination, defecation, vomiting, and parturition
List the fascial layers of the anterior abdominal wall from superficial to deep
Skin–> fatty layer (camper’s) –> Membranous layer (scarpas) –> Superficial investing fascia –> external oblique m. –> intm. Investing fascia –> internal oblique m. –> deep investing fascia –> transversus abdominis –> transversalis fascia –> extraperitoneal fat –> parietal peritoneum
This layer is continuous with the superficial fatty layers in the thorax, thigh, and perineum`
Camper’s fascia
This layer is continuous with the fascia lata in the thigh and with the deep perineal fascia; it is also continuous over the penis and scrotum
Scarpa’s fascia (membranous)
This layer of fascia is what holds sutures together
Deep (investing) fascia of the abdominal muscles
Fluid can possibly leak into this potential space
Between the membranous layer (Scarpa’s) of superficial fascia and the deep fascia of the external abdominal oblique muscle
The _____ is formed by the fusion of the abdominal muscles and their associated fascias; It also encloses the rectus abdominis and pyramidalis mm.
Rectus sheath
The layers of fascia and aponeuroses of the muscles forming the rectus sheath are arranged differently in the upper abdominal wall than they are in the lower wall and the ____ is where this arrangement changes
Arcuate line
List the arrangement of layers ABOVE THE ARCUATE LINE (slide 47)
skin–> fatty layer of superficial fascia (camper’s) –> membranous layer of superficial fascia (Scarpa’s) –> Aponeurosis of ext. abdominal oblique fascia (2 layers) –> 1 layer of internal abdominal oblique Aponeurosis –> Rectus abdominis muscle –> 1 layer of internal abdominal oblique Aponeurosis –> Aponeurosis of transversus abdominis (2 layers)–> transversalis fascia –> extraperitoneal tissue –> parietal peritoneum
List the arrangement of layers BELOW THE ARCUATE LINE (slide 48)
Skin–> fatty layer of superficial fascia (camper’s) –> membranous layer of superficial fascia (Scarpa’s) –> Aponeurosis of ext. abdominal oblique (2 layers) –> Aponeurosis of int. Abdominal oblique (2 layers) –> Aponeurosis of transversus abdominis (2 layers) –> rectus abdominis muscle –> transversalis fascia –> extraperitoneal tissue –> parietal peritoneum
Where does deep venous drainage occur in the abdomen?
within the abdominal wall muscles along with arteries
Where does superficial drainage occur in the abdomen?
Within Camper’s fascia
Sensory dermatome for Xiphoid region is ___
T7
Sensory dermatome for umbilical region is ___
T10
Sensory dermatome for inguinal fold region is ___
L1
List the spinal cord contributions for:
A) Iliohypogastric n.
B) Ilioinguinal n.
C) Genitofemoral n.
A) Iliohypogastric n=L1 (sometimes T12)
B) Ilioinguinal n=L1
C) Genitofemoral n.=L1 and L2
This anterior abdominal wall nerve exits the posterior abdominal wall between QUADRATUS lumborum and psoas muscles, enters the anterolateral abdominal wall and runs between muscles, exits to become cutaneous
Iliohypogastric n. (L1, maybe T12) ; gives off a lateral cutaneous branch and anterior cutaneous branch (supplies suprapubic region)
This anterior abdominal wall nerve exits the posterior abdominal wall between QUADRATUS lumborum and psoas muscles, enters the anterolateral abdominal wall between muscles, and enters the inguinal canal and emerges through the superficial inguinal ring; it also supplies the groin, thigh & scrotum/labium majus
Ilioinguinal n. (L1)
This anterior abdominal wall nerve exits the posterior abdominal wall through psoas m. And runs between the peritoneum and the psoas m.
Genitofemoral n. (L1 and L2)
Genital branch –> enters inguinal canal through deep inguinal ring and exits through superficial inguinal ring; innervates Cremaster m. Or is cutaneous to labium majus
Femoral branch(es)–> exits inferior to inguinal ligament, cutaneous to femoral triangle area
This type of anterior abdominal wall hernia is usually small and wider transversely and usually heals spontaneously
Umbilical hernia in INFANT
This type of anterior abdominal wall hernia results from weakened abdominal wall around the umbilicus, usually superior to umbilical scar and requires surgical repair
Umbilical hernia in ADULTS
More common in WOMEN
This type of anterior abdominal wall hernia does not involve the umbilicus, protrudes through the lines alba, is usually superior to the umbilicus, and repaired surgically if large or symptomatic
Epigastric hernia (hernia of the linea alba)
More common in MEN
Describe where the inguinal canal begins and ends
Begins=deep inguinal ring (about midpoint of inguinal l.)
Ends=Superficial inguinal ring
During the descent of the testes, the testes are attached to the ____ which is attached inferiorly to the labial-scrotal fold. It guides the migration.
Gubernaculum
This pouch of peritoneum develops and pushes into labial-scrotal swelling as the testes reach the deep inguinal ring
Processus vaginalis
Descent of the testes process:
When the processus vaginalis (normally) closes off and becomes an isolated pocket of peritoneum, this structure arises:
Tunica vaginalis
Match the layers of the scrotum and coverings of testis to the corresponding layers of anterior abdominal wall (SLIDE 88):
A) SubQ tissue (fatty/membranous)
B) External oblique muscle and fascia
C) Internal oblique muscle
D) Fascia of both superficial and deep surfaces of internal oblique m.
e) Transversalis fascia
F) Peritoneum
A) SubQ tissue (Darto's fascia) and Darto's muscle B) External spermatic fascia C) Cremaster muscle D) Cremasteric fascia E) Internal spermatic fascia F) Tunical vaginalis
In the female, the gubernaculum forms:
The round ligaments of the ovary (ovarian ligaments) and the round ligaments of the uterus
In a ____ hernia, herniating bowel passes LATERAL to inferior epigastric vessels to enter deep inguinal ring
These are more common in young MALE CHILDREN
Indirect (congenital)
Most inguinal hernias are INDIRECT
In a ____ hernia, herniating bowel passes MEDIAL to inferior epigastric vessels, pushing through peritoneum and transversalis fascia in inguinal triangle to enter inguinal canal
These are more common in older MALES
Direct (acquired)
____ carry sperm from testes to head of epididymis
____ is connective tissue capsule of the testis
____ is a space of visceral layer of the tunica vaginalis
Efferent ductules
Tunica albuginea
Sinus epididymis
____ hernias exit the abdomen through the femoral canal, inferior to the inguinal ligament and are more common in WOMEN
Femoral
