Anterior Abdominal Wall and Inguinal Region Flashcards
What is camper’s fascia?
superficial, fatty fascia that covers the abdominal wall
what is scarpa’s fascia? what does it attach to?
superficial fascia that is deep to the campers (fatty) fascia of the abdominal wall; it is the “membranous layer”;
it attaches to the deep thigh fascia inferior to the inguinal ligament and is more developed in the lower anterior abdominal wall
what does the deep fascia of the abdominal wall cover?
the superficial and deep surfaces of the individual anterior abdominal wall muscles; each muscle has its own deep fascia and several contribute to the coverings of the spermatic cord
what is the transversals fascia?
deep fascia covering the innermost surface of the deepest anterior wall muscle layer; derived posteriorly from the thoracolumbar fascia
what is the origin of the external abdominal oblique?
slips from ribs V - XII
what is the insertion of the external abdominal oblique
iliac crest and linea alba through its aponeurosis, lower extent of its aponeurosis forms the inguinal ligament between ASIS and public tubercle
what nerve innervates the external abdominal oblique
anterior rami of lower 6 thoracic spinal nerves T7-12
what is the action of the external abdominal oblique
compress abdominal contents during maximal expiration, coughing and defecation, trunk flexion and rotation
what is the origin of the internal abdominal oblique?
thoracolumbar fascia, iliac crest, lateral 2/3 of inguinal ligament
what is the insertion of the internal abdominal oblique?
inferior border to ribs IX - XII and the linea alba, pubic crest and pectineal line through its aponeurosis
what is the innervation of the internal abdominal oblique
anterior rami of lower 6 thoracic spinal nn T7-12 plus L1
what is the action of the internal abdominal oblique
compress abdominal contents during maximal expiration, coughing and defecation, trunk flexion and rotation
what is the origin of the tranversus abdominis muscle?
thoracolumbar fascia, iliac crest, costal cartilages of lower few ribs
what is the insertion of the tranversus abdominis muscle?
its aponeurosis attaches to linea alba, pubic crest and pectineal line
what is the innervation of the tranversus abdominis muscle?
anterior rami of lower 6 thoracic spinal nn T7-12 plus L1
what is the action of the tranversus abdominis muscle?
compresses abdominal contents during maximal expiration, coughing and defection
what is the conjoined tendon?
fusion of the tranversus abdominis aponeurosis and the internal abdominal oblique aponeurosis
what is the origin of the rectus abdominis?
pubic crest, pubic tubercle, and pubic symphysis
what is the insertion of the rectus abdominis?
costal cartilages of ribs V-VII and the xiphoid process
what nerve innervates the rectus abdominis?
anterior rami of lower 6 thoracic spinal nn T7-12
what is the action of the rectus abdominis?
compress abdominal contents during maximal expiration, coughing and defection, flex trunk
what is the rectus sheath?
dense CT that encloses the rectus abdominis muscle
what are the anterior and posterior layers of the rectus sheath formed by? where?
aponeuroses of the external/internal abdominal oblique and transversus abdominis muscles; the aponeuroses meet at the lateral edge of the rectus abdominis (linea semilunaris) and fuse in the midline (linea alba)
what aponeurosis contribute to the anterior vs posterior rectus sheaths? (ABOVE THE UMBILICUS)
anterior = external abdominal oblique aponeurosis + internal abdominal oblique aponeurosis
posterior = transversus abdominis aponeurosis + internal abdominal oblique aponeurosis
what aponeurosis contribute to the anterior vs posterior rectus sheaths? (BELOW THE UMBILICUS)
anterior = transversus abdominis aponeurosis + internal abdominal oblique aponeurosis
posterior layer of the rectus sheath is absent inferior to the arcuate line; thus the rectus abdominis is in contact with the transversalis fascia
when is the rectus abdominis in contact with the trasnversalis fascia?
inferior to the arcuate line
what is the transversalis fasica derives from?
derived posteriorly from the throacolumbar fascia
what is the transversalis fascia located?
deep to the anterior abdominal wall muscular fascia
what fills the space between the transversalis fascia and the parietal peritoneum?
extraperitoneal CT
what are the thoracoabdominal nn a continuation of?
the ventral rami of spinal nerves T 7-11 (intercostal nn) continuing into the anterior abdominal wall
what nerves enter the anterior abdominal wall? what do they innervate? how do they continue/pathway in the body?
thoracoabdominal nn, subcostal n (T12), iliohypogastric and ilioinguinal nn (L1);
innervate all of the muscles of the anterior abdomen; continue inferiorly and medially and within the neurovascular plane
where is the neurovascular bundle of the anterior abdominal wall located?
between the transversus abdominis adn interal abdominal obliques mm
what does the xiphoid process receive dermatomal innervation from?
T7
what does the umbilicus receive dermatomal innervation from?
T10
what does the pubis receive dermatomal innervation from?
L1 via iliohypogastric n
what does the ilinguinal nerve supple? course?
enters the inguinal canal (as it continue to descend medially); supplies the anterior scrotum/labium majus and upper medial thigh
what does the superior epigastric artery arise from? course? supply?
branches from the internal throacic and descends within the POSTERIOR rectus sheath; anastomoses with the inferior epigastric artery
what does the inferior epigastric artery arise from? course? supply?
branches from the external iliac artery before the eternal iliac artery passes inferior to the inguinal ligament; courses superiorly and medially in the extraperitoneal CT; penetrates the transversalis fascia anterior to the arcuate line; anastomoses with the superior epigastric artery wihtin the substance of the rectus abdominis muscle
what doe the posterior intercostals and subcostal veins drain into? supply?
drain into the azygous system; anteriorly they anastomoses with the superior and inferior epigastric veins
what is the course of the thoracoepigastric vein? what does it train into? what does it pick up blood from (what veins drain into it)
runs within the superficial fascia of the lateral part of the thorax and abdomen;
drains into the SVC via the lateral thoracic veins and into the IVC via the superficial epigastric veins;
tributaries near the umbilicus anastomose with the paraumbilical vv and ultimately drain into the portal vein;
what happens to the veins during abdominal portal hypertension?
blood flow through the portal vein can be impeded to such a degree that retrograde flow through the paraumbilical vein that the thoracoepigastric tributaries enlarges their diameter to form the caput medusae
what is the caput medusae?
during portal hypertension (in the abdominal wall) the blood flow through the portal vein can be impeded to such a degree that retrograde flow through the paraumbilical vein that the thoracoepigastric tributaries enlarg
where do superficial lymphatic of the anterior abdominal wall drain into?
the axillary and superficial inguinal nodes
what is the course of lymphatics in the abdominal wall?
drain along the posterior intercostal and superior/inferior epigastric veins to reach lumbar, parasternal, and external iliac nodes
what is the inguinal canal?
an oblique passage through the fasical and muscular layers in the lower anterior abdominal wall;
what does the inguinal canal connect?
the scrotum/labium majus to the retroperitoneal region
what does the inguinal canal transmit?
the ductus deferens in males and the rough ligament of the uterus in females
where is the inguinal canal located?
superior and parallel to the inguinal ligament, extending from the deep to the superficial inguinal ring
what passes inferior to the inguinal ligament?
the femoral vessels
what makes up the floor of the inguinal canal?
laterally = inguinal ligament (inferior extent of ext abd oblique aponeurosis)
medially = lacunar ligament
what is the inguinal ligament formed by?
inferior extent of ext abd oblique aponeurosis
what is the lacunar ligament formed by?
a posterior extension of the inguinal ligament attaching to the pectin pubis
what is the pectineal ligament formed by?
an extension of lacunar ligament along the pectineal line of the pelvis
what is the anterior wall of the inguinal canal formed by?
laterally = aponeurosis of external abdominal oblique + lower fibers of internal abdominal oblique arising from the inguinal ligament
medially -= superficial inguinal ring
where does the inguinal ligament lie in relation to the inguinal canal contents?
lies anterior to the contents of the inguinal canal
what forms the cresmasteric muscle?
internal abdominal oblique fibers
what forms the medial posterior wall of the inguinal canal?
fibers of the internal abdominal oblique that arch over the spermatic cord or round ligament + aponeurosis of transversus abdominis
what forms the lateral posterior wall of the inguinal canal?
transversalis fascia
what is the internal spermatic fascia?
an evagination of the tranversalis fascia ensheathing the ductus deferens, testis, and blood vessels;
where is the deep inguinal ring formed? located?
formed in the internal spermatic fascia ;
located = about midway between the pubic symphysis and ASIS; located lateral to the inferior epigastric vessels
what is the middle spermatic (cresmasteric) fascia derived from?
derived from the fascia of the internal abdominal oblique muscle;
what do the lowermost fibers of the internal abdominal oblique muscle continue onto?
the surface of the spermatic cord as the cremasteric muscule
what is the cremasteric muscle innervated by? what muscle action does this innervation cause?
the genital branch of the genitofemoral nerve; raises the testicle for temperature regulation
what confirms the integrity of L1-L2 spinal cord segments?
cresmasteric relex elicited by stroking the upper, medial thigh
what is the external spermatic fascia ? what is it derived from?
outermost covering of the spermatic cord; derived from the fascia of the external abdominal oblique muscle
what is the inguinal (Hasselbach’s) Triangle?
a potential weak area in the anterior abdominal wall bounded by the inguinal ligament, the inferior epigastric vessels, and the lateral border of the rectus abdominis muscle
what is an inguinal hernia?
a protrusion of abdominal contents (usually a loop of the small intestine) protruding through a defect in the musculofascial walls of the inguinal canal; more frequent in males
what is a direct inguinal hernia? what inguinal coverings are associated? how does it emerge
abdominal content protruding through the inguinal triangle; acquires the following coverings (from internal to external): peritoneum, extraperitoneal CT, transversalis fascia, conjoint tendon, external abdominal oblique aponeurosis and fascia; does not usually protrude through the superficial inguinal ring into the scrotum
what is an indirect inguinal hernia? what coverings are associated? where is it found? how does it emerge?
protrusion of the abdmonial content through the inguinal canal ALWAYS originates lateral to the inferior epigastric artery; acquires the coverings of the spermatic cord+ peritoneum; emerges through the superficial inguinal ring and usually enters the scrotum; associated with a patent processus vaginalis
what are the peritoneal folds: located?structures included?
located on the inner surface of the lower anterior abdominal wall; retroperitoneal structures extending superiorly from the region of the bladder
what are the peritoneal folds covered by?
parietal peritoneum
what is the median umbilical fold?
remnant of the embryonic urachus extending from the apex of the bladder to umbilicus; single midline structure
what are the mediaL umbilical folds?
remnants of the obliterated umbilical artery extending from just lateral of the bladder to the umbilicus; located lateral to the median umblilical fold; define the supravesical fossae in conjunction with the median umbilical fold
what is the alteral umbilical folds
formed by the inferior epigastric artery as the course medially and superiorly to enter the rectus sheath; located lateral to the medial umbilical folds; define the medial umbilical fossae in conjunction with the medial umbilical folds; the lateral umbilical fossae are located lateral to the lateral umbilical folds
