Anterior Abdominal Wall And Peritoneal Cavity Flashcards
1
Q
What separated the abdomen and thorax
A
Diaphragm
2
Q
What does the abdominal cavity contain
A
Gastrointestinal tract
Hepatobiliary system
Urinary system
Endocrine system
Spleen
Great vessels
3
Q
What does the gastrointestinal tract contain
A
Stomach
Small and large intestine
4
Q
What does the hepatobiliary system contain
A
Liver
Gallbladder
5
Q
What does the urinary system contain
A
Kidney
ureters
6
Q
What does the abdominal endocrine system contain
A
Pancreas
Adrenal glands
7
Q
Great vessels of the abdomen
A
Abdominal aorta
Inferior vena cava
8
Q
What are the abdominal walls composed of
A
Skin
Subcutaneous tissue
Muscles and their associated aponeuroses (flat tendons)
9
Q
Aponeuroses
A
Flat tendons- anteriorly the muscles of the abdominal wall become apneurotic
Fibres of the 3 fuse together and in the midline they fuse with those on the opposite side forming a tough midline raphe (linea alba)
Also form the rectus sheath
10
Q
How many lumbar vertebrae are there
A
5
11
Q
Functions of the abdominal wall
A
Protect abdominal viscera
Increases intra-abdominal pressure eg for defecation and childbirth
Maintain posture and move the trunk
12
Q
What is the internal aspect of the abdominal wall lined with
A
Parietal peritoneum - serous membrane
13
Q
Key bony landmarks of abdominal cavity
A
• Xiphisternum
• Costal margin
• Iliac crests
• Anterior superior iliac spines (ASIS)
• Pubic tubercles
• Pubic symphysis (a fibrocartilaginous joint).
14
Q
Four quadrants of the abdomen
A
Left and right upper and lower quadrants
15
Q
Vertical line of abdomen
A
Runs down the midline through the lower sternum, umbilicus and Punic symphysis
16
Q
Horizontal line of abdomen
A
Runs through umbilicus
17
Q
4 imaginary lines that divide abdomen into 9 regions
A
Right and left mid clavicular lines
Subcostal line
Intertubercular line
18
Q
Right and left midclavicular lines
A
Extend vertically from midclavicular point to mid-inguinal point (halfway between anterior superior iliac spine and pubic tubercle)
19
Q
Subcostal line
A
Horizontal line drawn through the inferior-most parts of the right and left costal margins (10th costal cartilage)
20
Q
Which costal cartilage does the Subcostal line run through
A
10th
21
Q
Intertubercular line
A
Horizontal line through the tubercles of the right and left iliac crests and body of L5
22
Q
Which lumbar vertebra does the intertubercular line run through
A
L5
23
Q
9 regions of abdominal wall
(Starting at top going right to left)
A
Right hypochondrium
Epigastrium
Left hypochondrium
Right flank
Umbilical region
Left flank
Right iliac fossa
Suprapubic region
Left iliac fossa
24
Q
Transpyloric plane position
A
Horizontal line that passes through tips of right and left 9th costal cartilages
Lies half away between superior border of manubrim and pubic symphysis
25
Transpyloric plane transects
Pylorus of stomach
Gallbladder
Pancreas
Hila of kidneys
26
Transumbilical plane
Position varies depending on amount of subcutaneous fat present
Lie approximately at level of L3
27
Intercristal plane
horizontal line drawn between the highest points of the right and left iliac crests.
It cannot be palpated from the anterior aspect of the abdominal wall
It is used to guide procedures on the back (e.g. lumbar puncture).
28
McBurney’s point
Surface marking of the base of the appendix
Lies 2/3 of the way along a line drawn for the umbilicus to right anterior superior iliac spine
29
How many pairs of muscles comprise the anterolateral abdominal wall
4
30
4 pairs of muscles in anterolateral abdominal wall
External oblique
Internal oblique
Transversus abdominis
Rectus abdominis
31
Orientation of fibres in external oblique muscle
Diagonally - medially and inferiorly
32
Orientation of fibres in internal oblique muscles
Diagonally - medially and superiorly
33
Orientation of fibres in transversus abdominis muscles
Horizontally
34
Orientation of fibres in rectus abdominis muscles
Straight
35
Left and right rectus abdominis muscles
Lie either side of midline and either side of the linea alba
Attached to sternum and costal margin superior,y and pubis inferiorly
36
What is the rectus abdominis surrounded by
Aponeurotic rectus sheath
37
Order of sheets of muscle fibres in abdominal wall
Superficial to deep
External oblique
Internal oblique
Transversus abdominis
38
Role of 3 muscles in abdominal walls
When contract together increases intra-abdominal pressure
39
Role of oblique muscles when contract alone
Act as lateral flexors of the lumbar spine
40
What is rectus sheath composed of
aponeuroses of external oblique, internal oblique and Transversus abdominis
41
Linea alba
A tough midline raphe (seam) where all fibres of aponeuroses fuse
42
Composition of rectus abdominis muscle
Muscle segments interspersed with horizontal tendinous bands
43
Function of rectus abdominis
When the muscle segments hypertrophy with exercise, they bulge either side of the tendinous bands and can be seen on the anterior abdominal wall as bulges – the ‘six-pack’.
Rectus abdominis is a flexor of the lumbar spine.
44
What forms the anterior wall of the rectus sheath
EO aponeurosis and anterior layer of IO aponeurosis
45
What form the posterior wall of the rectus sheath
Posterior layer of the IO aponeurosis
Transversus abdominis aponeurosis
46
Transversalis fascia position
Lies deep to transversus abdominis
Lies superficial to parietal peritoneum
47
Inguinal ligament
most inferior part of the external oblique aponeurosis is attached to the anterior superior iliac spine laterally and the pubic tubercle medially, forming the inguinal ligament.
48
Which arteries supply the anterolateral abdominal wall
Musculophrenic artery
Superior epigastric artery
Inferior epigastric artery
All accompanied by deep veins
49
Musculophrenic artery
Branch of internal thoracic
50
Superior epigastric artery
Continuation of internal thoracic
Descends in rectus sheath
51
Inferior epigastric artery
Branch of external iliac artery
Ascends in the rectus sheath and anastomoses with the superior epigastric
52
When nerves innervate the anterolateral abdominal wall
Thoraco-abdominal nerves T7-T11
Subcostal nerve
Iliohypogastric and ilioinguinal nerves
53
Thoraco-abdominal nerves
T7-T11
Continuation of intercostal nerves
Somatic nerves contain sensory and motor fibres
54
Subcostal nerve
Originates from T12 spinal nerve
Runs along inferior border of 12th rib
55
Iliohypogastric and ilioinguinal nerves
Branches of L1 spinal nerve
56
Inguinal canal
Oblique passageway through the muscles of the anterior abdominal wall
Lies superior to the medial Healy of the Inguinal ligament
Passes through each layer of the abdominal wall as it r]travels medially and inferiorly
57
Length of Inguinal canal
5cm
58
What does the Inguinal canal extend from and to
Deep Inguinal ring laterally (an aperture in the transversalis fascia) to the superficial Inguinal ring medially (an aperture in the external oblique aponeurosis)
59
Anterior border of the Inguinal canal
External oblique aponeurosis
Laterally only: internal oblique aponeurosis
60
Posterior border of the Inguinal canal
Transversalis fascia
Medially only: medial fibres of the aponeuroses of the internal oblique and transversus abdominis
61
Roof of the Inguinal canal
Transversalis fascia
Arching fibres if the internal oblique and transversus abdominis
62
Floor of the Inguinal canal
Inguinal ligament (the lower border of the external oblique aponeurosis)
63
Conjoint tendon
medial fibres of the aponeuroses of the internal oblique and transversus abdominis
64
Abdominal wall hernias
A hernia is an abnormal protrusion of tissues or organs from one region into another through an opening or defect. Herniae of the anterior abdominal wall may occur if the muscles are weak or have been incised during surgery. A segment of the small intestine may protrude through a defect in the wall, forming a visible and palpable lump under the skin.
65
Laparotomy
This term describes the surgical opening of the anterior abdominal wall, undertaken for major operations where good access to the abdomen is needed. A midline sagittal incision of the linea alba involves minimal risk to nerves and muscles. Ideally, muscles are split, rather than cut. Where possible, keyhole surgery (laparoscopy) is performed, as it is associated with less post-operative pain, faster wound healing and a smaller risk of wound infection and post-operative hernia.
66
Abdominal aortic aneurysm (AAA)
This is an abnormal swelling of the wall of the aorta. The affected portion of the wall becomes distended, but it is weak and prone to rupture. An aneurysm may be detected on abdominal examination, felt as a pulsatile mass in the midline of the abdomen. Examination of the abdomen must always include palpitation of the aorta, as detection can be lifesaving. Sudden rupture of an AAA carries an extremely high mortality rate.
67
Inguinal hernia
An inguinal hernia is a protrusion of abdominal contents (normally part of the greater omentum or loops of small intestine) through the anterior abdominal wall into the inguinal canal. Inguinal hernias are indirect or direct.
68
Indirect Inguinal hernia
In an indirect inguinal hernia, intra-abdominal contents are forced through the deep inguinal ring and into the canal. The abdominal contents may even be forced along the canal and through the superficial ring. From here, the hernia may extend into the scrotum in males or into the labia majora in females. Indirect hernias are more common than direct hernias. They are more likely to get stuck in the canal and become ‘irreducible’. Potentially, herniated tissue can ‘strangulate’ and become ischaemic. This is a surgical emergency.
69
Direct Inguinal hernia
In a direct inguinal hernia, intra-abdominal contents are forced through the posterior wall of the inguinal canal (i.e. the relatively weak transversalis fascia) and directly through the superficial ring. The herniated abdominal contents do not pass through the deep inguinal ring in direct inguinal hernias. Although they are less common than indirect hernias, direct inguinal hernias are often easier to reduce.
70
Which is more common an indirect or direct Inguinal hernia
Indirect
71
Peritoneum
A serous membrane that lines the abdominal wall and covers the viscera within it
Parietal and visceral peritoneum continuous with each other
72
Parietal peritoneum
Lines abdominal wall
Can be seen with the naked eye
73
Innervation of parietal peritoneum
Somatic nerves that supply the overlying muscles and skin
74
Pain from the parietal peritoneum
Usually sharp, severe and well localised to the abdominal wall
75
Visceral peritoneum
Covers abdominal viscera
76
Innervation of visceral peritoneum
Visceral sensory nerves
77
Pain from the visceral peritoneum
Can be severe
Usually dull and diffuse
May be perceived as nausea or distension
78
Peritoneal cavity
A thin film of peritoneal fluid lies in it- allows viscera to slide freely alongside each other
79
Intraperitoneal viscera
almost completely covered by peritoneum e.g. the stomach
80
Retroperitoneal viscera
posterior to the peritoneum, hence only covered by peritoneum on their anterior surface e.g. the pancreas and abdominal aorta.
81
Secondarily retroperitoneal viscera
These organs were intraperitoneal in early development but came to be ‘stuck down’ onto the posterior abdominal wall.
82
Mesenteries
Folds of peritoneum that contain fat and suspend the small intestine and parts of the large intestine from the posterior abdominal wall
83
What are embedded in the mesenteries
Arteries that supply the intestine (from the abdominal aorta) and veins that drain the gut (tributaries of the portal venous system)
84
Greater and lesser omenta
Folds of peritoneum that are usually fatty and connect the stomach to other organs
85
Greater omentum
hangs from the greater curvature of the stomach and lies superficial to the small intestine
86
Lesser omentum
connects the stomach and duodenum (the first part of the small intestine) to the liver. The hepatic artery, the hepatic portal vein, and the bile duct (the ‘portal triad’) are embedded within its free edge.
87
Portal triad
Hepatic artery
Hepatic portal vein
Bile duct
88
Ligaments
Folds of peritoneum that connect organs to each other or to the abdominal wall
89
Falciform ligament
connects the anterior surface of the liver to the anterior abdominal wall
90
Coronary and triangular ligaments
connect the superior surface of the liver to the diaphragm.
91
Peritoneal folds
raised from the internal aspect of the lower abdominal wall and are created by the structures they overlie, like carpet running over a cable. Sometimes they are difficult to see.
92
Median umbilical fold
lies in the midline and represents the remnant of the urachus, an embryological structure that connects the bladder to the umbilicus.
93
Medial umbilical folds
• Lateral to the median umbilical fold lie the medial umbilical folds. These represent the remnants of the paired umbilical arteries, which returned venous blood to the placenta in foetal life.
94
Lateral umbilical folds
Lateral to the medial umbilical folds are the lateral umbilical folds. The inferior epigastric arteries lie deep to these peritoneal folds. They supply the anterior abdominal wall.
95
Order of peritoneal folds
Median —> medial —> lateral
96
2 regions of peritoneal cavity
Greater and lesser sac
97
Lesser sac/ omental bursa
Smaller
Space that lies posterior to the stomach and anterior to the pancreas
98
Greater sac
Larger
Remaining part of peritoneal cavity
99
Epiploic Foramen
greater and lesser sacs communicate with each other via a passageway that lies posterior to the free edge of the lesser omentum
100
What does the GI system develop from
Embryonic gut tube
which lies in the midline of the abdominal cavity, suspended from the posterior abdominal wall by the dorsal mesentery. Major branches of the abdominal aorta that supply the developing gut tube travel through the dorsal mesentery.
ventral mesentery connects the stomach to the anterior abdominal wall. As the liver grows within it, the anterior part of the ventral mesentery becomes the falciform ligament and the posterior part becomes the lesser omentum.
101
Dorsal mesentery
Major branches of the abdominal aorta that supply the developing gut tube travel through
102
Ventral mesentery
connects the stomach to the anterior abdominal wall. As the liver grows within it, the anterior part of the ventral mesentery becomes the falciform ligament and the posterior part becomes the lesser omentum.
103
Peritonitis
Peritonitis describes infection and inflammation of the peritoneum. It may be localised (i.e. to the region of peritoneum adjacent to an inflamed / infected organ) or generalised (affecting the whole peritoneum). Peritonitis may be caused by inflammation of an organ (e.g. the pancreas) or rupture of a hollow viscus (e.g. the stomach or bowel). Rupture of the intestine allows faecal matter and bacteria to contaminate the peritoneum. Because the peritoneum has a large surface area and is semi-permeable, peritonitis can lead to sepsis and is hence a life-threatening condition. Peritonitis is extremely painful.
104
Peritoneal adhesions
In a healthy abdomen, a thin layer of peritoneal fluid allows the abdominal viscera to slide freely alongside each other. Adhesions are pathological fibrous connections between the parietal and visceral peritoneum. When the peritoneum is irritated (e.g. by infection) it produces fibrin which causes the parietal and visceral peritoneum to adhere to each other. These connections may become fibrous. They can cause chronic abdominal pain and they increase the risk of volvulus (twisting) of the intestine, because it can no longer move freely.
105
Ascites
Ascites is an increased volume of peritoneal fluid. It occurs secondary to other pathology, such heart failure, liver failure or intra-abdominal malignancy. The abdomen may become very distended, and it is very uncomfortable. An ascitic drain can be used to remove the fluid and relieve symptoms, but fluid will usually reaccumulate.
106
Growth, migration, and rotation of organs during development
responsible for the formation of the lesser sac and results in some organs being ‘pushed’ onto the posterior abdominal wall and becoming retroperitoneal.
107
Inguinal canal contents
Different between males and females
108
3 parts of the developing gut tube
Foregut
Midgut
Hindgut
109
Boundaries of foregut
Oesophagus—> Ends halfway along duodenum
110
Boundaries of midgut
Halfway along duodenum —> 2/3 of the way along the transverse colon
111
Boundaries of hindgut
2/3 of the way along the transverse colon —> ends at upper anal canal
112
Peritonitis
Inflammation/ infection of the peritoneum
113
Adhesions
Fibrous connections between the parietal and visceral peritoneum
Tethers organs to each other or to the abdominal wall
114
Ascites
Increased volume of peritoneal fluid
115
Visceral pain from foregut
Epigastrium
116
Visceral pain from midgut
Umbilicus
117
Visceral pain from hindgut
Suprapubic region
118
Structures in left upper quadrant
Spleen
Stomach
119
Structures in right upper quadrant
Liver
120
Which abdominal visceral are protected by the ribs
Spleen
Liver
121
Which quadrant contains the appendix
Right lower quadrant
122
Which artery supplies the foregut structures
Celiac trunk
123
Which artery supplies the midgut structures
Superior mesenteric artery
124
Which artery supplies the hindgut structures
Inferior mesenteric artery
125
Anterior superior iliac spines (ASIS)
Most anterior point of pelvis
126
Which side of the vertebral column is the descending aorta
Patient’s left
127
Which side of the vertebral column is the inferior vena cava
Patient’s right
128
Tubercles of iliac crests
Widest part of pelvis
129
How to identify McBurney’s point
2/3 of the way along a line drawn from the umbilicus to the right ASIS
130
What layer lies between the parietal peritoneum and transversus abdominis
Transversalis fascia
131
What parts of the large intestine are intraperitoneal
Transverse colon
132
What parts of the large intestine are retroperitoneal
Ascending and descending colon
133
What connects the small intestine and colon to the POSTERIOR abdominal wall
Mesenteries
134
What hangs over the anterior surface of the abdominal viscera
Omenta
135
What is the inferior border of the abdominal cavity
Inguinal ligaments / pubic tubercles and pubic symphysis
136
What layer of tissue lies directly below the skin in the midline
Camper’s fascia- fatty layer of superficial fascia
137
Camper’s fascia
Fatty layer of superficial fascia directly below the skin
138
Scarpa’s fascia
Membranous layer to superficial fascia
Lies deep to Camper’s fascia
139
What lies deep to camper’s fascia
Scarpa’s fascia
140
Which nerves supply sensation to the anterior abdominal wall
Thoraco-abdominal nerves (T7-T11)
Iliohypogastric nerve (L1)
Ilioinguinal nerve (L1)
Subcostal nerve (T12)
141
Position of IVC and abdominal aorta in abdomen
IVC = right
Aorta = left
142
Which nerves supply the parietal peritoneum
Thoracoabdominal and subcostal nerves
143
What lies between the transversalis abdominus and parietal peritoneum
Transversalis fascia
144
What goes through the diaphragm at T12
T12
aorta perforates the diaphragm
thoracic duct perforates the diaphragm
azygous vein perforates the diaphragm
coeliac trunk leaves the aorta
