Anterior abdominal wall/inguinal Flashcards
What are the 9 regions of the abdominal wall?
- RH = right hypochondriac
- LH = left hypochondriac
- RL = right lateral
- LL = left lateral
- RI = right inguinal
- LI = left inguinal
- ER = epigastric
- UR = umbilical
- HR = hypogastric
What are the 4 quantrants of the abdomen
- RUQ = upper right
- LUQ = upper left
- RLQ = lower right
- LLQ = lower left
What are the 4 planes of the abdomen?
A.Subcostal
B.Transumbilical
C.Transtubercular
D.Midclavicular
What makes up the arterial and venous anastomoses in the abdomen?
branches of the internal thoracic (from subclavian), inferior epigastric (from internal iliac), superficial circumflex iliac + musculophrenic
What makes up the venous anastomosis between the systemic and portal circulation? Why is it important?
The Paraumbilical veins. This is clinically significant in cases of portal hypertension.
Where does the substantial superficial venous network within the superficial fascia drain into?
the deep veins of the upper and lower extremities
Why is the transumbilical plane important?
Its an important landmark in normal venous and lymphatic drainage of the superficial tissues: above the plane, drainage is in the cranial direction; below the plane, drainage is in the caudal direction
How many muscle layers are there in the abdomen? Which direction do they run? What specific muscles are they in the abdomen?
3, perpendicular, rectus abdominis and quadratus lumborum
How is the blood supply and nerves arranged in the abdomen?
segmentally
What is the difference btwn the two fascia layers in the abdomen?
Outer, fatty layer (CAMPER’S)-Continues into thigh and perineum. Fatty layer of labia majora.Fuses with deep layer before continuing into external genitalia.
Deep, fibrous layer (SCARPA’S membranous layer) Confined to lower abdominal wall. Nearly devoid of fat. Attaches to the deep fascia of the thigh (fascia lata) just below the inguinal ligament. Fuses with the superficial layer in the scrotum to form the dartos layer.Forms Colles’ fascia in the perineum (also known as the superficial perineal fascia)
What is the clinical significant for the two layers of fascia?
Surgical wound closure. The potential space between Camper’s and Scarpa’s fasciae is susceptible to to fluid or pus accumulation
Tell me more about the different layers of Scarpa fascia?
Membranous layer is deeper and confined to abdomenal wall. Membranous layer connects to fascta lata below inguinal ligament
Why is the arrangement of scarpas fascia clinically important?
fluid from the perinuem (blood, urine, pus) can accumulate in this space and even into the lower abdomen. but will not enter anterior thigh
What are the anterolateral abdominal wall consists muscles? Hint: 3 pair of flat muscles and two others
External Oblique Muscles
Internal Oblique Muscles
Transverse Abdominis Muscles
and
1 pair of midline vertical muscles
Rectus Abdominis
Where in a transverse section is the peritoneam, thoracolumbar facia, tansversalic fascia and the extraperitoneal fat?
Tell me more about the transversalis fascia?
lies deep to the muscle layers, it is the deep fascial layer of the abdomen (endoabdominal fascia) and forms a continuous sheet of fascia lining the inner abdominal wall, analogous to the endothoracic fascia.
What lies deep to the TF? What lies deeper than that?
extra-peritoneal fat, deeper still is the peritoneum, the serous membrane lining the abdominal cavity (akin to the parietal pleura).
Picture where the external oblique is, inguinal ligament, linea abna
Where is the orgin and insertion of the external oblque?
Origin: external surfaces of ribs 5-12, thoracolumbar fascia
Insertion: linea alba, pubic tubercle, iliac crest
Picture the external oblque? What is its function along with the IO?
What is the orgin and insertion of the IO?
Origin: thoracolumbar fascia, anterior 2/3 of iliac crest, lateral half of inguinal ligament
Insertion: inferior borders of ribs 10-12, linea alba, pubic crest and pectineal line (via conjoint tendon)
Picture the transversus abdominus? What is its function?
What is the origin and insertion of the transversus abdominis?
Origin: internal surface of ribs 7-12, thoracolumbar fascia, iliac crest, lateral third of inguinal ligament
Insertion: linea alba, pubic crest and pectineal line (conjoint tendon)
Picture the Rectus abdominin, Rectus sheath and
Tendinous intersections
What is the rectus shealth made up of?
aponeuroses of the three flat abdominal muscles
Where deos the Rectus abdominis run with? and whats its function?
runs from the pubic crest to the xiphoid process and nearby ribs 5-7. Flexes the trunk and compresses abdominal viscera.
What anchors the muscles to the anterior layer of the rectus sheath
tendinous intersections
What are the Rectus Abdominis and the three flat muscles of the anterolateral abdominal wall innvervated by?
T7-T12 inter/sub-costal nerves and L1 (iliohypogastric and ilioinguinal divisions)
Picture the Superior epigastric artery and the Inferior epigastric artery, what are the branches of? ITS DIFFERENT!
Where deos the inferior epigastric vessels enter the rectus shealth? Why is this anatomsos important?
at the articulate line, it offers one alternate route to the lower extremity in the event of narrowing of the abdominal aorta
What is the artuclate line?
the inferior border of the posterior leaflet of the rectus sheath.
Picutre where the acruate line is?
Where does the arcuate line go in regards to the inferior epigastic vessels?
Tell me about the shealth that enclosed the rectus abdominus muscle?
it composed of combinations of anterior and posterior laminae of the aponeurotic portions of the oblique muscles. The anterior layer of the rectus sheath provides points of attachment, tendinous intersections (inscriptions), to the anterior layer of the rectus muscles.
What is the relationship between the arcuate line and the rectus shealth? What is above the arcuate line?
The arcuate line is the crescentic lower border of the posterior layer of the rectus sheath. Above the arcuate line, the anterior layer is formed by the aponeurosis of the external oblique and the internal oblique; below the arcuate line, by all three aponeurosis
What lines the entire abdominopelvic cavity and is separated from the peritoneum by a layer of fat-filled extraperitoneal connective tissue
transversalis fascia
Picture of section above the arcuate line?
What happens below the arcuate line>
all three muscle layers of aponeuroses pass anterior to the rectus muscle.
What forms the posterior layer of the rectus shealth BELOW the arcuate line>
The transversalis fascia, extraperitoneal fat, and parietal peritoneum
What is the clinical significance of the arrangement of the rectus shealth?
abdominal hernias
What is a spigellian hernia?
Hernia of the semilunar line-common in obses people, they are ventral hernias occurring through the spigelian fascia along the Spieghel’s semilunar line and lie under the external oblique aponeurosis just outside the outer border of the rectus or “six-pack” muscles. AKA spigelian hernia belt
Who gets a spigellian hernia? Symptoms? Dx?
Women, around 50, The symptoms may vary from well-localized constant abdominal pain with or without palpable lump to vague inconstant ache. Clinically it is difficult to feel a definite bulge or a hernial defect as they are typically submuscular.
DX: ultrasound or CT
TX: surgical- orgen tension free technique
What is an umbilical hernia? Who is it common in?
hernia through umbilicus, common in newborns, women obese people
What is an epigastric hernia? Who gets it?
through the linea alba in the epigastric region- obsesity
All hernias are asscoaited with…
aging, obseity, trauma, srugery, congenital
What are the boundaries of the inguinal canal?
roof: arches of IO and TA, conjoint tendon
floor: turned under inferior border of EO
anterior wall: EO aponeurosis reinforced laterally by IO
posterior wall: transversalis fascia laterally, conjoint tendon medially
What are the openings of the canal?
deep inguinal ring, a normal ‘defect’ in the transversalis fascia
superficial ring, opening in EO, surrounded by medial and lateral crura and intercrural fibers
Picture of the inguinal canal
Where does the spermatic cord exit the abdominal cavity?
lateral to the inferior epigastric vessels, under the arch of transversus abdominis. Muscle fibers from IO elongate as the cremaster muscle, and become one of the coverings of the spermatic cord, the cremasteric fascia.
What determines the decent of the tests? What do they develop from>
gubernaculum, develop from undifferentiated gonads on posterior abdominal wall
When does th edecent of the testes begin? When is it complete?
decent begins at 7th month, decent is normally compete at birth
What are the ductus deferens and the neurovasular supply attached to?
superior pole
What connects the inferior pole of the gonad to the labrioscrotal folds
The gubernaculum, a cord of connective tissue, (undifferentiated, at this time).
What is the path of the processes vaginalis
Crosses the pelvic brim, passes though the transversalis fascia (forming the deep inguinal ring) and under the arch of transversus abdominis. GOes over the abdominal wall for a short distance medially, then pushes anteriorally through the superfiical inguinal ring, following the gubernauculum
What are the borders of the inguinal triangle
Inguinal ligament-inferiorally
Inferior epigastric vessels-laterally
Lateral border of rectus abdominis-medially
What nerve lines withint the spermatic cord
gentiofemoral nerve
where does ilioinguinal nerve lie
inguinal canal but lateral to the cord
Know the tunica vaginalis, parietal and visceral layers along with the epididymis of the scrotum
What are indirect ingional hernias assocaited with?
assocaited with congeital patent processus vaginalis, connection bwtn the abdominal cavity and scrotum is open
Where does a indirect inguinal hernia exit from?
exits abdominal cavity lateral to the inferior epigastric vessels. The hernia follows the path taken by the testes as they “descended”: deep ring, inguinal canal, superficial ring, scrotal sac. It is surrounded by the layers of the spermatic cord. The hernial sac may advance into the scrotal sac.
Where is an direct hernia? What is it due to? Where does it go?
lies medial to the inferior epigastric vessels. It is usually a result of increased intra-abdominal pressure pushing on the weak area, the inguinal triangle. The hernial sac protrudes into the abdominal wall, but not into the scrotum.
Who gets direct hernias?
Men weightliftors
What is a variocolcele causes by?
dilation of the tortuous veins of the pampiniform plexus
What side is more common in a vaciococele
left side, due to venous drainage of left testucular vein into the left renal vein as opposed to the right testicular vein, which drains directly into the inferior vena cava
When does a varicocele feel alright-when the patient is in what postion?
laying down.
What are consquences of a varicocele?
decreace sperm production and fertility, due to congested blood flow that can rise the temp around the testes
What is a hydrocele?
fluid in the tunica vaginalis,
what is the cause of a hydrocele?
infection of the testis, or epididymis, trauma, tumor or it may be idiopathic
What goes the gubernaculum attach to in a female?
uterus
What becomes the ovarian ligament or round ligament of the ovary
gubernaculum between the ovary and the uterus
what becomes the round ligament of the uterus
The part which lies between the uterus and the labia majora, which traverses the inguinal canal, and which is visible at the superficial ring. It persists in the inguinal canal and attaches to the labia majora
What are the three folds in the internal surface of the anteriolateral abdominal wall?
Umbilical Folds:
Lateral (2)
Medial (2)
Median (1)
What does the median umbical fold cover?
the median umbilical ligament (remnant of the urachus). The urachus is an remnant of the embryonic allantois.
What does the Medial umbilical folds cover?
medial umbilical ligaments (or the obliterated umbilical arteries).
what does the lateral umbilical folds cover?
covering the inferior epigastric vessel
What is wrong in a femoral hernia?
the hernial sac exits the abdominal cavity, inferior to the inguinal ligament within the femoral sheath.
What layer is the internal spermatic fascia derived from?
fascia transfersalis-
What layer is the cremaster muscle and fascia derived from?
internal oblique
Whta layer is the external spermatic fascia derived from
external oblique
