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Anatomy CAM202 > Anterolateral Abdominal Wall > Flashcards

Anterolateral Abdominal Wall Flashcards

1
Q

What is the Abdominopelvic Cavity?
What is it bounded by?
What does it further divide into?- at which level.

A

• Bounded by diaphragm superiorly & pelvic diaphragm inferiorly
• It is a single cavity that is further divided into the abdominal cavity proper & pelvic cavity at the level of the superior pelvic aperture (pelvic brim); note that there is no real physical separation between the abdominal & pelvic cavities
o No real separation; but the peritoneum does end around this area, and the nerve supplies differ

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2
Q

What is the skeleton of the Abdomen?

A
  • The lower ribs provide some support & protection of the upper abdominal contents
  • The upper abdominal contents are protected by ribs 6-12, posteriorly the lumbar vertebrae and inferiorly the ala (wing) of ilium and superior sacrum offer support and some protection
  • Conversely, the ribs can damage the liver & spleen if broken following trauma to the rib cage
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3
Q

What are the layers of the anterolateral wall?

A 
•	Skin & superficial fascia. 2 layers;
o	Fatty/Camper’s fascia
o	Very thin, slightly tougher layer: Membranous/Scarpa’s fascia
•	External abdominal oblique
•	Internal adominal oblique  
•	Transversus adbominus
•	Transversalis (endoabdominal) fascia
•	Extraperitoneal fat				bottom 3 fused in cadavers
•	Parietal peritoneum
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4
Q

Muscles: External Abdominal Oblique- direction of fibres? Action? Innervation?

A

‘hands in pockets’

  • Compress & support abdominal viscera
  • Flex and laterally rotate the trunk

T6-T12, L1 ventral rami of spinal nerves

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5
Q

Internal Abdominal Oblique - direction of fibres? Action? Innervation?

A

at 90 degrees run opposite to external, but lower region is more horizontal, similar to transversus abdominus
- Compress & support abdominal viscera
- Flex and laterally rotate the trunk
T6-T12, L1 ventral rami of spinal nerves

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6
Q

Transversus abdominus

direction of fibres? Action? Innervation?

A

Transverse direction

  • Compress & support abdominal viscera
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7
Q

Rectus Abdominus

A

2 double, strap like muscles running downwards
(normally hidden as the EO aponeurosis is usually covering it)

  • Flexes the trunk
  • Compresses abdominal viscera
  • Controls the tilt of the pelvis
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8
Q

Pyramidalis

A

About 80% of the population have a small muscle in the anterior rectus sheath at the lower end of the rectus abdominus

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9
Q

What aponeuroses are at the rectus sheath?

A

• Rectus sheath = aponeuroses of EO (external oblique), IO, TA (transversus abdominus)
• Note there are differences between the superior ¾ and inferior ¼ of the rectus sheath.
o The anterior rectus sheath superiorly consists of the EO aponeurosis & half of the IO aponeurosis, whilst posteriorly it consists of half of the IO aponeurosis & TA aponeurosis
o Just below the level of the umbilicus (arcuate line), the EO, IO & TA aponeuroses all pass in front of rectus abdominus (only thing left behind is the transversalis fascia)
o The level at which the posterior rectus sheath stops = arcuate line
• Reinforce abdominal wall creating an incomplete compartment around rectus abdominus (and pyramidalis).

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10
Q

What does the rectus sheath contain?

A

• Contains the superior & inferior epigastric arteries and veins, lymph vessels & distal portions of the thoracoabdominal nerves & abdominal portions of anterior rami of spinal nerves T7-12

Anchor the rectus muscle to the anterior rectus sheath
o Linea alba (white line) = tendinous portion between the two rectus muscles
o Linea semilunaris: between the rectus & oblique muscles
o Tendinous intersections within the rectus abdominus

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11
Q

Internal Surface of the Anterolateral Abdominal wall- what liament/folds are here?

A

If peritoneum is on top of the structure it’s a fold

Median umbilical ligament/fold – formed by the fibrous remnant of the urachus that joined the bladder to the umbilical cord

Medial umbilical ligaments/folds are formed by the remnants of the umbilical arteries

Lateral umbilical fold is formed by the inferior epigastric vessels (in adults)

Ligamentum teres hepatis (round ligament of liver) is a remnant of the umbilical vein & a fold of peritoneum the Falciform ligament

Hesselbach’s (inguinal) triangle
o Between rectus abdominus & epigastric vessels is a thin layer which is a weak area

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12
Q

Where is the neurovascular plane located?

A

• Neurovascular plane located between internal oblique & transversus abdominus OR posterior to the rectus abdominus

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13
Q

Thoracoabdominal nerves are the distal parts of WHICH intercostal nerves?

A

• Thoracoabdominal nerves are the distal parts of T7-T11 intercostal nerves.

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14
Q

Which intercostal nerves suplply skin above the umbilicus?

A

o T7-9 supply skin above the umbilicus

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15
Q

Which intercostal nerves supply skin around the umbilicus?

A

o T10 supplies skin around the umbilicus

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16
Q

Which intercostal nerves supply skin below the umbilicus?

A

• Below the umbilicus is supplied by the subcostal nerve (T12) and the iliohypogastric & Ilioinguinal nerves (L1)

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17
Q

Which arteries supply the anterolateral abdominal wall?

A

Superior epigastric
o Continues from internal thoracic artery
o Run just behind rectus abdominus

Inferior epigastric
o From external iliac artery
o Run just behind rectus abdominus.
• Also:

Musculophrenic branches (come down onto the sides), Deep circumflex iliac ⇒ from external iliac

Lumbar/posterior intercostal, Superior circumflex iliac and superficial epigastric ⇒ from the femoral artery

Provide indirect anastomoses between arch of aorta & abdominal aorta

18
Q

Which veins drain the anterolateral abdominal wall?

A

Deep veins – as for arteries

Superficial veins subcutaneous venous plexus can drain to:
o internal thoracic veins superomedially
o the lateral thoracic vein superolaterally
o the superficial & inferior epigastric veins inferiorly

Anastomoses also occur with the paraumbilical veins
o Paraumbilical veins
-Lateral thoracic, superficial epigastric veins
- Clinically Important in someone with chronic liver disease (varicose veins)
• The superficial veins are of clinical significance as they provide collateral pathways if SVC or IVC is blocked (eg portal hypertension)

19
Q

Lymphatics of the Anterolateral abdo wall

A

• Superficial
o Above umbilicus: to anterior axillary nodes or parasternal nodes
o Below umbilicus: to superficial inguinal nodes
• Deep: to external iliac, parasternal, lumbar nodes

20
Q

What is the inguinal canal?

A

• A passage through anterior abdominal wall from deep inguinal ring to superficial inguinal ring, connecting the extraperitoneal space of the abdomen with the scrotum or labia majora.
• In the male, it contains the spermatic cord; in females the round ligament of uterus.
o Also blood & lymph vessels and the ilioinguinal nerve
• It is formed to allow the testis which develop in the extraperitoneal connective tissue of the posterior abdominal cavity to move to the scrotum where the temperature is slightly lower. In about 3% of males (30% of premature births) the testis (usually unilaterally) is undescended.
o Undescended testes have a high risk of malignancy.
o Connects extraperitoneal space of abdomen (not going into abdominal space) to the scrotum (male) or labia majora (women)

21
Q

Development of the Inguinal Canal: Descent of the gonads- what are the first two steps?

A
  1. Gubernaculum (genitoinguinal ligament) runs from the gonadal ridge (testis in males) to the inguinal region, through abdominal wall, to labioscrotal swelling
  2. An out-pouching (evagination) of the parietal peritoneum (Processus vaginalis) follows the gubernaculum to scrotum
    a. The processes vaginalis is immediately anterior to the gubernaculum in the inguinal canal
    b. As the processus vaginalis descends, it pulls with it the layers of the anterior abdominal wall, which fuse together to form a fibrous process
22
Q

Development of the Inguinal Canal: Descent of the gonads- what are the LAST steps?

A
  1. The testes (with their nerves & vessels) descend into the scrotum via the processus vaginalis
  2. The stalk of the processus vaginalis is obliterated leaving a small remnant of the parietal peritoneum surrounding the testis called the tunica vaginalis
  3. Ovaries descend to the pelvis (gubernaculum becomes round ligament of uterus)
23
Q

The adult inguinal canal

A
  • Transmits spermatic cord, round ligament to uterus in females
  • Inguinal canal is located just superior to the inguinal ligament which runs from the ASIS to the pubic tubercle.
  • The inguinal ligament is formed from the thickened free edge of external oblique aponeurosis & forms the floor of the inguinal canal (ie inguinal canal sits on top of inguinal ligament)
24
Q

What does the spermatic cord contain?

A

• The spermatic cord contains:

o ductus deferens, testicular vessels, lymphatics & nerves

25
Q

External Oblique aponeurosis

A

• The thickened inferior free edge forms the inguinal ligament
o which forms the floor of the inguinal canal (inguinal canal sits on top of inguinal ligament)
o Inguinal ligament = DCT running from ASIS to pubic tubercle
• Contributes to the anterior wall of inguinal canal &
• A gap in aponeurosis forms the superficial inguinal ring (just superior to the pubic tubercle).
• Forms the external spermatic fascia of the spermatic cord.

26
Q

Internal Oblique Aponeurosis

A
  • Contributes to anterior wall of inguinal canal laterally (anteriorly to deep inguinal ring)
  • Contributes to the roof of inguinal canal & to the conjoint tendon, which forms the posterior wall medially.
  • Forms the cremaster muscle & fascia of the spermatic cord
27
Q

Transverse Abdominus

A
  • DOES NOT contribute to the spermatic cord
  • Forms the roof of inguinal canal
  • Fuses with IO to from the conjoint tendon forming the posterior wall medially (posterior to the superficial inguinal ring)
28
Q

Transversalis Fascia

A
  • continuous with the femoral sheath
  • Forms the posterior wall of the inguinal canal
  • Evagination of this layer forms the deep inguinal ring – near the midpoint, and about 1-2cm superior to the inguinal ligament, and lateral to inferior epigastric vessels
  • Follows down spermatic cord to form the internal spermatic fascia of the spermatic cord
29
Q

Posterior to the inguinal canal

A

Deep to the deep ring, the testicular vessels, ductus deferens separate & travel in different directions. All are extraperitoneal

30
Q

What forms the ANTERIOR WALL of the INGUINAL CANAL?

A
  • External oblique aponeurosis

- Internal oblique laterally

31
Q

What forms the POSTERIOR WALL of the INGUINAL CANAL?

A
  • Transversalis fascia to parietal peritoneum

- Conjoint tendon medially

32
Q

What forms the FLOOR WALL of the INGUINAL CANAL?

A
  • Inguinal ligament mainly

- Lacunar ligament medially

33
Q

What forms the ROOF WALL of the INGUINAL CANAL?

A
  • Internal oblique

- Transversus abdominus (forms roof & fuses with IO to form conjoint tendon)

34
Q

Compare the layers of the abdominal wall, spermatic cord and testes

A
35
Q

Inguinal Canal Contents- Male

A

Male – The Spermatic Cord
• Spermatic cord contains:
o ductus (vas) deferens, testicular artery and pampiniform plexus of vv (testicular vv), genital branch of genitofermoral nerve, lymphatics, autonomic nerves, other vessels
o Fascia layers: external spermatic, cremasteric, internal spermatic & the Inguinal branch of ilioinguinal nerve (sits more on outside)
• Testes sit outside as need a slightly lower temperature – fertility reasons

36
Q

Inguinal Canal Contents- Female

A
  • Round ligament of uterus, genital branch of genitofemoral nerve, vessels & fascia layers
  • Inguinal branch of ilioinguinal nerve
37
Q

Inguinal Triangle (Hesselbach’s) what are the boundaries?

A

• Boundaries
o Rectus abdominus
o Inferior epigastrics
o Inguinal ligament
• Note also the location of the femoral ring just below the inguinal ligament & the location of the Deep inguinal ring lateral to the inferior epigastrics.
• Prone to weakness over time
o Directly on the other side is an opening which is the superficial ring

38
Q

What is the classification of inguinal hernias?

A

Inguinal hernias classified as direct or indirect

39
Q

What is an indirect inguinal hernia?

A

o Originates lateral to inferior epigastric vessels
o Passes through the deep inguinal ring into inguinal canal (thus ‘indirectly’ through abdominal wall) & exits via the superficial ring
o Predisposing factor: congenitally patent processus vaginalis
• vulnerable, too large, too much intra-abdominal pressure

40
Q

Direct Hernia

A

o Starts medial to inferior epigastric vessels & passes directly through the anterior abdominal wall (inguinal triangle region)
• Doesn’t go through deep ring, pushes through the anterior abdominal wall & then out through the superficial ring
• Becomes a problem when some of the bowel comes through, cuts off blood supply to bowel & bowel dies.

Anatomy CAM202 (7 decks)

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