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Gross III Exam 2 > Anterolateral Abdominal Wall > Flashcards

Anterolateral Abdominal Wall Flashcards

0
Q

What makes up the superficial fatty layer

A

campers fascia
superficial fascia just deep to the dermis
–may be several inches thick

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1
Q

What are the two parts of the superficial fascia

A

superficial fatty layer

deep membranous layer

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2
Q

What makes up the deep membranous layer of the anterolateral abdominal wall

A
  • scarpas fascia
  • thin layer of dense irregular connective tissue overlying deep fascia
  • allows for independent movement of superficial and/or deep fasci
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3
Q

What is the deep membranous layer continuous with

A

dartos and colles fascia of scrotum and perineum

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4
Q

What is deep investing fascia

A

dense irregular connective tissue surrounding abdominal muscles and their aponeurosis

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5
Q

What is another name for the endoabdominal fascia

A

Tranversalis fascia on the anterolateral abdominal wall

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6
Q

What is the endoabdominal fascia

A

Loose connective tissue between muscles/aponeuroses and parietal peritoneum

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7
Q

What does the endoabdominal fascia provide

A

potential plane for surgical dissection for extraperitoneal and/or intraperitoneal organs

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8
Q

What is liposuction

A

suction or ultrasound assisted suction to remove unwanted fat from superficial fatty layers

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9
Q

What are the clinical issues regarding fascial layers

A
  • Deep membranous layer is always included when suturing incisions
  • Potential space exists between scarpas and the deep fascia
  • -urine from a ruptured urethra may accumulate here
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10
Q

What direction are the muscles fibers oriented in the external oblique

A

inferolaterally (hands in pocket)

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11
Q

What is the origin for the external oblique

A

Ribs 5-12

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12
Q

What is the insertion of the external oblique

A

Linea alba, pubic tubercle, and anterior 1/2 of iliac crest

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13
Q

What is the action of the external oblique

A

compress abdominal viscera, flex, and rotate trunk

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14
Q

What is the innervation of the external oblique

A

T6-T11 thoracoabdominal nn

subcostal n

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15
Q

Where does the aponeurosis of the external oblique begin

A

approximately midclavicular line–linea semilunaris

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16
Q

Where does the external oblique aponeurosis decussate

A

Midline–at linea alba

–Fibers intertwine with contralateral abdominal wall mm

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17
Q

What does the inferior margin of the external oblique aponeurosis do

A

Thicken and rolls underneath to form the inguinal ligament

  • extends from the ASIS to pubic tubercle
  • anterosuperior attachment point for fascia lata
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18
Q

How are the fibers oriented in the internal oblique

A

Anteromedially from ASIS

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19
Q

What is the origin of the internal oblique

A

Thoracolumbar fascia, anterior 2/3 of iliac crest and inguinal ligament

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20
Q

What is the insertion of the internal oblique m

A

Ribs 10-12, linea alba and pectin pubis

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21
Q

What is the action of the internal oblique m

A

compress abdominal viscera, flex, and rotate trunk

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22
Q

What is the innervation of the internal oblique muscle

A

T6-11 thoracoabdominal nn
subcostal nn
iliohypogastric nn
ilioliguinal nn

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23
Q

Where does the aponeurosis for the internal oblique m begin

A

approximately at midclavicular line (linea semilunaris)

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24
Q

How is the conjoint tendon formed

A

inferomedial fibers of internal oblique m aponeurosis join with aponeurotic fibers of transversus abdominis m

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25
Q

What does the conjoint tendon form

A

medial part of posterior wall of inguinal canal

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26
Q

Which direction do the fibers run for the transversus abdominis

A

transversomedially

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27
Q

What is the origin of the transversus abdominis

A

Thoracolumbar fascia, ribs 7-12, iliac crest and inguinal ligament

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28
Q

Where does the transversus abdominis insert

A

linea alba, pubic crest, and pectin pubis (via conjoint tendon)

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29
Q

What is the action of the transversus abdominis

A

compress and support abdominal viscera

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30
Q

What is the innervation of the transversus abdominis

A

T6-11 thoracoabdominal nn
subcostal nn
iliohypogastric nn
ilioinguinal nn

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31
Q

Where does the Transversus abdominis aponeurosis begin

A

approximately at midclavicular line (linea semilunaris)

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32
Q

What does the transversus abdominis aponeurosis contribute to

A

rectus sheath

–posterior above arcuate line, anterior below

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33
Q

What are the physical characteristics of the rectus abdominis mm

A

superior: wider and thinner
inferior: narrower and thicker

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34
Q

How is the rectus abdominis attached to the rectus sheath

A

3 tendinous intersections

–create six pack, but one or more may be missing

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35
Q

Where is the linea alba located

A

midline between 2 rectus abdominis mm

36
Q

Where is the linea semilunaris located

A

lateral margin of each rectus abdominis m

37
Q

What is the origin of the rectus abdominis

A

pubic symphysis and pubic crest

38
Q

What is the insertion of the rectus abdominis

A

xiphoid process and costal cartilages 5-7

39
Q

What is the action of the rectus abdominis m

A

flexes the trunk and compresses abdominal viscera

40
Q

What is the innervation of the rectus abdominis

A

T6-T11 thoracoabdominal nn

subcostal nn

41
Q

What is the pyramidalis m

A

Small triangular muscle overlapping inferior portion of rectus abdominis m

  • spans between pubis and linea alba
  • functions to tense linea alba
42
Q

What are the combined function of the anterior abdominal wall muscles

A

-move trunk and maintain posture
-protect abdominal viscera
-compress abdominal viscera assists in:
>elevating thoracic diaphragm during forced expiration, coughing
>defecation (Jim: That means taking a dump)
>Micturition
>Partuition

43
Q

What is the rectus sheath

A

fibrous envelope surrounding rectus abdominis m

44
Q

What forms the rectus sheath

A

decussation/interweaving of aponeuroses of lateral abdominal wall mm

45
Q

What is the linea alba

A

midpoint of the decussation of the rectus sheath

46
Q

What is the umbilical ring

A

defect in libea alba through which fetal umbilical aa an v passed
–all lateral abdominal wall aponeuroses fuse at umbilicus

47
Q

What is the linea semilunaris

A

transition to aponeurosis for each of the lateral abdominal wall mm

48
Q

What is the arcuate line

A

located on posterior rectus sheath about 1/4 up from pubic crest
-landmark for structural change in posterior rectus sheath

49
Q

What is the decussation

A

aponeurotic fibers intertwine across the midline

–intertwining occurs both within and between aponeurotic strata

50
Q

What is the anterior rectus sheath superior to the arcuate line composed of

A

aponeurosis of external oblique m

anterior lamina of aponeurosis of internal oblique m

51
Q

What is the posterior rectus sheath superior to arcuate line composed of

A 
posterior lamina of aponeurosis of internal oblique m
aponeurosis of transversus abdominis m
Transversalis fascia
extra peritoneal fat
parietal peritoneum
52
Q

What is the anterior rectus sheath inferior to the arcuate line composed of

A

aponeurosis of external oblique m
aponeurosis of internal oblique m
aponeurosis of transversus abdominis

53
Q

What is the internal surface of anterior abdominal wall inferior to arcuate line is composed of

A

Transversalis fascia
extraperitoneal fat
parietal peritoneum

54
Q

What is a congenital umbilical hernia

A

usually small and due to incomplete aponeurotic fusion around umbilical ring

55
Q

What is an acquired umbilical hernia

A
  • most common in women and obese people
  • may occur as weakness in the anterior abdominal wall arises
  • -possible causes include aging, obesity, surgery, and trauma
56
Q

What is a epigastric hernia

A
  • occur midline between xiphoid process and umbilicus
  • usually in obese people over the age of 40
  • consists of peritoneal sac covered only by skin and fatty tissue
57
Q

What are and where are the thoracoabdominal nn found

A
  • Anterior abdominal branches of VPR of T6-T11
  • In plane between internal oblique and transversus abdominis
  • –become more superficial while passing anteromedially
58
Q

What does the thoracoabdominal nn innervate

A

Abdominal wall mm and skin in corresponding dermatomes

59
Q

Where does the thoracoabdominal nn branch from and where does it terminate

A

branch to form lateral cutaneous nn

terminate as anterior cutaneous nn

60
Q

What is the subcostal n

A

anterior continuation of VPR of T12

61
Q

What does the subcostal n innervate

A

lateral abdominal wall mm

62
Q

What dermatome is the subcostal n associated with

A

sensory for T12 dermatome via lateral or anterior cutaneous nn

63
Q

What is the iliohypogastric n

A

superior terminal branch of VPR of L1

–anterior cutaneous component pierces external abdominal oblique m

64
Q

What does the iliohypogastric n innervate

A

internal oblique and transversus abdominis

hypogastric skin and skin over iliac crest superior to inguinal canal

65
Q

What is the ilioinguinal n

A

inferior terminal branch of VPR of L1

  • -passes through inguinal canal with round l/spermatic cord
  • -exits via superficial inguinal ring
66
Q

What does the ilioinguinal n innervate

A

internal oblique and transversus abdominis

skin of anterior scrotum/labia majora, mons pubis, and medial thigh

67
Q

What are the posterior intercostal, subcostal, and lumbar aa

A

segmental branches from thoracic and/or lumbar descending aorta

68
Q

What are the posterior intercostal, subcostal, and lumbar aa supplying

A

lateral hypochondriac, right/left lateral (flank), and lumbar regions

69
Q

What is the musculophrenic a

A

one of two terminal branches of internal thoracic a in 6th intercostal space
–descends hypochondriac region and anterolateral thoracic diaphragm

70
Q

What does the musculophrenic a supply

A

hypochondriac region and anterolateral thoracic diaphragm

71
Q

What is the superior epigastric a

A

one of two terminal branches of internal thoracic a in 6h intercostal space
–descends between posterior rectus sheath and rectus abdominis m

72
Q

What does the superior epigastric a supply

A

rectus abdominis m, and upper umbilical region

–anastomoses with inferior epigastric a deep to rectus abdominis

73
Q

What is the inferior epigastric a

A

branches from external iliac a just superior to inguinal l

–ascends in transversalis fascia and enters rectus sheath inferior to arcuate line

74
Q

What does the inferior epigastric a supply

A

rectus abdominis m and lower abdominal region

–anastomoses with superior epigastric a deep to rectus abdominis

75
Q

What is the deep circumflex iliac a

A

branches from the external iliac a just superior to inguinal l.
–parallels inguinal l. to pass towards ASIS

76
Q

What does the deep circumflex iliac a supply

A

deep inguinal region

–anastomoses with iliolumbar a

77
Q

What is the superficial circumflex iliac a

A

branches from femoral a just inferior to inguinal l.

–parallels inguinal l. to pass towards ASIS

78
Q

What does the superior circumflex iliac a

A

supplies skin inguinal region

79
Q

What is the superficial epigastric a

A

branches from femoral a just inferior to inguinal l.

–ascends in superficial fascia towards umbilicus

80
Q

What does the superfical epigastric a supply

A

supply skin in pubic and lower umbilical regions

81
Q

What is the venous drainage superior to umbilicus

A

lateral thoracic v to axillary v to subclavian v

internal thoracic v to subclavian v

82
Q

What is the venous drainage inferior to umbilicus

A

inferior epigastric v to external iliac v

superficial epigastric v to femoral v to external iliac v

83
Q

What are the paraumbilical vv

A

small superficial tributaries of hepatic portal v

84
Q

What is the thoracoepigastric v

A

sometimes develop between lateral thoracic v and superficial epigastric v
–presence may indicate underlying problems with venous return

85
Q

Where do the superficial lymphatics drain

A

primarily: axillary nodes
sometimes: small percentage drain to parasternal nodes

86
Q

Where do the superficial lymphatics drain below the transumbilical plane

A

superficial inguinal nodes

87
Q

Where do the deep lymphatics of anterlateral abdominal wall drain to

A

nodes along external iliac a

Gross III Exam 2 (11 decks)

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