Anterolateral Abdominal Wall, Inguinal Region and Peritoneum Flashcards
1
Q
What is the space bounded by the abdominal walls, diaphragm, and pelvis?
A
abdominal cavity
2
Q
What does the abdominal cavity form the major part of?
A
abdominopelvic cavity
3
Q
What is enclosed anterolaterally by dynamic musculo-aponeurotic abdominal walls?
A
abdominal cavity
4
Q
What is separated superiorly from the thoracic cavity and posteriorly from the posterior thoracic vertebrae by the diaphragm?
A
abdominal cavity
5
Q
What is under the thoracic cage superiorly extending to the 4th intercostal space?
A
abdominal cavity
6
Q
What is continuous inferiorly with the pelvic cavity and is lined with peritoneum (a serous membrane)?
A
abdominal cavity
7
Q
Where is the location of most of the digestive organs, spleen, kidneys, and ureters for most of their course?
A
abdominal cavity
8
Q
What are the 4 quadrants of the abdomen?
A
- right upper quadrant
- right lower quadrant
- left upper quadrant
- left lower quadrant
9
Q
What are the 9 abdominal regions?
A
- right hypochondriac
- epigastric
- left hypochondriac
- right lateral
- umbilical
- left lateral
- right inguinal
- pubic
- left inguinal
10
Q
Where is the subcostal plane found in relation to the costal cartilages?
A
10th costal cartilage
11
Q
What regions are found in the subcostal plane of the abdomen?
A
- epigastric (E)
- umbilical (U)
- pubic (P)
- hypochondriac (H)
- lumbar (L)
- inguinal (I)
12
Q
Where can you find the transtubercular plane?
A
between the iliac tubercles and L5 vertebra
13
Q
Where can you find the transumbilical plane?
A
around the umbilicus and IVD L3-L4
14
Q
Where are these organs found?
- liver (right lobe)
- gallbladder
- stomach (pylorus)
- duodenum
- ascending colon (superior part)
- transverse colon (right half)
- pancreas (head)
- right suprarenal gland
- right colic flexure
- right kidney
A
right upper quandrant
15
Q
Where are these organs found?
- liver (left lobe)
- spleen
- stomach
- jejunum and proximal ileum
- pancreas (body and tail)
- left kidney
- left suprarenal gland
- left colic flexure
- transverse colon (left half)
- descending colon (superior part)
A
left upper quadrant
16
Q
Where are these organs found?
- cecum
- appendix
- most of the ileum
- ascending colon (inferior part)
- right ovary
- right uterine tube
- right ureter (abdominal part)
- right spermatic cord (abdominal part)
- uterus (if enlarged)
- urinary bladder (if very full)
A
right lower quadrant
17
Q
Where are these organs found?
- sigmoid colon
- descending colon (inferior part)
- left ovary
- left uterine tube
- left ureter (abdominal part)
- left spermatic cord (abdominal part)
- uterus (if enlarged)
- urinary bladder (if very full)
A
left lower quadrant
18
Q
Thoraco-abdominal nerves run from what levels?
A
T7-T11 + T12 (subcostal)
19
Q
What vertebral level dermatome supplied the nipple?
A
T4
20
Q
What vertebral level dermatome supplied the xiphoid process?
A
T7
21
Q
What vertebral level dermatome supplied the umbilicus?
A
T10
22
Q
What vertebral level dermatome supplied the groin/inguinal region?
A
L1
23
Q
The dermatomes of major landmarks follows what rule?
A
the rule of “3”
24
Q
What supplies sensory innervation to the skin on the anterior surface of the external genitalia and medial surface of the thigh after providing motor innervation to the anterolateral abdominal wall?
A
ilioinguinal nerve (L1)
25
What are the two layers of fascia of the abdominal wall?
- superficial fascia - fatty layer (Camper's fascia)
- superficial fascia - membranous layer (Scarpa's fascia)
26
What are the layers of the thorax from superficial to deep?
- skin/integument
- superficial fascia
- deep fascia
- muscle/bone
- endothoracic fascia
- cavity (serous sac and membranes)
27
What are the layers of the abdominal cavity from superficial to deep?
- skin/integument
- superficial fascia
**fatty: Camper's fascia
**membranous: Scarpa's fascia
- deep fascia (invests muscles)
- musculotendinous
- transversalis fascia (endoabdominal fascia)
- cavity (serous sac and membranes)
28
What is Scarpa's fascia only present between?
the umbilicus and inguinal region
29
What is the name for the parietal fascia of the thorax?
endothoracic fascia
30
What is the name for the parietal fascia of the abdomen?
endoabdominal fascia (transversalis fascia deep to the transversus abdominis muscles)
31
What is this describing:
- superficial thigh fascia
- pubis and perineum superficial perineal fascia
Fatty: Camper's fascia
32
What is this describing:
- fascia lata distal to inguinal region
- fuses linea alba and public symphysis
Membranous: Scarpa's fascia
33
What covers the abdominal muscles and spermatic cord?
deep fascia of the abdomen
34
What creates a "gutter" for the spermatic cord?
aponeurosis of the external oblique muscles
35
What are the 2 flat muscles that make up the anterolateral abdominal muscles?
- external oblique
- internal oblique
- transversus abdominis
36
What are the actions of the anterolateral abdominal muscles?
lateral flexion and rotation of the vertebral column; compression of abdominal content
37
What contributes to the anterior layer of the rectus sheath?
aponeurosis of external oblique
38
What contributes to the anterior and posterior layers of the rectus sheath?
aponeurosis of internal oblique
39
What contributes to the posterior layer of the rectus sheath?
aponeurosis of transversus abdominis
40
The external oblique muscle originates on what?
5th - 12th ribs
41
What does the external oblique muscle attach to?
- linea alba
- iliac crest
- pubic tubercle
42
What does the internal oblique muscle originate on?
- thoracolumbar fascia
- iliac crest
- CT-deep to inguinal ligament
43
What does the internal oblique muscle attach to?
- 10th-12th ribs
- linea alba
- conjoint tendon
44
What is the origination of the transverus abdominis?
- 7th-12th costal cartilage
- thoracolumbar fascia
- iliac crest
- CT-deep to inguinal ligament
45
What does the transversus abdominis muscle attach to?
- linea alba
- pubic crest (conjoint tendon)
46
What are the two vertical muscles in the anterolateral body wall?
rectus abdominis
47
What does the rectus abdominal muscle original on?
pubic symphysis and crest
48
What does the rectus abdominis muscle attach to?
xyphoid cartilage
49
What are the actions of the rectus abdominis?
- flex torso
- rotate torso
- compress and support viscera
50
What is the innervation of the external oblique muscle?
thoraco-abdominal and subcostal nerves (T7-T12)
51
What is the innervation of the internal oblique and transversus abdominis?
- thoraco-abdominal (T7-T11)
- subcostal and first lumbar nerve
52
What is the innervation of the rectus abdominis muscle?
thoraco-abdominal and subcostal nerves (T7-T12)
53
What are the actions of the external and internal oblique muscles?
- compresses and supports abdominal viscera
- flex and rotate trunk
54
What are the actions of the transversus abdominis muscle?
compresses and supports abdominal viscera
55
What are the actions of the rectus abdominis muscle?
- flexes trunk
- compresses abdominal viscera
- stabilizes and controls tilt of pelvis
56
What are the functions of the anterior abdominal wall?
- protection of abdominal organs
- postural support
- childbirth
- defecation and urination
- breathing
- coughing and singing
57
What forms a strong, expandable support for the abdominal region?
the muscles of the anterolateral abdominal wall
58
What protects the abdominal viscera from injury?
the muscles of the anterolateral abdominal wall
59
What compresses the abdominal viscera to maintain or increase intra-abdominal pressure?
the muscles of the anterolateral abdominal wall
60
What does compressing the abdominal viscera and increasing intra-abdominal pressure do?
- elevates the relaxed diaphragm to expel air (respiration, coughing, voluntary burping)
61
What produces the force required for defecation, micturition, vomiting, and parturition?
the muscles of the anterolateral abdominal wall
62
What produces anterior and lateral flexion and rotation of the trunk and help maintain posture?
the muscles of the anterolateral abdominal wall
63
What is the most inferior part of the external oblique aponeurosis?
inguinal ligament
64
What is the thickened inferior margin of the transversalis fascia?
iliopubic tract
65
The inguinal ligament and iliopubic tract extend from what?
anterior superior iliac spine to the pubic tubercle
66
Most of the fibers of the inguinal ligament insert into the pubic tubercle, but some fibers:
1. attach to superior ramus of the pubis lateral to the pubic tubercle as the lacunar ligament & continue to run along the pectin pubis as the pectineal ligament
2. arch superiorly to blend with the contralateral external oblique aponeurosis as the reflected inguinal ligament
67
The internal oblique aponeurosis superior to T10 has how many layers?
2 layers
- anterior sheath
- posterior sheath
68
Inferior to T10, what is missing posterior to the rectus abdominis muscle?
no rectus sheath posterior
69
Inferior to T10, what is in direct contact with the transversalis fascia since there is no aponeurosis on the posterior aspect of the rectus abdominis muscle?
rectus abdominis muscles
70
What is an area of demarcation visible from the peritoneal surface of the abdominal wall residing one-third the distance between the umbilicus and the pubis?
arcuate line
71
What is a good landmark to see the epigastric muscles?
arcuate line
72
What are the borders of the Hesselbach's triangle?
- lateral border of rectus abdominis muscle (medial)
- inferior epigastric vessels (lateral)
- inguinal ligament (inferior)
73
What type of hernia goes through the deep inguinal ring?
indirect hernia
74
What type of hernia goes through hesselbach's triangle?
direct hernia
75
What arteries branch off the internal thoracic artery?
- superior epigastric a
- musculophrenic a
76
What arteries branch off the aorta?
- intercostal (posterior)
- subcostal aa
77
What branches off the external iliac a?
- femoral a
- inferior epigastric a
78
What branches off the femoral a?
superficial epigastric a
79
What supplies the superior abdominal wall?
internal thoracic a
80
What supplies the middle abdominal wall?
aorta
81
What supplies the inferior abdominal wall?
external iliac a
82
If something gets blocked in the venous system, what can provide flow into the axillary vein?
thoraco-epigastric vein
83
What are the superficial veins of the abdominal wall?
- axillary v
- thoraco-epigastric v
- superficial epigastric v
- femoral v
84
What provides a potential collateral pathway for blood normally draining via the IVC to return to the heart via the SVC when the IVC is blocked?
a venous anastomosis between the superficial epigastric vein and the thoraco-epigastric vein
85
What do the superficial lymphatic vessels of the abdominal wall accompany?
the subcutaneous veins
86
Superficial lymphatic vessels superior to the umbilicus drain mainly into what?
axillary lymph nodes
87
What are the different lymphatics of the abdominal wall?
- transumbilical plan
- scrotum
- testis
88
What does the inguinal ligament run from?
from ASIS to pubic tubercle
89
What is the relationship between the inguinal canal and the gonads?
indirect hernias
90
What is a passage in the lower anterior abdominal wall located just above the inguinal ligament?
inguinal canal
91
What functions as a passageway for structures between the intra and extra-abdominal structures?
inguinal canal
92
What transmits the spermatic cord, gonadal vessels, and lymphatics in males?
inguinal canal
93
Usually indirect hernias are _________ related
gestationally
94
What is 2MALTS related to?
boundaries of the inguinal canal
95
What are the boundaries of the inguinal canal?
- superior/roof
** internal abdominal oblique
** transversus abdominis
- anterior
** external abdominal oblique aponeurosis
** internal abdominal oblique aponeurosis
- inferior/floor
** inguinal ligament
** lacunar ligament
- posterior
** transversalis fascia
** conjoint tendon
96
What overlies the superficial inguinal ring in the anterior wall of the abdomen?
conjoint tendon
97
What is the inferior border of the inguinal ligament?
- femoral a., v., n.
- lymphs
98
What is the superior border of the inguinal ligament?
- spermatic cord/round ligament of uterus
99
What are the layers of the spermatic cord?
1. internal spermatic fascia (transversalis fascia)
2. internal oblique and transversus abdominis (arcades)
3. cremasteric m. and fascia (IO)
4. external spermatic fascia (EO)
100
What has no contribution to the spermatic cord?
transversus abdominis muscle
101
What percent of all hernias are inguinal hernias?
75%
102
Of the inguinal hernias, how many are direct and how many are indirect?
25% are direct
50% are indirect
103
Direct hernias are due to what?
a defect in the abdominal wall (acquired)
104
Indirect hernias are usually what?
congenital
105
Inguinal hernias are rarely found where?
in the scrotum
106
Both direct and indirect hernias are more common in who?
males
107
What are predisposing factors of direct hernias?
- weak abdominal wall
- over 40 year old males
108
What is the frequency of direct hernias?
less common
109
What are the coverings at exit from abdominal cavities of the direct hernias?
peritoneum and F. transversalis
110
What is the course of direct hernias?
travels medial 1/3 of inguinal canal
111
Where do direct hernias exit from the anterior abdominal wall?
- superficial ring
- lateral to spermatic cord
- rarely enters scrotum
112
What is related to persistent processus vaginalis?
indirect hernias
113
What are the predisposing factors for indirect hernias?
- patent processus vaginalis
- younger male
114
What is the frequency of indirect hernias?
more common
115
What are the coverings at exit form the abdominal cavity for indirect hernias?
peritoneum + 3-fascial coverings of SC
116
What is the course of indirect hernias?
traverse entire inguinal canal
117
Where do indirect hernias exit from the anterior abdominal wall?
- superficial ring
- within spermatic cord
- commonly into scrotum/labia majus
118
What type of hernias happen in the upper abdomen at the midline?
epigastric
119
What type of hernias occur at the site of previous surgical incision?
incisional
120
What type of hernias occur at the navel?
umbilical
121
What type of hernias occur in the femoral canal?
femoral
122
What type of hernias occur near the opening of the inguinal canal?
direct inguinal
123
What type of hernias occur at the opening of the inguinal canal?
indirect inguinal
124
What are the subdivisions of the GIT?
- foregut
- midgut
- hindgut
125
What does the foregut give rise to?
- pharynx
- esophagus
- stomach
- cranial 1/3 of duodenum
- liver
- pancreas
- gallbladder
126
What develops independently in the GIT?
spleen
127
What is the blood supply of the foregut?
celiac artery (celiac trunk)
128
What does the midgut extend from?
1/3 the way along duodenum to about 2/3 the way across transverse colon
129
What does the midgut give rise to?
- caudal 2/3 of duodenum
- jejunum
- ileum
- cecum
- appendix
- ascending colon
- cranial 2/3 of transverse colon
130
What is the blood supply to the midgut?
superior mesenteric artery
131
What does the hindgut extend from?
2/3 the way across transverse colon to cloacal membrane (partition separating the endo derived cranial 1/2 of anal canal from ecto derived 1/2 of anal canal)
132
What does the hindgut give rise to?
- 1/3 transverse colon
- descending colon
- sigmoid colon
- rectum
- cranial 1/2 of anal canal
133
What is the blood supply to the hindgut?
inferior mesenteric artery
134
What lines the internal surface of the abdominopelvic wall?
parietal peritoneum
135
What invests viscera (organs) such as the spleen and stomach?
visceral peritoneum
136
What is the double layer of parietal peritoneum?
mesentery
137
What is the double layer of parietal peritoneum between organs?
omentum
