d Flashcards
What are the boundaries of the abdominal cavity?
The abdominopelvic cavity includes both the [abdomen and the pelvis], which are separated by the imaginary border of the [pelvic inlet]. Thus, it is located in between the thoracic diaphragm and the pelvic diaphragm. It is lined by peritoneum.
- Can go has high as the 4thintercostal space.
- Above the pelvic inlet is called the greater pelvis.
What are the divisions of the abdominal wall in 9 regions?
From R–> L
- RH (right hypochondrium)
- E (epigastric)
- LH (left hypochondriac)
- RL (right flank; lateral region)
- U (umbilical)
- LL (left flank; lateral region)
- RI (right inguinal; groin)
- P (pubic)
- LI (left inguinal; groin)
Describe the 4 quadrant division of the abdomen and the organs in each.
The 4 quadrants are separated by the [median plane] (up and down) and the [transumbilical plane] (L-R): RUQ, LUQ, RLQ, LLQ.
What are the contents in the RUQ?
- R lobe of the liver
- gallbladder
- R kidney
- R adrenal gland
- Pylorus of the stomach
- Dudodenum (1-3)
- Ascending colon (superior part)
- Transverse colon (right side)
- Head of the pancrease
What are the contents in the LUQ?
- L lobe of the liver
- Spleen
- L kidney
- L adrenal gland
- Stomach
- Jejunum and superior part of the ileum
- Descending colon (superior part)
- Transverse colon (L side)
- Body and tail of the pancreas
What are the contents in the RLQ?
- Appendix
- Cecum
- Ascending colon (inferior part)
- Most of the ileum
- R ovary
- R uterine tube
- R ureter
- R spermatic cord
- bladder
- Uterus
What are the contents in the LLQ? (8)
- Descending colon (inferior part)
- Sigmoid colon
- L ovary
- L uterine tube
- L ureter
- L spermatic cord
- Bladder
- uterus
Name the 6 important abdominal planes.
- Xiphersternal plane goes from the 7th rib–> T9
- Transplyloric plane goes from the 9th rib–> L1
- Subcostal plane goes from 10th rib–> L3
- Supracristal plane goes from the top of the iliac crests –> L4
- Transtubercle plane is at L5 (widest part of the hips and is located between the iliac tubercles at the ileocecal junction)
- Interspinous plane is between ASIS–> S2
What organs are in the transpyloric plane (L1)?
- Stomach (pylorus)
- Gallbladder
- Neck of the pancreas
- SMA
- HPV
- Hilia of the kidney
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What organs are in the subcostal plane (L3)?
Below 10th rib–> L3
Transverse colon
What organs are in the transtubercle plane (L5)?
Ileocecal junction
What organs are in the interspinous plane (S2)?
Located between the ASIS and is where the appendix and sigmoid colon is located.
If we wanted to located the appendix or the sigmoid colon, what plane would we look at and what part of the abdomen?
Both the appendix and the sigmoid colon are located at the [interspinous plane]. However, the appendix is located at the RLQ and the sigmoid colon is located at the LLQ.
If we wanted to locate the transverse colon, what plane would we look at and what areas of the abdomen?
- The transverse colon is located at the subcostal plane (below the 10th rib–> L3).
- The R side of the transverse colon is located in the RUQ and the L side is located in the LUQ.
What plane would we find the ileocecal junction?
Transtubercule plane
What are the layers of the abdominal wall?
Skin→ Camper’s fascia → Scarpa’s fascia → EO muscle → IO muscle → Transversus abdominis m. → Transversalis fascia → extraperitoneal fat → parietal peritoneum
What is the outer layer of the abdominal wall made up of?
Outer layer of the abdominal wall has 4 parts: [Skin, CF, SF and aponeurosis],
- Tough and thick
- Covers the rectus abdominus and forms a rectus sheath.
During liposuction, ______ fascia is removed. If ______ fascia is removed, it causes a botched liposuction.
During liposuction, Camper’s fascia is removed. If Scarpa’s fascia is removed, it causes a botched liposuction.
_______ fascia is a fatty layer of the superficial fascia.
Camper’s fascia is a fatty layer of the superficial fascia.
___________ is a deep membranous layer of fascia.
Scarpa’s fascia is the membranous underlying CT later of superficial fascia.
What would happen if you had bleeding between Scarpa’s fascia and the abdominal aponeurotic tissue?
- Scarpa’s fascia is continous with Colle’s fascia of the perinium, but also fused with the fascia lata of the lower limb.
- Not go into leg, but it would go into Colle’s fascia.
What happens when Scarpa’s fascia enters the scrotum?
It changes its name to Dartos fascia.
What is the linea alba?
The central meeting of two aponeurosis.
What are the 3 anterior abdominal muscles?
1. External oblique m.
2. Internal oblique m.
3. Transversus abdominis m.
Where does the external oblique m. –> EO aponeurosis?
At the linea semilunares (located at the mid-clavicular line)
External oblique m.
O:
Insertion:
Innervation:
Action:
O: External surface of ribs 5-12
Insertion: Aponeurosis, linea alba, anterior iliac crest and pubic tubercle
N: Ventral rami of intercostal nerves (T7-T12): thoracoabdominal N (T7-T11) and Subcostal N (T12)
Axn: Compress the abdomen, increase intra-abdominal pressure, flex and rotate the trunk, retain posture.
What makes the inguinal ligament? and what does it make?
- Lower part of the E.O m rolls under
- Opening of the superficial inguinal canal
Origin and insertion of the internal oblique m
[thoracolumbar fascia, anterior iliac crest and the lateral inguinal L]–>
[lower part of ribs 10-12, linea alba and the pectin pubis via the conjoint tendon]
N and axn of IO m.
Nerves: thoracoabdominal n, subcostal n, ilioinguinal n and iliohypogastric n.
Action:
- Compress abdomen
- Support abdomen
- Flex and rotate abdomen
Where does the transversus abdominus m. become aponeurotic?
Linea semilunaris
Origin and insertion of the tranvsersus abdominus muscle
[inside of the costal cartilage of ribs 7-10, thoracolumbar fascia, iliac crest and lateral inguinal ligament]
–>
[linea alba with EO aponeurosis, pubic crest and pectin pubis via the conjoint tendon]
Transversus abdominis m
N:
AXN:
- N: thoracoabdominal n (T7-11), subcostal n (T12), ilioinguinal n (L1), iliohypogastric
- Axn (L1):
- Compress abdomen
- Support the abdomen
What is special about the rectus abdominis muscle?
- It is wider at the top than it is at the bottom.
- It has tendinous intersections that make part of the rectus sheath at the xiphoid, midway and umbilical levels.
O and I of the rectus abdominus m
- [pubic symphysis and pubic crest]–>
- [xiphoid process and the 5th-7th costal cartilages]
Rectus abdominus m.
N:
Axn:
N:
- Ventral rami of intercostal nerves: thoracoabdominal nerves (T7-T11) and subcostal n (T12)
Axn:
- Compress abdomen
- Flex abdomen
What is the border of the rectus abdominus m called?
Linea semilunares
Which abdominal muscle does not help to make the linea alba?
Rectus abdominis m.
The fibers run from [the pubic symphysis and pubic crest]–> [costal cartilage of ribs 5-7 and the xiphoid process]
what muscle is important for retinaing posture?
external oblique m
Subcostal incision
Parallel to, but 2.5 cm away from the inferior costal margin
gives us access to: gallbladder, spleen, biliary tract
Midline incision
Xiphoid process–> pubic symphysis
done rapdily because not alot of BV, nerves, but takes a long time to heal
Paramedial incision
From costal margin–> iliac crest, along the linea semilunares.
this opens the rectus sheath and allows us to push rectus muscle aside and go into the peritoneum.
Gridline (mcburneys point)
muscle splitting done in appendictomy
suprapubic line
at pubic hair line,
done in most OB/GYN surgeries
Lymphatic system above the transumbilical plane (T10)
If above the transumbilical plane, you can go to two LN
- Axillary LN- if on lateral side of upper body
- Parasternal LN- if on medial side of upper body
Lymphatic system below T10
Drain into the superficial inguinal LN
Deep LN drain the deep veins in the abdomen. What are the deep LN?
1. External iliac LN
2. Common iliac LN
3. Lumbar LN
What is the rectus sheath and where is it located?
- Fascia and aponeurosis of muscles that encompasses the RA m.
- It is located below and above the arcuate line, with different contents.
What is the arcuate line?
Arcuate line is a transition where all EO, IO and TA aponeuroses become anterior to the rectus abdominis m. it is located 1/3 of the way between the BB and pubic tubercle
Thus, below the line, the rectus abdominis is in contact with ___________
transversalis fascia
Above the arcuate line
- Anterior: EO, IO aponeurosis
- Posterior: IO, TA aponeurosis and the TF
Below the arcuate line
Anterior: EO, IO, TA aponeurosis
Posterior: TF
_____________ aponeurosis is always anterior.
External obliqye aponeurosis
What is the highest point in the body that the abdomino-pelvic cavity stretches?
goes up to the 4th intercostal space
Where does the Neurovasculature of the abdomen lie?
between the internal oblique muscle and the transversus abdominis muscle
Thoracoabdominal nerves innervate T7-T11 which is a continuation of intercostal N., while subcostal N is under rib 12.
What is another name for these nerves?
Anterior rami
L1 is split into two different nerves. What are they?
Iliohypogastric
Ilioinguinal
From the internal thoracic A, splits into two which are?
the musculophrenic and superior epigastric As.
The superior epigastric, which is posterior to rectus abdominis, will anastamose with what at the belly button?
inferior epigastric A,
which is a branch off of the external iliac A.
What are the two abdominal wall arteries that come off the femoral A?
1. Superficial epigastric
2. Superficial circumflex iliac A
abdominopelvic cavity can go as high up as
4th intercostal spacwe
abdominopelvic cavity is seperated by your pelvic inlet, creating the thoracic diaphragm and pelvic diaphram. what is everything above the pelvic inlet callec?
greater pelvis
Iliohypogastric N (L1) and
ilioinguinal n (L1)
describe their distribution
Iliohypogastric nerve: motor to IO and TA;
sensory to upper inguinal and hypogastric region
Ilioinguinal N is motor to the lower IO and TA
sensory to the lower inguinal, anterior scrotum and labia and medial thigh.
