Exam 3 - lecture 22 ANterior abdominal Wall Flashcards
What are the borders of the abdomen ?
- Superior
- costal cartialges 7 - 12
- Xiphoid process
- lvl 10th cartiliage
- lvl T10 - T11
- Xiphisternal angle is level with body of T10
- Inferior
- Pubic bine and iliac crest
- lvl of L4
- Pubic bine and iliac crest
- Umbilicus
- lvl IV disc L3- 4
What are the landmarks for the anterior abdominal wall including the linea alva and lines associated witht he rectus abdominis?
- Linea alba
- locate alon the midline
- = connective tissue raphe
- locate alon the midline
- Linea semilunaris
- scalloped lateral border on eachs ide of rectus abdominis
- Linea Transversa
- Tendinous bands of rectus abdominis
- one pair just below xiphoid process
- one pair intersecting umbilicus
- one pair half way between other two pairs
- creats 6 pack
- Tendinous bands of rectus abdominis
What quandrants of the anterior abdominal wall and the intersecting lines that define them?
- Formed by intersecting lines
- intersect at umbilicus
- Quadrants
- upper left
- upper right
- lower left
- lower right
What the intersecting lines (planes) that define the nine qudrants of the anterian abdominal wall
Verical plane
- left and right lateral planes = midclavicular planes
Horizontal planes
- Transpyloric plane
- midway between jugular notch and pubic symphysis (b/w xiphoid and umbilicus) (lower margin of rib cage)
- Intertubercular plane
- through tubercles of iliac crests at level of L5
What are the nine quadrants of the abdominal wall and their contents?
- Right and left hypochondriac (1,2)
- contain the liver
- Epigastric (3 )
- liver, stomach, pancreas
- Right and left lateral (lumbar) (4, 5)
- Right contains ascending colon
- Left contains descending colon
- Umblical (6)
- contains small intenstine and transverse colon
- Right and elft inguinal (7, 8)
- right contains ileocecal junction and appendix
- left contains sigmoid colon
- Hypogastric (9)
- contains small intestine, urinary bladder (full), pregnant uterus
What are the cutaneous nerves that supply cutaneous innervation to the anterior abdominal wall and differentiate the innveration over xiphoid , umblicial and inguinal regions
- Ventrla rami of T7 through L1
- pass inferiorly and medially in plane between transverse and internal oblique muscles
- motor innervation
- to abdominal muscles
- cutaneous innervation
- lateral cutaneous branches
- anterior cutaneous branches
- penetrate rectus sheath
- Ventral Rami of T7 through T11
- = Throracoabdominal nerves
- T7 to dermatome over xipoid process
- T10 at level of umbilicus
- L1 just above pubic symphysis
- = Throracoabdominal nerves
- Subcostal nerve
- ventral ramus of l1
- gives rise to
- iliphypogastric nerve
- ilioinguinal nerve
- gives rise to
- ventral ramus of l1
WHat are the layers of the abdominal wall in order from superfical to deep?
Subcutaneous Fascia
- Superfical
- campers fascia
- continuous with fascia over thorax and thigh
- fatty layer
- Deep superfical
- scarpa’s fascia
- membranous layer
- continous into perineum as
- superfical perineal fascia = colle’s fascia
Deep
- Thin layer covering anteror of abdominal muscle
Transversalis fasica
- deep to transcersus abdominis
- fibroelastic CT with adipose tissue
- = extraperitoneal connective tissue
Peritoneum
- serous membrane
- = parietal peritoneum
What is difference between the arterial supply above the umbilicus and below the umbilicus
- Above umbilicus
- posterior intercoastal arteries 10 -11
- subcoastal artery
- lumbar arties 1 -4
- terminal branches of internal thoracic arteries
- musculophrenic arteries
- superior epigastric arteries
- Below umbilicus
- branches of external iliac arteries
- deep epigastric arteries
- deep circumflex arteries
- Branches of femoral arteries
- superfical epigastric arteries
- superficial circum flex iliac arteries
- superfical external pudendla arteires
- branches of external iliac arteries
What is the venous drainage of the abdominal wall above and below the umbilical level
- Deep veins are paired with arteries
- Superfical veins
- Above the umbilicus
- drain into the internal thoracic veins
- below the umbilicus
- drain into the femoral veins via the greater saphenous and external iliac veins
- drain into the external iliac veins via the inderior epigastric veins
- Above the umbilicus
What is the lympahtic drainage of the abdominals>
- Above the umbilicus
- drain into the axillary and sternal nodes
- Below the umbilicus
- drain into the superfical inguinal nodes
What is the arterial supply to the anterior abdominal wall?
- Superfical epigastric artery, superfical circumflex iliac artery, and superfical external pudenal artery
- arise from the femoral artery
- Deep circumflex iliac artery and deep epigastric artery
- branch from the external iliac artery
What does the superior epigastric and the inferior epigastric artieries supply?
- Superior epigastric
- terminal branch of internal thoracic
- descends in rectus sheath posterior to muscle
- antasmose with inferior epihastric
- Inferior epigastric
- arises from external iliac artery
- enters rectus sheath at arcuate line
- branches
- cremasteric artery
- pubic artery
WHat are the characterisics of the muscle layers in the abdominal region?
- General characterisics
- Three large flat sheets connecting rib cage to hip bone
- muscular posteriorly and laterally
- aponeurotic anteriorly and medially
- three anterolateal sheets
- external olbique
- internal olbique
- transcersus abdominus
- Vertically oriented pair on either side of the midline
- rectus abdominus
- Innervations
- lower intercostal spinal nerve
- subcoastal spinal nerve
- first lumbar spinal nerve
What are the actual muscle layers?
- Linea alba
- Median raphe
- Extends from Xiphoid to pubic symphysis
- Lies between paired rectus abdominus muscles
- =fusion of aponeuroses of transversus abdominus, internal olbique, and external olbique
- Linea semilunaris
- along lateral margin of rectus abdominus
- crosses costal margin near tip of 9th costal cartialge
- arcuate line
- lower free edge of posterior lamina
- lies midway between umbilicus and pubis
- Inguinal ligament
- thickened lowerd border of deep fascia of external oblique muscle
- from anterior superior iliac spine to pubic tubercle
- Rectus sheath
- connective tissue covering rectus abdominis muscles
- formed from aponeruosis of internal olbiques
- splits enclose rectis obdominis in the upper thrree fourths of the wall
- only overs the atnerior surface of the rectus in the lower part of the abdomen
What is the orgin, insertion, action, and innervation for the external oblique ?
- Origin
- external surfaces of ribs 5 - 12
- Insertion
- linea alba, pubic tubercle, anterior half of illac crest
- Action
- compressses and supports abdominal viscera; flexes and rotates trunk
- innervation
- T7 - T11, Subcostal nerve
