Exam 4: Anterior Abdominal Wall Flashcards
Middle upper quadrant
Epigastric
Right Upper Quadrant
R. Hypochondriac
Left upper quadrant
L. Hypochondriac
Right middle quadrant
R. Lumbar
Middle middle quadrant
Umbilical
Left middle quadrant
L. Lumbar
Right lower quadrant
R. Iliac
Lower middle quadrant
Hypogastric
Left lower quadrant
L. Iliac
Umbilicus
Level L3-L4, innervation T10
Lines Alba
Palpable vertical facial line in center of abdominal region
Inguinal Ligament
tight fusion of fascial layers, forming a shelf in which the spermatic cord (round ligament) rests
Pelvic Landmarks
Iliac crest, Anterior superior iliac spine, Pectin pubis (pectineal line), Pubic tubercle
Anterior abdominal cavity spans from
Costal arch coming from ribs 60-10 and Xyphoid process to
Illiac crest and inguinal ligament (ASIS to pubic tubercle)
Functions of Abdominal Wall
Protection and stabilization of abdominal contents
Trunk rotation and flexion
Maintain and control intra-abdominal pressure
Respiration - opposes diaphragm during exhalation
Camper’s fascia
superficial fascia under skin
Adipose (fatty) layer coursin with cutaneous nerves and blood vessels
Scarpa’s fascia
Membranous fascial layer deep to Camper’s fascia
Scarpa’s fascia become what in the scrotum?
Dartos fascia
Scarpa’s fascia becomes what in the perineum
Colles’ fascia
External Oblique
O: External surfaces of ribs 5-12
I: Linea alba, pubic tubercle, and anterior half of iliac crest
A: Compress and support abdominal viscera; flex and rotate trunk
I: Thoraco-abdominal nerves (anterior rami of T7-11) and subcostal nerves
Internal oblique
O: Thoracolumbar fascia, anterior 2/3 of Iliac crest, and connective tissue deep to inguinal ligament
I: Inferior borders of ribs 10-12, linea alba, and pubis via conjoin tendon
A: compress and support abdominal viscera; flex and rotate trunk
I: Thoraco-abdominal nerves (anterior rami of T7-11) and first lumbar nerve (L1)
Rectus abdominus
O: Pubic symphysis and pubic crest
I: Xiphoid process and costal cartilages 5-7
A: Flexes trunk (lumbar vertebrae) and compresses abdominal viscera; stabilizes and controls pelvic tilt
I: Thoraco-abdominal nerves (anterior rami of inferior 6 thoracic nerves)
Transversus abdominus
O: Internal surfaces of ribs 7-12 costal cartilages, thoracolumbar fascia, iliac crest, and connective tissue deep to inguinal ligament
I: Linea alba with aponeurosis of internal oblique, pubic crest, and pectin pubis via conjoin tendon
A: Compresses and supports abdominal viscera
I: Thoraco-abdominal nerves (anterior rami of T7-T11) and first Lumbar nerve (L1)
Above arcuate line, internal oblique fascia
splits, contributing to both anterior sheath fusing with external oblique aponeurosis and posteriorly fusing with transversus abdominus
Below arcuate line, internal oblique fascia
doesn’t split; all passes anteriorly to rectus
posterior wall is only transversalis fascia and parietal peritoneium
Weaker - prone to hernias
Transversalis fascia
layer of fascia that lines internal abdominal wall and forms the deep inguinal ring
Parietal peritoneum
Serous lining of peritoneum
Produces serous fluid that lubricates the abdominal organs
It is usually not fused tightly with the transversalis fascia - can contain fat stores
Inferior epigastric arteries and veins are located between transversalis fascia and parietal peritoneum
Innervated by somatic body wall nerves
Falciform ligament
last remnant of ventral mesentery
Round ligament
remnant of fetal umbilical vein (main O2 from placenta to fetus)
Median umbilical fold
urachus (remnant of allantois, drains fetal bladder) and paraumbilical veins (can become enlarged and patent during portal hypertension)
Medial umbilical folds
2 of these, on either side of median umbilical fold
Remnants of umbilical arteries (returns low O2 blood back to placenta)
Lateral umbilical folds
2 of these
inferior epigastric arteries and veins
Somatic innervation is from
ventral rami of spinal nerves (intercostal nerves) running from T7-L2
Intercostal nerves become thoracoabdominal nerves as they cross the costal cartilage
Thoraco-abdominal nerves (T7-T11)
Continuation of lower intercostal nerves
Run between 2nd and 3rd layers of abdominal muscles; lateral and anterior cutaneous branches enter subcutaneous tissue
Innervate muscles of anterolateral wall and overlying skin
Subcostal nerve (T12)
From Anterior ramus of L1 spinal nerve
Courses on inferior border of 12th rib, then onto subumbilical abdominal wall
Innervates muscles of anterolateral abdominal wall and overlying skin superior to iliac crest and inferior to umbilicus
Iliohypogastric nerve (L1)
From anterior ramus of T12 spinal nerve
Pierces transversus abdominus muscle; branches pierce external oblique aponeurosis of most inferior abdominal wall
Innervates skin overlying iliac crest, upper inguinal and hypogastric regions; internal oblique and transversus abdominis
Ilioinguinal nerve (L1)
from anterior ramus of L1 spinal nerve
Passes between 2nd and 3rd layer of abdominal muscles, then transverses inguinal canal
Innervates skin of scrotum or labia majus and mons pubis, and adjacent medial aspect of thigh; most inferior internal oblique and transversus abdominus
Musculophrenic a.
From internal thoracic a.
Descends along costal margin
To abdominal wall of hypochondriac region, anterolateral, diaphragm
Superior epigastric a.
From internal thoracic a.
Descends in rectus sheath deep to rectus abdominus
To Rectus abdominus and superior part of anterolateral wall
Posterior intercostal a. (10th and 11th)
From Aorta
Continues beyond ribs to descend in abdominal wall between internal oblique and transversus abdominus
To lateral region of abdominal wall
Subcostal a.
from Aorta
Continues beyond ribs to descend in abdominal wall between internal oblique and transversus abdominus
To lateral region of abdominal wall
Inferior epigastric a.
From external iliac a.
Runs superiorly and enters rectus sheath, runs deep to rectus abdominus
To rectus abdominus and medial part of anterolateral abdominal wall
Deep circumflex iliac a.
From external iliac a.
Runs on deep aspect of anterior abdominal wall, parallel to inguinal ligament
To iliacus muscle and inferior part of anterolateral abdominal wall
Superficial circumflex iliac a.
From femoral a.
Runs in superficial fascia long inguinal ligament
To superficial abdominal wall of inguinal region and adjacent anterior thigh
Superficial epigastric a.
From femoral a.
Runs in superficial fascia towards umbilicus
To subcutaneous tissue and skin over pubic and inferior umbilical region
Anastomoses between aorta
Posterior intercostals
Posterior subcostals
Lumbar arteries
Anastomoses between internal thoracic a.
Superior epigastric
Musculophrenic - anterior intercostals
Anastomoses between external iliac
Inferior epigastric
Deep circumflex iliac
Anastomoses between Femoral
Superficial epigastric
Superficial circumflex iliac
Where would you make an incision for an appendicitis
Gridiron (through muscle layers at McBurney point)
Where would you make an incision for gallbladder
Subcostal (below costal cartilage)
Where would you make an incision for transverse colon or small intestines?
Median (on linea alba)
Where would you make an incision for ovaries
Transverse
Where would you make an incision for a hysterectomy?
Suprapubic
If have an illness above Transumbilical plane will have huge lymph nodes in
Armpits (axillary lymph nodes)
If have an illness below transumbilical plane will have huge lymph nodes in
Superficial inguinal lymph nodes
