EXAM3_G20_Anterolateral_Abdominal_Wall Flashcards
The horizontal cuts of the abs making a 6 pack is called?
Tendinous intersections
What vert level is the umbilicus at?
L4
What are lines lateral to midaxillary line and crescent shape?
Semilunar lines
What is the defined line of the costal cartilage at the anatomical thoracic outlet on the anterior side?
Costal margin
What are the superior boundaries of the anterolateral abdominal wall?
Costal margin and xiphoid process
What are the 3 inferior boundaries of the anterolateral abdominal wall?
- Iliac crest (l4 vert level)
- Inguinal ligament (ASIS to Pubic tubercle)
- Pubic crest and tubercle
What is the lateral bump on the pubic bone called
pubic tubercle
What is medial to the pubic tubercle but lateral to the pubic symphysis?
Pubic crest
What is the lateral line of the hip pointing down towards the pubic tubercle?
Pectineal line
what is the continuous serous membrane called in the abdominal cavity?
Peritoneum
What are the lines that divide the abdomen into RU.RL LU LL quadrants?
Transumbilical plane (horizontal line) Median plane (vertical line)
The lines that divide the body into 9 regions
Subcostal plane (rib 10, L2 vert level) - horizontal Transtubercular plane (iliac tubercle, L5 vert level)- hz Midclavicular planes (left and right)
What are the two horizontal lines that make up the 9 regions of abdominal wall?
Subcostal plane
Transtubercular Plane
What are the 9 regions of the ab wall?
R. Hypochondraic Epigastric L. Hypochondraic
R. Lateral Umbilical L. Lateral
R. Inguinal Pubic L. Inguinal
7 Layers of the anterolateral abdominal wall
SCSDTEP
skin campers scarpas deep transversalis extraperitoneal parietal peritoneum
Superficial fascia consists of 2 layers?
Camper’s fascia (thick/fatty)
Scarpa’s fascia (thin/membranous)
Deep fascia consists of ?
Epimysium of each of the muscle layers
Endo-abdominal fascia cosists of
Transversalis fascia (anterolateral part)
fainting after urinating is called
Micurition
Parturition
Giving birth
What two muscles flex and rotate the trunk?
External and internal oblique
Transversus abdominis DOES NOT flex or rotate trunk
What muscle tenses the linea alba?
Pyramidalis muscles
the external oblique is homologous to
external intercostal muscles
ends anteriorly forming part of the rectus sheath
The inguinal ligament is formed by the inferior margins of the
rectus sheath
undercurving fibrous band formed by the external oblique
what is the function of the inguinal ligament?
Retaining band for deep structures of lower limb
Torsional movements come from contralateral internal and external obliques working together. The internal obliques end in an _____ _____ that forms part of the rectus sheath
anterior aponeurosis forms part of the rectus sheath
Transversus abdominis function?
increases ab pressure- anterior aponeurosis forms part of the rectus sheath
- arches over inguinal ligament and contributes to the area of weakness
Rectus abdominis attaches to xiphoid process and ribs 5,6,7 tapers inferior and separated by the ___ ___ and packs are created by ___ ____.
Linea alba
Tendinous intersections
What are the surgical landmark for cut on median plane?
Pyramidalis - tenses linea alba
What is the strong fibrous covering enclosing the rectus abdominis which is formed by aponeurosis of all 3 flat abdominal muscles?
Rectus sheath (anterior and posterior portions)
What sheath does NOT extend all the way down to the pubic crest? What happens 3/4 of the way toward pubic crest?
Posterior rectus sheath
Passes anterior and fuses with anterior rectus sheath causing the ARCUATE LINE
What is the Arcuate line?
Posterior rectus sheath passing anterior and fusing with the anterior rectus sheath
what is the wall inferior to the Arcuate line prone to herniation?
b/c this part is only reinforced by the transversalis fascia
Edge of the rectus abdominis and the inguinal ligament is the area of weakness where herniation of abdominal wall occurs is called ?
Inguinal (Hesselbach’s) triangle
What passes through the inguinal triangle (hesselbach’s triangle)
Inferior epigastric artery and vein
Innervation of the anterolateral abdominal wall is mainly by these four nerves:
- thoraco-abdominal nn
(continuation of T7-T11 intercostal nn.) - Subcostal nn (anterior ramus of T12)
- Iliohypogastric nn
(terminal branches of L1 Anterior ramus) - Ilioinguinal nn
(terminal branches of L1 anterior ramus)
Continuation of intercostal nerves of T7-T11 are called?
Thoracoabdominal nerves
Terminal branches of L1 anterior ramus makes what two nerves?
Iliohypogastric nn
ilioinguinal nn
What nerve pierces the Lateral ab wall and enters the lateral superficial fascia?
Lateral Cutaneous branches of the t10 abdominal nerve
What nerves pierce the rectus abdominis (anterior) and enter anterior superficial fascia?
Anterior cutaneous branches of the t10 abdominal nerve
what incision is used for appendectomy?
Gridiron incision (right iliac crest area in direction of groin to pubic)
transverse abdominal incision would be same spot just opposite direction
three incisions of the abdominal wall
Median incision
Left paramedian incision
Subcostal incision
what innervates cutaneous nerves over rectus abdominis? and lateral abdominal wall?
T7-T10 thoracoabdominal nerve & subcostal nerve
What superficial cutaneous nerves innervates the DIP’s area?
Iliohypogastric nerve L1
What superficial cutaneous nerves innervate the groin area?
Ilioinguinal nerve L1
What supplies blood to the lateral region of the abdominal wall?
10th & 11th posterior intercostal & Subcostal arteries
What supplies the superficial pubic & umbilical regions with blood? what is it a branch from?
Superficial epigastric artery (branch from femoral artery)
What supplies medial part of anterolateral wall with blood? What is it a branch from?
Inferior epigastric (branch of external iliac artery)
Inferior epigastric can anastomose with ?
superior epigastric that branches off internal thoracic
don’t mix up superficial epigastric and superior epigastric!
External iliac artery branches into?
inferior epigastric artery
where does superficial epigastric artery come from?
branch of femoral artery
Venous drainage of anterolateral abdominal wall
Most drain directly into tributaries of SVC and IVC
Some drain into liver (mixes w/ gut blood) hepatic portal vein
What happens if there is a blockage in the portal system?
diverts Gut blood into caval system which dilates to accommodate flow
What drains deep wall superior to the transumbilical plane?
Superior epigastric vein>internal thoracic>SVC
What drains deep lateral wall superior to transumbilical plane?
Subcostal 10th & 11th posterior intercostal veins
into azygous system>SVC
What drains deep wall inferior to transumbilical plane?
Inferior epigastric vein>
into external iliac vein>IVC
Cavo-Caval anastomosis is the
communication of blood between deep and superficial veins
What two veins drain the wall superior to transumbilical plane? where do they drain?
- Thoraco-epigastric vein
- Lateral Thoracic vein
- drain into AXILLARY Vein then into SVC
What drains superficial wall inferior to transumbilical plane?
Superficial epigastric vein into femoral vein into IVC
What vein can drain into the porta-caval (porto-systemic) anastomosis? from abdominal wall to liver via this system?
Paraumbilical veins
Obstruction of hepatic portal v due to cirrhosis or liver fibrosis makes gut blood divert into paraumbilical veins. Where does the blood drain?
Portal-caval anastomosis between paraumbilical and caval veins (thoraco-epigastric) passes portal blood to IVC and SVC
What is the classic clinical sign of obstructed hepatic portal system? what veins distended?
Caput Medusa-
Paraumbilical ,lateral thoracic, thoraco-epigastric
superficial Lymph drainage- superior and inferior to umbilicus?
sup- drains to axillary nodes
inf- drain to inguinal nodes
deep lymph drainage -
iliac and lumbar nodes
