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Colin GI > GA Anterior Abdominal Wall > Flashcards

GA Anterior Abdominal Wall Flashcards

1
Q

At what landmark does the abdomen reach most superiorly?

A

4th intercostal space

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2
Q

What organs are protected parly by the ribs?

A

Liver, spleen, kidney, stomach

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3
Q

What lines form the abdominal quadrants?

A

The linea alba (midline) and the transumbilical line (horizontal line through belly button)

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4
Q

What do you call the 4 abdominal quadrants?

A

Right Upper Quadrant (RUQ), Left Upper Quadrant (LUQ), Right Lower Quadrant (RLQ), and Left Lower Quadrant (LLQ)

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5
Q

What organs are found in the RUQ?

A 
Liver (right lobe)
Gal Bladder
Stomach (pylorus)
Pancreas (head)
Right Kidney
Right Adrenal Gland
Duodenum (parts 1-3)
Superior Part of Ascending Colon
Right half of Transverse Colon
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6
Q

What organs are found in the LUQ?

A 
Liver (left lobe)
Stomach
Spleen
Left Kidney
Left Adrenal Gland
Jejunum and proximal ileum
Left Half of Transverse Colon
Superior Part of Descending Colon
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7
Q

What organs are found in the RLQ?

A 
Inferior Part of Asceding Colon
Appendix
Cecum
Right Ureter
Right Uterine Tube (fallopian tube)
Right Ovary
Right Spermatic Cord
Bladder (if full)
Uterus (if enlarged)
Most of the Ileum
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8
Q

What organs are found in the LLQ?

A 
Inferior Part of the Descending Colon
Left Ureter
Left Uterine Tube (fallopian tube)
Left Ovary
Uterus (if enlarged)
Bladder (if full)
Left Spermatic Cord
Sigmoid colon
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9
Q

What lines form the 9 Abdominal Regions?

A

Two vertically along both mid-clavicular lines

One horizontally connecting both Iliac tubercles

One following the subcostal plane

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10
Q

What are the 9 regions called?

A 
Right Hypocondriac (RH)
Epigastric (E)
Left hypocondriac (LH)
Right Flank (lateral region) (RL)
Umbilical (U)
Left Flank (lateral region) (LL)
Right Inguinal (groin) (RI)
Pubic (P)
Left Inguinal (groin) (LI)
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11
Q

What rib and spine segment are associated with the Xyphosternal joint?

A

7th rib, T9

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12
Q

What muscle and spine segment do you associate with Rib 8?

A

Rectus Abdominus M. and T11

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13
Q

What Rib and spine segment are associated with the Transpyloric Plane?

A

9th rib, L1

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14
Q

What rib and spine segment are associated with the subcostal plane?

A

10th rib, L3

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15
Q

What bony landmark and spine segment are associated with the Supracristal plane?

A

Iliac crest, L4

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16
Q

What bony landmark and spine segment are associated with the Transtubercular Plane?

A

Iliac tuebrcle (widest part of the hips), L5

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17
Q

What bony landmark and spine segment are associated with the Interspinous Plane?

A

The Anterior Superior Iliac Spine (ASIS), S2

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18
Q

What are the layers of the anterior abdominal wall in order of most outer to most inner layer?

A 
Skin
Campers Fascia (Superficial fatty layer)
Scarpa's Fascia (Deep membranous layer)
External Oblique M.
Internal Oblique M.
Transversus Abdominis M.
Transversalis Fascia
Extraperitoneal Fat
Parietal Peritoneum
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19
Q

Which layer is the location of fat removed during a liposuction procedure?

A

Campers fascia

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20
Q

What causes a botched liposuction?

A

When too much fat is removed, the deep fascia bonds with the skin forming wrinkles.

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21
Q

What landmark indicates the transition point from muscle to aponeurosis of the External Oblique/Internal Oblique/Transversus Abdominis?

A

The midclavicular line

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22
Q

Which aponeuroses contribute to the linea alba?

A

All three layers of aponeuroses (external obliques, internal obliques, and transversus abdominis)

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23
Q

Which aponeurosis forms the inguinal ligament?

A

The External Oblique aponeurosis

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24
Q

What structures form the borders between segments of the Rectus Abdominis?

A

Tendinous Intersections

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25
Q

What direction do the muscle fibers of the external oblique muscle follow?

A

“Hands in pockets”

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26
Q

Relating to External oblique muscle, what direction do the muscle fibers travel?

A

Perpendicular to External Oblique muscle fibers (which run in the “hands in pockets” direction)

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27
Q

What direction do the transversus abdominis muscle fibers travel?

A

In a horizontal/circumferencial direction around the waist

28
Q

What is the pyramidalis muscle, where is it located, what does it do, and what is special about it?

A

Triangle-shaped muscle found just above the Pubic Symphysis

Pulls on the Linea Alba

20% of population does not have it

29
Q

What are the functions of the abdominal muscles?

A
  • Flex (Pull on rib cage)
  • Rotate the trunk
  • Side-bending
  • Forced expiration
  • Create increased abdominal pressure (used for pooping, childbirth, coughing, etc)
  • Protection of abdominal contents
30
Q

When doing a rotational crunch, how are the muscles working together?

A

When doing a rotated crunch to the right, The right external oblique muscles and the left internal oblique muscles contract simultaneously to form this motion (since the muscle fibers of these two muscles follow the same direction)

Known as strap muscles

31
Q

What tissues form the anterior and posterior rectus sheath?

A

The aponeuroses of the three abdominal muscles (external obliques, internal obliques, and transversus abdominis)

32
Q

What is the arcuate line?

A

The transition point where the composition of the rectus sheath is rearranged.

33
Q

Describe the compostion of the rectus sheath above the arcuate line

A

The transversalis fascia is posterior to the rectus abdominis muscle

The aponeurosis of the Transversus Abdominis Muscle is posterior to the rectus abdominis muscle

The aponeurosis of the Internal Oblique Muscle bifurcates and surrounds the rectus abdominis muscle (is both anterior and posterior)

The aponeurosis of the External Oblique Muscle is anterior to the rectus abdominis muscle

34
Q

Describe the composition of the rectus sheath below the arcuate line

A

The transversalis fascia is posterior to the rectus abdominis muscle

The Transversus Abdominis Muscle is anterior to the rectus abdominis muscle

The Internal Oblique Muscle is anterior to the rectus abdominis muscle

The External Oblique Muscle is anterior to the rectus abdominis muscle

35
Q

Approximately where is the arcuate line located?

A

1/3rd of the way below the belly button

36
Q

Between which muscle layers is the neurovasculature located?

A

Between the Internal Oblique Muscle and the Transversus Abdominis Muscle

37
Q

Which anterior rami are associated with the Thoraco-abdominal Nerves?

A

T7-T11

Also known as anterior intercostal nerves

38
Q

What anterior rami is associated with the subcostal nerve?

A

T12

39
Q

What are the two nerves that come from L1 rami and what do they do?

A

Iliohypogastric nerve - cutaneous sensation in the upper inguinal region/superior hypogastric region

Ilio-inguinal nerve - follows the inguinal canal; provides sensation to the inguinal canal, cutaneous sensation to the medial thigh, and descends into the scrotum/labia majora

40
Q

Which thoraco-abdominal nerve innervates the umbillicus?

A

T10

Note: umbillicus is not located in exact same position on every person (some are higher, some are lower)

41
Q

What major artery descends into the abdomen from the thorax and what two arteries does it form after it bifurcates?

A

The Internal Thoracic A.

Forms into the Musculophrenic A. and the Superior Epigastric A.

42
Q

Where can you find the Musculophranic A.?

A

Descending off the Internal Thoracic A. and follows long the costal margin

43
Q

Where can you find the Superior Epigastric A.?

A

Posterior to the Rectus Abdominis M., but anterior to the posterior rectus sheath

44
Q

What are the three major costal arteries found in the anterior wall of the abdomen?

A

10th Posterior Intercostal A.
11th Posterior Intercostal A.
Subcostal A.

45
Q

What is the major artery that ascends from the below the inguinal ligament and what 3 major arteries branch off of it?

A

External Iliac A. (also called the Femoral A. if you follow it down)

Inferior Epigastric A., Deep Circumflex Iliac A. and Superficial Circumflex Iliac A. branch off the External Iliac A.

46
Q

What two major arteries form an anastomosis, and where does it form?

A

The Superior Epigastric A. and the Inferior Epigastric A.

They usually form an anastomosis near the umbillicus

47
Q

Where can you find the Inferior Epigastric A.?

A

Posterior to the Rectus Abdominis M.

48
Q

Which artery travels across the arcuate line?

A

The external iliac A./Inferior Epigastric A.

49
Q

What considerations should be made when performing a midline incision from the xyphoid process to the pubic symphysis?

A

Bad for recovery because linea alba is where abdominal muscles anchor to, and contractions of muscles will cause them to be pulled apart

Good place for sutures (aponeurosis/linea alba)

Good for avoiding nerves

Good for procedure stops blood supply, but bad for recovery for same reason

50
Q

What considerations should be made when performing a subcostal incision, parallel to, but 2.5 cm inferior of costal margin?

A

Risk for cutting nerves

Less risk for cutting blood supply since incision is inferior to Musculophrenic A. (but should watch for superior epigastric)

Not terribly concerned with muscle tension

51
Q

What considerations should be made when performing a Suprapubic incision at the pubic hairline (horizontal with sight convexity; used for C-Section)?

A

Not terribly concerned with muscle tension (inferiorly, abdominal muscles are not as close to skin)

Important to watch for L1 nerves (Iliohypogastric N. and Ilio-inguinal N.)

Important to watch for Inferior Epigastric A.

52
Q

What considerations should be made when performing a Paramedian incision from the costal margin to iliac crest along linea semilunaris?

A

Great place to put stitches, but also bad because pull of muscles can pull on stitches.

Potential to cut through many nerves, completely denervating rectus abdominis muscle

Potential to cut through several arteries as well.

This incision should only performed in an emergency

53
Q

What are the three forms of ventral abdominal hernias and where are they located?

A

Umbilical hernia - Umbilicus

Epigastric hernia - Superior to umbilicus on the linea alba

Spigelian hernia - along the linea semilunaris

54
Q

What are the two forms of groin hernias?

A

Inguinal Hernia

Femoral Hernia

(See inguinal lecture cards)

55
Q

What is the boundary used when mapping out the direction of lymph flow?

A

Transumbilical Plane (hroizontally over the belly button)

56
Q

Where does superficial lymph flow if in vessels above the transumbilical plane?

A

Flows to the Axillary Lymph Nodes

57
Q

Where does superficial lymph flow if in vessels below the transumbilical plane?

A

Flows to the Superficial Inguinal Lymph Nodes

58
Q

Where does superficial lymph flow if really close to midline?

A

Flows tot he Parasternal Lymph Nodes

59
Q

What is path of flow for deep abdominal lymph?

A

External Iliac Nodes drain into Common Iliac Nodes, which drain into Lumbar (aka, Caval or Aortic) nodes

60
Q

What is the Median Umbilical Fold and what is it a remnant of?

A

The Median Umbilical Fold is a fold of tissue found superior to the bladder that follows midline,

It is a remnant of the urachus (used to be elantois)

61
Q

What are the Medial Umbilical Folds and what are they a remnant of?

A

The Medial Umbilical fold is a fold of tissue found lateral to the Median Umbilical Fold.

There are two on either side and they are the Obliterated Umbilical Arteries

62
Q

What are the Lateral Umbilical Folds?

A

Lateral umbilical folds (found more lateral to midline than the Medial Umbilical folds) are tissue that cover the posterior side of the Inferior Epigastric Vessels.

63
Q

What are the Supravesical Fossae?

A

Found on both sides of the bladder but medial to the Medial Umbilical Folds

64
Q

What are the Medial Inguinal Fossae and what type Hernia form within them?

A

Region medial to Inferior Epigastric Vessels, but lateral to Medial Umbilical Folds

Direct Inguinal Hernias

65
Q

What are the Lateral Inguinal Fossae what type of Hernia form within them?

A

Region lateral to the Inferior Epigastric Vessels

Indirect Inguinal Hernias

66
Q

What is Prune Belly Syndrome?

A

3 Main Features:

  • Anterior abdominal wall muscles deficient or absent
  • Urinary tract anomalies (such as very large bladder)
  • Bilateral cryptorchidism (two undescended testicles)

Colin GI (10 decks)

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