GIT-Anterior Abdominal Wall & Inguinal Region Flashcards
Where can the gallbladder be palpated?
Around the tip of the right 9th costal cartilage
Abdomen is bounded superiorly by ____ and inferiorly by the _____
Abdomen can be divided into 4 quadrants (Transumbilical plane and median plane)
Abdomen is bounded superiorly by cartilages of 7th to 10th ribs and inferiorly by the inguinal ligament and pelvis.
What are some organs found in the Right Upper Quadrant?
Liver
Diaphragm
Gallbladder
What are some organs found in the Left Upper Quadrant?
Spleen
Stomach
What can be found at the Right Lower Quadrant?
Anterior superior iliac spine
Appendix
Inguainal ligament
What can be found at the Left Lower Quadrant?
Descending colon
Sigmoid colon
Abdomen has 9 regions:
Subcostal plane- Cuts through the ____ border of the ____ and body of the ____ vertebra
Intertubular plane- Lies between ____ tubercles and ____ vertebra
2 ____ plane- Pass from the ____ of the clavicles to ____ points
Subcostal plane- Cuts through the inferior border of the 10th costal cartilage and body of the L3 vertebra
Intertubular plane- Lies between iliac tubercles and L5 vertebra
2 midclavicular plane- Pass from the midpoint of the clavicles to mid-inguinal points
What plane cuts through the pylorus of the stomach, the tip of the 9th costal cartilage and the lower border of the L1 vertebra?
Transpyloric plane
There are 2 Linea Semilunaris which pass along the ____ border of the ____ and cross the costal margin at the tip of the ____ costal cartilage
There are 2 Linea Semilunaris which pass along the lateral border of the rectus abdominis and cross the costal margin at the tip of the 9th costal cartilage
The Linea Alba passes in the ____ line to the symphysis pubis. It is formed by the fusion of the ____ of both sides.
The Linea Alba passes in the median line to the symphysis pubis. It is formed by the fusion of the rectus sheath of both sides.
What makes up the amdominal wall fascia?
Skin
Subcutaneous tissue
- Superficial fascia
o Superficial fatty layer
o Deep Membranous layer
- Investing Deep fascia
Muscles and their aponeurosis
Deep fascia
Extraperitoneal fat
Parietal peritoneum
Which layer of the superficial fascia is continuous with the superficial fat of the rest of the body?
Superfiicial fatty layer
Which layer of the superficial fascia blends with the deep fascia of the upper tigh, the penis and scotum and into perineum as Colles’ fascia
Deep membranous layer
What arbitrarily seprates the abdominal from the pelvic cavity?
Note that abdominal and pelvic cavities are continuous
Pelvic Inlet (Pelvic Brim)
What are the muscles of the anterior wall?
Paired vertical rectus abdominis muscles within rectus sheath
What are the muscles of the lateral wall? (Most superficial to least)
External Oblique
Internal Oblique
Transverses Abdominis
What are the muscles of the posterior wall?
Post vertebral muscles - erector spinae group
Psoas major
Quandratus lamborum
Iliacus muscles
The three flat muscle fibres (EOM, IOM and Transversus Abdominis) continus anteriorly as ____ and contributes to the ____
The three flat muscle fibres (EOM, IOM and Transversus Abdominis) continus anteriorly as aponeuretic sheets and contributes to the rectus sheath
External oblique muscle and aponeurosis forms ____ in the aponeurosis (a hole in the External Oblique Aponeurosis), immediately above and lateral to ______.
The lower aponeurotic edge is rolled ____ and forms the ____, stretches between the ASIS to pubic tubercle.
External oblique muscle and aponeurosis forms superficial inguinal ring in the aponeurosis (a hole in the External Oblique Aponeurosis), immediately above and lateral to
pubic tubercle
The lower aponeurotic edge is rolled inwards and forms the inguinal ligament, stretches between the ASIS to pubic tubercle.
External oblique muscle fibres are directed ____ and ____
Downward and Forward
Internal oblique muscles are directed ____ and _____
Downward and backward
Lowest fibres of internal oblique and transverse abdominis join to form the ____?
Conjont tendon
Transverse abdominis muscle fibres are directed ____
Horizontally
Where does the neurovascular plane lie between?
Between the Internal oblique and Transversus abdominis
Does rectus abdominis recieve segmental nerve supply?
Yes, T7 to T12
(Part 1) What is the rectus sheath formed by?
Aponeurises of external, internal oblique and transversus abdominis
(Part 2) What is the midline where rectus sheaths meet called?
Linea Alba
(Part 3) Where does anterior wall of the sheath extend from?
It exends from xiphoid process and costal cartilages above to pubic symphysis and pubic crest below
Above the umbilicus:
Internal oblique aponeurosis ____ and encloses the ____
The external oblique aponeurosis is in ____
The transversus abdominis behind the ____ muscle
Below the umbilicus:
All 3 aponeurotic layers are ____ to the rectus muscle
Above the umbilicus:
Internal oblique aponeurosis split and encloses the rectus abdominis
The external oblique aponeurosis is in front
The transversus abdominis behind the rectus abdominis muscle
Below the umbilicus:
All 3 aponeurotic layers are anterior to the rectus muscle
What demarcates the transition between the posterior rectus sheath and the transversalis fascia?
Posterior rectus sheath covers the superior three quaters of the rectus abdominis and the transversalis fascia covers the inferior quater
Arcuate line
Posterior wall of the rectus sheath is ____, stops short below the ____ at the arcuate line
Posterior wall of the rectus sheath is incomplete, stops short below the umbilicus at the arcuate line
Deep inguainal ring (a hole in the transversalis fascia) is located about ____ above the midpoint of the ____
1.5cm, inguinal ligament
What does the transversalis fascia lines?
Anterolateral abdominal wall
Lies between the transversus abdominis nuscle and peritoneum
What are the 2 main arteries that supplies to the rectus muscle?
Superior epigastric artery - terminal branch of internal mammary
Inferior epigastric artery - Branch of external iliac
These 2 vessels enters the rectus sheath and anastomose forming a potential by-pass to abdominal aorta
List some examples of blood supply of the flank muscles
Flank muscles are segmentally supplied by:
- Intercoastal arteries 7-11
- Subcostal artery
- Lumbar arteries
- Deep circumflex iliac arteris
Venous drainage: Deep veins bearing the same names accompany the arteries
What dermatomes for epigastrium?
T7 to T9
The umbilicus belongs to which dermatome?
T10
What dermatomes for inferior to the umbilicus?
T11-T12
Dermatomes for inguinal and pubis?
L1
T7 to T11 are supplied by ____ nerves?
Thoraco-abdominal nerves
What is the nerve that supplies T12?
Subcostal nerve
Nerve supply of external oblique muscle?
Anterior rami of T7-T11 spinal nerves
Nerve supply of internal oblique muscle?
Anterior rami of T7-T12 and L1 spinal nerves
Nerve supply of the rectus abdominis?
Anterior rami of T7 to T12
What are some functions of the anterolateral abdominal wall?
- Compress the abdominal content and increase the intra-abdominal pressure to aid expiration, evacuation of urine, faeces, parturition, heavy lifting
- Helps to maintain posture
- Supports viscera “guarding mainly the intestines”
- Flex and rotate the trunk
What is the most poerful flexor of the vertebral column (lower thoracic & lumbar)
Rectus abdominis
External and internal obliques of both sides are important partners in this action
The inguinal region is located between ____ and ____
Anterior superior iliac spine and pubic tubercle
Weakness of this area causes hernia
Hernias occurs more in male or female?
Male
How long is the inguinal canal in adults?
4cm
The inguinal canal extended from ____ inguinal ring (a hole in transversalis fascia) to ____ inguinal ring (a hole in external oblique aponeurosis)
Deep inguinal ring to superficial inguinal ring
In males, the inguinal canal consits of __, ilioinguinal nerve, blood and lympathic vessels
Spermatic cord
In females, the inguinal canal consits of ____ , ilioinguinal nerve, blood and lympatic vessels.
Round ligament
What are the 4 walls of the inguinal canal?
Anterior:
* External oblique aponeurosis
* Internal oblique muscle reinforce lateral 3rd
Floor:
* Rolled inferior edge (gutter like) of external oblique aponeurosis (inguinal ligament)
Roof:
* Arching fibres of internal oblique
* Medially conjont tendon (with transverse abdominis)
Posterior wall:
* Transvesalis fascia
* Medially conjont tendon
Think of roof and floor, anterior and posterior (4 sides)
What type of hernia are more common in young males?
Indirect inguinal hernia
Occurs through the deep inguinal ring
What type of hernia is more common in older people?
Direct inguinal hernia
Occurs through the posterior wall
What is the defination of a hernia?
A hernia is an abnormal protusion of an orfan through the structure that usually contains the organ.
What are the 3 things that makes up a hernia?
- Sac (e.g. Peritoneum)
- Defect (the hole through which the hernia has occured)
- Contents of the sac (e.g. bowel)
What are some clinical features of hernia?
- Lump in the groin
- May come and go
- There all time
- Painful
- Vomiting, constiptation
- Associated conditions
What factors helps to prevent the occurance of hernia?
- Oblique passage
- Posterior wall (immediately behind the superficial inguinal ring) is reinforced by the conjont tendon
- When intra-abdominal pressure increase upon cough and straining, the roof compresses the contents of the canal against the floor, so that the canal is completely closed (contents cannot be herniated)
What are some common hernias in the inguinal region?
Inguinal hernia
Femoral hernia
Where is the mid inguinal point located?
1/2 way between ASIS and Pubic Symphysis
Landmark for femoral artery in groin
Where is the midpoint of inguinal ligament located?
halfway between ASIS and pubic tubercle
Landmark for deep inguinal ring and indirect inguinal hernia. Medial to this for direct inguinal hernia.
Briefly descrbibe direct inguinal hernias
Acquired
- Bulge through weakened fascia of abdominal wall
- Directly behind the superficial inguinal ring
- Medial to the inferior epigastric vessels
- Rarely enter the scrotum
- Common in elderly men with weak abdominal muscles
Herniating bowel passes medial to inferior epigastric vessels, pushing through peritoneum and transversalis fascia in inguinal triangle to enter inguinal canal
Briefly describe indirect inguinal hernia
Congenital
- Traverses inguinal canal
- Same course as spermatic cord
- Enter inguinal canal at the deep inguinal ring
- Lateral to the inferior epigastric vessels
- Can pass into the scrotum or labia majora
- Male > Female
- Congenital, injury
Herniating bowel passes lateral to inferior epigastric vessels to enter deep inguinal ring
What hernia is more common in older age group?
Direct inguinal hernia
Direct inguinal hernia is due to ____ defect in ____ wall of inguinal canal
Associated with chronic ____ and ____ musculature
The hernia’s path is ____ through the ____ wall of the inguinal canal but it dosent enter the _____
Defect is in ____ wall of the inguinal canal ____ to the inferior epigastric vessels
Direct inguinal hernia is due to acquired defect in posterior wall of inguinal canal
Associated with chronic straining and weakened musculature
The hernia’s path is straight through the posterior wall of the inguinal canal but it dosent enter the scrotum
Defect is in posterior wall of the inguinal canal medial to the inferior epigastric vessels
Indirect Inguinal Hernia
- Most ____ type
- Tend to be in ____
- The hernia takes an ____ path through the abdominal wall
- The defect is a ____ ring
- The hernia passes through the inguinal canal and into the ____
Indirect Inguinal Hernia
- Most common type
- Tend to be in younger adults and children
- The hernia takes an indirect path through the abdominal wall
- The defect is a dilated deep ring
- The hernia passes through the inguinal canal and into the scrotum
- Superficial inguinal ring is palpable above and ____ to the pubic tubercle by invaginating the scotal skin with the finger
- Follow the spermatic cord to the superficial ring
- If the ring is ____, it may admit the finger without causing pain
- Superficial inguinal ring is palpable above and lateral to the pubic tubercle by invaginating the scotal skin with the finger
- Follow the spermatic cord to the superficial ring
- If the ring is dilated, it may admit the finger without causing pain
A hernia produces an impulse against the finger when the patient coughs
