Gross 2 Abdominal Wall Flashcards
What are the boundaries of the abdominal area?
Superiorly: Diaphragm
Inferiorly: Iliac Crest down to inguinal Lig. to pub. symphysis, pelvic floor muscles
Anteriorly: Abdominal Musculature
Posteriorly: Lumbar Vertebrae / QL
Laterally: Abdominal Musculature
What are the four Abdominal Regions Planes of the Abdomen? What are the structures associated with each plane?
- Subcostal {Vert. Lvl. L2/L3 disc}: Costal Cartilage Lowest level
- Transtubercular {Vert. Lvl. L5 body}: Iliac Tubercles
- Right Mid-Clavicular: Mid-Clavicle to Inguinal Ligament
- Left Mid- Clavicular: Mid-Clavicle to Inguinal Ligament
What are the two Abdominal Quadrant Planes in the abdomen? What are the structures associated with each plane?
- Transumbilical {Vert. Lvl. L3/L4 disc}: Umbilicus
- Median Plane: Midline of body through umbilicus
What are the 9 regions of the Abdomen?
- R. Hypochondrium / Epigastric / L. Hypochondrium
- R. Lumbar (Flank) / Umbilical / L. Lumbar (Flank)
- R. Inguinal / Pubic / L. Inguinal
What are the 4 Quadrants of the Abdomen?
Right Upper Quadrant / Left Upper Quadrant
Right Lower Quadrant / Left Lower Quadrant
The Abdomen can be divided into 4 areas, what are those areas and what do they contain?
- Anterior/Lateral Abdominal Wall: formed by the abdominal walls
- Inguinal: Containing the inguinal ligament and canal
- Posterior Abdominal Wall: Containing the lumbar spine and their disc, the lumbar nerve plexus, fascia, diaphragm, iliopsoas, QL, transverse abdominis, Internal and External oblique
- Abdominal Cavity: Containing the abdominal organs and BVs
One of the areas of the Abdomen is the Anterior/Lateral Abdominal Wall, what are the boarders to this area?
Superiorly: 7th - 10th costal cartilage, Xiphoid
Inferiorly: Upper Pelvis
Anteriorly: Rectus Abdominis
Laterally: External/Internal Oblique, Transverse abdominis
What are the layers of the Anterolateral Wall?
Superficial to deep
- Skin
- Subcutaneous Tissue
–Campers (Superficial fatty layer)
–Scarpa (Deep membranous layer)
- Muscles and Associated fascia
- Transverse Fascia
- Extraperitoneal Fat
- Parietal Peritoneum
What are the muscles of the Anterior Wall and Anterolateral Wall?
Anterior Wall: Rectus Abdominus, and this muscle is on both sides of the midline
Anterolateral Wall: 3 broad muscles and thin sheets of muscle that are aponeurotic anteriorly
(External Oblique, Internal Oblique, Transverse Abdominus)
What are the functions of the Anterolateral Abdominal Muscles?
- Increases intra-abdominal pressure
- Protects the abdominal viscera
- Expands walls during inspiration
- Helps maintain posture
- Movement of the trunk/turning
One of the areas of the Abdomen is the Posterior Abdominal Wall, what are the boarders to this area?
Medially: Lumbar vertebrae and disc, and Psoas M.
Laterally: QL, IO and EO, and Transverse Abdomens
Superiorly: Diaphragm
One of the areas of the Abdomen is the Inguinal, what are the borders to this area?
Superior-Lateral: ASIS
Inferior-Medial: Pubic Tubercle
What are the contents in the Inguinal Region?
- Inguinal Ligament
- Iliopubic Tract
- Inguinal Canal
- Spermatic Cord (Males)
- Round Ligament of the Uterus (Female)
What is the Inguinal Ligament? What is the Subinguinal Space?
A ligament formed by the thickened infolding of the External Oblique (EO), also has:
–Lacunar Ligament: Medial boundary of the subinguinal space
–Pectineal Ligament
The Subinguinal Space is a passage way for neurovasculature for the lower limb
What is the Iliopubic Tract created by and what does it reinforce?
This is created by the inferior margin of the Transverse Fascia
- This reinforces the posterior wall and floor of the inguinal canal
What are the boundaries of the Inguinal Canal?
(Anterior wall, Posterior wall, roof, and floor)
Anterior Wall: External Oblique and fibers of the Internal Oblique Laterally
Posterior Wall: Transverse Fascia
Roof: Musculo-aponeurotic arcades (Internal Oblique + Transverse ABdominis)
Floor: Iliopubic Tract, Inguinal Lig., Lacunar Lig.
What are the Superficial and Deep Inguinal Rings? What are they formed/created by?
These serve as an entrance and exit
Superficial Ring:
- Formed by a split in the External Oblique Aponeurosis
- Held together by the internal crural fibers
Deep Ring:
- Created by an invagination of the Transversalis Fascia
- Located ~1 cm superior to the middle portion of the inguinal ligament
What contents would we find in the Inguinal Canal in a Male?
- Ilioinguinal Nerve
- Spermatic Cord
–This Cord contains:
Ductus Deferenes, Testicular A., Pampiniform Venous Plexus, Cremaster A., Genitofemoral N.
What contents would we find in the Inguinal Canal in Females? What is the function of the found ligament of the uterus?
- Round Ligament of the Uterus
- Ilioinguinal N.
- Genital Branch of the Genitofemoral N.
The round ligament maintains the position of the uterus
One of the areas of the Abdomen is the Posterior Abdomen Wall, what are the borders to this area?
Medially: Lumbar Vertebrae
Laterally: Quadratus Lumborum (QL)
One of the areas of the Abdomen is the Abdominal Cavity, what are the border to this area?
The space within the abdominal areas
What are the muscle(s) of the anterior wall?
The rectus abdominis (A wide vertical muscle on both sides of the mid-line)
What are the muscle(s) of the anterolateral wall?
Three broad and thin sheets of muscle that are aponeurotic anteriorly
- External Oblique (Most superficial)
- Internal Oblique
- Transverse Abdominis (Deepest)
If a person is doing a diagonal sit-up to the left side, what muscles are being activated?
- Left Rotation:
Right External Oblique + Left Internal Oblique
(EO=Contralateral rot.) (IO=Ipsilateral rot.) - Trunk Flexion:
Rectus Abdominus
If a person is doing a diagonal sit-up to the left side, what muscles are activated during the eccentric component? (Lowering trunk to floor)
- Right Rotation occurring Eccentrically:
Right External Oblique + Left Internal Oblique
-Trunk Flexion:
Rectus Femoris
Same as concentric
What muscles are activated during anterior and posterior tilt?
- Anterior Tilt:
—-Multifidi and Erector Spinae (Lumbar Extension)
—-Iliopsoas (Hip Flexor) - Posterior Tilt:
—-Rectus Abdominus (Abdominals)
—-Hamstrings (Hip Extensors)
What makes up the Rectus Sheath?
All the muscles (External/Internal Oblique, and Transverse Abdominis) are encapsulated by fascia/sheath. They encapsulate the Rectus Abdominis and attach at the midsagittal line to form the linea alba.
The muscels encapsulating the rectus will very by location
What muscle(s) encapsulate the Rectus Abdominis in the Epigastric Region?
- External Oblique forms the Anterior and Posterior part
What muscle(s) encapsulate the Rectus Abdominis in the Umbilical Region?
Anterior Part by External and Internal Oblique
Posterior Part by Internal Oblique, Transverse Abdominis and Transversalis Fascia
What muscle(s) encapsulate the Rectus Abdominis in the Hypogastric Region?
Anterior Part by External and Internal Oblique, and Transverse Abdominis
Posterior Part by Transversalis Fascia
What is the dysfunction of the Linea Alba? When is it most common?
Diastasis Recti: The Splitting of the Linea Alba
Most common in:
- Pregnancy
- Valsalva (Forces Exhalation against closed airway)
What are common causes of Abdominal Protuberance?
- Food
- Fluid
- Fat
- Feces
- Flatus (Gas)
- Fetus
How will an abdominal protuberance affect posture?
It’ll shift the Center Of Mass (COM) anteriorly, and this can lead to increased lumbar lordosis
What are abdominal pathologies?
Abdominal Hernias, and these hernias are names according to their region/area
What is the difference between Direct Hernias and Indirect Hernias?
Direct Hernia: Result of weakening in the Abdominal wall
Indirect Hernia: Passes through Inguinal Ring
What is the Neurovascular plane? Where does it lie?
- This contains the nerves and arteries supplying the anterolateral abdominal wall
- This lies between the internal oblique and transverse abdominus
What are the arteries that supply the Anterolateral Abdominal Wall? (8)
- Musculophrenic A.
- Superior Epigastric A.
- 10th and 11th posterior intercostal A.
- Subcostal A.
- Inferior Epigastric A.
- Deep Circumflex Iliac A.
- Superficial Circumflex A.
- Superficial Epigastric A.
What are the Primary Arteries the supply the Anterior Abdominal Wall? What regions will they supply?
- Superior Epigastric A. (Epigastric region)
- Inferior Epigastric A. (Pubic region)
- Superficial Epigastric A. (Pubic region)
The Superior and Inferior Epigastric will anastomose and will also supply the Umbilical region
What arteries supply the Hypochondriac Region?
Musculophrenic A.
What arteries supply the Lumbar Region?
Intercostal A.
Subcostal A.
What arteries supply the Inguinal Region?
Deep Circumflex Iliac A.
Superficial Circumflex Iliac A.
What is the pathway from the heart to the Right Superior Epigastric Artery?
Heart -> Aorta -> Brachiocephalic -> Subclavian A. -> Internal Thoracic -> Superior Epigastric A.
(If it were the left superior epigastric, it wouldnt go through brachiocephalic, it’ll go straight to subclavian)
What is the pathway from the heart to the Deep Circumflex Iliac Artery?
Heart -> Thoracic Aorta -> Abdominal Aorta -> Common Iliac A. -> External Iliac -> Deep Circumflex Iliac A.
Same pathway for Inferior Epigastric A.
Which nerve(s) innervate the muscles of the Anterolateral Abdominal Wall?
- Intercostal N.
- Subcostal N.
- Iliohypogastric N.
- Ilioinguinal N.
What are the layers of the internal surface of the Anterolateral Wall?
From Deep to Superficial
- Parietal Peritoneum
- Extra-Peritoneal Fat
- Transverse Fascia
What are the Parts of the Internal Surface of the Anterolateral Wall? What are in these parts?
- Supra-Umbilical
–Falciform Ligament (Attaches the liver to abdominal wall - Infra-Umbilical (3 Folds, 3 Fossas)
–Folds: Median, Medial, Lateral
–Fossas: Supravesical Fossae, Medial Inguinal Fossae, Lateral Fossae