I: Anterior Abdominal Wall Flashcards
What quadrant is the gall bladder located in?
epigastric
What quadrants might the appendix be located in?
mostly hypogastric
maybe umbilical or r. iliac
What is the vertebral level of the umbilicus?
L3-4
How does the abdominal wall function in respiration?
opposes diaphragm during exhalation
What is the adipose layer of the abdominal wall?
Camper’s fascia
the tough fibrous Scarpa’s fascia is deep to the camper’s fascia
What does scarpa’s fascia become in the scrotum? perineum?
scrotum -> dartos fascia
perineum -> colles fascia
Origin - external oblique
external surfaces of ribs 5-12
Insertion- external oblique
linea alba, pubic tubercle, anterior half of iliac crest
action- external oblique
compress and support abdominal viscera; flex and rotate trunk
Innervation- external oblique
thoraco-abdominal nerves (anterior rami of T7-T11) and subcostal nerves
Origin- internal oblique
thoracolumbar fascia, anterior 2/3 of iliac crest, and connective tissue deep to inguinal ligament
Insertion- internal oblique
inferior borders of ribs 10-12, linea alba and pubis via conjoin tendon
Action- internal oblique
compress and support abdominal viscera; flex and rotate trunk
Innervation- internal oblique
thoraco-abdominal nerves (anterior rami of T7-T11) and first lumbar nerve (L1)
How is the internal oblique different below and above the arcuate line?
above: tendons split and wrap anteriorly and posteriorly around the rectus abdominus
below: tendon fuses and wraps only anteriorly around the rectus abdominus
Origin- Transversus abdominus
internal surfaces of ribs 7-12 costal cartilages, thoracolumbar fascia, iliac crest, and connective tissue deep to the inguinal ligament
Insertion- transversus abdominus
linea alba with aponeurosis of internal oblique, pubic crest and pectin pubis via conjoin tendon
action- transversus abdominus
compresses and supports abdominal viscera
Innervation- transversus abdominus
thoraco-abdominal nerves (anterior rami of T7-T11) and first lumbar nerve (L1)
Origin- rectus abdominus
pubic symphysis and pubic crest
insertion- rectus abdominus
xiphoid process and costal cartilages 5-7
action- rectus abdominus
flexes trunk (lumbar vertebrae) and compresses abdominal viscera
- can acts as an antagonist to the diaphragm
- stabilizes and controls pelvic lift (antilordosis)
How is the rectus abdominus different above and below the arcuate line?
above: internal oblique fascia split contibuting to both anterior sheath fusing with external oblique aponeurosis and posteriorly fusing with transversus abdominus
below: all three aponeuroses pass anteriorly to the rectus and posterior wall is composed of only the transversalis fascia and parietal peritoneum (weaker area and prone to hernias)
What is the arcuate line?
horizontal line that demarcates the lower limit of the posterior layer of the rectus sheath
_________________: layer of fascia that lines the internal abdomial wall and forms the deep inguinal ring
transversalis fascia
__________________: serous lining of the peritoneum
parietal peritoneum
- produces a serous fluid that lubricates the abdominal organs
Where do you look for inferior epigastirc arteries and veins?
Between the transversalis fascia and parietal peritoneum
What innervates the parietal peritoneum?
somatic body wall nerves
Last remnant of ventral messentry
falciform ligament
remnant of fetal umbilical vein
round ligament / ligamentum teres
main O2 from placenta to fetus
fetal umbilical vein
remnant of allantosis and paraumbilical veins
median umbilical fold
drains fetal bladder
allantosis
remnants of umbilical arteries
medial umbilical folds
returns low O2 blood back to placenta
umbilical arteries
lateral umbilical folds contain…
inferior epigastric arteries and veins
somatic innervation of the anterior abdominal wall
ventral rami of spinal nerves T7-L2
Thoracoabdominal nerves
T7-T11
Subcostal nerve
T12
iliohypogastric nerve
L1
ilioinguinal nerve
L1
what do the thoracoabdominal nerves innervate?
muscles of anterolateral wall and overlying skin
What does the subcostal nerve innervate?
muscles of anterolateral abdominal wall and overlying skin superior to iliac crest and inferior to umbilicus
What does the iliohypogastric nerve innervate?
skin overlying iliac crest, upper inguinal and hypogastric regions; internal oblique and transvesus abdominus
What does the ilioinguinal nerve innervate?
skin of scrotum or labia majus and mons pubis, and adjacent medial aspect of thigh; most inferior internal oblique and transversus abdominus
What two arteries take their origin from the internal thoracic a. ?
musculophrenic and superior epigastric
“descends along costal margin” what a?
musculophrenic
“descend in rectus sheath deep to rectus abdominus” what a?
superior epigastric
what does the musculophrenic a supply?
abdominal wall of hypochondirac region, anterolateral, diaphragm
What blood supplies the rectus abdominus and superior part of anterolateral wall?
superior epigastric a.
what anterior abdominal arteries take their origin from the aorta AND supply the lateral region of abdominal wall?
subcostal a.
posterior intercostal a. (10th and 11th)
“continues beyond ribs to descend in abdominal wall between internal oblique and transversus abdominus” what a. ?
posterior intercostal a. (10th and 11th)
AND subcostal a. (essentially the 12th)
what anterior abdominal a. take their origin from the external iliac a.?
inferior epigastric a. and deep circumflex iliac a.
“runs superiorly and enters rectus sheath, runs deep to rectus abdominus” what anterior abdominal a.?
inferior epigastric a.
“runs on deep aspect of anterior abdominal wall, parallel to inguinal ligament” what anterior abdominal a. ?
deep circumflex a.
what does the inferior epigastric a. supply?
rectus abdominus and medial part of anterolateral abdominal wall
what does the deep circumflex iliac a. supply?
iliacus muscle and inferior part of anterolateral abdominal wall
what does the superficial circumflex iliac a. supply?
superficial abdominal wall of inguinal region and adjacent anterior thigh
the superficial circumflex iliac a. and superficial epigastric a. come off of…
femoral a.
what a. runs in superficial fascia along inguinal ligament?
superfical circumflex iliac. a.
“runs in superficial fascia towards umbilicus”
superficial epigastric a.
what does the superficial epigastric a. supply?
subcutaneous tissue and skin over pubic and inferior umbilical region
What 3 arteries anastomose with aorta?
- posterior intercostals
- subcostals.
- lumbar a.
What 2 arteries anastomose with int. thoracic a.?
- superior epigastric
2. musculophrenic via anterior intercostals
What 2 arteries anastomose with ext. iliac a.?
- inferior epigastric
2. deep circumflex iliac
What 2 arteries anastomose with femoral a?
- superficial circumflex iliac a.
2. superficial eppigastric a.
where does lymph drain in the anterior abdominal wall ABOVE transumbilical plane? BELOW?
ABOVE: axillary lymph nodes
BELOW: superficial inguinal nodes