Jan29 M3-Anatomy Lecture 1 Flashcards
extraperitoneal fatty tissue location
between peritoneum and transversalis fascia
7 layers of the anterior abdomen
skin, superficial fascia, deep fascia, anterolateral wall muscles, transversalis fascia, extraperitoneal fatty tissue, peritoneum
superficial fascia components
Camper’s fascia (superficial fatty)
Scarpa’s fascia
(deep membranous)
deep fascia def
fascia coating/covering every muscle in the body
external oblique runs in what direction
hands in pockets.
starts on rib cage.
external oblique: 2 target places where it joins in the bottom
- inguinal ligament (free lower edge), connected to legs fascia
- anterior superior iliac spine (ASIS)
external oblique: midline extensions + name
beyond midclavicular line, going to midline is only deep fascia. aponeurosis
pubic tubercle location
bottom of linea alba (midline)
where 2 bands of external oblique fascia end up going
extend to pubic tubercle
bump on the hip: what it corresponds to
anterior superior iliac spine
internal oblique muscle limited to where and extensions
muscle doesn’t go medially under the ribs (between the costal margins (infrasternal angle)) and is mostly on the side
still aponeurosis
transversus abdominis direction and fascia
horizontal. fascia extending to midline
rectus abdominis covers name and origin
rectus sheath: formed by fascias of external oblique, internal oblique and transversalis abdominis
rectus abdominis origin and insertion and direction
starts on costal cartilage of costal margin. goes down to pubic crest (near pubic tubercles and pubic symphysis)
how many pubic tubercles and pubic crests and where
- inguinal ligament extends to pubic tubercle
- pubic crest is from pubic tubercle to midline
3 non muscular delineations of the rectus abdominis
- linea alba (middle forward extension of sheaths)
- linea semilunaris (sides)
- tendinous intersections
tendinous intersections attach to what structure anteriorly
rectus sheath
composition of the rectus sheath right below the xiphoid process (at costal margin level)
deep fascia of EO (external oblique) goes on top of rectus abdominis and makes anterior rectus sheath
rectus sheath composition in the middle of the abdomen
anterior: EO + half IO deep fascia
posterior: half of IO, TA, transversalis fascia (TF)
lower sheath (low abdomen) composition
anterior: EO + all IO + TA (transversus abdominis)
posterior: TF (transversalis fascia)
vessels feeding the rectus abdominis: location in relation to rectus sheath
between rectus abdominis and posterior rectus sheath
arcuate line def
(lower edge of posterior rectus sheath) transition line below umbilicus where no more posterior rectus sheath
below arcuate line, what is posterior to rectus abdominis
transversalis fascia
blood supply to the rectus abdominis
- superior epigastric arteries (from internal thoracic arteries)
- inferior epigastric arteries (from external iliac artery)
branchings after abdominal aorta
2 common iliacs. each gives external iliac (becomes femoral artery in the leg) and internal iliac (to the pelvis)
blood supply to side of the abdominal wall and origin (2)
- lumbar arteries (L1, L2, L3 and L4) from aorta. as if we had rib cage
- deep circumflex iliac artery (from external iliac)
link between superior and inferior epigastric artery
they anastomose in the rectus abdominis
how inferior epigastric a. reaches the rectus abdominis
pierces through the transversalis fascia and reaches rectus from below arcuate line
3 folds visible when looking at abdomen from inside and what causes them/origin
- median umbilical ligament (remnant of embryonic urachus
- medial umbilical ligament (remnant of embryonic umbilical artery)
- lateral umbilical folds (inferior epigastric vessels)
blood supply to abdomen: structure after deep circumflex ilieac
ascending branch of the deep circumflex iliac
blood supply to abdomen: branch originating from the femoral artery
superficial epigastric artery
venous drainage: 4 deep vessels
- superior epigastric v (to internal thoracic v)
- inferior epigastric v (to external iliac v)
- superficial CIRCUMFLEX iliac v (to femoral v)
venous drainage: 3 superficial vessels
- superficial epigastric v (to iliac v)
- thoraco epigastric v
- axillary v
2 (groups of) lymph nodes important for the abd wall
- axillary lymph nodes
- superficial inguinal lymph nodes
thoracic innervation to abd wall and what type of innervation
motor and sensory. anterior and lateral cutaneous branches of lowest five throacoabdominal (or intercostal) nerves (T7-T11) + subcostal nerve (T12)
landmark for T10
belly button
two L1 level innervation of abdominal wall and position relative to each other
Iliohypogastric nerve (L1) and Ilioinguinal nerve (L1), which is lower than the iliohypogastric n
iliohypogastric nerve motor innervation to where and sensory to where
- motor to muscles of abd wall
- sensory to suprapubic region + lateral aspects of the buttocks
ilioinguinal nerve motor innervation to where and sensory to where
- motor to muscles of abd wall
- sensory to upper medial part of the thigh, anterior part of the scrotum, mons pubis and labium majus
iliohypogastric nerve: how reaches the skin
pierces the EO 3-5 cm above the superficial inguinal ring
ilioinguinal nerve: how reaches the skin
emerges from superficial inguinal ring and passes on the surface of the spermatic cord
inguinal canal def
canal developed for spermatic cord to get through (since spermatic cord, testes and scrotum are made of layers of abd wall)
testes push against which abd layers in development
all layers except TA
so transversalis fascia, internal abd oblique, external abd oblique, Scarpa’s fascia, skin
how peritoneum relates to the testes
gets sucked in the testes during development even though they don’t push on it
name of descent of the testes (whole process)
processus vaginalis
diff abdo layers names once in the testes (inside to outside)
- obliterated processus vaginalis (perit): descent part
- visceral and parietal tunica vaginalis (perit)
- internal spermadic fascia (TF)
- Cremaster muscle (IO muscle)
- External spermadic fascia (EO aponeurosis)
- Dartos (Scarpa’s fascia)
- skin
deep inguinal ring def and location
where inguinal canal starts to form and stuff first starts to get through. halfway between ASIS and pubic tubercle
superficial inguinal ring def
where we see the spermatic cord coming off
3 structures important in hernial repair
conjoint tendon
lacunar ligament
Cooper’s ligament
conjoint tendon def
fusion of aponeuroses of TA and IO. Inserts on pubic crest in continuity with pectinal line (middle of pelvis anteriorly) Reinforcement of posteror wall of the inguinal canal
lacunar ligament def
backward and lateralward posterior projection of the inguinal ligament on the pectinal line, after it reaches the pubic tubercle
Cooper’s ligament def
extension of the lacunar ligament that runs on the pectineal line
conjoint ligament position relative to rectus abdominis
is where fascias come together in front of rectus
inguinal canal content in females
round ligament of the uterus
direct hernia def
direct bulging out of the front wall, medially to the inferior epigastric artery, through Hesselbach’s triangle
indirect hernia def
intestine pushing down into the scrotum (lateral to inferior epigastric artery)
3 borders of inguinal triangle or Hesselbach’s triangle
medial: lateral margin of rectus abdominis muscle/sheath
superlateral: epigastric vessels
inferior border: inguinal ligament
what is the weakness in the inguinal triangle
no transversalis fascia
condition where indirect hernia more likely to happen and explanation
patent processus vaginalis. no closure of the processus vaginalis (which comes from peritoneum)
can also have partial closure of the processus vaginalis
femoral hernias: occur where
below inguinal ligament, through the femoral canal/ring
mnemonic on structures near the femoral canal/ring
NAVEL. nerve, artery, vein, empty, lymphatics
condition where an artery sits right in front of the hernial canal (where femoral herniation might happen)
abberant obturator artery
abdominal hernias occur where and who can check for these
anterior abdominal wall. phys exam or CT
other name for femoral canal
femoral ring
