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Anatomy GI > Lecture 1 - Abdominal Anterolateral wall and posterior wall > Flashcards

Lecture 1 - Abdominal Anterolateral wall and posterior wall Flashcards

1
Q

What kinds of fascia are in the abdominal anterolateral wall?

A

It has superficial fascia that is connective tissue. There are two kinds:
1.) Above the umbilicus : single sheet of connective tissue that is continous with the superficial fascia in other regions of the body.

2.) Below the umbilicus: There are two layers that are the fatty superficial layer called camper’s fascia and the membranous deep layer called Scarpa’s fascia. Superficial vessels and nerves run between these layers of fascia.

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2
Q

What kind of muscles are in the anterolateral abdominal wall?

A

Two main groups:
1.) flat muscles - three of them that are situated laterally on either side of the wall.

2.) vertical muscles: two of them that are situated near the mid line of the body.

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3
Q

How are the flat muscles oriented and how does this effect the wall?

A

The flat muscles are stacked up on one another and their fibers run in different direcetions but they all meet and cross each other. This strenghtens the wall and reduces the risk of herniation. Also, each flat muscle forms an aponeurosis which covers the vertical abdominis muscle. These become intertwined in th emiddle forming the linea alba.

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4
Q
A
  1. ) External Oblique
  2. ) Rectus Abdominus
  3. ) Transverse Abdominus
  4. ) Internal Oblique
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5
Q

Where is the pyrimidalis muscle?

A

At the bottom of the abdominal wall, in the medial side. Small muscle

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6
Q

What is the arcuate line?

A

It is behind the rectus muscle, 1/3 the distance between the pubic symphysis and the umbilicus. The point at which the aponeurosis of the three lateral abdominal muscles pass anterior to the rectus abdominis.

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7
Q

What is in direct contact with the internal aspect of the rectus abdominis muscle?

A

transversalis fascia

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8
Q

What is the vasculature in terms of arteries in the anterior abdominal wall and where do these arteries come from?

A
  1. ) sueprior epigastric artery that comes from the internal thoracic artery.It travels deep to the rectus abdominis.
  2. ) Inferior epigastric artery that branches from the external iliac artery and also travels deep to the rectus abdominis.
  3. ). Superficial epigastric artery which brances from the femoral artery and travels superficial to the rectus sheath.
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9
Q

How is the anterior abdominal wall innervated?

A
  1. Innervated by the anterior rami of spinal nerves T7 to L1. These intercostal nerves travel between the neurovascualr plane between the internal and innermost intercostal muscles.
  2. When they pass the costal margin they become thoracoabdominal nerves, these travel betweent the neurovascular plane between the internal oblique and the transversus abdominis.
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10
Q

Thoracoabdominal nerves - T7-T11 - how they travel?

A

Enter abdominal wall at the costal margin.

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11
Q

Thoracoabdominal nerves - T12 - how it travel?

A

Called the subcostal nerve and it runs under the 12th rib

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12
Q

Thoracoabdominal nerves - L1 - what it divide into?

A
  1. iliohypogastric nerve
  2. ilioinguinal nerve
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13
Q

what are the abdominal quadrants and describe how each one is cut?

A

There are 4 and they are cut by 2 lines. The transumbilical plane which cuts horizontally creating and upper and lower quadrant. Then there is the median plane which cuts vertically creating a left and right quadrant.

  1. right upper
  2. right lower
  3. left upper
  4. left lower
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14
Q

Umbilicus is often used as a key landmark, what is its dermatome, vertebral level, and where is it?

A

Dermatome: T10

Vertebral level: L3/L4

At the midline

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15
Q

What is mcBurney’s point ?

A

It is 1/3 point on a line that is from the right anterior superior iliac spine to the umbilicus.

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16
Q

What are the abdominal Regions?

A

There are 9 different abdominal regions:

  1. ) Right hypochondriac
  2. ) Epigastric
  3. ) Left Hypochondriac
  4. ) Right lumbar
  5. ) Umbilical
  6. ) Left lumbar
  7. ) Right inguinal/iliac
  8. ) Hypogastric
  9. ) Left inguinal/iliac
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17
Q

What does the gubernaculum become?

A

In men: becomes the scrotal ligament

In women: upper: suspensory ligament of teh ovary, lower: round ligament of the uterus.

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18
Q

What does the process vaginalis become?

A

tunica vaginalis

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19
Q

What is the tunica vaginalis?

A

serous sheath of the testis and epididymis

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20
Q

How does scrotum come out?

A

The testicles go down and through what was the anterior abdominal wall to make a pouch called the scrotum.

21
Q

What is the inguinal ligament and where is it?

A

It is a fibrous, thickened and folded margin of the external oblique aponeurosis. It froms the floor of the inguinal canal and it extens from the anterior superior iliac spine and the pubic tubercle.

22
Q

What is the Lacunar Ligament ?

A

The deeper fibres of the external oblique aponeurosis pass posteriorly to attach lateral to the pubic tubercle to form an arch.

23
Q

Pectineal Ligament ?

A

Most lateral lacunar ligament fibers continue to run along pecten pubis. It is medial to the femoral canal. Forms the posterior border of the femoral canal.

24
Q

Reflected inguinal ligament?

A

Superior fibers of external oblique aponeurosis and lacunar ligament fan upwards crossing the linea alba instead of inserting onto the pubic tubercle.

25
Q

What are the boundaries of the inguinal canal?

A

Anterior: External oblique aponeurosis, and the exit to the inguinal canal is located at this wall - superolateral to the oubic tubercle.

Posterior: Transversalis Fascia, entrance to the inguinal canal is located in this wall an d is lateral to the inferior epigastric artery and vein

Roof: Conjoint Tendon, this forms the arching fibres of the internal oblique and transversus abdominis aponeuroses.

Floor: inguinal ligament

26
Q

What is the superficial inguinal ring and where is it?

A

It is an opening int he external oblique aponeurosis and is the exit of the inguinal canal. It is located superolateral to the pubic tubercle. It is medial to the inferior epigastric vessels.

27
Q

What is the deep inguinal ring?

A

Opening in the transversalis fascia and entrance of the inguinal canal. It is located half way along the inguinal ligament and is lateral to the inferior epigastric vessels.

28
Q

What are the contents of the inguinal canal?

A
  1. Ilioinguinal nerve
  2. Genital branch of the genitofemoral nerve
  3. Blood and lymphatic vessels
  4. Men: spermatic cord; women: round ligament of uterus
29
Q

What are the contents of the spermatic cord?

A
  1. Artery to ductus deferens
  2. Ductus deferens (excretory duct of the testis)
  3. lymphatics
  4. testicular artery
  5. cremasteric artery
  6. cremasteric vein
  7. obliterated processus vaginalis
  8. Pampiniform plexus of vv
  9. genital branch of the genitofemoral nerve
30
Q

What does the spermatic cord do and how does it travel?

A

Begins at the deep inguinal ring and travels through the inguinal canal. It then Comes out the superficial inguinal ring and ends at the scrotum.

31
Q

What is the dartos?

A

It is the continuation of the scarpic fascia

32
Q

What is the cremaster muscle ?

A

covers the testis. The muscle moves the testis, promoting healthy and motile sperm. The cremaster muscle lowers and raises the testis in order to control its temperature.The cremaster muscle is striated and innervated by the genitofemoral nerve to elecate the testis (to protect them)

33
Q

What covers the spermatic cord?

A
  1. ) External spermatic fascia: comes from the investing fascia of the external oblique muscle
  2. ) Cremaster fascia and muscle: Comes from the investing fascia of the internal oblique. The cremaster muscle is striated and innervated by the genitofemoral nerve to elecate the testis (to protect them)
  3. ) Internal spermatic fascia: comes from the transversalis fascia
34
Q

What is the scrotum appearance caused by and what does this muscle also do?

A

It is a cutaneuos, muscular sac that has a wrinkled appearance. It is rugose (wrinkled) because of teh smooth muscle fibers of the dartos muscle that are extremely thin. Protect testis by raising them up to the trunk like in the cold (to get warmer near the body). The dartos muscle recieves autonomic innervation and is a continuation of scarpa’s fascia.

35
Q

What covers the scrotum?

A
  1. ) Skin
  2. ) Dartos muscle and superficial fascia: comes from the scarpa’s fascia and the dartos muscle recieves autonomic innervation.
  3. ) External spermatic fascia: comes from the investing fascia of the external oblique muscle
  4. ) Cremaster fascia and muscle: Comes from the investing fascia of the internal oblique.
  5. ) Internal spermatic fascia: comes from the transversalis fascia
36
Q

Arterial supply of the scrotum?

A
  1. ) It is by the external pudendal artery that comes from the femoral artery. Also, it forms the anterior scrotal branches.
  2. ) Internal pudendal artery that coems from the internal iliac artery and forms the perineal artery and posterior scrotal branches.
37
Q

What is the venous and lymphatic drainage of the scrotum?

A

Venous:

  1. ) anterior scrotal veins goes into external pudendal which goes into femoral.
  2. ) Posterior scrotal veins goes into the internal pudendal

Lymphatic:

Lymph from the skin of the scrotum initially drains into the superficial inguinal lymph nodes.

38
Q

What is the innervation of the scrotum?

A

Anterior cutaneous innervation:

  1. Ilioingunal nerve becoems the anterior scrotal nerves (L1)
  2. Gentital branch of the genitofemoral nerve (L1-L2)

Posterior cutaneous innervation:

  1. Pedendal nerves becomes the posterior scrotal nerves (S2-S4)
  2. Perineal branches of posterior femoral cutaneous nerve (S2-S3)
39
Q

What are the testis and what are they attached to?

A

They are a firm yet mobile organ that are parired and suspended within the scrotum. Each is anchored inferiorly by the scrotal ligament and they produce sperm and testosterone. Function below human body temp.

40
Q

What are the coverings of the testes?

A
  1. Skin
  2. Tunica dartos - from Scarpa’s fascia
  3. External spermatic fascia - from EO fascia
  4. Cremaster muscle and fascia - from IO fascia
  5. Internal spermatic fascia - from transversalis fascia
  6. Tenica Vaginalis - parietal and visceral (more inwards) layers
41
Q

What is the epididymis?

A

It is an elongated and tightly coiled convoluted tube that is located on the posterior surface and superior pole of the testis. It stores sperm until they mature and its arterial supply is from the testicular artery.

3 parts:

  1. Head: recieves efferent ductules
  2. Body: Narrower in diameter
  3. Tail: continuos with ductus deferens
42
Q

Arteries for the testes?

A
  1. Testicular arteries
  2. Artery of ductus deferens
  3. Cremasteric Artery
43
Q

Venous drainage of the testicles?

A
  1. Pampiniform plexus
  2. Veins of ductus deferens

Order: 1.) Pampiniform plexus of veins to 2.) right or left testicular veins, 3.) to right IVC and left to left renal vein.

44
Q

What is a herniation and what kinds of herniation are there?

A

Hernia is when an organ is displaced and protrudes through the wall of the cavity that contains it.

Kinds:

  1. Umbilical hernia
  2. Femoral hernia
  3. Direct inguinal hernia
  4. Indirect inguinal hernia
  5. Incisional hernia

Acquired: pushes through the posterior wall of the inguinal canal

Congenital: moves through a open processus vaginalis (born with it, not genetic)

45
Q

Indirect vs Direct inguinal hernia

A

Indirect:

  • lateral to the inferior epigastric artery
  • Originates from the deep inguinal ring
  • Travels through all of the inguinal canal
  • emerges from the superficial inguinal ring
  • herniated content covered by all 3 layers of spermatic corf and peritoneum
  • more likely to enter the scrotum

Direct:

  • medial to the inferior epigastric artery
  • Originates from the hasselbach triangle (pushes through the ab wall)
  • Travels through the medial part of the inguinal canal
  • Emerges from the superficial inguinal ring
  • Heniated content is only covered by the transversalis fascia and parietal peritoneum
  • Less likely to enter the scrotum
46
Q

What is the hasselbach’s traiangle and what are its borders?

A

Located between the medial and lateral peritoneal (umbilical) folds and it is a weak area in the posterior wall of the inguinal canal.

Medial border: Lateral broder of the rectus abdominis

Lateral border: Inferiro epigastric vessels

Inferior border: Inguinal ligament of poupart

47
Q

How to treat hernia?

A

hernioplasty or herniorrhaphy

48
Q

Cremasteric muscle reflex?

A

Causes rapid elevation of the testus eleicited by stroking the skin of the ipsilateral thigh.

Reason: general somatic afferent; femoral branch of genitofemoral nerve and ilioinguinal nerve

General somatic efferent: contraction of the cremaster muscel that is innervated by the genital branch of the gentitofemoral nerve

49
Q

What is spermatic cord torsion?

A

It is testicular torsion or the twisiting of the spermatic cord. Venous drainage of the testis become obstructed and results in arterial ischemia, edema, and hemorrhage.

Anatomy GI (8 decks)

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