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Y1 - Anatomy of the Abdomen, Peritoneum and Pelvis > Lecture 1 - Anatomy of the abdominal wall, inguinal region and hernias > Flashcards

Lecture 1 - Anatomy of the abdominal wall, inguinal region and hernias Flashcards

1
Q

What are the bony landmarks of the abdominal and pelvic cavities?

A

Superiorly - sternum and xiphoid process
Anteriorly - costal margin
Laterally - iliac crest, iliac fossa and anterior superior pubic ramus
Inferiorly - pubic symphysis, pubic tubercle and superior pubic ramus
Posteriorly - thoracic and lumbar vertebrae, sacrum and pelvic bones

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2
Q

What separates the abdominal and pelvic cavities?

A

Pelvis inset/brim

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3
Q

What separates the thoracic and abdominal cavities?

A

Diaphragm

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4
Q

What visceral structures are found in the abdominal and pelvic cavities?

A
  • Stomach, duodenum and small/large intestines
  • Liver, pancreas and spleen
  • Kidney, ureters and bladder
  • Reproductive organs
  • Abdominal vessels
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5
Q

How can the abdomen be divided into different regions?

A
  • 9 regions

- 4 quadrants

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6
Q

How is the abdomen divided into 9 regions?

A
  • 2 vertical lines at each mid-clavicular line
  • Horizontal line at subcostal plane
  • Horizontal line at inter tubercular plane
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7
Q

Where is the subcostal place found?

A

At the bottom of the last costal cartilage on rib 10 at vertebral level L2.

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8
Q

Where is the intertubecular plane found?

A

In line with the iliac crest at the vertebral level L5.

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9
Q

What are the 9 regions that the abdomen can be divided into?

A
  • Epigastric reigion (L and R hypochondriac regions laterally)
  • Umbilical region (L and R lumbar regions laterally)
  • Hypogastric/pubic regions (L and R iliac/inguinal regions laterally)
    (Moving downwards from most superior to most inferior)
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10
Q

How is the abdomen divided into four quadrants?

A
  • Horizontal line at transumbilical plane (in line with belly button)
  • Vertical line at lineament alba (from top of manubrium)
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11
Q

What are the four quadrants?

A
  • Upper R
  • Upper L
  • Lower R
  • Lower L
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12
Q

What is found in the upper R quandrant?

A
  • Liver
  • Right kidney
  • Colon
  • Pancreas
  • Gall bladder
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13
Q

What is found in the upper L quadrant?

A
  • Liver
  • Spleen
  • Left kidney
  • Stomach
  • Colon
  • Pancreas
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14
Q

What is found in the lower R quadrant?

A
  • Colon
  • Small intestine
  • Major artery and vein to the right leg
  • Ureter
  • Appendix
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15
Q

What is found in the lower L quadrant?

A
  • Colon
  • Small intestine
  • Major artery and vein to the left leg
  • Ureter
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16
Q

What are the margins of the anterolateral abdominal wall?

A
  • Costal margin, xiphoid process, iliac crest, ASIS, pubic symphysis and tubercle
  • Umbilicus and epigastric fossa
  • Rectus abdominis, linea alba and linea semilunaris
  • Abdominal wall muscle sheets
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17
Q

What is the nerve supply for the anterograde-lateral abdominal wall?

A
  • Subcostal nerve (T12)

- Hypogastric and ilioinguinal nerves (L1)

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18
Q

What muscles make up the anterior abdominal wall?

A

Paired vertical rectus abdominis muscles within the rectus sheath.

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19
Q

What muscles make up the lateral abdominal wall?

A

3 layers of flat sheet muscles that continue anteriorly and contribute to the rectus sheath.

  • External oblique
  • Internal oblique
  • Transversus abdominis
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20
Q

What muscles make up the posterior abdominal wall?

A
  • Post vertebral muscles (erector spinae group)
  • Psoas major
  • Quadratus lumborum
  • Iliacus muscles
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21
Q

How is blood supplied to the abdominal muscles (lateral wall)?

A

Neurovascular plane lies between the transverses abdomens and internal oblique muscle layers.

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22
Q

How is lymph drained from the abdominal wall?

A

There are no lymph nodes in the abdominal wall.

Superficial
Above transumbilical plane - to pectoral group of axillary nodes
Below transumbilical plane - superficial inguinal nodes

Deep
Accompany deep veins
Above transumbilical plane - to mediastinal nodes
Below transumbilical plane - to external iliac and para-aortic nodes

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23
Q

What is the function of the abdominal muscles?

A
  • Compress the abdomen and increase intra-abdominal pressure to aid expiration, evacuation of urine/faeces, parturition and heavy lifting
  • Supports viscera and guards the intestines
  • Flex and rotate the trunk
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24
Q

What is the orientation of the external oblique muscles?

A

Inferiorly and anteriorly.

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25
Q

What is the orientation of the internal oblique muscles?

A

Directed inferiorly and posteriorly (at right angles to the external obliques)

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26
Q

What is the orientation of the transverses abdominis muscles?

A

Horizontal

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27
Q

What are the attachments for the external oblique muscles?

A
  • External surface of the lower 8 ribs
  • Free posterior border
  • Fans out to attach to xiphoid process, linea alba, pubic crest, pubic tubercle and the anterior half of the iliac crest
  • Fuses medially with the rectus sheath
  • Lower aponeurotic edge is rolled inwards and forms the inguinal ligament
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28
Q

What are the attachments for the internal obliques?

A

Laterally

  • Thoracolumbar fascia
  • Iliac crest (anterior 2/3rds)
  • Inguinal ligament (lateral half)

Medial

  • Lower 3 ribs and CCs
  • Xiphoid process
  • Rectus sheath
  • Conjoint tendon
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29
Q

What are the attachments of the transverses abdominis muscles?

A

Lateral

  • Lower 6 CCs
  • Thoracolumbar fascia
  • Iliac crest (anterior 2/3rds)
  • Inguinal ligament (lateral third)

Medial

  • Xiphoid process
  • Linea alba
  • Pubic symphysis
  • Conjoint tendon
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30
Q

What are the rectus abdominis muscles?

A

A long strap muscle of the anterior abdominal wall that encloses the rectus sheath. It has two heads and is divided into segments by tendinous intersections (3) which are attached to the anterior wall of the rectus sheath.

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31
Q

What are the attachments of the rectus abdominis muscles?

A

Superiorly

  • 5-7th CCs
  • Xiphoid process

Inferiorly

  • Pubic symphysis
  • Pubic crest

Posteriorly

  • Posterior wall is incomplete, stopping short of the umbilicus at the arcuate line
  • Below the arcuate line the rectus abdominis muscle is in contact with the transversalis fascia
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32
Q

What is the conjoint tendon?

A

The lowest fibres of the internal oblique aponeurosis and similar fibres of the tranevrsus abdominis aponeuronosis join to forth conjoint tendon. It is attached medially to the linea alba/.

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33
Q

What is the rectus sheath?

A

The most powerful flexor of the vertebral column that is formed by the aponeuroses of the 3 muscles making up the lateral abdominal wall.

  • Long flat muscle
  • Paired muscle
  • Separated by linea alba
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34
Q

Describe the structure of the rectus sheath above the umbilicus.

A

Upper 3/4 of the sheath (above the point at which is halfway between umbilicus and pubic symphysis)

  • Internal oblique muscle sheet splits and encloses the rectus abdominis either side
  • External oblique is anterior to the rectus abdominis
  • Transversus abdominis is posterior to the rectus abdominis
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35
Q

What are main muscles that make up the posterior wall?

A
  • Psoas major
  • Quadratus lumborum
  • Iliacus
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36
Q

What movement is the psoas major muscle important in?

A

A flexor of the hip and the trunk.

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37
Q

What movement is the quadratus lumborum involved in?

A

Lateral flexor of the trunk.

38
Q

What is the psoas major attached to?

A

Attached to the bodies and discs of all 5 lumbar vertebrae and the less tronchanter of the femur.

39
Q

What nerves supply the posterior wall muscles?

A

Psoas major - L2-4
Quadratus lumborum - T12 and L1-4
Iliacus - femoral nerve (L2-4)

40
Q

What is the quadratus lumborum attached to?

A

Attached to the lower border o the 12th rib and the transverse process of the 5th lumbar vertebrae and adjacent iliac crest

41
Q

What is the blood supply for the rectus muscle?

A
  • Superior epigastric artery (terminal branch of internal thoracic)
  • Inferior epigastric artery
    Form a potential by-pass to the abdominal aorta.
42
Q

Where does the inferior epigastric artery branch from?

A

External iliac artery.

43
Q

What is the blood supply for the flank muscles?

A
  • Intercostal arteries (10-11)
  • Subcostal artery
  • Lumbar arteries
  • Deep circumflex iliac arteries
44
Q

What is the nerve supply for the rectus muscle?

A

T7-T12

45
Q

What is the nerve supply for the different flank muscles?

A

External - T7-111
Internal - T7-12 and L1
Transversus abdominis - T 7-T12 and L1

46
Q

What is the dermatome for T7?

A

Epigastrium

47
Q

What is the dermatome for the umbilicus?

A

T10

48
Q

What is the dermatome for the inguinal ligament?

A

L1

49
Q

What is the inguinal region?

A

The junction between the anterior abdominal wall and the thigh between the ASISad pubic tubercle.

50
Q

Which part of the inguinal region is herniation common?

A

Anterior abdominal wall is weakened in the inguinal region which is where a potential site where most abdominal hernias occur.

51
Q

In which gender are hernias more common?

A

Males (8x more common)

52
Q

What does the inguinal canal contain that is found in both females and males?

A

Ilioinguinal nerve

53
Q

What is present in the male inguinal canal?

A

Testis and spermatic cord descend from the abdomen into the scrotum via the inguinal canal.

54
Q

When do the testis enter the spermatic cord and when do they reach the scrotum?

A

Inguinal canal - 28th week

Scrotum - 32-36th week

55
Q

What is present in the female inguinal canal?

A

The uterine round ligament descends through the developing inguinal canal.

56
Q

How long is the inguinal canal?

A

4cm

57
Q

Where is the inguinal canal found?

A
  • Extends from the deep inguinal ring (hole int eh transversals fascia) to the superficial inguinal ring (hole in the external oblique aponeurosis)
  • Deep ring is 1.5cm above the midpoint of the inguinal ligament
  • Superficial ring is immediately above and medial to the pubic tubercle
58
Q

What are the walls of the inguinal canal?

A

Anterior - external oblique aponeurosis and internal oblique muscles reinforces the lateral 3rd of the canal
Inferior - rolled inferior edge of external oblique aponeurosis (inguinal ligament)
Superior - arching fibres of the internal oblique muscle and transverse abdominis muscles as well as conjoint tendon medially
Posterior- transversalis fascia and medially conjoint tendon

59
Q

What is the femoral canal?

A

Another canal below the inguinal ligament which the femoral artery and the femoral vein pass through.

60
Q

What are the walls of the femoral canal?

A

Superior - inguinal ligament
Inferior - pectineus fascia
Medial - lacunar ligament
Lateral - femoral vein

61
Q

What is a hernia?

A

A condition in which part or whole of an organ or tissue is abnormally protruding through the wall of the structure containing the organ or tissue.

62
Q

Which form of inguinal hernias are more common?

A

Indirect inguinal hernia.

63
Q

Which gender are femoral hernias more common in?

A

Female (rare in men), increasing in frequency with age and number of pregnancies.

64
Q

What is a direct inguinal hernia?

A

Tends to go through Hesselbach’s triangle (inguinal triangle) which is always medial to the inferior epigastric vessels. They are bounded by:

  • Inferior epigastric artery laterally
  • Rectus abdominis muscle medially
  • Inguinal ligament inferiorly
65
Q

What is an indirect inguinal hernia?

A

A hernia that can develop when part of the processes vaginalis remains open and therefore is thought of as congenital. They are always lateral to the inferior epigastric vessels and enter the inguinal canal via the deep inguinal ring.

66
Q

What are common clinical signs of a hernia?

A
  • Lump or profusion in the groin
  • Appears intermittently or present all the time
  • Can be painless, painful or uncomfortable
  • May be reducible or irreducible
  • May be strangulated with tissue death
67
Q

What is strangulation of a hernia associated with?

A
  • Vomiting
  • Constipation
  • Intestinal obstruction
    A MEDICAL EMERGENCY
68
Q

What are the risk factors for a direct inguinal hernia?

A
  • Older age groups

- Associated with chronic straining and weak musculature

69
Q

What are the risk factors for an indirect inguinal hernia?

A
  • Younger adults and children
70
Q

What are the risk factors or a femoral hernia?

A
  • Common in the elderly and females
71
Q

What are common features of a femoral hernia?

A
  • Appear below or lateral to the pubic tubercle
  • Tend to be irreducible and hot if strangulated
  • Have a high incidence of obstruction and strangulation leading to tissue death
72
Q

What level is the subcostal plane found?

A

L3

73
Q

What level is the intertubercular plane found?

A

L5

74
Q

What is the relation of the iliac tubercle and the ASIS?

A

The iliac tubercle is located 5cm posterior to the ASIS on the iliac crest.

75
Q

What are the different layers of the abdominal wall?

A
  • Skin
  • Superficial fascia (Campers - fatty, Scarpas - membranous)
  • Muscles
  • More fascia
  • Peritoneum
76
Q

What makes up the erector spinae group?

A
  • Iliocostalis
  • Longissimus
  • Spinalis muscles
77
Q

Where do the external obliques originate?

A

The outer surface of the lower eight ribs (5-12)

78
Q

Where do the external oblique insert?

A

Lateral lip of the iliac crest.

79
Q

What forms the inguinal ligament?

A

The lower border of the aponeurosis of the external oblique.

80
Q

Where does the inguinal ligament run from?

A

ASIS to the pubic tubercle.

81
Q

Where do the internal obliques originate?

A
  • Thoracolumbar fascia
  • Iliac crest
  • Lateral 2/3s of the inguinal ligament
82
Q

Where do the internal obliques insert?

A
  • Inferior border of the lower three or four ribs
  • Xiphoid process
  • Aponeurosis ends at the linea alba
  • Attached to pubic crest
83
Q

Where do the transversus abdominis muscles originate?

A
  • Thoracolumbar fascia
  • Iliac crest
  • Lateral 1/3 of inguinal ligament
  • Costal cartilages of the lower six ribs (7-12)
84
Q

Where do the transversus abdominis muscles insert?

A
  • Aponeurosis ends at linea alba

- Pubic crest

85
Q

Describe the structure of the rectus sheath below the umbilicus.

A

In the bottom 1/4 of the sheath, all the aponeurosis randomly move to the front so they are all anterior to the rectus abdominis muscle. The point of transition is called the arcuate line.

86
Q

What is directly behind the transversus abdominis muscle?

A

Transversalis fascia

87
Q

What is the arcuate line?

A

The point at which the aponeurosis move anterior to the rectus abdominis muscles in the rectus sheath.

88
Q

What is the processus vaginalis?

A

An embryonic outpouching - can cause development of congenital hernias.

89
Q

What is the difference between direct and indirect hernias?

A

Direct - acquired

Indirect - congenital

90
Q

What are the borders of a femoral hernia?

A

Superior - inguinal ligament
Lateral - femoral vein
Inferior - pectineal ligament
Medial - lacunar ligament

91
Q

What is the main difference between inguinal and femoral hernias?

A

Inguinal hernias are medial and above the pubic tubercle whereas as femoral hernias are lateral and below the pubic tubercle.

Y1 - Anatomy of the Abdomen, Peritoneum and Pelvis (10 decks)

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