Lecture 1: Anterior Abdominal Wall Flashcards
What are the divisions of the abdomen?
H: Hypochondrium L: Lateral flank I: Inguinal E: Epigastric U: Umbilical P: Pubic
Left/right: H,L,I
Middle: E,U,P
+ all 4 quadrants
Where is the transpyloric plane?
What organs are on this level?
L1 level
Organs: gall bladder fundus, pylorus,pancreatic neck, root of transverse mesocolon, kidney hila
Vessels: SMA origin, hepatic portal vein
Where is the subcostal plane and what is found here?
Where is the transtubercle plane and what is found here?
Where is the interspinous plane and what is found here?
- L3, inferior 10th cartilage; transverse colon
- L5 between iliac tubercles; iliocecal junction
- S2 between ASIS; appendix, sigmoid colon
What characterizes the abdominopelvic cavities?
Located?
Separated by?
Lined by?
Located between thoracic and pelvic diaphragm
A separated from P by pelvic inlet
periotneum (continuous between A and P)
What are the borders of the anteriolateral abdominal wall?
Location?
Made of?
Upper border: catilage 7-10
Lower border: inguinal ligament and pelvic bones
-mostly muscle and aponeurosis
What are the layers of the anteriolateral abdominal wall?
skin > camper’s fascia > scarpa’s fascia > aponeurosis > transversalis fascia > extraperitoneal fat > parietal peritoneum
What is the difference between Camper’s and Scarpa’s fascia?
-fatty layer of superficial fascia vs. membranous underlying CT layer of superficial fascia
What happens to Scarpa’s fascia in the perineum and the lower limb?
Perineum: continuous with Colle’s fascia
Lower limb: fused with fascia lata
OINA:
External oblique muscle
O: outer lower 6 ribs
I: linea alba and aponeurosis
N: ventral rami T7-12 (intercostal ns.)
A: compress abdomen and increase intra-abdominal pressure, move trunk and retain posture
OINA:
Internal Oblique muscle
O: iliac crest and thoracolumbar fascia
I: lower 10-12 ribs, aponeurosis, linea alba, forms conjoint tendon/inguinal falx in the lower part
N: T7-L1
A: compress and supports viscera, lateral flexion and rotation
What happens to the aponeurosis of the IOM?
Upper 3/4 of muscle: splits the rectus muscle
Lower 1/4: all go anteriorly
OINA:
Transversus Abdominis muscle
O: lower 7-12 rib, thoracolumbar fascia, iliac crest and upper inguinal ligament
I: linea alba, pecten pubis and pubic crest
N: T7-L1
A: compresses and supports viscera
OINA:
Rectus Abdominis Muscle
O: pubic symphysis and pubic crest
I: xiphoid processs and outer 5-7th cartilage
N: T7-12
A: flex and compress abdomen
What level are the tendinous insertions in the rectus abdominis muscles at?
What borders the rectus abdominis m. laterally?
- xiphoid, midway, umbilicus (form the 6 pack)
- linea semilunaris
What muscle is missing in 20% of patients?
pyramidis muscle, small muscle in lower rectus abdominis
Describe the rectus sheath
Anterior:
Aponeurosis of EO, lower 1/4 IO, lower 1/4 TA
Posterior:
TA aponeurosis
All the aponeurosis will merge anterior below the arcuate line, connecting to the trasversalis fascia behind the rectus sheath
What are the main nerves of the anterior abdominal wall?
Be able to draw them
- thoraco-abdominal ns. (T7-11) with their lateral cutaneous branches
- subcostal, iliohypogastric and ilioinguinal
What does the subcostal n. innervate?
What does the iliohypogastric n. innervate?
What does the ilioinguinal n. innervate?
- sensory superior to the iliac crest
- IO and TA motor, sensory to upper inguinal and hypogastric regions
- lower iO and TA motor, sensory to lower inguinal, anterior genitals and medial thigh
What are the arteries of the anterior abdominal wall?
Be able to draw them
-Lumbar arteries
-Superficial epigastric a.
superficial circumflex a
deep circumflex iliac a
inferior epigastric a
superior epigastric a.
What folds are found on the interior surface of the anterior abdominal wall?
Fossas?
Identify this on slide image
- median (from urachus), medial (from umbilical arteries), lateral umbilical folds (fold from inferior epigastric a)
- medial and lateral inguinal fossas
- supravesicular fossa
Which nodes do superficial vessels above the umbilicus drain?
Which nodes do superficial vessels below the umbilicus drain?
Which nodes to deep lymph vessels go?
Axillary and some to parasternal nodes
Superficial inguinal nodes
travel with deep veins of the abdominal wall
Be able to draw/identify where the common abdominal incisions are
Ok
What incision do you make if you wanna... access the gall bladder? appendix? peritoneum? obstetrical/gynecological structures? make a rapid incision?
Subcostal Gridline Paramedian (through the rectus muscle) Suprapubic Midline (since there are few vessels and nerves here)
