Lecture 14: Abdominal Wall + Inguinal Region Flashcards by JT Cornelius

List the layers of the abdomen from superficial to deep

Skin
Superficial Fascia
Muscles covered by deep fascia
Transversalis fascia
Parietal Peritoneum
Abdominal cavity

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What are the 4 Quadrants of he abdomen (going clockwise)

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List the nine regions of the abdomen

image

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What is the dividing line for the superficial lymphatic drainage of abdominal wall

Umbilicus

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Describe lymph flow above the umbilicus

Axillary lymph nodes - specifically pectoral

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Describe lymph flow below the umbilicus

Superficial inguinal lymph nodes

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What is the dividing line for the superficial venous drainage of abdominal wall

Umbilicus

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What drains the abdominal region above the umbilicus

Axillary V

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What drains the abdominal region below the umbilicus

External Iliac + femoral veins

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List the abdominal wall muscles superficial to deep

External oblique
Internal oblique
Transversus abdominis & Rectus abdominus

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What are tendinous intersections

They subdivide the rectus abdominis into multiple segments

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What forms the rectus sheath

Interlaced aponeuroses of abdominal muscles (ant/post rectus sheath)

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What does the rectus sheath enclose

Rectus abdominis muscle
superior/inferior epigastric vessels
anterior rami T7-12

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What is the linea alba

Fibrous vertical band connecting L/R sheaths

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T/F: The rectus sheath is the same composition throughout all levels

False; it changes

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What is the arcuate line?

Arched line where posterior sheath abruptly ends (approx b/t umbilicus and pubic symph.)

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What is the rectus sheath composition like BELOW the ribs / ABOVE arcuate line. Also, describe the anterior/posterior rectus sheath at this level.

The internal oblique aponeurosis splits to enclose rectus abdominis muscles.
Ant rectus sheath: from external oblique and part of the internal oblique
Post rectus sheath: from transverse and part of internal oblique

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What is the rectus sheath like below the arcuate line?

All 3 aponeuroses travel in front of muscle (no posterior rectus sheath)

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Nerve supply ro rectus sheath/abdominal area

Anterior rami T7-11 [intercostal N]
T12 [subcostal nerve]
L1 [lumbar]

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The L1 spinal nerve splits into two named nerves. What are they?

Iliohypogastric (sup)
Ilioinguinal (inf)

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Does the ilioinguinal nerve travel through the inguinal canal?

yes

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Where do nerves travel in relation to internal oblique and transversus abdominis muscles

Between

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What is the plane called where nerves travel between int. oblique and transversus abdominis

Transversus abdominis plane

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What is a transversus abdominis plane (TAP) block

Anesthetic technique to numb nerves of the abdominal wall. Done for laparoscopic surgeries, some hernia repairs, and hysterectomies.

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Superior Epigastric Artery: continuation of _______ artery

Internal thoracic

Inferior Epigastric Artery: branch of _________artery

External iliac

Posterior Intercostal, Subcostal and Lumbar Arteries off of the _______

aorta

Superficial Epigastric Artery : branch of _______ artery

Femoral

What is the inguinal canal

Tunnel through inferior abdominal wall

What does the inguinal canal connect

abdominal cavity w/ scrotum/labia

What is a potential weak spit in the abdominal wall

Inguinal canal

The deep inguinal ring

Tunnel entrance; lateral 'ring', entrance of "tunnel" from abdominal cavity

Superficial inguinal ring

Medial ring, opening into scrotum/labia

What are the borders of the inguinal canal

Anterior wall: external oblique aponeurosis Posterior wall: transversalis fascia (lateral 2/3) and conjoint tendon (medial 1/3) Floor: inguinal ligament (inferior attachment of external oblique)

What are the contents of the inguinal canal

Ilioinguinal nerve Spermatic cord or round ligament of the uterus Genitofemoral nerve (quite small)

What is the function of the genitofemoral nerve

Sensory to thigh, motor to muscle of spermatic cord

a protrusion of abdominal contents through the abdominal wall is known as a

Hernia

Do you think inguinal hernias are more common in males or in females? Why?

Inguinal hernias are more common in males (b/c spermatic cord keeps that tunnel 'open')

What are the 2 types of inguinal hernias

indirect direct

Indirect (‘congenital’) Inguinal Hernia - describe it

takes an indirect path out of the abdomen (through the entire “tunnel”) Hernial sac starts lateral to the inferior epigastric vessels More common with testes

Direct (Acquired) Inguinal Hernia

Hernia goes ‘directly’ through superficial ring (NOT through the canal) Hernial sac leaves abdominal cavity medial to the inferior epigastric vessels More common in older males (over age 40) with weak abdominal muscles

Direct Inguinal Hernia

‘neck’ of the hernial sac tends to be wide, since it isn’t constricted by the inguinal canal

Why does an inguinal hernia protude when coughing

B/c intra-abdominal pressure is increased, decreased abdominal space in abdomen

What peritoneum lines the abdominal wall

Parietal peritoneum

What peritoneum covers the abdominal/pelvic viscera

Visceral peritoneum

What is the peritoneal cavity

Serous fluid secreted in this space

Define mesentery

a double layer of peritoneum that connects some intestines to the posterior abdominal wall

What is found between the layers of mesentery?

Blood vessels, nerves, lymphatics, fat between the layers of mesentery

What is omentum?

A double layer (fold) of peritoneum that connects the stomach to another organ

What is greater omentum?

stomach --> transverse colon

What is lesser omentum?

Stomach (and part of duodenum) to liver

Parietal Peritoneum innervation

T7-L1 (same innervation as abdominal wall)

Where is pain felt in parietal peritoneum?

Tends to be precisely localized and severe

What is rebound tenderness?

common clinical sign of inflamed parietal peritoneum

Visceral peritoneum

Innervation via ANS

Visceral peritoneum pain tends to be...

Dull and poorly localized (referred pain)

What is the foregut supplied by?

Celiac trunk

What is the midgut supplied by?

Superior mesenteric artery

What is the hindgut supplied by?

Inferior mesenteric artery

Lymphatic drainage of the GI tract - lymphatic drainage will eventually go

go to nodes that cluster around arteries of the same name Celiac lymph nodes Superior mesenteric lymph nodes Inferior mesenteric lymph nodes

Innervation of the GI tract

almost soley from ANS Parasympathetics from Vagus (CN X) and pelvic splanchnic nerves (S2-S4) Sympathetics from thoracic splanchnic nerves (T5-T12) and lumbar splanchnic nerves (L1, L2)