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GI Exam I > Lecture 2: Anterior Abdominal Wall > Flashcards

Lecture 2: Anterior Abdominal Wall Flashcards

1
Q

What 9 structures are found in the RUQ?

A

Liver: right lobe

Gallbladder

Stomach: pylorus

Duodenum: parts 1-3

Right suprarenal gland

Right kidney

Right colic (hepatic) flexure

Ascending colon: superior part

Transverse colon: right tail

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2
Q

What 10 structures are found in the LUQ?

A

Liver: left lobe

Spleen

Stomach

Jejunum and proximal ileum

Pancreas: body and tail

Left kidney

Left suprarenal gland

Left colic (splenic) flexure

Transverse colon: left half

Descending colon: superior part

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3
Q

What 10 structures are found in the RLQ?

A

Cecum

Appendix

Most of ileum

Ascending colon

Right ovary

Right uterine tube

Right ureter: abdominal part

Right spermatic cord: abdominal part

Uterus (if enlarged)

Bladder (if very full)

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4
Q

What structures are found in the LLQ?

A

Sigmoid colon

Descending colon: inferior part

Left ovary

Left uterine tube

Left ureter: abdominal part

Left spermatic cord: abdominal part

Uterus (if enlarged)

Bladder (if very full)

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5
Q

Label A-I (9 regions of the anterior abdominal wall)

A

A) Right Hypochondrium

B) Epigastric

C) Left Hypochondriac

D) Right Flank (lateral)

E) Umbilical

F) Left flank (lateral)

G) Right inguinal (groin)

H) Pubic

I) Left inguinal (groin)

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6
Q

Label the Transverse planes A-G

A

A) Xiphisternal

B) Transpyloric

C) Subcostal

D) Supracristal

E) Transtubercular

F) Interspinous

G) Suprapubic

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7
Q

What structures are found within the Transpyloric plane (L1)?

A

Gallbladder fundus

Pylorus

Pancreatic neck

SMA origin

Hepatic portal vein

Root of transverse mesocolon

Hila of kidneys

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8
Q

The subcostal plane (L3) is at the level of which organ?

A

Transverse colon

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9
Q

The transtubercle plane (L5) is at the level of which organ?

A

Iliocecal junction

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10
Q

The interspinous plane (S2) is at the level of which organs?

A

Appendix and sigmoid colon

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11
Q

What is the superficial and deep layers of the anterior abdominal wall called?

A

Superficial: Campers (fatty)

Deep: Scarpa’s (membranous)

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12
Q

What are the layers of the anterolateral abdominal wall, starting with the skin?

A

Skin

Campers fascia (superficial)

Scarpa’s (deep membranous)

External oblique

Internal oblique

Transversus abdominis

Transversalis fascia

Extraperitoneal fat

Parietal peritoneum

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13
Q

What is the target layer of liposuction?

A

Removal of the superficial fatty layer: Camper’s

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14
Q

What is the origin, insertion, and innervation of external oblique muscle?

A

Origin: lower 6 ribs

Insertion: aponeurosis and linea alba, anterior iliac crest and pubic tubercle

Innervation: Thoraco-abdominal nerves T7-T11 and Subcostal nerve

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15
Q

What is the action of the external oblique muscle?

A

Compress abdomen and increase intra-abdominal pressure; move trunk and retain posture

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16
Q

What is the origin, insertion, and innervation of the Internal Oblique muscle?

A

Origin: iliac crest

Insertion: Lower 10-12 ribs, aponeurosis, linea alba and pubic crest

Innervation: Thoraco-abdominal nerves T6-T12

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17
Q

The cremasteric muscle arises from?

A

Some fibers of the internal oblique follow spermatic cord to make the cremasteric muscle

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18
Q

What is the action of the internal oblique?

A

Compress and support viscera, laterally flexes and rotates

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19
Q

What is the orign, insertion, and innervation of the Transversus Abdominis muscle?

A

Origin: lower 7-12 costal cartilages, thoracocolumbar fascia, iliac crest

Insertion: linea alba, pectin pubis and pubic crest

Innervation: Thoraco-abdominal nerves (T6-T12)

20
Q

What is the origin, insertion, and innervation of Rectus Abdominis m.?

A

Origin: Pubic symphysis and pubic crest

Insertion: Xiphoid process and outer surface of 5th-7th intercostal cartilages

Innervation: Thoraco-abdominal nerves (ventral rami T6-T12)

21
Q

What is the action of the Rectus Abdominis muscle?

A

Flexes trunk and compresses abdominal viscera; stabilizes and controls tilt of pelvis

22
Q

Rectus abdominis prevents what kind of tilt of pelvis?

A

Prevents anterior tilt of pelvis

23
Q

Above the arcuate line what makes up the anterior and posterior components of the Rectus Sheath?

A

Anterior: Aponeurosis of Internal and External Oblique

Posterior: Transversalis fascia and Aponeurosis of Transversus abdominis

24
Q

Below the arcuate line what makes up the anterior and posterior components of the Rectus Sheath?

A

Anterior: Aponeurosis of external/internal oblique and transversus abdominis

Posterior: Transversalis fascia

25
Q

What are the nerves from T-7-T11; what anterior abdominal structures do they run between at the mid-axillary line?

A
  • Thoraco-abodominal nerves, which are continuations of intercostal nerves.
  • Run between Internal Oblique and Transversus Abdominis m.
26
Q

What is the nerve at T12; runs along?

A

Subcostal nerve; runs along inferior 12th rib; motor; sensory is superior to iliac crest

27
Q

What are the nerves at L1?

A

There are two branches

  • Iliohypogastric goes to hypogastric region
  • Ilioninguinal goes to the inguinal region.
28
Q

What is McBurney’s point?

A

Location of the Appendix, which is right side of abdomen, 1/3 of the distance from the ASIS to the umbilicus

29
Q

The internal thoracic artery comes down and branches into?

A

Musculophrenic a. and Superior epigastric a.

30
Q

Where does the inferior epigastric artery arise from; where does it run?

A

Branch of the External Iliac artery; runs posterior to the Rectus abdominis m, but anterior to the posterior layer of rectus sheath.

31
Q

What anastomoses around the umbilicus?

A

The superior and inferior epigastric arteries

32
Q

Embryological origin of median umbilical fold?

A

Remenant of Urachus

33
Q

Embryologic origin of medial umbilical fold?

A

Remenant of Umbilical arteries

34
Q

What is found in the lateral umbilical folds?

A

Inferior epigastric artery and vein

35
Q

The medial inguinal fossae is in which space; which type of hernia occurs here?

A

Inguinal triangle; direct hernia

36
Q

Which hernia type occurs in the lateral inguinal fossae?

A

Indirect hernias

37
Q

Discuss midline incisions

A
  • The rectus sheath is strong and can support sutures
  • Poor vasculature, which means no bleeding, but also slow healing
  • No problems with nerves
  • Not an ideal cut, but good if rapid incision necessary
38
Q

What are the pros and cons of the subcostal surgical incision; organs accessed?

A
  • Musculature is fine
  • Concenred about superior epigastric artery
  • Only nerves are cutaneous.
  • Not a bad cut
  • Access to gallbladder, bilary tract, and spleen
39
Q

What are the pros and cons of a suprapubic surgical incision; common area for what surgery?

A
  • No real problems here
  • Muscles run in the same orientation as the incision
  • Need to be aware of iliohypogastric and ilioinguinal nerves
  • Common area for C-section
40
Q

What are the pros and cons of a paramedian surgical incision?

A
  • Tight musculature means lots of muscular pull
  • The aponeurosis is tough so holds sutures well
  • Low blood supply so not too much bleeding, but slow healing
  • You have all of the thoracoabdominal nerves, which means if you cut those you lose innervation to the rectus abdominis, it atrophies and dies
  • Used mainly for liver transplant
41
Q

What are the 3 ventral hernias?

A

1) Umbilical - common in newborns
2) Epigastric - thru linea alba
3) Spigelian - rare; semilunaris

42
Q

Superior to the transumbilical plane where does most of the lymph drain to?

A

Majority to axillary LN and some to parasternal LN

43
Q

Superficial vessels below umbilicus drain into which lymph nodes?

A

Superficial inguinal LN’s (also the scrotum, gluteal region, and lower limb)

44
Q

What are the deep lymphatics and what do they accompany?

A

External iliac nodes, common iliac nodes, lumbar/arotic/caval nodes which accompany the deep veins of the abdominal wall.

*Testicular cancer will metastasize into the lumbar/aortic/caval lymph nodes

45
Q

Label A-E and state the embryological origin?

A

A) Lateral inguinal fossae

B) Medial inguinal fossae

C) Supravesical fossae

D) Median umbilical fold

E) Medial umbilical fold

46
Q

Prune belly syndrome is a problem with development of what embryologically?

A

Paraxial mesoderm, specifically the hypomere and hypaxial muscles failing to form

47
Q

3 main features of prune belly syndrome?

A

1) Anterior abdominal wall muscles deficient or absent
2) Urinary tract anomalies (i.e., very large bladder)
3) Bilateral cryptorchidism (2 undescended testicles)

GI Exam I (14 decks)

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