Lecture 22

Question 1

Superior Border of Abdomen

Answer 1

Costal cartilages 7-12, xiphoid process at level of 10th cartilage, level with T10-11; xiphisternal angle is level with body of T10

Question 2

Inferior Border of Abdomen

Answer 2

Pubic bone and iliac crest; level of L4

Question 3

Umbilicus

Answer 3

Level of IV disc L3-4

Question 4

Linea Alba

Answer 4

Located along the midline; known as connective tissue raphe; extends from xiphoid to pubic symphysis; lies between paired rectus abdominus muscles; fusion of aponeuroses of transversus abdominus, internal/external oblique

Question 5

Linea Semilunaris

Answer 5

Scalloped lateral border on each side of rectus abdominis; crosses costal margin near tip of 9th costal cartilage

Question 6

Linea Transversa

Answer 6

Tendinous bands of rectus abdominis; one pair just below xiphoid process, one pair intersecting umbilicus, and one pair halfway between other 2 pairs; creates a six pack

Question 7

Quadrants

Answer 7

Formed by 2 intersecting lines that intersect at umbilicus; upper left/right and lower left/right

Question 8

Regions

Answer 8

Divided into 9 regions by 2 pairs of planes; vertical planes (left/right lateral planes or midclavicular planes) and horizontal planes (transpyloric plane midway between jugular notch and pubic symphysis between xiphoid and umbilicus and intertubercular plane through tubercles of iliac crests at level of L5)

Question 9

Regions 1 and 2

Answer 9

Right and left hypochondriac regions; contain liver; upper right/left

Question 10

Region 3

Answer 10

Contains liver, stomach, pancreas; upper middle

Question 11

Regions 4 and 5

Answer 11

Right and left lateral (lumbar); right contains ascending colon and left contains descending colon; middle right/left

Question 12

Region 6

Answer 12

Umbilical; contains small intestine and transverse colon; middle middle

Question 13

Region 7 and 8

Answer 13

Right and left inguinal; right contains ileocecal junction and appendix and left contains sigmoid colon; lower right/left

Question 14

Region 9

Answer 14

Hypogastric; contains small intestine, urinary bladder, pregnant uterus; lower middle

Question 15

Cutaneous Nerves of Abdomen

Answer 15

Derived from ventral rami of T7-L1; pass inferiorly and medially in plane between transverse and internal oblique muscles; motor innervation to abdominal muscles; cutaneous innervation (lateral cutaneous branches and anterior cutaneous branches that form the penetrate rectus sheath)

Question 16

Thoracoabdominal Nerves

Answer 16

Ventral rami of T7-T11; T7 to dermatome over xiphoid process, T10 at level of umbilicus, L1 just above pubic symphysis; form subcostal nerve; ventral ramus of L1 gives rise to iliohypogastric and ilioinguinal nerves

Question 17

Superficial Subcutaneous Fascia

Answer 17

Camper’s fascia, continuous with fascia over thorax and thigh; fatty layer

Question 18

Deep Superficial Subcutaneous Fascia

Answer 18

Scarpa’s fascia; membranous layer that continues into perineum as superficial perineal fascia (Colle’s Fascia)

Question 19

Deep Cutaneous Fascia

Answer 19

Thin layer covering anterior surface of abdominal muscles

Question 20

Transversalis Fascis

Answer 20

Deep to transversus abdominis; fibroelastic CT with adipose tissue (extraperitoneal connective tissue)

Question 21

Peritoneum

Answer 21

Serous membrane; also known as parietal peritoneum

Question 22

Arterial Supply Above Umbilicus

Answer 22

Posterior intercostal arteries 10-11, subcostal artery, lumbar arteries 1-4, and terminal branches of internal thoracic arteries (musculophrenic and superior epigastric arteries)

Question 23

Arterial Supply Below Umbilicus

Answer 23

Branches of external iliac arteries (deep epigastric and deep circumflex arteries) and branches of femoral arteries (superficial epigastric, superficial circumflex iliac, and superficial external pundendal arteries)

Question 24

Where do the superficial arteries of the abdomen arise from?

Answer 24

From femoral artery

Question 25

Where do the deep arteries of the abdomen branch from?

Answer 25

Branch of external iliac artery

Question 26

Venous Drainage of Abdomen

Answer 26

Deep veins are paired with arteries; superficial veins above the umbilicus drain into the internal thoracic veins; superficial veins below the umbilicus drain into the femoral veins via the greater saphenous and external iliac veins and drain into external iliac veins via the inferior epigastric veins

Question 27

Lymphatic Drainage of Abdomen

Answer 27

Above the umbilicus drain into axillary and sternal nodes; below the umbilicus drain into superficial inguinal nodes

Question 28

Superior Epigastric Artery of Anterior Abdominal Wall

Answer 28

Terminal branch of internal thoracic, descends in rectus sheath posterior to muscle, and anastomoses with inferior epigastric

Question 29

Inferior Epigastric Artery of Anterior Abdominal Wall

Answer 29

Arises from external iliac artery, enters rectus sheath at arcuate line, and branches into cremasteric and pubic arteries

Question 30

Muscle Layers (Muscles and Innervation)

Answer 30

Three anterolateral sheets (external oblique, internal oblique, transversus abdominus) and a vertically oriented pair on either side of the midline (rectus abdomins); innervated by lower intercostal spinal, subcostal spinal, and first lumbar spinal nerve)

Question 31

Arcuate Line

Answer 31

Lower free edge of posterior lamina; lies midway between umbilicus and pubis

Question 32

Inguinal Ligament

Answer 32

Thickened lower border of deep fascia of external oblique; from anterior superior iliac spine to pubic tubercle

Question 33

Rectus Sheath

Answer 33

Connective tissue covering rectus abdominis muscles; formed from aponeurosis of internal obliques; splits to enclose rectus abdominis in the upper three-fourths of the wall; only covers the anterior surface of the rectus in the lower part of the abdomen

Question 34

External Oblique 1. Origin 2. Insertion 3. Action 4. Innervation

Answer 34

1. External surfaces of ribs 5-12 2. Linea alba, pubic tubercle, anterior half of iliac crest 3. Compresses and supports abdominal viscera; flexes and rotates trunk 4. T7-11; subcostal nerve

Question 35

Internal Oblique 1. Origin 2. Insertion 3. Action 4. Innervation

Answer 35

1. Thoracolumbar fascia, anterior 2/3 of iliac crest, lateral 1/2 of iliac ligament 2. Linea alba, pubic crest, and pubis 3. Compresses and supports abdominal viscera; flexes and rotates trunk 4. T7-11; subcostal nerve; L1

Question 36

Transversus Abdominis 1. Origin 2. Insertion 3. Action 4. Innervation

Answer 36

1. Internal surfaces of costal cartilages 7-12; thoracolumbar fascia; iliac crest; lateral inguinal ligament 2. Linea alba, pubic crest, and pubis 3. Compresses and supports abdominal viscera 4. T7-11; subcostal nerve; L1

Question 37

Rectus Abdominus 1. Origin 2. Insertion 3. Action 4. Innervation

Answer 37

1. Pubic symphysis and pubic crest 2. Xiphoid process and costal cartilages 5-7 3. Compresses and supports abdominal viscera; flexes trunk 4. T7-11; subcostal nerve

Question 38

Inguinal Canal

Answer 38

Oblique passage through lower abdominal wall; site of potential weakness; transmits spermatic cord in males and round ligament of uterus in females; extends between superficial and deep inguinal rings

Question 39

Superficial Inguinal Ring

Answer 39

Triangular defect in the aponeurosis of the external oblique muscle layer; superficial opening of the inguinal canal; lies above and lateral to pubic tubercle; larger in males; transmits spermatic cord in males and round ligament of uterus in females

Question 40

Inguinal Ligament

Answer 40

Thickened lower border of external oblique aponeurosis; from anterior superior iliac spine to pubic tubercle

Question 41

Deep Inguinal Ring

Answer 41

Opening of the evagination of the transversalis fascia; lies above inguinal ligament midway between anterior iliac spine and pubic tubercle

Question 42

Inguinal Canal in Males (Spermatic Cord)

Answer 42

Vas deferens; ilioinguinal nerve; genital branch of genitofemoral nerve; testicular arteries and veins (form pampiniform plexus); lymph vessels; cremaster muscle

Question 43

Inguinal Canal in Females

Answer 43

Ilioguinal nerve, round ligament, and lymph vessels

Question 44

Direct Inguinal Hernia

Answer 44

Occurs in older men (rarely women), due to weakness in abdominal wall behind or lateral to superficial inguinal ring; passes directly through abdominal wall to superficial inguinal ring; does not extend into scrotum; has sac formed by peritoneum

Question 45

Indirect Inguinal Hernia

Answer 45

Transverses deep and superficial inguinal rings and inguinal canal; lies within coverings of spermatic cord; may descend into scrotum; more common than direct inguinal hernia; more common in boys and young men; may be congenital

Question 46

Femoral Hernia

Answer 46

Occurs within femoral canal; more common in females

Question 47

Umbilical Hernia

Answer 47

Occurs at site where umbilical cord penetrates between muscles and fascia of anterior wall

Question 48

Median Umbilical Fold

Answer 48

Midline peritoneal fold on inner abdominal wall above bladder; contains median umbilical ligament (remnant of embryonic urachus)

Question 49

Medial Umbilical Folds

Answer 49

Paired peritoneal folds on either side of median fold; contain medial umbilical ligaments (remnants of umbilical arteries)

Question 50

Lateral Umbilical Folds

Answer 50

Paired peritoneal folds lateral to medial folds; contain inferior epigastric vessels from deep inguinal to arcuate line

Question 51

Falciform Ligament

Answer 51

Double layer of peritoneum; attaches liver to anterior abdominal wall and to inferior surface of diaphragm; contains ligamentum teres hepatis (round ligament of liver) (remnant of left umbilical vein)