Lectures 1 And 2- Anterior Abdominal Wall Outline Flashcards
General considerations
-Abdomen
Region of the trunk that is below the respiratory diaphragm and above the pelvic brim or inlet
Respiratory diaphragm
- Anterior landmark?
- Posterior landmark?
- Anteriorly costal cartilages of rib 6
- Posteriorly vertebral body of T12
Contents of the abdomen?
- Peritoneal cavity
- GI organs and associated glands
- Kidneys, ureters, and suprarenal glands
- Nerves, lymphatic system, and blood vessels
Anterolateral abdominal wall surface anatomy
-Divided into?
Divided into anterior, lateral (flank, loin), and posterior walls
Anterolateral abdominal wall surface anatomy
-Surface landmarks?
- Xiphoid process of sternum
- Costal margins (right and left)
- Iliac crest
- Pubic bone
- Linea terminalis
- Inguinal ligament
Iliac crest
- ASIS
- Tubercle of iliac crest
Pubic bone
- Pubic symphysis
- Pubic tubercle
- Pubic crest
Linea terminalis
-Separates?
Separates false pelvis from true pelvis
Linea terminalis components?
- Pectin pubis
- Arcuate line
- Sacral promontory
Inguinal ligament
-Goes from where to where?
From ASIS to pubic tubercle
Soft tissue landmarks
-Linea semilunaris-Where is it?
Lateral border of rectus abdominis
Soft tissue landmarks
- Linea alba
- Where is it?
- Midline from xiphoid to pubic symphysis
- Divides anterior wall into right and left halves
- Bloodless
Soft tissue landmarks
-Umbilicus
Naval
Plane or lines of reference
-Horizontal planes?
- Subcostal
- Transtubercular
- Supracristal
- Transumbilical
- Transpyloric
Subcostal
- 10th costal cartilages
- Superior border of LV3
Transtubercular
- Tubercles of iliac crest
- Body of LV5
Supracristal
- Highest points of iliac crests
- Spinous process of LV4
Transumbilical
- Passes through LV3-4 disc
- Almost corresponds with supracristal plane
Transpyloric
- Halfway between jugular notch and pubic symphysis
- body of LV1
- passes through pyloric sphincter
Vertical (sagittal) planes
- Midclavicular (lateral) planes
- Midsagittal (median)
Midclavicular (lateral) planes
- Midpoint of clavicle
- Midinguinal point
Midsagittal (median)
- Linea alba
- Passes through umbilicus
The abdominal quadrant system
-Divided by what planes?
Midsagittal and transumbilical
Right Upper Quadrant (RUQ)
-Contents?
Gallbladder, duodenum, right pleura, and right lobe of liver
Left Upper Quadrant (LUQ)
-Contents?
Spleen, stomach, left pleura, and tail of pancreas
Right Lower Quadrant (RLQ)
-Contents?
Right ureter, cecum, ileal diverticulum, vermiform appendix
Left Lower Quadrant (RUQ)
-Contents?
Left ureter and sigmoid colon
Quadrants can be used to describe?
General location of pain, palpable or audible abnormalities, specific viscera
The abdominal regional system
-Divided by what planes?
Subcostal, transtubercular, and midclavicular planes
The abdominal regional system
-9 regions?
- Right and left hypochondriac (RH and LH)
- Right and left lateral (RL and LL)
- Right and left inguinal (iliac) (RI and LI)
- Epigastric (epigastrium)
- Umbilical
- Hypogastric
The abdominal regional system can also describe?
Locations of pain, tumor, etc
Muscles and aponeuroses of abdominal wall
-General considerations-organized into 3 groups?
- Anterior
- Anterolateral
- Posterior
Muscles and aponeuroses of abdominal wall
-3 groups-Anterior?
Rectus abdominis, [pyramidalis]
Muscles and aponeuroses of abdominal wall
-3 groups-Anterolateral?
External abdominal oblique, internal abdominal oblique, transversus abdominis muscles
Muscles and aponeuroses of abdominal wall
-3 groups-Posterior?
Iliacus, psoas major and minor, quadratus lumborum
Muscles and aponeuroses of abdominal wall
The 3 pairs of flat, layered mm. with fibers running in different directions; strengthen wall
Muscles and aponeuroses of abdominal wall
- Clinical:
- How is this relevant to abdominal surgery?
- What happens when this is not done?
- In abdominal surgery, each layer is traversed by splitting it parallel to its fibers, rather than cutting across the fibers
- When the fibers are cut perpendicular to their axis, they scar so that the layers adhere to one another and make normal movements painful
Anterior and Anterolateral muscles
- External abdominal oblique
- Fibers-origins and insertions?
Superolateral origins and inferomedial insertions
Where does the external oblique aponeurosis begin?
Midclavicular line
External abdominal oblique
-Specialized parts?
Lines alba, inguinal ligament, superficial inguinal ring, and lacunar ligament
External abdominal oblique
- Specialized parts-inguinal ligament
- lower margin of?
- attached at?
- Lower margin of aponeurosis (rolls under)
- Attached at ASIS and pubic tubercle
External abdominal oblique
-Specialized parts-superficial inguinal ring?
- Triangular opening in external oblique aponeurosis
- Lateral crus
- Medial crus
- Intercrural fibers
External abdominal oblique
- Specialized parts-superficial inguinal ring
- Intercrural fibers
- function?
- which way do they run?
- Intercrural fibers
- Reinforcing fibers
- Run perpendicular to the crura and join them
External abdominal oblique
- Specialized parts-Lacunar ligament
- Extension of?
- Crossed by?
- Attaches to?
- Extension of the inguinal ligament
- Crossed by spermatic cord
- Attaches to pectineal line lateral to pubic tuburcle
- Crescent-shaped (concave) lateral free border (sharp)
Internal abdominal oblique
-fibers-which way do they run?
- Inferolateral origins to superomedial insertions
- Usually run perpendicular to external oblique
Internal abdominal oblique
- What is special about the fibers of this muscle in the hypogastric and inguinal regions?
- Function?
The fibers run parallel to the external oblique aponeurosis and provide support for abdominal wall
Internal abdominal oblique
- Specializations-Cremaster muscle
- What is it?
- Derived from?
- Muscular layer of spermatic cord
- Derived from internal oblique muscle
Internal abdominal oblique
- Specializations-Conjoint tendon (flax inguinalis)
- What is it?
- Join with?
- The most medial and inferior tendinous fibers of internal oblique
- Join with similar fibers of transversus abdominis
Internal abdominal oblique
- Specializations-Conjoint tendon (flax inguinalis)
- Attaches medially to?
- Laterally?
- Attaches medially to linea alba
- Has a lateral free border
Transversus abdominis
- Location relative to other abdominal muscles?
- Which way do the fibers run?
- Innermost layer of muscles
- Fibers of muscle and aponeurosis run mostly horizontal
Transversus abdominis
-When does it become aponeurosis?
At about linea semilunaris
Transverus abdominis joins with internal oblique to form?
Conjoint tendon
Where do nerves and vessels run relative to the abdominal muscles?
Between the internal oblique and the transversus abdominis
Rectus abdominis
-Description?
Pair of strap-like, vertical muscles
- Broad and flat superiorly
- Narrow and thick inferiorly
Rectus abdominis
-crossed by?
Tendinous intersections
Rectus abdominis
-Enclosed within?
Specialized rectus sheath (fuses with intersections)
Pyramidalis muscle
-Location relative to rectus abdominis? Between?
-Lies anterior to inferior end of rectus abdominis between linea alba and pubic crest (tenses the linea alba)
