Module 02A - Abdomen Flashcards
Cheryl, 37, had her 3rd and last child 1 year ago. She has been experiencing some lower back pain for the past year since her pregnancy and thought it was due to the extra weight she was carrying in her abdomen. She decided to undergo liposuction to remove the extra weight in her abdomen. It is now 1 most post-surgery and despite the liposuction procedure and taking on a part-time dog walking job, she still has an expanded abdomen as well as back pain
What are some likely diagnoses and which one is most likely?
Complications from liposuction can cause bruising, swelling, and damage to the other layers
Where is the epigastric region of the anterior abdomen?
Superior most and Medial
(top and center)
Epi means above
Where is the hypogastric region of the anterior abdomen?
Inferior most and medial
(bottom and center)
hypo means below
Where is the right inguinal region?
Inferior right
Where is the left lumbar region?
Left of center and middle horizontally
Where is the umbilical region?
in the middle
Where is the left hypochondriac region?
Left superior
What are the 9 layers from surface to deep of the abdominal wall?
Skin Superficial Fascia Investing Fascia External Oblique Internal Oblique Transversus Abdominis Transversalis Fascia Extraperitonel Fat Parietal Peritoneum
Which Layer of the abdominal wall would have been targeted during Cheryl’s liposuction surgery?
Camper’s layer of the Superficial Fascia
Describe the Superficial fascia
It is composed of a fatty layer, Camper’s layer, and a membranous layer, Scarpa’s fascia
What is the rectus Sheath?
layer of fascia that envelopes the rectus abdominis muscle
The internal oblique, external oblique and transversus abdominis become aponeuroti, forming the strong tendinous rectus sheath that encloses the rectus abdominis muscles
Where is the linea alba?
Midline of the rectus sheath
What is the function of the rectus sheath?
Protective layer within the anterior abdominal that supports and protects the contents of the abdomen
What is rectus abdominis diastasis?
Condition where the rectus abdominis muscles become separated due to thinning of the linea alba. Result in protrusion of the abdominal contents
What are the 2 main arteries that supply the anterior abdominal wall
Superior epigastric artery
Inferior epigastric artery
Describe the origin and the path of the superior epigastric artery
It is a terminal branch of the internal thoracic (mammary) artery.
It enters the rectus sheath posteriorly and anastomoses with the inferior epigastric arter
Where does the inferior epigastric artery originate?
External iliac artery
What is a rectus sheath hematoma?
Results from bleeding into the rectus sheath from damage to the superior and/or inferior epigastric arteries and/or their branches
can result from a direct tear of the rectus sheath of of the abdominal wall
What are the 2 groups of lymph nodes responsible for the superficial lymphatic drainage of abdomen?
Axillary lymph nodes
Inguinal lymph nodes
What are the 3 groups of lymph nodes responsible for the deep lymphatic drainage of the abdomen?
Lumbar lymph nodes
Common iliac lymph nodes
external iliac lymph nodes
What is the inguinal canal?
A clinically important passageway approx 4-6 cm in length, located in the lower anterior abdominal wall.
Important passageway for structure between the abdominal region and the pelvic region
What are the 2 ends of the inguinal canal called?
Superficial inguinal ring
Deep inguinal ring
What structures passes through the inguinal canal only in females?
round ligament of the uterus
What structures passes through the inguinal canal only in males?
spermatic cord
What are structures that pass through the inguinal canal in both sexes?
ilioinguinal nerve
What does the ilioinguinal nerve supply?
upper thigh in both males and females
females: skin of upper labia majora and mons pubis
males: supplies the skin of the upper scrotum and root of the penis
What is an inguinal hernia?
When contents of the abdominal cavity protrude into the inguinal canal
What is the inguinal canal weak spot in females?
Where connective tissue from the uterus attaches to the tissue surrounding the pubic bone
generalized pain in anterior abdominal wall, and can thus be difficult to diagnose
Bruising, bulging and pain especially when bending over
What is the inguinal canal weak spot in males?
Where the spermatic cord enters the scrotum
What are the borders of the posterior abdominal wall?
Superiorly by the diaphragm
Inferiorly: 3 major paired muscles: psoas major, iliacus, and quadratus lumborum
What are the origin and insertion of the iliopsoas muscles?
Psoas major originates on the lumbar vertebrae and together with the iliacus merges into the iliopsoas attaching to the lesser trochanter of the femur
What are the origin and insertion of the quadratus lumborum muscles?
Thin flat muscle that originated on the iliac crest and lumbar vertebrae and inserts on rib 12
How can a “tight” quadratus lumborum muscles affect the structures at its origin and insertion?
It can increase the load on a few anatomical structures. Its often asymmetric and can cause pelvic misalignment, it may pull at the ribs, limiting reaching and breathing. When both are tight it may cause compression on the spine, resulting in back pain
What is the lumbar plexus?
Network of nerve fibres responsible for supplying innervation to the skin and musculature of the lower limb
Innervation pattern of these nerves are directly applicable to clinicians as they aid them in locating sources of pain
Where is the lumbar plexus?
Formed in the psoas major muscle by the lumbar spinal nerves 1-4. Branches of the plexus emerges from the psoas major and further divide into several cords
What are the 7 main cords that make up the lumbar plexus?
1- iliohypogastric nerve (spinal nerve L1)
2- Ilioinguinal nerve (spinal nerve L1)
3- genitofemoral nerve (spinal nerve L1 and L2)
4- Lateral femoral cutaneous nerve (spinal nerve L2 and L3)
5- femoral nerve (Spinal nerve L2-L4)
6- Obturator nerve (spinal nerves L2-L4)
7- Lumbosacral trunk (spinal nerves L4 and L5
What does the iliohypogastric (spinal nerve L1) nerve supply?
Skin and muscles of the lower anterior abdominal wall
What does the ilioinguinal (spinal nerve L1) nerve supply?
runs through inguinal canal to supply the upper medial thigh root of penis and anterior scrotum or skin of the mons pubis and labium majus
What does the genitofemoral (spinal nerve L1 and L2) nerve supply?
Divides into 2 branches genital branch and femoral branch
Supplies small area of skin on upper anterior thigh
What does the Lateral femoral cutaneous nerve (spinal nerve L2 and L3) nerve supply?
Skin of the anterolateral thigh
What does the femoral nerve (spinal nerve L2-L4) nerve supply?
muscles of the anterior compartment of the thigh, hip, knee joints and skin of the anterior thigh
What does the obturator nerve (spinal nerve L2-L4) nerve supply?
Muscles of the medial compartment of the thigh, hip, and knee joints and the skin of the medial thigh
What structure foes the lumbosacral trunk join?
Sacral nerves 1-4 ventral rami to form the sacral plexus
What is femoral nerve entrapment?
Pinching of the femoral nerve at some point along its course. Causes pain numbness or weakness along the front of the thigh
Most common cause is disc herniation at L2/3 or L3/4
Where is the lumbar sympathetic trunk located?
Runs down the posterio abdominal wall alteral to the vertebral column
Describe the parasympathetic innervation of the posterior abdominal wall
Branches of the left and right vagus nerves called vagus trunks carry parasympathetic fibres to the aortic plexus.
Spinal nerves S2-4 called pelvic splanchnic nerves carry parasympathetic fibres to the superior hypogastric plexus
What structures are associated with the aortic plexus?
prevertebral ganglia; celiac, superior, inferior mesenteric, and aorticorenal ganglia
What does the aortic plexus innervate?
organs of the abdomen including stomach, small and large intestine and kidneys
What does the superior hypogastric plexus innervate?
organs of the pelvis; uterus, prostate, bladder, rectum, perineum
In an individual experiencing diabetic gastroparesis, which autonomic nerve or autonomic nerve plexus would be implicated?
A) lumbar sympathetic trunk
B) celiac trunk
c) anterior and posterior vagal trunks
C
What is gastroparesis?
Impaired innervation to the abdominal viscera, dysmotility can result. No structural abnormalities within the gut and no inflammation
Symptoms: bloating, abdominal pain, nausea and vomiting
What is the abdominal aorta?
It refers to the portion of the aorta that passes through the abdomen, starting at the abdominal hiatus
Describe the pathway of the aorta through the abdomen and its branching off
Starting at the aortic hiatus the aorta becomes the abdominal aorta, then bifurcates in the to Left and right common iliac arteries. Each iliac artery then bifurcates into an external iliac artery and an internal iliac artery
What can cause weakened i abdominal aorta?
prolonged hypertension
What’s an aortic dissection?
Tearing or rupturing of the aorta, due to its weakening after trauma. People with a history of hypertension are more at risk, because hypertension weakens the walls of the vessels
Abdominal pain, weakness, fainting, death by bleeding out
what are the 3 anterior unpaired visceral branches branching off of the abdominal aorta?
Celiac artery
Superior mesenteric artery
Inferior mesentery artery
Where does the celiac artery orginate?
abdominal aorta
Where does the celiac artery form?
from the abdominal aorta at the level of T12
What branches does the celiac artery give off? (3)
left gastric artery
common hepatic
splenic arteries
What structures do the celiac artery and its branches supply?
foregut (distal esophague to proximal duodenum) structures
where foes the Superior Mesenteric Artery form?
from the abdominal aorta at the level of L1
What are the branches of the Superior Mesenteric Artery? (5)
Inferior pancreaticoduodenal artery jejunal artery ileal artery middle colic artery right colic artery
What does the Superior Mesenteric Artery and its branches supply?
Midgut (distal duodenum, proximal half of transverse colon) gut
What are the branches of the inferior mesenteric artery? (3)
Left colic artery
sigmoidal arteries
superior rectal artery
What structures do the inferior mesenteric artery and its branches supply?
Hindgut (distal third of the transverse colon to the rectum)
What are the 3 lateral paired visceral branches of the aorta?
Suprarenal arteries
Renal Arteries
Gonadal arteries
Where do the left and right suprarenal arteries form?
Abdominal aorta at the level of L1
Where do the left and right renal arteries form?
abdominal aorta at the level between L1 and L2
Where do the left and right gonadal arteries form?
Abdominal aorta at the level of L2
What are the posterior parietal branches?
Right and left inferior phrenic arteries Lumbar Arteries (4 pairs)
Where do the right and left phrenic arteries originate from?
Abdominal aorta
What do the posterior parietal branches supply?
Musculoskeletal structures of the posterior abdominal wall