Module 2A: The Abdomen Flashcards
How many regions is the anterior abdominal wall divided into
-9
What are the 9 regions of the anterior abdominal wall
-epigastric
-umbilical
-hypogastric
-left hypochondriac
-left lumbar
-left inguinal
-right hypochondriac
-right lumbar
-right inguinal
Layers of anterior abdominal wall superficial to deep
-skin
-superficial fascia
-investing fascia
-external oblique
-internal oblique
-transversus abdominis
-transversalis fascia
-extraperitoneal fat
-parietal peritoneum
Most common target of liposuction
-anterior abdominal wall
-superficial fascia layer
What structures are visible in superior view of rectus sheath
-linea alba
-rectus abdominus
-transversus abdominus
-rectus sheath
-external oblique
-internal oblique
What structures are visible in anterior view of rectus sheath
-rectus sheath
-external oblique
-linea alba
What structures are visible in posterior view of rectus sheath
-rectus abdominus
-rectus sheath
Rectus abdominis diastasis (RAD)
-condition where rectus abdominus muscles become separated due to thinning and widening of the linea alba, resulting in protrusion of abdominal contents
Rectus abdominis diastasis symptoms
-protruding midline
-lower back pain
2 main arteries of anterior abdominal wall
-superior epigastric artery
-inferior epigastric artery
Superior epigastric artery
-branch of internal thoracic artery
Inferior epigastric artery
-branch of the external iliac artery
Rectus sheath hematoma
-result of bleeding into the rectus sheath from damage to the superior and/or inferior epigastric arteries/their branches
How can rectus sheath hematoma happen
-from a direct tear of rectus sheath or of the abdominal muscles
Rectus sheath hematoma symptoms
-bruising
-tenderness
-pain
-bulging of the abdomen
Lymphatic drainage of the anterior abdominal wall
-superficial lymphatic drainage
-deep lymphatic drainage
Superficial lymphatic drainage
-drainage to the axillary nodes from above the umbilicus and to the superficial inguinal nodes below the umbilicus
Deep lymphatic drainage
-drainage to the external iliac, common iliac, and lumbar nodes
The inguinal canal
-clinically important passageway for structures between abdominal and pelvic regions
What are the 2 inguinal rings
-superficial inguinal ring
-deep inguinal ring
Superficial inguinal ring
-opening in external oblique aponeurosis
-superior to pubic tubercle
Deep inguinal ring
-invagination of tranversalis fascia
-superior to midpoint of inguinal ligament
Male contents of inguinal canal
-spermatic cord
Female contents of inguinal canal
-round ligament
Ilioinguinal nerve passage
-passes through canal exiting through the superficial inguinal ring
What does the ilioinguinal nerve supply in males
-skin of adjacent upper thigh
-skin of upper scrotum
-root of the penis
What does the ilioinguinal nerve supply in females
-skin of adjacent upper thigh
-skin of upper labia majora
-skin of mons pubis
Inguinal hernia
-occurs when contents of the abdominal cavity protrude into the inguinal canal
Where does inguinal hernia commonly occur in males
-in inguinal canal where spermatic cord enters scrotum
Where does inguinal hernia commonly happen in females
-where the round ligament of the uterus attaches to the tissue surrounding the pubic bone
Major superior muscles of the posterior abdominal wall
-larger right cura
-smaller left cura
Larger right cura
-originates from the bodies of L1-3
Smaller left cura
-originates from bodies of L1-2
Major inferior muscles of the posterior abdominal wall
-psoas major
-iliacus
-quadratus lumborum
Iliopsoas muscle origin and insertion
-origin: lumbar vertebrae
-insertion: lesser trochanter of the femur
Quadratus lumborum origin and insertion
-origin: iliac crest and lumbar vertebrae
-insertion: rib 12
Tight quadratus lumborum
-when muscles on one side of abdominal wall becomes tight it may lift the corresponding side of one’s pelvis causing a misalignment
Tight quadratus lumborum symptoms
-limited reaching and breathing
-back pain
Lumbar plexus formation
-formed in psoas major muscle from ventral rami of spinal nerves 1-4
Nerves of the lumbar plexus
-iliohypogastric
-ilioinguinal
-genitofemoral
-lateral femoral cutaneous
-femoral
-obturator
-lumbosacral trunk
Iliohypogastric nerve roots
-L1
Iliohypogastric nerve innervation
- skin and muscles of lower abdominal wall
Ilioinguinal nerve roots
-L1
Ilioinguinal nerve innervation
-skin of upper medial thigh
-root of penis
-anterior scrotum
-skin of mons pubis
-labium majus
Genitofemoral nerve roots
-L1 & 2
Genitofemoral nerve division
-divides into genital and femoral branches
Lateral femoral cutaneous nerve roots
-L2 & 3
Lateral femoral cutaneous nerve innervation
-skin of anterolateral thigh
Femoral nerve roots
-L2-4
Femoral nerve innervation
-muscles of thigh and hip
-knee joints
-skin of anterior thigh
Obturator nerve roots
-L2-4
Obturator nerve innervation
-medial compartment of thigh
-hip
-knee joints
-skin of medial thigh
Lumbosacral trunk roots
-L4 & 5
Lumbosacral trunk formation
-joins S1-4 to form sacral plexus
Femoral nerve entrapment
-pinching of the femoral nerve
Femoral nerve entrapment symptoms
-pain
-numbness
-weakness along front of thigh
Most common cause of femoral nerve entrapment
-disc herniation at level L2/3 or L3/4
What is neuropathy
-the damage or dysfunction of nerves
Autonomic system divisions
-sympathetic
-parasympathetic
Sympathetic nerves
-lumbar sympathetic trunk runs down posterior abdominal wall lateral to the vertebral column
Parasympathetic nerves
-branches of left and right vagus nerves called “vagal trunks” carry parasympathetic fibres to aortic plexus
Pelvic splanchnic nerve roots
-S2-4
What do pelvic splanchnic nerves carry
-parasympathetic fibres to the superior hypogastric plexus
Parts of the autonomic plexus
-aortic (prevertebral) plexus
-superior hypogastric plexus
Aortic (prevertebral) plexus innervation
-stomach
-small and large intestine
-kidneys
What is the aortic (prevertebral) plexus associated with
-prevertebal ganglia
Superior hypogastric plexus innervation
-uterus
-prostate
-bladder
-rectum
-perineum
Diabetic gastroparesis
-impaired innervation to abdominal viscera, dysmotility can result
Diabetic gastroparesis symptoms
-bloating
-abdominal pain
-nausea
-vomiting
Abdominal aorta
-after passing through the aortic hiatus, the aorta is considered this
At what level does the abdominal aorta bifurcate
-level L4/5
What does the abdominal aorta bifurcate into
-left and right common iliac arteries
What do the left and right common iliac arteries bifurcate into
-external iliac and internal iliac arteries
Aortic dissection (tear)
-trauma to abdominal aorta could result in a weakened abdominal aorta tearing or rupturing
Aortic dissection (tear) symptoms
-abdominal pain
-weakness
-fainting
Who is at higher risk of an aortic dissection
-those with a history of hypertension
Anterior unpaired visceral branches of aorta
-celiac artery
-superior mesenteric artery
-inferior mesenteric artery
Celiac artery level
-T12
Celiac artery branches
-left gastric
-common hepatic
-splenic
Celiac artery innervation
-foregut structures
Superior mesenteric artery level
-L1
Superior mesenteric artery branches
-inferior pancreaticoduodenal
-jejunal
-ileal
-middle and right colic
Superior mesenteric artery innervation
-midgut structures
Inferior mesenteric artery level
-L3
Inferior mesenteric artery branches
-left colic
-sigmoidal
-superior rectal (hemorrhoidal)
Inferior mesenteric artery innervation
-hindgut structures
Lateral paired visceral branches of aorta
-suprarenal
-renal
-gonadal
Types of suprarenal arteries
-right and left
Suprarenal arteries level
-L1
Types of renal arteries
-right and left
Renal arteries level
-between L1 and L2
Types of gonadal arteries
-right and left
Gonadal arteries level
-L2
Posterior parietal branches of aorta
-right and left inferior phrenic
-lumbar
Right and left inferior phrenic arteries location
-just below aortic hiatus near beginning of abdominal aorta
Right and left inferior phrenic arteries innervation
-inferior surface of diaphragm
Lumbar arteries location
-four pairs that run in series with intercostal arteries
Lumbar arteries innveration
-posterior abdominal wall
Splenic artery infarction
-condition where splenic artery is obstructed
Splenic artery infarction symptoms
-severe pain in upper left quadrant of abdomen that is usually slow to develop
Inferior vena cava formation
-formed by union of right and left common iliac veins at L5
Inferior vena cava tributaries
-right left renal veins
-hepatic veins
-inferior phrenic veins
-lumbar veins
-left suprarenal veins
-right gonadal veins
Inferior vena cava syndrome
-obstruction of inferior vena cava due to compression and/or infarction of major tributaries
Inferior vena cava syndrome symptoms
-edema below diaphragm
-blood clot or tumour
Layers of the peritoneum
-parietal
-visceral
Parietal peritoneum
-lines inferior surface of diaphragm, abdominal walls, and forms over pelvic viscera
Visceral peritoneum
-covers organs so when their visceral surfaces are in contact with each other or with parietal peritoneum, the serous fluid between the surfaces allows free movement
Peritonitis
-inflammation of peritoneum caused by bacterial infection
Peritonitis symptoms
-abdominal pain
-weight loss
-tenderness of abdomen
Peritoneal folds
-omenta
-mesenteries
Omenta
-large double folds of peritoneum consisting of greater and lesser
Greater omenta
-hanging below the stomach
Lesser omenta
-hanging between stomach and liver
Omenta purpose
-helps to cushion the intestines and act as a protective barrier for infection and trauma of underlying abdominal organs
Mesenteries
-double folds of peritoneum anchor abdominal organs to posterior abdominal wall, helping keep the organs in place while still allowing for some mobility
Different types of peritoneal organs
-intraperitoneal
-retroperitoneal
Intraperitoneal
-almost completely covered by peritoneum
Retroperitoneal
-found behind peritoneum and only covered anteriorlu
Peritoneal sac
-space between the parietal and visceral layers of the peritoneum
Sacs of the peritoneal cavity
-greater sac
-lesser sac
Greater sac of the peritoneum
-extends from diaphragm to pelvis
Lesser sac of the peritoneum
-lies behind stomach, extending upward to diaphragm, downward between layers of greater omentum, as far left as the spleen, and to the right
Innervation of the parietal peritoneum
-network of nerves including the phrenic, lower intercostal nerves, and several others
Innervation of the visceral peritoneum
-visceral sensory nerves that accompany autonomic nerves
Parietal peritoneum pain sensitivity
-well localized sensitivity to pain
Visceral peritoneum pain sensitivity
-pain is poorly localized
Reactive lymphadenopathy
-occurs when lymph nodes become swollen due to an immune response from lymphocytes
Reactive lympadenopathy symptoms
-tenderness
-pain
-warmth upon touch of affected lymph nodes
Pre-aortic lymph nodes location
-located on anterior surface of aorta in close proximity to major unpaired branches of aorta
Pre-aortic lymph nodes drainage
-drain lymph from foregut, midgut, and hindgut structures
Para-aortic lymph nodes location
-along length of aorta, on right and left sides
Para-aortic lymph nodes drainage
-drain lymph from posterior abdominal wall, kidneys, suprarenal glands, ureters, gonads, uterus, and uterine tubes
