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Org Ana: Abdominal Wall Flashcards

1
Q

where is the abdomen located

A

region of the trunk that lies between the diaphragm and pelvic inlet

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2
Q

describe the structure of the abdomen

A

soft tissue region
little bony framework
has an intact abdominal wall for support of its contents

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3
Q

what are the common abdominal problems

A

acute pain
swellings
blunt and penetrating trauma

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4
Q

what are the boundaries of the abdomen

A

superior - diaphragm
inf - pelvic inlet

ant - lower part of thoracic cage and rectus abdominis, tranversus abdominis and fascia, external oblique
post - lumbar vertebrae and IV discs

lat - by the 12th rib and upper part of pelvis, iliacus, psoas, quadratus lumborum, aponeuroses of origin of transversus abdominis

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5
Q

what are the bones founded anteriorly at the abdominal wall

A

xiphoid process
costal margin - cc of rib 7-10
lower ribs

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6
Q

which organs do the bones of the anterior abdominal wall cover

A

liver, stomach, spleen, kidneys

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7
Q

what are the bones at the posterior of the abdominal wall

A

lumbar vertebrae - L1-L5

pelvis - Os coxae; ilium, ischium and pubis

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8
Q

what is the iliopectineal line

A

demarcates the true and false pelvis

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9
Q

what is the purpose of the posterior bones of the abdominal wall

A

attachment for muscles and some protection of the organs

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10
Q

what forms the quadrants of the abdomen

A

by transumbilical horizontal plane passing though umbilicus and IV disc bet L3-L4 intersecting the vertical median plane

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11
Q

what are the organs of the RUQ

A

right lobe of liver, gallbladder

distal stomach - pylorus, 1st 3 parts of duodenum, head of pancreas

R adrenal gland, R kidney,

R hepatic flexure of colon, sup ASCENDING colon, R transverse colon

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12
Q

what are the organs of LUQ

A

L lobe of liver, spleen and most of stomach

second and third portion of jejunum and proximal ileum

body and tail of pancreas, L adrenal gland and L kidney

L splenic flexure of colon, sup DESCENDING colon, L transverse colom

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13
Q

what are the organs of RLQ

A

cecum, appendix and most of ileum

inf ASCENDING colon

R ovary. R uterine tube, R ureter, R spermatic cord

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14
Q

what are the organs of LLQ

A

sigmoid colon, inf DESCENDING colon

L ovary, L uterine tube, L ureter, L spermatic cord

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15
Q

how are the regions of the abdomen formed

A

into 9 by:

2 longitudunal lines - R and L midclavicular

2 transverse planes - subcostal and intertubercular

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16
Q

right hypochondriac region

A

liver, galbladder

R kidney

ascending colon, transverse colon, small intestine

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17
Q

epigastric region

A

esophagus, liver, stomach, pancreas and spleen

R and L adrenal glands and R and L kidneys

transverse colon and small intestine

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18
Q

left hypochondriac region

A

liver, stomach, pancreas and spleen

L kidney

transverse and descending colon

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19
Q

right lumbar region

A

liver, galbladder

R kidney

ascending colon and small intestine

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20
Q

umbillical region

A

stomach and pancreas

R and L kidneys and ureters

transverse colon and small intestine

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21
Q

left lumbar region

A

L kidney

small intestine and descending colon

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22
Q

right iliac region

A

appendix

R ovary and fallopian tube

ascending colon, cecum, small intestine

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23
Q

hypogastric region

A

rectum, bladder and uterus

R and L ureters, ovaries, fallopian tubes

sigmoid colon

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24
Q

left iliac region

A

L ovary and fallopian tube

descending and sigmoid colon, small intestine

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25
Q

what does the transpyloric plane cross

A

costal margin on each side at 9th CC; L1

opening of stomach into duodenum on R or pyloric orifice

neck of pancreas

approx pos of the hila of kidneys

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26
Q

what does the transpyloric plane cross

A

pass through tips of 9th CC

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27
Q

what does the subcostal plane cross

A

lowest point of CC; L3

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28
Q

what does the intercristal plane cross

A

plane passing the highest point of iliac crest; L4

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29
Q

what does the intertubercular plane cross

A

line joining tubercles of iliac crest; L5

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30
Q

what are the functions of the anterior abdominal wall

A

firm but flexible boundary keeping abdominal viscera in cavity and maintain their anatomical position

protects abdominal viscera from injury

assists in forceful expiration, coughing, vomiting, defecation, peeing, giving birth; inc intraabdominal psi

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31
Q

what is the function of oblique muscles

A

oblique muscles laterally flex and rotate trunk

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32
Q

what is the function of pyramidalis

A

keeps linea alba taut

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33
Q

what is the function of rectus abdominis

A

flexes trunk and stabilize pelvis

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34
Q

what is the function of anterior and lateral muscles

A

assists diaphragm in relaxing para may space abdominal viscera

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35
Q

what are the 7 layers of the anterolateral abdominal wall

A

skin
superficial fascia
deep fascia
muscles
transversalis fascia
extraperitoneal fascia
parietal peritoneum

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36
Q

where is the skin attached

A

loosely attached to all underlying structures except at the umbilicus

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37
Q

what are lines of cleavage

A

natural lines of the skin that run downward and forward

horizontal around the trunk

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38
Q

what is the umbilicus

A

scar tissue representing the site of attachment if umbilical cord

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39
Q

what is the nerve supply of the skin of abdominal wall

A

from anterior rami of T7-T12 and L1

T7-T11 becomes the lower 5 intercostal nerves
T12 is subcostal nerve
L1 is iliohypogastric and ilioinguinal nerve

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40
Q

what are the dermatomes of the abdominal wall

A

T7 - epigastrium at xiphoif

T10 - umbilicus

L1 - above inguinal ligament and symphysis pubis

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41
Q

what is the arterial blood supply of the skin at midline of the abdominal wall

A

midline - from superior and inferior epigastric arteries

flanks - intercostal

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42
Q

what is the arterial blood supply of the skin at flanks of the abdominal wall

A

flanks - intercostal, lumbar and deep circumflex iliac

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42
Q

what is the arterial blood supply of the skin at inguinal region of the abdominal wall

A

superficial epigastric, sficial circumflex iliac and sficial external pudendal (from femoral)

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43
Q

what is the venous drainage of the skin of the abdominal wall

A

above umbilicus - lateral thoracic to axillary

below umbilicus - superficial epigastric and great saphenous to femoral vein

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44
Q

what is the composition of the superficial fascia above umbilicus

A

single sheet of CT continous w the superficial fascia in other regions of the body

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45
Q

what is the composition of the superficial fascia below umbilicus

A

divides into camper’s fascia (superficial fatty layer) and the scarpa’s fascia (membranous deep layer)

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46
Q

describe camper’s fascia

A

usually thick and thicker on obese patients

continous with sficial fat of the rest of body

becomes the dartos muscle (smooth muscle) scrotum

47
Q

describe scarpa’s fascia

A

thinner and fades out laterally and becomes continous w sficial fascia of back and thorax

inferiorly fuese w deep fascia of thigh; 1 finger below inguinal ligament

becomes colle’s fascia in scrotum or labia majora

posteriorly fused to perineal body and becomes posterior margin of perineal membrane

48
Q

describe the deep fascia

A

thin layer of CT covering the muscles

immediately deep to scarpa’s fascia

49
Q

what are the 2 main groups of muscle in abdominal wall

A

flat (transverse) - laterally on each side of abdomen

vertical - near midline of boday

50
Q

what are the flat muscles

A

external oblique
internal oblique
transversus abdominis

51
Q

describe the aponeuroses of flat muscles

A

each flat muscles form an aponeurosis at anteromedial whoch covers rectus abdominis

they entwine at midline forming linea alba

52
Q

what is the transversalis fascia

A

thin layer of fascia betw muscle layer - abdominal wall and parietal peritoneum

continous w fascia of pelvic wall

53
Q

what is the femoral sheath

A

downward prolongation of transversalis and iliac fascial linings around the femoral vessels and lymphatics

54
Q

what does the fascia transversalis do inferior to arcuate line

A

w parietal peritoneum it forms the posterior wall of rectus sheath

55
Q

what does the fascia transversalis do at midpoint

A

spermatic fascia pierces it to form deep inguinal ring

also forms internal spermatic fascia from the margins of ring

56
Q

what is the rectus sheath

A

long fibrous sheath that encloses rectus abdominis and pyramidalis

57
Q

what forms the rectus sheath

A

aponeuroses of the 3 lateral abdominal muscles

58
Q

what forms the walls of the rectus sheath above the costal margin

A

ant - formed by apon of external oblique

post - by 5-7 cc and intercostal space

59
Q

what forms the rectus sheath betw the costal margin and arcuate line (ASIS)

A

aponeurosis of internal oblique splits to enclose the rectus muscle

external oblique aponeurosis is directed in front of the muscle

transversus aponeurosis is directed behind the muscle

60
Q

what forms the rectus sheath betw the arcuate line (ASIS) and pubis

A

ant - apon of all 3 muscles

post - absent posy wall

rectus muscle is in contact w fascia transversalis

61
Q

what is extraperitoneal fat

A

fat betw transversalis and parietal peritoneum

62
Q

what is parietal peritoneum

A

serous membrane that forms the abdominal wall

63
Q

what is the nerves of the anterior abdominal wall

A

lower 6 thoracic and 1st lumbar

phrenic - central part of diaphragmatic peritoneum

T12 - pyramidalis

L1 - ilioinguinal nerve enters inguinal ring to supply skin above inguinal ligament and symphysis pubis

64
Q

what is the dermatomes of the anterior abdominal wall

A

T7 - xiphoid process

T10 - umbilicus

L1 - pubis

65
Q

what are the arteries of anterior abdominal wall

A

superior epigastric
- terminal branch of internal thoracic
- supplies upper central part

inferior epigastric
- branch of external iliac
- lower central part

deep circumflex iliac
- lower lateral part

lower 2 posterior intercostal arteries and 4 lumbar
- lateral part

66
Q

what is the inguinal canal

A

oblique passage through lower part of anterior abdomen; both sexes

67
Q

where does the inguinal canal start and end

A

deep inguinal ring to superficial inguinal ring

68
Q

compare the inguinal canal in male and female

A

male - structures to pass to and from testis from abdomen

female - passage of round ligament from uterus to labium majus

69
Q

what is the anterior wall of inguinal canal

A

Anterior wall: Aponeurosis of external oblique muscle, reinforced by internal oblique from inguinal ligament

70
Q

what is the posterior wall of inguinal canal

A

Posterior wall: conjoint tendon

71
Q

what is the inferior wall of inguinal canal

A

formed by rolled inferior edge of aponeurosis of the external oblique

72
Q

what is the superior wall of inguinal canal

A

formed by arching lowest fibers of the internal oblique and transversus abdominis

72
Q

what is the deep inguinal ring

A

oval opening in fascia transversalis above the inguinal ligament

73
Q

what is the purpose of the deep inguinal ring

A

Allow structures of spermatic cord to pass to and from the testes to abdomen

Transmit ilioinguinal nerve

74
Q

what is the superficial inguinal ligament

A

triangular in shape from external oblique

75
Q

what makes up the spermatic cord

A

● Vas deferens

● Testicular artery and vein

● Testicular lymph vessels

● Autonomic nerves

● Processus vaginalis

● Cremasteric artery

● Artery of vas deferens

● Genital branch of genitofemoral nerve

76
Q

what is the vas deferens

A

● Cordlike structure at the posterior spermatic cord

● Transports spermatozoa from epididymis to urethra

77
Q

what foes the testicular artery do

A

(from abdominal aorta)

● Branch from the abdominal aorta at the level of L2

● Supplies testes and epididymis

78
Q

what does the testicular veins do

A

● Pampiniform plexus at the posterior of the testis leaves and becomes a single vein at the deep inguinal ring

● Drains to left renal vein on the left and into the inferior vena cava on the right

79
Q

what are the covering of the spermatic cord

A

External spermatic fascia (from external oblique aponeurosis)

Cremasteric fascia (from internal oblique muscle)

Internal spermatic fascia (from fascia transversalis)

80
Q

what is the scrotum

A

● Outpouching of the lower anterior abdominal wall

81
Q

what are the contents of the scrotum

A

● Testes

● Epididymides

● Lower ends of spermatic cord

82
Q

compare the layers of abdominal wall to scrotum

A

Abdominal wall
● Skin

● Camper’s fascia

● External oblique fascia

● Internal oblique muscle

● Transversalis fascia

Scrotum
● Skin

● Dartos muscle

● External spermatic fascia

● Cremasteric fascia

● Internal spermatic fascia

83
Q

what is the lymph of scrotum

A

ascends to inguinal canal to reach lumbar nodes at L1

84
Q

what is the testis

A

● Firm mobile organ within the scrotum

● Left testis is usually lower than right

● Tunica albuginea
- Tough fibrous capsule of testes

85
Q

what is the epididymis

A

● Posterior to the testis

● Part: head, body and tail

86
Q

what are the functions of the epididymis

A

● Provides storage for spermatozoa and allows them to mature

● For absorption of fluid

● Contains substance added to the seminal fluid to provide nourishment for the maturing sperm

87
Q

what is the labia major

A

● Prominent hair bearing folds of skin formed by enlargement of genital swellings fetus

● Contains adipose and terminals stands of the round ligaments of the uterus

88
Q

what are the bones of the posterior abdominal wall

A

lumbar vertebrae

12th pair of ribs

ilium

89
Q

what are the muscles of PAW

A

● Psoas major

● Quadratus lumborum

● Transversus abdominis

● Iliacus

● Posterior part of diaphragm

90
Q

how does a hernia develop

A

develops when the outer layers of the abdominal wall are weak, allowing the inner lining of the abdomen to push through

intestine or abdominal tissue slips causing it to bulge out or protrude beneath the skin

91
Q

what is indirect hernia

A

most common and congenital

most common in males; children and young adults

right side usually more affected

neck of hernia is narrow

92
Q

what direct hernia

A

common in old men bc of weak abs

common in male

neck of hernia is wide

93
Q

what is femoral hernia

A

common in females

neck lies at femoral ring

94
Q

inguinal hernia

A

common in male

95
Q

spigelian hernia

A

● Hernia of linea semilunaris usually below the umbilicus

96
Q

umbilical hernia

A

● Congenital or acquired

often in pediatric

paraumbilical hernia in adults - more common in women

97
Q

what is omphalocele

A

congenital umbilical hernia

caused by failure of midgut to return to abdominal cavity; nasa labas yung organs

98
Q

lumbar hernia

A

Occurs through the lumbar triangle (petit’s triangle), a weak area in posterior abdomen

● Neck of the hernia is large and incidence of strangulation is low

99
Q

describe acquired umbilical hernia

A

Acquired infantile is small hernia caused by weakness of the scar the umbilicus at linea alba

That is why we don’t want to tug on the umbilical cord during delivery, you have to cut it and maintain the integrity of this cord in the abdominal wall until it dries and falls off

100
Q

what are the boundaries of petit’s triangle

A

● Anteriorly by posterior margin of external oblique muscle

● Posteriorly by the anterior border of latissimus dorsi

● Inferiorly by iliac crest

101
Q

what is diastasis recti

A

occus in elderly multiparous women

bc excessive stretch of rectus sheath aggravated by coughing and straining

102
Q

how to treat diastasis recti

A

abdominal belt

exercise

103
Q

what determines the type of abdominal incision

A
  1. Position and direction of the nerve and the abdominal wall
  2. Direction of the muscle fiber
  3. Arrangement of the aponeurosis forming the rectus sheath
  4. Direction of the line of cleavage
104
Q

paramedian

A

for maximal exposure for what we want to see inside

105
Q

Pfannenstiel

A

bikini cut/area, for c-section

106
Q

pararectus

A

Anterior wall of rectus sheath is incised medially and parallel to the lateral of the rectus muscle

● Disadvantage: the opening is small and any longitudinal extension require one or more segmental nerves of the rectus abdominis to be divided, rectus muscle weakness

107
Q

midline incision

A

Made through the linea alba

● Rapid method in gaining entrance to the abdomen

● Does not damage muscle, its nerve and blood supply

108
Q

structures penetrated in midline incision

A

● Skin

● Camper’s

● Scarpa’s

● Deep fascia

● Linea alba

● Fascia transversalis

● Extraperitoneal fat

● Parietal peritoneum

109
Q

transrectus

A

through the rectus abdominis muscle longitudinally

● Has a disadvantage of sectioning the nerve supply to the part of the muscle

110
Q

transverse

A

Above or below the umbilicus that can extend from flank to flank

● Is rare to damage more than one segmental nerve thus post op weakness of the muscle is minimal

● Gives good exposure and is well tolerated

111
Q

mcburney’s

A

Used for cecostomey or appendectomy

● Gives limited exposure only

● Oblique incision made in the right iliac region 2 inches above and medial to the ASIS (or ⅔ from umbilicus)

112
Q

layers in mcburney

A

● Skin

● Superficial fascia (camper’s and scarpa’s)

● Deep fascia

● External oblique muscle

● Internal oblique muscle

● Transversus abdominis

● Transveralsis fascia

● Peritoneum

113
Q

ASW layers lateral to rectus sheath

A

● Skin

● Fatty layer

● Membranous layer

● Deep fascia

● External oblique muscle or aponeurosis

● Internal oblique muscle or aponeurosis

● Transversus abdominis muscle or aponeurosis

● Fascia transversalis

● Extraperitoneal connective tissue (fat)

● Peritoneum

114
Q

ASW layers at midline

A

● Skin

● Fatty layer

● Membranous layer

● Deep fascia

● Linea alba

● Fascia transversalis

● Extraperitoneal connective tissue

● Parietal peritoneum

115
Q

ASW layers anterior to rectus sheath

A

● Skin

● Fatty layer

● Membranous layer

● Deep fascia

● Anterior wall of rectus sheath

● Rectus muscle

● Posterior wall of rectus sheath

● Transveralsis fascia

● Extraperitoneal fat

● Parietal peritoneum

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