Organization of abdomen Flashcards
What vertebral level is the transpyloric plane
LV1
what vertebral level is the subcostal plane
LV3
what level is the transumbilical plane
LV3/LV4
what vertebral level is the supracristal plane
LV4
what vertebral level is the transtubercular plane
LV5
Interspinous plane
SV1
what are the osseous structures in the anterolateral abdominal wall
LV1-5
Ribs 7-12
pelvic girdle
what are the layers of fascia in abdomen
superficial–>campers
deeper–>scarpas
where does the deep layer of fascia in abdomen attach
iliac crest, fascia lata below inguinal ligament and pubic tubercle
what and where is the transversalis fascia
lines all abdominopelvic cavity, deep to muscle layer
where and what is the subserous fascia
loose fatty CT between transversalis fascia and peritoneum
what is the peritoneum
serous membrane which lines abdominopelvic cavity
What is the origin and insertion of the external abdominal obliques
origin: outer surfaces of ribs 1-5
insertion: anterior iliac crest
what is the action of the external abdominal obliques
flexion of vertebral column and pelvis, compression and support of the viscera
one side causes lateral flexion of trunk and rotation to opposite side
what is the innervation for external abdominal obliques
intercostal, subcostal and iliohypogastric
what is the origin and insertion of the internal abdominal oblique
thoracolumbar fascia, anterior iliac crest and lateral inguinal ligament
insertion: inferior borders of ribs 9-12
what is the action on internal abdominal oblique
flexion of vertebral column and pelvis, compression and support of abdominal viscera
one side acting alone does lateral flexion of trunk and rotation to same side
what is the innervation of the internal abdominal obliques
intercostal, subcostal, iliohypogastric, ilioinguinal
what is the origin and innervation of transversus abdominis
inner ribs 7-12, thoracolumbar fascia, anterior iliac crest and lateral inguinal ligament
insertion: aponeurosis to linea alba
what is the action of transverses abdominins
compression and support of abdominal viscera
what is the innervation of transversus abdominis
intercostal, subcostal, iliohypogastric and ilioinguinal
origin and insertion of rectus abdominis
origin: pubic symphysis and pubic crest
insertion: costal cartilages 5-7 and xiphoid cartilage
what is the action of rectus abdominis
flexion of vertebral column and pelvis
what is the innervation of rectus abdomins
ventral rami T6-T12 (intercostal and subcostal)
what structure is imbedded in rectus abdominis
tendinous intersections
origin and insertion of pyramidalis
pubic bone anterior to rectus abdominis
insertion on the linea alba
what is the action of pyramidalis
tense the linea alba
what innervates pyramidalis
subcostal n
What is clinically important about th emusculature of the anterolateral wall of abdomen
muscle fibers should be split parallel to fiber direction and so each layer has to be split differently
where is the arcuate line
midway between umbilicus and pubic symphysis
describe the rectus sheath above the arcuate line
internal abdominal oblique aponeurosis splits into anterior and posterior laminae
Anterior:composed of external and internal abdominal oblique aponeuroses
Posterior: internal abdominal oblique and transversus abdominis aponeuroses
what is the rectus sheath like below the arcuate line
all 3 muscle aponeuroses pass anterior so the anterior: internal and external abdominal oblique and transversus abdomens aponeuroses
posterior: transversalis fascia
where is the linea alba and what attaches to it
midline from xiphoid process to pubic symphysis
attachment of external, internal and transverses aponeuroses
what is the line semilunaris
lateral, fused border of rectus sheath
What is the median umbilical fold and what runs in it
from apex of the bladder to the umbilicus and the median umbilical ligament (urachus) is found in the fold
how many medial umbilical folds are there
2
what are the medial umbilical folds
run toward umbilicus–> occluded parts of the umbilical aa
what are found within the lateral umbilical folds
inferior epigastric aa
where is the supravesical fossa
between median and medial umbilical folds
what can occur clinically in the supravesical fossa
supravesical hernias
where is the medial inguinal fossa
area between medial and lateral folds
where is the sitre for direct inguinal hernia
medial inguinal fossa
where is the lateral inguinal fossa
area lateral to lateral umbilical fold
where is the site for indirect inguinal hernias
lateral inguinal fossa
what nerves provide dermatomes of abdomen
T7-L1
where do nerves of the abdomen course through
transversus abdominis and internal oblique
what nerve provides cutaneous branches to suprapubic region
iliohypogastric
what nerve provides cutaneous branches to perineal region
ilioinguinal
what aa in superfical abdomen come from femoral?
superficial epigastric
superficial circumflex iliac artery
What are the deep arteries in abdomen
musculophrenic superior epigastric inferior epigastric posterior intercostal and subcostal aa lumbar a deep circumflex iliac a
what is the terminal branch of the internal thoracic a
musculophrenic and superior epigastric
what does the superior epigastric anastomose with
inferior epigastric
where does inferior epigastric branch off of
off external iliac a
what does the inferior epigastric a have to pierce to anastomose
the posterior layer of rectus sheath
Where are the posterior intercostal and subcostal aa found
between internal abdominal and transversus abdominis mm
where do the lumbar aa course
along the posterior intercostal aa
what is the deep circumflex iliac a a branch of
external iliac a
where does the lateral thoracic vein drain to
axillary
where do the musculophrenic and superior epigastric veins drain to
internal thoracic vein
where do the superficial epigastric and superficial circumflex iliac vv drain to
femoral vein
what is the portal-cabal anastomosis
vessels around umbilicus
what is the thoracoepigastric vein
venous anastomosis between lateral thoracic vein and superficial epigastric vein
what do the musculophrenic and superior epigastric aa drain to
internal thoracic vein
what do the inferior epigastric and deep circumflex iliac vv drain to
external iliac vein
where do the lumbar vv drain to
inferior vena cava
where do the posterior intercostal and subcostal vv drain to
azygos
what are the superficial lymph plexuses of the abdomen and their relation to transumbilical plane
axillary and parasternal lymph nodes are superior to transumbilical plane
superficial inguinal lymph nodes are inferior to transumbilical plane
what are the deep lymph nodes called in abdomen
external iliac nodes
lumbar lymph nodes
parasternal nodes
where do the lymph come from that drain into external iliac nodes
via channels which parallel inferior epigastric and deep circumflex iliac vessels
where do the lymph come from that drain into lumbar lymph nodes
lumbar vessels
where do the lymph come from that drain into parasternal nodes
superior epigastric vessels
where is the inguinal region
between ASIS and pubic tubercle
what are the two ligaments that reinforce inguinal region and what is the area of weakness called
inguinal ligament and thickening of transversalis fascia (iliopubic tract)
the area is called myopectineal orifice
what is the inguinal ligament a continuation of
inferior rolled under part of the external oblique aponeurosis
what does the path of the inguinal ligament mark transition of
abdomen to thigh
what are the parts of the inguinal ligament
lacunar, pectineal and reflected
describe the lacunar ligament
medial fibers of inguinal log that attach to lateral pubic tubercle to form medial border of femoral canal
describe the pectineal ligament
lateral continuation of lacunar ligament fibers attaching to pectineal line of superior pubic ramus
describe the reflected ligament
continuation of superomedial fibers of inguinal ligament which attach to linea alba
What runs through inguinal canal
spermatic cord or round ligament of uterus
what is the gubernaculum
thickligament attaches testes to anterior body wall at future site of deep inguinal ring
what forms the deep inguinal ring
the transversalis fascia
what is the deep inguinal rign
entrance to inguinal canal from abdominal cavity
what is the superficial inguinal ring
exit from inguinal canal into scrotum or labiamajora
what forms the superficial inguinal ring
split in fibers of external abdominal oblique aponeurosis
lateral crus- pubic tubercle
medial crus- pubic crest
intercrural fibers- fibers which arch between medial and lateral crus
What are the boundaries of the inguinal canal
anterior- external oblique aponeurosis
floor- inguinal log
roof- internal oblique and transverses abdominis
posterior- transversalis fascia laterally, reinforced medially by tendon
what is the tendon that reinforces the transversals fascia
conjoint- falx inguinalis
fibers of transversus abdominis
what runs in the male inguinal canal
spermatic cord, ilioinguinal n and genital branch of genitofemoral
what are the contents of the spermatic cord
ductus deferens testicular a a of ductus deferens pampiniform plexus autonomic and lymph of testes
what cover the testes and spermatic cord
dartos fascia (superficial abdominal fascia) and external abdominal aponeurosis
cremaster m and fascia
transversalis fascia
tunica vaginalis(evagination of peritoneum)
what runs thorugh a female inguinal canal
round lig of uterus, ilioinguinal n, genital branch of genitofemoral n
what happens in females when the processus vaginalis fails to close
forms a pouch called Cana; of Nuck and cysts can form
2/3 of all ingunal hernias are of what type
indirect–lateral inguinal fossa and passes through deep inguinal ring
more common in males
what is acongenital indirect hernia caused by
failure of proximal processus vaginalis to close
what is a direct hernia and what causes it
medial inguinal fossa (hesselbach’s triangle)
when weakness in anteiror body wall posterior to superficial inguinal ring
what tendon provides natrual protection of a direct hernia
conjoint
what type of hernia can extend into scrotum or labia majora
indirect
what side is most common for an indirect hernia
right side
where do the 2 types of hernias occur relative to the inferior epigastric vessels
indirect is lateral
direct is medial
