Organization of the abdomen Flashcards
1
Q
what vertebra level is the xiphoid process
A
TV10
2
Q
what vertebra level is the umbiicus
A
LV3/LV4
3
Q
what are some structures in the right upper quadrant
what part of the stomach, duodenum, pancreas, colon
A
right liver lobe gallbladder stomach (pylorus) duodenum parts 1-3 pancreas--> head right suprarenal gland right kidney right colic (hepatic) flexure superior part of the ascending colon right half of the transverse colon
4
Q
what are some structures in the left upper quadrant ?
A
left liver lobe spleen stomach jejunum and proximal ileum body and tail of pancreas left kidney left suprarenal gland left hepatic flexure transverse colon --> left half superior part of the descending colon
5
Q
what are some structures in the right lower quadrant
A
cecum appendix most of ileum inferior part of ascending colon right ovary right uterine tube right ureter (abdominal part) right spermatic cord (abdominal part) uterus (if enlarged) urinary bladder (if very full)
6
Q
what are some structures in the left lower quadrant?
A
sigmoid colon descending colon (inferior part) left ovary left uterine tube left ureter (abdominal part) left spermatic cord (abdominal part) uterus (if enlarged) urinary bladder (if very full)
7
Q
what is method 1 for dividing the abdomen ?
how many regions ?
how many lines?
where do these lines intersect?
A
Four regions
one horizontal line and one vertical line intersecting at the umbilicus
4 regions:
right and left upper and lower quadrants
8
Q
what is method 2 for dividing the abdomen ?
how many lines dividing into how many regions?
what are the regions named?
A
Two horizontal lines and Two midclavicular lines dividing the abdomen into 9 regions
Two horizontal lines:
Subcostal line - along lowest limit of costal margin LV3
Transtubercular line- through iliac crests at LV5
Regions: Right and left hypochondriac right and left lateral regions Right and left inguinal epigastric umbilical pubic
9
Q
what plane is at LV1
A
transpyloric plane
10
Q
what level is the subcostal plane
A
LV3
11
Q
transumbilical plane is what vertebral level
A
LV3/LV4
12
Q
what plane is at the LV4
A
supracristal plane
13
Q
what plane is at LV5
A
transtubercular plane
14
Q
what plane is at SV1
A
interspinous plane
15
Q
what are the 3 major osseous structures of the abdominal wall
A
lumbar vertebrae 1-5
ribs 7-12
pelvic girdle
16
Q
what are the 2 layers of superficial fascia of the abdominal wall?
A
superficial fatty layer (Camper’s fascia)
deeper membranous layer (Scarpa’s fascia)
17
Q
what is Scarpa’s fascia continuous with?
What does Scarpa’s fascia attach to?
A
continuous with Colle’s and Darto’s fascia of the perineum
attaches to the iliac crest, fascia lata below inguinal ligament, pubic tubercle
18
Q
what is the fundiform ligament >
A
specialization of Scarpa’s fascia
19
Q
what are the 3 layers of the deeper fascia of the abdominal wall
A
transversalis fascia –> lines all of abdominopelvic cavity, deep to muscle layer
subserous fascia–> loose, fatty CT between transversalis fascia and peritoneum
peritoneum–> serous membrane which lines the abdominopelvic cavity
20
Q
origin of the external abdominal oblique
A
outer surfaces of ribs 5-12
20
Q
what is contained in the lateral umbilical folds
A
inferior epigastric arteries
20
Q
where is the supravesical fossa
what type of hernia occurs here
A
- Area between median and medial umbilical folds.
2. Supravesical hernias can occur here.
20
Q
where is the medial inguinal fossa
what type of hernia occur here
A
area between medial and lateral folds
site of DIRECT inguinal hernias
20
Q
where is the lateral inguinal fossa
what type of hernia’s occur here
A
- Area lateral to lateral umbilical fold
2. Site of INDIRECT inguinal hernias.
20
what two ligaments reinforce the groin and the area of weakness called the myopectineal orifice
inguinal ligament (strongest)
iliopubic tract (thickening of transversalis fascia)
20
insertion of external abdominal oblique
anterior iliac crest
| via external abdominal oblique aponeurosis attaches to linea alba from xiphoid process to pubic symphysis
20
what is the action of the external abdominal oblique muscle?
one side acting alone?
innervation?
flexion of the vertebral column and pelvis
compression and support of abdominal viscera
one side acting alone causes lateral flexion of trunk and rotation to OPPOSITE side (torsional movement of trunk)
20
what is the origin of the internal abdominal oblique muscle
thoracolumbar fascia
anterior iliac crest
lateral inguinal ligament
20
what is the insertion of the internal abdominal oblique muscle
inferior borders of ribs 9-12
via internal abdominal oblique aponeurosis to linea alba from xiphoid process to pubic symphysis
20
what is the action of the internal abdominal oblique muscle
flexion of the vertebral column and pelvis
compression and support of abdominal viscera
one side acting alone causes lateral flexion of trunk and rotation to the same side
20
what is the innervation of the internal abdominal oblique
intercostals
subcostal
iliohypogastric
ilioinguinal
20
what do the inferior fibers of the IAO muscle give rise to?
| what is the function of this structure
cremaster muscle
plays an important role in temperature regulation of the testes
20
what is the arcuate line
line that demarcates the lower limit of the posterior layer of the rectus sheath.
It is also where the inferior epigastric vessels perforate the rectus abdominis.
20
what are the origin and insertion of the transversus abdominis
origin- inner surface of ribs 7-12
thoracolumbar fascia
anterior iliac crest
lateral inguinal ligament
insertion:
via aponeurosis to linea alba
20
what is the action of the transversus abdominis
compression and support of abdominal viscera
20
what is the innervation of the transversus abdominis
intercosta
subcostal
iliohypogatric
ilioinguinal
20
what is the origin of the rectus abdominis
pubic symphysis and pubic crest
20
insertion of the rectus abdominis
costal cartilages of 5-7
| xiphoid process
20
what is the action of the rectus abdominis
flexion of the vertebral column and pelvis
20
what is the innervation of the rectus abdominis
ventral rami T6-T12 (intercostal, subcostal)
20
what are the tendinous intersection of the rectus abdominis
3-4 attachments of the rectus abdominis to the rectus sheath
20
what is the origin and insertion of the pyramidalis
origin:
pubic bone
anterior to rectus abdominis
insertion:
linea alba
20
what is the action of the pyramidalis
tenses linea alba
20
what is the innervation of the pyramidalis
subcostal n
20
what is the clnical signficance of anterolateral musculature fiber direction ?
important in surgery
Muscle fibers should be split parallel to their fiber direction. Thus, each layer will require to be split in a different direction.
20
what are the layers of the anterolateral abdominal wall starting from most exterior
```
skin
superficial (Camper's) fascia (fatty layer)
superficial fascia (membranous) Scarpa's
external abdominal oblique muscle
internal oblique
transversus abdominis
transversalis fascia
extraperitoneal fascia
parietal peritoneum
```
20
what does the rectus sheath surround and what is it formed from
rectus abdominis and pyramidalis
formed from decussation of external and internal abdominal oblique and transversus abdominis aponeurosis
20
what is the composition/organization of the rectus sheath above the arcuate line
the internal abdominal oblique aponeurosis splits into anterior and posterior laminae.
Thus, here the anterior layer of the rectus sheath is composed of external and internal abdominal oblique aponeuroses.
The posterior layer of the rectus sheath is composed of internal abdominal oblique and transversus abdominis aponeuroses.
20
what is the composition/organization of the rectus sheath below the arcuate line
All 3 muscle aponeuroses pass anterior to rectus abdominis.
Here the anterior layer is composed of external and internal abdominal oblique and transversus abdominis aponeuroses.
The posterior layer is composed of only transversalis fascia.
20
what attaches to the linea alba
where does it extend from
midline site of attachment of external, internal and transversus aponeuroses
extends/runs from xiphoid process to pubic symphysis
20
what is the linea semilunaris
lateral, fused border of rectus sheath
20
where does the median umbilical fold run
runs from the apex of the bladder to the umbilicus
the median umbilical ligament (urachus) is found within this fold
20
where does the medial umbilical ligament run
runs towards umbilicus
the medial umbilical ligaments (occluded portion of umbilical aa) are found within the folds
20
what are the dermatomes of the abdomen?
T7-L1
20
what are the cord levels of the thoracoabdominal and subcostal nerves
T7-T12
20
where do nerves of the abdomen course? between what layers...
course between the transversus abdominis and internal oblique
20
what branches do the thoracoabdominal and subcostal nerves provide?
lateral cutaneous branches and anterior cutaneous branches
20
where do the iliohypogastric and ilioinguinal nn pierce through and through what muscle as they course anteriorly?
pierce the internal oblique near the ASIS
run between the internal and external oblique, then terminate as anterior cutaneous branches to the suprapubic region (iliohypogastric) or anterior scrotal/labial branches to the perineal region (ilioinguinal).
20
what are two arteries that are superficial and branches off the femoral artery?
1. Superficial epigastric a.
| 2. Superficial circumflex iliac a.
20
what are the 7 deep arteries of the abdomen
```
musculophrenic
superior epigastric
inferior epigastric
posterior intercostal
subcostal
lumbar
deep circumflex iliac
```
20
what are the two arteries of the abdomen that are branches off the internal thoracic artery
musculophrenic
| superior epigastric
20
where does the superior epigastric artery run?
| with what artery does it anastomose ?
2. runs between rectus abdominis and posterior layer of rectus sheath.
3. Anastomoses with inferior epigastric a. in region of umbilicus.
20
where does the inferior epigastric artery give off from the external iliac a.
where does it ascend in the body wall ?
what does it pierce and anastomose with?
given off medial to the deep inguinal ring
2. Ascends along anterior body wall, covered with peritoneum to form the lateral umbilical fold.
3. Pierces posterior layer of rectus sheath to anastomose with superior epigastric a.
20
through what muscle layers do the posterior intercostal and subcostal aa's course? as well as the lumbar artery
between internal abdominal and transversus abdominus muscles
20
what deep artery branches from the external iliac artery
deep circumflex iliac a.
20
what are the three major veins that the abdomen drains into ?
a. axillary vein via lateral thoracic vein.
b. internal thoracic vein via musculophrenic and superior epigastric vv.
c. femoral vein via superficial epigastric and superficial circumflex iliac vv.
20
what are the major veins that deep veins drain into?
a. internal thoracic vein via musculophrenic and superior epigastric vv.
b. external iliac vein via inferior epigastric and deep circumflex iliac vv.
c. IVC via lumbar vv.
d. azygos vein via posterior intercostal and subcostal vv.
20
what anastomosis is around the umbilicus
a portal-caval anastomosis
20
what is the thoracoepigastric vein a venous anastomosis between?
b/w lateral thoracic vein and superficial epigastric
20
superior to the transumbilical plane where does superficial lymph drain?
axillary and parasternal lymph nodes
20
inferior to the transumbilical plane where does the superficial lymph drain
superficial inguinal lymph nodes
20
what are three locations that deep lymphatic material drain ?
a. To external iliac nodes via channels which parallel inferior epigastric and deep circumflex iliac vessels.
b. To lumbar lymph nodes via channels which parallel lumbar vessels.
c. To parasternal nodes via channels which parallel superior epigastric vessels.
20
where is the inguinal region
between the ASIS and pubic tubercle
GROIN
20
where is the location of the L1 dermatome
iliac crest
ASIS
Inguinal region
anterior scrotum or labia majora
20
what are the dermatomes of the abdomen?
T7-L1
20
what is the dermatome of T10
umbilicus
20
what cord levels are the iliohypogastric and ilioinguinal nn
L1
iliohypogastric - superior
ilioinguinal - inferior
20
what is the major superficial artery supply of the abdomen
a. Mostly perforating branches of deeper arteries (see below).
b. Also directly from branches of femoral artery
1. Superficial epigastric a.
2. Superficial circumflex iliac a.
20
what is the dermatome of T10
umbilicus
20
where is the location of the L1 dermatome
iliac crest
ASIS
Inguinal region
anterior scrotum or labia majora
20
what are the cord levels of the thoracoabdominal and subcostal nerves
T7-T12
20
what cord levels are the iliohypogastric and ilioinguinal nn
L1
iliohypogastric - superior
ilioinguinal - inferior
20
where do nerves of the abdomen course? between what layers...
course between the transversus abdominis and internal oblique
20
what branches do the thoracoabdominal and subcostal nerves provide?
lateral cutaneous branches and anterior cutaneous branches
20
where do the iliohypogastric and ilioinguinal nn pierce through and through what muscle as they course anteriorly?
pierce the internal oblique near the ASIS
run between the internal and external oblique, then terminate as anterior cutaneous branches to the suprapubic region (iliohypogastric) or anterior scrotal/labial branches to the perineal region (ilioinguinal).
20
what is the major superficial artery supply of the abdomen
a. Mostly perforating branches of deeper arteries (see below).
b. Also directly from branches of femoral artery
1. Superficial epigastric a.
2. Superficial circumflex iliac a.
20
what are two arteries that are superficial and branches off the femoral artery?
1. Superficial epigastric a.
| 2. Superficial circumflex iliac a.
20
what are the 7 deep arteries of the abdomen
```
musculophrenic
superior epigastric
inferior epigastric
posterior intercostal
subcostal
lumbar
deep circumflex iliac
```
20
what are the two arteries of the abdomen that are branches off the internal thoracic artery
musculophrenic
| superior epigastric
20
where does the superior epigastric artery run?
| with what artery does it anastomose ?
2. runs between rectus abdominis and posterior layer of rectus sheath.
3. Anastomoses with inferior epigastric a. in region of umbilicus.
20
where does the inferior epigastric artery give off from the external iliac a.
where does it ascend in the body wall ?
what does it pierce and anastomose with?
given off medial to the deep inguinal ring
2. Ascends along anterior body wall, covered with peritoneum to form the lateral umbilical fold.
3. Pierces posterior layer of rectus sheath to anastomose with superior epigastric a.
20
through what muscle layers do the posterior intercostal and subcostal aa's course? as well as the lumbar artery
between internal abdominal and transversus abdominus muscles
20
what deep artery branches from the external iliac artery
deep circumflex iliac a.
20
what are the three major veins that the abdomen drains into ?
a. axillary vein via lateral thoracic vein.
b. internal thoracic vein via musculophrenic and superior epigastric vv.
c. femoral vein via superficial epigastric and superficial circumflex iliac vv.
20
what are the major veins that deep veins drain into?
a. internal thoracic vein via musculophrenic and superior epigastric vv.
b. external iliac vein via inferior epigastric and deep circumflex iliac vv.
c. IVC via lumbar vv.
d. azygos vein via posterior intercostal and subcostal vv.
20
what anastomosis is around the umbilicus
a portal-caval anastomosis
20
what is the thoracoepigastric vein a venous anastomosis between?
b/w lateral thoracic vein and superficial epigastric
20
superior to the transumbilical plane where does superficial lymph drain?
axillary and parasternal lymph nodes
20
inferior to the transumbilical plane where does the superficial lymph drain
superficial inguinal lymph nodes
20
what are three locations that deep lymphatic material drain ?
a. To external iliac nodes via channels which parallel inferior epigastric and deep circumflex iliac vessels.
b. To lumbar lymph nodes via channels which parallel lumbar vessels.
c. To parasternal nodes via channels which parallel superior epigastric vessels.
20
where is the inguinal region
between the ASIS and pubic tubercle
GROIN
20
what muscle aponeurosis forms the inguinal ligament and where does the inguinal ligament extend from?
where in relation to the inguinal ligament do muscles and neurovascular bundles pass?
1. Inferior, “rolled-under” portion of external oblique aponeurosis extending from ASIS to pubic tubercle.
2. Marks transition from abdomen to thigh.
3. Muscles, neurovascular bundle of lower limb passes INFERIOR to inguinal ligament.
20
what are three ligaments off the inguinal ligament
lacunar ligament
pectineal ligament
reflected ligament
20
what is the lacunar ligament and where does it attach
medial fibers of inguinal ligament which attach lateral to pubic tubercle; crescent-shaped ligament which forms medial border of femoral canal.
20
what is the pectineal ligament and where does it attach
lateral continuation of lacunar ligament fibers attaching to the pectineal line of the superior pubic ramus.
20
what is the reflected ligament and where does it attach
continuation of superomedial fibers of inguinal ligament which attach to the linea alba.
20
what is the inguinal canal
1. Oblique passage through anterolateral body wall allowing for passage of the spermatic cord (round ligament of uterus) into scrotum (labia majora).
forms during gonadal descent from abdomen to scrotum (or labia)
20
what is the gubernaculum
thick ligament attaching testes to anterior body wall at future site of deep inguinal ring.
20
what is the deep inguinal ring?
what does it form from ?
where is it located in relation to the epigastric arteries?
what abnormality can occur here?
a. Entrance to inguinal canal from abdominal cavity.
b. Formed as an evagination in transversalis fascia.
c. Located lateral to inferior epigastric arteries
d. Site of indirect inguinal hernias
20
what is the superficial inguinal ring?
| what is it formed from?
a. Exit from inguinal canal into scrotum or labia majora.
| b. Formed from split in fibers of the external abdominal oblique aponeurosis.
20
where does the lateral crus attach
pubic tubercle
20
where does the medial crus attach
pubic crest
20
where do the intercrural fibers of the superficial inguinal ring arch b/w?
fibers which arch between medial and lateral crus
20
what are the boundaries of the inguinal canal (anterior, floor, roof, posterior)
a. Anterior – external oblique aponeurosis
b. Floor – inguinal ligament
c. Roof – internal oblique and transversus abdominis
d. Posterior – transversalis fascia laterally; reinforced medially by conjoint tendon.
20
what can occur in the inguinal triangle
direct inguinal hernia
20
what is the conjoint tendon composed of?
| where does it attach?
1. The conjoint tendon (falx inguinalis) is composed of the inferior-most fibers of the internal and transversus abdominis muscles.
2. Attaches to the pubic bone posterior to the superficial inguinal opening.
20
what are the general contents of the spermatic cord?
```
ductus deferens
testicular artery
artery of ductus deferens
pampiniform plexus of veins
autonomic and lymphatics of testes
```
20
what is the ductus deferens
muscular tube which transports sperm from epididymis.
20
what is the testicular artery a branch of
abdominal aorta
20
what is the artery of the ductus deferens a branch of
superior vesicle artery
20
what do the pampiniform plexus of veins merge to form
testicular vein
20
what are the coverings of the spermatic cord staring most exterior
```
skin
dartos fascia and muscle
external muscle and fascia
cremaster muscle and fascia
internal spermatic fascia
tunica vaginalis
```
20
what is dartos fascia
superficial fascia of abdominal wall
20
what is external spermatic fascia origin
external abdominal oblique aponeurosis
20
what is cremaster muscle and fascia origins
internal abdominal oblique muscle
20
what is the internal spermatic fascia origin
transversalis fascia
20
what is the tunica vaginalis origin
evagination of peritoneum which forms the serous cavity around testes
20
what is the canal of nuck caused by
in females if the processus vaginalis fails to close
20
```
what are indirect inguinal hernia's.
congenital or acquired?
what is the cause
occur in what fossa?
how far do herniated materials extend and into what
```
a. Represent 2/3 of all inguinal hernias.
b. More common in males; and more common on right side.
c. Congenital; caused by a failure of proximal processus vaginalis to close.
d. Occur in lateral inguinal fossa; lateral to inferior epigastric vessels.
e. Herniated material passes through deep inguinal ring and into inguinal canal.
f. May extend all the way to scrotum (or labia majora). pass through superficial ring
20
what are direct inguinal hernia's
congenital or acquired? what is the cause
what tendon provides protection against this type of hernia
how far does this type of hernia extend
a. Represent 1/3 of all inguinal hernias.
b. More common in males.
c. Acquired; caused by a weakness in anterior body wall posterior to superficial inguinal ring.
d. The conjoint tendon provides a natural protection against direct hernias.
e. Occur in medial inguinal fossa (Hesselbach’s triangle); medial to inferior epigastric vessels.
f. Do not extend into scrotum or labia majora. but may pass through superficial inguinal ring
20
which type of hernia is usually unilateral and right
indirect
132
which type of hernia is more common in elderly
direct
133
between what layers of the abdominal wall is prostheses for repairing inguinal hernias placed
between transversalis fascia and the parietal peritoneum
