Region 2 - Abdominal Walls Flashcards
1
Q
Where is the trans-umbilical plane?
A
IV disc between L3 and L4
2
Q
What are the 2 divisions of the abdominal superficial fascia below the umbilicus?
A
Superficial (fatty) - Camper’s fascia
Deep (membranous) - Scarpa’s fascia
3
Q
What layer of abdominal fascia is continuous over the inguinal ligament and into the fascia of the thigh and perineum?
A
Camper’s (superficial fatty) fascia
4
Q
How does Camper’s fascia contribute to the structure of the penis?
A
Loses fatty layer
Fuses with deeper layer (Scarpa’s fascia)
Becomes dartos fascia of scrotum
5
Q
How does Camper’s fascia contribute to the female external genitalia?
A
Retains fatty layer
Contributes to fascia of labia majora
6
Q
Where does the Scarpa’s fascia attach in the abdomen?
A
Pubic symphysis
Linea alba in midline
7
Q
What does Scarpa’s fascia attach to in the perineum?
A
Posterior part of perineal membrane
- Superficial part ie Colles’ fascia
8
Q
What does Scarpa’s fascia contribute to in the male external genitalia?
A
Fascia of penis
Dartos fascia of scrotum
Fundiform ligament of penis
9
Q
What does Scarpa’s fascia contribute to in the female external genitalia?
A
Labia majora
10
Q
What direction do the external oblique fibres run in?
A
Inferomedially (hands in pockets)
11
Q
What is the origin of the external obliques?
A
Ribs 5-12
12
Q
Where do the external obliques insert?
A
Iliac crest
Linea alba
13
Q
Where does the external oblique aponeurosis run from and to?
A
From xiphoid
To pubic symphysis
14
Q
What does the lower border of the external oblique aponeurosis form?
A
Inguinal ligament
15
Q
What are the functions of the external obliques?
A
Flex trunk by using both
Turn to ipsilateral side by using one
16
Q
What innervates the external obliques?
A
Anterior rami T7-T12 via:
- Thoracoabdominal nerves (T7-T11)
- Subcostal nerve (T12)
17
Q
What direction do the fibres of the internal obliques run in?
A
Superomedially
18
Q
What are the origins of the internal obliques?
A
Thoracolumbar fascia
Inguinal ligament
Iliac crest
19
Q
What are the insertions of the internal obliques?
A
Ribs 9-12
20
Q
Where does the aponeurosis of the internal obliques end?
A
Linea alba
Pectineal line
Pubic crest
21
Q
What are the functions of the internal obliques?
A
Flex trunk by using both
Bend trunk to one side by using one
22
Q
What innervates the internal obliques?
A
Anterior rami T7-L1 via:
- Thoracoabdominal nerves (T7-T11)
- Subcostal nerve (T12)
- Iliohypogastric and ilioinguinal nerves (L1)
23
Q
What are the origins of the transversus abdominis?
A
Thoracolumbar fascia
Iliac crest
Inguinal ligament
Costal cartilages of ribs 7-12
24
Q
What are the insertions of the transversus abdominis?
A
Linea alba
Pubic crest
Pectineal line
25
What innervates the transversus abdominis?
Anterior rami T7-L1 via:
- Thoracoabdominal nerves (T7-T11)
- Subcostal nerve (T12)
- Iliohypogastric and ilioinguinal nerves (L1)
26
What is the function of the transversus abdominis?
Support abdominal wall
27
What are the origins of the rectus abdominis?
Pubic tubercle
Pubic crest
Pubic symphysis
28
What are the insertions of the rectus abdominis?
Xiphoid process
| Costal cartilages of ribs 5-7
29
What are the functions of the rectus abdominis?
Flexes trunk
| Supports/Compresses abdominal wall
30
What innervates the rectus abdominis?
Anterior rami T7-T12 via:
- Thoracoabdominal nerves (T7-T11)
- Subcostal nerve (T12)
31
What is the origin of the pyramidalis?
Pubis
32
What is the insertion of the pyramidalis?
Linea alba
33
What is the function of the pyramidalis?
Tenses linea alba
34
What innervates the pyramidalis?
Anterior ramus T12 (subcostal nerve)
35
Where does the rectus sheath lie above the costal margin?
Directly on costal cartilage
36
Where is the arcuate line?
Half way between umbilicus and pubic bone
37
What is the structure of the rectus sheath above the arcuate line?
Aponeuroses of external oblique and half of internal oblique are anterior to rectus abdominis
Aponeuroses of half of internal oblique and transversus abdominis are posterior to rectus abdominis
38
What is the structure of the rectus sheath below the arcuate line?
All aponeuroses anterior to rectus abdominis
39
From superficial to deep, what are the layers of the abdominal wall?
Skin
Superficial (fatty) layer of superficial fascia (Camper's)
Deep layer of superficial fascia (Scarpa's)
Muscles and deep fascia
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum
40
What is the median umbilical ligament?
Remnant of urachus
41
What are the medial umbilical ligaments?
Remnants of umbilical arteries
42
What do the lateral umbilical folds contain?
Inferior epigastric vessels
43
What nerves supply the anterior abdominal wall?
Lateral cutaneous branches of intercostal nerves 7-11 (T7-T11), subcostal nerve (T12) and iliohypogastric and ilioinguinal nerve (L1)
Anterior cutaneous branches of T7-T12
44
What is the arterial supply of the anterior abdominal wall?
Musculophrenic artery (from internal thoracic)
Femoral artery branches:
- Superficial epigastric
- Superficial circumflex iliac
45
What is the superficial lymphatic drainage of the anterior abdominal wall?
Superficial inguinal
Anterior axillary
Posterior axillary
46
What is the deep lymphatic drainage of the anterior abdominal wall?
```
Parasternal nodes (internal thoracic artery)
Lumbar nodes (abdominal aorta)
External iliac nodes
```
47
Where does the inguinal canal lie?
Superiorly to the medial half of the inguinal ligament
48
How long is the inguinal canal?
~4cm
49
What does the inguinal canal carry generally in males?
Structures to/from testis and abdomen
| Ilioinguinal nerve
50
What does the inguinal canal carry generally in females?
Round ligament of uterus to labia majora
| Ilioinguinal nerve
51
What is the superficial inguinal ring?
Triangular-shaped defect in external oblique aponeurosis
52
What forms the base of the superficial inguinal ring?
Pubic crest
53
What are the margins of the superficial inguinal ring attached to?
Lateral crus to pubic tubercle
| Medial crus to pubic crest
54
What does the superficial inguinal ring give rise to?
External spermatic fascia
55
What forms the intercrural fibres of the superficial inguinal ring?
Superficial layer of deep fascia over external oblique
56
Where do the intercrural fibres lie in the superficial inguinal ring?
Superolaterally
57
What is the function of the intercrural fibres?
Support the superficial inguinal ring
58
What ligament can become fibrous and blend with the superficial inguinal ring?
Round ligament
59
What is the deep inguinal ring?
Oval opening in the transversalis fascia
60
Where is the deep inguinal ring located?
Halfway between ASIS and pubic symphysis (~1.3cm above inguinal ligament)
61
Where do the inferior epigastric vessels lie in relation to the deep inguinal ring?
Medially
62
What fascia does the deep inguinal ring give rise to?
Internal spermatic/round ligament
63
What forms the anterior wall of the inguinal canal?
External oblique aponeurosis
Internal oblique muscle fibres:
- In lateral third (weak area of deep ring in post. wall)
64
What forms the posterior wall of the inguinal canal?
Transversalis fascia
Conjoint tendon:
- In medial third (weak area of superfic. ring in ant. wall)
65
What is the conjoint tendon?
Common insertion of internal oblique and transversus abdominis
66
Where does the conjoint tendon insert?
Pubic crest
| Pectineal line
67
What forms the roof of the inguinal canal?
Transversalis fascia laterally
| Internal oblique and transversus abdominis muscle fibres centrally
68
What forms the floor of the inguinal canal?
```
Inguinal ligament
Lacunar ligament (medial)
```
69
Where does the lacunar ligament originate and what direction does it move in?
Medial end of inguinal ligament
| Superoposteriorly
70
Where does the lacunar ligament insert?
Pectineal line (superior pubic ramus) at pectineal ligament
71
What does the free edge of the lacunar ligament form?
Medial margin of femoral ring
72
How are the weak areas of the inguinal canal reinforced?
Oblique course
Compressed by internal oblique and transversus abdominis
Squatting (defaecation/childbirth) - Thighs protect wall
73
What is an indirect inguinal hernia?
Protrusion of tissue via deep inguinal ring
74
What is a direct inguinal hernia?
Protrusion of tissue by pushing through posterior wall into inguinal canal
75
Where does the spermatic cord begin and end?
Begin - Deep inguinal ring
| End - Testis
76
What are the contents of the spermatic cord?
Ductus deferens (and artery)
Testicular artery and veins
Cremasteric artery (from inf. epigastric)
Genital branch of genitofemoral nerve
Lymph vessels
ANS nerves (SNS from renal/aortic plexuses)
77
What structures in the spermatic cord lie outside the internal spermatic fascia?
Cremasteric artery
| Genital branch of genitofemoral nerve
78
What does the genital branch of the genitofemoral nerve supply?
Cremaster muscle
79
What are the coverings of the spermatic cord?
- Peritoneal diverticulum (processus vaginalis) from L1
- Internal spermatic fascia = Deep ring ie. transversalis fascia)
- Cremaster muscle (fascia) = Internal oblique
- External spermatic fascia = Superficial ring ie. external oblique
80
What is the function of the cremaster muscle?
Raises testes and scrotum for warmth and protection
81
What is the tunica vaginalis?
Closed off sac - a remnant if processus vaginalis
82
What cells form the gubernaculum?
Mesenchyme
83
Where does the gubernaculum descend through and to?
Through inguinal canal
| To labiosacral swelling
84
At what point in development do the testes move through the inguinal canal?
7th-8th months
85
Why do the testes have the same coverings as the inguinal canal?
Follow gubernaculum
86
Why do the ovaries stay in the pelvis instead of descending?
Gubernaculum is stuck to uterus
87
What do the seminiferous tubules open into?
Rete testis
88
What temperature are the testes in relation to the abdomen?
3 degree celcius cooler
89
Where does lymph from the testes and epididymis drain to?
Para-aortic nodes at root of testicular artery (L2)
90
Where does lymph from the scrotal wall and fascia drain to?
Superficial inguinal nodes
91
What modalities is the parietal peritoneum sensitive to?
Pain
Touch
Temperature
Pressure
92
What is the anterolateral parietal peritoneum innervated by?
Lower 6 thoracic nerves (T7-T12)
93
What is the central part of the parietal peritoneum innervated by?
Phrenic nerve
94
What is the pelvic part of the parietal peritoneum innervated by?
Obturator nerve
95
What is the visceral peritoneum sensitive to?
Stretch (via ANS afferents)
96
What are the retroperitoneal organs?
```
Primary:
- Kidneys
- Suprarenal glands
Secondary:
- 2nd, 3rd and 4th parts duodenum
- Ascending and descending colon
- Pancreas
- Upper 2/3rds rectum
```
97
What is a secondary retroperitoneal organ?
Were once mobile but now stuck to body wall
98
Where is the greater omentum suspended from?
Greater curvature of stomach and proximal duodenum
99
What does the greater omentum fold back to cover?
Anterior transverse colon
100
How is the greater omentum four-layered?
Each part is a double layer which folds back onto each other
101
What divides the greater sac?
Transverse colon
102
What is contained in the supracolic compartment of the greater sac?
Liver
Gallbladder
Stomach
103
What is contained in the infracolic compartment of the lesser sac?
Intestines
104
The blood vessels carried by the greater omentum supply what structures?
Itself:
- Via left and right gasto-omental (epiploic) vessels
Greater curvature of stomach
105
What is the other name for the lesser sac?
Omental bursa
106
Where is the lesser sac?
Portion of peritoneal cavity behind lesser omentum and stomach
107
Where does the lesser omentum originate?
Liver
108
Where does the lesser omentum attach and via what?
```
Lesser curvature of stomach (hepatogastric lig.)
Proximal duodenum (hepatoduodenal lig.)
```
109
What collection of structures is contained in the hepatoduodenal ligament?
Portal triad:
- Hepatic artery (left ant.)
- Bile duct (right ant.)
- Portal vein (post.)
110
How do the greater and lesser sacs communicate?
Epiploic (omental) foramen
111
What is the function of the mesentery proper?
Carries vessels, nerves and lymphatics to/from most of small intestine (jejunum and ileum)
112
What vessels run in the mesentery proper?
Jejunal and ileal branches of superior mesenteric artery and vein
113
Other than the mesentery proper, what other 'mesenteries' exist?
Transverse mesocolon
Sigmoid mesocolon
Vermiform appendix mesocolon
114
What is the function of peritoneal fluid?
Lubrication
115
In what direction does peritoneal fluid flow and via what?
Superiorly
| Via left and right paracolic gutters
116
Where does peritoneal fluid flow towards?
Subphrenic spaces
117
What are the paracolic gutters?
Grooves between:
- Ascending/Descending colon
- Posterolateral abdominal wall
118
What are the parts of the posterior abdominal wall fascia named after?
Muscles
119
What is the posterior abdominal wall fascia continuous with?
Pelvic fascia
120
Where does the femoral sheath lie?
Deep to inguinal ligament
121
What are the contents of the femoral sheath (from lateral to medial)?
Femoral artery
Femoral vein
Lymph vessels (in femoral canal)
122
What forms the anterior wall of the femoral sheath?
Transversalis fascia
123
What forms the posterior wall of the femoral sheath?
Iliopsoas fascia
124
What is the function of the femoral sheath?
Allows proximal femoral vessels to glide under inguinal canal during hip motion
125
From roughly superior to inferior, what are the nerves on the posterior abdominal wall?
```
Subcostal
Iliohypogastric
Ilioinguinal
Genitofemoral
Lateral femoral cutaneous
Femoral
Obturator
Lumbosacral trunk
```
126
What vertebral levels does the right crus of the diaphragm extend from?
L1-L3
127
What vertebral levels does the left crus of the diaphragm extend from?
L1-L2
128
What is the origin of the quadratus lumborum muscle?
Iliac crest
129
What are the insertions of the quadratus lumborum muscles?
12th rib
| L1-L4 transverse processes
130
What are the functions of the quadratus lumborum muscles?
```
One bends trunk to same side
Both:
- Pressure
- Forced expiration
- Support for 12th rib
```
131
What innervates the quadratus lumborum?
Anterior rami T12-L4
132
What fascia layers blend at the lateral border of the quadratus lumborum?
Middle layer of lumbar fascia with anterior layer
133
What does the anterior layer of the lumbar fascia form superiorly?
Lateral arcuate ligament
134
What is the origin of the iliacus?
Iliac fossa
135
What is the insertion of the iliacus?
Lessuer trochanter of femur
136
What is the function of the iliacus?
Flexion of hip
137
What is the innervation of the iliacus?
Femoral nerve (L2-L4)
138
What are the origins of the psoas?
T12-L4 vertebral bodies and IV discs (superficial)
| L1-L5 (deep)
139
What is the insertion of the psoas?
Lesser trochanter of femur
140
What are the functions of the psoas?
Hip flexion
One = Bends trunk laterally
Both = Raise trunk from supine
141
What is the innervation of the psoas?
Direct lumbar plexus branches L2-L4
142
What is the long tendon anterior to psoas major called?
Psoas minor
143
What is the name of the lumbar fascia arch that passes over psoas major?
Medial arcuate ligament
144
At what level does the abdominal aorta bifurcate?
L4
145
Excluding lumbar arteries, what are the paired lateral branches off of the abdominal aorta?
```
Inferior phrenic arteries (T12)
Suprarenal arteries (L1):
- Superior
- Middle
Renal arteries (L1)
Gonadal arteries (L2)
```
146
At what vertebral level is the IVC formed?
L5
147
Where do lumbar veins 1 and 2 drain to?
Ascending lumbar -> Azygos/Hemiazygos
148
Where do lumbar veins 3 and 4 drain to?
IVC
149
Where does the 5th lumbar vein drain to?
Iliolumbar vein -> Common iliac
150
Where does the right gonadal vein drain?
IVC
151
Where does the left gonadal vein drain to?
Left renal vein
152
What contributes SNS fibres to the coeliac plexus?
```
Coelic ganglia (greater splanchnic nerves)
Aorticorenal ganglia (lesser splanchnic nerves)
```
153
What contributes PNS fibres to the coeliac plexus?
Fibres from posterior (and anterior) vagal trunks
154
Where is the coeliac plexus situated?
Around the coeliac trunk (prevertebral)
155
What does the coeliac plexus supply?
Foregut organs
156
What is the alternate name for the coeliac plexus?
Solar plexus
157
What contributes SNS fibres to the superior mesenteric plexus?
Superior mesenteric ganglion (gretaer and lesser splanchnic nerves)
158
What contributes PNS fibres to the superior mesenteric plexus?
Fibres from posterior (and anterior) vagal trunks
159
Where is the superior mesenteric plexus situated?
Around the superior mesenteric artery (prevertebral)
160
What does the inferior mesenteric plexus supply?
Hindgut up to the descending colon
161
What contributes SNS fibres to the inferior mesenteric plexus?
Inferior mesenteric ganglion (lumbar splanchnic nerves L1-L2)
162
What contributes PNS fibres to the inferior mesenteric plexus?
Pelvic splanchnic nerves S2-S4
163
What does the superior hypogastric plexus supply?
Ureteric and testicular plexuses
164
What contributes SNS fibres to the superior hypogastric plexus?
Lumbar splanchnic nerves L3-L4
165
What contributes PNS fibres to the superior hypogastric plexus?
Pelvic splanchnic nerves S2-S4
166
What does the inferior hypogastric plexus supply?
Sigmoid colon
Rectum
Bladder
(Via smaller plexuses)
167
What contributes SNS fibres to the inferior hypogastric plexus?
```
Hypogastric nerves (from sup. hypogastric plexus) - Pre- and postganglionic T10-T12
Sacral splanchnic nerves
```
168
What contributes PNS fibres to the inferior hypogastric plexus?
Pelvic splanchnic nerves
169
What does lymph join the intestinal trunk as? What vertebral level is this?
Cisterna chyli
| At L1/2
170
What forms the lumbar plexus?
Anterior rami L1-L4
171
Where do the branches of the lumbar plexus form?
Within psoas muscle
172
What is the root value for the iliohypogastric and ilioinguinal nerves
Anterior rami L1
173
What is the sensory distribution of the iliohypogastric nerve?
Lateral gluteal skin
| Pubic skin
174
What is the sensory distribution of the ilioinguinal nerve?
Medial thigh skin
| Root of penis/scotrum OR mons pubis/labia majora
175
What is the motor distribution of the iliohypogastric and ilioinguinal nerves?
Internal obliques
| Transversus abdominis
176
What is the root value for the genitofemoral nerve?
L1-L2
177
What is the sensory distribution of the genitofemoral nerve?
Scotrum/Mons pubis
| Skin of upper anterior thigh
178
What is the motor distribution of the genitofemoral nerve?
Cremaster muscle
179
What are the root values for the lateral cutaneous nerve of thigh?
Anterior rami L2-L3
180
What is the sensory distribution of the lateral cutaneous nerve of thigh?
Anterior and lateral thigh
181
What are the root values of the femoral nerve?
L2-L4
182
What is the sensory distribution of the femoral nerve?
Skin of:
- Anterior thigh
- Medial leg
183
What is the motor distribution of the femoral nerve?
Pectineus
Iliacus
Anterior compartment of thigh
184
What are the root values of the obturator nerve?
L2-L4
185
What is the sensory distribution of the obturator nerve?
Skin of medial thigh
186
What is the motor distribution of the obturator nerve?
Obturator externus
Medial compartment of thigh
(May supply pectineus)
