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regional gross anatomy > Region 2 - Abdominal Walls > Flashcards

Region 2 - Abdominal Walls Flashcards

1
Q

Where is the trans-umbilical plane?

A

IV disc between L3 and L4

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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

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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

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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

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5
Q

How does Camper’s fascia contribute to the female external genitalia?

A

Retains fatty layer

Contributes to fascia of labia majora

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6
Q

Where does the Scarpa’s fascia attach in the abdomen?

A

Pubic symphysis

Linea alba in midline

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7
Q

What does Scarpa’s fascia attach to in the perineum?

A

Posterior part of perineal membrane

- Superficial part ie Colles’ fascia

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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

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9
Q

What does Scarpa’s fascia contribute to in the female external genitalia?

A

Labia majora

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10
Q

What direction do the external oblique fibres run in?

A

Inferomedially (hands in pockets)

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11
Q

What is the origin of the external obliques?

A

Ribs 5-12

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12
Q

Where do the external obliques insert?

A

Iliac crest

Linea alba

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13
Q

Where does the external oblique aponeurosis run from and to?

A

From xiphoid

To pubic symphysis

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14
Q

What does the lower border of the external oblique aponeurosis form?

A

Inguinal ligament

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15
Q

What are the functions of the external obliques?

A

Flex trunk by using both

Turn to ipsilateral side by using one

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16
Q

What innervates the external obliques?

A

Anterior rami T7-T12 via:

  • Thoracoabdominal nerves (T7-T11)
  • Subcostal nerve (T12)
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17
Q

What direction do the fibres of the internal obliques run in?

A

Superomedially

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18
Q

What are the origins of the internal obliques?

A

Thoracolumbar fascia
Inguinal ligament
Iliac crest

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19
Q

What are the insertions of the internal obliques?

A

Ribs 9-12

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20
Q

Where does the aponeurosis of the internal obliques end?

A

Linea alba
Pectineal line
Pubic crest

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21
Q

What are the functions of the internal obliques?

A

Flex trunk by using both

Bend trunk to one side by using one

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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)
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23
Q

What are the origins of the transversus abdominis?

A

Thoracolumbar fascia
Iliac crest
Inguinal ligament
Costal cartilages of ribs 7-12

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24
Q

What are the insertions of the transversus abdominis?

A

Linea alba
Pubic crest
Pectineal line

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25
Q

What innervates the transversus abdominis?

A

Anterior rami T7-L1 via:

  • Thoracoabdominal nerves (T7-T11)
  • Subcostal nerve (T12)
  • Iliohypogastric and ilioinguinal nerves (L1)
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26
Q

What is the function of the transversus abdominis?

A

Support abdominal wall

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27
Q

What are the origins of the rectus abdominis?

A

Pubic tubercle
Pubic crest
Pubic symphysis

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28
Q

What are the insertions of the rectus abdominis?

A

Xiphoid process

Costal cartilages of ribs 5-7

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29
Q

What are the functions of the rectus abdominis?

A

Flexes trunk

Supports/Compresses abdominal wall

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30
Q

What innervates the rectus abdominis?

A

Anterior rami T7-T12 via:

  • Thoracoabdominal nerves (T7-T11)
  • Subcostal nerve (T12)
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31
Q

What is the origin of the pyramidalis?

A

Pubis

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32
Q

What is the insertion of the pyramidalis?

A

Linea alba

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33
Q

What is the function of the pyramidalis?

A

Tenses linea alba

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34
Q

What innervates the pyramidalis?

A

Anterior ramus T12 (subcostal nerve)

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35
Q

Where does the rectus sheath lie above the costal margin?

A

Directly on costal cartilage

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36
Q

Where is the arcuate line?

A

Half way between umbilicus and pubic bone

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37
Q

What is the structure of the rectus sheath above the arcuate line?

A

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

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38
Q

What is the structure of the rectus sheath below the arcuate line?

A

All aponeuroses anterior to rectus abdominis

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39
Q

From superficial to deep, what are the layers of the abdominal wall?

A

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

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40
Q

What is the median umbilical ligament?

A

Remnant of urachus

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41
Q

What are the medial umbilical ligaments?

A

Remnants of umbilical arteries

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42
Q

What do the lateral umbilical folds contain?

A

Inferior epigastric vessels

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43
Q

What nerves supply the anterior abdominal wall?

A

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

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44
Q

What is the arterial supply of the anterior abdominal wall?

A

Musculophrenic artery (from internal thoracic)
Femoral artery branches:
- Superficial epigastric
- Superficial circumflex iliac

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45
Q

What is the superficial lymphatic drainage of the anterior abdominal wall?

A

Superficial inguinal
Anterior axillary
Posterior axillary

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46
Q

What is the deep lymphatic drainage of the anterior abdominal wall?

A 
Parasternal nodes (internal thoracic artery)
Lumbar nodes (abdominal aorta)
External iliac nodes
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47
Q

Where does the inguinal canal lie?

A

Superiorly to the medial half of the inguinal ligament

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48
Q

How long is the inguinal canal?

A

~4cm

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49
Q

What does the inguinal canal carry generally in males?

A

Structures to/from testis and abdomen

Ilioinguinal nerve

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50
Q

What does the inguinal canal carry generally in females?

A

Round ligament of uterus to labia majora

Ilioinguinal nerve

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51
Q

What is the superficial inguinal ring?

A

Triangular-shaped defect in external oblique aponeurosis

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52
Q

What forms the base of the superficial inguinal ring?

A

Pubic crest

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53
Q

What are the margins of the superficial inguinal ring attached to?

A

Lateral crus to pubic tubercle

Medial crus to pubic crest

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54
Q

What does the superficial inguinal ring give rise to?

A

External spermatic fascia

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55
Q

What forms the intercrural fibres of the superficial inguinal ring?

A

Superficial layer of deep fascia over external oblique

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56
Q

Where do the intercrural fibres lie in the superficial inguinal ring?

A

Superolaterally

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57
Q

What is the function of the intercrural fibres?

A

Support the superficial inguinal ring

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58
Q

What ligament can become fibrous and blend with the superficial inguinal ring?

A

Round ligament

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59
Q

What is the deep inguinal ring?

A

Oval opening in the transversalis fascia

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60
Q

Where is the deep inguinal ring located?

A

Halfway between ASIS and pubic symphysis (~1.3cm above inguinal ligament)

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61
Q

Where do the inferior epigastric vessels lie in relation to the deep inguinal ring?

A

Medially

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62
Q

What fascia does the deep inguinal ring give rise to?

A

Internal spermatic/round ligament

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63
Q

What forms the anterior wall of the inguinal canal?

A

External oblique aponeurosis
Internal oblique muscle fibres:
- In lateral third (weak area of deep ring in post. wall)

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64
Q

What forms the posterior wall of the inguinal canal?

A

Transversalis fascia
Conjoint tendon:
- In medial third (weak area of superfic. ring in ant. wall)

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65
Q

What is the conjoint tendon?

A

Common insertion of internal oblique and transversus abdominis

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66
Q

Where does the conjoint tendon insert?

A

Pubic crest

Pectineal line

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67
Q

What forms the roof of the inguinal canal?

A

Transversalis fascia laterally

Internal oblique and transversus abdominis muscle fibres centrally

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68
Q

What forms the floor of the inguinal canal?

A 
Inguinal ligament
Lacunar ligament (medial)
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69
Q

Where does the lacunar ligament originate and what direction does it move in?

A

Medial end of inguinal ligament

Superoposteriorly

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70
Q

Where does the lacunar ligament insert?

A

Pectineal line (superior pubic ramus) at pectineal ligament

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71
Q

What does the free edge of the lacunar ligament form?

A

Medial margin of femoral ring

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72
Q

How are the weak areas of the inguinal canal reinforced?

A

Oblique course
Compressed by internal oblique and transversus abdominis
Squatting (defaecation/childbirth) - Thighs protect wall

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73
Q

What is an indirect inguinal hernia?

A

Protrusion of tissue via deep inguinal ring

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74
Q

What is a direct inguinal hernia?

A

Protrusion of tissue by pushing through posterior wall into inguinal canal

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75
Q

Where does the spermatic cord begin and end?

A

Begin - Deep inguinal ring

End - Testis

76
Q

What are the contents of the spermatic cord?

A

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
Q

What structures in the spermatic cord lie outside the internal spermatic fascia?

A

Cremasteric artery

Genital branch of genitofemoral nerve

78
Q

What does the genital branch of the genitofemoral nerve supply?

A

Cremaster muscle

79
Q

What are the coverings of the spermatic cord?

A
  • 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
Q

What is the function of the cremaster muscle?

A

Raises testes and scrotum for warmth and protection

81
Q

What is the tunica vaginalis?

A

Closed off sac - a remnant if processus vaginalis

82
Q

What cells form the gubernaculum?

A

Mesenchyme

83
Q

Where does the gubernaculum descend through and to?

A

Through inguinal canal

To labiosacral swelling

84
Q

At what point in development do the testes move through the inguinal canal?

A

7th-8th months

85
Q

Why do the testes have the same coverings as the inguinal canal?

A

Follow gubernaculum

86
Q

Why do the ovaries stay in the pelvis instead of descending?

A

Gubernaculum is stuck to uterus

87
Q

What do the seminiferous tubules open into?

A

Rete testis

88
Q

What temperature are the testes in relation to the abdomen?

A

3 degree celcius cooler

89
Q

Where does lymph from the testes and epididymis drain to?

A

Para-aortic nodes at root of testicular artery (L2)

90
Q

Where does lymph from the scrotal wall and fascia drain to?

A

Superficial inguinal nodes

91
Q

What modalities is the parietal peritoneum sensitive to?

A

Pain
Touch
Temperature
Pressure

92
Q

What is the anterolateral parietal peritoneum innervated by?

A

Lower 6 thoracic nerves (T7-T12)

93
Q

What is the central part of the parietal peritoneum innervated by?

A

Phrenic nerve

94
Q

What is the pelvic part of the parietal peritoneum innervated by?

A

Obturator nerve

95
Q

What is the visceral peritoneum sensitive to?

A

Stretch (via ANS afferents)

96
Q

What are the retroperitoneal organs?

A 
Primary:
- Kidneys
- Suprarenal glands
Secondary:
- 2nd, 3rd and 4th parts duodenum
- Ascending and descending colon
- Pancreas
- Upper 2/3rds rectum
97
Q

What is a secondary retroperitoneal organ?

A

Were once mobile but now stuck to body wall

98
Q

Where is the greater omentum suspended from?

A

Greater curvature of stomach and proximal duodenum

99
Q

What does the greater omentum fold back to cover?

A

Anterior transverse colon

100
Q

How is the greater omentum four-layered?

A

Each part is a double layer which folds back onto each other

101
Q

What divides the greater sac?

A

Transverse colon

102
Q

What is contained in the supracolic compartment of the greater sac?

A

Liver
Gallbladder
Stomach

103
Q

What is contained in the infracolic compartment of the lesser sac?

A

Intestines

104
Q

The blood vessels carried by the greater omentum supply what structures?

A

Itself:
- Via left and right gasto-omental (epiploic) vessels
Greater curvature of stomach

105
Q

What is the other name for the lesser sac?

A

Omental bursa

106
Q

Where is the lesser sac?

A

Portion of peritoneal cavity behind lesser omentum and stomach

107
Q

Where does the lesser omentum originate?

A

Liver

108
Q

Where does the lesser omentum attach and via what?

A 
Lesser curvature of stomach (hepatogastric lig.)
Proximal duodenum (hepatoduodenal lig.)
109
Q

What collection of structures is contained in the hepatoduodenal ligament?

A

Portal triad:

  • Hepatic artery (left ant.)
  • Bile duct (right ant.)
  • Portal vein (post.)
110
Q

How do the greater and lesser sacs communicate?

A

Epiploic (omental) foramen

111
Q

What is the function of the mesentery proper?

A

Carries vessels, nerves and lymphatics to/from most of small intestine (jejunum and ileum)

112
Q

What vessels run in the mesentery proper?

A

Jejunal and ileal branches of superior mesenteric artery and vein

113
Q

Other than the mesentery proper, what other ‘mesenteries’ exist?

A

Transverse mesocolon
Sigmoid mesocolon
Vermiform appendix mesocolon

114
Q

What is the function of peritoneal fluid?

A

Lubrication

115
Q

In what direction does peritoneal fluid flow and via what?

A

Superiorly

Via left and right paracolic gutters

116
Q

Where does peritoneal fluid flow towards?

A

Subphrenic spaces

117
Q

What are the paracolic gutters?

A

Grooves between:

  • Ascending/Descending colon
  • Posterolateral abdominal wall
118
Q

What are the parts of the posterior abdominal wall fascia named after?

A

Muscles

119
Q

What is the posterior abdominal wall fascia continuous with?

A

Pelvic fascia

120
Q

Where does the femoral sheath lie?

A

Deep to inguinal ligament

121
Q

What are the contents of the femoral sheath (from lateral to medial)?

A

Femoral artery
Femoral vein
Lymph vessels (in femoral canal)

122
Q

What forms the anterior wall of the femoral sheath?

A

Transversalis fascia

123
Q

What forms the posterior wall of the femoral sheath?

A

Iliopsoas fascia

124
Q

What is the function of the femoral sheath?

A

Allows proximal femoral vessels to glide under inguinal canal during hip motion

125
Q

From roughly superior to inferior, what are the nerves on the posterior abdominal wall?

A 
Subcostal
Iliohypogastric
Ilioinguinal
Genitofemoral
Lateral femoral cutaneous
Femoral
Obturator
Lumbosacral trunk
126
Q

What vertebral levels does the right crus of the diaphragm extend from?

A

L1-L3

127
Q

What vertebral levels does the left crus of the diaphragm extend from?

A

L1-L2

128
Q

What is the origin of the quadratus lumborum muscle?

A

Iliac crest

129
Q

What are the insertions of the quadratus lumborum muscles?

A

12th rib

L1-L4 transverse processes

130
Q

What are the functions of the quadratus lumborum muscles?

A 
One bends trunk to same side
Both:
- Pressure
- Forced expiration
- Support for 12th rib
131
Q

What innervates the quadratus lumborum?

A

Anterior rami T12-L4

132
Q

What fascia layers blend at the lateral border of the quadratus lumborum?

A

Middle layer of lumbar fascia with anterior layer

133
Q

What does the anterior layer of the lumbar fascia form superiorly?

A

Lateral arcuate ligament

134
Q

What is the origin of the iliacus?

A

Iliac fossa

135
Q

What is the insertion of the iliacus?

A

Lessuer trochanter of femur

136
Q

What is the function of the iliacus?

A

Flexion of hip

137
Q

What is the innervation of the iliacus?

A

Femoral nerve (L2-L4)

138
Q

What are the origins of the psoas?

A

T12-L4 vertebral bodies and IV discs (superficial)

L1-L5 (deep)

139
Q

What is the insertion of the psoas?

A

Lesser trochanter of femur

140
Q

What are the functions of the psoas?

A

Hip flexion
One = Bends trunk laterally
Both = Raise trunk from supine

141
Q

What is the innervation of the psoas?

A

Direct lumbar plexus branches L2-L4

142
Q

What is the long tendon anterior to psoas major called?

A

Psoas minor

143
Q

What is the name of the lumbar fascia arch that passes over psoas major?

A

Medial arcuate ligament

144
Q

At what level does the abdominal aorta bifurcate?

A

L4

145
Q

Excluding lumbar arteries, what are the paired lateral branches off of the abdominal aorta?

A 
Inferior phrenic arteries (T12)
Suprarenal arteries (L1):
- Superior
- Middle
Renal arteries (L1)
Gonadal arteries (L2)
146
Q

At what vertebral level is the IVC formed?

A

L5

147
Q

Where do lumbar veins 1 and 2 drain to?

A

Ascending lumbar -> Azygos/Hemiazygos

148
Q

Where do lumbar veins 3 and 4 drain to?

A

IVC

149
Q

Where does the 5th lumbar vein drain to?

A

Iliolumbar vein -> Common iliac

150
Q

Where does the right gonadal vein drain?

A

IVC

151
Q

Where does the left gonadal vein drain to?

A

Left renal vein

152
Q

What contributes SNS fibres to the coeliac plexus?

A 
Coelic ganglia (greater splanchnic nerves)
Aorticorenal ganglia (lesser splanchnic nerves)
153
Q

What contributes PNS fibres to the coeliac plexus?

A

Fibres from posterior (and anterior) vagal trunks

154
Q

Where is the coeliac plexus situated?

A

Around the coeliac trunk (prevertebral)

155
Q

What does the coeliac plexus supply?

A

Foregut organs

156
Q

What is the alternate name for the coeliac plexus?

A

Solar plexus

157
Q

What contributes SNS fibres to the superior mesenteric plexus?

A

Superior mesenteric ganglion (gretaer and lesser splanchnic nerves)

158
Q

What contributes PNS fibres to the superior mesenteric plexus?

A

Fibres from posterior (and anterior) vagal trunks

159
Q

Where is the superior mesenteric plexus situated?

A

Around the superior mesenteric artery (prevertebral)

160
Q

What does the inferior mesenteric plexus supply?

A

Hindgut up to the descending colon

161
Q

What contributes SNS fibres to the inferior mesenteric plexus?

A

Inferior mesenteric ganglion (lumbar splanchnic nerves L1-L2)

162
Q

What contributes PNS fibres to the inferior mesenteric plexus?

A

Pelvic splanchnic nerves S2-S4

163
Q

What does the superior hypogastric plexus supply?

A

Ureteric and testicular plexuses

164
Q

What contributes SNS fibres to the superior hypogastric plexus?

A

Lumbar splanchnic nerves L3-L4

165
Q

What contributes PNS fibres to the superior hypogastric plexus?

A

Pelvic splanchnic nerves S2-S4

166
Q

What does the inferior hypogastric plexus supply?

A

Sigmoid colon
Rectum
Bladder
(Via smaller plexuses)

167
Q

What contributes SNS fibres to the inferior hypogastric plexus?

A 
Hypogastric nerves (from sup. hypogastric plexus) - Pre- and postganglionic T10-T12
Sacral splanchnic nerves
168
Q

What contributes PNS fibres to the inferior hypogastric plexus?

A

Pelvic splanchnic nerves

169
Q

What does lymph join the intestinal trunk as? What vertebral level is this?

A

Cisterna chyli

At L1/2

170
Q

What forms the lumbar plexus?

A

Anterior rami L1-L4

171
Q

Where do the branches of the lumbar plexus form?

A

Within psoas muscle

172
Q

What is the root value for the iliohypogastric and ilioinguinal nerves

A

Anterior rami L1

173
Q

What is the sensory distribution of the iliohypogastric nerve?

A

Lateral gluteal skin

Pubic skin

174
Q

What is the sensory distribution of the ilioinguinal nerve?

A

Medial thigh skin

Root of penis/scotrum OR mons pubis/labia majora

175
Q

What is the motor distribution of the iliohypogastric and ilioinguinal nerves?

A

Internal obliques

Transversus abdominis

176
Q

What is the root value for the genitofemoral nerve?

A

L1-L2

177
Q

What is the sensory distribution of the genitofemoral nerve?

A

Scotrum/Mons pubis

Skin of upper anterior thigh

178
Q

What is the motor distribution of the genitofemoral nerve?

A

Cremaster muscle

179
Q

What are the root values for the lateral cutaneous nerve of thigh?

A

Anterior rami L2-L3

180
Q

What is the sensory distribution of the lateral cutaneous nerve of thigh?

A

Anterior and lateral thigh

181
Q

What are the root values of the femoral nerve?

A

L2-L4

182
Q

What is the sensory distribution of the femoral nerve?

A

Skin of:

  • Anterior thigh
  • Medial leg
183
Q

What is the motor distribution of the femoral nerve?

A

Pectineus
Iliacus
Anterior compartment of thigh

184
Q

What are the root values of the obturator nerve?

A

L2-L4

185
Q

What is the sensory distribution of the obturator nerve?

A

Skin of medial thigh

186
Q

What is the motor distribution of the obturator nerve?

A

Obturator externus
Medial compartment of thigh
(May supply pectineus)

regional gross anatomy (14 decks)

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