Serrat - Abdominal Wall Flashcards
Borders of the anterior abdominal wall:
Superior
Inferior
Superior border - xiphoid process, costal cartilages ribs 7-10
Inferior border - iliac crest, inguinal ligament, pubic bone
Linear tendinous raphe extending along midline from xiphoid process to pubic symphysis. Formed by fusion of the insertions of the anterolateral abdominal. Wall muscles.
Marks medial border of two rectus abdominis muscles
Linea alba
CT along lat borders of rectus abdominis extending from 9th costal cartilage to pubic tubercule; formed by fusion of aponeuroses of anterolateral abd wall muscles
Linea semilunares
Fibrous CT bands w/in rectus abdominis muscles. Produce washboard stomach appearance. There are usually three above the umbilicus and rarely one below
Linea transversae
Structures deep to right upper quadrant
Stomach, pylorus
Dudenum
Ascending colon (superior part)
right colic (hepatic) flexure
Transverse colon, right half
Liver (right lobe)
Gallbladder
Pancreas (head)
Kidney (right) Adrenal gland (right)
Left Upper Quadrant (structures deep )
Stomach
Jejunum
Ileum, proximal
Transverse colon, left half
Left colic (splenic) flexure
Descending colon, superior part
Liver, left lobe
Spleen
Pancreas, body and tail
Kidney, left
Adrenal (suprarenal) gland, left
What is McBurney’s Point?
Location of tenderness on surface from projection in acute appendicitis. Located 1/3 of the way between the right anterior superior iliac spine and umbilicus
Surface projection of pain in acute diverticulitis
Left lower
Surface projection of pain in acute pancreatitis
Epigastric
Surface projection of pain in acute cholecystitis
Right hypochondrial
Five F’s of abdominal protrusion
Fluid
Food/fat
Feces
Fetus
Flatus
Abdominal quadrants are defined by ?
Transumbilical and midline planes
The fatty layer of the superficial fascia of the anterior abdominal wall that contains superficial epigastric vessels (which are enlarged in caput medusae)
Continues as superficial fascia of thigh
Fat extends into labia majora in females
In males, this is represented by dartos muscle
Camper’s fascia
The membranous layer of the superficial fascia of the anterior abdominal wall, fused w/ deep fascia of thigh (fascia lata)
Continues in perineum and scrotum as Colle’s fascia (females and males)
Forms superficial fascia and fundiform ligament of the penis in males
Scarpa’s fascia
The thoracoabdominal nerves come from T 7 thru T 11 and are a continuation of ?
The intercostals
Subcostal nerve comes from what spinal cord level ?
T12
The iliohypogastric nerve comes from what spinal cord level?
L1
The ilioinguinal nerve comes from what spinal cord level?
L1
The arterial supply of the anterior abdominal wall is derived from which four major vessels?
Internal thoracic (off of subclavian)
Aorta
External iliac
Femoral artery
The anastomoses between the superior epigastric artery and the inferior epigastric artery forms in the rectus sheath and makes a major connection between which two major arteries?
Subclavian artery (internal thoracic (superior epigastric artery ))
External iliac artery (inferior epigastric artery)
The common insertion of transversus abdominis and internal oblique muscle on the pubis
Conjoint tendon
The deep investing fascia covers the underlying abdominal muscles and continues as?
Suspensory ligament and deep fascia of the penis
Scarpa’s fascia is fused with ?
Deep fascia of thigh (fascia lata)
The superficial epigastric vessels, which are enlarged in caput medusae, are contained in which layer?
Camper’s Fascia
Camper’s Fascia continues as _____ in thigh?
Superficial fascia
The campers fascia fat extends into _________ in females?
Labia majora
The campers fascia is represented by ______ in the male scrotum
Dartos muscle
Contents of the rectus sheath?
Rectus abdominis and pyrimidalis muscles
Sup. And inf. Epigastric vessels
Terminal ends of T7 - T12 nerves
Incomplete CT envelope that surrounds each rectus abdominis muscle, formed by aponeuroses of the anterolateral muscles
Rectus sheath
Marks the change in fascia contributing to the anterior and posterior layers of the rectus sheath; occurs below the umbilicus at a point midway between the umbilicus and the pubis
Arcuate line
Inferior to the arcuate line, the rectus is in direct contact with _______
Transversalis fascia
All three aponeurosis form the anterior rectus sheath, inferior to the arcuate line
Above the arcuate line, the rectus is _____
Completely enveloped in an aponeurosis sheath
Occurs along linea semilunares at or below arcuate line
Spigelian hernia
The thoracoabdominal nerves come from spinal cord levels?
T7 - T11
The inferior and superior epigastric arteries form major anastomoses of the subclavian artery and external iliac artery and anastamose within ________
Rectus sheath
Venous drainage of the abdomen is primarily into ______ and _______ veins through superficial veins found in camper’s fascia
Axillary and femoral v=
Condition in which veins of the anterior abdominal wall become hard and dilated. Involves the superficial epigastric veins of the caval system and the paraumbilical veins of the portal system
Can be caused by cirrhosis of the liver, chronic hepatitis or portal hypertension
Caput medusae
The _________ is in the midline and connects the anterior abdominal wall and the bladder and contains the obliterated urachus / allontoic duct
Median umbilical fold
_____ occur on each side of the midline and cover the obliterated umbilical arteries, running from internal iliac artery to umbilicus.
(Umbilical arteries are embryonic rudiments that arose from the internal iliac artery in the pelvis)
Medial umbilical folds
Not embryonic rudiments. Cover the inferior epigastric vessels and will bleed if cut
Lateral umbilical folds
Herniation of intestinal loops through the umbilical ring; occurs from increased intra-abdominal pressure in area of weakness of the umbilical scar. Common in newborns
Umbilical hernia
A small hernia that often occurs in infants and children; hernia occurs thru defect in linea alba and protrudes during crying, straining or coughing. Usually resolves by 3-5 years w/o treatment
Acquired infantile umbilical hernia
Common in females, obesity, pregnancy, or ascites, along with weakened abdominal wall. Call a paraumbilical hernia when the sac does not protrude thru the umbilical scar but instead thru the linea alba in the region of the umbilicus.
Acquired adult umbilical hernias
_________ occurs thru linea alba above umbilicus in the epigastric region
Epigastric hernia
Occurs along linea semilunares - usually in obese people > 40 years of age. Usually at or below arcuate line where rectus abdominus is in direct contact w/ transversalis fascia
Spigelian hernia
A hernia that passes lateral to the inferior epigastric artery
Indirect hernia
Will go thru inguinal canal and often pass into the testicles
A hernia that passes medial to the inguinal canal
Direct hernia
Hesselbach’s triangle is the region in which direct inguinal hernias enter. What are the boundaries of hesselbach’s triangle?
Medial - rectus abdominus muscle
Lateral - inguinal ligament
Superior - inferior epigastric artery
