The abdomen Flashcards
important thing about quadrants
-know where to auscultate, percuss, and palpate the patients and to record the locations of findings during a physical exam
what is the division between the upper and lower quadrants?
umbilical
RUQ
Right upper Quadrant
- liver; right lobe
- gallbladder
- stomach; pylorus
- duodenum: parts 1-3
- pancreas: head
- right suprarenal gland
- right kidney
- right colic (hepatic)
- ascending colon; superior part
- transverse colon; right half
LUQ
Left upper quadrant
- Liver; left lobe
- spleen
- stomach
- jejunum and proximal ileum
- pancreas; body and tall
- left kidney
- left suprarenal gland
- left colic (splenic) flexure
- transverse colon: left half
- descending colon: superior part
RLQ
right lower quadrant
- cecum
- appendix
- most of ileum
- ascending colon: inferior part
- right ovary
- right uterine tube
- right ureter: abdominal part
- right spermatic cord: abdominal part
- uterus (if enlarged)
- urinary bladder (if very full)
LLQ
left lower quadrant
- 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)
what are other regions of clinical significance?
- epigastric region
- hypogastric region
- umbilical region
- right and left iliac regions
epigastric region
the upper central region of the abdomen. It is located between the costal margins and the subcostal plane
hypogastric region
region of the abdomen located below the umbilical region. The pubis bone constitutes its lower limit
umbilical region
area centralized on the umbilicus (naval)
Right and Left iliac and regions
region of the abdomen, on either side of the hypogastric regions, and below the lumbar regions
wings on the pelvis
iliac crest
abdominal skin
loosely attached except at the umbilicus where the scar tissue makes a strong attachment. Skin collagen runs in the natural lines of cleavage that mimic the dermatomes pattern
lines of cleavage
skin collagen runs in these natural lines that mimic the dermatomes pattern. In surgery, they cut in horizontal lines BC it scars less
cutaneous nerve supply
- anteriorly from the anterior rami of the spinal nerves of the lower 6 thoracic vertebrae and 1st lumbar vertebrae
- the thoracic nerves are the lowest 5 intercostals and the subcostal nerve
- the 1st lumber is the iliohypogastric and the ilioinguinal nerve
T-12 nerve
subcostal nerve
L-1
branches into iliohypogastric nerve and ilioinguinal nerve
What dermatome is the epigastric area?
T7, near the xiphoid process
What dermatome is near umbilicus?
T10
What dermatome is near the inguinal canal?
L1
Fatty layer (Campers fascia)
the fat that no one likes. superficial to the membranous layer (Scarpa’s fascia)
Skin blood supply at midline
-superior and inferior epigastric artery
What does the superior epigastric artery arise from?
internal throacic artery
what doe the inferior epigastric artery arise from?
external iliac artery
superior and inferior epigastric artery
they anastomose near the epigastric area
inguinal region blood supply for skin
superficial epigastric
- superficial circumflex iliac
- superficial external peddle arteries
Lateral abdominal cutaneous branches of nerves
come off of the costal nerves and loop around
anterior abdominal cutaneous branch
comes off the front of the costal nerves and loops back
venous drainage of the skin: superiorly
lateral thoracic into the axillary vein (armpit)
venous drainage of the skin: inferiorly
superficial epigastric and the great saphenous vein into the femoral vein
Lymph drainage of the skin of abdomen
- above the level of the umbilicus is upward to the anterior axillary (pectoral) group of nodes.
- Below the level of the umbilicus, the lymph drains downward and laterally to the superficial inguinal nodes
Fascia
a thin sheath of fibrous tissue enclosing a muscle or organ
superficial fascia
- a loose fatty layer (Campers)
- continuous with fat found all over the body. Found just below the skin
-A tough membranous layer (Scarpa’s) that lies beneath the fatty layer and just precedes the muscular layer of the abdomen.
Deep fascia
a thin layer of fascia that envelopes the muscles of the abdominal wall
Muscles of the abdomen
External oblique
internal oblique
transversus
rectus abdominus
external oblique
mose external muscle found laterally
runs anterior-inferiorly (forward and down)
internal oblique
lies below the external oblique
muscle fibers run anterior-superiorly (forward and up)
Fibers run at 90 degrees from the external oblique
transversus
lies below the internal oblique
deepest abdominal wall muscle
rectus abdominus
- long strap muscle that extends along the whole length of the anterior abdominal wall.
- broader above and lies close to the midline, being separated from its fellow by the linea alba
rectus sheath
“tendon” for broad thin muscles
rectus sheath
- long fibrous sheath that encloses the rectus abdominis muscles and contains the anterior rami of the lower six thoracic nerves
- formed by the aponeuroses of the three later abdominal muscles
- multilayered, tough
Aponeurosis
a sheet of pearly white fibrous tissues that takes the place of a tendon in sheet-like muscles having a wide area of attachment
thickness of abdominal muscles
- muscles have different thicknesses depending on where you look at them
- the 3 abdominal muscles tun laterally and taper near the midline where it becomes the aponeurosis, or the rectus sheath
What nerves have cutaneous branches?
intercostals
Fascia transversalis
thin layer of fascia that lines the transverses abdominis muscles and is continuous with a similar layer lining the diaphragm and the iliac muscle
inguinal canal
- allows structures to pass to and from the testis to the abdomen in males
- in females, it allows the round ligament of the uterus to pass from the uterus to the labium majus
anterior wall of inguinal canal
external oblique aponeurosis
posterior wall of inguinal canal
conjoint tendon medially, fascia transversalis laterally
roof or superior wall of inguinal canal
arching lowest fibers of the internal oblique and transverses abdominus muscles
floor or inferior wall of inguinal canal
upturned lower edge of the inguinal ligament and, at its medial end, the lacunar ligament
spermatic cord
structures that pass through the inguinal canal to and from the testis
-begins at the deep inguinal ring lateral to the inferior epigastric artery and ends at the testis
superficial inguinal ring
internal oblique and transverse oblique aponeuroses wraps around inside of this and sticks it like tape to the top
inguinal ligament
very strong attachment from the iliac spine to the pubic tubercle
