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UCL anatomy year 1 - Rosh > The abdominal wall > Flashcards

The abdominal wall Flashcards

1
Q

Where is the inguinal canal?

A

Between ASIS and pubic tubercle

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2
Q

What 2 horizontal lines form the 9 regions of the abdomen? What are the 9 regions?

A

Transpyloric (L1)
Transtubercular (L5)

Right hypochondriac
Epigastric
Left hypochondriac
Right lumbar
Umbilical
Left lumbar
Right iliac
Hypogastric/pubic
Left iliac
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3
Q

What are the five (bilaterally paired) muscles in the anterolateral abdominal wall?

A

Three “flat”/lateral muscles:

  • Internal oblique
  • External oblique
  • Transversus abdominus

Two vertical muscles:

  • Rectus abdominus
  • Pyramidalis
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4
Q

What is linea alba?

A

Midline of abdominal muscles aponeurosis from xiphoid process to the pubic symphysis

Formed by aponeurosis of external oblique, internal oblique, transversus abdominis

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5
Q

What is linea semilunaris?

A

The curved tendinous structure that runs on the lateral edges of rectus abdominis. The tendinous intersections of rectus abdominis unite there.

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6
Q

External obliques

A

Origin: External surfaces of 5th–12th ribs

Insertion: Linea alba, pubic tubercle, and anterior half of iliac crest

Function: Rotate the trunk, flex spine

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7
Q

Internal obliques

A

Origin: Thoracolumbar fascia, anterior two-thirds of the iliac crest, and lateral half of inguinal ligament

Insertion: Inferior borders of 10th–12th ribs, linea alba, and pecten pubis via conjoint tendon

Function: Compress and support abdominal viscera, flex and rotate the trunk

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8
Q

Transversus abdominis

A

Origin: Internal surfaces of 7th–12th costal cartilages, thoracolumbar fascia, iliac crest, and lateral third of inguinal ligament

Insertion: Linea alba with aponeurosis of internal oblique, pubic crest, and pecten pubis via conjoint tendon

Function: Compresses and supports abdominal viscera

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9
Q

Rectus abdominus

A

Origin: Pubic symphysis and pubic crest

Insertion: Xiphoid process and 5th–7th costal cartilages

Function: Flexes trunk (lumbar vertebrae) and compresses abdominal viscera, stabilizes and controls tilt of pelvis (antilordosis)

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10
Q

Pyramidalis muscle

A

Connects from line alba to the anterior surface of the pubis and the anterior pubic ligament

Function: tenses linea alba

When present, surgeons use the attachment of the pyramidalis to the linea alba as a landmark for an accurate median abdominal incision

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11
Q

What are the anterolateral abdominal wall layers?

A 
Skin
Camper’s fascia (superficial subcutaneous fat)
Scarpa’s fascia (deep membranous layer)
Superficial investing fascia
External oblique
Intermediate investing fascia
Internal oblique
Deep investing fascia
Transversus abdominis
 Endoabdominal (transversalis) fascia
Extraperitoneal
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12
Q

What is the Rectus sheath?

A

Formed from the aponeurosis of the internal and external obliques and the transverses abdominus.

Contents: rectus abdominis and pyramidalis muscles, superior and inferior epigastric arteries and veins, lymphatic vessels, termination parts of lower five intercostal nerves (T7- T11), and the termination of the 12th thoracic nerve (T12)

Arcuate line (between umbilicus and pubic symphysis) = where the structure of the rectus sheath changes

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13
Q

What are the contents of the rectus sheath?

A

rectus abdominis and pyramidalis muscles, superior and inferior epigastric arteries and veins, lymphatic vessels, termination parts of lower five intercostal nerves (T7- T11), and the termination of the 12th thoracic nerve (T12)

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14
Q

Why is the arcuate line important?

A

ABOVE arcuate line, rectus sheath splits deep and superficial to the rectus abdominis  has anterior and posterior wall

BELOW the arcuate line, rectus sheath goes superficial to the rectus abdominis  only has anterior wall, no posterior

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15
Q

What is the innervation of the anterior abdominal wall?

A

T6-L1
Thoracoabdominal nerve - anterior cutaneous branch and lateral cutaneous branch (ventral rami T6-T12)

L1: ilioinguinal and iliohypogastric

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16
Q

What are umbilical folds?

A

folds of parietal peritoneum

We have 5:

  • A single midline median umbilical fold
  • Bilateral medial umbilical folds
  • Bilateral lateral umbilical folds
17
Q

What is the arterial supply of the anterior abdominal wall?

A

There is a dual blood supply to the anterior abdominal wall:

  • Superior epigastric artery anastomoses with inferior epigastric artery (from external iliac artery)
  • Key: superior epigastric artery is continuation of the anterior thoracic artery

The flat/lateral muscles:

  • Dual supply
  • Musculophrenic from anterior thoracic artery anastomoses with circumflex artery from external iliac artery
18
Q

What is the venous drainage of the anterior abdominal wall?

A

Superficial veins:

  • Thoracoepigastric vein drains into axillary vein
  • Superficial inferior epigastric vein drains into femoral vein

Deep Veins:

  • Superior epigastric vein drains into subclavian vein
  • Inferior epigastric vein drains into femoral vein
19
Q

What is Caput medusae?

A

Portal hypertension (following damage to the liver) can result in dilated abdominal veins surrounding the umbilicus:

  • Blood backs up as it cannot pass through the liver so it tries to find an alternative route.
  • The blood backs up into the external iliac vein and femoral vein and ascends up to the thoracoepigastric veins to axillary veins.
  • Causes dilation of veins
20
Q

What is the lymphatic drainage?

A

Superior to umbilicus drains: to axillary lymph nodes

Inferior to umbilicus drains: to superficial inguinal and superficial subinguinal lymph nodes

21
Q

What is the inguinal canal?

A

The inguinal canal is an oblique opening in the anterior abdominal wall through which the spermatic cord can pass in males.
The testes like to be cool, so are kept outside the abdominal cavity

Spermatic cord: contains blood supply, nerves, muscles, and ductus deferens. Life support for the testes

Inferior epigastric artery and vein pass medial to the deep inguinal ring

Contents of the inguinal canal in females: round ligament, genital branch of the genitofemoral nerve, and the ilioinguinal nerve

22
Q

What are the components of the inguinal canal?

A

Anterior wall – aponeurosis of the external oblique, reinforced by the internal oblique muscle laterally.

Posterior wall – transversalis fascia.

Roof – transversalis fascia, internal oblique, and transversus abdominis

Floor – inguinal ligament (a ‘rolled up’ portion of the external oblique aponeurosis), thickened medially by the lacunar ligament

23
Q

What are the borders of the Hesselbach’s triangle?

A

Medial – lateral border of the rectus abdominis muscle.
Lateral – inferior epigastric vessels.
Inferior – inguinal ligament.

24
Q

What are direct and indirect hernias?

A

Indirect inguinal hernia (more common in children, incomplete closure of canal):

  • Through inguinal canal
  • Lateral to the inferior epigastric vessels

Direct inguinal hernia:

  • Through body wall
  • Medial to inferior epigastric vessels
25
Q

What are the Surgical Approaches to the Abdomen?

A
  1. Median/Midline incision: cuts through lines alba, easily avoids muscle, nerves, and blood vessels. Lower median incisions (below umbicus) sometimes used for reaching female pelvic viscera.
  2. Paramedian incisions: cuts through rectus sheath. May be favoured over median incision because the linea alba has poor blood supply and can have issues with healing
  3. Muscle-splitting incision: used for appendectomy, goes through external and internal obliques and transverses abdomens
  4. McBurney incision: at McBurney’s point- one third of the way from ASIS to umbilicus. Location of the base of the appendix, old-fashioned incision site for appendectomy
  5. Suprapubic (Pfannenstiel or Kerr) incision: made at pubic hairline, used for gynaecological and obstetrical procedures, such as cesarean section or removal of tubal pregnancy
  6. Subcostal incision: for gallbladder and biliary duct surgery
26
Q

Blood supply and innervation to the abdominal wall muscles

A

The anterior and lateral muscles innervation:

  • Thoracoabdominal nerve (T6-T12)
  • Ilioinguinal and iliohypogastric

Blood supply of anterior abdominal muscles:
Superior epigastric and inferior epigastric –> anastomose

Blood supply of lateral abdominal muscles:
Musculophrenic branch of internal thoracic artery and circumflex branch of external iliac –> anastomosis

Venous drainage:
Superficial:
-Thoracoepigastric vein drains to subclavian vein
-Superficial inferior epigastric vein drains to femoral vein

Deep Veins:

  • Superior epigastric vein drains into subclavian vein
  • Inferior epigastric vein drains into femoral vein

UCL anatomy year 1 - Rosh (9 decks)

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