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37 Cards in this Set
- Front
- Back
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What forms the posterior abdominal wall? |
Ribs 9-12 posterior to the diaphragm 5 Lumbar Vertebrae (curved anteriorly and tend to push into the abdomen) Iliac Bones |
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What lines divide the abdomen and what areas are formed? |
Mid-clavicular lines Sub-costal margin and Inter-tubercular line Left and right Hypochondrium Epigastrium Left and right Lumbar / Loin / Flank Umbilical Right and Left Iliac fossa Suprapubic |
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Where is the transpyloric plane and what structures go through it? |
It is a transverse plane in the middle of the suprasternal notch and the pubic symphysis Posterior to Anterior L1 Vertebral body End of the spinal cord Origin of the portal vein an SMA Renal hila Neck of the pancreas 2nd part of the duodenum Duodenojejunal flexure Tips of the 9th Costal cartillage Fundus of the gall bladder |
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External Oblique Muscle |
Origin: Lower 8 ribs Path: Downwards and forwards Insertion:Most posterior fibers descend to the anterior half of the iliac crest giving a posterior free border. At ASIS it becomes aponeurotic and is rolled up as the inguinal ligament to the pubic tubercle Innervation: T7 - T12 |
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Internal Oblique Muscle |
Origin: Lumbar Fascia, Anterior 2/3 of the iliac crest, lateral 2/3 of the inguinal ligament Path: Upwards and forwards at right angles to external oblique. Run medial to the costal margin and linea alba dividing to enclose the rectus abdominis, creating the rectus sheath above the arcuate line. Fibres from the inguinal ligament arch over the inguinal canal and join the lower fibres of tranversus abdominis to form the conjoint tendon Insertion: Conjoint tendon inserts behind the inguinal canal onto the pubic crest, extending laterally to the pectineal line Innervation: T7 - T12 (iliolingual nerve (L1) for conjoint tendon |
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Transversus Abdominis |
Origin: Lower 6 costal cartilages, lumbar fascia, anterior 2/3 of the iliac crest, lateral 1/2 of the inguinal ligament Path: Fibres become aponeurotic and pass behind Rectus Abdominis to fuse with the internal oblique aponeurosis at the linea alba. Lower fibres form a conjoint tendon with the Internal Oblique Insertion: Conjoint tendon inserts behind the inguinal canal onto the pubic crest, extending laterally to the pectineal line Innervation: T7 - T12(iliolingual nerve (L1) for conjoint tendon |
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Rectus Abdominis |
Origin: 2 heads from the pubic symphysis and pubic crest Path: Superior Insertion: Anterior aspect of the 5th to 7th costal cartilages Innervation: T7 - T12 |
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What runs in between internal oblique and transversus abdominis? |
Intercostal neurovascular bundle |
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What is the Rectus Sheath? |
The aponeurosis from all of the anterior abdominal muscles External Oblique: Fibres pass anterior to Rectus abdominis and fuse with the linea alba down to the public symphysis Internal Oblique: Divides into 2 layers to enclose Rectus abdominis then fuses with the other aponeuroses in the midline Transversus Abdominis: Fuses with the posterior layer of the Internal Oblique aponeurosis Changes below the arcuate line |
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What is the arcuate line? |
3-4 cm below the umbilicus, all 3 aponeuroses pass anteriorly over the rectus sheath The free lower edge is the arcuate line Below this level the Rectus Abdominis lies on Transversalis fascia |
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What is Transversalis Fascia? |
A layer of fascia that clothes the inner aspect of the anterior abdominal wall and peritoneal cavity |
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What forms the six pack? |
The anterior sheath is attached to the Rectus Abdominis by transverse tendinous intersections in 3 places: At the xiphisternum At the umbilicus One in between |
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What is the blood supply of Rectus Abdominis? |
Superior Epigastric Artery |
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What is the relations of blood vessels to the muscles of the anterior abdominal wall? |
Superior Epigastric Artery runs between the posterior sheath of the internal oblique and the rectus abdominis The Superior Epigastric Artery anastamoses with the Inferior Epigastric Artery The Inferior Epigastric Artery behind rectus abdominis where the sheath is deficient and then between the sheath and the muscle |
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What are the functions of the muscles of the anterior abdominal wall? |
Move the trunk (Rectus abdominis is the most powerful flexor) Depress the ribs (except transversus abdominis) Compress the abdomen in coughing and sneezing Support the abdominal viscera |
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What is the lymphatic drainage of the muscles of the anterior abdominal wall? |
Above the umbilicus - Pectoral group of axillary nodes Below the umbilicus - Superficial inguinal nodes |
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What ligaments are visible on the internal abdominal wall? |
Falciform Ligament Ligamentus Teres Lateral umbilical folds Medial umbilical ligament Median umbilical ligament |
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What is the inguinal canal and what are its boundaries? |
An Oblique canal above the medial half of the inguinal ligament Post. wall: Laterally - transversalis fascia; Medially - conjoint tendon Ant. wall: External oblique aponeurosis, reinforced laterally by the origin of the internal oblique from the inguinal ligament Roof: Conjoint tendon formation Floor: Inverted edge of the inguinal ligament and lacunar ligament medially |
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What is the entrance of the inguinal canal? What artery ascends medial to it? |
Deep Ring An opening in the transversalis fascia above the midpoint of the inguinal ligament Inferior epigastric artery ascends medial to it |
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What is the exit of the inguinal canal? |
Superficial ring (in external oblique aponeurosis) Opening is triangular: Base is medial to the pubic tubercle Sides are sloping upwards & laterally from the pubic tubercle and symphysis Conjoint tendon protects it posteriorly |
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What is the advantage of the passage of the inguinal canal? |
Oblique passage through 3 abdominal muscles Prevents the abdominal contents from prolapsing when intra-abdominal pressure is raised |
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What is the general structure that passes through the inguinal canal regardless of sex? What is its function? |
Ilioinguinal nerve Enters laterally by passing between internal and external oblique Supplies skin of medial thigh Male: Supplies base of penis and anterior scrotum Female: Supplies anterior labia |
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What is herniation? |
Abnormal protrusion of a tissue through an opening |
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What are the two types of inguinal hernia? |
Indirect: Hernial sac enters the inguinal canal through the deep ring and may extend to the scrotum Lateral to the inferior epigastric artery Direct: Hernial sac bulges directly through the posterior wall of the inguinal canal Medial to the inferior epigastric artery |
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Peritoneal Cavity |
Walls are lined by parietal peritoneum Visceral peritoneum is a continuation, and is reflected over many abdominal viscera The cavity is the single continuous space between the parietal and visceral peritoneum. Composed of greater (main) and lesser (posterior to the stomach and anterior to the pancreas) sacs with the epiploic foramen connecting them |
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What is the peritoneal cavity divided by and into? |
Divided by the transverse colon and its mesentery Into supracolic and infracolic compartments |
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Psoas Major |
(2 symmetrical muscles) Origin: All lumbar vertebrae, their intervening discs, transverse processes Path: Inferiorly, medial to the iliac bone Insertion: Via the iliopsoas tendon (illiacus) onto the lesser trochlanter of the femur Innervation: L1-L3 Function: Flexor of the hip joint and trunk |
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Quadratus Lumborum |
Runs between the posterior part of the iliac crest, 12th rib and lumbar transverse processes Functions: Stabilises vertebral collumn and fixes the 12th rib for diaphramatic movements |
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What are the medial and lateral arcuate ligaments with respect to Psoas Major and Quadratus Lumborum? |
Thickened upper borders of the fascia from the muscles Psoas - Medial Quadratus - Lateral |
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Peritoneal Spaces
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Right and left subphrenic spaces lie in between the diaphragm and the liver on either side of the falciform ligament The right subhepatic space is below the liver The left subhephatic space lies in the lesser sac |
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Function of the Hepatic Portal System
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Drains the: Pancreas Gall Bladder Spleen GI Tract from lower oesophagus to the upper anal canal |
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Portal Vein |
Union of Splenic and Superior Mesenteric Veins Anterior to the right crus of the diaphragm & IVC Posterior to the neck of the pancreas at L1 Inferior Mesenteric Vein joins the Splenic Vein at a variable distance along it |
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Portosystemic Anastamoses function and problems
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Areas where the venous drainage can enter either the systemic or portal system When Portal pressure is raised (in from alcoholism leading to liver disease), toxic substances can enter the systemic circulation |
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Sites of the Porto Systemic Anastamoses
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Site - Portal - Venous Lower Oesophagus - Left Gastric - Azygous Veins Lower Rectum (anal canal) - Superior Rectal - Middle and inferior rectal Around Umbilicus - Veins in Ligamentum teres - Superior & Inferior Epigastric Arteries Retroperitoneal (Left Colon) - Colic - Abdominal Wall veins Bare area of the liver - Branches of Portal vein - Inferior Phrenic vein Near Ductus Venosus - Left branch of portal - IVC |
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Lumbar Plexus formation |
Formed behind or within psoas major by the anterior rami of the upper 4 lumbar spinal nerves |
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Relations of the Lumbar Plexus |
T12 (subcostal nerve) passes under the lateral arcuate ligament, observed on the posterior abdominal wall |
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Nerves of the Lumbar Plexus |
Iliohypogastric (L1 - main branch) Ilioinguinal (L1, collateral branch) - Runs in the inguinal canal and is mostly sensory Supply the conjoint tendon Pass between the transversus abdominis and internal oblique Genitofemoral nerve (L1 - 2) - Splits into two nerves Femoral branch (L1) - supplies the skin over the anterior thigh Genital Branch (L2) - runs in the inguinal canal to supply the spermaticord and cremasteric muscle Lateral femoral cutaneous nerve (L2, 3) - Across Iliacus & Enters the thigh posterior to the lateral inguinal ligament and medial to the ASIS Femoral nerve (L2, 3, 4) - Passes into the anterior thigh Supplies quadriceps, sartorius, pectineus and the skin on the thigh Obturator nerve (L2, 3, 4) - Supplies the sin on the medial side of the thigh Most of L4 contributes to the Lumbar Plexus and the rest joins L5 to form the Lumbosacral Trunk |
