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48 Cards in this Set

  • Front
  • Back
Median arcuate ligament
formed by the fusion of the medial extension of the fibrous parts of the two crura at the midline.

aorta runs behind the median arcuate ligament
Medial arcuate ligament
the fibrous part of each crus extends, and arches also laterally to get attached to the tip of the first lumbar vertebra forming the medial arcuate ligament

the psoas major muscle runs behind the medial arcuate ligament
Lateral arcuate ligament
from the top of the transverse process of the first lumbar vertebra a thickened fibrous tissue (the lateral arcuate ligament) extends up and laterally to get attached to the 12th rib.

the quadratus lumborum muscle runs behind the lateral arcuate ligament.
The deep fascia of the back:
2 layers:
1. superficial layer
2. deeper layer (invests the deep muscles of the back).. AKA "Thoracolumbar Fascia"... made up of 3 layers:
-posterior (runs behind erector spinae muscle)
-middle (runs behind quadratus lumborum muscle, and anterior to erector spinae)
-anterior (runs in front of the quadratus lumborum (between it and the psoas)
7 layers of the anterolateral wall of the abdomen:
1. skin
2. superficial fasica
3. deep fascia
4. muscular layer (four muscles)
5. transVersalis fascia
6. eXtraperitoneal fatty tissue
7. parietal peritoneum (serosa)
Which layers do the inferior epigastric vessels run through?
the inferior epigastric layers run between layers five and seven (they pierce layer five near umbilicus)
Linea alba
where the 3 apneuroses meet in the midline and unite with those of the opposite side.
a scar on linea alba.
at level of L3-4
External Oblique Muscle:
(nearly fan-shaped)
(fibers radiating downwards)

Origin: the external surface of the lower 8 ribs (interdigitating with serratus ant. and lat. dorsi)

Insertion: from backwards forwards into 3 sites in the following fashion:
-into the external lip of the anterior 2/3 of the iliac crest with only muscle fibers (no fibrous tissue) resulting in the *free fleshy* posterior vertical border of the muscle; and a fixed fleshy insertion
-into three spots: the ASIS, the pubic tubercle then the symphysis pubis with fibrous tissue (aponeurosis) resulting in the *free fibrous* (aponeurotic) inferior edge formed of 2 portions: a lateral larger one (the inguinal ligament) hanging between the ASIS and the pubic tubercle; and a medial smaller curved one (the superficial inguinal rung) between the pubic tubercle and the symphysis pubis
-inot the linea alba with fibrous tissue (aponeurosis) resulting the *fixed fibrous* (aponeurotic) anterior edge of the muscle

Nerve Supply: T7-L1
Internal Oblique Muscle:
(nearly fan-shaped like external oblique)
(fibers radiating upwards, MOST of the fibers are perpendicular to those of external oblique)

Origin: (3 L's)
(a) posterior fibers: transverse processes of lumbar vertebrae, and posterior 1/3 of iliac crest: indirectly through lumbar (thoracolumbar) fascia
(b) intermediate fibers: anterior 2/3 of iliac crest (fleshy fibers directly from the intermediate lip)
(c) anterior fibers: lateral 2/3 of inguinal ligament (fleshy fibers directly from the groove)

(a) the most posterior fibers: with fleshy fibers to last three ribs (nearly vertical fibers resulting in more or less straight fixed fleshy posterior edge)
(b) the most anterior fibers: (fibers from inguinal ligament) with an aponeurosis to the pubic crest after arching over the spermatic cord (forming roof of inguinal canal) (arching free fleshy edge of the muscle)
(c) fibers in between: with aponeurosis to the costal margin; and to the linea alba after splitting to enclose rectus muscle: these fibers form most of the internal oblique muscel fibers and they are directed upwards and medially (perpendicular to the fibers of external oblique)

Nerve supply: T7-L1

**The internal oblique is the thickest muscle of the anterior abdominal wall and it is considered the "master muscle"
Transversus Abdominus Muscle
(not fan-shaped)

Origin: the muscle fibers run horizontally (from behind forwards) from the following 4 areas:
(a) inner surfaces of the lower 6 costal cartilages (interdigitating with diaphragm)
(b) transverse processes of lumbar vertebrae, and posterior part of iliac crest: indirectly through lumbar fascia
(c) inner lip of anterior 2/3 of iliac crest (direct attachment to the iliac crest)
(d) lateral 1/3 of the inguinal ligament

(a) the most anterior fibers: the same like internal oblique; the aponeuroses of the arching fibers of both meet in the pubic crest forming the *conjoint tendon*
(b) the rest of the muscle fibers: with an aponeurosis to the linea alba: these fibers form the majority of the fibersof transversus abdominus and are directed horizontally

Nerve Supply: T7-L1

Actions: acting on one side (follows internal oblique-the master- of the same side): if the pelvis if fixed, laterally flexes trunk and rotates it to the same side.
Actions of the 2 oblique and the transversus muscles:
-support and protection of abdominal viscera
-abdominothoracic rhythm: the 4 muscles relax to make room for the abdominal viscera when the thoracic diaphragm descends furing diaphragmatic inspiration, and contract during either resting and forced expiration
-during coughing (momentary forced expiration) the thoracic diaphragm is relaxed and glottis closed: contraction of the abdominal wall muscles increases intra-abdominal pressure pushing up the relaxed diaphragm against the lungs expelling air (the glottis remains closed during the building up of intra-abdominal pressure then suddenly opens to allow expulsion of a forceful jet of air; which is the cough itself)
-during defecation, urination... the thoracic diaphragm is kept FIRM in its lowered position during contraction (ideally straining must follow a deep inspiration) by the closure of the glottis keeping inspired air trapped in the lungs to push against it (thoracic diaphragm); meanwhile the pelvic diaphragm is also contracting except puborectalis to allow expulsion of feces: contraction of both diaphragms is associated with contraction of the anterolateral abdominal muscles to increase the intra-abdominal pressure
-in lifting weights, all muscles of anterolateral wall are contracted to form a tense ball to support the vertebral column
bilateral and unilateral contraction
1. if the pelvis is fixed, bilateral contraction of the external oblique flexes trunk whereas if thorax is fixed the result will be superior tilt of the anterior part of the pelvis

2. if the pelvis is fixed, unilateral contraction of the internal oblique syngerized with the contraction of external oblique of the opposite side results in hte lateral flexion, and rotation of the trunk to that side of the internal oblique.
Rectus Abdominus Muscle
Origin: pubic crest and the ligaments in front of symphysis pubis (by tendinous fibers)

Insertion: xiphoid (of sternum), costal margin (cartilages of 5, 6, 7th ribs)

Nerve Supply: T7-T12

-flexes trunk first 30 degrees. the contraction of strong iliopsoas muscle complete the action of trunk flexion (sitting up)
-compresses viscera
-stabilizes and controls tilt of the pelvis (antilordosis)

*Note: the rectus abdominus lies within the rectus sheath (formed by splitting of internal oblique aponeurosis into an anterior layer fusing with the external oblique aponeurosis, and a posterior on fusing with the transversus abdominus aponeurosis
2 special charcateristics of rectus abdominus muscle:
1. linea semilunaris
2. tendinous intersections

these are transverse fibrous interruptions anchoring the anterior surface of rectus to the anterior layer of the rectus sheath
Inguinal canal
Starts: at deep inguinal ring
Ends: at superficial inguinal ring

(the inguinal canal is the pathway taken by the processus vaginalis, and the migrating testis with its vessels through the abdominal wall, the ends of this pathway can be marked by the deep and the superficial rings
Hernias (Indirect and Direct)
Direct inguinal Hernia: usually occurs in men over 40
-due to weakness of abdominal wall the medial to inferior epigastric artery + other underlying causes (such as chronic coughing)
-does not pass through the whole length of the inguinal canal, nor does it reach the scrotum
-neck of hernial sac is medial to the deep inferior epigastric artery

Indirect Inguinal Hernia: most common in children and young adults
-viscus protrudes at the improperly contracted deep inguinal ring through the opened processus vaginalis
-does pass through inguinal canal- into spermatic cord, so attaining all cord covereings.
-more common in males than females
-neck of hernial sac is immediately lateral to the inferior epigastric artery
Quadratus Lumborum:
-the posterior (medial) iliac crest (posterior 2 inches)
-the iliolumbar ligament
-transverse process of lumbar vertebrae

-12th rib (the inferior aspect of its medial half)
-transverse process of lumbar vertebrae

Nerve Supply: L1-4 (or T12-L3)

-unilateral contraction: ipsi-lateral flexion of the vertebral column at the lumbar spinal area
-bilateral contraction: stabilizes the 12th rib assisting the diaphragm, so it is considered a RESPIRATORY muscle
-bilateral contraction: increasing lumbar bracing during weight lifting
-while balancing the body's weight on the upper extremities and bracing the upper torso the muscle could be used for ipsilateral elevation and anterior tilt of the pelvis in patients with ambulatory problems.
Striae gravidarum
when someone is pregnant, the connective tissue of layer 1 can get stretched and you get red lines
Linea Nigra:
dark skin over linea alba because of pregnancy
Diastasis Recti:
-if you ask patient (who just delivered) to sit up from supine position they will have bulge.. General weakness
-can occur to a man (if he is very overweight and loses a lot of weight)
Myotatic Contraction
when a muscle is stretched before contraction (think of a cat and how it crouches before springing forward)

myotactic reflex = petellar tendon reflex
The subcostal nerve:

runs behind the lateral arcuate ligament
The Lumbar Plexus
1. iliogypogastric and ilioinguinal (L1):
-runs behind the medial arcuate ligament
-its injury can result in hernia

2. genitofemoral (L1,2)

3. Femoral ((L2-4)

4. Lateral femoral cutaneous (L2, 3)
-leaves abdomen behind the very lateral end of the inguinal ligament, just medial to the ASIS

5. Obturator (L2-4)

6. Lumbrosacral Trunk (L4,5)
Arteries of posterior abdominal wall:
the abdominal aorta has the following branches:

-paired parietal branches:
(1) phrenic (inferior)
(2) lumbar (4 pairs)

-paired visceral branches:
(2) renal
(3) gonadal

unpaired parietal branches:
(1) medial sacral

unpaired visceral branches:
(1) celiac: giving off splenic, hepatic, and left gastric
(2) superior mesenteric
(3) inferior mesenteric

*the abdominal aorta ends by dividing into right and left common iliac arteries at L4
Veins of posterior abdominal wall:
the inferior vena cava (IVC) has the following tributaries:

paired parietal tributaries:
(1) lumbar (4 pairs)
(2) phrenic (inferior)

paired visceral tributaries:
(1) suprarenal (the right drains directly into IVC, the left drains into the left renal vein)
(2) renal
(3) gonadal (the right drains directly into IVC, the left drains into the left renal vein)
(4) hepatic

unpaired visceral tributaries: (all drain into portal circulation before IVC)
(1) the superior and inferior mesenteric veins
(2) splenic
(3) portal

unpaired parietal tributaries:
(1) median sacral

*The right common iliac vein joins its left counterpart at L5 forming the IVC
*The ascending lumbar veins form azygos and hemiazygos running into the thorax
Lithotomy injury:
if a patient is left in the lithotomy position for several hours, they will pinch their obturator nerve against the bone (as it is naturally in a stretched state, and in abduction it is stretched even further, getting compressed against the bone).. this injury results in weakened abduction as well as numbness on the inner thigh
The 9 clinical regions of the abdomen:
1. right hypochondriac region
2. epigastric region
3. left hypochondriac region
4. right lumbar region
5. umbilical region
6. left lumbar region
7. right iliac region
8. super-pubic region
9. left iliac region
retroperitoneal organ
organ, which lies posterior to peritoneal cavity (e.g. the kidney), buried behind parietal peritoneum
intraperitoneal organ
organ, which lies in the peritoneal cavity (e.g. the stomach, spleen...) and is entirely wrapped by visceral peritoneum except at a tiny strip of surface where it receives its neurovascular bundle, which is sheathed in two layers of peritoneum (mesentery) continuous with the parietal peritoneum on the posterior abdominal wall at the spot of migration of the organ.
The esophagus (where it starts/ends.. its anatomical location)
a fibromuscular vertical tube.

runs from just after the cricopharyngeal constriction (C6) and ends at the GE junction

upper part runs behind trachea (BEHIND THE LEFT PRIMARY BRONCHUS); following that it runs behind the heart to the right of the aorta then in front of the aorta before leaving the thorax

-passes through the diaphragm just left to midline at T10 to enter the abdomen.
The Stomach:
J-shaped sac (resulting in 2 curves: greater (lower, convex) curve and lesser (upper, concave) curve).

from the left hypochondriac to the epigastric regions of the abdomen, curving downwards to pass by the umbilical region.

begins at gasroesophageal junction and ends at gastroduodenal junction

3 parts:
(1) fundus (in left hypochondrium)
(2) body
(3) pyloric part (divided into the pyloric antrum and the pyloric canal)
hepatogastric ligament
between the lesser curvature of the stomach and the liver.. part of the lesser omentum
The Small Intestine
starts at gastroduodenal junction to the ileocecal junction
(1) duodenum
(2) jejunum
(3) ileum

*the duodenum is extraperitoneal (except a small part of the first part)
*the jejunum and ileum are intraperitoneal (have a mesentery and are not fixed to the posterior abdominal wall)

between the 1st and 3rd lumbar vertebrae

The common bile duct and pancreatic duct both open at the middle of the medial side of its 2nd part at the major duodenal papilla after raising and distending the mucosa into an ampulla of Vater.

the jejunum and ileum are about 20ft long whereas the duodenum is about 10 inches.
the Large Intestine
from the ileocecal junction/caecum to the anorectal junction

(1) ascending colon (no mesentery.. against the posterior abdominal wall)
(2) transverse colon (it has a mesentery, therefore intraperitoneal... attached to greater curvature of stomach by greater omentum)
(3) descending colon (no mesentery.. lies against posterior abdominal wall)
(4) sigmoid colon (has a mesentery.. commonest site of diverticulosis)
(5) rectum (starts at S3.. joins the anal canal at levator ani muscle {in front of coccyx}... has 3 curves.. 13cm long... )

*wall of intestine is sacculated (caused by 3 bands of longitudinal muscle: taenia coli)
The Spleen
in the left hypochondrium region (protected by ribs)

intraperitoneal organ (moves up and down w/ respiration)

injury to lower left ribs can lead to potentially life threatening damage (referred pain in left shoulder.. phrenic nerve.

largest axis is vertical and is tilted (the 10th rib marks this axis)

2 poles: posterior (5cm from T10 spine) and anterior (10th rib at mid-aXillary line)

2 borders: lower (11th rib) and upper (has a notch, marked by the 9th rib)
The Pancreas
*retroperitoneal organ (applied to vertebral column crossing it horizontally from the duodenum on the right to the spleen on the left:

situated in the epigastric region, and left hypochondriac regions of the abdomen.

consists of a head (nestled into the C of the duodenum), short neck, body, and tail

pancreatic duct supplies enzymes to duodenum
The Liver
largest gland in the body

right lobe is bigger than the left lobe

empties into duodenum via the common bile duct (bile is temporarily stored in the gallbladder)

in the right hypochondrium region of abdomen.. crosses the midline to occupy part of the left hypochondrium

porta hepatis (gate of the liver) is on its visceral side (concave)

Falciform ligament: divided the liver into right and left lobes (located on the convex diaphragmatic side)

the caudate and quadrate lobes are in between the left and right lobes (caudate being superior to quadrate)... porta hepatis lies between these two lobes
Falciform ligament
divides the liver into right and left lobes

located on the convex diaphragmatic side (anterior)
The Celiac Trunk:
gives blood supply from the lower end of the esophagus to the ampulla of Vater (the middle of the second part of the duodenum), liver, spleen, and most of the pancreas
The Superior Mesenteric Artery:
gives blood supply from the ampulla of Vater to splenic flexure of colon (part of the head of the pancreas)
Inferior Mesenteric Artery:
gives blood supply from the splenic flexure to the anus (upper 2/3 only)
Venous drainage of the gastro-intestinal system:
blood (containing nutrients) from the stomach and the intestines does not drain directly into the heart but first into the liver through the PORTAL VEIN

the portal vein itself is formed behind neck of pancreas by junction of the splenic vein and the superior mesenteric vein; then it ascends to enter the liver at the porta hepatis

the inferior mesenteric vein frequently drains into the splenic

The lower 1/3 of the anus is served by SYSTEMIC venous circulation, while the upper 2/3 by the inferior mesenteric vein (PORTAL venous circulation)
The Kidney
in the paravertebral gutter


from T12-L3

the right kidney is lower than the left

convex laterally, concave medially (indented by hilum).. long axis is almost vertical

it has outer cortex and inner medulla

medial to quadratus lumborum and lateral to psoas m.

renal vein, renal artery, and the pelvis of the ureter (VAP, from anterior to posterior)
^all at the hilum

costodiaphragmatic recess: separates the left kidney from 11th and 12th rib, but the right from only the 12th
The Ureter (the abdominal part of the ureter)

expanded upper end; which is called the pelvis of the ureter, drains urine from the kidney (into the bladder)

anterior to psoas major m. (alongside the tips of the lumbar vertebrae)

crosses the brim of the pelvis anterior to the bifurcation of the common iliac artery
The Suprarenal Glands
supromedial to the kidneys


endocrine glands with inner medulla and outer cortex.
gastro-esophageal reflux disease.. if GE junction is too short (in the chest) you have GERD. It should be in the abdomen. If you have GERD you need an operation to lower GEJ.
Ampulla of Vater
2nd part of the duodenum.. this is where the common bile duct and the pancreatic duct joint the small intestine