B5: Anatomy Exam 1

thoracic diaphragm

What compromises the ceiling of the abdominal cavity?

plane of the pelvic inlet (linea terminalis, which is comprised of the pectineal line, arcuate line, pubic crest, sacral ala, and sacral promontory)

What compromises the floor of the abdominal cavity?

Note: there is really no true floor because it is continuous with the pelvic cavity

lumbar vertebral column, deep mm. of the posterior abdominal wall, intrinsic back mm.

What compromises the posterior wall of the abdominal cavity?

musculoaponeurotic abdominal mm.

What compromises the anterolateral border of the abdominal cavity?

abdominal cavity

What acts a protective and flexible container for abdominal viscera and contents?

Note: contents include digestive organs, parts of the urogenital system, spleen, and major neuro-vasculature structures

musculoaponeurotic abdominal mm.

What makes up the anterior/anteriolateral boundary of the abdominal cavity and serves to provide dynamic support by contracting during respiration, locomotion, elimination, ingestion, pregnancy, fat deposition, and posture/core support as well as pathology?

peritoneum

What lines the abdominal walls and reflects onto abdominal viscera as a double-layered reflection to provide passage for blood vessels, nerves, and lymphatics?

parietal fluid

What fills the peritoneal cavity for lubrication along with adipose tissue?

median plane

Which abdominal reference plane:

-vertical line through the midline

midclavicular line

Which abdominal reference plane:

-vertical line through the midpoint of the clavicle

linea semilunaris

Which abdominal reference plane:

-vertical line through the lateral border of the rectus sheath

transpyloric plane

Which abdominal reference plane:

-horizontal lines through the points where the semilunar line meets the costal margin

-located at ~L1

-halfway between the jugular notch and pubic crest

-useful horizontal plane that provides orientation to the internal anatomy of the abdomen

-passes through/near the pylorus of the stomach, ampulla of the duodenum, celiac trunk, SMA, origin of portal v., neck of pancreas, and left colic flexure of large intestine

subcostal plane

Which abdominal reference plane:

-horizontal line through the lowest point of the costal margin

intertubercular plane

Which abdominal reference plane:

-horizontal line through the tubercles of the iliac crest

interspinous plane

Which abdominal reference plane:

-horizontal line through the ASIS

trans-umbilical plane

Which abdominal reference plane:

-horizontal line through the umbilicus

musculoaponeurotic abdominal mm.

What makes up the anterior/anterolateral boundary of the abdominal cavity and serves to protect abdominal viscera, assist in respiration, and assist in expelling thoracic, abdominal, or pelvic contents during micturition, defecation, and childbirth?

Hint: consists of skin and subcutaneous tissue (superficial fascia) composed mainly of fat, muscles and their aponeuroses and deep fascia, extraperitoneal fat, and parietal peritoneum & 3 musculotendinous layers

> skin

> superficial fatty layer of subcutaneous tissue (camper fascia)

> deep membranous layer of subcutaneous tissue (scarpa fascia)

> superficial investing fascia

> external oblique m.

> intermediate investing fascia

> internal oblique m.

> deep investing fascia

> transversus abdominus

> endoabdominal (transversalis) fascia

> extraperitoneal fat

> parietal peritoneum

Which of the following is the correct order of the layers of the anterolateral abdominal wall?

superficial fascia

Which fascia of the abdominal wall:

-below the umbilicus

-includes the camper (fatty) fascia that is superficial and the scarpa (membranous) layer which is deep and continuous with colles' fascia and fascia lata of perineum and thigh, respectively

rectus sheath

Which fascia of the abdominal wall:

-aponeuroses of external oblique, internal oblique, and trasnversus abdominis mm.

transversalis fascia

Which fascia of the abdominal wall:

-fascia lining the internal aspect of the abdominal wall

-deep to transversus abdominus m. (laterally) and rectus m. (medially)

ventral primary rami T6-L1

What is the general innervation for the muscles of the anterior abdominal wall (e.g., external and internal oblique, tranversus abdominis, rectus abdominis, and pyramidalis)?

external oblique mm

Which muscle of the anterior abdominal wall:

-Proximal Attachment: ribs 5-12 (lower 8 ribs)

-Distal Attachment: linea alba, pubic tubercle via lacunar ligament, ASIS, iliac crest

-Action: flex and rotate trunk, support & compress abdominal vicera

-Innervation: ventral primary rami T7-T11 and subcostal n. (T12)

-inferior border forms the inguinal ligament

-"hands in pockets" pattern of fibers

-largest, most superficial muscle which wraps around the lateral abdominal wall from ribcage

internal oblique mm

Which muscle of the anterior abdominal wall:

-Proximal Attachment: thoracolumbar fascia, iliac crest, lateral inguinal ligament

-Distal Attachment: 10-12th ribs, costal cartilages of the lower 4 ribs, linea alba, pectin pubis via conjoint tendon

-Action: flex and rotate trunk, compress and support abdominal viscera

-Innervation: segmental ventral rami (T6-L1)

-"hands in opposite pockets" fiber direction

transversus abdominis mm

Which muscle of the anterior abdominal wall:

-Proximal Attachment: internal surface of ribs 7-12, thoracolumbar fascia, iliac crest

-Distal Attachment: linea alba, pubic crest, pectin pubis via conjoint tendon

-Action: stabilize the trunk and maintain abdominal tone as well as compress and support abdominal viscera

-Innervation: segmental ventral rami (T6-L1)

-has transverse fibers, innermost layer

rectus abdominis mm

Which muscle of the anterior abdominal wall:

-Proximal Attachment: costal cartilages 5-8, xiphoid process

-Distal Attachment: pubic symphysis and pubic crest

-Action: flex trunk, counter to erector spinae mm., to initiate a concentric contraction, one must be in a position against gravity (e.g., sit ups)

-Innervation: segmental ventral rami (T6-T12)

-contains tendinous intersections (provides that "6 pack" look)

pyramidalis mm

Which muscle of the anterior abdominal wall:

-Proximal Attachment: anterior pubic crest

-Distal Attachment: linea alba

-Action: tenses linea alba

-Innervation: T12

-absent in ~20% of population

-lies anterior to inferior part of rectus abdominus m., in the rectus sheath

rectus sheath

What structure encloses the rectus muscle and pyramidalis muscle and consists of external and internal oblique aponeurosis as well as the transversus abdominis aponeurosis?

Note: broken into anterior and posterior parts relative to the rectus abdominis m.

arcuate line

What dermarcates the transition between components of the posterior wall of the rectus sheath?

above

Components of the rectus sheath (above/below) the arcuate line include (from superficial to deep):

-Anteriorly: aponeurosis of external oblique m. and aponeurosis of 1/2 internal oblique m.

-rectus abdominus m.

-Posteriorly: aponeurosis of other 1/2 internal oblique m., aponeurosis of transversus abdominis m., transversalis fascia, peritoneum

below

Components of the rectus sheath (above/below) the arcuate line include (from superficial to deep):

-Anteriorly: aponeurosis of external & internal oblique mm. and transversus abdominis m.

-Rectus abdominis m.

-Posteriorly: transversalis fascia and peritoneum

true

T/F: each dermatome has fibers from nerves above and below it, thus if the T10 dermatome is damaged, you would see and issue with nerves from T9-T11

internal thoracic a.

What is the origin of the superior epigastric a.?

superior epigastric a.

What artery is a terminal branch of the internal thoracic a. & supplies the superior part of the rectus sheath?

inferior epigastric a.

What artery is a branch of the external iliac a. superior to the inguinal ligement and runs superiorly in the transversalis fascia to enter the rectus sheath below the arcuate line?

superficial epigastric a.

What artery is a subcutaneous branch of the femoral a. & is important to visualize in laparoscopic and open (incisional) procedures, esp. OBGYN?

superior epigastric a., inferior epigastric a., superificial epigastric a., and branches of posterior intercostal and subcostal aa.

What vasculature supplies the anterior abdominal wall?

above

venous drainage of the anterior abdominal wall (above/below) the umbilicus includes:

-thoraco-epigastric v. to axillary v.

-superior epigastric v. to internal thoracic v.

below

venous drainage of the anterior abdominal wall (above/below) the umbilicus includes:

-superficial epigastric v. to femoral v.

-inferior epigastric v. to external iliac v.

above

lymphatic drainage of the anterior abdominal wall (above/below) the umbilicus includes:

-axillary and parasternal lymph nodes

below

lymphatic drainage of the anterior abdominal wall (above/below) the umbilicus includes:

-superficial inguinal lymph nodes

incisional hernia

What can result from improperly healed muscular and aponeurotic layers post surgery (incision) and involves the protrusion of omentum (peritoneum), fat, or an organ through a surgical incision?

epigastric

What type of hernia:

-through the linea alba

incisional

What type of hernia:

-occurs through a scar because they are always weaker than the tissue they replace

umbilical

What type of hernia:

-through the umbilical ring

inguinal

What type of hernia:

-through the inguinal canal (indirect) or lower abdominal wall (direct)

femoral

What type of hernia:

-through the femoral canal

parietal

(parietal/visceral) peritoneum:

-lines internal surface abdominopelvic wall

-neurovascular supply matches regions of wall it lines

-somatic innervation sensitive to pressure, pain, temp, and laceration

-pain is localized

visceral

(parietal/visceral) peritoneum:

-invests viscera

-neurovascular supply matches respective organs covered

-visceral innervation sensitive to stretching and chemical irritation

-produces referred pain to dermatomes providing sensory fibers

omenta

What is a double-layered extension of peritoneum that contains neurovasculature of GI organs, binding viscera to viscera?

mesentery

What is a double-layered extension of peritoneum encasing connective tissue and neurovasculature, attaches the intraperitoneal viscera to the body wall, and has nomenclature specific to its location (e.g., transverse mesocolon)?

fold

What is a raised, reflection of parietal peritoneum on the interior abdominal wall caused by vasculature or obliterated structures?

ligament

What is a double-layer of peritoneum that connects viscera to viscera or viscera to abdominal wall?

falciform ligament

Which peritoneal ligament/fold:

-contains ligamentum teres hepatis (round ligament of liver)

-superior to the umbilicus

on exam!! said to know these!!

ligamentum teres

Which peritoneal ligament/fold:

-superior to the umbilicus

-contains obliterated umbilical v.

on exam!! said to know these!!

median umbilical fold

Which peritoneal ligament/fold:

-inferior to umbilicus

-runs from apex of bladder to umbilicus

-contains remnant of urachus

on exam!! said to know these!!

medial umbilical fold

Which peritoneal ligament/fold:

-inferior to umbilicus

-contains occluded (fetal) umbilical aa.

on exam!! said to know these!!

lateral umbilical fold

Which peritoneal ligament/fold:

-inferior to umbilicus

-contains inferior epigastric a. and v.

on exam!! said to know these!!

intraperitoneal

(intraperitoneal/retroperitoneal) organs are almost completely enclosed by the visceral layer of the peritoneum and are suspended within the peritoneal cavity by mesenteries

retroperitoneal

(intraperitoneal/retroperitoneal) organs lie posterior to the peritoneal cavity and can be primary or secondary

primary

(primary/secondary) retroperitoneal structures lie posterior to the peritoneal cavity, are not suspended by mesentery, and are covered by peritoneum only on their anterior surface

secondary

(primary/secondary) retroperitoneal structures were previously intraperitoneal structures that become fixed to the posterior abdominal wall when their mesentery fused with the parietal peritoneum of the posterior abdominal wall during development

intraperitoneal

(intraperitoneal/primarily retroperitoneal/secondarily retroperitoneal) organs include:

-stomach

-small intestine

-spleen

-liver

-gallbladder

-cecum with vermiform appendix

-large intestine (transverse and sigmoid colon)

primarily retroperitoneal

(intraperitoneal/primarily retroperitoneal/secondarily retroperitoneal) organs include:

-kidneys

-suprarenal glands

secondarily retroperitoneal

(intraperitoneal/primarily retroperitoneal/secondarily retroperitoneal) organs include:

-duodenum (Descending, horizontal, and ascending)

-pancreas

-ascending and descending colon

retroperitoneal

(intraperitoneal/retroperitoneal) structures include:

-SADPUCKER acronym!

S = suprarenal (adrenal) glands

A = aorta and IVC

D = duodenum (2nd-4th parts)

P = pancreas (except tail)

U = ureters

C = colon (descending and ascending)

K = kidneys

E = esophagus (thoracic portion)

R = rectum (partially)

-injuries can cause blood or gas accumulation within the posterior space!!

greater sac

What makes up the entire peritoneal cavity except the lesser sac?

lesser sac

What is a small extension of the peritoneal cavity that lies behind the stomach and lesser omentum and communicates with the greater sac through the omental foramen?

Hint: also known as the omental bursa

transverse mesocolon

What divides the abdominal cavity into supracolic and infracolic compartments?

supracolic

(supracolic/infracolic) compartment of the abdominal cavity includes the stomach, liver, and spleen

infracolic

(supracolic/infracolic) compartment of the abdominal cavity includes the small intestine, ascending and descending colons and is further divided into R and L spaces by mesentery of tbhe small intestine

inguinal region

What extends between the ASIS And the pubic turbercle and is an area where structures enter and exit the abdominal (peritoneal) cavity, thus is a potential site for herniation?

inguinal ligament

What is the inferior margin of the external oblique aponeurosis that turns under and attaches from the ASIS To the pubic tubercle?

subinguinal space

What is a space posterior to the inguinal ligament?

inguinal canal

What is a short passage (4-6 cm) that extends inferiorly and medially through the abdominal wall, is superior to the inguinal ligament and also parallels it, and is the pathway by which structures pass through the abdominal wall to and from the external genitalia?

deep inguinal ring

What is the opening of the inguinal canal (through the transversalis fascia)?

superficial inguinal ring

What is the exit from the inguinal canal?

femoral hernia

What type of hernia generally presents BELOW the inguinal ligament and bulges into the thigh?

hesselbach's triangle

What is an anatomical triangle formed by the inguinal ligament, inferior epigastric vessels, and lateral border of the rectus abdominis, and is considered a weakness and cause of direct inguinal hernias?

deep inguinal ring

Where do indirect inguinal hernias occur?

femoral canal

where do femoral hernias occur?

Hesselbach's triangle

Where do direct inguinal hernias occur?

male

contents of the inguinal canal in a (male/female) include:

-spermatic cord which includes the genital branch of the genitofemoral nerve

-ilioinguinal nerve

female

contents of the inguinal canal in a (male/female) include:

-round ligament (embryonic remnant that inserts on the labia majora)

-ilioinguinal nerve

male

In (male/female) development:

-Testes develop extra-peritoneally in the lumbar region

-During development the male gubernaculum is a fibrous tract connecting the testes to the anterior abdominal wall.

-Processus vaginalis (outpouching of peritoneum) traverses the inguinal canal and enters the scrotum.

-Testes descend into the scrotum.

-The spermatic cord and testis have coverings that are derived from the abdominal wall

female

In (male/female) development:

-female gubernaculum connects the ovaries and uterus to the developing labium majora

-After development part of the gubernaculum becomes the round ligament of the uterus, which traverses the inguinal canal and maintains ante version of the uterus

transversalis fascia

What fascia forms the deep inguinal ring (indirect hernia) and posterior wall of the inguinal canal (direct hernia)?

transversus abdominis m.

The spermatic cord passes under the arch of the _________ muscle which forms the roof of the inguinal canal

internal oblique m.

What muscle makes up the roof of the inguinal canal and has cremasteric muscle fibers that surround the testis and cord as it passes into the scrotum (cremasteric reflex lost with testicular torsion) and contributes to the conjoint tendon (used for direct hernia repair)?

external oblique m.

What muscle's aponeurosis forms the anterior wall of the inguinal canal, has its floor made up of the inguinal ligament, and an opening in its aponeurosis forms the superficial ring?

aponeurosis of external oblique m. > aponeurosis of internal oblique m. > aponeurosis of transversus abdominis m. > hesselbach's triangle > transversalis fascia

What is the correct order of the layers of the inguinal region from superficial to deep?

Contraction of abdominal musculature (that raises intra-abdominal pressure) compresses the deep inguinal ring and inguinal canal to decrease risk of herniation

How do the layers of the inguinal canal protect against herniation?

iliohypogastric n.

Which nerve at risk of damage during open repair of an inguinal hernia:

-L1

-pierces internal oblique m. and runs in plane between internal and external oblique mm.

-not within inguinal canal

ilioinguinal n.

Which nerve at risk of damage during open repair of an inguinal hernia:

-L1

-pierces internal oblique (does not enter canal through deep inguinal ring)

-courses through inguinal canal, exits the superficial inguinal ring

-MOST COMMONLY INJURED NERVE --> Patients present with numbness or pain in the medial thigh and upper scrotum

genital br. of genitofemoral n.

Which nerve at risk of damage during open repair of an inguinal hernia:

-exits abdomen and travels within the spermatic cord

-femoral br. travels with femoral a. in subinguinal space

-innervates cremaster m. (cremasteric reflex)

-

nerves of the subinguinal region (femoral br. of genitofemoral, lateral femoral cutaneous, and femoral n.)

Which nerves are at risk of damage during iaparoscopic repair of an inguinal hernia?

peritoneum

What is a continuous serous membrane made of mesothelium which lines the abdominal cavity?

parietal

(parietal/visceral) peritoneum:

-lines internal abdominal wall

-somatic innervation (dermatomes) that is WELL LOCALIZED

visceral

(parietal/visceral) peritoneum:

-invests organs that protrude into abdominal cavity

-autonomic innervation that is sensitive to stretching and chemical irritation but the pain is referred and sensation is POORLY localized

ligament

What is a fold of peritoneum supporting any of the abdominal viscera?