Anterior Abdominal Wall & Inguinal Canal

Identify the surface landmarks that define the abdominal quadrants , and recognize the position of the abdominal viscera in relation to those quadrants

Surface Landmarks

Xiphoid Process

Tendinous intersection of rectus abdominis

Linea semilunaris

Location of linea alba

Umbilicus

Pubic Symphysis

Inguinal Groove (location of inguinal ligament)

ASIS

Rectus Abdominis

External Oblique

Serratus Anterior

Describe the structural components that form the abdominal wall, its neurovascular supply , and lymphatic drainage

Describe the composition and organization of the anterior abdominal wall musculature and fascia

Describe the developmental origin and structure of the inguinal canal and its contents

Compare and contrast direct versus indirect inguinal hernias with respect to their development, populations, and causes

Overview of the Abdomen

Region of the trunk between the — and —

Bounded by the — superiorly

Continuous with the — inferiorly

Contains the — and parts of the —

thorax ; pelvis

diaphragm

pelvic cavity

alimentary canal ; urogenital system

What are the abdominal quadrants and what planes are used to divide them?

Right Upper Quadrant (RUQ)

Right Lower Quadrant (RLQ)

Left Upper Quadrant (LUQ)

Left Lower Quadrant (LLQ)

Median Plane (going vertically down midsagittal plane)

Transumbilical Plane (going vertically across mid abdomin)

What are the abdominal regions and what planes are used to divide them?

The Right Upper Quadrant Contains

Liver: Right Lobe

Gallbladder

Stomach: pylorus

Duodenum: parts 1-3

Pancreas: head

Right suprarenal gland

Right kidney

Right Colic (hepatic) flexure

Ascending colon: superior part

Transverse color: right half

The Left Upper Quadrant Contains

Liver: Left lobe

Spleen

Stomach

Jejunum and proximal ileum

Pancreas: body and tail

Left kidney

Left suprarenal gland

Left colic (splenic) flexure

Transverse colon: left half

Descending Colon: superior part

The Right Lower Quadrant Contains

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)

The Left Lower Quadrant Contains

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)

Superficial to Deep Layers of the Abdominal Wall

Skin

Superficial Fascia of subcutaneous tissue (fatty layer: camper fascia ; membranous later: scarpa fascia)

Muscles covered by deep (investing) fascia (external oblique, internal oblique, transversus abdominis)

Transversalis Fascia

Extraperitoneal Fat (variable)

Parietal Peritoneum

Abdominal Cavity

The — is the dividing line for superficial lymphatic drainage of the abdominal wall

Above Umbilicus: —

Below Umbilicus: —

umbilicus

axillary lymph nodes

superficial inguinal lymph nodes

Venous Drainage

Above Umbilicus: —

Below Umbilicus: —

Axillary Veins

External Iliac and Femoral Veins

Caput Medusae

Dilation of — radiating from the umbilicus

Caused by —, diversion of blood into hepatic portal vein —> — (within the falciform ligament)

superficial abdominal wall

hepatic portal hypertension ; paraumbilical veins

Superficial Fascia

Above umbilicus - superficial fascia is — layer

Below umbilicus - superficial fascia is divided into : — and —

only one

Superficial Fatty Layer (Camper’s Fascia) Continuous with superficial adipose tissue throughout the body

Deep Membranous Layer (Scarpa’s Fascia) Continuous with Colles Fascia around the scrotum , fuses deep fascia of the thigh

Superficial Fascia

There is a — between the deep membranous layer of superficial fascia and the deep fascia covering abdominal muscles

• Fluid can accumulate here (in lower abdomen, scrotum, pelvis)

• Fluid here will — spread into the thigh

potential space

not

Penile / Bulbar Urethral Injury

Tramatic — injury

Can — the penile / bulbar urethra

Results in — of blood / urine into the potential space (b/w scarpa’s fascia and deep investing fascia of abdominal muscles)

straddle

rupture

extravasation

Abdominal Wall Muscles

External Oblique

Internal Oblique

Transversus Abdominis

Rectus Abdominis

• Tendinous Intersections subdivide rectus abdominis into multiple segements