Anterolateral Abdominal Wall and Inguinal Canal

What is the abdominal cavity?

Space between thoracic and pelvic cavities

What is the superior border of the abdominal cavity?

Thoracic diaphragm

What is the inferior border of the abdominal cavity?

Pelvic inlet

What is the abdominal cavity lined with?

Parietal peritoneum

What is this bone called?

Os Coxa

What is indicated by A?

Ilium

What is indicated by B?

Pubis

What is indicated by C?

Ischium

What is indicated by D?

Iliac Crest

What is indicated by E?

Anterior Superior Iliac Spine (ASIS)

What is indicated by F?

Pectineal line (pectin pubis)

What is indicated by G?

Pubic tubercle

What is indicated by H?

Pubic crest

What is indicated by I?

Pubic symphysis

What is indicated by J?

Arcuate line of the ilium

What is indicated by K?

Auricular surface

What is indicated by L?

Pubic ramus

What is the midclavicular plane?

Midpoint of the clavicles to the mid-inguinal point

What is the subcostal plane?

Across the inferior border of the 10th costal cartilage

What is the transtubercular plane?

Passes through the iliac tubercles on each side and across the body of L5

What region is indicated by A?

Right hypochondrium

What region is indicated by B?

Epigastric

What region is indicated by C?

Left hypochondrium

What region is indicated by D?

Right flank (lateral)

What region is indicated by E?

Umbilical

What region is indicated by F?

Left flank (lateral)

What region is indicated by G?

Right inguinal

What region is indicated by H?

Pubic (hypogastric)

What region is indicated by I?

Left inguinal

What is the median plane?

Longitudinal line that separates the body into right and left halves

What is the transumbilical plane?

Transverse line that passes through the umbilicus, between L3 and L4

What are the major components of the RUQ?

Right lobe of liver, gallbladder, right kidney

What are the major components of the LUQ?

Spleen, stomach, left kidney, pancreas

What are the major components of the RLQ?

Appendix and cecum

What are the major components of the LLQ?

Sigmoid colon, inferior portion of the descending colon

What is McBurney’s Point?

Superficial landmark for the appendix

Where is McBurney’s Point located?

2/3 between the umbilicus and ASIS (RLQ)

What are the two layers of superficial fascia of the abdominal cavity?

Camper’s and Scarpa’s

What is Camper’s fascia?

Fatty superficial layer, most superficial, just deep to the skin

What is Scarpa’s fascia?

Membranous layer, deep to Camper’s, fuses with the fascia lata of the thigh and continues into the perineum as the superficial perineal fascia (Colle’s) attaching to the penis, and extends into the labia majora in the vulva

What is the anterior muscle of the abdominal wall?

Rectus abdominus

What are the lateral (flank) muscles of the abdominal wall?

External oblique, internal oblique, and transversus abdominus

What innervates all muscles of the abdominal wall?

Ventral rami of T6-T12 and L1

What is the general action of all 4 abdominal wall muscles?

Compress and support abdominal viscera

What are the attachments of external oblique?

Ribs 5-12, linea alba, pubic tubercle, and iliac crest

What innervates the external oblique?

T7-T12

What is the fiber orientation of external oblique?

Supero-lateral to infero-medial (hands in pockets)

What are the attachments of internal oblique?

Thoracolumbar fascia, iliac crest, inguinal ligament, inferior borders of ribs 10-12, linea alba, pectineal line

What innervates internal oblique?

T6-T12 and L1

What is the fiber orientation of internal oblique?

Infero-lateral to supero-medial (choking yourself)

What are the attachments of transversus abdominus?

7th-12th costal cartilages, thoracolumbar fascia, iliac crest, inguinal ligament, linea alba, pubic crest, pectineal line

What innervates transversus abdominus?

T6-T12 and L1

What is the fiber orientation of transversus abdominis?

Transversely

What is ipsilateral contraction?

A muscle contraction that occurs on the same side of the body as a reference point

What is contralateral contraction?

A muscle action that produces movement on the opposite side of the body from where the contracting muscle is located

What occurs during ipsilateral contraction of the abdomen?

External and internal oblique muscles contract from the same side

What occurs during contralateral contraction of the abdomen?

External oblique from one side contracts and internal oblique from the opposite side contracts; twist toward side of contracted internal oblique

What are the attachments of the rectus abdominus?

Pubic symphysis, pubic crest, xiphoid process, 5-7th costal cartilages

What innervates rectus abdominus?

T6-T12

What separates the different muscle bellies of the rectus abdominus?

Tendinous intersections

What separates the right and left muscles of the rectus abdominus?

Linea alba

What encases the rectus abdominus?

Rectus sheath

What forms the rectus sheath?

Crossing of the aponeuroses of external oblique, internal oblique, and transversus abdominus

What are the contents of the rectus sheath?

Rectus abdominus (superior 2/3), superior and inferior epigastric arteries, lymphatic vessels, distal portions of thoracoabdominal nerves

What is the arcuate line?

Point where rectus abdominus travels within the rectus sheath

What are the contents of the anterior rectus sheath above the arcuate line?

Aponeuroses of external and internal obliques

What are the contents of the posterior rectus sheath above the arcuate line?

Aponeuroses of internal oblique and transversus abdominus

What are the contents of the anterior rectus sheath belowthe arcuate line?

Aponeuroses for all three flank muscles

What is located posterior the rectus abdominus inferior to the arcuate line?

Transversalis fascia

What are Spigelian hernias?

Weakness in the abdominal wall at the juncture of the arcuate line and lateral rectus sheath

What are the 6 F’s of abdominal enlargement?

Fat, fluid, fetus, food, flatus, feces

Above the umbilicus, how are the superficial veins oriented?

Network is drained into the axillary vein via the lateral thoracic vein

Below the umbilicus, how are the superficial veins oriented?

Network is drained into the femoral vein via the superficial epigastric vein

What is the para-umbilical vein?

Connection of the networks through the umbilicus and along the ligamentum teres of the liver to the portal vein

What supplies the lateral abdominal wall?

Intercostal and subcostal arteries and veins

What supplies the rectus abdominus?

Super and inferior epigastric artery and veins

What composes the lateral fold?

Inferior epigastric artery and vein

What composes the medial fold?

Remnants of the umbilical artery

What composes the median fold?

Remnants of the urachus

What composes the ligamentum teres hepatis?

Umbilical vein

Above the umbilicus, how is lymphatic drainage oriented?

Drain to anterior axillary lymph nodes

Below the umbilicus, how is lymphatic drainage oriented?

Drain to superficial inguinal lymph nodes

Where does lymphatic drainage from the scrotum go?

Superficial inguinal lymph nodes

Where does lymphatic drainage from the testes go?

Lumbar lymph nodes

What are the thoraco-abdominal nerves?

Continuations of the T7-T11 intercostal nerves

What is the sensory innervation of T7-T9?

Skin superior to the umbilicus

What is the sensory innervation of T10?

Skin around the umbilicus

What is the sensory innervation of T11?

Skin inferior to the umbilicus

What is the T12 nerve also known as?

Subcostal nerve

What is the sensory innervation of the subcostal nerve?

Skin superior to the iliac crest and inferior to the umbilicus

What is the motor innervation of the iliohypogastric nerve (L1)?

Internal oblique and transversus abdominus

What is the sensory innervation of the iliohypogastric nerve (L1)?

Region of skin from iliac crest and superior to inguinal ligament

What is the motor innervation of the ilioinguinal nerve (L1)?

Internal oblique and transversus abdominus

What is the sensory innervation of the ilioinguinal nerve (L1)?

Skin of lower inguinal region, mons pubis, anterior labium majora/scrotum, and medial thigh

Where the ilioinguinal nerve found?

Travels through inguinal canal, but does not pass through the deep inguinal ring.

What is the motor innervation of the genital branch of the genitofemoral nerve (L1-L2)?

Cremaster muscle

What is the sensory innervation of the genital branch of the genitofemoral nerve (L1-L2) ?

Root of penis and anterolateral surface of scrotum/labium majora and mons pubis

Where is the genital branch of the genitofemoral nerve (L1-L2) found?

Within the inguinal canal

What is the sensory innervation of the femoral branch of the genitofemoral nerve (L1-L2) ?

Small area of skin on the medial aspect of the superior anterior thigh

What is the cremasteric reflex used to test for?

Injury of L1