Brigs anatomy exam 2

origin of the external abdominal oblique m

ribs 5-12

insertion of the external abdominal oblique m

aponeurosis to the linea alba

iliac crest

pubic crest

innervation of the external abdominal oblique m

ventral rami of the lower 6 thoracic spinal nerves

iliohypogastric n

ilioinguinal n

same an internal abdominal oblique and transversus abdominus

action of the external abdominal oblique m

support and compress abdominal contents

flexion and rotation of trunk

same as internal abdominal oblique

origin of the internal abdominal oblique m

lumbar fascia

iliac crest

lateral 2/3 of the inguinal ligament

insertion of the internal abdominal oblique m

aponeurosis to ribs 10-12

xiphoid process

linea alba

pubic symphysis

innervation of internal abdominal oblique

ventral rami of lower 6 thoracic spinal nerves

iliohypogastric n.

ilioinguinal n.

same as external abdominal oblique and transversus abdominus

action of the internal abdominal oblique m

support and compress abdominal contents

flexion and rotation of the trunk

same as external abdominal oblique

origin of the transversus abdominis m

ribs 7-12

lumbar fascia

iliac crest

lateral 1/3 of inguinal ligament

insertion of transversus abdominis m

xiphoid process

linea alba

pubic symphysis

same as internal oblique minus ribs

innervation of the transversus abdominis m

ventral rami of lower 6 thoracic spinal nerves

iliohypogastric n

ilioinguinal n

same as both obliques

action of the transversus abdominus m

support and compress abdominal contents

-acts as a girdle to abdomen, helps with IAP

origin of the rectus abdominis m

pubic crest

pubic symphysis

insertion of the rectus abdominis m

costal cartilage of ribs 5-7

note: these are 3 tendonous structures in the belly muscles

innervation of rectus abdominis m

ventral rami of the lower 6 thoracic spinal nerves

note: this is lacking ilio muscles seen in obliques and transversus abdominis

action of the rectus abdominis m

support and compress abdominal contents

flex the trunk

2 planes in the quadrant method

median

transumbilical

RUQ organs

liver

colon

R kidney

gallbladder

pancreas

LUQ organs

liver

colon

L kidney

stomach

spleen

pancreas

RLQ organs

colon

small intestine

appendix

ureter

major a and v to R leg

R kidney

LLQ organs

colon

small intestine

L kidney

ureter

major a and v to L leg

9 regions

umbilical

hypogastric

epigastric

L and R iliac

L and R lumbar

L and R hypochondriac

3 planes for regions

subcostal

transtubercular

midclavicular

Umbilicus level

L3-L4 in someone lean

pubic crest

bony ridge lateral from pubic symphysis to pubic tubercle

pubic tubercle

small, rounded elevation where inguinal ligament attaches

iliac crest

bony ridge coming posteriorly from anterior superior iliac spine

iliac tubercle

thickened part of iliac spine 6cm posterior to anterior superior iliac spine

inguinal groove

separates abdomen and leg

-site of inguinal ligament which goes from ASIS to pubic tubercle

epigastric fossa

pit under xiphoid process

linea alba

from fascial planes surrounding abdominal muscles

-xiphoid process to pubic symphysis

-location of medial borders of rectus abdominis

linea semilunaris

curved groove from 9th costal cartilage to pubic tubercle

-location of lateral borders of rectus abdominis

midinguinal point

midpoint of line between ASIS and pubic symphysis

superior border of abdominal wall

L and R costal margins

inferior border of abdominal wall

horizontal line connecting anterior and superior iliac spines

lateral border of abdominal line

vertical line through anterior superior iliac spines

Horizontal planes (4)

1. transpyloric @ L1

2. subcostal @ L3

3. transumbilical @ L3-L4

4. transtuberculear @ L5

transpyloric plane

L1

midway between suprasternal notch and pubic symphysis

-passes pylorus of stomach

two layers of superficial fascia in the abdominal wall

1. camper's fascia - fat (fat little campers)

2. scarpa's fascia - deep fascia blends with fascia lata from thigh

Anterior wall of the rectus sheath

formed of the aponeuroses of the internal and external oblique muscles

posterior wall of the rectus sheath

formed from the aponeuroses of the internal oblique and transversus abdominis muscles

what do the aponeuroses form in the middle

linea alba

arcuate line

posterior wall of the rectus sheath between umbilicus and pubic rami

-formed as posterior and anterior rectus sheaths fuse

below arcuate line

no posterior rectus sheath, just a thin layer known as transversalis fascia

Inguinal ligament

-formed by aponeuroses of external abdominal oblique as it reflects inwards

-attached laterally to anterior superior iliac spine

-attached medially to pubic tubercle

lacunar ligament

-also EAO aponeuroses, but it is reflected anteriorly

-attaches to pectineal ligament and line on innominate bone

-is an extension of the inguinal ligament

-medial border of inguinal triange

Location of the inguinal canal

medial 1/2 of the inguinal ligament, directly superior

-is ~5cm long and connects the abdominal cavity to the external abdominal wall w/ reproductive structures

inguinal canal contents

males = spermatic cord

females = round ligament

significance of an oblique course in the inguinal canals

hernia

borders of inguinal canal

anterior - aponeurosis of the external abdominal oblique

posterior - transversalis fascia and conjoint tendon

inferior - inguinal and lacunar ligaments

superior - internal abdominal oblique and transversus abdominis muscles

superficial inguinal ring

medial end of the inguinal canal

-superior and lateral to the pubic tubercle

-arched opening in the IAO aponeurosis

-medial and lateral crus

medial and lateral crus attachments of the inguinal ring

medial crus - pubic symphysis

lateral crus - pubic tubercle

deep inguinal ring

lateral end of inguinal canal

-goes through the transversalis fascia superior to the external iliac artery

-courses medially to the external iliac artery

-runs lateral to the inferior epigastric artery

function of the round ligament

smooth muscle that anchors the labia majora

reflected ligament

is the inguinal ligament reflected superiorly to the linea alba

conjoint tendon

aponeuroses of the IAO and transversus abdominis

-reinforce posterior wall of inguinal canal

direct inguinal hernia

older males

-peritoneal bulge through the posterior wall of the inguinal canal due to thin transversalis vascia

hasselbach's triange - direct inguinal hernias - borders

lateral - inferior epigastric artery

inferior - inguinal ligament

medial - rectus abdominis muscle

indirect inguinal hernias

most common, usually R sided

-peritoneal contents push through the deep inguinal ring into inguinal canal

femoral hernia

more in females

-peritoneal bulge passes through femoral ring to femoral canal

2 types of umbilical hernias

congenital and acquired

congenital umbilical hernias

when the midgut does not return to abdominal cavity during fetal development

acquired umbilical hernias

infancy: weakness in scar of umbilicus in linea alba

adult: more in women, umbilical region of linea alba

epigastric hernia

high intra-abdominal pressure

-in the large portion of the linea alba between the xiphoid and umbilicus

-middle-aged laborers

superior border of the abdominal cavity

diaphragm

inferior border of the abdominal cavity

none b/c it is continuous with the pelvic cavity

which muscular and fascial structures form the anterior, posterior, lateral walls of the abdominal cavity

external abdominal oblique

internal abdominal oblique

transversus abdominis

rectus abdominis

transversalis fascia

ribs

Peritoneum

-thin, serous membrane of abdominal and pelvic cavity

-mesothelium as "middle" layer

-thin basement layer of alveolar CT

Structure of the peritoneum

folds back on itself to create 2 layers: visceral and parietal

parietal peritoneum

lines the peritoneal cavity

visceral peritoneum

covers the external surfaces of abdominal organs

2 specializations of the peritoneum

omentum and mesothelium

omentum

greater and lesser

-double-layered peritoneum with adipose, blood vessels, and lymphatic cells

-connects the stomach to body wall or other viscera

greater omentum

has a free edge

is connected to one organ, greater curvature of stomach

3 ligaments that bind the stomach to other structures (formed by the greater omentum)

gastrophrenic ligament

gastrosplenic ligament

gastrocolic ligament

lesser omentum

attaches one organ to another

connects the lesser curvature of stomach to the duodenum

what 2 ligaments are formed by the lesser omentum connection the stomach to the duodenum

1. hepatogastric ligament

2. hepatoduodenal ligament

what is contained within the hepatoduodenal ligament?

the portal triad

portal vein, hepatic artery, bile duct

mesentery

double layered peritoneum that anchors organs to the abdominal wall

-contains blood vessels, nerves, and lymph vessels to supply organs

function of omentum

some degree of lymphatic protection against infection spread

Lesser sac

space between the stomach and posterior abdominal wall

-posterior to lesser omentum and superior to transverse colon

greater sac

remainder of the peritoneal cavity, anterior to lesser omentum

epiploic forament

opening between the greater and lesser sac which allows communication

anterior border of the epiploic foramen

the portal triad on the gastroduodenal ligament

posterior border of the epiploic foramen

inferior vena cava

superior border of the epiploic foramen

caudate lobe of the liver

inferior border of the epiploic foramen

duodenum, portal vein, hepatic artery, bile duct

7 different mesenteries

1. mesentery proper

2. sigmoid mesocolon

3. transverse mesocolon

4. mesoappendix

5. falciform ligament (only ligament to anterior abdominal wall)

6. ligamentum teres (remanent from umbilical vein in fetus)

7. coronary ligament (between liver and diaphragm)

importance of compartments, gutters, and recesses

allow for flow of ascites fluid and infectious material between the abdomen and pelvis

Supracolic compartment

Greater sac above the transverse colon containing the liver, stomach, and spleen

-divided into smaller sections by visceral ligaments

2 subdivisions of the supracolic compartment

1. L and R subphrenic spaces - divided by coronary ligaments

2. hepatorenal pouch

Infracolic compartment

Greater sac below the transverse colon containins small intestine, ascending and descending colon

-divided by mesentery proper

2 infracolic compartment subdivisions

1. R infracolic space

2. L infracolic space

divided by the mesentery proper

peritoneal gutters

a means for the supra and infracolic compartments to communicate

4 peritoneal gutters

1. R lateral paracolic gutter

2. L lateral paracolic gutter

3. Gutter to the right of the mesentery

4. Gutter to the left of the mesentery

Right paracolic gutter

lateral to the ascending colon

-communication between the lesser sac and pelvis

-pathway for infection between hepatorenal pouch and pelvis

left paracolic gutter

lateral to the descending colon

gutter to the right of the mesentery

is bounded both inferiorly and superiorly

gutter to the left of the mesentery

is open to the pelvis

what is the only gutter that does not connect to the pelvis?

the gutter to the right of the mesentery