Anterior and Posterior Abdominal Wall

Superficial fatty layer of subcutaenous tissue

camper fascia

deep membranous layer of subcutaneous tissue

scarpa fascia

functions of anterior abdominal wall

strong, expandable support

protects viscera

compress viscera (coughing, respiration)

produce force (defaction, vomiting)

flexion and rotation of trunk

maintain posture

External abdominal oblique

passes inferomedially

joins serratus anterior and latismus dorsi

INFERIOR margin forms ingunial canal

Internal Abdominal Oblqiue

fibers run perpendicular from external

IAO orgin

from thorcolumbar fascia and iliac crest

IAO insertion

inferior ribs, linea alba, pubisc

what gives 6 pack look

rectus abdominus

rectus abdominus enclosed in

rectus sheath

rectus abdominus orginates

pubic crest

symphysis

rectus abdominus inserts

xiphoid process and lower costal cartilages

pyramidalis

absesbt in about 20% of ppl

helps tense linea alba

somatic belly button

T12

sensory of groin

iliohypogastric nerve and ilio-inguinal nerve (L1)

thoraco-abdominal nerves

T7-T11

Inguinal region extends from

ASIS and pubic tubercle

inguinal region

where structures exit and enter abdominal cavoty

common site of herinas

inguinal ligament

inferior portion of external oblique aponeurosis

inguinal canal

formed due to the relocation of the gonads during fetal development

anterior border of inguinal canal

external abdominal oblique aponeurosis

reinforced by internal abdominal oblique

posterior inguinal border

transversalis fascia

reinforced by internal abdominal oblique and transversus abdominus

roof of inguinal canal

transversalis fascia and aponeurotic arches of EAO, IAC and transversus abdominus

floor of inguinal canal

inguinal ligament

contents of inguinal canal

spermatic cord

round ligament of uterus

blood and lympthatic vessel

ilioinguinal and genitofemoral nerves

Deep (internal ) ring

internal entrance

folding outward of transversalis fascia lateral to the inferior epigastric vessels

superficial (internal) ring

exit from canal

increases intra-abdominal pressure

can force structures through the inguinal canal (hernias)

inguinal triangle

area of potential weakness

common site for direct inguinal herinas

Spermatic cord

contains structures running to and from the testis and suspends testis in the scrotum

Spermatic cord contents

cremaster muscle

ductus deferens

testicular artery

pampiniform venous plexous

genitofemoral nerve

lympathic vessels

sympathetic nerve fibers

epididymus and testis covered by

tunica vaginalis

ductus deferens

tube that conveys sperm from the epididymis to the ejaculatory duct (prostate)

cremaster muscle formed by

internal abdominal oblique

cremaster muscle function

reflexively draws the testis superiorly in the scrotum (temperature regulation)

cremaster innervated by

genitofemoral nerve

testes

produce spermatoza and hormones

testosterone

Epididymis

transport of newly formed sperm and storage until mature

Scrotum

cutaneous sac that contains testes

DIRECT inguinal hernia weakness of

anterior abdominal wall in inguinal triangle

Direct inguinal hernia only in

peritoneum and transversalis fascia

direct inguinal hernia exits via

superficial ring

rarely enters the scrotum

lateral to spermatic cord

direct inguinal hernia and inferior epigastic vessles

MEDIAL to inferior epigastric vessels

Indirect Inguinal hernia and birth

may be from the processus vaginalis remianing open instead of closing after birth

inguinal hernia transversus

the inguinal canal and typically enters the spermatic cord

then scrotum/ labia majorum

indirect hernia and inferior epigastric vessels

LATERAL

liposuction

surigical method for removing unwanted fat

endoabdominal fascia provides

a plane that can be opened

allows surgeron to apporach organs in posterior abdominal wall without entering the membranous peritoneal sac

Between transversalis fascia and pareital perioneum is a space used for ____

placing prosthesis when repairing inguinal hernias

Abdominal Surgical Incisions

when possible follow clevage lines or muscle fibers

bc of overlapping innervation, 1-2 small nerves may be cut w/out noticeable muscle loss or sensation loss

longitudinal incisions

offer good exposure to viscera and can be extended as nessescay

median incisions

made along linea alba (from xiphoid process to pubic symphsis)

realtively bloodless and avoids major nerves

may undergo necrosis if incision not properly sewn

Paramedian incision

costal margin to pubic hairline

passes thru rectus sheath

moves muscle lateral to avoid injuiry

Transverse incision

made thru anterior layer of rectus sheath and rectus abdominus

superior and inferior expansion is difficult

incision on left side

spleen access

incisional hernia

protursion of omentum or organ thru surgical incision

can be resukt of muscular and aponeurotic layers not healing

minimially invasive surgery

many abdominal procedures performed using laproscope

minimizes nerve injury, incisional hernia, comtamination thru open wound

Abdomen Protuberunce

food

fluid

fat

feces

flacus

fetus

could also bc in old ppl abdominal muscles are weak and pelvis tilts anteriorly

palpation of anterlateral abdominal wall

warm hands are important to keep abdominal muscles from tensing

guarding can occur when organ is inflammed to protect viscera from pressure

patient is laying down, thighs and knees bent, and arms at side

reversal of venous flow

when flow in superior or inferior vena cava is obstructed, collateral pathways made (with anatomses btwn systemic veins)

allows blood to return to heart

Hydrocele of spermatic cord

presesnce of excess fluid in a persisnet processus vaginalis

may be bc of indirect hernia

Hematocela

collection of blood in tunica vaginalis

(from ruotured branches of testicular artery)

trauma may produce bruise

Vesectomy

part of ductus deferns cut

ejeculated fluid has no sperm

unexplled sperm degenerates in epidydimus

Variocele

pampiniform veins become dialated and torturous

visible only when standing or straining

palpating = bag of worms

usually on left side

cremaster reflex

caused by lightly stroking skin on thigh

ilio-inguinal nerve supplies skin

extremly active in children

testicular cancer

lymphenougous drainage

approached thru inguinal incision

commonly mistaken for hydrocele

Liver spinal nerves

presynaptic

parasympathetic

t6-t9

Gallbladder spinal nerve

postsynaptic

sympathetic

t6-t9

supraadrenal gland spinal nerve

pre and post synaptic

sympathetic

t6-L2

kidney spinal nerve

post synpatic

sympathetic

t10-L1

stomach spinal nerve

presyanptic

parasympatic

t6-t9

Pancrease spinal nerve

presynaptic

parasympathetic

t8-t10

cecum spinal level

T10

Asceding spinal level

t10

parasympathetic

transverse spinal level

t11

sympathetic

descedning spinal level

T12-L1

both

sigmoid spinal level

s2

both

Respiratory diaphragm seperates

thoracic and abdominal cavities

Respiratory diaphragm cheif muscle

of inspiration

(inspiration = descends and contracts)

respiratpry diaphragm innerveated by

phrenic nerve

Caval opening

IVC- t8

opening in central tendon

Esphageal hiatus

esphagus- t10

formed by right crus of diaphragm

Aortic hiatus

aorta: t12

opening posterior to diaphragm

subcostal nerve

T12

ilioinguinal nerve

L1

genitofemoral nerve

on top of psoas major

motor to cremasseter

iliohypogastric nerve

L1

femoral nerve

l2, l3, l4

referred pain from diaphragm

referred to shoulder along phrenic (c3-C5)

irrataion of perpherial regions of diaphragm refer to skin over costal margins of anterolateral abdominal wall

rupture of diaphragm and herination of viscera

result of sudden increase in abdominal pressur e

car accident

usaully on left side bc liver provides barrier

Congeinital dipahragm herina

part of stomach and intesine herinate thru large posterolateral defect

always on left

left lung has no room to inflate = death

Collateral routes for abdominopelvic blood

3 collateral routes for when IVC is obstructed

2 routes = superior and inferior epigastric veins

last route = epidural venous plexus (communicates with lumbar and azygous veins)

IVC anomalies are common

Section of phrenic nerve

in neck = complete paralysis and atrophy of corresponding ½ of diaphragm

recoingzed radiographically ( permeant elevation and paradoxial movement)

Abdominal Aortic Aneurysm

tumor in stomach or pancreas may be mistaken as aneurism

actue rupture = severe pain in abdomen or back (high mortality rate)

deceted by palpation

can be repaired by surgeons inserting proethstic graft and sewing aorta wall for protection

Psoas Abcess

result of TB spreading in lumbar region from vertebrae to psoas fascia

forms pus

large intestine, cecum, appendix, sigmoid colon, may be trapped causing pain

Posterior Abdominal Pain

iliospoas muscle has realtionships with appendix, sigmoid colon, pancreas, lumbarlymph nodes, nerves of posterior abdominal wall

any of these structures become diseased causes pain when iliospoas moves