Gross anatomy Week 5
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Questions and Answers

What is the function of the transversalis fascia?

  • To form the rectus sheath
  • To line the inner surface of the anterolateral abdominal wall
  • To provide additional support to the pyramidalis muscle
  • To cover the deep surface of the transversus abdominis (correct)

    • What is the characterization of the extraperitoneal fascia?

  • A layer of loose connective tissue with a variable amount of fat (correct)
  • A fibrous band that extends from the xiphoid process to the pubic symphysis
  • A layer of dense connective tissue
  • A serous membrane that lines the inner surface of the anterolateral abdominal wall

    • How many muscles are present on each side of the anterolateral abdominal wall?

  • 2 broad and thin muscles
  • 5 broad and thin muscles
  • 3 broad and thin muscles (correct)
  • 4 broad and thin muscles

    • What is the name of the muscle present anterior to the lower part of the rectus abdominis?

    <p>Pyramidalis</p> Signup and view all the answers

    What is the function of the aponeuroses of the 3 flat muscles?

    <p>To form the rectus sheath</p> Signup and view all the answers

    What is the origin of the external oblique muscle?

    <p>Outer surface of the lower 8 ribs</p> Signup and view all the answers

    What is the direction of the fibers of the external oblique muscle on an anterior view?

    <p>Inferiorly and medially</p> Signup and view all the answers

    What is the structure formed by the fusion of the aponeuroses of the 3 right flat muscles and the 3 left flat muscles?

    <p>Linea alba</p> Signup and view all the answers

    Which of the following nerves does not enter the rectus sheath?

    <p>Iliohypogastric nerve</p> Signup and view all the answers

    What is the level of the T10 dermatome?

    <p>At the level of the umbilicus</p> Signup and view all the answers

    What is the purpose of mapping out regions on the anterolateral abdominal wall?

    <p>To locate and record symptoms and signs of abdominal diseases</p> Signup and view all the answers

    What is the level of the subcostal plane?

    <p>Body of L3, near its upper border</p> Signup and view all the answers

    What is the function of the nerves of the anterolateral abdominal wall?

    <p>Provide motor and sensory innervation to muscles and skin of the anterolateral abdominal wall</p> Signup and view all the answers

    What is the midclavicular plane?

    <p>A vertical plane that passes through the midpoint of the clavicle and intersects halfway a line connecting the anterior superior iliac spine (ASIS) to the pubic tubercle</p> Signup and view all the answers

    What is the posterior wall of the rectus sheath formed by?

    <p>Aponeurosis of transversus abdominis muscle</p> Signup and view all the answers

    What is the location of the arcuate line?

    <p>Half-way between the umbilicus and pubic symphysis</p> Signup and view all the answers

    How many regions are formed by the 2 midclavicular planes and 2 horizontal planes (subcostal and transtubercular)?

    <p>9 regions</p> Signup and view all the answers

    Which artery supplies the upper central part of the anterior abdominal wall?

    <p>Superior epigastric artery</p> Signup and view all the answers

    What is the lower part of the anterolateral abdominal wall composed of?

    <p>Pubic, hypogastric region or hypogastrium, right and left inguinal (iliac) regions</p> Signup and view all the answers

    What is the significance of the arcuate line?

    <p>It marks the lower end of the posterior aponeurotic wall of the rectus sheath</p> Signup and view all the answers

    What is the deepest layer of the anterolateral abdominal wall?

    <p>Parietal peritoneum</p> Signup and view all the answers

    What are the three aponeuroses that pass anterior to the rectus abdominis muscle in the lower 1/4 of the anterior abdominal wall?

    <p>External oblique, internal oblique, and transversus abdominis</p> Signup and view all the answers

    What is Camper's fascia?

    <p>A superficial, fatty layer of the superficial fascia</p> Signup and view all the answers

    What is the purpose of the deep (investing) fascia?

    <p>To cover the superficial and deep surfaces of the flat abdominal muscles</p> Signup and view all the answers

    What is the origin of the superior epigastric artery?

    <p>Internal thoracic artery</p> Signup and view all the answers

    What is the attachment of the posterior wall of the rectus sheath?

    <p>Transversalis fascia</p> Signup and view all the answers

    What is the function of Scarpa's fascia?

    <p>To fuse with the fascia lata of the thigh</p> Signup and view all the answers

    What is the relationship between the transtubercular plane and the body of L5?

    <p>The transtubercular plane lies at the level of the body of L5, near its upper border</p> Signup and view all the answers

    What is the insertion point of the lower fibers of the external oblique muscle?

    <p>Xiphoid process, linea alba, and pubic bone</p> Signup and view all the answers

    What is the function of the pyramidalis muscle?

    <p>Tensor of the linea alba</p> Signup and view all the answers

    What is the action of the transversus abdominis muscle on trunk movements?

    <p>It contributes little to trunk movements</p> Signup and view all the answers

    What is the boundary between the abdomen and thigh formed by?

    <p>Inguinal ligament</p> Signup and view all the answers

    What is the location of the superficial inguinal ring?

    <p>Immediately superior to the pubic tubercle</p> Signup and view all the answers

    What is the origin of the rectus abdominis muscle?

    <p>Pubic symphysis and pubic crest</p> Signup and view all the answers

    What is the function of the anterolateral abdominal muscles in increasing intra-abdominal pressure?

    <p>They help in evacuation of contents of abdominal and pelvic hollow organs</p> Signup and view all the answers

    What is the contents of the rectus sheath?

    <p>Rectus abdominis, pyramidalis, terminal parts of lower 5 intercostal nerves, subcostal nerve, and superior and inferior epigastric vessels</p> Signup and view all the answers

    What is the action of the oblique muscles on the trunk?

    <p>They are involved in flexion, lateral flexion, and rotation of the trunk</p> Signup and view all the answers

    What is the location of the inguinal ligament?

    <p>Lower border of the external oblique aponeurosis</p> Signup and view all the answers

    Which artery anastomoses with the superior epigastric artery?

    <p>Inferior epigastric artery</p> Signup and view all the answers

    Which vein drains into the axillary vein?

    <p>Superficial veins of the anterolateral abdominal wall</p> Signup and view all the answers

    Which lymph node receives lymph drainage from the superficial lymph vessels below the level of the umbilicus?

    <p>Superficial inguinal lymph node</p> Signup and view all the answers

    Which artery supplies the lower lateral part of the anterior abdominal wall?

    <p>Deep circumflex iliac artery</p> Signup and view all the answers

    Which vein accompanies the deep circumflex iliac artery?

    <p>Deep circumflex iliac vein</p> Signup and view all the answers

    Which artery originates from the distal part of the external iliac artery?

    <p>Inferior epigastric artery</p> Signup and view all the answers

    Which lymph node receives lymph drainage from the deep lymph vessels that follow the arteries and deep veins?

    <p>Internal thoracic lymph node</p> Signup and view all the answers

    Which vein drains into the azygos vein?

    <p>Lower posterior intercostal vein</p> Signup and view all the answers

    What is the main content of the spermatic cord in males?

    <p>Spermatic cord (formed by structures running between testis and abdominopelvic cavity) and ilioinguinal nerve</p> Signup and view all the answers

    What is the location of the deep inguinal ring in relation to the ASIS and pubic tubercle?

    <p>Halfway between ASIS and pubic tubercle</p> Signup and view all the answers

    What is the feature of the neck of a hernia sac in relation to an indirect inguinal hernia?

    <p>narrow</p> Signup and view all the answers

    What percentage of abdominal hernias occur in the inguinal region?

    <p>75%</p> Signup and view all the answers

    What is the term used to describe the relationship of the stomach to its peritoneal covering?

    <p>Intraperitoneal</p> Signup and view all the answers

    What is the neck of the hernial sac in a direct inguinal hernia?

    <p>Wide</p> Signup and view all the answers

    What is the boundary of the inguinal triangle?

    <p>Inferior epigastric vessels laterally, rectus abdominis medially, and inguinal ligament inferiorly</p> Signup and view all the answers

    What is the name of the peritoneal fold that connects the liver to the anterior abdominal wall?

    <p>Falciform ligament</p> Signup and view all the answers

    What is the term used to describe the relationship of the duodenum to its peritoneal covering?

    <p>Retroperitoneal</p> Signup and view all the answers

    What is the origin of an indirect inguinal hernia?

    <p>Persistence of the processus vaginalis</p> Signup and view all the answers

    What is the function of the hepatoduodenal ligament?

    <p>Contains ducts, blood vessels, lymph vessels, and nerves traveling to and from the liver</p> Signup and view all the answers

    What is the name of the peritoneal fold that hangs down from the greater curvature of the stomach?

    <p>Greater omentum</p> Signup and view all the answers

    What type of fold is the greater omentum?

    <p>Four-layered peritoneal fold</p> Signup and view all the answers

    What is the key relationship of the greater omentum?

    <p>It attaches the stomach to the transverse colon</p> Signup and view all the answers

    What type of intestines have a mesentery?

    <p>Intraperitoneal intestines</p> Signup and view all the answers

    What is the function of the mesentery?

    <p>To allow blood vessels, lymph vessels, and nerves to reach the intestines</p> Signup and view all the answers

    What is the transverse mesocolon?

    <p>A fold of peritoneum that attaches the transverse colon to the posterior abdominal wall</p> Signup and view all the answers

    What is formed by the space between the 2 anterior and 2 posterior layers of the greater omentum?

    <p>An obliterated space</p> Signup and view all the answers

    What happens to some parts of the digestive tract during development?

    <p>They adhere to the posterior abdominal wall, lose their mesentery, and become retroperitoneal</p> Signup and view all the answers

    What is the main characteristic of secondary retroperitoneal organs?

    <p>They are more fixed in position and do not have a mesentery</p> Signup and view all the answers

    What is the communication between the lesser sac and the greater sac called?

    <p>The epiploic foramen</p> Signup and view all the answers

    What is the purpose of the mesentery?

    <p>To connect the loops of the small intestine to the posterior abdominal wall</p> Signup and view all the answers

    What is the name of the part of the peritoneal cavity located posterior to the lesser omentum and stomach?

    <p>The lesser sac</p> Signup and view all the answers

    What is the superior extension of the lesser sac called?

    <p>The superior recess</p> Signup and view all the answers

    What structure forms the posterior boundary of the epiploic foramen?

    <p>Inferior vena cava</p> Signup and view all the answers

    Which of the following nerves innervates the peritoneum that covers the peripheral part of the undersurface of the diaphragm?

    <p>Lower 5 intercostal nerves</p> Signup and view all the answers

    What is the name of the fibrous cord that extends from the apex of the urinary bladder to the umbilicus?

    <p>Median umbilical ligament</p> Signup and view all the answers

    What is the name of the compartment located below the transverse colon and its mesentery?

    <p>Infracolic compartment</p> Signup and view all the answers

    Which of the following statements is true about pain originating from the parietal peritoneum?

    <p>It is usually more intense and well localized</p> Signup and view all the answers

    What is the name of the fold formed by the peritoneum that covers the median umbilical ligament?

    <p>Median umbilical fold</p> Signup and view all the answers

    Match the following organs with their classification based on their relationship to the peritoneum:

    <p>stomach = intraperitoneal organ jejunum = intraperitoneal organ ileum = intraperitoneal organ transverse colon = intraperitoneal organ sigmoid colon = intraperitoneal organ spleen = intraperitoneal organ most of duodenum = retroperitoneal organ pancreas = retroperitoneal organ ascending colon = retroperitoneal organ descending colon = retroperitoneal organ kidneys = retroperitoneal organ suprarenal glands = retroperitoneal organ abdominal aorta = retroperitoneal organ IVC = retroperitoneal organ</p> Signup and view all the answers

    The contents of the inguinal canal in females include the round ligament of uterus, genital branch of genitofemoral nerve, and ilioinguinal nerve.

    <p>True</p> Signup and view all the answers

    The structure that lies parallel and immediately above the medial part of the inguinal ligament is known as the [blank].

    <p>inguinal Canal</p> Signup and view all the answers

    Is the statement true: Above the level of the umbilicus, lymph drains upward toward the anterior axillary lymph nodes, and below the level of the umbilicus, lymph drains downward toward the superficial inguinal lymph nodes?

    <p>True</p> Signup and view all the answers

    Study Notes

    Regions of the Anterolateral Abdominal Wall

    • The anterolateral abdominal wall is divided into 4 quadrants: upper right, upper left, lower right, and lower left quadrants, by a vertical plane and a horizontal plane that intersect at the umbilicus.
    • The 4 quadrants are further divided into 9 regions by 2 midclavicular planes and 2 horizontal planes (subcostal and transtubercular planes).

    Regions of the Anterolateral Abdominal Wall (continued)

    • The upper part (above subcostal plane) consists of: epigastric region (center), right and left hypochondriac regions.
    • The middle part (between subcostal and transtubercular planes) consists of: umbilical region (center), right and left lateral regions (lumbar regions or flanks).
    • The lower part (below transtubercular plane) consists of: pubic region, hypogastric region (center), and right and left inguinal (iliac) regions.

    Layers of the Anterolateral Abdominal Wall

    • From superficial to deep: skin, superficial fascia, muscles with their deep (investing) fasciae, transversalis fascia, extraperitoneal fascia, and parietal peritoneum.

    Superficial Fascia

    • Divided into 2 layers in the lower part of the anterior abdominal wall: superficial, fatty layer (Camper's fascia), and deep, membranous layer (Scarpa's fascia).

    Abdominal Muscles

    • 3 flat muscles on each side: external oblique, internal oblique, and transversus abdominis.
    • On each side of the anterior midline, there is a long, vertical muscle (rectus abdominis) and a small muscle (pyramidalis) anterior to the lower part of rectus abdominis (absent in about 20% of people).

    Muscles of the Anterolateral Abdominal Wall (continued)

    • The 3 flat muscles are muscular (fleshy) posterolaterally and aponeurotic (fibrous) anteromedially.
    • Their aponeuroses pass medially and enclose rectus abdominis (and pyramidalis, if present) to form the rectus sheath.
    • In the midline of the anterior abdominal wall, the aponeuroses of the 3 right flat muscles join the aponeuroses of the 3 left flat muscles to form the linea alba.

    External Oblique

    • Origin: outer surface of the lower 8 ribs.
    • Insertion: into the xiphoid process, linea alba, and pubic bone.
    • Inguinal (Poupart's) ligament: lower border of the external oblique aponeurosis that extends from the anterior superior iliac spine (ASIS) to the pubic tubercle.

    Transversus Abdominis

    • Lies deep to the internal oblique.
    • Origin: deep surface of the lower 6 costal cartilages, thoracolumbar fascia, iliac crest, and lateral ⅓ of the inguinal ligament.
    • Insertion: into the xiphoid process, linea alba, and pubic bone.

    Rectus Abdominis

    • Long strap muscle that extends along the whole length of the anterior abdominal wall.
    • Divided into segments by 3 transverse fibrous bands (tendinous intersections or inscriptions).

    Actions of the Anterolateral Abdominal Muscles

    • Their tone plays an important role in supporting and protecting abdominal organs.
    • Oblique muscles are involved in flexion, lateral flexion, and rotation of the trunk.
    • Rectus abdominis flexes the trunk.
    • Transversus abdominis contributes little to trunk movements.
    • By contracting simultaneously with the diaphragm, with the glottis of the larynx closed, anterolateral abdominal muscles increase intra-abdominal pressure, helping with evacuation of the contents of abdominal and pelvic hollow organs.

    Rectus Sheath

    • Formed by the aponeurosis of the 3 flat abdominal muscles.
    • Contents: rectus abdominis, pyramidalis (if present), terminal parts of the lower 5 intercostal nerves and subcostal nerve, and superior and inferior epigastric vessels.

    Nerves of the Anterolateral Abdominal Wall

    • Ventral rami of T7 to T11 spinal nerves (7th to 11th intercostal nerves) and ventral ramus of T12 spinal nerve (subcostal nerve).
    • Ventral ramus of L1 spinal nerve (iliohypogastric and ilioinguinal nerves).

    Dermatomes of the Anterolateral Abdominal Wall

    • T7: just inferior to the tip of the xiphoid process.
    • T10: level of the umbilicus.
    • L1: pubic symphysis and area immediately superior to it.

    Arteries of the Anterolateral Abdominal Wall

    • Superior epigastric artery: terminal branch of the internal thoracic artery.
    • Inferior epigastric artery: originates from the distal part of the external iliac artery.
    • Deep circumflex iliac artery: originates from the distal part of the external iliac artery.
    • 10th and 11th posterior intercostal arteries, subcostal artery, and lumbar arteries.

    Veins of the Anterolateral Abdominal Wall

    • Superficial veins: form a network that radiates out from the umbilicus.
    • Deep veins: accompany corresponding arteries and drain into internal thoracic, external iliac, posterior mediastinal, and lumbar (para-aortic) veins.

    Lymphatic Drainage of the Anterior Abdominal Wall

    • Superficial lymph vessels: above the level of the umbilicus, lymph drains upward toward the anterior axillary lymph nodes; below the level of the umbilicus, lymph drains downward toward the superficial inguinal lymph nodes.
    • Deep lymph vessels: follow arteries and deep veins and drain into internal thoracic (parasternal), external iliac, posterior mediastinal, and lumbar (para-aortic) lymph nodes.

    Inguinal Canal

    • Oblique passage, approximately 4 cm in length, through the lower part of the anterior abdominal wall
    • Lies parallel and immediately above the medial part of the inguinal ligament
    • Contents:
      • In males: spermatic cord (formed by structures running between the testis and abdominopelvic cavity) and ilioinguinal nerve
      • In females: round ligament of uterus (fibrous cord that extends from the uterus to the labium majus), genital branch of genitofemoral nerve, and ilioinguinal nerve
    • Openings:
      • Deep inguinal ring (opening in transversalis fascia) located approximately halfway between the ASIS and pubic tubercle
      • Superficial inguinal ring (opening in aponeurosis of external oblique) located immediately superior to the pubic tubercle
    • Walls:
      • Anterior: aponeurosis of external oblique
      • Posterior: transversalis fascia
      • Inferior: inguinal ligament
      • Superior: lower borders of internal oblique and transversus abdominis

    Abdominal Hernia

    • Protrusion of abdominal contents beyond the normal confines of the abdominal wall
    • Has three parts: hernial sac, contents of the sac, and coverings of the sac
    • Sac: pouch (diverticulum) of parietal peritoneum
    • Contents: may consist of any structure found within the abdominal cavity (e.g., piece of omentum, loop of small intestine, etc.)
    • Coverings: formed by layers of the abdominal wall through which the hernial sac passes
    • Approximately 75% of abdominal hernias occur in the inguinal region (most common type of abdominal hernia)

    Types of Inguinal Hernias

    • Indirect inguinal hernia:
      • Most common type of inguinal hernia (2/3 to 3/4 of inguinal hernias)
      • Hernial sac leaves the abdominal cavity lateral to the inferior epigastric vessels, through the deep inguinal ring
      • Results from a persistent processus vaginalis (outpouching of peritoneum that in the fetus is responsible for the formation of the inguinal canal)
      • More common in children and young adults
    • Direct inguinal hernia:
      • Hernial sac leaves the abdominal cavity medial to the inferior epigastric vessels
      • Hernial sac protrudes through an area of relative weakness in the posterior wall of the inguinal canal
      • Inguinal (Hesselbach's) triangle is bounded by the inferior epigastric vessels (laterally), rectus abdominis (medially), and inguinal ligament (inferiorly)

    Intraperitoneal and Retroperitoneal Relationships

    • Intraperitoneal organ: organ that is almost totally covered with peritoneum
    • Retroperitoneal organ: organ that is located posterior to the peritoneal sac and is only covered with peritoneum anteriorly

    Peritoneal Folds

    • Ligament: two-layered peritoneal fold that connects an organ to the abdominal wall or another organ
    • Examples:
      • Falciform ligament: connects the liver to the anterior abdominal wall
      • Coronary ligament: connects the liver to the diaphragm
      • Splenorenal ligament: connects the spleen to the left kidney
      • Gastrosplenic ligament: connects the spleen to the stomach
    • Omentum: peritoneal fold that passes from the stomach and proximal part of the duodenum to another organ
      • Lesser omentum: two-layered peritoneal fold that connects the lesser curvature of the stomach and the 1st part of the duodenum to the visceral surface of the liver
      • Greater omentum: hangs down from the greater curvature of the stomach, like an "apron", in front of the loops of the jejunum and ileum
    • Mesentery: two-layered peritoneal fold that connects the intestines to the posterior abdominal wall
      • Allows blood vessels, lymph vessels, and nerves to reach the intestines from the posterior abdominal wall
      • Examples:
        • Mesentery of small intestine (or just simply "the mesentery"): connects the loops of the jejunum and ileum to the posterior abdominal wall
        • Transverse mesocolon (mesentery of transverse colon): connects the transverse colon to the posterior abdominal wall
        • Sigmoid mesocolon (mesentery of sigmoid colon): connects the sigmoid colon to the posterior abdominal and pelvic walls

    Secondary Retroperitoneal Organs

    • Early in development, all parts of the digestive tract are intraperitoneal and have a mesentery
    • With further development, some parts of the digestive tract adhere to the posterior abdominal wall, lose their mesentery, and become retroperitoneal (more fixed in position)

    Lesser Sac (Omental Bursa)

    • Part of the peritoneal cavity located posterior to the lesser omentum and stomach
    • Superior recess: upward extension of the lesser sac, located between the liver and diaphragm
    • Inferior recess: downward extension of the lesser sac between the 2 anterior and 2 posterior layers of the greater omentum
    • On the left, it is closed by the spleen, gastrosplenic ligament, and splenorenal ligament
    • On the right, it communicates with the greater sac via the omental (epiploic) foramen

    Epiploic (Omental) Foramen (Opening of Lesser Sac, Foramen of Winslow)

    • Boundaries:
      • Anteriorly: right, free border of the lesser omentum (hepatoduodenal ligament)
      • Posteriorly: inferior vena cava
      • Superiorly: caudate lobe of the liver
      • Inferiorly: 1st part of the duodenum

    Peritoneal Folds in the Lower Part of the Anterior Abdominal Wall

    • 1 median umbilical fold: formed by the peritoneum that covers the median umbilical ligament
    • 2 medial umbilical folds (1 on each side): formed by the peritoneum that covers the medial umbilical ligaments
    • 2 lateral umbilical folds (1 on each side): formed by the peritoneum that covers the inferior epigastric vessels

    Other Subdivisions of the Abdominal Cavity

    • The transverse colon and its mesentery (transverse mesocolon) divide the abdominal cavity into supracolic and infracolic compartments
    • Supracolic compartment: located above the transverse colon and its mesentery, contains the stomach, liver, gallbladder, and spleen
    • Infracolic compartment: located below the transverse colon and its mesentery, contains most of the small and large intestines
    • Free communication between the supracolic and infracolic compartments via the paracolic gutters

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    Related Documents

    Regions of the Anterolateral Abdominal Wall PDF
    Week 5 Lecture Notes on Inguinal and Abdominal Hernias PDF

    Description

    Learn about the regions of the anterolateral abdominal wall, including the abdominal quadrants and how symptoms and signs of abdominal diseases are recorded.

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