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HS - Anterolateral abdominal wall; Inguinal Region
Terms in this set (64)
What are the layers of the superficial fascia of the anterior abdominal wall, starting from the skin?
Camper's fascia (superficial fatty layer)
Scarpa's fascia (deep membranous layer)
What are all of the layers of the anterior abdominal wall, starting from the skin?
-Fatty layer (Camper's)
-Membranous layer (Scarpa's)
External oblique m.
Internal oblique m.
Transversus abdominis m.
What vessels are found in the superficial fascia about 7.5 cm lateral to the midline?
Superficial epigastric artery and vein
The anterior cutaneous nerves that enter the superficial fascia about 2-3 cm lateral to the midline are branches of...?
Intercostal nn (T7 to T11)
Subcostal n. (T12)
Iliohypogastric and ilioinguinal nn. (L1)
What dermatome innervates the skin overlying the tip of the xiphoid process?
What dermatome innervates the skin of the umbilicus?
What dermatome innervates the skin superior to the pubic symphysis?
What dermatome innervates the skin overlying the pubic symphysis?
The lateral cutaneous nerves that enter the superficial fascia are branches of...?
Describe the important venous anasomosis of the superficial epigastric vein.
The superficial epigastric vein anastomoses with the lateral thoracic vein in the superficial fascia. This is a collateral channel for blood return from the femoral vein to the axillary vein.
What is caput medusae?
Superficial veins of abdominal wall become engorged and visible around umbilicus, do to obstruction of inferior vena cava or hepatic portal vein.
What three flat muscles form the anterolateral abdominal wall?
What muscle completes the anterior abdominal wall near the midline?
Describe the characteristics of the attachments of the three flat muscles.
Fleshy proximal attachments (to the ribs, vertebrae, and pelvis)
Broad, aponeurotic distal attachments (to the ribs, linea alba, and pubis)
Which of the three flat muscles contribute to the formation of the rectus sheath and the inguinal canal?
The testes pass through the abdominal wall during development, dragging the ductus deferens behind it, through what passage?
Where is the inguinal canal located?
Superior to the medial half of the inguinal ligament.
Extends from the superficial (external) inguinal ring to the deep (internal) inguinal ring.
In the male, the inguinal canal contains _________. In the female, the inguinal canal contains _________.
Male: spermatic cord
Female: round ligament of the uterus
What muscle forms the most superficial portion of the inguinal canal?
External oblique m.
What are the proximal and distal attachments of the external oblique muscle?
Proximal: External surfaces of ribs 5 to 12.
Distal: Linea alba, pubic tubercle, anterior half of the iliac crest
What direction do the fibers of the external oblique muscle course?
Superolateral to inferomedial
In the inguinal region, the ______ is a opening in the external oblique aponeurosis.
Superficial inguinal ring
Describe the lateral crus of the superficial inguinal ring.
Lateral (inferior) crus is a portion of the aponeurosis of the external oblique muscle and forms the lateral margin of the superficial inguinal ring. Attached to the pubic crest.
Describe the medial crus of the superficial inguinal ring.
Medial (superior) crus is a portion of the aponeurosis of the external oblique muscle and forms the medial margin of the superficial inguinal ring. Attached to the pubic crest.
Describe the intercrural fiber of the superficial inguinal ring.
They span across the crura superolateral to the superficial inguinal ring, and prevent the crura from spreading apart.
Describe the external spermatic fascia.
Thin layer of fascia that extends from the external oblique aponeurosis onto the spermatic cord (or round ligament of the uterus). It is the contribution of the external oblique m. to the layers of the spermatic cord.
What nerve emerges from the inguinal canal at the superficial inguinal ring, anterior to the spermatic cord (or round ligament of the uterus)?
What does the ilioinguinal nerve supply?
Sensory fibers to the skin on the anterior surface of the external genitalia and the medial aspect of the thigh.
What is the inferior border of the aponeurosis of the external oblique muscle?
Inguinal ligament. Attached to the ASIS and the pubic tubercle
Describe the lacunar ligament.
Formed by the medial fibers of the inguinal ligament that turn posteriorly to attach to the pecten pubis.
What muscle lies deep to the external oblique muscle?
Internal oblique muscle
(Forms the intermediate layer of the inguinal canal)
What are the attachments of the internal oblique muscle?
Proximal: Thoracolumbar fascia, Iliac crest, lateral half of the inguinal ligament
Distal: Inferior borders of ribs 10-12, linea alba, pubic crest, pecten pubis
What is the contribution of the internal oblique muscle to the coverings of the spermatic cord?
Cremaster muscle and fascia
What two nerves may be found in the intermuscular plane between the external oblique and the internal oblique muscles?
Just medial to the superficial inguinal ring the aponeurosis of the internal oblique becomes fused with the aponeurosis of the transversus abdominis to form the...?
What muscle lies deep to the internal oblique m.?
Transversus abdominis m.
(Contributes to the deepest layer of the inguinal canal)
The fiber direction of the transversus abdominis are similar to the (internal/external) oblique.
What lines the inner surface of the abdominal muscles?
At what location do the testes pass through the transversalis fascia during development?
Deep inguinal ring
Where is the deep inguinal ring located?
Superior to the midpoint of the inguinal ligament.
What vessels can be found just medial to the spermatic cord, through the transversalis fascia, within the layer of extraperitoneal fascia?
Inferior epigastric a. and v.
What are the boundaries of the inguinal canal?
Deep - deep inguinal ring
Superficial - superficial inguinal ring
Anterior - aponeurosis of the external oblique m.
Inferior (floor) - inguinal ligament and lacunar ligament
Superior (roof) - the arching fibers of the internal oblique and transversus abdominis mm.
Posterior - transversalis fascia, reinforced medially by the conjoint tendon.
What is an inguinal hernia?
A protrusion of abdominal viscera through the weak area of the abdominal wall that is the inguinal canal.
What is the difference between an indirect inguinal hernia and a direct inguinal hernia?
An INDIRECT inguinal hernia exits the abdominal cavity THROUGH the deep inguinal ring LATERAL to the inferior epigastric vessels, and it follows the inguinal canal (an indirect course through the abdominal wall).
A DIRECT inguinal hernia exits the abdominal cavity MEDIAL to the inferior epigastric vessels and follows a direct course through the abdominal wall.
The rectus sheath is formed by the aponeuroses of the three flat abdominal muscles. What are the contents of the rectus sheath?
Rectus abdominis muscle
Superior and inferior epigastric vessels
Terminal ends of the ventral rami of spinal nerves T7 to T12
The anterior wall of the rectus sheath is firmly attached to the anterior surface of the rectus muscle by several...?
What are the attachments of the rectus abdominis muscle?
Inferior: Symphysis and body of the pubis
Superior: costal cartilages of ribs 5 to 7
What is the action of the rectus abdominis muscle?
Flex the trunk
Describe the nerves that innervate the rectus abdominis muscle?
Branches of 6 nerves (T7 to T12) enter the lateral side of the rectus sheath and innervate the rectus abdominis m. and then emerge as anterior cutaneous branches.
Upon transecting the rectus abdominis muscle at the level of the umbilicus, and reflecting the halves superiorly and inferiorly, what two sets of vessels can be observed?
Superior epigastric artery and vein
Inferior epigastric artery and vein
Describe the epigastric vessel anastomoses.
The superior epigastric vessels anastomose with the inferior epigastric vessels within the rectus sheath, and form important collaterals if the inferior vena cava or aorta is occluded.
What is the inferior limit of the posterior wall of the rectus sheath?
The arcuate line. Located midway between the pubic symphysis and the umbilicus. At the level of the arcuate line, the inferior epigastric vessels enter the rectus sheath.
What fascia is found inferior to the arcuate line?
The transversalis fascia
What two layers are found deep to the transversalis fascia?
Thin layer of extraperitoneal fascia
What forms the linea alba?
Fusion of the aponeuroses of the right and left flat abdominal muscles (external oblique, internal oblique, tranversus abdominis)
What muscle is found anterior to the inferior end of the rectus abdominis muscle?
Pyramidalis m. Frequently absent. Attaches to the anterior surface of the linea alba and draws down on the linea alba.
What vessel gives origin to the superior epigastric artery?
Internal thoracic artery
What vessel gives origin to the inferior epigastric artery?
External iliac artery
What nerve passes through the superficial inguinal ring?
A congenital inguinal hernia is usually (direct/indirect)?
Where is McBurney's point?
Right side of abdomen, one-third of the distance from the anterior superior iliac spine to the umbilicus.
The median umbilical fold contains the...?
Remnant of the urachus
The rectus abdominis muscle:
A. Takes origin from the margins of the lower 8 ribs
B. Inserts into the linea alba
C. Is completely surrounded by the rectus sheath inferior to the arcuate line
D. Is innervated by branches of the ventral primary rami of spinal nerves T7-T12
E. Is one continuous sheet of muscle that crosses the midline.
D. The rectus abdominis muscle is innervated by branches of the ventral primary rami of spinal nerves T7 to T12
A surface feature may be used to locate the bifurcation of the abdominal aorta. It is the same landmark used to locate a safe level to enter the lumbar subarachnoid space to collect CSF. What landmark is this?
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