When does the umbilical ring close in adults?
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It is closed by connective tissue in adults.
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When does the umbilical ring close in adults?
It is closed by connective tissue in adults.
What are the divisions of the abdomen?
What is the width of the femoral ring?
Approximately 1cm.
Which nerves are responsible for the innervation of the abdominal wall?
Ventral rami of lower six thoracic spinal nerves (T7 - T12), iliohypogastric nerve, ilioinguinal nerve.
How many processes do Lumbar Vertebrae have?
Three additional processes.
What are the contents of the rectus sheath?
Rectus abdominis muscle, pyramidalis muscle, superior & inferior epigastric vessels, anterior rami of spinal nerves T7 - T12, lymphatic vessels, and the lower six intercostal vessels.
What structures run to and from the testes within the spermatic cord?
Ductus deferens, artery and vein of ductus deferens, testicular artery, pampiniform plexus of veins, cremasteric artery, lymphatic vessels, autonomic testicular nerve plexus, genital branch of genitofemoral nerve, vestige of process vaginalis.
What are the walls of the Inguinal Canal?
Anterior wall: aponeurosis of external oblique, inferior fibers of internal oblique. Posterior wall: transversalis fascia & conjoint tendon.
What are the anterior axillary lymph nodes responsible for draining?
Lymphatic drainage above the umbilicus.
What reinforces the transversalis fascia in the lower part of the transverse abdominis muscle?
Conjoint tendon (falx inguinalis) and Interfoveolar (Hesselbach’s) ligament.
What is the function of the cremasteric fascia within the spermatic cord?
It has a loop of cremasteric muscle to pull the testes during cold temperature.
Where does the spermatic cord begin and end?
It begins at the deep inguinal ring and ends in the scrotum.
What is the level of the Intertubercular (intercristal) plane?
At the level of the 4th lumbar vertebra.
What is the rectus sheath?
The sheath covering the rectus abdominis and pyramidalis, formed by the aponeurosis of 3 flat abdominal muscles.
How is the abdomen divided into quadrants?
By perpendicular lines joining at the umbilicus.
What are the four quadrants of the abdomen?
What are the three tendinous intersections that interrupt the rectus sheath?
One near the umbilical level, one near the xiphoid process, and the third about midway between the two.
What forms the skeleton of the abdominal wall superioanteriorly and superiolaterally?
Ribs and costal cartilages.
What area do the inguinal lymph nodes drain?
Lymphatic drainage below the umbilicus.
What forms the skeleton of the abdominal wall posteriorly?
Lumbar vertebral bones and intervertebral discs.
How many regions does the abdominal wall have?
It has 9 regions formed by two vertical and two transverse lines.
What are the two fascia that cover the abdominal wall?
What bones contribute to the upper part of the hip bone in the skeleton of the abdominal wall?
Lumbar vertebrae.
What are the names of the two transverse lines that form the regions of the abdominal wall?
What are the fundiform and suspensory ligaments of the penis formed from?
Condensed superficial and deep fascia of the abdominal wall.
What are the names of the two vertical lines that form the regions of the abdominal wall?
What vessels do the posterior mediastinal, parasternal, and external iliac lymph nodes collect from abdominal muscles through?
Posterior intercostal vessels, superior epigastric vessels, inferior epigastric vessels.
Where is the umbilicus found?
Midway between xiphoid process and symphysis pubis.
What are the suspensory ligaments of the clitoris formed from?
Condensed superficial and deep fascia of the abdominal wall.
What are the nine regions of the abdominal wall?
i. Right hypochondrium ii. Epigastric iii. Left hypochondrium iv. Right lumbar (lateral) v. Umbilical region vi. Left lumbar (lateral) vii. Right inguinal (iliac) viii. Hypogastric or suprapubic region ix. Left inguinal (iliac)
What structures does the Transpyloric plane pass through?
Pylorus, duodenojejunal junction, neck of pancreas, and hilum of kidneys.
Where are the fundiform and suspensory ligaments of the penis formed in males?
Above the arcuate line.
What is the tunica vaginalis and what is its relation to the parietal peritoneum?
The tunica vaginalis is part of the parietal peritoneum and is a remnant of the vaginal process.
Where does the Transpyloric plane lie in relation to the jugular notch and pubic symphysis?
Midway between them.
What structures pass through the umbilical ring during fetal life?
Omphaloenteric duct, allantois, two umbilical arteries, and one umbilical vein.
What can a persistent vaginal process in the spermatic cord lead to?
It can lead to an inguinal hernia by communicating the abdominal cavity to the scrotum.
Where are the fundiform and suspensory ligaments of the clitoris formed in females?
Above the arcuate line.
What is the femoral ring also known as?
Annulus Femoralis.
What forms the roof of the Inguinal Canal?
Free border of internal oblique & transverse abdominis muscle.
What forms the floor of the Inguinal Canal?
Inguinal & lacunar ligaments.
What are the two rings of the inguinal canal?
What occurs if a hernia is extended and filled by amnion?
It is called omphalocele.
Which artery supplies the abdominal wall from the internal thoracic artery?
Superior epigastric artery.
What separates the abdominal wall from the thorax?
The diaphragm.
What is the ilioinguinal nerve in the inguinal canal related to?
It is related to both sexes.
From which artery do the lumbar arteries arise?
Abdominal aorta.
What divides the Communications of the Abdomen with the Thigh Space into two parts?
The arch of connective tissue extending from the inguinal ligament to the iliopectine eminence of the pubic bone.
What is the arch extending from the inguinal ligament to the iliopectine eminence of the pubic bone called?
Iliopectine arch.
Which type of inguinal hernia is less common?
Direct inguinal hernia.
What are the contents of the Vascular space (lacuna vasorum)?
Femoral artery, femoral branch of genitofemoral nerve, femoral vein, and femoral lymph nodes.
What are the boundaries of the inguinal triangle?
Inferiorly by the medial half of the inguinal ligament, medially by the lateral border of the rectus abdominis muscle, and laterally by the inferior epigastric artery.
What is the structure that disappears at the 2nd month during fetal life?
Omphaloenteric duct.
What is Linea Nigra in the context of pregnancy?
A dark (reddish brown) line extending from xiphoid process to symphysis pubis along linea alba, more intense below the umbilicus.
What are Striae Gravidarum and how do they appear?
Bands of short reddish-brown lines on the abdominal wall, buttocks, and thigh due to over distension. After parturition, they become white lines known as linea albicantes.
What are the boundaries of the Superficial Inguinal Ring?
Base: pubic crest, sides: crura of external oblique aponeurosis, floor: reflected ligament (continuation of inguinal ligament).
What forms the anterior wall of the rectus sheath above the costal margin?
Aponeurosis of external oblique muscles.
What is an umbilical hernia?
It is the protrusion of midgut through the umbilicus, caused by weakness of the umbilical scar.
Describe the Linea Alba (White line, Hunter's line).
It is a 1cm wide fibrous band running vertically from the xiphoid process to the symphysis pubis, formed by the fusion of aponeurosis of muscles. At the umbilicus, it forms the umbilical ring.
What nerve innervates the Pyramidalis Muscle?
Subcostal nerve.
What forms the posterior wall of the rectus sheath between the costal margin and arcuate line?
Aponeurosis of transverse abdominis and posterior layer of internal oblique muscle.
Where do Spigelian hernias occur?
Along the lateral border of the rectus sheath through the semilunar line at the level of the arcuate line.
What forms the posterior wall of the rectus sheath below the arcuate line?
Formed by transversalis fascia.
Where is the arcuate line located?
At the midpoint between the umbilicus and pubic symphysis.
Which arteries supply the abdominal wall from the femoral artery?
Superficial epigastric and superficial circumflex iliac arteries.
From which artery do the inferior epigastric and deep circumflex iliac arteries originate?
External iliac artery.
Why are femoral hernias more common in females than males?
Due to the relatively wide pelvis and increased abdominal pressure during pregnancy.
Where is the Deep Inguinal Ring found?
On the transversalis fascia, midway & 1-2cm above inguinal ligament.
Where do the lower 5 (6) posterior intercostal arteries originate from?
Aorta.
What may a weakness of the femoral septum lead to?
Femoral hernia.
What is the insertion point of the Rectus Abdominis Muscle?
Xiphoid process & 5th-7th costal cartilage.
What is the insertion of the External Oblique Muscle?
Linea alba, outer lip of iliac crest, anterior superior iliac spine, pubic tubercle, and pubic crest.
What are the types of abdominal surgical incisions?
Median or midline, paramedian, gridiron (muscle splitting), suprapubic (Pfannenstiel), transverse, and subcostal incisions.
What are the actions of the External Oblique Muscle?
Unilateral contraction tilts trunk, bilateral contraction flexes trunk, elevation of the pelvis, compression of the abdomen, expiration or defecation, fixation of trunk during carrying.
Why are inguinal incisions considered high risk?
Because the inguinal nerves will be in danger.
What is a femoral hernia?
It is the protrusion of abdominal contents into the femoral canal, caused by increased intra-abdominal pressure and weakened femoral septum.
Where is McBurney's point located?
At the lateral 1/3rd and medial 2/3rd of the line joining the right anterior superior iliac spine and the umbilicus.
How many paired muscles are there in the anterolateral wall of the abdominal wall?
Five paired muscles.
What is the weakness of the femoral ring called?
Femoral septum.
What is the origin of the Rectus Abdominis Muscle?
Upper surface of pubis.
What is the origin of the External Oblique Muscle?
External surface of 5th - 12th ribs.
What do the medial umbilical folds contain?
They contain the medial umbilical ligaments and are formed by obliterated umbilical arteries.
What forms the anterior wall of the rectus sheath below the arcuate line?
Formed by the aponeurosis of three muscles.
What is an incisional hernia?
It protrudes through an operative incision.
What is the medial inguinal fossa also known as, and what is it a potential site for?
It is also known as the inguinal triangle (Hesselbach’s ∆) and is a potential site for direct inguinal hernia.
What are the layers of the abdominal wall?
a. Skin, b. Subcutaneous tissue, c. Muscles & fascia or bones, d. Extraperitoneal tissue, e. Peritoneum.
What is the femoral ring filled with?
Loose extraperitoneal CT (connective tissue).
What is the origin of the Pyramidalis Muscle?
Anterior surface of the body of pubis and anterior pubic ligament.
What is the insertion point of the Pyramidalis Muscle?
Linea alba.
What forms the anterior wall of the rectus sheath between the costal margin and arcuate line?
Aponeurosis of external oblique and internal oblique muscles.
What are the boundaries of the femoral ring?
Lateral: septum between femoral vein & femoral canal, Posterior: superior ramus of pubis, Medial: lacunar ligament, Anterior: medial part of inguinal ligament.
What are the two types of inguinal hernias?
Direct and indirect.
What is the innervation source for the Rectus Abdominis Muscle?
Anterior rami of lower six thoracic nerves.
What is the action of the Transverse Abdominis Muscle?
Compress & support abdominal viscera, increase intra-abdominal pressure.
What are the contents of the Muscular space (lacuna muscularum)?
Iliopsoas muscle, femoral nerve, and lateral femoral cutaneous nerve.
What is the location of the Pyramidalis Muscle?
It lies anterior to the inferior part of rectus abdominis and pubis.
What are the boundaries of the abdominal wall posteriorly?
Body of 5 lumbar vertebrae, lumbar intervertebral discs, crura of diaphragm, quadratus lumborum, psoas muscle, part of iliacus muscle & iliac bone.
What are the actions of the Rectus Abdominis Muscle during unilateral contraction?
Tilt & rotate on the side.
How does the abdominal wall increase intra-abdominal pressure?
It contracts.
What is the function of the median umbilical fold?
It extends from the apex of the umbilicus to the umbilicus and covers the median umbilical ligament, which joins the fetal bladder to the umbilicus.
Which veins correspond to the superficial epigastric and superficial circumflex iliac arteries?
Superficial epigastric and superficial circumflex iliac veins.
What are the names of the two veins that are the same as the arteries supplying the abdominal wall?
Paraumbilical and thoracoepigastric veins.
What are the two spaces into which the Communications of the Abdomen with the Thigh Space divided?
Which type of inguinal hernia is more common?
Indirect inguinal hernia.
What is the insertion of the Internal Oblique Muscle?
Linea alba, lower border of 3 or 4 ribs, xiphoid process, pubic crest & pectineal line.
What are the objectives related to the abdominal wall?
Describe abdominal wall & boundaries, Discuss muscles of abdominal wall, Identify NVB of abdominal wall, Locate weak points of abdominal wall, Discuss clinical significance of abdominal wall.
What are the contents of the inguinal canal in males?
Spermatic cord.
What forms the posterior wall of the rectus sheath above the costal margin?
Related to 5th-7th costal cartilages and intercostal spaces.
What is a paraumbilical hernia?
It is the protrusion of abdominal contents through the linea alba just above the umbilicus.
What does the abdominal wall do to accommodate expansions?
It distends considerably.
What action does the Pyramidalis Muscle perform?
It tenses the linea alba.
Where does the falciform ligament run to and what does it contain?
It runs from the umbilicus to the liver and contains the round ligament of the liver (ligamentum teres hepatis), which is a remnant of the obliterated umbilical vein.
What is the supravesical fossa and where does it lie?
It lies between the median and medial folds and is formed as peritoneal reflects from the anterior abdominal wall to the bladder.
What is the origin of the Internal Oblique Muscle?
Thoracolumbar fascia, lateral 2/3rd of inguinal ligament, anterior 2/3rd of iliac crest, anterior superior iliac spine.
What are the innervation sources for the Transverse Abdominis Muscle?
8th-12th intercostal nerves, iliohypogastric nerve, ilioinguinal nerve.
What is the Semilunar line (Spigelius' line) and where is it located?
It is a slight groove parallel to the lateral edge of the rectus sheath.
What is the largest and most superficial flat muscle in the abdominal wall?
External Oblique Muscle.
What is the space between the inguinal ligament and hip bone called?
Communications of the Abdomen with the Thigh Space.
Where do interstitial hernias occur?
Between the layers of the abdominal wall, for example, between the peritoneum and transversalis fascia.
What are the actions of the Rectus Abdominis Muscle during bilateral contraction?
Flexes the trunk.
What is the innervation of the External Oblique Muscle?
5th - 12th intercostal nerves, iliohypogastric nerve, ilioinguinal nerve.
Why are pararectus incisions considered high risk?
Because the nerves of the rectus abdominis muscle are being cut.
What is the action of the Rectus Abdominis Muscle during expiration or defecation?
Elevate pelvis & expiration or defecation.
