Download G08: Anterior abdominal wall

Case
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•
Male patient brought to the ED
Chief complaint
• Abdominal cramping
• Body-wracking chills
• Symptoms
• Dull pain in the upper right quadrant of
the abdomen
• Vomiting and diarrhea for 3-4 hours
Abdomen
- Conceptual Overview • Functions
• Houses and protects major viscera
• Changes in intra-abdominal pressure
• Breathing
• Urination
• Defecation
• Parturition
Anterior Abdominal Wall
- Surface Landmarks •
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Xiphoid process
Costal margin
9th costal cartilage
Iliac crest
Pubic tubercle
Umbilicus
Anterior Abdominal Wall
- Surface Landmarks -
Unit II, p 3
Vermiform Appendix
- Surface Landmarks • McBurney's point
• Superficial landmark for
the vermiform appendix
• Diagonal line from the
umbilicus to the anterior
superior iliac spine
• Point located ~2/3 from
the umbilicus
Unit II, p 3
Subdividing the Abdomen
- Planes (Lines) • Horizontal (4)
• Transpyloric (L1)
• Transumbilical
Unit II, p 4
Vertebral Levels and
Associated Landmarks
• T9 - Xiphoid process
• L1 - Transpyloric plane
(pylorus, pancreatic
neck, duodeno-jejunal
flexure, hila of kidneys)
• L3 - Subcostal plane
• L3/4 – Umbilicus
• L4 - Iliac crest plane
Unit II, p 4
Subdividing the Abdomen
- Planes (Lines) • Horizontal
• Subcostal
• Transtubercular
Unit II, p 4
Subdividing the Abdomen
- Planes (Lines) • Vertical (2)
• Midclavicular
• Zones (9)
• 4 horizontal planes
• 2 vertical planes
Unit II, p 4
Subdividing the Abdomen
- Quadrants -
Unit II, p 4
Anterior Abdominal Wall
- Structure (Layers) -
Unit II, p 4
Anterior Abdominal Wall
- Superficial Fascia • Two (2) layers
• Superficial layer of the superficial fascia
• Fatty layer = Camper's fascia
• Deep layer of the superficial fascia
• Membranous layer = Scarpa's fascia
• Contiguous with the membranous
fascia of the perineum (Colles’ fascia)
Anterior Abdominal Wall
- Superficial Fascia -
Blood Supply
Unit II, p 5
Anterior Abdominal Wall
- Blood Supply -
Unit II, p 5
Anterior Abdominal Wall
- Nerves -
(Subcostal n)
Unit II, p 6
Anterior Abdominal Wall
- Muscles •
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External abdominal oblique
Internal abdominal oblique
Transverse abdominal
Rectus abdominis
Pyramidalis
Functions
• Compress and support viscera
• Flex and rotate the trunk
Anterior Abdominal Wall
- Muscles -
Unit II, p 7
Anterior Abdominal Wall
- Muscles -
Unit II, p 7
Rectus Sheath
Above the arcuate line
Below the arcuate line
Unit II, p 7
Inguinal Ligament
- Surface Landmarks • Anterior superior iliac
spine
• Pubic tubercle
• Inguinal ligament
• Aponeurosis of the
external abdominal
oblique muscle
Inguinal Ligament
Unit II, p 8
Internal
Abdominal
Oblique and
Transverse
Abdominal mm
External
Abdominal
Oblique m
Unit II, p 8
Inguinal Canal - Walls
~4 cm long
Unit II, p 8
Deep Inguinal Ring
Unit II, p 8
Deep Inguinal Ring and the
Inguinal Triangle
Inguinal
triangle
Unit II, p 9
Inguinal Canal - Contents
Male
Female
Inguinal nerve
Inguinal nerve
Spermatic cord
Round ligament of the uterus
Ductus deferens
Artery of the ductus
Testicular artery and vein
(pampiniform plexus of
veins)
Lymphatics
Autonomic nerves
Cremasteric Reflex
- Testing Spinal Cord Function at L1 • Sensory limb - Ilioinguinal nerve (L1;
medial side of the thigh)
• Motor limb - Genital branch of the
genitofemoral nerve (L1)
• Reflex - Contraction of cremasteric
muscle (extension of internal abdominal
oblique muscle)
• Testis is retracted (raised)
Inguinal Hernias
- Direct vs Indirect • Key structure
• Inferior epigastric artery
• Is the hernia medial (direct) or lateral
(indirect) to the inferior epigastric artery?
Inguinal Hernias
- Direct vs Indirect -
Peru ’06 Amazon Jungle
Kristi Rose, MD
(2008)
Dr. Ballsack’s
4th Subject
Peru ’06 Amazon Jungle