origin: pubic symphysis and crest --> insert at xiphoid and 5th-7th costal cartilages
Origin and insertion of external oblique
External surfaces of 5th – 12th ribs insert at Linea alba, pubic tubercle, anterior ½ of iliac crest
Origin and insertion of internal oblique
Thoacolumbar fascia, anterior 2/3 of iliac crest, lateral 1/3 of inguinal ligament insert at inf. Border of 10th-12th ribs, linea alba, and pecten pubis via conjoined tendon
Origin and insertion of transversus abdominus
Internal surfaces of 7th-12th costal cartilages, thoracolumbar fascia, iliac crest, lateral 1/3 of inguinal ligament insert at linea alba, pecten pubis via conjoined tendon
McBurney's Point; 2/3 from umbilicus to anterior iliac spine
What is located 1/3 below umbilicus and marks the end of the posterior sheath?
Arcuate Line; 3/4 of rectus located above this point, important when making and closing incisions
The superior epigastric arteries are the continuation of which arteries?
internal mammary (thoracic) artery. They travel posterior to rectus muscle within posterior rectus sheath
Where do the inferior epigastric arteries originate?
the last branch of the external iliac artery anastomoses with the superior
Where are the deep circumflex iliac arteries located?
In the lower abdomen
Superficial areas above the umbilicus drain to which lymphatic region?
Axillary
Superficial areas below the umbilicus drain to which lymphatic region?
Inguinal
Deep areas above the umbilicus drain to which lymphatic region?
Para-aortic nodes, internal mammary nodes
Deep areas below the umbilicus drain to which lymphatic region?
inguinal, external iliac, common iliac
Which nerves innervate the xiphoid?
T5-6
Which nerve innervates the umbilicus?
T10
Which nerve innervates the pubis?
L1
A spinal cord transection from a car accident causes cutaneous loss of sensation where?
Xiphoid
Name the function of the psoas muscle
Flexes the spine; hip
Name the function of the iliacus
Flexes the hip/thigh
Where do the ileopsoas muscles (psoas major, psoas minor, iliacus) originate and insert?
Originates at ileac fossa and lumbar spine and inserts into the lesser trochanter of the femur.
Which muscle group will be inflammed in appendicitis?
Ileopsoas muscles
Which muscle extends and laterally flexes the spine?
Quadratus lumborum; spans from iliac crest to lowest rib and to vertebrae
Which muscle runs laterally around the appendix?
Psoas muscle; Psoas Test: Patient in supine position tries to flex right hip against resistance; pain in pelvis during this maneuver is a positive test
List the attachments of the diaphragm
Sternal: posterior aspect of xiphoidCostal: last 6 costal cartilagesLumbar: L1-L3 (crura)
Name the three structures pass through the central tendon of the diaphragm
IVC: T8Esophagus: T10(Vagus nerve also passes through with esophagus)Aorta: T12
In what position is the diaphragm lowest?
Standing
CDH
Congental Diaphragmatic Hernia; Failure of the diaphragm to fuse during fetal developmentUnilateral with pulmonary hypoplasiaOccurs in approximately 1/2200 live births50% mortalitySurgical correction
Which structures can herniate in an abdominal hernia?
extraperitoneal fat, peritoneum, omentum, bowel, or other viscera through a defect in the transversalis fascia
Name the structures that go through the inguinal canal.
Contains spermatic cord(M)/round ligament of uterus(F) and ilioinguinal nerve (M+F)
Name the boundaries of the inguinal canal.
Floor: top of inguinal ligamentCeiling: aponeurosis of internal oblique and transverse abdominal musclesAnterior: external obliquePosterior: transversalis fascia
Name the origin and insertion of the inguinal ligament
anterior-superior iliac spine to the pubic tubercle
Which structure pulls the testes into the scrotum and at what point of development does this occur?
Gabernaculum; 7 months in utero
Where does an indirect hernia occur?
Through the process vaginalis
Where does a direct hernia penetrate?
Through a weakness in the wall
This is a fascial defect lateral to inferior epigastric vessels through which the testes pass by means of the process vaginalis into the scrotum
Internal (deep) inguinal ring
Name the borders of Hesselbach's triangle.
bounded by the inguinal ligament inferiorly, the lateral border of the rectus muscle medially and the inferior epigastric vessels laterally; direct hernia's occur within the triangle
This type of hernia passes lateral to the inferior epigastrics, is congenital and more common, enters the inguinal canal through the deep ring.
Indiret hernia
Passes medial to epigastrics ( in Hesselbach’s triangle)Aquired weakness in abdominal wallUsually in adults
Direct hernia
List the contents of the spermatic cord.
Vas DeferensTesticular artery- a branch of the abdominal aortaCremasteric artery-a branch of the inferior epigastric arteryArtery of the vas deferens- a branch of the inferior vessicle arteryPampiniform Plexus of VeinsCremasteric MuscleSympathetic nerve f
Name the hernia that is inferior to the inguinal ligament and which occur 70% of the time in women
Poultry
