Anatomy Block 5 Oral Quiz Review
3/3/2013 12:08:00 AM
Teach or demonstrate the following:
1.) The four layers of the abdominal fascia
1. Superficial Fascia (Camper’s)=fatty, subcutaneous fascia
2. Membranous fascia (Scarpa’s) = deeper membranous fat
3. Deep Investing Fascia = ‘felt’ fascia that covers the abdominal muscles
4. Endoabdominal Fascia = fascia of the transversalis muscle
Note: arcuate line differences
2.) The four muscles of the abdominal wall
1. Rectus abdominus
a. Paired muscles that run vertically
i. Origin – Pubis
ii. Insertion – Costal cartilages 5-7, xiphoid process
iii. Innervation – (T7-T12) segmental nerves
iv. Action – Flexion of the lumbar spine
2. Transversus abdominus
a. Muscle of the lateral & anterior abdomen
b. Horizontal (transverse) fibers & deepest muscle layer
i. Origins
 Iliac crest
 Inguinal ligament
 Thoracolumbar fascia
 Costal cartilages 7-12
ii. Insertions
 Xiphoid, linea alba
 Pubic crest & pectin pubis via conjoint tendon
iii. Innervation
 Thoracoabdominal nn. (T6-T11)
 Subcostal nerve (T12)
 Iliohypogastric nerve (L1)
 Ilioinguinal nerve (L1)
iv. Action – Compresses abdominal contents
3. External oblique
a. Largest, most superficial abdominal muscle
b. ‘Hands in pockets’ fiber direction
i. Origin – Ribs 5-12
ii. Insertions
 Iliac crest
 Pubic tubercle
 Linea alba
iii. Innervation
 Thoracoabdominal nn. (T7-T11)
 Subcoastal nerve (T12)
iv. Action – contralateral rotation of the torso
4. Internal oblique
a. Rotate your ‘hands in pockets’ 90°
b. Inferior layer to external oblique
i. Origin
 Inguinal ligament
 Iliac crest
 Thoracolumbar fascia
ii. Insertions
 Linea alba
 Pectin pubis (via conjoint tendon)
 Ribs 10-12
iii. Innervation
 Thoracoabdominal nn. (T6-T11)
 Subcostal nerve (T12)
 Iliohypogastric nerve (L1)
 Ilioinguinal nerve (L1)
iv. Action
 Compresses abdomen
 Unilateral contraction will rotate vertebral column
ispilaterally
3.) The organization of the neurovascular bundles in the abdominal
wall and relate these structures to back, flank and anterior
abdominal wall pain.
When considering pain of the lower back, flank, or anterior abdomen, one
should know that the dermatomal map of the anterolateral abdomen is
almost identical to the distribution of peripheral nerves. The spinal levels
T7-T12 do not participate in plexus formation. The exception to this rule is
at the L1 level (iliohypogastric & ilioinguinal). Here, the dermatome has two
peripheral nerves and explains why a swift kick to Sam Sauce’s nuts will also
elicit epigastric pain.
This photo is sort of helpful and sort of hilarious.
4.) Describe the four routes of the venous drainage of the anterior
and posterior abdominal wall
1. Superior epigastric vein & branches of musculophrenic vein
 to the internal thoracic
o to the subclavian
2. Inferior epigastric vein & deep circumflex iliac vein
 to the external iliac vessels
3. Superficial circumflex iliac vein & superficial epigastric vein
 to the femoral vein
4. Posterior intercostal vein of 11th intercostal space & anterior branches of
the subcostal veins
 to the azygos/hemiazygos system
5.) The five umbilical peritoneal folds




The peritoneal folds refer to the five, one unpaired and two paired,
foldings in the anterior peritoneum
(1) Median umbilical fold
o overlies the median umbilical ligament
 extends from bladder’s apex to umbilicus
(2) Medial umbilical folds
o overlie the occluded remains of umbilical arteries
(2) Lateral umbilical folds
o overlie the inferior epigastric vessels
o only fold that’s over a functioning adult structure
o extends from the inguinal ring to the arcuate line
o
6.) The borders of the inguinal canal and its contents; relate these
structures to direct and indirect inguinal hernias and to focal and
diffuse abdominal pain
The inguinal canal passes obliquely through the lower abdominal wall,
extending between the superficial and deep inguinal rings. The borders of
the canal are
 Anterior: aponeurosis of external oblique, fleshy internal oblique

Superior: Medial crus of ext obl., musculoaponeurotic arches of
internal oblique & transverse abdominus, transversalis fascia
 Posterior: Transversalis fascia, conjoint tendon (medial), and deep
inguinal ring (lateral)
 Inferior: Inguinal ligament, lacunar ligament (medial), iliopubic
tract (lateral)
Contents are
 Male
o Spermatic cord
 Vas deferens






Ilioinguinal nerve
Genital branch of genitofemoral nerve
Testicular arteries/veins
 Pampiniform plexus
Lymph vessels
Cremaster muscle
Female
o Round ligament of the uterus
o Ilioinguinal nerve
o Lymph vessels
Direct hernia
 Passes directly through the abdominal wall (Hesselbach’s Δ) to the
superficial inguinal ring, forming peritoneal sac
o Linea semilunaris (lateral rectus border)
o Inferior epigastric vessels
o Inguinal ligament
 Due to muscular weakness or increased intrabdominal pressure
 More common in aging men

Indirect




Does not extend to scrotum
hernia
Traverses the superficial, deep inguinal rings
Is within the covering of spermatic cord
May descend into scrotum
can be congenital, common in younger males
7.) The location of the kidney, adrenal gland, urinary pelvis and
ureter on a human and on an abdominal plain film and relate these
structures to the presentation of flank pain
Along mid-clavicular line
 Left kidney: T12-L3
 Right Kidney: T12.5-L3.5
 Pelvis’: L1-L2
 Adrenals: T11
The ureters emerge ~L2 and descend in parallel (approx. linea semilunaris)
and hit the bladder, which is midline, just superior to the pubis and inguinal
ligaments.
On abdominal plain film:
 P – renal pelvis
 * - ureter
 B – bladder
 Adrenals – unmarked
 K - kidney
3/3/2013 12:08:00 AM
3/3/2013 12:08:00 AM