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1. List the 3 muscle layers of the anterolateral abdominal wall order from
superficial to deep. What is the orientation of their fibers? What is the
innervation of these muscle layers?
Superficial
o External oblique
Fibers run inferomedially (pocket muscles)
Middle
o Internal oblique
Fibers run inferolaterally
o Rectus abdominis
Deep to internal oblique
Fibers run vertically
Deep
o Transverse abdominal
Fibers run horizontally
Innervation
o Ventral rami of T7-T12
2. How does each layer of the anterior abdominal wall contribute to the
formation of the rectus sheath above the level of the umbilicus?
Anterior rectus sheath
o External oblique aponeurosis + Anterior lamina of internal oblique
aponeurosis
Posterior rectus sheath
o Posterior lamina of internal oblique aponeurosis + Transverse
abdominal aponeurosis + Transversalis fascia
3. What is the arcuate line? What forms the posterior aspect of the rectus
sheath below this line?
Arcuate line
o Demarcates the transition between the posterior rectus sheath
covering the superior of rectus abdominis and the transversalis
fasica covering the inferior
Below the arcuate line
o Anterior rectus sheath
External oblique aponeurosis + internal oblique aponeurosis +
Transverse abdominal aponeurosis
o Posterior rectus sheath
Only the transversalis fascia
4. Where does the inferior epigastric artery arise?
Inferior epigastric artery
o Arises from the external iliac artery
o Runs superiorly and enters the rectus sheath
5. Where does the inferior epigastric artery run within the rectus sheath?
Deep to the rectus abdominis within the sheath, superficial to transverse
abdominal in the area of the sheath
6. With what vessel does the inferior epigastric artery anastomose?
19. Through what component of the inguinal canal does the hernia
protrude?
Indirect hernia
o Deep and superficial inguinal ring (within cord)
Direct hernia
o Superficial inguinal ring only
20. Where is the location of the deep inguinal ring with relation to the
inferior epigastric artery? Where is the inferior epigastric artery going?
Deep inguinal ring
o Lateral to inferior epigastric a.
Inferior epigastric a.
o Arises from external iliac a. just superior to the inguinal ligament
travels superiorly through the transversalis fascia to enter the rectus
sheath inferior to the arcuate line
Branches enter rectus abdominis and anastamose with superior
epigastric a.
21. Which type of inguinal hernia is most common in older men? Are
inguinal hernias more common in men or women?
Older men
o Direct (acquired) hernias are most common
o Inguinal hernias are much more common in men than women
22. Describe the attachments, actions, innervation, and blood supply of
each abdominal muscle
External Oblique m.
o Origin external surface of ribs 5-12
o Insertion Linea alba + pubic tubercle + Anterior half of iliac crest
o Action compress abdomen + flex and rotate trunk + active in forced
expiration
o Innervation Ventral rami of T7-T12
Internal Oblique m.
o Origin lateral 2/3 of inguinal ligament + iliac crest + thoracolumbar
fascia
Veins
Follow retrograde course same names as arteries
Paraumbilical vv. potential portal system anastomosis
o Caput medusa = bulging of superficial venous
network
23. Diagram the layers of the anterior abdominal wall and their
contributions to the inguinal region
o
PP Parietal peritoneum
TF transversalis fascia
o Deep inguinal ring
TA Transverse abdominal
o Conjoint tendon
IO internal oblique
o Conjoint tendon
EO external oblique
o Superficial inguinal ring
24. Determine between what two layers the neurovascular structures
travel along the anterolateral abdominal wall
Nerves
o Thoracoabdominal (T7-T11) between 2nd and 3rd layers of abdominal
muscles (between internal abdominal m. and transverse abdominal m.)
o Subcostal n. (T12) pierces transverse abdominal m. and follows
same path as IC nerves
o Iliohypogastric n.(L1) runs between Internal oblique (pierces at distal
end) and transverse abdominal m.
o Ilioinguinal n. (L1) runs between Internal oblique and transverse
abdominal m.
Vasculature
o Musculophrenic a. pierces transverse abdominal m. anterior to
posterior
o Superior epigastric a. runs mostly behind Transverse abdominal m.
o Inferior epigastric a. runs mostly behind Transverse abdominal m.
o 10th and 11th posterior IC aa. runs between IO and TA
o Subcostal inferior epigastric a. enters rectus sheath and runs deep
to rectus abdominis
o Deep circumflex iliac a. deep to TA
o Superficial epigastric a. superficial to EA
25. Diagram the contributions of the layers of anterior abdominal wall to
the rectus sheath above and below the arcuate line
Above arcuate line
o Anterior rectus sheath
External oblique aponeurosis + Anterior lamina of internal
oblique aponeurosis
o Posterior rectus sheath
Posterior lamina of internal oblique aponeurosis + Transverse
abdominal aponeurosis + Transversalis fascia
Below arcuate line
o Below the arcuate line
Anterior rectus sheath
External oblique aponeurosis + internal oblique
aponeurosis + Transverse abdominal aponeurosis
Posterior rectus sheath
Only the transversalis fascia
26. Outline the path of lymphatic drainage for the abdominal wall.
Above umbilicus axillary nodes