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Lecture 17
Thoracic/Anterior Abdominal Walls
61
Anatomy
Graduate
10/11/2009

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Term
skeleton of anterior thoracic wall consists of
Definition
sternum (manubrium, body, xiphoid process), ribs, costal cartilage
Term
features of the sternum include
Definition
suprasternal (jugular) notch, sternal angle, xiphisternal joint
Term
what is the steranal angle?
Definition
joint between the manubrium and the body of the sternum; at level of 2nd costal cartilages and level of intervetebral disc 4
Term
what is the xiphisternal joint?
Definition
joint between the body of the sternum and the xiphoid process; indicates level of the diaphragm
Term
how many pairs of true, false, and floating ribs are there?
Definition
7 pairs of true ribs, that attach directly to the sternum, 5 pairs of false ribs that articulate with the cartilage of the ribs above, 2 pairs of floating ribs that end in the musculature
Term
which pairs of ribs are true ribs
Definition
ribs 1-7
Term
which pairs of ribs are false ribs?
Definition
ribs 8-10
Term
which pairs of ribs are floating ribs?
Definition
ribs 11 and 12
Term
what are the landmarks of a typical rib bone (rib 3-9)?
Definition
head articulates with vertebral bodies, neck, tubricle for articulation with transverse process of lower of the 2 vertebrae with which the head articulates, shaft with a posterolateral angle and a costal groove on the inferior of the rib
Term
what is the intercostal space and what is in the space?
Definition
space between ribs filled with external, internal, and innermost intercostal muscles, as well as blood vessels and nerves
Term
describe external intercostal muscles
Definition
run obliquely and downward, only goes to the chondrocostal junction, that space is filled with transparent external intercostal membrane
Term
describe interal intercostal muscles
Definition
middle layer, run perpendicular to the external intercostal muscles, extend to the sternum and are visible thru the external intercostal membrane
Term
describe the innermost intercostal muscles
Definition
also considered the deep part of the internal intercostal muscles, Has a discontinuous muscle layer with innermost intercostal muscles laterally, subcostal muscles posteriorly, and transversus thoracis muscles anteriorly; membranous areas may separate these components; Is separated from the internal intercostal layer by the intercostal nerve and vessels
Term
name the order for the intercostal blood vessels and nerve
Definition
vein is superior, artery is middle, nerve is inferior
Term
what is the function of the intercostal muscles?
Definition
still being debated, at the least they prevent intercostal spaces from bulging out during expiration and sucked inward during inspiration, also maintain spacing of ribs
Term
what innervates intercostal muscles?
Definition
intercostal nerves from the anterior rami of T1-11; subcostal nerve is from anterior ramus of T12, located below 12th rib
Term
where do the anterior cutaneous branches of the intercostal nerves emerge into the superfiscial fascia?
Definition
just lateral to the sternum
Term
where does the lateral cutaneous branches pierce the intercostal and serratus anterior muscles
Definition
at the midaxillary line
Term
describe posterior intercostal arteries
Definition
from the thoracic aorta, except those for intercostal spaces 1-2, which come from a branch of the subclavian artery
Term
describe anterior intercostal arteries
Definition
intercostal spaces 1-6 from the internal thoracic arteries and to spaces 7-10 from the musculophrenic branches of the internal thoracic arteries
Term
where is the abdominal region?
Definition
between the thorax and the pelvis, extends up into the ribs to the inferior side of the diaphragm and down into the hip bones
Term
the abdomen consists of:
Definition
muscular abdominal wall and the vertebral column, extends up into ribs and down into pelvis
Term
inferior boundaries of abdomen
Definition
right/left wings of ileum, muscles of anterior abdominal wall attach to the iliac crests laterally and the pubic bones anteriorly
Term
how many abdominal muscle layers are there?
Definition
3 and they correspond to those in the intercoastal spaces in the thorax
Term
describe most superficial layer of abdominal muscles
Definition
External oblique muscle, which has a flat tendon (external oblique aponeurosis) extending to the midline and helping to form the anterior layer of the sheath for the rectus abdominis muscle
Term
what makes up the inguinal ligament?
Definition
The inferior free edge of the external oblique aponeurosis between the anterior superior iliac spine and the pubic tubercle is rolled under to form the inguinal ligament
Term
the inguinal ligament contains what in men? in women?
Definition
In males, inguinal ligament holds the spermatic cord, in females it holds the round ligament of the uterus
Term
describe the internal oblique muscle
Definition
Lies deep to the external oblique with fibers running superomedially, perpendicular to those of the external oblique
Term
the internal oblique muscle's aponeurosis surrounds what muscle and forms the anterior and posterior layers of it's sheath?
Definition
rectus abdominus
Term
which muscle lies deep to the internal oblique muscle and what does it do?
Definition
transverse abdominis muscle helps to form the posterior layer of the rectus sheath
Term
what makes up the conjoint tendon and what is it's other name?
Definition
inferomedial fibers of internal oblique and transversus abdominis muscle to form the falx inguinalis
Term
what does the conjoint tendon do?
Definition
it arches over the spermatic cord to attach to the pubic crest and pecten pubis
Term
where is the rectus abdominis muscle?
Definition
Extends vertically upward from the pubic crest to costal cartilages 5-7
Term
the rectus sheath is made up of
Definition
the aponeuroses of the three flat abdominal muscles
Term
what is the arcuate line?
Definition
Arcuate line is about ½ way between the inguinis and the pubic symphysis
Term
describe the rectus sheath ABOVE the arcuate line
Definition
Arcuate line is about ½ way between the inguinis and the pubic symphysis
Term
describe the rectus sheath BELOW the arcuate line
Definition
all three aponeuroses passing anterior to the rectus abdominis; the posterior surface of the rectus is in contact with transversalis fascia
Term
what is the function of the abdominal wall muscles?
Definition
move the trunk and increase intra-abdominal pressure
Term
how do the abdominal muscles move the trunk?
Definition
Contracting bilaterally, they flex the trunk; Contracting unilaterally, one external oblique and the contralateral internal oblique rotate and bend the trunk toward the side of the internal oblique
Term
what happens when the abdominal muscles increase intra-abdominal pressure?
Definition
Help empty the bladder and rectum, Help with forceful expiration of air from the lungs (e.g., in coughing), Aid in childbirth
Term
why is the inguinal region weak?
Definition
it contains a passageway, the inguinal canal, that transmits the spermatic cord in males and the round ligament of the uterus in females
Term
what lies superior to the medial half of the inguinal ligament?
Definition
the inguinal canal
Term
what is the inguinal canal?
Definition
an oblique passage directed inferiorly and medially through the abdominal wall from the deep inguinal ring, an outpouching of transversalis fascia, to the superficial inguinal ring in the external oblique aponeurosis
Term
what are the boundaries of the inguinal canal?
Definition
anterior wall formed mainly by the external oblique aponeurosis with reinforcement laterally from the internal oblique aponeurosis, a posterior wall formed mainly by transversalis fascia reinforced medially by the conjoint tendon, A roof formed by the arching fibers of the internal oblique and transversus abdominis muscles, a floor formed by the inguinal ligament reinforced medially by the lacunar ligament
Term
what passes thru the inguinal canal?
Definition
the spermatic cord in the male and the round ligament of the uterus in the female
Term
what is a hernia?
Definition
the protrusion of an organ or other structure from its normal anatomic enclosure
Term
is a hernia congenital or acquired defect in the abdominal wall?
Definition
can be either
Term
inguinal hernias account for how many abdominal hernias?
Definition
90%
Term
what is an inguinal hernia?
Definition
protrusions of parietal peritoneum and viscera (e.g., small intestine) from the abdominal cavity through an opening or weak spot in the abdominal wall
Term
what is an indirect inguinal hernia?
Definition
follows the path of descent of the testis through the abdominal wall
Term
what is a direct inguinal hernia?
Definition
push directly through the abdominal wall more medially
Term
which inguinal hernia is more common, direct or indirect?
Definition
indirect, and happens in both males/females but is more common in males
Term
what is the path of an indirect inguinal hernia?
Definition
Leaves the abdominal cavity lateral to the inferior epigastric artery, follows the path of descent of the testis through the inguinal canal and exits the superficial inguinal ring
Term
what is an outpocketing of the peritoneal cavity?
Definition
persistent processus vaginalis, a congenital inguinal hernia
Term
can persistent processus vaginalis happen in women?
Definition
yes as a canal of Nuck
Term
what is entrapment/incarceration of an indirect inguinal hernia?
Definition
bowel obstruction; requires surgical intervention to repair hernia
Term
what is strangulation of an indirect inguinal hernia?
Definition
loss of blood supply; requires surgical intervention to repair hernia
Term
what is the path of a direct inguinal hernia?
Definition
Leaves the abdominal cavity medial to the inferior epigastric artery, pushes directly into the inguinal canal through or around a weak conjoint tendon
Term
what is the Hesselbach's triangle and why is it important?
Definition
inguinal triangle formed by the inferior epigastric artery laterally, the rectus abdominis medially, and inguinal ligament inferiorly where a direct inguinal hernia protrudes
Term
is a direct inguinal hernia acquired or congenital?
Definition
classified as acquired
Term
is a direct inguinal hernia more or less likely to descend into a scrotum than a direct inguinal hernia?
Definition
less likely
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