Abdomen
How many spinal nerves are in the cervical spine?
8
What is a Nerve plexus?
A fusion, bifurcation and rejoining in a complex fashion
What dermatomes are responsible for the shoulders?
C6, C7 and C8
Where are the two spinal cord enlargements?
Cervical (C4-T1) Lumbar enlargement (L2-S3)
Why are there 8 cervical nerves and 7 cervical vertebrae
Cervical spinal nerves exit above their respective vertebrae
Which vertebral rami form a plexus?
Cervical, lumbar, sacral and brachial
What is the Dorsal Root Ganglion
Collection of nerve cell bodies located in the intervertebral foramen
Which ribs are the easiest to fracture? And why?
Floating ribs because they are the smallest, weakest, closest to ground
Where does the spinal cord span to?
Foramen magnum to L1 & L2
What is the function of the thoracic wall?
Framework and protection for the thoracic viscera (heart, lungs, etc)
Primary causes for diastasis recti
Giving birth (being over 35 y/o, multiple births, small stature)
What is the cauda equina
Horse hair-like structures below conus medullaris
Which nerve sends sensation to mons pubis/ upper groin?
Illioguinal nerve
Rectus abdominus m get blood from?
Inferior epigastic artery
Where do rectus abdominis mm attach?
-Costal cartilage of ribs 5-8 -Sternum -Pubic crest -Pubic symphysis
What are the differences between Direct hernias and indirect hernias
-Direct are acquired through heavy lifting and indirect are congenital -Direct emerge medial to the inferior epigastric a., direct are lateral -Direct- Abdominal contents travel thought the superficial ring only, indirect- travel through both deep and superficial rings
Which abdominal muscles flex and rotate the trunk?
-External oblique -Internal oblique
What structures are inside the inguinal canal
-Ilioinguinal nerve (L1) -Spermatic cord (male) -Round ligament of the uterus (female)
What muscles make up the Anterolateral abdominal wall?
-R/L rectus abdominis mm -External obliques -Internal obliques -Transverse abdominis mm
What muscle/s are innervated by ventral (anterior) rami of 77-T12 and L1
-Rectus abdominis -External obliques -Internal obliques -Transverse abdominis
What muscles are innervated by the Thoracoabdominal nn
-Rectus abdominous -External obliques -Internal obliques -Transverse abdominous
Layers of the anterolateral abdominal wall
-Skin -Superficial facia -External oblique m -Internal oblique muscle -Transversus abdmonis -Transveralis facia -Parietal peritoneum
What are the functions of abdominal wall muscles
-Stabilize the trunk (posture) -Flexion -Lateral flexion -Torsion -Abdominal compression (Valsalva maneuver)
When below the arcuate line which layers are below the rectus?
-Transversal facia -Parietal peritoneum
How many intercostal spaces do intercostal muscles span?
1
How are the ribs numbered?
12 pairs of ribs are numbered consecutively from superiorly to inferiorly
Where is McBurney's point
2/3 of the way from umbilicus to ASIS
what does bursae do
avoids friction, facilitates gliding
Does the spinal nerve have motor or sensory modalities?
both
what is a synovial sheath
bursae surrounding a tendon, running through a tunnel (tendon sheath)
Which spinal nerves exit above their respective vertebrae
cervical
what is bursae
cleft of CT between muscles, tendons and/or bones
what are ligaments made of
connective tissue
Where is the dorsal primary ramus?
deep back
Which rib does the inferior costal facet of the thoracic vertebra articulate with?
different rib
What are somatic sensory fibers from the periphery to the CNS
dorsal root
what does the vertebral canal contain (4)
epidural/extradural fat, internal vertebral venous plexus, meninges and spinal cord
What anchors the spinal cord
filum terminale
where does the vertebral canal span from
foramen magnum to entire vertebral column
The body of a thoracic vertebra has what shape?
heart
Where is gray matter located on the spinal cord
inner region
What part of the ischium do we sit on?
ischial tuberosity
What is the blood supply of serratus anterior?
lateral thoracic artery
What creates the medial line down your 6 pack abs?
linea alba
Lateral margin of rectus abdominis
linea semilunaris
What is the innervation of serratus anterior?
long thoracic nerve
What is white matter composed of
myelinated axons
what do ligaments do
permit some movements and yield applied forces
Just the body of rib 7 is touching which rib?
rib 8
The body and transverse process of T8 is touching which rib?
rib 8
where does serratus anterior attach
ribs 1-9 and anterior and medial border of scapula and inferior angle
The vertebral foramen of a thoracic vertebrae is what shape?
round
Opening created by ligaments through which nerovasculature and muscles pass though the ischium
sciatic foramen
Concavities formed from contours of the coxal bone
sciatic notches
Are dorsal rami segmental or in a plexus?
segmental
what is the function of adipose tissue (4)
stores energy, insulate, secretes hormones, GF, cytokines, leptin and cushions/protects body
what is a Ganglion cyst
swollen or inflamed synovial sheath
What part of the rib is the weakest/ most likely to fracture?
the angle
What part of the rib articulates with vertebral bodies?
the head
Which rib does the superior costal facet of the thoracic vertebra articulate with?
the same rib
Which rib does the transverse costal facet of the thoracic vertebra articulate with?
the same rib
Which direction do the internal intercostal muscles go in?
towards the chin
What is the function of white matter
transmits messages
Which way do innermost intercostal muscles go to?
transverse
Which flank muscle does not contribute to the inguinal canal?
transversus abdominis
What two structures for to create the spinal nerve
ventral and dorsal root
What is the function of anterior (ventral) horn gray matter
Innervate skeletal muscles
Which nerves supply segmental motor and sensory innervation to the abdominal wall
Intercostal/subcostal/L1 nerves
Which intercostal muscles are insufficient posteriorly?
Internal intercostal mm Inner most intercostal mm
Where does venous drainage of the thoracic cavity occur?
Into the venae comitantes anteriorly, brachiocephalic vv, azygoes vv
Where is the conus medullaris ?
L2
Intercostal arteries and lumbar arteries supply blood to where?
Lateral wall (flank) muscles
What are the 3 parts of the sternum?
Manubrium Body Xiphoid Process
What is gray matter composed of
Neuronal and glial cell bodies
Where is white matter located on the spinal cord
Outer region
What are the two types of gray matter
Posterior (dorsal) horn - receive sensory info and Anterior (ventral) horn- somatic motor nn that innervate skeletal mm
What is the function of the serratus anterior?
Protraction of scapula (Draws scapula forward) Cranial rotation of glenoid fossa
What is the function of posterior (dorsal) horn gray matter?
Receive sensory info
Which abdominal muscle stabilizes and controls tilt of the pelvis?
Rectus abdominis
Which muscles do you see when somebody has a 6 pac?
Rectus abdominis muscle
What is the function of the great radicular artery
Reinforce blood supply to lumbosacral enlargement
What are the 3 regions above the transphyloric plane
Right hypochondriac, Epigastric, Left hypochondriac
What are the 3 regions below the transtubercular plane
Right inguinal, Hypogastric, Left inguinal
What are the 3 regions in the middle
Right lumber Umbilical Left lumbar
how are ribs numbered in relation to vertebrae
Same number as the vertebrae they touch twice
What does the posterior intercostal aa branch into
Segmental spinal aa
What is the sensory pathway of the spinal cord and spinal nerve?
Sensation occurs from dorsal and ventral ramus, travels down dorsal root ganglion, to through the dorsal rot then into the dorsal horn, dorsal horn sends signal to thalamus then to brain
What does the segmental spinal aa branch into
Several radicular aa- follow nerve root to cord and (8-10)Segmental medullary aa- reinforce longitudinal vessels
What would happen if the great radicular artery is occluded
Spinal cord infarction, spinal cord ischemia then potential paralysis of pelvis and lower limbs
What is the purpose of intercrural fibers?
Strengthen and prevent "banana peeling"
Which nerve is located just below the ribs?
Subcostal nerve
Which parts of the thoracic vertebrae articulate with the ribs
Superior costal facet, Transverse costal facet, Inferior costal facet
Rectus abdominus m gets its blood supply from which artery?
Superior epigastric artery
What are spinal ganglia lacking?
Synapses
Which dermatomes are responsible for the thorax?
T1-T12
Which ventral (anterior) rami create the thoracoabdominal nerves?
T7-T12 and L1
What creates the horizontal lines to your 6 pac abs?
Tendinous intersection
Why can the veins in the internal vertebral venous plexus flow both ways
They lack valves
Which vertebral rami are segmental?
Thoracic (T2-T11)
What structures make up the thoracic wall?
Thoracic vertebrae, Sternum, Ribs
Which spinal nerves exit below their respective vertebrae
Thoracic, lumbar, sacral, coccygeal
What happens if there's too much blood in spinal cord?
Too much pressure
Which plane is across the inferior border of the 10th costal cartilage and the body of L1 vertebra
Transpyloric (subcostal) plane
Which plane is across the iliac tubercles
Transtubercular plane
When above the arcuate line, what layers are below the rectus?
Transvers abdominis, Transversal facia, Parietal peritoneum
What are the layers of the superficial inguinal canal?
Transversalis facia Internal oblique external oblique
Which abdominal muscle stabilizes and maintains intraabdominal pressure
Transverse Abdominis
What are the 3 different type of ribs?
True Ribs (vertebrosternal) 1-7 False ribs (vertebrocostal) 8-10 Floating Ribs (vertebral) 11-12
Which part of the rib articulated with the transverse processes of the vertebrae?
Tubercle
What happens with trunk torsion?
Twist towards contracted internal obliques
What causes pain of the round ligament of the uterus?
When the uterus stretches during pregnancy, the ligament cannot stretch
Where do ribs attach/articulate
With the vertebrae posteriorly articulate with the body and transverse process of vertebra of the same number and with the body of the vertebrae directly superior
Which direction do the external intercostal muscles go in?
X, medial and inferior
Which abdominal muscles compress and support abdominal viscera?
All 4! Rectus abdominis, external/internal obliques and transverse abdominis
What veins drain into the internal vertebral venous plexus
Anterior and posterior spinal veins
Where is the transumbilical plane
At the level of T10 and umbilicus
Where are spinal taps preformed
Between L3 and L4, in the cauda equina
What is the separation or right and left rectus abdominis muscles due to linea alba stretching?
Diastatsis Recti
Which type of hernial protrusion recedes when patient lays down?
Direct inguinal hernia
What is the function of the internal vertebral venous plexus
Drains the vertebral column
Which intercostal muscles are insufficient anteriorly?
External intercostal mm and Inner most intercostal mm
What are the 3 types of intercostal muscles?
External intercostal muscles Internal intercostal muscles Innermost intercostal muscles
Which of the flank muscles attach to the ribs?
External obliques (ribs 5-12)
Order of flank muscles superficial to deep
External obliques, Internal obliques, Transverse abdominis
Which muscles work together to perform the Valsalva maneuver?
Flank and rectus abdominous mm
Where would you feel pain if your appendix ruptures?
Mcburneys point, Accute and sharp pain
Which plane bisects the clavicles halfway between
Midclavicular planes (L/R)
Where is the arcuate line?
Midway point between umbilicus and pubic symphysis
What is the Dorsal Primary Ramus?
Mixed motor and sensory fibers innervating epaxial muscles and overlying skin
What is the Ventral primary Ramus?
Mixed motor and sensory fibers that innervate hypaxial muscles and overlying skin
What makes abs visible to the naked eye?
Muscle bellies of rectus abdominis muscles are well developed and low amounts of Camper's facia
Which part of the rib houses the nerves, arteries and veins
The Costal Groove
Where does rib 2 articulate with the manubrium and body of sternum?
The Sternal Angle
What is a dermatome?
The dorsal and ventral rami or each spinal nerve that are responsible for innervating Strip of skin
Which facet of the thoracic vertebra does not articulate with the same rib?
The inferior costal facet
What are the 4 quadrants of the anterolateral abdominal wall
Upper right Upper left Lower right Lower left
What is used clinically to check for inguinal hernia, prolapsed uterus or bladder, varicoceles...
Valsalva Maneuver
What maneuver is creating an increase in intra-abdominal pressure by breathing in, contracting abdominal mm and attempting to exhale
Valsalva maneuver
Innervation of rectus abdominis muscles
Ventral (anterior) rami T7-T12 and L1
What is the motor pathway for the spinal cord and spinal nerve?
Ventral Horn releases a signal, travels down dorsal root, to the spinal nerve, sends it to both the dorsal ramus and ventral ramus
Where are the motor fibers that innovate somatic muscles?
Ventral Root
What happens with lateral trunk flexion?
You bend towards the contracted side
