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Time Completed: 01:07:02

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82

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Anatomy

Abdomen

Question 91 of 180

A patient presents with a superficial stab wound to the rectus sheath. Which of the following muscles is contained within the rectus sheath:

Answer:

The rectus sheath encloses the rectus abdominis and pyramidalis muscles, the superior and inferior epigastric vessels, the termination of intercostal nerves T7 - T11 and the 12th thoracic nerve and the accompanying vessels.

The rectus sheath is formed by the aponeuroses of the three flat anterior abdominal wall muscles.

Derivation

  • The anterior wall of the sheath is formed by the aponeurosis of the external oblique and half of the aponeurosis of the internal oblique (which splits at the lateral margin of the rectus abdominis).
  • The posterior wall of the sheath is formed by the other half of the aponeurosis of the internal oblique and by the aponeurosis of the transversus abdominis.

The rectus sheath completely encloses the upper three-quarters of the rectus abdominis in the above formation but only covers the anterior surface of the lower one-quarter of the muscle. At this point (midway between the umbilicus and the pubic symphysis), the anterior wall is formed by the aponeuroses of all three muscles, there is no posterior wall to the rectus sheath and the rectus abdominis muscle is in direct contact with the transversalis fascia. Marking this point of transition is the arcuate line.

By Henry Vandyke Carter [Public domain], via Wikimedia Commons

Rectus Sheath (enclosing upper three-quarters of rectus abdominis muscle). (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Rectus Sheath (covering lower one-quarter of rectus abdominis muscle). (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

Contents

In addition to the rectus abdominis muscle, the rectus sheath also encloses:

  • the pyramidalis muscle
  • the superior and inferior epigastric vessels
  • the termination of intercostal nerves T7 - T11
  • the 12th thoracic nerve and the accompanying vessels

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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