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Reproduction Week 4 2018/19 > 1: Anatomy - Surgical incisions > Flashcards

1: Anatomy - Surgical incisions Flashcards

1
Q

What

a) horizontal
b) vertical

incisions are most commonly carried out in obs & gynae?

A

a) Lower segment caesarean section

b) Laparotomy incision

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2
Q

At what level are Caesarean sections carried out?

A

2cm above pubic symphysis

measured as two finger breadths

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3
Q

On which line is a Caesarean incision made?

A

Suprapubic line

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4
Q

What are the three layers of abdominal fascia called?

Where are they found relative to the abdominal muscles?

A

Superficial - Camper’s fascia, Scarpa’s fascia; found superficial to external obliques

Deep - transversalis fascia; found deep to rectus abdominis and transversus abdominis

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5
Q

What are the four groups of abdominal wall muscles?

A

External obliques

Internal obliques

Rectus abdominis medially

Transversus abdominis laterally

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6
Q

What are the three layers of intercostal muscles?

A

External intercostals

Internal intercostals

Innermost intercostals

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7
Q

Which direction do the external oblique muscles run in?

A

Hands in pockets

Anterior direction

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8
Q

The external oblique muscles run in an (anterior / posterior) direction.

A

anterior direction

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9
Q

Which ribs do the external obliques attach to superiorly?

A

Ribs 5 - 11

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10
Q

Which structures do the external obliques attach to inferiorly?

A

Iliac crests

Pubic tubercle

Linea alba

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11
Q

What structure is a flattened aponeurosis found in the midline?

A

Linea alba

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12
Q

What structures are flattened aponeuroses found laterally?

A

Linea semilunaris

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13
Q

What is an aponeurosis?

A

Flattened tendon

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14
Q

The external obliques run in the same direction as which respiratory muscles?

A

External intercostals

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15
Q

Which direction do the internal obliques run in?

A

Posteriorly

i.e the opposite of external intercostals, remember hands in pockets

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16
Q

What fascia is found posteriorly?

A

Thoracolumbar fascia

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17
Q

Which abdominal muscles attach to the thoracolumbar fascia?

A

Internal obliques

Transversus abdominis

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18
Q

Which bony feature of the pelvis do all of the abdominal muscles attach to?

A

Iliac crest

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19
Q

Which flattened tendons make up the borders of rectus abdominis?

A

Linea alba in the midline

Linea semilunaris laterally

Tendinous intersections between the groups of muscles

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20
Q

What structures does the linea alba attach to superiorly and inferiorly?

A

Xiphoid process of the sternum superiorly

Pubic symphysis inferiorly

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21
Q

Which structure is made up of the combined aponeuroses of transversus abdominis, external oblique and internal oblique?

A

Rectus sheathe

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22
Q

Is rectus abdominis part of the rectus sheathe?

A

No

As in it doesn’t have an aponeurosis to contribute, it’s just surrounded by the rectus sheathe

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23
Q

Transversus abdominis is described as a corset muscle - why?

A

Keeps the abdominal organs contained within the abdominal cavity

Force of gravity pushes all these muscles downwards, creating a need for support

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24
Q

What is the advantage of tendinous intersections between the muscle groups of rectus abdominis?

A

Prevents bowstringing

If rectus abdominis was one long muscle it would contract in a weird way

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25
Q

What horizontal line marks a change in the structure of the rectus sheathe?

A

Arcurate line

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26
Q

Where exactly is the arcurate line?

A

Halfway between umbilicus and pubic crest

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27
Q

Describe the structure of the rectus sheathe above and below the arcurate line.

A

Above acurate line:

external oblique anterior to rectus, internal oblique split into two leaflets, one anterior and one posterior to rectus, transversalis fascia posterior to rectus

Below arcurate line:

everything is anterior to rectus apart from transversalis fascia

This gets asked about in exams

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28
Q

Which muscle is always superficial to rectus abdominis in the rectus sheathe?

A

External oblique

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29
Q

Which muscle splits into anterior and posterior leaflets in the rectus sheathe above the acurate line?

A

Internal oblique

Anterior leaflet is superficial to rectus, posterior leaflet is deep to rectus

30
Q

Describe the structure of the rectus sheathe above the arcurate line.

A

External oblique superficial to rectus

Internal oblique split into two leaflet - anterior leaflet superficial to rectus, posterior leaflet deep

Transversalis fascia deep to rectus

31
Q

Describe the structure of the rectus sheathe below the arcurate line.

A

External oblique superficial to rectus

Internal oblique superficial to rectus

Transversalis fascia deep to rectus

32
Q

Name the layers of the abdominal wall from superficial to deep.

A

Skin

Subcutaneous fat

Superficial fascia - Camper’s and Scarpa’s fascia

External oblique

Internal oblique

Rectus / Transversus abdominis

Transversalis fascia

Parietal and visceral peritoneum

33
Q

The layers of the spermatic cord from superficial to deep are

external spermatic fascia

cremasteric fascia

internal spermatic fascia

tunica vaginalis

which layers of the abdominal wall do these structures come from?

A

External spermatic fascia derived from external obliques

Cremasteric fascia derived from internal obliques

Internal spermatic fascia derived from transversalis fascia

Tunica vaginalis derived from parietal peritoneum

34
Q

Which layers of the spermatic cord are given off by

a) parietal peritoneum
b) transversalis fascia
c) internal oblique
d) external oblique?

A

a) Tunica vaginalis

b) Internal spermatic fascia

c) Cremasteric fascia

d) External spermatic fascia

35
Q

Which nerves supply the intercostal muscles?

What is their source?

A

Intercostal nerves

Anterior rami of thoracic spinal nerves (T7 - T11)

36
Q

What is the blood supply of the

a) anterior
b) posterior

intercostal spaces?

A

a) Internal thoracic artery
b) Throracic aorta

37
Q

What is the blood drainage of the

a) anterior
b) posterior

intercostal spaces?

A

a) Internal thoracic vein

b) Azygous vein

38
Q

What are the internal thoracic arteries and veins also known as in women?

A

Internal mammary arteries and veins

39
Q

Which nerves supply the abdominal muscles?

A

Thoracoabdominal nerves

Subcostal nerve

Iliohypogastric nerve

Ilioinguinal nerve

40
Q

The intercostal nerves are derived from the anterior rami of which spinal nerves?

A

T7 - T11

41
Q

The (ventral / dorsal) rami of spinal nerves provide motor fibres.

A

ventral rami

42
Q

Which nerves are thoracoabdominal nerves a continuation of?

A

Intercostal nerves

43
Q

Which spinal levels are the thoracoabdominal nerves derived from?

A

T7 - T11

same as intercostals (because they’re the same nerves)

44
Q

What are the spinal levels of the

thoracoabdominal nerves

subcostal nerves

iliohypogastric nerves

ilioinguinal nerves?

A

Thoracoabdominal nerves - T7 - T11

Subcostal nerves - T12

Iliohypogastric nerves - L1

Ilioinguinal nerves - L1

45
Q

Where in the rectus sheathe do the nerves of the abdominal wall travel?

A

Between internal oblique and transversus abdominis

i.e the anterior rectus sheathe, above AND below the arcurate line

46
Q

Which arteries supply the anterior abdominal wall?

A

Superior epigastric artery

Inferior epigastric artery

although the inferior epigastric supplies the vast majority of the blood

47
Q

Which anterior abdominal artery gives most of the blood supply?

A

Inferior epigastric artery

48
Q

Where are the superior and inferior epigastric arteries found in relation to the rectus sheathe?

A

Deep to rectus abdominis

49
Q

In which layer of the abdominal wall are the

a) thoracoabdominal nerves
b) superior and inferior epigastric artery

found?

A

a) Between internal oblique and transversus abdominis (anterior rectus sheathe)
b) Deep to rectus abdominis (posterior rectus sheathe)

50
Q

Which major arteries are the

a) superior
b) inferior epigastric arteries a branch of?

A

a) Internal thoracic / mammary artery

b) External iliac artery

51
Q

The superior epigastric artery is (anterior / posterior) to rectus abdominis.

The inferior epigastric artery is (anterior / posterior) to rectus abdominis.

A

They’re both posterior to rectus abdominis

52
Q

Which type of incision can damage the thoracoabdominal, subcostal, iliohypogastric or ilioinguinal arteries?

A

Midline laparotomy incision

53
Q

The superior epigastric arteries are a branch of?

A

Internal thoracic / mammary artery

54
Q

The inferior epigastric arteries are a branch of?

A

External iliac artery

55
Q

In a caesarean section, are the rectus abdominis muscles cut?

A

No

The linea alba is cut and they’re pushed laterally

56
Q

Which organ needs to be pushed inferiorly in a Caesarean section?

A

Bladder

You do not want to cut this

57
Q

What is the suprapubic line also known as?

A

Pfannenstiel / Kerr line

58
Q

Where is the deep inguinal ring found?

A

Halfway between ASIS and pubic tubercle

59
Q

What triangle is formed from the lateral border of rectus abdominis, the inguinal ligament inferiorly and the inferior epigastric artery medially?

A

Inguinal triangle

or Hesselbach’s triangle

60
Q

What are the borders of the inguinal triangle?

A

Lateral border of rectus abdominis

Inferior epigastric artery superiorly

Inguinal ligament inferiorly

61
Q

The deep inguinal ring is found halfway between the ASIS and the pubic tubercle.

Hernias MEDIAL to this must be ___.

A

direct

i.e popping through a muscular weakness, because the superficial inguinal ring is lateral to the deep one

62
Q

The deep inguinal ring is halfway between the ASIS and the pubic tubercle.

Hernias LATERAL to this must be ___.

A

indirect

because the superficial ring, when indirect hernias pop out, is lateral to the deep inguinal ring

63
Q

How do you tell the difference between a direct and indirect inguinal hernia on examination?

A

Reduce the hernia and then put pressure on the deep inguinal ring (halfway between ASIS and pubic tubercle), then ask the patient to cough

If it pops out, it’s direct (through rectus muscle)

If it doesn’t, it’s indirect (it passes through the deep inguinal ring, which you’re blocking)

64
Q

Direct inguinal hernias occur (medial / lateral) to the inferior epigastric artery.

A

medial

because they herniate through the rectus, which is the medial border of the inguinal triangle

65
Q

Indirect inguinal hernias occur (medial / lateral) to the inferior epigastric artery.

A

lateral

because they pop through the deep inguinal ring, which is lateral to the inguinal triangle

66
Q

What is a hysterectomy?

A

Removal of the uterus

67
Q

Which incision is used to carry out an abdominal hysterectomy?

A

Suprapubic / Pfannenstiel incision

same as for Caesarean section

68
Q

Which phrase describes the relationship between the ureter and the uterine artery?

A

Water under the bridge

The ureter is always posterior to the uterine artery

69
Q

What does the ureter do when you touch it?

A

Vermiculates

which means it wriggles like a worm - peristalsis

70
Q

Which artery can be damaged by a lateral abdominal port procedure?

A

Inferior epigastric artery

71
Q

Which structure passes posterior to the bladder in males?

A

Vas deferens

Reproduction Week 4 2018/19 (9 decks)

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