1. Anterior Abdominal Wall (Brauer)

Question 1

Which aponeuroses are anterior / posterior to rectus abdominis below the arcuate line?

Answer 1

Anterior: external oblique, internal oblique, transversus abdominis

Posterior: transversalis fascia

Question 2

Into which other nodes do the external iliac nodes drain?

Answer 2

The external iliac notes drain into the common iliac nodes, which drain into the lumbar (caval/aortic) nodes.

Question 3

What anterior abdominal wall fossa is of the site of direct inguinal hernias?

Answer 3

The medial inguinal fossa

Question 4

Which fold of the internal surface of the abdominal wall is a remnant of the urachus?

Answer 4

The median umbilical fold

Question 5

What is the function of the illioinguinal nerve?

Answer 5

Provide sensation through the inguinal canal.

Passes into the anterior scrotum / labia majora.

Cutaneous sensation to the medial thigh.

Question 6

Why might a midline incision through the linea alba have a long recovery time?

Answer 6

Because of contraction of the muscles pulling apart, and lack of a dedicated blood supply.

Question 7

What are the risks of a subcostal incision?

Answer 7

Cutting the intercostal nerves, and possibly the superior epigastric artery.

(Note: subcostal incisions typically avoid the musculophrenic artery and subcostal nerve)

Question 8

To what vertebra and rib does the transpyloric plane correspond?

Answer 8

L1

Rib 9

Question 9

Where is the trans-tubercular plane found, and to which vertebra does it correspond?

Answer 9

The trans-tubercular plane is found at the widest part of the hips.

It corresponds with L5

Question 10

Where is the neurovasculature of the abdominal compartment located?

Answer 10

Between the internal oblique muscle and the transversus abdominis muscle.

Question 11

What root gives rise to the illiohypogastric and illioinguinal nerves?

Answer 11

L1

Question 12

What rib and vertebra is associated with the xiphisternal plane?

Answer 12

Rib 7

T9

Question 13

What roots make up the thoraco-abdominal nerves?

Answer 13

The anterior rami of T7-T11

(Same as the intercostal roots)

Question 14

What are the dangers of a paramedian incision (along the linea semilunaris)?

Answer 14

Very large potential to cut the thoraco-abdominal nerves, eliminating control of the rectus abdominis and other abdominal muscles.

Question 15

What are the eight layers of the anterior abdominal wall in order from superficial to deep (not including skin)?

Answer 15

Camper’s fascia
Scarpa’s fascia
External oblique muscle
Internal oblique muscle
Transversus abdominis
Transversalis fascia
Extra peritoneal fat
Parietal peritoneum

Question 16

Where are epigastric hernias likely to occur?

Answer 16

In the linea alba

Question 17

What is the function of the illiohypogastric nerve?

Answer 17

Provides cutaneous sensation to the upper inguinal region and the superior hypogastric region.

Question 18

What do we call Scarpa’s fascia when it enters the scrotum?

Answer 18

Dartos fascia

Question 19

Where does the superior epigastric artery run? (Between what muscles)

Answer 19

Behind rectus abdominis, between rectus abdominis and the posterior rectus sheath.

Question 20

Where does the deep circumflex iliac artery run?

Answer 20

From the external iliac artery medially up the inguinal ligament.

Question 21

What major artery and gives rise to the inferior epigastric artery?

Answer 21

The external iliac artery

Question 22

The medial umbilical fold is the remnant of what structure?

Answer 22

The obliterated umbilical artery

Question 23

There is an unnamed plane at the eighth rib – to what vertebra does it correspond?

Answer 23

T11

Question 24

What landmark and vertebra defines the supracristal plane?

Answer 24

Top the iliac crest

L4

Question 25

What is a Spigelian hernia?

Answer 25

A rare hernia occurring in the linea semilunaris

Question 26

To what rib and vertebra does the subcostal plane correspond?

Answer 26

The base of rib 10

L3

Question 27

Where is the medial inguinal fossa found?

Answer 27

Medial to the inferior epigastric vessels / the lateral umbilical fold.

Question 28

Lymph close to the center of the abdomen just above the umbilicus travels to which lymph nodes?

Answer 28

Anterior diaphragmatic lymph nodes – then to the parasternal lymph nodes

Question 29

Where does lymph superior to the trans-umbilical plane travel?

Answer 29

Axillary lymph nodes (pectoral, central, apical, clavicular)

Question 30

What two branches of the internal thoracic artery supply the abdominal cavity?

Answer 30

The musculophrenic and superior epigastric

Question 31

Where does lymph inferior to the trans-umbilical plane in the abdominal cavity travel?

Answer 31

Superficial inguinal lymph nodes (same as the scrotum)

Question 32

Where are the supravesical fossae of the anterior abdominal wall found?

Answer 32

Lateral to the superior margin of the bladder, but medial to the edge of the medial umbilical fold

Question 33

What nerve root innervates the umbilicus?

Answer 33

T10

Question 34

Which aponeuroses are anterior / posterior to rectus abdominis above the arcuate line?

Answer 34

Anterior: external oblique, internal oblique

Posterior: internal oblique, transversus abdominis, transversalis fascia

Question 35

What anterior abdominal wall fossa is the location of indirect inguinal hernias?

Answer 35

The lateral inguinal fossa (lateral to the inferior epigastric vessels)

Question 36

What is the lateral umbilical fold?

Answer 36

A fold of tissue covering the inferior epigastric vessels