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4. Gastrointestinal > 10.9-10 > Flashcards

10.9-10 Flashcards

1
Q

Layers of abdominal wall:

A 
Skin.
Superficial fascia.
Three layers of muscle.
Deep fascia - transversalis fascia.
Extraperitoneal fat.
Peritoneum.
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2
Q

Attachments of muscles of abdominal walls (like boundaries of abdomen):

A

Costal margin
Superior aspect of pelvis: anteriorly = pubic crest (pubic tubercle is lateral bump of bone of pubic crest), and posterior = iliac crest (ASIS is anterior bump of bone on iliac crest).

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3
Q

How do 3 layers of abdominal muscles attach to costal margin?

A

Over, edge to edge, and under!

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4
Q

The 3 muscles layers of the anterior abdominal wall are fleshy ___ and aponeurotic ___.

A

Laterally

Medially

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5
Q

Abdominal muscles - there are 2 aponeurotic extensions from left and right that join in ___ in a vertical raphe called ___ ___.

A

In midline to form linea alba.

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6
Q

The abdominal muscles extend posteriorly as far as the ___ ___.

A

Thoracolumbar fascia.

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7
Q

Muscles of abdominal wall:
Outer layer = ___
Middle layer = ___
Inner layer = ___

A

External oblique.
Internal oblique.
Transversus abdominus.

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8
Q

Fibres of external oblique run in “___ ___” direction.

A

Front pocket (like external intercostals!).

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9
Q

External oblique overlaps the ___ ___ and up to and edge-to-edge with ___ ___ and ___ ___.

A

Thoracic cage.

Up to and edge-to-edge with pectoralis major and serratus anterior.

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10
Q

External oblique attaches to the ___ half of the ___ ___, then jumps and attaches to the ___ ___ and ___ ___

A

Attaches to the anterior half of iliac crest, jumps and attaches to pubic tubercle and pubic crest.

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11
Q

There is a free inferior edge to the ___ ___ called the ___ ___.

A

External oblique.

Free edge is called the inguinal ligament.

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12
Q

The inguinal ligament extends form the ___ to ___ to form a ___ opening.

A

ASIS to pubic tubercle to form a triangular opening.

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13
Q

The ___ ___ is thickened and turns under self.

A

Inguinal ligament.

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14
Q

Fibres of internal oblique run in “___ ___” direction.

A

“Back pocket” direction (like inter intercostals!).

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15
Q

The internal oblique muscle attaches to the ___ ___ (edge-to-edge) and joins the other internal oblique muscle at the ___ ___ in the midline.

A

Costal margin.

Linea alba.

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16
Q

Internal oblique attaches to the ___ half of the ___ ___ and the ___.

A

Anterior half of iliac crest and the ASIS.

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17
Q

Some fibres of internal oblique originate beyond the ASIS from the ___ / of the inguinal ligament.

A

Lowermost fibres of internal oblique originate from the lateral 2/3 of the inguinal ligament.

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18
Q

The lowermost fibres of internal oblique do not go up to the linea alba, but arch up, over and down to insert into the ___ ___ independently.

A

Pubic crest.

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19
Q

The inner layer of abdominal wall muscles is the ___ ___.

A

Transversus abdominus.

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20
Q

Fibres of transversus abdominus run in a ___ direction.

A

Horizontal i.e. transverse!

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21
Q

The transversus abdominus muscle attaches ___ the costal margin, in the same plane as the ___.

A

Under, in the same plane as the diaphragm.

22
Q

Fibres of transversus abdominus come from the ___ half of the ___ ___, AND the lowermost fibres come from the ___ / (to /) of the inguinal ligament.

A

Anterior half of the iliac crest.

Lowermost fibres from the lateral 1/3 (to 1/2) of the inguinal ligament.

23
Q

The lowermost fibres of the transversus abdominus muscle do not join at the ___ ___, but arch up, over and down to insert into ___ ___, like the ___ ___ muscle.

A

Do not join at the linea alba.

Arch up, over and down to insert into pubic crest, like the internal oblique muscle.

24
Q

Internal oblique and transversus abdominus attach to the pubic crest by a ___ ___.

A

Conjoined tendon.

25
Q

The rectus abdominis muscle originates inferiorly from the ___ ___.

A

Pubic crest, and fibres diverge as the ascend (wider as up).

26
Q

Rectus abdominis crosses anterior to the costal margin and attaches to costal cartilages ___, ___ and ___.

A

5, 6, 7 (edge-to-edge with pectoralis major!).

27
Q

There are ___ tendinous intersections of rectus abdominis.

A

3

28
Q

The levels of the 3 tendinous intersections of rectus abdominis:

A

Level of umbilicus.
Level of xiphisternum.
Level halfway between two.

29
Q

The arcuate line is approx. 1 inch ___ the ___.

A

Under the umbilicus.

30
Q

Above the arcuate line - relationship of aponeuroses to rectus abdominis.

A

External oblique aponeurosis anterior (forming front of rectus sheath), transversus abdominus aponeurosis posterior (forming back of rectus sheath).

Internal oblique aponeurosis splits – half in front (anterior leaf) and half in back (posterior leaf)!

31
Q

Below the arcuate line - relationship of aponeuroses to rectus abdominis.

A

All aponeuroses in front of rectus abdominis (forming anterior rectus sheath).
Therefore, NO posterior rectus sheath.

Rectus abdominis is directly on transversalis fascia/extraperitoneal fat/parietal peritoneum.

32
Q

The neurovascular plane in the anterior abdominal wall is between the ___ and ___ layers.

A

Intermediate and deep i.e. between internal oblique and transversus abdominus.

33
Q

There is segmental innervation of the anterior abdominal wall: ___ = umbilicus, and ___ = groin (spinal nerves).

A 
T10 = umblilicus.
L1 = groin.

Therefore, T7/8/9 = anterior abdominal wall above umbilicus.
Therefore, T11/12 = between umbilicus and groin.

34
Q

There is a crescentic extension of inguinal ligament to the pectineal line of the pubic bone - called the ___ ___.

A

Lacunar ligament.

35
Q

There is a linear extension from the lacunar ligament called the ___ ___.

A

Pectineal ligament.

36
Q

The testes develop in ___ __ on the ___ abdominal wall and descend to scrotum.

A

Extraperitoneal fat on posterior abdominal wall.

37
Q

The testes pass ___ ___, ___ ___, ___ ___ and ___ ___ to descend to scrotum.

A

Transversalis fascia.
Transversus abdominis.
Internal oblique.
External oblique.

38
Q

The testes first pass through the ___ ___, by creating a deficiency in it.

A

Fascia transversalis.

39
Q

The deficiency in fascia transversalis for the testes occurs halfway between ___ and ___ ___, a fingers breadth above the inguinal ligament.

A

ASIS and pubic tubercle.

40
Q

The deficiency in fascia transversalis is called the ___ or ___ ___ ___.

A

Deep or internal inguinal ring.

41
Q

Remember - there is a hole in ___ ___ at the inguinal ligament (triangular opening), called the ___ or ___ ___ ___.

A

External oblique, called the superficial or external inguinal ring.

42
Q

Remember - the lowermost fibres of ___ ___ and ___ ___ originate from the ___ part of the ___ ___, and arch up, over and down to insert into ___ ___ by a ___ ___.

A

Internal oblique and transversus abdominus originate from lateral part of the inguinal ligament, insert into pubic crest by a conjoined tendon.

43
Q

The testes pass through deep/internal inguinal ring, move ___ and pass under the arching fibres of ___ and ___, before passing through the superficial/external inguinal ring.

A

Medially and pass under the arching fibres of transversus abdominus and internal oblique.

44
Q

As testes descend, they take ___, ___, ___, ___ and the ___ ___ (duct).

A

Nerves, arteries, veins, lymphatics and vas deferens (duct).

45
Q

As testes pass each layer of anterior abdominal wall, they gain a cover for protection: after deep/internal inguinal ring, they gain ___ ___ ___, after passing under the arching fibres of transversus abdominis and internal oblique they gain ___ ___, and after exiting the superficial/external inguinal ring, they gain ___ ___ ___.

A

Internal spermatic fascia (from transversalis fascia).
Cremasteric fascia.
External spermatic fascia (from external oblique).

46
Q

The cremasteric fascia has some associated ___ fibres, important in ___ retraction.

A

Muscles fibres - cremaster muscle.

For testicular retraction!

47
Q

Abdominal hernia:

A

Abnormal protrusion of abdominal contents through abdominal wall!

48
Q

Inguinal hernias - can be bilateral ___ or ___.

A

Direct or indirect.

49
Q

Bilateral indirect inguinal hernia is a protrusion through the ___ ___, into the inguinal canal.

A

Deep ring, i.e. following path of the testes!

50
Q

Bilateral direct inguinal hernia does NOT enter the ___ ___, and not in scrotum.

A

DO NOT enter the inguinal canal, and not the scrotum!

51
Q

The ___ ___ is the weakest point of the anterior abdominal wall, between the ___ ___ artery and ___ ___.

A

Inguinal TRIANGLE

Between the inferior epigastric artery and rectus abdominis.

52
Q

___ ___ is superolateral in the paravertebral gutter, and ___ is inferolateral in the paravertebral gutter.

A

Quadratus lumborum
Iliacus
Both next to psoas major

4. Gastrointestinal (13 decks)

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