3.2.5. ANATOMY - Abdominal wall, testic, spermatic cord Flashcards
How does the rectus sheath differ above and below the arcuate line? Why do we care?
From the arcuate line inferiorly, the internal oblique aponeurosis no longer divides to form both an anterior leaf and a posterior leaf, of the rectus sheath. Instead, as one goes toward the pubis, all layers of the rectus sheath except for the transversalis fascial layer are now anterior to the rectus muscle (GA p 107, 109; N 245, 246). This has implications on the etiology (origin) and repair of some hernias. Hernias are abnormal openings in the musculofascial layer through which viscera can protrude. They can be dangerous to the patient since a viscus (e.g., a segment of intestine) can become caught within the hernia and its blood supply can be twisted (so-called strangulation-obstruction) – this can be rapidly lethal if the viscus perforates.
Largest muscle on the abdominal wall?
External oblique is the largest muscle on the abdominal wall
What is the medial umbilical ligament? Where is it?
It is a shrivelled piece of tissue that represents the remnant of the embryonic urachus. It extends from the apex of the bladder to the umbilicus, on the deep surface of the anterior abdominal wall. It is covered by the median umbilical fold
Why do we care about the medial umbilical ligament? What does it do?
It may be used as a landmark for surgeons who are performing laparoscopy, such as laparoscopic inguinal hernia repair.
No function in the human body
Attachment points for the inguinal ligament
The inguinal ligament (Poupart’s ligament) is a band running from the pubic tubercle to the anterior superior iliac spine
Hesselbach’s triangle?
Hesselbach’s triangle: the inguinal triangle contains a depression referred to as the medial inguinal fossa, through which direct inguinal hernias protrude through the abdominal wall
- Medial border: Lateral margin of the rectus sheath, also called linea semilunaris
- Superolateral border: Inferior epigastric vessels
- Inferior border: Inguinal ligament,
Where is the inguinal canal with respect to the inguinal ligament?
What makes up its boundaries?
Inguinal canal is superior and parallel to the inguinal ligament.
Anterior wall formed from the aponeurosis of the external oblique m.
Internal oblique m. fibers form the roof
What landmark helps us find the inguinal canal?
Can always find the pubic tubercle (landmark)
Where do the rectus abdominis muscles insert?
Insert on the pubic crest
Risks of doing a TRAM flap?
Developed decades ago and is no longer recommended or performed at the Johns Hopkins Breast Center, because of the risk of hernia or abdominal bulge and the limit on lifting anything over 20 pounds post surgery.
What do we do during a TRAM flap surgery?
The tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, is tunneled beneath the skin to the chest, creating a pocket for an implant—or in some cases, creating the breast mound itself
Origin and insertion for the internal oblique muscle?
Originates at thoracodorsal fascia and inserts on the midline after becoming aponeurotic
Why do we care about the conjoint tendon?
The conjoint tendon serves to protect what would otherwise be a weak point in the abdominal wall. A weakening of the conjoint tendon can precipitate a direct inguinal hernia
Where is the arcuate line?
Above or below the ASIS
Identify the external oblique, internal oblique, and transverse abdominis arches
What structures does the spermatic cord contain? What are the names of the layers surrounding the testis?
Where is the round ligament of the uterus? What is this the female analogue of (what structure is it in the male)?
What are the external female genitalia structures? (Objectives only includes the labium majus)
What is the scrotal raphe?
Know the male genitalia structures in detail. This includes:
scrotal (gubernacular) ligament
Head, body, and tail epididymis
Tunica vaginalis and albigunea
etc.
Be able to identify structures within the spermatic cord:
testicular artery
pampiniform plexus of veins
ductus deferens
etc.
What is the largest muscle of the abdominal wall?
External oblique is the largest muscle on the abdominal wall
Where is the superficial inguinal ring in comparison to the pubic tubercle?
How are the external layers of the abdominal wall organized? (i.e. skin through parietal peritoneum)
If you look superiorly (from below the hip), how will the inguinal ligament attatch to the hip? What lies between the inguinal ligament and the hip?
