3.2.5. ANATOMY - Abdominal wall, testic, spermatic cord

Question 1

Answer 1

Question 2

Answer 2

Question 3

Answer 3

Question 4

Answer 4

Question 5

Answer 5

Question 6

Answer 6

Question 7

Answer 7

Question 8

Answer 8

Question 9

Answer 9

Question 10

Answer 10

Question 11

Answer 11

Question 12

Answer 12

Question 13

Answer 13

Question 14

Answer 14

Question 15

Answer 15

Question 16

How does the rectus sheath differ above and below the arcuate line? Why do we care?

Answer 16

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.

Question 17

Largest muscle on the abdominal wall?

Answer 17

External oblique is the largest muscle on the abdominal wall

Question 18

What is the medial umbilical ligament? Where is it?

Answer 18

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

Question 19

Why do we care about the medial umbilical ligament? What does it do?

Answer 19

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

Question 20

Attachment points for the inguinal ligament

Answer 20

The inguinal ligament (Poupart’s ligament) is a band running from the pubic tubercle to the anterior superior iliac spine

Question 21

Hesselbach’s triangle?

Answer 21

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,

Question 22

Where is the inguinal canal with respect to the inguinal ligament?

What makes up its boundaries?

Answer 22

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

Question 23

What landmark helps us find the inguinal canal?

Answer 23

Can always find the pubic tubercle (landmark)

Question 24

Where do the rectus abdominis muscles insert?

Answer 24

Insert on the pubic crest

Question 25

Risks of doing a TRAM flap?

Answer 25

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.

Question 26

What do we do during a TRAM flap surgery?

Answer 26

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

Question 27

Origin and insertion for the internal oblique muscle?

Answer 27

Originates at thoracodorsal fascia and inserts on the midline after becoming aponeurotic

Question 28

Why do we care about the conjoint tendon?

Answer 28

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

Question 29

Where is the arcuate line?

Answer 29

Above or below the ASIS

Question 30

Identify the external oblique, internal oblique, and transverse abdominis arches

Question 31

What structures does the spermatic cord contain? What are the names of the layers surrounding the testis?

Question 32

Where is the round ligament of the uterus? What is this the female analogue of (what structure is it in the male)?

Question 33

What are the external female genitalia structures? (Objectives only includes the labium majus)

Question 34

What is the scrotal raphe?

Question 35

Know the male genitalia structures in detail. This includes:

scrotal (gubernacular) ligament

Head, body, and tail epididymis

Tunica vaginalis and albigunea

etc.

Question 36

Be able to identify structures within the spermatic cord:

testicular artery

pampiniform plexus of veins

ductus deferens

etc.

Question 37

What is the largest muscle of the abdominal wall?

Answer 37

External oblique is the largest muscle on the abdominal wall

Question 38

Where is the superficial inguinal ring in comparison to the pubic tubercle?

Question 39

How are the external layers of the abdominal wall organized? (i.e. skin through parietal peritoneum)

Question 40

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?