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Clinical Anatomy > Abdomen 1 > Flashcards

Abdomen 1 Flashcards

1
Q

label what you can

A
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2
Q

what level is the umbilicus?

A

L4

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3
Q

what are the superior and inferior boundaries of the abdomen?

A

Superior boundaries = xiphoid process and costal margin
Inferior boundary = pubic symphysis; inguinal ligament and iliac crest

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4
Q

label what you can

A
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5
Q

through which planes/ lines is the abdomen divided?

A
  • The abdomen is divided into 9 regions via two vertical midclavicular lines and horizontally via the transpyloric plane (L1 – marks the pylorus of the stomach) and the transtubercular plane (L4/L5)
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6
Q

what level is the transpyloric plane, subcostal plane and the transtubercular plane?

how to identify the transpyloric plane and transtubercular plane?

A

transpyloric plane - L1
subcostal plane - L2
transtubercular plane - L4/L5

  • To identify the transpyloric plane point = find the midway point between the jugular notch and the pubic symphysis (identifying the subcostal plane at L2 is easier so often preferred) its the middle of these 2
  • To identify the transtubercular plane = palpate for the iliac crest, the plane runs between the two crest
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7
Q

how to split the abdomen into 4 quadrants?

A
  • The abdomen can also be divided into 4 regions by using the transumbilical plane at the level of the umbilicus (L4) and the median plane
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8
Q

what is inguinal ligament and what are its attachments

A

Pubic tubercle and ASIS
continuation of exernal oblique muscle, where free border folds in under itself
pubic tubercle and ASIS

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9
Q

what is the superficial fascia?

A

the outer layer (below skin) and is composed of two distinct layers:
Camper’s Fascia – fatty and continuous with the superficial fascia of the thigh and penis; dartos fascia of the scrotum and perineum and labia majora
Scarpa’s Fascia – membranous (composed of elastic and connective tissue) and continuous with the fascia lata of the thigh; superficial ligaments of the penis; colles’ fascia and the perineum and labia majora

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10
Q

how many rectus sheath do we have?

what is the rectus sheath components

A

2 - anterior and posterior (only covers 2/3rds of posterior aspect of rectus abdominis)

composed of the aponeurosis of external and internal obliques and the transversus abdominis (ALL THE 3 FLAT MUSCLES)

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11
Q

what is extravasion of urine?

A

where urine pools in scrotum and abdominal wall
- a rupture of the urethra leading to collection of urine and blood in superficial perineal space, scrotum and potentially the lower anterior abdominal wall

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12
Q

label

A
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13
Q

all the abdominal muscles, functions, fibre direction, nerve supply

A
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14
Q

Thoracolumbar fascia

A
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15
Q

Iliohypogastric and ilioinguinal nerve L1

A
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16
Q

Give the layers of the lateral abdominal wall

A
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17
Q

what is the transversalis fascia

A

Very thick layer of investing fascia
Runs all the way around the abdominal cavity
Becomes continuous with the fascia of the muscles of the back of the abdominal wall

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18
Q

what is the linea alba
Legnth of linea alba
Why is the linea alba the site of surgical incision?
why is the linea alba white?

A

formed when the left and right sides of the aponeurosis converge with the fibres crossing over and forming a thickening in the midline.
- suspensory ligaments of penis and clit are attached here
- umbillical ring is also here (opening where umbillical vessels used to pass in the fetus)
Xiphoid process to pubic crest
avascular
made of collagen

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19
Q

label what u can

A
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20
Q

the internal oblique aponeurosis is split into two layers, they are?

A

Anterior and posterior laminae

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21
Q

Why do hernia’s usually occur lower down in the abdomen?

Difference in superior and inferior rectus sheath

A

Less posterior layers of Rectus sheath below arcuate line, hence hernias are more common lower down

superior: 2 layers of aponeurosis
inferior: all aponeurosis pass anterior to rectus abdominis muscle, and weaker as only formed by transversalis fascia and parietal peritoneum in posterior side

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22
Q

what are the branches that give into the femoral artery?

A

superficial epigastric (NOT SUPERIOR EPIGASTRIC)
superficial circumflex illiac

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23
Q

where does superior epigastric come from and what does it anastomose with?

A

internal thoracic artery
with inf epigastric (comes from external iliac), which enters envelope of rectus sheath

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24
Q

List all the arteries that supply abdominal wall and where they branch from?

A
  1. superior epigastric artery (branch of internal thoracic artery and comes with musculophrenic artery but taht geos into CC)
  2. inferior epigastric artery - enters envelop of rectus sheath and runs behind and in teh rectus abdominus muscle (from External iliac artery)
  3. superficial epigastric artery (branch of the femoral artery and comes with superficial circumflex artery)

The musculophrenic artery, deep circumflex iliac artery, and subcostal arteries supply the lateral abdominal wall. The superficial epigastric veins and the superficial ili

25
Q

where does the inferior epigastric artery run?

A

behind rectus abdominis muscle and then within

26
Q

whats this

A

rectus sheath hematoma

inferior epigastric can burst/rupture and cause a bleed within the rectus sheath
*Rupture in inferior epigastric artery which ascends between rectus abdominis and posterior laminae of rectus sheath.
*More common in patients on anticoagulants (always check drug history).

27
Q

label what u can

A
28
Q

what is the lacunar ligament

what is pectineal (coopers) ligament?

A

extension of inguinal ligament
attatches to pectin pubis
extends around posteriorly into pectinear (coopers ligament)

Extension of lacunar ligament that passes along the pectin pubis

29
Q

label correctly

A
30
Q

what is the conjoint tendon?

A

where aponeurosis (inferiorly) of internal oblique and transverse abdominis fuse to form the thickened conjoint tendon

31
Q

what is the inguinal canal, ist entry + exit, its functions (EVERYTHING)?

A

An oblique passage that extends downwards and medially through the lower anterior abdominal wall;
is approx. 4cm
two openings:
- deep inguinal ring (entrance in the transversalis fascia), lateral to epigastric vessels
- superficial inguinal ring (exit in the external oblique aponeurosis)

function =
In males – allows passage of the spermatic cord to pass to and from testis
In females – it permits the passage of the round ligament of the uterus

32
Q

label:

A
33
Q

Where do the gonads develop?

A

between transversalis fascia and parietal peritoneum

34
Q

label what you can

A
35
Q

function of gubernaculum and the tissue its made of?

A

developed at 7 weeks gestation
mesenchymal tissue
function: Assist in descent of testes from abdomen into developing scrotum (atttaches to the gonads)

36
Q

label what you can

A
37
Q

what is Process vaginalis

A

Tubular extension of peritoneal cavity
Herniates through abdominal wall along path formed by gubernaculum
2-3 months gestation
Obliterates and closes in a downwards direction
- Scrotal part remains patent as the tunica vaginalis (whats left of process vaginalis basically, in scrotum and it lays next to testes)

  • PV creates the deep inguinal canal
38
Q

what is the Deep inguinal ring and location of it (in relation to epigastric artery)

A

ALWAYS LATERAL TO INF EPIGASTRIC ARTERY

Evagination of the transversalis fascia produced by process vaginalis
The deep inguinal ring has an important relationship with the inferior epigastric vessel (located lateral to the inferior epigastric artery)
- When trying to find the deep inguinal ring, it is 1cm superior to the inguinal ligament on its midway point between the ASIS and the pubic tubercle

39
Q

what is Superficial inguinal ring and its location

A

The superficial inguinal ring is the terminal end of the inguinal canal and is a triangular opening in the aponeurosis of the external oblique muscle. - It is 2-3cm superior and lateral to the pubic tubercle can be felt on a patient if pressing hard enough

40
Q

walls of inguinal canal

A

MALT

41
Q

what is the superior wall of the inguinal canal?

what is the anterior wall of the inguinal canal?

what is the inferior wall of the inguinal canal

what is the posterior wall of the inguinal ligament?

A

2 muscles
- internal oblique muscle
- transverse abdominis muscle

2 Aponeurosis
- of external oblique
- and internal oblique

2 ligaments
- inguinal
and
- lacunar

2 Ts
- transversalis fascia - where deep ing ring
- conjoint tendon (OB + TA)

42
Q

what does that cremasteric muscle and fascia do?

A

surrounds scrotum, retracts testis when its cold, cremasteric reflex

43
Q

Give the layers of the testes

A

DSC: dartos, spermatic, cremasteric
only difference is that it has dartos fascia instead of superficial fascia and this is made of muscle not membraneous tissue

44
Q

Contents of male inguinal canal !3!

A

spermatocord - has vas deferens, where sperm travels up
- lymphatics
- tunica vaginalis (remnant of process vaginalis)
- testicular artery, cremasteric artery, artery to vas deferens
- sympathetic nerve, genital branch of genitofemoral nerve

45
Q

Contents of female inguinal canal

A

just the illoguinal nerve and round ligament

46
Q

what is the Ilioinguinal nerve

A

Travels from uterus through the inguinal rings to spread around the labia majora - L1

47
Q

direct vs indirect inguinal hernia

A

direct = hernia passes directly through abdominal wall, medial to inferior epigastric artery

indirect = hernia passes trhough the deep ingual ring, into legnth of canal, lateral to inf epigastric artery
: if tunica vaginalis doesnt from correctly, then teh pathway is there for gut to pass through

48
Q

Why are inguinal hernias more common in males?

A

Due to thickness of spermatic cord

49
Q

what is this?

A

varicocele
pampiniform plexus becomes dilated and tortuous resulting ina bag of worms appearance to the scrotum

50
Q

what is this?

A

Hydrocele -
excess fluid build up in the tunica vaginalis. Diagnosis involves shining a light under the swelling, if it illuminates it indicates there is no solid mass present and is fluid (transillumination positive)

51
Q

What is this?

A

Testicular torsion -
twisting of the spermatic cor above its attachment to the testis, cutting off the blood supply

52
Q

A 46-year-old man is undergoing surgical repair of a gastric ulcer. An incision is made 2.5 cm left of midline, extending from just below the level of the xiphoid process to the level of the umbilicus. The surgeon retracts the rectus abdominis muscle and incises the posterior rectus sheath. At the level of the incision, aponeuroses from which of the following muscles contribute to this portion of the sheath?

A

Internal Oblique and Transversus abdominis

53
Q

An 82-year-old man must have a direct inguinal hernia surgically repaired. During the open procedure, the superficial inguinal ring needs to be reconstructed. Which of the following structures will be involved in completing this part of the surgical procedure?

A

Aponeurosis of the external oblique

54
Q

During a routine physical examination of a 4-year-old boy, a pediatrician discovers a mass in the child’s right inguinal region. The mass extends from just above the midpoint of the inguinal ligament to a point above and medial to the pubic tubercle. Which of the following best describes what the physician has identified?

A

Indirect inguinal hernia

55
Q

A 48-year-old man notices a “bulge in his groin” when he lifts a heavy object or coughs. His physician can reduce the mass by manipulation, but it promptly reappears with his next strain or cough. It is located above and just lateral to the pubic tubercle. The most likely diagnosis of this problem is which of the following?

A

Indirect inguinal hernia

56
Q

where does the inf epigastric artery arise from and drain into?

A

external iliac artery
drains into external iliac vein

57
Q

what does the lateral umbilical fold do?

A

overlies the inf epigastric artery

58
Q

what are the borders of Hesselbach’s (inguinal) triangle?

A
59
Q

which hernia emerges medial to the pubic tubercle? and enters the scrotum

A

indirect

Clinical Anatomy (22 decks)

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