Abdomen

Question 1

Most superficial abdominal muscles

Interdigitate w/ serratus anterior and latissimus dorsi

OBLIQUELY DOWNWARD and MEDIALLY

Form aponeurosis

Answer 1

External Oblique

Question 2

Deep to external oblique

UPWARD and MEDIAL

internal oblique + transversus abdominis = CONJOINT TENDON

Answer 2

Internal Oblique

Question 3

Innermost
Flat

contribute to CONJOINT TENDON

Answer 3

Transversus abdominis

Question 4

On either side of linea alba

Segmented = tendinous intersections

lateral borders convex = LINEA SEMILUNARIS

Answer 4

Rectus abdominis

Question 5

Not always present abdominal muscle

Tenses linea alba

Answer 5

Pyramidalis

Question 6

Subcostal plane

Answer 6

10th rib; L3

Question 7

Umbilicus

Answer 7

level of IVC; L3-L4

Question 8

Transtubercular

Answer 8

iliac tubercle; L5

Question 9

Layers of Abdominal Wall

Answer 9

Skin

Superficial FATTY layer (Camper)

Superficial MEMBRANOUS layer (Scarpa)

Deep Fascia

External Oblique

Internal Oblique

Transversus abdominis

Transversalis fascia

Extraperitoneal fat

Parietal peritoneum

Question 10

Contents of Rectus Sheath

Answer 10

Rectus abdominis
Pyramidalis
Superior epigastric vessels
Inferior epigastric vessels
Lower 5 intercostal and subcostal vessels and nerves

Question 11

Crescent shaped line marking the inferior limit of the rectus sheath

Midway b/w umbilicus and pubic crest

Answer 11

ARCUATE LINE (LINEA SEMICIRCULARIS)

potential site for Spigelian hernia

Question 12

Rectus sheath ABOVE the arcuate line

Answer 12

ANTERIOR - external oblique + internal oblique

POSTERIOR - transversus abdominis + internal oblique

Question 13

Rectus sheath BELOW the arcuate line

Answer 13

ANTERIOR - EO + IO +TA

POSTERIOR - no layer of rectus sheath

Question 14

Boundaries of Inguinal/Hesselbach Triangle

potential site of herniation (direct)

Answer 14

SUP and LAT - inferior epigastric artery

INF and LAT - inguinal ligament/Poupart ligament

MEDIAL - rectus abdominis (lateral)

Question 15

1 1/2 in (4 cm) long

Begins at the DEEP INGUINAL RING (hole in fascia transversalis) to SUPERFICIAL INGUINAL RING (hole in external oblique aponeurosis)

Parallel and above the inguinal ligament

Answer 15

INGUINAL CANAL

Question 16

Walls of Inguinal Canal

Answer 16

ANT - EOM aponeurosis
POST - Transversalis fascia and conjoint tendon
SUP/ROOF - IO and TA
INF/FLOOR - inguinal ligament

Question 17

Contents of Inguinal Canal

Answer 17

MALE - spermatic cord
FEMALE - round ligament of uterus

BOTH - ilioinguinal nerve

Question 18

Structures w/n the spermatic cord

3 arteries
2 nerves
2 others
1 vein
1 lymphatic vessels

Answer 18

testicular artery
cremasteric artery
artery of vas deferens

autonomic nerves
genital branch of genitofemoral nerve

vas deferens
processus vaginalis

testicular veins (pampiniform plexus)

testicular lymph vessels

Question 19

Glistening transparent serous membrane

Answer 19

PERITONEUM

Parietal - lines the internal surface of the abdomino-pelvic wall

Visceral - lines the investing organ/viscera

Question 20

Sensitive to pressure, pain, heat and cold

pain is LOCALIZED

Answer 20

Parietal peritoneum

Question 21

Insensitive to touch, heat and cold

Stimulated by stretching

pain is POORLY LOCALIZED

Answer 21

Visceral peritoneum

Question 22

Covered with visceral peritoneum

Answer 22

Intraperitoneal organs

Question 23

Outside, external or posterior to the parietal peritoneum

Partially covered with peritoneum (usually on one surface)

Answer 23

Extraperitoneal, Retroperitoneal and Subperitoneal

Question 24

Peritoneal Organs

-inside the peritoneum

Answer 24

esophagus
stomach
1st part duodenum
jejunum/ileum
cecum and appendix
transverse/sigmoid colon
superior rectum
liver, biliary tree
spleen

Question 25

Retroperitoneal organs

Answer 25

SAD PUCKER ``` Suprarenal gland (adrenals) Abdominal aorta (IVC) Duodenum (2nd-4th) Pancreas Ureters Colon (ascending and descending) Kidneys Esophagus Rectum (middle) ```

Question 26

Primary Retroperitoneal Organs

Answer 26

``` Kidney Ureter Urinary bladder Uterus Fallopian tube Aorta IVC Suprarenal glands ```

Question 27

Secondary Retroperitoneal Organs

Answer 27

Duodenum (2nd-4th) Pancreas Colon (ascending and descending) Rectum (middle)

Question 28

Extraperitoneal Organ

Answer 28

Inferior Rectum

Question 29

Potential space b/w the parietal and visceral layers of peritoneum Peritoneal fluid - lubricates enabling the viscera to move over each other with friction NO ORGANS MALES - completely closed

Answer 29

Peritoneal Cavity

Question 30

Main and larger part of the peritoneal cavity Extends from DIAPHRAGM to the PELVIS

Answer 30

Greater Sac

Question 31

Smaller part Lies POSTERIOR to the STOMACH and LESSER OMENTUM

Answer 31

Lesser Sac 2 recesses: SUPERIOR INFERIOR

Question 32

Opening from the greater sac into the lesser sac (omental bursa) immediately inferior to the HEPATODUODENAL LIGAMENT

Answer 32

FORAMEN OF WINSLOW/EPIPLOIC FORAMEN ANT - hepatoduodenal ligament (portal vein, hepatic artery, bile duct) - PORTAL TRIAD POST - IVC SUP - caudate lobe liver INF - superior part of duodenum

Question 33

Extensions of the visceral peritoneum

Answer 33

PERITONEAL REFLECTIONS Mesentery Ligaments Omentum

Question 34

4 layered greater curvature of stomach "abdominal policemen"

Answer 34

GREATER OMENTUM 3 parts gastrophrenic gastrosplenic gastrocolic

Question 35

2 layered | connects lesser curvature of stomach, duodenum and proximal part of the duodenum to the liver

Answer 35

LESSER OMENTUM 2 parts hepatoduodenal ligament hepatogastric ligament

Question 36

Hepatoduodenal artery conducts the portal triad

Answer 36

PORTAL VEIN - posterior COMMON BILE DUCT - anterior and to the right HEPATIC ARTERY - anterior and to the left

Question 37

Outpouching of the lower abdominal wall whereby layers of the abdominal wall continue into the scrotal area to cover the spermatic cord and testes

Answer 37

Scrotum

Question 38

Cancer of the scrotum will metastasize to

Answer 38

SUPERFICIAL INGUINAL NODES

Question 39

Cancer of the testes will metastasize to

Answer 39

DEEP LUMBAR NODES

Question 40

In a vasectomy the scalpel will cut through the ff layers in succession

Answer 40

Skin -- Colles fascia and Dartos muscle -- External spermatic fascia -- Cremasteric and fascia and muscle -- Internal spermatic fascia -- Extraperitoneal TUNICA VAGINALIS -- NOT CUT

Question 41

Cremasteric reflex - Stroking the skin of the superior and medial thigh stimulates sensory fibers that run with

Answer 41

ILIOINGUINAL NERVE (afferent limb) GENITAL BRANCH OF THE GENITOFEMORAL NERVE (efferent limb) - cause contraction of the cremasteric muscle -- elevation of testes

Question 42

2 recommended areas of abdominal wall entry for paracentesis

Answer 42

2 cm BELOW the umbilicus in the midline 5 cm or 3 cm superior and medial to the ASIS on either side