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X. MRCS: Anatomy > Abdomen: Abdominal Wall, Hernias, Peritoneum > Flashcards

Abdomen: Abdominal Wall, Hernias, Peritoneum Flashcards

1
Q

Layers of the abdominal wall: anterolateral

A 
Skin
Camper's Fascia (fatty)
Scarpa's Fascia (membranous)
External oblique
Internal oblique
Transversus abdominis
Transversalis fascia
Extra peritoneal fascia
Parietal peritoneum
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2
Q

Layers of the abdominal wall: posterior

A
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3
Q

Muscles of the anterior abdominal wall

A 
Rectus abdominis
Pyramidialis
External oblique
Internal oblique
transversus abdominis
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4
Q

Rectus abdominis

A

Long paired muscle. Split in 2 by linea alba. Muscles is intersected by fibrous strips, tendinous intersections. Giving rise to ‘6-pack’ shape.
Origin: crest of pubis
Insertion: diploid process, costal cartilage ribs 5-7
Innervation: Thoracoabdominal nerves (T7-T11
Function: depresses the ribs

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5
Q

Internal oblique

A

Origin: inguinal ligament, iliac crest, lumbodorsal fascia
Insertion: ribs 10-12
Innervation: thoracoabdominal nerves (T7-T11), subcostal nerve, branches of lumbar plexus
Function: compresses abdominal cavity, ipsilateral rotation of torso

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6
Q

External oblique

A

Origin: ribs 5-12
Insertion: iliac crest, pubic tubercle
Innervation: thoracoabdominal nerves (T7-T11) and subcostal nerve (T12)
Function: contralateral rotation of torso

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7
Q

Transversus abdominis

A

Origin: inguinal ligament, costal cartilage 7-12, iliac crest, thoracolumbar fascia
Insertion: conjoint tendon, xiphoid process, linea alba, pubic crest
Innervation: thoracoabdominal nerves (T7-T11), subcostal nerve (T12), branches of lumbar plexus
Function: compression of abdominal cavity

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8
Q

Pyramidalis

A

Origin: pubic crest and pubis symphysis
Insertion: linea alba
Innervation: subcostal n. (T12)
Function: tenses linea alba

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9
Q

Linea alba

A

Midline of abdomen

Formed from the aponeuroses of external oblique, internal oblique, transverse abdominis

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10
Q

Rectus sheath

A

Formed by the aponeurosis of external oblique, internal oblique and transverses abdominis

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11
Q

Linea semilunaris

A

Formed from the lateral border of rectus abdominis

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12
Q

Superficial fascia of abdominal wall

A

Above umbilicus: single sheet

Below umbilicus: superficial: Camper’s fascia and deep: Scarpa’s fascia

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13
Q

Camper’s Fascia

A

Superficial fatty layer of fascia

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14
Q

Scarpa’s fascia

A

Deep membranous later of fascia

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15
Q

Incisions into the abdomen

A 
Midline
Paramedian
Pararectal
Gridiron
Lanz
Pfannenstiel
Transverse
Kocher, Rooftop (Chevron), Mercedes-Benz
Rutherford-Morrison
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16
Q

Midline incision

A

Xiphisternum to pubis symphasis (or any length along this plane)
Layers: skin, camper’s, Scarpa’s, linea alba, transversales fascia, extra-peritoneal fascia, parietal peritoneum

17
Q

Gridiron incision

A

Centred over McBurney’s point (2/3 distance between umbilicus & ASIS)
Layers: skin, Camper’s, Scarpa’s, external oblique, internal oblique, transversus abdominis, transversals fascia, extra-peritoneal facia, parietal peritoneum
Risk of injury to ilioinguinal and iliohypogastric nerves
Arc can be extended anteriorly and laterally to form Rutherford-Morrison (to access ascending bowel)

18
Q

Lanz incision

A

Inferior to the Gridiron incision

High risk of severing the ilioinguinal and ilihypogastric nerves

19
Q

Pfannenstiel incision

A

Curvilinear incision is made through skin and subcutaneous fat. Longitudinal incision is made through linea alba.

20
Q

Kocher Incision

A

Parallel to subcostal margin on right
Used to access liver and biliary tree. Used of open cholecystectomy.
Mirrored on contralateral side to create Rooftop/Chevron incision. Extended down midline to create Mercedes Benz incision.
Risk of injuring superior epigastric vessels. Lateral extension risks damage to intercostal nerves.

21
Q

Types of Hernia

A 
Indirect inguinal 
Direct inguinal
Femoral 
Umbilical
Epigastric
Spigelian
Obturator
Lumbar
22
Q

Borders of the inguinal canal

A

Anterior wall: aponeurosis of external oblique, reinforced by internal oblique laterally
Posterior wall: transversalis fascia
Roof: transversals fascia, internal oblique, transversus abdominis
Floor: inguinal ligament, thickened medially by the lacunar ligament

23
Q

Openings of the inguinal canal

A

Deep (internal) ring

Superficial (external) ring

24
Q

Deep (internal) ring

A

Midpoint of inguinal ligament
Lateral to epigastric vessels
Created by transversalis fascia

25
Q

Superficial (external) ring

A

End of the inguinal canal
Superior to pubic tubercle
Triangle shaped opening
Formed by the evagination of external oblique

26
Q

Contents of the inguinal canal

A

Spermatic cord (males only)
Round ligament (females only)
Ilioinguinal nerve
Genital branch of genitofemoral n.

27
Q

Coverings of the spermatic cord

A

External spermatic fascia: derived from scarpa’s fascia
Cremaster muscle and fascia: derived from internal oblique
Internal spermatic fascia: derived from transversalis fascia

28
Q

Contents of the spermatic cord

A 
Vessels:
Testicular artery
Cremasteric artery and vein
Artery to vas deferens
Pampiniform plexus of testicular veins

Nerves:
Genital branch of genitofemoral nerve
Autonomic nerve fibres

Others:
Vas deferens
Processus vaginalis
Lymph vessels (drain to para-aortic)

29
Q

Inguinal ligament

A

Formed from external oblique aponeurosis

Runs from pubic tubercle to ASIS

30
Q

indirect inguinal hernia

A

80%

Bowel enters inguinal canal via deep inguinal ring

31
Q

Direct inguinal hernia

A

20%

Bowel enters inguinal canal directly through weakness in posterior wall, termed Hesselbach’s triangle

32
Q

Borders of Hesselbach’s Triangle

A

Medial: lateral border of Rectus abdominis muscle
Lateral: inferior epigastric vessels
Inferior: inguinal ligament

33
Q

Muscles of the posterior abdominal wall

A

Erector Spinae
Quadratus Lumborum
Psoas Major
Psoas Minor
Iliac

34
Q

Fascia of the posterior abdominal wall

A

Psoas fascia

Thoracolumbar fascia: Posterior, middle, anterior

35
Q

Psoas Major

A

Insertion: Vertebral bodies of T12-L4, transverse process of L1-L5
Insertion: ileopsoas tendon on lesser trochanter of hip
Action: flexion of hip, lat rotation of thigh
Innervation: anterior ramp of spinal nerves (L1-3)
Blood supply: lumbar branch of olio lumbar artery

36
Q

Iliacus

A

Origin: iliac fossa
Insertion: lesser trochanter of femur
Action: hip flexion
Innervation: femoral nerve (L1-3)
Blood supply: iliolumbar, circumflex iliac, obturator, femoral

37
Q

Erector Spinae

A

3 muscles: Iliocostalis, Longissimus, Spinalis (lateral to medial: I like standing)

X. MRCS: Anatomy (18 decks)

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