Abdominal Wall

Question 1

Anterolateral abdominal wall layers from superficial to deep

Answer 1

Skin
Superficial campers fascia 
Deep scarpas fascia
Investing fascia layers of EO
EO muscle 
Investing fascia layers of IO
IO muscle
Investing Fascia layers of TA
TA muscle
Endoabdominal fascia 
Subcutaneous fat (if present)
Parietal paratoneum

Question 2

Functions of abdominal wall muscles combined

Answer 2

Respiration, dedication, micturation and parturition

“Valsalva maneuver”

Question 3

Above arcuate line spread of muscle aponeruosis

Answer 3

EO and 1/2 IO aponeruosis in front of rectus abdominis

TA and 1/2 IO aponeruosis in front of rectus abdominis

Question 4

Below Arcuate line spread of muscle aponeruosis

Answer 4

EO, IO and TA aponeruosis all anterior to rectus abdominis

posterior rectus abdominis is primary site of herniations

Question 5

What fascial layer sits in front of potential space in the inguinal/abdonminal area?

Answer 5

Scarpas fascia

lower limbs do not pull here though

Question 6

What abdominal muscle also forms inguinal regions?

Answer 6

IO

Question 7

Subcostal nerve

Answer 7

Anterior/ventral rami of T12

Innervated skin from illiac crest to the umbillicus

Stimulates muscles of anterolateral abdominal wall

Question 8

Thoracoabdominal nerves

Answer 8

anterior rami of T6-T11

Supplies muscles and skin above the umbilicus and below the costal margin.

Question 9

Iliohypoogastric Nerve

Answer 9

anterior/ventral rami of L1

Stimulates skin over inguinal ligament and superolateral thigh

Innervated IO and TA muscles

Question 10

Ilioinguinal nerve

Answer 10

Anterior/ventral rami of L1

Stimulates skin of the superomedial thigh, scrotum and labia major

Innervated IO and TA muscles

Question 11

Genitofemoral nerve

Answer 11

Anterior/ventral rami of L1-L2

Stimulates skin of femoral triangle

Innervated cremaster, mons pubis and labia Majora Muscles

Question 12

Venous drainage in abdominal wall

Answer 12

Superomedial = internal thoracic vein

Lateral = lateral thoracic vein

Inferiorally =. Superficial and inferior epigastric veins

Question 13

Lymphatic drainage in abdominal wall

Answer 13

Above T10 (umbiliicus) = axillary nodes

Below T10 (umbillicus) = Inguinal nodes

Question 14

Falciform ligament contains what?

Answer 14

Round ligament of liver and para-umbilical vein

Found between liver and superior wall

Question 15

Umbilical folds from medial to lateral and their contents

Answer 15

Median umbilical fold: median umbilical ligament and Rachel’s (Allentois)

Medial umbilical fold: medial umbilical ligaments

Lateral umbilical fold: inferior epigastric vessels

Question 16

Types of peritoneal fossea from medial to lateral

Answer 16

Peritoneal fossa= sites prone to herniation

Supravescial fossae: between median and medial umbilical folds

Medial inguinal fossa: between medial and lateral umbilical folds
most common site for direct herniations

Lateral inguinal fossa: lateral to the lateral umbilical folds
most common site for indirect herniations

Question 17

Rectus sheath hematoma

Answer 17

Accumulation of blood in rectus sheath duration tearing of the epigastric artery or anticoagulation meds

Question 18

Congenital umbilical hernia

Answer 18

Umbillicus fails to seal after ligation of umbilical cord

Question 19

Acquired umbilical hernia

Answer 19

Extraperitoneal fat protrudes where aponeruosis fibers interlace and are weakened

Question 20

Epigastric hernia

Answer 20

Herniations of usually fat along weakened portions of the linea alba

• very painful (nerve compression)

Question 21

Spegelian hernia

Answer 21

Herniation of usually fat along semilunar lines

Question 22

High risk incisions

Answer 22

Pararectus incisions: lateral border of rectus sheath (site of nerve supply for RA)

Inguinal incisions: may cut ilioinguinal nerve

Question 23

Direct vs indirect herniations

Answer 23

Direct: acquired through intense pressure and weakness of aponeruosis stealths

Indirect: congenital through defects in birth

• 75% of hernias occur in inguinal region
• most common in males