Abdominal Wall And Cavity

Question 0

What does a median incision go through?

Answer 0

Linea alba

Question 1

In a paramedial incision, which way would you displace the muscle and why?

Answer 1

Laterally, towards its nerve supply

Question 2

Which incision would you use to access the gallbladder?

Answer 2

Subcostal

Question 3

What would you use a pfannenstiel incision for?

Answer 3

C section

Question 4

What happens to the rectus sheath at the arcuate line?

Answer 4

Above line, rectus abdominis covered anterior and posterior by aponeuroses of flat muscles of abdo wall
Below line, all 3 aponeuroses are anterior to muscle and so only fascia behind. This leaves region vulnerable to herniation

Question 5

Which vessels are contained in rectus sheath?

Answer 5

Superior and inferior epigastric artery and veins

Question 6

What are the 5 layers of the anterior abdominal wall?

Answer 6

Skin
Superficial fascia
Muscles and aponeuroses
Transversalis fascia
Parietal peritoneum

Question 7

Where does the inguinal ligament run?

Answer 7

From ASIS to pubic tubercle

Question 8

Which muscle runs from rib 5-12 to anterior iliac crest, linea alba and pubic tubercle?

Answer 8

External oblique

Question 9

What is an aponeurosis?

Answer 9

Broad flat sheet of tendon

Question 10

What is the linea alba?

Answer 10

Midline fibrous aponeuroses

Question 11

Why can you safely inject a needle or cannula into linea alba?

Answer 11

Avascular

Question 12

Where does lymph of the anterior abdominal wall drain to?

Answer 12

Above umbilicus - axillary nodes

Below umbilicus - inguinal nodes

Question 13

What is a hernia?

Answer 13

Protrusion of tissue or organ through its retaining tissue

Question 14

Name 3 sites for an anterior abdominal wall hernia

Answer 14

Umbilical
Inguinal
Femoral

Question 15

What is hesselbachs triangle?

Answer 15

Area of bulging of direct hernia. Medial to inferior epigastric artery. Bordered by rectus abdominis and inguinal ligament

Question 16

Which type of anterior abdo wall hernia are women and men most likely to get?

Answer 16

Men - indirect inguinal

Women - femoral

Question 17

What are the differences in contents of inguinal canal in males and females?

Answer 17

Males - spermatic cord and contents

Females - round ligament of uterus and lymphatics from uterus

Question 18

What are the boundaries of the abdomen?

Answer 18

Diaphragm to pelvic girdle

Question 19

What vertebral level is the Subcostal plane on?

Answer 19

L3

Question 20

What vertebral level is the supracristal plane on?

Answer 20

L4

Question 21

What vertebral level is the transtubercular plane on?

Answer 21

L5

Question 22

What planes divide the abdomen into the 9 regions?

Answer 22

Mid clavicular lines
Subcostal plane
Transtubercular plane

Question 23

What does the external oblique aponeurosis lower free border form?

Answer 23

Inguinal ligament

Question 24

Where does the internal oblique run from and to?

Answer 24

From iliac crest and inguinal ligament | To linea alba, pubic bone and ribs 9-12

Question 25

What do the lower aponeurosis of the internal oblique form?

Answer 25

Part of the conjoint tendon

Question 26

Which arteries are united by the epigastric arteries?

Answer 26

Subclavian artery and external iliac artery

Question 27

What can the vascular supply of the abdominal wall provide a bypass for?

Answer 27

Descending aorta

Question 28

What nerve is at risk from a gridiron incision?

Answer 28

Ilioinguinal

Question 29

What serves as a reference point to differentiate between an inguinal and a femoral hernia?

Answer 29

Pubic tubercle Above and medial - inguinal Below and lateral - femoral

Question 30

What are the borders of the lumbar (petit) triangle?

Answer 30

External oblique Latissimus dorsi Iliac crest

Question 31

What is the deep inguinal ring?

Answer 31

Invagination of transversalis fascia | Lies between the midpoint of inguinal ligament and the midinguinal point (1cm above the inguinal ligament)

Question 32

What is the superficial inguinal ring?

Answer 32

Lies supero-lateral to the pubic tubercle | Point of emergence of spermatic cord (male) or round ligament and coverings (female)

Question 33

What forms the tunica vaginalis?

Answer 33

Testicle is retroperitoneal and descends through the anterior abdominal wall and pulls a fold of peritoneum with it that forms the tunica vaginalis

Question 34

What forms the posterior wall of the inguinal canal?

Answer 34

Transversalis fascia

Question 35

What level does the coeliac trunk, SMA and IMA branch from the aorta?

Answer 35

T12 L1 L3

Question 36

What pain modalities are viscera not sensitive to?

Answer 36

Cutting or thermal stimuli

Question 37

What are the 2 compartments of the greater sac?

Answer 37

Supracolic and infracolic

Question 38

Why does the lesser sac become sectioned off?

Answer 38

Pancreas, liver, duodenum and gallbladder become secondarily retroperitoneal

Question 39

How does the stomach rotate to reach its adult position?

Answer 39

Rotates to right about longitudinal axis & clockwise about sagittal axis

Question 40

What does the ventral mesentery become?

Answer 40

Lesser omentum

Question 41

What does the dorsal mesentery become?

Answer 41

Greater omentum

Question 42

Describe the surface anatomy of the liver

Answer 42

Right costal margin Follows upper limit of diaphragm 5th rib at mid clavicular line Associated with costodiaphragmatic recess

Question 43

What holds the liver in place?

Answer 43

Peritoneum

Question 44

Which part of the liver is in contact with the diaphragm?

Answer 44

Bare area

Question 45

What are the 4 lobes of the liver?

Answer 45

Left Right Caudate Quadrate

Question 46

What is the porta hepatis?

Answer 46

Entry and exit point for portal vein, bile duct, hepatic artery and autonomics from liver

Question 47

What structures form a H shape on the posterior of the liver?

Answer 47

``` Ligamentum venosum Ligamentum teres Porta hepatis IVC Gallbladder ```

Question 48

Which peritoneal recesses can accumulate fluid / be a focus for abscess formation?

Answer 48

Sub-phrenic space | Hepato-renal space - Morison's pouch

Question 49

What are the functions of the peritoneum?

Answer 49

Facilitate movement between abdominal organs and between organs and the abdominal wall Produce peritoneal fluid which contains leukocytes and antibodies

Question 50

What is the difference between intraperitoneal and retroperitoneal organs?

Answer 50

Intraperitoneal organs are almost completely covered by peritoneum and suspended by a mesentery whereas retroperitoneal organs are only partially covered by peritoneum

Question 51

What is the dermatome supply of the following regions – epigastric, umbilicus and suprapubic?

Answer 51

Epigastric: T7 Umbilicus: T10 Suprapubic: L1