Abdominal Wall and Inguinal Region

Question 1

Which is more external- Camper’s Fascia or Scarpa’s fascia?

Answer 1

Camper’s Fascia

Question 2

External Oblique m.

Answer 2

Inn: T7-T12
Action(s): compresses & supports abdominal viscera; flexes & rotates trunk

Question 3

Internal Oblique m.

Answer 3

Inn: T6-T12, L1
Action(s): compresses & supportes abdominal viscera; flexes & rotates trunk

Question 4

Transversus Abdominis Muscle

Answer 4

Inn: T6-T12, L1
Action(s): compresses & supports abdominal viscera

Question 5

Rectus Abdominis m.

Answer 5

Inn: T6-T12
Action(s): flexes trunk and compresses abdominal viscera, stabilizes and controls tilt of pelvis

Question 6

Diastasis Recti Abdominus (DRAM)

Answer 6

Seperation of rectus abdominis at the linea alba during preganany

Question 7

Pyramidalis M.

Answer 7

Inn: T12
Action(s): tenses the linea alba

Question 8

Medial abdominal wall

Answer 8

Skin
Camper’s Fascia
Scarpa’s Fascia
Anterior Rectus Sheath
Rectus Abdominis
Posterior Rectus Sheath
Transversalis Fascia
Extraperitoneal Fat
Parietal Peritoneum

Question 9

Anterio-Lateral abdominal wall

Answer 9

Skin
Camper’s Fascia
Scarpa’s Fascia
Deep Muscular Fascia
External Oblique m.
Deep Muscular Fascia
Internal Oblique m.
Deep Muscular Fascia
Transverse Abdominis m.
Transversalis Fascia
Extraperitoneal Fat
Parietal Peritoneum

Question 10

Rectus Sheath

Answer 10

-Aponeurotic (tendinous) sheath
-Envelops rectus abdominus & Pyramidalis mm.
-Consists of anterior & posterior layers
NOTE: structure of the sheath is relative to the arcuate line which is 1/3 the distance between the umbilicus & public symphysis

Question 11

Below arcuate line….

Answer 11

All apneurotic layers are anterior to the sheath, NO posterior

Question 12

Above arcuate line…

Answer 12

There is both a posterior and anterior rectus sheath

Question 13

Arcuate line-clinical significance

Answer 13

Can have a spigelian hernia!

Question 14

Innervation of the abdomen

Answer 14

Continuation of the intercostal nn.
-T 10 nerve
-Subcostal n. T12
- Iliohypogastric n. (L1)
-Ilioinguinal n. (L1)

Question 15

dermatome umbilicus

Answer 15

T10

Question 16

dermatome pubic symphysis

Answer 16

L1

Question 17

Arterial Supply of abdominal Wall

Answer 17

1) Superficial circumflex iliac a. (from femoral a.)
2) Superficial epigastric a. (from femoral a.)
3) Deep circumflex iliac vessels (from external iliac a.)
4) Inferior epigastric vessels (from external iliac a.)
5) Superior epigastric vessels (branch of internal thoracic)
6) Musculophrenic vessels (branch of internal thoracic a.)

Question 18

Corona mortis artery

Answer 18

crown of death between obturator artery and external iliac artery that needs to be mindful of for anterior approach for hip surgery

Question 19

Portal Caval Anastomoses

Answer 19

1) Gastric vv. & esophageal vv.
2) Paraumbilical vv. & epigastric vv.
3) Superior rectal vv. & middle/inferior rectal vv.
4) Colic vv. & retroperitoneal vv.

Question 20

Caput Medusae

Answer 20

Results of obstructed portal HTN
-Anastomosis provides collateral pathway to the heart

Question 21

Deep Ring

Answer 21

Opening in transversalis fascia (located lateral to the inferior epigastric vessels)

Question 22

Superficial ring

Answer 22

Opening in external oblique aponeurosis (superolateral to pubic tubercle)
-Medial crus- attach to pubic symphysis
-Lateral crus- attach to pubic tubercle

Question 23

Anterior wall of inguinal canal

Answer 23

external oblique aponeurosis

Question 24

posterior wall of inguinal canal

Answer 24

transversalis fascia & conjoint tendon
- fusion of internal oblique, transversus abdominis aponeuroses medially

Question 25

roof of. inguinal canal

Answer 25

internal oblique & transversus abdominis (laterally), medial crus (medially)

Question 26

Floor of inguinal canal

Answer 26

iliopubic tract (laterally), inguinal ligament (centrally), lacunar ligament (medially)

Question 27

Spermatic Cord derivatives

Answer 27

External spermatic fascia -External aponeurotic fascia and external oblique Cremasteric fascia and muscle -Internal abdominal oblique and aponeurosis Internal spermatic fascia -Transversalis fascia

Question 28

Female inguinal canal contents

Answer 28

1. Round ligament of uterus 2. Genital branch of genitofemoral n. (L1,L2)

Question 29

Indirect (congenital) inguinal hernias

Answer 29

LATERAL TO INFERIOR EPIGASTRIC VESSELS -extends through entire inguinal canal -commonly enters scrotum or labia majora -more common type of hernia -more in males than females -usually from persistent processus vaginalis in males (connects peritoneum with descended testis) -Referred to as canal of Nuck in females

Question 30

Direct (acquired) inguinal hernias

Answer 30

MEDIAL TO INFERIOR EPIGASTRIC VESSELS -through inguinal triangle -emerges through conjoint tendon by or at superficial ring -usually does not enter scrotum or labia majora -more common in males than females -usually associated with weakened abdominal wall

Question 31

Inguinal (Hesselbach's) triangle

Answer 31

Located med. to inf. epigastric vessels Borders: -Medial= rectus abdominis m. -Lateral= inf. epigastric vessels -Inferior= inguinal ligament

Question 32

Abdominal hernia

Answer 32

Out-pouching of abdominal viscera within a sac -Hernial sac composed of 3 layers- peritoneum, extraperitoneal fat & transversalis fascia -90% occur in inguinal region

Question 33

Umbilical hernia

Answer 33

through umbilical ring most common in newborns more common in females & obese individuals

Question 34

Epigastric hernia

Answer 34

Through linea alba most common over 40 usually associated with obesity

Question 35

Femoral hernia

Answer 35

Through femoral ring & canal More common in females than males (femoral ring is wider)