Abdominal Wall and Inguinal Region

Question 1

Describe the division of the abdomen in 4 quadrants

Answer 1

vertical line through midline, horizontal line through umbilicus

Question 2

Describe the division of the abdomen in 9 regions

Answer 2

left and right midclavicular lines, a superior horizontal/subcostal line at the edge of the 10th rib, and inferior horizontal/transtubercular line that passes through the iliac tubercles

Question 3

Describe the two layers of superficial fascia

Answer 3

1. Camper’s: superficial, fatty

2. Scarpa’s: deep, membranous

Question 4

In males, the superficial + deep layer of superficial fascia in the scrotum area is called what?

Answer 4

Dartos

Question 5

What are the two vertical abdominal wall muscles?

Answer 5

rectus abdominus and pyramidalis

Question 6

This muscle arises from the lower ribs to the iliac crest and passes inferomedially, becoming an aponeurosis as it approaches the midline. The lowermost part of this muscle forms the inguinal ligament. The midline fusion of of the aponeuroses on both sides forms the linea alba.

Answer 6

external oblique

Question 7

What is the innervation of the external oblique?

Answer 7

anterior rami of lower 6 thoracic nerves

Question 8

There are three ligaments associated with the external oblique. Describe the inguinal ligament attachments

Answer 8

ASIS to pubic tubercle

Question 9

There are three ligaments associated with the external oblique. Describe the lacunar ligament (medial end of the inguinal ligament) attachments

Answer 9

attaches to pectin pubis

Question 10

There are three ligaments associated with the external oblique. Describe the pectineal (cooper’s) ligament

Answer 10

extension of the lacunar ligament along the pectin pubis

Question 11

This muscle is deep to the external oblique. Its fibers course more or less perpendicular to those of the external oblique. It arises from the thoracolumbar fascia, iliac crest, and lateral part of the inguinal ligament, and courses superomedially to become part of the aponeurosis as it nears the midline.

Answer 11

internal oblique

Question 12

The inferior part of the aponeurosis of the internal oblique fuses with the aponeurosis of the deeper lying transversus abdominis muscle forming the ____ tendon

Answer 12

conjoint

Question 13

What is the innervation of the internal oblique?

Answer 13

anterior rami of lower six thoracic nerves + L1

Question 14

Transversus abdominis is innervated by the anterior rami of the lower six thoracic nerves + L1, like internal oblique. True of false?

Answer 14

true

Question 15

The transversalis fascia is a membranous sheath that lies deep to the transversus abdominis muscles and lines the abdominal wall. The thickened inferior margin forms the ____ tract

Answer 15

iliopubic

Question 16

The extraperitoneal fascia consists of a variable amount of fat between the transversalis fascia and the peritoneum. The EF is abundant in the posterior abdominal wall. The viscera found within the EF is referred to as _____

Answer 16

retroperitoneal

Question 17

This is a serous membrane that lines the abdominal cavity

Answer 17

peritoneum

Question 18

Give the origin, insertion, action and innervation of rectus abdominis

Answer 18

origin: pubic bone
insertion: costal cartilages and xyphoid process
action: compress abdominal contents, flex trunk, tense wall
innervation: ant. rami of T7-12

Question 19

Give the origin, insertion, action and innervation of pyramidalis

Answer 19

origin: front of pubis and pubic symphysis
insertion: linea alba
innervation: Ant. rami of T12
action: tenses linea alba

Question 20

The rectus sheath encloses the rectus abdominis muscles in a variable fashion that changes at the ____ line, a landmark visible posterior to the rectus abdominis muscles, about the level of 1/3 of the distance from the umbilicus to the pubis

Answer 20

arcuate

Question 21

Describe the formation of the rectus sheath above and below arcuate line

Answer 21

above: ant. wall -aponeurosis of external oblique and half of internal oblique; post. wall - other half of internal oblique, transversus abdominis
below: ant. wall - all three abdominal muscles; post. wall - simply the transversalis fascia

Question 22

The rectus abdominis is a ____ of the vertebral column, while the external oblique and internal oblique aid in ____ ____ and ____ of the trunk

Answer 22

flexor; lateral flexion, rotation

Question 23

This nerve supplies the skin just above the pubis

Answer 23

iliohypogastric nerve

Question 24

For the following nerves, give their dermatomal pattern: T7, T10, and L1

Answer 24

T7 = xiphoid process
T10 = umbilicus
L1 = pubis

Question 25

This artery is a landmark for hernias

Answer 25

inferior epigastric artery

Question 26

Give the artery supply of the superficial abdomen. Superior and inferior

Answer 26

Sup. : branches of musculophrenic a.

inf. : branches of superficial epigastric (medially) and superficial circumflex iliac (laterally)

Question 27

Give the artery supply of the deep abdomen. Superior and inferior

Answer 27

Sup. : superior epigastric a. (medially) and branches of posterior intercostal aa. and 12th subcostal a. (laterally)

inf. : inferior epigastric a. (medially) and deep circumflex iliac a. (laterally)

Question 28

Lymphatics drainage from the region superior to the umbilicus tend to drain into the ____ nodes, while the region inferior to the umbilicus drains into the ____ ____ nodes

Answer 28

axillary; superficial inguinal

Question 29

Abdominal hernias occur due to weakness in the layers of the abdominal wall. Where does an umbilical hernia occur?

Answer 29

through umbilical ring

Question 30

Abdominal hernias occur due to weakness in the layers of the abdominal wall. Where does an epigastric hernia occur?

Answer 30

at the midline between the xiphoid process and umbilicus

Question 31

Abdominal hernias occur due to weakness in the layers of the abdominal wall. Where does a spigelian hernia occur?

Answer 31

along the semilunar lines

Question 32

During development, an outputting of the peritoneum forms called the processes vaginalis, which acquires the various layers of the anterior abdominal wall to form a tube, the ____ ____

Answer 32

inguinal canal

Question 33

The decent of the testes not the scrotum is dependent on the development of what?

Answer 33

the gubernaculum

note: connects testes to the labioscrotal swellings

Question 34

As the testes descend, they pass through the inguinal canal. In females, the ovaries become associated with the uterus and the only structure which is found in the inguinal canal is the _____ ligament

Answer 34

round

Question 35

The ____ inguinal ring is the beginning of the inguinal canal found halfway between ASIS and pubic symphysis, while the ___ inguinal ring is the end of the canal - it is an opening in the external oblique aponeurosis

Answer 35

deep; superficial

Question 36

The medial crus of the superficial ring is attached to the pubic _____. The lateral crus of the superficial ring is attached to the pubic ____.

Answer 36

symphysis; tubercle

Question 37

Give the roof, floor, ant. and post. walls of the inguinal canal

hint: MALT (roof, ant. wall, floor, post. wall)

Answer 37

roof: internal oblique and transversus abdominis muscles (M)
ant. wall: aponeurosis of the external oblique (A)
floor: inguinal ligament (L)
post. wall: transversalis fascia and reinforced by conjoint tendon (T)

Question 38

Give the contents of the inguinal canal in males

Answer 38

spermatic cord (3,3,3,1)
3 vessels
3 aas.
3 fascias
1 - (genitofermoral nerve)

Question 39

The ilioinguinal nerve is a content of the inguinal canal in both males and females. What muscles does it pass obliquely across? Perforates what? Pierces what? Accompanies what?

Answer 39

qudaratus lumborum and iliacus; perforates transversus abdominis; pierces obliquus internus; accompanies spermatic cord

Question 40

The ilioinguinal nerve becomes what nerve in males and females?

Answer 40

males: anterior scrotal nerve
females: anterior labial nerve

Question 41

Describe an indirect inguinal hernia

Answer 41

most common form; usually on right side; due to persistence of processus vaginalis, through which part of the bowel escapes through the inguinal canal into the scrotum; origin is LATERAL to the inferior epigastric vessels

Question 42

Describe a direct inguinal hernia

Answer 42

common in old men; usually bilateral; due to weakness in conjoint tendon which allows bulging at superficial ring. Origin is MEDIAL to the inferior epigastric vessels. Hesselbach’s triangle is involved.

Question 43

What are the borders of Hesselbach’s triangle?

Answer 43

medial: lateral margin of semilunar line
superilateral: inferior epigastric vessels
inferior border: inguinal ligament