Abdominal Wall/ Inguinal Region Flashcards
liposuction
surgical method for removing unwanted subcutaneous fat
where can fluid accumulate in abdominal fascia?
between membranous layer of subQ (scarpa’s fascia) and deep fascial covering of rectus abdominus & external obliques (potential space)
what’s important about the fascia lata of the thigh that parallels the inguinal ligament?
accumulated fluid in abdominal wall can’t move inferiorly because of the fusal of the deep fascia of the thigh with scarpa’s fascia
what layer reduces risk of infection during abdominal surgery?
transveralis fascia
what is space of Bogros? why is it important?
-anterolateral part of potential space between transversalis fascia and parietal peritoneum -used for placing prosthetics when repairing inguinal hernias (typically in men)
what causes abdominal protrusion?
food, fluid, fat, feces, flatus, & fetus (six F’s)
what is ascites?
abnormal accumulation of serous fluid in peritoneal cavity
what can cause lordosis with respect to the abdominal region?
tumors or excess fat can cause the pelvis to tilt anteriorly at hip joints
where do abdominal hernias typically occur?
inguinal, umbilical, & epigastric regions
which type of hernia is common in neonates?
umbilical hernia because of weak abdominal wall in umbilical ring or incomplete closure of abdominal wall after umbilical cord ligation
acquired umbilical hernias occur most commonly in?
women and obese people
what is an epigastric hernia?
hernia in the epigastric region through the linea alba (midline between xiphoid process and umbilicus)
what is a spigelian hernia?
-hernia that occurs along semilunar lines -common in people older than 40 -associated with obesity
what is guarding of muscles?
involuntary spasms due to cold hands during palpitation
what is important about the superficial abdominal reflex?
-contraction of abdominal muscles when strokes lateral to medial towards umbilicus -diseased organ or injury will cause rapid reflex -obese people unlikely to produce reflex
an inguinal hernia and abdominal wall muscle weakness is indicative of?
injury to the nerves of anterolateral abdominal wall -inferior thoracic spinal nerves T7-T12 -ilio-inguinal & iliohypogastric nerves (L1)
what muscle is an exception to the use of langer’s lines in surgery?
rectus abdominus can be transected because its fibers run short distances between tendinous intersections & segmental nerves are lateral in rectus sheath (can be preserved)
what is an important complication of a median or midline incision?
linea alba has small vessels and nerves, but may undergo necrosis if edges are not sewn together properly
what kind of incisions are used for an appendectomy?
gridiron (muscle splitting)
what and where is McBurney’s incision?
oblique incision made at McBurney’s point, 2.5 cm superomedial to anterior superior iliac spine, to umbilicus
what are Pfannenstiel (suprapubic) incisions & what are they used for?
- horizontal incisions at pubic line
- used for gynecological & obstetrical operations (C-sections)
what incisions provide access to the gallbladder and bilary ducts (right side) & spleen (left side)?
subcostal incision: parallel & 2.5 cm inferior to costal margin to avoid 7th/8th thoracic spinal nerves
which incisions are considered to be high risk?
- pararectus: along lateral border of rectus abdominus, can cut off nerve supply
- inguinal: repairing hernias, can injure ilio-inguinal nerve
what can result if the muscular & aponeurotic layers of abdomen do not heal properly from a surgery?
incisional hernia; protrusion of omentum or organ
what’s important about endoscopic surgery?
- allows for minimally invasive surgery; small incisions using remotely operated instruments
- reduces risk for infection, cut nerves, incisional hernias
what clinical problem does this picture indicate?
- obstructed flow to inferior or superior vena cava
- anastomoses with thoraco-epigastric vein allows for venous blood return to heart
what is cryptorchism?
undescended or unretractable testis (usually unilaterally and in inguinal canal)
why is an undescended testis clinically relevant?
greatly increased risk for malignancy because its unpalpable and cancer goes undetected
what is an external supravesical hernia and which nerve can be damaged in its repair?
- goes through supravesical fossa & medial to an inguinal hernia
- can damage iliohypogastric nerve during the repair
what structure is clinically relevant in infants with erythroblastosis fetalis or hemolytic disease?
postnatal patent umbilical vein (when occluded, forms round ligament of liver)
where can tumors near the round ligament of the uterus spread?
from uterus to labium majus (homolog of scrotum & distal attachment of round ligament) & then to superficial inguinal nodes
what is a direct inguinal hernia?
acquired inguinal hernia that rarely passes through scrotum
what is an indirect inguinal hernia?
congenital inguinal hernia that usually passes into scrotum (labium majus in females)
how and where do you palpate the superficial inguinal ring?
- superolateral to pubic tuberacle by invaginating skin of upper scrotom with index finger
- important for finding inguinal hernias
what nerve is the cremasteric reflex testing and why is it important?
- rapid elevation of testes
- tests ilio-inguinal nerve
- hyperactive reflex may indicate undescended testes
if the processus vaginalis persists in females, what forms?
small peritoneal pouch called canal of Nuck in inguinal canal, which may extend into labium majus and cause indirect inguinal hernia
what is a hydrocele?
- excess fluid in persistant processus vaginalis
- can cause indirect inguinal hernia
- may be located in testis or spermatic cord (see pic)
how is a hydrocele detected?
transillumination: shining light on scrotal enlargement (serous fluid glows red)
what is a hematocele & how does it occur?
- blood in tunica vaginalis
- results from rupture of branches of testicular artery from trauma
- can cause hematoma
- transillumination: blood does not glow
what is torsion of spermatic cord & how is it fixed?
- twisting of cord which can lead to necrosis of testes
- venous/arterial obstruction, edema, hemorrhage
- testes are surgically fixed to scrotal septum
describe the innervation of the scrotum and why its important?
- anterolateral surface of scrotum supplied by L1 (ilio-inguinal nerve)
- posteroinferior surface supplied by S3 (pudendal nerve)
- to anesthetize, spinal agent must be injected in different locations
what is the difference between a spermatocele and an epididymal cyst?
- spermatocele: cyst in epididymis near the head, milky, usually asymptomatic
- epididymal cyst: cyst anywhere on epididymis
- see pic
what is the appendix of the testes?
-vesicular remnant of cranial end of paramesonephric (müllerian) duct, which forms half of uterus in female
what are the appendices of the epididymis?
- remnants of cranial end of mesonephric (wolffian) duct, forms part of ductus deferens
- attached to head of epididymus
what is a varicocele and why does it occur?
- dilation of pampiniform plexus of veins
- result from defective venous valves in testicular vein, & kidney/renal vein problems
- occurs mostly on left side because right side drains into IVC easier
where does cancer of the testis metastastize to?
initially to retroperitoneal lumbar lymph nodes (inferior to renal veins) & then to mediastinal & supraclavicular nodes
where does cancer of the scrotum metastastize to?
superficial inguinal lymph nodes (in subQ inferior to inguinal ligament and along terminal part of great saphenous vein)
why do cancers of testis and scrotum metastastize to different places?
because testes come from posterior abdominal wall to scrotum during development
how else can testicular cancer metastastize?
by hematogenous spread of cancer cells via blood to lungs, liver, brain, & bone
