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Anatomy - BB Exam 2 > Abdominal Wall/ Inguinal Region > Flashcards

Abdominal Wall/ Inguinal Region Flashcards

1
Q

liposuction

A

surgical method for removing unwanted subQ fat using percutaneously placed suction tube and high vacuum pressure

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2
Q

why will fluid accumulated in the potential space b/w Scarpa’s fascia and deep fascia not spread inferiorly down into thigh?

A

fascia lata (deep fascia of thigh) fuses with Scarpa’s fascia along a line 2.5 cm inferior and parallel to inguinal ligament

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3
Q

significance of transversalis fascia in surgery

A

-provides a plane to access structures on or in anterior aspect of the posterior abdominal wall w/o entering membranous peritoneal sac - minimizes risk of contamination

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4
Q

space of Bogros

A

anterolateral part of potential space b/w transversalis fascia and parietal peritoneum used for placing prostheses when repairing inguinal hernias

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5
Q

why is a prominent abdomen normal in infants/young children?

A
  • their GI tracts contain a large amount of air
  • anterolateral abdominal cavities enlarging
  • ab muscles gaining strength
  • relatively large liver
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6
Q

six common causes of abdominal protrusion

A
  • food
  • fluid
  • fat
  • feces
  • flatus
  • fetus
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7
Q

ascites

A

abnormal accumulation of serous fluid in the peritoneal cavity

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8
Q

what is eversion of umbilicus a sign of?

A

increased intra-abdominal pressure - from ascites or large mass

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9
Q

site of abdominal hernias

A

anterolateral abdominal wall

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10
Q

what patients are umbilical hernias common in?

A

neonates - herniation through umbilical ring

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11
Q

what patients acquired umbilical hernias most common in?

A

women and obese people

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12
Q

epigastric hernia

A

hernia in the epigastric region through the linea alba - occurs in midline b/w the xiphoid process and umbilicus

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13
Q

spigelian hernias

A

hernias occuring along semilunar lines

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14
Q

who usually experiences spigelian hernias?

A

people older than 40 and obese people

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15
Q

why are warm hands important in palpating abdominal wall?

A

cold hands make the anterolateral abdominal muscles tense, producing involuntary spasms of muscles (guarding)

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16
Q

what is a clinical sign of acute abdomen?

A

intense guarding that cannot be willfully repressed

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17
Q

best position to palpate abdominal wall

A

patient in supine position w/ thighs and knees semiflexed and upper limbs placed at sides

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18
Q

superficial abdominal reflex

A

quickly stroking horizontally, lateral to medial, towards the umbilicus - usually feel contraction of abdominal muscles

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19
Q

when are the nerves of the abdominal wall at risk of injury?

A

surgical incisions or trauma at any level of the abdominal wall

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20
Q

injury to nerves of anterolateral abdominal wall

A

may result in weakening of muscles - if in inguinal region, can predispose patient to inguinal hernia

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21
Q

how do surgeons choose where to make abdominal incisions?

A

try to follow Langer’s lines - aim for incision that allows adequate exposure, best cosmetic effect, and minimizes injury

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22
Q

when are longitudinal incisions preferred?

A

for exploratory operations - offer good exposure of and access to viscera and can be extended w/ minimal complication

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23
Q

what incisions can be made rapidly without cutting muscle, major blood vessels, or nerves?

A

median or midline incisions

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24
Q

where can median/midline incisions be made?

A

alone any part or length of the linea alba from the xiphoid process to pubic symphysis

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25
Q

where are paramedian incisions made?

A

in sagittal plane, may extend from costal margin to pubic hairline

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26
Q

what are gridiron (muscle-splitting) incisions used for?

A

appendectomy

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27
Q

McBurney incision

A

made at McBurney point - 2.5 cm superomedial to the ASIS on the spino-umbilical line

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28
Q

where are suprapubic/ Pfannenstiel incisions made and what are they used for ?

A

bikini line - used for most gynecological and obstetrical operations

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29
Q

where are transverse incisions made and why?

A

muscle belly of rectus abdominis - a new transverse band forms when the muscle segments are rejoined

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30
Q

what are subcostal incisions used for?

A

R side: access to gallbladder and biliary ducts

L side: access to spleen

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31
Q

where are subcostal incisions made?

A

parallel but at least 2.5 cm inferior to costal margin to avoid 7th and 8th thoracic spinal nerves

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32
Q

what are high-risk incisions?

A

pararectus and inguinal incisions

33
Q

where are pararectus incisions made and why high risk?

A

along lateral border of the rectus sheath - high risk b/c may cut the nerve supply to rectus abdominis

34
Q

what are inguinal incisions made for and why high risk?

A

repair of hernias - may injure the ilio-inguinal nerve

35
Q

incisional hernia

A

protrusion of omentum or organ through a surgical incision when the muscular and aponeurotic layers do not heal properly

36
Q

benefit of endoscopic surgery

A
  • minimize potential for nerve injury, incisional hernia, comtamination through open wound
  • minimize healing time
37
Q

reversal of venous flow and collateral pathways of superficial abdominal veins

A

when SVC or IVC blocked, anastamoses b/w tributaries (thoraco-epigastric) provide collateral pathways to return blood to heart

38
Q

cryptorchidism

A

condition where testes are undescended or are not retractable - greatly increases risk of malignancy that is not palpable

39
Q

where do you find undescended testis?

A

somewhere along normal path of prenatal descent - usually in inguinal canal

40
Q

external supravesical hernia

A

hernia that leaves peritoneal cavity through the supravesical fossa medial to that of a direct inguinal hernia

41
Q

what nerve may be damaged in repair of external supravesical hernia?

A

iliohypogastric nerve

42
Q

umbilical vein catheterization

A

done through the round ligament of the liver (remnant of umbilical vein) for exchange transfusion during early infancy

43
Q

where does lymphogenous metastasis of cancer most commonly occur?

A

along lymphatic pathways that parallel the venous drainage of the primary tumor organ

44
Q

where can metastatic uterine cancer cells spread?

A

labium majus

45
Q

most common type of abdominal hernia

A

inguinal hernia - 75% of abdominal hernias

46
Q

in what sex do most inguinal hernias occur?

A

male b/c passage of spermatic cord through inguinal canal

47
Q

inguinal hernia

A

protrusion of parietal peritoneum and viscera through a normal or abnormal opening from the cavity in which they belong

48
Q

which type of inguinal hernia is more common?

A

indirect - more than 2/3 of them

49
Q

direct inguinal hernia

A

hernia through Hesselbach’s triangle

50
Q

indirect inguinal hernia

A

hernia through the processus vaginalis

51
Q

how do you palpate the superficial inguinal ring?

A

invaginate skin of upper scrotum with index finger - follow spermatic cord with finger to superficial inguinal ring

52
Q

how do you determine if there is a hernia at the superficial inguinal ring?

A

while palpating ring, ask patient to cough - if pressure on finger, hernia present - DOES NOT DISTINGUISH WHICH TYPE OF HERNIA

53
Q

how do you palpate the deep inguinal ring?

A

felt as a skin depression superior to the inguinal ligament

54
Q

what palpations indicate indirect hernia?

A

impulse at the superficial ring and mass at site of the deep ring

55
Q

how do you palpate a direct inguinal hernia?

A

put finger on Hesselbach’s triangle and ask patient to cough - pressure indicates hernia

56
Q

cremasteric reflex

A

lightly stroke skin on medial aspect of superior part of thigh -> rapid elevation of the testis on the same side (contraction of cremaster muscle)

57
Q

canal of Nuck

A

small peritoneal pouch formed by a persistent processus vaginalis in females - can get cysts here

58
Q

hydrocele

A

presence of excess fluid in a persistent processus vaginalis

59
Q

hydrocele of testis

A

hydrocele confined to the scrotum - distends the tunica vaginalis

60
Q

hydrocele of spermatic cord

A

hydrocele confined to the spermatic cord - distends the persistent part of the stalk of the processus vaginalis

61
Q

how do you detect a hydrocele?

A

transillumination - red glow indicates excess serous fluid

62
Q

hematocele of testis

A

collection of blood in the tunica vaginalis that results from rupture of branches of the testicular artery by trauma to testis

63
Q

how do you differentiate b/w a hydrocele and hematocele?

A

hematocele and hematoma do not transilluminate

64
Q

hematoma

A

accumulation of blood, usually clotted, in any extravascular location

65
Q

scrotal hematocele

A

effusion of blood into the scrotal tissues

66
Q

torsion of the spermatic cord

A

twisting obstructs venous drainage, resulting in edema, hemorrhage, and subsequent arterial obstruction - medical emergency

67
Q

where does torsion of spermatic cord usually occur?

A

just above the upper pole of the testis

68
Q

how is recurrent torsion of spermatic cord prevented?

A

surgical fixation of both testes to the scrotal septum

69
Q

where do you inject spinal anesthetic agent to anesthetize the anterolateral surface vs. posteroinferior surface of scrotum?

A

inject more superiorly for anterolateral surface than for posteroinferior surface - anterolateral supplied by lumbar plexus (mostly L1 - ilio-inguinal nerve); posteroinferior supplied by sacral plexus (mostly S3 - pudendal nerve)

70
Q

spermatocele

A

retention cyst in the epididymis, usually near the head, containing milky fluid - asymptomatic

71
Q

epididymal cyst

A

collection of fluid anywhere in epididymis

72
Q

appendix of testis

A

vesicular remnant of the cranial end of the paramesonephric (mullerian) duct attached to upper pole of testis- forms half of uterus in female

73
Q

appendices of epididymis

A

remnants of the cranial end of the mesonephric (wolffian) duct attached to head of epididymis - forms part of ductus deferens in male

74
Q

varicocele

A

dilated and tortuous pampiniform plexus of veins, usually only visible when standing or straining - feels like bag of worms

75
Q

where do varicoceles predominantly occur?

A

left side

76
Q

what causes varicoceles?

A

defective valves of testicular vein, kidney or renal vein problems

77
Q

how do all testicular tumors metastasize?

A

lymphogenous metastasis - testicular may also metastasize by hematogenous to lungs, liver, brain, bone

78
Q

metastasis of testis cancer

A

initially to retroperitoneal lumbar lymph nodes -> mediastinal and supraclavicular nodes

79
Q

metastasis of scrotum cancer

A

to superficial inguinal lymph nodes

Anatomy - BB Exam 2 (24 decks)

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