Abdominal Wall, Inguinal Region, Hernias Flashcards

1
Q

What are the bony landmarks of the Abdomen

A

Sternum and Xiphoid Process
Costal Margin, costal cartilages, ribs
Iliac crest, iliac fossa, ASIS,
Public Symphysis, pubic tubercle, pubic ramus,
Thoracic and lumbar vertebrae, Sacrum, and pelvic bones

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2
Q

What visceral structures are found in the abdomen

A

Stomach, duodenum, small intestines, liver, pancreas, spleen, kidneys, ureters, urinary bladder, reproductive organs, abdominal vessels

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3
Q

What are the 9 regions that the abdomen can be divided into

A

Right Hypochondriac, epigastric, left hypochondriac,
Right lumbar, umbilical, left lumbar,
Right Iliac, Hypogastric, Left Iliac

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4
Q

What are the two fascia found immediately below the skin and what are their characteristics

A

Camper’s fascia: fatty fascia

Scarpa’s fascia: membranous layer

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5
Q

What muscles make up the posterior wall of the abdomen

A

Quadrates lumbers, posts major, iliac muscles

Post-vertebral muscles

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6
Q

What muscles make up the lateral wall of the abdomen

A

External Oblique
Internal Oblique
Transversalis Abdominis

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7
Q

What muscles make up the anterior wall of the abdomen

A

The paired vertical rectus abdominal muscles within the rectus sheath.

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8
Q

What is an aponeurosis

A

Thin but strong fibrous sheet of tissue that replaces a tendon in muscles that are flat and sheet-like and have a wide area of attachment.

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9
Q

What are some functions of the three sheet-like muscles

A

Compresses the abdomen and increases intra-abdominal pressure to aid expiration and evacuation of feces, urine, and parturition

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10
Q

What are the attachments of external oblique

A

Bottom 8 ribs, free posterior border, xiphoid prices, linea alba, pubic crest and tubercle, anterior 1/2 of iliac crest

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11
Q

What is the direction of the external oblique muscle fibers

A

Infero-medially

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12
Q

How is the inguinal ligament made and where does it attach

A

Formed by the rolling inwards of the lower aponeurotic border of the external oblique. It extends from the ASIS to the pubic tubercle.

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13
Q

What are the attachments of the internal oblique; lateral and medial

A

Laterally: Thoracolumbar fascia, anterior 2/3 of iliac crest, lateral 1/2 of inguinal ligament
Medially: lower 3 ribs and costal cartilages, xiphoid process, rectus sheath and conjoint tendon

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14
Q

State the direction of the internal oblique

A

Infero-laterally

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15
Q

What are the attachments of the transverse abdominus

A

Laterally: bottom 6 costal cartilages, anterior 2/3 iliac crest, lateral 1/2 of inguinal ligament
Medially: Xiphoid process, linea alba, pubic symphysis, conjoint tendon

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16
Q

Direction of transverses abdominis

A

Horizontally

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17
Q

Where does the neurovascular bundle lie

A

Between internal oblique and transverses abdominis

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18
Q

What are the points of attachment of rectus abdominis

A

5-7 costal cartilages, xiphoidprocess, pubic symphysis and pubic crest

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19
Q

What structure divides the rectus abdominis into segments`

A

Transverse tendinous intersections

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20
Q

What is the rectus sheath formed by

A

Aponeurosis of three flat muscles

21
Q

What is the function of rectus abdominis

A

Flexor of the vertebral column

22
Q

Points of attachment of quadrates lumborum

A

Lower border of 12th rib
Transverse process of L5
Iliac crest

23
Q

Points of attachment for psoas major

A

All 5 lumbar vertebra

Lesser trochanter

24
Q

What plane carries the nervous and blood supply to abdominal wall

A

Neuromuscular plane - found between internal oblique and transverses abdominis

25
Q

Describe blood supply to rectus sheath

A

Superiorly: Blood supply comes from superior epigastric artery which is a branch of the internal thoracic
Inferiorly: Blood comes from inferior epigastric after which comes from External iliac artery.
Two arteries anastomose creating collateral circulation of abdominal aorta

26
Q

Which vessels supply flank muscles

A

Intercostal arteries 7-11
Subcostal artery
Lumbar arteries
Deep circumflex

27
Q

Which nerves supply abdominal wall

A

T7-L1

28
Q

What nerves supply abdominal muscles

A

EO: T7-L1
IO: T7-L1
TA: T7-L1

29
Q

What nerves supply rectus abdominis

A

T7-T12

30
Q

What is the difference in the innervation of the visceral and parietal peritoneum

A

The parietal peritoneum has the same segmental somatic sensory innervation as the abdominal wall
Visceral peritoneum has NO somatic sensory innervation

31
Q

Which three nerves innervate the anterolateral abdominal wall

A

Subcostal nerves(T12), ilioinguinal nerve (L1) Iliohypogastric (L1)

32
Q

Which nerves provide motor supply to quadrates lumborum, psoas major, and iliacus

A

Quadratus Lumborum: T12-L4
Psoas: L2-L4
Iliacus: L2-L4

33
Q

Where is the lumbar plexus formed

A

L1-L4

34
Q

Which line defines the border between the lymphatic drainage to different groups of lymph nodes?

A

Transumbilical plane

35
Q

Where does the inguinal ligament attach to the pelvis

A

ASIS and Pubic tubercle

36
Q

How long is the inguinal canal

A

4cm

37
Q

Are hernias more common in males or females

A

Males

38
Q

What are the contents of the Inguinal Canal

A

Males: Spermatic cord(Artery of ductus deferent, cremasteric artery, testicular artery, genital branch of genitofemoral nerve, cremasteric nerve, autonomic nerve, Ductus dererens, pampiniform plexus, lymphatics) + Ilioinguinal Nerve

Female: Round ligament + Ilioinguinal Nerve

39
Q

At what stage do the testes usually enter the inguinal canal and drop into the scrotum

A

Testicular decent starts at week 7. Enters inguinal canal at week 28. Enters scrotum at week 32-36.

40
Q

What facts increase the risk of hernias in women

A

Age and pregnancies

41
Q

Where are the superficial and deep inguinal rings positioned

A

Superficial: Immediately above and medial to pubic tubercle
Deep: 1.5 cm above midpoint of inguinal ligament

42
Q

The superficial and deep inguinal rings are holes in which fascia/muscle

A

Superficial: EO
Deep: TF

43
Q

What is the conjoint tendon

A

The lowest fibers of IO and TA come together to form the Conjoint Tendon. Attached medially to the pubic crest

44
Q

What makes up the four walls of the Inguinal canal

A

Anterior: EO(the whole way) + IO(lateral third)
Posterior: TF + Conjoint tendon(medially)
Superior: IO + TF + Conjoint tendon(medially)
Inferior: Inguinal Ligament

45
Q

What region do direct hernias occur

A

Hesselbach’s Triangle - medial to the inferior epigastric vessels

46
Q

Where is the defect in indirect inguinal hernias positioned

A

Dilatation of the deep inguinal ring - lateral to inferior epigastric vessel

47
Q

What types of patients have direct hernias

A

Older patients - associated wth chronic straining and weak musculature.

48
Q

What types of patients have indirect hernias

A

Young adults and children