Abdominal Wall, Inguinal Region, Peritoneal Cavity- Clinical Correlations

Question 1

fascia and fascial spaces of the abdominal wall

Answer 1

the space between the membranous layer and deep fascia covering the rectus abdominis and external oblique muscles is a potential space for fluid accumulation
When closing surgical incisions, surgeons include the membranous layer when suturing because of its strength
spread of fluid is restricted inferiorly because the membranous layer of subcutaneious tissue fuses with the deep fascia on the thigh along a line inferior and parallel to the inguinal ligament

Question 2

Abdominal surgical incisions

Answer 2

surgeons usually split muscle fibers instead of transecting them to prevent necrosis
Rectus abdomenis is an exception because its muscle fibers are short and its nerves entering the lateral part of the rectus sheath can be located and preserved

Question 3

incisional hernia

Answer 3

protrusion of omentum or an organ through a surgical incision or scar

Question 4

protuberance of the abdomen

Answer 4

six common causes of abdominal protrusion ar the 6F’s

Food, fluid, fat, feces, flatus or fetus

Question 5

palpation of anterolateral abdominal wall

Answer 5

involuntary spasms of the anterolateral abdominal spasm during palpation make the abdominal wall tense (guarding) to protect the viscera from pressure which is painful in case of an abdominal infection

Question 6

hydrocele of the testis

Answer 6

presence of EXCESS FLUID in persistent tunica vaginalis

Question 7

hematocele of the testis

Answer 7

a collection of BLOOD in the cavity of the tunica vaginalis

Question 8

vasectomy

Answer 8

a ligation and transection or removal of a segment of the DUCTUS DEFERENS on each side to sterilize a man

Question 9

varicocele

Answer 9

the incompetent valves in the testicular vein may cause dilated and tortuous pampiniform plexus of veins resulting in a palpable enlargement that feels like a bag of worms

Question 10

testicular cancer

Answer 10

cancer of the testis metastasizes initially to the lumbar lymph nodes
cancer of the scrotum metastasizes initially to superficial inguinal lymph nodes
due to testes relocating from dorsal abdominal wall whereas scrotum develops from an outpouching of the anterolateral abdominal wall during fetal development

Question 11

cremasteric reflex

Answer 11

stroking the skin on the medial side of the superior part of the thigh that is supplied by ilioinguinal nerve with an applicator stick elevates the testis on that side due to contraction of the cremaster muscle

Question 12

inguinal hernia

Answer 12

protrusion of the parietal peritoneum and viscera such as the small intestine through a normal or abnormal opening from the abdominal cavity

Question 13

direct inguinal hernia

Answer 13

weakness of the anterior abdominal wall in inguinal triangle leads to protrusion of peritoneum plus transversalis fascia through the superficial inguinal ring medial to inferior epigastric vessels
herniated part traverses only medial third of the inguinal canal lateral to the cord

Question 14

indirect inguinal hernia

Answer 14

parent processus vaginalis in a young person leads to protrusion of peritoneum of processus vaginalis plus all three facial coverings of the cord/round ligament through the deep inguinal ring lateral to the INFERIOR epigastric vessels
the herniated part traverses through the entire inguinal canal passing into the scrotum/labium majus

Question 15

palpation of the superficial inguinal ring

Answer 15

palpable superolateral to the pubic tubercle by invaginating the skin of the upper scrotum with the index finger
detection of an impulse against the examining finger, when the person coughs, and a mass at the deep ring suggests an indirect hernia

Question 16

cysts and hernias of canal of Nuck

Answer 16

persistent processus vaginalis in females forms a small peritoneal pouch in the inguinal canal called the canal of Nuck that may extend to the labium majus
in female infants, such remnants can enlarge and form cysts that may lead to an INDIRECT inguinal hernia

Question 17

peritonitis

Answer 17

infection and inflammation of peritoneum due to bacterial contamination
causes severe abdominal pain, tenderness, guarding, nausea and or vomiting, fever, and constipation

Question 18

ascites

Answer 18

excess fluid in the peritoneal cavity
occurs as a result of mechanical injury or pathological conditions such as portal hypertension and cancer cell metastasis

Question 19

peritoneal adhesions

Answer 19

may be seen when peritoneum is damaged or as a complication of abdominal surgeries
inflamed peritoneal surfaces are sticky with fibrin that becomes fibrosed resulting in abnormal attachments between the visceral peritoneum of adjacent viscera or between the visceral peritoneum of a viscus and the parietal peritoneum of the adjacent abdominal wall resulting in adhesions

Question 20

adhesiotomy

Answer 20

surgical separation of the adhesions

Question 21

abdominal paracentesis

Answer 21

surgical puncture of the peritoneal cavity with a needle inserted through the anterolateral abdominal wall to aspirate the ascitic fluid in case of generalized peritonitis

Question 22

functions of greater omentum

Answer 22

the structure is large and fat-laden
prevents the visceral peritoneum from adhering to the parietal peritoneum and is very mobile with the peristaltic movements of the viscera