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Surgery Finals 2nd Sem > Abdominal Wall part 1 > Flashcards

Abdominal Wall part 1 Flashcards

1
Q

inferiorly by the

A

symphysis pubis

Pelvic bones

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2
Q

posteriorly by the

A

vertebral column

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3
Q

origin and develops as bilateral migrating sheets, which originate in the paravertebral region and envelop the future abdominal area

A

Mesodermal

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4
Q

The leading edges of these structures develop into the ________________, which eventually meet in midline of the anterior abdominal wall

A

rectus abdominus muscles

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5
Q

The muscle fibers of the rectus abdominus are arranged vertically and are encased within an aponeurotic sheath, the anterior and posterior layers of which are fused in the midline at the

A

Linea alba

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6
Q

The rectus abdominus has insertions on the

A

symphysis pubis and pubic bones
anteroinferior aspects of the fifth and sixth ribs
seventh costal cartilage
xiphoid process

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7
Q

The lateral border of the rectus muscles assumes a convex shape that gives rise to the surface landmark, the

A

Linea semilunaris

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8
Q

There are usually three tendinous intersections or inscriptions that cross the rectus muscles

A

Level of xiphoid process
Level of umbilical
halfway between the xiphoid process and the umbilicus

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9
Q

The complexities of the anterior and posterior aspects of the rectus sheath are best understood in their relationship to the

A

arcuate line (semicircular line of Douglas

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10
Q

Above the arcuate line

The anterior rectus sheath is formed by the

A

external oblique aponeurosis

external lamina of the internal oblique aponeurosis

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11
Q

Above the arcuate line

The posterior rectus sheath is formed by the

A

internal lamina of the internal oblique aponeurosis
transversus abdominis aponeurosis,
transversalis fascia

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12
Q

Below the arcuate line

The anterior rectus sheath is formed by the

A

external oblique aponeurosis
The laminae of the internal oblique aponeurosis
The transversus abdominis aponeurosis

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13
Q

There is no aponeurotic posterior covering of this lower portion of the rectus muscles, although the ___________ remains a contiguous structure on the posterior aspect of the abdominal wall in this area as well

A

transversalis fascia

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14
Q

The majority of the blood supply to the muscles of the anterior abdominal wall is derived from the

A

superior

inferior epigastric arteries

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15
Q

The superior epigastric artery arises from the

A

internal thoracic artery

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16
Q

The inferior epigastric artery arises from the

A

external iliac artery

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17
Q

also contributes to the abdominal wall blood supply

A

branches of the subcostal and lumbar arteries

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18
Q

The lymphatic drainage of the abdominal wall is predominantly to the major nodal basins in the

A

superficial inguinal and axillary areas

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19
Q

The motor nerves to the rectus muscles,
the internal oblique muscles,
and the transversus abdominis muscles run from the

A

anterior rami of spinal nerves at the T6 to T12 levels

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20
Q

The overlying skin is innervated by afferent branches of the

A

T4 to L1 nerve roots

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21
Q

Umbilicus nerve root

A

T10

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22
Q

The rectus muscles, the external oblique muscles, and the internal oblique muscles work as a unit to

A

flex the trunk anteriorly or laterally

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23
Q

Rotation of the trunk is achieved by the contraction of:  the

A

external oblique muscle

contralateral internal oblique muscle

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24
Q

diaphragm is relaxed when the abdominal musculature is contracted

A

expiration of air from the lungs or a cough if this contraction is forceful

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25
Q

diaphragm is contracted when the abdominal musculature is contracted (Valsalva maneuver

A

micturition, defecation, and childbirth

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26
Q

connects the embryonic and fetal midgut to the yolk sac

A

Vitelline duct

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27
Q

During the sixth week of development, the abdominal contents grow too large for the abdominal wall to contain and the embryonic midgut

A

herniates into the umbilical cord

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28
Q

While outside the confines of the developing abdomen, it undergoes a

A

270degree counterclockwise rotation

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29
Q

Defects in abdominal wall closure may lead to

A

omphalocele or gastroschisis

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30
Q

, viscera protrude through an open umbilical ring and are covered by a sac derived from the amnion

A

omphalocele

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31
Q

, the viscera protrude through a defect lateral to the umbilicus and no sac is present

A

gastroschisis

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32
Q

is a fibromuscular, tubular extension of the allantois that develops with the descent of the bladder to its pelvic position

A

urachus

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33
Q

Persistence of urachal remnants can result in ________________ with drainage of urine from the umbilicus

A

cysts as well as fistulas to the urinary bladder,

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34
Q

describes a clinically evident separation of the rectus abdominus muscle pillars, generally as a result of decreased tone of the abdominal musculature

A

Rectus abdominis diastasis (or diastasis recti)

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35
Q

The characteristic bulging of the abdominal wall in the epigastrium is sometimes mistaken for a

A

ventral hernia

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36
Q

Diastasis may be congenital, as a result of a more lateral insertion of the rectus muscles to the

A

ribs and costochondral junctions

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37
Q

Diastasis but is more typically an acquired condition with

A

advancing age, obesity, or following pregnancy

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38
Q

In the postpartum setting, rectus diastasis tends to occur in women of

A

advanced maternal age,
after multiple or twin pregnancies, or
in women who deliver high-birthweight infants

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39
Q

provides an accurate means of measuring the distance between the rectus pillars and will differentiate rectus diastasis from a true ventral hernia if clarification is required

A

CT Scan

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40
Q

Surgical correction of a severe rectus diastasis by plication of the anterior rectus sheath may be undertaken for

A

cosmetic indications

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41
Q

Rectus Sheath Hematoma

The terminal branches of the superior and inferior epigastric arteries course deep to the posterior aspect of the

A

left and right rectus pillars

and penetrate the posterior rectus sheath

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42
Q

Injury to these vessels or to any of the network of collateralizing vessels within the rectus sheath and muscles can result in a

A

rectus sheath hematoma

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43
Q

Spontaneous rectus sheath hematomas have been described in the

A

elderly and

anticoagulation therapy

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44
Q

Rectus sheath hematoma

Patients frequently describe the sudden onset of unilateral abdominal pain that may be confused with lateralized peritoneal disorders such as

A

appendicitis

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45
Q

Below the arcuate line, a hematoma may cross the midline and cause

A

bilateral lower quadrant pain

46
Q

Rectus Sheath hematoma

Pain typically increases with contraction of the

A

rectus muscles and a

tender mass may be palpated

47
Q

RSH

The ability to appreciate an intraabdominal mass is ordinarily degraded with

A

contraction of the rectus muscles

48
Q

is a palpable abdominal mass that remains unchanged with contraction of the rectus muscles and is classically associated with rectus hematoma

A

Fothergill’s sign

49
Q

RSH

may show a solid or cystic mass within the abdominal wall, depending on the chronicity of the bleeding event

A

Abdominal ultrasonography

50
Q

RSH

is the most definitive study for establishing the correct diagnosis and excluding other intra-abdominal disorders

A

Computed tomography

51
Q

RSH

may be observed without hospitalization

A

Small,
unilateral, and
contained hematomas

52
Q

RSH

will likely require hospitalization, as well as potential resuscitation

A

Bilateral or large hematomas

53
Q

RSH

Reversal of ______________ in the acute setting is frequently, but not always, necessary

A

warfarin (Coumadin) anticoagulation

54
Q

RSH

Emergent operative intervention or angiographic embolization is required infrequently, but may be necessary if

A

hematoma enlargement,
free bleeding, or
clinical deterioration occur

55
Q

RSH

Surgical therapy consists of

A

evacuation of the hematoma and

ligation of any bleeding vessel

56
Q

Abdominal Wall Hernias

represent defects in the parietal abdominal wall fascia and muscle through which intra-abdominal or preperitoneal contents can protrude

A

Hernias of the anterior abdominal wall, or ventral hernias,

57
Q

Ventral hernias may be congenital or acquired. Acquired hernias may develop via slow architectural deterioration of the muscular aponeuroses or they may develop from failed healing of an anterior abdominal wall incision

A

Incisional hernia

58
Q

AWH

The most common finding is a mass or bulge on the anterior abdominal wall, which may increase in size with

59
Q

AWH

Physical examination reveals a bulge on the anterior abdominal wall that may reduce spontaneously, with

A

recumbency, or with manual pressure

60
Q

AWH

A hernia that cannot be reduced is described as __________ and will require emergent surgical correction

A

incarcerated

61
Q

AWH

Incarceration of an intestinal segment may be accompanied by

A

nausea, vomiting, and significant pain

62
Q

AWH

Should the blood supply to the incarcerated bowel be compromised, the hernia is described as ___________, and the localized ischemia may lead to infarction and perforation

A

strangulated

63
Q

AWH

Primary ventral hernias (nonincisional) also are termed

A

“true” ventral hernias

64
Q

AWH

are located in the midline between the xiphoid process and the umbilicus

A

Epigastric hernias

65
Q

AWH

____________ develop at the umbilical ring and may be present at birth or develop gradually during the life of the individual

A

Umbilical hernias

66
Q

AWH

can occur anywhere along the length of the Spigelian line or zone—an aponeurotic band of variable width at the lateral border of the rectus abdominus

A

Spigelian hernias

67
Q

AWH

Spigelian hernia The most frequent location of these rare hernias is at or slightly above the level of the

A

arcuate line

68
Q

AWH

These are not always clinically evident as a bulge, and may come to medical attention because of pain or incarceration

A

Spigelian hernia

69
Q

Patients with advanced liver disease, ascites, and umbilical hernia enlargement of the umbilical ring usually occurs in this clinical situation as the result of increased intraabdominal pressure from

A

uncontrolled ascites

70
Q

AWH

Patients with refractory ascites may be candidates for

A

transjugular intrahepatic portocaval shunting (TIPS),
nonselective surgical portosystemic shunt, or
liver transplantation

71
Q

AWH

is best performed after the ascites is controlled

A

Umbilical hernia repair

72
Q

AWH

may be asymptomatic or present with pain, incarceration, or strangulation

A

Incisional hernias

73
Q

AWH

Risk factors for the development of a ventral incisional hernia include

A 
postoperative wound infection, 
malnutrition, 
obesity, 
immunosuppression, and 
chronically increased intra-abdominal pressure
74
Q

Several techniques for the repair of ventral hernias:

A

primary repair
open repair with mesh
laparoscopic repair with mesh

75
Q

Primary repair, even for small hernias (abdominal wall defects less than 3 cm), is associated with a high subsequent recurrence rate, often caused by

A

failure to appreciate the multiple small defects that also are present

76
Q

of incisional hernias generally requires overlapping the prosthesis onto the anterior or posterior surfaces of intact abdominal wall fascia for a distance of at least 3 to 4 cm from defect edge

A

Open mesh repair

77
Q

is an inert substance that induces no inflammatory response, eventual tissue ingrowth within the interstices of the mesh will result in dense attachment to whatever tissues it is in contact with

A

Polypropylene

78
Q

generally involves laterally placed ports for midline defects and contralaterally placed ports for lateral defects

A

Laparoscopic repair

79
Q

The contents of the hernia sac are completely reduced, but in contrast to open repairs,

A

the sac itself is left in place

80
Q

The fascial edges of the hernia defect identified, an appropriate-size piece of _____________________ is fashioned to allow sufficient overlap (i.e., 3 to 4 cm) onto healthy abdominal wall

A

PTFE or composite polypropylene/PTFE mesh

81
Q

Omentum surgical anatomy

develops from the dorsal mesogastrium, which begins as a double-layered structure

A

greater omentum

82
Q

OSA

The spleen develops in between the two layers, and later in development the two layers fuse, giving rise to the

A

intraperitoneal spleen and the gastrosplenic ligament

83
Q

OSA

The _________________ are those segments of the greater omental apron that connect the named structures

A

gastrocolic ligament and gastrosplenic ligament

84
Q

OSA

In the adult, the greater omentum lies in between the _____________________ and usually extends into the pelvis to the level of the _____________

A

anterior abdominal wall and the hollow viscera,

symphysis pubis

85
Q

OSA

The ), develops from the mesoderm of the septum transversum, which connects the embryonic liver to the foregut

A

lesser omentum, (hepatoduodenal and hepatogastric ligaments

86
Q

OSA

are located in the inferolateral margin of the lesser omentum, which also forms the anterior margin of the foramen of Winslow

A

The common bile duct,
portal vein,
and hepatic artery

87
Q

OSA

The blood supply to the greater omentum is derived from the

A

right and left gastroepiploic arteries

88
Q

OSA

The venous drainage parallels the arterial supply to a great extent with the ______________ ultimately draining into the ___________

A

left and right gastroepiploic veins

portal system

89
Q

The consequent local production of _____ contributes to the ability of the omentum to adhere to areas of injury or inflammation

90
Q

Interruption of the blood supply to the omentum is a rare cause of an acute abdomen that may be secondary to torsion of the omentum around its vascular pedicle, thrombosis or vasculitis of the omental vessels, or omental venous outflow obstruction

A

Omental infarction

91
Q

OI

Diagnosis is more likely to be made in

A

Male adults

92
Q

OI

Depending on the location of the infarcted omental tissue, this disease process may mimic

A 
appendicitis, 
cholecystitis, 
diverticulitis, 
perforated peptic ulcers, 
or ruptured ovarian cysts
93
Q

OI

Patients typically present with localized

A

right lower quadrant,
right upper quadrant,
or left lower quadrant pain

94
Q

OI

Physical examination typically reveals a

A

mild tachycardia and a

low-grade temperature elevation

95
Q

OI

Abdominal examination may demonstrate a

A

tender,
palpable mass associated with
guarding and rebound tenderness

96
Q

OI

Either _____________ or____________will show a localized, inflammatory mass of fat density

A

abdominal computed tomography or

ultrasonography

97
Q

Treatment of omental infarction depends on the _________ with which the diagnosis is made

98
Q

Cystic lesions of the omentum and mesentery are related disorders, likely resulting from

A

lymphatic degeneration

99
Q

Omental cysts are far less common than

A

mesenteric cysts

100
Q

OC

Physical examination reveals a

A

freely mobile intra-abdominal mass

101
Q

OC

Both __________________ reveal a well-circumscribed, cystic-mass lesion arising from the greater omentum

A

computed tomography and abdominal ultrasound

102
Q

OC

Treatment involves

A

resection of all symptomatic omental cysts

103
Q

OC.

Resection of these benign lesions is easily accomplished via

A

laparoscopic techniques

104
Q

Benign tumors of the omentum include

A

lipomas,
myxomas, and
desmoid tumors

105
Q

The omentum is derived from mesoderm, primary malignant tumors of the omentum are considered

A

sarcomas

Liposarcomas, leiomyosarcomas, rhabdomyosarcomas, fibrosarcomas, and mesotheliomas

106
Q

Primary tumors of the omentum are

107
Q

Metastatic tumors involving the omentum are

A

quite common

108
Q

ON

have a high preponderance of omental involvement

A

Metastatic ovarian tumors

109
Q

Malignant tumors of the _______________________ may also metastasize to the omentum

A

stomach, small intestine, colon, pancreas, biliary tract, uterus, and kidney

110
Q

The abdominal wall is defined superiorly by

A

Costal margins

Surgery Finals 2nd Sem (5 decks)

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