Abdominal Wall- Real Flashcards
what layers are reconstructed when closing paramedian incision above arcuate line
peritoneum, transversalis fascia, rectus muscle, rectus sheath, superficial fascia, skin
what layers are reconstructed when closing paramedian below the arcuate line
peritoneum, transversalis fascia, posteiror rectus sheath, rectus muscle, anterior rectus sheath, superficial fascia, skin
what lymph nodes are affected by melanoma on th left lateral region of the abdominal wall
parasternal nodes
what lymph nodes are affected by testicular carcninoma
external iliac nodes
what is the advantage of a paramedian and midline incision compared to a pararectus incision
paramedian- don’t compromise the nerve and blood supply to the rectus muscle as is done with pararectus
what complications go with severing/compressing a nerve on the anterior abdominal wall? (iliohypogastric or ilioinguinal)
muscle weakens which could lead to a hernia
what is the abdominal wall
skin to transversals fascia
what is the abdominal cavity
trasversali fascia down
what is the transversals fascia
deep fascia of transversalus abdomens, psoas, diaphragm, iliac us, and pelvic musculature
what layers are in the abdominal wall
skin
2 layers of superficial fascia (campers and scarpas)
3 muscle layers (internal and external oblique, transversalus abdomins)
what are the areas in the abdominal cavity
subserous fascia
retroperitoneal space
peritoneum
periotoneal cavity
where does the skin over the scrotum and labia major come from
abdominal wall skin
describe camper’s fascia
superficial layer of superficial layer of the anteriolateral abdominal wall
fat layer
where is liposuction done
camper’s fascia
describe the scarpa’s fascia
deep layer of superficial layer of the anteirolateral abdominal wall
no fat
tough fibrous layer that attaches to the fascia kata, ishiopubic rami, and ishial tuberosity
what layer are subcutaneous sutures put into
scarpa’s fascia
what is collie’s fascia
scarpa’s fascia in the perineum
defines the area of blood/urine extravasation after penial bulb injury
what is darts fascia
fusion of camper’s and scarpa’s fascia in the scrotum
fat of camper’s is lost, but stays in labia
what is the purpose of the scrotum and how is it accomplished
decrease the temperature of the testis by smooth muscle controlling its position relative to the body
what are the abdominal muscles
external oblique
internal oblique
transversus abdominis
where is the deep fascia
both sides of each of the abdominal muscles
what are the functions of the abdominal muscles
support and protect abdominal viscera
increase intraabdominal pressure for things
trunk motor control
what special structures are formed by the abdominal muscles
rectus sheath
inguinal canal
spermatic cord
what is formed by the external oblique aponeurosis
inguinal ligament anterior layer of rectus sheath superficial inguinal ring pectinate ligament lacunar ligament external spermatic fascia
what and where is the inguinal ligament
thickening of the inferior edge of the external oblique muscle, spanning between the ischium spine and pubic tubercle
forms the floor of the inguinal canal
what and where is the superficial inguinal ring
V shaped opening in this aponeurosis of the external oblique muscle
spermatic cord passes through it
superior and lateral to the pubic tubercle
what and where is the pectineal ligament
extension of the lacunar ligament, lateral to the pubis (formed by external oblique aponeurosis)
what and where is the lacunar ligament
triangular ligament between the pubis and inguinal ligament that forms the medial floor of the inguinal canal
extension- pectineal ligament
what forms the superior and posterior wall of inguinal canal
internal oblique
what is the origin of the cremaster muscle
internal oblique muscle
what is the purpose and innervation of the cremaster muscle
covers testis and elevates
innervated by femoral nerve
what structures are formed from the aponeurosis of the internal oblique muscle
rectus sheath
conjoint tendon
how does the internal oblique aponeurosis form the rectus sheath
above arcuate line- splints into anterior and posterior layers
below arcuate line- all anteiror
what is the conjoint tendon
internal oblique and transversus abdominis aponeuroses merge to form the posterior wall of the inguinal canal
what happens if the conjoint tendon is weakened?
direct inguinal hernia
what part of the inguinal canal does the transverses abdomins form
superior and posterior walls
what structures does the transversus abdominis aponeurosis form
conjoint tendon rectus sheath trasversali fascia deep inguinal ring internal spermatic fascia
how does the transversus abdominis form the rectus sheath
above arcuate line- posterior
below arcuate line- anterior
what and where is the deep inguinal ring
internal opening of inguinal canal, medial to the inferior epigastric vessels
where are the superior and inferior epigastric arteries
posterior to the rectus abdominis
where is the arcuate line
midway between the umbilicus and the pubic symphysis
what forms the rectus sheath above the arcuate line
anterior- external oblique and anterior internal oblique
posterior- posterior internal oblique and transversus abdominis
what forms the rectus sheath below the arcuate line
anterior- all 3 muscle aponeuroses
posterior- transversalis fascia
why are there more layers below the arcuate line than above
support the abdomen
what levels supply the abdomen
T7-L1
where is the iliohypogastric nerve
L1, lowest nerve on the abdominal wall
where is the ilioinguinal nerve
L1, travels through inguinal canal and innervates the scrotum/labia majora
what happens when abdominal nerves are compressed
muscle weakess which can lead to hernia
what is the basis for referred pain
distribution of fibers- structures on the same level are innervated the same
ex: T10 gets umbilicus and appendix, appendicitis starts as umbilicus pain
what are the deep muscular arteries that supply the abdomen
superior epigastric musculophrenic intercostal 10, 11 subcostal inferior epigastric deep iliac circumflex
what are the branches from the external iliac artery that supply the abdomen
inferior epigastric
deep iliac circumflex
what are the superficial arterial branches that supply the abdomen
superficial epigastric
superficial iliac circumflex
where do the superficial arterial branches supplying the abdomen come from and what layer are they in
femoral artery
camper’s fascia
what arteries can easily be injured in laproscopic surgery
superficial and inferior epigastric artteries
what is the superficial lymphatic drainage above the umbilicus
parasternal nodes–> superior epigastric nodes-> axillary nodes via path of thoracoepigastric veins
what is the superficial lymphatic drainage below the umbilicus
superficial and deep inguinal nodes via path of superficial epigastric v
what is the deep lymphatic drainage above the umbilicus
internal thoracic nodes-> supericar epigastric and lumbar nodes via path of T9-T11 arteries
what is the deep lymphatic drainage below the umbilicus
external iliac nodes via path of deep iliac circumflex and inferior epigastric vessels
what are the 5 folds of the internal surface of anterior abdominal wall
median umbilical fold
2 medial umbilical folds
2 lateral umbilical folds
what is the median umbilical fold a remnant of
urachus
what is the medial umbilical folds remnants of
umbilical artery
what is near the lateral umbilical folds
inferior epigastric vessels
what are the 5 fossa of the internal surface of the anterior abdominal wall
supravesicular fossa
medial inguinal fossa (2)
lateral inguinal fossa
where is the supra vesicle fossa
between the 2 medial umbilical folds, including line of median umbilical fold
where is the medial inguinal fossa
between the medial and lateral folds
where is the inguinal triangle
in the medial inguinal fossa
what forms the inguinal triangle
edge of rectus
inguinal ligament
inferior epigastric vessels
where is a direct inguinal hernia
inguinal triangle
where is the lateral inguinal fossa
lateral to the lateral umbilicus fold
where is an indirect inguinal hernia
lateral inguinal fossa
what are the advantages of a median incision
good access for exploratory surgery
minimal bleeding
where is a paramedian incision
lateral to midline
where is a gridiron incision
aka McBurney
anterior to ilium wing
used for appendectamy
where is a transverse incision
horizontally over the iliac crest
where is a suprapubic incision
above pubic symphysis
what is a disadvantage of a paramedian incision
limited access
what is an advantage of a suprapubic incision
avoids peritoneal cavity
where is a subcostal incision
under ribs
used for gallbladder or spleen access
where is a pararectus incision
lateral edge of rectus sheath
why are pararectus incisions bad
cuts off nerve and blood supply to rectus sheath
how should muscle be reflected
towards the nerve bundle to avoid stretching issues
where is the superficial epigastric artery and vein and where do they come from
lateral to the line alba in the campers fascia
originate from the femoral vessels
fiber direction of the external oblique
superiolateral to inferiomedial
fiber direction of the internal oblique
superiomedial to inferiolateral
where is the lateral crus and what does it attach to
lateral portion of the superficial inguinal ligament and attaches to the pubic tubercle
where is the medial crus and what does it attach to
medial portion of superficial inguinal ligament and attaches to the pubic crest
where are the intercrural fibers
fibers going across the top of the inguinal canal and hold the cruses together
where is the external spermatic fascia
external oblique aponeurosis that extends into the spermatic cord
where is the ilioinguinal nerve
comes out of the superficial inguinal ring anterior to spermatic cord/round ligament of the uterus
what does the ilioinguinal nerve innervate
anterior genital surface and the medial thigh
where is the lacunar ligament
triangular looking ligament behind the spermatic cord
where is the pectineal ligament
line near lacunar ligament, behind the spermatic cord
where is the conjoint tendon
behind the lacunar ligament, forms the posterior inguinal wall
where is the cremaster muscle
muscle extension from the internal oblique muscle that originates medially and laterally to join with the spermatic cord
what plane are the ilioinguinal and iliohypogastric nerves found
intermuscular plane between the external and internal obliques
what is the fiber direction of the transversus abdominis
same as internal oblique- inferolateral to superiomedial
where is the transversalis fascia
below the transversus abdominis
how is the deep inguinal ring identified
lateral to the inferior epigastric vessels and the ductus deferens passes through it
what structures are in the rectus sheath
rectus abdominis
pyramidalis muscle
superior and inferior epigastric vessels
where is the semilunar line
line lateral to rectus abdominis
where are tendinous intersections
connections between the anterior rectus sheath and anterior rectus muscle
where is the pyramidal is muscle
between the anterior surface of the pubis and linea alba
where are the inferior epigastric artery and vein
inferior posterior rectus abdomens and superficial to the posterior rectus sheath above the arcuate line and then enter the rectus sheath at the arcuate line and pass in the transveralis fascia behind the inguinal canal
where are the superior epigastric artery and vein
superior posterior rectus abdominis and superficial to the posterior rectus sheath above the arcuate line
where do inferior epigastric vessels enter the rectus sheath
arcuate line
where is the ductus deferens
center of spermatic cord
where is the pampiniform plexus of veins
inside the internal spermatic fascia surrounding the testicular artery anteriorly to ductus deferencs
where is the tunica vaginalis
covering of the testis (2 layers- parietal and visceral)
parts of the epididymis
head- superior to testis
body- behind testis
tail- infeiror to testis
appendix- little bump on the head
what is the tunica albuginea
fibrous capsule of the testis- very thick inferiorly
where is the genitofemoral nerve
passes anteiror to inguinal canal from medial to lateral and extends into the thigh area
