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HS Exam 2 > Abdominal Wall- Real > Flashcards

Abdominal Wall- Real Flashcards

1
Q

what layers are reconstructed when closing paramedian incision above arcuate line

A

peritoneum, transversalis fascia, rectus muscle, rectus sheath, superficial fascia, skin

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2
Q

what layers are reconstructed when closing paramedian below the arcuate line

A

peritoneum, transversalis fascia, posteiror rectus sheath, rectus muscle, anterior rectus sheath, superficial fascia, skin

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3
Q

what lymph nodes are affected by melanoma on th left lateral region of the abdominal wall

A

parasternal nodes

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4
Q

what lymph nodes are affected by testicular carcninoma

A

external iliac nodes

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5
Q

what is the advantage of a paramedian and midline incision compared to a pararectus incision

A

paramedian- don’t compromise the nerve and blood supply to the rectus muscle as is done with pararectus

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6
Q

what complications go with severing/compressing a nerve on the anterior abdominal wall? (iliohypogastric or ilioinguinal)

A

muscle weakens which could lead to a hernia

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7
Q

what is the abdominal wall

A

skin to transversals fascia

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8
Q

what is the abdominal cavity

A

trasversali fascia down

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9
Q

what is the transversals fascia

A

deep fascia of transversalus abdomens, psoas, diaphragm, iliac us, and pelvic musculature

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10
Q

what layers are in the abdominal wall

A

skin
2 layers of superficial fascia (campers and scarpas)
3 muscle layers (internal and external oblique, transversalus abdomins)

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11
Q

what are the areas in the abdominal cavity

A

subserous fascia
retroperitoneal space
peritoneum
periotoneal cavity

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12
Q

where does the skin over the scrotum and labia major come from

A

abdominal wall skin

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13
Q

describe camper’s fascia

A

superficial layer of superficial layer of the anteriolateral abdominal wall
fat layer

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14
Q

where is liposuction done

A

camper’s fascia

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15
Q

describe the scarpa’s fascia

A

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

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16
Q

what layer are subcutaneous sutures put into

A

scarpa’s fascia

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17
Q

what is collie’s fascia

A

scarpa’s fascia in the perineum

defines the area of blood/urine extravasation after penial bulb injury

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18
Q

what is darts fascia

A

fusion of camper’s and scarpa’s fascia in the scrotum

fat of camper’s is lost, but stays in labia

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19
Q

what is the purpose of the scrotum and how is it accomplished

A

decrease the temperature of the testis by smooth muscle controlling its position relative to the body

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20
Q

what are the abdominal muscles

A

external oblique
internal oblique
transversus abdominis

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21
Q

where is the deep fascia

A

both sides of each of the abdominal muscles

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22
Q

what are the functions of the abdominal muscles

A

support and protect abdominal viscera
increase intraabdominal pressure for things
trunk motor control

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23
Q

what special structures are formed by the abdominal muscles

A

rectus sheath
inguinal canal
spermatic cord

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24
Q

what is formed by the external oblique aponeurosis

A 
inguinal ligament
anterior layer of rectus sheath
superficial inguinal ring
pectinate ligament
lacunar ligament
external spermatic fascia
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25
Q

what and where is the inguinal ligament

A

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

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26
Q

what and where is the superficial inguinal ring

A

V shaped opening in this aponeurosis of the external oblique muscle
spermatic cord passes through it
superior and lateral to the pubic tubercle

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27
Q

what and where is the pectineal ligament

A

extension of the lacunar ligament, lateral to the pubis (formed by external oblique aponeurosis)

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28
Q

what and where is the lacunar ligament

A

triangular ligament between the pubis and inguinal ligament that forms the medial floor of the inguinal canal
extension- pectineal ligament

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29
Q

what forms the superior and posterior wall of inguinal canal

A

internal oblique

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30
Q

what is the origin of the cremaster muscle

A

internal oblique muscle

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31
Q

what is the purpose and innervation of the cremaster muscle

A

covers testis and elevates

innervated by femoral nerve

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32
Q

what structures are formed from the aponeurosis of the internal oblique muscle

A

rectus sheath

conjoint tendon

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33
Q

how does the internal oblique aponeurosis form the rectus sheath

A

above arcuate line- splints into anterior and posterior layers
below arcuate line- all anteiror

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34
Q

what is the conjoint tendon

A

internal oblique and transversus abdominis aponeuroses merge to form the posterior wall of the inguinal canal

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35
Q

what happens if the conjoint tendon is weakened?

A

direct inguinal hernia

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36
Q

what part of the inguinal canal does the transverses abdomins form

A

superior and posterior walls

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37
Q

what structures does the transversus abdominis aponeurosis form

A 
conjoint tendon
rectus sheath
trasversali fascia
deep inguinal ring
internal spermatic fascia
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38
Q

how does the transversus abdominis form the rectus sheath

A

above arcuate line- posterior

below arcuate line- anterior

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39
Q

what and where is the deep inguinal ring

A

internal opening of inguinal canal, medial to the inferior epigastric vessels

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40
Q

where are the superior and inferior epigastric arteries

A

posterior to the rectus abdominis

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41
Q

where is the arcuate line

A

midway between the umbilicus and the pubic symphysis

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42
Q

what forms the rectus sheath above the arcuate line

A

anterior- external oblique and anterior internal oblique

posterior- posterior internal oblique and transversus abdominis

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43
Q

what forms the rectus sheath below the arcuate line

A

anterior- all 3 muscle aponeuroses

posterior- transversalis fascia

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44
Q

why are there more layers below the arcuate line than above

A

support the abdomen

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45
Q

what levels supply the abdomen

A

T7-L1

46
Q

where is the iliohypogastric nerve

A

L1, lowest nerve on the abdominal wall

47
Q

where is the ilioinguinal nerve

A

L1, travels through inguinal canal and innervates the scrotum/labia majora

48
Q

what happens when abdominal nerves are compressed

A

muscle weakess which can lead to hernia

49
Q

what is the basis for referred pain

A

distribution of fibers- structures on the same level are innervated the same
ex: T10 gets umbilicus and appendix, appendicitis starts as umbilicus pain

50
Q

what are the deep muscular arteries that supply the abdomen

A 
superior epigastric
musculophrenic
intercostal 10, 11
subcostal
inferior epigastric
deep iliac circumflex
51
Q

what are the branches from the external iliac artery that supply the abdomen

A

inferior epigastric

deep iliac circumflex

52
Q

what are the superficial arterial branches that supply the abdomen

A

superficial epigastric

superficial iliac circumflex

53
Q

where do the superficial arterial branches supplying the abdomen come from and what layer are they in

A

femoral artery

camper’s fascia

54
Q

what arteries can easily be injured in laproscopic surgery

A

superficial and inferior epigastric artteries

55
Q

what is the superficial lymphatic drainage above the umbilicus

A

parasternal nodes–> superior epigastric nodes-> axillary nodes via path of thoracoepigastric veins

56
Q

what is the superficial lymphatic drainage below the umbilicus

A

superficial and deep inguinal nodes via path of superficial epigastric v

57
Q

what is the deep lymphatic drainage above the umbilicus

A

internal thoracic nodes-> supericar epigastric and lumbar nodes via path of T9-T11 arteries

58
Q

what is the deep lymphatic drainage below the umbilicus

A

external iliac nodes via path of deep iliac circumflex and inferior epigastric vessels

59
Q

what are the 5 folds of the internal surface of anterior abdominal wall

A

median umbilical fold
2 medial umbilical folds
2 lateral umbilical folds

60
Q

what is the median umbilical fold a remnant of

A

urachus

61
Q

what is the medial umbilical folds remnants of

A

umbilical artery

62
Q

what is near the lateral umbilical folds

A

inferior epigastric vessels

63
Q

what are the 5 fossa of the internal surface of the anterior abdominal wall

A

supravesicular fossa
medial inguinal fossa (2)
lateral inguinal fossa

64
Q

where is the supra vesicle fossa

A

between the 2 medial umbilical folds, including line of median umbilical fold

65
Q

where is the medial inguinal fossa

A

between the medial and lateral folds

66
Q

where is the inguinal triangle

A

in the medial inguinal fossa

67
Q

what forms the inguinal triangle

A

edge of rectus
inguinal ligament
inferior epigastric vessels

68
Q

where is a direct inguinal hernia

A

inguinal triangle

69
Q

where is the lateral inguinal fossa

A

lateral to the lateral umbilicus fold

70
Q

where is an indirect inguinal hernia

A

lateral inguinal fossa

71
Q

what are the advantages of a median incision

A

good access for exploratory surgery

minimal bleeding

72
Q

where is a paramedian incision

A

lateral to midline

73
Q

where is a gridiron incision

A

aka McBurney
anterior to ilium wing
used for appendectamy

74
Q

where is a transverse incision

A

horizontally over the iliac crest

75
Q

where is a suprapubic incision

A

above pubic symphysis

76
Q

what is a disadvantage of a paramedian incision

A

limited access

77
Q

what is an advantage of a suprapubic incision

A

avoids peritoneal cavity

78
Q

where is a subcostal incision

A

under ribs

used for gallbladder or spleen access

79
Q

where is a pararectus incision

A

lateral edge of rectus sheath

80
Q

why are pararectus incisions bad

A

cuts off nerve and blood supply to rectus sheath

81
Q

how should muscle be reflected

A

towards the nerve bundle to avoid stretching issues

82
Q

where is the superficial epigastric artery and vein and where do they come from

A

lateral to the line alba in the campers fascia

originate from the femoral vessels

83
Q

fiber direction of the external oblique

A

superiolateral to inferiomedial

84
Q

fiber direction of the internal oblique

A

superiomedial to inferiolateral

85
Q

where is the lateral crus and what does it attach to

A

lateral portion of the superficial inguinal ligament and attaches to the pubic tubercle

86
Q

where is the medial crus and what does it attach to

A

medial portion of superficial inguinal ligament and attaches to the pubic crest

87
Q

where are the intercrural fibers

A

fibers going across the top of the inguinal canal and hold the cruses together

88
Q

where is the external spermatic fascia

A

external oblique aponeurosis that extends into the spermatic cord

89
Q

where is the ilioinguinal nerve

A

comes out of the superficial inguinal ring anterior to spermatic cord/round ligament of the uterus

90
Q

what does the ilioinguinal nerve innervate

A

anterior genital surface and the medial thigh

91
Q

where is the lacunar ligament

A

triangular looking ligament behind the spermatic cord

92
Q

where is the pectineal ligament

A

line near lacunar ligament, behind the spermatic cord

93
Q

where is the conjoint tendon

A

behind the lacunar ligament, forms the posterior inguinal wall

94
Q

where is the cremaster muscle

A

muscle extension from the internal oblique muscle that originates medially and laterally to join with the spermatic cord

95
Q

what plane are the ilioinguinal and iliohypogastric nerves found

A

intermuscular plane between the external and internal obliques

96
Q

what is the fiber direction of the transversus abdominis

A

same as internal oblique- inferolateral to superiomedial

97
Q

where is the transversalis fascia

A

below the transversus abdominis

98
Q

how is the deep inguinal ring identified

A

lateral to the inferior epigastric vessels and the ductus deferens passes through it

99
Q

what structures are in the rectus sheath

A

rectus abdominis
pyramidalis muscle
superior and inferior epigastric vessels

100
Q

where is the semilunar line

A

line lateral to rectus abdominis

101
Q

where are tendinous intersections

A

connections between the anterior rectus sheath and anterior rectus muscle

102
Q

where is the pyramidal is muscle

A

between the anterior surface of the pubis and linea alba

103
Q

where are the inferior epigastric artery and vein

A

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

104
Q

where are the superior epigastric artery and vein

A

superior posterior rectus abdominis and superficial to the posterior rectus sheath above the arcuate line

105
Q

where do inferior epigastric vessels enter the rectus sheath

A

arcuate line

106
Q

where is the ductus deferens

A

center of spermatic cord

107
Q

where is the pampiniform plexus of veins

A

inside the internal spermatic fascia surrounding the testicular artery anteriorly to ductus deferencs

108
Q

where is the tunica vaginalis

A

covering of the testis (2 layers- parietal and visceral)

109
Q

parts of the epididymis

A

head- superior to testis
body- behind testis
tail- infeiror to testis
appendix- little bump on the head

110
Q

what is the tunica albuginea

A

fibrous capsule of the testis- very thick inferiorly

111
Q

where is the genitofemoral nerve

A

passes anteiror to inguinal canal from medial to lateral and extends into the thigh area

HS Exam 2 (24 decks)

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