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Reproduction and Sexual Health > Anatomy 4 - Obs and Gynae Surgical Incisions > Flashcards

Anatomy 4 - Obs and Gynae Surgical Incisions Flashcards

1
Q

What are other names for suprapubic incision?

A

Bikini line

Pfannenstiel

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2
Q

What is the suprapubic incision used for?

A

Lower segment C-section

Abdominal hysterectomy

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3
Q

What method of cutting allows for better healing of skin?

A

Cutting along Langer lines

Or using relaxed skin tension lines

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4
Q

What is a relaxed skin tension line?

A

Parallel to dermal collagen bundles

Perpendicular to muscle contraction

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5
Q

WHat are the layers of the anterolateral abdominal wall?

A 
Skin 
Superficial fasica
Rectus sheath
Anterior - Rectus abdominis
Lateral - External oblique
            - Internal oblique
            - transverse abdominis
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6
Q

Describe the superficial fascia above the umbilicus

A

Single sheet of connective tissue

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7
Q

Describe the superficial fascia below the umbilicus

A

Superficial fatty layer (camper’s fascia)

Deep membranous layer (scarpa’s fascia)

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8
Q

What happens to the superficial fascia at the level of the perineum?

A

Scarpa’s fascia becomes Colles’ fascia

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9
Q

What is the deep fascia of the penis called?

A

Buck’s fascia

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10
Q

What are the flat muscles of the abdominal wall?

A

External oblique
Internal oblique
Transverse abdominis

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11
Q

What are the vertical muscles of the abdominal wall?

A

Rectus abdominis
Pyramidalis
(also sometimes the sternalis - not in everyone)

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12
Q

What is the largest and most superficial abdominal wall flat muscle?

A

External oblique

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13
Q

What direction do fibres run in external oblique?

A

Inferiomedially

Hands in pockets

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14
Q

What happens as the fibres of the external oblique approach the midline?

A

Form an aponeurosis - linea alba

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15
Q

What is an aponeurosis?

A

Broad flat tendon

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16
Q

Origin and insertion of external oblique?

A

Origin: ribs 5 - 12
Insertion: iliac crest, pubic tubercle and linea alba

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17
Q

What muscle is just deep to external oblique?

A

Internal oblique

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18
Q

What direction do fibres run in internal oblique?

A

Superiomedially

hands on chest

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19
Q

What happens as the fibres of the internal oblique approach the midline?

A

Form an aponeurosis - linea alba

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20
Q

What movements do internal oblique help with?

A

Twisting movements

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21
Q

Origin and insertion of internal oblique?

A

Origin: ribs 10 - 12
Insertion: thoracolumbar fascia, iliac crest and linea alba

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22
Q

What direction do fibres run in transverse abdominis?

A

Transversely

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23
Q

Origin and insertion of transverse abdominis?

A

Origin: lower ribs
Insertion: thoracolumbar fascia, iliac crest and linea alba

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24
Q

What divides the rectus abdominis into 3/4 smaller muscles?

A

Tendonus intersections

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25
Q

Why is the rectus abdominis broken up into smaller muscles?

A

Improve mechanical efficiency

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26
Q

What is main movement of rectus abdominis?

A

Flexion at trunk

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27
Q

What is formed at the lateral border of the two rectus abdominis muscles?

A

Linea semilunaris

28
Q

Where does rectus abdominis stretch from and to?

A

From xiphoid process

To pubic symphysis

29
Q

What is the pyramidalis?

A

Small triangular shaped muscle

30
Q

What is deep to the pyramidalis?

A

Rectus abdominis

31
Q

Where does pyramidalis stretch from>

A

Pubic bone

To linea alba

32
Q

What is the function of the pyramidalis?

A

Tenses the linea alba

33
Q

Where is the rectus sheath found?

A

Immediately deep to superficial fasica

34
Q

What makes up the rectus sheath?

A

Combined aponeurosis of 3 flat muscles

35
Q

What does the rectus sheath enclose?

A

Rectus abdominis

36
Q

Why is the rectus sheath stitched closed after operations?

A

To increase strength of wound

Reduce risk of herniation

37
Q

What makes up anterior wall of rectus sheath?

A

Aponeurosis of external obliques and half of internal oblique

38
Q

What makes up posterior wall of rectus sheath?

A

Aponeurosis of half of internal oblique and the transverse abdominis

39
Q

Where is the arcuate line found?

A

Third of way inferior between umbilicus and pubic bone

40
Q

What happens to the aponeuroses at the arcuate line?

A

Here, all of the aponeuroses move to the anterior wall of the rectus sheath (i.e. there is no posterior wall)
Rectus abdominis is in direct contact with transversalis fascia

41
Q

In what direction does the nerve supply to the anterolateral abdo wall enter?

A

From lateral direction

42
Q

What do the 7th-11th intercostal nerves become?

A

Thoraco-abdominal nerves

43
Q

What spinal nerve is the subcostal nerve?

A

T12 (anterior division of 12th thoracic nerve)

44
Q

What spinal nerve is the iliohypogastric nerve?

A

L1 (superior branch of the anterior ramus of spinal nerve L1)

45
Q

What spinal nerve is the ilioinguinal nerve?

A

L1 (inferior branch of the anterior ramus of spinal nerve L1)

46
Q

Where do the nerves to the anterolateral abdo wall travel through?

A

Travel in plane between internal oblique and transverse abdominis

47
Q

What arteries supply the anterior abdominal wall?

A

Superior epigastric arteries

Inferior epigastric arteries

48
Q

What are the superior epigastric arteries a continuation of?

A

Internal thoracic (mammary) artery

49
Q

What is anterior to the superior epigastric and inferior epigastric arteries?

A

Rectus abdominis

50
Q

What artery foes inferior epigastric arteries branch from?

A

External iliac

51
Q

What arteries supply the lateral abdominal wall?

A

Intercostal and subcostal arteries

52
Q

What are the intercostal and subcostal arteries a continuation of?

A

Posterior intercostal arteries

53
Q

How can you minimise injury to muscle when incising?

A

Incising in same direction as muscle fibre

54
Q

What happens to the rectus muscles in lower segment C-section?

A

Not cut
Separated in opposite direction - moved towards nerve supply
Cut down linea alba

55
Q

What layers are opened in lower segment C-section?

A 
Skin and fascia
Anterior rectus sheath
Rectus abdominis
Fascia and peritoneum
Retract bladder
Uterine wall
Amniotic sac
56
Q

What layers need to be stitched closed in lower segment C-section?

A

Uterine wall with visceral preitoneum
Rectus sheath
Fascial layer if large BMI
Skin

57
Q

Why are lower segment C-sections better than large laparotomy?

A

Less risk of incisional hernias and dehiscence

58
Q

What layers are opened in laparotomy?

A

Skin and fascia
Linea alba
Peritoneum

59
Q

What layers are stitched closed in laparotomy?

A

Peritoneum and linea alba
Fascia if large BMI
Skin

60
Q

What must be avoided if a lateral port is to be inserted via laparoscopy?

A

Inferior epigastric artery

61
Q

Where does the inferior epigastric artery emerge?

A

Medial to deep inguinal ring

62
Q

Where is the deep inguinal ring?

A

Midway between ASIS and pubic tubercle

63
Q

In what direction does the inferior epigastric artery travel towards the rectus abdominis?

A

Superiomedial direction

64
Q

What occurs at Hesselbach’s triangle?

A

Site of direct inguinal (i.e. into abdominal wall) hernia

65
Q

Where is ureter in relation to uterine artery?

A

WATER UNDER BRIDGE

Ureter under/ inferior to artery

Reproduction and Sexual Health (18 decks)

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