Anatomy Lecture 5 Abdominal Incisions

Question 1

Name 3 different common surgical incisions on the abdomen

Answer 1

Laparotomy
Laparoscopy
Suprapubic ‘bikini line’ incision

Question 2

What common operations are performed using a suprapubic ‘bikini line’ incision?

Answer 2

Lower segment caesarean section

Abdominal hysterectomy

Question 3

Name the layers cut through in a lower segment caesarean section

Answer 3

ddd

Question 4

What abdominal wall muscle attaches “between lower ribs and iliac crest, pubic tubercle and linea alba”?

Answer 4

External obliques

Question 5

What abdominal wall muscles attaches “between lower ribs, thoracolumbar fascia, iliac crest and linea alba”?

Answer 5

Internal obliques and transversus abdominis

Question 6

What direction to the fibres of the external obliques run?

Answer 6

Hands in pockets - same as external intercostals

Question 7

What direction to the fibres of the internal obliques run?

Answer 7

Hands on chest - same as internal intercostals

Question 8

What direction to the fibres of the transversus abdominis run?

Answer 8

Transverse direction

Question 9

What is the linea alba?

Answer 9

Midline blending of aponeuroses

Question 10

What is the superior attachments of the rectus abdominis?

Answer 10

Xiphoid process and costal cartilages

Question 11

What is the inferior attachments of the rectus abdominis?

Answer 11

Pubic bones - symphysis

Question 12

What is the name of the part of the rectus abdominis that divides each rectus abdominis into 3 or 4 smaller muscles?

Answer 12

Tendinous intersections

Question 13

What is the function of the tendinous intersections of the rectus abdominis?

Answer 13

Improved mechanical efficiency

Question 14

What does the linea alba run between?

Answer 14

Xiphoid process to the pubic symphysis

Question 15

The __________ is immediately deep to superficial fascia

Answer 15

rectus sheath

Question 16

What is the rectus sheath formed of?

Answer 16

combined aponeuroses of anterolateral abdominal wall muscles

Question 17

The rectus sheath surrounds the ______

Answer 17

rectus abdominis

Question 18

Following abdominal incisions, the rectus sheath should always be stitched closed. T or F

Answer 18

True

to increase the strength of the wound and reduce the risk of wound complications e.g. incisional hernia

Question 19

Name the 2 parts of the rectus sheath?

Answer 19

Anterior and posterior

Question 20

At the level of a suprapubic incision, what parts of the rectus sheath are cut?

Answer 20

Only anterior part

Question 21

At the level of a suprapubic incision, where is the anterior part of the rectus sheath in relation to the rectus abdominis?

Answer 21

Anterior

here formed of external oblique, internal oblique and transversus abdominis aponeurosis

Question 22

What layer of the abdominal wall is between the transversus abdominis and extra-peritoneal fat?
(deep to extra-peritoneal fat is parietal peritoneum)

Answer 22

Transversalis fascia

Question 23

The nerve supply to the anterolateral abdominal wall enters from a ______ direction

Answer 23

Lateral

Question 24

Nerve supply to the anterolateral abdominal wall: the __th to __th intercostal nerves become the ______ nerves

Answer 24

7th-11th

thoracoabdominal

Question 25

The nerves supplying the anterolateral abdominal wall travel between the ____ and ____ layers.

Answer 25

Internal oblique and transversus abdominis

Question 26

Name 3 named nerves, and their vertebral levels, that supply the anterolateral abdominal wall

Answer 26

Subcostal T12 Iliohypogastric L1 Ilioinguinal L1

Question 27

Name the 2 main arteries that supply the L and R anterior abdominal wall

Answer 27

Superior epigastric arteries | Inferior epigastric arteries

Question 28

What artery is the superior epigastric artery a continuation of?

Answer 28

Internal thoracic

Question 29

What artery is the inferior epigastric artery a branch of?

Answer 29

External iliac artery

Question 30

Where do the superior epigastric and inferior epigastric arteries lie in relation to the rectus abdominis?

Answer 30

Posterior

Question 31

What arteries supply the lateral abdominal wall?

Answer 31

Intercostal and subcostal arteries

Question 32

The intercostal and subcostal arteries are continuations of the ______ and emerge at the lateral aspect

Answer 32

posterior intercostal arteries

Question 33

When incising muscle, to minimise traumatic injury to muscle fibres, incise in the _____ direction as muscle fibre

Answer 33

same

Question 34

Name the layers cut through in a lower segment caesarean section

Answer 34

``` Skin Superficial fascia Anterior rectus sheath RECTUS ABDOMINIS SEPARATED NOT CUT Fascia Parietal peritoneum Visceral peritoneum Uterine wall Amniotic sac ```

Question 35

What cautions are made to prevent injury to the bladder during a LSCS?

Answer 35

Retrate bladder | Catheter inserted pre-op

Question 36

What layers should be stitched closed in a lower segment caesarean section?

Answer 36

Uterine wall Visceral peritoneum Rectus sheath Skin

Question 37

Name the layers cut through in a laparotomy | midline incision

Answer 37

Skin Fascia Linea alba Peritoneum

Question 38

What layers should be stitched closed in a laparotomy?

Answer 38

Peritoneum Linea alba Skin

Question 39

A laparotomy is relatively bloodless. T or F

Answer 39

True

Question 40

What complications are at an increased risk in laparotomy compared to suprapubic incisions?

Answer 40

Increases wound complications e.g. dehiscence, incisional hernia

Question 41

Where are the sites of laparoscopy?

Answer 41

Subimbilical +- lateral port

Question 42

What structure should you be careful of when inserting a lateral port laparoscopy?

Answer 42

Inferior epigastric artery

Question 43

What is the route of the inferior epigastric artery after branching off the external iliac?

Answer 43

Just medial to the deep inguinal ring Superomedial direction Posterior to rectus abdominis Anastomoses with superior epigastric

Question 44

What are the 2 approaches to hysterectomy

Answer 44

Abdominal and vaginal

Question 45

What structure must you be cautious of during a hysterectomy?

Answer 45

Differentiate the ureter from the uterine artery

Question 46

How do you differentiate the ureter from the uterine artery?

Answer 46

Ureter inferior to the artery (water under the bridge) | Ureter pulses when touches

Question 47

What is more medial to the bladder, the ureter or the uterine artery?

Answer 47

Ureter

Question 48

Where is the deep inguinal ring?

Answer 48

Halfway between ASIS and pubic tubercle