ANATOMY OF O&G SURGERY Flashcards
Give layers of abdominal wall from external to internal (anterior)
skin superficial fascia rectus sheath rectus abdominus rectus sheath
Give layers of abdominal wall from external to internal (lateral)
skin superficial fascia external oblique internal oblique transversus abdominus transversalis fascia extraperitoneal fat parietal peritoneum
Where do the external obliques attach?
Between the lower ribs and iliac crest, pubic tubercle and linea alba
What direction do the external obliques run in?
same direction as external intercostals (hands in pockets)
Where do the internal obliques attach?
Between the lower limbs, thoracolumbar fascia, iliac crest and linea alba
What direction do the internal obliques run in?
same direction as internal intercostals
Where does the transversus abdominus attach?
Between the lower ribs, thoracolumbar fascia, iliac crest and linea alba
What direction does transversus abdominus run?
horizontally
What is the linea alba?
midline blending of aponeurosis
Where does the linea alba span?
from the xiphoid process to the pubic symphysis
What do the tendinous intersections do to the rectus abdominus?
divide it into 3/4 smaller muscles to improve efficiency
What is the rectus sheath?
a combined aponeurosis of anterolateral abdominal wall muscles
Which layers does the iliolinguinal nerve run between?
internal oblique and transversus abdominus
Which muscle’s aponeurosis forms the inguinal ligament?
external oblique
Which nerves supply the anterolateral abdominal wall?
thoracoabdominal nerves (T12-L1)
Name the nerves supplying the anterolateral abdominal wall
subcostal (T12)
Iliohypogastric (L1)
Ilioinguinal (L1)
Path of thoracoabdominal wall nerves
7th-11th intercostal nerves become the thoracoabdominal nerves
enter laterally
Which vessels supply the anterior abdominal wall?
superior and inferior epigastric
Where do the anterior abdominal wall vessels lie?
posterior to rectus abdominus
What is
a) the superior epigastric artery a continuation of?
b) the inferior epigastric artery a branch of?
a) internal thoracic
b) external iliac
Which vessels supply the lateral abdominal wall?
the intercostal and subcostal arteries
What are the intercostal and subcostal arteries a continuation of?
posterior intercostal arteries
When incising a muscle which direction should you go?
same as muscle fibre
What is LCSC?
Lower segment Caesarean section
What happens to the rectus muscles in an LSCS incision?
they are not cut but separated from each other in a lateral direction
Which layers are opened in a LSCS?
skin and fascia anterior rectus sheath rectus abdominus fascia and peritoneum bladder retracted uterine wall amniotic sac
Which layers are stitched closed in a LSCS?
uterine wall with visceral peritoneum
rectus sheath
fascial layer if increased BMI
skin
What is the risk associated with a vertical midline incision in laparotomy?
it is relatively bloodless so wound healing may not be good and there is inc risk of complications eg, dehiscence, hernia
What layers are opened and closed in laparotomy?
skin and fascia
linea alba
peritoneum
What incisions are necessary in a laparoscopy?
a sub-umbilical incision +/- lateral ports
In a laparoscopy, what can the lateral ports damage?
inferior epigastric artery
Describe the path of the inferior epigastric artery
Emerges medial to the deep inguinal ring then passes in a superomedial direction
Where is the deep inguinal ring?
half way between ASIS and pubic tubercle
What are the two types of hysterectomy?
abdominal and vaginal
Which of the ureter and uterine artery is inferior?
ureter
water under the bridge
Layers cut during lower segment C section
Skin Superficial fascia Deep fascia Anterior rectus sheath Rectus abdominis muscle Transversalis fascia Extraperitoneal connective tissue Peritoneum Uterus
