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Y3 Obs and Gynae Anatomy > Anatomy of Obs and Gynae Surgical Incisions > Flashcards

Anatomy of Obs and Gynae Surgical Incisions Flashcards

1
Q

List the two most common surgical incisions in O+G and their anatomical locations

A

Lower segment C-section (suprapubic, ‘bikini line’)

Laparoscopy (vertical midline incision)

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2
Q

Which anatomical lines are used to determine location of incision and layers incised?

A

Langer’s lines

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3
Q

List the layers of the anterolateral abdominal wall from superficial to deep

A 
Skin
Superficial fascia
External oblique
Internal oblique
Transverse abdominus
Rectus sheath
Rectus abdominus
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4
Q

What is the linea alba?

A

Midline blending of aponeuroses

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5
Q

What is an aponeurosis?

A

Flat sheet or ribbon of tendon-like material that anchors a muscle or connects it with the part that the muscle moves

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6
Q

List the attachments of external oblique

A

Lower ribs (5-11)
Iliac crest
Pubic tubercle
Linea alba

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7
Q

Describe the orientation of fibres of external oblique

A

‘Hands in pockets’

Same direction as external intercostals - inferomedial

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8
Q

List the attachments of internal oblique

A

Lower ribs (912)
Thoracolumbar fascia (posterior)
Iliac crest
Linea alba

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9
Q

Describe the orientation of fibres of internal oblique

A

‘Hands in chest’

Same direction as internal intercostals - inferolateral

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10
Q

List the attachments of transverse abdominus

A

Lower ribs
Thoracolumbar fascia
Iliac crest
Linea alba

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11
Q

Describe the orientation of fibres of transverse abdominus

A

‘Corset muscle’

Transverse!

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12
Q

What structures divide each rectus abdominus into 3 or 4 smaller muscles?

A

Tendinous intersections

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13
Q

What is the function of tendinous intersections?

A

Improve mechanical efficiency

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14
Q

List the attachments of rectus abdominus

A

Xiphoid process and costal cartilages

Pubic bones and pubic symphysis

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15
Q

What is the rectus sheath?

A

Deep to superficial fascia, strong fibrous layer surrounding rectus abdominus muscles

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16
Q

What is the clinical relevance of the rectus sheath?

A

Combined aponeuroses of anterolateral abdominal wall muscles

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17
Q

What is the arcuate line?

A

Horizontal line that demarcates the lower limit of the posterior layer of the rectus sheath

18
Q

When undertaking a suprapubic incision, both layers of rectus sheath will be present. True/ False?

A

False

Only anterior rectus sheath below the arcuate line

19
Q

List the layers of the internal surface of the abdominal wall, up to the anterolateral abdominal wall muscles

A

Transversalis fascia
Extraperitoneal fat
Parietal peritoneum

20
Q

List the spinal nerves that supply the abdominal wall from superior to inferior, and give their nerve roots

A

7th - 11th intercostal nerves
Subcostal (T12)
Iliohypogastric (L1)
Ilioinguinal (L1)

21
Q

What do the intercostal nerves become when they leave the thorax and enter the abdomen?

A

Thoracoabdominal nerves

22
Q

State the course of the nerves that supply the abdominal wall

A

Travel in plane between internal oblique and transverse abdominus

23
Q

Describe the blood supply to the anterior abdominal wall

A

Internal thoracic artery –> Superior epigastric arteries

External iliac artery –> Inferior epigastric arteries

24
Q

Describe the blood supply to the lateral abdominal wall

A

Posterior intercostal arteries –> Intercostal and subcostal arteries

25
Q

The blood supply to the anterior abdominal wall passes posterior to what muscle?

A

Rectus abdominus

26
Q

How does a surgeon minimise trauma to muscle fibres?

A

Incise in same direction as muscle fibre

27
Q

During a LSCS incision, muscles are cut. True/ False?

A

False

Rectus muscles are seperated in lateral direction, moving them towards nerve supply

28
Q

List the layers when opening, from superficial to deep, in a LSCS incision

A 
Skin + fascia
Anterior rectus sheath
Rectus abdominus
Transverse fascia + peritoneum
Retract bladder
Uterine wall
Amniotic sac
29
Q

List the layers to stitch closed, from deep to superficial, in a LSCS incision

A

Uterine wall with visceral peritoneum
Rectus sheath
Fascial layer if increased BMI
Skin

30
Q

List the layers when opening, from superficial to deep, in a laparotomy

A

Skin + fascia
Linea alba
Peritoneum

31
Q

List the layers to stitch closed, from from deep to superficial, in a laparotomy

A

Peritoneum + linea alba
Fascia if increased BMI
Skin

32
Q

What is the clinical consequence of limited bleeding in a midline incision?

A

Poor healing

Increased risk of wound complications (dehiscence, incisional hernia)

33
Q

List the possible sites for insertion of a laparoscopy port

A

Sub-umbilical (most common)

Lateral

34
Q

Which vessels are at risk if a lateral port is used in laparoscopy? Why?

A

Inferior epigastric arteries

Emerge medial to deep inguinal ring

35
Q

State the surface anatomy landmark used to identify the deep inguinal ring

A

Superior to the halfway point between ASIS and pubic tubercle

36
Q

What is Hesselbach’s triangle?

A

Space bounded by the lateral border of the rectus abdominis medially, the inguinal ligament inferiorly, and the inferior epigastric vessels laterally.

37
Q

How are the pelvic organs viewed in laparoscopy?

A

Position of uterus manipulated by grasping cervix with forceps

38
Q

List the different types of hysterectomy procedures

A

Abdominal

Vaginal

39
Q

Where is the incision made for an abdominal hysterectomy

A

Suprapubic or ‘bikini line’

Same as LSCS

40
Q

Which vessels are at risk during hysterectomy? How can they be differentiated?

A

Ureter and uterine artery
Ureter passes inferior to artery, ‘water under bridge’
Ureter often vermiculates when touched

Y3 Obs and Gynae Anatomy (7 decks)

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