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Obs and Gynae > Anatomy of Surgical Incisions > Flashcards

Anatomy of Surgical Incisions Flashcards

1
Q

What does LSCS stand for?

A

Lower segment caesarean section

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2
Q

Label these incisions

A
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3
Q

What are the layers of the anterolateral abdominal wall?

A

skin

superficial fascia

rectus sheath

rectus abdominis (anterior)

external oblique, internal oblique, transversus abdominis (anterolateral)

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4
Q

What is the linea alba?

A

midline blending of aponeuroses

runs from the xiphoid process to the pubic symphysis

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5
Q

What direction do the fibres of the external and internal obliques run in?

A

The same direction as the external and internal intercostals

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6
Q

What seperates each rectus abdominis?

A

tendinous intersections

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7
Q

Where is the rectus sheath?

A

immediately deep to superficial fascia

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8
Q

What is the rectus sheath?

A

combined aponeuroses of anterolateral abdominal wall muscles

strong fibrous layer

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9
Q

What does the rectus sheath surround?

A

rectus abdominis muscles

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10
Q

What is incised anteriorly in a suprapubic incision?

A

rectus sheath

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11
Q

What incision is used for an LSCS?

A

suprapubic

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12
Q

What is the nerve supply to the anterolateral abdominal wall?

A

7th-11th intercostal nerves - become thoracoabdominal nerves

T12 - subcostal

L1 - iliohypogastric and ilioinguinal

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13
Q

What blood vessels supply the anterior abdominal wall?

A

superior and inferior epigastric arteries

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14
Q

What is the inferior epigastric artery a branch of?

A

external iliac artery

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15
Q

Where do the superior and inferior epigastric arteries anatomose?

A

roughly at the umbilicus

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16
Q

In relation to the deep inguinal ring, where is the inferior epigastric artery?

A

just medial to it

17
Q

What is the superior epigastric artery a continuation of?

A

the internal thoracic artery

18
Q

In relation to rectus abdominis, where do the inferior and superior epigastric arteries lie?

A

posterior

19
Q

What is the blood supply to the lateral abdominal wall?

A

intercostal and subcostal arteries

20
Q

Label these arteries.

A
21
Q

What are the intercostal and subcostal arteries continuations of?

A

posterior intercostal arteries

22
Q

When incising muscle, what direction do you go in?

A

to minimise traumatic injury to muscle fibres, incise in the same direction as the muscle fibre

23
Q

What happens to the rectus muscles in an LSCS?

A

they are seperated from each other in a lateral direction (NOT CUT)

with fingers - want to go with natural lines of weakness

24
Q

What procedures are performed to protect the bladder in an LSCS?

A

uterovesical fold deflected down to keep bladder away from where you are cutting

25
Q

What increases the chances of wound complications in a midline incision?

A

its relatively bloodless which means healing is not as good

26
Q

What must be avoided when inserting a lateral port?

A

the inferior epigastric artery

27
Q

How can the inferior epigastric artery be avoided?

A
  • emerges just medial to the deep inguinal ring (halfway between ASIS and pubic tubercle)
  • passes superomedially posterior to the rectus abdominis
  • a few inches either side of umbilicus

avoid these areas

28
Q

How can you tell between the ureter and uterine artery during a hysterectomy?

A

ureter passes inferior to artery

ureter often ‘vermiculates’ when touched (like a worm)

29
Q

What are the layers that you have to go through in an LCSC?

A

skin

superficial fascia

deep fascia

anterior rectus sheath

rectus abdominus

transversalis fascia

extra peritoneal connective tissue

peritoneum

uterus

30
Q
A
31
Q

Which artery is most likely to be the cause of bleeding during an insertion of a lateral port, during female laparascopic sterilisation?

A

inferior epigastric

32
Q

Which artery is most likely to be the source of bleeding in an incision of a Bartholin’s abscess?

A

internal pudendal

33
Q

Which artery is most liklely to be the source of bleeding in a dissection of the lower end of the ureter?

A

uterine artery

‘water under the bridge’ - ureter passes under uterine artery

Obs and Gynae (27 decks)

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