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Block 3: Anatomy & Embryo > Ant Abdominal wall & Inguinal region > Flashcards

Ant Abdominal wall & Inguinal region Flashcards

1
Q

What organs are in the upper left quadrant?

A

stomach, spleen

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2
Q

Which quadrant is the appendix in? What else is in that quadrant?

A

Lower right. Also contains right inguinal canal.

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3
Q

What is the superior border of the abdomen? be specific.

Inferior border?

A

Thoracic diaphragm, which extends to the 4th intercostal space on the right side and the 5th intercostal space on the left side.
Inferior border is pelvic inlet (tilts forward), which is a space surrounded by the pelvic brim.

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4
Q

Lines of pleural reflection anteriorly, midclavicular, midaxillary, and vertebral lines

A

ribs 6, 8, 10, 12

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5
Q

What makes up the pelvic brim?

A
  1. The ala, body, and promontory of the sacrum
  2. Arcuate line of ileum
  3. Part of pecten of pubis (oblique ridge joining arcuate with pubic tubercle)
  4. Pubic crest
  5. Pubic symphysis.
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6
Q

What is the false pelvis, and what are its borders?

A

Actually a part of the abdomen. extends from iliac crests to pelvic inlet

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7
Q

Iliac fossa is part of what area?

A

Abdomen.

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8
Q

What are all the layers of the anterolateral wall, superficial to deep?

A
  1. Skin
  2. Camper’s fatty layer
  3. Scarpa’s fascia
  4. external oblique m
  5. internal oblique m
  6. transversus abdominis m
  7. Transversalis fascia
  8. Extraperitoneal fat/space
  9. peritoneum
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9
Q

What two venous systems interconnect in the camper’s layer? What do they radiate around?

A

Thoracoepigastric v and superficial epigastric v. Radiate around the umbilicus.

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10
Q

Go through the thoracoepigastric v pathway back to the heart

A
  1. Thoracoepigastric v. drains into axillary v.
  2. Axillary v. drains into subclavian v
  3. subclavian v. drains into brachiocephalic v.
  4. Brachiocephalic v. drains into SVC
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11
Q

Pathway of superficial epigastric v. back to heart

A
  1. Superficial epigastric v. drains into great saphenous v.
  2. Great saphenous v. drains into femoral v.
  3. Femoral v. drains into external iliac v.
  4. External iliac v. drains into common iliac v.
  5. Common iliac v. drains into IVC.
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12
Q

What 5 things could cause distention of the superficial epigastric vv and thoracoepigastric vv?

A 
liver disease
right sided heart failure 
portal v obstruction
IVC obstruction
SVC obstruction
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13
Q

What is caput medusae?

A

Distension of veins radiating from umbilicus region, specifically the superficial epigastric and thoracoepigastric vv.

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14
Q

External oblique m origin and insertion? Action?

fiber direction?

A

Hands in pocket direction.
O: inferior 1/2 of ribs
I: linea alba and iliac crest
A: Flexes trunk, rotates trunk, compresses/supports abdominal viscera.

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15
Q

What makes the inguinal ligament?

A

External oblique m. aponeurosis folding back.

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16
Q

Internal oblique m origin and insertion? Action?

Fiber direction?

A

O: Thoracodorsal fascia on lower medial back
I: Linea alba (and lower ribs)
A: Flexes trunk, rotates trunk, compresses/supports abdominal viscera (same as external, but opposite direction of rotation)
Fibers run perpendicular to external oblique when above iliac crest, and parallel when below iliac crest.

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17
Q

Transversus abdominis m. origin and insertion? Action?

A

O: Inferior half of ribs, thoracodorsal fascia, and iliac crest
I: Linea alba
A: compress/support abdominal viscera

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18
Q

Two major causes of low back pain?

A

Obesity and weak abdominal mm.

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19
Q

Tetraplegia/quadriplegia also cause paralysis of what mm? Nerves?
Increases risk of?

A

Trunk mm, and diaphragm.
Intercostal T1-T11 nn
abdominal T7-L1 nn!!!
Causes poor cough, increasing risk of lung infection/aspiration

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20
Q

Transversalis fascia is part of what other fascia? Where is that other fascia?

A

Part of endoabdominal fascia, which separates the abdominal mm from the next layer (extraperitoneal fat/space)

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21
Q

What nerve roots are sensory/motor to anterolateral abdominal wall? Break those down further.

A

T7-L1
T7-T11 are called thoracoabdominal nn
T12- becomes subcostal n
L1 branches into iliohypogastric n and ilioinguinal n.

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22
Q

Between what structures are the iliohypogastric and iliinguinal nn located?

A

Between external and internal oblique mm.

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23
Q

Rectus abdominis is on the _______ abdominal wall.

A

anteromedial

24
Q

Rectus abdominis medial and lateral borders? superior and inferior?
action?

A

medial is the linea alba.
Lateral is the linea semilunaris
Superior is infrasternal angle, and inferior is the pubis
Flexes lumbar region

25
Q

Rectus abdominis m. is surrounded by what?

A

anterior and posterior rectus sheath

26
Q

when the posterior rectus sheath ends, what fascia is seen inferior to it? Where does it end?

A

Ends at the Arcuate Line (inferior to umbilicus). Inferior to this you can see the transversalis fascia.

27
Q

Innervation of the rectus sheath?

A

T7-T12 nn

thoracoabdominal nn and subcostal n

28
Q

Lymphatic drainage above and below rectus sheath?

A

Above umbilicus: To parasternal/axillary nodes

Below umbilicus: T o horizontal superficial inguinal nodes.

29
Q

Where should the needle be placed for a nerve block of the anterior abdominal wall?

A

Between the rectus abdominis m. and the posterior rectus sheath.

30
Q

What blood vessels are in the rectus sheath? What are they branches of?

A

Superior epigastric a/v, which are terminal brr of the internal thoracic a/v.
Inferior epigastric a/v, which are brr of the external iliac a/v

31
Q

The anastomosis of the superior and inferior epigastric vv provide an alternative route when what is blocked?
What would be the pathway?

A

When IVC or SVC are blocked.
Inferior epigastric v. to superior epigastric v.
superior epigas. v. to internal thoracic v.
internal thoracic v. to subclavian v.
subclavian v. to brachiocephalic v to superior vena cava
RUNS IN EITHER DIRECTION.

32
Q

Upper 2/3 of rectus sheath made from? (anterior and posterior)

A

Anterior portion made from:
External oblique aponeurosis
Anterior 1/2 of internal oblique aponeurosis

Posterior portion:
Posterior 1/2 of internal oblique aponeurosis
transversus abdominis aponeurosis

33
Q

Lower 1/3 of rectus sheath made from? (ant and post)

A

Anterior:
Fusion of the aponeuroses of the internal/external obliques, and the transversus abdominis oblique aponeurosis

Posterior:
Posterior layer ends at arcuate line.

34
Q

Inguinal ligament attachments

A

ASIS and pubic tubercle

35
Q

The space deep to the inguinal ligament is called?

What happens in this space?

A

Subinguinal space.

External iliac a/v travel here and name becomes femoral a/v

36
Q

Spermatic cord is within?

A

the inguinal canal

37
Q

What is the lateral crus of the inguinal lig?

A

Closest part of it to the pubic tubercle.

38
Q

Inguinal canal contains

A

ilioinguinal n, spermatic cord in males or round ligament in females.

39
Q

Ilioinguinal n. branches after exiting the inguinal canal and becomes?

A

Anterior scrotal/labial n, which are sensory to the anterior scrotum/anterior labia majora.

40
Q

Deep and superficial inguinal rings connect what? Defects in what?

A

Deep inguinal ring connects inguinal canal to abdominal cavity, and is a defect in the transversalis fascia.
Superficial inguinal ring connects inguinal canal w/superficial fascia, and is a defect in the external oblique aponeurosis.

41
Q

Borders of Inguinal Triangle of Hesselbach?

Why is this significant?

A

Inferior: inguinal lig
Lateral: inferior epigastric a.
medial: semilunar line (lateral border of rectus abdominis m)

  • Direct inguinal hernias go through this
42
Q

Superficial and deep inguinal rings location to Inguinal triangle?

A

Deep ring is lateral to it

Superficial ring is in it.

43
Q

Superficial ring is surrounded by?

A

Medial (superior) crus- external oblique aponeurosis attachment to pubic crest
Lateral (inferior) crus- continuation of inguinal ligament to pubic tubercle.
Intercrural fibers- external oblique apon.

44
Q

Posterior wall of superficial ring is made of what in a small percentage of people? risk factor for?

A 
Conjoint tendon (inguinal falx)
Risk factor for direct inguinal hernia.
45
Q

Borders of inguinal canal?

A

Ant: Ext. oblique apo
Post: Transversalis fascia
floor: inguinal lig
roof: Int. oblique and transversus abdominis fibers.

46
Q

Lacunar and pectineal ligaments in relation to the inguinal ligament?
Importance?

A

Lacunar lig. is a posteromedial reflection of the inguinal lig.
Pectineal lig. is a posterolateral reflection of the lacunar lig, and rides on the pectin of the pubis. Continues POSTERIOR to external iliac a/v
It is also a SUTURE POINT FOR HERNIA REPAIRS.

47
Q

What is an inguinal hernia? Significance?

A

SI comes through superficial inguinal ring. Can descend into scrotum. Not painful. Most common surgical procedure.

48
Q

Indirect inguinal hernia is where? How common? Type of hernia?

A

Lateral to inguinal ring, and enters inguinal canal indirectly through the deep inguinal ring.
Most common groin hernia. ‘above’ inguinal lig.

49
Q

Where is a direct inguinal hernia? How does it enter the canal?

A

Inside Inguinal triangle. directly enters inguinal canal via defect, such as the conjoint tendon. ‘above’ inguinal ligament.

50
Q

Femoral hernia leaves abdomen how? Commonality?

A

Via femoral ring opening in femoral canal. More common in women. Below inguinal ligament.

51
Q

Where/what is the iliopubic tract? attachments? Why is it important in hernia repair?

A

Thickening of transversalis fascia. Posterior to inguinal ligament, paralleling it. Also goes from ASIS to pubic tubercle.
You can’t see inguinal ligament from inside ant. abdominal wall, but you can see the iliopubic tract deep to the peritoneum.

52
Q

all inguinal hernias will be _____ to inguinal ligament.

A

anterior

53
Q

All femoral hernias will be ____ to inguinal lig

A

posterior

54
Q

What is the triangle of doom?

A

Contains external iliac a/v, and genital br. of genitofemoral n.
In between vas deferens and testicular a/v.
If these are damaged in hernia repair, poor outcome/death.

55
Q

Gray’s: The pain from an indirect hernia is due to compression of what nerve?

A

Ilioinguinal nerve

56
Q

Gray’s: What nodes receive lymph drainage from stomach?

A

Celiac

57
Q

Gray’s: What general area drains lymph to the lumbar nodes?

A

Structures inferior to the stomach

Block 3: Anatomy & Embryo (8 decks)

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