Anterior Abdominal and Inguinal - Acht

Question 1

Name the main features of the 2 layers of superficial abdominal fascia:

Answer 1

Fatty layer (camper’s) - outer, fatty layer - continuous with superficial fascia of thorax, thigh, perineum - continues into external genitalia Membranous Layer (scarpa’s) - confined to lower abdominal wall -attaches to deep fascia of thigh, below inguinal ligament -fuses with Camper’s layer in scrotum to form DARTOS layer

Question 2

label

Answer 2

Question 3

label

Answer 3

Question 4

label!

Answer 4

remember the semilunaris because the edge sort of curves in a moon shape

Question 5

A bleed from the perineum can enter which potential space?

Answer 5

potential space between scarpa’s and camper’s fasciae

Question 6

The extraperitoneal fat lies superficial to the peritoneum (serous membrane lining the abdominal cavity).

What is directly superficial to the extraperitoneal fat?

Answer 6

The transversalis fascia

(plate 317)

Question 7

What vessels do the superior and inferior epigastric vessels branch from?

Answer 7

Superior Epigastric Vessels = Branch of Internal Thoracic

Inferior Epigastric Vessels = Branch of External Iliac

Question 8

How does relationship between the rectus abdominus and the 3 layers of rectus sheath (external oblique aponeurosis, internal oblique aponeurosis, transverse abdominus aponeurosis) change from above to below the arcuate line?

Answer 8

Above the arcuate line:

Anterior layer is formed by aponeurosis of the external oblique and internal oblique

Below the arcuate line:

All three layers form anterior layer of rectus sheath

Transversalis fascia, extraperitoneal fat, and parietal peritoneum form posterior layer of rectus sheath

Question 9

What kind of hernia occurs through the linea alba in the epigastric region? (associted with obesity)

Answer 9

Epigastric hernia!

Question 10

Describe a spigelian hernia to me:

Answer 10

Hernia throguh the semilunar line

(common in obese individuals)

Question 11

What is it called when you get a hernia through the umbilicus? In what pts is it common?

Answer 11

Umbilical hernia: common in newborns and obese

Question 12

What determines the pathway for the normal descent of the testes?

Answer 12

The gubernaculum

(connective tissue attaching the inferior pole of tests to scrotum)

Question 13

As the teste descends, a portion of the peritoneum is pushed along into the scrotum as well. What is this tissue called during development? What is it called in the adult male?

Answer 13

Processus vaginalis

Is covers the adult teste as the tunica vaginalis.

Question 14

Identify the structures that make up the Inguinal or Hesselbach’s Triangle:

Answer 14

Borders:

Inguinal Ligament

Inferior Epigastric Vessels

Lateral border of rectus abdominus

Question 15

What is the innermost covering around the teste called?

Answer 15

Tunica albuginea

Question 16

Name of the structure connecting the vas deferens to the teste?

Answer 16

epididymis

Question 17

What are the names of the coily tubes filling the core of the testes?

Answer 17

Seminiferous tubules

Question 18

Explain the differences between an indirect and direct inguinal hernia:

Answer 18

Indirect hernias:

• Usually associated with a congenital patent processus vaginalis.
• The connection between the abdominal cavity and scrotum is open.
• The hernia follows the path taken by the testes as they “descended”:
  
  • deep ring, inguinal canal, superficial ring, scrotal sac

Direct Hernia

• Lies medial to the inferior epigastric vessels
• Usually acquired as result of increased intra-abdominal pressure pushing on the weak area, the inguinal triangle
• Hernial sac protrudes into the abdominal wall, but not into the scrotum.

Question 19

Patient arrives in ER with bag of worms appearance in the upper part of the scrotal area on one side.

Your attending asks you a few questions.

1) What is the name of this problem?
2) Which testicle is most likely being affected and why?
3) The patient and his wife have experienced fertility problems. Can you explain why?

Answer 19

1. Called a varicole
2. Most likely the left testicle is affected. The left panpiniform plexus veins drains into the renal vein first and then the inferior vena cava. The right panpinifrom plexus veins drain directly into the vena cava. Obstruction of the left renal vein can cause fluid stasis presenting as a tortuous mass on the surface of the scrotum.
3. Congested blood flow in the scrotum can raise the temperature around the testicle, this can decrease sperm production and fertility.

Question 20

What is it called when fluid filles within the tunica vaginalis potential space?

Answer 20

hydrocele

Question 21

What structure covers the remnant of the urachus?

Answer 21

median umbilical fold

Question 22

What adult structure covers the obliterated umbilical arteries?

Answer 22

The medial umbilical folds

Question 23

What do the lateral umbilical flds cover?

Answer 23

the inferior epigastric vessels

Question 24

Where does the hernial sac exit the abdominal cavity in a femoral hernia?

Answer 24

inferior to the linguinal ligament, within the femoral sheath

Question 25

What landmark marks the inferior border of the posterior leaflet of the rectus sheath?

Answer 25

Arcuate line

Question 26

Surgical approaches to the abdomen sometimes require a midline incision through what structure?

Answer 26

Semilunar line

Question 27

Which of the following structures passes through the deep inguinal ring?

Answer 27

Round ligament of the uterus

Question 28

A patient arrives in the ED with a palpable hernia at the superficial ring. Is this a direct inguinal hernia?

Answer 28

Insufficient information to make a diagnosis.
Ya that’s a little tricky, but just think back to what is the actual difference between the two :)

Question 29

Developmentally, what gives rise to the cremasteric muscle and fascia?

Answer 29

As the teste descends it takes with it part of the internal oblique muscle, which eventually gives rise to both of these structures