Anterior Abdominal + Pelvic Region

Question 1

describe Camper’s fascia

Answer 1

• Males
  
  • loses most of its fat, fuses with Scarpa’s layer (deeper) to form Dartos fascia
• Females
  
  • retains the fat and forms part of labia major

Question 2

describe the external oblique (EO)

Answer 2

• action:
  
  • bilateral: anterior flexion of trunk
  • unilateral: lateral flexion, rotation
• innervation:
  
  • segmental nerves (T7-12)

Question 3

describe the inguinal ligament

Answer 3

• anterior superior iliac spine (ASIS) to pubic tubercle
• medial thickening = lacunar ligament

Question 4

name the anterior abdominal wall muscles

Answer 4

• rectus (straight) abdominis
  
  • longitudinal midline muscle with tendinous intersection
  • closely packed within the rectus sheath
  • action: flexion, tenses wall
  • innervation: segmental nerves (T7-12)
• pyramidalis
  
  • small triangular muscle anterior to rectus abdominis inferiorly
  • action: tenses the linea alba
  • innervation: T12

Question 5

describe the blood supply of anterior abdominal wall

Answer 5

• internal thoracic
  
  • superior epigastric
  • musculophrenic
• inferior epigastric
• superficial and deep circumflex iliac
• superficial epigastric

Question 6

describe Hesselbach’s triangle

Answer 6

• medial: lateral border of the rectus sheath with rectus abdominis
• inferior: inguinal ligament
• lateral: inferior eipgastric artery

inguinal hernias can occur here

Question 7

describe the abdominal incisions

Answer 7

• Median: at the linea alba, good for exploratory laparotomy; advantage is that no blood vessels cross the area, good suture repair
• Para-median: laterally to the linea alba
• Pfannenstiel: above the pubic symphysis (bikini line)
  
  • C-section
• Linea semilunaris: incision is made at the linea semilunaris
• Kocher: subcostal
  
  • for access to the gallbladder

Question 8

describe McBurney’s Point

Answer 8

• 2/3 the distance from the umbilicus to the anterior superior iliac spine (ASIS)
• location at the base of the cecum
  
  • origin of the appendix

Question 9

describe the inguinal region

Answer 9

• provides passage from the abdominal cavity to the lower limb and perineum
  
  • in males the pathway of the spermatic cord
• the testes develop intra-abdominally
  
  • descends into the scrotum by passing through the abdominal wall
  • creates the inguinal canal
  • spermatic cord is formed as the testes pass through the different layers, obtaining a portion of each

Question 10

describe the boundaries of the inguinal canal

Answer 10

• anterior wall: EO aponeurosis
• floor: inguinal ligament, lacunar ligament
• posterior wall: transversalis fascia
• roof: inferior edge of IO, TA and conjoint tendon

Question 11

name the spermatic cord layers and derivatives

Answer 11

• internal spermatic fascia: formed by transversalis fascia
• cremaster muscle: formed by IO muscle and aponeurosis
• external spermatic fascia: formed by EO aponeurosis
• Daros muscle: muscle layer that allows for puckering of skin
• tunica vaginalis: formed by parietal peritoneum

Question 12

describe a direct inguinal hernia

Answer 12

• pass medial to the inferior epigastric vessels and therefore only through the superficial ring
  
  • usually due to a strain, picking up a heavy object

Question 13

describe an indirect inguinal hernia

Answer 13

• passes through both the deep (lateral to the inferior epigastric vessels) and superficial ring
  
  • more commonly due to a patent processus vaginalis, congenital

Question 14

how to differentiate between an indirect inguinal hernia and a hydrocele

Answer 14

• hydrocele: collection of fluid in the tunica vaginalis
  
  • usually in infants
  • transillumination reveals that it’s just fluid
• indirect hernia: does not transilluminate