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COM-GI > Anterior abdominal wall > Flashcards

Anterior abdominal wall Flashcards

1
Q

Make up of linea terminalis

Border between what?

A

Pectin pubis, arcuate line, sacral promontory

True (below) and false (above) pelvis

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2
Q

Vertical defining lines of abdomen

A

Linea alba - center

Linea semilunaris (lateral borders of rectus abdominis on each side)

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3
Q

Subcostal plane

A

10th costal cartilage

Superior border of L3

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4
Q

Transtubercular plane

A

Tubercles of iliac crests

L5

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5
Q

Transumbilical plane

A

L3-L4

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6
Q

Transpyloric line

A

T12-L1

1/2 way between suprasternal notch and pubic symphysis

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7
Q

Midclavicular plane

A

Through middle of clavicle down to middle of inguinal ligament

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8
Q

Midsagittal plane

A

Down linea alba from xiphoid to pubic symphysis

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9
Q

Planes used to make abdominal quadrants

A

Transumbilical

Median sagittal

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10
Q

Organs in RUQ

A

GB, duodenum, R. pleura, R lobe of liver, R kidney

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11
Q

Organs in LUQ

A

Spleen, stomach, left pleura, tail of pancreas, L kidney

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12
Q

What are the R and L pleura in the RUQ and LUQ?

Border what?

Clinical significance?

A

Lies over liver

Space between L and R = costodiaphragmatic recess

A stab wound to the liver could also collapse a lung

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13
Q

Organs in RLQ

A

R ureter, cecum, ileal diverticulum, ascending colon, appendix

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14
Q

Organs in LLQ

A

L ureter, descending colon

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15
Q

Lines that make up the 9 regions

A

Midclavicular (x2)

Subcostal (L3 sup. border)

Transtubercular (L5 body)

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16
Q

Names of top 3 regions

A

R and L hypochondriac

Epigastric

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17
Q

Names of middle 3 regions

A

R and L lumbar/lateral

Umbilical

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18
Q

Names of lower 3 regions

A

R and L inguinal/iliac

Hypogastric/pubic

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19
Q

functions of anterolateral superficial abdominal muscles

A

Flex, rotate, side-bend trunk

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20
Q

A good longitudinal incision to avoid any major vessels or nerves, but undergo necrosis after incision is what?

A

Median/midline incision (linea alba)

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21
Q

A longitudinal incision made just lateral to the linea alba is called what?

A

Paramedian incision

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22
Q

Generally when making incisions in the anterior abdominal wall, how should cuts be made in relation to the muscles?

A

Parallel to the muscle fibers

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23
Q

About how far is McBurney’s Point from the ASIS?

A

2.5 cm superomedially towards the umbilicus (1/3 of the way)

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24
Q

What nerve must be found and preserved when cutting at McBurney’s Point?

A

Iliohypogastric n.

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25
Q

Which incision is used for a C-section and other OB/GYN procedures?

Which nerves must be found and saved here?

A

Suprapubic (just above hairline)

Iliohypogastric and Ilioinguinal

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26
Q

Is rectus abdominis m. transected along tendinous intersections?

Why or why not?

A

NO

Cutaneous nerves and branches of superior epigastric vessels pierce through those

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27
Q

How are the gallblader, bile ducts, and spleen reached surgically?

What nerves must be avoided here?

A

Subcostal incisions

7th and 8th thoracic spinal nerves

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28
Q

What forms the linea alba?

A

Fusion of R and L abdominal aponeuroses, especially external abdominal oblique

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29
Q

At which point does external abdominal oblique m. become aponeurotic?

A

Midclavicular line

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30
Q

What forms the inguinal ligament?

From where to where?

What opening is right above it?

A

Lower border of external abdominal oblique aponeurosis

Pubic tubercle to ASIS

Superficial inguinal ring

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31
Q

Clinical relevance of edges of superficial inguinal ring?

Names?

A

Strong and suture-able

Medial crus, lateral crus, intercrural fibers

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32
Q

2 ligaments of importance below the inguinal ligament

A

Lacunar ligament

Pectineal ligament

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33
Q

Lacunar ligament

Shape?
Borders?

A

Extension of inguinal ligament inferomedial to femoral canal

Triangular

Apex = pubic tubercle
Base = empty space w/ lymph (of femoral canal region)
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34
Q

Pectineal ligament

Clinical significance

A

Extension laterally from the apex of the lacunal ligament

Can constrict a femoral hernia

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35
Q

Muscle that borders lateral edge of femoral canal

A

Iliopsoas

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36
Q

What muscle surrounds the spermatic cord?

What is it an extension of?

A

Cremaster m.

Internal abdominal oblique m.

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37
Q

What is formed inferiorly by the aponeuroses of IAO m. and TA m.?

Clinical significance?

A

Conjoint tendon

Protects weak part in abdominal wall, helps prevent direct inguinal hernias

38
Q

Purpose of tendinous intersections in rectus abdominis m.?

A

Shorter muscle fibers = stronger force of contraction

39
Q

Rectus abdominis m. is enclosed in what?

A

Rectus sheath

40
Q

Muscle that functions to tense the linea alba

A

Pyramidalis m.

41
Q

The anterior abdominal wall muscles also aid in what visceral-initiated actions?

How? (3)

A

Respiration, coughing, sneezing, urination, defecation, vomiting

Pushes up on diaphragm for breathing
Pushes in on abdominal contents for coughing, etc.
Pushes down on pelvic diaphragm for urination, etc.

42
Q

2 layers of superficial fascia in the abdominal wall:

Fatty layer just deep to the skin in the abdomen

Membranous layer just deep to ^^^

A

Camper’s fascia/fat

Scarpa’s fascia

43
Q

Camper’s fascia is continuous with what?

A

Superficial fatty layers in the thigh

44
Q

Scarpa’s fascia is continuous with what?

Also continuous over what pelvic stuff?

A

Fascia lata and deep perineal fascia

Pubic bone, scrotum, penis

45
Q

What is deep perineal fascia?

Continuous with what?

A

Fascia over genitalia

Scarpa’s fascia

46
Q

Function of deep fascial layers around muscles

A

Allow muscles to move past each other w/o much friction

47
Q

Where can fluid sometimes leak within the fascial layers of the abdomen?

Stopped by what?

A

Between Scarpa’s fascia and the deep fascia of the EAO m. - superficial to the inguinal ligament

Scarpa’s fascia as it wraps around under spermatic cord and over pubic bone

48
Q

Where do the layerings of the rectus sheath change?

How?

A

Arcuate line of the rectus sheath

Above: 3-4 fascial layers on each side of rectus abdominis

Below: All 6 layers in front of rectus abdominis, only transversalis fascia behind it

49
Q

Superficial arterial system of the anterior abdomen runs in where?

Includes what arteries?

A

Superficial (Camper’s) fascia

Superficial circumflex iliac a.
Superior epigastric a.
External pudendal a.

50
Q

Artery that runs laterally along costal margin

Arteries that run along anterior side of rectus abdominis

Artery that runs parallel to inguinal ligament DEEP to it from femoral a.

A

Musculophrenic

Sup/Inf. epigastrics

Deep circumflex iliac a.

51
Q

Artery that runs parallel to inguinal ligament SUPERFICIAL to it from femoral a.

Artery that runs up abdominal wall from femoral a.

A

Superficial circumflex iliac a. (both)

52
Q

Deep venous drainage of anterolateral abdominal wall drain into what veins?

Contained where?

A

Subclavian vv.
External iliac vv.
Lumbar and intercostal vv.

W/in abdominal wall muscles w/ arteries

53
Q

Superficial abdominal wall venous drainage is contained where?

Use what veins?

Clinical relevance?

A

W/in camper’s fascia

Thoracoepigastric vv.
Superficial epigastric v.

Femoral –> axillary bypass mechanism if necessary

54
Q

Sensory dermatomes of:

Xiphoid
Umbilicus
Inguinal fold

A

T7

T10

L1

55
Q

Intercostal mm. innervated by what spinal nerves?

Subcostal m. innervated by what spinal n.?

Lumbar muscles innervated by what spinal n.?

A

T7-11

T12

L1-4

56
Q

Nerves that supply the skin, muscles, and parietal peritoneum of ant. abd. wall

A

Cutaneous branches of ventral rami

57
Q

Nerve roots of Iliohypogastric n.

Runs where?

A

T12/L1

Btwn QL and Psoas m. –> between ant. wall muscles –> cutaneous in hypogastric region

58
Q

Nerve root of ilioinguinal n.

Runs where?

A

L1

Enters inguinal canal from between ant. wall muscles –> superficial inguinal ring –> groin, thigh, scrotum/labia

59
Q

Nerve roots of genitofemoral n.

Runs where?

A

L1-2

Pierces psoas major –> deep inguinal ring (genital branch) OR below inguinal ligament to cutaneous femoral triangle (femoral branch)

60
Q

Superficial lymphatic drainage to what 2 lymph node sets?

A

Up from umbilicus –> ant. axillary sternal nodes

Down from umbilicus –> superficial inguinal nodes

61
Q

Deep lymphatic drainage goes to what lymph nodes?

A

Along post. intercostal aa. and lumbar vessels to deep abdominal nodes

62
Q

Lymph from testes/scrotum drains to where?

A

Deep abdominal nodes (part of deep drainage system)

63
Q

Cause of infant’s umbilical hernia

Cure?

A

Umbilical scar doesn’t heal

Heals on its own

64
Q

.
Cause of adult umbilical hernia

Most often where exactly, and in what gender?

Cure?

A

Weak abdominal muscles around umbilicus + increased abdominal pressure

Superior to umbilicus (more in women)

Surgical repair

65
Q

Hernia type more common in men

Cause?

A

Epigastric hernia

Increased intra-abdominal pressure

66
Q

Spigelian hernia

A

Hernia through linea semilunaris, below the arcuate line

67
Q

3 structures that form the inguinal canal

A

EAO aponeurosis

IAO muscle

TA muscle

68
Q

Clinical significance of “turn your head and cough”

A

IAO and TA muscles can contract and push down on inguinal canal contents, causing herniation through the canal

69
Q

Floor of inguinal canal

Roof

Anterior to it

Posterior to it

A

Inguinal and lacunar ligaments

IAO muscle

EAO muscle

Transversalis fascia + conjoint tendon

70
Q

Inguinal canal contents must pierce through ___ at the deep inguinal ring

A

Transversalis fascia

71
Q

What vessels become the femoral a. and v.?

Where?

Important branches from them?

A

External iliac aa. and vv.

Past the inguinal ligament

Inferior epigastric, cremasteric

72
Q

Testes start at what vertebral level? Where?

Why is this significant?

A

L1, retroperitoneal

Blood supply and lymph come to/from L1 level, NOT lower down

73
Q

Testes are pulled down via what?

Name of peritoneal pouch that encases them as they pull through the peritoneum

A

Gubernaculum

Processus vaginalis

74
Q

At what time are the testes at the deep inguinal ring?

At what time are they pulled through the inguinal canal?

A

7 mo.

9 mo.

75
Q

Cryptorchidism

Clinical significance?

A

Undescended testes

High risk of testicular cancer due to higher temperatures inside the body

76
Q

Hydroceles

Cause?

A

Fluid build-up in tunica vaginalis

The peritoneum it originated from has cells that make fluid

77
Q

Hematocele

A

Blood between tunica vaginalis and testicle

78
Q

4 fascial layers around testes and spermatic cord (w/ origins)

A

Internal spermatic fascia (transversalis fascia)

Cremaster m./fascia (IAO)

External spermatic fascia (EAO)

Tunica vaginalis (peritoneum)

79
Q

Which muscle or fascia from anterior abdominal wall does NOT contribute to the spermatic cord or testes?

Why?

A

Transversus abdominis

Too high up, does not border the start of these structures

80
Q

The gubernaculum is attached inferiorly to what?

A

Labiosacral fold

81
Q

Why don’t ovaries descend down all the way like testes do?

A

Get caught on developing uterus

82
Q

What can cause pain in the labia?

A

Pulling of gubernaculum remnant since ovaries get caught on uterus

83
Q

.

Instead of the spermatic cord, what is contained in the inguinal canal of a female?

A

Round ligament of the uterus

84
Q

3 layers of scrotal wall

A

Skin
Dartos fascia
Dartos m.

85
Q

The line on the external side of the scrotum between the 2 testes is called what?

Associated with what?

A

Scrotal raphe

Scrotal septum (inside)

86
Q

What forms the inner layers of the scrotum and the septum?

A

Fundiform ligament

87
Q

How does the tunica vaginalis cover the testis?

A

Covers ONLY one half (not posterior side)

88
Q

How does sperm get from testis to epididymis?

A

Through efferent ductules

89
Q

Direct vs. indirect inguinal hernias are distinguished based on which side of ___ they protrude through

Always superior to what?

A

Inferior epigastric vessels

Inguinal ligament

90
Q

Direct inguinal hernia protrudes through what?

More common in whom?

A

Hesselbach’s triangle (weak conjoint tendon)

Older males

91
Q

What is hesselbach’s triangle?

A

Space between inguinal ligament, lateral border of rectus abdominis, and inferior epigastric vessels

92
Q

Indirect inguinal hernias protrude through what?

Common cause?

A

Deep and superficial inguinal rings

Incomplete closure of processus vaginalis as it’s pinched off when testis descends through canal

COM-GI (9 decks)

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