Anterior Abdominal Wall (Ach) - W1

Question 1

Camper’s fascia

Answer 1

• outer, fatty layer
• continuous with superficial fascia of thorax, thigh, and perinem
• continues into external genitalia

Question 2

Scarpa’s fascia

Answer 2

• deep, fibrous, membranous
• Fuses with superifical layer of scrotum to form dartos layer
• forms colle’s fascia in the perineum - attaches to urogenital diaphgram.
• attaches to deep fascia of the thigh.

Question 3

Where do the apopneurosis of the 3 sets of muscle fibers intersect?

Answer 3

linea alba

Question 4

What is the semilunar line

Answer 4

The location where the external oblique becomes tendinous.

Question 5

3 flat muscles of abdominal wall:

Answer 5

1. external oblique - superolateral to inferomedial fibers
2. internal oblique - inferolateral to superomedial fibers
3. transversus abdominis - mostly transverse fibers

Question 6

What forms the fibrous arch of the conjoint tendon?

Answer 6

• internal oblique and transverus abdominis fusion

Question 7

Pair of strap muscles on the anterior surface that extend from the xiphoid process and adjacent costal cartilages to pubic crest.

Answer 7

• rectus abdominis

Question 8

Describe the divisions of the arcuate line of the rectus sheath:

Answer 8

• above line: anterior layer is formed by aponeurosis of external and internal obliques
• Below line: anterior layer consists of all 3 aponeuroses

Question 9

Describe the transversalis fascia

Answer 9

• lines entire abdominopelvic cavity - below arcuate line
• forms posteiror layer of rectus sheath

Question 10

3 folds on the inernal surface of anterolateral bdominal wall - inferior to umbilicus:

Answer 10

1. median umbilical fold - covers remannt of urachus
2. mediAL umbilicial fold - covers umbilical arteries
3. lateral umbilical folds - cover inferior epigastric vessels

Question 11

What are the nerves of the abdominal wall that are motor to muscles, and sensory to skin and periotneum?

Answer 11

1. Intercostal nerve (T7-T11)
2. Subcostal nerve (T12)
3. Ilioinguinal and iliohypogastric nerves (branches of L1)

run between internal oblique and transversalis fascia.

Question 12

Describe the arteries of the abdomen and where they come from.

Answer 12

• Superior epigastric artery: descends behind rectus abdominus
  
  • comes off internal thoracic
• Inferior epigastric artery: ascends
  
  • comes off external iliac
• lower 2 intercostal arties
• 4 lumbar arteries
• veins correspond to arteries
• there are extensive anastomses

Question 13

Cause and common population affected by umbilical hernias

Answer 13

• common in newborns - weak anterior wall
• result form increased intra-abdominal pressure in presence of incompletel closure of anterior abdominal wall after ligation of umbilical cord after birth
• Acquired - can form in women and obese. May result from trauma, surgery.
  
  • FAT protrudes

Question 14

Common population, assocation, and location for epigastric hernias

Answer 14

• common with obesity
• occurs above belly button
• protrusion through linea alba

Question 15

Risk factor and location for spigelian hernias

Answer 15

• hernia of the semilunar line
• common in obese individuals

Question 16

Where does the inguinal ligament extend from and where is it found?

Answer 16

• ASIS to pubic tubercle
• found at lower border of external oblique aponeurosis

Question 17

What forms the inguinal canal

Answer 17

• processus vaginalis and testes during development

Question 18

Explain the descent of the tests

Answer 18

1. route follows gubernaculum testes
2. pouch of peritoneum that pushes through the deep inguinal ring - aka processus vaginalis
3. gonads descend retoperitoneally in 7th-8th month
4. it is not an active process - just related to growth

Question 19

What does the female inguinal canal contain? What is the equivalent of the gubernaculum?

Answer 19

• contains the ilioinguinal nerve
• round ligament of uterus –> terminates as labia majora

Question 20

What is found in the inguinal canal?

Answer 20

1. ilioinguinal nerve of L1
2. spermatic cord (male)
3. round ligament of uterus (female)

Question 21

Describe the boundaries of the inguinal canal

Answer 21

• Anterior = aponeurosis of external oblique
• Posterior = fascia transversalis laterally, conjoint tendon medially
• Floor = rolled under edge of external oblique aponeurosis
• Roof = low fibers of conjoint tendon

Question 22

What are the components of the spermatic cord?

Answer 22

• ductus deferens
• testicular artery
• testicular vein
• lymph vessels
• remants of processus vaginalis
• genital branch of genitofemoral nerve (supplies cremaster)
• ANS fibers

Question 23

What does the fascia transversalis form in the spermatic cord?

Answer 23

internal spermatic fascia

Question 24

What does the internal oblique become in the spermatic cord

Answer 24

cremaster muscle and fascia

Question 25

What does the external oblqiue muscle become in the spermatic cord?

Answer 25

External spermatic fascia

Question 26

Indirect hernia

Answer 26

• occurs in male children frequently
• hernia follows route of testicular descent - may have patent processus vaginalis
• same coverings as spermatic cord
• exits cavity lateral to inferior epigastric vessels (in deep inguinal ring)

Question 27

Congenital indirect hernia

Answer 27

• bowel herniates into patent processus vaginalis
• bowel herniates through deep inguinal ring, inguinal canal and superficial ring

Question 28

Direct hernia

Answer 28

• bulges through posterior abdominal wall in region of conjoint tendon
• occurs medial to epigastric vessels
• more common in elderly males w/weak abdominal muscles

Question 29

Femoral hernia

Answer 29

• more common in females - wider pelvis
• found lateral to pubic tubercle
  
  • inferior ​to inguinal ligament

Question 30

Describe the borders of the rectus shealth:

Answer 30

• anterior = pt of attachment (tendinous intersections)
• lower posterior = arcuate line
• above arcuate = IO and EO
• below arcuate line = all 3 aponeuroses in front