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CSF3 Exam 3 > Anterior abdominal wall and Hernia- Wilson > Flashcards

Anterior abdominal wall and Hernia- Wilson Flashcards

1
Q

Why is differential diagnosis in the abondmical cavity sometimes difficult?

A
  • there are lots of different organ systems in the abdominal cavity: GI, kidney, endocrine, urinary system
  • there are not a lot of landmarks
  • damage in one region of the abdominal cavity can be similar to damage in another region (appendicitis symptoms similar to endometriosis)
  • size and shape of the abdominal cavity is variable even within an individual during a certain period of time
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2
Q

Rigid muscles during physical abdominal examination can denote what?

A

-inflammation of some underlying structure as rigid muscles do protective guarding of the organs to prevent further damage

OR

if the physician touches the pt with cold hands; use warm hands to prevent involuntary muscular contraction

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3
Q

What is the difference between palpation, percussion, and auscultation?

A

palpation: feel, push the abdomen wall anteriorly and laterally
percussion: thumping the abdomen to listen for sounds of hollow or solid organs
auscultation: using stethoscope; abdomen is very noisy; lack of noise is pathological and is an emergency situation

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4
Q

How are the positions of GI or peritoneal organs in the abdominal cavity?

A

GI tract is constantly changing its position depending on the state of nutrition or how soon or late the individual ate or drank

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5
Q

What are examples of factors that contribute to the variability in size and shape of the abdomen?

A
  • pregnancy
  • obesity
  • weight loss
  • hernias
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6
Q

What dermatome is the umbilicus found in fat and thin individuals?

A

dermatome T10 in both fat and thin individuals

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7
Q

Which dermatome is the inguinal fold located?

A

L1

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8
Q

What is the landmark for the lymphatic drainage of the anterior abdominal wall?

A

umbilicus

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9
Q

The skin and lymphatic above the umbilicus will go to which nodes?

A

anterior axillary lymph nodes

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10
Q

The skin and lymphatic below the umbilicus will go to which nodes?

A

superficial inguinal lymph nodes

-the lower half of the anus is also drained here

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11
Q

What vertebral level is the umbilicus located?

A

L3, L4

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12
Q

What boundary divides the abdominal cavity into two?

A

linea alba

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13
Q

What boundary is between the muscles that form the anterior abdominal wall and those that form the anterolateral abdominal wall?

A

linea semilunaris

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14
Q

The intersection of what two boundaries is the neck of the gallbladder found?

A

subcostal margin and the linea semilunaris

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15
Q

What planes divide the abdomen into 4 quadrants?

A
  • transumbilical plane

- medial plane

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16
Q

What planes divide the abdomen into 9 regions?

A
  • midclavicular lines to the midinguinal point
  • subcostal plane
  • transtubercular plane
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17
Q

Of the nine abdominal regions, which ones are the most important and why?

A

The centrally located ones:

  • epigastrium
  • periumbilical
  • hypogastrium

Visceral pain arising from inflammation of a GI tract structure will be referred to the midline.

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18
Q

Which is the main organ found in the upper left quadrant of the abdomen?

A

stomach

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19
Q

Why is visceral pain arising from inflammation of a GI tract structure referred to the midline?

A

the GI tract originates embryologically as a midline structure

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20
Q

Sensory fibers from the stomach to the duodenum return to which spinal segments? Where is pain referred to?

A

T5, T6, T7

Pain is referred to the epigastrium.

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21
Q

Sensory fibers from the jejunum to the right colic flexure return to which spinal segments?

A

T8, T9, T10

Pain is referred to the umbilical region.

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22
Q

Sensory fibers from the transverse colon to the rectum return to which spinal segments?

A

T11, T12, L1

Pain is referred to the hypogastrium.

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23
Q

Inflammation in the upper half of the anus can produce pain where in the abdominal regions?

A

in the hypogastrium

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24
Q

Deep to the skin, the superficial fascia of the abdomen forms which two distinct layers? What are characteristics of each?

A

Camper’s fascia: fat (may be removed by liposuction)

Scarpa’s fascia: membranous, very little fat

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25
Q

Why is Scarpa’s fascia important clinically?

A

below the umbilicus you can anchor sutures in this scarpa fascia to close up abdominal surgeries; the fascia is strong enough and will keep the wound closed

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26
Q

The Scarpa’s fascia is continuous with what fascia in the perineum?

A
  • Dartos fascia surrounding the penis and scrotum
  • Colles’ fascia near anus

these are all the same fascia just differently named due to differing locations

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27
Q

In males you may have rupture of the penile urethra after trauma in the area. This liquid material may dissects its way along the course of the Scarpa’s fascia. The urine from a rupture penile urethra may extravasate into the what areas?

A
  • superficial perineal pouch
  • scrotum
  • penis
  • anterior abdominal wall to the umbilicus (where Scarpa’s fascia fuses with the rectus sheath)
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28
Q

Why does liquid from penile urethral rupture not travel to the thigh or anal region?

A

No liquids extravascate to thigh or anus because Scarpa’s fascia fuses with the fascia lata in the thigh and the perineum body

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29
Q

Before the evolution of lungs & the thorax, the muscles of the trunk of vertebrates was organized into 3 layers: external, internal and innermost. The 3 intercostal muscles will continue into the abdomen & form what 3 layers of abdominal oblique muscles?

A
  • external abdominal oblique
  • internal abdominal oblique
  • transverse abdominis
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30
Q

How do the 3 layers of abdominal oblique muscle run?

A
  • external abdominal oblique: runs inferomedially (hands into pocket)
  • internal abdominal oblique; runs superolaterally perpendicular to the external abd oblique m.
  • transverse abdominis: rune transversely
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31
Q

All three anterolateral abdominal muscle attach to what common tendon?

A

linea alba

32
Q

What is the vertically oriented muscle immediately behind the rectus sheath (anterior lamina)?

A

rectus abdominis: anterior abdominal wall

33
Q

What is the cause for the tendinous intersections in the rectus abdominis?

A

it is segmented due to origins from different somites; remain attached through tendinous division (nice 6 packs if you exercise)

34
Q

What is the arcuate line?

A

it is below the umbilicus that

35
Q

What is the most important landmark in the abdomen?

A

umbilicua

36
Q

Above the arcuate line, the fascia of the anterolateral abdominal muscles will go in what direction of the rectus abdominis to join the linea alba?

A
  • External abdominal fascia goes anterior the rectus abdominis to join linea alba
  • Internal abdominal fascia splits half go anterior and other half posterior of the rectus abdominis to joint linea alba
  • Transverse fascia goes posterior the rectus abdominis to join linea alba
37
Q

Below the arcuate line, the fascia of the anterolateral abdominal muscles will go in what direction of the rectus abdominis to join the linea alba?

A

All three muscle fascia will join together to go anterior of the rectus abdominis to join the linea alba

38
Q

What are the 9 layers of the anterior abdominal wall?

A
  • skin
  • Carpa’s fascia
  • Scarpa’s fascia
  • external abdominal oblique
  • internal abdominal oblique
  • transverse abdominis
  • endoabdominal fascia
  • subserous space
  • parietal peritoneum
39
Q

What is the clinical importance of the subserous space?

A

this fat-filled extraperitoneal space provides a surgical plane for accessing retroperitoneal organs without opening the peritoneal cavity. (space of Bogros)

40
Q

What is the innervation of the parietal peritoneum?

A

GSA somatic fibers from VPR

41
Q

Where does the VPR innervating the parietal peritoneum travel?

A

in between the transverse abdominis and internal abdominal oblique to terminate near the linea alba

42
Q

What is the parietal peritoneum?

A

Parietal peritoneum is a serous membrane that lines the body wall producing serous fluid

43
Q

What type of pain will be produced if the parietal peritoneum is traumatized or infected?

A

since it has somatic innervation the pain will be sharp (similar to cut to the finger)

44
Q

What are the 4 functions of the abdominal muscles?

A
  • Movements of the vertebral column
  • Valsalva maneuver involved in voiding (removing abdominal contents)
  • Breathing with accessory respiratory muscles
  • Protection and guarding of any organs in the abdominal cavity that are inflamed or injured
45
Q

What are the movements produced by the anterolateral abdominal wall?

A
  • rotation
  • lateral bending
  • flexion
46
Q

With common insertions into the linea alba, the external & internal abdominal obliques act like as a common digastric muscle. Explain.

A

The external oblique on one side is functionally continuous with the internal oblique on the other side.

It’s like a digastric muscle so when you rotate your body in one direction the external oblique will rotate the vertebral column contralaterally and the internal oblique muscle on the other side will rotate the vertebral column ipsilaterally.

47
Q

Contraction of abdominal muscles increases intra-abdominal pressure in the Valsalva maneuver
Necessary for voiding contents in what?

A
  • urination
  • defecation
  • vomiting
  • parturition (pushing baby through birth canal)
48
Q

The abdominal muscles are involved in forced expiration by fixing and/or__________ the ribs.

A

depressing

49
Q

Palpation of the abdomen can reveal muscle rigidity that occurs when muscles contract to __________deep structures that are inflamed or injured.

A

protect or “guard”

50
Q

Where is the McBurney’s point located and why is this area significant?

A
  • draw a line from the umbilicus to the the superior iliac spine
  • the distal third of that line is where the McBurney’s point is located
  • this is significant for location for incision to do an appendectomy (appendix)
51
Q

Muscle Fibers are Split, NOT Cut during abdominal surgery. Why?

A

cutting muscles fibers cause necrosis

52
Q

What are scenarios of the effect of cutting abdominal nerves and arteries?

A
  • paralysis of muscles distal to incision
  • bulging (and herniation) of the area of incision
  • necrosis
53
Q

The anastomosis running on and supplying the anterior of the abdominal wall is between what two arteries?

A

superior epigastric and inferior epigastric artery

54
Q

Incisions in the abdominal cavity should follow which cleavage lines? Why?

A

Langer lines: tension/wrinkle lines of the skin

  • although the subcutaneous CT is loose irregular tissue often time the collagen fibers have a predominant direction in they run called Langer lines
  • the scar will run parallel along the wrinkle diminishing visible surgical scars
  • if you cut across the Langer lines the wound itself with gape open but if you cut parallel the natural tendon of the skin, the incision will close properly
55
Q

An incision at McBurney’s point cuts a nerve as it passes through the oblique muscles. Which functional components are compromised?

A

???

56
Q

What is a hernia?

A

Protrusion of (a part of) an organ through a wall that normally contains it

57
Q

Where do the testes develop early in development?

A

upper abdomen

58
Q

The peritoneum herniates through the antero-lateral abdominal wall forming what?

A

process vaginalis

59
Q

The testis descend through the anterolateral abdominal wall to the scrotum forming what?

A

inguinal canal

60
Q

During development testis descend from an abdominal position to reach the scrotum. Why does it descend?

A

Has to do this to produce viable sperms as the temperature needs to be cooler than 98.6

61
Q

What are the two openings of the inguinal canal and what’s their importance?

A

deep inguinal ring (entrance): where the testes enter to go down the abdominal wall

superficial inguinal ring (exit): where the testes leave the abdominal wall to reach the scrotum

62
Q

What is the spermatic cord?

A

the cord-like structure in males formed by the vas deferens (ductus deferens) and surrounding tissue that runs from the deep inguinal ring down to each testicle. Its serosal covering, the tunica vaginalis, is an extension of the peritoneum that passes through the transversalis fascia

Contains the life support system to the testes; its like the umbilical cord to testes

Testicular artery and veins, nerve, and lymphatic and vas deferens duct that transports sperm from testes to the penis

63
Q

T/F. The inguinal canal passes through three abdominal muscles or their aponeuroses.

A

True

64
Q

The three muscles of the abdominal wall provide what three coverings to the testis and the spermatic cord?

A

1) external spermatic fascia: Is part of the aponeurosis of the external abdominal oblique
2) cremaster muscle: Are skeletal muscle fibers from the internal abdominal oblique; the lowest fibers get elongated and form a loop around the testes so these fibers can
3) internal spermatic fascia

65
Q

What is found lateral to the inferior epigastric artery?

A

deep inguinal ring: where the vas deferens, testicular vessels and lymphatic enter the inguinal canal

66
Q

What are the boundaries of the inguinal triangle?

A

inferior border: inguinal ligament

superolateral border: inferior epigastric artery

Medial border: rectus abdominis

67
Q

After descent of the testes through the anterior abdominal wall, the inguinal canal obliterates. However it may persist resulting in what?

A

inguinal hernia

68
Q

Failure for a testis to descend results?

A

sterility

69
Q

What is the importance of the inguinal triangle?

A

it is where a DIRECT inguinal hernia can form

70
Q

What is the most common type of inguinal hernia?

A

INDIRECT

71
Q

A direct inguinal hernia passes straight through the abdominal wall without traversing the inguinal canal.
The gut herniates directly though the inguinal triangle, _________ to the inferior epigastric artery.

A

medial

Pulse will be felt lateral to the finger as you push the herniated sac into and out of the abdominal wall for DIRECT inguinal hernia
????

72
Q

An indirect inguinal hernia traverses the abdominal wall by passing indirectly through the inguinal canal.
The gut herniates_______ to the inferior epigastric artery.

A

lateral

take finger and press on scrotum and if artery is medial to finger you have indirect inguinal hernia

73
Q

What are other types of hernia in the abdominal wall?

A
  • hernia of linea alba
  • umbilical hernia
  • incisional hernia
  • hernia of linea semilunaris
74
Q

The most inferior fibers of what muscle forms the cremaster muscle and the middle spermatic fascia?

A

internal abdominal oblique

75
Q

What is the cremaster muscle innervated by? What is its function? How can you test it?

A

innervated by genitofemoral nerve from L1 and L2

76
Q

What forms the internal spermatic fascia as the testis descends through the abdominal wall?

A
  • Transverse abdominis
  • pulls the testis up to regulate temperature and for protection
  • cremaster reflex: rub the internal thigh of a male and the testis should elevate if functioning properly

CSF3 Exam 3 (8 decks)

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