Anterior Abdominal Wall and Inguinal region

Question 1

Rectus abdominis muscle is enclosed by an aponeurotic sheath, which is derived from the aponeuroses of which three muscles? [3]

Answer 1

Rectus abdominis muscle is enclosed by an aponeurotic sheath, which is derived from the aponeuroses of external oblique, internal oblique and transversus abdominis

Question 2

What is the difference in abdominal wall anatomy above and below the arcuate line?

Answer 2

Below arcuate line the abdo wall is weaker

Question 3

Which arteries supply the abdomen wall and which arteries are they derived from?

Answer 3

Internal thoracic artery becomes superior epigastric artery

External iliac artery runs superiorly and becomes inferior epigastric artery: Most substantial & clinically relevant

Lower intercostal and lumbar arteries run laterally across the abdominal wall

Question 4

Which two points does the inguinal ligament run between? [2]

Answer 4

ASIS to pubic tubercle

Question 5

Which structures are found within the spermatic cord? [4]

Answer 5

Testicular artery
Ductus/Vas deferens
Pampiniform venous plexus (testicular vein)
Genital branch of genitofemoral nerve
Ilioinguinal nerve (runs with cord)

Question 6

Surrounding the spermatic cord and testes are layers derived from which layers of the abdominal wall? [3]

Answer 6

External spermatic fascia
Cremaster muscle
Internal spermatic fascia

Question 7

Label A-G

Answer 7

Question 8

Which of the following is located outside of the external spermatic fascia

Vas deferens
Cremaster muscle
Genitofemoral nerve
Testicular vessels
Ilioinguinal nerve

Answer 8

Which of the following is located outside of the external spermatic fascia

Vas deferens
Cremaster muscle
Genitofemoral nerve
Testicular vessels
Ilioinguinal nerve

Question 9

At which point in the abdominal wall is the:

• Deep inguinal ring
• Superfical inguinal ring

Answer 9

• Deep inguinal ring: point at which the contents of the spermatic cord enter the abdominal wall.
• Superfical inguinal ring: point at which the spermatic cord emerges from the abdominal wall.

Question 10

Describe how the external oblique, internal oblique and transvesus abdominis surround the spermatic cord [3]

Answer 10

External oblique: : aponeurosis surrounds spermatic cord

Internal oblique: muscle fibres cover spermatic cord

Transversus abdominis: absent to spermatic cord structure

Question 11

Explain the journey of the testes through the inguinal canal

Answer 11

1. The testes develop on the **posterior abdominal wall **and descend through the inguinal canal to reach the scrotum, guided by the gubernaculum
2. As they descend, take venous and arterial supply, nerve supply and lymphatic drainage
3. The peritoneum sticks to the testes and creates the processus vaginalis
4. Goes through the transervalis fascia, which becomes the internal spermatic fascia
5. Takes muscular covering from internal oblique, which becomes the cremaster muscle
6. The external oblique becomes the external spermatic fascia
7. The processus vaginalis gets longer and longer until the top pinches off: get sac of peritoneum called tunica vaginalis

Question 12

Which structure is found at the mid point of inguinal ligament? [1]

Answer 12

Deep inguinal ring

Question 13

Label A-C [3]

Answer 13

A: Internal spermatic fascia
B: cremaster muscle
C: external spermatic fascia

Question 14

Label A-D [4]

Answer 14

A: transversalis fascia
B: transversalis abdominis
C: internal oblique
D: external oblique

Question 15

How does the round ligament of uterus develop?

Answer 15

Ovaries descent also guided by gubernaculum into pelvis.

Gubernaculum structure continues onto labia majoria. After maturation is called the round ligament of the uterus

Question 16

Which structure does a direct inguinal hernia pass through? [1]

Where does a direct hernia emerge? [1]

Which population is it common in? [1]

Answer 16

Which structure does a direct hernia pass through? [1]
Hesselbach’s triangle

Where does a direct hernia emerge? [1]
Superficial inguinal ring

Which population is it common in? [1]
Males over 40

Question 17

Where does a direct inguinal herniation occur in relation to the inferior epigastric vessels?

Answer 17

Medial to the inferior epigastric vessels

Question 18

Which structure does an indirect inguinal hernia pass through? [1]

Where does an indirect hernia emerge? [1]

Which population is it common in? [1]

Answer 18

Which structure does an indirect inguinal hernia pass through? [1]
Pass all the way along the inguinal canal

Where does an indirect hernia emerge? [1]
In the scrotum

Which population is it common in? [1]
Children

Question 19

Where does an indirect inguinal herniation occur in relation to the inferior epigastric vessels?

Answer 19

Where does an indirect inguinal herniation occur in relation to the inferior epigastric vessels?
Lateral

Question 20

If hernia develops lateral to EPV: direct/ indirect hernia?

If hernia develops medial to inferior epigastric vessels: direct / indirect hernia?

Answer 20

If hernia develops lateral to EPV: indirect hernia?

If hernia develops medial to inferior epigastric vessels: direct hernia

Question 21

Which structures make the border of Hasselbach’s trianglge? [3]

Answer 21

Question 22

Name 3 other types of hernias that exist other than inguinal hernias

Answer 22

Incisional: Following surgery to the abdomen the scar creates a weakness in the abdominal wall

Umbilical: Usually in babies, when the rectus abdominis is not fully joined in the midline

Femoral: Herniation into the femoral canal (beneath the inguinal ligament so below and lateral to pubic tubercle) most common in females