Anterior abdominal wall and inguinal region

Question 1

What are the 9 regions of the abdomen divided by the mid-clavialar lines, transtubercular and subcostal planes?

Answer 1

1. RH = right hypochondriac
2. LH = left hypochondriac
3. RL = right lateral
4. LL = left lateral
5. RI = right inguinal
6. LI = left inguinal
7. ER = epigastric
8. UR = umbilical
9. HR = hypogastric

Question 2

What lines separate the abomen into quadrants?

Answer 2

the midsagittal and perpendicular plane at the umbilicus

Question 3

What are the two layers of superficial fascia for the abdomen?

Answer 3

1. CAMPER’s facia: outer, fatty layer

2. SCARPA’s fascia: deep fibrous or membranous layer

Question 4

Fill in the blanks for Camper’s fascia:

1. continuous with the superficial fascia of the _____, ___ and ___
2. Fuses with the deep layer before continuous into the ______
3. Clinically important in _______

Answer 4

a. Continuous with superficial fascia of thorax, thigh and perineum.
b. Fuses with deep layer before continuing into external genitalia.
c. Clinically important in closing abdominal incisions

Question 5

Fill in the blanks for Scarpa’s fascia:

1. Confined to the _____ wall.
2. Attaches to the deep fascia of the ____ just below the _____ ligament.
3. Fuses with the superficial layer in the scrotum forming the ______.
4. Forms ____ fascia in the perineum which attaches to the ______.

Answer 5

a.Confined to lower abdominal wall
b.Attaches to the deep fascia of the thigh (fascia lata) just below the inguinal ligament
c.Fuses with the superficial layer in the scrotum forming the dartos layer
(Dartos = Camper’s + Scarpa’s minus the fat plus smooth muscle).
d.Forms Colles’ fascia in the perineum (AKA the superficial perineal fascia), which attaches to the urogenital diaphragm.

Question 6

Three pairs of flat muscles in the anterior abdominal wall have aponeuroses that extend to the anterior midline where the fibers intersect to form what?

Answer 6

the linea alba

Question 7

What are the three pairs of flat anterolateral abdominal muscles?

Answer 7

1. external oblique
2. internal oblique
3. transverse abdominis

Question 8

What direction do the external oblique fibers go?

Answer 8

superolateral to inferomedial

Question 9

What direction do the internal oblique fibers go?

Answer 9

inferolateral to superomedial

Question 10

What direction do the transversus abdominis fibers go?

Answer 10

mostly transverse

Question 11

What is the fibrous arch forced by the fusion of the aponeuroses of the internal oblique and transversus abdominis muscles as they insert on the pectineal ligament?

Answer 11

the conjoint tendon or falx inguinalis

Question 12

What paris of strap muscles extend from the xiphoid process and adjacent costal carilages (ribs 5-7) down to the pubic crest. Aka…the anterior abdominal muscles…

Answer 12

rectus abdominus

Question 13

What is the rectus abdominis enclosed in?

Answer 13

the rectus sheath

Question 14

What is the rectus sheath composed of?

Answer 14

the anterior and posterior laminae of the aponeurotic portions of the oblique muscles

the anterior layer of the rectus sehath provides points of attachment (tendinous intersections) to the anterior layers of the rectus muscles)

Question 15

What is the arcuate line?

Answer 15

it’s the screscentic lower border of the posterior layer of the rectus sheath

Question 16

Above the arcuate line, the anterior layer is formed by aponeurosis of which muscles? How about below the arcuate line?

Answer 16

above: the internal and external obliques
below: all three - the internal and external obliques and the transverse abdominis

Question 17

THe transversalis fascia lines the entire abdominopelvic cavity and is separated from the peritoneum by a layer of what?

Answer 17

fat-filled extraperitoenal connective tissue

Question 18

The internal surface of the anterolateral abdominal wall has several anatomical folds or elevations of periteonum caused by underlying structures. What are the three inferior ot the umbilicus?

Answer 18

median umbilical fold
medial umbilical folds
lateral umbilical folds

Question 19

What does the median umbilical fold cover?

Answer 19

it covers the median umbilical ligament, which is a remnant of the urachus, an embryonic connection between the bladder and the umbilicus

Question 20

What does the medial umbilical fold cover?

Answer 20

the medial umbilical ligaments, which are the obliterated umbilical arteries

Question 21

What does the lateral umbilical fold cover?

Answer 21

the inferior epigastric vessels

Question 22

What are the main groups of nerves for the anterior abdominal wall?

Answer 22

intercostal nerves (T7-T11)
subcostal nerve (T12)
ilioinguinal and iliohypogastric nerves (branches of L1)

Question 23

What are the two general things these groups of nerves carry?

Answer 23

1. motor (somatic efferent) to the muscles of the anterior abdominal wall
2. sensory (somatic afferent) fibers from the skin and peritoneum

Question 24

What level supplies the skin around the umbilicus?

Answer 24

T10

Question 25

The nerves course between what two muscles?

Answer 25

internal obliques and transversus abdominis

Question 26

What terminal branch of the internal thoracic arter descends behind the rectus abdominis within the rectus sheath?

Answer 26

the superior epigastric artery

Question 27

What does the superior epigastric artery anatomos with?

Answer 27

with the inferior epigastric artery within the rectus abdominis?

Question 28

What is the inferior epigastric artery a branch of?

Answer 28

the external iliac artery - just above the inguinal ligament

Question 29

Does the inferior epigastric artery ascend in front of or behind the rectus muscle within the rectus sheath?

Answer 29

behind it

Question 30

What other arteries are involved in the anterior abdomen?

Answer 30

the lowe rtwo posteiror intercostal arteries and four lumbar arteries (off the abomdinal aorta)

Question 31

Describe an umbilical hernia?

Answer 31

usually a smally outpuching into the umbilical ring

Question 32

Who are umbilical hernias most common in and why>

Answer 32

newborns because he anterior abdominal wall is relatively weak

Question 33

What's the usually cause of umbilical hernias?

Answer 33

increased intra-abdominal pressure in the presence of incomplete closure of the anterior abdominal wall after ligation of the umbilical after birth

Question 34

Who gets acquired umbilical hernias?

Answer 34

women and obese people - or as the result of trauma or surgical incisions

Question 35

Where is an epigastric hernia/

Answer 35

in the epigastric region through the linea alba

Question 36

Where is a spigelian hernia located?

Answer 36

along the semiluar lines or arcuate line

Question 37

WHat's the risk factor for spigelian hernias?

Answer 37

obesity

Question 38

What hernis is the result of protrusion of omentum or an organ through a surgical incision?

Answer 38

incisional hernia - duh

Question 39

The inwardly curved lower border ord the external oblique aponeurosis is what?

Answer 39

the inguinal ligament

Question 40

THe inguinal ligament extends form where to where?

Answer 40

the anterior superior iliac spine down to the pubic tubercle

Question 41

What is the inguinal canal?

Answer 41

an oblique passage through the abdominal wall just above the inguinal ligament

Question 42

What forms the inguinal canal?

Answer 42

the processus vaginalis and the testes during development

Question 43

The gonads "descend" retroperitoneally along the posterior abdominal wall during what month of development?

Answer 43

7-8th month of development

Question 44

Descend follows what band of connective tissue?

Answer 44

the gubernaculum testes (which attaches to the inferior pole of the gonad and to the labioscrotal fold)

Question 45

As the testes descend they acquire covering from each of the abdominal layers. What does the fascia trasnversalis give rise to?

Answer 45

the internal spermatic fascia

Question 46

As the testes descend they acquire covering from each of the abdominal layers. What does the internal oblique muscle give rise to?

Answer 46

cremasteric fascia | cremasteric muscle

Question 47

As the testes descend they acquire covering from each of the abdominal layers. What does the external oblique muscle give rise to?

Answer 47

the external spermatic fascia

Question 48

In females, what does the inguinal canal contain?

Answer 48

the ilioinguinal nerve and the round ligament of the uterus (the female version of the gubernaculum)

Question 49

What does the found ligament of the uterus terminate in?

Answer 49

the labia majora

Question 50

In males, what does the inguinal canal contain?

Answer 50

the spermatic cord and the ilioinguinal nerve

Question 51

What are the two openings of the inguinal canal?

Answer 51

1. the deep inguinal ring (which is a normal defect in the fascia transversalis) 2. the superficial inguinal ring (triangular opening in the aponeurosis of the external oblique)

Question 52

What makes the anteiror boundary of the inguinal canal?

Answer 52

the aponeurosis of the external oblique (reinforeced laterally by fibers of the internal oblique)

Question 53

What makes the posterior boundary of the inguinal canal?

Answer 53

the fascia transversalis laterally and the conjoint tendon medially

Question 54

WHat makes the floor boundary of the inguinal canal?

Answer 54

the folled-under edge of the external oblique aponeurosis and the lateral crus of the superficial ring

Question 55

What makes the roof boundary of the inguinal canal?

Answer 55

the arching lowest fibers of the conjoint tendon

Question 56

What structures are in the spermatic cord?

Answer 56

1. ductus deferens 2. testicular artery 3. testicular vein 4. lymph vessels 5. remnants of the processus vaginalis 6. genital branch of genitofemoral nerve 7. autonomic nerve fibers traveling with arteries

Question 57

What are the two outer layers of the scrotum?

Answer 57

``` skin dartos muscle (continuous with sueprficial fascia of abdomen - replaces the fat of camper's fascia) ```

Question 58

What covers the anterior and lateral sides of the testis - a remnant of the processus vaginalis?

Answer 58

the tunica vaginalis

Question 59

What's the more dense connective tissue covering of the testis?

Answer 59

tunica albuginea

Question 60

What filles the lobules?

Answer 60

the seminiferous tubules

Question 61

What's the network of ductules drained by the efferent ductules?

Answer 61

the rete testis

Question 62

What collects sperm transmit to the ductus deferens?

Answer 62

epididymis

Question 63

What are the two types of inguinal hernias?

Answer 63

direct or indirect

Question 64

What is an indirect inguinal hernia?

Answer 64

occurs with a patent processus vaginalis where hernia stru ctures follow the route of testicular descent

Question 65

Who gets indirect inguinal hernias?

Answer 65

male children

Question 66

The neck of the hernia (where it exits) lies lateral to what in the deep inguinal ring?

Answer 66

the inferior epigastric vessels

Question 67

What are the two types of indirect inguinal hernias?

Answer 67

congenital (where bowel herniates into a patent processus vaginalis before or around birth) acquired (bowel herniates through deep ring, superficial ring or inguinal canal, pushing a pouch of peritoneum)

Question 68

What is a direct inguinal hernia?

Answer 68

when gut bulges through the psoterior abdominal wall of the inguinal canal in the region of the conjoiunt tendon

Question 69

Who usually gets direct inguinal hernias?

Answer 69

elderly males with weak abdominal muscles

Question 70

In a direct inguinal hernia the neck of the hernia lies ____ to the inferoir epigastric vessels?

Answer 70

medial | unlike indirects which is lateral

Question 71

What are the boundaries of the inguinal triangle (Hesselbach's triangle)?

Answer 71

inferior epigastric artery laterally rectus abdominis medially inguina ligament inferiorly

Question 72

So which hernia - direct or indirect - lies within the inguinal triangle?

Answer 72

a direct inguinal hernia passes medial to the inferior epigastric artery, so it's located within the triangle an indirect is lateral to the triangle

Question 73

Femoral hernias herniate through what?

Answer 73

the femoral canal below the inguinal ligament

Question 74

Who gets femoral hernias and why?

Answer 74

females because of their wider pelvis

Question 75

Femoral hernias are always found ___ to the pubic tubercle.

Answer 75

lateral to the pubic tubercle unlike inguinal which are always medial to the pubic tubercle.

Question 76

What is a vericocele?

Answer 76

when the pampiniform plexus of veins bcome dilated and tortuous, producing a varicocele (bag of worms)

Question 77

Which side do varicoceles usually occur?Why?

Answer 77

99% of the time on the left because of the angle at which the left testicular vein enters the left renal vein making it more susceptible to obstruction or reversal of flow

Question 78

What is a hydrocele?

Answer 78

excess fluid in a persistent processus vaginalis - may be associated with an indirect inguinal hernia

Question 79

What is secreting an abnormal amount of serous fluid in a hydrocele?

Answer 79

the visceral layer of the tunica vaginalis

Question 80

What physical exam technique do we use for detection of a hydrocele?

Answer 80

transillumination (transmission of light as a red glow in a dark room)