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GI Week 1 > Anterior abdominal wall and inguinal region > Flashcards

Anterior abdominal wall and inguinal region Flashcards

1
Q

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

A
  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
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2
Q

What lines separate the abomen into quadrants?

A

the midsagittal and perpendicular plane at the umbilicus

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3
Q

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

A
  1. CAMPER’s facia: outer, fatty layer

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

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4
Q

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 _______
A

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

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5
Q

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 ______.
A

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.

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6
Q

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?

A

the linea alba

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7
Q

What are the three pairs of flat anterolateral abdominal muscles?

A
  1. external oblique
  2. internal oblique
  3. transverse abdominis
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8
Q

What direction do the external oblique fibers go?

A

superolateral to inferomedial

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9
Q

What direction do the internal oblique fibers go?

A

inferolateral to superomedial

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10
Q

What direction do the transversus abdominis fibers go?

A

mostly transverse

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11
Q

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?

A

the conjoint tendon or falx inguinalis

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12
Q

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…

A

rectus abdominus

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13
Q

What is the rectus abdominis enclosed in?

A

the rectus sheath

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14
Q

What is the rectus sheath composed of?

A

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)

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15
Q

What is the arcuate line?

A

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

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16
Q

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

A

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

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17
Q

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

A

fat-filled extraperitoenal connective tissue

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18
Q

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?

A

median umbilical fold
medial umbilical folds
lateral umbilical folds

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19
Q

What does the median umbilical fold cover?

A

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

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20
Q

What does the medial umbilical fold cover?

A

the medial umbilical ligaments, which are the obliterated umbilical arteries

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21
Q

What does the lateral umbilical fold cover?

A

the inferior epigastric vessels

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22
Q

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

A 
intercostal nerves (T7-T11)
subcostal nerve (T12)
ilioinguinal and iliohypogastric nerves (branches of L1)
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23
Q

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

A
  1. motor (somatic efferent) to the muscles of the anterior abdominal wall
  2. sensory (somatic afferent) fibers from the skin and peritoneum
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24
Q

What level supplies the skin around the umbilicus?

A

T10

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25
Q

The nerves course between what two muscles?

A

internal obliques and transversus abdominis

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26
Q

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

A

the superior epigastric artery

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27
Q

What does the superior epigastric artery anatomos with?

A

with the inferior epigastric artery within the rectus abdominis?

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28
Q

What is the inferior epigastric artery a branch of?

A

the external iliac artery - just above the inguinal ligament

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29
Q

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

A

behind it

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30
Q

What other arteries are involved in the anterior abdomen?

A

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

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31
Q

Describe an umbilical hernia?

A

usually a smally outpuching into the umbilical ring

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32
Q

Who are umbilical hernias most common in and why>

A

newborns because he anterior abdominal wall is relatively weak

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33
Q

What’s the usually cause of umbilical hernias?

A

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

34
Q

Who gets acquired umbilical hernias?

A

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

35
Q

Where is an epigastric hernia/

A

in the epigastric region through the linea alba

36
Q

Where is a spigelian hernia located?

A

along the semiluar lines or arcuate line

37
Q

WHat’s the risk factor for spigelian hernias?

A

obesity

38
Q

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

A

incisional hernia - duh

39
Q

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

A

the inguinal ligament

40
Q

THe inguinal ligament extends form where to where?

A

the anterior superior iliac spine down to the pubic tubercle

41
Q

What is the inguinal canal?

A

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

42
Q

What forms the inguinal canal?

A

the processus vaginalis and the testes during development

43
Q

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

A

7-8th month of development

44
Q

Descend follows what band of connective tissue?

A

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

45
Q

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

A

the internal spermatic fascia

46
Q

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

A

cremasteric fascia

cremasteric muscle

47
Q

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

A

the external spermatic fascia

48
Q

In females, what does the inguinal canal contain?

A

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

49
Q

What does the found ligament of the uterus terminate in?

A

the labia majora

50
Q

In males, what does the inguinal canal contain?

A

the spermatic cord and the ilioinguinal nerve

51
Q

What are the two openings of the inguinal canal?

A
  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)
52
Q

What makes the anteiror boundary of the inguinal canal?

A

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

53
Q

What makes the posterior boundary of the inguinal canal?

A

the fascia transversalis laterally and the conjoint tendon medially

54
Q

WHat makes the floor boundary of the inguinal canal?

A

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

55
Q

What makes the roof boundary of the inguinal canal?

A

the arching lowest fibers of the conjoint tendon

56
Q

What structures are in the spermatic cord?

A
  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
57
Q

What are the two outer layers of the scrotum?

A 
skin
dartos muscle (continuous with sueprficial fascia of abdomen - replaces the fat of camper's fascia)
58
Q

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

A

the tunica vaginalis

59
Q

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

A

tunica albuginea

60
Q

What filles the lobules?

A

the seminiferous tubules

61
Q

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

A

the rete testis

62
Q

What collects sperm transmit to the ductus deferens?

A

epididymis

63
Q

What are the two types of inguinal hernias?

A

direct or indirect

64
Q

What is an indirect inguinal hernia?

A

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

65
Q

Who gets indirect inguinal hernias?

A

male children

66
Q

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

A

the inferior epigastric vessels

67
Q

What are the two types of indirect inguinal hernias?

A

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)

68
Q

What is a direct inguinal hernia?

A

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

69
Q

Who usually gets direct inguinal hernias?

A

elderly males with weak abdominal muscles

70
Q

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

A

medial

unlike indirects which is lateral

71
Q

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

A

inferior epigastric artery laterally
rectus abdominis medially
inguina ligament inferiorly

72
Q

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

A

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

73
Q

Femoral hernias herniate through what?

A

the femoral canal below the inguinal ligament

74
Q

Who gets femoral hernias and why?

A

females because of their wider pelvis

75
Q

Femoral hernias are always found ___ to the pubic tubercle.

A

lateral to the pubic tubercle

unlike inguinal which are always medial to the pubic tubercle.

76
Q

What is a vericocele?

A

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

77
Q

Which side do varicoceles usually occur?Why?

A

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

78
Q

What is a hydrocele?

A

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

79
Q

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

A

the visceral layer of the tunica vaginalis

80
Q

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

A

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

GI Week 1 (13 decks)

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