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Mid Sem 1 Vis Systems > Anterior Abdominal Wall and Inguinal Region > Flashcards

Anterior Abdominal Wall and Inguinal Region Flashcards

1
Q

When the skeletal muscles of the abdomen contract, what happens to the intra-abdominal pressure?

A

It increases. Assisting in evacuation processes such as urination, defecation and child birth.

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2
Q

What are the anterior abdominal wall layers from superficial to deep?

A
  1. Skin
  2. Superficial fascia fatty layer(CAMPER’S FASCIA)
  3. Superficial fascia membranous layer (SCARPA’s FASCIA)
  4. External oblique
  5. Internal oblique
  6. Transversus abdominus
  7. Transversalis fascia
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3
Q

What are the names of peritoneum and what is it called when it reflects?

A

Parietal and Visceral peritoneum.

Parietal reflects off the wall and forms a double layered membrane called ‘mesentery’.

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4
Q

What anchors the abdominal muscles?

A

Costal margin

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5
Q

How does the top layer (External oblique) attach to the costal margin?

A

It attaches to the costal margin slightly and attaches to anterior aspect of the lower part of thoracic cage.

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6
Q

How does the middle layer ( internal oblique) attach to the costal margin?

A

It attaches edge-to-edge with the costal margin.

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7
Q

How does the deepest layer (Transversus Abdominus) attach to the costal margin?

A

It underlaps the costal margin slightly and is continuous with the muscular diaphragm.

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8
Q

Where are the 3 layers of muscle fleshy and aponeurotic?

A

Fleshy - Laterally

Aponeurotic - medially

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9
Q

What is the vertical line called, where the muscles interdigitate with the same muscle? (i.e their other half)

A

Linea Alba

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10
Q

How is ‘free inferior edge’ of the external oblique formed?

A

Inferior attachment of EO is to the anterior 2/3s of the iliac crest, as far as the ASIS and then jumps and attaches to the pubic tubercle and pubic crest. Middle part is free and therefore say that EO has a ‘free inferior edge’.

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11
Q

What is the ‘free inferior edge’ of the external oblique?

A

Free inferior edge of EO is thickened and rolls inwards and is officially called the inguinal ligament.

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12
Q

What is the inguinal ligament?

A

Free inferior edge of EO, extending from the ASIS to the pubic tubercle (the part with no attachment).

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13
Q

How are the external oblique fibres directed?

A

Similar to external intercostal muscles, fibres are directed antero- inferiorly i.e. front pocket muscles.

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14
Q

How are the internal oblique fibres directed?

A

Fibres run in the same direction as internal intercostal and innermost intercostal muscles – directed posteroinferiorly i.e. ‘back pocket’

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15
Q

How are the internal oblique superior fibres attached?

A

Superiorly attaches edge- to- edge to the costal margin.

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16
Q

How are the internal oblique medial fibres attached?

A

Medially attaches to the linea alba in the midline, where it meets the opposite IO muscle and inter-digitates in this white line.

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17
Q

How are the internal oblique posterior fibres attached?

A

Posteriorly stretch as far as thoracolumbar fasia.

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18
Q

How are the internal oblique inferior fibres attached?

A

Inferiorly, the anterior 2/3rds of iliac crest and the lowermost fibres actually attach to/ arise from the lateral 2/3rds of the inguinal ligament (medial 1/3rd does not attach to the IO).

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19
Q

Why do the 3 layers have their own fibre direction?

A

Gives you maximum strength when contracting anterior abdominal wall.

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20
Q

How are the transversus abdominus superior fibres attached?

A

Superiorly underlaps the costal margin and is continuous with the muscular diaphragm.

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21
Q

How are the transversus abdominus medial fibres attached?

A

Medially- one transversus abdominus muscle inter-digitates with another transversus abdominus muscle at the linea alba.

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22
Q

How are the transversus abdominus posterior fibres attached?

A

Posteriorly goes around laterally as far as the thoracolumbar fascia.

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23
Q

How are the transversus abdominus inferior fibres attached?

A

Inferiorly- the lowermost fibres attach to the anterior 2/3rds of the iliac crest just like the other two (all anchor here) but the lowermost fibres of transversus abdominus continue beyond attachment to iliac crest and ASIS continue in their origin from the lateral 1/3 part of the inguinal ligament. These fibres arch to insert into pubic crest via conjoined tendon.

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24
Q

How are the rectus abdominus fibres directed?

A

They are divergent. Ascend from their origin at the body and crest of the pubis, they become wider. i.e VERY LONG

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25
Q

What are the attachments of the rectus abdominus?

A

Overlapping the front of the rib cage and inserting into costal cartilages 5, 6, and 7 and is edge-to-edge with pec major.

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26
Q

What is the vertical ascent of the rectus abdominus muscle disrupted by?

A

3-4 Tendinous intersections.

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27
Q

What do the tendinous intersections create?

A

6- pack muscles with shorter fibres, which is a much more powerful arrangement than less, longer fibres.

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28
Q

Where are the 3 tendinous intersections?

A

1) Level of the umbilicus,

2) Level of the xiphisternum 3) Half- way between.

29
Q

All three abdominal muscles (EO, IO and TA) meet at the midline. How do these muscles get past the rectus abdominus to insert into the line alba?

A

They create a rectus sheath.

30
Q

Where does the posterior rectus sheath stop abruptly?

A

Roughly half-way bw the umbilicus and the pubic crest, in a slight arch called the arcuate line.

31
Q

What is the arcuate line?

A

Where posterior rectus sheath because suddenly all three aponeuroses (EO, IO and TA) pass in front of transversus abdominus from that point downwards.

32
Q

How do the three aponeurosis relate to the rectus abdominus in their path to the linea alba? i.e how are the rectus sheath’s created?

A
  • IO splits and sends anterior leaf in front and posterior leaf goes behind muscle belly.
  • EO goes in front (along with anterior leaf from IO) =Forms the anterior rectus sheath.
  • TA goes behind (along with posterior leaf from IO) =Forms the posterior rectus sheath.
33
Q

How does the whole arrangement of the rectus sheath change?

A

All three aponeuroses pass in front of rectus abdominus and only an anterior rectus sheath exists

34
Q

Where does the whole arrangement of the rectus sheath change?

A

At a point at 1⁄2 way bw the umbilicus and the pubic crest

35
Q

What is the segmental innervation to muscles of anterior abdominal wall muscles?

A

Ventral rami of T6- L1.

36
Q

What are the markers for the ventral rami innervation?

A

T10 is umbilicus and L1 is groin. By definition, T11 and 12 is bw umbilicus and groin whilst T7,8 and 9 are above umbilicus.

37
Q

What terminal branches does the internal thoracic divide into?

A

1) Musculophrenic

2) Superiorepigastric

38
Q

Where does the superioepigastric artery run and what does it supply?

A

Superior epigastric artery runs down deep to rectus abdominus in the rectus sheath, supplying the muscles of the anterior abdominal wall.

39
Q

Where do the superior and inferior epigastric arteries meet, and what happens when they do?

A

Within the posterior compartment of rectus sheath.
They anastomose deep to rectus abdominus, providing the major arterial supply to the muscles of the anterior abdominal wall.

40
Q

The external iliac artery gives branch to which artery that supplies the anterior abdominal wall?

A

Inferior epigastric artery

41
Q

Where does the SUPERFICIAL epigastric artery arise from, and how is it different to the other epigastric arteries?

A

Arises from the femoral artery, running over the structures of the anterior abdominal wall in the superficial fascia, towards the umbilicus.
It differs in that, it is not in rectus sheath and not part of anastomosis at all.

42
Q

Structures associated with the abdomen can drain into which systems?

A

Caval system (into the IVC) or the portal system (into the portal vein).

43
Q

What area is important in portal hypertension + give example of such a site?

A

Where there is an area of overlap and the structures can drain either into the portal system or the caval system.
Anterior abdominal wall is one of these sites of overlap/ anastomoses bw the portal system and the caval system.

44
Q

The inguinal region is defined as the transition zone between?

A

Lower abdomen and upper thigh

45
Q

What is the lacunar ligament?

A

Inward extension from the inguinal ligament at its medial end, onto the pectineal line of the pubic

46
Q

What is the pectineal ligament?

A

From the lacunar ligament, there is a small linear extension of the inguinal ligament along the pectineal line

47
Q

Where do the gonads develop?

A

Extraperitoneal fat layer in the superior lumbar region of the posterior abdominal wall

48
Q

What is the foetal passage way for the testes?

A

Testes migrate to the scrotum via a passageway through the anterior abdominal wall called the inguinal canal. By the 12th week of development, testes have migrated to pelvis and by the 28th week, they are close to the deep ring (entry point to the inguinal canal). Takes three days for them to travers the inguinal canal before they get down to the scrotum.
- In its descent, has to pass through the structures of the anterior abdominal wall

49
Q

What are the superficial and deep rings?

A

Superficial ring: medial opening in external oblique aponeurosis Deep ring: deficiency (“outpouching”) in fascia transversalis

50
Q

What is the inguinal canal?

A

Slit-like passage extending downwards and medially above and parallel to medial half of inguinal ligament

51
Q

What is the floor of inguinal canal?

A

Inguinal Ligament

52
Q

What is the roof of the inguinal canal?

A

Arching fibres of internal oblique and transversus abdominus

53
Q

What is the anterior wall of the inguinal canal?

A

Anterior Wall: external oblique aponeurosis, internal oblique muscle(lat)

54
Q

What is the posterior wall of the inguinal canal?

A

Posterior Wall: transversalis fascia, conjoint tendon (med)

55
Q

What is the actual passage way of the testes?

A
  • Testes has to get from extraperitoneal fat down into the scrotum. Skin and superficial fascia of the anterior abdominal wall is obviously continuous with that of the testes and scrotum so testes do not have to go through these layers. It does have to get through the fascia transversalis and the three layers of muscle (TA, IO and EO) to go down into scrotum.
  • Passage that testes takes through those structures (bw the extraperitoneal fat where it develops and skin and superficial fascia it comes to lie against) is called the inguinal canal.
  • Testes develops in extraperitoneal fat so the FIRST layer it needs to get through to lie just beneath the skin and superficial fascia is FASCIA TRANSVERSALIS. Testes punches through and creates an invagination/ deficiency in the fascia transversalis half-way bw the ASIS and pubic tubercle i.e. half-way along the inguinal ligament marking the entry point of the inguinal canal and this is called the deep ring/ internal ring. =Thus when testes has entered the deep ring of the inguinal canal, it has already pierced the transversalis fascia.
  • SECOND: Then has to get through the transversus abdominus and internal oblique- so it passes underneath the arching fibres of these muscles (lowermost fibres arise from lateral part of the inguinal ligament and arch upwards, over and downwards to insert into the pubic crest via conjoined tendon). Thus arching fibres go over the top of the testes to form the roof of the inguinal canal, allowing the testes and spermatic cord to pass beneath them with inguinal ligament forming the floor of this canal.
  • THIRD: All that is left for the testes to travel through is the external oblique muscle. There is a triangular slit-like deficiency called the superficial/ external ring in the external oblique where it attaches to the pubic crest, through which the testes and spermatic cord have to travel to exit the inguinal canal and enter the scrotum.
56
Q

What happens to the spermatic cord structures as the testes descend?

A
  • As the testes descend, they bring with them the spermatic cord structures after them which include the duct of the testes (vas deferens) and neurovascular structures associated with the testes (testicular arteries, veins and lymphatics and nerves).
57
Q

Where are the structures of the testes single, and where are they ensheathed?

A

=At the level of the extraperitoneal fat, before the structures have entered the inguinal canal via the deep ring these structures of the testes are singular and distinguished from one another. After they enter the inguinal canal via deep inguinal ring, they are no longer individual but are collectively ensheathed.

58
Q

Spermatic cord takes a covering around it with each structure it passes through such that it has three coverings around it. What are these 3 layers?

A

(1) As the spermatic cord pierces the fascia transversalis, it is ensheathed in the first layer of fascia termed the internal spermatic fascia. (2) Second layer of wrapping around the spermatic cord comes from the arching fibres of the transversus abdominus and internal oblique called the cremaster fascia. There are some muscle fibres associated with it, derived from the arching fibres of the internal oblique muscle called the cremaster muscle.
(3) Third and final layer of wrapping is derived from the external oblique as the structures exits the inguinal canal via the superficial ring called the external spermatic fascia. Technically, the spermatic cord is only completed as it exits the inguinal canal and acquires its third and outer layer of covering.

59
Q

Why do the testes need to leave the abdominal environment, and what allows them to have this passage?

A

Inguinal canal allows for a passageway for the testes for testes to get out of abdominal cavity (where it is far too warm for sperm production) and into the scrotum for a cooler environment.

60
Q

What is a hernia?

A

Abnormal protrusion of abdominal contents through the abdominal wall.

61
Q

Why do we have hernias in the abdomen?

A

Since the inguinal canal creates a passageway from the abdominal cavity into the scrotum, this generates potential points of weakness through abdominal wall and therefore the development of hernia’s.

62
Q

How do hernia’s arise?

A

Each time we push the diaphragm down , bring pelvic floor up and contract anterior abdominal wall muscles, we dramatically increase intra-abdominal pressure for defecation, urination and child birth. If there is a point of weakness in the abdominal wall and we are consistently raising intra-abdominal pressure, there is potential for protrusion of abdominal contents through these points

63
Q

What is an inguinal hernia?

A

Defined as protrusion of abdominal contents through the deep ring in the inguinal canal.

64
Q

What is the passage for the abdominal contents?

A
  • Abdo contents go through the deep ring half-way through the ASIS and the pubic tubercle, a finger’s breadth above the inguinal ligament, turned downwards and medially for roughly 3 cms before coming out the superficial ring- the deficiency in the EO and its attachment to the pubic tubercle and pubic crest, before entering the scrotum.
65
Q

How can we reduce the hernia?

A

By getting two fingers and pushing the abdominal contents back into the abdominal cavity- push up through the superficial ring and EO, back along the line of the inguinal canal and push them back through the deep ring half way through the ASIS and pubic tubercle and a finger’s width above the inguinal ligament. Following this, apply pressure to the deep ring and get patient to cough to stop these contents going back into it.

66
Q

What happens if the contents continually pass through the ring?

A

It sets up an inflammatory processes and vessels associated with the blood supply of the herniation’s contents can be compressed and become ischaemic. Thus surgeons must reduce these and repair the deep ring.

67
Q

What does an INDIRECT HERNIAE arise from?

A

Arise from incomplete closure of the processus vaginalis, hence the herniated peritoneal contents extend into the scrotum (or labia).

68
Q

What is the process vaginalis?

A

When the testes and spermatic cord descend into the scrotum, they drag with them an out-pouching from the peritoneal cavity called the process vaginalis so that they have a direct line of communication bw the peritoneal cavity and the scrotum. Usually this is closed so that the testes in the scrotum does not have a communication with the peritoneal cavity.

69
Q

What is a BILATERAL DIRECT INGUINAL HERNIA?

A

Normal scrotum and diffuse bulging in the region of the inguinal canal.
Bilateral= both sides but more common is unilateral.
Protrusion forwards into the inguinal canal through an area of weakness in its posterior canal.

Mid Sem 1 Vis Systems (10 decks)

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