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MD3002 - GI Anatomy > Anterior and Lateral Wall, Inguinal Region and Hernias > Flashcards

Anterior and Lateral Wall, Inguinal Region and Hernias Flashcards

1
Q

What are the 2 planes that divide the adbomen into 4 quadrants

A
  • transumbilical plane - L3/4 intervertebral disc (through umbilicus)
  • Median/mid-sagittal plane - through the xiphoid process and pubic symphysis
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2
Q

What are the 4 quadrants of the abdomen?

A
  1. right upper quadrant
  2. left upper quadrant
  3. right lower quadrant
  4. left lower quadrant
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3
Q

What planes split the abdomen into 9 regions?

A
  • midclavicular line - mid point of clavicle (x2)
  • Subcostal plane - L3 vertebrae, lowest point of the costal margins (10th costal cartilages)
  • Trans-tubercular/intertibercular plane - L5 vertebra, iliac tuburcles
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4
Q

What are the 9 regions of the abdomen?

A
  1. Right hypochondrium
  2. Epigastric region
  3. Left hypochondrium
  4. Right lumbar region (loin, flank)
  5. umbilical region
  6. left lumbar region
  7. Right inguinal region (groin)
  8. Hypogastric region (pubic, suprapubic)
  9. Left inguinal region
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5
Q

From superificial to deep give the layers of the abdominal wall

A
  • Skin
  • Subcutaneous fascia
    • subcutaneous fatty layer (Camper’s fascia)
    • Deep membranous layer (Scarpa’s fascia)
  • Abdominal muscles (3 layers)
  • Transveralis fascia
  • Extraperiotneal fat
  • parietal peritoneum
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6
Q

Give the properties of the skin of the anterior abdominal wall

A
  • attached to subcutaneous tissues except at umbilicus
  • Natural lines of cleavage in the skin are constant running downward and forward almost horixontally around the trunk
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7
Q

What do Langer’s Lines correspond with?

A

skin creases

NB: incisions made across the lines of skin tension promote hypertrophic scarring (oblique or S-shaped incisions may be preferred)

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8
Q

What is the abdominal wall continous with?

A

perineum wall

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9
Q

What is camper’s fascia continous with?

A

Cruveilheir’s fascia (subcutaneous tissue of the perineum)

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10
Q

What is Scapa’s fascia continous with?

A

Colles’ (perineal) fascia and dartos fascia

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11
Q

What muscles are contained within the abdominal wall?

A

3 flat muscles, vertical strap-like muscles and pyramidalis

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12
Q

What are the main (common) functions of the abdominal wall muscles?

A
  • support abdominal contents
  • raise intra-abdominal pressure
  • withstand pressure from descent of diaphragm
  • respiration
  • support vertebral column
  • flex, laterally flex and rotate the trunk
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13
Q

What nerves supply the abdominal wall muscles?

A
  • thoraco-abdominal (7th-11th intercostal nerves)
  • subcostal nerve (12th intercostal)
  • some branches from L1
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14
Q

What is the vertical strap like muscle in the abdominal wall?

A

rectus abdominis

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15
Q

What is the origin of rectus abdominis

A

pubic creat and pubic symphysis

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16
Q

What is the insertion of rectus abdominis

A

5th-7th costal cartilage and xiphoid process

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17
Q

What is the action of rectus abdominis

A

stabilises the pelvis during gait

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18
Q

What is each rectus abdominis muscle enclosed in?

A

rectus sheath; formed by aponeuroses of the flat muscles of the abominal wall

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19
Q

How many tendinous intersections are within rectus abdominis

A

three

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20
Q

Describe the power of the rectus abdominis muscle

A

minimal

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21
Q

Draw a diagram of the rectus sheath (transverse section) above the arcurate line

A
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22
Q

Where is the arcuate line?

A

1/3 between umbilicus and pubic symphysis

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23
Q

What is linea alba?

A

fusion of aponeurosis; tendinous structure

good place to enter the abdomen during surgery as it is bloodless

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24
Q

Draw a diagram of the rectus sheath below the arcuate line

A
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25
Q
A

green = semilunar line

red = arcuate line

blue = linea alba

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26
Q

What do all aponeurosis fuse as in the midline?

A

linea alba

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27
Q

What is at the inferior border of the aponeurosis of transversus abdominis

A

arcuate line

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28
Q

What enter the rectus sheath at the arcuate line?

A

inferior epigastric vessels, pass anterior to the arcuate line

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29
Q

What is the origin of external oblique muscle?

A

lower 8 ribs

30
Q

What is the insertion of external oblique muscle?

A
  • iliac crest
  • linea alba
  • xiphoid process
  • pubic tubercle
  • anterior superior iliac spine
31
Q

How do the fibres of external oblique muscle run?

A

infero-medially

32
Q

What muscle is the external oblique muscle similar to?

A

external intercostal muscle

33
Q

What is the inguinal ligament?

A

lower border of the aponeurosis of the external oblique muscle

34
Q

Where does the inguinal ligament extend between?

A

attached to and extends between the ASIS and pubic tubercle

35
Q

What occurs at the medial end of the inguinal ligament?

A

fibres turn posterolaterally and attach to the pubic pectan

this is called the lacunar ligament

36
Q

What border so the lacunar ligament form

A

medial border of the femoral canal

37
Q
A

red = external oblique

38
Q

What is the superificial inguinal

A

defect on the aponeurosis of the external oblqiue, just above the pubic tubercle

superificial opening of the inguinal canal

39
Q

What is the femoral canal?

A

conical shaped potential space

opening of the canal is formed by femoral vein, inguinal ligament and lacunar ligament

40
Q

Where does thoraco-lumbar fascia pass between

A

from iliac crest to the 12th rib in 3 layers

41
Q

What occurs in the thoraco-lumbar fascia?

A

three layers fuse and provide the origin to the transversus abdoominis and internal oblique muscles but not external oblique

42
Q

What can occur in the weak area of the thoraco-lumbar fascia

A

lumbar hernia

43
Q

What is the originof internal oblique muscle?

A
  • thoracolumbar fascia
  • iliac crest (anterior 2/3)
  • lateral 2/3 of inguinal ligament
44
Q

What is the insertion of the internal oblique muscle?

A
  • inferior 3-4 ribs
  • linea alba
  • xiphoid process
  • pubic crest
45
Q

What is the nerve innervation of internal oblique muscle?

A

iliohypogastric (L1) nerve

46
Q

How do the fibres of internal oblique muscle run?

A

supero-medially and inferioly to conjoint tendon

47
Q

What is the origin of transversus abdominis

A
  • thoracolumbar fascia
  • iliac crest
  • lateral 1/3 of inguinal ligmanet
  • inferior 6 ribs and CC
48
Q

What is the insertion of transversus abdominis

A
  • linea alba
  • xiphoid process
  • pubic crest
49
Q

What is the nerve innervation of transversus abdominis

A
  • iliohypogastric (L1) nerves
  • ilioinguinal nerve (supplies inferior most fibres)
50
Q

Conjoint tendon =

A

inguinal falx

51
Q

What is the conjoint tendon?

A

fibres of internal oblique arising from the inguinal ligament arch medially over the spermatic cord and unite with transversus abdominis aponeruosis to form the conjoint tendon

52
Q

What does the conjoint tendon attach to?

A

attaches to the pubic crest and pectineal line behind the superificial inguinal ring

53
Q

What is the function of the conjoint tendon?

A

supports the superficial inguinal ring

54
Q

What is transverslais fascia

A

thin layer of CT that lines the transversus abdominis muscle internally

55
Q

What is the inguinal canal?

A

passage tgrough the anterior abdominal wall

56
Q

What does the inguinal canal connect the abdomen to?

A
  • scotum in makes
  • labia majoria in females
57
Q

What are the two openings of the inguinal canal?

A

deep inguinal ring and superifical inguinal ring

58
Q

What are the contents of the inguinal canal?

A
  • Ductus deferens in males
  • testicular artery in males
  • round ligament of uterus un females (ligamentum teres)
  • genital branch of genitofemoral nerves (L1/2)
  • ilioinguinal nerve (doesnt pass through all of the canal)
59
Q

Where is the deep inguinal ring?

A

opening in the transversalis fascia

Found in the lateral inguinal fossa

  • lateral to the lateral umbilical fold
  • 1cm above the midway between the ASIS and pubic symphysis (mid-inguinal portion)
60
Q

Where is the superifical inguinal ring?

A

traingular opening ion the external oblique aponeurosis

61
Q

What is the superifical inguinal ring supported by?

A

supported from behind by the conjoint tendon

62
Q

What are the anterior relations of the inguinal canal

A
  • external oblique
  • internal oblique laterally
63
Q

What are the posterior relations of the inguinal canal

A
  • conjoint tendon medially
  • transversalis fascia laterally
64
Q

What is on the roof of the inguinal canal?

A

arching inferior edges of internal oblique and transversalis abdominis

65
Q

What comprises the floor of the inguinal canal?

A
  • inguinal ligament
  • lacunar ligament medially
66
Q

What is a hernia?

A

a condition which part of an organ is displcaed and protrudes through the wall of the cavity containing

67
Q

Where does an inguinal hernia usually occur?

A

usually appears above & medial to the pubic tubercle

68
Q

Where does a femoral hernia usually occur?

A

passes through the femoral canal & appears below & lateral to the pubic tubercle

69
Q

Where does a direct inguinal hernia occur?

A

area on the posterior wall of the inguinal canal, medial to the inferior epigastric vessels - Hesselbach’s triangle

One the medial corner of Haselbach’s (inguinal) triangle is the inguinal falx (conjoint tendon)

70
Q

Who is a weaker conjoint tendon more common in?

A

males

71
Q

What occurs in a direct inguinal hernia?

A

Fat or small bowel pushes the peritoneum and transversalis fascia

May pass through the superficial inguinal ring to enter the scrotum

  • Parallel to spermatic cord
  • Covered by peritoneum, transversalis fascia (and conjoint tendon)
72
Q

What occurs in an indirect inguinal hernia?

A

abdominal cintents pass through the deep inguinal ring

contents are covered by all layers of the spermatic cord

MD3002 - GI Anatomy (11 decks)

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