Blue Boxes 2: Abdominal Wall Flashcards
How do you elicit the superficial abdominal reflex?
Quickly stroking horizontally, lateral to medial, toward the umbilicus
What nerves are succeptible to injury in surgical incisions or trauma at any level of the abdominal wall?
Inferior thoracic spinal nerves (T7 - T12) and the iliohypogastric and ilio-inguinal nerves (L1)
Why is the rectus abdominis a surgical procedural exception?
Because surgeons transect it directly across its muscle bellies. Its muscle fibers run short distances between tendinous intersections, and the segmental nerves supplying it enter the lateral part of the rectus sheath where they can be located and preserved
Surgically, are muscles and viscera retracted toward, or away from their neurovascular supply?
Toward
Why can medial abdominal incisions preferably be made along the linea alba?
Because it only transmits small vessels and nerves to the skin, a midline incision is relatively bloodless and avoids major nerves. However, because of its poor blood supply, the linea alba may undergo necrosis if its edges are not aligned properly during closure
The direction of oblique and transverse incisions is decided by what factors?
Muscle fiber orientation, nearby hard tissue, minimizing potential nerve damage.
What is a Gridiron Incision?
Muscle-splitting
Where is McBurney point?
2.5cm superomedial to the ASIS on the spino-umbilical line
What type of incision is often used for an appendectomy? Where is this incision made?
Gridiron incision at McBurney point
During an appendectomy at McBurney point, what nerve runs deep to the internal oblique and must be identified and preserved?
Iliohypogastric
What are Suprapubic (Pfannenstiel) incisions?
“bikini” incisions made at the pubic hairline
What are suprapubic incisions used for?
Most gynecological and obstetrical operations, ex cesarean section
What nerves are identified and preserved during suprapubic incisions?
iliohypogastric and ilio-inguinal
Why are transverse incisions not made through the tendionous intersections of the rectus abdominus and instead are made through the muscle body
Cutaneous nerves and branches of the superior epigastric vessels pierce these fibrous regoins of the muscle
What type of incision would you use for an expoloratory procedure of the abdomen?
Median or midline incision, because it can be extended superiorly and inferiorly without created much more damage
