Exam 3 Flashcards
Nine regions of the anterior abdominal wall (Fig. 4.23)
1) Right Hypochondrium
2) Epigastric
3) Left Hypochondrium
4) Right Flank (Lateral)
5) Umbilical
6) Left Flank (Lateral)
7) Right Groin (Inguinal)
8) Pubic
9) Left Groin (Inguinal)
The two vertical planes of the abdomen are called ____ planes. They extend from the MIDpoints of the CLAVICLEs to the midpoints of lines joining the ASIS to the pubic symphysis
midclavicular
A horizontal plane joining the LOWest point of the COSTAL margin on each side. It lies at the inferior margin of rib 10 (L.V. 3 level).
Subcostal Plane
A horizontal plane which JOINS the TUBERCLES of the iliac crests (L.V. 5 level)
Transtubercular Plane
The 3 superior regions of the abdomen that lie above the subcostal plane are?
Right Hypochondrium
Epigastric
Left Hypochondrium
The 3 middle regions of the abdomen that lie below the subcostal plane but above the transtubercular plane are?
Right Flank (Lateral) Umbilical Left Flank (Lateral)
The 3 inferior regions of the abdomen that lie below the transtubercular plane are?
Right Groin (Inguinal) Pubic Left Groin (Inguinal)
The liver lies mostly in the ____ and ____ regions
right hypochondrium, epigastric
The spleen and the fundus and body of stomach are found in the ____ region.
left hypochondrium
The 4 quadrants of the stomach are?
Right Upper
Left Upper
Right Lower
Left Lower
The gallbladder can be found in the ____ quadrant.
right upper
The appendix can be found in the ____ quadrant.
right lower
The 4 abdominal quadrants are divided by a ____ plane (the vertical plane through the midline) and a _____ plane (the horizontal plane through the umbilicus).
median; transumbilical
The umbilicus is a variable landmark which lies between L.V. __ and __
2, 5
The 13 layers of the anterior abdominal wall
Skin, superficial layer of superficial fascia (camper’s fascia), deep layer of superficial fascia (scarpa’s fascia), deep (investing) layer, external oblique muscle, internal oblique muscle, transverse abdominal muscle, transverse list fascia, extraperitoneal fascia, parietal peritoneum, peritoneal cavity, visceral peritoneum, abdominal organs
Two layers of fascia in the ant. abdominal wall
Superficial fascia
Deep (investing) fascia
Subdivisions of superficial fascia
Superficial layer (Camper'so Fascia) Deep layer (Scarpa's Fascia)
A thin fatty layer of fascia which is continuous with the superficial fascia of the perenium and thigh.
Superficial layer (Camper’s Fascia)
A membranes layer of fascia which is firmly fastened to the fascia lata of the thigh, just below the inguinal ligament
Deep layer (Scarpa’s Fascia)
The ____ fascia covers each of the anterior abdominal wall muscles on its anterior and posterior surface
Deep (investing)
Between ____ and the ____ fascia covering external oblique, there is a potential space where fluid can accumulate.
Scarpa’s fascia, deep (investing)
Rupture of the spongy ____ allows accumulation of urine within potential space
urethra
Urine can spread SUPERIORLY/INFERIORLY in the anterior abdominal wall within the potential space. Making it very red and puffy.
Superiorly
T/F? Extravasation of urine cannot spread superiorly to the thigh due to the firm attachment of Scarpa’s fascia to the fascia lata.
False - inferiorly
T/F? Extravasation of urine is almost exclusive to females because the urethra is longer, more superficial, and more horizontally oriented.
False - males
A median tendinous raphe (largest in the body) which extends from the xiphoid process to the pubic symphysis. Anterior abdominal wall muscles insert into this raphe via their aponeuroses.
Linea Alba
Name the 5 muscles of the anterior abdominal wall
External Oblique, Internal Oblique, Transversus Abdominis, Rectus Abdominis, Pyramidalis
Origin - External Oblique Muscle
Lower 8 ribs
Insertion - External Oblique Muscle
iliac crest, ASIS, pubic tubercle, linea alba via aponeurosis
Innervation - External Oblique Muscle
anterior primary rami of lower 6 thoracic nerves
Function - External Oblique Muscle
compress the abdomen, supports abdominal viscera, lateral flexor of trunk
Fibers of the External Oblique Muscle run which direction?
Downward and FORWARD (like putting your hands in your pockets).
Origin - Internal Oblique Muscle
lumbar fascia, iliac crest, lateral 2/3 of inguinal ligament
Insertion - Internal Oblique Muscle
lower 3 ribs, linea alba by aponeurosis
Innervation - Internal Oblique Muscle
anterior primary rami of lower 6 thoracic nerves and first lumbar nerve
Function - Internal Oblique Muscle
compress the abdomen, supports abdominal viscera, lateral flexor of trunk
Fibers of the Internal Oblique Muscle run which direction?
Downward and BACKWARD
Origin - Transversus Abdominis Muscle
lower 6 costal cartilages, lumbar fascia, iliac crest, lateral 1/3 of inguinal ligament
Insertion - Transversus Abdominis Muscle
into linea alba by aponeurosis
Innervation - Transversus Abdominis Muscle
anterior primary rami of lower 6 thoracic and first lumbar nerve
Function - Transversus Abdominis Muscle
compresses abdomen, supports abdominal viscera, acts as an internal back brace
The fibers of the Transversus Abdominis Muscle run which direction?
HORIZONTALLY across the abdomen
Origin - Rectus Abdominis Muscle
pubic crest and pubic symphisis
Insertion - Rectus Abdominis Muscle
xiphoid process and costal cartilages of ribs 5-7
Innervation - Rectus Abdominis Muscle
anterior primary rami of the lower 6 thoracic nerves
Function - Rectus Abdominis Muscle
compress the abdomen, supports abdominal viscera, anterior flexor of trunk
The ____ is a curved line along the lateral border of the rectus abdominis muscle (topographical feature in toned individuals).
Linea Semilunaris
3 bundles of connective tissue which run transversely across the rectus abdominis muscle and which fuse with the rectus sheath.
Tendinous Intersections
Small and often absent slip of muscle which lies anterior to the rectus abdominis within its sheath.
Pyramidalis Muscle
Origin - Pyramidalis Muscle
body of pubis
Insertion - Pyramidalis Muscle
linea alba
Innervation - Pyramidalis Muscle
subcostal nerve
Function - Pyramidalis Muscle
tenses linea alba
Fibers of the Internal Pyramidalis Muscle run which direction?
obliquely
Name 4 functions that Anterior Abdominal Wall muscles are active in.
vomiting, coughing, sneezing, bowel movements, micturition (peeing), parturition (birth)
The rectus sheath is formed by the aponeuroses of the ____, ____, & ____ muscles
external oblique, internal oblique, transversus abdominis
Which of the following structures is not found in the rectus sheath?
A. Superior & Inferior Epigastric Arteries
B. Anterior Primary Rami of Lower 6 Thoracic Nerves
C. Pyramidalis Muscle
D. Transversus Abdominis Muscle
E. Rectus Abdominis Muscle
D. Transversus Abdominis Muscle
A crescent shape line in the posterior layer of the rectus sheath. It is located midway between the umbilicus and pubic crest.
Arcuate Line
Above the arcuate line, what layer of the rectus sheath is composed of the aponeuroses of the EXTERNAL AND INTERNAL OBLIQUE MUSCLES.
Anterior Layer
Above the arcuate line, what layer of the rectus sheath is composed of the aponeuroses of the INTERNAL OBLIQUE AND TRANSVERSUS ABDOMINIS MUSCLES.
Posterior Layer
T/F - Below the arcuate line, the aponeurosis of the internal oblique muscle splits to enclose the rectus abdominis?
False - Above
Below the arcuate line, the anterior layer of the rectus sheath is formed by the ____, ____, & ____ muscles?
external oblique, internal oblique, transversus abdominis
Below the arcuate line, the posterior layer of the rectus sheath is formed by the ____ fascia?
transversalis fascia
Name the 5 folds present on the posterior surface of the anterior abdominal wall, below the umbilicus.
MediAN Umbilical Fold x 2
MediAL Umbilical Fold x1
Lateral Umbilical Fold x2
What two folds form the boundaries of the Supravesical Fossa?
Median & Medial Umbilical Folds
What two folds form the boundaries of the Medial Inguinal Fossa?
MediAL & Lateral Umbilical Folds
What two folds form the boundaries of the Lateral Inguinal Fossa?
Lateral to the Lateral Umbilical Folds
The ____ ____ lies above the umbilicus and contains the obliterated umbilical vein. It is the free edge of the falciform ligament of the liver.
Ligamentum Teres
Which of the following arteries DOES NOT contribute to the blood supply of the anterior abdominal wall?
A. Deep Circumflex Artery
B. Superior & Inferior Epigastric Arteries
C. Lumbar Arteries
D. None of the above
D. None of the above
The ____ artery supplies the anterior abdominal wall and is a branch of the INTERNAL THORACIC ARTERY.
superior epigastric
The ____ & ____ arteries supply the anterior abdominal wall and are branches of the EXTERNAL ILIAC ARTERY.
inferior epigastric, deep circumflex
The ____ arteries supply the anterior abdominal wall and are branches of the ABDOMINAL AORTA.
lumbar
Innervation - Anterior Abdominal Wall
Lower 6 Thoracic Nerves
The lower 6 thoracic nerves run between what two muscle layers in the anterior abdominal wall?
Internal Oblique & Transversus Abdominis
The ____ ____ is formed by the lower edge of the external oblique aponeurosis.
Inguinal Ligament
The inguinal ligament extends from the ____ to the ____
ASIS; pubic tubercle
The most medial fibers of the inguinal ligament which are inserted into the superior pubic ramus.
Lacunar Ligament
A lateral extension of the lacunar ligament along the pecten pubis (pectineal line).
Pectineal Ligament
The ____ canal is an oblique passage 3-5cm in length through the anterior abdominal wall.
Inguinal Canal
The inguinal canal begins at the ____ inguinal ring and ends at the ____ inguinal ring.
deep; superficial
Within the anterior abdominal wall the ____ inguinal ring lies LATERAL and INTERNAL, the ____ inguinal ring lies MEDIAL and EXTERNAL
deep, superficial
T/F - The inguinal canal is much larger in the female than the male.
False - Larger in the male. Transmits the spermatic cord in the male which is thick, and the round ligament of the uterus in the female which is thin.
Name the two structures that pass through the inguinal ring in males.
Spermatic Cord, Ilioinguinal Nerve
Name the two structures that pass through the inguinal ring in females.
Round Ligament of the Uterus, Ilioinguinal Nerve
This tendon is formed by the fusion of the aponeuroses of the internal oblique and transverseus abdominis muscles as they insert into the pubic crest and pecten pubis deep to the inguinal ligament. It strengthens the posterior wall of the medial half of the inguinal canal.
Conjoint Tendon (Inguinal Falx)
The anterior wall of the inguinal canal is formed by ____
the aponeuroses of the external oblique muscle
The posterior wall of the inguinal canal is formed by ____
the conjoint tendon and transversalis fascia
The roof of the inguinal canal is formed by ____
the arching fibers of the internal oblique and transversus abdominis
The floor of the inguinal canal is formed by _____
the inguinal and lacunar ligaments
The superficial inguinal ring is formed by the splitting of the ____ aponeurosis into two cura.
external oblique
The ____ crus inserts into the pubic TUBERCLE. Some of its fibers reflect to the superior pubic ramus as the lacunar ligament.
lateral
The ____ crus inserts into the pubic CREST.
medial
These fibers strengthen the apex of the superficial inguinal ring.
Intercrural Fibers
The deep inguinal ring is an opening within the ____ fascia. It is located above the inguinal ligament midway between the ASIS and the pubic symphysis. It lies just lateral to the inferior epigastric vessels.
transversalis
The Inguinal Triangle is bounded MEDIALLY by the ____
lateral edge of the rectus abdominis
The Inguinal Triangle is bounded LATERALLY by the ____
inferior epigastric vessels
The Inguinal Triangle is bounded INFERIORLY by the ____
inguinal ligament
This is an area of potential weakness in the anterior abdominal wall. DIRECT INGUINAL HERNIAS OCCUR HERE.
Inguinal Triangle
T/F - Before birth the inguinal canal is longer and much more oblique than in the adult.
False - shorter and much less oblique
T/F - Before birth the superficial inguinal ring lies almost directly anterior to the deep inguinal ring.
True
T/F - During childhood the inguinal canal lengthens and assums its characteristically oblique position.
True
The inguinal canal is ____ in adults. This allows the canal to be compressed by the muscles of the anterior abdominal wall when they contract
oblique
T/F - The same muscles which increase intra-abdominal pressure (promoting hernia) also narrow the inguinal canal (preventing hernia).
True
The ____ reinforces the posterior wall of the inguinal canal.
conjoint tendon
A ____ is an abnormal protrusion of tissue through an opening.
hernia
In inguinal hernias, abdominal viscera (usually the ____ intestine) protrude through the inguinal region.
small
T/F - Inguinal hernias are more common in males than females.
True - due to the large diameter of the inguinal canal for passage of the spermatic cord, and the fact that the scrotum is an out pouching of the anterior abdominal wall. It creates a large potential spaces for abdominal viscera to fill.
The ____ of the female are homologous to the scrotum of the male, but are mostly filled with fat
labia majora
There are two kinds of inguinal hernias: ____ & ____
Direct & Indirect
____ hernias pass through the deep inguinal ring, inguinal canal, and superficial inguinal ring before DESCENDING INTO THE SCROTUM (or labia majora).
Indirect
____ hernias punches directly through the posterior wall of the inguinal canal, bypassing the deep inguinal ring. Causes a general buldging of the inguinal canal, but DOES NOT DESCEND INTO THE SCROTUM.
Direct
____ hernias pass MEDIAL to the inferior epigastric vessels.
Direct - M.D.
____ hernias pass LATERAL to the inferior epigastric vessels.
Indirect - I.L.
____ hernias may be CONGENITAL (associated with a patent processus vaginalis - embryonic outpouching) OR ACQUIRED (through forced opening of the passage - trauma/heavy lifting).
Indirect
____ hernias are ALWAYS ACQUIRED (due to weakness in the conjoint tendon or transversalis fascia)
Direct
____ hernias account for 25% of inguinal hernias, occurring mostly in men over 40 due to weak anterior abdominal wall muscles.
Direct
____ hernias account for 75% of inguinal hernias.
Indirect
____ hernias pass through femoral canal. Occurs inferior to the inguinal ligament. They are more common in females.
Femoral
____ hernias are caused from incomplete closure of the anterior abdominal wall after ligation of the umbilicus at birth. Also caused by defects in the linea alba due to surgery or pregnancy.
Umbilical
The spermatic cord begins at the ____ and ends at the ____
deep inguinal ring; testis
Three layers of fascia covering the spermatic cord derived from the anterior abdominal wall. (Figure 89)
External Spermatic Fascia
Cremastaric Fascia
Internal Spermatic Fascia
____ fascia is derived from the anterior abdominal wall.
External Spermatic Fascia
____ fascia is derived from the internal oblique aponeurosis.
Cremasteric Fascia
Cremasteric Fascia can be recognized by the presence of many bundles of muscle fibers, collectively referred to as the ____ muscle.
cremaster
The cremaster muscle is derived from the ____ muscle
internal oblique
Origin - Cremaster Muscle
internal oblique muscle, inguinal ligament, pubic tubercle, pubic crest
Insertion - Cremaster Muscle
spermatic cord
Innervation - Cremaster Muscle
genital branch of genitofemoral nerve (L1, L2)
Function - Cremaster Muscle
retracts testis
____ fascia is derived from the transversalis fascia
Internal Spermatic Fascia
9 structures contained within the spermatic cord.
Ductus Deferens Testicular Artery Pampiniform Plexus of Veins Artery to the Ductus Deferens Cremasteric Artery Genital Branch of Genitofemoral Nerve Remnant of Processus Vaginalis Autonomic Nerves Lymphatics
The muscular duct which transports sperm from the epididymis to the ejaculatory duct.
Ductus Deferens
The testicular artery is a branch of the ____ ____.
abdominal aorta
An extensive network of veins which makes up the bulk of the spermatic cord.
Pampiniform Plexus
The pampiniform plexus veins join together at the deep inguinal ring to form the ____ vein.
testicular
The ____ testicular vein drains into the LEFT RENAL VEIN
left
The ____ testicular vein drains directly into the INFERIOR VENA CAVA
right
The Artery to the Ductus Deferens is a branch of the ____ ____ artery
superior vesical artery
The Cremasteric Artery is a branch of the ____ ____ artery
inferior epigastric artery
Innervation - Cremaster Muscle
Genital Branch of Genitofemoral Nerve
The lymphatics of the spermatic cord drain into the ____ lymph nodes
lumbar
The Ilioinguinal Nerve runs through the ____ canal and ____ inguinal ring.
inguinal; superficial
T/F - The ilioinguinal nerve is part of the spermatic cord
False - The ilioinguinal nerve accompanies the spermatic cord but is not part of it.
The Inguinal Nerve has two branches: ____ Branch, and Anterior ____ or ____ Nerve.
Femoral
Scrotal/Labial
The femoral branch of the inguinal nerve supplies the ____ part of the thigh.
upper medial
The anterior scrotal nerve supplies the ____ of the penis and ____ part of the scrotum.
root; anterior
The anterior labial nerve supplies the ____ ____ and anterior part of the ____ ____.
mons pubis; labia majora
The ____ is an outpouching of the anterior abdominal wall.
scrotum
The contents of the scrotum are the ____, the ____, and the ____ part of the spermatic cord.
testis, epididymis; lower
The ____ muscle of the scrotum is derived from the subcutaneous tissue and the superficial and deep fascia of the anterior abdominal wall. (Fig 90 & pg. 111)
dartos
T/F - The dartos muscle is smooth muscle functioning in temperature regulation and is under somatic control. (Fig 90 & pg. 111)
False - under autonomic control
The ____ ____ fascia is derived from the external oblique muscle. (Fig 90 & pg. 111)
external spermatic
The ____ fascia & ____ muscle are derived from the internal oblique muscle. (Fig 90 & pg. 111)
cremasteric; cremaster
T/F - The internal spermatic fascia is derived from the transversus abdominis muscle aponeurosis. (Fig 90 & pg. 111)
False - it is derived from the TRANSVERSALIS FASCIA. The transversus abdominis has no continuation into the scrotum.
T/F - The extraperitoneal fascia has no continuation into the scrotum. (Fig 90 & pg. 111)
True
The ____ ____ is derived from the peritoneum of the anterior abdominal wall. (Fig 90 & pg. 111)
tunica vaginalis
____ Muscle: smooth muscle fibers which are firmly adherent to the skin of the scrotum. It functions in temp regulation of the testis.
Dartos Muscle
Two layers of the Tunica Vaginalis. (Fig 91 & pg. 112)
Parietal Layer & Visceral Layer
Between the two layers of the Tunica Vaginalis is a cavity that contains serous fluid. If too much fluid accumulates in the cavity it can cause a ____. (Fig 91 & pg. 112)
hydrocele
Two functions of the testes: produce ____ & secrete ___ (Fig 91 & pg. 112)
produce spermatazoa & secrete androgens
The fibrous outer covering of the testis. It lies deep to the visceral layer of the tunica vaginalis. (Fig 91 & pg. 112)
Tunica Albuginea
T/F - The Tunica Albuginea is the deepest layer of the scrotum (Fig 91 & pg. 112)
False - the VISCERAL LAYER of the Tunica Vaginalis is the deepest layer of the scrotum. The Tunica Albuginea is the outer covering of the testis.
The testis is divided by ____ into numerous wedge shaped portions called ____. (Fig 91 & pg. 112)
septa; lobules
A fibrous compartment in the posterior of the testis where the septa converge. (Fig 91 & pg. 112)
Mediastinum Testis
The functional, sperm producing portion of the testis. Each lobule contains 2-3 of these. (Fig 91 & pg. 112)
Seminiferous tubules
Seminiferous tubules unite to form ____ tubules (Fig 91 & pg. 112)
straight
An elaborate network of canals located within the mediastinum testis into which the straight tubules empty. (Fig 91 & pg. 112)
Rete Testis
Ducts which connect the rete testis to the head of the epididymis. (Fig 91 & pg. 112)
Efferent Ductules
A C-shaped structure attached to the superior and posterior aspect of the testis. Its function is to store sperm until they mature.
Epididymis
Three parts of the epididymis
Head, Body, Tail
The ____ of the epididymis is located along the posterior surface of the testis.
body of epididymis
The ____ ends in the ductus deferens.
tail of epididymis
The ____ is connected to the superior surface of the testis by the EFFERENT DUCTULES.
head of the epididymis
The testis lymphatics drain into the ____ nodes.
lumbar nodes
The scrotum lymphatics drain into the ____ ____ nodes
superficial inguinal nodes
A ligament present in the fetus which connects the testis to the scrotum. It contracts to pull the testis downward and through the inguinal canal during its descent.
Gubernaculum Testis
Testes are undescended at birth in ____% of FULL TERM infants.
3%
Testes are undescended at birth in ____% of PREMATURE infants.
37%
The absence of one or both testes from the scrotum. It is the most common birth defect of the male genitalia.
Cryptorchidism
Undescended testes are most commonly found in the ____ ____ and the condition is usually (unilateral/bilateral)?
inguinal canal
unilateral
T/F - Most testes descend in the first weeks or months after birth.
True
T/F - If testes do not descend there is an increased risk of cancer and infertility, but androgen secretion is unimpaired.
True
T/F - Testicular cancer spreads to abdomen NOT groin.
True
The ____ is a smooth membrane which lines the abdomen cavity.
peritoneum
____ peritoneum lines the abdominal walls.
Parietal
____ peritoneum covers the abdominal organs.
Visceral
A potential space between the parietal and visceral peritoneum. It is empty except for a film of serous fluid.
Peritoneal Cavity
T/F - The peritoneal cavity is a completely CLOSED sac in the male.
True
The peritoneal cavity in the female communicates with the exterior through the ____ ____. Infections of the vagina can spread to the peritoneal cavity via this route.
uterine tubes
A test for patency of the uterine tubes uses ___ introduced into the uterus. It normally enters the uterine tubes and then the peritoneal cavity. If it does not, there is an obstruction.
dye
