Exam I slides

Question 1

Which is deeper: camper’s fascia or sharper’s fascia?

Answer 1

Scamper’s fascia

Question 2

Scamper’s fascia is continuous with what important anatomical features?

Answer 2

Penis and scrotum

Question 3

What is deep/investing fascia an important landmark for?

Answer 3

This is where sutures are held

Question 4

Where is the potential space in the penis, and why is this space relevant?

Answer 4

Between membranous/Scaper’s facia and deep/investing facia of the abdominal oblique muscle. Important because if the urethra breaks, urine will flow into this area.

Question 5

What are the soft tissue landmarks of the anterior and lateral abdominal wall?

Answer 5

1) Linea semilunaris: lateral border of rectus abdomens, what forms the six-pack.
2) Linea alba: aka white line. Abdominal midline. Where muscles fro each side meet, and overlap.
3) Umbilicus
4) Superficial inguinal line: around pelvis

Question 6

Where are the following planes:

1) Transplyloric
2) Subcostal
3) Supracrestal
4) Transtubercular
5) Interspinous

Answer 6

1) Transverse plane midway between the superior borders of the pubic symphysis and the manubrium
2) Plane at the lowest level of the costal margin (the inferior margin of the tenth costal carriage)
3) Plane passing through the summits of the iliac crest
4) Plane at the level of the iliac tubercles (the iliac tubercle lies about 5 cm postolateral to the anterior superior iliac spine)
5) Plane at the level of the anterior superior iliac spine

Question 7

What are the muscles of the anterior abdominal wall?

Answer 7

External obliques, internal obliques, transversus abdominal, and rectus abdominus

Question 8

What are the muscles of the posterior abdominal wall?

Answer 8

Iliacus, psoas major, psoas minor, and quadratus lumborum

Question 9

What are the layers of fascia, muscle, and skin above an below the arcuate line?

Answer 9

Above: skin, fatty layer of superficial fascia, membranous layer of superficial fascia, aponeurosis of external abdominal oblique fascia (2 layers), one layer of internal abdominal oblique aponeurosis, rectus abdominis muscles, one layer of internal abdominal oblique aponeurosis, aponeurosis of transverses abdominus (2 layers), transversals fascia, extraperitoneal tissue, and parietal peritoneum.

Below: skin, fatty layer of superficial fascia, membranous layer of superficial fascia, aponeurosis of external abdominal oblique fascia (2 layers), aponeurosis of internal abdominal oblique (2 layers), aponeurosis of transverses adsominus (2 layers), rectus abdominis muscles, transversals fascia, extraperitoneal tissue, and parietal peritoneum.

Question 10

Which muscles form the inguinal line?

Answer 10

The external obliques, attach from superior iliac spine to pubic tubercle

Question 11

Which posterior abdominal muscles goes under the inguinal line and attaches to the less trochanter of the femur?

Answer 11

Iliacus

Question 12

Describe the deep system of abdominal arteries.

Answer 12

Superiorly: originate from subclavian.
Mid-abdominally: branch to form abdominal aorta
Inferiorly: external iliac artery

Question 13

Describe the superficial system of abdominal arteries.

Answer 13

Superiorly: Perforating branches
Inferiorly: Branches of the femoral branch

Question 14

Order of anterior deep arteries from superior to inferior:

Answer 14

musculophrenic, superior epigastric, intercostal, subcostal, lumbar, inferior epigastric, deep circumflex illiac

Question 15

Order of anterior superficial arteries from superior to inferior:

Answer 15

superficial circumflex iliac, superficial epigastric, external pudendal (superficial and deep branch)

Question 16

Where does the superficial artery system run?

Answer 16

Camper’s fascia

Question 17

Most important superficial vein?

Answer 17

Thoracoepigastric, runs from thorax to femoral vein. Used for bypasses.

Question 18

Sensory dermatomes of the anterior abdominal wall

Answer 18

T7-L1
T7 - xiphoid region
T10 - umbilical region
L1 - inguinal fold

Question 19

Iliohypogastric nerve

Answer 19

L1 (sometimes T12)
Lateral cutaneous branch, anterior cutaneous branch
Supplies suprapubic region

Question 20

Ilioinguinal nerve

Answer 20

L1
Enters inguinal canal and emerges through superficial inguinal ring.
Supplies groin, scrotum, and labia majus

Question 21

Genitofemoral Nerve

Answer 21

L1 and 2
Genital branch: exits inguinal canal through superficial inguinal ring. Innervates the cremaster muscle or is cutaneous to the labia magus.
Femoral branch: cutaneous to femoral triangle area.

Question 22

Compare direct and indirect inguinal hernias

Answer 22

Both are more common in males
Direct: does not go through inguinal canal, protrudes in lower anterior abdominal wall
Indirect: travels through entire inguinal canal, may go all the way to scrotum. Most common in small children.

Question 23

Compare femoral hernias to inguinal hernias

Answer 23

Femoral are inferior to inguinal ligament, while others are superior.
Originates in the femoral triangle, and occurs in upper thigh.

Question 24

Where are the posterior abdominal wall nerves located?

Answer 24

Subcostal - T12
Iliohypogastric - T12
Lateral cutaneous - L2+3
Genitofemoral - L1+2 (at psoas)
Femoral - L2+4

Question 25

What is a common place for aneurisms to occur in the posterior abdominal wall?

Answer 25

The aortic bifurcation

Question 26

Where do the right and left testicular/ovarian veins supply respectively?

Answer 26

Right - vena cava

Left - renal vein

Question 27

Which kidney is slightly lower and why?

Answer 27

Right, because the liver push down on it

Question 28

Which muscle do you have to go through to get to the kidney?

Answer 28

Quadratus lumborum

Question 29

Where is peri vs paranephric fascia located?

Answer 29

Peri: inferior to renal fascia
Para: superior to renal fascia

Question 30

What are the five segments of the kidney?

Answer 30

Superior, anterosuperior, anteroinferior, inferior, and posterior

Question 31

What does white and red tissue of the kidney make up?

Answer 31

White: cortex
Red: pyramids

Question 32

Flow of urine through kidneys

Answer 32

Pyramids –> papilla (tip) –> minor calyx –> major calyx –> renal pelvis –> ureter –> bladder

Question 33

Where are the three constriction points in the ureter?

Answer 33

1) where the pelvis joins the ureter proper
2) crossing internal iliac at pelvic brim
3) right as the ureter go into bladder

Question 34

What organ does the ventral mesentary surround?

Answer 34

The liver

Question 35

Differentiate parasympathetic innervation for foregut, hindgut, and midgut

Answer 35

Fore+Mid: vagus

Hind: splanchnic

Question 36

What become the urachus?

Answer 36

Allantois

Question 37

Describe the development of the stomach

Answer 37

The straight tube turns dorsally or to the left 90 degrees clockwise. The left side is now anterior, while the right side is now posterior. Same with the vagal trunk.

Question 38

Stomach goes ______, while liver goes ______

Answer 38

left, right

Question 39

What brings the ventral and dorsal parts of the pancreas together?

Answer 39

Rotation of the stomach

Question 40

Omphalocele v. gastroschisis

Answer 40

O: herniation into umbilical cord, covered
G: herniation into amniotic cavity, uncovered

Question 41

When would a patient present with fecal matter leaking from umbilicus?

Answer 41

Vitelline fistula

Question 42

High v. low anal malformations

Answer 42

In relation to where anal canal ends, either below pelvic diaphragm or above. High is more difficult to treat, because there is no muscle available to form a sphincter.