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Abdomen Part 1 By Martha-Angella > General Questions > Flashcards

General Questions Flashcards

1
Q
  1. The abdomen is the region between the ___ and ____ .
A

Thorax and pelvis

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2
Q
  1. The separation between the thorax and the abdomen is the _____ diaphragm
A

Respiratory

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3
Q
  1. When separating the abdomen into four quadrants, the ____ is the midpoint.
A

Umbilicus

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4
Q

Name the four quadrants of the abdomen

A

We have a right upper quadrant, right lower quadrant, left upper quadrant, and left lower quadrant for the abdomen.

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5
Q

When we talk about the anterolateral abdominal wall, we are talking about the ____ margin that is approximately from rib _ to rib _ and the ___ process on each side

A

subcostal, rib 10 to rib 7, xiphoid

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6
Q

What are the four muscles that makeup the anterolateral abdominal wall?

A

The rectus abdominis, the external oblique, the internal oblique, and the transverse abdominis

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7
Q

What are the muscles from superficial to deep in the anterolateral abdominal wall ?

A

The rectus abdominis, the external oblique, the internal oblique, and the transverse abdominis

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8
Q

The rectus abdominis is encased in a tendinous sheath or aponeurosis of the other (__) anterolateral abdominal wall muscles.

A

Three

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9
Q

The 3 aponeurosis’ are fused along the midline at what is called the ____ and they are fused at what is called the ____ . They split again. They surround the rectus abdominis and reattach and refuse at the linea alba.

A

linea alba; semi lunar line

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10
Q
  1. As the external oblique runs down in an inferomedial direction, the outer layer of the sheath definitely (does not have/has) external oblique aponeurosis in it, but we can’t say for sure how much of the internal oblique aponeurosis and how much of the transverse abdominis aponeurosis is in it.
A

Has

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11
Q

The (external oblique/rectus abdominis) is a vertically oriented muscle that runs from the subcostal margin to the superior ramus and body of the pubic bone

A

rectus abdominis

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12
Q

There are transverse intersections of tendon on the (rectus abdominis/internal oblique) and what this does is it separates the muscle into variably distinct segments and that allows for a change in pull of the muscle as it contracts at each segment.

A

rectus abdominis

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13
Q

The (internal oblique/external oblique) has an inferomedial fiber orientation.

A

External oblique

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14
Q

The (rectus abdominis/external oblique) has multiple attachment sites and it is covering the entire anterolateral abdominal wall. It is the most external component.

A

External oblique

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15
Q

The (rectus abdominis/internal oblique) has a superomedial fiber orientation and almost a 90-degree change in orientation from the fibers of the external oblique.

A

Internal oblique

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16
Q

The internal oblique is attached to part of the inguinal ligament (not distally), but as it comes through the inferior portion of the abdomen, it joins with the transverse abdominis tendon and creates what is called the ____ tendon.

A

Conjoint

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17
Q

The internal oblique covers (the entire/ half of the) anterolateral abdominal wall.

A

The entire

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18
Q

The internal oblique runs further (anteriorly/posteriorly) than the external oblique and it attaches to the thoracolumbar fascia.

A

Posteriorly

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19
Q

The thoracolumbar fascia has this combined connection with what two muscles in the anterolateral abdominal wall?

Those two muscles will surround the quadratus lumborum with its anterior layer and middle layer, so there is a connection with these two muscles to lumbar stability. When it contracts it will pull on the thoracolumbar fascia and that is going to effect spinal stability.

A

The internal oblique and transverse abdominis

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20
Q

If we go with standing position (up right anatomic position) and I draw a line of pull. If the internal oblique contracts, the moving component is the (pelvis/thorax) and the line of pull is (contralateral/ipsilateral).

A

thorax; ipsilateral

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21
Q

So, when we are in anatomical neutral with feet on the ground and we contract our left internal oblique, it is going to contract to the (right/left)

A

Left

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22
Q

If the thorax is the moving component, the right external oblique when contracted will pull the thorax to the (right/left).

A

Left

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23
Q

The left internal oblique and the right external oblique can work (against each other/synergistically) together to turn the trunk.

A

synergistically

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24
Q

In anatomic neutral with our feet on the ground, using the trunk as the moving component, the external obliques when it contracts will turn the trunk (contralaterally/ipsilaterally).

A

Contralaterally

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25
Q

In anatomic neutral with our feet on the ground, using the trunk as the moving component, the internal obliques when it contracts will turn the trunk (contralaterally/ipsilaterally).

A

ipsilaterally

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26
Q

In anatomic neutral with our feet on the ground, using the pelvis as the moving component, the internal obliques when it contracts will turn the trunk (contralaterally/ipsilaterally).

A

Contralaterally

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27
Q

If the internal oblique and external oblique on the same side contract, you are going to get a (rotation/side bend) versus gravity.

A

Side bend

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28
Q

A synergistic action between the internal and external obliques will go in the direction of the (external/internal) oblique if the thorax is the moving component.

A

Internal

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29
Q

The transverse abdominus along with the internal oblique join with the thoracolumbar fascia (anteriorly/posteriorly). (Anteriorly/posteriorly) they join together at the conjoint tendon.

A

posteriorly; anteriorly

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30
Q

The conjoint tendon can be found (inferior/superior) to the superficial ring of the inguinal canal and you are going to find it (superficial/deep) to the external oblique aponeurosis and (medial/lateral) to the rectus abdominis.

A

superior; deep; lateral

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31
Q

The nerves and blood vessels of the anterolateral abdominal wall will run in-between what two muscles?

A

The internal oblique and transverse abdominis

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32
Q

The ventral rami that are coming around anteriorly from T7-T11 are known as ___ nerves because they run around the ribs. But when they enter the abdomen as they continue along their path and enter the abdomen, they become the ___ nerves.

A

intercostal; thoraco-abdominal

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33
Q

The T12 intercostal nerve is called the ____ nerve and it continues to the posterior abdominal wall and helps supply the anterolateral abdominal wall muscles.

A

Subcostal

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34
Q

The subcostal artery is at the level of T__

A

12

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35
Q

Anything that has the name SUBcostal means that it is below the level of T__

A

12

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36
Q

The lumbar portion of the lumbosacral plexus (lumbar plexus) originates inside the ____ muscle .

A

Psoas major

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37
Q

The psoas major and quadratus lumborum aid in lumbar (mobility/stability).

A

Stability

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38
Q

The inguinal ligament runs from the ____ to the _____

A

ASIS to the pubic tubercle

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39
Q

The inguinal canal is located (superior/inferior) to the inguinal ligament

A

Superior

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40
Q

The midpoint of the inguinal ligament is the location of the (superficial/deep) inguinal ring

A

Deep

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41
Q

From the midpoint of the inguinal ligament, just lateral to the pubic tubercle (4-5 cm long, sloping inferomedially) is the ____ canal.

A

Inguinal

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42
Q

The inguinal canal is (on top of/under) the inguinal ligament and the inguinal ligament is a part of the inguinal canal. The inguinal canal is not the full length of the inguinal ligament.

A

On top of

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43
Q

The inguinal ligament is part of the (internal/external) oblique aponeurosis. It is a thickening of the most inferior portion of the (internal/external) oblique to create that inguinal ligament.

A

external; external

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44
Q

At the transversalis fascia is where you are going to find the (superficial/deep) inguinal ring.

A

Deep

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45
Q

The deep inguinal ring is found more (medial/lateral) to the superficial inguinal ring.

A

Lateral

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46
Q

The superficial ring of the inguinal canal comes out through the (internal/external) oblique aponeurosis.

A

External

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47
Q

What makes up the floor of the inguinal canal ?

A

The inguinal ligament

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48
Q

What makes up the roof of the inguinal canal?

A

The internal oblique and the transverse abdominis

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49
Q

What makes up the anterior wall of the inguinal canal?

A

The external oblique aponeurosis

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50
Q

What makes up the posterior wall of the inguinal canal?

A

The transversalis fascia, the inferior fibers of the internal oblique, and the conjoint tendon

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51
Q

The (superficial/deep) ring of the inguinal canal is a defect (there is a hole and it is not perfectly covered like it is supposed to be) of the external oblique aponeurosis and it’s an actual ring.

A

Superficial

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52
Q

The (superficial/deep) inguinal ring is a depression more than a hole.

A

Deep

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53
Q

The superficial inguinal ring and deep inguinal ring (do not overlap/ overlap) and that’s important because if they overlap and you increase your abdominal pressure, a lot of stuff would come right out of the hole, so this is a way of keeping stuff in the pelvic cavity versus letting it shoot outside.

A

Do not overlap

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54
Q

As we contract our (internal/external) oblique muscle, we are compressing the superficial ring against the posterior abdominal wall.

A

External

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55
Q

The idea of the ___ canal is to get certain things out of the pelvic cavity to the external environment, but not allow things that aren’t supposed to come out slide out.

A

inguinal

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56
Q

The ___ cord exits the superficial ring and this cord contains the ductus deferens and associated blood vessels and lymph nodes

A

Spermatic

57
Q

You will find the spermatic cord and a branch of the ilioinguinal nerve coming out of the superficial ring of the inguinal canal for a biological (male/female).

A

Male

58
Q

You will find the round ligament of the uterus and the branch of the ilioinguinal nerve coming out of the superficial ring of the inguinal canal for a biological (male/female).

A

Female

59
Q

In an (direct/indirect) inguinal hernia, what is coming out, is coming through that canal.

A

Indirect

60
Q

In a (direct/indirect) inguinal hernia, what is coming out, is coming out next to the canal.

A

Direct

61
Q

The (direct/indirect) inguinal hernia is the more common hernia and the hernia they used to perform in sports physicals.

A

Indirect

62
Q

A (direct/indirect) inguinal hernia is where there is a weakness in the abdominal wall muscles and it pushes through them and exits through the superficial inguinal ring in the process.

A

Direct

63
Q

An (direct/indirect) inguinal hernia can be formed if pressure builds up in the abdomen and if there is any opening in the deep inguinal ring it is going to get pushed into the canal and as the pressure keeps building up it can work its way down the canal.

A

Indirect

64
Q

A (direct/indirect) inguinal hernia means you tore something in the abdomen wall or you had a defect there that no one knew about and the increased intrabdominal pressure pushed it out.

A

Direct

65
Q

For athletic pubalgia (sports hernia), what we know for sure is that there is a weakness or deficit of some sort in the ___ region but there’s no actual herniation of the tissue. There are no intestines coming out.

A

Inguinal

66
Q

In athletic pubalgia there are many tendons and ligaments coming together and they are all pulling on each other, and when there’s weakness in one it is going to lead to (increased/decreased) tension on the other and that is when patients end up with athletic pubalgia.

A

Increased

67
Q

The spleen is in the (right/left) (upper/lower) quadrant of the abdominal viscera

A

Left upper

68
Q

Half of the descending colon is in the (right/left) upper quadrant and (right/left) lower quadrant of the abdominal viscera

A

left; left

69
Q

The kidneys are found in the right and left posterior abdominal wall and found in the right and left (upper/lower) quadrants of the abdominal viscera

A

Upper

70
Q

The stomach is found in the (right/left) (upper/lower) quadrant of the abdominal viscera

A

Left upper

71
Q

The liver is found in the (right/lower) (upper/lower) quadrant of the abdominal viscera

A

Right upper

72
Q

The ascending colon is in the (right/left) upper and lower quadrant of the abdominal viscera

A

Right

73
Q

The duodenum is in the (right/left) (upper/lower) quadrant of the abdominal viscera

A

Right upper

74
Q

The abdominal aortic artery runs right down the midline of your vertebral bodies (T__ - L_).

A

T12-L4

75
Q

You will find the uterus in the (abdominal/pelvic) cavity for biological females.

A

Pelvic

76
Q

You will find the urinary bladder in the (abdominal/pelvic) cavity for both biological males and females.

A

Pelvic

77
Q

The greater ___ is part of the (parietal/ visceral) peritoneum that makes up the surrounding lining or internal surface of the abdominal pelvic wall.

A

omentum; visceral

78
Q

The (parietal/visceral) peritoneum is very large and covers the whole area on the inner wall

A

Parietal

79
Q

The (parietal/visceral) peritoneum is smaller than the parietal peritoneum and covers each individual organ.

A

Visceral

80
Q

The (parietal/visceral) peritoneum lines the internal abdominal pelvic wall and the (parietal/visceral) peritoneum lines the actual viscera themselves, so it is two layers.

A

parietal; visceral

81
Q

To get to the spleen you have to move the ___

A

Stomach

82
Q

The kidneys are retroperitoneal, they sit (in front of/behind) the (parietal/visceral) peritoneum in the right and left quadrants of the abdominal viscera.

A

behind; parietal

83
Q

At L__the abdominal aorta splits into common iliac arteries.

A

4

84
Q

You will find the fallopian tube (uterine tube) in the (abdominal/pelvic) cavity for biological females.

A

Pelvic

85
Q

What is the origin of external oblique?

A

It arises just lateral to the anterior extremities of the lower eight ribs. The Upper four interdigitate with serratus anterior and the Lower four interdigitate with lat dorsi.

86
Q

Describe the insertion of external oblique

A

It inserts into the outer half of the iliac crest, inguinal ligament, pubic tubercle, the aponeurosis of the rectus sheath and linea alba, and xiphisternum

87
Q

Borders of external oblique

A

It has Three borders: a posterior muscular, and an upper and lower aponeurotic. The first two lie free. The latter is rolled.

88
Q

Arterial supply of external oblique

A

Branches of superior and inferior epigastric, superficial epigastric, the lumbar and deep circumflex arteries, superficial circumflex iliac arteries, ascending branch of deep circumflex artery

89
Q

Borders of lumbar triangle of petit

A

Anterior border is the posterior margin of external oblique
Posterior border is the anterior margin of lat dorsi
Base is the iliac crest
Floor is the internal oblique

90
Q

What artery is at risk in a gridiron incision?

A

The ascending branch of the deep circumflex iliac artery

91
Q

What planes divide the abdomen into nine regions?

A

Left and right midclavicular lines: extend down to midinguinal points

Intertubercular plane: runs between the tubercles of the iliac crests

Transpyloric plane: found midway between the jugular notch and the top of the pubic symphysis. (Some clinicians use the supcostal plane, a little lower).

92
Q

Name the nine abdominal regions

A

Three rows from superior to inferior:
Left and right hypochondral and epigastric
Left and right lumbar and umbilical
Left and right iliac and hypogastric or suprapubic

93
Q

Innervation of external oblique

A

Lateral cutaneous branches of the lower intercostal and subcostal nerves (T7-12)

94
Q

What are the attachments and significance of the upper border of the external oblique aponeurosis

A

Runs free from the fifth rib to the xiphisternum. Is the only structure in the anterior rectus sheath above the costal margin.

95
Q

Describe the Innervation of internal oblique

A

Lower intercostal and subcostal nerves (T7-12) and iliohypogastric and ilioinguinal nerves (L1). The lowest fibres are innervated by L1 which is hence responsible for the integrity of the inguinal canal

96
Q

Innervation of transversus abdomens

A

Lower intercostal and subcostal nerves (T7-12) and iliohypogastric and ilioinguinal nerves (L1). The lowest fibres are innervated by L1 which is hence responsible for the integrity of the inguinal canal

97
Q

Innervation of pyrimidalis

A

Subcostal nerve T12

98
Q

Origin and insertion of the inguinal ligament of Poupart

A

ASIS to pubic tubercle

99
Q

What happens to the inguinal ligament when the thigh is extended?

A

The fascia lata pulls the ligament downward in a gentle convexity

100
Q

What abdominal muscles arise from which part of the inguinal ligament?

A

The edge of the ligament is inrolled. The internal oblique and transverses muscles arise from the lateral part of this gutter

101
Q

Describe the relations of the superficial inguinal ring

A

V shaped gap above and lateral to the pubic tubercle. The gap extends down to the pubic crest, medial to the tubercle. The aponeurosis is attached to the medial part of the pubic crest, beside the pubic symphysis.

102
Q

Describe the relations and give the eponym of the lacunar ligament

A

Gimbernat

Arises from the medial end of the inguianl ligament and extends backwards to the pectineal line

103
Q

What are the intercrural fibres?

A

Found at the apex of the superficial inguinal ring, fibres running at right angles to those of the aponeurosis. These blend and prevent the crura from separating.

104
Q

Where does the reflected part of the inguinal ligament run?

A

From the pubic tubercle, fibres running upwards and medially behind the spermatic cord to interdigitate in the linea alba

105
Q

The linea alba is (vascular/avascular)

A

Avascular

106
Q

Origin of internal oblique muscle

A

Lumbar fascia, anterior two thirds of iliac crest and lateral two thirds of inguinal ligament

107
Q

Insertion of internal oblique muscle

A

Costal margin, aponeurosis of rectus sheath (both ant and post), conjoint tendon to pubic crest and pectineal line.
The anterior configuration changes at the conjoint tendon
A free lower border arches over the spermatic cord - laterally in front of the cord, medially behind the cord

108
Q

Origin of transverse abdominis

A

Costal margin (from inside each costal cartilage, interdigitating with the costal origins of the diaphragm), lumbar fascia of quadrates lumborum,internal lip of iliac crest, the fascia over iliacus, and the lateral half of inguinal ligament deep to OM

109
Q

Insertion of transverses abdominus

A

Aponeurosis of post rectus sheath above arcuate line, and ant rectus sheath below arcuate line, fusing behind Internal Oblique Muscle fibres then together forming the conjoint tendon to pubic crest and pectineal line

110
Q

Origin of rectus abdominus

A

Two heads per belly; medial from pubic crest and lateral from pubic symphysis.

111
Q

Insertion of rectus abdominus

A

Most to 5th, 6th, 7th costal cartilages (= EOM), some to medial inferior costal margin (i.e. lower border of 7th costal cartilage = IOM, and the xiphisternal fibres of the diaphragm = int oblique)

IOM= internal oblique muscle
EOM= external oblique muscle

112
Q

Insertion of rectus abdominus

A

Most to 5th, 6th, 7th costal cartilages (= EOM), some to medial inferior costal margin (i.e. lower border of 7th costal cartilage = IOM, and the xiphisternal fibres of the diaphragm = int oblique)

IOM= internal oblique muscle
EOM= external oblique muscle

113
Q

Action of rectus abdominus

A

Flexes trunk, aids forced expiration and increases Intra abdominal pressure

114
Q

Action of external and internal oblique muscles

A

Support, expiration, raises intra abdominal pressure (IAP) and with muscles of opposite side abducts and rotates trunk

115
Q

Action of transversus abdominus

A

Support, expiration, conjoint tendon supports inguinal canal

116
Q

Action of pyrimidalis

A

Reinforces rectus sheath

117
Q

Origin of pyrimidalis

A

Pubic crest, anterior to origin of rectus abdominus, but posterior to RA’s sheath.

118
Q

Insertion of pyrimidalis

A

Lower linea alba, approx 4cm or 1.5inch above its origin

119
Q

Describe the body of rectus abdominus

A

The two bellies lie edge to edge below the arcuate line. Separated by the linea alba above the arcuate line. Three tendinous intersections - umbilicus, xiphisternum, and one between these two. Sometimes also found below the umbilicus. Intersections are superficial only - do not involve the posterior sheath.

120
Q

Linea alba origin and insertion

A

From xiphoid process to pubic symphysis. Lower portion very narrow. Broadens from just below the umbilicus.

121
Q

Which muscles form what parts of the rectus sheath?

A

EOM anterior, TAM posterior, IOM splits around. Below the arcuate line all pass anteriorly. Here TAM and IOM fuse completely, EOM only fuses in the midline.

EOM= External oblique muscle
TAM= transverse abdominis muscle
IOM= internal oblique muscle

122
Q

What is the semilunar line?

A

A shallow and bloodless groove running from the pubic tubercle to the costal margin (at the transpyloric plane), formed by the splitting of Internal oblique muscle aponeurosis around Rectus abdominis

123
Q

Describe the nerve supply to rectus abdominis and its sheath

A

Posterior intercostal nerves T7-11 pass between TAM and IOM and enter the sheath and enter the midline of the rectus by piercing the posterior layer of IO aponeurosis.. They pass through the anterior sheath to become the anterior cutaneous nerves.
T7 runs up, T8 transverse, the rest obliquely downwards

124
Q

How do cutaneous nerves to the lateral abdominal wall arise?

A

Posterior intercostal nerves T7-11 run between IOM and TAM. Before reaching the sheath they give off lateral cutaneous branches which pierce IOM and EOM to the skin and supply EOM also.

125
Q

What does the subcostal nerve supply?

A

T12 subcostal supplies Ant abdominal Wall, Rectus abdominis muscle , Pyramidalis muscle , and has a lateral cutaneous branch to the buttock

126
Q

Describe the vascular supply to the anterior abdominal wall

A

Superior epigastric artery passes through the diaphragm to anastomose with inf epigastric artery within rectus abdominus. Inferior epigastric arises from the external iliac artery at the inguinal ligament, passes behind the conjoint tendon and enters RA via the arcuate line. The deep circumflex iliac artery arises from ext iliac, runs laterally to ASIS between TAM and iliac fascia, and anastomoses with iliolumbar and gluteal arteries. At the ASIS it gives off an ascending branch which enters the NV plan to anastomose with IEA and lumbar arteries.
Lumbar arteries supply the anterolatereal abdominal wall but do not reach the rectus sheath.

127
Q

Describe the venous drainage of the anterior abdominal wall

A

Veins accompany arteries

128
Q

Describe the lymphatic drainage of the abdominal wall

A

Superficial lymph drainage in quadrants to the pectoral group of axillary nodes above and the superficial inguinal below. Deep is into extra peritoneal tissue then above to mediastinal and below to external iliac and para-aortic

129
Q

What are the four actions of the abdominal muscles?

A

Move the trunk - ant and wall is the flexor of the vertebral column but not TAM

Depress the ribs for expiration - recti and obliques, not TAM

Compress the abdomen EOM, IOM, and aided strongly by TAM

Support the viscera

EOM and IOM but not transversus are abductors and rotators of the trunk - L) EOM works with R) IOM and vice versa. Needed for one armed movements e.g. tennis.

130
Q

What are the contents of the rectus sheath?

A

Rectus abdominus
Pyramidalis
The ends of the lower six thoracic nerves and their accompanying posterior intercostal vessels

131
Q

How else may the arcuate line be known?

A

The semicircular line of Douglas :)

132
Q

How does the diaphragm overcome being weaker than the abdominal wall?

A

Closure of the glottis =/- closure of the mouth and nasopharynx

133
Q

How do you test the anterior abdominal wall muscles?

A

Test Rectus abdominis by lying on back and raising head without using the arms. No specific tests for the others.

134
Q

What layers does a midline incision go through?

A

Skin, subcutaneous tissue, line alba, transversalis fascia, extra peritoneal fat and peritoneum. No major vessels or nerves involved.

135
Q

Describe a paramedian incision

A

3cm from the midline, sheath split <1cm from the midline, and posterior wall incised.

136
Q

What incision is 3cm parallel to and below the R) costal margin?

A

Kocher incision or R) subcostal.

Double Kocher = rooftop = good access to upper abdomen

137
Q

What is a gridiron incision?

A

A transverse muscle splitting technique

138
Q

What lower abdominal transverse incision is used for pelvic access?

A

Pfannenstiel incision.

139
Q

What is a lumbar incision used for?

A

An extra peritoneal approach to the kidney and upper ureter.

Abdomen Part 1 By Martha-Angella (7 decks)

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