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GI Midterm > Lecture 1 And 2 PPT Ant. Abd. Wall > Flashcards

Lecture 1 And 2 PPT Ant. Abd. Wall Flashcards

1
Q

Pelvic inlet (linea terminalis)

A

Separates the true pelvis from the false pelvis

  • Superior to the linea terminalis is the abdomen/false pelvis
  • Inferior to the linea terminalis is the true pelvis
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2
Q

Pelvic inlet is formed by?

A
  • Pectin pubis (pubic bone)
  • Arcuate line (ilium)
  • Sacral promontory (sacrum)
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3
Q

Linea semilunaris

A
  • Lateral border of the rectus abdominis muscle

- Aponeurosis

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4
Q

Linea alba

A
  • Midline

- Aponeurosis

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5
Q

4 horizontal abdominal planes?

A
  • Subcostal
  • Transtubercular
  • Transumbilical
  • Transpyloric
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6
Q

Subcostal plane

A
  • 10th costal cartilage

- Superior border of LV3

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7
Q

Transtubercular plane

A
  • Tubercles of the iliac crests

- Body of LV5

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8
Q

Transumbilical plane

A
  • LV3-4

- Similar to supracristal plane

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9
Q

2 vertical planes

A

Midclavicular and midsagittal

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10
Q

Midclavicular

A

Midpoint of clavicle and midinguinal point

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11
Q

Midsagittal (median)

A
  • Linea alba

- Passes though umbilicus

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12
Q

Contents of abdominal quadrants

-Right Upper Quadrant (RUQ)

A

Gallbladder, duodenum, right pleura, liver (right lobe) and right kidney

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13
Q

Left Upper Quadrant

-Contents?

A

Spleen, stomach, left pleura, tail of the pancreas, left kidney

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14
Q

Right lower quadrant

-Contents?

A

Right ureter, cecum, ileal diverticulum, vermiform appendix

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15
Q

Left lower quadrant

-Contents?

A

Left ureter, descending and sigmoid colon

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16
Q

9 abdominal regions

A

See slide 19/20

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17
Q

Muscles and aponeuroses

-Organized into three groups-Anterior?

A

Rectus abdominis and pyramidalis

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18
Q

Anterolateral?

A

EO, IO, and transversus abdominis

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19
Q

Posterior?

A

Iliacus, psoas major/minor, and quadratus lumborum

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20
Q

McBurney’s point

  • Where is it located?
  • Used for what common surgery?
A
  • 1/3 of the way between the ASIS and the umbilicus (going lateral to medial)
  • Used for appendectomies
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21
Q

External abdominal oblique

-Which way do the fibers run?

A

Inferomedially (hands in pockets)

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22
Q

External abdominal oblique

-Characteristics of the aponeurosis?

A
  • Wide
  • Begins at midclavicular lines
  • Goes to midline
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23
Q

External abdominal oblique

-Aponeurosis goes to midline to meet aponeurosis of the other side-forming?

A

Linea alba

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24
Q

External abdominal oblique

-Inguinal ligament

A

Specialized part of the lower free margin of the aponeurosis

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25
Q

Where does the inguinal ligament attach?

A

The ASIS and the pubic tubercle

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26
Q

Superficial inguinal ring

A

A triangular opening in the EO aponeurosis between the pubic tubercle and the pubic symphysis

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27
Q

Superficial inguinal ring

-Formed by?

A
  • Medial crus
  • Lateral crus
  • Intercrural fibers
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28
Q

Lacunar ligament

  • How is it formed?
  • Where is the apex?
A

An “extension” of the inguinal ligament

  • triangular in shape
  • apex at pubic tubercle
  • base is concave, lateral and sharp
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29
Q

The lacunar ligament is important for what type of hernia? How?

A

Femoral hernia

-Its sharp free edge cuts into the femoral canal which enlarges with a femoral hernia

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30
Q

Pectineal ligament

A

The lateral-posterior extension of the lacunar ligament that runs along the pectineal line
-Can also form a sharp border that can constrict a femoral hernia

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31
Q

Internal abdominal oblique

-Which way do the fibers run?

A

Superomedially

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32
Q
  • *Cremaster muscle is from which layer?**

- surrounds?

A

the internal oblique layer

-Surrounds the spermatic cord

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33
Q

The internal oblique helps to form the?

A

Conjoint tendon

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34
Q

Transversus abdominis muscle

  • Location relative to the other layers?
  • Aponeurosis-where does it begin?
A
  • Innermost of the three layers

- Wide aponeurosis begins at the semilunaris

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35
Q

Transversus abdominis muscle

-Which way do the fibers run?

A

Horizontally

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36
Q

Conjoint tendon

-formed by?

A

Transversus abdominis (medially) and internal oblique

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37
Q

Where do nerves and vessels run?

A

Between internal oblique and transversus abdominis

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38
Q

Rectus abdominis

-characteristics?

A

Strap muscles

broad superiorly and narrow inferiorly

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39
Q

Rectus abdominis

-Tendinous intersections-position relative to fibers?

A

Perpendicular to fibers

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40
Q

Rectus abdominis

-Enclosed by?

A

Rectus sheath

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41
Q

Pyramidalis

  • Attaches to?
  • Action?
A
  • Often absent
  • Attaches to the pubic crest
  • Tenses linea alba
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42
Q

Rectus abdominis

-Function?

A
  • Fixes abdomen-contracts to maintain stability

- Flexes (brings thoracic cage closer to thighs)

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43
Q

External oblique

-Function?

A

-Unilaterally-lateral bending and twisting toward midline

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44
Q

Internal oblique

-Function?

A

-Lateral bending and twisting toward ilium

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45
Q

Transversus abdominis

-Function?

A
  • Primarily a girdle (supporting abdomen)

- Important for Valsalva manuever, defecation, parturition (anything where you are contracting)

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46
Q

Camper’s fascia

A
  • More superficial

- Fatty layer

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47
Q

Camper’s fascia

-Continuous with?

A

Continuous with the superficial fatty layers in the thorax, thigh and perineum

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48
Q

Scarpa’s fascia

A
  • Deep to Camper’s

- Membranous layer

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49
Q

Scarpa’s fascia

-Continuous with?

A

Continuous with the fascia lata in the thigh and the deep perineal fascia (penis/scrotum)

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50
Q

Deep fascia of the abdominal wall

  • Compared to the membranous layer of superficial fascia?
  • Why is it clinically important?
A

Investing fascia of the muscles

  • Does not follow the same pattern as the membranous layer of superficial fascia
  • Clinically important, holds sutures
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51
Q

Potential space between Scarpa’s fascia and the deep fascia of the EO musle
-Why is this significant?

A

Fluid can leak into this space

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52
Q

Rectus sheath-formed by?

A

Formed by the fusion of the abdominal muscles and their associated facias (EO, IO and transversus abdominis)

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53
Q

Rectus sheath encloses?

A

the rectus abdominis muscle and pyramidalis muscle (if present)

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54
Q

Internal thoracic artery splits into?

A

Musculophrenic and superior epigastric arteries

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55
Q

Deep system of arteries

A

Musculophrenic, superior and inferior epigastric, intercostal, subcostal, lumbar, deep circumflex iliac

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56
Q

Inferior epigastric artery

-If a hernia is medial to this artery, what type of hernia is it?

A

Direct inguinal hernia

If hernia is Lateral to inferior epigastric artery, it is an indirect inguinal hernia

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57
Q

Superficial system of arteries

A

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

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58
Q

Anterior abdominal wall veins

-Deep drainage-where are the veins located?

A

Within abdominal wall muscles along with arteries

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59
Q

Anterior abdominal wall veins

-Deep drainage-What veins do they drain to?

A

-to subclavian vein, external iliac, lumbar, and intercostal veins

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60
Q

Anterior abdominal wall veins

-Superficial drainage-Where are the veins located?

A

Within Camper’s fascia

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61
Q

Anterior abdominal wall veins

-Superficial drainage-3 main veins?

A

THORACOEPIGASTRIC, lateral thoracic, and superficial epigastric

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62
Q

Thoracoabdominal intercostal nerves

  • Lateral cutaneous branches
    • where do they emerge?
    • Bifurcate into?
A

Emerge anterior axillary region

Bifurcate into anterior and posterior branches

63
Q

Thoracoabdominal intercostal nerves

-Anterior cutaneous branches end with?

A

medial and lateral branches

64
Q

Anterior abdominal wall nerves

-Sensory dermatomes

65
Q

T7-region?

A

Xiphoid region (tip)

66
Q

T10-region?

67
Q

L1-region?

A

Inguinal fold region

68
Q

Intercostal nerves

69
Q

Subcostal nerve?

70
Q

Lumbar nerves?

71
Q

Anterior abdominal wall nerves

  • Branches of?
  • Lie between what muscles?
A
  • Branches of ventral rami and intercostal nerves

- Lie between IO and tranversus abdominis

72
Q

Anterior abdominal wall nerves

-Pierce the rectus sheath to innervate what muscle?

A

Rectus abdominis

73
Q

Anterior abdominal wall nerves

-Supply?

A

Skin, muscles, and parietal peritoneum

74
Q

Iliohypogastric n

A

L1 (and T12 sometimes)

75
Q

Ilioinguinal n

76
Q

Genitofemoral n

77
Q

Iliohypogastric n

-Where does it run?

A
  • Exits the posterior abdominal wall between the quadratus lumborum and psoas muscles
  • Enters the anterolateral abdominal wall and runs between muscles
  • Exits to become cutaneous (lateral and anterior cutaneous branches)
78
Q

Iliohypogastric n

-What region does it supply?

A

Suprapubic region

79
Q

Ilioinguinal nerve

-Where does it run?

A
  • Exits the posterior abdominal wall between quadratus lumborum and psoas muscles
  • Enters the anterolateral wall between muscles
  • Enters the inguinal canal and emerges through the superficial inguinal ring
80
Q

Ilioinguinal nerve

-What does it supply?

A

Supplies groin, thigh, and scrotum/labium majus

81
Q

Genitofemoral nerve

-Where does it run?

A

Exits posterior abdominal wall through psoas muscle

-Runs between the peritoneum and psoas muscle

82
Q

Genitofemoral n

-Genital branch-where does it run?

A

-Enters the inguinal canal through the deep inguinal ring and exits the inguinal canal through the superficial inguinal ring

83
Q

Genitofemoral n

-Genital branch-what does it innervate?

A

Innervates the cremaster muscle or is cutaneous to the labium majus

84
Q

Genitofemoral n

-Femoral branch-where does it exit?

A

Exits inferior to the inguinal ligament

85
Q

Genitofemoral n

-Where is it located relative to the femoral triangle?

A

Cutaneous to the femoral triangle area

86
Q

Anterior abdominal wall lymphatics

  • Superficial lymphatic drainage
    • Superiorly?
A

Drains superiorly from umbilical region to anterior axillary and sternal nodes

87
Q

Anterior abdominal wall lymphatics

  • Superficial lymphatic drainage
    • Inferiorly?
A

Drains inferiorly from umbilical region to superficial inguinal nodes

88
Q

Anterior abdominal wall lymphatics

-Deep lymphatic drainage

A
  • Along posterior intercostal and lumbar vessels to deep abdominal nodes
  • From testes to deep abdominal nodes
89
Q

Umbilical hernias-in infants

A
  • Involve the umbilicus
  • Scar of umbilicus did not heal completely
  • Usually small and wider transversely
  • Usually heal spontaneously
90
Q

Umbilical hernias-in adults

  • result from?
  • Where are they usually located?
  • more common in what gender?
A
  • Result from weakened abdominal wall around umbilicus
  • Usually superior to umbilical scar
  • More common in women
  • Require surgical repair
91
Q

Epigastric hernias

  • Protrudes through?
  • Where are they located usually?
  • More common in what gender?
A
  • Do not involve the umbilicus
  • Protrudes through the linea alba
  • Are usually superior to the umbilicus
  • More common in men
92
Q

Inguinal canal

-Floor?

A

Inguinal and lacunar ligaments

93
Q

Inguinal canal

-Roof?

A

Internal abdominal oblique fibers

94
Q

Inguinal canal

-Anterior wall?

A

External abdominal oblique

95
Q

Inguinal canal

-Posterior wall?

A

Transversalis fascia and conjoint tendon

96
Q

Where does the inguinal canal start?

A

Deep inguinal ring

97
Q

Where does the inguinal canal end?

A

Superficial inguinal ring

98
Q

Hesselbach’s triangle is only covered by?

A

Transversalis fascia

99
Q

Rectus sheath-above the arcuate line

-Order (from outside to inside)?

A
  • Skin
  • Camper’s
  • Scarpa’s
  • Aponeurosis of EO fascia (2 layers)
  • 1 layer of IO aponeurosis
  • Rectus abdominis muscle
  • Arcuate line
  • 1 layer of IO aponeurosis
  • Aponeurosis of transversus abdominis (2 layers)
  • Transversalis fascia
  • Extraperitoneal tissue
  • Parietal peritoneum
100
Q

Rectus sheath-Below the arcuate line

-Order (from outside to inside)?

A
  • Skin
  • Camper’s
  • Scarpa’s
  • EO aponeurosis (2 layers)
  • IO aponeurosis (2 layers)
  • Transversus abdominis aponeurosis (2 layers)
  • Rectus abdominis muscle
  • Arcuate line
  • Transversalis fascia
  • Extraperitoneal tissue
  • Parietal peritoneum
101
Q

The deep system of arteries

-originate superiorly from?

A

the subclavian artery to the internal thoracic

102
Q

The deep system of arteries

-originate inferiorly from?

A

the external iliac artery

103
Q

The deep system of arteries

-branches in the mid-abdomen come from?

A

the abdominal aorta

104
Q

The superficial system of arteries

-originate superiorly from?

A

Perforating branches

105
Q

The superficial system of arteries

-Originate inferiorly from branches of the?

A

femoral artery

106
Q

Where does the ductus deferens (round ligament) exit the abdomen?

A
  • Posterior to the peritoneal cavity

- As the ductus emerges and goes through the anterior wall, it picks up layers as it goes through them

107
Q

External iliac artery and vein are posterior to peritoneal cavity
-Once they cross the inguinal ligament, they become?

A

Femoral artery and vein

108
Q

Main branches of the femoral artery/vein?

A
  • Inferior epigastric artery/vein

- Cremasteric arteries

109
Q

Where does the spermatic cord enter the canal?

A

Deep inguinal ring

110
Q

Descent of the testes

-Testes develop?

A
  • Testes develop retroperitoneally from the urogenital ridge of mesoderm in the upper lumbar/lower thoracic region
    • migrate inferiorly
111
Q

Testes are attached to the?

-What is its function?

A
  • Gubernaculum which is attached inferiorly to the labial-scrotal fold
  • It guides the migration
112
Q

Descent of the testes-process

  • By the 7th month?
  • Meanwhile?
A
  • The testes have reached the deep inguinal ring

- Meanwhile, a pouch of peritoneum, processus vaginalis develops and pushes into labial-scrotal swelling

113
Q

Descent of the testes-process cont

-As the testes go through?

A
  • As the testes go through the inguinal canal, they carry layers of anterior abdominal wall muscles and fasciae with them
  • The gubernaculum “shortens” and pulls the testes into the developing scrotum
  • The processus vaginalis continues to develop within the labial-scrotal fold
114
Q

Descent of the testes-process

  • Testes are now within the scrotum (around the time of birth)
    • Where do they slide in?
A

posterior to the processus vaginalis (should close)

115
Q

What do the testes pull down with them?

A

Epididymus, ductus deferens, testicular vessels, nerves, and lymphatics

116
Q

The processus vaginalis (normally) closes off and becomes an isolated pocket of peritoneum called the?

A

Tunica vaginalis

117
Q

Cryptorchidism

A
  • Undescended testes
  • Unilateral or bilateral
  • Associated with a higher incidence of testicular cancer
118
Q

Hydrocele/Hematocele

A

water (?) or blood in the tunica vaginalis

119
Q

As the testes descends through inguinal canal, it “acquires” what fascial layers?

A
  • Internal spermatic fascia
  • Cremaster fascia and muscle
  • External spermatic fascia
  • Tunica vaginalis (partially covers testes)
120
Q

Descent of the ovaries

-Primative ovaries are also attached to a?

A

Gubernaculum which is attached to the labioscrotal fold

121
Q

Descent of the ovaries

-process?

A
  • Ovaries descend into the pelvis and attach to the developing uterus
  • The gubernaculum becomes attached to the posterior area of the developing uterus
122
Q

Descent of the ovaries

-The gubernaculum forms?

A

the round ligaments of the ovary (ovarian ligaments) and the round ligaments of the uterus

123
Q

Female inguinal canal contents?

A
  • Round ligament of the uterus
  • Ilioinguinal n
  • Genital branch of genitofemoral n
124
Q

Where does the round ligament enter the inguinal canal?

A

Deep inguinal ring

125
Q

Where does the round ligament exit the inguinal canal?

A

Superficial inguinal ring through the EO muscle

126
Q

Male inguinal canal contents?

A
  • Ductus deferens,
  • Ductus deferens artery
  • Ilioinguinal n
  • Genital branch of genitofemoral n
  • Testicular artery
  • Pampiniform plexus of veins
  • Lymphatics
127
Q

Where does the spermatic cord exit the inguinal canal?

A

Superficial inguinal ring through the EO muscle

128
Q

Coverings of the spermatic cord?

A
  • External spermatic fascia
  • Cremasteric fascia and muscle with genital branch of genitofemoral n
  • Internal spermatic fascia
129
Q

All contents of the inguinal canal (male) are surrounded by?

A

Internal spermatic fascia

130
Q

The testis and epididymis are partially covered by?

A

the tunica vaginalis (2 layers-parietal and visceral)

131
Q

Testes is held to scrotum by?

A

gubernaculum

132
Q

Function of efferent ductules?

A

Carry sperm from testes to head of epididymis

133
Q

Ductus deferens is continuous with?

A

Tail of epididymis

134
Q

Ductus deferens continues through spermatic cord into?

135
Q

Tunica albuginea

A

Connective tissue capsule of the testis

136
Q

Rete testis

137
Q

Sinus epididymis

A

A space of visceral layer of tunica vaginalis

138
Q

Femoral hernias exit the abdomen through the?

A

femoral canal, INFERIOR TO THE INGUINAL LIGAMENT

139
Q

Direct inguinal hernia-location relative to the inferior epigastric artery?

A

neck of the hernial sac is MEDIAL

140
Q

Direct inguinal hernia

  • How does it happen?
  • Usually due to?
A
  • Pushes “directly” through the anterior abdominal wall through a “weak” abdominal triangle
  • Usually due to a weak conjoint tendon
141
Q
  • Which type of hernia is more often bilateral-direct or indirect?
  • More common in?
A
  • Direct inguinal hernias are more often bilateral than indirect
  • More common in older males
142
Q

Indirect inguinal hernia-location relative to the inferior epigastric artery?

A

Neck of the hernial sac lies LATERAL to the inferior epigastric artery

143
Q

Indirect inguinal hernia

  • How does it happen?
  • Often due to?
A
  • Pushes through the deep inguinal ring, through the deep inguinal ring, and exits through the superficial inguinal ring
  • Often due to incomplete closure of the processus vaginalis
144
Q

Indirect inguinal hernias

-common in?

A

Common in young males

145
Q

Most inguinal hernias are which type?

146
Q

Only layer that is lost when talking about spermatic is the?

A

Transversus abdominis

147
Q

2 muscles that draw the testes closer to the body when it needs to be warmed?

A

Cremaster and dartos muscles

148
Q

Layers of the anterior abdominal wall and the layers of the scrotum that are derived from them:
-What is derived from Scarpa’s fascia?

A

Dartos muscle/fascia

149
Q

What is derived from the EO muscle?

A

External spermatic fascia

150
Q

What is derived from IO muscle?

A

Cremaster muscle

151
Q

What is derived from the fascia of both superficial and deep surfaces of the IO muscle?

A

Cremasteric fascia

152
Q

What is derived from the transversalis fascia?

A

Internal spermatic fascia

153
Q

What is derived from peritoneum?

A

Processus vaginalis and tunica vaginalis

GI Midterm (11 decks)

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