Lecture 10 DA

Question 1

Which muscle is responsoble for retracting the testes when it’s cold, and what structure is it derived from?

Answer 1

It is the cremaster muscle, which is derived from internal oblique fibres (try not to nuke this word pls).

Question 2

What is a hernia? What is an abdominal hernia?

Answer 2

A hernia is a protrusion of contents, anywhere.

An abdominal hernia is a protrusion of abdominal contents.

Question 3

What kind of disease is bilateral indirect inguinal hernia, and what happens to those afflicted?

Answer 3

It is a congenital disease, where there is a protrusion through the deep ring into the inguinal canal, to the scrotum, following the testis through the canal.
It can be pushed back up through the rings by pushing superiorly, then laterally.
Once fully retracted, placing a finger over the inguinal ligament will stop the hernia redeveloping. Asking the patient to cough will mean you can feel it trying to redevelop. If you let go, you can see the hernia redevelop after coughing.

Question 4

What is an indirect hernia?

Answer 4

It is the incomplete closure of the processus vaginalis. Abdominal contents can bulge through it.

Question 5

What is the processus vaginalis?

Answer 5

It is the perotineal pouch taken by the testis as it descends, and is normally obliterated. Fully incomplete obliteration is called patent processus vaginalis, where partial incomplete obliteration is known as partially patent p. v.

Question 6

What is a bilateral direct inguinal hernia?

Answer 6

It occurs when the abdominal muscles bulge against weak abdoinal muscles. Specifically, this occurs medially and inferiorly, lateral to the rectus absominus muscle. There is a window of weak muscle in this disease. It is called the inguinal triangle.

Question 7

Where is the psoas major in relation to the transverse vertebrae? Where can psoas minor be found, and what is special about it?

Answer 7

Psoas major overlies the transverse processes, and psoas minor overlies the psoas major muscle. It is a vestigial muscle.

Question 8

Where is the quadratus lumborum muscle found?

Answer 8

It is found edge to edge laterally to psoas major, and above iliacus. Its fibres are on the same plane as iliacus, and will eventually merge to form the iliopsoas.

Question 9

How are the anterior and posterior abdominal wall muscles connected?

Answer 9

They are connected by a strong fascia.

Question 10

At what vertebral levels does psoas major attach and insert, and what can be said about its fibres relative to its lateral border?

Answer 10

It attached from T12-L5, attaching to the disks as well. Its lateral border is oblique, but its fibres are still straight.

Question 11

Where does psoas major pass relative to the inguinal ligament?

Answer 11

It passes under the inguinal ligament. It inserts to the lesser trochanter of the femur as iliopsoas.

Question 12

Describe the attachment and insertions of the quadratus lumborum muscle.

Answer 12

It attaches to the tips of the transverse processes, and inserts to the 12th rib, stabilising it. Acts as a lateral flexor and attaches to the posterior half of the iliac crest.

Question 13

Where does ilIacus originate from?

Answer 13

It originates from the iliac fossa. It is a converging muscle.

Question 14

If iliacus and psoas major merge later on, does that mean they are in the same fascia?

Answer 14

No, they have their own fascia.

Question 15

Where is psoas major in relation to the vertebral body?

Answer 15

It is edge to edge with the vertebral body.

Question 16

Where is quadratus lumborum relative to the vertebral body?

Answer 16

It is posterior to it, and edge to edge with psoas major.

Question 17

What is the clinical significance of tuberculosis melitus to the vertebral body?

Answer 17

It can grow in the vertebral body, and then rupture into psoas major fascia. It is a very strong fascia, so rather than rupture, it becomes an abcess in the groin.

Question 18

How many layers of the thoracolumbar fascia are there, and where do they attach/insert?

Answer 18

There are 3 layers
Posterior attaches to the tips of the spinous processes
Middle attaches to the tips of the transverse processes
Anterior overlies the transverse processes
All fuse at the tip of the 12th rib, an attachment to transversus abdominus, as does internal and external oblique. It doesn’t anchor, so there is a free posterior border, due to latissimus dorsi.

Question 19

Where does the fascia of erector spinae originate from?

Answer 19

It originates from the middle and posterior fascia layers of psoas major.

Question 20

Where is the lumbar plexus found?

Answer 20

It is found entirely in psoas major. Its branches emerge from its lateral borders. They mostly move with psoas to the lower limbs however.

Question 21

Describe the pathway taken by the groins neurovascular supply.

Answer 21

It begins by emerging onto quadratus lumborum, where it enters the neurovascular layer of the anterior abdominal wall, to head to the groin.

Question 22

What shape is the abdominal cavity?

Answer 22

Kidney-shaped.

Question 23

What is a mesentery?

Answer 23

A double folded perotineum.

Question 24

What is meant by retro and intraperotineal?

Answer 24

Retroperotineal - Covered by perotineum anteriorly, but against the posterior abdominal wall posteriorly.
Intraperotineal - within the perotineum.

Question 25

Where are the kidneys found?

Answer 25

They are found in the aravertebral gutters, slightly behind the vertebral body. It overlies quadratus lumborum, and found under the 12th ribs.

Question 26

Do the kidneys move?

Answer 26

Yes, they move up and down with the diaphragm.

Question 27

Where are the two kidneys relative to each other?

Answer 27

The right kidney is pushed down by the liver.

Question 28

What are the dimensions of the kidney?

Answer 28

It is 10cm tall, 5cm wide, and 2.5cm thick. It is bean-shaped.

Question 29

Where are the adrenal glands found? Are they symmetrical?

Answer 29

They are found at the apex of the kidneys. They are not symmetrical.

Question 30

What are the solid viscus?

Answer 30

Kidney, stomach, pancreas and spleen.

Question 31

What are solid viscera borders determined by?

Answer 31

They are determined by surrounding structures. They will always have a hilum at which their neurovacular supply enters.

Question 32

What is the kidney surrounded by?

Answer 32

A fat pad, and then a fascia called renal fascia over the fat.

Question 33

Describe the innter structure of the kidney.

Answer 33

It has an outer cortex, which is paler and continuous. It surrounds the inner medulla, which is darker, discontinuous and cone shaped, called medullary pyramids.

Question 34

Which direction does the kidneys hilum face?

Answer 34

It faces anteromedially.

Question 35

Describe the vessels at the hilum in order of appearance (superficial to deep).

Answer 35

Superficial most
Vein
Artery
Pelvis (Ureter)
Deepest

Question 36

Where is the renal sinus found?

Answer 36

Just past the renal hilum.

Question 37

Where does blood supply to the kidney come from, and where does it originate?

Answer 37

It is supplied by the renal artery, and it is a branch off the abdominal aorta. It is horizonal and direct.

Question 38

Where is the IVC relative to the aorta? How does this affect the right renal artery?

Answer 38

It lies to the right of the aorta. The right renal artery will pass behind the IVC on its way to the kidney.

Question 39

What happens to the renal artery after entering the kidney?

Answer 39

It splits into segmental arteries, each of which supply one segment of the kidney. A vein drains each segment.