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Reproduction and Sexual Health > O and G surgical incisions > Flashcards

O and G surgical incisions Flashcards

1
Q

name 4 types of common O + G surgical incisions

A
  • lower segment caesarean section (LSCS)
  • laparotomy
  • laparoscopy
  • abdominal (and vaginal) hysterectomy
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2
Q

what kind of procedure involves a vertical midline incision?

A
  • laparotomy
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3
Q

what 2 procedures involve a supra-pubic incision?

A
  • LSCS, abdominal hysterectomy
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4
Q

describe layers of anterolateral abdominal wall

A
  • skin
  • superficial fascia
  • rectus sheath
  • rectus abdomnis
    laterally
  • external oblique muscle
  • internal oblique muscle
  • transversus abdominis

then reach internal lining of abdominal cavity

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5
Q

external obliques run in what kind of direction

A
  • anteroinferior direction from ribs 5-12
  • run in same direction as external intercostals
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6
Q

where do external oblique muscles attach between?

A
  • lower ribs and iliac crest, pubic tubercle, and linea alba
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7
Q

at mid-clavicular line and spino-umbilical line (line between ASIS and umbilical area) turns into an aponeurosis and this is described as a

A
  • flattened tendon
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8
Q

internal obliques run in the same direction as

A
  • the internal intercostals (Opposite direction of external obliques)
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9
Q

internal obliques attach between where?

A
  • lower ribs, thoracolumbar fascia, iliac crest and linea alba
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10
Q

fibres from external oblique blend in with what other fibres?

A
  • internal obliques
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11
Q

transversus abdominis attach between where?

A
  • between lower costal cartilages, thoracocolumbar fascia, iliac crest and linea alba
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12
Q

rectus abdomins lie between where

A
  • 5-6th costal cartilages towards pubic symphysis
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13
Q

rectus abdominis divide into 3 or 4 smaller muscles by

A
  • tendinous intersections
    > why you have 6 pack/8 pack
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14
Q

within linea alba there is a defect called the

A
  • umbilical ring
  • fetal umbilical vessels pass here to reach placenta
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15
Q

how is linea alba formed?

A
  • formed by interweaving of muscle aponeuroses
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16
Q

where is rectus sheath located

A
  • immediately deep to superficial fascia
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17
Q

what is rectus sheath

A
  • combined aponeuroses of anterolateral abdominal wall muscles
  • surrounds rectus abdominis muscles (external oblique (anterior), internal oblique, transverse abdominis muscle and more centrally rectus abdominis)
18
Q

what else runs through rectus sheath

A
  • nerves and vessels
19
Q

what is always contributing to anterior rectus sheath?

A
  • external oblique muscles
20
Q

below belly button describe rectus sheath

A
  • anterior rectus sheath, as muscles all aponeurose anteriorly to rectis abdominis muscle
  • does this about a 1/3 of the way between umbilicus and pubic crest
21
Q

above belly button describe rectus sheath

A
  • anterior and posterior rectus sheath
22
Q

internal surface of abdominal wall

A

from most superficial
- tranversalis fascia
- layer of extra peritoneal fat
- parietal peritoneum (most internal)

once through this in peritoneal cavity and can access abdominal organs

23
Q

nerves that supply anterolateral abdominal wall enter from what direction?

A
  • lateral direction
  • come from 7th to 11th intercostal nerves (intercostal space) and become thoracoabdominal nerves (abdominal wall)
    > continuation
24
Q

describe 3 other nerve supplies to anterolateral abdominal wall and where they arise from?

A
  • subcostal (T12)
  • iliohypogastric (L1)
  • ilioinguinal (L1)

> these nerves supply both motor and sensory innervation to abdominal wall muscles

25
Q

nervous supply to anterolateral abdominal wall is found where

A
  • between internal oblique and transverse abdominis muscle
26
Q

what supplies anterior abdominal wall

A
  • superior epigastric arteries - continuation of internal thoracic
  • emerges at superior aspect of abdominal wall
27
Q

sup epigastric arteries anastomose just above umbilicus with what artery?

A
  • inferior epigastric artery
    > branch of external iliac arteries
  • emerges at inferior aspect of abdominal wall
28
Q

what supplies lateral abdominal wall

A
  • intercostal and subcostal arteries
    > continuations of posterior intercostal arteries
  • emerge at lateral aspect
29
Q

from about 12 weeks gestation what can be palpated on a pregnant women

A
  • uterine fundus just above pubic symphysis
    > grows about 1cm a week
30
Q

incising muscle - what are 3 important things to consider?

A
  • minimise traumatic injury to muscle fibres - incise in same direction in muscle
  • avoid damaging nerves - particularly motor nerves
  • avoid interrupting blood supply
31
Q

LSCS incision - what layers are incised?

A
  • skin and superficial fascia
  • anterior rectus sheath
  • rectus abdominis - these muscles are not cut - separated in a lateral direction
  • fascia and peritoneum are then incised, ensure bladder is retracted
  • uterine wall
  • amniotic sac
32
Q

what layers are stitched closed in LSCS incision?

A
  • uterine wall w visceral peritoneum
  • rectus sheath
  • skin
33
Q

laparotomy - what layers are opened?

A
  • skin and fascia
  • linea alba
  • peritoneum
34
Q

laparotomy - what layers are stiched closed?

A
  • peritoneum and linea alba
  • fascia
  • skin
35
Q

midline incision in laparotomy - what are complications?

A
  • relatively bloodless area
    > however this increases chance of wound complicationse.g. dehiscence, incisional hernia
36
Q

laparoscopy - what kind of incision?

A
  • sub-umbilical incision may be all that is required
  • however if lateral port in required - care must be taken to avoid damaging inferior epigastric artery
37
Q

laparoscopy - what can you do to enable view of pelvic organs

A
  • position of uterus can be manipulated by grasping cervix w forceps inserted through vagina
38
Q

avoiding inferior epigastric artery is particularly important in what procedure

A
  • laparoscopy
39
Q

inferior epigastric artery is a branch of?

A
  • external iliac artery
  • emerges just medial to deep inguinal ring/femoral pulse point (midway between ASIS and pubic tubercle)
40
Q

inferior epigastric artery passes in what direction?

A
  • superomedial direction post to rectus abdominis
  • forms post aspect of inguinal triangle - site of direct inguinal hernias
41
Q

what 2 ways can a hysterectomy be performed?

A
  • abdominal - LSCS incision
  • vaginal
42
Q

during hysterectomy, extreme care must be taken to differentiate ureter from uterine artery - what direction does ureter pass in relation to artery?

A
  • passes inferior to artery - water under the bridge
    > ureter will often ‘vermiculate’ (wiggle) when touched

Reproduction and Sexual Health (29 decks)

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