Session 3 - Abdominal wall and the mesenteries

Question 1

What are the three borders of the abdominal wall?

Answer 1

• Anterior
  
  • Lateral (Together with anterior sometimes known as anterolateral)
  • Posterior

Question 2

What is the anterolateral abdominal wall bound by superiorly and inferiorly?

Answer 2

• Superiorly by the cartilages of the 7th-10th ribs and xiphoid process of the sternum
  
  • Inferiorly by the inguinal ligament and the superior margins of the anterolateral aspects of the pelvic girdle

Question 3

What does the anterolateral abdominal wall consist of (in order)

Answer 3

• Skin
  
  • Subcutaneous tissue
  • Muscle and their aponeurosis
  • Deep fascia
  • Extraperitoneal fate
  • Parietal peritoneum

Question 4

Where are the bony attachment points of the ribs?

Answer 4

• Ribs
  
  • Spine
  • Illiac crest

Question 5

What is needed in the midline of the abdomen for muscles to contract against?

Answer 5

• Linae albase

Question 6

What are the three layers of muscles of the abdominal wall?

Answer 6

• External obliques (Attached to ribs)
  
  • Internal obliques (attached to illiac crest)
  • Transversalis abdominus (Attached to lumbar verterbra)

Question 7

What exists below the three layers of muscle?

Answer 7

• The transveralis fascia

Question 8

What is the purpose of the greater omentum?

Answer 8

• Walls off areas of infection

Question 9

What is the arcuate line?

Answer 9

• The point at which the posterior rectus abdominal sheath stops at a point 1/3rd from the umbilicus to the symphysis pubis

Question 10

What is divarication of recti?

Answer 10

• Due to laxity of linea alba

Question 11

Why does bleeding occur in rectus abdominus muscle?

Answer 11

• Due to warfarin use and in which haemorrhage

Question 12

What is Cullen’s sign?

Answer 12

• Sign of pancreatitis

Haemorrhage into rectus abdominu

Question 13

What is the umbilicus?

Answer 13

Embryological remenant found at spinal level L3

Question 14

What is the epigastric fossa?

Answer 14

• Slight depression in the epigastric region, just inferior to the xiphoid process
  
  • Noticeable when a person is in the supine position because the abdominal organs spread out

Question 15

What is commonly felt at epigastric fossa?

Answer 15

• Heartburn

Question 16

What is the linea alba?

Answer 16

• Aponeuroses of abdominal muscles, separating the left and right rectus abdominis

Question 17

What happens if one has a lax linea alba?

Answer 17

• Muscles spread apart

Called divarication of recti

Question 18

What is the pubic crest and symphisis?

Answer 18

• Upper margins of the pubic bones and the cartilaginous joints that unite them. Can be felt at the inferior end of the linea alba.

Question 19

What is the inguinal groove?

Answer 19

• Skin crease that is parallel and just inferior to the inguinal ligament (runs between ASIS and pubic tubercle). Marks the division between the abdominal wall and the thigh.

Question 20

What are the semilunar lines?

Answer 20

• Slight curves tendinous lines on either side of the rectus abdominis

Question 21

What are the tendinous intersections of rectus abdominis?

Answer 21

• Tendinous lines running horizontally across rectus abdominis

Question 22

What is the arcuate line?

Answer 22

• Where the fibrous sheath of the rectus abdominous stops 1/3 of the way from the umbilicus to the pubic crest

Question 23

What is McBurney’s point?

Answer 23

• 2/3rds of the distance between the umbillicus and anterior superior illiac spine
  
  • Appendicectomy
  • Use a gridiron incision

Question 24

How many muscles are present in the abdominal wall?

Answer 24

• 5

Question 25

Name the three flat muscles of the abdominal wall

Answer 25

* External oblique * Internal oblique * Transversus abdominis

Question 26

Name the two vertical muscles of the abdominal wall

Answer 26

• Rectus abdominis and pyramidalis

Question 27

In what direction do the oblique flat muscle run?

Answer 27

• Diagonally and perpendicular to each other

Question 28

In which direction do the fibres of transversus abdominus run?

Answer 28

• Transversely

Question 29

What is the origin of external oblique

Answer 29

• External surfaces of the 5th to 12th ribs

Question 30

What is the insertion of external oblique

Answer 30

* Linea alba * Pubic tubercle * Anterior half of iliac crest

Question 31

What is the origin of the internal oblique?

Answer 31

* Thoracolumbar fascia * Anterior two thirds of iliac crest * Connective tissue deep to lateral third of inguinal ligament

Question 32

What is the insertion of the internal oblique?

Answer 32

* Inferior borders of the 10th to 12th ribs * Linea alba * Pectin pubis

Question 33

What is the origin of the transversus abdominis?

Answer 33

* Internal surfaces of 7th to 12th costal cartilages * Thoracolumbar fascia * Iliac crest

Question 34

What is the insertion of the transversus abdominis?

Answer 34

• Linea alba with aponeuroses of internal oblique

Question 35

What is the rectus sheath?

Answer 35

* Tendinous sheath which encloses the rectus abdominus (vertical muscle, forms the abs!) * Formed from the strong, sheet like aponeuroses of the three flat musclees

Question 36

Where does the linea alba extend to and from?

Answer 36

• Xiphoid process to the pubic symphysis

Question 37

What are the two muscles found in the rectus sheath?

Answer 37

• Rectus abdominis

Question 38

Does the rectus sheath completely extend all the way to the pubic symphsis?

Answer 38

* Posterior rectus sheath disappears at arcuate line | * 1/3 way from ubilicus to pubic crest

Question 39

What is the linea semilunaris?

Answer 39

• Curved tendinous line places on either side of the rectus abdominus

Question 40

What are the tendinous horizontal lines breaking up the rectus abdominis called?

Answer 40

• Tendinous intersections

Question 41

What occurs if muscle is used as a sutural locaiton?

Answer 41

• Eventual incisional hernia through weakness in wall

Question 42

Name four different abdominal inscisions

Answer 42

* Midline incision * Transverse incsision * Appendicectomy * Gridiron incision

Question 43

What is a midline incision?

Answer 43

• Surgeons suture the linea alba together to provide strong closure

Question 44

What is a transverse incision?

Answer 44

• surgeons suture the external oblique aponeuroses

Question 45

Where is an appendicectomy incision placed?

Answer 45

* McBurney's point * 2/3rds of the distance between the umbilicus and ASIS Through a gridiron muscle splitting incision

Question 46

What is gridiron incision?

Answer 46

* Put scissors in and open and close them to separate out the muscle fibres, followed by the next two layers. * This is in order to separate out the fibres of the external and internal obliques and the transversalis