Sievert 1

Question 1

List the layers of the abdominal wall

Answer 1

1. skin
2. superficial fascia
3. muscle with investing fascia
4. transversalis fascia
5. parietal peritoneum

Question 2

The superficial fascia of the anterior abdominal wall is composed of two layers, a more superficial fatty layer called (blank)’s and a deeper membranous layer called (blank)’s

Answer 2

Camper’s; Scarpa’s

Question 3

In which layer are men especially prone to laying down excess fat?

Answer 3

Camper’s layer

Question 4

There is a potential space between Scarpa’s fascia and the investing fascia of the (blank)

Answer 4

external oblique muscle

Question 5

Scarpa’s layer is continuous with the (blank) so it has relevance for extravasation of urine

Answer 5

superficial perineal fascia

Question 6

Four muscles form the anterior abdominal wall

Answer 6

External oblique
Internal oblique
Transversus abdominis
Rectus abdominis

Question 7

Where does the external abdominal oblique muscle arise from?

Answer 7

Ribs 5-12

Question 8

What are the three sites of attachment of the external abdominal oblique?

Answer 8

1. linea alba
2. anterior iliac crest
3. pubic tubercle

Question 9

The inferior border of this muscle reflects slightly on itself to create the (blank) and the anterior border of the (blank)

Answer 9

external abdominal oblique; inguinal ligament; inguinal canal

Question 10

Where does innervation to the external abdominal oblique come from?

Answer 10

T7-T12

Question 11

What is the action of the external abdominal oblique?

Answer 11

Action is to rotate the trunk to the opposite side, raise intra-abdominal pressure, and assist with flexion against resistance.

Question 12

Where does the internal abdominal oblique arise posteriorly?

Answer 12

The lateral part of the thoraco-lumbar fascia

Question 13

Where does the internal abdominal oblique arise inferiorly?

Answer 13

From the iliac crest and the lateral half of the inguinal ligament

Question 14

The internal abdominal oblique also inserts into the pecten pubis and pubic crest via the (blank) along with the transversus

Answer 14

conjoint tendon

Question 15

Where does innervation to the internal abdominal oblique come from?

Answer 15

Ventral ramus of T6-T11 intercostal nerves, subcostal and L1 spinal

Question 16

What is the action of the internal abdominal obliques?

Answer 16

To rotate the trunk to the same side, compress the abdominal viscera and assist with flexion of the trunk against resistance.

Question 17

The internal abdominal obliques also play a role in support of the intrinsic back muscles by virtue of their origin from (blank)

Answer 17

the thoraco-lumbar fascia

Question 18

Where does the transversus abdominis muscle arise from?

Answer 18

From the lateral part of the thoraco-lumbar fascia posteriorly, the 7th-12th costal cartilages, and inferiorly from the iliac crest and lateral third of the inguinal ligament

Question 19

The transversus abdominis muscle courses anteromedially to insert into the (blank) with its fibers running parallel to what plane?

Answer 19

linea alba; transverse plane

Question 20

The transversus abdominis muscle also inserts into the pecten pubis and pubic crest via the (blank) tendon, like the internal oblique.

Answer 20

Conjoint

Question 21

Where does innervation to the transversus abdominis come from?

Answer 21

T6-T11 intercostal nerves, subcostal, and L1 spinal

Question 22

What is the action of the transversus abdominis muscle?

Answer 22

Compresses the abdominal viscera, and plays a role in support of the back muscles due to its connection to the thoraco-lumbar fascia

Question 23

The two anterior abdominal wall muscles that play an important role in supporting and strengthening the back by virtue of their attachment to the thoracolumbar fascia

Answer 23

Internal abdominal oblique; transversus abdominus

Question 24

The Rectus Abdominis arises inferiorly from the (blank). It courses superiory to insert into the (blank) and (blank)

Answer 24

pubic symphysis and crest
xiphoid process
5-7th costal cartilages

Question 25

Where does innervation to the rectus abdominis come from?

Answer 25

T6-T11 intercostal nerves and the subcostal

Question 26

What is the action of the rectus abdominis?

Answer 26

To flex the trunk against resistance, compress the abdominal viscera and stabilize the tilt of the pelvis

Question 27

A connective tissue sleeve formed by the aponeurotic tendons of the lateral three abdominal wall muscles

Answer 27

Rectus sheath

Question 28

What are the two paired rectus muscles separated by?

Answer 28

linea alba

Question 29

How many "bellies" is the rectus abdominis divided into? What divides them?

Answer 29

four; tendinous intersections with the anterior wall of the rectus sheath

Question 30

The arcuate line is about halfway between the (blank) and the (blank)

Answer 30

umbilicus; pubic symphysis

Question 31

Describe what happens to the layers of the abdominal wall above the arcuate line vs below the arcuate line.

Answer 31

Above the arcuate line, aponeurotic fibers of the transversus and some from the internal pass posterior to the rectus abdominis muscle. However, below the arcuate line, all three layers pass ANTERIOR to the rectus muscle.

Question 32

The (blank) is an interdigitation of all aponeurotic fibers in the midline

Answer 32

linea alba

Question 33

Where does the blood supply from the abdominal wall come from?

Answer 33

T10, T11 intercostal arteries the subcostal artery the superior epigastic as a branch of the external iliac the deep circumflex iliac

Question 34

T/F: there are significant anastomotic connections between the arteries supplying the abdominal wall, especially the superior and deep inferior epigastrics.

Answer 34

True

Question 35

Which two arteries run within the sheath?

Answer 35

Superior and inferior epigastric arteries

Question 36

end of internal thoracic artery, branch of subclavian artery

Answer 36

Superior epigastric artery

Question 37

branch of external iliac artery

Answer 37

Inferior epigastric artery

Question 38

Which artery can a surgeon use for bypass because of two collateral flow situations?

Answer 38

Internal thoracic artery

Question 39

The venous drainage is accomplished by rich anastomotic connections between the veins accompanying the arteries. The only unpredictable vessel is the obliterated (blank) with numerous small paraumbilical vein tributaries

Answer 39

umbilical vein

Question 40

Transparent fascia that lines the entire abdominal wall

Answer 40

Transversalis fascia

Question 41

The transversalis fascia is (blank) to the transversus abdominis muscle

Answer 41

Deep

Question 42

Parietal layer fused to all surfaces of abdominal wall except where it covers certain organs which are retroperitoneal

Answer 42

Peritoneum

Question 43

What innervates the skin and muscle of the anterior abdominal wall?

Answer 43

T6-T11 intercostal nerves and the subcostal nerve (T12)

Question 44

What innervates the inferior aspect of the abdominal wall?

Answer 44

L1 nerve via the iliohypogastric and ilioinguinal nerves

Question 45

Cutaneous nerves provide sensation Subxiphoid area Umbilical area Suprapubic area

Answer 45

T6 T10 T12/L1

Question 46

Which two nerves supply the anterior wall of the scrotum in males and the anterior aspect of the labia majora in females?

Answer 46

iliohypogastric and ilioinguinal nerves

Question 47

Between which two layers do all anterior rami of spinal nerves travel?

Answer 47

The two deepest layers: inntermost and internal

Question 48

The inguinal canal is formed by the descent of the (blank) in the male and the (blank) in the female

Answer 48

testis; round ligament of the uterus

Question 49

The testis and ovary both develop in the (blank) abdominal wall and migrate during development

Answer 49

posterior

Question 50

The (blank) is thought to control the | descent of the testis and ovary

Answer 50

gubernaculum

Question 51

As the testis descends, what does it drag with it? These layers make up the coverings and contents of the (blank).

Answer 51

peritoneium, transversalis fascia, internal oblique, and external oblique; spermatic cord

Question 52

The peritoneum surrounds the testis forming a celomic sac for the testis which was originally part of and connected to the peritoneal sac in the abdominal cavity by the (blank)

Answer 52

processus vaginalis

Question 53

The processus vaginalis normally closes off leaving the (blank) isolated from its origin in the abdomen.

Answer 53

tunical vaginalis

Question 54

As the testis enters the deep ring, it drags some of what muscle with it? What muscle does it pierce to form the superficial ring?

Answer 54

internal oblique; external oblique

Question 55

The lateral umbilical fold is formed by what vessels?

Answer 55

deep inferior epigastric vessels

Question 56

The medial umbilical fold is formed by what arteries?

Answer 56

Obliterated umbilical arteries

Question 57

The midline fold is the median umbilical fold and is formed by the obliterated (blank)

Answer 57

urachus

Question 58

Borders of the inguinal triangle Medial? Lateral? Inferior?

Answer 58

Medial: rectus abdominis Lateral: deep inferior epigastric Inferior: inguinal ligament

Question 59

What is the name of the tendon that arches across the triangle, and may reveal a weak area if its arch is too high?

Answer 59

Conjoint tendon

Question 60

The weak area is (blank) to the deep ring and is found in the inguinal triangle.

Answer 60

Medial

Question 61

A hernia through the medial portion of the inguinal canal - medial to inferior epigastric artery. This is through Hesselbach’s Triangle

Answer 61

Direct

Question 62

A hernia through lateral portion of inguinal canal - usually through patent processus vaginalis. Follows the course of descent of the testis.

Answer 62

Indirect

Question 63

Which type of hernia will be surrounded by all layers of the spermatic cord, because it passes through the processus vaginalis?

Answer 63

Indirect

Question 64

Where do femoral hernias occur?

Answer 64

Inferior to the inguinal ligament

Question 65

What is a femoral hernia bordered by? Medially? Anterosuperiorly? Posteroinferiorly?

Answer 65

lacunar ligament; inguinal ligament; pectineal ligament

Question 66

The femoral sheath is transversalis fascia surrounding what three things? Which thing is most medial?!

Answer 66

femoral artery, femoral vein, and lymphatics which are found in the canal. The lymphatics are the most medial.

Question 67

Four boundaries of the femoral canal?

Answer 67

Inguinal ligament anterosuperiorly; lacunar ligament medially; pectineal ligament posteroinferiorly; and femoral vein laterally

Question 68

Define fibrous adhesions.

Answer 68

Fibrous adhesion: strong fibrous bands often encountered after previous operative procedures

Question 69

Stage 1 appendicitis causes inflammation, which creates what kind of pain?

Answer 69

visceral pain, poorly localized

Question 70

Stage 2 appendicitis causes the whole organ to become enlarged, thickened and red, and causes what two types of pain?

Answer 70

visceral and localized pain due to involvement of the parietal peritoneum

Question 71

Stage 3 appendicitis causes perforation, allowing inflammatory material to pour into the greater sac. What kind of pain does this cause?

Answer 71

diffuse parietal irritation

Question 72

(blank) hernias will not necessarily have all the layers because they pass under the conjoint tendon and do not pass through the (blank)

Answer 72

Direct; processus vaginalis

Question 73

Is the femoral nerve within the femoral sheath?

Answer 73

No; only the artery, vein, and lymphatics

Question 74

The femoral sheath blends with the fascia of the (blank).

Answer 74

Thigh