SP1

Question 1

which quadrant for appendicitis?

Answer 1

right lower quadrant RLQ

Question 2

muscles of anterolateral abdominal wall

Answer 2

rectus abdominis
external oblique
internal oblique
transverse abdominus

Question 3

upper anterior abdominal wall deep to superficial (7)

Answer 3

peritoneum
preperitoneal (subperitoneal) fat
posterior rectus sheath (facia)
rectus abdominus muscle
anterior rectus sheath (fascia)
subcutaneous fat
skin

Question 4

consideration in choosing incisions (7)

Answer 4

adequacy of exposure for underlying pathology
minimization of trauma
minimization of hemorrhage
maximization of wound strength
length of time required for closure
ease and rapidity of access
cosmetic results

Question 5

subcostal incision

Answer 5

oblique skin incision made 2-5 cm below the costal margin

Question 6

advantages of subcostal incision

Answer 6

less painful than upper midline incision

excellent cosmetic results

Question 7

applications of RIGHT subcostal incision

Answer 7

R subcostal (kocher): gallbladder, biliary system

Question 8

applications of LEFT subcostal incision

Answer 8

L subcostal: spleen, adrenal gland

Question 9

mid abdominal transverse incision

Answer 9

skin incision extending from just above/below the umbilicus lateral to the lumbar region

Question 10

McBurney incision (3)

Answer 10

• used on appendix*
• oblique skin incision made over McBurney’s point in the right lower quadrant
• muscle-splitting incision (external & internal oblique, transverse abdomens)

Question 11

applications of McBurney incision

Answer 11

Rocky Davis incision: alternative to McBurney; straight transverse incision over point

Question 12

inguinal incision

Answer 12

• oblique skin incision made 2-5 cm superior and parallel to inguinal crease
• muscle splitting incision

Question 13

applications of inguinal incision

Answer 13

Left to Right inguinal incision: inguinal canal (inguinal and femoral heniorrhaphy

Question 14

vertical midline incision closure

Answer 14

closure may be reinforced with retention sutures to prevent postoperative wound dehiscence & evisceration

Question 15

vertical midline incision advantages/applications (2)

Answer 15

• excellent exposure to entire abdominopelvic cavity & retroperitoneum
• aorta (AAA), kidneys

Question 16

paramedian incision (3)

Answer 16

• vertical skin incision made 4cm lateral to the midline on either side
• may be upper or lower
• muscle splitting incision

Question 17

pfannenstiel incision

Answer 17

• curved transverse skin incision made 1cm superior to symphysis pubis (usually within pubic hair line)
• muscle splitting incision

Question 18

thoracoabdominal incision

Answer 18

• muscle cutting*

- curved skin incision, which breaches both pleural & abdominal cavities

Question 19

applications of left thoracoabdominal incisions

Answer 19

distal esophagus
stomach
anterior spine
adrenal gland
kidney