Surface Features MD4

Question 1

Answer 1

Linea alba:

• forms from fusion of aponeurosis of abdominal muscles, separates left and right rectus abdominis muscles, fibrous line from xiphoid process down to pubic symphysis
• becomes pigmented in pregnancy (linea nigra)

Question 2

Answer 2

Linea Semilunaris:

• tendinous line on lateral boundary of rectus abdominis, formed by aponeurosis of internal oblique, hernia through it is a spontaneous lateral ventral hernia

Question 3

Answer 3

Umbilicus:

• previous attachment site of umbilical cord
• umbilical hernias: abdominal contents herniate out through umbilicus (surrounded by peritoneum), d/t open umbilicus, incr abdominal pressure d/t obesity, heavy lifting, long Hx of coughing, multiple pregnancies

Question 4

Answer 4

Superficial Inguinal Ring:

• exit of inguinal canal, conducts spermatic cord into scrotum
• on exam, impulse felt w/ coughing for both direct & indirect hernias

Question 5

Answer 5

Spermatic Cord:

• contains structures going to and from testes, suspends testes
• runs from deep inguinal ring, thru inguinal canal, out superficial inguinal ring, to scrotum and posterior testes
• contains:

1. vas deferens (sperm from testes) & its aa.
2. pampiniform venous plexus
3. testicular aa.
4. cremaster aa.
5. lymphatics
6. autonomics, genital branch of genitofemoral nn. (cremaster muscle)

• vasectomy: cut and ligate ends of vas deferens

Question 6

Answer 6

Hernias:

• protrusion of organ or tissue thru opening
• 6 Fs: fat, food, fluid, feces, flatus, fetus (put pressure on abdominal wall)

Indirect Hernia:

• 75% of abdominal hernias
• lateral to inferior epigastric vessels, travels thru spermatic cord to scrotum
• more common on right side in men, assoc w/ persistent processus vaginalis, congenital

Direct Hernia:

• less common
• acquired, d/t weakened abdominal wall of inguinal lig.
• medial to inferior epigastric vessels, lateral to conjoint tendon, in inguinal triangle
• rarely goes to scrotum

Pantaloon hernia (direct & indirect on same side)

Obturator hernia (through obturator foramen (opening b/w pubic bone and ischium), rare, women, assoc. w/ bowel obstruction

Femoral hernia (through wall of femoral canal, just below inguinal lig.), assoc. w/ bowel obstruction

Answer 7

Umbilical Lig

• Median Umbilical lig.: remnant of urachus (umbilicus to bladder)
• Medial Umbilical lig.: obliterated umbilical aa.
• direct hernia is lateral to it
• Lateral Umbilical lig.: inferior epigastric aa.

Question 8

Answer 8

Hesselbech’s Triangle

• point of weakness, possible site of direct hernias
• Borders:
• linea semilunaris (lateral border of rectus abdominis)
• inferior epigastric aa.

inguinal lig.

Question 9

Answer 9

Dermatomes

area of skin supplied by one spinal cord segment (dorsal + ventral rami)

Question 10

Answer 10

Pubic Tubercle

• attachment site of inguinal lig.