Wet Room 1

Question 1

What structures form the “walls” of the abdominal cavity?

Answer 1

1. The dynamic musculo-aponeurotic abdominal walls enclose anterolaterally.
2. The diaphragm separates the abdominal cavity from the thoracic cavity superiorly and the posterior thoracic vertebrae also.
3. Under cover of the thoracic cage superiorly extending to the 4th intercostal space.
4. Continuous inferiorly with the pelvic cavity

Question 2

How is the abdominal cavity divided by clinicians?

Answer 2

Either:
Right Upper Quadrant, Left upper quadrant, Right lower quadrant and left lower quadrant.
OR
Right and left hypochondriac, Right and left lateral, right and left inguinal, epigastric, umbilical and pubic (hypogastric)

Question 3

What are the names of the 4 planes which divide the abdominal cavity into 9 regions?

Answer 3

Subcostal plane: passing through the inferior border of the 10th costal cartilage on each side.
Transtubular Plane: passing through the iliac tubercles and the body of the L5 vertebrae.
2 Verticle Midclavicular planes: Midpoint of clavicle to the midlinguinal points

Question 4

What are the names of the 2 planes which divide the abdominal cavity into 4 quadrants?

Answer 4

Transumbilical plane: passing through the umbilicus and intervertebral disc between L3 and L4.
Median Plane: running longitudinally.

Question 5

Name the 3 flat muscles in the anterolateral abdominal wall from outer to inner layer

Answer 5

1. External oblique: fibres run inferomedially.
2. Internal oblique: fibres fan out. Lateral with external obliques towards the pelvis and perpendicular to obliques superiorly towards thoracic cage.
3. Transversus abdominis: Fibres run horizontally

All three end anteriorly in a strong aponeurosis.

Question 6

What do the aponeurosis of the external oblique, internal oblique and transverses abdominis between the midclavicular line and the midline form?

Answer 6

The rectus sheath which encloses the rectus abdominis

Question 7

Name the 2 vertical muscles of the anterolateral abdominal wall

Answer 7

1. Rectus abdominis: Enclosed in the rectus sheath. Fibres run between three or more tendinous intersections
2. Pyramidalis: small triangular muscle that lies in the rectus sheath anterior to the inferior part of the rectus abdomens. Arises from the pubic crest and attaches along the lines alba.

Question 8

What is the action of the obliques?

Answer 8

Compress and support abdominal viscera

Flex and rotate trunk

Question 9

What is the action of the transverses abdominis?

Answer 9

Compresses and supports abdominal viscera

Question 10

What is the action of the Rectus abdominis?

Answer 10

Flexes trunk (lumbar vertebrae) and compresses abdominal viscera.
Stabilises and controls tilt of the pelvis

Question 11

How does the rectus sheath differ above and below the umbilicus?

Answer 11

Below: Sheath is anterior to the rectus abdominis
Above: Sheath is both anterior and posterior to the rectus abdominis

Question 12

What organs and structures are present in the right hypochondriac region?

Answer 12

Liver
Gall Bladder
Small intestine
Ascending colon
Transverse colon
Right kidney

Question 13

What organs and structures are present in the Epigastric region?

Answer 13

Oesophagus
Stomach
Pancreas
small intestine
Transverse colon
Liver
Right and left adrenal glands

Question 14

What organs and structures are present in the left hypochondriac region?

Answer 14

Stomach
Left kidney
Spleen
small intestine
Transverse colon
descending colon

Question 15

What organs and structures are present in the right lumbar region?

Answer 15

Gall bladder
Right kidney
Ascending colon
Small intestine

Question 16

What organs and structures are present in the umbilical region?

Answer 16

Cisterna chyli
Stomach
Pancreas
small intestine
Transverse colon

Question 17

What organs and structures are present in the left lumbar region?

Answer 17

Small intestine
Descending colon
Left kidney

Question 18

What organs and structures are present in the right inguinal region?

Answer 18

Small intestine
Appendix
Caecum and ascending colon
Right ovary

Question 19

What organs and structures are present in the hypogastric region?

Answer 19

Small intestine
Sigmoid colon
Rectum
right and left ureters
Urinary bladder
uterus
Vas deferens
Prostate (unless its seamus' das which extends up to his throat)

Question 20

What organs and structures are present in the left inguinal region?

Answer 20

small intestine
descending colon
sigmoid colon
Left ovary

Question 21

At what vertical level is the umbilicus and what dermatome supplies it?

Answer 21

L3-L4

T10

Question 22

Which thoracic spinal segments innervate the anterior abdominal wall?

Answer 22

Ventral Rami

Question 23

How is the inguinal canal formed?

Answer 23

The inguinal canal is formed during the relocation of the gonads during metal development. It is formed from layers of the anterior abdominal wall as these layers push through the wall obliquely, thus forming a canal.

The canal is approximately 4cm long and lies parallel to and above the medial half of the inguinal ligament.

Question 24

The lateral border of the rectus abdominis and the rectus sheath is formed by what? (Surface anatomy point of view)

Answer 24

Semilunar lines.
Visible in individuals with good muscle definition these grooves extend from the inferior costal margin near the 9th costal cartilages to the pubic tubercles.

Question 25

What groove indicates the position of the inguinal ligament in terms of surface anatomy?

Answer 25

Inguinal groove

Question 26

Name the two surface landmarks of the iliac pelvis bone

Answer 26

Iliac crest and anterior superior iliac spine

Question 27

The inguinal ligament is attached to which two bony points if the hip?

Answer 27

Pubic tubercle and the anterior superior iliac spine

Question 28

The inguinal ligament is attached to which two bony points if the hip?

Answer 28

Pubic tubercle and the anterior superior iliac spine.

Question 29

What is the inguinal region?

Answer 29

Where structures exit and enter the abdominal cavity. The migration of the testes from the abdomen into the perineum accounts for many of the structural features of the region.

Question 30

Where does the inguinal canal lie in relation to the inguinal ligament?

Answer 30

The inguinal canal lie parallel to and just superior the medial half of the inguinal ligament.

Question 31

What passes through the inguinal canal?

Answer 31

The main structure passing through is the spermatic cord (conveys the vas deferens in males, vestigial round ligament of uterus in females). Blood and lymphatic vessels - Testicular artery - Cremasteric artery (cremaster muscle) - Deferential artery (Vas deferens) - Pampiniform venous plexus Ilio-inguinal nerve

Question 32

What are the two openings to the inguinal canal?

Answer 32

``` The deep (internal) ring: internal entrance The superficial (external) inguinal ring: Slit like opening in the aponeurosis of the external oblique superolateral to the pubic tubercle. ```

Question 33

What are the two openings to the inguinal canal?

Answer 33

``` The deep (internal) ring: internal entrance (superiorly) The superficial (external) inguinal ring: Slit like opening in the aponeurosis of the external oblique superolateral to the pubic tubercle. (inferiorly) ```

Question 34

What forms the anterior wall of the inguinal canal?

Answer 34

The external oblique aponeurosis throughout the length of the canal

Question 35

What forms the posterior wall of the inguinal canal?

Answer 35

Trasversalis fascia. Reinforced medially by merging of internal oblique and transverses abdomens aponeurosis into a common tendon (inguinal falx)

Question 36

What forms the roof of the inguinal canal?

Answer 36

``` Laterally = transversalis fascia centrally = musculo-aponeurotic arches of internal oblique Medially = medial crus and intercrural fibres ```

Question 37

What forms the floor of the inguinal canal?

Answer 37

Inguinal ligament

Question 38

What is the relationship of the deep inguinal ring to the inferior epigastric vessels?

Answer 38

Deep inguinal ring lies laterally

Question 39

Where does the superficial ring lie in relation to the pubic tubercle?

Answer 39

Superolateral

Question 40

What is an indirect hernia?

Answer 40

An indirect hernia is the most common inguinal hernia. It results from a weakness in the deep inguinal ring, allowing abdominal contents to enter into the inguinal canal lateral to the inferior epigastric vessels.

Question 41

What is a direct hernia?

Answer 41

Direct hernias account of 1/3 of inguinal hernias. Abdominal contents do not pass through the deep inguinal ring, but simply push through a weak spot in the muscles making up the posterior wall of the inguinal canal, allowing contents to enter the canal and, again, even pass through the superficial inguinal ring.

Question 42

What is a femoral hernia?

Answer 42

These occur below the inguinal ligament, when abdominal contents pass into the weak area at the posterior wall of the femoral canal medial to the inferior epigastric vessel;s. These (unlike indirect hernias) are more common in females. The risk of strangulation is high

Question 43

What is an umbilical hernia?

Answer 43

Abdominal contents pass through a weakness at the site of the passage of the umbilical cord through the abdominal wall. In adults umbilical hernias are acquired rather than congenital. Abnormal fibres at the line alba may also contribute to the weakness of the wall.

Question 44

What does the external oblique form in the scrotum?

Answer 44

External spermatic fascia

Question 45

What does the internal oblique form in the scrotum?

Answer 45

Cremasteric fascia

Question 46

What does the transversalis fascia form in the scrotum?

Answer 46

Internal spermatic fascia