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Reproduction Week 4 2018/19 > 1: Anatomy - Surgical incisions > Flashcards

1: Anatomy - Surgical incisions Flashcards

(71 cards)

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1
Q

What

a) horizontal
b) vertical

incisions are most commonly carried out in obs & gynae?

A

a) Lower segment caesarean section

b) Laparotomy incision

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2
Q

At what level are Caesarean sections carried out?

A

2cm above pubic symphysis

measured as two finger breadths

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3
Q

On which line is a Caesarean incision made?

A

Suprapubic line

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4
Q

What are the three layers of abdominal fascia called?

Where are they found relative to the abdominal muscles?

A

Superficial - Camper’s fascia, Scarpa’s fascia; found superficial to external obliques

Deep - transversalis fascia; found deep to rectus abdominis and transversus abdominis

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5
Q

What are the four groups of abdominal wall muscles?

A

External obliques

Internal obliques

Rectus abdominis medially

Transversus abdominis laterally

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6
Q

What are the three layers of intercostal muscles?

A

External intercostals

Internal intercostals

Innermost intercostals

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7
Q

Which direction do the external oblique muscles run in?

A

Hands in pockets

Anterior direction

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8
Q

The external oblique muscles run in an (anterior / posterior) direction.

A

anterior direction

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9
Q

Which ribs do the external obliques attach to superiorly?

A

Ribs 5 - 11

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10
Q

Which structures do the external obliques attach to inferiorly?

A

Iliac crests

Pubic tubercle

Linea alba

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11
Q

What structure is a flattened aponeurosis found in the midline?

A

Linea alba

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12
Q

What structures are flattened aponeuroses found laterally?

A

Linea semilunaris

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13
Q

What is an aponeurosis?

A

Flattened tendon

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14
Q

The external obliques run in the same direction as which respiratory muscles?

A

External intercostals

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15
Q

Which direction do the internal obliques run in?

A

Posteriorly

i.e the opposite of external intercostals, remember hands in pockets

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16
Q

What fascia is found posteriorly?

A

Thoracolumbar fascia

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17
Q

Which abdominal muscles attach to the thoracolumbar fascia?

A

Internal obliques

Transversus abdominis

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18
Q

Which bony feature of the pelvis do all of the abdominal muscles attach to?

A

Iliac crest

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19
Q

Which flattened tendons make up the borders of rectus abdominis?

A

Linea alba in the midline

Linea semilunaris laterally

Tendinous intersections between the groups of muscles

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20
Q

What structures does the linea alba attach to superiorly and inferiorly?

A

Xiphoid process of the sternum superiorly

Pubic symphysis inferiorly

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21
Q

Which structure is made up of the combined aponeuroses of transversus abdominis, external oblique and internal oblique?

A

Rectus sheathe

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22
Q

Is rectus abdominis part of the rectus sheathe?

A

No

As in it doesn’t have an aponeurosis to contribute, it’s just surrounded by the rectus sheathe

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23
Q

Transversus abdominis is described as a corset muscle - why?

A

Keeps the abdominal organs contained within the abdominal cavity

Force of gravity pushes all these muscles downwards, creating a need for support

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24
Q

What is the advantage of tendinous intersections between the muscle groups of rectus abdominis?

A

Prevents bowstringing

If rectus abdominis was one long muscle it would contract in a weird way

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25
What horizontal line marks a change in the structure of the rectus sheathe?
**Arcurate line**
26
Where exactly is the **arcurate line**?
**Halfway between umbilicus and pubic crest**
27
Describe the structure of the **rectus sheathe** above and below the arcurate line.
**Above acurate line:** external oblique anterior to rectus, internal oblique split into two leaflets, one anterior and one posterior to rectus, transversalis fascia posterior to rectus **Below arcurate line:** everything is anterior to rectus apart from transversalis fascia This gets asked about in exams
28
Which **muscle** is **always superficial** to rectus abdominis in the rectus sheathe?
**External oblique**
29
Which muscle splits into anterior and posterior leaflets in the rectus sheathe **above the acurate line**?
**Internal oblique** Anterior leaflet is superficial to rectus, posterior leaflet is deep to rectus
30
Describe the structure of the rectus sheathe **above** **the arcurate line**.
**External oblique superficial to rectus** **Internal oblique split into two leaflet - anterior leaflet superficial to rectus, posterior leaflet deep** **Transversalis fascia deep to rectus**
31
Describe the structure of the rectus sheathe **below the arcurate line**.
**External oblique superficial to rectus** **Internal oblique superficial to rectus** **Transversalis fascia deep to rectus**
32
Name the layers of the abdominal wall from superficial to deep.
**Skin** **Subcutaneous fat** **Superficial fascia** - Camper's and Scarpa's fascia **External oblique** **Internal oblique** **Rectus / Transversus abdominis** **Transversalis fascia** **Parietal and visceral peritoneum**
33
The layers of the **spermatic cord** from superficial to deep are **external spermatic fascia** **cremasteric fascia** **internal spermatic fascia** **tunica vaginalis** which layers of the abdominal wall do these structures come from?
**External spermatic fascia** derived from **external obliques** **Cremasteric fascia** derived from **internal obliques** **Internal spermatic fascia** derived from **transversalis fascia** **Tunica vaginalis** derived from **parietal peritoneum**
34
Which layers of the **spermatic cord** are given off by a) **parietal peritoneum** b) **transversalis fascia** c) **internal oblique** d) **external oblique**?
**a) Tunica vaginalis** **b) Internal spermatic fascia** **c) Cremasteric fascia** **d) External spermatic fascia**
35
Which **nerves** supply the intercostal muscles? What is their source?
**Intercostal nerves** **Anterior rami of thoracic spinal nerves (T7 - T11)**
36
What is the blood **supply** of the a) **anterior** b) **posterior** intercostal spaces?
a) **Internal thoracic artery** b) **Throracic aorta**
37
What is the blood **drainage** of the a) **anterior** b) **posterior** intercostal spaces?
**a) Internal thoracic vein** **b) Azygous vein**
38
What are the **internal thoracic arteries** and **veins** also known as in women?
**Internal mammary arteries and veins**
39
Which nerves supply the **abdominal muscles**?
**Thoracoabdominal nerves** **Subcostal nerve** **Iliohypogastric nerve** **Ilioinguinal nerve**
40
The **intercostal nerves** are derived from the anterior rami of which spinal nerves?
**T7 - T11**
41
The **(ventral / dorsal)** rami of spinal nerves provide motor fibres.
**ventral rami**
42
Which **nerves** are **thoracoabdominal nerves** a continuation of?
**Intercostal nerves**
43
Which **spinal levels** are the **thoracoabdominal nerves** derived from?
**T7 - T11** same as intercostals (because they're the same nerves)
44
What are the **spinal levels** of the **thoracoabdominal nerves** **subcostal nerves** **iliohypogastric nerves** **ilioinguinal nerves**?
**Thoracoabdominal nerves** - T7 - T11 **Subcostal nerves** - T12 **Iliohypogastric nerves** - L1 **Ilioinguinal nerves** - L1
45
Where in the **rectus sheathe** do the nerves of the abdominal wall travel?
Between **internal oblique** and **transversus abdominis** i.e the **anterior rectus sheathe, above AND below the arcurate line**
46
Which **arteries** supply the anterior abdominal wall?
**Superior epigastric artery** **Inferior epigastric artery** although the inferior epigastric supplies the vast majority of the blood
47
Which **anterior abdominal artery** gives most of the blood supply?
**Inferior epigastric artery**
48
Where are the **superior and inferior epigastric arteries** found in relation to the rectus sheathe?
**Deep to rectus abdominis**
49
In which layer of the abdominal wall are the a) **thoracoabdominal nerves** b) **superior and inferior epigastric artery** found?
a) **Between internal oblique and transversus abdominis** (anterior rectus sheathe) b) **Deep to rectus abdominis** (posterior rectus sheathe)
50
Which major arteries are the a) **superior** b) **inferior epigastric arteries** a branch of?
**a) Internal thoracic / mammary artery** **b) External iliac artery**
51
The **superior epigastric artery** is **(anterior / posterior)** to rectus abdominis. The **inferior epigastric artery** is **(anterior / posterior)** to rectus abdominis.
**They're both posterior to rectus abdominis**
52
Which type of incision can damage the **thoracoabdominal, subcostal, iliohypogastric** or **ilioinguinal arteries**?
**Midline laparotomy incision**
53
The **superior epigastric arteries** are a branch of?
**Internal thoracic / mammary artery**
54
The **inferior epigastric arteries** are a branch of?
**External iliac artery**
55
In a caesarean section, are the rectus abdominis muscles cut?
**No** The linea alba is cut and they're pushed laterally
56
Which **organ** needs to be pushed inferiorly in a Caesarean section?
**Bladder** You do not want to cut this
57
What is the **suprapubic line** also known as?
**Pfannenstiel / Kerr line**
58
Where is the **deep inguinal ring** found?
**Halfway between ASIS and pubic tubercle**
59
What triangle is formed from the **lateral border of rectus abdominis, the inguinal ligament inferiorly** and the **inferior epigastric artery** medially?
**Inguinal triangle** or Hesselbach's triangle
60
What are the borders of the inguinal triangle?
**Lateral border of rectus abdominis** **Inferior epigastric artery superiorly** **Inguinal ligament inferiorly**
61
The **deep inguinal ring** is found halfway between the **ASIS** and the **pubic tubercle**. **Hernias** MEDIAL to this must be \_\_\_.
**direct** i.e popping through a muscular weakness, because the superficial inguinal ring is lateral to the deep one
62
The **deep inguinal ring** is halfway between the **ASIS** and the **pubic tubercle.** **Hernias** LATERAL to this must be \_\_\_.
**indirect** because the superficial ring, when indirect hernias pop out, is lateral to the deep inguinal ring
63
How do you tell the difference between a **direct** and **indirect inguinal hernia** on examination?
**Reduce the hernia and then put pressure on the deep inguinal ring (halfway between ASIS and pubic tubercle), then ask the patient to cough** If it pops out, it's **direct** (through rectus muscle) If it doesn't, it's **indirect** (it passes through the deep inguinal ring, which you're blocking)
64
**Direct inguinal hernias** occur (**medial / lateral**) to the **inferior epigastric artery**.
**medial** because they herniate through the rectus, which is the medial border of the inguinal triangle
65
**Indirect** **inguinal hernias** occur (**medial / lateral**) to the **inferior epigastric artery**.
**lateral** because they pop through the deep inguinal ring, which is lateral to the inguinal triangle
66
What is a **hysterectomy**?
**Removal of the uterus**
67
Which incision is used to carry out an **abdominal** **hysterectomy**?
**Suprapubic / Pfannenstiel incision** same as for Caesarean section
68
Which phrase describes the relationship between the **ureter** and the **uterine artery**?
**Water under the bridge** The ureter is always posterior to the uterine artery
69
What does the **ureter** do when you touch it?
**Vermiculates** which means it wriggles like a worm - peristalsis
70
Which artery can be damaged by a **lateral abdominal port** procedure?
**Inferior epigastric artery**
71
Which structure passes **posterior** to the bladder in **males?**
**Vas deferens**

Reproduction Week 4 2018/19 (9 decks)

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