L18- Abdominal Wall and Inguinal Region Flashcards

1
Q

Where is the abdomen located?

A

Part of the trunk between the thorax and pelvis

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2
Q

The Os Coxae is composed of what?

A

The ilium, ischium and pubis

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3
Q

At what level does the ilic crest fall?

A

L4 level

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4
Q

At what level does the iliac tubercle fall?

A

L5 level

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5
Q

The umbilicus usually falls at what level?

A

at the L4 level

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6
Q

What line separates the abdominal muscles down the midline?

A

Linea alba

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7
Q

What separates the abdominal muscles transversely?

A

Tendinous intersections

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8
Q

What line runs medially and inferiorly on the abdominal muscles? (sex lines ;)

A

Inguinal groove

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9
Q

What two planes separate the abdominal wall into quadrants?

A

median and transumbilical

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10
Q

What fascial layer lies just deep to the skin?

A

Camper’s fascia

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11
Q

What fascial layer lies deep to camper’s fascia?

A

Scarpa’s fascia

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12
Q

What are the functions of the muscles of the abdominal wall?

A

-contain and protect the viscera -defecation, micturition, parturition -flexion and rotation of trunk -tilt pelvis -maintaining posture -accessory muscle of forced respiration

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13
Q

What are the three flat muscles of the abdomen? What do they do?

A

-external abdominal oblique -internal abdominal oblique -transversus abdominis Work to flex and rotate the trunk

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14
Q

What is the vertical muscle of the trunk? What does it do?

A

Rectus abdominis -flexes trunk and tilts the pelvis

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15
Q

What is the origin and insertion of the external oblique?

A

Origin: Ribs 5-12 Insertion: Iliac crest, pubic tubercle, linea alba

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16
Q

What is the innervation of the external oblique?

A

Lower thoracic anterior rami

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17
Q

What is the action of the external oblique?

A

support abdominal viscera, flex trunk

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18
Q

What direction do the fibers of the external oblique run?

A

infero-medially

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19
Q

What is the origin and insertion of the internal oblique?

A

Origin: thoracolumbar fascia and iliac crest Insertion: Ribs 10-12, linea alba, pectineal line

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20
Q

What is the innervation of the internal oblique?

A

Lower thoracic anterior rami

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21
Q

What is the action of the internal oblique?

A

Support abdominal viscera and flex trunk

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22
Q

What direction do the fibers of the internal oblique run?

A

supero-medial (pretty much horizontal)

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23
Q

What is the origin and insertion of the transversus abdominis?

A

Origin: thorcolumbar fascia, iliac crest, ribs 7-12 Insertion: linea alba, pubic crest, pectineal line

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24
Q

what is the innervation of the transversus abdominis?

A

Lower thoracic anterior rami

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25
Q

what is the action of the transversus abdominis?

A

support the abdominal viscera

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26
Q

What direction do the fibers of transversus abdominis run?

A

horizontally

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27
Q

What is the origin and insertion of the rectus abdominis?

A

Origin: pubic symphysis and pubic crest Insertion: Xiphoid process and costal cartilages 5-7

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28
Q

what is the innervation of the rectus abdominis?

A

lower thoracic anterior rami

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29
Q

what is the action of the rectus abdominis?

A

support the abdominal viscera and flex the trunk

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30
Q

What direction do the fibers of the rectus abdominis run?

A

vertically

31
Q

What cuts across the rectus abdominis? (gives the 6-pack look)

A

tendinous intersections

32
Q

What is origin and insertion of the pyramidalis?

A

Origin: pubic crest Insertion: linea alba

33
Q

what is the innervation of pyramidalis?

A

subcostal nerve- T12

34
Q

what is the action of the pyramidalis?

A

pulls linea alba inferiorly

35
Q

Where is the pyramidalis?

A

within the rectus sheath anterior to rectus abdominis

36
Q

What is the rectus sheath composed of?

A

aponeurosis of other abdominal muscles

37
Q

The rectus sheath encloses what?

A

the rectus abdominis and pyramidalis

38
Q

Superior to the umbilicus, the aponeurosis of what muscle encloses the rectus abdominis?

A

The internal oblique splits to surround it

39
Q

Inferior to the arcuate line, what parts of the sheath pass anteriorly to the rectus abdominis?

A

All 3 aponeuroses from the EO, IO and TA (the transversalis fascia passes posteriorly)

40
Q

Why is the rectus sheath a point of weakness inferior to the arcuate line?

A

It is only composed of the transversalis fascia at that point. Vulnerable to herniation

41
Q

The xiphoid dermatome runs at what level?

A

T5 (sometimes T6)

42
Q

The umbilicus dermatome runs at what level?

A

T10

43
Q

The pubis dermatome runs at what level?

A

L1

44
Q

What is a TAP block?

A

A transversus abdominis plane block: anesthesia injected between the internal oblique and transverses abdominis

45
Q

What are caval-caval anastomoses?

A

If the IVC is blocked, the poorly oxygenated blood can become rerouted and travel back to the heart

46
Q

Where does the caval-caval anastomosis lie?

A

Between the IVC and SVC (superior and inferior epigastric veins)

47
Q

What are the portal-caval anastomoses?

A

the communication between the caval (IVC/SVC) and portal venous systems (paraumbilical veins communication with superficial epigastric veins)

48
Q

What is caput medusea the result of?

A

Due to a portal vein obstruction/portal hypertension. Blood backsup and causes an enlargement of the epigastric veins

49
Q

Name the two openings of the inguinal canal

A

the deep ring and superficial ring

50
Q

What is formed by the transversalis fascia and is the entrance to the inguinal canal?

A

The deep inguinal ring

51
Q

What is the exit to the inguinal canal and splits the external oblique aponeurosis?

A

The superficial inguinal ring

52
Q

Where can you palpate the inguinal rings?

A

Deep: 1cm superior to the inguinal ligament at midpoint superficial: superior and lateral to pubic tubercle

53
Q

What is the gubernaculum in males?

A

The fibrous tract connection the developing testes to the anterior abdominal wall at the scrotum

54
Q

What is the out pocketing of the peritoneum into the developing scrotum called?

A

processus vaginalis

55
Q

What is the spermatic cord made up of?

A

Vessels, nerves, ductus deferens and muscle layers (- vas deferens -testicular arteries -pampiniform plexus -genital branch of genitofemoral nerve -testicular plexus of nerves -lymphatics)

56
Q

What is the function of the scrotal ligament?

A

anchors testes to skin (remnant of gubernaculum)

57
Q

What does the gubernaculum in females derive into?

A
  • round ligament of the uterus
  • ovarian ligament: anchors ovaries to uterus
58
Q

The labia majora and scrotum are outpocketings of what?

A

the abdominal wall

59
Q

What runs through the inguinal canal in females?

A
  • round ligament of the uterus
  • ilioinguinal nerve (L1)
  • genital branch of genitofemoral nerve (L1-L2)
60
Q

What runs through the inguinal canal in males?

A
  • ilioinguinal nerve (L1)
  • genital branch of genitofemoral nerve (L1-L2)
  • spermatic cord
61
Q

Name the fascial layers of the spermatic cord from outer to inner.

A

1) external spermatic fascia
2) cremasteric fascia (& muscle)
3) internal spermatic fascia

62
Q

The cremasteric muscle helps to do what?

A

ascend and descend the testes

63
Q

The dartos fascia can be found where?

A

deep to the skin on the scrotum

64
Q

What is the somatic innervation of the scrotum and labia majora?

A

branches of the ilioinguinal and genitofemoral nerves (also motor to cremaster muscle)

65
Q

What is a direct (acquired) hernia?

A

pushes through the abdominal fascia, enters posterior wall of inguinal canal, rarely enters scrotum/labia majora Less common!

66
Q

What is a indirect (congenital) hernia?

A

Most common Enters the deep inguinal ring, transverses the inguinal canal, exits the superficial ring, can enter the scrotum/labia majora more common in men as their canal has been stretched by the descent of the testes

67
Q

What is the cremasteric reflex?

A

scratch on upper thigh contracts the cremaster muscle as genital branch of genitofemoral nerve innervates both (L1-L2)

68
Q

Where does the lymph superior to the umbilicus drain?

A

The axillary nodes

69
Q

Where does the lymph inferior to the umbilicus drain?

A

superficial inguinal nodes

70
Q

The lymphatics of the testes and ovaries drain into what?

A

Mostly lumbar nodes (often metastatic pathway in cancer)

71
Q

The lymphatics of the scrotum and labia majora drain into what?

A

superficial inguinal nodes

72
Q

Identify a, b, c

A
  • a: Pubic Tubercle
  • b: Pubic symphysis
  • c: Pectineal line
73
Q

Identify

A

Linea semilunaris (semilunar lines)

74
Q

Identify

  • red/brown region
  • green/purple region
  • dark blue region
A
  • hypochondriac
  • lateral (lumbar)
  • inguinal