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Flashcards in ABDOMEN Deck (32):
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9 Abdominal regions

R hypochondriac

R lumbar

R inguinal

Epigastric

Umbilical

Hypogastric

L hypochondriac

L lumbar

L inguinal

1

Paracentesis

MIDLINE APPROACH

Skin

Superficial fascia (Camper & Scarpa)

LINEA ALBA

Transversalis fascia

Extraperitoneal fat

Parietal peritoneum

2

Paracentesis

FRANK APPROACH

Skin

Superficial fascia (Camper & Scarpa)

EXTERNAL OBLIQUE MUSCLE

INTERNAL OBLIQUE MUSCLE

TRANSVERSE ABDOMINIS

Transversalis fascia

Extraperitoneal fat

Parietal peritoneum

3

Level of umbilicus

L3-L4

4

Level of subcostal plane

10th rib; L3

5

Level of transtubercular

Iliac tubercle; L5

6

The dermatome level of umbilicus

T10

7

Guide of DERMATOMES

C2 - back of head
C5 - tip of shoulder
C6- thumb
C7 - middle finger
C8 - small finger
T4 - nipple
T10 - umbilicus
L1 - inguinal
L4 or L5 - big tor
S1 - small toe
S5 - perianal region

8

Muscles of the abdomen

External oblique

Internal oblique

Transversus abdominis

Rectus abdominis

Pyramidalis

9

EXTERNAL OBLIQUE

Most superficial

Free inferior margin = inguinal ligament

Interdigitate with serratus anterior and latissimus dorsi

OBLIQUELY DOWNWARD AND MEDIALLY

From aponeurosis

10

INTERNAL OBLIQUE

Deep to external oblique

UPWARD AND MEDIAL

Aponeurotic fibers of internal oblique and transvershs abdominis = CONJOINT TENDON

From aponeurosis which splits to form rectus sheath

11

TRANSVERSUS ABDOMINIS

Innermost

Flat

Ends in aponeurosis

Contribute to conjoint tendon

12

RECTUS ABDOMINIS

On either side of linea alba

Segmented = tendinous intersections

Lateral border convex = LINEA SEMILUNARIS

13

PYRAMIDALIS

Not always present

Tenses linea alba

14

At the level below the anterior superior iliac spines, the posterior wall of the rectus sheath is formed by

TRANSVERSALIS FASCIA

15

Cresenteric border on the posterior wall

Midway between umbilicus and pubic crest

Arcuate line

16

Contents of RECTUS SHEATH

Rectus abdominis

Pyramidalis

Superior epigastric vessels

Inferior epigastric vessels

Lower 5 intercostals and subcostal vessels and nerves

17

Blood supply of rectus sheath

Superior epigastric - from internal thoracic (1st part of subclavian)

Inferior epigastric - from external iliac

Deep circumflex iliac - from external iliac

18

Venous drainage of rectus sheath

Superior epigastric - to internal thoracic

Inferior epigastric - to external iliac

Deep circumflex iliac - to external iliac

19

Nerve supply rectus sheath

Ventral rami of the lower sicpx thoracic nerves and first lumbar nerve

20

Hesselbach's triangle

Inferior epigastric artery - superior and lateral inguinal ligament/POUPART's ligament

Inferior and lateral rectus abdominis

Medial

21

Inguinal canal

Anterior - EOM APONEUROSIS

Posterior - TRANSVERSALIS FASCIA AND CONJOINT TENDON

Superior - INTERNAL OBLIQUE AND TRANSVERSALIS ABDOMINIS

Inferior - INGUINAL LIGAMENT

Males - SPERMATIC CORD

Females - ROUND LIGAMENT

Common structure - ILIOINGUINAL NERVE (L1)

22

Abnormal cysts in the spermatic cord

HYDROCELE - accumulation of serous fluid

HEMATOCELE - accumulation of blood, results from rupture of testicular blood vessels after trauma

SPERMATOCELE - cysts containing sperm that develops in th epididymis

VARICOCELE - results from dilatations of tributaries of testicular vein

23

INDIRECT INGUINAL HERNIA

Passes LATERAL to inferior epigastric vessels

Congenital type; processus vaginalis

Children and young adults

Neck of hernial sac is narrow

Enters the scrotum





24

DIRECT INGUINAL HERNIA

Acquired type

Elderly

Neck of hernial sac is wide

MEDIAL to inferior epigastric vessels

Never enters the scrotum

25

Are either direct or indirect

Both types may emerge through the superficial inguinal rings and pass superficial to the inguinal ligament

INGUINAL HERNIAS

26

Protrude through the anterior abdominal wall lateral to inferior epigastric vessels

Enter the deep inguinal ring and appear at the superficial ring

COVERED BY PERITONEUM AND LAYERS OF SPERMATIC CORD

INDIRECT INGUINAL HERNIA

27

Protrude through the posterior wall and medial to inferior epigastric vessels

COVERED ONLY BY EXTERNAL SPERMATIC FASCIA

DIRECT INGUINAL HERNIA

28

Cremaster muscle is derived from what layer of the abd wall

INTERNAL OBLIQUE

29

Layers of the ABDOMINAL WALL

Skin
Superficial fascia (Campers and Scarpas)
Deep fascia
Muscles
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum

30

Derivatives of the abdominal layers

Skin = SKIN
Superficial fascia = DARTOS MUSCLES
External oblique = EXTERNAL SPERMATIC FASCIA
Internal oblique = CREMASTER MUSCLE
Transversalis abdominis = none
Transversalis fascia = INTERNAL SPERMATOC FASCIA
Extraperitoneal fat = none
Peritoneum = TUNICA VAGINALIS

31

Utilizes sensory and motor fibers in the ventral ramus of the L1 SPINAL NERVE

Stroking the skin of the superior and medial thigh stimulates sensory fibers of the ILIOINGUINAL NERVE

Motor fibers from the GENITAL BRANCH OF THE GENITOFEMORAL cause the cremaster muscle to contract, elevating the testis

CREMASTERIC REFLEX