ABDOMEN

Question 1

Paracentesis

MIDLINE APPROACH

Answer 1

Skin

Superficial fascia (Camper & Scarpa)

LINEA ALBA

Transversalis fascia

Extraperitoneal fat

Parietal peritoneum

Question 2

Paracentesis

FRANK APPROACH

Answer 2

Skin

Superficial fascia (Camper & Scarpa)

EXTERNAL OBLIQUE MUSCLE

INTERNAL OBLIQUE MUSCLE

TRANSVERSE ABDOMINIS

Transversalis fascia

Extraperitoneal fat

Parietal peritoneum

Question 3

Level of umbilicus

Answer 3

L3-L4

Question 4

Level of subcostal plane

Answer 4

10th rib; L3

Question 5

Level of transtubercular

Answer 5

Iliac tubercle; L5

Question 6

The dermatome level of umbilicus

Answer 6

T10

Question 7

Guide of DERMATOMES

Answer 7

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

Question 8

Muscles of the abdomen

Answer 8

External oblique

Internal oblique

Transversus abdominis

Rectus abdominis

Pyramidalis

Question 9

EXTERNAL OBLIQUE

Answer 9

Most superficial

Free inferior margin = inguinal ligament

Interdigitate with serratus anterior and latissimus dorsi

OBLIQUELY DOWNWARD AND MEDIALLY

From aponeurosis

Question 10

INTERNAL OBLIQUE

Answer 10

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

Question 11

TRANSVERSUS ABDOMINIS

Answer 11

Innermost

Flat

Ends in aponeurosis

Contribute to conjoint tendon

Question 12

RECTUS ABDOMINIS

Answer 12

On either side of linea alba

Segmented = tendinous intersections

Lateral border convex = LINEA SEMILUNARIS

Question 13

PYRAMIDALIS

Answer 13

Not always present

Tenses linea alba

Question 14

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

Answer 14

TRANSVERSALIS FASCIA

Question 15

Cresenteric border on the posterior wall

Midway between umbilicus and pubic crest

Answer 15

Arcuate line

Question 16

Contents of RECTUS SHEATH

Answer 16

Rectus abdominis

Pyramidalis

Superior epigastric vessels

Inferior epigastric vessels

Lower 5 intercostals and subcostal vessels and nerves

Question 17

Blood supply of rectus sheath

Answer 17

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

Inferior epigastric - from external iliac

Deep circumflex iliac - from external iliac

Question 18

Venous drainage of rectus sheath

Answer 18

Superior epigastric - to internal thoracic

Inferior epigastric - to external iliac

Deep circumflex iliac - to external iliac

Question 19

Nerve supply rectus sheath

Answer 19

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

Question 20

Hesselbach’s triangle

Answer 20

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

Inferior and lateral rectus abdominis

Medial

Question 21

Inguinal canal

Answer 21

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)

Question 22

Abnormal cysts in the spermatic cord

Answer 22

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

Question 23

INDIRECT INGUINAL HERNIA

Answer 23

Passes LATERAL to inferior epigastric vessels

Congenital type; processus vaginalis

Children and young adults

Neck of hernial sac is narrow

Enters the scrotum

Question 24

DIRECT INGUINAL HERNIA

Answer 24

Acquired type

Elderly

Neck of hernial sac is wide

MEDIAL to inferior epigastric vessels

Never enters the scrotum

Question 25

Are either direct or indirect Both types may emerge through the superficial inguinal rings and pass superficial to the inguinal ligament

Answer 25

INGUINAL HERNIAS

Question 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

Answer 26

INDIRECT INGUINAL HERNIA

Question 27

Protrude through the posterior wall and medial to inferior epigastric vessels COVERED ONLY BY EXTERNAL SPERMATIC FASCIA

Answer 27

DIRECT INGUINAL HERNIA

Question 28

Cremaster muscle is derived from what layer of the abd wall

Answer 28

INTERNAL OBLIQUE

Question 29

Layers of the ABDOMINAL WALL

Answer 29

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

Question 30

Derivatives of the abdominal layers

Answer 30

``` 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 ```

Question 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

Answer 31

CREMASTERIC REFLEX

Question 32

9 Abdominal regions

Answer 32

R hypochondriac R lumbar R inguinal Epigastric Umbilical Hypogastric L hypochondriac L lumbar L inguinal