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MD3002 GI > abdominal wall 1 > Flashcards

abdominal wall 1 Flashcards

1
Q

what are the quadrants of the abdomen?

A
  • trans umbilical plane (L3/4)
  • midline
  • this creates 4 quadrants (right and left upper and lower)
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2
Q

how are the surface regions split for neonates?

A
  • midclavicular lines
  • subcostal plane (L3)
  • intertubercular line (iliac crest tubercles) -L5

This creates:
- the right and left hypochindrium, flank and groin
- midline- epigastric, umbilical and pubic region.

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3
Q

what are the layers of the abdomen from superficial to deep?

A
  • skin
  • superficial fascia: (camper’s fascia (fatty) and scarpa’s fascia (membranous)
  • muscular layers: (with investing fascia) (external oblique, internal oblique, transversus abdominis)
  • transversalis fascia
  • extraperitoneal fascia
  • parietal peritoneum
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4
Q

what will Camper’s and Scarpa’as fascia be continous with?

A

it continous into the perineum

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5
Q

how would you describe the structure of the skin?
why do we cut parralel to these lines?

A

the skin has Langers lines on it:
- we ideally cut parallel to the lines otherwise tension will occur across the incision and lead to a larger scar

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6
Q

what are the 3 flat muscles of the abdominal wall?

A
  • external oblique
  • internal oblique
  • transversus abdominalis
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7
Q

what is the one straight muscle?

A

rectus abdominis

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8
Q

what is the small inconsistent muscle of the abdomen?

A

pyramidalis

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9
Q

what is the function of the abdominla wall muscles?

A
  • supports anterolateral abdominal wall
  • supports and protects the abdominal viscera
  • maintains and raises the intraabdominal structures (antagonise diaphragmatic action, forced expiration)
  • flexes and roated the trunk
  • aids posture
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10
Q

describe the innervation of the abdominal wall muscles?

A

supplied by 3 different nerves:
- thoracoabdominal nerves (anterior rami of T6-11)
- subcostal nerve (T12)
- iliohypogastric (L1)

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11
Q

rectus abdominis:
- attachments
- innervation?
- function?

A

attachments:
- from pubic crest, symphyis, tubercle to costal cartillages of rivs 5,6,7 and xiphoid process

innervation:
- anterior rami of T6-T12

function:
- flexes the trunk, compresses viscera, stabilises the pelvis (resists anterior tilt)

Has 6 tendinous intersections (6 pack)

within the rectus sheath

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12
Q

pyramidalis:
- attachments?
- function?
- innervation?

A

this muscle is only found in 70% of people

attachments:
- pubic crest to linea alba

function:
- tenses linea alba

innervation:
- anterior rami of T12

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13
Q

what forms the abdominal wall rectus sheath?
what do they all unite to form?

A

formed from aponeuroses of:
- external oblique
- internal oblique
- tranversus abdominis
- tranversalis fascia

  • They unite centrally to form linea alba from pubic sympysis to xiphoid process
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14
Q

what happens to the abdominal wall rectus sheath above the arcuate line?
and below the arcuate line?

A
  • above the arcuate line, internal oblique aponeurosis splits to cover rectus abdominis anteriorly and posterirly.
  • below the arcuate line, aponeuroses are anterior to rectus abdominis
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15
Q

what is contained within the rectus sheath?

A
  • abdominis
  • pyramidalis
  • superior and inferior epigastric vessels.
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16
Q

inguinal ligament:
- where is it?
- attachments?
- where does its fibres insert?
- what does these insertions create?

A
  • it is at the lower border of the external oblique aponeurosis
  • attaches to the ASIS to the pubi tubercle
  • some fibres insert on pecten pubis, forming the lacunar ligament
17
Q

Lacunar Ligament?
- what are its posterior extension called?

A

this is the medial border of the femoral triangle
- it has a posterior extension along pectineal line termed pectineal ligament

18
Q

describe the thoraco- lumbar fascia?
where is the weak spot?

A
  • this is tough strong fascia in the lumbar region
  • there is a weak spot between lat dorsi and external oblique, this is called the Triangle of Petit (inferior lumbar triangle)… a lumbar hernia can occur here.
19
Q

where does the thoracolumbar fascia insert onto?

A

inserts onto the iliac crest, lumbar vertebra and ribs.

20
Q

what 2 muscles will insert into the thoraco lumbar fascia?

A

internal oblique and transversus abdominalis.

21
Q

internal oblique:
- innervation?

A

Innervation:
- T6-L1 anterior rami

22
Q

transversus abdominis:

innervation?

A

innervation:
- T6-L1 anterior rami

23
Q

what 2 thing will the conjoint tendon connect?
what is anterior to it?

AKA - inguinal Flax

A

the internal oblique and transversus abdominis share an insertion on the pubic crest and pectineal line via the conjoint tendon.

  • the superficial inguinal ligament ring opens anteriorly
24
Q

what will pass through the inguinal canal fro males and females?

what is the inguinal canal?

A

This is a passage within the inferior aspect of the anterior abdominal wall and it allows structures to pass from the abdominal cavity externally.

male = spermatic cord

female = round ligament of the uterus

both= genital branch of genitofemoral nerve L1, 2 and ilioinguinal nerve L1.

has a deep and superficial ring

25
Q

what is Processus Vaginalis?

A

this is an outpuching of the peritoneum that proceeds testes descent, it should then close.
Failure to close = increased risk of indirect inguinal hernia.

26
Q

what happens as the devloping testes descend through the inguinal canal?

A

it picks up layers of the abdominal wall, which become equivelant structures in the spermatic cord

27
Q

where is the opening of the superficial ring of the inguinal canal?
what will reinforce the opening posterioly?

A
  • the triangular opening is in the external oblique aponeurosis
  • the conjoint tendon will reinforce the opening posteriorly.
28
Q

the inguinal canal also has a deep ring, where is it?

A
  • in the lateral inguinal fossa.
  • this is lateral to the lateral umbilical cord.

it is an evagination of the transversalis fascia

29
Q

what is an abdominal hernia?

A

a protusion of an organ through the wall of the body cavity
can be:
- incisional
- epigastric
- umbilical
- inguinal (3/4 are inguinal)
- femoral

30
Q

where is a direct inguinal hernia likely to occur?

boundries of triangle

A

in the Inguinal Hesselbach’s trinagle:
- lateral = inferior epigasstric vessels
- medial = rectus abdomins
- inferior = inguinal ligament

Likely to occur if there is weakness in the anterior abdominal wall.

31
Q

what are direct inguinal hernias?

A

small bowel/fat protusion that is covered by peritoneum and transversalis fascia.
- runs alongside the spermatic cord
- may enter the scrotum but this is not common

32
Q

what are indirect inguinal hernias?

A

these ones will enter through the deep inguinal ring via persistent processus vaginalis
- the contents are covered by layers of spermatic cord
- LIKELY to enter the scrotum

33
Q

what is a rectus sheath haematoma?

A
  • bleeding into the rectus sheath, happens post trauma usually.
  • epigastric vessels or muscles are damaged
  • can be managed conservatively.
34
Q

what is the layer of fascia that is directly superficial to the extraperitoneal fascia?

A

transversalis fascia

35
Q

in a patient with a hernia at the T8 dermatome with no history of surgery, what type of hernia is likely to be present?

A

epigastric

36
Q

give a summary of hernias?

A
  • they usually present with a lump
  • often increase in size on coughing or straining
  • they reduce in size or disappear when relaxed or supine
  • irreducible but non obstructed hernias may cause litle pain
  • if a hernia causes obstruction, it will be tense tender and irredcable. (colicky abdominal pain, distension and vomitting may occur.)
  • if trangulation occurs the lump will become red and tender
37
Q

What are the boundaries of the Inguinal canal?
Posterior
Anterior
Roof
Floor

A

MD3002 GI (10 decks)

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