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Flashcards in Abdominal Wall Deck (40)
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Functions of the abdominal wall?

Firm flexible wall to keep abdominal viscera in the abdominal cavity Protect abdominal viscera from injury Maintain anatomical position of viscera against gravity Assist in forceful expiration by pushing viscera upwards Involved in any action (eg vomiting, coughing) that increases intra-abdominal pressure

1

What are the layers of the abdominal wall?

Skin Superficial fascia/subcutaneous fascia Muscles and associated fascia Parietal peritoneum Visceral peritoneum

2

Composition of subcutaneous tissue above the umbilicus?

Single sheet of connective tissue continuous with superficial fascia in other regions of the body

3

Composition of subcutaneous tissue below the umbilicus?

Two layers -fatty superficial layer -membranous deep layer

4

Epithelium of the peritoneum?

Simple squamous

5

What separates the parietal peritoneum from muscular layers of the abdominal wall?

Extra peritoneal connective tissue Can contain lots of fat

6

Which layer of the peritoneum is sensitive to pain?

Parietal

7

Which layer of the peritoneum is only sensitive to stretching and chemical irritation?

Visceral peritoneum

8

What is in the peritoneal cavity?

Just a small amount of lubricating liquid

9

At what vertebral level is the umbilicus?

L3

10

What and where is the epigastric fossa?

A slight depression in the epigastric region Inferior to xiphoid process Heartburn is commonly felt here

11

What and where is the linea alba?

Aponeuroses of the abdominal muscles Separates left and right rectus abdominis

12

Clinical relevance of linea alba?

If linea albas is lax, when rectus abdominis contracts, muscles spread apart and get divarication of the recti Often seen in pregnancies as it gets weakened

13

Where is the inguinal groove? What does it mark?

Skin crease just inferior to the inguinal ligament Marks division of abdominal wall and thigh

14

What are the semilunar lines?

Slight curved, tendinous line on either side of the rectus abdominis

15

What is the proper term for what you see in a six pack?

Tendinous intersections of rectus abdominis

16

What is the arcuate/Douglas's line?

Where the posterior layer of the rectus sheath stops and just have the anterior layer.

17

Boundaries of the abdominal wall?

Costal cartilages of ribs 7-10 and xiphoid process of sternum, to the superior margins of anterolateral pelvic girdle

18

What type of incision is this?

Median incision

Can be continued to curve around the umbilicus

19

Why is a median incision good?

Cut into linea alba - limited blood loss because it is poorly vascularised

Major nerves avoided

Can be used in any procedure that requires access to abdominal cavity

 

 

20

What type of incision is shown here? Why is it useful?

Paramedian incision

Provides access to more lateral structures such as kidneys, spleen, adrenals

21

Disadvantage of paramedian incision?

Ligates blood supply to muscles median to incision - atrophy

22

What type of incision is shown here? Advantages?

Causes least damage to nerve supply and abdominal muscles

Heals well

23

Name this incision. Advantages?

Suprapubic incision

Used when access to pelvic organs is needed

24

Disadvantage of a suprapubic incision?

Can perforate the badder because the fascia thins around the bladder area

25

Name this incision. Advantages?

Gridiron incision - done at McBurney's point

Can split the muscle fibres without cutting them and allows for excellent healing

26

How is a gridiron incision done and where?

Two perpendicular lines which split the muscle fibres

Performed at McBurney's point which is 1/3 of the distance between ASIS and umbilicus

27

What are primarily retroperitoneal organs?

Organs which have developed and remained outside of the parietal peritoneum

28

Examples of primarily retroperitoneal organs?

Oesophagus

Rectum

Kidneys

29

What are secondarily retroperitoneal organs?

Organs which were initially peritoneal, suspended by mesentery. During embryogensis, they became retroperitoneal. Their mesentery fuses with the posterior abdominal wall.

30

Examples of secondarily retroperitoneal organs?

Ascending and descending colon

31

Name the retroperitoneal organs

Suprarenal glands

Aorta

Duodenum (except cap)

Pancreas

Ureters

Colon

Kidneys

Esophagus

Rectum

32

What is a mesentery?

Double layer of visceral peritoneum. Connects an intraperitoneal organ to abdominal wall.

Provides a pathway for lymphatics, vessels and nerves from the body wall to the viscera

33

How many layers of peritoneum are in the greater omentum?

4

34

Where does the greater omentum go from and to?

Greater curvature of the stomach to proximal part of duodenum. Then folds back up and attaches to anterior surface of transverse colon.

35

Where does the lesser omentum go from and to?

Lesser curvature of the stomach and proximal part of the duodenum to the liver

36

Name the two parts of the lesser omentum

Hepatogastric ligament

Hepatoduodenal ligament

37

What are peritoneal ligaments made of?

Double folds of peritoneum

Connect viscera together or to abdominal wall

38

Name the ligaments which connect the liver to other things and what they connect it to

Falciform ligament - anterior abdominal wall

Hepatogastric ligament - stomach

Hepatoduodenal ligament - duodenum

39

Name the ligaments of the stomach and where they connect it to

Hepatogastric

Gastrophrenic ligament - diaphragm

Gastrosplenic ligament - spleen

Gastrocolic (greater omentum) - transverse colon