Abdominal Wall/ Inguinal Region

Question 1

liposuction

Answer 1

surgical method for removing unwanted subcutaneous fat

Question 2

where can fluid accumulate in abdominal fascia?

Answer 2

between membranous layer of subQ (scarpa’s fascia) and deep fascial covering of rectus abdominus & external obliques (potential space)

Question 3

what’s important about the fascia lata of the thigh that parallels the inguinal ligament?

Answer 3

accumulated fluid in abdominal wall can’t move inferiorly because of the fusal of the deep fascia of the thigh with scarpa’s fascia

Question 4

what layer reduces risk of infection during abdominal surgery?

Answer 4

transveralis fascia

Question 5

what is space of Bogros? why is it important?

Answer 5

-anterolateral part of potential space between transversalis fascia and parietal peritoneum -used for placing prosthetics when repairing inguinal hernias (typically in men)

Question 6

what causes abdominal protrusion?

Answer 6

food, fluid, fat, feces, flatus, & fetus (six F’s)

Question 7

what is ascites?

Answer 7

abnormal accumulation of serous fluid in peritoneal cavity

Question 8

what can cause lordosis with respect to the abdominal region?

Answer 8

tumors or excess fat can cause the pelvis to tilt anteriorly at hip joints

Question 9

where do abdominal hernias typically occur?

Answer 9

inguinal, umbilical, & epigastric regions

Question 10

which type of hernia is common in neonates?

Answer 10

umbilical hernia because of weak abdominal wall in umbilical ring or incomplete closure of abdominal wall after umbilical cord ligation

Question 11

acquired umbilical hernias occur most commonly in?

Answer 11

women and obese people

Question 12

what is an epigastric hernia?

Answer 12

hernia in the epigastric region through the linea alba (midline between xiphoid process and umbilicus)

Question 13

what is a spigelian hernia?

Answer 13

-hernia that occurs along semilunar lines -common in people older than 40 -associated with obesity

Question 14

what is guarding of muscles?

Answer 14

involuntary spasms due to cold hands during palpitation

Question 15

what is important about the superficial abdominal reflex?

Answer 15

-contraction of abdominal muscles when strokes lateral to medial towards umbilicus -diseased organ or injury will cause rapid reflex -obese people unlikely to produce reflex

Question 16

an inguinal hernia and abdominal wall muscle weakness is indicative of?

Answer 16

injury to the nerves of anterolateral abdominal wall -inferior thoracic spinal nerves T7-T12 -ilio-inguinal & iliohypogastric nerves (L1)

Question 17

what muscle is an exception to the use of langer’s lines in surgery?

Answer 17

rectus abdominus can be transected because its fibers run short distances between tendinous intersections & segmental nerves are lateral in rectus sheath (can be preserved)

Question 18

what is an important complication of a median or midline incision?

Answer 18

linea alba has small vessels and nerves, but may undergo necrosis if edges are not sewn together properly

Question 19

what kind of incisions are used for an appendectomy?

Answer 19

gridiron (muscle splitting)

Question 20

what and where is McBurney’s incision?

Answer 20

oblique incision made at McBurney’s point, 2.5 cm superomedial to anterior superior iliac spine, to umbilicus

Question 21

what are Pfannenstiel (suprapubic) incisions & what are they used for?

Answer 21

• horizontal incisions at pubic line
• used for gynecological & obstetrical operations (C-sections)

Question 22

what incisions provide access to the gallbladder and bilary ducts (right side) & spleen (left side)?

Answer 22

subcostal incision: parallel & 2.5 cm inferior to costal margin to avoid 7th/8th thoracic spinal nerves

Question 23

which incisions are considered to be high risk?

Answer 23

• pararectus: along lateral border of rectus abdominus, can cut off nerve supply
• inguinal: repairing hernias, can injure ilio-inguinal nerve

Question 24

what can result if the muscular & aponeurotic layers of abdomen do not heal properly from a surgery?

Answer 24

incisional hernia; protrusion of omentum or organ

Question 25

what's important about endoscopic surgery?

Answer 25

- allows for minimally invasive surgery; small incisions using remotely operated instruments - reduces risk for infection, cut nerves, incisional hernias

Question 26

what clinical problem does this picture indicate?

Answer 26

- obstructed flow to inferior or superior vena cava - anastomoses with thoraco-epigastric vein allows for venous blood return to heart

Question 27

what is cryptorchism?

Answer 27

undescended or unretractable testis (usually unilaterally and in inguinal canal)

Question 28

why is an undescended testis clinically relevant?

Answer 28

greatly increased risk for malignancy because its unpalpable and cancer goes undetected

Question 29

what is an external supravesical hernia and which nerve can be damaged in its repair?

Answer 29

- goes through supravesical fossa & medial to an inguinal hernia - can damage iliohypogastric nerve during the repair

Question 30

what structure is clinically relevant in infants with erythroblastosis fetalis or hemolytic disease?

Answer 30

postnatal patent umbilical vein (when occluded, forms round ligament of liver)

Question 31

where can tumors near the round ligament of the uterus spread?

Answer 31

from uterus to labium majus (homolog of scrotum & distal attachment of round ligament) & then to superficial inguinal nodes

Question 32

what is a direct inguinal hernia?

Answer 32

acquired inguinal hernia that rarely passes through scrotum

Question 33

what is an indirect inguinal hernia?

Answer 33

congenital inguinal hernia that usually passes into scrotum (labium majus in females)

Question 34

how and where do you palpate the superficial inguinal ring?

Answer 34

- superolateral to pubic tuberacle by invaginating skin of upper scrotom with index finger - important for finding inguinal hernias

Question 35

what nerve is the cremasteric reflex testing and why is it important?

Answer 35

- rapid elevation of testes - tests ilio-inguinal nerve - hyperactive reflex may indicate undescended testes

Question 36

if the processus vaginalis persists in females, what forms?

Answer 36

small peritoneal pouch called canal of Nuck in inguinal canal, which may extend into labium majus and cause indirect inguinal hernia

Question 37

what is a hydrocele?

Answer 37

- excess fluid in persistant processus vaginalis - can cause indirect inguinal hernia - may be located in testis or spermatic cord (see pic)

Question 38

how is a hydrocele detected?

Answer 38

transillumination: shining light on scrotal enlargement (serous fluid glows red)

Question 39

what is a hematocele & how does it occur?

Answer 39

- blood in tunica vaginalis - results from rupture of branches of testicular artery from trauma - can cause hematoma - transillumination: blood does not glow

Question 40

what is torsion of spermatic cord & how is it fixed?

Answer 40

- twisting of cord which can lead to necrosis of testes - venous/arterial obstruction, edema, hemorrhage - testes are surgically fixed to scrotal septum

Question 41

describe the innervation of the scrotum and why its important?

Answer 41

- anterolateral surface of scrotum supplied by L1 (ilio-inguinal nerve) - posteroinferior surface supplied by S3 (pudendal nerve) - to anesthetize, spinal agent must be injected in different locations

Question 42

what is the difference between a spermatocele and an epididymal cyst?

Answer 42

- spermatocele: cyst in epididymis near the head, milky, usually asymptomatic - epididymal cyst: cyst anywhere on epididymis - see pic

Question 43

what is the appendix of the testes?

Answer 43

-vesicular remnant of cranial end of paramesonephric (müllerian) duct, which forms half of uterus in female

Question 44

what are the appendices of the epididymis?

Answer 44

- remnants of cranial end of mesonephric (wolffian) duct, forms part of ductus deferens - attached to head of epididymus

Question 45

what is a varicocele and why does it occur?

Answer 45

- dilation of pampiniform plexus of veins - result from defective venous valves in testicular vein, & kidney/renal vein problems - occurs mostly on left side because right side drains into IVC easier

Question 46

where does cancer of the testis metastastize to?

Answer 46

initially to retroperitoneal lumbar lymph nodes (inferior to renal veins) & then to mediastinal & supraclavicular nodes

Question 47

where does cancer of the scrotum metastastize to?

Answer 47

superficial inguinal lymph nodes (in subQ inferior to inguinal ligament and along terminal part of great saphenous vein)

Question 48

why do cancers of testis and scrotum metastastize to different places?

Answer 48

because testes come from posterior abdominal wall to scrotum during development

Question 49

how else can testicular cancer metastastize?

Answer 49

by hematogenous spread of cancer cells via blood to lungs, liver, brain, & bone