Abdominal Wall, Inguinal Region, Hernias

Question 1

What are the bony landmarks of the Abdomen

Answer 1

Sternum and Xiphoid Process
Costal Margin, costal cartilages, ribs
Iliac crest, iliac fossa, ASIS,
Public Symphysis, pubic tubercle, pubic ramus,
Thoracic and lumbar vertebrae, Sacrum, and pelvic bones

Question 2

What visceral structures are found in the abdomen

Answer 2

Stomach, duodenum, small intestines, liver, pancreas, spleen, kidneys, ureters, urinary bladder, reproductive organs, abdominal vessels

Question 3

What are the 9 regions that the abdomen can be divided into

Answer 3

Right Hypochondriac, epigastric, left hypochondriac,
Right lumbar, umbilical, left lumbar,
Right Iliac, Hypogastric, Left Iliac

Question 4

What are the two fascia found immediately below the skin and what are their characteristics

Answer 4

Camper’s fascia: fatty fascia

Scarpa’s fascia: membranous layer

Question 5

What muscles make up the posterior wall of the abdomen

Answer 5

Quadrates lumbers, posts major, iliac muscles

Post-vertebral muscles

Question 6

What muscles make up the lateral wall of the abdomen

Answer 6

External Oblique
Internal Oblique
Transversalis Abdominis

Question 7

What muscles make up the anterior wall of the abdomen

Answer 7

The paired vertical rectus abdominal muscles within the rectus sheath.

Question 8

What is an aponeurosis

Answer 8

Thin but strong fibrous sheet of tissue that replaces a tendon in muscles that are flat and sheet-like and have a wide area of attachment.

Question 9

What are some functions of the three sheet-like muscles

Answer 9

Compresses the abdomen and increases intra-abdominal pressure to aid expiration and evacuation of feces, urine, and parturition

Question 10

What are the attachments of external oblique

Answer 10

Bottom 8 ribs, free posterior border, xiphoid prices, linea alba, pubic crest and tubercle, anterior 1/2 of iliac crest

Question 11

What is the direction of the external oblique muscle fibers

Answer 11

Infero-medially

Question 12

How is the inguinal ligament made and where does it attach

Answer 12

Formed by the rolling inwards of the lower aponeurotic border of the external oblique. It extends from the ASIS to the pubic tubercle.

Question 13

What are the attachments of the internal oblique; lateral and medial

Answer 13

Laterally: Thoracolumbar fascia, anterior 2/3 of iliac crest, lateral 1/2 of inguinal ligament
Medially: lower 3 ribs and costal cartilages, xiphoid process, rectus sheath and conjoint tendon

Question 14

State the direction of the internal oblique

Answer 14

Infero-laterally

Question 15

What are the attachments of the transverse abdominus

Answer 15

Laterally: bottom 6 costal cartilages, anterior 2/3 iliac crest, lateral 1/2 of inguinal ligament
Medially: Xiphoid process, linea alba, pubic symphysis, conjoint tendon

Question 16

Direction of transverses abdominis

Answer 16

Horizontally

Question 17

Where does the neurovascular bundle lie

Answer 17

Between internal oblique and transverses abdominis

Question 18

What are the points of attachment of rectus abdominis

Answer 18

5-7 costal cartilages, xiphoidprocess, pubic symphysis and pubic crest

Question 19

What structure divides the rectus abdominis into segments`

Answer 19

Transverse tendinous intersections

Question 20

What is the rectus sheath formed by

Answer 20

Aponeurosis of three flat muscles

Question 21

What is the function of rectus abdominis

Answer 21

Flexor of the vertebral column

Question 22

Points of attachment of quadrates lumborum

Answer 22

Lower border of 12th rib
Transverse process of L5
Iliac crest

Question 23

Points of attachment for psoas major

Answer 23

All 5 lumbar vertebra

Lesser trochanter

Question 24

What plane carries the nervous and blood supply to abdominal wall

Answer 24

Neuromuscular plane - found between internal oblique and transverses abdominis

Question 25

Describe blood supply to rectus sheath

Answer 25

Superiorly: Blood supply comes from superior epigastric artery which is a branch of the internal thoracic Inferiorly: Blood comes from inferior epigastric after which comes from External iliac artery. Two arteries anastomose creating collateral circulation of abdominal aorta

Question 26

Which vessels supply flank muscles

Answer 26

Intercostal arteries 7-11 Subcostal artery Lumbar arteries Deep circumflex

Question 27

Which nerves supply abdominal wall

Answer 27

T7-L1

Question 28

What nerves supply abdominal muscles

Answer 28

EO: T7-L1 IO: T7-L1 TA: T7-L1

Question 29

What nerves supply rectus abdominis

Answer 29

T7-T12

Question 30

What is the difference in the innervation of the visceral and parietal peritoneum

Answer 30

The parietal peritoneum has the same segmental somatic sensory innervation as the abdominal wall Visceral peritoneum has NO somatic sensory innervation

Question 31

Which three nerves innervate the anterolateral abdominal wall

Answer 31

Subcostal nerves(T12), ilioinguinal nerve (L1) Iliohypogastric (L1)

Question 32

Which nerves provide motor supply to quadrates lumborum, psoas major, and iliacus

Answer 32

Quadratus Lumborum: T12-L4 Psoas: L2-L4 Iliacus: L2-L4

Question 33

Where is the lumbar plexus formed

Answer 33

L1-L4

Question 34

Which line defines the border between the lymphatic drainage to different groups of lymph nodes?

Answer 34

Transumbilical plane

Question 35

Where does the inguinal ligament attach to the pelvis

Answer 35

ASIS and Pubic tubercle

Question 36

How long is the inguinal canal

Answer 36

4cm

Question 37

Are hernias more common in males or females

Answer 37

Males

Question 38

What are the contents of the Inguinal Canal

Answer 38

Males: Spermatic cord(Artery of ductus deferent, cremasteric artery, testicular artery, genital branch of genitofemoral nerve, cremasteric nerve, autonomic nerve, Ductus dererens, pampiniform plexus, lymphatics) + Ilioinguinal Nerve Female: Round ligament + Ilioinguinal Nerve

Question 39

At what stage do the testes usually enter the inguinal canal and drop into the scrotum

Answer 39

Testicular decent starts at week 7. Enters inguinal canal at week 28. Enters scrotum at week 32-36.

Question 40

What facts increase the risk of hernias in women

Answer 40

Age and pregnancies

Question 41

Where are the superficial and deep inguinal rings positioned

Answer 41

Superficial: Immediately above and medial to pubic tubercle Deep: 1.5 cm above midpoint of inguinal ligament

Question 42

The superficial and deep inguinal rings are holes in which fascia/muscle

Answer 42

Superficial: EO Deep: TF

Question 43

What is the conjoint tendon

Answer 43

The lowest fibers of IO and TA come together to form the Conjoint Tendon. Attached medially to the pubic crest

Question 44

What makes up the four walls of the Inguinal canal

Answer 44

Anterior: EO(the whole way) + IO(lateral third) Posterior: TF + Conjoint tendon(medially) Superior: IO + TF + Conjoint tendon(medially) Inferior: Inguinal Ligament

Question 45

What region do direct hernias occur

Answer 45

Hesselbach's Triangle - medial to the inferior epigastric vessels

Question 46

Where is the defect in indirect inguinal hernias positioned

Answer 46

Dilatation of the deep inguinal ring - lateral to inferior epigastric vessel

Question 47

What types of patients have direct hernias

Answer 47

Older patients - associated wth chronic straining and weak musculature.

Question 48

What types of patients have indirect hernias

Answer 48

Young adults and children