Abdominal Wall part 1 Flashcards by joseph dizon

inferiorly by the

symphysis pubis

Pelvic bones

How well did you know this?

Not at all

Perfectly

posteriorly by the

vertebral column

How well did you know this?

Not at all

Perfectly

origin and develops as bilateral migrating sheets, which originate in the paravertebral region and envelop the future abdominal area

Mesodermal

How well did you know this?

Not at all

Perfectly

The leading edges of these structures develop into the ________________, which eventually meet in midline of the anterior abdominal wall

rectus abdominus muscles

How well did you know this?

Not at all

Perfectly

The muscle fibers of the rectus abdominus are arranged vertically and are encased within an aponeurotic sheath, the anterior and posterior layers of which are fused in the midline at the

Linea alba

How well did you know this?

Not at all

Perfectly

The rectus abdominus has insertions on the

symphysis pubis and pubic bones
anteroinferior aspects of the fifth and sixth ribs
seventh costal cartilage
xiphoid process

How well did you know this?

Not at all

Perfectly

The lateral border of the rectus muscles assumes a convex shape that gives rise to the surface landmark, the

Linea semilunaris

How well did you know this?

Not at all

Perfectly

There are usually three tendinous intersections or inscriptions that cross the rectus muscles

Level of xiphoid process
Level of umbilical
halfway between the xiphoid process and the umbilicus

How well did you know this?

Not at all

Perfectly

The complexities of the anterior and posterior aspects of the rectus sheath are best understood in their relationship to the

arcuate line (semicircular line of Douglas

How well did you know this?

Not at all

Perfectly

Above the arcuate line

The anterior rectus sheath is formed by the

external oblique aponeurosis

external lamina of the internal oblique aponeurosis

How well did you know this?

Not at all

Perfectly

Above the arcuate line

The posterior rectus sheath is formed by the

internal lamina of the internal oblique aponeurosis
transversus abdominis aponeurosis,
transversalis fascia

How well did you know this?

Not at all

Perfectly

Below the arcuate line

The anterior rectus sheath is formed by the

external oblique aponeurosis
The laminae of the internal oblique aponeurosis
The transversus abdominis aponeurosis

How well did you know this?

Not at all

Perfectly

There is no aponeurotic posterior covering of this lower portion of the rectus muscles, although the ___________ remains a contiguous structure on the posterior aspect of the abdominal wall in this area as well

transversalis fascia

How well did you know this?

Not at all

Perfectly

The majority of the blood supply to the muscles of the anterior abdominal wall is derived from the

superior

inferior epigastric arteries

How well did you know this?

Not at all

Perfectly

The superior epigastric artery arises from the

internal thoracic artery

How well did you know this?

Not at all

Perfectly

The inferior epigastric artery arises from the

external iliac artery

How well did you know this?

Not at all

Perfectly

also contributes to the abdominal wall blood supply

branches of the subcostal and lumbar arteries

How well did you know this?

Not at all

Perfectly

The lymphatic drainage of the abdominal wall is predominantly to the major nodal basins in the

superficial inguinal and axillary areas

How well did you know this?

Not at all

Perfectly

The motor nerves to the rectus muscles,
the internal oblique muscles,
and the transversus abdominis muscles run from the

anterior rami of spinal nerves at the T6 to T12 levels

How well did you know this?

Not at all

Perfectly

The overlying skin is innervated by afferent branches of the

T4 to L1 nerve roots

How well did you know this?

Not at all

Perfectly

Umbilicus nerve root

T10

How well did you know this?

Not at all

Perfectly

The rectus muscles, the external oblique muscles, and the internal oblique muscles work as a unit to

flex the trunk anteriorly or laterally

How well did you know this?

Not at all

Perfectly

Rotation of the trunk is achieved by the contraction of:  the

external oblique muscle

contralateral internal oblique muscle

How well did you know this?

Not at all

Perfectly

diaphragm is relaxed when the abdominal musculature is contracted

expiration of air from the lungs or a cough if this contraction is forceful

How well did you know this?

Not at all

Perfectly

diaphragm is contracted when the abdominal musculature is contracted (Valsalva maneuver

micturition, defecation, and childbirth

connects the embryonic and fetal midgut to the yolk sac

Vitelline duct

During the sixth week of development, the abdominal contents grow too large for the abdominal wall to contain and the embryonic midgut

herniates into the umbilical cord

While outside the confines of the developing abdomen, it undergoes a

270degree counterclockwise rotation

Defects in abdominal wall closure may lead to

omphalocele or gastroschisis

, viscera protrude through an open umbilical ring and are covered by a sac derived from the amnion

omphalocele

, the viscera protrude through a defect lateral to the umbilicus and no sac is present

gastroschisis

is a fibromuscular, tubular extension of the allantois that develops with the descent of the bladder to its pelvic position

urachus

Persistence of urachal remnants can result in ________________ with drainage of urine from the umbilicus

cysts as well as fistulas to the urinary bladder,

describes a clinically evident separation of the rectus abdominus muscle pillars, generally as a result of decreased tone of the abdominal musculature

Rectus abdominis diastasis (or diastasis recti)

The characteristic bulging of the abdominal wall in the epigastrium is sometimes mistaken for a

ventral hernia

Diastasis may be congenital, as a result of a more lateral insertion of the rectus muscles to the

ribs and costochondral junctions

Diastasis but is more typically an acquired condition with

advancing age, obesity, or following pregnancy

In the postpartum setting, rectus diastasis tends to occur in women of

advanced maternal age, after multiple or twin pregnancies, or in women who deliver high-birthweight infants

provides an accurate means of measuring the distance between the rectus pillars and will differentiate rectus diastasis from a true ventral hernia if clarification is required

CT Scan

Surgical correction of a severe rectus diastasis by plication of the anterior rectus sheath may be undertaken for

cosmetic indications

Rectus Sheath Hematoma The terminal branches of the superior and inferior epigastric arteries course deep to the posterior aspect of the

left and right rectus pillars | and penetrate the posterior rectus sheath

Injury to these vessels or to any of the network of collateralizing vessels within the rectus sheath and muscles can result in a

rectus sheath hematoma

Spontaneous rectus sheath hematomas have been described in the

elderly and | anticoagulation therapy

Rectus sheath hematoma Patients frequently describe the sudden onset of unilateral abdominal pain that may be confused with lateralized peritoneal disorders such as

appendicitis

Below the arcuate line, a hematoma may cross the midline and cause

bilateral lower quadrant pain

Rectus Sheath hematoma Pain typically increases with contraction of the

rectus muscles and a | tender mass may be palpated

RSH The ability to appreciate an intraabdominal mass is ordinarily degraded with

contraction of the rectus muscles

is a palpable abdominal mass that remains unchanged with contraction of the rectus muscles and is classically associated with rectus hematoma

Fothergill's sign

RSH may show a solid or cystic mass within the abdominal wall, depending on the chronicity of the bleeding event

Abdominal ultrasonography

RSH is the most definitive study for establishing the correct diagnosis and excluding other intra-abdominal disorders

Computed tomography

RSH may be observed without hospitalization

Small, unilateral, and contained hematomas

RSH will likely require hospitalization, as well as potential resuscitation

Bilateral or large hematomas

RSH Reversal of ______________ in the acute setting is frequently, but not always, necessary

warfarin (Coumadin) anticoagulation

RSH Emergent operative intervention or angiographic embolization is required infrequently, but may be necessary if

hematoma enlargement, free bleeding, or clinical deterioration occur

RSH Surgical therapy consists of

evacuation of the hematoma and | ligation of any bleeding vessel

Abdominal Wall Hernias represent defects in the parietal abdominal wall fascia and muscle through which intra-abdominal or preperitoneal contents can protrude

Hernias of the anterior abdominal wall, or ventral hernias,

Ventral hernias may be congenital or acquired. Acquired hernias may develop via slow architectural deterioration of the muscular aponeuroses or they may develop from failed healing of an anterior abdominal wall incision

Incisional hernia

AWH The most common finding is a mass or bulge on the anterior abdominal wall, which may increase in size with

Valsalva

AWH Physical examination reveals a bulge on the anterior abdominal wall that may reduce spontaneously, with

recumbency, or with manual pressure

AWH A hernia that cannot be reduced is described as __________ and will require emergent surgical correction

incarcerated

AWH Incarceration of an intestinal segment may be accompanied by

nausea, vomiting, and significant pain

AWH Should the blood supply to the incarcerated bowel be compromised, the hernia is described as ___________, and the localized ischemia may lead to infarction and perforation

strangulated

AWH Primary ventral hernias (nonincisional) also are termed

"true" ventral hernias

AWH are located in the midline between the xiphoid process and the umbilicus

Epigastric hernias

AWH ____________ develop at the umbilical ring and may be present at birth or develop gradually during the life of the individual

Umbilical hernias

AWH can occur anywhere along the length of the Spigelian line or zone—an aponeurotic band of variable width at the lateral border of the rectus abdominus

Spigelian hernias

AWH Spigelian hernia The most frequent location of these rare hernias is at or slightly above the level of the

arcuate line

AWH These are not always clinically evident as a bulge, and may come to medical attention because of pain or incarceration

Spigelian hernia

Patients with advanced liver disease, ascites, and umbilical hernia enlargement of the umbilical ring usually occurs in this clinical situation as the result of increased intraabdominal pressure from

uncontrolled ascites

AWH Patients with refractory ascites may be candidates for

transjugular intrahepatic portocaval shunting (TIPS), nonselective surgical portosystemic shunt, or liver transplantation

AWH is best performed after the ascites is controlled

Umbilical hernia repair

AWH may be asymptomatic or present with pain, incarceration, or strangulation

Incisional hernias

AWH Risk factors for the development of a ventral incisional hernia include

``` postoperative wound infection, malnutrition, obesity, immunosuppression, and chronically increased intra-abdominal pressure ```

Several techniques for the repair of ventral hernias:

primary repair open repair with mesh laparoscopic repair with mesh

Primary repair, even for small hernias (abdominal wall defects less than 3 cm), is associated with a high subsequent recurrence rate, often caused by

failure to appreciate the multiple small defects that also are present

of incisional hernias generally requires overlapping the prosthesis onto the anterior or posterior surfaces of intact abdominal wall fascia for a distance of at least 3 to 4 cm from defect edge

Open mesh repair

is an inert substance that induces no inflammatory response, eventual tissue ingrowth within the interstices of the mesh will result in dense attachment to whatever tissues it is in contact with

Polypropylene

generally involves laterally placed ports for midline defects and contralaterally placed ports for lateral defects

Laparoscopic repair

The contents of the hernia sac are completely reduced, but in contrast to open repairs,

the sac itself is left in place

The fascial edges of the hernia defect identified, an appropriate-size piece of _____________________ is fashioned to allow sufficient overlap (i.e., 3 to 4 cm) onto healthy abdominal wall

PTFE or composite polypropylene/PTFE mesh

Omentum surgical anatomy develops from the dorsal mesogastrium, which begins as a double-layered structure

greater omentum

OSA The spleen develops in between the two layers, and later in development the two layers fuse, giving rise to the

intraperitoneal spleen and the gastrosplenic ligament

OSA The _________________ are those segments of the greater omental apron that connect the named structures

gastrocolic ligament and gastrosplenic ligament

OSA In the adult, the greater omentum lies in between the _____________________ and usually extends into the pelvis to the level of the _____________

anterior abdominal wall and the hollow viscera, | symphysis pubis

OSA The ), develops from the mesoderm of the septum transversum, which connects the embryonic liver to the foregut

lesser omentum, (hepatoduodenal and hepatogastric ligaments

OSA are located in the inferolateral margin of the lesser omentum, which also forms the anterior margin of the foramen of Winslow

The common bile duct, portal vein, and hepatic artery

OSA The blood supply to the greater omentum is derived from the

right and left gastroepiploic arteries

OSA The venous drainage parallels the arterial supply to a great extent with the ______________ ultimately draining into the ___________

left and right gastroepiploic veins | portal system

The consequent local production of _____ contributes to the ability of the omentum to adhere to areas of injury or inflammation

fibrin

Interruption of the blood supply to the omentum is a rare cause of an acute abdomen that may be secondary to torsion of the omentum around its vascular pedicle, thrombosis or vasculitis of the omental vessels, or omental venous outflow obstruction

Omental infarction

OI Diagnosis is more likely to be made in

Male adults

OI Depending on the location of the infarcted omental tissue, this disease process may mimic

``` appendicitis, cholecystitis, diverticulitis, perforated peptic ulcers, or ruptured ovarian cysts ```

OI Patients typically present with localized

right lower quadrant, right upper quadrant, or left lower quadrant pain

OI Physical examination typically reveals a

mild tachycardia and a | low-grade temperature elevation

OI Abdominal examination may demonstrate a

tender, palpable mass associated with guarding and rebound tenderness

OI Either _____________ or____________will show a localized, inflammatory mass of fat density

abdominal computed tomography or | ultrasonography

Treatment of omental infarction depends on the _________ with which the diagnosis is made

certainty

Cystic lesions of the omentum and mesentery are related disorders, likely resulting from

lymphatic degeneration

Omental cysts are far less common than

mesenteric cysts

OC Physical examination reveals a

freely mobile intra-abdominal mass

OC Both __________________ reveal a well-circumscribed, cystic-mass lesion arising from the greater omentum

computed tomography and abdominal ultrasound

OC Treatment involves

resection of all symptomatic omental cysts

OC. Resection of these benign lesions is easily accomplished via

laparoscopic techniques

Benign tumors of the omentum include

lipomas, myxomas, and desmoid tumors

The omentum is derived from mesoderm, primary malignant tumors of the omentum are considered

sarcomas Liposarcomas, leiomyosarcomas, rhabdomyosarcomas, fibrosarcomas, and mesotheliomas

Primary tumors of the omentum are

uncommon

Metastatic tumors involving the omentum are

quite common

ON have a high preponderance of omental involvement

Metastatic ovarian tumors

Malignant tumors of the _______________________ may also metastasize to the omentum

stomach, small intestine, colon, pancreas, biliary tract, uterus, and kidney

The abdominal wall is defined superiorly by

Costal margins

Abdominal Wall part 1 Flashcards

(110 cards)