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Flashcards in Abdominal Wall- Real Deck (111):
1

what layers are reconstructed when closing paramedian incision above arcuate line

peritoneum, transversalis fascia, rectus muscle, rectus sheath, superficial fascia, skin

2

what layers are reconstructed when closing paramedian below the arcuate line

peritoneum, transversalis fascia, posteiror rectus sheath, rectus muscle, anterior rectus sheath, superficial fascia, skin

3

what lymph nodes are affected by melanoma on th left lateral region of the abdominal wall

parasternal nodes

4

what lymph nodes are affected by testicular carcninoma

external iliac nodes

5

what is the advantage of a paramedian and midline incision compared to a pararectus incision

paramedian- don't compromise the nerve and blood supply to the rectus muscle as is done with pararectus

6

what complications go with severing/compressing a nerve on the anterior abdominal wall? (iliohypogastric or ilioinguinal)

muscle weakens which could lead to a hernia

7

what is the abdominal wall

skin to transversals fascia

8

what is the abdominal cavity

trasversali fascia down

9

what is the transversals fascia

deep fascia of transversalus abdomens, psoas, diaphragm, iliac us, and pelvic musculature

10

what layers are in the abdominal wall

skin
2 layers of superficial fascia (campers and scarpas)
3 muscle layers (internal and external oblique, transversalus abdomins)

11

what are the areas in the abdominal cavity

subserous fascia
retroperitoneal space
peritoneum
periotoneal cavity

12

where does the skin over the scrotum and labia major come from

abdominal wall skin

13

describe camper's fascia

superficial layer of superficial layer of the anteriolateral abdominal wall
fat layer

14

where is liposuction done

camper's fascia

15

describe the scarpa's fascia

deep layer of superficial layer of the anteirolateral abdominal wall
no fat
tough fibrous layer that attaches to the fascia kata, ishiopubic rami, and ishial tuberosity

16

what layer are subcutaneous sutures put into

scarpa's fascia

17

what is collie's fascia

scarpa's fascia in the perineum
defines the area of blood/urine extravasation after penial bulb injury

18

what is darts fascia

fusion of camper's and scarpa's fascia in the scrotum
fat of camper's is lost, but stays in labia

19

what is the purpose of the scrotum and how is it accomplished

decrease the temperature of the testis by smooth muscle controlling its position relative to the body

20

what are the abdominal muscles

external oblique
internal oblique
transversus abdominis

21

where is the deep fascia

both sides of each of the abdominal muscles

22

what are the functions of the abdominal muscles

support and protect abdominal viscera
increase intraabdominal pressure for things
trunk motor control

23

what special structures are formed by the abdominal muscles

rectus sheath
inguinal canal
spermatic cord

24

what is formed by the external oblique aponeurosis

inguinal ligament
anterior layer of rectus sheath
superficial inguinal ring
pectinate ligament
lacunar ligament
external spermatic fascia

25

what and where is the inguinal ligament

thickening of the inferior edge of the external oblique muscle, spanning between the ischium spine and pubic tubercle
forms the floor of the inguinal canal

26

what and where is the superficial inguinal ring

V shaped opening in this aponeurosis of the external oblique muscle
spermatic cord passes through it
superior and lateral to the pubic tubercle

27

what and where is the pectineal ligament

extension of the lacunar ligament, lateral to the pubis (formed by external oblique aponeurosis)

28

what and where is the lacunar ligament

triangular ligament between the pubis and inguinal ligament that forms the medial floor of the inguinal canal
extension- pectineal ligament

29

what forms the superior and posterior wall of inguinal canal

internal oblique

30

what is the origin of the cremaster muscle

internal oblique muscle

31

what is the purpose and innervation of the cremaster muscle

covers testis and elevates
innervated by femoral nerve

32

what structures are formed from the aponeurosis of the internal oblique muscle

rectus sheath
conjoint tendon

33

how does the internal oblique aponeurosis form the rectus sheath

above arcuate line- splints into anterior and posterior layers
below arcuate line- all anteiror

34

what is the conjoint tendon

internal oblique and transversus abdominis aponeuroses merge to form the posterior wall of the inguinal canal

35

what happens if the conjoint tendon is weakened?

direct inguinal hernia

36

what part of the inguinal canal does the transverses abdomins form

superior and posterior walls

37

what structures does the transversus abdominis aponeurosis form

conjoint tendon
rectus sheath
trasversali fascia
deep inguinal ring
internal spermatic fascia

38

how does the transversus abdominis form the rectus sheath

above arcuate line- posterior
below arcuate line- anterior

39

what and where is the deep inguinal ring

internal opening of inguinal canal, medial to the inferior epigastric vessels

40

where are the superior and inferior epigastric arteries

posterior to the rectus abdominis

41

where is the arcuate line

midway between the umbilicus and the pubic symphysis

42

what forms the rectus sheath above the arcuate line

anterior- external oblique and anterior internal oblique
posterior- posterior internal oblique and transversus abdominis

43

what forms the rectus sheath below the arcuate line

anterior- all 3 muscle aponeuroses
posterior- transversalis fascia

44

why are there more layers below the arcuate line than above

support the abdomen

45

what levels supply the abdomen

T7-L1

46

where is the iliohypogastric nerve

L1, lowest nerve on the abdominal wall

47

where is the ilioinguinal nerve

L1, travels through inguinal canal and innervates the scrotum/labia majora

48

what happens when abdominal nerves are compressed

muscle weakess which can lead to hernia

49

what is the basis for referred pain

distribution of fibers- structures on the same level are innervated the same
ex: T10 gets umbilicus and appendix, appendicitis starts as umbilicus pain

50

what are the deep muscular arteries that supply the abdomen

superior epigastric
musculophrenic
intercostal 10, 11
subcostal
inferior epigastric
deep iliac circumflex

51

what are the branches from the external iliac artery that supply the abdomen

inferior epigastric
deep iliac circumflex

52

what are the superficial arterial branches that supply the abdomen

superficial epigastric
superficial iliac circumflex

53

where do the superficial arterial branches supplying the abdomen come from and what layer are they in

femoral artery
camper's fascia

54

what arteries can easily be injured in laproscopic surgery

superficial and inferior epigastric artteries

55

what is the superficial lymphatic drainage above the umbilicus

parasternal nodes--> superior epigastric nodes-> axillary nodes via path of thoracoepigastric veins

56

what is the superficial lymphatic drainage below the umbilicus

superficial and deep inguinal nodes via path of superficial epigastric v

57

what is the deep lymphatic drainage above the umbilicus

internal thoracic nodes-> supericar epigastric and lumbar nodes via path of T9-T11 arteries

58

what is the deep lymphatic drainage below the umbilicus

external iliac nodes via path of deep iliac circumflex and inferior epigastric vessels

59

what are the 5 folds of the internal surface of anterior abdominal wall

median umbilical fold
2 medial umbilical folds
2 lateral umbilical folds

60

what is the median umbilical fold a remnant of

urachus

61

what is the medial umbilical folds remnants of

umbilical artery

62

what is near the lateral umbilical folds

inferior epigastric vessels

63

what are the 5 fossa of the internal surface of the anterior abdominal wall

supravesicular fossa
medial inguinal fossa (2)
lateral inguinal fossa

64

where is the supra vesicle fossa

between the 2 medial umbilical folds, including line of median umbilical fold

65

where is the medial inguinal fossa

between the medial and lateral folds

66

where is the inguinal triangle

in the medial inguinal fossa

67

what forms the inguinal triangle

edge of rectus
inguinal ligament
inferior epigastric vessels

68

where is a direct inguinal hernia

inguinal triangle

69

where is the lateral inguinal fossa

lateral to the lateral umbilicus fold

70

where is an indirect inguinal hernia

lateral inguinal fossa

71

what are the advantages of a median incision

good access for exploratory surgery
minimal bleeding

72

where is a paramedian incision

lateral to midline

73

where is a gridiron incision

aka McBurney
anterior to ilium wing
used for appendectamy

74

where is a transverse incision

horizontally over the iliac crest

75

where is a suprapubic incision

above pubic symphysis

76

what is a disadvantage of a paramedian incision

limited access

77

what is an advantage of a suprapubic incision

avoids peritoneal cavity

78

where is a subcostal incision

under ribs
used for gallbladder or spleen access

79

where is a pararectus incision

lateral edge of rectus sheath

80

why are pararectus incisions bad

cuts off nerve and blood supply to rectus sheath

81

how should muscle be reflected

towards the nerve bundle to avoid stretching issues

82

where is the superficial epigastric artery and vein and where do they come from

lateral to the line alba in the campers fascia
originate from the femoral vessels

83

fiber direction of the external oblique

superiolateral to inferiomedial

84

fiber direction of the internal oblique

superiomedial to inferiolateral

85

where is the lateral crus and what does it attach to

lateral portion of the superficial inguinal ligament and attaches to the pubic tubercle

86

where is the medial crus and what does it attach to

medial portion of superficial inguinal ligament and attaches to the pubic crest

87

where are the intercrural fibers

fibers going across the top of the inguinal canal and hold the cruses together

88

where is the external spermatic fascia

external oblique aponeurosis that extends into the spermatic cord

89

where is the ilioinguinal nerve

comes out of the superficial inguinal ring anterior to spermatic cord/round ligament of the uterus

90

what does the ilioinguinal nerve innervate

anterior genital surface and the medial thigh

91

where is the lacunar ligament

triangular looking ligament behind the spermatic cord

92

where is the pectineal ligament

line near lacunar ligament, behind the spermatic cord

93

where is the conjoint tendon

behind the lacunar ligament, forms the posterior inguinal wall

94

where is the cremaster muscle

muscle extension from the internal oblique muscle that originates medially and laterally to join with the spermatic cord

95

what plane are the ilioinguinal and iliohypogastric nerves found

intermuscular plane between the external and internal obliques

96

what is the fiber direction of the transversus abdominis

same as internal oblique- inferolateral to superiomedial

97

where is the transversalis fascia

below the transversus abdominis

98

how is the deep inguinal ring identified

lateral to the inferior epigastric vessels and the ductus deferens passes through it

99

what structures are in the rectus sheath

rectus abdominis
pyramidalis muscle
superior and inferior epigastric vessels

100

where is the semilunar line

line lateral to rectus abdominis

101

where are tendinous intersections

connections between the anterior rectus sheath and anterior rectus muscle

102

where is the pyramidal is muscle

between the anterior surface of the pubis and linea alba

103

where are the inferior epigastric artery and vein

inferior posterior rectus abdomens and superficial to the posterior rectus sheath above the arcuate line and then enter the rectus sheath at the arcuate line and pass in the transveralis fascia behind the inguinal canal

104

where are the superior epigastric artery and vein

superior posterior rectus abdominis and superficial to the posterior rectus sheath above the arcuate line

105

where do inferior epigastric vessels enter the rectus sheath

arcuate line

106

where is the ductus deferens

center of spermatic cord

107

where is the pampiniform plexus of veins

inside the internal spermatic fascia surrounding the testicular artery anteriorly to ductus deferencs

108

where is the tunica vaginalis

covering of the testis (2 layers- parietal and visceral)

109

parts of the epididymis

head- superior to testis
body- behind testis
tail- infeiror to testis
appendix- little bump on the head

110

what is the tunica albuginea

fibrous capsule of the testis- very thick inferiorly

111

where is the genitofemoral nerve

passes anteiror to inguinal canal from medial to lateral and extends into the thigh area