Anatomy 4 - Obs and Gynae Surgical Incisions

Question 1

What are other names for suprapubic incision?

Answer 1

Bikini line

Pfannenstiel

Question 2

What is the suprapubic incision used for?

Answer 2

Lower segment C-section

Abdominal hysterectomy

Question 3

What method of cutting allows for better healing of skin?

Answer 3

Cutting along Langer lines

Or using relaxed skin tension lines

Question 4

What is a relaxed skin tension line?

Answer 4

Parallel to dermal collagen bundles

Perpendicular to muscle contraction

Question 5

WHat are the layers of the anterolateral abdominal wall?

Answer 5

Skin 
Superficial fasica
Rectus sheath
Anterior - Rectus abdominis
Lateral - External oblique
            - Internal oblique
            - transverse abdominis

Question 6

Describe the superficial fascia above the umbilicus

Answer 6

Single sheet of connective tissue

Question 7

Describe the superficial fascia below the umbilicus

Answer 7

Superficial fatty layer (camper’s fascia)

Deep membranous layer (scarpa’s fascia)

Question 8

What happens to the superficial fascia at the level of the perineum?

Answer 8

Scarpa’s fascia becomes Colles’ fascia

Question 9

What is the deep fascia of the penis called?

Answer 9

Buck’s fascia

Question 10

What are the flat muscles of the abdominal wall?

Answer 10

External oblique
Internal oblique
Transverse abdominis

Question 11

What are the vertical muscles of the abdominal wall?

Answer 11

Rectus abdominis
Pyramidalis
(also sometimes the sternalis - not in everyone)

Question 12

What is the largest and most superficial abdominal wall flat muscle?

Answer 12

External oblique

Question 13

What direction do fibres run in external oblique?

Answer 13

Inferiomedially

Hands in pockets

Question 14

What happens as the fibres of the external oblique approach the midline?

Answer 14

Form an aponeurosis - linea alba

Question 15

What is an aponeurosis?

Answer 15

Broad flat tendon

Question 16

Origin and insertion of external oblique?

Answer 16

Origin: ribs 5 - 12
Insertion: iliac crest, pubic tubercle and linea alba

Question 17

What muscle is just deep to external oblique?

Answer 17

Internal oblique

Question 18

What direction do fibres run in internal oblique?

Answer 18

Superiomedially

hands on chest

Question 19

What happens as the fibres of the internal oblique approach the midline?

Answer 19

Form an aponeurosis - linea alba

Question 20

What movements do internal oblique help with?

Answer 20

Twisting movements

Question 21

Origin and insertion of internal oblique?

Answer 21

Origin: ribs 10 - 12
Insertion: thoracolumbar fascia, iliac crest and linea alba

Question 22

What direction do fibres run in transverse abdominis?

Answer 22

Transversely

Question 23

Origin and insertion of transverse abdominis?

Answer 23

Origin: lower ribs
Insertion: thoracolumbar fascia, iliac crest and linea alba

Question 24

What divides the rectus abdominis into 3/4 smaller muscles?

Answer 24

Tendonus intersections

Question 25

Why is the rectus abdominis broken up into smaller muscles?

Answer 25

Improve mechanical efficiency

Question 26

What is main movement of rectus abdominis?

Answer 26

Flexion at trunk

Question 27

What is formed at the lateral border of the two rectus abdominis muscles?

Answer 27

Linea semilunaris

Question 28

Where does rectus abdominis stretch from and to?

Answer 28

From xiphoid process | To pubic symphysis

Question 29

What is the pyramidalis?

Answer 29

Small triangular shaped muscle

Question 30

What is deep to the pyramidalis?

Answer 30

Rectus abdominis

Question 31

Where does pyramidalis stretch from>

Answer 31

Pubic bone | To linea alba

Question 32

What is the function of the pyramidalis?

Answer 32

Tenses the linea alba

Question 33

Where is the rectus sheath found?

Answer 33

Immediately deep to superficial fasica

Question 34

What makes up the rectus sheath?

Answer 34

Combined aponeurosis of 3 flat muscles

Question 35

What does the rectus sheath enclose?

Answer 35

Rectus abdominis

Question 36

Why is the rectus sheath stitched closed after operations?

Answer 36

To increase strength of wound | Reduce risk of herniation

Question 37

What makes up anterior wall of rectus sheath?

Answer 37

Aponeurosis of external obliques and half of internal oblique

Question 38

What makes up posterior wall of rectus sheath?

Answer 38

Aponeurosis of half of internal oblique and the transverse abdominis

Question 39

Where is the arcuate line found?

Answer 39

Third of way inferior between umbilicus and pubic bone

Question 40

What happens to the aponeuroses at the arcuate line?

Answer 40

Here, all of the aponeuroses move to the anterior wall of the rectus sheath (i.e. there is no posterior wall) Rectus abdominis is in direct contact with transversalis fascia

Question 41

In what direction does the nerve supply to the anterolateral abdo wall enter?

Answer 41

From lateral direction

Question 42

What do the 7th-11th intercostal nerves become?

Answer 42

Thoraco-abdominal nerves

Question 43

What spinal nerve is the subcostal nerve?

Answer 43

T12 (anterior division of 12th thoracic nerve)

Question 44

What spinal nerve is the iliohypogastric nerve?

Answer 44

L1 (superior branch of the anterior ramus of spinal nerve L1)

Question 45

What spinal nerve is the ilioinguinal nerve?

Answer 45

L1 (inferior branch of the anterior ramus of spinal nerve L1)

Question 46

Where do the nerves to the anterolateral abdo wall travel through?

Answer 46

Travel in plane between internal oblique and transverse abdominis

Question 47

What arteries supply the anterior abdominal wall?

Answer 47

Superior epigastric arteries | Inferior epigastric arteries

Question 48

What are the superior epigastric arteries a continuation of?

Answer 48

Internal thoracic (mammary) artery

Question 49

What is anterior to the superior epigastric and inferior epigastric arteries?

Answer 49

Rectus abdominis

Question 50

What artery foes inferior epigastric arteries branch from?

Answer 50

External iliac

Question 51

What arteries supply the lateral abdominal wall?

Answer 51

Intercostal and subcostal arteries

Question 52

What are the intercostal and subcostal arteries a continuation of?

Answer 52

Posterior intercostal arteries

Question 53

How can you minimise injury to muscle when incising?

Answer 53

Incising in same direction as muscle fibre

Question 54

What happens to the rectus muscles in lower segment C-section?

Answer 54

Not cut Separated in opposite direction - moved towards nerve supply Cut down linea alba

Question 55

What layers are opened in lower segment C-section?

Answer 55

``` Skin and fascia Anterior rectus sheath Rectus abdominis Fascia and peritoneum Retract bladder Uterine wall Amniotic sac ```

Question 56

What layers need to be stitched closed in lower segment C-section?

Answer 56

Uterine wall with visceral preitoneum Rectus sheath Fascial layer if large BMI Skin

Question 57

Why are lower segment C-sections better than large laparotomy?

Answer 57

Less risk of incisional hernias and dehiscence

Question 58

What layers are opened in laparotomy?

Answer 58

Skin and fascia Linea alba Peritoneum

Question 59

What layers are stitched closed in laparotomy?

Answer 59

Peritoneum and linea alba Fascia if large BMI Skin

Question 60

What must be avoided if a lateral port is to be inserted via laparoscopy?

Answer 60

Inferior epigastric artery

Question 61

Where does the inferior epigastric artery emerge?

Answer 61

Medial to deep inguinal ring

Question 62

Where is the deep inguinal ring?

Answer 62

Midway between ASIS and pubic tubercle

Question 63

In what direction does the inferior epigastric artery travel towards the rectus abdominis?

Answer 63

Superiomedial direction

Question 64

What occurs at Hesselbach's triangle?

Answer 64

Site of direct inguinal (i.e. into abdominal wall) hernia

Question 65

Where is ureter in relation to uterine artery?

Answer 65

WATER UNDER BRIDGE | Ureter under/ inferior to artery