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Flashcards in Ant Abd Wall Deck (65):
1

What are the names of the upper abdominal sections, lateral the midclavicular lines? B/w them? Middle? Lateral to middle? Lower middle? Lower lateral?

- Hypochondriacs
- Epigastric
- Umbilical
- Flanks
- Hypogastric/suprapubic/pubic
- Inguinal

2

Name the layers of the abdominal wall, superficial to deep?

1 - Skin
2 - Superficial Fascia (Camper’s, then Scarpa’s)
3 - External Oblique
4 - Internal Oblique
5 - Transverse Abdominis
6 - Transversalis fascia
7 - Extrapertioneal CT
8 - Peritoneum

3

Above the umbilicus, what makes up the superficial fascia?

Fat

4

Below the umbilicus, what makes up the superficial fascia?

Superficial: Fascia of Camper's (fatty)
Deep: Fascia of Scarpa's (membranous)

5

During descent of the testes, what does Camper's fascia become?

Dartos muscle

6

During descent of the testes, what does Scarpa's fascia become?

Colle's fascia

7

What are the 3 anterolateral mm. of the abd wall?

External oblique, internal oblique, and transversus abdominis mm.

8

What are the 3 mm. that are close to the midline of the abd wall?

Rectus abdominis, pyramidalis (not always present), and cremaster mm.

9

External oblique m: OIIA?

O: External surfaces of ribs 5–12
I: Linea alba, pubic tubercle, anterior half of iliac crest

I: Ventral rami of six inferior thoracic nerves
A: Compresses and supports abdominal viscera, flexes and rotates trunk

10

Internal oblique m: OIIA?

O: Thoracolumbar fascia, anterior 2/3 of iliac crest, lateral half of inguinal ligament
I: Inferior borders of ribs 10–12, linea alba, pubis via conjoint tendon

I: Ventral rami of six inferior thoracic and first lumbar nerves
A: Compresses and supports abdominal viscera, flexes and rotates trunk

11

Transversus abdominis m: OIIA?

O: 7–12, thoracolumbar fascia, iliac crest, lateral third of inguinal ligament
I: Linea alba with aponeurosis of internal oblique, pubic crest, and pecten pubis via conjoint tendon

I: Ventral rami of six inferior thoracic and first lumbar nerves
A: Compresses and supports abdominal viscera

12

Pyramidalis m (not too important): OIIA?

O: Body of pubis, anterior to rectus abdominis
I: Linea alba

I: Iliohypogastric nerve
A: Tenses linea alba

13

Rectus abdominis m: OIIA?

O: Pubic symphysis, pubic crest
I: Xiphoid process, costal cartilages 5–7

I: Ventral rami of six inferior thoracic nerves
A: Flexes trunk, compresses abdominal viscera

14

Where is the insertion of the cremaster m?
Nerve supply?
Action?

- Pubic tubercle
- Genital branch of genitofemoral n.
- Suspends testes and is part of the cremasteric reflex

15

What is the rectus sheath and what comes together to form it?

- An aponeurotic sheath
- Formed by aponeuroses of the internal/external obliques + transversus abdominus mm.

16

What is contained within the rectus sheath?

- 2 mm: rectus abdominus and pyramidalis
- 2 vessels: inferior and superior epigastric vessels
- Lower 6 intercostal nn.

17

What forms the anterior rectus sheath layer above the arcuate line? Below?

Above: Aponeuroses of internal and external obliques mm (ant layer)

Below: Aponeuroses of internal and external obliques + transverse abdominis mm

18

What forms the posterior rectus sheath layer above the arcuate line? Below?

Above: Aponeuroses of internal oblique + transverse abdominis mm (post layer)

Below: Rectus abdominis is in contact w/transversalis fascia

19

What is the arcuate line?
What is an event takes place there?

- Marks inferior limit of posterior rectus sheath
- It's where the inferior epigastric vessels ascend to perforate the rectus abdominis m.

20

What is the linea alba?
What forms it?
Where does it span from?

- A tendinous median raphe between the two rectus abdominis muscles
- Formed by the fusion of the aponeuroses of the external oblique, internal oblique, and transverse abdominal muscles
- Extends from the xiphoid process to the pubic symphysis.

21

What is the linea semilunaris?

A curved line along the lateral border of the rectus abdominis

22

By what week of pregnancy have the testes descended retroperitoneally, from superior lumbar region to post abd wall to deep inguinal rings?

26 weeks

23

What changes are going on in the fetus as the testes descend, dragging vessels and nerves from the post abd wall?

Fetal pelvis enlarges, body/trunk elongates

24

What is the gubernaculum testes?

A mesenchymal band that extends from the caudal part of testis along the course of its descent (in the inguinal canal) to blend with the scrotal fascia

25

What is the umbilical dermatome?

T10

26

What branches of what artery supply the ant abd wall's upper half?

Internal thoracic a, branches into musculophrenic and superior epigastric aa.

27

What branch of what artery supply the ant abd wall's lower half?

External iliac a branches into inferior epigastric a.

28

What is the processus vaginalis?

A diverticulum or outpouching of the peritoneum which develops ventral to the gubernaculum

29

What does the gubernaculum testes do for the processus vaginalis during descent of the testes?
What does it do for the testis?

The gubernaculum forms a path through the anterior abdominal wall for the processus vaginalis to follow during formation of the inguinal canal.
- It anchors the testis to the scrotum and guides its descent into the scrotum.

30

What is trailing the testis during descent?

Ductus deferens

31

What does the transversalis fascia become in the scrotum?

Internal spermatic fascia

32

What does the internal oblique m become in the scrotum?

Cremasteric m.

33

What does the external oblique aponeurosis become in the scrotum?

External spermatic fascia

34

What does the testis project into, w/in the scrotum?

Processus vaginalis

35

During the perinatal period, part of the processsus vaginalis obliterates to form the _______________, covering the front and sides of the testes.

Tunica vaginalis (serous membrane)

36

What is the inguinal canal?
What direction is it angled?

- An oblique passage in the lower part of the anterior abdominal wall just above the medial ½ of the inguinal ligament (larger in males)
- Directed downwards, forwards, and medially

37

Where does the inguinal canal start and end?

Begins at deep inguinal ring, ends at superficial inguinal ring (pw of testes descent)

38

What are the boundaries of the inguinal canal?

Ant wall: External oblique aponeuroses, lateral 1/3 internal oblique fibers

Post wall: Transversalis fascia, medial 1/3 of conjoint tendon

Roof: Arched fibers of internal oblique (low arched) & transversus abdominis (high arched).

Floor: Inguinal ligament

39

What layer contains the deep inguinal ring?

Transversalis fascia (becomes internal spermatic fascia)

40

What passes through the deep inguinal ring?

- Spermatic cord (males) or round ligament (females)
- Genital branch of genitofemoral n.

41

What are the boundaries of the inguinal triangle (Hesselbach's triangle).

Medial: linea semilunaris (lateral edge of rectus abdominus)
Lateral: lateral umbilical fold (inf epigastric vessels)
Inferior: inguinal ligament

42

What injury commonly occurs at the inguinal triangle?

- Direct inguinal hernia

43

What forms the conjoint tendon?

What does it support?

The high arching fibers of the transversus abdominis m. + internal oblique m.

-Works as a support to the superficial inguinal ring (at posterior end of ring)

44

What does the transversus abdominis m become in the scrotum?

Trick: it's not represented

45

What is the lacuna ligament?

A triangular posterior extension from the medial end of inguinal ligament

46

What is the superficial inguinal ring?

-A triangular opening, lies in the external oblique aponeurosis superolateral to the pubic crest.
- Its base is the pubic crest.
- Its sides are medial & lateral crura.

47

What passes through the superficial inguinal ring?

- Spermatic cord (males) or round ligament of uterus (females)
- Ilioinguinal nerve

48

What does the ilioinguinal n. do prior to entering superficial inguinal ring?

- First pierces Transversus abdominis m. to run between it & internal oblique (neurovascular plane)
- Then pierces the lower part of internal oblique
- Then enters the canal to exit through the superficial inguinal ring (*Iliohypogastric n. is not in canal!)

49

What is the spermatic cord?

A group of structures which meet at the deep inguinal ring & traverse the inguinal canal down to the posterior border of testis at the scrotum
- Loves 3's!

50

What are the 3 coverings of the spermatic cord?

Creme sandwich (b/w fascia bread)
1) External spermatic fascia (from external oblique m.)
2) Cremaster muscle and fascia (from internal oblique m.)
3) Internal spermatic fascia (from transversalis fascia)

51

What are the 3 arteries of the spermatic cord?

- Testicular a.
- Cremasteric a.
- Artery of Vas

52

What are the 3 V's of the spermatic cord?

- Vas deferens (ductus deferens)
- Pampiniform Venous plexus
- Vestige of processus Vaginalis

53

What are the 3 nerves of the spermatic cord?

- Genital branch of genitofemoral n.
- Sympathetic plexus around the testicular a.
- Sympathetic plexus around the artery of Vas

54

What is an inguinal hernia?

It is the protrusion of abdominal contents (usually intestine) within a sac of peritoneum into the inguinal region (canal)

55

What's going on during an indirect inguinal hernia?
Does it reach the scrotum?
On what side of the inf epigastric a. is it?
Is it congenital or acquired?

- Passes through the deep ring, inguinal canal & superficial ring.
- Descends into the scrotum.
- Lies lateral to the inferior epigastric artery.
- It is congenital, associated with the persistence of processus vaginalis.

56

What's going on during a direct inguinal hernia?
Does it reach the scrotum?
On what side of the inf epigastric a. is it?
Is it congenital or acquired?

- Occurs through a weakened area of the abdominal wall muscles as the hernia pushes its way directly through the posterior wall of the inguinal canal (i.e. through the inguinal triangle).
- It is unusual for the direct hernia to reach the scrotum.
- Lies medial to the inferior epigastric artery.
- It is acquired hernia.

57

What type of inguinal hernia is more common?

Indirect (2 out of 3)

58

What layer contains the 5 umbilical folds (ligaments)?

Parietal peritoneum (suprapubically), via structures running in the extraperitoneal tissue

59

What are the medial umbilical folds?

- Raised by medial umbilical ligaments (obliterated umbilical artery)

60

What are the lateral umbilical ligaments?

- Raised by the inferior epigastric arteries in their way to rectus sheath.

61

What/where is the median umbilical fold?

- Raised by median umbilical ligament (fibrosed Urachus)
- Extends from apex of the urinary bladder towards the umbilicus.

62

What lines span horizontally across the rectus abdominis m?

Tendoneous lines

63

What is a remnant of the gubernaculum testis?

Scrotal ligament

64

What was processus vaginalis a layer of?

Peritoneum (parietal, I believe)

65

What vertebral level would you typically find the belly button?

L4