Anterior Abdominal Wall And Inguinal-1/4/16

Question 1

Identify the TRANSTUBERCULAR PLANE

Answer 1

• Tubercles of iliac crests

- Body of LV5

Question 2

Identify the TRANSUMBILICAL PLANE

Answer 2

• LV3-4

- Similar to supracrestal plane

Question 3

Identify the SUBCOSTAL PLANE

Answer 3

• 10th costal cartilages

- Superior border LV3

Question 4

Identify the TRANSPYLORIC PLANE

Answer 4

• T12-LV1
• Halfway between jugular notch and pubic symphysis
• Goes through pyloric part of stomach which is “fixed”

Question 5

Identify the MIDCLAVICULAR PLANE

Answer 5

• Midpoint of clavicle

- Midinguinal point

Question 6

Identify the MIDSAGITTAL PLANE

Answer 6

• Linea Alba

- Passes through umbilicus

Question 7

List contents of the RUQ

Answer 7

Gallbladder
duodenum 
Right pleura
Liver (right lobe)
Right kidney

Question 8

List contents of LUQ

Answer 8

Spleen
Stomach
Left pleura
Pancreas tail
Left kidney

Question 9

List contents of RLQ

Answer 9

Right ureter
Cecum
Iliad diverticulitis
Vermiform appendix

Question 10

List contents of LLQ

Answer 10

Left ureter

Descending and sigmoid colon

Question 11

List the regions of the upper abdomen

Answer 11

R and L hypochondriac

Epi gastric

Question 12

List the regions of the mid-abdomen

Answer 12

R and L lumbar (lateral)

Umbilical

Question 13

List the regions of the lower abdomen

Answer 13

R and L inguinal (iliac)
Hypo gastric (pubic)

Question 14

List the anterior abdominal wall muscles

Answer 14

Rectus abdominis and sometimes pyramidalis

Question 15

List the anterolateral abdominal muscles

Answer 15

External oblique
Internal oblique
Transversospinalis abdominis

Question 16

List the Posterior abdominal muscles

Answer 16

Iliacus
Psoas major and minor
QUADRATUS lumborum

Question 17

The _____ ligament is an “extension” of the inguinal l. And is important in FEMORAL HERNIAS

Answer 17

Lacunar

Question 18

The cremaster muscle is from which abdominal muscle layer?

Answer 18

Internal oblique

Question 19

What are the functions of the anterior abdominal wall muscles?

Answer 19

1) Flex trunk (anteriorly)
2) Laterally flex trunk
3) Rotate the trunk
4) assist in respiration
5) important in valsalva maneuver
6) also act during coughing, sneezing, urination, defecation, vomiting, and parturition

Question 20

List the fascial layers of the anterior abdominal wall from superficial to deep

Answer 20

Skin–> fatty layer (camper’s) –> Membranous layer (scarpas) –> Superficial investing fascia –> external oblique m. –> intm. Investing fascia –> internal oblique m. –> deep investing fascia –> transversus abdominis –> transversalis fascia –> extraperitoneal fat –> parietal peritoneum

Question 21

This layer is continuous with the superficial fatty layers in the thorax, thigh, and perineum`

Answer 21

Camper’s fascia

Question 22

This layer is continuous with the fascia lata in the thigh and with the deep perineal fascia; it is also continuous over the penis and scrotum

Answer 22

Scarpa’s fascia (membranous)

Question 23

This layer of fascia is what holds sutures together

Answer 23

Deep (investing) fascia of the abdominal muscles

Question 24

Fluid can possibly leak into this potential space

Answer 24

Between the membranous layer (Scarpa’s) of superficial fascia and the deep fascia of the external abdominal oblique muscle

Question 25

The _____ is formed by the fusion of the abdominal muscles and their associated fascias; It also encloses the rectus abdominis and pyramidalis mm.

Answer 25

Rectus sheath

Question 26

The layers of fascia and aponeuroses of the muscles forming the rectus sheath are arranged differently in the upper abdominal wall than they are in the lower wall and the ____ is where this arrangement changes

Answer 26

Arcuate line

Question 27

List the arrangement of layers ABOVE THE ARCUATE LINE (slide 47)

Answer 27

skin--> fatty layer of superficial fascia (camper's) --> membranous layer of superficial fascia (Scarpa's) --> Aponeurosis of ext. abdominal oblique fascia (2 layers) --> 1 layer of internal abdominal oblique Aponeurosis --> Rectus abdominis muscle --> 1 layer of internal abdominal oblique Aponeurosis --> Aponeurosis of transversus abdominis (2 layers)--> transversalis fascia --> extraperitoneal tissue --> parietal peritoneum

Question 28

List the arrangement of layers BELOW THE ARCUATE LINE (slide 48)

Answer 28

Skin--> fatty layer of superficial fascia (camper's) --> membranous layer of superficial fascia (Scarpa's) --> Aponeurosis of ext. abdominal oblique (2 layers) --> Aponeurosis of int. Abdominal oblique (2 layers) --> Aponeurosis of transversus abdominis (2 layers) --> rectus abdominis muscle --> transversalis fascia --> extraperitoneal tissue --> parietal peritoneum

Question 29

Where does deep venous drainage occur in the abdomen?

Answer 29

within the abdominal wall muscles along with arteries

Question 30

Where does superficial drainage occur in the abdomen?

Answer 30

Within Camper's fascia

Question 31

Sensory dermatome for Xiphoid region is ___

Answer 31

T7

Question 32

Sensory dermatome for umbilical region is ___

Answer 32

T10

Question 33

Sensory dermatome for inguinal fold region is ___

Answer 33

L1

Question 34

List the spinal cord contributions for: A) Iliohypogastric n. B) Ilioinguinal n. C) Genitofemoral n.

Answer 34

A) Iliohypogastric n=L1 (sometimes T12) B) Ilioinguinal n=L1 C) Genitofemoral n.=L1 and L2

Question 35

This anterior abdominal wall nerve exits the posterior abdominal wall between QUADRATUS lumborum and psoas muscles, enters the anterolateral abdominal wall and runs between muscles, exits to become cutaneous

Answer 35

Iliohypogastric n. (L1, maybe T12) ; gives off a lateral cutaneous branch and anterior cutaneous branch (supplies suprapubic region)

Question 36

This anterior abdominal wall nerve exits the posterior abdominal wall between QUADRATUS lumborum and psoas muscles, enters the anterolateral abdominal wall between muscles, and enters the inguinal canal and emerges through the superficial inguinal ring; it also supplies the groin, thigh & scrotum/labium majus

Answer 36

Ilioinguinal n. (L1)

Question 37

This anterior abdominal wall nerve exits the posterior abdominal wall through psoas m. And runs between the peritoneum and the psoas m.

Answer 37

Genitofemoral n. (L1 and L2) Genital branch --> enters inguinal canal through deep inguinal ring and exits through superficial inguinal ring; innervates Cremaster m. Or is cutaneous to labium majus Femoral branch(es)--> exits inferior to inguinal ligament, cutaneous to femoral triangle area

Question 38

This type of anterior abdominal wall hernia is usually small and wider transversely and usually heals spontaneously

Answer 38

Umbilical hernia in INFANT

Question 39

This type of anterior abdominal wall hernia results from weakened abdominal wall around the umbilicus, usually superior to umbilical scar and requires surgical repair

Answer 39

Umbilical hernia in ADULTS More common in WOMEN

Question 40

This type of anterior abdominal wall hernia does not involve the umbilicus, protrudes through the lines alba, is usually superior to the umbilicus, and repaired surgically if large or symptomatic

Answer 40

Epigastric hernia (hernia of the linea alba) More common in MEN

Question 41

Describe where the inguinal canal begins and ends

Answer 41

Begins=deep inguinal ring (about midpoint of inguinal l.) Ends=Superficial inguinal ring

Question 42

During the descent of the testes, the testes are attached to the ____ which is attached inferiorly to the labial-scrotal fold. It guides the migration.

Answer 42

Gubernaculum

Question 43

This pouch of peritoneum develops and pushes into labial-scrotal swelling as the testes reach the deep inguinal ring

Answer 43

Processus vaginalis

Question 44

Descent of the testes process: When the processus vaginalis (normally) closes off and becomes an isolated pocket of peritoneum, this structure arises:

Answer 44

Tunica vaginalis

Question 45

Match the layers of the scrotum and coverings of testis to the corresponding layers of anterior abdominal wall (SLIDE 88): A) SubQ tissue (fatty/membranous) B) External oblique muscle and fascia C) Internal oblique muscle D) Fascia of both superficial and deep surfaces of internal oblique m. e) Transversalis fascia F) Peritoneum

Answer 45

``` A) SubQ tissue (Darto's fascia) and Darto's muscle B) External spermatic fascia C) Cremaster muscle D) Cremasteric fascia E) Internal spermatic fascia F) Tunical vaginalis ```

Question 46

In the female, the gubernaculum forms:

Answer 46

The round ligaments of the ovary (ovarian ligaments) and the round ligaments of the uterus

Question 47

In a ____ hernia, herniating bowel passes LATERAL to inferior epigastric vessels to enter deep inguinal ring These are more common in young MALE CHILDREN

Answer 47

Indirect (congenital) Most inguinal hernias are INDIRECT

Question 48

In a ____ hernia, herniating bowel passes MEDIAL to inferior epigastric vessels, pushing through peritoneum and transversalis fascia in inguinal triangle to enter inguinal canal These are more common in older MALES

Answer 48

Direct (acquired)

Question 49

____ carry sperm from testes to head of epididymis ____ is connective tissue capsule of the testis ____ is a space of visceral layer of the tunica vaginalis

Answer 49

Efferent ductules Tunica albuginea Sinus epididymis

Question 50

____ hernias exit the abdomen through the femoral canal, inferior to the inguinal ligament and are more common in WOMEN

Answer 50

Femoral