Anterior Abdominal Wall And Inguinal Canal

Question 1

4 quadrants of the anterior abdominal wall?

What planes separate them?

Answer 1

RUQ, RLQ, LUQ, LLQ

Vertical plane and horizontal plane

Question 2

Subcostal plane is a horizontal plane that lies at which vertebrae?

Answer 2

L3 (upper border)(lower margin of 10th costal cartilages)

Question 3

Intertubercular plane is horizontal and lies where?

Answer 3

Right and left iliac crest - body of L5

Question 4

Vertical planes are located where

Answer 4

Midclavicular planes

Question 5

9 regions of anterior abdominal wall?

Answer 5

Epigastric region-right and left hypochondriac
Umbilicial region- right and left lumbar
Hypogastric region- right and left inguinal

Question 6

Layers of the ant abdominal wall from superficial to deep (6)

Answer 6

Skin, superficial fascia, muscles with their deep fascia, transversalis fascia, extraperitoneal fascia, parietal peritoneum

Question 7

Superficial fascia divides into two layers. What are they and explain

Answer 7

Campers- more superficial, can be thick, continuous with superficial fat

Scarpas- more deep, fuses with fascia lata of thigh, right below the inguinal ligament

Question 8

Where would blood accumulate if there was damage to your urethra

Answer 8

Scarpas fascia (continuous with superficial fascia of the penis) (would not affect the thigh, because potential space is closed when scarpas fuses with fascia lata)

Question 9

Inguinal ligament separates __ and __?

What forms the inguinal ligament?

Answer 9

Abdomen and thigh

Lower border of external oblique aponeurosis folding back on itself

Question 10

What forms the conjoint tendon

Answer 10

Lowest tendinous fibers of internal oblique and transversus abdominis

Question 11

How to the upper fibers of the internal oblique run in relation to the fibers of the external oblique

Answer 11

Perpendicular

Question 12

Name contents of rectus sheath (muscles, nerves, and vessels)

Answer 12

Rectus abdominis, pyramidalis, superior and inferior epigastric vessels, and 7-11 intercostal and subcostal nerves

Question 13

1. What forms the anterior wall of the rectus sheath?

2. Posterior wall?

Answer 13

Both walls are formed when the internal oblique aponeurosis splits into two lamina then:

1. Anterior lamina joins aponeurosis of ext oblique
2. Posterior lamina joins aponeurosis of transversus abdominis

Question 14

Arcuate line divides what?

What level is it located ?

Answer 14

Marks lower end of posterior aponeurotic wall of rectus sheath

Level of ASIS

Question 15

Difference in rectus abdominis below and above arcuate line?

Answer 15

Above the line- rectus abdominis is in contact with anterior and posterior layer of rectus sheath

Below the line- just in contract with anterior layer of rectus sheath

Question 16

4 nerves of the anterior abdominal wall?

Where do these nerves run for a large part of their course?

What do these nerves supply (sensory and motor)

Answer 16

7-11 intercostal nerves, subcostal nerve, iliohypogastric and ilioinguinal nerves

Forward between int oblique and transversus abdominis

Sensory: skin, parietal peritoneum, and ant abdominal wall. Motor: muscles of ant abdominal wall

Question 17

Course of 7-11 intercostal and subcostal nerve and what they innervate

Answer 17

Enter rectus sheath and supply rectus abdominis and pyramidialis (subcostal only) -> terminate by piercing ant wall of rectus sheath to supply skin of ant abdominal wall

Question 18

1. Course of iliohypogastric and ilioinguinal nerves
2. Iliohypogastric supplies?
3. Ilioinguinal supplies?

Answer 18

1. Do not enter rectus sheath; pierce int oblique anteriorly and run between this muscle and ext oblique aponeurosis
2. Pierces ext oblique aponeurosis above superficial inguinal ring to supply suprapubic skin
3. Emerges through superficial inguinal ring to supply skin of superomedial thigh and ext genitalia

Question 19

3 dermatomes of the ant abdominal wall

Answer 19

T7- inferior to the tip of the xiphoid process
T10- level of umbilicus
L1- pubic symphysis and area immediately superior to it

Question 20

Superior epigastric artery

1. Terminal branch of?
2. Where does it enter abdominal wall?
3. What does it supply?
4. What does it anastomose with?

Answer 20

1. Internal thoracic artery (splits at ~6th intercostal space)
2. Between sternal and costal origins of the diaphragm
3. Upper central part of anterior abdominal wall
4. Inferior epigastric artery

Question 21

Inferior epigastric artery

1. Originates from?
2. Supplies?

Answer 21

1. Distal part of external iliac artery (just above inguinal ligament
2. Lower central part of anterior abdominal wall

Question 22

Deep circumflex iliac artery

1. Originates from
2. Runs?
3. Supplies?

Answer 22

1. Distal part of external iliac artery (same place as inferior epigastric)
2. Superior/laterally toward ASIS
3. Lower lateral part of anterior abdominal wall

Question 23

10th and 11th posterior intercostal arteries, subcostal and lumbar arteries supply?

Answer 23

Upper lateral part of anterior abdominal wall

Question 24

Superficial epigastric and superficial circumflex iliac arteries (branches of femoral arteries) supply?

Answer 24

Superficial fascia/skin of lower part of anterior abdominal wall

Question 25

Musculophrenic artery supplies?

Answer 25

Anterior abdominal wall, just inferior to costal margin

Question 26

External iliac artery gives off what two branches? When does it change its name to femoral artery?

Answer 26

Inferior epigastric artery and deep circumflex iliac artery When it leaves inguinal ligament to enter the thigh

Question 27

Superficial veins of anterior abdominal wall drain superiorly into? Inferiorly?

Answer 27

Superiorly into axillary vein via lateral thoracic vein | Inferiorly into femoral vein via superficial epigastric vein

Question 28

Clinical significance of superficial veins of anterior abdominal wall

Answer 28

May provide collateral circulation during blockage of either vena cava

Question 29

Where do the following deep veins drain into: 1. Superior epigastric vein 2. Inferior epigastric and deep circumflex iliac veins 3. Lower posterior intercostal and subcostal veins 4. Lumbar veins

Answer 29

1. Internal thoracic vein 2. External iliac vein 3. Right side- azygos; left side- hemiazygos 4. IVC

Question 30

Occlusion of the IVC would cause what

Answer 30

Superficial veins of anterior abdominal wall to become dilated

Question 31

Lymphatic drainage of: 1. Superficial lymph vessels above umbilicus 2. Below level of umbilicus

Answer 31

1. Drains upward toward anterior axillary lymph nodes | 2. Drains downward toward superficial inguinal lymph nodes

Question 32

Deep lymph vessels drain into

Answer 32

Internal thoracic (parasternal), external iliac, posterior mediastinal and lumbar (para-aortic) lymph nodes

Question 33

Location of the inguinal canal

Answer 33

Lies parallel and immediately above medial part of inguinal ligament

Question 34

Contents of inguinal canal in: 1. Males 2. Females

Answer 34

1. Spermatic cord and ilioinguinal nerve (genitofemoral nerve is part of the spermatic cord) 2. Round ligament of uterus, genitofemoral and ilioinguinal nerve

Question 35

Location of deep inguinal ring? Location of superficial inguinal ring?

Answer 35

Opening in transversalis fascia; Between ASIS and pubic tubercle Opening in aponeurosis of external oblique; immediately superior to pubic tubercle

Question 36

Borders of inguinal canal: 1. Posterior 2. Anterior 3. Inferior 4. Superior

Answer 36

1. Transversalis fascia 2. Aponeurosis of ext oblique 3. Inguinal and lacunar ligaments 4. Lower borders of internal oblique and transversus abdominis

Question 37

3 parts of an abdominal hernia

Answer 37

1. Sac- pouch of parietal peritoneum 2. Contents- can be any structure found within abdominal cavity 3. Coverings- formed by layers of abdominal wall

Question 38

Most common type of abdominal hernia

Answer 38

Inguinal (more in males than females)

Question 39

Comparatively, what are the differences between indirect and direct hernias

Answer 39

Indirect is more common, considered congenital in origin (tunica vaginialis not closing up), and more common in children/young adults, runs a longer course Direct more common in older men with weak abdominal muscles, acquired in origin, runs a shorter course

Question 40

How can you tell the difference between an indirect and direct inguinal hernia?

Answer 40

Indirect- leaves abdominal cavity lateral to inferior epigastric vessels Direct- leaves abdominal cavity medial to inferior epigastric vessels ~both go through deep inguinal ring

Question 41

What is Hesselbachs triangle? Boundaries?

Answer 41

Area where direct hernias protrude Laterally- inferior epigastric vessels Medially- rectus abdominis Inferiorly- inguinal ligament