Anterior and Lateral Wall, Inguinal Region and Hernias

Question 1

What are the 2 planes that divide the adbomen into 4 quadrants

Answer 1

• transumbilical plane - L3/4 intervertebral disc (through umbilicus)
• Median/mid-sagittal plane - through the xiphoid process and pubic symphysis

Question 2

What are the 4 quadrants of the abdomen?

Answer 2

1. right upper quadrant
2. left upper quadrant
3. right lower quadrant
4. left lower quadrant

Question 3

What planes split the abdomen into 9 regions?

Answer 3

• midclavicular line - mid point of clavicle (x2)
• Subcostal plane - L3 vertebrae, lowest point of the costal margins (10th costal cartilages)
• Trans-tubercular/intertibercular plane - L5 vertebra, iliac tuburcles

Question 4

What are the 9 regions of the abdomen?

Answer 4

1. Right hypochondrium
2. Epigastric region
3. Left hypochondrium
4. Right lumbar region (loin, flank)
5. umbilical region
6. left lumbar region
7. Right inguinal region (groin)
8. Hypogastric region (pubic, suprapubic)
9. Left inguinal region

Question 5

From superificial to deep give the layers of the abdominal wall

Answer 5

• Skin
• Subcutaneous fascia
  
  • subcutaneous fatty layer (Camper’s fascia)
  • Deep membranous layer (Scarpa’s fascia)
• Abdominal muscles (3 layers)
• Transveralis fascia
• Extraperiotneal fat
• parietal peritoneum

Question 6

Give the properties of the skin of the anterior abdominal wall

Answer 6

• attached to subcutaneous tissues except at umbilicus
• Natural lines of cleavage in the skin are constant running downward and forward almost horixontally around the trunk

Question 7

What do Langer’s Lines correspond with?

Answer 7

skin creases

NB: incisions made across the lines of skin tension promote hypertrophic scarring (oblique or S-shaped incisions may be preferred)

Question 8

What is the abdominal wall continous with?

Answer 8

perineum wall

Question 9

What is camper’s fascia continous with?

Answer 9

Cruveilheir’s fascia (subcutaneous tissue of the perineum)

Question 10

What is Scapa’s fascia continous with?

Answer 10

Colles’ (perineal) fascia and dartos fascia

Question 11

What muscles are contained within the abdominal wall?

Answer 11

3 flat muscles, vertical strap-like muscles and pyramidalis

Question 12

What are the main (common) functions of the abdominal wall muscles?

Answer 12

• support abdominal contents
• raise intra-abdominal pressure
• withstand pressure from descent of diaphragm
• respiration
• support vertebral column
• flex, laterally flex and rotate the trunk

Question 13

What nerves supply the abdominal wall muscles?

Answer 13

• thoraco-abdominal (7th-11th intercostal nerves)
• subcostal nerve (12th intercostal)
• some branches from L1

Question 14

What is the vertical strap like muscle in the abdominal wall?

Answer 14

rectus abdominis

Question 15

What is the origin of rectus abdominis

Answer 15

pubic creat and pubic symphysis

Question 16

What is the insertion of rectus abdominis

Answer 16

5th-7th costal cartilage and xiphoid process

Question 17

What is the action of rectus abdominis

Answer 17

stabilises the pelvis during gait

Question 18

What is each rectus abdominis muscle enclosed in?

Answer 18

rectus sheath; formed by aponeuroses of the flat muscles of the abominal wall

Question 19

How many tendinous intersections are within rectus abdominis

Answer 19

three

Question 20

Describe the power of the rectus abdominis muscle

Answer 20

minimal

Question 21

Draw a diagram of the rectus sheath (transverse section) above the arcurate line

Answer 21

Question 22

Where is the arcuate line?

Answer 22

1/3 between umbilicus and pubic symphysis

Question 23

What is linea alba?

Answer 23

fusion of aponeurosis; tendinous structure

good place to enter the abdomen during surgery as it is bloodless

Question 24

Draw a diagram of the rectus sheath below the arcuate line

Answer 24

Question 25

Answer 25

green = semilunar line red = arcuate line blue = linea alba

Question 26

What do all aponeurosis fuse as in the midline?

Answer 26

linea alba

Question 27

What is at the inferior border of the aponeurosis of transversus abdominis

Answer 27

arcuate line

Question 28

What enter the rectus sheath at the arcuate line?

Answer 28

inferior epigastric vessels, pass anterior to the arcuate line

Question 29

What is the origin of external oblique muscle?

Answer 29

lower 8 ribs

Question 30

What is the insertion of external oblique muscle?

Answer 30

* iliac crest * linea alba * xiphoid process * pubic tubercle * anterior superior iliac spine

Question 31

How do the fibres of external oblique muscle run?

Answer 31

infero-medially

Question 32

What muscle is the external oblique muscle similar to?

Answer 32

external intercostal muscle

Question 33

What is the inguinal ligament?

Answer 33

lower border of the aponeurosis of the external oblique muscle

Question 34

Where does the inguinal ligament extend between?

Answer 34

attached to and extends between the ASIS and pubic tubercle

Question 35

What occurs at the medial end of the inguinal ligament?

Answer 35

fibres turn posterolaterally and attach to the pubic pectan this is called the lacunar ligament

Question 36

What border so the lacunar ligament form

Answer 36

medial border of the femoral canal

Question 37

Answer 37

red = external oblique

Question 38

What is the superificial inguinal

Answer 38

defect on the aponeurosis of the external oblqiue, just above the pubic tubercle superificial opening of the inguinal canal

Question 39

What is the femoral canal?

Answer 39

conical shaped potential space opening of the canal is formed by femoral vein, inguinal ligament and lacunar ligament

Question 40

Where does thoraco-lumbar fascia pass between

Answer 40

from iliac crest to the 12th rib in 3 layers

Question 41

What occurs in the thoraco-lumbar fascia?

Answer 41

three layers fuse and provide the origin to the transversus abdoominis and internal oblique muscles but not external oblique

Question 42

What can occur in the weak area of the thoraco-lumbar fascia

Answer 42

lumbar hernia

Question 43

What is the originof internal oblique muscle?

Answer 43

* thoracolumbar fascia * iliac crest (anterior 2/3) * lateral 2/3 of inguinal ligament

Question 44

What is the insertion of the internal oblique muscle?

Answer 44

* inferior 3-4 ribs * linea alba * xiphoid process * pubic crest

Question 45

What is the nerve innervation of internal oblique muscle?

Answer 45

iliohypogastric (L1) nerve

Question 46

How do the fibres of internal oblique muscle run?

Answer 46

supero-medially and inferioly to conjoint tendon

Question 47

What is the origin of transversus abdominis

Answer 47

* thoracolumbar fascia * iliac crest * lateral 1/3 of inguinal ligmanet * inferior 6 ribs and CC

Question 48

What is the insertion of transversus abdominis

Answer 48

* linea alba * xiphoid process * pubic crest

Question 49

What is the nerve innervation of transversus abdominis

Answer 49

* iliohypogastric (L1) nerves * ilioinguinal nerve (supplies inferior most fibres)

Question 50

Conjoint tendon =

Answer 50

inguinal falx

Question 51

What is the conjoint tendon?

Answer 51

fibres of internal oblique arising from the inguinal ligament arch medially over the spermatic cord and unite with transversus abdominis aponeruosis to form the conjoint tendon

Question 52

What does the conjoint tendon attach to?

Answer 52

attaches to the pubic crest and pectineal line behind the superificial inguinal ring

Question 53

What is the function of the conjoint tendon?

Answer 53

supports the superficial inguinal ring

Question 54

What is transverslais fascia

Answer 54

thin layer of CT that lines the transversus abdominis muscle internally

Question 55

What is the inguinal canal?

Answer 55

passage tgrough the anterior abdominal wall

Question 56

What does the inguinal canal connect the abdomen to?

Answer 56

* scotum in makes * labia majoria in females

Question 57

What are the two openings of the inguinal canal?

Answer 57

deep inguinal ring and superifical inguinal ring

Question 58

What are the contents of the inguinal canal?

Answer 58

* Ductus deferens in males * testicular artery in males * round ligament of uterus un females (ligamentum teres) * genital branch of genitofemoral nerves (L1/2) * ilioinguinal nerve (doesnt pass through all of the canal)

Question 59

Where is the deep inguinal ring?

Answer 59

opening in the transversalis fascia Found in the lateral inguinal fossa * lateral to the lateral umbilical fold * 1cm above the midway between the ASIS and pubic symphysis (mid-inguinal portion)

Question 60

Where is the superifical inguinal ring?

Answer 60

traingular opening ion the external oblique aponeurosis

Question 61

What is the superifical inguinal ring supported by?

Answer 61

supported from behind by the conjoint tendon

Question 62

What are the anterior relations of the inguinal canal

Answer 62

* external oblique * internal oblique laterally

Question 63

What are the posterior relations of the inguinal canal

Answer 63

* conjoint tendon medially * transversalis fascia laterally

Question 64

What is on the roof of the inguinal canal?

Answer 64

arching inferior edges of internal oblique and transversalis abdominis

Question 65

What comprises the floor of the inguinal canal?

Answer 65

* inguinal ligament * lacunar ligament medially

Question 66

What is a hernia?

Answer 66

a condition which part of an organ is displcaed and protrudes through the wall of the cavity containing

Question 67

Where does an inguinal hernia usually occur?

Answer 67

usually appears above & medial to the pubic tubercle

Question 68

Where does a femoral hernia usually occur?

Answer 68

passes through the femoral canal & appears below & lateral to the pubic tubercle

Question 69

Where does a direct inguinal hernia occur?

Answer 69

area on the posterior wall of the inguinal canal, medial to the inferior epigastric vessels - Hesselbach's triangle One the medial corner of Haselbach's (inguinal) triangle is the inguinal falx (conjoint tendon)

Question 70

Who is a weaker conjoint tendon more common in?

Answer 70

males

Question 71

What occurs in a direct inguinal hernia?

Answer 71

Fat or small bowel pushes the peritoneum and transversalis fascia May pass through the superficial inguinal ring to enter the scrotum * Parallel to spermatic cord * Covered by peritoneum, transversalis fascia (and conjoint tendon)

Question 72

What occurs in an indirect inguinal hernia?

Answer 72

abdominal cintents pass through the deep inguinal ring contents are covered by all layers of the spermatic cord