Ch 2 Abdominal Wall/Chest

Question 1

What is fascia?

Answer 1

-A fibrous tissue network
-Contains rich supply of blood vessels + nerves
-Weak

Question 2

What are the 2 layers to the abdominal wall?

Answer 2

Superficial + deep

Question 3

Differentiate b/w the superficial + deep layers of the abdominal wall?

Answer 3

Superficial:
-Attaches to skin
-Composed of connective tissue + fat

Deep:
-Loosely connected to superficial layer by fibrous strands
-Covers muscles + divides them into groups

Question 4

What are aponeuroses?

Answer 4

-Layers of flat tendinous fibrous sheets with strong connective tissues
-Minimal supply of blood vessels + nerves
-Strong

Question 5

What is the most known aponeuroses?

Answer 5

The rectus sheath

Question 6

Purpose of aponeuroses?

Answer 6

Serves as tendons to attach muscles + nerves

Question 7

2 main differences b/w fascia + aponeuroses?

Answer 7

Fascia:
-Rich supply of blood vessels
-Weak

Aponeuroses:
-Minimal supply of blood vessels
-Strong

Question 8

Arrange the TRV abdominal muscle, internal oblique + external oblique muscles in order from superficial to deep?

Answer 8

-External oblique (most superficial)
-Internal oblique
-TRV abdominal (deepest)

Question 9

What is the peritoneal membrane?

Answer 9

Thin sheet of tissues dividing the abdominal cavity into peritoneal + retroperitoneal compartments

Question 10

The abdominopelvic cavity is lined with ___?

Answer 10

A thin continuous layer of peritoneum

Question 11

The peritoneal cavity is completely sealed in males or females?

Answer 11

Males

Question 12

Why is the peritoneal cavity not completely sealed in females?

Answer 12

B/c it communicates with the external environment via the fallopian tubes

Question 13

Differentiate b/w the visceral + parietal peritoneum?

Answer 13

Visceral:
-peritoneum covering organs/viscrea

Parietal:
-peritoneum lining walls of the abdominopelvic cavity

Question 14

Where are bare areas located?

Answer 14

At the hila of organs, where the peritoneum is absent (part of retroperitoneum)

Question 15

What is the purpose of bare areas?

Answer 15

To allow for vessels, nerves + lymph to enter/exit the organ

Question 16

In which direction does the external oblique, internal oblique + TRV abdominis muscles run?

Answer 16

External: left
Internal: right
TRV: horizontal

Question 17

What is the rectus abdominis?

Answer 17

Our 6 pack muscles

Question 18

What is the rectus sheath?

Answer 18

Strong connective tissue fascia that encases the rectus abdominis + pyramidalis muscles, as well as some arteries, veins, lymphatic vessels + nerves

Question 19

What is the linea alba?

Answer 19

-Midline fibrous structure that runs from the xiphoid process to the symphysis pubis

-It separates the right + left rectus abdominis muscles vertically!!

Question 20

What is an umbilical ring?

Answer 20

Defect in the linea alba at the umbilicus

Question 21

What is the inguinal canal?

Answer 21

Oblique passage b/w the abdominal wall formed during fetal development

Question 22

What is the linea semilunaris + where is it located?

Answer 22

-A vertical, curved structure that runs along the lateral edges of the rectus abdominis

-Site of union where tendons of the lateral abdominal muscles meet the rectus sheath

Question 23

What is the arcuate line?

Answer 23

-An imaginary line located approx half way from the umbilicus to the pubis symphysis

-It refers to the transition terminating the posterior rectus sheath (still an anterior sheath)!!

Question 24

Above or below the arcuate line there is no longer a posterior rectus sheath?

Answer 24

Below (is a weak spot for hernias)

Question 25

What occurs superior to the arcuate line?

Answer 25

The rectus sheath completely surrounds the rectus abdominis muscle to reach the linea alba

Question 26

What occurs inferior to the arcuate line?

Answer 26

-Absent posterior layer of rectus sheath -Abscesses or hematomas in the rectus abdominis can rupture more easily now + enter the abdominopelvic cavity

Question 27

SF of muscles?

Answer 27

-Echogenic (medium level) -Uniform texture

Question 28

When does the inguinal canal form?

Answer 28

During fetal development

Question 29

How long is the inguinal canal?

Answer 29

4cm long

Question 30

What is the location of the inguinal canal, in relation to the inguinal ligament?

Answer 30

Canal is superior + medial to ligament

Question 31

What does the inguinal canal contain in males vs females?

Answer 31

Males: spermatic cord Females: round uterine ligament

Question 32

What are the 2 openings in the inguinal canal?

Answer 32

-Deep (internal) ring -Superficial (external) ring

Question 33

Differentiate b/w the deep + superficial rings in the inguinal canal?

Answer 33

Deep: -Round opening in the transversalis fascia -Found lateral to the inferior epigastric arteries Superficial: -V shaped opening in external oblique aponeurosis

Question 34

The ___ are potential sites for herniation?

Answer 34

Inguinal canal

Question 35

An opening in the external oblique is a ___ inguinal ring?

Answer 35

Superficial

Question 36

An opening in the transversalis fascia is a ___ inguinal ring?

Answer 36

Deep

Question 37

What is the posterior abdominal wall composed of?

Answer 37

-Lumbar vertebra -Posterior abdominal wall muscles -Diaphragm -Fascia -Lumbar plexus -Fat, nerves, blood vessels + lymphatics

Question 38

Location of psoas major + minor in regards to the spine?

Answer 38

Major: lateral Minor: medial

Question 39

Location of psoas muscles in regards to the kidney?

Answer 39

Posterior/medial

Question 40

Which muscle is the kidney bed?

Answer 40

Quadratus lumborum

Question 41

The iliacus lies lateral or medial?

Answer 41

Lateral

Question 42

Which to muscles join to form the iliopsoas muscle?

Answer 42

Iliacus + psoas

Question 43

Which probe to use for scanning the abdo wall?

Answer 43

Highest frequency probe (may need stand-off pads too)

Question 44

SF of skin?

Answer 44

Hyperechoic + 1-4mm thick

Question 45

SF of fat?

Answer 45

Hypoechoic (to muscle + sheaths)

Question 46

SF of rectus anterolateral muscle?

Answer 46

-Hypoechoic to sheath + skin -Hyperechoic to fat

Question 47

SF of rectus sheath, linea alba + semilunaris?

Answer 47

Hyperechoic (to muscle), may shadow

Question 48

What is the diaphragm?

Answer 48

Double dome-shaped musculotendinous division that separates the thoracic cavity from the abdominal cavity

Question 49

___ forms the right + left domes of the diaphragm?

Answer 49

Concave surfaces (roof of abdomen)

Question 50

Does the RT or LT diaphragm dome sit higher?

Answer 50

RT - b/c of liver

Question 51

The central part of the diaphragm is depressed by the ___?

Answer 51

Pericardium

Question 52

Differentiate b/w inhalation + exhalation?

Answer 52

Inhalation: -Contraction + flattening of diaphragm as chest cavity enlarges Exhalation: -Diaphragm relaxes + returns to dome shape

Question 53

What is diaphragm crura?

Answer 53

-Tendinuous structures extending from the diaphragm to the vertebral column -Forms a "tether" for muscular contraction

Question 54

The RT or LT crus is larger + longer?

Answer 54

RT - it appears as a triangular mass anterior to the Ao

Question 55

Which crus is shorter?

Answer 55

Left

Question 56

What are diaphragmatic apertures?

Answer 56

Openings which permit structures to pass b/w the thorax + abdomen (ex. esophagus, blood vessels, nerves + lymphatic vessels)

Question 57

What are the 3 large openings?

Answer 57

Caval, esophageal + aortic (they allow for the passage of vessels, nerves + lymphatics)

Question 58

What is a caval hiatus?

Answer 58

-IVC ascends through here into the thorax -Most superior opening of the 3 large apertures

Question 59

What does an esophageal hiatus allow?

Answer 59

-Allows esophagus to pass from thorax into abdomen -Located superior/left of the Ao hiatus

Question 60

What is an Ao hiatus?

Answer 60

-When the Ao passes from thorax into abdomen -Passes through crura

Question 61

Which hiatus/opening/aperture is the most superior?

Answer 61

Caval

Question 62

SF of the diaphragm?

Answer 62

Thin, curvilinear, hyperechoic band on adults Note: an additional thin, echogenic line may be seen on the thoracic side. This is an artifact (mirror image of diaphragm/liver interface)

Question 63

Where does the crura lie in regards to the upper abdominal Ao?

Answer 63

Anterior

Question 64

SF of crura?

Answer 64

Thin hypoechoic bands that thicken during deep inspiration

Question 65

What are diaphragmatic slips?

Answer 65

-Normal prominent muscle insertions -May cause hepatic invaginations

Question 66

SF of diaphragmatic slips?

Answer 66

SAG: hyperechoic bands that thicken on inspiration TRV: focal hyperechoic masses (can look pathological, must be careful)

Question 67

3 functions of the thoracic cavity?

Answer 67

-Respiratory -Cardiovascular -Lymphatic

Question 68

What are the 3 internal cavities that the thoracic cavity contains?

Answer 68

-Pericardial cavity -RT + LT pleural cavities

Question 69

What is the pericardial cavity?

Answer 69

Double lined membrane (visceral + parietal pericardium)

Question 70

What are the RT + LT pleural cavities?

Answer 70

Double lined membranes (visceral + parietal pleura)

Question 71

What is the mediastinum?

Answer 71

Space in chest that contains the pericardial cavity, esophagus, great vessels, thymus, etc.

Question 72

Location of parietal + visceral layers?

Answer 72

Parietal: outer Visceral: inner

Question 73

List 2 benefits to thoracic cavity sonography?

Answer 73

-Portable -Aids in thoracentesis

Question 74

List 2 windows we use to image the thoracic cavity?

Answer 74

-Abdomen (liver + spleen) -Intercostal

Question 75

List 2 sonographic appearances of the thoracic cavity?

Answer 75

-Pleura seen as echogenic lines -Gliding/sliding sign