Chapter 1 - Anterior Abdominal Wall(from pyramidalis)

Question 1

Deep N of AAW

Answer 1

lower 6 thoracic N, iliohypogastric and ilioinguinal N

they finally emerge as cutaneous N

Question 2

Deep arteries of AAW

Answer 2

2 from above - superior epigastric, musculophrenic
2 from below - inferior epigastric, deep circumflex iliac
Branches of intercostal, subcostal and lumbar

Question 3

Superior epigastric A

Answer 3

• from internal thoracic A
• begins in 6th intercostal space
• enters rectus sheath
• runs vertically down
• supplies rectus
• ends by anastamosing with inferior epigastric A
• gives muscular, cutaneous banches
• gives hepatic branch for falciform ligament
• gives anastamotic branch at level of xiphoid process

Question 4

Musculophrenic A

Answer 4

• from internal thoracic A
• runs downwards and laterally
• pierces diaphragm b/w 7th-8th cartilages
• gives branches to diaphragm, AAW and 7, 8, 9 intercostal spaces

Question 5

Inferior epigastric A

Answer 5

• from external iliac A
• arises from just above inguinal ligament
• passes medial to deep inguinal ring
• pierces fascia transversalis
• enters rectus sheath
• supplies rectus muscle
• anastamoses with sup. epigastric A
• gives:
  cremasteric branch
  pubic branch
  muscular branch
  cutaneous branch

Question 6

Deep circumflex iliac A

Answer 6

• from external iliac A
• runs behind inguinal ligament
• continues along iliac crest
• pierces transversus abdominis
• anastamoses with superior gluteal, lateral circumflex femoral and superficial circumflex iliac A

Question 7

Definition of rectus sheath

Answer 7

Aponeurotic sheath covering rectus abdominis

Question 8

Features of rectus sheath

Answer 8

ANTERIOR WALL
- complete
- adherent to tendinous intersections of muscle
POSTERIOR WALL
- incomplete
- deficient above costal margin and below arcuate line
- free from muscle

Both walls extend till linea semilunaris

Question 9

Formation of rectus sheath

Answer 9

ABOVE COSTAL MARGIN
AW: ext. oblique aponeurosis
PW: deficient

B/W COSTAL MARGIN, ARCUATE LINE
AW: ext. oblique aponeurosis + anterior lamina of int. oblique aponeurosis
PW: posterior lamina of int. oblique aponeurosis + aponeurosis of transversus

BELOW ARCUATE LINE
AW: Aponeurosis of all 3 flat muscles
PW: deficient

Question 10

Contents of rectus sheath

Answer 10

1. Rectus abdominis
2. Pyramidalis
3. Sup. epigastric A
4. Inf. epigastric A
5. Sup., Inf. epigastric venae comittantes
6. Terminal parts of lower 6 thoracic N

Question 11

Functions of rectus sheath

Answer 11

1. Checks bowing of rectus muscle
2. Increases efficiency of muscle
3. Maintains strength of AAW

Question 12

Define fascia transversalis

Answer 12

Part of fascia that lines inner surface of transversus abdominis

Question 13

Extent of fascia transversalis

Answer 13

A: adheres to linea alba
P: merges with anterior layer of thoracolumbar fascia. continues with renal fascia
Sup: continuous with diaphragmatic fascia
Inf: attached to inner lip of iliac crest and inguinal ligament
Med: attached to pubic tubercle

Question 14

Deep inguinal ring

Answer 14

• oval opening in fascia transversalis 1.2cm above midinguinal point
• lies lateral to inferior epigastric A
• transmits spermatic cord/round ligament of uterus

Question 15

Prolongations of fascia transversalis

Answer 15

1. Tubular prolongation surrounds spermatic cord - internal spermatic fascia
2. Forms anterior wall of femoral sheath

Question 16

Definition of spermatic cord

Answer 16

• oblique intermuscular passage in lower part of abdominal wall
• directed downwards, forwards, medially
• extends from deep inguinal ring to superficial inguinal ring

Question 17

Anterior boundaries of inguinal canal

Answer 17

Whole extent:
1. Skin
2. Superficial fascia
3. Ext. oblique aponeurosis
Lat 1/3:
1. Int. oblique muscle

Question 18

Posterior boundaries of inguinal canal

Answer 18

Whole extent:
1. Fascia transversalis
2. Extraperitoneal tissue
3. Parietal peritoneum
Medial 2/3
1. Conjoint tendon
2. Reflected part of inguinal ligament

Question 19

Roof and floor of inguinal canal

Answer 19

Roof: int. oblique, transversus abdominis
Floor: inguinal, lacunar ligament

Question 20

Structures passing through inguinal canal

Answer 20

1. Spermatic cord/round ligament of uterus. It enters through deep IR and goes out through SIR
2. Ilioinguinal N. It enters b/w ext. and int. oblique and passes out through SIR.

Question 21

Constituents of spermatic cord

Answer 21

1. Testicular A
2. Cremasteric A
3. A to ductus deferens
4. Genital branch of genitofemoral N
5. Ilioinguinal N
6. Autonomic N
7. Ductus deferens
8. Pampiniform plexus
9. Remains of processus vaginalis

Question 22

Coverings of spermatic cord

Answer 22

1. Internal spermatic fascia from fascia transversalis
2. Cremasteric fascia from muscle loops of cremaster M. Derived from int. oblique and transversus abdominis
3. External spermatic fascia from ext. oblique

Question 23

Describe hernia

Answer 23

• protrusion of abdominal contents through any of its walls or into ‘no entry’ zone within abdominal cavity
• consists of sac, contents, and coverings.
• sac consists of neck and body.

Question 24

Complications of hernia

Answer 24

1. Irreducibility - loop goes out but does not return
2. Obstruction - loop may get narrowed in parts and contents cannot move forward.
3. Strangulation - arterial supply is blocked and loop gets necrosed

Question 25

Internal hernia

Answer 25

- protrusion of loop of intestine within 'no entry' zone of abdominal cavity - usually in epiploic foramen/lesser sac/foramen of Winslow - mostly gets strangulated

Question 26

Congenital umbilical hernia

Answer 26

due to non-return of midgut loop into abdominal cavity

Question 27

Acquired infantile umbilical hernia

Answer 27

due to weakness of umbilical scar, a part of gut protrudes out. disappears as infant grows

Question 28

Paraumbilical hernia

Answer 28

loop of intestine protrudes through linea alba around umbilicus

Question 29

Femoral hernia

Answer 29

- seen more in females due to large pelvis, smaller blood vessels and larger femoral canal - neck lies below and lateral to pubic tubercle

Question 30

Inguinal hernia

Answer 30

- protrusion of loop of intestine through inguinal canal Indirect/Oblique - protrudes through DIR, inguinal canal, SIR, into scrotum. Direct - protrudes through posterior abdominal wall/ Hesselbachs triangle

Question 31

Coverings of indirect inguinal hernia

Answer 31

1. Extraperitoneal tissue 2. Internal spermatic fascia 3. Cremasteric fascia 4. External spermatic fascia 5. Skin

Question 32

Boundaries of Hesselbach's triangle

Answer 32

Inferior epigastric A Lateral border of rectus abdominis Inguinal ligament

Question 33

Coverings of lateral direct inguinal hernia

Answer 33

1. Extraperitoneal tissue 2. Fascia transversalis 3. Cremasteric fascia 4. External spermatic fascia 5. Skin

Question 34

Coverings of medial direct inguinal hernia

Answer 34

1. Extraperitoneal tissue 2. Fascia transversalis 3. Conjoint tendon 4. External spermatic fascia 5. Skin

Question 35

Epigastric hernia

Answer 35

occurs through upper part of linea alba

Question 36

Divarication of recti

Answer 36

- occurs in multiparous females with weak anterolateral abdominal muscles - loops of intestine protrude during coughing but return back

Question 37

Lumbar hernia

Answer 37

protrudes through lumbar triangle in posterior abdominal wall

Question 38

Boundaries of lumbar triangle

Answer 38

Iliac creat Anterior border of latissimus dorsi Posterior border of ext. oblique