Flashcards in Lecture 10 DA Deck (39):
Which muscle is responsoble for retracting the testes when it's cold, and what structure is it derived from?
It is the cremaster muscle, which is derived from internal oblique fibres (try not to nuke this word pls).
What is a hernia? What is an abdominal hernia?
A hernia is a protrusion of contents, anywhere.
An abdominal hernia is a protrusion of abdominal contents.
What kind of disease is bilateral indirect inguinal hernia, and what happens to those afflicted?
It is a congenital disease, where there is a protrusion through the deep ring into the inguinal canal, to the scrotum, following the testis through the canal.
It can be pushed back up through the rings by pushing superiorly, then laterally.
Once fully retracted, placing a finger over the inguinal ligament will stop the hernia redeveloping. Asking the patient to cough will mean you can feel it trying to redevelop. If you let go, you can see the hernia redevelop after coughing.
What is an indirect hernia?
It is the incomplete closure of the processus vaginalis. Abdominal contents can bulge through it.
What is the processus vaginalis?
It is the perotineal pouch taken by the testis as it descends, and is normally obliterated. Fully incomplete obliteration is called patent processus vaginalis, where partial incomplete obliteration is known as partially patent p. v.
What is a bilateral direct inguinal hernia?
It occurs when the abdominal muscles bulge against weak abdoinal muscles. Specifically, this occurs medially and inferiorly, lateral to the rectus absominus muscle. There is a window of weak muscle in this disease. It is called the inguinal triangle.
Where is the psoas major in relation to the transverse vertebrae? Where can psoas minor be found, and what is special about it?
Psoas major overlies the transverse processes, and psoas minor overlies the psoas major muscle. It is a vestigial muscle.
Where is the quadratus lumborum muscle found?
It is found edge to edge laterally to psoas major, and above iliacus. Its fibres are on the same plane as iliacus, and will eventually merge to form the iliopsoas.
How are the anterior and posterior abdominal wall muscles connected?
They are connected by a strong fascia.
At what vertebral levels does psoas major attach and insert, and what can be said about its fibres relative to its lateral border?
It attached from T12-L5, attaching to the disks as well. Its lateral border is oblique, but its fibres are still straight.
Where does psoas major pass relative to the inguinal ligament?
It passes under the inguinal ligament. It inserts to the lesser trochanter of the femur as iliopsoas.
Describe the attachment and insertions of the quadratus lumborum muscle.
It attaches to the tips of the transverse processes, and inserts to the 12th rib, stabilising it. Acts as a lateral flexor and attaches to the posterior half of the iliac crest.
Where does ilIacus originate from?
It originates from the iliac fossa. It is a converging muscle.
If iliacus and psoas major merge later on, does that mean they are in the same fascia?
No, they have their own fascia.
Where is psoas major in relation to the vertebral body?
It is edge to edge with the vertebral body.
Where is quadratus lumborum relative to the vertebral body?
It is posterior to it, and edge to edge with psoas major.
What is the clinical significance of tuberculosis melitus to the vertebral body?
It can grow in the vertebral body, and then rupture into psoas major fascia. It is a very strong fascia, so rather than rupture, it becomes an abcess in the groin.
How many layers of the thoracolumbar fascia are there, and where do they attach/insert?
There are 3 layers
Posterior attaches to the tips of the spinous processes
Middle attaches to the tips of the transverse processes
Anterior overlies the transverse processes
All fuse at the tip of the 12th rib, an attachment to transversus abdominus, as does internal and external oblique. It doesn't anchor, so there is a free posterior border, due to latissimus dorsi.
Where does the fascia of erector spinae originate from?
It originates from the middle and posterior fascia layers of psoas major.
Where is the lumbar plexus found?
It is found entirely in psoas major. Its branches emerge from its lateral borders. They mostly move with psoas to the lower limbs however.
Describe the pathway taken by the groins neurovascular supply.
It begins by emerging onto quadratus lumborum, where it enters the neurovascular layer of the anterior abdominal wall, to head to the groin.
What shape is the abdominal cavity?
What is a mesentery?
A double folded perotineum.
What is meant by retro and intraperotineal?
Retroperotineal - Covered by perotineum anteriorly, but against the posterior abdominal wall posteriorly.
Intraperotineal - within the perotineum.
Where are the kidneys found?
They are found in the aravertebral gutters, slightly behind the vertebral body. It overlies quadratus lumborum, and found under the 12th ribs.
Do the kidneys move?
Yes, they move up and down with the diaphragm.
Where are the two kidneys relative to each other?
The right kidney is pushed down by the liver.
What are the dimensions of the kidney?
It is 10cm tall, 5cm wide, and 2.5cm thick. It is bean-shaped.
Where are the adrenal glands found? Are they symmetrical?
They are found at the apex of the kidneys. They are not symmetrical.
What are the solid viscus?
Kidney, stomach, pancreas and spleen.
What are solid viscera borders determined by?
They are determined by surrounding structures. They will always have a hilum at which their neurovacular supply enters.
What is the kidney surrounded by?
A fat pad, and then a fascia called renal fascia over the fat.
Describe the innter structure of the kidney.
It has an outer cortex, which is paler and continuous. It surrounds the inner medulla, which is darker, discontinuous and cone shaped, called medullary pyramids.
Which direction does the kidneys hilum face?
It faces anteromedially.
Describe the vessels at the hilum in order of appearance (superficial to deep).
Where is the renal sinus found?
Just past the renal hilum.
Where does blood supply to the kidney come from, and where does it originate?
It is supplied by the renal artery, and it is a branch off the abdominal aorta. It is horizonal and direct.
Where is the IVC relative to the aorta? How does this affect the right renal artery?
It lies to the right of the aorta. The right renal artery will pass behind the IVC on its way to the kidney.