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82 Cards in this Set

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What is in the middle of the two pubic bones? What kind of joint is it?
-Pubic Symphysis
-Fibrocartilaginous Joint
What does the median and transumbilical plane divide the abdomen into? What is in these?
4 quadrants
Right Upper - liver
Left Upper - spleen
Right Lower - Appendix
Left Lower - n/a
What lines divide the abdomen into 9 parts? What are the parts?
Subcostal, transtubercular, and midclavicular
right hypochondriac, epigastric, left hypochondriac
right lumbar, umbilical, left lumbar
right inguinal (iliac), hypogastric, left inguinal (iliac)
Where and what are McBurney's point?
It is a point half-way between a line drawn between the ASIS and the umbilicus. Marks the spot deep to which is the vermiform appendix.
What is the linea semilunaris?
Lateral border of the rectus sheath
What is the linea transversa formed by? What is its significance?
Formed by tendinous inscriptions of rectus abdominis muscle. Horizontal lines that form 6 pack.
What is the linea alba? Where is it located?
Bloodless line that is at the midline.
What is the inguinal ligament?
The inferior border of the aponeurosis of external abdominal oblique
What type of sack is the peritoneum? What is the fluid buildup in this sack known as?
-Serous
-Ascites
What are the nine layers of the anterior abdominal wall? (superficial to deep)
Skin, Camper's Fascia, Scarpa's Fascia, EAO, IAO, Transverus Abdominus, Transversalis Fascia, X-tra Peritoneal Fatty Tissue, Peritoneum (Parietal Layer)
What are the Scarpa's and Camper's and where are they located?
Campers-fatty layer
Scarpas-membranous layer
Located at the inferior 1/4 of anterior abdominal wall
What is the transversalis fascia analogous to?
Endothoracic fascia of thorax
How many of the layers involve McBurney's Point?
All 9 of them
What is the vertically condensed portion of the Scarpa's?
Fundiform ligament
What do the intercostal vessels run between?
IAO and Transversus Abdominis
What is the tendon of the EAO termed? Where does it run to? What is the inferior portion known as? EAO arises from the outer surface of which ribs?
Aponeurosis, midline, inguinal ligament, Lower 8 Ribs
Where does the Inguinal Ligament run to and from?
ASIS to Pubic tubercle
The vertical fibers from the EAO run from what to what?
Origin at Lower 8 ribs to anterior 1/2 of the iliac crest
What is the origin and insertion for the IAO?
Origin: Thoracolumbar Fascia & Lateral 2/3 of Iliac Crest (Lateral 2/3 of inguinal ligament)
Insertion: Some fibers go medially to form component of rectus sheath and others go to lower 3-4 costal cartilages
What is a continuation of the IAO as it covers over the spermatic cord?
Cremaster muscle/fascia layer
What is the origin/insertion of Transversus Abdominis?
Origin: Thoracolumbar Fascia/Lateral 2/3 of inguinal
Insertion: Most into component of rectus sheath
What is the arcuate line? What is it posterior to? What is the clinical significance of it?
-The inferior border of the posterior part of the rectus sheath
-Transversus Abdominis muscle
-Bloodless for surgery and hernias occur here
Where does the rectus abdominis run from and to?
Runs from pubic crest to the xiphoid process and lower 5th, 6th, 7th costal cartilages
What is the rectus sheath composed of? Where are these located above and below arcuate line?
-Tissue from EAO, IAO, and Transversus Abdominis

Above: EAO/IAO run anterior to RA; TA runs posterior to RA
Below: EAO/IAO/TA all run anterior to RA
What is the round ligament?
What is left of the ligamentum teres
What is the median umbilical ligament? What was it?
The obliterated urachus (attaches apex of bladder and runs to umbilicus)
What happens in a patent urachus? What caused this?
Patient peas from umbilicus. Urachus never fully closed off to form median umbilical ligament.
What are the medial umbilical ligaments?
Obliterated umbilical artery
What is the significance of the lateral umbilical fold?
Covers the inferior epigastric vessels
What are the artery anastomoses composed of in the anterior abdominal wall?
Internal Thoracic, Intercostals, Deep circumflex ilium
Where is the watershed for the lymphatics of the anterior ab. wall? What happens superior/inferior to this watershed point?
Line is at the umbilicus. Superiorly drains into axillary nodes. Inferiorly drains into superficial inguinal lymph nodes, just inferior to inguinal ligament
What is the function of muscles in the abdominal wall?
To build up intra-abdominal pressure for partuition (birthing), micturation (urination), defecation, coughing, assiting in rotation, and lateral flexion.
What nerves innervate the abdominal muscles?
Lower 6 thoracic ventral rami
What are the only nerves that run between the EAO/IAO?
Ilioinguinal/Iliohypogastric
What is the clinical significance of cutting the nerves that go to the rectus abdominis (L1)?
Will cause astrophy of muscles, so the protection of abdomen is lost and herniation can occur.
A patient has a spinal cord lesion at T6. Will she exhibit difficulty expelling mucous from the bronchial tree?
Yes. Need lower 6 thoracic.
Talk about the formation of the scrotum and its function.
Begins as the processus vaginalis, an outpocketing or evagination of the anterior abdominal wall. What is formed is an indirect passageway through the ant. ab. wall in the inguinal region beginning internally at the peritoneum and protruding it and the other layers of the ant. abdominal wall in front of it. The end result is a cutaneous pouch, the walls of which, are continuous with the abdominal walls. The name of this cutaneous pouch is the scrotum, and its function is to house the testiticles.
What forms the internal (deep) ring? What forms the external (superficial) ring? What forms the adult deep ring?
Internal - Peritoneum
External - EAO
Adult Deep ring - Transversalis Fascia
What is the area between the interna (deep) and external (superficial) ring? How long is it?
Inguinal Canal - First 5 cm of Processes vaginalis
What is the pinched off portion of the peritoneal cavity?
Vaginal tunic
Why do testes have to descend?
To get to the right temperature, so the sperm doesn't die & higher incidence of testicular cancer
When does the processus vaginalis begin to occur?
8th week
What are the spermatic fascias that cover the spermatic cord and what do they come from?
Internal - Transversalis Fascia
Cremasteric - IAO
External - EAO
Why doesn't the transversus abdominis descend into the scrotum?
Processus vaginalis occurs inferior to transversus abdominus
What layer do the testes lie in?
X-tra peritoneal fatty tissue
What spinal cord levels does the testis arise from?
T10 to L1
At how many weeks is the testis about to begin descending? When is the testis ready to enter the deep ring? When does the testicle drop into the scrotum?
-11 Weeks
-28 Weeks
-32 Weeks
What causes the testes to descend?
Androgens (sex hormones)
What is the fibromuscular cord that drags the testes down?
Gubernaculum testis
If testis does not descend, what region is it usually caught in?
Inguinal canal
What are the outer and inner coverings of the testis?
Outer- parietal layer of tunica vaginalis
Inner- visceral layer of tunica vaginalis
What is the tunica albuginea? What does it do?
It is the white coat that you can see inside the transparent visceral layer of tunica vaginalis. It sends connective tissue through the testis to divide testis into lobules where the seminiferous tubules reside
Where do spermatozoa grow? What is the route after that?
-seminiferous tubules
-rete testis (mediastinal testis)->epididymis->vas deferens
What are the contents of the spermatic cord?
3 arteries: testicular, ductus deferens, cremasteric.
3 nerves: genital branch of the genitofemoral, cremasteric, autonomics.
3 other things: ductus deferens, pampiniform plexus, lymphatics.
What does the pampiniform plexus eventually turn into?
Testicular vein
Where do you check for cancer if you have testicular cancer? Where does lymph from the scrotum go?
Paraaortic lymph nodes (lumbar lymph nodes) because it descended from T10-L1.
Superficial inguinal lymph nodes.
What spinal nerves supply the skin of the scrotum? Which supply the testicle? How can you tell where a lesion is in the spinal cord?
S2-S4
T11
-Push slightly and is not felt but deeply and it hurts with a pinprick, then lesion lies in between T11 & S2
What is a hydrocele?
It is a collection of fluid secreted by the serous cells surrounding the tunica vaginalis.
What layers do you have to go through to tap the hydrocele?
Skin, superficial fascia (containing smooth muscle), continuation of Scarpa's layer, External Spermatic Fascia, Cremasteric fascia, internal spermatic fascia, parietal layer of tunica vaginalis.
What is the inguinal canal defined as? What is an inferior continuation of the EAO aponeurosis known as?
-The first 5 cm of the processus vaginalis
-inguinal ligament
What are the pubic crus's a specialization of? What does the medial/lateral crus attach to? What are intercrural fibers and what happens if they are cut?
-EAO aponeurosis
medial - attaches to pubic crest
lateral - attaches to pubic tubercle
-They connect the medial to the lateral crus
-If cut, superficial ring is enlarged & herniation is more common
What is a muscle that is found in most people that is at the inferior edge of the rectus sheath?
Pyramidalis
Where are the inferior epigastric vessels located in relation to the deep ring?
Vessels are medial to the deep ring
What nerve passes through the superficial ring? What does it innervate?
-Ilioinguinal nerve
-Innervates the anterior scrotum and anterior labia
What does the iliohypogastric nerve innervate?
Suprapubic skin
What is the conjoint tendon?
It is where the IAO and Transverus abdominis muscle come together to form part of the posterior wall of the inguinal canal (medial side).
What is the lacunar ligament?
It is the portion of the inguinal ligament that attaches to the pectineal line (a line posteriolateral to the pubic tubercle)
What is the floor, roof, posterior, and anterior borders of the inguinal canal?
Floor - Inguinal ligament/lacunar ligament
Roof - IAO/TA
Posterior - Transversalis fascia/conjoint tendon medially
Anterior - EAO
What is especially strong in the female?
Conjoint tendon
What represents the lacunar ligament extended laterally along the pectineal line?
Pectineal ligament
What borders of the inguinal canal does the EAO aponeurosis help form?
Anterior/Floor (as part of the inguinal ligament)
What are the border's of Hasselbach's triangle? Why is it important?
Lateral - inferior epigastric vessels
Medial - Lateral part of rectus Abdominis
Inferior - Inguinal ligament
-A direct inguinal hernia will occur here
What lies between where a direct vs. indirect hernia occurs?
Inferior Epigastric vessels
What are the hernia classifications?
-Location
-Reducible, Incarcerated, or Strangulated
-Congenital or Acquired
Why are there 6 times more anterior abdominal wall hernias in a male than a female?
Because of the prenatal penetration of the inguinal by the processus vaginalis and the spermatic cord
What is the result of the processus vaginalis in the female?
Labia majoris
Where would a femoral hernia be in relation to an indirect inguinal hernia?
Inferior to the inguinal hernia region
Does an indirect inguinal hernia presuppose a patent processus vaginalis?
Yes
What covers the outer layer of a hernia?
Peritoneum
Why would some OBGyns say that a direct hernia never occurs in women?
Due to the strength of the falx inguinalis in females (which covers the medial part of the posterior wall)
What type of people are prone to direct hernias?
Smokers or weightlifters. Anyone that increases intraabdominal pressure frequently.
What will physicians sometimes take from the thigh to place over the inguinal canal to repair herniation?
Gracilis muscle