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128 Cards in this Set

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What is the superior extent of the abdomen?
The diaphragm
What cavity is the abdominal cavity continuous with?
The Pelvic cavity.
What is the posterior extent of the abdominal cavity?
Posterior abdominal wall.
Define the abdomen.
The portion of the trunk between the thorax and the pelvis.
Define the abdominal cavity. What is it continuous with? What does it contain?
The large space enclosed by the abdominal wall, continuous with the pelvic cavity and. It contains the abdominal viscera and peritoneal cavity.
What is the anterior (anteriolateral) abdominal wall?
A musculocutaneous sheet anchored to the skeleton (ribs, lumbar vertebrae, pelvis)
What is the linea alba?
A white line or band of fibrous connective tissue that runs down the midline.
What is the linea semilunaris?
2 lines lateral to the linea alba (midline) that are crescent in shape.
How many directions of contraction are there in the abdomen? What is the purpose of contraction?
4 different directions of contraction, work to raise pressure in the abdomen.
What is the umbilicus a remenant of?
The old yolk sac and umbilical cord.
What are the 3 functions of abdominal muscles?
Bend and rotate trunk anteriorly and laterally (NOT posteriorly)
Support trunk (made mostly of water, forms a column which resists movment)
Raise abdominal pressure
What is the Valsalva maneuver?
Action of the abdominal muscles to raise abdominal pressure.
What sort of activities require a rise in abdominal pressure?
Loud speech, vomiting, defecation, child birth, active expiraction.
Describe rebound tenderness.
When you release after pushing down on a patient's abdomen there will be pain.
Do the abdominal muscles flex the trunk posteriorly?
NO!
What are the 6 causes of enlarged abdomen?
Fetus, fluid (ascites), fat (superficial or deep), flatus (gas), feces and tumor.
What does rigitity or rebound tenderness of the abdomen indicate?
Irritation of deep surface of abdomen.
What 2 planes are involved in the 4 quadrant division of the anterior abdominal wall?
Transumbilical plane (TUP), and the median plane
What 3 planes are involved in the 9 quadrant division of the anterior abdominal wall?
Midclavicular, subcostal, and transtuburcular planes.
At what spinal cord level is the umbilicus?
Passes between L3 and L4 vertebrae.
What are the three lateral levels (right and left) of the 9 region subdivision of the abdominal wall from most superior to inferior?
R/L Hypocondriac, R/L Lumbar, R/L Inguinal
At what spinal cord level is the subcostal plane?
L2
At what spinal cord level is the transtuburcular plane?
L5
What are the 3 medial regions of the 9 region subdivision of the anterior abdominal wall from most superior to inferior?
Epigastric, umbilical, hypogastric
What distinguishes Scarpa's fascia?
Membranous with NO Fat cells.
What is Scarpa's fascia continuous with?
Fascia of thighs (cannot follow it inferiorly here.
Where does Scarpa's fascia continue? Why is this important?
Into the scrotal and labia majora areas, this is important because blood can pool here during injury.
True/False the transversalis fascia is only found with the transversus abdominus muscle.
False, the transversalis muscle continues into areas with out transverse abdominal muscle (will be inplaces muscle is not)
Give the layers of the anterior abdominal wall from most superficial to deep (12).
Skin, Fatty superficial fascia (Camper's), Membranous deep layer of superficial fascial (Scarpa's), Deep fascia, External oblique muscle, Deep fascia, Internal oblique muscle, Deep fascia, Transverse abdominal muscle, Transversalis fascia, Endoabdominal (extraperitoneal) fat, Parietal peritoneum.
Describe Camper's fascia.
Fatty fascia that varies in thickness between individuals.
What is the deep fascia of the anterior abdominal wall continuous with?
The aponeurosis of the muscles.
What is the innervation of the anterior abdominal wall muscles?
Anterior rami of T7-T12 spinal nerves (Thoracoabdominal nerves) and sometimes L1.
What is the action of external oblique muscle?
With a stationary pelvis unilaterally causes the trunk to bend to that side.
What does the external oblique attach to medially?
Rectus sheath (aponeurosis of 3 muscles)
What is the superior attachment of the external oblique muscles?
Attach to lower ribs.
What is the inferior/medial attachment of the external oblique muslces?
Attach to iliac crest, anterior superior iliac spine, inguinal ligament and pubic tubercle.
What is the superficial inguinal ring a part of and what goes through ti?
It is formed by the external oblique muscle. It is a gap in the aponeurosis and the medial end of the inguinal canal. The spermatic cord goes through the ring.
What is the orientation of the internal oblique with respect to the external oblique?
90 degrees
What is the orientation of the external oblique fibers?
Hands in pockets direction.
What are the inferior attachments of the internal oblique muscle?
Anterior 2/3 of iliac crest, lateral 1/2 of inguinal ligament, conjoined tendon
What is the origin of the cremaster muscle?
It is part of the internal oblique muscle.
What is another name or the conjoined tendon? Where is it attached?
Falx inguinalis, attaches to peritoneal line of superior pubic ramus.
What are the superior attachments of the internal oblique muscle?
Lower ribs
What is the medial attachment of the internal oblique?
Contributes to rectus sheath.
What is the cremaster innervated from? Where is that nerve's origin?
Innervated by genital femoral nerve which is from ventral rami of L1
What is the cremaster reflex? What level does it occur at?
Testes elevate through contraction. It tests integrity of sensory moter at level of L1
What is the superior attachment of the transversus abdominus muscle?
Ribs and costal margin.
What major abdominal muscle does not contribute to the rectal sheath?
Rectus abdominus muscle
What are the inferior attachments of the transversus abdominis muscle?
Conjoined tendon, anterior 1/2 of iliac crest, lateral 1/3 of inguinal ligament.
Does the transversus abdominis muscle contribute to the spermatic cord?
NO, but the transversalis fascia does.
What is the posterior attachment of the transversus abdominis muscle?
Thoraco columnbar fascia.
What are the ridges between the groupings of rectus abdominis muscle called, what is their purpose and how many pairs are there?
The are called tendinous intersections (inscriptions). They are attachments points of CT to rectus sheath.
What is the superior attachment of the rectus abdominis muscle?
Ribs 5-7 and Xiphoid process.
What is the inferior attachment of the rectus abdominis muscle?
Pubic crest and pubic symphysis.
What is the pyramidalis muscle? What is attached to?
A triangular muscle anchored inferiorly to pubic crest and to linea alba.
What does the pyrimidalis muscle do?
Puts tension on linea alba
How many pairs of Tendinous intersections are there on the rectus abdominis muscle?
3 pairs
What is the Arcuate line? What is it's location?
A crescent shaped inferior porder of the posterior layer of the rectus sheath. It is located approximately 1/3 of the distance from the umbilicus to the iliac crest. There is no posterior rectus sheath below this.
What muscles contribute to the posterior and anterior rectus sheath superior to the arcuate line?
THe transverse abdominal muscle and internal oblique contribute to posterior, the external and internal oblique contribute to the anterior.
What muscles contribute to the posterior and anterior rectus sheath inferior to the arcuate line?
Posterior: NONE
Anterior: Transverse abdominal muscle, internal oblique, external oblique
Why would you need no posterior rectus sheath?
It is needed so blood supply (inferior epigastric artery can reach the muscles)
What do the anterior rami of spinal nerves innervate (motor, sympathetics, sensory)?
Motor- Abdominal Muscles
Sympathetics- Sweat glands, Blood vessels
Sensory- Skin, muscles, and parietal peritoneum
What is the pathway of anterior rami of spinal nerves in the abdomen? What do they travel between? What do they supply?
They travel between the internal oblique and transverse abdominis muscles. They pierce the rectus sheath to supply the rectus abdominis and provide anterior cutaneous branch.
What is the name of T7-T11 nerves in the abdomen?
Thoraco abdominal nerves.
What is the name of the T12 nerve in the abdomen?
Subcostal nerves
What is the name of L1 nerves in the abdomen?
Iliohypogastric nreve and ilioinguinal nerve.
What is the origin of thoraco abdominal nerves?
T7-T11
What is the origin of subcostal nerves?
T12
What is the origin of iliohypogastric nerve?
L1
What is the origin of iliohypoinguinal nerve?
L1
What dermatome surrounds the xiphoid process?
T5
What dermatomes is the umbilicis bwtween?
T9-T10
What are the two branches of the internal thoracic artery in the anterior abdominal wall from most lateral to most medial.
Most lateral: Musculophrenic artery
Most medial: Superior epigastric artery
What are the 3 branches of the thoracic aorta in the anterior abdominal wall from most superior to inferior?
Superior
10th posterior intercostal artery
11th posterior intercostal artery
Subcostal artery
When does the external iliac artery change name and what does it chage to?
It changes to femoral artery after it passes under the inguinal ligament.
What 2 branches does the external iliac artery give rise to?
The inferior epigastric artery (runs under rectus abdominus) and the deep circumflex iliac artery (runs laterally under obliques).
What 2 branches does the femoral artery give rise to?
THe Superficial epigastric artery (runs over rectus abdominus) and the superficial circumflex iliac artery (runs more inferiorly and laterally from superficial epigastric artery)
What is the mirror artery to the inferior epigastric artery if the mirror were placed above the umbilicus in a plane through the body?
The Superior epigastric artery
What is the mirror artery to the Musculophrenic artery if the mirror were placed above the umbilicus in a plane through the body?
The deep circumflex iliac artery.
Where is McBurney's point? What operation is it important for?
McBurney's point is made by drawing a line from the anterior superior iliac spine to the umbilicus and marking an X 1/3 along the way. Important for appendix removal.
Where is a subcostal incision made and for what operation is it frequently used?
A subcostal incision is made at the subcostal margin and is used for the removal of gall bladder on the right side.
Why is a median incision less preferable than a paramedian incision?
A median incision cuts the linea alba which does heal well. The paramedian incusion avoids this.
What operation is a suprapubic incision important for?
C-section
Describe the inguinal canal. Through where does it pass?
The inguinal canal is an oblique intermuscular passage through the inferior portion of the anterior abdominal wall.
What is the importance of the inguinal canal during development?
It serves as a route of passage for the testes from the posterior abdominal wall to the scrotom.
What does the inguinal canal contain in males? How about females?
Males: Spermatic cord
Females: Round ligament (gubernaculum or CT that runs from labia majora to ovary)
With respect to the inguinal ligament where does the inguinal canal run?
Parallel and superior to the inguinal ligmane along the medial one half of the ligament.
Describe the general pathway of the inguinal canal.
It runs deep (lateral) to superficial (medial).
From where to where does the inguinal canal run?
From the deep inguinal ring (lateral) to the superficial inguinal ring (medial).
What are the 4 coverings (2 muscles, 2 other) of the testicles?
External oblique, internal oblique, transversalis fascia, and parietal peritoneum.
Why does the transversalis muscle not cover the testicles?
The deep inguinal ring is medial to the attachment of the transversalis abdominis muscle and the inguinal ligament pulls the muscle laterally.
What connects the medial crus and lateral crus?
The intercrural fibers.
What are the medial and lateral crus and where do they attach?
The lateral and medial crus are formed by splitting of the diagonal fibers of the external abdominal oblique aponeurosis. Since the fibers split, they get different names. The lateral crus attaches to the pubic tubercle and the medial crus attaches to the pubic crest.
What forms the roof of the inguinal canal?
Fibers of internal abdominal oblique and trnasversus abdominis muscles.
What forms the floor of the inguinal canal?
The inguinal ligament throughout and the lacunar ligment medially.
What forms the anterior wall of the inguinal canal?
The external abdominal aponeurosis with abdominal oblique aponeurosis laterally.
What forms the posterior wall of of the inguinal canal?
Transversalis fascia with conjoined tendon (falx inguinalis) or the joining of the internal obdominal oblique and transversus abdominis aponeuroses medially.
Is the inguinal canal above or below the conjoined tendon (inguinal falx)?
Above.
What are the contents of the inguinal canal?
Spermatic cord in males, round ligament in females, blood vessels, lymphatic vessels and inlioinguinal nerve.
What forms a guttor or floor of the inguinal canal?
The inguinal ligament.
What does the round ligament connect in females?
The Labia majora and uterus.
What are the contents of the Spermatic cord? (6)
Ductus (Vas) Deferens
Testicular artery
Artery of Vas
Pampiniform plexus of veins (weblike)
Lymph vessels
Nerves
What are the 3 layers of the spermatic cord from most external to internal?
External spermatic fascia, cremasteric fascia, internal spermatic fascia (transversalis fascia).
What is the purpose of pampiniform plexus of veins?
Plays a role in heat exchange.
What is hydrocele? Where can it occur?
Excess fluid in a persistant process vaginalis. Can occur in cord or testes.
What is Hematocele? Where can it occur?
Blood accumulating in the saccus vaginalis. Can occur only in testes.
What is the thin visceral layer that covers the epididymis and testes?
The tunica vaginalis (visceral pleura).
What is the thicker layer that covers the testes and gives them their white appearance?
The tunica albuginea
What is the arterial supply to the testes and epididymus?
The testicular artery.
What is the venous drainage of the testes and epididymus and where do they drain into?
THe right testicular vein into renal vein and the left testicular vein into the inferior vena cava.
What is the nerve supply of the testes and epididymus?
Sympathetic ganglia
What can you avoid by making a surgical incision on the linea alba?
Nerves
Define hernia.
Abndormal protrusion of a structure from the cavity in which it belongs.
What is an inguinal hernia?
An abdominal hernia through the anterior abdominal wall in the inguinal region.
What forms the deep inguinal ring?
The transversalis fascia
Where do direct inguinal hernias occur? Where do they travel? Where does it enter the canal?
Medial to the inferior epigastric artery (within inguinal triangle) and travels through the posterior wall of the inguinal canal and exits via the superficial inguinal ring. ONLY the MEDIAL portion of the inguinal canal is traveled. LITERALLLY PIERCES THE CANAL AND SELDOM ENTERS THE SCROTOM!
How many layers of the spermatic cord usually cover the inguinal canal?
One or two
What forms the hernial sac in a direct hernia?
THe transversalis fascia.
Where does an indirect inguinal hernia occur?
Leaves the abdominal cavity lateral to the inferior epigastric arteyr and travels through the deep inguinal ring, the ENTIRE inguinal canal, and the superficial inguinal ring.
Where do indirect inguinal hernias orriginate?
They originate lateral to the inferior epigastric vessels.
How many layers of the spermatic cord are covered by an indirect hernia?
All 3 layers
What forms the hernial sac in in an indirect hernia?
The remains of the process vaginalis.
What attaches testes to the anterolateral abdominal wall in development?
The gubernaculum.
What does the gubernaculum persist as after development?
The scrotal ligament.
What does the genitofemoral nerve innervate?
The cremaster muscle
Define the medial, lateral and inferior boundaries of the inguinal triangle.
Medial - lateral border of the rectus abdominis muscle
Lateral - inferior epigastric vessels
Inferior - inguinal ligament
What type of hernias originate in the inguinal triangle?
Direct hernias
What type of hernias originate in the deep inguinal ring?
Indirect hernias.