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64 Cards in this Set
- Front
- Back
Anterolateral Abdominal Wall Layers |
Fascia Superficial fascia Deep Fascia Aponeuroses |
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Anterolateral Abdominal Wall Fascia layer Fibrous tissue network located____________________________ Rich supply of______________________ Composed of two layers:_______________,_______________ |
-between the skin and underlying structures -blood vessels and nerves -Superficial layer, Deep Layer |
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Superficial Fascia |
Attaches to the skin; composed of connective tissue containing varying quantities of fat |
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Deep Fascia 1- 2- 3- |
1- Underlies superficial layers and loosely joined by fibrous strands 2-Covers the muscles and partition them into groups 3-Thin densely packed and stronger than the superficial fascia |
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Aponeuroses layers of |
Layers of fat tendinous fibrous sheets fused with strong connective tissue that serves as tendons to attach muscles to fixed points |
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Aponeuroses Minimal _______________________ |
blood vessels and nerves |
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Aponeuroses Primarily located in ___________________ |
the ventral abdominal regions |
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Aponeuroses Primary function to__________________________ |
join muscles to the body parts |
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Multilayered Abdominal Wall Consists Of 1- 2- 3- 4- 5- 6- |
1-Skin 2-Subcutaneous Tissue (Superficial Fascia) 3-Muscles and their Aponeuroses 4-Deep Fascia 5-Extraperitoneal Fat 6-Parietal Peritoneum |
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Muscles of the Anterolateral Abdominal Wall |
Rectus Abdominis Pyramidalis External Oblique Internal Oblique Transversus Abdominis |
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Rectus Sheath Strong fibrous compartment for the _________________________________________________________________ |
Strong Fibrous compartment for the rectus abdominis muscle, pyamidalis muscle, arteries, veins, lymphatic vessels and nerves |
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Rectus sheath Anterior and posterior layers formed by |
Intercrossing and interweaving of the aponeuroses of the flat abdominal muscles |
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Rectus Sheath Lateral aspect of the rectus abdominis the aponeuroses fuses to form the___________________ |
Linea Semilunaris |
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Rectus Sheath Arcuate line is located ______________________________________ |
half way from the umbilicus to the pubis symphysis |
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Linea Alba Formed as the _______________________________________________ |
fibers of the anterior and posterior layers of the sheath interlace in anterior median line |
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Linea Alba Oriented______________________________________ |
vertically and corses the length of the anterior abdominal wall |
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Linea Alba It separates the____________________. It is wider____________________________________________________ |
It separates the bilateral rectus sheaths It is wider superiorly ans it narrows inferior to the umbilicus to the width of the pubis symphysis |
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Linea Alba It transmits____________________________ |
small vessels and nerves to the skin |
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Linea Alba In thin, muscular people, _______________________________________ |
a groove is visible in the skin overlying the linea alba |
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Umbilicus Umbilicus is the area where__________________________ |
all layers of the anterolateral abdominal wall fuse |
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Umbilicus The umbilical ring is a defect in the__________________________ |
Linea alba located underlying the umbilicus |
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Umbilicus The umbilical ring is the area through which |
the fetal umbilical vessels passed to and from the umbilical cord and placenta |
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Inguinal canal in an adult it is an _______________________________ |
oblique passage approx 4cm long |
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Inguinal Canal within the canal are the __________________in males and the___________________ in females |
spermatic cord in males round uterine ligament in females |
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Inguinal Canal also located within the canal in both sexes are |
blood and lymphatic vessels and the ilioinguinal nerves |
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Inguinal Canal How many openings? |
2 |
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Inguinal Canal the _________________serves as an entrance the_______________serves as the exit for the____________________ |
the Deep(internal)inguinal ring serves as an entrance and the Superficial (external) inguinal ring serves as the exit for the Spermatic Cord or the Round Ligament in females |
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Inguinal Canal Between the deep and superficial inguinal rings, the canal has________________________________________ |
2 walls(anterior and posterior), a roof and a floor |
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Posterior Abdominal Wall Composition (9) |
1-Lumbar Vertebra 2-Posterior Abdominal Wall Muscles 3-Diaphragm 4-Fascia 5-Lumbar Plexus 6-Fat 7-Nerves 8-Blood Vessels 9-Lymphatic Vessels |
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Muscles of the Posterior Abdominal Wall (8) |
1-Psoas Major 2-Iliacus 3-Quadratus Lumborum 4-Psoas Minor 5-Iliopsoas 6-Latissimus Dorsi 7-Erector Spinae 8-Transversospinal |
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Diaphragm A double domed, musculotenious partition separating _________________________ |
thoracic cavity form abdominal cavity |
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Diaphragm _______________________ faces and forms the floor of the thoracic cavity |
Convex superior surfaces |
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Diaphragm _______________________faces and forms the roof of the abdominal cavity |
Concave inferior surface |
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Diaphragm Concave surfaces form the right and left domes with_________________________________________________________ |
the right dome slightly higher because of the presence of the liver and the central part slightly depressed by the pericardium |
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Diaphragm __________________is fixed muscle origin attaching to the inferior margin of the thoracic cage and superior lumbar vertebrae |
Periphery |
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Major Muscle of Inspiration? |
Diaphragm |
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Diaphragm 3 Parts |
Muscular part Aponeurotic Part Central Tendon |
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Diaphragm Central tendon has no_______________and appears ____________________________________________________ |
Central tendon has no bony attachments and appears incompletely divided into what resembles three leaves of a wide cloverleaf |
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Diaphragm Attachments Area around the caval opening is suppounded by muscular part forming a continuous sheet divided into three parts based on areas of attachment 1 2 3 |
1-Sternal Part 2-Costal Part 3-Lumbar Part |
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Diaphragmatic Crura _________________________arising from anterior surfaces of the bodies of the superior three vertebrae |
Musculotendinous Bands |
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Diaphragmatic Crura ______________ is larger and longer than the __________appearing as ________________________________ |
Right crus is larger and longer than the Left crus appearing as triangular mass anterior to aorta |
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Diaphragmatic Crura It arised from the___________________________and appears_________________________________ |
It arises from the first 3 lumbar vertebrae and appears posteior to the caudate lobe of the liver |
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Diaphragmatic Crura Left Crus arised from the |
First 2 lumbar vertebrae |
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Diaphragmatic Apertures Permit_______________________________________ |
structures to pass between the thorax and abdomen |
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Diaphragmatic Apertures 3 Larger apertures are the_______________________________ |
Caval , Esophageal and Aortic and there are several small openings |
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Diaphragmatic Apertures Caval hiatus is primarily for the |
Inferior vena cava and shares opening with terminal branches of the right phrenic nerve and a few lymphatic vessels |
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Diaphragmatic Apertures Esophageal Hiatus is primarily for |
esophagus to course from the thorax into the abdominal cavity |
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Diaphragmatic Apertures Aortic Hiatus is opening for |
abdominal aorta to pass from thorax into abdomen |
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The diaphragmatic crura lie_________________________ and appear as __________________________________ |
lie anterior to upper abdominal aorta appear as thin hypoechoic bands that thicken during deep inspiration |
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The crus of the right hemidiaphragm contain |
medium density echoes |
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Diaphragm (sono techniques) In some patients, diaphragmatic slips appear as |
round focal echogenic masses when seen in transverse section |
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Diaphragmatic slips should not be ____________________________ Clarify by___________________________________ |
-mistaken for focal liver or peritoneal masses - clarify by rotatinf the transducer from its transverse orientation and scannin along the diaphragmatic slips long axis, noting their now elongated appearance |
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Periumbilical Abscess |
The mixed echo appearance demonstrates good acoustic transmission in case of peri-umbilical abscess |
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Two main categories of abdominal wall hernias |
1- Ventral(anterior or anterolateral abdominal wall) 2- Groin (indirect inguinal, direct inguinal, and femoral) |
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Three major factors aid in weak abdominal wall |
1- Abnormal collagen metabolism 2-Pressure overload such as obesity, heavy lifting, coughing, smoking, familial tendency or straining may contribute to either hernia formation or increases growth of an existing hernia and insufficient protein intake 3- Natural weak areas include where vessels penetrate the abdominal wall; where fetal migration of testis, spermatic cord or round ligament has occured and through aponeuroses |
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Primary ventral hernias account for _____% of the reparied ventral hernias in the US |
75% |
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Advantages of sonography over other imaging modalities |
1- Ability to scan the patient in both upright and supine positions 2-Ability to include dynamic maneuvers such as Valsalva and compression 3-Ability to document motion in real time |
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Scanning protocol to document hernia information includes |
1-Demonstrating an abdominal wall or groin defect 2-Determining the presence of bowel loops within a lesion 3-Exaggeration of the lesion on straining of the abdominal musculature 4- Reducibility of the lesion with pressure |
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Sonographic Evaluation Can Determine(hernias) |
1-Location, Size and contents of a hernia 2- At hernia site if there is interuption of the peritoneal line separating the muscles and abdominal contents 3-If the hernia sac is fluid filled, Contains peristaltic bowel, Mesenteric Fat |
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Neoplasms Primary Abdominal Wall Tumors Include (6) |
1-Lipomas 2-Areas of calcification in old surgical scars 3-Desmoid Tumors 4-Soft Tissue Sarcomas 5-Metastatic Carcinoma 6-Melanomas |
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Sarcomas Include (4) |
1-Liposarcoma 2-Rhabdomyosarcoma 3-Fibrosarcoma 4-Evidence endometriomas transform into sarcomas |
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Diaphragmatic Pathology If the diaphragm does not attach appropriately during fetal development it may result in (5) |
1-Pain 2-Eventration 3-Paralysis 4-Herniation 5-Peridiaphragmatic Abnormalities |
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Diaphragmatic Pathology Sonography Exam Documents |
1-Fluid adjacent to the diaphragm(pleural effusion or ascites) 2-Central diaphragmatic tendon as thin linear echo covering the dome of the liver 3-Peripheral muscle insertions posteriorly(sag scan) and posterolaterally (trans scan) as thick triangle shaped hypoechoic bands |
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Diaphragmatic Pathology Left hemidiaphragm more difficult to scan than right hemidiaphragm because of |
the presence of gas in the stomach and bowel |