Hs: Week 4: Abdominal Wall

Front 1

Name the 3 borders of the inguinal triangle.

Back 1

1. Linea semilunaris (lateral edge of rectus abdominis M
2. Inguinal L
3. Inferior epigastric vessels

*Common site of DIRECT inguinal hernia (medial to inferior epigastric vessels)

Front 2

What are the attachments of the inguinal ligament?

Back 2

1. Anterior superior iliac spine
2. Pubic tubercle

Front 3

The umbilicus is typically found at the level of what two vertebrae?

Back 3

L3, L4

Front 4

Name the 3 bones that fuse to form the coxal bone.

Back 4

1. Ileum
2. Ischium
3. pubis

Front 5

List 9 structures found in the right upper quadrant of the abdomen.

Back 5

1. Ascending colon
2. Right colic flexure
3. Transverse colon
4. Descending duodenum
5. Head of pancreas
6. Right hemidiaphragm
7. Liver
8. Gall bladder
9. Right kidney

Front 6

List 7 structures found in the right lower quadrant of the abdomen.

Back 6

1. Terminal ileum
2. Ileal cecal junction
3. Cecum
4. Appendix
5. Ascending colon
6. Bladder
7. Right ovary/ ductus deferens

Front 7

List 12 structures found in the left upper quadrant of the abdomen.

Back 7

1. Transverse colon
2. Left colic flexure
3. Descending colon
4. Jejunum
5. Ileum (a bit)
6. Spleen
7. Body/tail of pancreas
8. Stomach
9. Esophagus
10. Left kidney
11. Left hemidiaphragm
12. Terminal duodenum

Front 8

List 6 structures found in the left lower quadrant of the abdomen.

Back 8

1. Descending colon
2. Sigmoid colon
3. Jejunum (a bit)
4. Ileum
5. Ovary/ ductus deferens
6. Bladder

Front 9

List the layers of the abdominal wall beginning with the most superficial.

Back 9

1. Skin
2. Fatty layer of superficial fascia (Camper's fascia)
3. Membranous layer of superficial fascia (Scarpa's fascia)
4. Rectus sheath/abdominal MM
5. Transversalis fascia
6. Parietal peritoneum

Front 10

The membranous layer of superficial fascia in the abdomen is continuous with...?

Back 10

Superficial fascia of the penis and perineum
(same fascia as Darto's fascia in scrotum and Colle's fascia at the root of the penis)

Front 11

Where does the fatty layer of superficial fascia of the abdomen stop?

Back 11

It stops at the external genitalia, where it is tied down to the Inguinal L.

Front 12

What type of aponeurosis makes up the Inguinal L?

Back 12

The folded down border of the aponeurosis of the external abdominal oblique M.

Front 13

The superficial inguinal ring is a defect of which fascia?

Back 13

Aponeurosis of external abdominal oblique M.

Front 14

The ligamentum teres is a remnant of which structure?

Back 14

Obliterated Left umbilical V

Front 15

Which fold in the abdominal wall is created by the urachus?

Back 15

Median umbilical fold

Front 16

Which folds in the abdominal wall are created by the obliterated Umbilical AA?

Back 16

Medial umbilical folds

Front 17

Which folds in the abdominal wall are created by the inferior epigastric vessels?

Back 17

Lateral umbilical folds

Front 18

Which fossa is found between the median and medial umbilical folds?

Back 18

Supravesical fossa

Front 19

Which fossa is found between the medial and lateral umbilical folds?

Back 19

Medial inguinal fossa

Front 20

Which fossa is found lateral to the lateral umbilical folds?

Back 20

Lateral inguinal fossa

Front 21

Which veins (that are typically not visible) become visible with caput medusa?

Back 21

Thoracoepigastric V

(Caput medusa caused by portal hyptertension)

Front 22

The rectus sheath is tied down at which two places?

Back 22

1. Linea alba
2. Linea semilunaris

Front 23

"Linea nigra," hypopigmentation of aponeuroses can occur where?

Back 23

Along the linea alba
(typically seen during pregnancy)

Front 24

Above the arcuate line, which aponeuroses make up the anterior rectus sheath?

How about below the arcuate line?

Back 24

Anterior rectus sheath:
Above arcuate line: External and internal abdominal oblique M aponeuroses
Below arcuate line: External and internal abdom. oblique + Transversus abdominis aponeurosis

Front 25

Above the arcuate line, which aponeuroses make up the posterior rectus sheath?

How about below the arcuate line?

Back 25

Posterior rectus sheath:
Above arcuate line: Internal abdom. oblique + Tranversus abdominis aponueroses
Below arcuate line: NO RECTUS SHEATH (only transversalis fascia + parietal peritoneum)

Front 26

Segmental spinal nerves are found between which two abdominal muscle layers?

Back 26

Internal abdominal oblique and transversus abdominis MM.

Front 27

Nerve supply to the umbilicus comes from which segmental spinal nerves?

Back 27

T10, T11

Front 28

Which structures does the Subcostal N innervate?

Back 28

(subcostal N = T12)
1. Anterior abdominal wall MM
2. Skin on the side of the hip

Front 29

Which structres does the Iliohypogastric N innervate?

Back 29

(iliohypgoastric N = L1)
1. Internal abdominal oblique + transversus abdominis MM
2. Lateral sides of buttocks
3. Skin above pubis

Front 30

Which structures does the Ilioinguinal N innervate?

Back 30

1. Internal abdominal oblique + transversus abdominis MM
2. Skin on upper and middle parts of thigh
3. Root of penis/ mons pubis
4. Anterior part of scrotum/ labium majus

Front 31

Name 6 arteries that supply the anterior abdominal wall.

Back 31

1. Superior epigastric A
2. Musculophrenic A
3. Inferior epigastric A
4. Circumflex iliac A
5. External iliac/ femoral A
6. Segmental lumbar AA

Front 32

Where does the inguinal canal begin and end?

Back 32

Begins at deep inguinal ring (lateral to inferior epigastric vessels)
Ends at superficial inguinal ring (lateral to pubic tubercle).

Front 33

Name 3 superficial branches of the femoral artery that supply the inguinal region.

Back 33

1. Superficial circumflex iliac A
2. Superficial epigastric A
3. External pudendal A

Front 34

Describe the components of the conjoint tendon.

Back 34

Aponeuroses of internal abdominal oblique and transversus abdominis MM
(inserts into pubic tubercle)

Front 35

Name the 3 structures that make up the superficial inguinal ring.

Back 35

1. Medial crus
2. Lateral crus
3. Intercrural fibers.

Front 36

Which fascia makes up the deep inguinal ring?

Back 36

Transversalis fascia

Front 37

The superficial inguinal ring is lateral to...?

The deep inguinal ring is lateral to...?

Back 37

Pubic tubercle

Inferior epigastric vessels

Front 38

Name the major components of the spermatic cord.

Back 38

1. Ductus deferens
2. Testicular A
3. Pampiniform plexus of testicular VV
4. Ilioinguinal N

Front 39

The processus vaginalis forms just lateral to which artery?

Back 39

Inferior epigastric A

Front 40

Describe the layers of the spermatic cord beginning with the most superficial.

Back 40

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

Front 41

The external spermatic fascia is a derivative of which aponeurosis?

Back 41

External abdominal oblique aponeurosis

Front 42

The cremasteric fascia is a derivative of which aponeurosis?

Back 42

Internal abdominal oblique aponeurosis.

Front 43

The internal spermatic fascia is a derivative of which fascia?

Back 43

Transversalis fascia

Front 44

Darto's fascia is a derivative of which abdominal fascia?

Back 44

Membranous layer of superficial fascia (Scarpa's fascia).

Front 45

The tunical vaginalis layers found on the front and sides of the testes is a derivative of what fascia?

Back 45

Abdominal peritoneum
(double serous membrane--forms parietal and visceral layers of tunica vaginalis)
Forms innermost layer of the scrotum

Front 46

Which ligament is important in testicular descent?

Back 46

Gubernaculum testis

Front 47

Why does the scrotum appear to have a brownish hue?

Back 47

Due to the smooth muscle content--Darto's muscle

Front 48

Describe 2 ways to trigger the cremasteric reflex.

What are the afferent and efferent limbs of this reflex?

Back 48

Triggers:
1. Stroke thigh
2. Cold temperature

Reflex response:
Afferent limb: femoral branch of Genitofemoral N
Efferent limb: genital branch of Genitofemoral N

Front 49

What can cause torsion of the testicle?

Back 49

Incompetent Gubernaculum testis

Front 50

What layer forms the walls of the testes?

Back 50

Tunica albuginea (white layer with septi)

Front 51

The genital branch of the Genitofemoral N is found between which two layers of the spermatic cord?

Back 51

Between external spermatic and cremasteric fascia.

Front 52

Varicocele--"bag of worms"--is caused by what?

Back 52

Incompetent valve in the pampiniform veins.

Front 53

A blue dot found on the head of the epididymis is indicative of..?

Back 53

Torsion of the appendix testis (becomes anoxic)

Front 54

Metastasis of testicular cancer will travel to which lymph nodes?

Back 54

Travels through lymph along testicular A all the way to the abdominal A --> drains lymph to the posterior abdominal wall.

Front 55

The scrotum drains lymph to ______ nodes.

Back 55

Inguinal nodes

Front 56

T or F.

Lymph flow is counter to arterial flow.

Back 56

TRUE.

(example: testicular cancers travel UP towards the aorta).

Front 57

What is it called when fluid accumulates within the cavity of the tunica vaginalis or anywhere along the processus vaginalis?

Back 57

Hydrocele

Front 58

DIRECT inguinal hernias traverse the anterior abdominal wall _______ to the inferior epigastric A.

Back 58

MEDIAL

Front 59

INDIRECT inguinal hernias traverse the anterior abdominal wall _______ to the inferior epigastric A.

Back 59

LATERAL.

Front 60

Which type of inguinal hernia is usually considered an ACQUIRED defect?

Which type is considered a CONGENITAL defect?

Back 60

acquired --> DIRECT hernia

congenital --> INDIRECT hernia

Front 61

Which inguinal hernial follows the course of the process vaginalis?

Back 61

INDIRECT hernia

Front 62

Most DIRECT inguinal hernias occur in which abdominal wall fossa?

Back 62

Medial inguinal fossa.

Front 63

Which type of inguinal hernia is most likely to travel into the scrotum?

Back 63

INDIRECT hernia