Anatomy- The Anterior Abdominal Wall And The Inguinal Region

Front 1

Where does the diaphragm attach?

Back 1

1. 2 crura attach to 2 left or 3 right lumbar vert.
2. xiphoid process
3. inner surfaces of the lower 6 ribs
4. arcuate ligaments
5. to the central tendon

Front 2

Which dome of the diaphragm is higher?

Back 2

right dome

Front 3

The inferior surface of the diaphragm is covered by what? Exceptions?

Back 3

1. peritoneum (except for the bare area of the liver)

Front 4

What innervates the liver?

Back 4

C3,4, and 5

Front 5

When the diaphragm contracts, what happens to thoracic volume and what happens to abdomen volume?

Back 5

1. thoracic volume increases
2. abdomen volume decreases

Front 6

When the diaphragm relaxes, what happens to thoracic volume and what happens to abdomen volume?

Back 6

1. thoracic volume decreases
2. abdomen volume increases

Front 7

What happens if the diaphragm relaxes and the abdominal muscles contract at the same time?

Back 7

the abdominal volume increases and the abdominal pressure will also increase (vomiting, defecation)

Front 8

Where does the anterior abdominal wall extend from?

Back 8

anterior aspects of the rib cage to the pelvic girdle

Front 9

What are the superior attachments of the anterior abdominal wall?

Back 9

1. xiphoid process
2. costal cartilages of ribs 7-10

Front 10

What are the inferior attachments of the anterior abdominal wall?

Back 10

1. iliac crest
2. anterior superior iliac spine
3. inguinal ligament
4. pubic tubercle
5 pubic crest
6. pubic symphysis

Front 11

What does the umbilicis overlie and what does it divide the abdominal wall into?

Back 11

1. overlies the intervertebral disc between L3/4
2. divides abdominal wall into quadrants

Front 12

The xiphoid process is at what dermatome level?

Back 12

T7

Front 13

The umbilicus overlies what dermatome level?

Back 13

T10

Front 14

The pubic symphysis lies at what dermatome level?

Back 14

L1

Front 15

The umbilicus is tightly attached to what?

Back 15

underlying fascia

Front 16

The umbilicus contains what?

Back 16

1. remnants of allantois, umbilical arteries and vein
2. inferior epigastric arteries forming the lateral umbilical ligaments

Front 17

Remnants of the allantois are contained in what structure running to the umbilicus?

Back 17

median umbilical ligaments

Front 18

The remnants of umbilical arteries and vein running to the umbilicus are contained in what structures?

Back 18

1. arteries- medial umbilical ligaments
2. vein- ligamentum teres

Front 19

The inferior epigastric arteries form what structures related to the umbilicus?

Back 19

1. inferior epigastric arteries form the lateral umbilical ligaments

Front 20

Above the umbilicus the superficial fascia contains what?

Back 20

1. fat and connective tissue fibers as a single layer of tissue

Front 21

Below the umbilicus the superficial fascia contains what?

Back 21

divides into:
1. subcutaneous Camper's fascia
2. deeper membranous Scarpa's fascia

Front 22

Scarpa's fascia is continuous with what and attaches to what?

Back 22

1.superficial perineal fascia (Colle's fascia)
2. attaches to the fascia lata

Front 23

What is Scarpa's fascia used for in repairs to the abdominal wall?

Back 23

used for suturing the subcutaneous fascia

Front 24

In a rupture of the urethra what will happen to the urine?

Back 24

Urine will extravasate between Scarpa's fascia and the deep fascia of the anterior abdominal wall as high as the region

Front 25

What is the great flexor of the trunk?

Back 25

rectus abdominis

Front 26

From the rib cage to the pubic bone what is rectus abdominis made up of and what is it enclosed in?

Back 26

1. contains 3-4 transverse tendons
2. enclosed in the fascia investing the other 3 flat muscles of the anterior abdominal wall

Front 27

What are two functions of the rectus abdominis that it does for other regions of the body?

Back 27

1. fixes the rib cage for the neck muscles (lifting head from pillow)
2. fixes pelvis for hip flexors (raising legs from bed)

Front 28

What innervates the rectus abdominis?

Back 28

T6-T12 (segmental innervation)

Front 29

Where does the rectus abdominis attach superiorly?

Back 29

anterior surface of the xiphoid process and the adjacent 5-7 costal cartilages

Front 30

Where does the rectus abdominis attach inferiorly?

Back 30

attaches to the pubic crest and symphysis

Front 31

The lateral margin of the right rectus abdominis overlies what as it crosses over the costal margin?

Back 31

the gallbladder

Front 32

The two recti abdomini are separated by what? What is this structure? Where does it extend?

Back 32

1. linea alba
2. avascular insertion of the aponeurosis of the 3 flat anterior abdominal muscles
3. extends from xiphoid process to the pubic symphysis

Front 33

What is it said the linea alba is a site of?

Back 33

herniation

Front 34

What is the rectus sheath?

Back 34

1. the deep fascia investing the superficial and deep layers of the 3 flat abdominal muscles

Front 35

What does the rectus sheath envelope?

Back 35

rectus abdominis

Front 36

Superior to the umbilicus, what fascia runs anterior and posterior to the rectus abdominis muscles?

Back 36

anterior:
1. deep fascia of the external oblique
2.fascia covering the anterior surface of the internal oblique
posterior:
1. fascia of the posterior surface of the internal oblique
2. fascia of the transversus abdominis

Front 37

Below the umbilicus, what fascia runs anterior and posterior to the rectus abdominis muscles?

Back 37

anterior:
1. all of the deep fascia pass anterior to the rectus muscle

Front 38

How is blood supplied to the rectus abdominis?

Back 38

1. inferior epigastric artery
2. superior epigastric artery

Front 39

The inferior epigastric artery ascends through the abdomen where to do what at what level?

Back 39

1. ascends on the posterior surface of the rectus within its sheath
2. to anatstomose with the superior epigastric artery
3. near the level of the costal cartilage of rib 8

Front 40

Which direction does the nerve supply to the rectus abdominis come in? Why is this important for surgery?

Back 40

1. comes from lateral margin
2. surgery in this area should come from the medial margin of the rectus abdominis, but not on the linea alba since it is avascular

Front 41

Where should the incision be made for surgery on or near the rectus abdominis?

Back 41

1. in the anterior rectus sheath, on the medial side and the muscle should be retracted laterally.
2. Then the posterior aspect of the rectus sheath is incised

Front 42

The flat muscles of the anterior abdominal wall arise from where to pass where?

Back 42

1. arise from posterior and lateral aspects of the abdominal wall
2. pass anteriorly to end in aponeurosis at the lateral margin of the rectus

Front 43

The aponeurosis of the anterior abdominal wall joins with what and inserts where?

Back 43

1. joins with rectus sheath
2. inserts at the linea alba

Front 44

Motor nerves and arteries are found where in the anterior abdominal wall?

Back 44

between 2nd and 3rd layers of flat muscles of the anterior abdominal wall

Front 45

What function do the flat muscles of the anterior abdominal wall have?

Back 45

1. lateral flexors and rotators of the torso
2. help maintain intraabdominal pressure
3. assist in expiration and/or urination, defecation, and childbirth
4. also involved in coughing, vomiting and venous return to the heart

Front 46

Where does the external oblique muscle arise from?

Back 46

external aspects of lower 8 ribs

Front 47

The superior and lateral portions of the external oblique are defined as what while the medial and inferior portions are defined how?

Back 47

1. superior and lateral portions are muscular
2. inferior and medial portions are aponeurotic

Front 48

The fibers of the external oblique run what directions and from where to where?

Back 48

1. inferomedially
2. from R12-iliac crest

Front 49

The superior 1/2 of the external oblique insert where while the inferior 1/2 insert where?

Back 49

1. superior-anterior aspect of the rectus sheath
2. inferior- iliac crest, tubercle, ASIS, inguinal ligament, and pubic bone

Front 50

The lowermost fibers of the external oblique insert where?

Back 50

1. external lip of the iliac crest posteriorly, and more superior fibers insert into more anterior aspects of the iliac crest

Front 51

The free inferior border of the external oblique between the ASIS and the pubic tubercle is what?

Back 51

inguinal ligament

Front 52

A reflection of the inguinal ligament onto the pectineal line of the pubic bone is what?

Back 52

lacunar ligament

Front 53

The opening of the external oblique aponeurosis close to the pubic tubercle is what?

Back 53

superficial inguinal ring

Front 54

What is deep to the external oblique and how are its fibers oriented?

Back 54

1. internal oblique
2. perpendicular to the external oblique

Front 55

The internal oblique is what in its inferior and lateral aspects and what in its superior and medial aspects?

Back 55

1. inf. and lat- muscular
2. sup and med- aponeurotic

Front 56

Where does the internal oblique arise from?

Back 56

intermediate line of the iliac crest and the lateral 1/2 of the inguinal ligament

Front 57

The most posterior fibers of the internal oblique ascend to where?

Back 57

R9-12CC

Front 58

The anterior fibers of the internal oblique run where and contribute to what?

Back 58

1. superomedially
2. contribute to the ant. and post. layers of the rectus sheath, before inserting into the linea alba

Front 59

Internal oblique fibers arising from the lateral 1/2 of the linea alba (inferormedial) arch over what and insert into what?

Back 59

1. arch over the inguinal canal
2. insert into the pectineal line of the pubis

Front 60

The insertion of the internal oblique and that of the transversus abdominis at the pubic tubercle is called what?

Back 60

1. the conjoint tendon

Front 61

The transversus abdominis has what direction of fibers?

Back 61

horizontal

Front 62

The transversus abdominis has what type of origin with the most superior fibers arising from what?

Back 62

1. wide origin
2. lower 6CC

Front 63

Intermediate fibers of the transversus abdomnis arise from what?

Back 63

aponeurosis attached to the tips of the transverse processes of the lumbar vert.

Front 64

The inferior fibers of the transversus abdomnis arise from what?

Back 64

inner lip of the iliac crest and the lateral 1/2 of the inguinal ligament

Front 65

What is another name for the conjoint tendon?

Back 65

falx inguinalis

Front 66

The conjoint tendon fuses with what to do what?

Back 66

1. fuses with underlying transversalis fascia
2. reinforcing the wall posterior ot the superficial inguinal ring

Front 67

What does the cremaster muscle do? What is it derived from?

Back 67

1. invests the spermatic cord within the inguinal canal/elevates the testes in the scrotum
2. derived from muscle fibers of the internal oblique arching over the spermatic cord within the inguinal canal

Front 68

What innervates the cremaster muscle and is it under voluntary control?

Back 68

1. genital branch of the genitofemoral nerve (L1,2)
2. not under voluntary control

Front 69

What innervates the anterior abdominal wall? What are the nerves made up of? Where do they run?

Back 69

1.anterior rami of T7-T12
2. mixed nerves
3. run between the internal oblique and transversus abdominis muscles

Front 70

From superficial to deep what are the layers of the abdomen? (areas without the rectus abdominis)

Back 70

1. skin
2. superficial fascia (Camper's and Scarpa's)
3. external oblique aponeurosis
4. internal oblique
5. transversus abdominis
6. fascia transversalis
7. extraperitoneal fat
8. peritoneum

Front 71

From superficial to deep what are the layers in the walls of the scrotum?

Back 71

1. skin
2. Dartos muscle and fascia
(1&2 are the scrotum)
3.external spermatic fascia
4&5. cremaster muscle
6. internal spermatic fascia
(3-6 are coverings of the cord)
7. areolar tissue
8. processus vaginalis
(7 and 8 are constituents of the cord)

Front 72

What does the spermatic cord contain?

Back 72

neurovascular bundle supplying testes and cremaster muscle

Front 73

The processus vaginalis of the peritoneum lies adjacent to what?

Back 73

the testes and its neurovascular pedicle

Front 74

The spermatic cord lies within what area?

Back 74

inguinal canal

Front 75

As descending testis moves from the extraperitoneal fatty tissue and traverses the abdominal wall, it first encounters the abdominal wall layer formed by what?

Back 75

1. fascia transversalis which forms the internal spermatic fascia

Front 76

The proximal opening of the inguinal canal in the transversalis fascia is the deep inguinal ring located where?

Back 76

1. above mid-inguinal ligament
2. lateral to the inferior epigastric artery

Front 77

The internal oblique and its fascia give rise to what in the testicular region?

Back 77

cremaster muscle and its fascia

Front 78

The external oblique aponeurosis gives rise to what in the testicular region?

Back 78

external spermatic fascia

Front 79

The inguinal canal is located between what and is how long?

Back 79

1. between the superficial and deep inguinal rings
2. about 2 inches long

Front 80

The anterior wall, floor, posterior wall, and roof of the inguinal canal are formed by what?

Back 80

1. anterior wall- external oblique aponeurosis
2. floor- external oblique aponeurosis and is part of the inguinal ligament and lacunar ligament
3. posterior wall- fascia transversalis
4. arching fibers of the internal oblique and transversus abdominis running from the lateral 1/2 of the inguinal ligament to the conjoint tendon

Front 81

The deep inguinal ring is reinforced anteriorly by what?

Back 81

1. internal oblique muscle
2. aponeurosis of the external oblique

Front 82

The superficial inguinal ring is reinforced posteriorly by?

Back 82

conjoint tendon

Front 83

Indirect inguinal hernias enter what? How are they surgically defined?

Back 83

1. enters the deep inguinal ring
2. lying lateral to the inferior epigastric artery and invested in internal spermatic fascia

Front 84

Direct inguinal hernias protrude through what? Why does this occur, and where will the hernia lie?

Back 84

1. protrudes through the superficial inguinal ring
2. occurs when the conjoint tendon fails
3. hernia lies medial to the inferior epigastric artery, covered by external spermatic fascia

Front 85

What are the nerves related to the inguinal canal?

Back 85

1. ilioinguinal
2. iliohypogastric
3. genitofemoral nerves

Front 86

What level does the ilioinguinal nerve comes from and where does it run?

Back 86

1. L1
2. pierces internal oblique and runs in the inguinal canal as a sensory nerve
3. leaves the canal by the superficial inguinal ring and contributes to the L1 dermatome

Front 87

The ilioinguinal nerve's territory overlaps with what other dermatomes?

Back 87

S2,3

Front 88

The ilioinguinal nerve has terminal branches that innervate what?

Back 88

1. anterior skin of scrotum (anesthesia for vasectomy)
2. anterior aspect of the labium majus in females

Front 89

What level does the iliohypogastric nerve come from and where does it run/

Back 89

1. L1
2. is a sensory nerve as it pierces the external oblique aponeurosis above the superficial inguinal ring

Front 90

What is the function of the genital branch of the genitofemoral nerve?

Back 90

1. motor to the cremaster muscle
2. elicits the cremaster reflex over the L1,2 dermatomes (medial aspect of the thigh)

Front 91

In prenatal life, the gubernaculum connects what?

Back 91

the inferior pole of the developing gonad with the skin of the developing scrotum (labium majus)

Front 92

In the male, the gubernaculum also draws what into the inguinal canal with the testis?

Back 92

1. processus vaginalis
2. vas deferens

Front 93

When does the gonad descend into the iliac fossa? traverse the inguinal canal? reach the bottom of the scrotum?

Back 93

1. 3rd prenatal month
2.7th prenatal month
3. after birth

Front 94

In the female, the ovaries stay within the pelvis but what attaches the inferior pole of the ovary to the labium majus?

Back 94

1. round ligament of the ovary
2. round ligament of the uterus

Front 95

What is the equivalent of the gubernaculum testis in women?

Back 95

1. round ligament of the ovary
2. round ligament of the uterus

Front 96

The walls of the scrotum contain what muscles? What type of muscles are these? What type of innervation do they receive?

Back 96

1.Dartos muscles
2. smooth muscles
3. sympathetic innervation

Front 97

What are the dartos muscles derived from and what is their equivalent in females?

Back 97

1. R&L labioscrotal folds
2. labia majora

Front 98

What is the function of the dartos muscles?

Back 98

1. contains the testis and keeps them at a below-body temp

Front 99

The anterior scrotum or labium majus is innervated by what?

Back 99

ilioinguinal nerve (L1)

Front 100

The posterior scrotum (labium in females) is innervated by what?

Back 100

S2,3,4

Front 101

Vascularization of the scrotum is by what vessels?

Back 101

external and internal pudendal arteries and veins

Front 102

What are the external and internal pudendal arteries derived from?

Back 102

1. external- femoral arteries
2. internal- internal iliac arteries

Front 103

Lymphatic drainage of the scrotum is to what?

Back 103

superficial inguinal nodes

Front 104

Lymphatic drainage of the testes follows what?

Back 104

follows testicular arteries and veins along the spermatic cord to the abdominal lymph nodes

Front 105

What is the spermatic cord is made up of what fascia?

Back 105

1. external spermatic fascia
2. cremasteric fascia
3. internal spermatic fascia

Front 106

The spermatic cord contains what?

Back 106

1.processus vaginalis
2. loose connective tissue
3. vas deferens
4. testicular artery and sympathetic nerves
5. pampiniform plexus of veins
6. lymphatics
7. artery of the ductus deferens
8. genital branch of genitofemoral nerve

Front 107

The inferior portion of the processus vaginalis becomes what? What is the underlying cavity of this structure and what is is called when there is an accumulation of fluid in this cavity?

Back 107

1. tunica vaginalis
2. cavity of the tunica vaginalis
3. hydrocele

Front 108

Loose connective tissue of the spermatic cord is continuous with what?

Back 108

Extraperitoneal loose connective tissue

Front 109

The vas deferens is the spermatic duct and is a continuation of what? Where does it run? What does it reach?

Back 109

1. epididymis
2. runs from the testis through the inguinal canal, around the inferior epigastric artery
3. reaches the posterior aspect of the bladder and the seminal vesicle/ runs into ejaculatory duct

Front 110

The pampiniform plexus of veins form what in the abdomen?

Back 110

form a single testicular vein

Front 111

The testis are covered by what except for where?

Back 111

1. tunica vaginalis
2. except around the epididymis and where the spermatic cord enters the testis

Front 112

The testis has an outer covering called what? It is also called what posteriorly?

Back 112

1. tunica albuginea
2. mediastinum testis

Front 113

The testis are divided by septa into what? These contain what? These are connected to what?

Back 113

1. 250 pyrimidal compartments
2. seminiferous tubules
3. connected to rete testis via straight tubules

Front 114

The rete testis is connected to the head of the epididymis by what?

Back 114

efferent ductules (6-12)

Front 115

The epididymis is divided into what?

Back 115

1. head, body, and tail

Front 116

Where does the testicular artery arise, what does it pierce, and with what does it anastamose?

Back 116

1. arised from abdominal aorta at L2
2. pierces the mediastinum testis
3. anastomoses with the artery of the vas deferens and cremasteric artery

Front 117

What is the artery of the vas deferens derived from?

Back 117

1. inferior vesical branch of the internal iliac artery

Front 118

What is the cremasteric artery derived from?

Back 118

a branch of the inferior epigastric artery

Front 119

The right testicular vein joins what and the left joins what?

Back 119

1. right- inferior vena cava
2. left- left renal vein

Front 120

What is a varicocele and where does it happen?

Back 120

1. abnormal dilation and torsion of veins
2. testicular veins

Front 121

What is the treatment of a varicocele?

Back 121

catheter-directed embolization

Front 122

The lymphatics of the testis ends where?

Back 122

1. ends in the lymph nodes between the common iliac and renal vessels

Front 123

The lympathics of the scrotum and penis drain into what?

Back 123

inguinal nodes

Front 124

The testis are innervated how and by what fibers?

Back 124

1. sympathetically
2. from T6-T10 vasomotor fibers

Front 125

What types of fibers accompany sympathetic fibers in the testis and what doe this have to do with referred pain?

Back 125

1. afferent fibers accompany
2. pain is referred to T8-T10 dermatomes (pit of the stomach)

Front 126

The ductus derens is innervated by what? derived from what? made up of what?

Back 126

1. sympathetic fibers
2. derived from inferior hypogastric plexus
3. made up of fibers from T11,12, and L1