Ch 2 -Abdominal Wall And Diaphragm

Front 1

Anterolateral Abdominal Wall Layers

Back 1

Fascia

Superficial fascia

Deep Fascia

Aponeuroses

Front 2

Anterolateral Abdominal Wall

Fascia layer

Fibrous tissue network located____________________________

Rich supply of______________________

Composed of two layers:_______________,_______________

Back 2

-between the skin and underlying structures

-blood vessels and nerves

-Superficial layer, Deep Layer

Front 3

Superficial Fascia

Back 3

Attaches to the skin; composed of connective tissue containing varying quantities of fat

Front 4

Deep Fascia

1-

2-

3-

Back 4

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

Front 5

Aponeuroses

layers of

Back 5

Layers of fat tendinous fibrous sheets fused with strong connective tissue that serves as tendons to attach muscles to fixed points

Front 6

Aponeuroses

Minimal _______________________

Back 6

blood vessels and nerves

Front 7

Aponeuroses

Primarily located in ___________________

Back 7

the ventral abdominal regions

Front 8

Aponeuroses

Primary function to__________________________

Back 8

join muscles to the body parts

Front 9

Multilayered Abdominal Wall Consists Of

1-

2-

3-

4-

5-

6-

Back 9

1-Skin

2-Subcutaneous Tissue (Superficial Fascia)

3-Muscles and their Aponeuroses

4-Deep Fascia

5-Extraperitoneal Fat

6-Parietal Peritoneum

Front 10

Muscles of the Anterolateral Abdominal Wall

Back 10

Rectus Abdominis

Pyramidalis

External Oblique

Internal Oblique

Transversus Abdominis

Front 11

Rectus Sheath

Strong fibrous compartment for the _________________________________________________________________

Back 11

Strong Fibrous compartment for the rectus abdominis muscle, pyamidalis muscle, arteries, veins, lymphatic vessels and nerves

Front 12

Rectus sheath

Anterior and posterior layers formed by

Back 12

Intercrossing and interweaving of the aponeuroses of the flat abdominal muscles

Front 13

Rectus Sheath

Lateral aspect of the rectus abdominis the aponeuroses fuses to form the___________________

Back 13

Linea Semilunaris

Front 14

Rectus Sheath

Arcuate line is located ______________________________________

Back 14

half way from the umbilicus to the pubis symphysis

Front 15

Linea Alba

Formed as the _______________________________________________

Back 15

fibers of the anterior and posterior layers of the sheath interlace in anterior median line

Front 16

Linea Alba

Oriented______________________________________

Back 16

vertically and corses the length of the anterior abdominal wall

Front 17

Linea Alba

It separates the____________________.

It is wider____________________________________________________

Back 17

It separates the bilateral rectus sheaths

It is wider superiorly ans it narrows inferior to the umbilicus to the width of the pubis symphysis

Front 18

Linea Alba

It transmits____________________________

Back 18

small vessels and nerves to the skin

Front 19

Linea Alba

In thin, muscular people, _______________________________________

Back 19

a groove is visible in the skin overlying the linea alba

Front 20

Umbilicus

Umbilicus is the area where__________________________

Back 20

all layers of the anterolateral abdominal wall fuse

Front 21

Umbilicus

The umbilical ring is a defect in the__________________________

Back 21

Linea alba located underlying the umbilicus

Front 22

Umbilicus

The umbilical ring is the area through which

Back 22

the fetal umbilical vessels passed to and from the umbilical cord and placenta

Front 23

Inguinal canal

in an adult it is an _______________________________

Back 23

oblique passage approx 4cm long

Front 24

Inguinal Canal

within the canal are the __________________in males and the___________________ in females

Back 24

spermatic cord in males

round uterine ligament in females

Front 25

Inguinal Canal

also located within the canal in both sexes are

Back 25

blood and lymphatic vessels and the ilioinguinal nerves

Front 26

Inguinal Canal

How many openings?

Back 26

2

Front 27

Inguinal Canal

the _________________serves as an entrance

the_______________serves as the exit for the____________________

Back 27

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

Front 28

Inguinal Canal

Between the deep and superficial inguinal rings, the canal has________________________________________

Back 28

2 walls(anterior and posterior), a roof and a floor

Front 29

Posterior Abdominal Wall

Composition (9)

Back 29

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

Front 30

Muscles of the Posterior Abdominal Wall (8)

Back 30

1-Psoas Major

2-Iliacus

3-Quadratus Lumborum

4-Psoas Minor

5-Iliopsoas

6-Latissimus Dorsi

7-Erector Spinae

8-Transversospinal

Front 31

Diaphragm

A double domed, musculotenious partition separating _________________________

Back 31

thoracic cavity form abdominal cavity

Front 32

Diaphragm

_______________________ faces and forms the floor of the thoracic cavity

Back 32

Convex superior surfaces

Front 33

Diaphragm

_______________________faces and forms the roof of the abdominal cavity

Back 33

Concave inferior surface

Front 34

Diaphragm

Concave surfaces form the right and left domes with_________________________________________________________

Back 34

the right dome slightly higher because of the presence of the liver and the central part slightly depressed by the pericardium

Front 35

Diaphragm

__________________is fixed muscle origin attaching to the inferior margin of the thoracic cage and superior lumbar vertebrae

Back 35

Periphery

Front 36

Major Muscle of Inspiration?

Back 36

Diaphragm

Front 37

Diaphragm

3 Parts

Back 37

Muscular part

Aponeurotic Part

Central Tendon

Front 38

Diaphragm

Central tendon has no_______________and appears ____________________________________________________

Back 38

Central tendon has no bony attachments and appears incompletely divided into what resembles three leaves of a wide cloverleaf

Front 39

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

Back 39

1-Sternal Part

2-Costal Part

3-Lumbar Part

Front 40

Diaphragmatic Crura

_________________________arising from anterior surfaces of the bodies of the superior three vertebrae

Back 40

Musculotendinous Bands

Front 41

Diaphragmatic Crura

______________ is larger and longer than the __________appearing as ________________________________

Back 41

Right crus is larger and longer than the Left crus appearing as triangular mass anterior to aorta

Front 42

Diaphragmatic Crura

It arised from the___________________________and appears_________________________________

Back 42

It arises from the first 3 lumbar vertebrae and appears posteior to the caudate lobe of the liver

Front 43

Diaphragmatic Crura

Left Crus arised from the

Back 43

First 2 lumbar vertebrae

Front 44

Diaphragmatic Apertures

Permit_______________________________________

Back 44

structures to pass between the thorax and abdomen

Front 45

Diaphragmatic Apertures

3 Larger apertures are the_______________________________

Back 45

Caval , Esophageal and Aortic

and there are several small openings

Front 46

Diaphragmatic Apertures

Caval hiatus is primarily for the

Back 46

Inferior vena cava and shares opening with terminal branches of the right phrenic nerve and a few lymphatic vessels

Front 47

Diaphragmatic Apertures

Esophageal Hiatus is primarily for

Back 47

esophagus to course from the thorax into the abdominal cavity

Front 48

Diaphragmatic Apertures

Aortic Hiatus is opening for

Back 48

abdominal aorta to pass from thorax into abdomen

Front 49

The diaphragmatic crura lie_________________________ and appear as __________________________________

Back 49

lie anterior to upper abdominal aorta

appear as thin hypoechoic bands that thicken during deep inspiration

Front 50

The crus of the right hemidiaphragm contain

Back 50

medium density echoes

Front 51

Diaphragm (sono techniques)

In some patients, diaphragmatic slips appear as

Back 51

round focal echogenic masses when seen in transverse section

Front 52

Diaphragmatic slips should not be ____________________________

Clarify by___________________________________

Back 52

-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

Front 53

Periumbilical Abscess

Back 53

The mixed echo appearance demonstrates good acoustic transmission in case of peri-umbilical abscess

Front 54

Two main categories of abdominal wall hernias

Back 54

1- Ventral(anterior or anterolateral abdominal wall)

2- Groin (indirect inguinal, direct inguinal, and femoral)

Front 55

Three major factors aid in weak abdominal wall

Back 55

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

Front 56

Primary ventral hernias account for _____% of the reparied ventral hernias in the US

Back 56

75%

Front 57

Advantages of sonography over other imaging modalities

Back 57

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

Front 58

Scanning protocol to document hernia information includes

Back 58

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

Front 59

Sonographic Evaluation Can Determine(hernias)

Back 59

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

Front 60

Neoplasms

Primary Abdominal Wall Tumors Include

(6)

Back 60

1-Lipomas

2-Areas of calcification in old surgical scars

3-Desmoid Tumors

4-Soft Tissue Sarcomas

5-Metastatic Carcinoma

6-Melanomas

Front 61

Sarcomas

Include (4)

Back 61

1-Liposarcoma

2-Rhabdomyosarcoma

3-Fibrosarcoma

4-Evidence endometriomas transform into sarcomas

Front 62

Diaphragmatic Pathology

If the diaphragm does not attach appropriately during fetal development it may result in (5)

Back 62

1-Pain

2-Eventration

3-Paralysis

4-Herniation

5-Peridiaphragmatic Abnormalities

Front 63

Diaphragmatic Pathology

Sonography Exam Documents

Back 63

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

Front 64

Diaphragmatic Pathology

Left hemidiaphragm more difficult to scan than right hemidiaphragm because of

Back 64

the presence of gas in the stomach and bowel