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What vertabrae does the umbilicus overlie in a non-obese individual?
3rd and 4th lumbar
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Name the 2 fascias that make up the superficial fascia of the abdominal wall
- Superficial fatty layer: Camper's Fascia
- Deep membraneous layer: Scarpa's Fascia
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What fascia forms the fundiform ligament of the penis?
Deep membraneous or Scarpa's Fascia
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What are the functions of the muscles of the abdominal wall?
- Lateral flexor
- Rotation
- Increasing intra-abdominal pressure
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Where does the external oblique muscle originate and insert?
- Origin: Lower eight ribs
- Insertion: Iliac crest, pubic tubercle, linea alba
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What forms the ingunial ligament, and what is its other name?
- Formed by: Muscle aponeurosis of the external oblique
- Other Name: Poupart's Ligament
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Where does the internal oblique muscle originate and insert?
- Origin: Iliac crest and inguinal ligament
- Insertion:
- - Superior/middle fibers: Lower 3 ribs and linea alba
- - Inferior fibers: Pubis
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Where does the transversus abdominis originate and insert? What tendon does the muscle form?
- Origin: Lower 6 costal cartilages, iliac crest and ingunial ligament
- Insertion: Linea alba. Also forms the conjoint tendon (along with IO) that inserts on the pubis
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Where does the rectus abdominis originate and insert?
- Origin: Superior ramus of the pubis
- Insertion: Xiphoid process and costal cartilages of ribs 5-7
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What is the peritoneum and transversalis fascia?
- Peritoneum: Serous membrane that lines abdominal cavity
- Transversalis fascia: Membraneous sheeth that lines abdominopelvic cavity (deep to transversus abdominis)
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What is the arcuate line?
- Where the internal oblique aponeurosis no longer splits around the rectus muscle
- Location: Between umbilicus and pubic symphysis
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Where do the intercostal and subcostal nerves run in the abdominal wall and what do they supply?
- Location: Between IO and transversus abdominis
- Supply: Skin and muscles of abdominal wall
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What 2 nerves supply the inferior part of the abdominal wall?
- Iliohypogastric nerve (L1)
- Ilioinguinal nerve (L1)
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Name the dermatomes of xiphoid process, umbilicus and pubic symphysis:
- Xiphoid: Superior to T7
- Umbilicus: T10
- Pubic symphysis: L1
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Name the 3 main arteries of teh abdominal wall:
- External iliac branches: Inferior epigastric and deep circumflex iliac
- Internal thoracic branch: Superior epigastric
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Where does inferior epigastric artery enter the rectus sheath? What happens once it does?
- Enters at the arcuate line
- Anestomoses with superior epigastric and intercostal arteries
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What other arteries supply the abdominal wall?
- Intercostal
- Lumbar
- Superficial branches of femoral: Superficial epigastric, superficial circumflex iliac and superficial external pudendal
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Explain the relationship between the inguinal ligament and the lacunar ligament:
- Inguinal ligament: Goes from the anterior superior iliac spine to the pubic tubercle
- It flattens down, attaches to pectineal line of pubis and forms the lacunar ligament (Gimbernat's Ligament)
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Explain where the superficial and deep rings of the ingunial fascia are?
- Superficial: Through EO aponeurosis
- Deep: Finger-like diverticulum of transversalis fascia
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Name the 4 boundaries of the ingunial canal:
- Floor: Inguinal and lacunar ligaments
- Roof: Arching fibers of the IO and transversus abdominis
- Anterior Wall: Aponeurosis of EO
- Posterior Wall: Transversalis fascia and conjoint tendon
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Name the boundaries of the inguinal triangle?
- Lateral border of the rectus abdominis
- Inguinal ligament
- Inferior epigastric vessels
- Hesselbach's Triangle
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What is the first indication of the future inguinal canal?
Gubernaculum
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What structure carries the abdominal wall layers upon the descent of the testes?
Processus vaginalis
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Connect the layers of the abdominal wall with the layers of the scrotum/spermatic cord:
- Skin -- Skin in scrotum
- Superficial fascia -- Perineal fascia and dartos muscle
- EO -- External spermatic fascia
- IO -- Cremaster muscle and fascia
- Tranversus Abdominis -- NOTHING
- Transversalis fascia -- Internal spermatic fascia
- Extraperitoneal fat -- Areolar tissue in cord
- Peritoneum -- Tunica vaginalis
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Describe the begining location of the internal spermatic fascia, cremaster muscle and fascia, and the external spermatic fascia:
- Internal spermatic fascia: Entire length of canal
- Cremaster muscle/fascia: Middle of canal
- External spermatic fascia: At the superficial ring
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Name the components of the cord, beside the coverings:
- Ductus deferens
- Deferential artery and vein
- Testicular artery
- Pampiniform plexus of veins
- Lymphatics and autonomic nerves
- Genital branch of genitofemoral nerve
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What nerves suply the anterior scrotal and labial region?
Anterior scrotal and labial cutaneous nerves of the genitofemoral nerve and ilioinguinal nerve
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In the females, what happens to the gubernacula?
- Persists as the round ligament of the unterus
- It ends at the labia majora
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Describe the cremaster reflex and what nerves does it test?
- Genitofermoral (L1,2) and Ilioinguinal nerve (L1)
- Draws testes to a superior position in the scrotum
- More active in young boys
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What is a hydrocele?
Accumulation of fluid in tunica vaginalis or patent processus vaginalis
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What is a veriococele?
Dilation of the pampiniform plexus of veins
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Describe an indirect and direct inguinal hernia:
- Indirect: Follows route taken by testes before birth. Often due to patent processus vaginalis and common in young boys
- Direct: Protrusion through the inguinal triangle and passes through the superficial ring. Common in older males
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