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You are inserting a needle through the abdomen. Select the correct order of layers that it will pass as it continues into the viscera.
The correct order, with each layer included is: Skin, Camper’s fascia, Scarper’s fascia, external oblique, internal oblique, transversus abdomminus, tranversalis fascia, extraperitoneal fat, parietal peritoneum. Posteriorly, extraperitoneal fat is known as retroperitoneal fat. Lumbar fascia is a membranous portion found throughout the posterior thorax and abdomen.
Which statement is FALSE regarding innervations of the abdominal muscles?
The anterior abdominal muscles are supplied segmentally by the thoraco-abdominal nerves. These nerves are derived from the anterior rami of T6 or T7 to L 1 spinal nerves. The L 1 contribution is from the ilioinguinal nerve, as the iliohypogastric is thought to be purely cutaneous. The external oblique abdominis lacks a supply from L 1. The rectus abdominis is also often supplied by T7-T12 only. The thoracoabdominal nerves run around the trunk, sandwiched between the internal oblique abdominis and transversus abdominis muscles.
Select the option that describes the role of the internal oblique with respect to the inguinal canal.
The internal oblique forms the anterior wall of the first lateral third of the canal. The remaining anterior border is formed from the external oblique aponeurosis. The roof of the canal is provided by the fibres of the conjoint tendon, some of which is formed by the internal oblique (the remainder, by the transversus abdominis). The internal obliques do also provide slips of muscle and fascia within the inguinal canal; however this is known as the cremaster muscle, and cremasteric fascia, not ‘inguinal
Select all the structures that pass through the inguinal canal.
In addition to the spermatic cord and round ligament, the classic description of structures that pass through the inguinal canal is as follows: 3 arteries –> artery to vas deferens (or ductus deferens), testicular artery, cremasteric artery; 3 fascial layers–> external spermatic, cremasteric, and internal spermatic fascia; 3 other structures: pampiniform plexus, vas deferens (ductus deferens), testicular lymphatics; 3 nerves: genital branch of the genitofemoral nerve (L1/2), sympathetic and visceral afferent fibres, *ilioinguinal nerve (*N.B. OUTSIDE spermatic cord but travels next to it)
Which muscle is mainly responsible for the stabilisation of the lumbar spine?
Select ALL structures attached or continuous with the inguinal ligament.
Both the internal oblique and transversus abdominis arise from lateral portions of the inguinal ligament. Their fibres arch over and behind the inguinal canal to form the conjoint tendon, which attaches along the pubic crest. Inferiorly, the fascia lata of the thigh is continuous with the inguinal ligament, and of course, superiorly, the muscular and aponeurotic fibres of the external oblique run forwards and downwards.
The lesser omentum extends from the _____ to the __________ of the _______. The greater omentum hangs from the ______, and the _______ attaches the stomach to the transverse colon.
The lesser omentum extends from the liver to the lesser curvature of the stomach. The greater omentum hangs from the greater curvature of the stomach, and the gastrocolic ligament attaches the stomach to the transverse colon
Which is NOT a boundary of the inguinal canal?
Regarding Scarper’s fascia:
It is membranous in appearance , and is important in limiting the spread of infection, and more importantly fluid in the lower abdominal wall. It binds to the fascia lata of the thigh below the inguinal ligament. It also binds to structures in the perineum (region of the external genitalia) . This is important when considering rupture of the bulbar urethra, which may allow urine to leak out between the superficial fascia and abdominal wall. Urine flow will be limited by Scarpa’s fascia, and hence will build up behind the superficial fascia of the anterior abdominal wall. Posteriorly, Scarpa’s fascia binds to the thoracolumbar fascia, and the fascia lata of the buttock and thigh. Leaked urine cannot therefore reach the back or lower limb. In these patients, the urine can be felt behind the abdominal fascia.
Select the correct statement regarding hernias.
Select the correct statement regarding descent of the gonads.
The gubernaculum directs both the ovaries and testes through the inguinal canal. The remaining part, once the testis has reached its destination, is known as the scrotal ligament which attaches the testis to the scrotal wall.
Select the correct attachments of the external obliques.
The external oblique abdominis attaches to the lower ribs (usually ribs 5-12). The posterior part of the muscle attaches into the anterior part of the iliac crest. The lower part of the muscle folds back on itself (in a U-shape) to form the inguinal ligament. The medial end of the inguinal ligament inserts into the pubic tubercle . The rest of the muscle inter-digitates with its counterpart on the opposite side at the linea alba.
The inguinal triange (Hesselbach’s space) is an area of weakness in the abdominal wall. It’s medial border is:
The medial border is the rectus abdominus; the lateral border is the inferior epigastric artery, and the inferior border is the inguinal ligament.
Which layer does not contribute to fascia of the spermatic cord?
Select the FALSE statement regarding the gastrocolic ligament.
With regards to the abdominal cavity,
The abdominal cavity is bound by the diaphragm above and the pelvis inlet below- not the ‘pelvis’. The muscles that support the lateral aspect of the cavity are the external and internal obliques, and the transversus abdominus.
The abdominal wall is supplied by a number of branches. Select the FALSE statement.
Inferior phrenic arteries supply the diaphragm; 4 pairs of lumbar arteries supply the posterior musculature; the median sacral artery gives a contribution to the sacrum. The lower two intercostal arteries and the subcostal artery leave the costal margin to become the thoracoabdominal arteries. The internal thoracic artery crosses the costal margin to become the superior epigastric artery. The SE artery anastamoses with the inferior epigastric artery, a branch of the external iliac.
Describe the upwardly-directed venous drainage of the superficial veins of the abdomen.
The veins emanate from the region of the umbilicus (PU = para-umbilical) and drain either upwards towards the chest or downwards towards the top of the thigh. The upwardly-directed veins are called the thoraco-epigastric (TE) or thoraco-abdom inal veins. These connect to veins around the breast called the lateral thoracic veins (LT). In turn these drain into the axillary veins in the armpit (axilla). The lower veins are the superficial epigastric (SE), which together with the superficial circumflex iliac (SCI) veins drain to join the femoral vein (F) at the top of the thigh.
What is the most common type of hernia?
Inguinal hernias make up around 70% of all hernia cases. Umbilical hernias account for 14% of all hernias. Lumbar hernias are not very common.
The pouch of Douglas, also known as the rectouterine pouch, or retrovesical pouch, is in between the rectum and
The rectouterine pouch is the deepest peritoneal cavity in women, and is a common site for spread of pathologies. The other ‘pouch’ on women is the vesicouterine pouch.