Anterolateral Abdominal Wall Inguinal Canal

McBurney's Point is located where?

1/3 of the way up along diagonal line from the right anterior superior ilaic spine to the umbilicus

Layer deep to transversalis fascia of abdomen

Extraperitoneal fascia

Your patient eats a LOT of food. Which more superficial layer of the abdomen will they gain this fat in?

Fatty layer (camper's fascia)

Two layers of the superfiical fascia

Fatty layer (camper's fascia) membranous layer (Scarpa's fascia)

Patient has abdominal pain. Some of their muscles will contract to protect this region (as a reflex) where no ribs are located. What are these muscles?

Flat muscles

Layer deep to superficial fascia of the abdomen

Flat muscles - external oblique - internal oblique - transversus abdominsis

direct hernia ductus deferens

From left to right (counterclockwise)

cremasteric reflex checks integrity of which vertebral level

L1

Which level of the vertebral column is the superior mesenteric artery located at?

L1 (transpyloric plane)

The subcostal plane is found at which vertebral level

L3

Which level of the vertebral column is the inferior mesenteric artery located at?

L3 (subcostal plane)

Umbilicus is located at which vertebral levels?

L3-L4

Which level of the vertebral column is the bifucration of the aorta located at?

L4 (supracristal plane)

The transtubercular plane is found at which vertebral level

L5

Which level of the vertebral column is the formation of the inferior vena cava located at?

L5 (transtubercular plane)

Insertion of external oblique muscle

Linea alba pubic tubercle anterior 1/2 of iliac crest

Patient has referred pain in their abdominal wall, indicating they have visceral disease or inflammation. You have determined the patient has appendicitis. Describe the relationship of these nerve fibers that allow for this referred pain

Somatic sensory nerve of T10 dermatome enters teh spinal cord visceral nocieptive (pain) afferents of appendex enter the spinal cord and meet the somatic sensory afferents They both enter the second-order neuron and travel into the preganglionic nerve of T10 level

Plane that divides the epigastric region from the umbilical region

Subcostal plane

Which layer of the abdominal wall contains superficial veins

Superficial fatty layer (contains camper's fascia and superficial veins)

Two distinct layers of the superfiical fascia in the lower abdomen

Superfiical fatty Deep membranous

You touch the umbilicus cord area. Which dermatome is asigned to this area? Which level along the vertebrae is the umbilcus located

T10 L3/L4

Relationship between visceral peritoneum and parietal peritoneum

The two layers come together and form a structure that suspends the guts in the abdominal cavity When covering viscera, it is called visceral peritoneum The part lining the body cavity is the parietal peritoneum

You cut away the rectus abdominis musles What do you see above the arcuate line? below the arcuate line?

above: internal oblique fascia below: transversalis fascia

Tenderness of McBurney's Point indicates?

acute appendicitis

testicular innervation

all T10-T11 spinal segment

Your patient has blockage in their inferior vena cava. This means blood cannot return to the heart from the lower extremities. How do we get it back?

alternoute route: thoracoepigastric vein

which line is used to divide the above and below components of the posterior wall of the rectus sheath

arcuate line

Your patient is superficial as hell and wants liposuction to look smokin hot on Lido Beach. Which layer do you remove fat from in the abdomen?

camper's fascia

____ fascia is attached to fascia lata, preventing flow of fluids from the perineum into the lower limb and anal triangle area

colle's fascia

Muscle that lowers and elevates scrotum

cremaster muscle

Your patient is interested in penis elongation. Which structure can be cut and which layer does this structure arise from?

cut: fundiform ligament of penis arises from deep membranous layer (scarpa's fascia) of the superficial fascia (called fundiform, because will be more "fun" for them) (remember it is scarpa's , because they have an emotional scar about their length)

testicular vessels and ductus deferens both enter where?

deep inguinal ring

Which layer of the superficial fascia of the lower abdomen is the scarpa's fascia found in?

deep membranous

layer of superficial fascia that is distinct below the umbilicus

deep membranous

The surgeon sutured a layer w/in the superficial fascia. Using our knowledge, which layer did she suture?

deep membranous layer of superfine fascia

another name for "acquired hernia"

direct

direct hernia and indirect hernia are located where? in reference to inferior epigastric vessels?

direct: inguinal triangle, medial of inferior epigastric vessels indirect: deep inguinal canal, lateral of inferior epigastric vessels

all visceral pain fibers run w/ the sympathetic system except when?

except below the pelvic pain line

Which muscle has aponeurotic fibers that form the external spermatic fascia ?

external oblique muscle

A patient presents as obese, hypertensive, and diabetic. You diagnose them w/ a metabolic syndrome. Where do they most likely store a lot of fat? (besidescampser's fascia)

extraperitoneal fascia

Which layer can accumulate intraabdominal fat?

extraperitoneal fascia

Where does lymphatic drainage from below the umbilicus move?

goes downward to the superficial inguinal lymph node

Insertion of internal oblique muscle

inferior borders 10-12th ribs linea alba pecten pubic via conjoint tendon

lateral umbilical fold contains

inferior epigastric arteries (remember because the inferior epigastric arteries are lateral in inguinal triangle and medial to the deep inguinal ring)

lateral wall of inguinal triangle (hesselbach's)

inferior epigastric vessels of lateral umbilical fold

Patient presents w/ pain over their umbilicus. You determine the umbilical region is fine . What three issues may be occurring?

inflammation/disease of - appendix - distal ileum - cecum *discussing the rest as if the appendix is the diagnosis because this is most common* appendix pain afferents also go to the T10 spinal cord (like the umbilicis) so the somatic input from T10 dermatome goes back to T10 spinal cord level and so does the visceral input of the appendix

Free margin of external oblique muscle forms?

inguina ligament

origin of transversus abdominis muscle

inner surfaces of 7th-12th costal cartilages thoracocolumbar fascia iliac crest lateral 1/3 of inguinal canal ligament

how is cremasteric fascia innervated

innervated by genital branch of genitofemoral nerve (L1/L2)

Transversus abdominis muscle runs paralell to which muscle superficial to it?

internal oblique

You stroke the region near the cremaster muscle on the man. The scrotum reflexively retracts. Which anteriolateral abdominal muscle is responsible?

internal oblique muscle (it gives rise to cremaster muscle)

conjoint tendon made of

itnernal oblique and transversus abdominis

which organ level are testes associated w/ before descent

kidneys

Name the structure that creates a vertical indentation between rectus abdominus muscles

linea alba

Structure that pigments in pregnant females

linea alba (line of abs)

Insertion of transversus abdominis muscle

linea alba conjoint tendon which attaches to pecten pubis and pubic crest

structure that demarcates the rectus abdominas muscles

linea semilunaris

HOw to find superficial ring of inguinal canal

locate pubic tubercle the superficial ring is superior to pubic tubercle

As the appendix gets more inflamed, which quadrant of the body wall can you expect to find pain?

lower right quadrant

testicular cancer drains where?

lumbar nodes (up where testis originated) (which are in the caval/aortic area)

What passes through male inguinal canal? female?

male: spermatic cord female: round ligament

What structure is scarpa's fascia NOT attached to that allows blood to flow into penis, scrotal, perineal area

not attached to pubic symphysis, like rest of layers below (the layers attaching at pubic symphysis include deep fascia over the external oblique muscles because the flat muscles are deep)

medial umbilical fold contains

obliterated umbilical artery

Origin of external oblique muscle

outer surface of ribs 6-12

location relationship inguinal canal to inguinal ligament

parallel and superior to inguinal ligament

Which veins are distended in caput medusae

paraumbilical veins, thoracoepigastric, etc

Layer deep to extraperitoneal fascia of abdomen

peritoneum (parietal) = serous membrane that lines the peritoneal cavity

testis descend retroperitoneally posterior to ?

processus vaginalis

How to locate deep inguinal ring

pulse of femoral artery move finger up and medially

Posterior muscles of abdominal wall (3)

quadratus lumborum psoas major ilacus

medial border of hasselbach triangle

rectus abdominus muscle

Where does lymphatic drainage from above the umbilicus move?

rostrally to axillary lymph nodes

Which layer of superficial fascia can a surgeon suture?

scarpa's fascia

scarpa's fascia (membranous layer of superficial fascia) is continuous with which three fascia

superficial fascia of penis darto's fascia (of scrotum) colles' fascia (of perineum)

You perform liposuction on your patient in the camper's fascia. You knick the superficial veins and cause bleeding. Which layer of the superficial fascia of the lower abdomen is filling w/ blood?

superficial fatty layer (remember superficial fascia has two main components. The superficial fatty layer and the deep membranous layer)

Layer located deep to skin

superfiical fascia (which has two layers)

scrotal cancer drains where?

superfiical inguinal nodes (remember, because scrotal and superficial both start w/ an S)

The plane located at the highest points of the iliac crests is the

supracristal plane

male has cancer metastasis to lower lumbar region. He probably has cancer where?

testicular cancer that traveled to lumbar nodes

origin of internal oblique msucle

thoracocolumbar fascia aneterior 2/3 of iliac crest lateral 1/2 of inguinal ligament

The plane located at the level of tubercles of the iliac crest is the:

transtubercular plane (L5)

Which tissue continues over the smermatic cord as an internal spermatic fascia

transversalis fascia (it comes down from rectus sheath, because remember it helps make up the posterior wall of the rectus sheath)

4 anterolateral muscles of abdominal wall

transversus abdominus internal oblique external oblique rectus abdominus

median umbilical fold contains

urachus (from development)

2 layers of the anterolateral abdominal wall

visceral peritoneum and parietal peritoneum

Difference between above and below arcuate line

Above: rectus abdominus posterior rectal sheath includes - internal oblique - transversus abdominus - transversalis fascia below: rectus abdominus posterior rectal sheath is - transversalis fascia

Your patient presents w/ caput medusae. Twhat are two possible blockages that may have caused this distension?

Blockage of IVC or blockage of portal system. Route: IVC Portal system paraumbilical veins umbilical veins result: paraumbilcal veins and others such as thoraco-epigastric veins distend from back flow

Your patient has a history of drinking excessively. They present w/ portal hypertension caused by end-stage liver disease. As a result, their paraumbilical veins are distended. Diagnosis?

Caput Medusae (paraumbilical veins are small tributaries of the portal vein. So if hypertension occurs here, they will expand)

Plane that divides the umbilical region from the pubic region

Transtubercular plane

Layer deep to flat muscles of abdomen

Transversalis fascia

Where is pain referred that is caused by visceral disease and inflammation ? Why?

abdominal wall visceral afferents enter the spinal cord w/ somatic afferents