Transcript Document

ABDOMEN
Lu Xiaoli
Regional Anatomy & Operative Surgery
China Medical University
BOUNDARIES
Abdominopelvic Cavity

Abdominal Cavity

Pelvic Cavity
P242-fig.4.21
DIVISIONS
P242-fig.4.22
P243-fig.4.23
P243-fig.4.23
Which one of the following is not
one of the 9 regions of the abdomen?
A.
Right hypochondriac
B.
Left inguinal or iliac
C.
Epigastric
D.
Right upper
E.
Left lumbar
Which of the following is NOT true
concerning the peritoneal cavity?
A.
The peritoneal cavity is a potential
space.
B.
The peritoneal cavity contains organs
inside of it.
C.
The peritoneal cavity is filled with
fluid that lubricates its contents.
D.
The parietal and visceral peritoneum
are linings of the peritoneal cavity.
The usual location for an appendectomy
incision is the:
A.
left lower quadrant
B.
left upper quadrant
C.
right lower quadrant
D.
right upper quadrant
You were asked to assist in a
surgical operation on a young patient
to treat an ulcer in the first part of
the duodenum. You would expect that
the surgeon will approach the ulcer
by doing an anterior abdominal wall
incision in the following region:
A.
Epigastric
B.
Left inguinal
C.
Left lumbar
D.
Right hypochondrial
E.
Hypogastric
ABDOMINAL WALL
Abdominal wall
Anterolateral
abdominal wall
Posterior
abdominal wall
LAYERS




Skin
Superficial
fascia
Deep fascia
Muscles



Transversalis fascia
Extraperitoneal
fascia
Peritoneum
Superficial
fascia

Camper’s fascia

Scarpa's fascia
P245-fig.4.25~4.26
SUPERFICIAL
ARTERIES

Lateral




Median



Posterior intercostal a.
Subcostal a.
Lumbar a.
Epigastric a.
hypogastric a.
Inferior


Superficial epigastric a.
Superficial iliac a.
P255-fig.4.39
Superficial
veins
lateral thoracic
thoracoepigastric
paraumbilical
S epigastric
S circumflex iliac
subclavian
portal
femoral
Caput Medusae
(Medusa Head )
INNERVATIONS

Intercostal Nerve

T7-T12

10th Intercostal Nerve
MUSCLES
Anterior Group
•Rectus Abdominis
•Pyramidalis
Lateral Group
•External Oblique
•Internal Oblique
•Transversus
RECTUS
ABDOMINIS
Tendinous
Intersection (3)
 Linea Semilunaris

Rectus
Sheath
Arcuate
line
PYRAMIDALIS
LINEA ALBA
External
Oblique
Abdominis
Oblique
Internal
Abdominis
Transversus
Abdominis
Arteries






5 intercostal arteries
subcostal arteries
4 lumbar arteries
Superior epigastric
artery—internal thoracic
artery
Inferior epigastric artery
-external iliac artery
Deep iliac circumflex
artery- external iliac
artery
Inferior
epigastric artery
Lymphatic Drainage
Intercostal Lymphatic Nodes
Anterior →
Parasternal Lymphatic Nodes
Middle
→ Lumbar Lymphatic Nodes
Lower
→ External Iliac Lymphatic Nodes
Innervations

Intercostal n.
Anterior
cutaneous branch
 Lateral
cutaneous branch

T7-12 thoracic n.
 Iliohypogastric n.
 Ilioinguinal n.
 Genitofemoral n.

Transversalis Fascia
Extraperitoneal
Fascia
Parietal Peritoneum
Umbilical Folds



Median
-- median umbilical lig.
Medial
-- chorda arteriae
umbilicalis
Lateral
-- inferior epigastric a.
& v.
INCISIONS




Longitudinal
 Midline
 Paramedian
 Transrectal
Oblique
 Subcostal
 McBurney’s
Transverse
 Pfannenstiel
Combined
 Thoracal-abdominal
The inferior border of the rectus
sheath posteriorly is called the:
A.
Falx inguinalis
B.
Inguinal ligament
C.
Internal inguinal ring
D.
Arcuate line
E.
Linea alba
Following an emergency appendectomy
your patient complained of having
paresthesia (numbness) of the skin at the
pubic region. The most likely nerve that
has been injured during the operation is:
A.
Genitofemoral
B.
Iliohypogastric
C.
Subcostal
D.
Spinal nerve T10
E.
Spinal nerve T9
An obstetrician decides to do a
Caesarean section on a 25-yearold pregnant woman. A transverse
suprapubic incision is chosen for
that purpose. All of the following
abdominal wall layers will be
encountered during the incision
EXCEPT the:
A.
Anterior rectus sheath
B.
Posterior rectus sheath
C.
Rectus abdominis muscle
D.
Skin and subcutaneous tissue
E.
Transversalis fascia, extraperitoneal
fat, and peritoneum
Surgical approaches to the abdomen
sometimes necessitate a midline incision
between the two rectus sheaths, i.e.,
through the:
A.
Linea aspera
B.
Arcuate line
C.
Semilunar line
D.
Iliopectineal line
E.
Linea alba
The internal thoracic artery is
sometimes surgically cut near the
caudal end of the sternum and used
to supply blood to a region of the
heart. In these cases, maintenance
of adequate blood flow to the
rectus abdominis may be dependent
on increased flow through which
artery?
A.
Superficial epigastric
B.
Inferior epigastric
C.
Umbilical
D.
Superficial circumflex iliac
E.
Deep circumflex iliac
INGUINAL REGION
Boundaries
LAYERS
 Skin
 Superficial
 Camper’s
 Scarpa’s
layer
External
Oblique
Abdominis
Inguinal Lig.
Lacunar Lig.
Pectineal Lig. (cooper’s Lig.)
Reflected Ligament
Lateral Crus
Superficial Inguinal Ring
Intercrural Fibers
Medial Crus
 Internal
oblique abdominis
 transverse
abdominis
Conjoint Tendon
Cremaster
Cremaster
Conjoint Tendon
Transverse Abdominal Fascia
abdominal inguinal ring
(deep inguinal ring)


Extraperitoneal
fascia
Parietal
peritoneum


Medial inguinal
fossa
lateral inguinal
fossa
Descent Of Testis
4 lunar month
11 weeks
8 lunar month
Inguinal Canal




Roof
 internal oblique abdominis
 transversus abdominis
Floor
 inguinal ligament
 lacunar ligament
anterior wall
 external abdominal oblique aponeurosis
 internal abdominal oblique aponeurosis
posterior wall
 transversalis fascia
 conjoint tendon (falx inguinalis)
Contents (male)

spermatic cord
arteries: testicular artery, deferential
artery, cremasteric artery
 nerves: genital branch of the genitofemoral
nerve, nerve to cremaster, sympathetic
nerves
 vas deferens
 pampiniform plexus
 lymphatic vessels


ilioinguinal nerve
Contents (female)
round ligament of the uterus
 ilioinguinal nerve

Spermatic Fascia
 Internal
spermatic fascia
 Transversalis
fascia
 Middle
 cremaster
 External
 aponeurosis
abdominis
of external oblique
HERNIA

Inguinal hernia
Indirect
 Direct

Inguinal Triangle
(Hesselbach's triangle )
Direct Hernia
A medical student was asked by her
preceptor to palpate the margin of the
superficial inguinal ring of a healthy male
patient. After passing her finger down
the edge of the medial crus of the
superficial inguinal ring, she felt a bony
protuberance deep to the lateral edge of
the spermatic cord, which she correctly
identified as the :
A.
pecten pubis
B.
pubic symphysis
C.
pubic tubercle
D.
iliopubic eminence
E.
iliopectineal line
In order to reduce a hernia (return
it to the abdominal cavity), a surgeon
finds it necessary to ligate an artery in
the extraperitoneal connective tissue
(preperitoneal fat) running vertically
just medial to the bowel as the bowel
passes through the abdominal wall. This
artery is the:
A.
Deep circumflex iliac
B.
Inferior epigastric
C.
Superficial circumflex iliac
D.
Superficial epigastric
E.
Superficial external pudendal
During a laparoscopic examination of the
deep surface of the lower anterior
abdominal wall (using a lighted scope on a
thin tube inserted through the wall), the
attending physician noted something of
interest and asked the young resident to
look at the medial inguinal fossa. To do so,
the young doctor would have to look at the
area between the:
A.
inferior epigastric artery and urachus
B.
medial umbilical ligament and urachus
C.
inferior epigastric artery and lateral
umbilical fold
D.
medial umbilical ligament and inferior
epigastric artery
E.
median umbilical ligament and medial
umbilical ligament
If one were to make an incision
parallel to and 2 inches above the
inguinal ligament, one would find the
inferior epigastric vessels between
which layers of the abdominal wall?
A.
Camper's and Scarpa's fascias
B.
External abdominal oblique and internal
abdominal oblique muscles
C.
Internal abdominal oblique and
transversus abdominis muscles
D.
Skin and deep fascia of the abdominal
wall
E.
Tranversus abdominis muscle and
peritoneum
Which structure passes through the
deep inguinal ring?
A.
Iliohypogastric nerve
B.
Ilioinguinal nerve
C.
Inferior epigastric artery
D.
Medial umbilical ligament
E.
Round ligament of the uterus
A loop of bowel protrudes through
the abdominal wall to form a direct
inguinal hernia; viewed from the
abdominal side, the hernial sac would
be found in which region?
A.
Deep inguinal ring
B.
Lateral inguinal fossa
C.
Medial inguinal fossa
D.
Superficial inguinal ring
E.
Supravesical fossa
In a female with an indirect inguinal
hernia, the herniated mass lies along
side of which structure as it traverses
the inguinal canal?
A.
Iliohypogastric nerve
B.
Inferior epigastric artery
C.
Ovarian artery and vein
D.
Pectineal ligament
E.
Round ligament of the uterus
The skin of the mons pubis is supplied
by which nerve?
A.
Anterior scrotal
B.
Anterior labial
C.
Femoral branch of the genitofemoral
D.
Iliohypogastric nerve
E.
Subcostal nerve
During your peer presentation of the
inguinal region dissection, you would indicate
the position of the deep inguinal ring to be:
A.
B.
Above the anterior superior iliac spine
Above the midpoint of the inguinal
ligament
C.
Above the pubic tubercle
D.
In the supravesical fossa
E.
Medial to the inferior epigastric artery
A 45-year-old porter develops a
direct inguinal hernia. If the hernia
extended through the superficial
inguinal
ring,
it
would
be
surrounded by all of the abdominal
wall layers EXCEPT the:
A.
External spermatic fascia
B.
Internal spermatic fascia
C.
Peritoneum and extraperitoneal
connective tissue
D.
Weak fascia of the transversus
abdominis muscle lateral to the falx
The boundaries of the
triangle include all except:
A.
Arcuate line
B.
Inferior epigastric vessels
C.
Inguinal ligament
D.
inguinal
Lateral border of rectus abdominus
muscle
The superficial inguinal ring is an
opening in which structure?
A.
External abdominal oblique aponeurosis
B.
Falx inguinalis
C.
Internal abdominal oblique muscle
D.
Scarpa's fascia
E.
Transversalis fascia
Which nerve passes through the
superficial inguinal ring and may
therefore be endangered during inguinal
hernia repair?
A.
Femoral branch of the genitofemoral
B.
Ilioinguinal
C.
Iliohypogastric
D.
Obturator
E.
Subcostal
During exploratory surgery of
the abdomen, an incidental finding
was a herniation of bowel between
the lateral edge of the rectus
abdominis muscle, the inguinal
ligament and the inferior epigastric
vessels. These boundaries defined
the hernia as a(n):
A.
Congenital inguinal hernia
B.
Direct inguinal hernia
C.
Femoral hernia
D.
Indirect inguinal hernia
E.
Umbilical hernia
Superficial
layers
Skin
Superficial skin
Muscles
Anterolateral
Transversalis fascia
abdominal wall Deep layers
Subperitoneal
fascia
Parietal peritoneum
4 walls
Inguinal canal 2 openings
Inguinal region
triangle
Contens