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ABDOMEN Lu Xiaoli Regional Anatomy & Operative Surgery China Medical University China Medical University.

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Presentation on theme: "ABDOMEN Lu Xiaoli Regional Anatomy & Operative Surgery China Medical University China Medical University."— Presentation transcript:

1 ABDOMEN Lu Xiaoli Regional Anatomy & Operative Surgery China Medical University China Medical University


3 Abdominopelvic Cavity Abdominal Cavity Abdominal Cavity Pelvic Cavity Pelvic Cavity P242-fig.4.21

4 DIVISIONS P242-fig.4.22

5 P243-fig.4.23


7 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

8 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.

9 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

10 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:

11 A. Epigastric B. Left inguinal C. Left lumbar D. Right hypochondrial E. Hypogastric


13 Abdominal wall Anterolateral abdominal wall Posterior abdominal wall

14 LAYERS Skin Superficial fascia Deep fascia Muscles Transversalis fascia Extraperitoneal fascia Peritoneum


16 Superficial fascia Camper’s fascia Camper’s fascia Scarpa's fascia Scarpa's fascia P 245 -fig.4.25~4.26

17 SUPERFICIAL ARTERIES Lateral Lateral Posterior intercostal a. Posterior intercostal a. Subcostal a. Subcostal a. Lumbar a. Lumbar a. Median Median Epigastric a. Epigastric a. hypogastric a. hypogastric a. Inferior Inferior Superficial epigastric a. Superficial epigastric a. Superficial iliac a. Superficial iliac a. P 255 -fig.4.39

18 Superficial veins subclavian femoral paraumbilical S epigastric S circumflex iliac thoracoepigastric lateral thoracic portal


20 Caput Medusae (Medusa Head )

21 INNERVATIONS Intercostal Nerve Intercostal Nerve T7-T12 T7-T12 10 th Intercostal Nerve 10 th Intercostal Nerve

22 MUSCLES Anterior GroupLateral Group Rectus Abdominis Pyramidalis External Oblique Internal Oblique Transversus

23 RECTUS ABDOMINIS Tendinous Intersection (3) Tendinous Intersection (3) Linea Semilunaris Linea Semilunaris

24 Rectus Sheath

25 Arcuate line



28 External Oblique Abdominis

29 Oblique Internal Abdominis

30 Transversus Abdominis

31 Arteries 5 intercostal arteries 5 intercostal arteries subcostal arteries subcostal arteries 4 lumbar arteries 4 lumbar arteries Superior epigastric artery—internal thoracic artery Superior epigastric artery—internal thoracic artery Inferior epigastric artery -external iliac artery Inferior epigastric artery -external iliac artery Deep iliac circumflex artery- external iliac artery Deep iliac circumflex artery- external iliac artery

32 Inferior epigastric artery


34 Lymphatic Drainage Anterior → Intercostal Lymphatic Nodes Parasternal Lymphatic Nodes Middle → Lumbar Lymphatic Nodes Lower → External Iliac Lymphatic Nodes

35 Innervations Intercostal n. Intercostal n. Anterior cutaneous branch Lateral cutaneous branch

36 T7-12 thoracic n. T7-12 thoracic n. Iliohypogastric n. Iliohypogastric n. Ilioinguinal n. Ilioinguinal n. Genitofemoral n. Genitofemoral n.

37 Transversalis Fascia

38 Extraperitoneal Fascia

39 Parietal Peritoneum

40 Umbilical Folds Median Median -- median umbilical lig. Medial Medial -- chorda arteriae umbilicalis Lateral Lateral -- inferior epigastric a. & v.

41 INCISIONS Longitudinal Longitudinal Midline Paramedian Transrectal Oblique Oblique Subcostal McBurney’s Transverse Transverse Pfannenstiel Combined Combined Thoracal-abdominal


43 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

44 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

45 An obstetrician decides to do a Caesarean section on a 25-year- old 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:

46 A. Anterior rectus sheath B. Posterior rectus sheath C. Rectus abdominis muscle D. Skin and subcutaneous tissue E. Transversalis fascia, extraperitoneal fat, and peritoneum

47 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

48 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?

49 A. Superficial epigastric B. Inferior epigastric C. Umbilical D. Superficial circumflex iliac E. Deep circumflex iliac



52 Boundaries

53 LAYERS Skin Skin Superficial layer Superficial layer Camper’s Camper’s Scarpa’s Scarpa’s

54 External Oblique Abdominis Inguinal Lig. Lacunar Lig. Pectineal Lig. (cooper’s Lig.)

55 Superficial Inguinal Ring Medial Crus Lateral Crus Intercrural Fibers Reflected Ligament

56 Internal oblique abdominis Internal oblique abdominis transverse abdominis transverse abdominis

57 Cremaster Conjoint Tendon

58 Cremaster

59 Transverse Abdominal Fascia abdominal inguinal ring (deep inguinal ring)

60 Extraperitoneal fascia Extraperitoneal fascia Parietal peritoneum Parietal peritoneum Medial inguinal fossa Medial inguinal fossa lateral inguinal fossa lateral inguinal fossa

61 Descent Of Testis

62 4 lunar month 11 weeks 8 lunar month




66 Inguinal Canal Roof Roof internal oblique abdominis internal oblique abdominis transversus abdominis transversus abdominis Floor Floor inguinal ligament inguinal ligament lacunar ligament lacunar ligament anterior wall anterior wall external abdominal oblique aponeurosis external abdominal oblique aponeurosis internal abdominal oblique aponeurosis internal abdominal oblique aponeurosis posterior wall posterior wall transversalis fascia transversalis fascia conjoint tendon (falx inguinalis) conjoint tendon (falx inguinalis)

67 Contents (male) spermatic cord spermatic cord arteries: testicular artery, deferential artery, cremasteric artery arteries: testicular artery, deferential artery, cremasteric artery nerves: genital branch of the genitofemoral nerve, nerve to cremaster, sympathetic nerves nerves: genital branch of the genitofemoral nerve, nerve to cremaster, sympathetic nerves vas deferens vas deferens pampiniform plexus pampiniform plexus lymphatic vessels lymphatic vessels ilioinguinal nerve ilioinguinal nerve

68 Contents (female) round ligament of the uterus round ligament of the uterus ilioinguinal nerve ilioinguinal nerve

69 Spermatic Fascia Internal spermatic fascia Internal spermatic fascia Transversalis fascia Transversalis fascia Middle Middle cremaster cremaster External External aponeurosis of external oblique abdominis aponeurosis of external oblique abdominis

70 HERNIA Inguinal hernia Inguinal hernia Indirect Indirect Direct Direct

71 Inguinal Triangle (Hesselbach's triangle ) Direct Hernia

72 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 :

73 A. pecten pubis B. pubic symphysis C. pubic tubercle D. iliopubic eminence E. iliopectineal line

74 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:

75 A. Deep circumflex iliac B. Inferior epigastric C. Superficial circumflex iliac D. Superficial epigastric E. Superficial external pudendal

76 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:

77 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

78 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?

79 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

80 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

81 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?

82 A. Deep inguinal ring B. Lateral inguinal fossa C. Medial inguinal fossa D. Superficial inguinal ring E. Supravesical fossa

83 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

84 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

85 During your peer presentation of the inguinal region dissection, you would indicate the position of the deep inguinal ring to be: A. Above the anterior superior iliac spine B. Above the midpoint of the inguinal ligament C. Above the pubic tubercle D. In the supravesical fossa E. Medial to the inferior epigastric artery

86 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:

87 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

88 The boundaries of the inguinal triangle include all except: A. Arcuate line B. Inferior epigastric vessels C. Inguinal ligament D. Lateral border of rectus abdominus muscle

89 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

90 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

91 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):

92 A. Congenital inguinal hernia B. Direct inguinal hernia C. Femoral hernia D. Indirect inguinal hernia E. Umbilical hernia

93 Anterolateral abdominal wall abdominal wall Superficial layers layersSkin Superficial skin Deep layers Muscles Transversalis fascia Subperitoneal fascia Parietal peritoneum Inguinal region Inguinal canal triangle 4 walls 2 openings Contens

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