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SESSION 4 - Anterior Abdominal Wall 1. The external oblique muscle arises from the last (a) 6 ribs (b) 8 ribs (c) 10 ribs 2. As the external oblique arises it interdigitates with two other muscles. Which ones and on which ribs? 3. The lower free edge of the external oblique is the inguinal ligament. To which two bony points does it attach? 4. Does the external oblique reach posteriorly enough to attach to the lumbosacral fascia? 5. The external oblique becomes aponeurotic below a line joining which two points? 6. On reaching the pubic tubercle the inguinal ligament curls backwards and upwards to give which ligament? This ligament then becomes the medial wall of which canal? The ligament also extends along the superior pubic ramus and changes its name to which ligament? 7. The superficial inguinal ring is a triangular shaped defect in the lower medial part of the external oblique. What makes the base of the triangle? What are the two sides of the triangle called? What prevents the splitting of the upper outer fibres of the ring? 8. In order to arise from the lumbosacral fascia, to how much of which part of the iliac crest must the internal oblique be attached? 9. In order to lie anterior to the deep inguinal ring, to how much of which part of the inguinal ligament must the internal oblique be attached? 10. The lowest fibres of the internal oblique that arise from the inguinal ligament curl over the inguinal canal and attach to the pubic crest and pectineal line. (a) (b) (c) (d) What additional structure do they form? What other fibres join them? What is the nerve supply to this new structure? What type of hernia do you get if there is weakness of this new structure? 11. As the fibres of the internal oblique extend medially over the abdomen they become aponeurotic and provide a sheath for the rectus abdominis muscle. In the upper abdomen does this sheath (a) lie anterior to the rectus muscle only (b) lie posterior to the rectus muscle only (c) Split to lie anterior and posterior 12. What is the arcuate line? 13. What is the linea alba? 14. From how much of the iliac crest and inguinal ligament does the transversus abdominis rise? Does it lie lateral or anterior to the deep inguinal ring? 15. Does transversus abdominis lie anterior or posterior to the rectus abdominis muscle below the arcuate line? 16. Between which two muscles do neurovascular bundles run in the abdominal wall? 17. What is the name of the structures that bind the rectus abdominis muscle to the anterior rectus sheath in the upper abdomen and give a six pack appearance? 18. In the suprapubic region what two layers of tissue separate the rectus muscle from the bowel? 19. What is the main action of the rectus abdominis? 20. Which is the last costal cartilage to attach to the sternum? Does this knowledge help to remember the nerve supply of the abdominal wall muscles?