Workshop 16 Topography of the inguinal region. Surgical anatomy of the inguinal canal and its content. Surgical anatomy and treatment of inguinal hernia icon

Workshop 16 Topography of the inguinal region. Surgical anatomy of the inguinal canal and its content. Surgical anatomy and treatment of inguinal hernia




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НазваWorkshop 16 Topography of the inguinal region. Surgical anatomy of the inguinal canal and its content. Surgical anatomy and treatment of inguinal hernia
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Workshop 16

Topography of the inguinal region. Surgical anatomy of the inguinal canal and its content. Surgical anatomy and treatment of inguinal hernia.


  1. Identify the boundaries of the inguinal region:

  2. Identify the arteries that run in the inguinal area:

  3. Name the organs projecting into the right inguinal region:

  4. Name the organs projecting into the left inguinal region:

  5. Anterior wall of the inguinal canal without deviations includes:

  6. Superior wall of the inguinal canal includes:

  7. Inferior wall of the inguinal canal is:

  8. Inferior wall of the inguinal canal is:

  9. Posterior wall of the inguinal canal:

  10. What is the posterior wall of the inguinal canal reinforced by?

  11. What is a superficial inguinal ring limited by laterally and inferiorly?

  12. What is a superficial inguinal ring limited by laterally and superiorly?

  13. What is a superficial inguinal ring limited by medially and superiorly?

  14. What is a superficial inguinal ring limited by inferiorly and posteriorly?

  15. What is the medial part of the posterior wall of the inguinal canal reinforced by?

  16. What types of inguinal interspaces do you know?

  17. What does the shape of the inguinal interspace depend on?

  18. Identify the medial boundary of the inguinal interspace:

  19. Identify the superior boundary of the inguinal interspace:

  20. Identify the inferior boundary of the inguinal interspace:

  21. What are the weakest regions of anterior abdominal wall along the medial line:

  22. What anatomical formations are identified in the cellular tissue between internal oblique and transverse abdominal muscles?

  23. Name the elements of the spermatic cord:

  24. What nerve escorts the spermatic cord locating anteriorly and superiorly?

  25. What nerve escorts the spermatic cord locating inferiorly and posteriorly?

  26. What artery approaches the spermatic cord posteriorly?

  27. Name the peculiarities of topography of a. epigastrica inferior:

  28. When can the a. epigastrica inferior be injured?

  29. What is the entry for the oblique inguinal hernia?

  30. What is the entry for the direct inguinal hernia?

  31. What is a hernial sac composed by at congenital inguinal hernia?

  32. In what direction is the hernial orifice in oblique inguinal hernia dissected?

  33. In what direction is the hernial orifice in direct inguinal hernia dissected?

  34. Through what ostium in canalis inguinalis does the direct inguinal hernia run?

  35. Show the connection between hernial sac and funiculus spermaticus in oblique inguinal hernia:

  36. Show the connection between hernial sac and funiculus spermaticus in direct inguinal hernia:

  37. At oblique inguinal hernia the a. epigastrica inferior is located:

  38. At direct inguinal hernia the a. epigastrica inferior is located:

  39. Which wall of the inguinal canal is weakened at oblique inguinal hernia?

  40. What layers cover the hernial sac at oblique inguinal hernia?

  41. What layers cover the hernial sac at direct inguinal hernia?

  42. Identify the ways of herniotomy which strengthen only the anterior wall of canalis inguinalis:

  43. Identify the ways of herniotomy which strengthen only the posterior wall of canalis inguinalis:

  44. What is sutured to the inguinal ligament by the method of Girard?

  45. What is sutured to the inguinal ligament by the method of Girard-Spasokutsky?

  46. What is sutured to the inguinal ligament according to the method of Martynov?

  47. What is the way to perform duplication according to the method of Martynov?

  48. What tissues are sutured to the inguinal ligament according to the method of Bassini?

  49. What tissues are sutured to the inguinal ligament according to the method of Postemsky?

  50. How is the duplication performed according to the method of Postemsky?

  51. Name the authors of major techniques to perform operations at inguinal hernia:


! Identify the boundaries of the inguinal region:

line connecting both anterior superior iliac spine, lateral margin of rectal abdominal muscle, inguinal ligaments

# line that connects both anterior superior iliac spine, linea alba, inguinal ligament

costal arch and xyphoid process, iliac crest , inguinal ligaments

linea bicostarum, lateral margin of rectal abdominal muscle, inguinal ligaments


! Identify the arteries that run in the inguinal area:

a. epigastrica superficialis, a. circumflexa ilium superficialis, aa. pudendae externae, a.epigastrica inferior

# A. epigastrica superficialis, a. epigastrica superior, a. epigastrica inferior, a. circumflexa ilium superficialis, aa. pudendae externae

a. epigastrica superficialis, a. circumflexa ilium superficialis et profunda, aa. pudendae externae

a. epigastrica superior et inferior, a. circumflexa ilium superficialis et profunda, aa.pudendae externae


! Name the organs projecting into the right inguinal region:

caecum, appendix, ureter

# caecum, appendix, ureter, rectum

caecum, appendix, bladder

sigmoid, caecum, appendix


! Name the organs projecting into the left inguinal region:

sigmoid, ureter

# sigmoid, rectum, ureter

caecum, sigmoid, ureter

caecum, sigmoid, ureter, rectum


! Anterior wall of the inguinal canal without deviations includes:

aponeurosis of external oblique abdominal muscle, fibers of internal oblique abdominal muscle

# M. obliqus abdominis externus

external and internal oblique abdominal muscles

aponeurosis of external abdominal muscle


! Superior wall of the inguinal canal includes:

inferior margin of the internal oblique abdominal muscle, inferior margin of the transverse abdominal muscle

# aponeurosis of external abdominal muscle

aponeurosis of external abdominal muscle, inferior margin of internal and transverse abdominal muscles

lig. Inguinale


! Inferior wall of the inguinal canal is:

lig. inguinale

# Lig. Pectineale

inferior margin of the internal abdominal muscle

lig. inguinale, lig. Lacunare


! Posterior wall of the inguinal canal:

transverse fascia, aponeurotic fibers of internal oblique and transverse abdominal muscles

#aponeurosis of the external oblique abdominal muscle

transverse fascia of Hesselbach, ligament of Henlie


! What is the posterior wall of the inguinal canal reinforced by?

ligament of Hesselbach , ligament of Henlie

# ligament of Cooper

ligament of Gimbernat

ligament of Henlie


! What is a superficial inguinal ring limited by laterally and inferiorly?

crus laterale

# Crus mediale

lig. reflexum

fibrae intercruralis


! What is a superficial inguinal ring limited by laterally and superiorly?

fibrae intercruralis

#crus laterale

crus mediale

falx inguinalis


! What is a superficial inguinal ring limited by medially and superiorly?

crus mediale

#crus mediale, fibrae intercruralis

lig. reflexum

falx inguinalis


! What is a superficial inguinal ring limited by inferiorly and posteriorly?

lig. reflexum

#crus mediale

lig. pectineale

lig. lacunare


! What is the medial part of the posterior wall of the inguinal canal reinforced by?

falx inguinalis

#lig. interfoveolare

lig. lacunare

lig. Pectineale


! What types of inguinal interspaces do you know?

Fissured, oval, triangular

# fissured

oval

triangular


! What does the shape of the inguinal interspace depend on?

the height of internal oblique abdominal muscle, the height of transverse abdominal muscle, from the tight inferior part of the rectal muscle

# the height of internal oblique and transverse abdominal muscles

From the tight inferior part of the rectal abdominal muscle

From the point of fiber branching of the external oblique muscle aponeurosis


! Identify the medial boundary of the inguinal interspace:

lateral margin of compartment of the rectal abdominal muscle

# interfoveal ligament

Poupart\'s ligament

inferior margin of the oblique abdominal muscle


! Identify the superior boundary of the inguinal interspace:

inferior margin of the oblique abdominal muscle, inferior margin of the transverse abdominal muscle

# falx inguinalis

interfoveal ligament

Poupart\'s ligament


! Identify the inferior boundary of the inguinal interspace:

Poupart's ligament

# ligament of Gimbernat

ligament of Cooper

falx inguinalis


! What are the weakest regions of anterior abdominal wall along the medial line:

umbilical ring, linea alba

# inguinal ring, linea alba, Spigelian line

inguinal canal, inguinal ring, linea alba

inguinal ring, rhombus Lesgafti–Grunfeldi, linea alba


! What anatomical formations are identified in the cellular tissue between internal oblique and transverse abdominal muscles?

nn. intercostales, n. subcostalis, n. iliohypogastricus, n. ilioinguinalis, aa. intercostales posterior, a. lumbales, r. ascendens a. circumflexa ilium profunda

# Nn. intercostales, n. iliohypogastricus, n. ilioinguinalis, aa. intercostales anteriores et posteriores, aa. lumbalis

nn. intercostales, n. iliohypogastricus, n. ilioinguinales, aa. intercostales posteriores, a.epigastrica superior nn. intercostales, n. iliohypogastricus, n. ilioinguinalis, aa. intercostales posteriores, aa.lumbales, a. epigastrica inferior


! Name the elements of the spermatic cord:

a. testicularis, plexus testicualris, plexus pampiniformis, ductus deferens, a. ductus deferentis, plexus deferentioalis, processus vaginalis peritonaei

# A. testicularis, plexus pampiniformis, ductus deferens, a. ductus deferentis, processus vaginalis peritonaei a. testicularis, v. testicularis, ductus deferens, a. cremasterica, processus vaginalis peritonaei

a. testicularis, plexus testicularis, plexus pampiniformis, ductus deferens, a. ductus deferentis, plexus deferentialis, processus vaginalis peritonaei, a. cremasterica, n.ilioinguinalis, r. genitalis n. genitofemoralis


! What nerve escorts the spermatic cord locating anteriorly and superiorly?

n. ilioinguinalis

# N. iliohypogastricus

r. genitalis n. Genitofemoralis

r. femoralis n. genitofemoralis


! What nerve escorts the spermatic cord locating inferiorly and posteriorly?

r. genitalis n. genitofemoralis

# N. ilioinguinalis

n. iliohypogastricus

r. femoralis n. genitofemoralis


! What artery approaches the spermatic cord posteriorly?

a. cremasterica

# A. testicularis

a. ductus deferens

a. epigastrica inferior


! Name the peculiarities of topography of a. epigastrica inferior:

It branches from a. iliaca externa, runs in the preperitoneal cellular tissue behind the inguinal ligament, intersects the external margin of the rectal muscle and enters the rectus compartment, anastomoses with a. epigastrica superior

# it branches from a. iliaca interna, runs in the preperitoneal cellular tissue behind the inguinal ligament, intersects the external margin of the rectal muscle, anastomoses with a. epigastrica superior

It goes from a. iliaca communis, runs in the preperitoneal cellular tissue, makes plica umbilicalis lateralis, enters rectus compartment, is located between the anterior wall of compartment and muscle,

It branches from a. iliaca externa, forms plica umbilicalis medialis, runs parallel to the external margin of the rectal muscle, anastomoses with a. epigastrica superior


! When can the a. epigastrica inferior be injured?

at Lennander’s cutting, McBurney-Volkovich-Djakonov’s, Pfannenstiel’s, Pirogoff’s

# at McBurney-Volkovich-Djakonov’s cutting, Fedorov’s, Pirogoff’s

at Lennander’s cutting, McBurney-Volkovich-Djakonov’s, Pfannenstiel’s, Kocher’s, Pirogoff’s

at Lennander’s cutting, Rio-Branco, McBurney-Volkovich-Djakonov’s, Pfannenstiel’s, Pirogoff’s


! What is the entry for the oblique inguinal hernia?

fossa inguinalis lateralis

# Fossa inguinalis medialis

fossa femoralis

anulus umbilicalis


What is the entry for the direct inguinal hernia?

fossa inguinalis medialis

# Fossa inguinalis lateralis

fossa supravesicalis

fossa femoralis

skin, subcutaneous cellular tissue, superficial fascia of the skin, superficial fascia, transversal fascia, fascia spermatica interna


! What is a hernial sac composed by at congenital inguinal hernia?

processus vaginalis peritonei

# Fascia spermatica interna

fascia spermatica externa

fascia cremasterica


! In what direction is the hernial orifice in oblique inguinal hernia dissected?

Up and lateral

# up and medial

Down and medial

Down and lateral


! In what direction is the hernial orifice in direct inguinal hernia dissected?

up and medial

#Up and lateral

Down and medial

Down and lateral


! Through what ostium in canalis inguinalis does the direct inguinal hernia run?

superficial inguinal ring

# deep inguinal ring


! Show the connection between hernial sac and funiculus spermaticus in oblique inguinal hernia:

Is located inside the fascia spermatica interna, surrounded by elements of funiculus spermaticus

# Is located outside the fascia spermatica interna

Is located medially from the funiculus spermaticus

Is located laterally from the funiculus spermaticus


! Show the connection between hernial sac and funiculus spermaticus in direct inguinal hernia:

Is located outside fascia spermatica interna medially from the funiculus spermaticus

# Is located inside the fascia spermatica interna

Is located laterally from funiculus spermaticus

Is located below and behind from funiculus spermaticus


! At oblique inguinal hernia the a. epigastrica inferior is located:

medially from the hernial sac

# laterally from the hernial sac

Behind the hernial sac

Above the hernial sac


! At direct inguinal hernia the a. epigastrica inferior is located:

laterally from the hernial sac

# medially from the hernial sac

Behind the hernial sac

Above the hernial sac


! Which wall of the inguinal canal is weakened at oblique inguinal hernia?

anterior and posterior

# anterior

posterior

inferior


! What layers cover the hernial sac at oblique inguinal hernia?

skin, subcutaneous cellular tissue, superficial fascia, fascia cremasterica, m.cremaster, fascia spermatica interna, preperitoneal cellular tissue

# skin, subcutaneous cellular tissue, superficial fascia, transverse fascia, preperitoneal cellular tissue


! What layers cover the hernial sac at direct inguinal hernia?

skin, subcutaneous cellular tissue, superficial fascia, transverse fascia, preperitoneal cellular tissue

# skin, subcutaneous cellular tissue, superficial fascia

skin, subcutaneous cellular tissue, superficial fascia, fascia cremasterica, m.cremaster, fascia spermatica interna, preperitoneal cellular tissue

skin, subcutaneous cellular tissue, superficial fascia, transverse fascia, fascia spermatica interna


! Identify the ways of herniotomy which strengthen only the anterior wall of canalis inguinalis:

Girard’s, Spasokukotsky's, Martynov’s

# Girard’s, Martynov’s, Bassini’s

Girard’s, Bassini’s, Postempsky

Girard’s, Kimbarovsky, Martynov’s


! Identify the ways of herniotomy which strengthen only the posterior wall of canalis inguinalis:

Bassini’s, Postempsky

# Bassini’s, Postempsky, Kukudzhanov’s

Bassini’s, Kimbarovsky, Postempsky

Bassini’s, Kukudzhanov’s, Postempsky, Kimbarovsky


! What is sutured to the inguinal ligament by the method of Girard?

Lower margins of the internal oblique and transverse muscles, and the superior flap of aponeurosis of external oblique muscle is sutured by the second row of interrupted sutures

# inferior margin of internal oblique and transverse muscle, aponeurosis of the external oblique muscle

aponeurosis of the external oblique abdominal muscle, internal oblique and transverse abdominal muscles

internal oblique muscle, transverse muscle, transverse fascia


! What is sutured to the inguinal ligament by the method of Girard-Spasokutsky?

aponeurosis of external oblique muscle, internal oblique muscle, transverse muscle

# inferior margin of the internal oblique and transverse muscles, and by the second row of interrupted sutures – the superficial flap of aponeurosis of external oblique muscle

inferior margins of internal oblique and transverse muscles

inferior margins of internal oblique and transverse muscles, internal oblique muscle, transverse muscle, transverse fascia


! What is sutured to the inguinal ligament according to the method of Martynov?

a superficial flap of aponeurosis of external oblique abdominal muscle

# aponeurosis of external oblique abdominal muscle, internal oblique muscle, transverse muscle

inferior margin of internal oblique and transverse muscles, and by the second row of interrupted sutures – the superficial flap of aponeurosis of external oblique muscle

internal oblique muscle, transverse muscle, transverse fascia


!What is the way to perform duplication according to the method of Martynov?

a superior flap of aponeurosis of the external oblique muscle is sutured to the inguinal ligament by interrupted sutures, and the inferior flap of aponeurosis of external oblique muscle is fixed to the superior one

# a superior flap of aponeurosis together with internal oblique and transverse muscles is sutured to the inguinal ligament, and the inferior flap of aponeurosis of external oblique muscle is fixed to the superior one

Аponeurosis of the external oblique muscle, internal oblique muscle, transverse muscle and the margin of a rectal muscle are sutured to the inguinal ligament, and the inferior flap of aponeurosis of the external oblique muscle is fixed to the superior one

The inferior margin of aponeurosis of the external oblique muscle is sutured to the inguinal ligament, and a superior margin of aponeurosis of the external oblique muscle is fixed to the inferior one


! What tissues are sutured to the inguinal ligament according to the method of Bassini?

internal oblique muscle, transverse muscle, transverse fascia, margin of the rectal abdominal muscle

# super flap of the external oblique muscle aponeurosis

aponeurosis of the external oblique muscle, internal oblique muscle, transverse muscle

internal oblique muscle, transverse muscle, transverse fascia


! What tissues are sutured to the inguinal ligament according to the method of Postemsky?

super flap of the external oblique muscle aponeurosis, internal oblique muscle, transverse muscle and transverse fascia and margin of the rectal abdominal muscle

# aponeurosis of the external oblique muscle, internal oblique and transverse muscles

internal oblique muscle, transverse muscle and transverse fascia

a superior flap of aponeurosis of the external oblique muscle


! How is the duplication performed according to the method of Postemsky?

a margin of the rectal abdominal muscle is sutured to the inguinal ligament and periosteum of pubis, a superior flap of aponeurosis of the external oblique muscle together with underlying muscles and transverse fascia are fixed to the inguinal ligament, and the inferior flap of aponeurosis of the external oblique muscle is sutured to the superior one beneath the spermatic cord

# a superior flap of aponeurosis of the external oblique muscle is sutured to the inguinal ligament, and the inferior flap of aponeurosis of the external oblique muscle is fixed to the superior one

a superior flap of aponeurosis of the external oblique muscle together with underlying muscles are sutured to the inguinal ligament, and the inferior flap of aponeurosis is fixed to the superior one

inferior margin of the internal oblique muscle and transverse muscle together with a transverse fascia are fixed to the inguinal ligament, a superior flap of aponeurosis of the external oblique muscle is sutured to the inguinal ligament by the second row of sutures, and the inferior flap of aponeurosis is sutured to the superior one


! Name the authors of major techniques to perform operations at inguinal hernia:

Girard, Spasokutsky, Martynov, Bassini, Postemsky, Kukudzhanov

# Girard, Spasokutsky, Sapezhko, Martynov, Bassini, Postemsky

Girard, Spasokutsky, Mayo, Bassini, Martynov, Kimbarovsky

Girard, Spasokutsky, Martynov, Bassini, Mayo






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