Anterior Abdominal Wall & Inguinal

1.A 65-year-old man with chronic history of cough and constipation complained he noticed a gradually increasing swelling in the right groin and feels a dragging sensation at that site. On examination, it was noticed a globular swelling above the pubic tubercle which increased in size on coughing. The patient was diagnosed to have Inguinal hernia

• a) Based on the anatomical knowledge, what are the reasons for swellings in the groin region
• b) What are the boundaries of Inguinal canal
• c) What are the contents of Inguinal canal
• d) What are factors which maintain the Integrity of Inguinal canal
• e) What is Hesselbach’s triangle

2.A 14-year-old girl was brought to the hospital with complaints of fever, vomiting and acute pain around umbilicus. On examination, the surgeon found that she was having maximum tenderness at Mc Burney’s point. From the history and examination, he came to the diagnosis of acute appendicitis. Based on your anatomical knowledge, answer the following questions.

• a) Why is pain felt around umbilicus
• b) Where is Mc Burney’s point
• c) What are the various positions of vermiform appendix
• d) Briefly describe the blood supply, development and microscopy of vermiform appendix

3.A 70 – year old man presented with a swelling in the inguinal region on both the sides. He had cough since two months. The swelling reduces on rest and bulges on coughing.

• a) Which is the canal through which swelling is appearing.
• b) Write about boundaries of the canal and contents of the canal
• c) What are the factors which prevents the swelling in the normal individuals
• d) Write on Hesselbach’s triangle

4.Describe the inguinal canal under the following heading

• a) Boundaries and contents.
• b) Anatomical protective mechanisms for prevention of inguinal hernia.
• c) Anatomical basis of two types of inguinal hernia.
• d) What are the coverings of inguinal hernia

1.Explain the formation and contents of rectus sheath

2.Describe the muscles, nerves and vessels of anterior abdominal wall

3.Boundaries and contents of inguinal canal

4.Inguinal canal- extent, boundaries, contents and applied anatomy

1.Describe the anatomical basis of femoral hernia

2.Explain the anatomical basis of venous engorgements of anterior abdominal wall and anal canal in portal hypertension

3.Rectus abdominis muscle

4.Explain the anatomical basis of inguinal hernia

5.What is the anatomical basis of umbilical hernia

6.Boundaries of rectus sheath

1.Name the nerve passing through superficial inguinal ring

2.What forms posterior wall of rectus sheath below the arcuate line

3.Bony attachments of inguinal ligament

4.Point located at the junction between upper 2/3rd and lower 1/3rd of spinoumbilical line

5.What contributes to posterior wall of inguinal canal

1.During the repair, the internal spermatic fascia is identified and reflected to expose the ductus deferens and testicular vessels. Which of the following provides the internal spermatic fascia of the spermatic cord

• a) External oblique aponeurosis
• b) Internal oblique aponeurosis
• c) Transversus abdominis aponeurosis
• d) Transversalis fascia

2.The Hesselbach’s triangle is crossed by the medial umbilical ligament which is raised by the remnant/obliteration of

• a) Urachus
• b) Umbilical artery
• c) Left umbilical vein
• d) Vitello intestinal duct

3.The resident assisting the case reviews the surgical anatomy and commits to memory that the internal oblique abdominis contributes to

• a) Inguinal ligament
• b) Conjoint tendon
• c) Internal spermatic fascia
• d) Deep inguinal ring

4.Which of the following nerves is compressed by the herniating structure in the inguinal canal to give the patient pain

• a) Iliohypogastric
• b) Lateral femoral cutaneous
• c) Ilioinguinal
• d) Subcostal

5.Which of the following statements are true about inguinal canal

• 1) The length of inguinal canal is 8 cms.
• 2) The inguinal canal extends from Anterior Superior Illiac Spine to Pubic Symphysis.
• 3) The presence of inguinal canal is a cause of weakness in the lower part of anterior abdominal wall.
• 4) Lacunar ligament is related to floor of inguinal canal
• a) 3, 4
• b) 1, 3, 4
• c) 1, 2, 4
• d) 1, 2

6.The artery which is just medial to the deep inguinal ring is

• a) Superficial epigastric
• b) Superficial circumflex iliac
• c) Inferior epigastric
• d) Deep circumflex iliac

7.The deep inguinal ring is a deficiency in the

• a) External oblique aponeurosis
• b) Internal oblique muscle
• c) Transversalis fascia
• d) Transversus abdominis

8.The medial boundary of Hesselbach’s triangle is formed by

• a) Conjoint tendon
• b) Inferior epigastric artery
• c) Medial border of internal oblique
• d) Lateral border of rectus abdominis

9.Which defense mechanism closes the superficial inguinal ring when the external oblique muscle contracts

• a) Ball valve
• b) Shutter
• c) Flap valve
• d) Slit valve

10.Which one of the following structures has triple relation (anterior, roof and posterior) to the inguinal canal?

• a) Internal oblique
• b) External oblique
• c) Transversalis fascia
• d) Conjoint tendon