Abdominal Wall And Inguinal Canal

Question 1

Superficial Fascia Components

Answer 1

Camper’s fascia: superficial fatty layer

Scarpa’s Fascia: deep membranous layer
-continuous with the Dartos and Colle’s fascia in the perineum

Question 2

Anterior Cutaneous Branches of intercostal nerves

Answer 2

• innervate the anterolateral abdomen
• T7-T11
• Subcostal nerve (T12)
• iliohypogastric and ilioinguinal (L1)

-enter the superficial fascia

Question 3

Innervation of the Anterior Cutaneous Branches of Intercostal Nerves

Answer 3

T7: the skin overlying the tip of the xiphoid process
T10: the skin of the umbilicus
T12: the skin superior to the pubic symphysis
L1: the skin overlying the pubic symphysis

Question 4

Superficial Veins of the Abdominal Wall (in the clinic)

Answer 4

The superficial epigastric vein anastomoses with the lateral thoracic vein in the superficial fascia
This is an important collateral venous channel from the femoral vein to the axillary vein.
In patients who have an obstruction of the inferior vena cava or hepatic portal vein, the superficial veins of the abdominal wall may be engorged, and may become visible around the umbilicus (caput medusae)

Question 5

External (abdominal) oblique

Answer 5

-fibers extend from superolateral to inferomedial (hands in pocket)
-fibers end mediallly by forming an aponeurosis of the external oblique, part of the anterior rectus sheath
Action: unilaterally to bend the trunk in the same direction and to rotate the trunk to the opposite side
-bilaterally to flex the trunk, to compress the abdomen and to stabilize the pelvis

Question 6

Inguinal Ligament

Answer 6

Extending between the ASIS and the pubic tubercle. The Ligament appears as a linear indentation at the inferior aspect of the aponeurosis

Question 7

Superficial Inguinal Ring

Answer 7

Medial deficiency in the inferomedial aspect of the aponeurosis of the external oblique
-external opening of the inguinal canal

Question 8

Spermatic Cord

Answer 8

Exits thru the superficial inguinal ring.

Question 9

Round ligament of the uterus

Answer 9

Exits thru the superficial inguinal ring

Question 10

Inguinal Canal

Answer 10

A short oblique passageway thru deficiencies in the musculature of the anterior abdominal wall

Question 11

Internal (abdominal) oblique

Answer 11

Fibers Coursing from superomedial to inferolateral

-has an aponeurosis

Question 12

Semilunar Line

Answer 12

A cut that extends from the mid axillary line to the medial border between the external and internal obliques

Question 13

Transversus Abdominus

Answer 13

Fibers are oriented horizontally

Action: unilaterally to rotate the trunk to the same side
-bilaterally to compress the abdomen

Question 14

Rectus Sheath

Answer 14

Aponeurosis surrounding the rectus abdominus

Question 15

Rectus Abdominis

Answer 15

Action: flex the trunk, compress the abdomen, and to stabilize the pelvis
-cotains tendinous intersections (6 pack)

Question 16

Superior Epigastric Artery and Vein (deep surface of the rectus abdominis muscle and superficial to the posterior leaf of the rectus sheath)

Answer 16

On the superior half of the rectus abdominis muscle

Question 17

Inferior Epigastric artery and vein (between the deep surface of the rectus abdominis and the superficial surface of the posterior leaf of the rectus sheath)

Answer 17

On the inferior half of the rectus abdominis muscle

Question 18

Epigastric Anastomses (in the clinic)

Answer 18

The superficial Epigastric Vessels anastomose with the inferior Epigastric vessels within the rectus sheath. If the inferior vena cava becomes obstructed, the anastomoses between the inferior Epigastric and superior epigastric veins provides a collateral venous channel that drains in to the superior vena cava. If the aorta is occluded, collateral arterial circulation to the lower part of the body occurs thru the superior and inferior Epigastric arteries

Question 19

Arcuate Line of the Rectus Sheath

Answer 19

Demarcation located roughly midway between the pubic symphysis and umbilicus
-forms at the point where the posterior sheath of the rectus stops

Question 20

Below the Arcuate Line of the rectus sheath

Answer 20

Only the transversalis fascia and peritoneum line the posterior aspect of the rectus abdominis
-this deficiency allows the inferior artery and vein access into the rectus sheath, where they become embedded into the posterior aspect of the rectus abdominis

Question 21

Transversalis Fascia

Answer 21

Located between the rectus abdominis and parietal peritoneum, inferior to the arcuate line
-analogous to the endothroacic fascia of the thoracic region

Question 22

Inguinal Canal

Answer 22

Superficial portion: external oblique muscle
Intermediate layer: internal oblique muscle
Deepest layer: transversus abdominis muscle
Inferior Border: inguinal ligament

Question 23

Superficial Inguinal Ring (attachments)

Answer 23

Lateral crus (portion of the external oblique aponeurosis that forms lateral margin): attached to the pubic tubercle
Medial Crus (portion of the external oblique aponeurosis that forms medial margin): attached to the pubic crest
-intercrural fibers span across the crura superolateral to the superficial inguinal ring 
-they prevent the crura from spreading apart

Question 24

Ilioinguinal Nerve

Answer 24

The ilioinguinal nerve pierces the internal oblique and emerges from the inguinal canal at the superficial inguinal ring, anterior (and perhaps a little lateral) to the spermatic cord (or round ligament of the uterus). After it emerges it branches into terminal sensory branches. It is motor to the internal oblique, and sensory to skin of the proximal medial thigh and the skin over the root of the penis and upper part of the scrotum in males, or the skin covering the mons pubis and the adjoining labium magus in females

Question 25

Iliohypogastric Nerve

Answer 25

Runs parallel to the ilioinguinal nerve and superior to it, outside of the inguinal canal. it is motor to transversus abdominis and internal oblique and sensory to skin of posterolateral gluteal and suprapubic skin

Question 26

Deep Inguinal Ring

Answer 26

A slit in the transversalis fascia

Question 27

Cremaster Muscle

Answer 27

Lateral to the spermatic, muscle fibers connect the internal oblique muscle to the spermatic cord

• covers the spermatic cord in males
• supplied by the genital branch of the genitofemoral nerve
• raise and lower the testes in order to regulate scrotal temp

Question 28

Falciform ligament

Answer 28

• inner surface of the right upper quadrant

- connects the anterior abdominal wall to the surface of the liver

Question 29

Median Umbilical Fold

Answer 29

A midline fold extending inferiorly from the umbilicus, containing the obliterated urachus

Question 30

Medial Umbilical Fold

Answer 30

Paired folds extending inferiorly from the umbilicus, containing the obliterated umbilical arteries

Question 31

Lateral Umbilical Folds

Answer 31

They don’t pass upward toward the umbilicus

-paired folds containing the inferior epigastric artery and vein

Question 32

Deep Inguinal Rings Location

Answer 32

Lateral to the lateral umbilical folds, observe small depressions that mark these locations

Question 33

Supravesical Fossa

Answer 33

Between the median and medial umbilical folds, potential site for hernia

Question 34

Medial Inguinal Fossa

Answer 34

(location of Hesselbach’s triangle), between the medial and lateral Umbilical folds, potential site for a direct inguinal hernia

Question 35

Lateral Inguinal Fossa

Answer 35

Lateral to the lateral Umbilical folds, potential site for indirect inguinal hernia and the location of the deep Inguinal ring, often identified as a dimple in the peritoneum
-deep opening of the inguinal canal