Abdominal walls and hernias Flashcards
Define fasciae
a sheet or band of fibrous tissue such as lies deep to the skin or invests muscles and various body organs
Which structures does the abdominal wall extend between?
Anterior aspect of the ribcage and the pelvic girdle
How many muscle are there in the anterolateral abdominal wall?
5
List the 5 muscles in the anterolateral abdominal wall by category - 3 flat and 2 vertical
Flat: transversus abdominis, internal oblique and external oblique
Vertical: rectus abdominis and pyramidalis muscles
List the anterolateral abdominal wall muscles form deepest to most superficial
Transversus abdominis
Rectus abdominis
Internal oblique
External oblique
What is the linea alba composed of and where is it connected to?
A mainly connective tissue fibrous structure formed form the fusion of the aponeuroses of the abdominal muscles. It connects the xiphoid process to the pubic symphis
Which structures does the linea alba separate?
Left and right rectus abdominus muscles
In which direction does the internal oblique muscles run?
Diagonally ‘up’ from lateral to medial
In which direction does the external oblique muscle run?
Diagonally ‘down’ from lateral to medial - like someone putting their hands in their pockets!
What are aponeuroses?
Layers of flat broad tendons
What is the rectus sheath and what structures does it enclose?
It is formed from the aponeuroses of the transversus abdominis, internal and external oblique muscles.
It encloses the rectus abdominis muscles and the pyramidalis muscles
Define the 9 regions of the abdominal area
right hypochondriac region epigastric region left hypochondriac region right lumbar region umbilical region left lumbar region right iliac region hypogastric region left iliac region
What path does a direct hernia follow as it leaves the abdomen?
It passes through a weakness in the anterior abdominal wall = Hesselbach’s triangle.
Medial to the inferior epigastric vessels, above the inguinal ligament
What are the borders of Hesselbach’s triangle?
Inguinal ligament
Inferior epigastric vessels
Lateral border of rectus abdominus muscles
Where does an indirect hernia pass through?
Lateral to the inferior epigastric vessels, above the inguinal ligament and through the deep inguinal ring into the inguinal canal. If the pocessus vaginalis has failed to close the hernia can pass through the inguinal ring, out of the superficial inguinal ring and even into the scrotum
Which type of hernia can descend into the scrotum?
Indirect hernia - depending on where the processus vaginalis obliterates
Where does a femoral hernia pass?
Below the inguinal ligament
Which structure forms the floor of the inguinal canal?
Inguinal ligament
What forms the posterior wall of the inguinal canal?
Transversalis fascia
The conjoint tendon reinforces the medial aspect of the posterior wall
What forms the roof of the inguinal canal?
Arching fibres of internal oblique and the transverse abdominal muscle
What forms the anterior wall of the inguinal canal?
Aponeurosis of external oblique
What type of hernia might be precipitated by a weakened conjoint tendon?
Direct inguinal hernia
The conjoint tendon serves to reinforce the medial part of the posterior wall of the inguinal canal. It lies behind the superficial inguinal ring. This is the location a direct inguinal hernia can form, so if the conjoint tendon is weakened a direct inguinal hernia is more likely