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GastroIntestinal > Ant Abdominal Wall and Inguinal Lecture (Test 1) > Flashcards

Ant Abdominal Wall and Inguinal Lecture (Test 1) Flashcards

1
Q

The Abdomen

A
  • The Abdomen is the region of the Trunk that is below the Respiratory Diaphragm and above the Pelvic Brim or Inlet

Respiratory Diaphragm:

a) Anteriorly Costal Cartilages of Rib 6
b) Posteriorly Vertebral Body of T12

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2
Q

Contents of the Abdomen

A

1) Peritoneal cavity
2) G.I Organs and associate glands
3) Kidneys, Ureters, and Suprarenal Glands
4) Nerves, Lymphatics, and Blood Vessels

***Abdominal Wall consists of Bones, Muscles, Skin, and Fascia that enclose the Abdominal Cavity

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3
Q

Abdominal Wall Surface Anatomy

A
  • Divided into Anterior, Lateral (Flank, Loin), and Posterior Walls
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4
Q

Abdominal Wall Body Landmarks and Attachments

A

1) Xiphoid Process of Sternum
2) Costal Margins (Right and Left)

3) Iliac Crest and Tubercle of Iliac Crest
a) Anterior Superior Iliac Spine (ASIS)
b) Tubercle of the Iliac Crest

4) Pubic Bone
a) Pubic Symphysis
b) Pubic Tubercle
c) Pubic Crest

5) Linea Terminalis Separates “False Pelvis” from “true Pelvis”
a) Pectin Pubis (Pubic Bone)
b) Arcuate Line (Ilium)
c) Sacral Promontory (Sacrum)

6) Inguinal Ligament (From ASIS to Pubic Tubercle)

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5
Q

Abdominal Wall Soft Tissue Landmarks

A

1) Linea Semilunaris
- Lateral border of Rectus Abdomens Muscle, 5 to 8 cm from Midline

2) Linea Alba (White Line in midline from Xiphoid to Pubic Symphysis)
a) Divides Anterior Wall into Right and Left halves
b) Bloodless

3) Umbilicus (Naval)

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6
Q

Planes or Lines of Reference; Divide Abdomen into Regions and Quadrants

HORIZONTAL PLANES

A

1) SUBCOSTAL
- 10th Costal Cartilages
- Superior Border of LV3

2) TRANSTUBERCULAR
- Tubercles of Iliac Crest
- Body of LV5

3) SUPRACRISTAL
- Highest points of Iliac Crest
- Spinous Process of LV4

4) TRANSUMBILICAL
- Passes through LV3-4 disc
- Almost corresponds with Supracristal Plane

5) TRANSPYLORIC
- Halfway between Jugular Notch and Pubic Symphysis
- Body of LV1
- Passes through Pyloric Sphincter

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7
Q

Planes or Lines of Reference; Divide Abdomen into Regions and Quadrants

VERTICAL (SAGITTAL) PLANES

A

1) Midclavicular (Lateral) Planes
- Midpoint of Clavicle
- Midinguinal Point

2) Midsagittal (Median)
- Linea Alba
- Passes through Umbilicus

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8
Q

Midsagittal and Transumbilical (or Supracristal) Planes = 4 Quadrants

A

1) RIGHT UPPER (RUQ)
a) Gallbladder
b) Duodenum
c) Right Pleura
d) Right Lobe of the Liver

2) LEFT UPPER (LUQ)
a) Spleen
b) Stomach
c) Left Pleura
d) Tail of the Pancreas

3) RIGHT LOWER (RLQ)
a) Right Ureter
b) Cecum
c) Ileal Diverticulum
d) Vermiform Appendix

4) LEFT LOWER (LLQ)
a) Left Ureter
b) Sigmoid Colon

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9
Q

Quadrants Describe

A

1) General Location of Pain
2) Palpable or Audible Abnormalities
3) Specific Viscera

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10
Q

Abdominal Regional System

A

Subcostal, Transtubercular (or Supracristal) and Midclavicular Planes = 9 Regions

1) Right Hypochondriac (RH)
2) Left Hypochondriac (LH)
3) Right Lumbar (RL)
4) Left Lumbar (LL)
5) Right Inguinal (RI)
6) Left Inguinal (LI)
7) Epigastric Region (Epigastrium)
8) Umbilical Region
9) Hypogastric Region (Hypogastrium)

***Describe locations of pain, tumors, etc

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11
Q

Muscles anf Aponeurosis of Abdominal Wall

ORGANIZED in 3 GROUPS

A

1) ANTERIOR:
- Rectus Abdominus
- Pyramidalis

2) ANTERIOLATERAL:
- External Abdominal Oblique
- Internal Abdominal Oblique
- Transversus Abdominis Muscle

3) POSTERIOR:
- Iliac
- Psoas Major and Minor
- Quadrates Lumborum

**The 3 pairs of Flat, Layerd Muscles with fibers running in DIFFERENT Directions, STRENGTHEN WALL!!!!

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12
Q

Clinical: Abdominal Surgery

A
  • In Abdominal surgery, each layer is TRANSVERSED by Splitting it PARALLEL to its FIBERS, rather than Cutting across the Fibers.
  • When Fibers are CUT PERPENDICULAR to their Axis, they scar so that the layers ADHERE to ONE ANOTHER and MAKE NORMAL MOVEMENTS PAINFUL
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13
Q

External Abdominal Oblique

A

1) FIBERS:
- Supero-lateral ORIGINS to Infero-Medial INSERTIONS

2) External Oblique Aponeurosis begins MIDCLAVICULAR LINE

3) SPECIALIZED PARTS:
A) LINEA ALBA

B) INGUINAL LIGAMENT

  • Lower Margin of Aponeurosis (Rolls Under)
  • Attached to ASIS and Pubic Tubercle

C) SUPERFICIAL INGUINAL RING

  • Triangular opening in External Oblique Aponeurosis
  • Lateral Crus
  • Medial Crus
  • Intercrural Fibers (Reinforcing Fibers, Run Perpendicular to the Crura and Join them)

D) LACUNAR LIGAMENT

  • “Extension” of the Inguinal Ligament
  • Crossed by Spermatic Cord
  • Attaches to Pectineal Line LATERAL to PUBIC TUBERCLE
  • Crescent-shaped (Concave) Lateral Free Border (Sharp)
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14
Q

Internal Abdominal Oblique

A

1) FIBERS:
- Inferolateral Origins to Superomedial Insertions

2) Usually run PERPENDICULAR to EXTERNAL OBLIQUE
3) In hypogastric and Inguinal Regions they run PARALLEL to the Fibers of the External Oblique APONEUROSIS and provide support for Abdominal Wall

4) SPECIALIZED PARTS:
A) CREMASTER MUSCLE:
- Muscular Layer of Spermatic Cord
- Derived from Internal Oblique Muscle

B) CONJOINT TENDON (Falx Inguinalis)

  • The MOST MEDIAL and Inferior Tendinous fibers of Internal Oblique
  • Join with similar fiber os Transverses Abdomens
  • Attaches MEDIALLY to Linea Alba
  • Has a LATERAL FREE BORDER
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15
Q

Transversus Abdominis

A

1) Innermost layer of Muscles
2) Fibers of Muscle and Aponeurosis run mostly Horizontal
3) Becomes Aponeurosis at about Linea Semilunaris
4) Joins with Internal Oblique in forming CONJOINT TENDON
5) Nerves and Vessels run BETWEEN the Internal Abdominal Oblique and the Transverses Abdomens Muscle Layers (Similar to Intercostals Muscles)

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16
Q

Rectus Abdominis

A

1) Pair of Strap like, Vertical Muscles
- Broad and Flat Superiorly
- Narrow and Thick Inferiorly

2) Crossed by Tendinous Intersections
3) Enclosed within specialized Rectus Sheath (Fuses with Intersections)

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17
Q

Pyramidal Muscle

A

1) Lies ANTERIOR to INFERIOR End of Rectus Abdomens
2) Between Linea Alba and Pubic Crest
3) Tenses the Linea Alba

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18
Q

Actions of Abdominal Muscles

A

1) FLEXION of Trunk and Pelvis:
- Contraction of EO, IO, and RA Muscles BILATERALLY

2) ABDUCTION (Lateral Flexion) of Trunk:
- Contraction of EO on one side with IO on one side

3) ROTATION OF TRUNK:
- Contraction of EO on one side with IO on other side
- Fibers of EO on one side run in same direction as those of IO on other side

4) RESPIRATION:
- Assist in FORCED EXPIRATION by Compressing Abdominal contents, Forcing Viscera up AGAINST DIAPHRAGM

5) FIXATION OF ABDOMINAL WALL:
- Contraction of Abdominal and Thoracic Muscles together, with Glottis closed, Raises Throacoabdominal Pressure (VALSALVA MANEUVER)

6) ABDOMINAL WALL MUSCLES ALSO ACT IN:
- Coughing, Sneezing, Urination, Defecation, Emesis, Parturition

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19
Q

Deep Fascia of Abdominal Wall (Inventing Fascia of Abdominal Muscles)

A

1) Thin, Tough Investing Fascia of Muscles and Aponeurosis
2) “STOPS” at the thigh as it fuses with Fascia Lata
3) Continues over SPERMATIC CORD as EXTERNAL SPERMATIC FASCIA
4) Continues over PUBIS and PERINEAL MUSCLES as DEEP PERINEAL FASCIA
5) Continues over PENIS/CLITORIS as DEEP PENILE/ CLITORAL FASCIA

6) Thoracolumbar Fascia of Lumbar Region of back and Anterolateral Abdominal Wall
- Origin of Internal Oblique and Transverses Abdomens Muscles
- Splits into 3 Laminae that enclose DEEP BACK MUSCLES and Quadrates Lumborum Muscle of Posteior Abdominal Wall

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20
Q

Fascial Layers associates with Anterior Abdominal Wall Muscles

RECTUS SHEATH

A

1) Encloses Rectus Abdomens (And Pyramidalis if present)
2) Contains Anterior Rami of Lower 6 Thoracic Nerves, Superior and Inferior Epigastric Vessels and Lymphatics
3) Formed by Fusion of External Oblique, Internal Oblique, and Transverses Abdomens Aponeurosis

4) ABOVE the ARCUATE LINE; Internal Oblique Aponeurosis is split into 2 layers:
a) The ANTERIOR Layer of SHEATH is formed by FUSION of EXTERNAL OBLIQUE APONEUROSIS and Anterior portion of the SPLIT INTERNAL OBLIQUE APONEUROSIS

b) The POSTERIOR Layer is formed by fusion of the Posterior Layer of the Split Internal Oblique Aponeurosis and the Transverses Abdomens Aponeurosis

5) BELOW the ARCUATE LINE:
a) The ANTERIOR Layer is formed by Fusion of APONEUROSIS of ALL THREE MUSCLES: External Oblique, Internal Oblique, and Transverses Abdominis

b) There is NO POSTERIOR Layer in this area, where Rectus Abdomens lies DIRECTLY on the TRANSVERSALS FASCIA

6) ARCUATE LINE:
- INFERIOR Free Edge of the POSTERIOR Part of the Rectus Sheath
- Located about midway between Umbilicus and Pubic Crest (or Symphysis)

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21
Q

Fascial Layers associates with Anterior Abdominal Wall Muscles

Transversals Fascia

A

1) Thin, rather Transparent membrane
2) Lies on DEEP SURFACE of Transverses Abdomens Muscle and Aponeurosis

3) Specialized regions (named according to structures it is associated with)
- Diaphragm
- Iliac Muscle
- Psoas Muscle
- Femoral Artery

4) Separated from Peritoneal Membrane (Lining of Abdominal Cavity) in some areas by layer of Extra Peritoneal fat

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22
Q

Fascial Layers associates with Anterior Abdominal Wall Muscles

Linea Alba

A

“WHITE LINE”

1) Anterior Midline where Aponeurotic Fibers of the RECTUS SHEATH interlace to form a TOUGH RAPHE

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23
Q

Layers of Abdominal Wall at level of Umbilicus, just lateral to Midline, through the Rectus Sheath are:

A

1) Skin

2) Superficial Fascia (Subcutaneous Tissue)
- Fatty Superficial (Camper’s) Layer
- Membraneous Deep (Scarpa’s) Layer

3) Anterior Layer of Rectus Sheath
4) Rectus Abdominis Muscle
5) Posterior Layer of Rectus Sheath
6) Transversals Fascia
7) Extra Peritoneal (Subserous) Connective tissue and fat
8) Peritoneum

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24
Q

Arterial Supply of Anterior Abdominal Wall

A
  • Arterial supply to Abdominal wall is derived from several sources, providing opportunities for Collateral Circulation via ANASTOMOSES between the sources
    1) Superficial and Deep Vascular Beds

2) Deep Vessels course within the Muscular Layer
- Originate SUPERIORLY from SUBCLAVIAN Artery
- Originate in Mid-Abdomen from Aorta
- Originate INFERIORLY from External Iliac Artery

3) Superficial Vessels course in the SUBCUTANEOUS Connective Tissue
- Originate from perforation branches of deeper Vessels located within Muscular Layer
- Also originate from Branches of the Femoral Artery

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25
Q

The Deep Vascular System

A

1) Superior Epigastric Artery
A) Arises from the Internal Thoracic Artery, (A Branch of the Subclavian) which divides into Musculophrenic and Superior Epigastric Artery

B) Enters Rectus Sheath beneath Costal Margin

C) Anastomoses with Inferior Epigastric Artery within Rectus Abdomens Muscle

D) Supplies Upper Central Part of Anterior Abdominal Wall

2) Inferior Epigastric Artery
A) Arises from External Iliac Artery just above Inguinal Ligament

B) Runs SUPEROMEDIALLY along Medial Side of Deep Inguinal Ring

C) Courses toward Umbilicus in Exztraperitoneal (Subserous) Connective Tissue, raising along with its accompanying Vein the Lateral Umbilical Fold on the Internal Aspect of Anterior Abdominal Wall

D) Pierces Transversals Fascia at level of Arcuate Line to enter the Rectus Abdomens

E) Anastomoses with superior Epigastric Artery within Rectus Abdominis Muscle

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26
Q

Clinical Note: Epigastric Artery Anastomoses

A
  • Epigastric Arterial Anastomoses can provide COLLATERAL Circulation to lower part of Body when the Aorta is occluded.
  • Pulsations of Epigastric Arteries in such a case can erode the Adjacent ribs, producing a Radiographically observable “NOTCHED RIB” sign
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27
Q

Other Major (Deep) Anterior Abdominal Arteries

A

1) MUSCULOPHRENIC ARTERY:
- Arises by Bifurcation of Internal Thoracic Artery
- Courses along Costal Margin
- Supplies branches to Abdominal Wall and Diaphragm

2) POSTERIOR INTERCOSTAL ARTERIES 10 & 11; Subcostal Artery
- Arise from Thoracic Aorta and extend Ventromedially beyond Costal Margin onto Abdominal Wall, lying between Transverses Abdomens and Internal Oblique
- Enter Rectus Sheath laterally to Anastomose with Epigastric Arteries

3) LUMBAR ARTERIES:
- Abdominal counterparts of POSTERIOR INTERCOSTAL ARTERY
- Four on each side arise form Abdominal Aorta at level of LV1-4, course laterally to provide Branches to Posterior and Posterolateral Abdominal Wall Muscles

4) DEEP CIRCUMFLEX ILIAC ARTERY:
- Arises from External Iliac Artery
- Runs deep to Inguinal Ligament toward ASIS, then along Iliac Crest
- Suplies deep Inguinal Region of Lower Lateral Part of Abdominal Wall
- Anastomoses with Lower Intercostal Arteries by an Ascending Branch

28
Q

The Superficial Arteries arise from Femoral Artery (Run in Superficial Fascia)

A
  • Superficial Circumflex Iliac Artery (To Iliac Region)
  • Superficial Epigastric Artery (To Umbilical Region)
  • External Pudendal Artery (To Suprapubic, Pubic, Genital Regions)
  • Superficial Arteries arising from the femoral Anastomoses with perforating Branches of Deep Arteries
29
Q

Venous Drainage of the Anterior Abdominal Wall

General Consideration

A
  • Superficial and deep Veins tend to run with Arteries of the SAME NAME
30
Q

Superficial Draining (of Skin and Subcutaneous Tissue)

A

1) Rain SUPERIORLY to Axillary Vein via Thoracic and Thoracoepigastric Veins

2) Variably developed connections between Lateral Thoracic Veins (Axillary Vein Tributaries) and Superficial Epigastric Veins (Femoral Vein Tributaries)
- One of these is a System of Veins that follows the former Umbilical Artery (Paraumbilical Veins) and connect to the Superficial Veins within the Fatty Layer f the Anterior Abdominal Wall

  • When these Veins are Enlarged they form a “Caput Medusae”

3) This Superficial System of Veins drains Inferiorly to the Femoral Vein via Superficial Tributaries that empty through Saphenous opening in Femoral Triangle
- Superficial Epigastric Vein, Superficial Circumflex Iliac Vein, Superficial External, Pudendal Vein, All accompany Superficial Arteries of same names

  • May empty INDEPENDENTLY into Femoral Vein
31
Q

Deep Drainage of (Muscular Wall) via Veins that accompany deep arteries of same name

A

1) Tributaries fo Subclavian Vein:
- Superior Epigastric
- Musculophrenic Vein

2) Tributaries to External Iliac Vein:
- Inferior Epigastric
- Deep Circumflex Iliac Vein

3) Tributaries to Inferior Vena Cava: Lumbar Veins

4) Tributaries to Azygous System (Ultimately to Superior Vena Cava):
- Posterior Intercostal Vein 10 and 11
- Subcostal Vein

32
Q

Clinical Note: Veins of Abdominal Anastamose

A
  • Veins of Abdominal Anastomose to a HIGH DEGREE. If IVC is Obstructed, Blood may flow from Inferior Epigastric to Superior Epigastric Vein via Anastomoses, and from there to Subclavian Vein which empties to SVC.
  • Other Anastomoses, between Abdominal Wall Veins and Hepatic Portal System, will be described with Liver
33
Q

Lymphatics of Anterior Abdominal Wall

General Considerations

A

1) Subcutaneous Luympahtics usually drain to Superficial Lymph Nodes located in the Subcutaneous Tissue of THIGH and THORAX (Axilla)
2) Lymphatics of the Muscular Abdominal wall and Testes drain to Internal Nodes of the Abdomen and Thorax

34
Q

Lymphatics of Anterior Abdominal Wall

Superficial Layers (Skin, Subcutaneous Connective Tissue) of Abdomen, Perineum, and External Genitalia drain as follows:

A

1) ABOVE THE UMBILICUS:
- Cutaneous and Subcutaneous Lymphatics drain toward Sternal and Axillary Lymph Nodes

2) BELOW THE UMBILICUS:
- Cutaneous and Subcutaneous Lymphatics drain toward Superficial Inguinal Nodes

(NOTE: The Superficial Inguinal Nodes are arranged in a “T” located just Inferior to the Inguinal Ligament. They receive DRAINAGE from the Lower Abdomen, Perineum and Genitalia, and Lower Limb)

35
Q

Lymphatics of Anterior Abdominal Wall

Lymphatic Drainage of the Muscular Layers of the Abdominal wall parallels the Major Vascular Supplies. Four Main Groups:

A

1) Along the INFERIOR EPIGASTRIC Vessels to the External iliac Nodes (found along the External Iliac Artery)
2) Along the DEEP CIRCUMFLEX ILIAC Vessels to the External Iliac Nodules
3) Along the LUMBAR Vessels to the LUMBAR NODES (Found along the Lumbar part of the AORTA and IVC)
4) Along the SUPERIOR EPIGASTRIC Vessels to the STERNAL NODES (Found along the Internal Thoracic Vessels)

36
Q

Nerves of the Anterior Abdominal Wall

General Considerations

A

1) Dermatomes fo Abdominal Wall are supplied by Cutaneous Sensory Branches of Ventral Rami of Spinal Nerves T7- L1

2) Muscles of Abdominal Wall:
a) Innervated y Ventral Rami of Spinal Nerves T7 - L4
b) Abdominal Branches of T7 - T11 arise from Intercostal Nerves
c) Subcostal Nerves are from T12
d) Abdominal Branches of Ventral Rami of L1-L4 Originate within the LUMBAR PLEXUS

37
Q

Nerves of the Anterior Abdominal Wall

Thoracoabdominal Intercostal Nerves (T7-T12)

A

1) Continue beyond Costal Margin onto Abdominal Wall

2) Lie between Internal Oblique and Transverses Abdomens Muscle
- Run in Neuromuscular Plane
- Run with Arteries and Veins

3) Pierce Rectus Sheath Laterally to Innervate Rectus Abdomens Muscle
4) Supply Skin, Muscles, and Parietal peritoneum

5) Branch from Lateral Cutaneous Branches
- Arise at about Anterior Axillary Line
- Pierce Abdominal Muscles to Reach Dermis
- Bifurcate Into Anterior and Posterior Branches

6) Branch to form Anterior Cutaneous Branches
- Arise as terminal Branches of the Ventral Rami
- Enter Rectus Sheath laterally and exit from it Anteriorly to reach the DERMIS
- Bifurcate int MEDIAL and LATERAL Branches

38
Q

Nerves of the Anterior Abdominal Wall

Lumbar Nerves 1, 2

A

1) Are part of LUMBAR PLEXUS
- Lumbar Plexus is formed by Ventral Primary Rami of T12 through L4 Nerves
- Plexus has Anterior and Posterior divisions

2) ILIOHYPOGASTRIC and ILIOINGUINAL Nerves supply Cutaneous sensation to the Hypogastric, Inguinal, Anterior Perineal, and Superomedial Thigh Regions

A) ILIOHYPOGASTRIC Nerve (L1, Sometimes with contribution from L2 and/ or T12)
- Pierces IO Medial and Superior to the ASIS

  • Runs INFEROMEDIALLY between IO and EO Muscles
  • Sends a Lateral Branch to the Skin of the Gluteal Region
  • Innervates Anterolateral Abdominal Muscles
  • Communicates with Ilioinguinal Nerve
  • Terminates as Anterior Cutaneous Branches to Hypogastric (Suprapubic) Regions

B) ILIOINGUINAL Nerve (L1)
- Lies PARALLEL and Slightly Inferior to ILIOHYPOGASTRIC Nerve

  • Enters INGUINAL CANAL
  • Runs on Surface f SPERMATIC CORD or ROUND LIGAMENT of Uterus
  • Emerges through Superficial Inguinal Ring
  • Supplies Skin of Groin and Scrotum/Labrum Majus

C) GENITOFEMORAL Nerve (L1,L2)
- Exits the Intervertebral Foramen and runs through the PSOAS Major Muscle

  • Divides into a Genital Branch and a Femoral Branch either within the Muscle or after emerging from the Muscle
  • Branches run between the Muscle and the overlying Peritoneum
  • The Genital Branch of the GENITOFEMORAL Nerve ENTERS the DEEP INGUINAL Ring, Passes through the INGUINAL CANAL and emerges through the Superficial Inguinal Ring
  • The GENITAL BRANCH supplies the CREMASTER MUSCLE and Skin of the Scrotum in Males
  • The GENITAL BRANCH supplies the Skin of the LABIA MAJORA in Females
  • The Femoral Branch of the GENITOFEMORAL Nerve exits the Abdomen Inferior to the INGUINAL LIGAMENT (Sometimes through the Femoral Sheath)
  • The FEMORAL BRANCH Supplies the Skin of the Thigh over the FEMORAL TRIANGLE
39
Q

Hernias of the Abdominal Wall

Protrusion of any of the Abdominal contents outside the Abdominal Cavity

A
  • Include Herniations through the Diaphragm
  • Include Herniations at the Umbilicus
  • Include Herniations at any of the other weak spots in the Abdominal Wall
40
Q

Hernias of the Abdominal Wall

Umbilical Hernias in Infants

A
  • The “Scar” of the Umbilicus doesn’t heal completely

- Will usually heal with time

41
Q

Hernias of the Abdominal Wall

Umbilical Hernias in Adults

A
  • Result from a weakened Abdominal Wall around the Umbilicus
  • Usually are SUPERIOR to the Umbilical Scar
  • Are more common in Women
  • Require SURGICAL REPAIR
42
Q

Hernias of the Abdominal Wall

Epigastric Hernias (Hernia of the Linea Alba)

A
  • Do not involve the Umbilicus
  • Are Herniations that protrude through the Linea Alba
  • Usually are SUPERIOR to the Umbilicus
  • Are repaired SURGICALLY if Large or Symptomatic
43
Q

Hernias of the Abdominal Wall

Incisional hernias

A
  • Incisional hernias can occur at Surgical/ Laparotomy sites
44
Q

Hernias of the Abdominal Wall

Spigelian hernia

A
  • Spigelian Hernia is a Hernia at the Semilunar line of the Anterior Rectus Sheath
45
Q

Inguinal Canal Borders

A

Floor: Inguinal Ligament and Lacunar Ligament

Roof: Internal Abdominal Oblique Fibers

Anterior Wall: External Abdominal Oblique

Posterior Wall: Transversals Fascia and Conjoint Tendon

46
Q

Inguinal Canal

A
  • The Inguinal Canal “Starts” at the DEEP Inguinal Ring(About Midpoint of the Inguinal Ligament)
  • The Canal “Ends” at the SUPERFICIAL Inguinal Ring
47
Q

Inguinal Canal Cont

A
  • The Inguinal Canal passes OBLIQUELY trough the 3 layers of Anterolateral Abdominal Wall Muscles
  • The structures within the Inguinal Canal go “Under” the edge of each of these layers in SUCCESSION
  • The Canal “starts” at the DEEP Inguinal Ring (About Midpoint of the Inguinal Ligament)
  • The Canal “Ends” at the SUPERFICIAL Inguinal Ring
48
Q

Muscles involved in Inguinal Canal

A

The “Free” edges of the”

a) Transverses Abdominis
b) Internal Abdominal Oblique
c) External Abdominal Oblique

  • All form “ARCHES” over the structures within the Inguinal Canal
  • When the Abdominal Muscles CONTRACT, the Muscular edges tighten on the structures within the Canal

***CONJOINT TENDON can contract and close off the Opening

**CREMASTER Muscle comes from the INTERNAL Abdominal Oblique

49
Q

Deep Inguinal Ring

A
  • An EVAGINATION of Transversals Fascia

***Ilioinguinal Nerve

Note: The GENITOFEMORAL Nerve, Genital Branch and the ILIOINGUINAL Nerve all run with the Spermatic Cord

50
Q

Relationships

A
  • Ductus Deferens (Round Ligament) exits the Abdomen from POSTERIOR t o the Peritoneal Cavity
  • External Iliac Artery and Vein are POSTERIOR to the Peritoneal Cavity
    a) Once they cross beneath the Inguinal Ligament, they become FEMORAL

b) Inferior Epigastric Arteries and Vens branch from (empty into) them
c) The CREMASTERIC Arteries are also branched
- As the Ductus emerges and goes through the Anterior Wall, it picks up layers as it goes through them

51
Q

Inguinal Canal Contents: Male

A
  • Passes OBLIQUELY through Inferior Abdominal Wall
  • DEEP INGUINAL RING
    a) “Entrance” of Spermatic Cord into Canal
52
Q

Descent of the Testes

A
  • Testes develop RETROPERITONEALLY from the Urogenital ridges of MESODERM in the UPPER LUMBER/ LOEWR THORACIC REGION. They Migrate INFERIORLY!!!
  • Testes are attached to the GUBERNACULUM which is attached Inferiorly to the Labial- Scrotal fold. It guides the Migration!!!!!!!!
  • By the 7th month the Testes have reached the DEEP INGUINAL RING
  • Meanwhile, a pouch of Peritoneal, PROCESSES VAGINALIS develops and pushes into Labial-Scrotal Swelling (Becomes the TUNICA VAGINALIS)
  • As the Testes go through Inguinal Canal, they carry layers of Abdominal Wall Muscles and Fasciae with them
  • The GUBERNACULUM “Shortens” and PULLS the TEstes into the developing Scrotum
  • This processus Vaginalis continues to develop within the Labial-Scrotal Fold
  • Testes are now within the Scrotum (around the time of birth). They slide POSTERIOR to the Procesus Vaginalis which should close
  • The Testes have pulled the Epididymis, Ductus Deferens, Testicular Vessels, Nerves, and Lymphatics with them from the abdomen
  • The Processus Vaginalis (normally) closes off and becomes an isolated pocket of PERITONEUM, the TUNICA VAGINALIS
53
Q

Cryptochidism

A

A) Cryptorchidism: UNDESCENDED Testes

  • Unilateral or Bilateral
  • Often associated with PREMATURITY
  • Men with a history of Cryptorchidism have a higher incidence of Testicular Cancer

B) Hydroceles

C) Hematocele: Blood in the Tunica Vaginalis

54
Q

Testes Descent in Inguinal Canal

A

1) AS the Testes descends through the Inguinal Canal it “acquires” Fascial Layers:
- Internal Speramtic Fascia
- Cremaster Fascia and Muscle
- External Spermatic Fascia
- Tunica Vaginalis (partially covers testes)

55
Q

Corresponding Layers of Anterior Abdominal Wall, Scrotum, and Spermatic Cord

A

Abdominal Wall:

1) Skin
2) Subcutaneous Tissue (Fatty/ Membranous)
3) External Oblique Muscle and Fascia
4) Internal Oblique Muscle
5) Fascia of both Superficial and Deep surfaces of the Internal Oblique Muscle
6) Transversus Abdominis Muscle
7) Transversals Fascia
8) Peritoneum

Scrotum and Covering of Testes:

1) Skin
2) Subcutaneous Tissue (Dartos Fascia) and Dartos Muscle
3) External Spermatic Cord
4) Cremaster Muscle
5) Cremasteric Fascia
7) Internal Spermatic Fascia
8) Tunica Vaginalis (Visceral and Parietal Layers)

Coverings of Spermatic Cord:

2) Dartos Muscle/ Fascia (Including Scrotal Septum)
3) External Spermatic Fascia
4) Cremaster Muscle
5) Cremasteric Fascia
7) Internal Spermatic Fascia
8) Vestige of Processes Vaginalis

***Note: The only layer that is lost in the Scrotum is the TRANSVERSES ABDOMENS MUSCLE!!!!!!!

56
Q

Descent of the Ovaries

A
  • Primative Ovaries are also attached to a GUBERNACULUM which is attached to the Labioscrotal Fold
  • Ovaries descend into the Pelvis, attach to the developing Uterus
  • The Gubernaculum becomes attached to the POSTERIOR area of the developing Uterus
  • The Gubernaculum forms the ROUND LIGAMENTS of the Ovary (Ovarian Ligament) and the Round Ligament of the Uterus
57
Q

Inguinal Canal Contents: Female

A
  • Passes Obliquely through Inferior Abdominal Wall
  • Contains Round Ligament of the Uterus, Ilioinguinal nerve, Genital Branch of the Genitofemoral Nerve
  • DEEP Inguinal Ring: “Entrance” of Round Ligament into Canal
  • SUPERFICIAL Inguinal Ring: “Exit” point of Round Ligament through External oblique Muscle
58
Q

Contents of Spermatic Cord in Males

A

1) Ilioinguinal Nerve
2) Genital Branch of Genitofemoral Nerve
3) Ductus Deferens
4) Pampiniform Plexus (Testicular Veins)
5) Testicular Artery

59
Q

Scrotum

A
  • Fungiform Ligament
  • Suspensory Ligament
  • Scrotal Raphe (Externally)
  • Scrotal Septum (Internally)
  • DARTOS Fascia and DARTOS Muscle
60
Q

Coverings of the Spermatic Cord

A

1) External Spermatic Fascia
2) Cremasteric Fascia and muscle with Genital Branch of Genitofemoral Nerve
3) Internal Spermatic Fascia

All of the Following are surrounded by Internal Spermatic Fascia:

1) Ductus Deferens
2) Artery of the Ductus Deferens
3) Testicular Artery (with Autonomic Nerves)
4) Pampiniform Plexus of Veins
5) Lymphatics (drain to Lumbar Nodes) (With the Veins)

61
Q

Testis and Spermatic Cord

A
  • The Testis and Epididymis are partially covered by the Tunica Vaginalis
    a) Parietal Layer
    b) Visceral Layer

Epididymis:

a) Head
b) Body
c) Tail

  • Ductus Deferens
  • Testes is held to Scrotum by Gubernaculum

Note: The Appendix of the Testis: a Development Remnant of the PARAMESONEPHRIC DUCT)

62
Q

Testis and Epididymis

A
  • EFFERENT Ductules carry Sperm from Testes to HEAD of Epididymis
  • Ductus Deferens is CONTINUOUS with TAIL of Epididymis
  • Ductus Deferens continues through Spermatic Cord into Abdomen
  • **TUNICA ALBUGINEA:
  • Connective Tissue Capsule of the TEstis

***RETE TESTIS

  • **SINUS EPIDIDYMIS:
  • A Space of Visceral Layer of the Tunica Vaginalis

***SEMINIFEROUS TUBULES

63
Q

Femoral Hernias

A
  • Femoral hernias exit the Abdomen through the Femoral Canal, INFERIOR TO THE INGUINAL LIGAMENT
  • Femoral hernias are MORE COMMON in WOMEN than in Men
64
Q

Inguinal Hernias

A
  • Inguinal Hernias are differentiated by their location relative to the INFERIOR EPIGASTRIC Vessels
  • **Ex: Inferior Epigastric Artery
65
Q

DIRECT INGUINAL HERNIA

A
  • The NECK of the Inguinal Hernial Sac is MEDIAL to the Inferior Epigastric Artery
  • Pushes “DIRECTLY” through the Anterior Abdominal Wall through a “WEAK” Inguinal Triangle
  • Usually due to WEAK CONJOINT TENDON
  • Are more often BILATERAL than Indirect Inguinal hernias
  • MORE COMMON in OLDER MALES
66
Q

Indirect Inguinal Hernia

A
  • The Neck of the Hernial Sac lies LATERAL to the Inferior Epigastric Artery
  • Pushes through the Deep Inguinal Ring, through the Canal and exits the Superficial Ring
  • COMMON in YOUNG CHILDREN (Males)
  • Often dur to INCOMPLETE Closure of the Processes Vaginalis
  • MOST INGUINAL HERNIAS ARE INDIRECT!!!!!!!!!!!!!!
67
Q

Folds and Weak Spots in Abdominal Wall

A

FOLDS:
1) Median (Urachus)

2) Medial (Umbilical Artery)
3) Lateral (Inferior Epigastric Artery)

WEAK SPOTS:

1) Lateral Inguinal Fossa (Deep Inguinal Ring)
2) Medial Inguinal Fossa (HESSELBACH’s TRAINGLE)
3) Femoral Ring
4) Supravesical Fossa

***Can fix Hernias by putting a PATCH over all of these WEAK SPOTS!!!!!

GastroIntestinal (21 decks)

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