Anterior Abdominal Wall, Inguinal Region, Testis Flashcards
Layers of abdominal wall
- Skin
- Superficial fascia (Camper’s)
- Membranous layer of superficial fascia (Scarpa’s)
- 3 layers of abdominal muscles w/ corresponding 3 layers of overlaying deep fascia
- Transversalis fascia
- Parietal peritoneum
Surface anatomy of abdominal wall
- Linea abla
- Semilunar lines (bilateral)
- Tendinous intersections
- Umbilicus
- Inguinal ligaments
What nerves innervate the abdomen?
Thoracoabdominal:
- T7
- T8
- T9
- T10 (umbilicus)
- T11
- T12 (subcostal)
Nerves from lumbar plexus:
- L1 (iliohypogastric + ilioinguinal) (just above pubic symphysis)
Name the anterior abdominal wall muscles
1) External oblique (hands in pockets)
2) Internal oblique (perpendicular)
3) Transverse abdominal (horizontal)
4) Rectus abdominis (vertical)
Where does the rectus abdominis sheath change orientation and in what manner?
- Arcuate line
- Below umbilicus, internal abdominal oblique aponeurosis + transverse abdominal aponeurosis move to front of rectus abdominis muscle + transversalis fascia is the only thing posterior to RAM
Which abdominal muscles do the neurovascular bundles run in between?
- Internal oblique
- Transverse abdominal
Name the 3 folds of the anterior abdominal wall
1) Median umbilical fold
2) Medial umbilical folds
3) Lateral umbilical folds
Name the 3 fossae formed by the umbilical folds
1) Supravesical fossa
2) Medial inguinal fossa
3) Lateral inguinal fossa
Name the 3 structures that form the umbilical folds
1) Remnant of urachus –> median
2) Obliterated umbilical artery –> medial
3) Inferior epigastric artery + vein –> lateral
What is located in the medial inguinal fossa?
Superficial inguinal ring
What is located in the lateral inguinal fossa?
Deep inguinal ring
What are the borders of the inguinal triangle of Hesselbach?
- Medial = lateral border of the rectus abdominis muscle
- Lateral = inferior epigastric vessels
- Inferior = inguinal ligament
What is the significance of the inguinal triangle of Hesselbach?
Most direct hernias protrude through this
Name the 3 fascia of the scotrum + their origins
1) External spermatic fascia –> external abdominal oblique aponeurosis
2) Cremaster muscle + fascia –> internal abdominal oblique muscle
3) Internal spermatic fascia –> transversalis fascia
*Note: transverse abdominal muscle does not contribute to scrotal fascia
What is the Dartos muscle and where does it originate from?
- Wrinkles the skin of the scrotum
- Originates form Scarpa’s fascia
What are the contents of the spermatic cord?
1) Ductus deferens
2) Testicular artery
3) Pampiniform plexus of veins
What can be traced back to by following the spermatic cord?
Superficial inguinal ring
Inguinal hernia
Protrusion of a portion of an abdominal structure through the superficial inguinal ring
How to classify hernias based on contents
- Reducible
- Irreducible/incarcerated/obstructed
- Strangulated
Direct vs indirect inguinal hernias
Direct
- Medial to inferior epigastric vessels
- Always outside internal spermatic fascia
Indirect
- Lateral to inferior epigastric vessels
- Always within internal spermatic fascia
Which type of inguinal hernia tends to occur in older men?
Direct
Which type of inguinal hernia tends to occur in infants, children, and young adults?
Indirect (oblique)
What passes deep to the inguinal ligament?
- Femoral canal (containing deep inguinal LNs)
- Femoral sheath (containing femoral artery + vein)
- Femoral nerve
What type of hernia is more common in females?
Femoral hernia
Herniorrhaphy
- Surgical repair of hernia
- Many methods to push bulging tissue back + remove hernia sac
- Tension free (mesh) repairs
- Laparoscopic repairs –> transabdominal preperitoneal approach (TAPP)
Where is the primary site of sperm development?
Seminiferous tubules
Tunica vaginalis
Pouch of serous membrane that covers the testes
Name layers of the tunica vaginalis
- Parietal (outer)
- Visceral (inner)
- Cavity in between
Hydrocele
- Accumulation of fluid within tunica vaginalis
- Can see w/ US
- Qualifies as a scrotal mass
Name the types of scrotal masses
- Hydroceles (simple, of the cord, connecting, communicating w/ hernia)
- Varicocele (“bag of worms”)
- Spermatocele
- Testicular cancer
