Anterior Wall Flashcards
What are the two layers of superficial fascia?
Superficial fatty = fascia of campers
- continues into scrotum where if forms dartos fascia
dee membranous = fascia of scarpas
- continues into srotum where it helps to form dartos muscle by tracing it backwords
- continuous with fascia of perineum (colles fascia)
What are the three antero-lateral muscles?
1 external oblique
2 internal oblique
3 transversus abdominis
What are the three close to the midline?
1 rectus abdominis
2 pyramidalis
3 cremaster muscle
Dartos
thin layer of muscle fibers around the scrotum
External oblique
origin: external surfaces of ribs 5-12
insertion: linea alba, pubic tubercle, anterior half of iliac crest
innervation: ventral rami of six inferior thoracic nerves
main actions: compresses and supports abdominal viscera, flexes and rotates trunk
hand in pocket- down, forward, medial
Internal oblique
origin: thoracolumbar fascia, anterior 2/3 iliac crest, lateral half of inguinal ligament
insertion: inferior borers of ribs 10-12, linea alba, pubis via conjoint tendon
innervation: ventral rami of six inferior thoracic and first lumbar nerves
main actions: compresses and suoports adominca viscera, flexes and rotates trunk
hand in other pocket: up, forward, medial
Pyramidalis
origin: body of pubis, anterior to rectus abdominis
insertion: linea alba
innervation: iliohypogastric nerve
main actions: tenses linea alba
rectus abdominis
origin: pubic symphysis, pubic crest
insertion: xiphoid process, costal cartilagese 5-7
innervation: ventral rami of six inferior thoracic nerves
main actions: flexes trunk, compresses abdominal viscera
Tranversus abdominis
origin: internal surfaces of costal cartilages 7-12, thoracolumbar fascia, iliac crest, lateral third of inguinal ligament
insertion: linea alba with aponeurosis of internal oblique, pubic cfrest, and pecten pubis via conjoint tendon
innervation: ventral rami of six inferior thoracic and first lumbar nerves
main actions: compresses and supports abdominal viscera
Where does the inguinal ligament attach?
between anterior superior iliac spine and public tubercle
What are the 3 remaining abdominal wall layers?
1 transversalis fascia
2 extraperitonieal connective tissue
3 peritoneum
What is cremaster muscle derived from?
lower arched fibers of internal oblique
muscle fibers desecend on spermatic cord to form loops around it
what does the cremaster muscle do?
suspends testis and cremasteric reflex
keeps testical temperature regulated
inserted into pubic tubercle
supplied by genital branch of gentiofemoral nerve
what forms the rectus sheath?
aponeurotic sheath
fusion of external oblique, internal oblique, transverse muscles of abdomen
What is in the rectus sheath?
2 muscles
- rectus abdominis and pyramidalis
2 vessels
- superior and inferior epiastric vessels
lower 6 intercostal nerves
t/o umbilicus
What divides the walls of the sheath?
arcuate line
What is above the arcuate line in the anterior layer of the sheath?
aponeuroses of the xternal and internal oblique muscles
what is above the arcuate line in the posterior layer of the sheath?
aponeuroses of the internal oblique and transverse abdomininis muscles
What is below the arcuate line in the anterior layer of the sheath?
aponeuroses of the external olbique
internal oblique
and transverse abdominis
What is below the arcuate line in the posterior layer of the sheath?
rectus abdominis is in contact with the trasverasalis fascia
What are the three lines that the rectus abdominis relates to?
1 line alba
2 linea semilunaris
3 arcuate line
Why is the linea alba important for surgery?
good for cutting becasue it doesnt bleed a lot
What is the linea alba>
tendinous median raphe between the two rectus abdominis muslces
formed by the fusion of the aponeuroes of the external oblique, internal oblique, and transverse abdominal muscles
extends from the xiphoid process to the pubic symphysis
what is the linea semilunaris?
curved line along the lateral border of the reectus abdmoninis
what is the arcuate line>
cresecnet shaped line marking the inferior limit of the posterior layer of the rectus sheath
the inferior epigastric artery ascends to ender the shealth anterior to the line
when do the testis descend?
by 26 weeks
Where do the testis descend?
retroperitoneally (external to peritoneum)
from the superior lumbar region to the posterior abdmonial wall to the deep inguinal rings
drags vessels and nerves from posterior abdominal wall
occurs as the fetal pelvis enlarges and body or trunk of embryo elongates
What is the gubernaculum?
a mesenchymal band that extends from the caudal part of the testis along the course of its descent (in the inguinal canal) to blend with the scrotal fascia
plays a role in descent of testis
What is the processus vaginalis?
diverticulum of peritoneum
layer of abdomen
How do the gubernaculum and processus vaginlis relate?
gubernaculum forms path through anterior abdominal wall
processus vaginlis follows during formation of inguinal canal
anchors the tsetis to the scrotum ad guides descent into the scrotum
What enshealths the testis and ductus deferens as they descend?
fascial extensions of the abdominal wall
What does the exension of transversalis fascia vbecome?
internal spermatic fascia
what does the extension of internal oblique muscle become?
cremasteric muslce
what does the extension of external oblique aponeurosis become?
external spermatic fascia
where do the testis project in the scrotum?
distal end of the processus vaginalis
what happens to the processus during perinatal period?
stalk obliterates, and tunifa vaginais
What muscle is not represnted in the testical?
transversus abdominius
Why does dartos replace fascia for helping the cremaster?
fascia = too hot
What is the inguinal canal formed in relation to?
relocation of gonads (ovary or testes) during fetal development
Where is the inguinal canal?
oblique passage in the lower part of the anterior abdominal wall just about the medial 1/2 of the inguinal ligament
How big is the inguinal canal?
4 cm long
directed downwards, forwards, medially (like external oblique)
bigger in males than females
What are the start and end points of the inquinal canal?
begins at deep inguinal ring
ends at superficial inguinal ring
what are the boundaries of the inguinal canal?
anterior wall:
external oblique aponeurosis
internal oblique fibers (lateral 1/3)
posterior wall:
transversalis fasia
conjoint tendon (medial 1/3)
roof: arched fivers of internal oblique (low arched) transversus abdominis (high arched)
floor: inguinal ligament
What are the 3 features of the transversalis fascia?
1 lines the inner surface of transversus abdominis muscle as posterior wall of the canal
2 represented in scrotum as internal spermatic fasia
3 has the eep inguinal ring
Describe the deep inguinal ring?
oval opening in the trasversalis fascia
lateral to the inferior epigastric vessels
spermatic cord in males (or round ligment of uterus) pass through deep inguinal ring
What structures pass through the deep inguinal ring?
spermazotc cord in males
round ligament of uterus in females
What are the boundaries of the inquinal triangle (Hasselbachs triangle)?
medial: ilnea semilunaris = lateral edge of rectus abdominis
lateral: lateral umbilical fold (inferior epigastric vessels)
inferiorly: inguinal ligament
What is a common site of direct inguinal hernia?
inguinal triangle
-area of potential weakness = common site
hernia takes path of chord
Which way do fibers of transversus abdominis run?
transverse
except those that originate from inguinal ligament and are high arching
high arching + internal oblique = forms conjoint tendon
forms roof of canal
NOT represented in scrotum
Where do internal oblique fibers run?
most run upward, forward, medially except those that originate from inguinal ligament = low arching fibers
forms roof of canal with transverse abdominis
What forms the conjoint tendon and where does it go?
arching fibers + transversus abdominis
descends behind the superficial inguinal ring to be attqched to pubic crest and pectineal line
aids in extra support to the superficial inguinal ring
roof of canal
what is the relation of the internal oblique with the spermatic cord or round ligament?
anterior, above, posterior
What does the internal oblique represent as in the scrotum?
cremaster muscle
What are the low arches of the internal oblique like?
shutter
close when contracted to keep things from entering the canal
Describe the external oblique
hand in pocket
fibers run downward, forward, medial
forms anterior wall of canal
represnted in scrotum as external spermatic fascia
has the superficial inguinal ring
What two structures go through the superficial inguinal ring?
1 spermatic chord (male)
or round ligament (female)
2 ilioinguinal nerve
Describe the inguinal ligament
lower thickening border of the external oblique (folded upon itself)
forms floor of inquinal camal
gives partial orgin to internal oblique and Trans abdo (archinging)
lacunar ligament extension
What is the lacunar ligament>
a triangular posterior extension from the medial end of the inguinal ligament
Describe the superficial inguinal ring?
triangluar opening in external oblique aponeurosis superolateral to pubic crest base is pubic crest sides are medial and lateral crura all things pass through as cord
What does the ilioinguinal nerve pierce?
1 pierces transversus abdominis
-runs between it and internal oblique
2 pierces lower part of internal oblique
-enters canal to eit through superificial inguinal ring
Is the iliohypogastric nerve in the canal?
NO!
Where does the speramitc cord go?
met at deep inguinal ring
transverse the inguinal canal down to
posterior border of testes at scrotum
What are the 3 coverings of the spermatic cord?
1 external spermatic fascia (ex ob m)
2 cremaster muscle and fascia (int ob m)
3 internal spermatic fascia (transv fascia)
What are the 3 arteries in the spermatic cord?
1 testicular
2 cremastric
3 artery of vas
What are the 3 Vs of the spermatic cord?
1 vas deferens
2 pampiniform Venous plexus
3 Vestige of processus Vaginalis (reminent)
What are the 3 nerves of the spermatic cord?
1 genetical branch of genitofemoral nerve
2 sympathetic plexus around testicular artery
3 sympathetic plexus around artery of vas
What is an inguinal hernia?
protrusion of abdominal contents (usually intestine) within a sac of peritoneum into the inguinal region (canal)
much more common in males due to larger canal
What is an indirect hernia?
passes through deep ring, inguinal canal, and superficial ring (transverses canal)
lies lateral to the inferior epigastric artery
more common (2/3 hernias// 20 x more common in males)
congenital- associated with persistence of processus vaginalis
sac = within spermatic cord so commonly passing into the scrotum
What is a direct hernia?
acquired
MEDIAL to inferior epigastric artery
occurs through weakened area of abdominal wall muscles as the hernia pushes its way directly through the posterior wall of the inguinal canal
Through inguinal triangle
hernial sac = external and parallel to spermatic cord.
unusual to reach scrotum
Why do surgeons use the inferior epigastric artery?
landmark for hernias
lateral = indirect medial = direct
What are the 2 tunicas of the testes?
tunica vaginalis = comes from perieem
tunica albuginea = white covering testical
What are the 5 folds of the parietal peritoneum in the suprapubic region?
median umbilical fold
2 medial umbilical folds
2 lateral umbilical ligaments
What is the median umbilical fold?
raised by median umbilical ligament
fibrosed urachus
extend from apex of the urinary bladder towards the umbilicus
What is the medial umblical fold?
raised by medial umbilical ligaments
obliterated umbilical artery
what is the lateral umbilical ligament?
raised by inferior epigastric arteries on their way to rectus sheath
epigastric artery = landmark
What goes through the deep ring during testical descent?
perineu,m and transversalis fascia
What does perineum become?
tunica vaginalis parietal and visceral
What does transversalis fasica become?
internal spermatic fascia
What does internal oblique become?
cremaster m
what does external oblique become?
external spermatic
what does scarpas fascia become?
Dartos
