Anterior wall/ inguinal canal Flashcards
Navel Dermatome
T10
Gubernaculum
is a fibrous band extend from the caudal part of testis. It plays a role in the decent of the testis
Processus vaginalis
is a diverticulum or out pouching of the peritoneum
Abdominal wall derivative of dartos fascia and dartos muscle?
Subcutaneous tissue (campers fascia = superficial, forms dartos fascia) (scarpa's fascia = deep, forms dartos muscle, continuous with fascia of perineum aka Colle's fascia)
Abdominal wall derivative of external spermatic fascia?
External oblique muscle
Abdominal wall derivative of cremaster muscle/ fascia?
Internal oblique muscle/ fascia of internal oblique muscle
Abdominal wall derivative of internal spermatic fascia?
Transversalis fascia
Abdominal wall derivative of tunica vaginalis?
Peritoneum
Tunica vaginalis
is the pouch of serous membrane that covers the testes. It is derived from the vaginal process of the peritoneum, which in the fetus precedes the descent of the testes from the abdomen into the scrotum
Tunica albuginea
connective tissue covering testis
Inguinal canal
- oblique passage in the lower anterior abdominal wall
- 4cm long
- directed downward, forward, and medially
- greater in men than women
Fascia transversalis
- has the deep inguinal ring
- forms the posterior wall of the canal
- represented in the scrotal layers as internal spermatic fascia
Inguinal triangle (Hesselbach’s triangle)
Medially: linea semilunaris
Laterally: inferior epigastric vessels
Inferiorly: inguinal ligament
Deep inguinal ring
Males: spermatic cord
Females: round ligament
oval opening which lies in the transversalis fascia
Internal oblique features:
- directed up
- low arching fibers
- forms roof of the canal
- represented in scrotal layers as cremaster
Transversus abdominis features:
- directed transverse
- high arching fivers, together with the internal oblique forms Conjoint Tendon
- forms roof of the canal
External oblique features:
- directed “putting your hands in your pocket”
- superficial inguinal ring
- forms the anterior wall of the canal
- forms inguinal ligament which is the floor of the canal
- represented as external spermatic fascia
What 2 structures pass through the superficial inguinal ring?
Spermatic cord/ round ligament
Ilioinguinal nerve
What passes through the deep inguinal ring?
Spermatic cord/ round ligament
Inguinal canal boundaries?
Anterior: EO aponeurosis, IO fibers
Posterior: Transversalis fascia, conjoint tendon
Roof: arched fibers of IO (low arched) and transverses abdomens (high arched)
Floor: inguinal ligament
Spermatic cord 3 coverings?
external spermatic fascia, cremaster fascia, internal spermatic fascia
Spermatic cord 3 arteries?
testicular artery, cremastric artery, artery of vas
Spermatic cord 3 nerves?
Genital branch of genitofemoral
sympathetic plexus around testicular A
Sympathetic plexus around artery of Vas
Inguinal hernia
Protrusion of abdominal contents (usually intestine) within a sac of peritoneum into the inguinal region
Indirect inguinal hernia
Traverses inguinal canal within the spermatic cord (lateral to inferior epigastric vessels)
Direct inguinal hernia
External and parallel to the spermatic cord (medial to inferior epigastric vessel)
Conjoint tendon
descends behind the superficial inguinal ring to be attached to pubic crest & pectineal line so it aids extra support to the superficial inguinal ring
Direct: predisposing factors
weakness of anterior abdominal wall in inguinal triangle (ex. owing to distended superficial ring, narrow, inguinal falx, or attenuation of aponeurosis in males >40 years of age)
Indirect: predisposing factors
Potency of processus vaginalis (complete or at least superior part) in younger persons, the great majority of which are males
Hernia frequency
Direct: less common, 1/3
Indirect: more common, 2/3
Hernia exit from abdominal cavity
Direct: peritoneum plus transversalis fascia (lies outside inner one or tow fascial coverings of cord)
Indirect: peritoneum of persistent processus vaginalis plus all three fascial coverings of cord/ round ligament
Direct hernia course
passes through or around inguinal canal, usually traversing only medial third of canal, external and parallel to vestige of processes vaginalis
Indirect hernia course
traverses inguinal canal (entire canal if it is of sufficient size) within processes vaginalis
Exit from anterior abdominal wall
Direct: via superficial ring, lateral to cord, rarely enters scrotum
Indirect: via superficial ring inside cord, commonly passing into scrotum/ labium majus
Contents of the rectus sheath
Rectus abdominis and pyramidalis
Superior and inferior epigastric vessels
Lower 6 intercostal nerves
Rectus sheath above arcuate line
Anterior: internal and external oblique fuse
Posterior: internal and transverse fuse
Rectus sheath below arcuate line
Anterior: internal, external, and transverse fuse
Posterior: rectus abdominis contacts with transversals fascia
Linea alba
tendinous median raphe between the two rectus abdominis muscles, from by the fusion of the aponeuroses of the external, internal, and transverse muscles
extends from xiphoid process to the pubic symphysis
Linea semilunaris
curved line along the lateral border of rectus abdominis
Arcuate line
crescent shaped line marking the inferior limit of the posterior layer of the rectus sheath; anterior to line that inferior epigastric artery to enter sheath
Inguinal triangle
Medially: linea semilunaris (lateral edge of rectus abdomenus)
Laterally: lateral umbilical fold (formed by the inferior epigastric vessels)
Inferiorly: inguinal ligament
Umbilical folds
in the suprapubic region, the parietal peritoneum is raised into 5 folds by 5 structures and run in the extra peritoneal tissue
Median umbilical fold
raised by median umbilical ligament (fibroses urachus)
extends from apex of the urinary bladder towards the umbilicus
Medial umbilical folds (2)
raised by medial umbilical ligaments (obliterated umbilical artery)
Lateral umbilical ligaments (2)
raised by the inferior epigastric arteries in their way to rectus sheath
