Abdominal Wall 2
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Transcript of Abdominal Wall 2
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Abdominal Wall (2):
Inguinal Region
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Surface Anatomy
9 regions classification
Subcostal plane:
lowest costal margin,
10 cc, L3
Transtubercular plane:
iliac tubercles
what vertebral level?
Midclavicular planes:
mid clavicle
mid inguinal lig.
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9 Regions
Rt. & Lf. Hypochondriac
Rt. & Lf. Lumbar
Rt. & Lf. Inguinal
Epigastric
Umbilical
Hypogastric (pubic)
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4 Regions classification
Transumbilical plane
IV disc L3-L4
Midsagittal line
symphesis menti
symphesis pubis
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Inguinal Region
The inf. part of anterolateralabdominal wall
Area of weakness:
Passage of spermatic cordthrough a canal (inguinal)
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Inguinal Canal
Superior & parallel to medial ofinguinal ligament
Runs oblique in inferomedial direction
Contents
1:
Male: spermatic cord
Female: round lig. of uterus
2: ilioinguinal n. (L1)
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Openings of Inguinal Canal
Deep inguinal ring (Internal):
entrance to the canal
above the middle of inguinal ligament
Oval opening in transversalis fascia
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Superficial inguinal ring:
Triangular exit
Due to defect in ???
Lateral & Medial (margins) Borders crura
Crura: attachment site for external fasciacovering the spermatic cord
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Walls of the canal
Anterior:
External oblique aponeurosis
reinforced on lat. 1/3 by:
Internal oblique m.
Posterior:
Transversalis fascia
Reinforced medially by:
Insertion of int. oblique &transversus m. (Conjoint tendon)
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Conjoint Tendon
Merging of internal oblique aponeurosis & transversus abdominisaponeurosis to share a common insertion into pubic crest
Locatedposteromedial to
superficial ring
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Walls of Inguinal Canal
Roof:
arching fibers of Internal oblique m. & Transversus m.
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Walls of Inguinal Canal
Floor:
Inguinal Ligament
& Lacunar lig.
Lacunar Lig.:
medial continuation of inguinalligament
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Lacunar Lig.: a small part of inguinal ligament fibers that reflectedfrom pubic tubercle & attach to the pubic ramus
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Spermatic Cord
Contents
Ductus (vas) deferens
Testicular artery
a. to vas defernsCremasteric a.
Testicular Vein (pampiniform plexus)
Autonomic nerve fibersGenital branch of genitofemoral n.
(to cremaster muscle)
Lymphatic vessels
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Cremaster Muscle
Extension from lower part ofinternal oblique m.
Pass with spermatic cord to thescrotum
Fxn.
In cold environment:
elevates testis superiorly
In warm environment:
relaxes & testis descend in thescrotum
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Covering Fasciae of Spermatic Cord
External Spermatic Fascia:
from external oblique m.
attached to superficial ring
Cremasteric Fascia:
the cremaster m.
from internal oblique m.
Internal Spermatic Fascia:
transversalis fasciaattached to deep ring
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Inguinal Hernia
Hernia = L, rupture
Protrusion of abdominal organs to outside through abdominalwall weakness
Diaphragmatic hernia:usually in esophageal opening
-sliding or paraesophageal
Inguinal hernia: (in inguinal region)
Indirect (through inguinal canal)
Direct
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Indirect Hernia
75% of inguinal hernias are indirect
Part of the intestine pass through thecanal
Commonly enters the scrotum
20x males than
females
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Direct Hernia
Usually medial to inf. epigastric a.
In Inguinal triagle area:
inf. epig. A.
rectus abdominis
inguinal lig.
Forms an inguinal sac by
transversalis fascia
Doesnot enter the scrotum
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M - muscles
A aponeuroses
L - ligaments
T - transversalis/tendon