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Flashcards in abdominal wall and Inguinal region Deck (43):

abdominal cavity is

enclosed anterolaterally by dynamic musculo-aponeurotic abdominal walls
separated superiorly from thoracic cavity and posteriorly from the posterior thoracic vertebrae by the diaphragm
under cover of the thoracic cage superiorly extending to the 4th intercostal space
continuous with pelvic cavity


nine regions of abdominal cavity

right hypochondriac, epigastric, left hypochondriac
right lateral (lumbar), umbilical, left lateral (lumbar)
right inguinal (groin), pubic (hypogastric), left inguinal


planes that divide to 9 regions

horizontal: subcostal plane (through inferior border of 10th cosal cartilage on each side) and transtubercular plane (passing through the iliac tubercles and the body of L5)
vertical: 2 midclavicular planes: passing from midpoint of clavicles to midinguinal points


midinguinal point

midpoint of lines joining anterior superior iliac spines and superior edge of pubic symphysis


planes that define 4 quadrants

transumbilical: through umbilicus and L3/L4 IV disc
median plane: longitudinally through body


median umbilical fold

extending from apex of urinary bladder to umbilicus
covers median umbilical ligament


median umbilical ligament

remnant of urachus that joined apex of fetal bladder to umbilicus


two medial umbilical folds

lateral to median umblical fold
cover medial umbilical ligaments


medial umbilical ligaments

formed by occluded parts of umbilical arteries


two lateral umbilical folds

lateral to medial umbilical folds
cover inferior epigastric vessels


peritoneal fossae

depressions lateral to umbilical folds
location of hernias, determines classification


supravesical fossa

between median and medial umbilical folds
formed as peritoneum reflects from anterior abdominal wall onto the bladder
level rises and falls with filling and emptying of bladder


medial inguinal fossae

between the medial and lateral umbilical folds, areas also commonly called inguinal triangles (Hesselbach triangles)
potential sites for direct inguinal hernias


lateral inguinal fossae

lateral to lateral umbilical folds
include deep inguinal rings and are potential sites for most common type of inguinal hernia: indirect inguinal hernia


incisional hernia

protrusion of omentum (fold of peritoneum) or an organ through a surgical incision or scar


causes of protuberance of abdomen

food, fluid, fat, feces, flatus and fetus


musculophrenic artery

originates off internal thoracic artery
descends along costal margin
distributed along abdominal wall of hypochondriac region, anterolateral, diaphragm


superior epigastric artery

originates off of internal thoracic artery
descends in rectus sheath deep to rectus abdominis
distributed along superior rectus abdominis and superior part of anterolateral abdominal wall


inferior epigastric artery

originates off external iliac artery
runs superiorly and enters rectus sheath
runs deep to rectus abdominis
distributed along inferior rectus abdominis and medial part of anterolateral abdominal wall


drainage of abdominal lymphatic vessels

superior to umbilicus: drain to axillary lymph nodes
inferior: drain to superficial inguinal lymph nodes


inguinal region

extends between anterior superior iliac spine and pubic tubercle


inguinal hernia commonality

86% in males because of passage of spermatic cord through inguinal canal


inguinal ligament

most inferior part of external oblique aponeurosis


iliopubic tract

thickened inferior margin of transversalis fascia
runs parallel and deep (posterior) to inguinal ligament
reinforces posteror wall and floor of inguinal canal as it bridges structures (Hip flexors and neurovascular supply of LL) traversing the retro-inguinal space


lacunar ligament

fibers from inguinal ligament that attach to superior ramus of pubis, lateral to pubic tubercle
fibers continue to run along pectin pubis as pectineal ligament of Cooper


reflected inguinal ligament

fibers of inguinal ligament arch superiorly to blend with contralateral external oblique aponeurosis


inguinal canal

formed in relation to relocation of gonad during fetal development
about 4 cm long in adults
inferomedially directed oblique passage between superficial and deep inguinal rings
lies parallel and just superior to medial half of inguinal ligament


main structures of inguinal canal

spermatic cord: conveying ductus deferens in males and vestigial round ligament of uterus in females
also contains blood and lymphatic vessels and ilio-inguinal nerve


openings of inguinal canal

deep (internal) ring: internal entrance to canal, evagination of transversalis fascia superior to middle of inguinal ligament and lateral to inferior epigastric vessels
superficial (extenal) inguinal ring: exit: slit like opening in aponeurosis of external oblique, superolateral to pubic tubercle. lateral and medial crura are lateral and medial margins. intercrural fibers form superolateral margin of ring


boundaries of inguinal canal

anterior wall: external oblique aponeurosis. lateral part reinforced by internal oblique
posterior wall: transversalis fascia: medial part reinforced by merging of pubic attachments of internal oblique and transversus abdominis aponeuroses into common tendon: inguinal falx (conjoint tendon)
roof: laterally by transversalis fascia, centrally by musculo-aponeurotic arches of internal oblique and transversus abdominis muscles and medially by medial crus and intercrural fibers
floor: laterally by iliopubic tract, centrally by superior surface of inguinal ligament and medially by lacunar ligament


fascial coverings of spermatic cord

internal spermatic fascia: derived from transversalis fascia at deep inguinal ring
cremasteric fascia: derived from fascia of both superficial and deep surfaces of internal oblique muscle
external spermatic fascia: derived from external oblique aponeurosis and its investing fascia


passof spermatic cord

begins at deep inguinal ring lateral to inferior epigastric vessels, passes through the nguinal canal, exits at the superficial inguinal ring and ends in the scrotum at the tests


cremaster muscle

loops in cremasteric fascia
extends as a continuation of internal oblique muscle
contraction draws testis superiorly in scrotum,when it is cold


dartos muscle

smooth muscle of fat free subcutaneous tissue of scrotum (dartos fascia) which inserts into the skin
darts assists in testicular elevation as it produces contraction of skin of scrotum


innervation of cremaster

genitalbranch of genitofemoral nerve L1, L2
derivative of lumbar plexus


innervation of dartos



constituents of spermatic cord

ductus deferens, testicular artery, artery of ductus deferens, cremasteric artery, pampiniform venous plexus, sympathetic nerve fibers, genital branch of genitofemoral nerve, lymphatic vessels, vestige f processus vaginalis


ductus deferens

aka vas deferens
muscular tube that conveys sperms from epididymis to ejaculatory duct
courses through substance of prostate to open into prostatic part of urethra


testicular artery

arises from aorta (vertebral level L2) and supplies testis and epididymis


artery of ductus deferens

arises from inferior vesical artery


cremasteric artery

arises from inferior epigastric artery


pampiniform venous plexus

network formed by up to 12 veins that converge superiorly as the right or left testicular veins


vestige of processus vaginalis

may be seen as a fibrous thread in anterior part of spermatic cord extending between abdominal peritoneum and tunica vaginalis but also may not be detectable