Anterior Abdominal Wall MD4 Flashcards Preview

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Flashcards in Anterior Abdominal Wall MD4 Deck (20):
1

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Inguinal Canal

  • passage from deep inguinal ring to superficial inguinal ring that runs inferomedially, parallel & superior to the medial 1/2 of the inguinal lig.
  • carries the spermatic cord (males), round lig. (females), ilioinguinal nn (both)
  • formed in relation to relocation of testes during fetal development

*indirect inguinal hernias run through deep inguinal ring, inguinal canal, and superficial inguinal ring to descend into scrotum, most common

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Inguinal Ligament

  • from ASIS to pubic tubercle
  • continuation of external oblique aponeurosis
  • forms the floor of the inguinal canal

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3

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Hesselbach's Triangle/Inguinal Triangle

borders:

  • medial: lateral edge of rectus abdominis (linea semilunaris)
  • lateral: inferior epigastric vessels
  • inferior: inguinal lig.

*common site of direct inguinal hernias, less common than indirect

**picture shows view when looking outwards

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continuations of inguinal lig., deep fibers pass posteriorly to attach to superior pubic ramus

Lacunar lig.

  • arching fibers
  • only boundary of femoral canal that can be cut to release femoral hernia

Pectineal lig. (lig. of Cooper)

  • fibers continue laterally along pectineal line on the superior pubic ramus
  • strong, holds sutures well in repair of inferior floor of inguinal canal

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Deep Inguinal Ring

  • entrance to inguinal canal
  • transmits spermatic cord (males), round lig. (females), ilioinguinal nn. (both)
  • lateral to inferior epigastric vessels
  • common site of indirect inguinal hernias

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Camper's and Scarpa's Fascia

  • inferior to umbilicus there are two layers of subQ tissue

Camper's:

  • superficial fatty thick layer

Scarpa's:

  • deep thin membranous layer

 

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7

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Iliohypogastric nn.

  • superior branch off of anterior rami of L1
  • passes through posterior transversus abdominis mm.
  • supplies skin above iliac crest, upper inguinal and hypogastric regions, muscles (transversus abdominis, internal obliques)

Ilioinguinal nn.

  • inferior branch off of anterior rami of L1
  • transmitted through inguinal canal
  • supplies skin of lower inguinal, anterior scrotum and medial thigh, muscles (transversus abdominis, lowermost internal obliques)

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External Oblique mm.

  • actions: compression of abdominal cavity, aids in forced expiration, flexion, lateral flexion, rotation of spine
  • "opposite side rotators"

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Internal Oblique mm.

  • @ right angles to external obliques, deep to external obliques
  • actions: compresses abdomen (constantly active as antagonist to diaphragm, supports abdominal viscera), aids in forced expiration, rotation and flexion of trunk
  • "same side rotators"

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Transversus Abdominis mm.

  • actions: compression of abdominal cavity, depress ribs
  • deep to internal obliques

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Conjoint Tendon

  • common aponeuroses of transversus abdominis & internal oblique, insert upon pubic crest
  • strengthens posteromedial aspect of inguinal canal, prevents direct inguinal hernias

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Rectus Abdominis mm.

  • flexes trunk, compresses abdomen (supports abdominal viscera), antilordosis

Rectus Sheath

  • fusion of aponeuroses of ext, int obliques, transversus abdominis

above arcuate line:

  • ext obl + 1/2 of int obl (anterior)
  • the rest (1/2 int oblique, transversus abdominis, transversalis fascia) posterior

below:

  • everything anterior except transversalis fascia

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Round Ligament (of uterus)

  • passes through inguinal canal
  • from uterine horns->inguinal canal via deep inguinal ring-> labia majora

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Ductus Deferens/Vas Deferens

  • part of the spermatic cords
  • transports sperm from epididymis to ejaculator ducts

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Spermatic Cords

contains:

  • vas deferens
  • pampiniform venous plexus
  • testicular, cremasteric, deferential aa.
  • autonomics (genitofemoral, cremasteric nn., tesicular sympathetics)
  • lymphatics

*ilioinguinal nn runs alongside spermatic cord in inguinal canal

fascia:

  • continuations of external oblique aponeurosis, internal oblique, transversalis fascia
  • vasectomy includes either cutting or blocking vas deferens

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Inferior Epigastric Artery

  • arises from external iliac aa just above the inguinal lig.
  • enters rectus sheath, drops down b/w rectus abdominis & posterior rectus sheath
  • anastomoses w/ superior epigastric aa
  • gives rise to cremasteric aa in spermatic cord
  • hernias lateral to inferior epigastric (indirect), medial (direct)

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  • Crura are extensions of external oblique aponeurosis that define the margins of the superficial inguinal ring

Medial Crus- attaches to pubic crest

Lateral Crus- attaches to pubic tubercle

Intercrural fibers- fibers of fascia that pass from medial to lateral crus, preventing expansion of superficial inguinal ring

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Peritoneum: serous membrane lining inside of abdominal cavity and covering intrabdominal viscera

Parietal: originates from somatic mesoderm, sensitive to temp, pain, pressure, able to localize pain

Visceral: originates from splanchnic mesoderm, sensitive only to stretch & chemical irritation, unable to localize pain (often refers to midline of dermatome) (foregut = epigastric, midgut = umbilical, hindgut = pubic)

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Internal Thoracic aa.

-branch off of inferior 1st portion of subclavian aa.

-bifurcates into superior epigastric and musculphrenic aa.

-branches to anterior intercostal aa (which supply intercostal muscles & spaces)

-runs along side the sternum

-used in CABG

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Scrotum:

  • cutaneous sack housing the testes, originates from labioscrotal swellings
  • heavily pigmented skin layer and tunica dartos

Tunica Dartos:

  • continuation of camper's fascia containing dartos muscle
  • responsible for rugosity
  • regulates temp of testes: contraction of dartos muscle-> decr surface area for heat loss, incr thickness of layer, assists cremaster muscles in holding testes closer to body-> incr temp