Lecture 2 - Inguinal Canal and Hernias Flashcards by Damari Martin

Surface landmark locations: xiphoid process

Right under the sternum, at the top of the abdomen, between the costal margins

How well did you know this?

Not at all

Perfectly

Surface landmark locations: costal margins

Formed by ribs 7-10

How well did you know this?

Not at all

Perfectly

anterior superior iliac spine

bottom right of the stomach

Part of the pelvis

How well did you know this?

Not at all

Perfectly

Pubic tubercle

Bottom middle (opposite the xiphoid process in the abdominal regions)

How well did you know this?

Not at all

Perfectly

Inguinal ligament

bottom left of the abdomen(?)

How well did you know this?

Not at all

Perfectly

Midclavicular lines

Divide the stomach vertically into an equal split of three parts

How well did you know this?

Not at all

Perfectly

Subcostal line

Divides the stomach horizontally just below the costal margins, creating three regions above it (and three regions below with the intertubercular line)

How well did you know this?

Not at all

Perfectly

Intertubercular line

Divides the stomach horizontally just above the inguinal ligament and the anterior superior iliac spine to form three regions above and below it

How well did you know this?

Not at all

Perfectly

Abdominal region divisions

The abdomen is divided into nine equal parts formed by the midclavicular lines, subcostal line, and intertubercular line

The regions are numbered from 1-9 from the top right to the bottom left (correct POV)

How well did you know this?

Not at all

Perfectly

Abdominal region 1: what is it called, what organs are present here, what arteries are supplied here, what veins are present here, and what nerves innervate the region?

The right hypochondrium

The liver and the gallbladder are present here

Superior epigastric artery, intercostal arteries

Lateral thoracic vein

How well did you know this?

Not at all

Perfectly

Abdominal region 2: what is it called, what organs are present here, what arteries are supplied here, what veins are present here, and what nerves innervate the region?

Epigastrium

The stomach, liver, pancreas, duodenum, and adrenal glands are present here

Superior epigastric artery

???

How well did you know this?

Not at all

Perfectly

Abdominal region 3: what is it called, what organs are present here, what arteries are supplied here, what veins are present here, and what nerves innervate the region?

Left hypochondrium

The spleen, colon, and pancreas are present here

Superior epigastric artery, intercostal arteries

Lateral thoracic vein

How well did you know this?

Not at all

Perfectly

Abdominal region 4: what is it called, what organs are present here, what arteries are supplied here, what veins are present here, and what nerves innervate the region?

Right lumbar/flank

The gallbladder, right kidney, part of the liver, and the ascending colon are present here

Inferior epigastric artery, lumbar arteries, intercostal arteries

Lumbar veins

How well did you know this?

Not at all

Perfectly

Abdominal region 5: what is it called, what organs are present here, what arteries are supplied here, what veins are present here, and what nerves innervate the region?

Umbilicus region

Contains parts of the duodenum, jejunum, ileum, transverse colon (the section between the ascending and descending colons) and the bottom portions of both the left and right kidney

Inferior epigastric artery, maybe the intercostal and lumbar arteries too (not as significant tho)

Lumbar veins

T10

How well did you know this?

Not at all

Perfectly

Abdominal region 6: what is it called, what organs are present here, what arteries are supplied here, what veins are present here, and what nerves innervate the region?

Left lumbar/flank

Descending colon and the left kidney are present here

Inferior epigastric artery, lumbar arteries, intercostal arteries

Lumbar veins

How well did you know this?

Not at all

Perfectly

Abdominal region 7: what is it called, what organs are present here, what arteries are supplied here, what veins are present here, and what nerves innervate the region?

Right iliac fossa

The cecum, vermiform appendix and terminal ileum are present here

Inferior epigastric arteries, deep circumflex iliac arteries, and lumbar arteries

Superficial epigastric vein

T11

How well did you know this?

Not at all

Perfectly

Abdominal region 8: what is it called, what organs are present here, what arteries are supplied here, what veins are present here, and what nerves innervate the region?

Hypogastrium/suprapubic region

The small intestine, bladder and uterus are present here

Inferior epigastric arteries, and deep circumflex iliac arteries

Superficial epigastric vein

T12

How well did you know this?

Not at all

Perfectly

Abdominal region 9: what is it called, what organs are present here, what arteries are supplied here, what veins are present here, and what nerves innervate the region?

Left iliac fossa

The distal part of the descending colon and the proximal sigmoid colon are present here

Inferior epigastric arteries, deep circumflex iliac arteries, and lumbar arteries

Superficial epigastric vein

T11

How well did you know this?

Not at all

Perfectly

Abdominal wall layers: outer layer - sixth outermost layer

Outer layer - skin
Second outermost layer - superficial fatty layer of subcutaneous tissue (Camper’s fascia)
Third outermost layer - Deep membraneous layer of subcutaneous tissue (Scarpa’s fascia)
Fourth outermost layer - Trilminar Abdominal muscles (external oblique-internal oblique-transversus abdominis)
Fifth outermost layer - Transervsalis (endo abdominal) fascia
Sixth outermost layer - Parietal peritoneum

How well did you know this?

Not at all

Perfectly

External oblique muscles: origin, insertion, blood supply, innervation, and action

Lower 8 ribs

Xiphoid process, pubic crest, pubic tubercle, and anterior half iliac crest

Lower posterior intercostal arteries, subcostal artery, deep circumflex iliac artery

Motor: Intercostal nerves (T6- T12), Subcostal nerve (T12) Sensory: Iliohypogastric nerve (L1) and ilioinguinal

Flexion & rotation of trunk, increases intra abdominal pressure

How well did you know this?

Not at all

Perfectly

Internal oblique muscles: origin, insertion, blood supply, innervation and action

Anterior 2/3rds iliac crest, lateral 2/3rds inguinal ligament

Ribs 10-12, Xiphoid process, Linea alba,

Lower posterior intercostal and subcostal arteries. Superior and inferior epigastric arteries. Superficial and deep circumflex iliac arteries

Motor: Intercostal nerves (T6- T12), Subcostal nerve (T12) Sensory: Iliohypogastric nerve (L1) and ilioinguinal

Flexion & rotation of trunk, increases intra abdominal pressure

How well did you know this?

Not at all

Perfectly

Transversus abdominis muscles: origin, insertion, blood supply, innervation and action

lower 6 costal cartilages, anterior 2/3rds iliac crest, lateral 2/3rds inguinal ligament

Xiphoid process, Linea alba, pubic symphysis

Lower posterior intercostal arteries, arising from the descending thoracic aorta. Subcostal arteries, given off by the descending thoracic aorta. Superior epigastric artery, given off by the internal thoracic artery.

Motor: Intercostal nerves (T6- T12), Subcostal nerve (T12) Sensory: Iliohypogastric nerve (L1) and ilioinguinal

Flexion & rotation of trunk, increases intra abdominal pressure

Costal cartilages

Connects ribs 1-10 to the sternum

Tendon

Connects muscle to bone

Ligament

Connects bone to bone

Aponeurosis

A flat tendon - tendons are usually cylindrical Tendons in the trilaminar muscles are all aponeurosis

Trilaminar abdominal muscles aponeurosis girdle mesh formation

EO aponeurosis - connect towards the midline, inferiorly IO aponeurosis - connect towards the midline, superiorly TA aponeurosis - connect towards the left side of the body, in a sideways direction

Tenderness raphe

Strong, fibrous connective tissue - Linea Alba

Inguinal ligament

The most inferior part of the external oblique aponeurosis, when folded back on itself

ASIS

Anterior superior iliac spine - The parts of the external oblique aponeurosis that do not fold back on itself

Rectus abdominis: its basics

Very long, strap-like muscles that span the entire length of the anterior abdominal wall Needs tendinous intersections in between that tie it back to the underlying fascia

Rectus abdominis: origin, insertion, blood supply, innervation and action

Pubic symphysis and pubic crest The xiphoid process and the 5ᵗʰ-7ᵗʰ costal cartilages jxhjbschb T6-T12 Compresses abdominal contents, flexes vertebral column, accessory muscle of respiration

Rectus abdominis: what does the Linea alba do

Separate both Recti abdominus medially

Pyramidalis muscles: origin, insertion, blood supply, innervation and action

Front of the pubis and pubic symphysis Linea alba hdsbjhdsbhcjds T12 Tenses linea alba

The rectus sheath: above ASIS

Above anterior superior iliac spine - the layers are: Skin -> Camper's fascia -> Scarpa's fascia -> External oblique muscles -> internal oblique muscles -> Rectus abdominis muscles -> internal oblique muscles -> transversus abdominis muscles 0> transversalis fascia The aponeurosis for the internal oblique muscles runs both above and below the RA muscles.

The rectus sheath: below the ASIS

Below the anterior superior iliac spine - the layers are: Skin -> Camper's fascia -> Scarpa's fascia -> External oblique muscles -> internal oblique muscles -> transversus abdominis muscles -> Rectus abdominis muscles -> transversalis fascia The aponeurosis for the internal oblique muscles runs both above and below the RA muscles.

Difference between the rectus sheath above and below the ASIS

Above - Rectus abdominis muscles are superior to half of the IO aponeurosis as well as the TA aponeurosis Below - Rectus abdominis muscles are inferior to the EO, IO, and RA muscles

Arcuate line

The point at which the IO and TA aponeurosis changes from being deep to the RA to being superficial to it

Inferior epigastric artery: what does it do and what potential weaknesses are there?

Supplies the rectus abdominis muscles as well as the sheath with blood after slipping through the arcuate line Posterior stability decreased (?), the muscle may herniate as it's not solely surrounded by fascia (?)

Spiegalien hernia

Hernia related to the rectus abdominis muscle or the rectus sheath

Abdominal lymph drainage

Above the umbilicus, lymph is moved to the anterior axillary lymph nodes Below the umbilicus, lymph is moved to the superficial inguinal lymph nodes

The superficial inguinal ring

A defect located above and medial to the pubic tubercle and found within the EO aponeurosis Triangular shape Connects with the deep inguinal ring to form the inguinal canal

Deep inguinal ring

A defect found within the transversalis fascia Circular shape Connects with the superficial inguinal ring to form the inguinal canal

Inguinal canal: what is it, what is it made from, and what are its contents?

* natural opening * Parallel to the inguinal ligament * Extends from the DIR to the SIR (3-5cm long) Roof - fibres from IO and TA Anterior wall - EO aponeurosis reinforced by IO fibres Posterior wall - transversalis fascia and conjoint tendon (formed from lower fibres of IO and TA) Floor - inguinal and lacunar ligaments (formed from inguinal ligament and fascia lata fibres) Contents: Males - spermatic cord and ilioinguinal nerve Females - round ligament of the uterus and ilioinguinal nerve

Hernia

The protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall (Snell)

Epigastric hernia

Along the midline, above the umbilicus

Umbilical hernia

At the umbilicus

Inguinal hernia

At the Inguinal Canal, in the right and left areas of the suprapubic region, above where a femoral hernia would be

Femoral hernia

Roughly where the femoral artery will begin, in the left/right iliac fossa

Paracentesis: through which layers of the abdominal wall must the needle pass in order to reach the peritoneal cavity?

ns, ask someone?

Incisions: what structures are cut in a midline incision, to gain access to the abdominal cavity?

ns, ask soemone?

Incisions: how might you access intraabdominal structures without damaging the trilaminar muscles?

ns, ask someone?