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35. Abdominal Wall and Inguinal Canal
Yarneau
30
Anatomy
Graduate
10/04/2011

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Cards

Term
Boundaries of the abdominopelvic cavity
Definition
Muscle borders:
Superior: Respiratory diaphragm
Anterior and Lateral: Abdominal muscles
Inferior: Pelvic diaphragm (levator ani)
Inferior anterior: Urogenital diaphragm

Membrane border:
The peritoneum lines the cavity (parietal and visceral pleura)

Bone borders:
Ribs
Lumbar vertebrae
Pelvis
Term
Major dermatomes of the abdominopelvic thorax
Definition
1. T4
2. T6
3. T10
Term
T4 dermatome boundaries
Definition
From T4 to sternal angle.
Term
T6 dermatome boundaries
Definition
From T6 to the xiphoid (6th intercostal space).
Term
T10 dermatome boundaries
Definition
T10 to umbilicus
Term
Innervation of abdominal section
Definition
T7-L1

Know innervation of T10 and L1 specifically. Dull, vague midline pain s most likely referred pain from another organ.
Ex. T10 innervates appendix, when patient has appendicitis, referred pain is in bellybutton.
Term
L1 innervation
Definition
Done by two nerves: the iliohypogastric (superior) and the ilioinguinal (innervates genitalia). Inguinal hernia surgery can sever the ilioinguinal to produce numbness in genitalia).
Term
Superficial layers of the abdominal wall
Definition
From most superficial to deep
1. Skin
2. Campers fascia (fatty globular layer, disappears in males inferior to the pubis).
3. Scarpa's fascia (membranous layer), turns into Colle's fascia inferior to the pubis).
Term
Colle's Fascia
Definition
Continuation of Scarpe's fascia below the pubis.
Attaches to posterior edge of urogenital diaphragm, ischiopubic rami, fascia lata.
Covers in front, stops in back (like thong).
Term
Dartos muscle
Definition
Invisibly thin layer of smooth muscle
attaches to the inner surface of the scrotal skin.
Term
Rupture of male urethra
Definition
Urine escapes from the urethra and follows the Colles fascia anteriorly where it becomes the Scarpe's fascia, collects in anterior abdominal wall. Colles fascia closed off posteriorly, so urine does not make it to the thigh or anal region.
Term
Muscular layers of the abdominal wall
Definition
Deep to the skin, campers fascia, and scarpe's fascia.
1. External oblique
2. Internal oblique
3. Transversus abdominis

Rectus abdominis is medial to other abdominal muscles, source of 6 pack.

Muscles are incomplete, give rise to aponeurosi that covers the rectus abdominis anteriorly and posteriorly=rectus sheath. All aponeurosi have a defect in the inguinal region gives rise to the external and internal inguinal rings.
Term
Semilunar line
Definition
Where abdominal muscles stop and aponeurosis begins.
Term
Linea alba
Definition
Aponeurosi fuse at midline.
Term
External oblique
Definition
Fibers run inward and downwards.
Fibers stop at the semilunar line, and aponeurosis fuses with other aponeurosi at the linea alba.
Lower free edge of the aponeurosis=inguinal ligament (ASIS to pubic tubercle), forms femoral triangle.
Defect in the inguinal region is called the external inguinal ring.
Term
Internal oblique
Definition
Fibers go inward and upward
Lower fibers attach to inguinal ligament.
Forms an aponeurosis that splits to go anterior and posterior to the rectus abdominis.
Fibers from the internal oblique turn into the cremaster muscle of the testis.
Term
Cremaster muscle
Definition
Fibers from the internal oblique muscle that attach to the spermatic cord of the testis.
Term
Transversus abdominis
Definition
1. Muscle fibers run horizontally.
2. Aponeurotic fibers superior to arcuate line pass both anteriorly and inferiorly to rectus abdominis.
3. Fibers inferior to rectus abdominis pass only anteriorly to rectus abdominis.
4. Muscle fibers are absent in inguinal canal.
Term
Arcuate line
Definition
Point of transition where
superior aponeurosis fibers pass posterior to rectus abdominis
Inferior aponeurosis fibers pass anterior to rectus abdominis
Term
Descent of Testis
Definition
Testis are connected to the ductus deferens superiorly and the gubernaculum inferiorly.
The gubernaculum pulls the testis down through the processus vaginalis to the scrotum.
The testis picks up tissue from each layer of the abdominal wall as it descends to the scrotum.
Term
Process vaginalis
Definition
An out-pocketing of the peritoneal cavity that continues into the scrotum. Mostly disappears to form the tunica vaginalis.
Term
Gubernaculum
Definition
Pulls the testis into the scrotum.
Term
Round Ligament of Uterus
Definition
Remnant of gubernaculum
Passes through the inguinal canal
Connects from side of uterus to the labia majora.
Term
Deep Layers of Abdominal Wall
Definition
From most superficial to deep
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum
Term
Contents of Spermatic Cord
Definition
Testicle
Ductus deferens
Testicular artery
Pampiniform plexus of veins
Lymphatics
Nerve fibers from T10: why there is pain in abdomen when kicked in groin
Processes vaginalis
Tunica vaginalis
Term
Layers of Scrotum
Definition
1. Tunica vaginalis (processes vaginalis)– from peritoneum
2. Internal spermatic fascia—from transversalis fascia
(Nothing from transversus abdominis)
3. Cremasteric Muscle (and fascia) —from internal oblique
4. External Spermatic Fascia— from external oblique
5. Colles fascia – from Scarpa’s fascia
6. Dartos muscle and fascia (not shown)
7. Skin
Term
Hernias
Definition
Protrusion of an organ through the wall that normally contains it.
Term
Indirect Inguinal Hernias
Definition
Process Vaginalis normally obliterates but 5% of adults have a patent process vaginalis
Abdominal contents may herniate through a patent process vaginalis – this is called an indirect inguinal hernia
By definition- indirect inguinal hernias must pass through the deep inguinal ring, which is lateral to the inferior epigastric artery
Term
Direct Inguinal Hernia
Definition
Push through the abdominal wall in the region of Hesselbach's Triangle.
Boundaries are inferior epigastric artery, rectus abdominis, and inguinal ligament.
Term
Layers of the abdominal wall
Definition
Skin
Campers fascia
Scarpa’s fascia
External oblique
Internal oblique
Transversus abdominis
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum
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