Anterolateral Abdominal Wall
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What vertabrae does the umbilicus overlie in a non-obese individual?
3rd and 4th lumbar
Name the 2 fascias that make up the superficial fascia of the abdominal wall
- Superficial fatty layer: Camper's Fascia
- Deep membraneous layer: Scarpa's Fascia
What fascia forms the fundiform ligament of the penis?
Deep membraneous or Scarpa's Fascia
What are the functions of the muscles of the abdominal wall?
- Lateral flexor
- Increasing intra-abdominal pressure
Where does the external oblique muscle originate and insert?
- Origin: Lower eight ribs
- Insertion: Iliac crest, pubic tubercle, linea alba
What forms the ingunial ligament, and what is its other name?
- Formed by: Muscle aponeurosis of the external oblique
- Other Name: Poupart's Ligament
Where does the internal oblique muscle originate and insert?
- Origin: Iliac crest and inguinal ligament
- - Superior/middle fibers: Lower 3 ribs and linea alba
- - Inferior fibers: Pubis
Where does the transversus abdominis originate and insert? What tendon does the muscle form?
- Origin: Lower 6 costal cartilages, iliac crest and ingunial ligament
- Insertion: Linea alba. Also forms the conjoint tendon (along with IO) that inserts on the pubis
Where does the rectus abdominis originate and insert?
- Origin: Superior ramus of the pubis
- Insertion: Xiphoid process and costal cartilages of ribs 5-7
What is the peritoneum and transversalis fascia?
- Peritoneum: Serous membrane that lines abdominal cavity
- Transversalis fascia: Membraneous sheeth that lines abdominopelvic cavity (deep to transversus abdominis)
What is the arcuate line?
- Where the internal oblique aponeurosis no longer splits around the rectus muscle
- Location: Between umbilicus and pubic symphysis
Where do the intercostal and subcostal nerves run in the abdominal wall and what do they supply?
- Location: Between IO and transversus abdominis
- Supply: Skin and muscles of abdominal wall
What 2 nerves supply the inferior part of the abdominal wall?
- Iliohypogastric nerve (L1)
- Ilioinguinal nerve (L1)
Name the dermatomes of xiphoid process, umbilicus and pubic symphysis:
- Xiphoid: Superior to T7
- Umbilicus: T10
- Pubic symphysis: L1
Name the 3 main arteries of teh abdominal wall:
- External iliac branches: Inferior epigastric and deep circumflex iliac
- Internal thoracic branch: Superior epigastric
Where does inferior epigastric artery enter the rectus sheath? What happens once it does?
- Enters at the arcuate line
- Anestomoses with superior epigastric and intercostal arteries
What other arteries supply the abdominal wall?
- Superficial branches of femoral: Superficial epigastric, superficial circumflex iliac and superficial external pudendal
Explain the relationship between the inguinal ligament and the lacunar ligament:
- Inguinal ligament: Goes from the anterior superior iliac spine to the pubic tubercle
- It flattens down, attaches to pectineal line of pubis and forms the lacunar ligament (Gimbernat's Ligament)
Explain where the superficial and deep rings of the ingunial fascia are?
- Superficial: Through EO aponeurosis
- Deep: Finger-like diverticulum of transversalis fascia
Name the 4 boundaries of the ingunial canal:
- Floor: Inguinal and lacunar ligaments
- Roof: Arching fibers of the IO and transversus abdominis
- Anterior Wall: Aponeurosis of EO
- Posterior Wall: Transversalis fascia and conjoint tendon
Name the boundaries of the inguinal triangle?
- Lateral border of the rectus abdominis
- Inguinal ligament
- Inferior epigastric vessels
- Hesselbach's Triangle
What is the first indication of the future inguinal canal?
What structure carries the abdominal wall layers upon the descent of the testes?
Connect the layers of the abdominal wall with the layers of the scrotum/spermatic cord:
- Skin -- Skin in scrotum
- Superficial fascia -- Perineal fascia and dartos muscle
- EO -- External spermatic fascia
- IO -- Cremaster muscle and fascia
- Tranversus Abdominis -- NOTHING
- Transversalis fascia -- Internal spermatic fascia
- Extraperitoneal fat -- Areolar tissue in cord
- Peritoneum -- Tunica vaginalis
Describe the begining location of the internal spermatic fascia, cremaster muscle and fascia, and the external spermatic fascia:
- Internal spermatic fascia: Entire length of canal
- Cremaster muscle/fascia: Middle of canal
- External spermatic fascia: At the superficial ring
Name the components of the cord, beside the coverings:
- Ductus deferens
- Deferential artery and vein
- Testicular artery
- Pampiniform plexus of veins
- Lymphatics and autonomic nerves
- Genital branch of genitofemoral nerve
What nerves suply the anterior scrotal and labial region?
Anterior scrotal and labial cutaneous nerves of the genitofemoral nerve and ilioinguinal nerve
In the females, what happens to the gubernacula?
- Persists as the round ligament of the unterus
- It ends at the labia majora
Describe the cremaster reflex and what nerves does it test?
- Genitofermoral (L1,2) and Ilioinguinal nerve (L1)
- Draws testes to a superior position in the scrotum
- More active in young boys
What is a hydrocele?
Accumulation of fluid in tunica vaginalis or patent processus vaginalis
What is a veriococele?
Dilation of the pampiniform plexus of veins
Describe an indirect and direct inguinal hernia:
- Indirect: Follows route taken by testes before birth. Often due to patent processus vaginalis and common in young boys
- Direct: Protrusion through the inguinal triangle and passes through the superficial ring. Common in older males
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