Download File - COFFEE BREAK CORNER

ANATOMY OF ANTERIOR ABDOMINAL WALL Layers: 1. Skin (Langerhan’s line runs parallelly/horizontally) 2. Superficial fascia (Superficial fatty layer (Camper’s fascia), Deep membranous layer (Scarpa’s fascia)) 3. Muscles: (a) 2 vertical – rectus abdominis, pyramidalis (may absent) (b) 3 oblique – external and internal oblique ms, tranversus abdominis ms 4. Fascia transversalis 5. Extraperitoneal fat 6. Parietal layers of peritoneum Inguinal Ligaments (Poupart’s Ligament): Attachement: Laterally: to ASIS Medially: to pubic turbercle it has: a. Upper surface: towards the abdomen. Give partial origin to internal oblique and transverses abdominis b. Lower surface: towards the thigh Structures that passing below (deep relation): Ø Ms : pectineal, iliacus, psoas major Ø Vessels: femoral artery, femoral vein Ø Nerves: femoral nerve, femoral branch of genitofemoral nerve and lat. Cutaneous of the thigh Ø Fascia: transversalis fascia and iliacus fascia (femoral sheath) Ø Lymphatics Expansion: (1) Lacunar ligament Apex: attached to the pubic tubercle Borders: -­‐ Posterior border : attached to pectineal line -­‐ Anterior border: attached to inguinal ligament -­‐ Lateral border: free (2) Reflected ligament Consists of fibers from pubic tubercle to the linea alba, behind the spermatic cord SIR DIR External oblique Site Fascia transversalis aponeurosis External spermatic cord Margin Internal spermatic fascia Spermatic cord or round Transmit Spermatic cord or round ligament and ilioinguinal ligament nerve Triangle Shape round Inguinal Canal: Site: deep passage in the lower part of AAW Length: 4cm Beginning: DIR Termination: SIR Boundaries: Anterior wall: external oblique aponeurosis (whole length) Fleshy part of the internal oblique (lateral half) Posterior wall: transversalis fascia (whole length) Conjoint tendon (medial part) Reflected ligament Floor: Inguinal ligament (whole length) Lacunar ligament (medial inch) Roof: arched fibers of the internal oblique Contents: 1. Spermatic cord (in male) or round ligament (in female) 2. Ilioinguinal and genital branch of genitofemoral 3. Internal spermatic fascia 4. Cremastric muscle and fascia ** in oblique inguinal hernia, the hernia is lateral to inferior epigastric artery and enter the scrotum through inguinal canal Rectus Abdominis Ms Origin: pubic crest, symphysis pubis Insertion: xiphoid process 5th, 6th and 7th costal cartilage Nerve supply: lower 6 thoracic nerves Features: (a) Tendinous intersection (ms is divided into 4segments and 3 intersections) -­‐ Near xiphoid process -­‐ Midway between xiphoid process and umbilicus -­‐ At the umbilicus (b) Lateral border: linea semilunaris Rectus Sheath Divisions: Level Above costal margin () umbilicus and symphysis pubis Anterior wall External oblique ms -­‐external oblique ms -­‐ant lamina of the internal oblique aponeurosis Posterior wall 5th, 6th, 7th cc -­‐Post lamina of internal oblique aponeurosis -­‐transversus abdominis aponeurosis Fascia transversalis Below symphysis pubis Aponeurosis of external, internal and transverses abdominis ms Contents: ü Ms: rectus abdominis ms Pyramidalis (may absent) ü Vessels: superior and inferior epigastric vessels ü Nerves: lower 6th thoracic nerves Action of ms: (1) Oblique ms: lateral flexion and rotation of the trunk (2) Rectus abdominis: flexion of the trunk and stabilization of pelvis (3) Pyramidalis: stretches the linea alba (4) Accessory ms of respiration (5) Protect the abdominal contents and keep them in position (6) Raise the intrabdominal pressure during defecation and labor Arterial supply: Superficial arteries: -­‐ Superficial external pudendal artery -­‐ Superficial epigastric artery -­‐ Superficial circumflex iliac artery Deep arteries: (i)
From internal thoracic artery: -­‐ Superior epigastric -­‐ Musculophrenic (ii)
From aorta -­‐ post intercostals and subcostal artery -­‐ lumbar artery (iii)
from external iliac artery -­‐ inferior epigastric -­‐ deep circumflex iliac Venous drainage: Superficial veins: -­‐ superiorly: go to lateral thoracic vein à axillary vein -­‐ medially: go to paraumbilical vein à portal vein -­‐ inferiorly: go to superficial epigastric vein à femoral vein deep veins: -­‐ superior epigastric and musculophrenic à internal thoracic vein -­‐ inferior epigastric and deep circumflex iliac à external iliac vein -­‐ posterior intercostals vein àazygos vein -­‐ lumbar vein à IVC lymph drainage: skin: above umbilicus: to anterior axillary (pectoral) LN below umbilicus: to superficial inguinal LN deep structures: (with the deep arteries) 1. internal thoracic LN 2. para-­‐aortic LN 3. external iliac LN nerve supply: To the ms: • rectus abdominis: lower 6 thoracic nerves • oblique ms and transversus abdominis: lower 6 thoracic nerves, iliohypogastric and ilioinguinal nerves • pyramidalis: subcostal nerve to the skin: • lower 6th thoracic nerves -­‐ T10 supply skin at the level of umbilicus -­‐ T7,8,9 supplies region above umbilicus -­‐ T11, 12 and L1 supplies skin below umbilicus • Iliohypogastric and ilioinguinal nerves