Abdomen 2.pdf

M.B.Ch.B. M.Sc. Ph.D. Anatomy 24/9/2024 1  Learning Objectives 1. Label the Surface Topography of abdomen. 2. Describe the Anatomy of Groin (Inguinal Region). 3. Demonstrate the Inguinal Hernia. 4. Define Abdominal Cavity and Perito...

M.B.Ch.B. M.Sc. Ph.D. Anatomy 24/9/2024 1  Learning Objectives 1. Label the Surface Topography of abdomen. 2. Describe the Anatomy of Groin (Inguinal Region). 3. Demonstrate the Inguinal Hernia. 4. Define Abdominal Cavity and Peritoneum. 24/9/2024 Email :[email protected] Website :http://Alkafeel.edu.iq 2  Surface Topography of Abdomen Topographical divisions of the abdomen are used to describe the location of abdominal organs and the pain associated with abdominal problems. The two schemes most often used are: A. a four-quadrant pattern B. a nine-region organizational description. 24/9/2024 Email :[email protected] Website :http://Alkafeel.edu.iq 3  Four-quadrant Pattern Horizontal transumbilical plane passes through the umbilicus and the intervertebral disc between vertebrae L3 and L4. Vertical median plane. a. Right upper quadrant b. Left upper quadrant c. Right lower quadrant d. Left lower quadrant 24/9/2024 Email :[email protected] Website :http://Alkafeel.edu.iq 4  Nine Regions Pattern The superior horizontal plane (the subcostal plane) The inferior horizontal plane (the intertubercular plane) The vertical planes pass from the midpoint of the clavicles inferiorly to a point midway between the anterior superior iliac spine and pubic symphysis. a. Hypochondrials and epigastric. b. Lumbars and umbilical. c. Inguinals and hypogastric. 24/9/2024 Email :[email protected] Website :http://Alkafeel.edu.iq 5 Email :[email protected] Website :http://Alkafeel.edu.iq 6  Groin (Inguinal Region) It is the area of junction between the anterior abdominal wall and the thigh. The abdominal wall in this area is weakened due to developmental changes of gonads. This weakness of abdominal wall can cause peritoneal sac diverticulum with or without abdominal contents and leading to inguinal hernia, that can occur in both sexes, but it is more common in males. Email :[email protected] Website :http://Alkafeel.edu.iq 7  Groin (Inguinal Region) Before descent of testes or ovaries from their initial position high in the posterior abdominal wall, a peritoneal out-pouching (the processus vaginalis) forms, acquiring coverings from each: 1. Transversalis fascia forms its deepest covering 2. The musculature of the internal oblique 3. Superficial covering is the aponeurosis of the external oblique. Email :[email protected] Website :http://Alkafeel.edu.iq 8  Groin (Inguinal Region) A covering from the transversus abdominis muscle is not acquired because the processus vaginalis passes under the arching fibers of this abdominal wall muscle. As a result the processus vaginalis is transformed into a tubular structure with multiple coverings from the layers of the anterior abdominal wall. This forms the basic structure of the inguinal canal. Email :[email protected] Website :http://Alkafeel.edu.iq 9  Groin (Inguinal Region) The final event in this development is the descent of the testes into the scrotum or of the ovaries into the pelvic cavity. This process depends on the development of the gubernaculum, which extends from the inferior border of the developing gonad to the labioscrotal swelling. The processus vaginalis is immediately anterior to the gubernaculum within the inguinal canal. Email :[email protected] Website :http://Alkafeel.edu.iq 10  Inguinal Canal It is a slit-like passage that extends in a downward and medial direction, just above and parallel to the lower half of the inguinal ligament. It begins at the deep inguinal ring (at a point midway between the anterior superior iliac spine and the pubic symphysis) and continues for approximately 4 cm, ending at the superficial inguinal ring (superior to the pubic tubercle). Email :[email protected] Website :http://Alkafeel.edu.iq 11  Walls of the Inguinal Canal Anterior Wall: formed along its entire length by the aponeurosis of the external oblique muscle, reinforced laterally by the medial fibers of the internal oblique muscle. It contains superficial inguinal ring medially. Posterior Wall: formed along its entire length by the transversalis fascia, reinforced along its medial one-third by the conjoint tendon (the combined insertion of the transversus abdominis and internal oblique muscles into the pubic crest and pectineal line). Email :[email protected] Website :http://Alkafeel.edu.iq 12  Walls of the Inguinal Canal Roof (Superior Wall): formed by the arching fibers of the transversus abdominis and internal oblique muscles. Floor (Inferior Wall): formed by upturned lower edge of inguinal ligament, and lacunar ligament medially. Email :[email protected] Website :http://Alkafeel.edu.iq 13 Contents of Inguinal Canal Email :[email protected] Website :http://Alkafeel.edu.iq 14  Spermatic Cord It consists of structures passing between the abdominopelvic cavities and the testis, and the three fascial coverings that enclose these structures. The fascias enclosing the contents of the spermatic cord include: a. Internal spermatic fascia, arises from the transversalis fascia. Email :[email protected] Website :http://Alkafeel.edu.iq 15  Spermatic Cord b. Cremasteric fascia with the associated cremasteric muscle, which is the middle fascial layer and arises from the internal oblique muscle. c. External spermatic fascia, superficial covering of the spermatic cord, arises from the aponeurosis of the external oblique muscle. Email :[email protected] Website :http://Alkafeel.edu.iq 16  The Structures In The Spermatic Cord Include: 1. The ductus deferens 2. Artery to ductus deferens (from the inferior vesical artery) 3. Testicular artery (from the abdominal aorta) 4. Pampiniform plexus of veins (testicular veins) 5. Cremasteric artery and vein (small vessels associated with the cremasteric fascia) 6. Genital branch of the genitofemoral nerve (to cremasteric muscle) 7. Sympathetic and visceral afferent nerve fibers 8. Lymphatics 9. Remnants of the processus vaginalis. Email :[email protected] Website :http://Alkafeel.edu.iq 17  Round Ligament of Uterus The round ligament of the uterus is a cord-like structure that passes from the uterus to the deep inguinal ring where it enters the inguinal canal. It passes down the inguinal canal and exits through the superficial inguinal ring. At this point, it has changed from a cord-like structure to a few strands of tissue, which attach to the connective tissue associated with the labia majora. As it traverses the inguinal canal, it acquires the same coverings as the spermatic cord in men. Email :[email protected] Website :http://Alkafeel.edu.iq 18  Inguinal Hernia It is the protrusion or passage of a peritoneal sac, with or without abdominal contents, through a weakened part of the abdominal wall in the groin. It occurs because the peritoneal sac enters the inguinal canal either: 1. Indirectly, through the deep inguinal ring. 2. Directly, through the posterior wall of the inguinal canal. ❖ Inguinal hernias are therefore classified as either indirect or direct. Email :[email protected] Website :http://Alkafeel.edu.iq 19  Indirect Inguinal Hernia It is the most common of the two types of inguinal hernia and is much more common in men than in women. It occurs because some part, or all, of the embryonic processus vaginalis remains open or patent. It is therefore referred to as being congenital in origin. Email :[email protected] Website :http://Alkafeel.edu.iq 20  Direct Inguinal Hernia A peritoneal sac that enters the medial end of the inguinal canal directly through a weakened posterior wall is a direct inguinal hernia. It is usually described as acquired because it develops when abdominal musculature has been weakened, and is commonly seen in old men. The bulging occurs medial to the inferior epigastric vessels in the inguinal triangle (Hesselbach's triangle). Email :[email protected] Website :http://Alkafeel.edu.iq 21  Inguinal Triangle (Hesselbach's triangle) Triangular area bounded by: a. Laterally by the inferior epigastric artery. b. Medially by the rectus abdominis muscle. c. Inferiorly by the inguinal ligament. Email :[email protected] Website :http://Alkafeel.edu.iq 22 Inguinal Hernias Email :[email protected] Website :http://Alkafeel.edu.iq 23 1. Gray’s Anatomy for Students. 2. Clinical Anatomy by Regions. Richard S. Snell. 3. Clinically Oriented Anatomy. Keith L. Moore. Email :[email protected] Website :http://Alkafeel.edu.iq