oblique abdominis m. Transversus abdominis m. Rectus abdominis Linea alba Umbilicus Fascia transversalis Extra-peritoneal fat Parietal peritoneum Dr. Sherif Fahmy
that contains variable amount of fat. Below umbilicus: composed of two layers: 1-Superficial fatty (Camper’s fascia): That is continuous below with corresponding layer in the thigh. It replaced by Dartos muscle in the scrotum. 2-Deep membranous (Scarpa’s fascia): which ➢Forms fundiform ligament of penis. ➢Separates between superficial and deep dorsal veins of penis. ➢ Formes Coll’s fascia in the scrotum. ➢Continuous with corresponding layer in the thigh, fused with fascia lata one inch below inguinal ligament.
to escape of urine in superficial perineal pouch. •Urine will be accumulated deep to Scarpa’s fascia In the lower part of anterior abdominal wall. •Urine will be prevented to reach front of thigh due to fusion between Scarpa’s fascia with fascia lata.
the muscle form triple relation with spermatic cord. ➢Aponeurosis of the muscle splits into anterior and posterior lamina around rectus abdominis muscle (from costal margin till midway between umbilicus and symphysis pubis). ➢Conjoint tendon (Falx inguinalis). ➢Cremastric muscle.
runs transversely except lowermost that join the arching fibers and conjoint tendon). ➢It is lined with fascia transversalis. ➢Its aponeurosis lies behind rectus muscle from costal margin till midway between umbilicus and symphysis pubis, below which the aponeurosis splits to lie infront the muscle.
micturition,…..etc ➢Protect abdominal viscera against external trauma. ➢Keep organs in their position. ➢Oblique muscles bend the trunk laterally. ➢Rectus muscles bend the trunk foreword. ➢External oblique of one side and internal oblique of the opposite side rotate the trunk. Nerve supply: ➢Lower 6 thoracic nerves. ➢L1 gives additional nerve supply to internal oblique and transversus abdominis. ➢Subcostal to pyramidalis muscle.
Aponeurosis of external abdominal oblique m. -Aponeurosis of external abdominal oblique. -Anterior lamina of internal abdominal oblique m. 3 aponeuroses of lateral abdominal muscles. Conjoint tendon 5th, 6th and 7th costal cartilages. Aponeurosis of transversus abdominis m. Posterior lamina of internal abdominal oblique m. Fascia transversalis.
reflected laterally to avoid injury of nerves supplying it. ➢Malignant nodule in the umbilicus may be formed secondary to spread of cancer breast through lymphatics in the rectus sheath.
abdominis. Extensions: It is continuous with: Above: diaphragmatic fascia. Posterior: Renal fascia. Medially: fascia of other side. Below: ➢At inner lip of iliac crest. ➢Lateral to ext. iliac vessels: is continuous with fascia iliaca. ➢Infront ext. iliac vessels, it forms anterior wall of femoral sheath. ➢Medial to external iliac vessels, it is continuous with pelvic fascia. Deep inguinal ring: It is present in fascia transversalis ½ an inch above mid-inguinal point.
intercostal, subcostal and ilio-hypogastric nerves. ➢Anterior cutaneous branches of lower 5 intercostal, subcostal and ilio-hypogastric nerves. ➢Ilio- inguinal supplies the skin of external genitalia and upper medial side of thigh.
musculophrenic arteries (Terminal branches of internal thoracic artery). Below umbilicus: Superficial: Superficial epigastric artery and superficial circumflex iliac artery (Two of the superficial inguinal arteries from femoral artery). Deep: Inferior epigastric and deep circumflex iliac (branches of external iliac artery)
oblique inguinal hernia: Impaction of intestine lateral to the artery. In direct inguinal hernia: Impaction of intestine is medial to the artery. 2- Abnormal obturator artery
& IVC ➢Thoraco-epigastric vein. ➢Anastomosis between superior & inferior epigastric veins. Porto-systemic anastomosis: Around umbilicus, there is an anastomosis between systemic veins (epigastric) and portal vein (through paraumbilical veins). N.B. In case of portal hypertension, opening of porto-systemic anastomosis leading to formation of caput medusa.
axillary nodes. Below umbilicus: To superficial inguinal nodes. Deep: Above umbilicus: to parasternal nodes. Below umbilicus: to external iliac nodes. From area of umbilicus: to hepatic nodes.
-Superficial epigastric and superficial circumflex iliac vessels. Deep: -Iliacus, psoas major and pectineus muscles. -Femoral vessels, femoral nerve, lateral cutaneous n. of thigh and femoral sheath.
medial part of anterior abdominal wall. -Site: above medial ½ of inguinal ligament. -length: 4 cm -It has: - 2 openings: 1- Deep inguinal ring (in fascia transversalis). 2- Superficial inguinal ring (in ext. oblique aponeurosis). - 4 walls: -Anterior, posterior, floor and roof.
to pubic tubercle in the aponeurosis of ext oblique m. ½ inch above midinguinal point in the fascia transversalis Triangular Oval Shape Spermatic fascia External spermatic fascia Internal spermatic fascia Crura Lateral & medial No crura - Spermatic cord. - Ilio-inguinal nerve. - Contents of spermatic cord. Supporting factors - Approximation of posterior inguinal wall. - Cremastric reflex. Approximation of anterior inguinal wall. Structures passing
of internal oblique and transversus abdominis, abdominal wall is formed of aponeurosis of ext. abdominal oblique and fascia transversalis. -Presence of spermatic cord in the canal. -Presence of rings.
approximation of walls to each other by contraction of walls. Valvular: Support of each ring by the opposite wall. Narrowing of superficial ring: By upward and lateral pulling of external oblique aponeurosis. Intercrural fibers: Prevent widening of superficial ring. Cremastric reflex: Contraction of cremastric muscle leads to upward pulling of testis supporting superficial ring.
m. Deep inguinal ring Medial ½ of inguinal ligament Lateral umbilical ligament (obliterated umbilical ligament Floor of the triangle = posterior wall of inguinal canal
inner aspect of anterior abdominal wall above the medial ½ of inguinal ligament. -Posterior wall of inguinal canal is represented by the lower part of the triangle.
or omentum). Types of hernia: External (protrusion through weak abdominal wall): Inguinal (direct & indirect),femoral hernia, umbilical hernia and other abdominal hernia. Internal (protrusion through weak part of abdominal cavity) : 1- Diaphragmatic hernia. 2- Hernia in lesser sac of peritoneum.
vaginalis. 2- Weakness of the abdominal wall due to: obesity, pregnancy, weak scar or injury of a muscular nerve. 3- Increased intra-abdominal pressure: Due to chronic straining or abdominal swelling.
hernia passes. e.g. deep inguinal ring, femoral ring. 2- Hernial sac: formed of parietal peritoneum (neck, body and fundus). 3- Contents: any part of mobile abdominal contents e.g. intestine and omentum. 4- Coverings: from layers of abdominal wall.
of abdominal wall) Descent Reduction Types (site) Coverings It is the hernia that passes through deep inguinal ring. It is the hernia that pushes the posterior wall of inguinal canal It is the commonest type mainly in young age Less common, mainly in old age. Deep inguinal ring (lateral to inferior epigastric vessels) Hasselbach’s triangle (medial to inferior epigastric vessels) Forewords, downwards and medially. Forewards Upwards, laterally and backwards. Backwards Inguinal or inguino-scrotal Only inguinal In inguinal canal: Extraperitoneal fatty tissue, internal spermatic fascia, cremastric muscle and fascia, external oblique aponeurosis, superficial fascia and skin. In scrotum: coverings of spermatic cord Colle's fascia, dartos m., and Skin. In inguinal canal: Extraperitoneal fatty tissue, Fascia transversalis, conjoint tendon (medial type), internal spermatic fascia, cremasteric muscle and fascia, external oblique aponeurosis, superficial fascia and skin.
canal) More common in female (wide femoral ring) Above the inguinal ligament Below inguinal ligament. Above and medial to pubic tubercle Below and lateral to pubic tubercle. Descends forewords, downwards and medially. Descends downwards, forewords and upwards Reduction is upwards, laterally and backwards Reduction is downwards, backwards then upwards. Dr. Sherif Fahmy
hernia. ➢Infantile hernia: Occurs at the umbilicus in first year of life, due to weak scar tissue and continuous straining. ➢Adult para-umbilical: Defect of linea alba above umbilicus, usually in fatty multiparous females.
abdominal wall that contains testis, epididymis and lower part of spermatic cord. Features: - External median raphe and internal incomplete septum. - Left side is lower. - Corrugated skin. Layers of scrotum - Skin, Dartos muscle and Colle’s fascia. Coverings of spermatic cord. Parietal layer of tunica vaginalis. Arterial supply - Superficial and deep external pudendal - Posterior scrotal (br. From int. pudendal) Lymph drainage: Superficial inguinal nodes Nerve supply Ilio-inguinal (ant. 1/3) Posterior scrotal (from pudendal nerve) and posterior cut. N. of thigh (post.2/3).
Rete testis Efferent ductules (vasa efferentia) Convoluted efferent ductules (lobules) inside head of epididymis Testicular artery Pampiniform plexus Body Tail of epididymis Beginning of vas deferens Vestigue of processus vaginalis Mediastinum testis Tunica vasculosa
aorta. Venous: -Pampiniform plexus of veins which gives testicular vein which drain into IVC (on right side) and left renal vein (on left side). Lymph drainage: Para-aortic nodes.
more common on the left side due to: ➢Longer left testicular vein. ➢Left vein joins the left renal vein at right angle. ➢Pressure of pelvic colon (which contains heavy stool).
part of male external genital organs. Site: On the posterior border of testis, lateral to vas deferens and separated from lateral surface of the testis by a sinus of epididymis. Length: 5 cm that contains highly coiled duct (6 meters when uncoiled). Parts: ➢Head is the broad upper end that overlies upper end of testis. ➢Body is the longest part that lies postero-lateral to the testis. ➢Tail is the lower narrow part that continues as vas deferens. Blood supply: ➢Arterial: testicular and artery of vas. ➢Venous: pampiniform plexus of veins. Lymph drainage: Para-aortic nodes. Functions: Complete maturation of sperms and transmits sperms to the vas deferens.
that transmits sperms from epididymis to ejaculatory duct. Length: 45 cm Course: ➢It begins as a continuation of the tail of epididymis. ➢It passes upwards behind testis and medial to epididymis. ➢It ascends in the spermatic cord till it enters the abdominal cavity through the deep inguinal ring. ➢It descends on the lateral pelvic wall. ➢Then it descends on the back of urinary bladder where it is dilated to form ampulla of vas. ➢It ends by joining duct of seminal vesicle to form ejaculatory duct. Blood supply: ➢artery of vas from inferior vesical artery.
after its descend to scrotum. Site: in the inguinal canal and scrotum. Extension: begins at deep inguinal ring and extends till the posterior border of testis Contents: -Arteries: Testicular, artery of vas and cremastric. -Nerves: Cremastric, sympathetic plexus (T10) & ilio-inguinal nerve (?). -Vas deferens, pampiniform plexus of veins, lymph vessels and vestigue of processus vaginalis.
and covers abdominal viscera. It has the following parts: 1- Visceral layer: covers abdominal viscera, supplied by autonomic nerves and sensitive to stretch only. 2- Parietal layer: lines abdominal wall, supplied by somatic nerves and it is very sensitive that when irritated leads to pain, tenderness and rigidity. 3- Peritoneal fold: when peritoneum is in contact other peritoneal layer to form either ligament, omentum or mesentery. 4- Peritoneal cavity: It separates visceral from parietal. It is potential space.
in females it is opened by uterine tubes. Functions of peritoneum: 1- provides smooth surfaces for viscera to avoid friction. 2- Protects against infection as peritoneal fluid contains antibodies. 3- Allows rapid healing of abdominal wounds. 4- Can localize the spread of infection (policeman of the abdomen). 5- Storage of fat.
sac: It is the part of peritoneal sac that fills most of abdominal cavity. 2- Lesser sac: It is the part of the peritoneal sac that is present behind stomach.
mesentery into: Supracolic compartment. That is divided into right and left parts by falciform ligament. Infracolic compartment. That is divided into upper right and lower left sides by mesentery of small intestine.
and lesser omentum. It communicates with the greater sac through opening of lesser sac (epiploic foramen). It is composed of: ➢Main part behind stomach and lesser omentum. ➢Superior recess (extension): behind liver (caudate lobe). ➢Inferior recess (extension): inside the greater omentum. ➢Splenic recess (extension): at hilum of spleen.
left at level of 7th costal cartilage (T11) 40 cm from incisors. -Controlled by physiological sphincter: -Acute angle. -Pinch-like action of right crus of diaphragm. -Mucosal rosette. -Effect of high intra-abdominal pressure on esophagus. -Circular muscle fibers around cardiac orifice.
is present at the transpyloric plane, ½ an inch to the right from median plane. -It is controlled by anatomical sphincter (pyloric sphincter) which is formed of thickened circular muscle fibers. -It is marked on the surface by a groove and prepyloric vein of Mayo.
of esophagus. -It is drained by left gastric vein to portal and esophageal veins to azygos vein. -In case of portal hypertension, this anastomosis will be opened to form esophageal and gastric varices.
duct then retrograde spread to left supra-clavicular nodes (Virchow’s glands). ➢Retrograde spread of malignant cells may reach hepatic nodes. ➢Retrograde spread may reach skin of umbilicus from hepatic nodes through ligamentum teres inside falciform ligament to form a malignant nodule in the umbilicus known as Sister Joseph nodule.
peritoneum. Relations: Superficial: left lobe of the liver. Deep: lesser sac. Attachments: Gastric: lesser curvature and 1st inch of duodenum. Hepatic: Hilum of the liver and fissure of ligamentum venosum. Contents: In right free margin: portal vein, hepatic artery and common bile duct. Along lesser curvature: Left gastric vs., right gastric vs. and lymph nodes. Extraperitoneal fat, lymph vessels and autonomic nerves
peritoneum. Relations: Superficial: anterior abdominal wall. Deep: small intestine and parts of large intestine. Attachments: Gastric: Lower 2/3 of the greater curvature and 1st inch of duodenum. Colic: to transverse colon or pancreatic to anterior border of body of pancreas. Contents: -In right free margin: portal vein, hepatic artery and common bile duct. -Along greater curvature: Left gastroepiploic vs., right gastroepipoic vs. and lymph nodes. -Extraperitoneal fat, lymph vessels and autonomic nerves
to diaphragm. Gastro-splenic ligament: Double layer of peritoneum that extends from upper part of greater curvature to hilum of spleen. Contents: Short gastric vessels, left gastro-epiploic vessels, extraperitoneal fat, lymphatics and autonomic nerves.
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