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Anatomy of the
Abdomen (4)
Abbas A. Abbas Shawka
Medical student – 2nd stage
• Groin (inguinal region)
Inguinal region
• Transitional area between the
abdominal wall, pelvic wall and
lower limb.
• This are is substantially we...
Processus vaginalis
• An outpouching of peritoneum that penetrate the AAW before the
descent of testis and ovaries from th...
Processus vaginalis
• This outpouckiting then will
converted into tubular structure
when penetrating the AAW, and
this wil...
Round ligament of uterus
- In women
- Remnant of the gubernaculum
- When uterus descent to the
pelvic cavity the only rema...
Inguinal canal
- 4cm slit-like passage.
- Extends from deep inguinal ring
to superficial inguinal ring
downward and medial...
Deep inguinal ring
- at a point midway between the
anterio superior iliac spine and
the pubic symphysis.
- above the ingui...
Superficial inguinal ring
• is superior to the pubic tubercle.
• It is a triangular opening in the
aponeurosis of the exte...
Superficial inguinal ring
• the superficial inguinal ring is
actually the beginning of the
tubular evagination of the
apon...
Anterior wall of inguinal canal
• Aponeurosis of EO
• Re-inforced laterally by fibers of
IO that originate from lateral 2/...
Posterior wall of inguinal canal
• Tranversalis fascia
• Inforced in medial 1/3 by
conjoint ligamne t( inguinal falx )
wic...
Roof & floor of inguinal canal
• Roof :
- Arching fibers of TA & IO as they
came from the common origion
to insert in a co...
Spermatic cord
• Occupy the inguinal canal
extending from abdomen to
pelvic cavity.
• 3 fascial covering, each acquired
as...
Fascia covering the spermatic cord
• Three fascias enclose the contents of the spermatic cord:
The internal spermatic fas...
Inguinal hernia
Protrusion of peritoneal
sac, with or without
abdominal viscera ..
Direct inguinal
Hernia
InDirect inguina...
InDirect inguinal hernia
• The most common
• Men > women
• When embryonic processus
vaginalis remains open or patent,
then...
Direct inguinal hernia
• A peritoneal sac that enters the
medial end of the inguinal canal
directly through a weakened pos...
Inguinal triangle
• inguinal triangle (Hesselbach's triangle) , which is bounded:
1. laterally by the inferior epigastric ...
Thank You
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Anatomy of the Abdomen (4)

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these lectures will covers the regional anatomy of the abdomen, source of these lectures is Grey`s anatomy for students Textbook, with pictures from Netter Atlas & Sobotta

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Anatomy of the Abdomen (4)

  1. 1. Anatomy of the Abdomen (4) Abbas A. Abbas Shawka Medical student – 2nd stage • Groin (inguinal region)
  2. 2. Inguinal region • Transitional area between the abdominal wall, pelvic wall and lower limb. • This are is substantially weak, due to the changes happened during the development of gonads … • However, this are is more weak in men, due to migration of testis outside the body. • naming this weak areas, anatomical location, borders & components passing through it is of high important considering the anatomy of this region.
  3. 3. Processus vaginalis • An outpouching of peritoneum that penetrate the AAW before the descent of testis and ovaries from their initial location in posterior abdominal wall. • This penetrating structure will acquire the following covering :- • 1- deep layer ( from transversalis fascia ) • 2- intermediate layer ( from IO muscle • 3- superficial layer ( from EO muscle ) • It will NOT acquire a covering from TA muscle !!
  4. 4. Processus vaginalis • This outpouckiting then will converted into tubular structure when penetrating the AAW, and this will form the basis for inguinal canal. • Gubernaculum:- - is important in the development & descent of testis. - it is hange between the inferior border of the gonads and the labioscrotal swelling. • Testicular descent complete by formation of spermatic cord in men. 1- testis 2- tunica vaginalis 3- processus vaginalis 4- Gubernaculum 5- superficial inguinal ring 1 2 3 4 5
  5. 5. Round ligament of uterus - In women - Remnant of the gubernaculum - When uterus descent to the pelvic cavity the only remanaent in the inguinal canal will be the round ligament of uterus. • If this developmental sequence fail in one of the sexual developments, then the AAW will be substantially weak and susceptible to inguinal hernia.
  6. 6. Inguinal canal - 4cm slit-like passage. - Extends from deep inguinal ring to superficial inguinal ring downward and medially - Its contents include : 1) Genitofemoral nerve 2) Spermatic cord in male (M) & round ligament of uterus in female (F). 3) Ilio-inguinal nerve pass through a portion of this canal and exit through superficial inguinal ring.
  7. 7. Deep inguinal ring - at a point midway between the anterio superior iliac spine and the pubic symphysis. - above the inguinal ligament and immediately lateral to the inferior epigastric vessels . - Although sometimes referred to as a defect or opening in the transversalis fascia, it is actually the beginning of the tubular evagination of transversalis fascia that forms one of the coverings (the internal spermatic fascia) of the spermatic cord in men or the round ligament of the uterus in women.
  8. 8. Superficial inguinal ring • is superior to the pubic tubercle. • It is a triangular opening in the aponeurosis of the external oblique, with its apex pointing superolaterally and its base formed by the pubic crest. • The two remaining sides • of the triangle (the medial crus and the lateral crus) are attached to the pubic symphysis and the pubic tubercle, respectively. • At the apex of the triangle the two crura are held together by crossing (intercrural) fibers, which prevent further widening of the superficial ring.
  9. 9. Superficial inguinal ring • the superficial inguinal ring is actually the beginning of the tubular evagination of the aponeurosis of the external oblique onto the structures traversing the inguinal canal and emerging from the superficial inguinal ring. • This continuation of tissue over the spermatic cord is the external spermatic fascia .
  10. 10. Anterior wall of inguinal canal • Aponeurosis of EO • Re-inforced laterally by fibers of IO that originate from lateral 2/3 of inguinal ligament. • IO also contribute to ( creamastric fascia ) wich contain the creamastric muscle to the covering of structures traversing the inguinal canal.
  11. 11. Posterior wall of inguinal canal • Tranversalis fascia • Inforced in medial 1/3 by conjoint ligamne t( inguinal falx ) wich is the combined insertion of both TA & IO on pubic crest and pectineal line.
  12. 12. Roof & floor of inguinal canal • Roof : - Arching fibers of TA & IO as they came from the common origion to insert in a common insertion at conjoint ligament. • Floor : - Reinforced by the medial end of inguinal ligament (IL). - Rolled-under free margin of EO aponeurosis will form a gutter like place in which it lies the Inguinal canal contents. TA IO
  13. 13. Spermatic cord • Occupy the inguinal canal extending from abdomen to pelvic cavity. • 3 fascial covering, each acquired as previously mentioned.  Components 1. the ductus deferens, 2. the artery to the ductus deferens (from the inferior vesical artery) , 3. the testicular artery (from the abdominal aorta) , 4. the pampiniform plexus of veins (testicular veins) , 5. the cremasteric artery and vein (small vessels associated with the cremasteric fascia), 6. the genital branch of the genitofemoral nerve (innervation to the cremasteric muscle), 7. sympathetic and visceral afferent nerve fibers, 8. Lymphatics 9. remnants of the processus vaginalis.
  14. 14. Fascia covering the spermatic cord • Three fascias enclose the contents of the spermatic cord: The internal spermatic fascia, which is the deepest layer, arises from the transversalis fascia and is attached to the margins of the deep inguinal ring. The cremasteric fascia with the associated cremasteric muscle, which is the middle fascial layer, arises from the internal oblique muscle. The external spermatic fascia, which is the most superficial covering of the spermatic cord, arises from the aponeurosis of the external oblique muscle and is attached to the margins of the superficial inguinal ring
  15. 15. Inguinal hernia Protrusion of peritoneal sac, with or without abdominal viscera .. Direct inguinal Hernia InDirect inguinal Hernia Through depp inguinal ringThrough superficial inguinal ring
  16. 16. InDirect inguinal hernia • The most common • Men > women • When embryonic processus vaginalis remains open or patent, then it is described as being congenital in origin. • The sac enters the inguinal canal, passing through the deep inguinal ring, lateral to the inferior epigastric vessels . • The extent of its excursion depends on the amount of processus vaginalis that remains patent. • If the entire processus vaginalis remains patent, the peritoneal sac may traverse the length of the canal, exit the superficial inguinal ring, and continue into the scrotum in men or the labia majus in women.
  17. 17. 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 mature men. • The bulging occurs medial to the inferior epigastric vessels in the inguinal triangle. • This type o f inguinal hernia does not traverse the entire length of the inguinal canal but may exit through the superficial inguinal ring. When this occurs, the peritoneal sac acquires a layer of external spermatic fascia and can extend, like an indirect hernia, into the scrotum.
  18. 18. Inguinal triangle • inguinal triangle (Hesselbach's triangle) , which is bounded: 1. laterally by the inferior epigastric artery. 2. medially by the rectus abdominis muscle. 3. inferiorly by the inguinal ligament. 12 3
  19. 19. Thank You
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these lectures will covers the regional anatomy of the abdomen, source of these lectures is Grey`s anatomy for students Textbook, with pictures from Netter Atlas & Sobotta

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