Bisc 130 Anterior Abdominal Wall / Inguinal Region And Hernias Ii

Front 1

What is the ASIS?

Back 1

The anterior superior iliac spine (landmark of the anterior abdominal wall)

Front 2

What is the significance of the linea alba?

Back 2

It is the midline, where the external obliques and tendons meet the symmetrical tendons and external obliques.
This line may darken during pregnancy.

Front 3

What are the layers of the anterior wall (superficial to deep)?

Back 3

1. Skin
2. Camper's fascia
3. Scarpa's fascia
4. Rectus abdominus muscle
5. External obliques
6. Internal obliques
7. Transversus abdominus
8. Inguinal ligament
9. Conjoined tendon
10. Transversalis fascia
11. Preperitoneal fat
12. Peritoneum

Front 4

What are the two components of the Camper's fascia?

Back 4

Camper's fascia --> fatty layer, nerves, and vessels

1. Panniculus adiposus ('apron of fat')
2. Caput medusae: veins in the anterior abdominal wall

Front 5

What is the significance of the caput medusae?

Back 5

The veins increase in size if there is a portal obstruction.
Venous drainage to the liver is compromised, so the blood drains into the caput medusae and they swell.

Front 6

Which is deeper in the anterior abdominal wall, the Scarpa's fascia or the Camper's fascia?

Back 6

Scarpa's fascia (membranous layer)

Front 7

Rectus abdominis muscle

Back 7

Origin: Pubic crest
Insertion: Costal cartilages 5-7
Action: Flexes the vertebral column
Innervation: Lower 5-6 intercostal and subcostal nerves

Front 8

External oblique muscle

Back 8

**Fibers run downward and medial**

Origin: Lower 8 ribs
Insertion: Iliac crest, linea alba
Action: Compresses the abdomen, both sides flex vertebral column; can rotate trunk to opposite side with unilateral contraction
Innervation: Lower 5 intercostal, iliohypogastric, and ilioinguinal nerves

Front 9

Internal oblique muscle

Back 9

**Fibers run upward and medial**

Origin: Lumbar fascia, iliac crest, lateral 1/2 of inguinal ligament
Insertion: Cartilage of lower four ribs, linea alba
Action and Innervation: same as external obliques

Front 10

Where is the inguinal ligament located?

Back 10

From the ASIS to the pubic symphysis - made from the lower tendonous fibers of the external oblique

Front 11

Where is the transversalis fascia located? What is the name of its aponeurosis?

Back 11

The transversalis fascia is located deep to the transversis abdominus muscles and aponeurosis. The aponeurosis is known as the conjoined tendon.

Front 12

Transversus abdominis muscle

Back 12

Origin: Iliac crest, lateral 1/3 inguinal ligament, cartilage of lower six ribs
Insertion: Linea alba
Action: Compresses the abdomen and increases intraabdominal pressure
Innervation: Lower 5 intercostal, iliohypogastric, and ilioinguinal nerves

Front 13

What is the deepest layer of the anterior abdominal wall?

Back 13

Peritoneum

Front 14

Where are the external and internal rings located?

Back 14

The internal inguinal ring is located at the level of the transversalis fascia.
The external inguinal ring is located at the level of the external abdominal obliques.

Front 15

Where is the inguinal canal?

Back 15

Located between the external and internal inguinal rings.

Front 16

What passes through the inguinal canal?

Back 16

The spermatic cord or the round ligament of the uterus

Front 17

What is the inferior epigastric artery?

Back 17

Artery from the external iliac that ascends deep to the rectus abdominus muscle then anastomoses with the superior epigastric artery.

Front 18

What do the cremaster and dartos muscles do?

Back 18

Contract to move the testes up (or relax to move them down) to maintain the proper temperature for spermatogenesis.

Front 19

A posterior rectus sheath (around the rectus abdominus muscle) exists above/below the arcuate line.

Back 19

Above; aponeuroses form the sheath - create an anterior and posterior layer

Front 20

Are hernias more likely to happen above or below the arcuate line? Why?

Back 20

Below the arcuate line, because all three layers are anterior and there is little reinforcement.

Front 21

What are the two components of the posterior layer of the rectus sheath above the arcuate line?

Back 21

The internal obliques and transversus abdominus

Front 22

What are the borders of Hesselbach's triangle? What is the significance of this area?

Back 22

Borders:
1. Rectus abdominus
2. Inguinal ligament
3. Inferior epigastric artery

Significance: Hernias often occur here (area of weakness)

Front 23

What is a direct/acquired hernia?

Back 23

Protrusion of abdominal contents into transversalis fascia.
Usually occur later in life, and are more common in males than females.

Front 24

What is the path of the descending testis?

Back 24

-Testis develops between the peritoneum and transversalis fascia in the fetal male.
-Descends into the internal ring, through the inguinal canal, through the external ring and finally to the scrotum.

Front 25

What are the two muscles found in the spermatic cord? What do they originate from?

Back 25

1. Cremaster muscle - internal oblique
2. Dartos muscle - Camper's fascia

Front 26

What layer of the anterior abdominal wall does NOT encounter the descending testis?

Back 26

Transversus abdominus

Front 27

What do the following layers become when evaginated by the descending testis?
1. Peritoneum
2. Preperitoneal fat
3. Transversalis fascia
4. Internal oblique
5. External oblique
6. Scarpa's fascia
7. Camper's fascia
8. Skin

Back 27

1. Peritoneum --> processus vaginalis
2. Preperitoneal fat --> fat
3. Transversalis fascia --> internal spermatic fascia
4. Internal oblique --> Cremaster muscle
5. External oblique --> external spermatic fascia
6. Scarpa's fascia --> Colles' fascia
7. Camper's fascia --> Dartos muscle
8. Skin --> Skin

Front 28

Besides the evaginated layers, what are the contents of the spermatic cord?

Back 28

The ductus deferens and NAV to the testes

Front 29

What is an indirect or congenital hernia?

Back 29

A hernia present at birth that may never present with symptoms or could have symptoms later in life.
It is a failure of the funicular portion of the processes vaginalis to obliterate (wall off). This causes abdominal contents to go through the open pouch to the inguinal canal and possibly to the scrotum.

Front 30

What are the two divisions of the processus vaginalis in males? What happens to them after the testis descends?

Back 30

1. Vaginal portion (more inferior): becomes the tunica vaginalis, a coating of the testes
2. Funicular portion: obliterates (walls off) to close opening - turns into CT

Front 31

Where is the gubernaculum attached in males? What does it do?

Back 31

It is a fibrous cord from the testis to the base of the scrotum.
There is an apparent shortening of the gubernaculum to bring the testes down into the scrotum.

Front 32

True or false: An indirect/congenital hernia can occur in males or females.

Back 32

True

Front 33

What is the treatment for a congenital hernia?

Back 33

The hernia is reduced and sewn over to obliterate the funicular portion.

Front 34

What are the two divisions of the gubernaculum in females? What does it do?

Back 34

1. Proper ligament (superior); from ovary to uterus
2. Round ligament: from the uterus through the inguinal canal to the labia majorus

The gubernaculum prevents the ovary from descending through the inguinal canal - keeps the ovaries in the abdomen.

Front 35

What happens if the gubernaculum is not properly attached in females?

Back 35

The ovaries could descend through the inguinal canal to the labium majorus.