Internal abdominal wall and inguinal region. Mathew Wedel, 2015
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1 Internal abdominal wall and inguinal region Mathew Wedel, 2015
2
3 gut tube umbilicus
4 gut tube
5 dorsal mesentery visceral peritoneum gut tube FOREGUT dorsal mesentery parietal peritoneum MIDGUT & HINDGUT gut tube visceral peritoneum ventral mesentery parietal peritoneum
6 Aorta dorsal mesentery visceral peritoneum gut tube FOREGUT dorsal mesentery parietal peritoneum MIDGUT & HINDGUT gut tube visceral peritoneum ventral mesentery parietal peritoneum
7 anterior superior iliac spine (ASIS) pubic tubercles pubic symphysis
8 anterior superior iliac spine (ASIS) inguinal ligament (Poupart s ligament pubic tubercles iliopectineal arch pubic symphysis
9 lacuna musculorum together constitute retroinguinal space lacuna vasorum
10 lateral femoral cutaneous N femoral N iliacus (lateral) and psoas (medial) MM lacuna musculorum together constitute retroinguinal space lacuna vasorum
11 pectineal ligament (Cooper s ligament) lacunar ligament (Gimbernat s ligament) lacuna musculorum together constitute retroinguinal space lacuna vasorum
12 external iliac A&V (become femoral A&V past inguinal lig.) femoral ring (entrance to femoral canal) lacuna musculorum together constitute retroinguinal space lacuna vasorum
13 falciform ligament (ventral mesentery) - single ligamentum teres (obliterated umbilical V) - single umbilicus - single
14 falciform ligament (ventral mesentery) - single ligamentum teres (obliterated umbilical V) - single umbilicus - single median umbilical lig. (obliterated urachus) - single bladder
15 medial umbilical lig. (obliterated umbilical A) - paired falciform ligament (ventral mesentery) - single ligamentum teres (obliterated umbilical V) - single umbilicus - single median umbilical lig. (obliterated urachus) - single internal iliac A (many branches, see future lecture) - paired bladder
16 medial umbilical lig. (obliterated umbilical A) - paired rectus abdominis M falciform ligament (ventral mesentery) - single ligamentum teres (obliterated umbilical V) - single umbilicus - single median umbilical lig. (obliterated urachus) - single internal iliac A (many branches, see future lecture) - paired bladder
17 Contrast the unpaired, midline structures associated with the gut tube and urogenital system with the bilaterally paired structures derived from the iliac vessels. medial umbilical lig. (obliterated umbilical A) - paired lateral umbilical fold (inferior epigastric A&V) - paired internal iliac A (many branches, see future lecture) - paired rectus abdominis M bladder falciform ligament (ventral mesentery) - single ligamentum teres (obliterated umbilical V) - single umbilicus - single median umbilical lig. (obliterated urachus) - single
18 interfoveolar ligament (Hesselbach s ligament) - continuous with transversus abdominis M deep inguinal ring (in lateral umbilical fossa)
19 interfoveolar ligament (Hesselbach s ligament) - continuous with transversus abdominis M deep inguinal ring (in lateral umbilical fossa) testicular A&V (internal spermatic vessels) ductus deferens
20 deep inguinal ring (in lateral umbilical fossa) femoral ring (entrance to femoral canal)
21 deep inguinal ring (in lateral umbilical fossa) supravesical fossa femoral ring (entrance to femoral canal)
22 deep inguinal ring (in lateral umbilical fossa) Hesselbach s triangle (medial inguinal fossa) - lies posterior to superficial inguinal ring supravesical fossa femoral ring (entrance to femoral canal)
23 deep inguinal ring (in lateral umbilical fossa) x Hesselbach s triangle (medial inguinal fossa) - lies posterior to superficial inguinal ring supravesical fossa femoral ring (entrance to femoral canal) Cross-section diagram by Rocco Cusari, from: x
24 INdirect inguinal hernia Peritoneal contents pass through INguinal canal, including both deep and superficial rings. May not involve any tearing of tissues, especially if processus vaginalis is patent. Accounts for ~75% of inguinal hernias. Ten times more common in males than in females, because of larger inguinal canal.
25 Direct inguinal hernia Peritoneal contents push through tear in abdominal wall, most commonly emerging through superficial inguinal ring. Necessarily involves tearing the conjoint tendon (internal oblique and transversus abdominis aponeuroses). May also tear external oblique aponeurosis if hernia proceeds through supravesical fossa (rare). Accounts for ~25% of inguinal hernias, mostly in males older than 40.
26 Femoral hernia Peritoneal contents pass through femoral ring, emerge inferior to inguinal ligament. May not involve any tearing of tissues. More common in females than in males, because of proportionally wider bone structure of female pelvis.
27 Triangle of Pain - contains major nerves Triangle of Doom - contains major vessels
28 Blank version to practice on
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