DR UTOM-OBONG AKPAN INTRODUCTION TO THE ABDOMEN The transpyloric plane It is a transverse line drawn midway between
The suprasternal notch
& The symphysis pubis
The subcostal plane
It is a transverse line drawn between the lowest points of the costal margin
The supracrestal plane
It is a transverse line drawn between the highest points of the iliac crests
The intertubercular plane
a transverse line drawn between
the 2 tubercles of the2 iliac crests
The lateral vertical plane A vertical line drawn from the midclavicular point The body planes to the midinguinal point The anterior abdominal wall is divided into
9 regions by 2 transverse lines
The transpyloric plane
&The intertubercular plane
The Rt. & Lt.
lateral vertical planes and 2 vertical line
divisions of the abdomen
The 9 regions are 3 in the middle From above downward
Epigastrium Umbilical Hypogastrium 3 on the right side & 3 on the left side From above downward
Rt. & Lt. Hypochondrium
Rt. & Lt. Lumbar region Rt. & Lt. Iliac region Divisions of the abdomen Layers of anterolateral abdominal wall 1- Skin. 2- Superficial fascia: a- Superficial fatty layer (Camper’s fascia). b- Deep membranous (Scarp’s fascia). NO DEEP FASCIA 4- Muscular layers: a. External oblique. b. Internal oblique. c. Transversus abdominis. 5- Fascia transversalis. 6- Extra peritoneal fatty tissue 7- Parietal peritoneum. External Oblique Origin:
Outer surface of lower 8 ribs.
Direction of its fibers:
Downward, Forward, and Medially.
Insertion: Xiphoid process, Linea alba, Symphysis pubis Pubic crest, Pubic tubercle, ASIS. Anterior ½ of outer lip of iliac crest. Layers of the Anterior Superficial Abdominal Wall inguinal ring 1- Skin. 2- Superficial fascia: a- Superficial fatty layer, (Camper’s fascia) b- Deep membranous layer, (Scarpa’s fascia) No Deep Fascia in the anterior abdominal wall 3- External oblique muscle. 4- Internal oblique muscle. 5- Transversus abdominis muscle. 6- Fascia Transversalis. 7- Extraperitoneal fatty Tissue. 8- Peritoneum. Femoral ring Layers of the Anterior Superficial Inguinal Ring: It’s an oval slit in the lower aponerotic fibers of the Abdominal Wall External oblique just above & lateral to the pubic tubercle. 1- Skin. The lateral crus attaches to pubic tubercle & the medial crus attaches to pubic crest. 2- Superficial fascia: Its base is formed by the lateral part of pubic crest a- Superficial fatty layer, (Camper’s fascia) b- Deep membranous layer, (Scarpa’s fascia) No Deep Fascia in the anterior abdominal wall 3- External oblique muscle. 4- Internal oblique muscle. 5- Transversus abdominis muscle. 6- Fascia Transversalis. 7- Extraperitoneal fatty Tissue. 8- Peritoneum. Internal Oblique Origin: •Lateral 2/3 of inguinal ligament, •Anterior 2/3 of iliac crest, •Lumbar fascia.
Direction of its Fibers:
upward forward and medially (at right angle with the fibers of external oblique).
Insertion: ▪Lower 3 ribs and their costal cartilages, ▪Xiphoid process, ▪Linea alba, ▪Pubic crest and ▪Pectineal line. Transversus Abdominis Origin: • Lateral 1/3 of inguinal ligament, • Anterior 2/3 of inner lip of iliac crest, • Lumber fascia and • Lower 6 costal cartilages.
Direction of its fibers:
• Horizontally.
Insertion: • Xiphoid Process, • Linea alba, • Pubic crest, and • Pectineal line. • It is an oblique intramuscular INGIUNAL CANAL passage in the lower medial part of the Anterior Abdominal Wall. • It runs just above and parallel to the medial half of the inguinal ligament. • Its length is about 2 inches (5 cm), long in adult. • Its gives a passage for the spermatic cord in male, or round ligament of the uterus in female. • Also it gives a passage for the Ilioinguinal nerve in both sexes. • It connects between the superficial and deep inguinal rings. Superficial Inguinal Ring
• It’s an oval slit in the
lower aponerotic fibers of the external oblique just above & lateral to pubic tubercle . • The lateral crus attaches to pubic tubercle & the medial crus attaches to pubic crest. Deep Inguinal Ring
It is an opening in the fascia transversalis 1 cm above the middle of the inguinal ligament (midpoint of inguinal ligament point) It lies lateral to the inferior epigastric vessels Deep ring Superficial inguinal ring
INGUINAL CANAL Anterior. Wall: External oblique along whole length Internal oblique along lateral half. Posterior. Wall: Fascia Transversalis along whole length. Conjoint tendon along the medial part. Reflected ligament along the medial part. Ant. Wall: External oblique along whole length Anterior wall: Internal oblique along lateral half. Deep Inguinal Ring: Its an opening in the fascia transversalis 1cm above the middle of the inguinal ligament and lateral to the Posterior wall inferior epigastric vessels. Floor: Inguinal ligament supported medially by the Lacunar ligament. Roof: Arching lower fibers of internal oblique. Boundaries of the Inguinal canal
Ant. Wall: External oblique along whole length
Internal oblique along lateral half. Post. Wall: Fascia transversalis along whole length. Conjoint tendon along the medial half. Reflected ligament along the medial part. Floor: Inguinal ligament supported medially by the Lacunar ligament. Roof: Arching lower fibers of internal oblique. The inguinal canal is a potential weak MECHANICS point in the anterior abdominal wall. But it posses a protective mechanisms
Protective mechanisms • Oblique trajectory. • Anterior wall reinforced laterally by the internal oblique in front of the deep ring. • Posterior wall reinforced medially by the conjoint tendon behind the superficial ring. • On coughing and straining (micturition and defecation ) the arching lower fibers of the internal oblique and transversus abdominis contract and flatten the roof of the canal, compressing it's content.
• In great straining (defecation and
parturition), the person naturally assumes squatting position, in which the anterior abdominal wall is protected by the thighs.
23 Shutter Mechanism ABDOMINAL HERNIAS DEFINITION
• A protrusion of part of the abdominal
contents outside of the abdomen.
PARTS
1. Hernial sac. 2. Contents of the sac. 3. Coverings of the sac.
HERNIAL SAC • It is a pouch of peritoneum (diverticulum) • It has a neck and a body.
HERNIAL CONTENT
• Any mobile structure from the abdominal
cavity usually loop of intestine or part of greater omentum.
HERNIAL COVERINGS
• Formed by the layers of abdominal wall.
25 TYPES OF ABDOMINAL HERNIAE
• Inguinal- most common- (indirect or direct).
• Femoral. • Umbilical (congenital or acquired). • Epigastric. • Separation of the two recti abdominis muscles. • Hernia of linea semilunaris (Spigelian hernia). • Internal hernia.
