Anterior Abdominal Wall/ Inguinal Region (Week 9)

Camper’s Fascia

Superficial fatty layer of superficial fascia

Scarpa’s Fascia

Deep, thin membranous layer of superficial fascia

Ribs 5-12

External abdominal oblique origin(s)

Linea alba, iliac crest, pubic tubercule

External abdominal oblique insertions - (3)

T7-T11, subcostal nerve T12 (T7-T12)

External abdominal oblique innervations - (2)

Thoraco-lumbar fascia, iliac crest, inguinal ligament

Internal abdominal oblique origins - (3)

Ribs 10-12, linea alba, pecten pubis

Internal abdominal oblique insertions - (3)

T7-T11, subcostal nerve T12, L1 (T7-L1)

Internal abdominal oblique innervations - (3)

Ribs 7-12, thoraco-lumbar fascia, iliac crest, inguinal ligament

Transverse abdominal oblique origins - (4)

Linea alba, pubic crest, pecten pubis

Transverse abdominal oblique insertion - (3)

T7-T11, subcostal nerve T12, L1 (T7-L1)

Transverse abdominal oblique innervations - (3)

Pubic symphysis, pubic crest

Rectus abdominis origin - (2)

Xiphoid process, 5-7 costal cartilages

Rectus abdominis insertions - (2)

T7-T12

Rectus abdominis innervation - (1)

Superficial veins

Venous vasculature within Camper’s fascia

Paraumbilical vein

Vein appears only when portal vein/liver is obstructed

T7-T11

Thoracoabdominal nerve spinal roots

T12-L1

Lumbar plexus spinal roots

Testis in abdomen, testis descends, testis in scrotum

Descent of Testes Steps 1-3

In utero development to male

Open, closed

Descent of testes

2. When testis ascends, the processus vaginalis is __ (open/closed)

3. When testis is in scrotum, the processus vaginalis is __ (open/closed)

Anterior wall

Aponeurosis of external abdominal oblique (Inguinal canal border)

Posterior wall

Transversalis fascia reinforced medially by conjoint tendon (Inguinal canal border)

Roof

Internal abdominal oblique and transversus abdominis m. (Inguinal canal border)

Floor

Medial half of inguinal ligament and lacunar ligament (Inguinal canal border)

Deep inguinal ring, internal spermatic fascia, internal oblique

Spermatic cord passes

1. Through __ __ __ in transversalis fascia

2. Picks up fibers which become __ __ __

3. Under lower boarder of the __ __ muscle

Cremaster, superficial inguinal ring, external spermatic fascia

Spermatic cord passes

1. Through deep inguinal ring in transversalis fascia

2. Picks up fibers which become internal spermatic fascia

3. Under lower boarder of the internal oblique muscle

4. Picks up fibers from layer which become the __ muscle

5. Through __ __ __ in external abdominal oblique

6. Picks up fibers that become the __ __ __

Tunica vaginalis, processus vaginalis

The __ vaginalis lies anterior surface of testes and is remnant of the __ __

Tunica, descent of testes

• The __ vaginalis lies on the anterior surface of the testes

• Remnant of the processus vaginalis that extended into the scrotum during the __ __ __

External spermatic fascia

Derived from external abdominal oblique aponeurosis (fascia)

Cremasteric fascia and muscle

Derived from internal abdominal oblique (fascia)

Internal spermatic fascia

Derived from transversalis fascia (fascia)

Vas deferens, deferent, testicular, pampiniform plexus, peri aortal nodes

Spermatic cord contents - (5)

• __ __ (duct)

• __ artery and __ artery

• __ __ of veins

• Lymphatic drain to __ __ in posterior abdomen

L1-L2

Genitofemoral nerve spinal roots

Genital branch of genitofemoral nerve

Nerve passes through superficial ring and descends alongside spermatic cord

Ilioinguinal nerve

Nerve within the inguinal canal but not within spermatic cord

All ages, less, unilateral, lateral, deep inguinal ring, does

Indirect inguinal hernia

• Occur at __ (all ages/elderly)

• __ (more/less) common

• Majority are __ (unilateral/bilateral)

• Herniates __ (medial/lateral) to inferior epigastric vessels

• Passes through __ ___ __ due to failure of closure of processus vaginalis

• Passes through superficial ring, __ (does/not) enter scrotum

Elderly, more, bilateral, medial, anterior body wall, not

Direct inguinal hernia

• Occur at __ (all ages/elderly)

• __ (more/less) common

• Majority are __ (unilateral/bilateral)

• Herniates __ (medial/lateral) to inferior epigastric vessels

• Passes through __ ___ __ within Hesselbech’s triangle

• Passes through superficial ring, __ (does/not) enter scrotum

Supravesical Fossa

Space with level changes with bladder volume

Medial inguinal fossa

Site of direct inguinal hernias (rare)

Lateral inguinal fossa

Site of indirect inguinal hernias (common)