Abdomen

ملحق ANATOMY OF ANTERIOR WALL & INGUINAL REGION

أ.د.عبد الجبار الحبيطي

A mid line canula through anterior abdominal wall passes through the following layers:

1-Skin
2-Superficial fascia
3-Linea alba
4-Transversalis fascia&extraperitoneal fat
5-The parietal peritoneum.

The superficial inguinal ring : is triangular in shape located just above the pubic tubercle.It is related to the Conjoint tendon posteriorly ,which forms part of the posterior wall of the inguinal canal (medial part) .The conjoint tendon reinforces the superficial inguinal ring.
The Deep Inguinal Ring(D.I.R) is about half an inch above the mid point of inguinal ligament,it is a defect through the Transversalis fascia & the inferior epigastric artery runs just medial to it.

Deep to the inguinal ligament the following structures pass:

1-Iliacus & psoas major Ms
2-External iliac vessels (just below lig, become Femoral)
3-The Femoral nerve
4- The lateral cutaneous nerve of the thigh.


The Cremaster muscle forms loops on the spermatic cord,it reaches the base of the scrotum.It is supplied by genital branch of genitofemoral nerve( cremasteric nerve ), it elevates the testes ,while cremasteric reflex is by ilioinguinal nerve .The cremaster muscle is absent in the female.

The Conjoint tendon:It lies behind the S.I.R & reinforces it .It is formed by contributions from the aponeurosis of both internal oblique & transversus abdominis & is attached to the pubic crest. It forms part of posterior wall of the inguinal canal& supplied by ilioinguinal nerve.

The following structures are seen at the level of the transpyloric plane:

1-Fundus of the gall bladder.
2-the upper limit of the hilum of right kidney. 3-The tip of the 9th costal cartilage.
4-The pylorus of stomach.
5-Body of L1 vertebra.
6-Origin of superior mesenteric artery.

The Rectus Abdominis Muscle:

1- Helps in flexion of the trunk
2-Is supplied by lower 5 intercostal nerves
3-Shows three tendinous intersections on its anterior surface.
4-The rectus sheath is not attached to its posterior surface.

On tapping Hydrocele (Tunica vaginalis is distended with fluid) the Canula passes through:

1-Skin
2- Dartos muscle(smooth m.fs) & membranous layer of the superficial fascia
3-External spermatic fascia
4-Cremaster fascia
5-Internal spermatic fascia
6- The parietal layer of Tunica Vaginalis .


To withdrow fluid from peritoneal cavity aneedle(just lateral to the inferior epigastric artery ) should pass through the following layers:
1-Skin
2- Superficial fascia
3-External oblique M
4-Internal oblique M
5-Transversus abdominis M
6-Transversalis fascia
7-Extraperitoneal fat
8-Parietal peritoneum.

The Mid-inguinal point is the point located at the middle of the distance between the Anterior superior iliac spine & Pubic symphysis.