Abdomino pelvic cavity

1-upper and lower borders

2- 2 cavities w/ in

1-anterior border- thoracic diaphram

Posterior border- pelvic diaphram

2-abdominal cavity and pelvic cavity

1-planes that intersect to create quadrants

2-Quadrants of abdominopelvic cavity

Midsaggital and Horizontal Plane that intersects umbilicus into

RUQ

LUQ

RLQ

LLQ

Abdominal Region Planes (4)

How many total regions?

-R & L Midclavicular lines vertically

-Subcostal plane: transverse hitting most inferior part of ribcage

Transtubercular plane of illium:transverse at the level of the iliac tubercles and L5

9 Regions

Define:

1) Hypochondric

2) Epigastric

3) Inguinal

Define:

1) Hypochondric

2) Epigastric

3) Inguinal

(Superior)

R.Hypochondric   Epigastric   L. Hypochondric

R. Lateral Lumbar  Umbilical  L. Lateral Lumbar

R. Inguinal   Hypogastric(pubic)    L. Inguinal

(Inferior)

Musculature of Anterior Wall of Abdominal Cavity

1)Superior

2) Midline Connective Tissue

3) lateral to midline Connective Tissue membrane, like apeuronosis

4) most external Muscular fibers laterally

1) Pec major

2) Linea Alba

3) Rectus Sheeth just lateral to linea alba- 2 layers, ant and post

4) External oblique muscle is most external muscle laterally

Rectus Abdominus

1) Deep to

2) between abs (6 pack effect)

3) sup and inf boundaries

4) antagonistic to

5) function

6) what is just deep to this?

7) where does this muscle connect

1) Anterior rectus sheath

2) tendinous intersections run transversly

3) verticle inferior midline aspect of ribcage to pubic bone

4) erector spinae (holds vertebral column erect)

5) flex vertebral column, especially lumbar region and a little thoracic....brings body foward

6) posterior rectus sheath

7)inferior aspect of the rib cage down then connects to the pubic bone

Rectus Sheath

1) function

2) musculature lateral to rectal sheath

1) Anterior and posterior rectus sheath encloses rectus abdominus muscle

2) External oblique (external), internal oblique (intermediate), transverse abdominal (deepest)

anterior lateral Abdominal Wall Lateral to Rectus Abdominus

1) superficial to deep

1) Skin>superifical and deep subcutaneous (fatty) tissue>superficial investing or (deep) fascia>external oblique>intermediate investing or (deep) fascia>internal oblique>deep investing or (deep) fascia>transverse abdominal>endoabdominal or (transversalis) fascia>extraperitoneal fat> parietal peritoneum

1) the connective tissue sheaths around external oblique>internal oblique>transverse abdominals associated (names)

2) what do these sheaths lead into?

1) Investing (deep) facia: superficial, intermediate, deep

2) form into aponeurosis (borad, flat, tendon-like structure of parallel collagen fibers)

What is deep to tranverse abdominal muscle 3 in order

External Oblique

1) shape

2) direction

3) Gives rise to what?

4)attachments

1) Large, broad, flat

2) Same direction of external intercostal - inferiorly and toward midline like putting hands in pockets

3) Gives rise to inguinal ligament - thickening of aponeurosis of external oblique

4) ribs superiorly and iliac crest inferiorly and aponuerosis medially

Internal Oblique

1) angle/ direction

Transverse Abdominal Muscle

1) angle

3) what can be visualized laterally between transverse and internal oblique muscles?

1) run transversly/horizontally

3) Intercostal nerves (from intercostal spaces of lower thorax) coarse through and innervate anterior abdominal wall muscles and dermatomes of abdominal wall

What do the external obliques, internal obliques, and transversus abdominis mucles do collectively?

BUMS

1) Add strength to abdominal wall  b/c they run at 3 different angles

2) Mov´t: Obliques do lateral flexion and rotation (facet joints) of vertebral column

3) Breathing: change pressures during exhale and inhale

4) Coughing and Sneezing - contraction causes volume in cavity to decr and push air out

5) Urination and Defecation - contract urinary bladder

**Maneuvers of internal viscera and mov´t of vertebral column**

***BUMS:

Breathing/coughing/sneezing, Urination/defecation,

Movement of vertebral column (lateral flexation), Strength of abdominal wall

Rectus Sheath - Aponeurosis of EO, IO, TA fascias

1) Where does aponeurosis of 3 muscles (EO, IO, TA) sheaths form?

2) interdigitation.  what does it do to rectus sheath?

3) Fascias in relation to rectus abdominus (RA) in a Cross sectional cut superior to  the umbilicus, Anterior to posterior:?

4) Cross sectional cut in pelvic region Anterior to posterior:?

5) What is the point of this?

1) Medially to 3 muscles and lateral to rectus abdominis (RA)

2) Complex interdigitation of aponeuroses of the muscles of both sides.  Meshlike arrangement.  Adds strength to rectus sheath.

3) (superior to arcuate line) Anterior to posterior: EO aponeurosis passes anterior to RA; IO aponeurosis splits into 2 laminae around ant/post aspects of RA; TA apo goes posterior; transversalis fascia

4) (inferior to arcuate line) All three muscle fascias go anterior to RA.  transversalis fascia goes posterior

5) Posterior layer is weaker inferiorly

observed on the Posterior layer of the rectus sheath

Represents a transition point - posterior layer changes in terms of aponeuroses that make it up

Anterior Wall of rectus sheath superficial to RA

1)superior to Arcuate Line

2) Inferior to Arcuate Line

1) External Oblique Aponeurosis & Anterior lamina of internal oblique aponeurosis

2) All 3 aponeurotic layers

Posterior Wall of rectus sheath

1) Superior to arcuate line

2) Inferior to arcuate line

1) Posterior lamina of internal obluque aponeurosis & tranverse abdominis aponeurosis

2) Deficiency!  transversalis fascia ONLY

Superior To Arcuate Line

List the structures anterior to posterior 8

SEAR

PTTP

1) Skin

2) EO aponeurosis

3) Ant lamina of IO aponeurosis

4) Rectus Abdominis

5) post lamina of IO apo

6) TA apo

7) transversalis fascia

8) Peritoneum

INFERIOR To Arcuate Line

List the structures anterior to posterior 7

S3, RTP

1) Skin

2) EO aponeurosis

3) IO aponeurosis

4) TA aponeurosis

5) Rectus Abdominis

6) transversalis fascia

7) Peritoneum

Blood Vessel Within Rectus Sheath

1)  superior supply

2) inferior supply

3) where do the vessels run

1) Superior Epigastric a. (terminal branch) DESCENDS from internal thoracic a. 

2) Inferior Epigastric a.  (ASCENDS from femoral a.)

**Important landmark relative to inguinal region**

3) posterior wall of the restus sheath

Intercostal Nerves assoc. w/ anterior abdominopelvic region

1) spinal nerve #s associated with anterior abdominal wall

2) T12 nerve  - special location and name

3) L1 nerve innervations

4) 1-Origins of all nerves in this region and innervations

5) innervation of 1-Nipple and 2-Umbilicus Dermatomes

1) thoracoabdominal or (intercostal nerves T7-11

2) T12 = ¨subcostal n.¨  INFERIOR to rib 12, not between ribs, not ic nerve (only have 12 ribs)

3) Innervate Inguinal and pubic region inferiorly within abdominal pelvic anterior wall

4) 1-ventral primary rami. (Independent no plexuses T1-T12  Each nerve represents single spinal segment. ) 2-They all innervate lateral and anterior dermatomes and muscles of anterior abdominal wall.

5) 1-T4, 2-T10

Inguinal Ligament

1) Derivation

2) Bony attachments

3) Orientation

4) Forms 1 what border of what structure?

1) Derived from EO apo - thickening of apo

2) Ilium @ anterior superior iliac spine (ASIS) & pubic bone @ pubic tubercle

3) Obliquely: ASIS is superior and lateral; pubic tubercle is inferior and medial

4) Inferior border or floor of inguinal canal

Inguinal Canal - General

1) Shape

2) Orientation within

3) Internal Opening and Association

4) External Opening

1) Tube

2) Passes through anterior abdominal wall obliquely, sometimes parallel with inferior medial aspect of inguinal ligament

3) deep inguinal ring associated with potential weakening of transversalis fascia

4) Superficial Inguinal ring is a potential weaking within EO apo

1) Layers of the rectus sheath

2) Forms Inguinal Ligament

3) Association with superficial inguinal ring

4) Continous into external spermatic fascia covering spermatic cord and testes

1. Connective Tissue Surrounding the Superficial Inguinal Ring forms

2. What holds it all together?

3. What adds to strength?

1)Medial Crus

Lateral Crus

2) Intercrural fibers (connective tissue) hold the two crural together.

3. All run in different directions, adding to strength

Superficial inguinal ring is medial and inferior to the deep inguinal ring

canal course obliquely

Anterior view of Parietal Peritoneium

1) what type of membrane lines it?

2) Inguinal Triangle Borders

3) Location of deep inguinal ring

4) Importance of triangle

1) Serous membrane that lines abdominal cavity

2) Point of reference.  Medial Border = rectus abdominis muscle.  Inferior= Iliopubic tract-condensation of connective tissue between ilium and pubic bone.  LATERAL BORDER is key! = Inferior epigastric artery (medial) & vein (lateral). 

4) Deep inguinal ring is LATERAL to inferior epigastric vessels

4) Hernias through deep inguinal ring and medial to inf epigastric vessels in the triangle

Spermatic Cord:

 1) path in inguinal region

2) Covering derived from...

3) Path of EO

4) Path of IO and ultimate function

5) transversalis fascia path

6) What doesn´t contribute to covering of cord?

1) travels through inguinal canal

2) structures of anterior abdominal wall travel down over spermatic cord and then over testes

3) EO forms external spermatic fascia(EO>superficial inguinal ring>inguinal ligament>external spermatic fascia, covers spermatic cord >covers testes in scrotum)

4) IO>cremasteric muscle and fascia (covers spermatic cord)>testes covering.  Cremastric skeletal muscles contract, causing testes to move superiorly.  **Cremasteric reflex**

5) forms deep inguinal ring> extends as internal spermatic fascia over spermatic cord>testes covering

6) Transverse Abdominis Fascia

Male, Early in Utero

1) Where are the testes and kidneys at 7wks?

2) Processus vaginalis process

3) Gubernaculum, function.

4) Path of descending testes

5) 1-Tunica Vaginalis testis and 2-origins

1) within posterior wall of abdomen.

2) Process vaginalis is most anterior midline structure of peritineal cavity.  It begins forming a second cavity, ultimately sealing off and becomeing scrotal sack.

3) connective tissue guidewire connecting to testes, shortens and draws testes towards scrotum

4) Passes through anterior abdominal wall via inguinal ring

6) 1-Srotum 2-whose innerlining was peritineal cavity which was separted when process vaginalis dropped and separated into second cavity

Female, Utero Development

1) Upper Gubernaculum devlopes into...function

2) Lower Gubernaculum develops into...function and path

3) Location of uterine development

1) Ovarian ligament: anchors ovary to uterus

2) Round ligament of uterus: anchors uterus to connective tissue of labia majora via INGUINAL CANAL

3) Uterus develops in middle of gubernaculum.

Testes:

1) cavity of Tunica Vaginalis and derivation

2) Serous membranes and associations.

1)Space/cavity around testis in scrotal sack derived from peritoneal cavity via the process vaginalis

2) Visceral and parietal layers of tunica vaginalis, same as perintoneal cavity

Sperm Passage through duct system of testes. 

 before the spermatic cord

1) Seminiferous tubule: sperm made

2) Straight tubule

3) Rete testis (in mediastinum of testis)

4) Efferent ductules

5) Epididymis: head, body, tail

6) Ductus deferens is constituent of spermatic cord

Inguinal hernias:

1) What is the hernia and what does it herniate through?

2) Direct inguinal hernia

3) Indirect inguinal hernia

(#2 & #3 in relation to vessels, triangle, spermatic cord, & congenitality)

4) Terminology refers to

5) Testing

1) Loop of bowel-commonly ilium of small intestine-pushing through potential weaking in interior abdominal wall (peritoneum & transversalis fascia)

2) MEDIAL to inferior epigastic vessels (medial to deep inguinal ring) and pushes through peritoneum and transversalis fascia in inguinal triangle to enter inguinal canal, parallelling spermatic cord.  ACQUIRED.

3) LATERAL to inferior epigastric vessels and enters deep inguinal ring, descending length of inguinal canal, within spermatic cord. CONGENITAL. ( Peritoneal cavity remains

confluent with the processus vaginalis, (fails to seal))

4) Shortest distance of herniated bowel

5) Palpate superficial ring while increasing abdominal pressure (cough), pushing bowel into area if there is a hernia

Inguinal Hernia Anatomy from Superficial Posterior View

**This is a picture....describe it first, then look, fool***

Contents of Inguinal Canal

1) F

2) M

1) Round ligament of uterus & ilioinguinal nerve 2) Spermatic cord & ilioinguinal nerve

Contents of Spermatic Cord:

-LIST and explain

¨DTP, LAG¨

****1) Ilioinguinal Nerve