transversus abdominis rectus abdominis Posterior group Quadiatus
lumborum Psoas major Obliquus externus absominis General direction of fibers: downward, forward and
medially (run down and inward) Structures Inguinal ligament Lacunar ligament pectineal ligament Superficial inguinal ring triangular-shaped
defect in aponeurosis of obliquus externus abdominis above pubic tubercle Inguinal ligament pectineal ligament
Superficial inguinal ring Lacunar ligament Superficial inguinal ring Obliquus internus abdominis
Deep to obliquus externus abdominis General direction of fibres: upwards, forwards and medially Transversels abdominis Deep to obliquus
internus inguinal ligament lacunar ligament pectineal ligament Inguinal falx : arch over spermatic cord, inserted with transverses abdominis fiber into medial part
of pecten of pubis Cremaster : around the spermatic cord and testis Inguinal falx Rectus abdominis Position: lie on to either of midline
Origin: pubic crest and symphysis Insertion: xiphoid and 5th7th costal cartilages Has 3-4 tendinous intersections linea semiluaris arcuate line Linea alba tendinous raphe between right and left recti from xiphoid to pubic symphysis.
Linea alba Deep vessels and nerves Arteres Superior and inferior epigastric arteris Lower posterior intercostal a. Subcostal a.
Four lumbar a. Nerves Intercostal n.(6-11) Subcostal n. Nerves Iliohypogastric n.
Ilioinguinal n. Genitofemoral n. Regional anatomy Sheath of rectus abdominis
Ant layer formed by fusion of aponeurosis of obliquus externus abdominis and anterior leaf of aponeurosis of obliquus internus abdominis Post layer Formed by fusion of posterion leaf of aponeurosis of
obliquus internus abdominis and aponeurosis of transverses abdominis Absent in about 4-5cm below the umbilicus, where aponeuroses of all three muscles form anterior layer the lower free border named arcuate line
Below this line rectus abdominis in contact with transverse fascia arcuate line The Inguinal Region Boundary Layers and characteristics
Inguinal canal Inguinal triangle Hernias Direct inguinal hernias Indirect inguinal hernias Femoralhernias Inguinal region Boundaries Inguinal ligament
Lateral margin of rectus abdominis A horizontal line stretching from anterior iliac spine to laeral margin of rectus abdominis Inguinal canal Position: oblique passage, 4cm long, located
1.5cm above medial half of inguinal lig. Boundaries Ant wall Aponeurosis of obliquus externus
abdominis Obliquus internus abdominis (lateral third of wall) Posterior wall Transverse fascia Inguinal flax medially Roof arched lower
fibers of obliquus internus and transversua abdominis Floor inguinal lig Two openings Superficial inguinal ring
Deep inguinal ring defect in transverse fascia 1.5cm above midpoint of inguinal ligament Structures passing through the inguinal canal Spermatic cord and ilioinguinal nerve in males Round ligament of uterus and ilioinguinal
nerve in females Descent of testes Seven-week embryo showing the testis before its descent from the dorsal abdominal wall Fetus at 28 week the testis passing through the inguinal canal
Muscle-splitting incision Median or midline incision Left paramedian incision Transverse incision Suprapubic incision
Regional anatomy The peritoneum Ling Shucai .General features The peritoneum is a thin serous membrane that line the walls of the abdominal and pelvic cavities and cover the organs within these cavities
Parietal peritoneum lines the walls of the abdominal and pelvic cavities Visceral peritoneum covers the organs Peritoneal cavity the potential space between the parietal and visceral layer of peritoneum, in the mail, is a closed sac, but in the female, there is a communication
with the exterior through the uterine tubes, the uterus, and the vagina Function Secretes a lubricating serous fluid that continuously moistens the associated organs Absorb Support viscera
.The relationship between viscera and peritoneum Intraperitoneal viscera Interperitoneal viscera Retroperitoneal viscera Intraperitoneal viscera Interperitoneal viscera
Retroperitoneal viscera Interperitoneal viscera . Formative formation by peritoneum The omentum
The mesenteries and mesocolons The ligaments
The peritoneal recesses, pouches, fossae and folds Omentum two-layered fold of peritoneum that extends from stomach to adjacent organs Lessor omentum
Greater omentum Lessor omentum Hepatogastric ligament extends from porta hepatis to lesser
curvature of stomach Hepatoduodenal ligament Extends from porta hepatis to superior part of
duodenum Contains common bile duct, proper hepatic a. and hepatic portal v. Omental foramen Behind the right border of
hepatoduodenal ligament Superior caudate lobe of liver Inferior superior part of duodenum Anterior hepatodudenal ligament Posterior peritoneum covering the inferior vena cava
Greater omentum four-layered fold of peritoneum, the anterior two layers descend from the greater curvature of stomach and superior part of duodenum and hangs down like an apron in front of coils of small intestine, and then
turns upward and attaches to the transverse colon. If an infection occurs in the intestine, plasma cells formed in the lymph nodes combat the infection and help prevent it from spreading to the peritoneum. Lessor omentum
Greater omentum Omental bursa Position situated behind the lesser omentum and stomach Walls Superior peritoneum which covers the caudate lobe of liver and
diaphragm Anterior formed by lesser omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater omentum Inferior conjunctive area of anterior and posterior two layers of greater omentum
Posterior formed by posterior two layers of greater omentum, transverse colon and transverse mesocolon, peritoneum covering pancreas, left kidney and suprarenal gland Left formed by the
spleen, gastrosplenic ligament and splenorenal ligament Right formed by omental foramen The Omental bursa
(lesser sac) communicates with the greater sac through the omental foramen. Mesenteries or mesocolons twolayered fold of peritoneum that attach part of the intestines to the posterior abdominal
wall The mesenteries and mesocolons Mesentery suspends the small intestine from the posterior abdominal wall Broad and a fan-shaped Consists of two peritoneal
layers Intestinal border folded, 7 m long Radix of mesentery 15 cm long Directed obliquely from left side of L2 to in front of right sacroiliac joint Mesoappendix
Triangular mesentery extends from terminal part of ileum to appendix Appendicular artery runs in free margin of the mesoappendix Transverse mesocolon a double fold of peritoneum which connects
the transverse colon to the posterior abdominal wall Sigmoid mesocolon inverted V-shaped, with apex located in front of left ureter and division of common iliac artery Ligaments two-layered folds of
peritoneum that attached the lesser mobile solid visera to the abdominal wall Ligaments of liver Falciform ligament of liver Coronary ligament Left and right triangular ligaments
Hepatogastric ligament Hepatoduodenal ligament Ligamentum teres hepatis Ligaments of spleen
Pouches In male - rectovesical pouch In female Rectouterine pouch between rectum and
uterus Vesicouterine pouch between bladder and uterus .Peritoneal subdivisions The transverse colon and transverse mesocolon divides the greater sac into supracolic and infracolic
compartments. Supracolic compartments (subphrenic space) lies between diaphragm and transverse colon and transverse mesocolon Infracolic compartments. lies below the transverse colon and transverse mesocolon Subphrenic Space
Suprahepatic recess Left suprahepatic recesses left anterior suprahepatic spaces left posterior suprahepatic spaces Right suprahepatic recesses right anterior suprahepatic spaces right posterior suprahepatic spaces bare area of live (extraperitoneal space) Infrahepatic recess Right infrahepatic recesses (hepatorenal
recess) Left infrahepatic recesses left anterior infrahepatic space left posterior infrahepatic space ( Suprahepatic recess lies between the diaphragm and live the falciform ligament divides it into right and left suprahepatic recesses Left suprahepatic recesses
left anterior suprahepatic spaces left posterior suprahepatic spaces Right suprahepatic recesses right anterior suprahepatic spaces right posterior suprahepatic spaces bare area of live (extraperitoneal space)
Infrahepatic recess lies between the live and transverse colon and transverse mesocolon the ligamentum teres hepatic divides it into right and left infrahepatic recesses Right infrahepatic recesses (hepatorenal recess ) Left infrahepatic recesses
left anterior infrahepatic space left posterior infrahepatic space Infracolic compartments lies below the transverse
colon and transverse mesocolon Right paracolic sulcus lies lateral to the ascending colon. It communicates with the hepatorenal recess and the pelvic cavity. It provides a route for the spread of infection between the pelvic and the upper abdominal region. Left paracolic sulcus lies lateral to the descending colon.
It is separated from the area around the spleen by the phrenicocolic ligament, a fold of peritoneum that passes from the colic flexure to the diaphragm. Right mesenteric sinus triangular space, lies between root of mesentery, ascending colon, right 2/3 of transverse colon and
transverse mesocolon Left mesenteric sinus lies between root of mesentery, descending colon, right 1/3 of transverse colon and transverse mesocolon, its widens below where it is continuous with the cavity of the pelvis
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