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ANTERIOR ABDOMINAL WALL Part 4

    RELATION OF INFERIOR EPIGASTRIC ARTERY TO DEEP INGUINAL RING (SE)
     Inferior epigastric artery is a branch of external iliac artery & arises just above the inguinal  ligament
      Deep inguinal ring lies lateral to stem of inferior epigastric artery
                                                                     


    INGUINAL RINGS (SUPERFICIAL/DEEP) (SA)
       Deep inguinal ring:
    Is an oval gap in fascia transversalis situated about 1.25 cm above the midinguinal point & lateral to 
     Stem of inferior epigastric artery
       Superficial inguinal ring:
    Is a triangular gap in external oblique aponeurosis
    Base is formed by pubic crest
    2 sides of triangle are called as medial & lateral crura

    MENTION THE CONTENTS OF INGUINAL CANAL    (SA)
       Spermatic cord in males or Round ligament of uterus in females (entire content)
       Ilioinguinal nerve (partial content )– enters canal by piercing internal oblique muscle about 2.5 cm      below  &  medial to anterior superior iliac spine. It is situated superficial to spermatic cord

      CONTENTS OF INGUINAL CANAL IN FEMALE     (SA)
        Round ligament of uterus (entire content)
        Ilioinguinal nerve (partial content )– enters canal by piercing internal oblique muscle about 2.5 cm below & medial to anterior superior iliac spine. It is situated superficial  round ligament

      INGUINAL TRIANGLE - BOUNDARIES    (SA)        
          Inguinal triangle is bounded
               Medially – lateral border of rectus abdominis
               Laterally – inferior epigastric artery
               Below – inguinal ligament
               Floor – peritoneum, extra peritoneal tissue, fascia transversalis



                                                    
        It is divided into medial & lateral parts by obliterated umbilical artery/ medial umbilical ligament                                       






     HESSELBACH’S TRIANGLE (SA)


                                                        
         

    Inguinal triangle is bounded
               Medially – lateral border of rectus abdominis
               Laterally – inferior epigastric artery
               Below – inguinal ligament
        It is divided into medial & lateral parts by obliterated umbilical artery/ medial umbilical ligament
        Direct inguinal hernia occurs through this triangle when there is weakness of abdominal wall

    SPERMATIC CORD – COVERINGS, CONTENTS    (SA)
    Coverings of spermatic cord:
      From within outwards,
      Internal spermatic fascia – derived from fascia transversalis
      Cremasteric fascia – derived from the internal oblique muscle
      External spermatic fascia – derived from external oblique aponeurosis

    Contents of spermatic cord:
    Vas deferens
    Artery to vas deferens & sympathetic plexus around it
    Cremasteric artery
    Testicular artery
    Pampiniform plexus of veins
    Lymphatics from testis
    Genital branch of Genitofemoral nerve
    Remains of processus vaginalis

    NAME THE STRUCTURES PROTECTING THE SUPERFICIAL & DEEP INGUINAL RING (SA)
             Superficial inguinal ring is guarded from behind by conjoint tendon & reflected part of inguinal 
              ligament
             Deep inguinal ring is guarded from front by internal oblique muscle




    SITES OF HERNIA IN THE ABDOMEN (SA)
         External sites:
    Epigastric region
    Umbilicus
    Paraumbilical region
    Inguinal region
     Lumbar region
    Incisional hernia
         Internal sites:
         Paraduodenal recess
    Epiploic foramen
      
    COVERINGS OF OBLIQUE INGUINAL HERNIA (SA)   
         From within outwards
          Peritoneum
          Extra peritoneal tissue
          Internal spermatic fascia
          Cremasteric muscle & fascia
          External spermatic fascia
          Skin.

    THE DIFFERNCE BETWEEN DIRECT AND INDIRECT INGUINAL HERNIA (SA)



    INDIRECT INGUINAL HERNIA
    DIRECT INGUINAL HERNIA
    1
    Aetiology
    Preformed sac
    Weakness of posterior wall of inguinal canal
    2
    Precipitating
     -
    Chronic bronchitis, enlarged prostate 
    3
    On standing
    Does not come out
    Come out
    4
    Direction of the sac
    Sac comes through the deep inguinal ring
    It comes out of Hesselbachs triangle
    5.
    Obstruction
    Common, as neck is narrow 
    Not common because neck is wide
    6.
    Internal ring occlusion test
    Not seen
    The swelling is seen
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