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