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Anatomy of Abdomen - part 1 @samiotounsi

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بسم الله الرحمن الرحيم
Anatomy of Abdomen based on BRS Anatomy 7ed.
Part 1 out of 4

- For the original PDF HQ version ;) Email me or fallow me on twitter
*Twiter : http://twitter.com/samiotounsi
*Email : iamsami.md@gmail.com
.. . Enjoy and Have Fun Study

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Anatomy of Abdomen - part 1 @samiotounsi

  1. 1. PARTONE-ANTERIOR Txt & Atlas
  2. 2. Hi Future Doctors  <3 This work took from my time and effort to improve my review method. As you know already, its really hard to open your Anatomy book + atlas + dictionary especially when you have only little time to finish a certain topic , especially when Your First language is not English. So I made this reviewer which is combined of all the three things I mentioned earlier So here it is now between your hands , I hope this will help you like how it helped me In return , all I need from you is your prayers for me and family ^_^ Thank you and God bless you ,, In this version I followed the BRS Anatomy 7e txt but the pictures was from different sources the sources were : Atlas of Human Anatomy, 6e – Netter | Grays Anatomy for Students 2e | McMinn's Seventh 7e | Clinically Oriented Anatomy - Moore 7e | And other pictures from google (sorry i wasnt able to get the exact site) please inform me if there is any suggestions or notes or errors in this file Here is my personal email address, feel free to contact me [ iamsami.md@gmail.com ] "Learning Medicine without understanding Can be torture, But with clear concepts it become Fun and pleasure”
  3. 3. PART ONE - ANTERIOR
  4. 4. I. ABDOMEN P184 - Is divided topographically by two transverse (horizontal ) and two longitudinal (vertical ) planes into nine regions: • Right and left hypochondriac, |6,3| • epigastric, |1| • right and left lumbar, |8,5| • umbilical, |9| • right and left inguinal (iliac), |7,4| • hypogastric (pubic). |2| -Is also divided by vertical and horizontal planes through the umbilicus into four quadrants: • right and left upper quadrants, • right and left lower quadrants.
  5. 5. The umbilicus lies at the level of the intervertebral disk between the third and fourth lumbar vertebrae. Its region is innervated by the 10th thoracic nerve. L3 L4
  6. 6. II. MUSCLES OF THE ANTERIOR ABDOMINAL WALL (Table 5-1) P185
  7. 7. III. FASCIAE AND LIGAMENTS OF THE ANTERIOR ABDOMINAL WALL P185 - Are organized into • superficial (tela subcutanea) • deep layers. The superficial layer has two layers; • the superficial fatty layer (Camper’s fascia), • the deep membranous layer (Scarpa’s fascia)
  8. 8. A. Superficial Fascia B. Deep Fascia C. Linea Alba D. Linea Semilunaris E. Linea Semicircularis (Arcuate Line) F. Lacunar Ligament (Gimbernat’s Ligament) G. Pectineal (Cooper’s) Ligament H. Inguinal Ligament (Poupart’s Ligament) I. Iliopectineal Arcus or Ligament J. Reflected Inguinal Ligament K. Falx Inguinalis (Conjoint Tendon) L. Rectus Sheath
  9. 9. 1. Superficial (Fatty) Layer of the Superficial Fascia (Camper’s Fascia) ■ Continues over the inguinal ligament to merge with the superficial fascia of the thigh. ■ Continues over the pubis and perineum as the superficial layer of the (superficial perineal fascia.) A : Superficial Fascia
  10. 10. 2. Deep (Membranous) Layer of the Superficial Fascia (Scarpa’s Fascia) ■ Is attached to the fascia lata just below the inguinal ligament. ■ Continues over the pubis and perineum as the membranous layer (Colles’s fascia) of the superficial perineal fascia.
  11. 11. ■ Continues over the penis as the superficial fascia of the penis and over the scrotum as the tunica dartos, which contains smooth muscle. ■ May contain extravasated urine between this fascia and the deep fascia of the abdomen, resulting from rupture of the spongy urethra .
  12. 12. ■ Covers the muscles and continues over the spermatic cord at the superficial inguinal ring as the external spermatic fascia. ■ Continues over the penis as the deep fascia of the penis (Buck’s fascia) and over the pubis and perineum as the deep perineal fascia. B: Deep Fascia
  13. 13. ■ Is a tendinous median raphe between the two rectus abdominis muscles, formed by the fusion of the aponeuroses of the external oblique, internal oblique, and transverse abdominal muscles. ■ Extends from the xiphoid process to the pubic symphysis and, in pregnancy, it becomes a pigmented vertical line (linea nigra), probably due to hormone stimulation to produce more melanin. C: Linea Alba Aponeurosis: a sheet of pearly-white fibrous tissue that takes the place of a tendon in sheetlike muscles having a wide area of attachment.
  14. 14. ■ Is a curved line along the lateral border of the rectus abdominis. D: Linea Semilunaris
  15. 15. ■ Is a crescent-shaped line marking the inferior limit of the posterior layer of the rectus sheath just below the level of the iliac crest. E. Linea Semicircularis (Arcuate Line)
  16. 16. ■ Represents the medial triangular expansion of the inguinal ligament to the pectineal line of the pubis. ■ Forms the medial border of the femoral ring and the floor of the inguinal canal. F. Lacunar Ligament (Gimbernat’s Ligament)
  17. 17. ■ Is a strong fibrous band that extends laterally from the lacunar ligament along the pectineal line of the pubis. G. Pectineal (Cooper’s) Ligament
  18. 18. ■ Is the folded lower border of the aponeurosis of the external oblique muscle, extending between the anterior superior iliac spine and the pubic tubercle. ■ Forms the floor (inferior wall) of the inguinal canal. H. Inguinal Ligament (Poupart’s Ligament)
  19. 19. ■ Is a fascial partition that separates the muscular (lateral) and vascular (medial) lacunae deep to the inguinal ligament. 1. The muscular lacuna transmits the iliopsoas muscle. 2. The vascular lacuna transmits the femoral sheath and its contents, including the femoral vessels, a femoral branch of the Genitofemoral nerve, and the femoral canal. I. Iliopectineal Arcus or Ligament
  20. 20. ■ Is formed by fibers derived from the medial portion of the inguinal ligament and lacunar ligament and runs upward over the conjoint tendon to end at the linea alba. J. Reflected Inguinal Ligament
  21. 21. ■ Is formed by the aponeuroses of the internal oblique and transverse muscles of the abdomen and is inserted into the pubic tubercle and crest. ■ Strengthens the posterior wall of the medial half of the inguinal canal. K. Falx Inguinalis (Conjoint Tendon)
  22. 22. ■ Is formed by fusion of the aponeuroses of the external oblique, internal oblique, and transverse muscles of the abdomen. ■ Encloses the rectus abdominis and Sometimes the pyramidal muscle. ■ Also contains the : superior and inferior epigastric vessels and the ventral primary rami of thoracic nerves 7 to 12. L. Rectus Sheath
  23. 23. 1. Anterior Layer of the Rectus Sheath a. Above the arcuate line: aponeuroses of the external and internal oblique muscles. b. Below the arcuate line: aponeuroses of the external oblique, internal oblique, and transverse muscles. 2. Posterior Layer of the Rectus Sheath a. Above the arcuate line: aponeuroses of the internal oblique and transverse muscles. b. Below the arcuate line: rectus abdominis is in contact with the transversalis fascia
  24. 24. IV. INGUINAL REGION P187 A. Inguinal (Hesselbach’s) Triangle B. Inguinal Rings C. Inguinal Canal
  25. 25. ■ Is an area of potential weakness and hence is a common site of a direct inguinal hernia. Left side of the body Right side of the body A. Inguinal (Hesselbach’s) Triangle
  26. 26. ■ Is bounded : medially by the linea semilunaris (lateral edge of the rectus abdominis), laterally by the inferior epigastric vessels, and interiorly by the inguinal ligament.
  27. 27. 1. Superficial Inguinal Ring ■ Is a triangular opening in the aponeurosis of the external oblique muscle that lies just lateral to the pubic tubercle. 2. Deep Inguinal Ring ■ Lies in the transversalis fascia, just lateral to the inferior epigastric vessels. B. Inguinal Rings
  28. 28. ■ Begins at the deep inguinal ring and terminates at the superficial ring. C. Inguinal Canal
  29. 29. ■ Transmits the spermatic cord (male) or the round ligament of the uterus (female) and the genital branch of the genitofemoral nerve, both of which also run through the deep inguinal ring and the inguinal canal. An indirect inguinal hernia (if present) also passes through this canal. Although the ilioinguinal nerve runs through part of the inguinal canal and the superficial inguinal ring, it does not pass through the deep inguinal ring.
  30. 30. 1. Anterior wall: aponeuroses of the external oblique and internal oblique muscles. 2. Posterior wall: aponeurosis of the transverse abdominal muscle and transversalis fascia. 3. Superior wall (roof): arching fibers of the internal oblique and transverse muscles. 4. Inferior wall (floor): inguinal and lacunar ligaments.
  31. 31. V. SPERMATIC CORD, SCROTUM, AND TESTIS P189 A. Spermatic Cord B. Fetal Structures C. Scrotum D. Testes
  32. 32. V. SPERMATIC CORD, SCROTUM, AND TESTIS P189 A. Spermatic Cord ■ Is composed of the: • ductus deferens; (testicular, cremasteric), • deferential arteries; • ampiniform plexus of testicular veins; • genital branch of the genitofemoral and cremasteric nerves and the testicular sympathetic plexus; • lymph vessels. [These are all conjoined by loose connective tissue.]
  33. 33. ■ Has several fasciae: 1. External spermatic fascia, derived from the aponeurosis of the external oblique muscle. 2. Cremasteric fascia (cremaster muscle and fascia), originating in the internal oblique muscle. 3. Internal spermatic fascia, derived from the transversalis fascia.
  34. 34. B. Fetal Structures 1. Processus Vaginalis Testis 2. Tunica Vaginalis 3. Gubernaculum Testis
  35. 35. 1. Processus Vaginalis Testis ■ Is a peritoneal diverticulum * in the fetus that evaginates into a developing scrotum and forms the visceral and parietal layers of the tunica vaginalis testis. ■ Normally closes before birth or shortly thereafter and loses its connection with the peritoneal cavity. ■ May result in a congenital ** “indirect inguinal hernia if it persists.” ■ May cause fluid accumulation “hydrocele processus vaginalis” if it is occluded. •a peritoneal diverticulum in the embryonic lower anterior abdominal wall that traverses the inguinal canal; in the male it forms the tunica vaginalis testis and normally loses its connection with the peritoneal cavity; a persistent processus vaginalis in the female is known as the canal of Nuck. ** congenital : (especially of a disease or physical abnormality) present from birth.
  36. 36. 2. Tunica Vaginalis ■ Is a double serous membrane, a peritoneal sac that covers the front and sides of the testis and epididymis. ■ Is derived from the abdominal peritoneum and forms the innermost layer of the scrotum.
  37. 37. 3. Gubernaculum Testis ■ Is the fetal ligament that connects the bottom of the fetal testis to the developing scrotum. ■ Appears to be important in testicular descent (pulls the testis down as it migrates). ■ Is homologous to the ovarian ligament and the round ligament of the uterus.
  38. 38. C. Scrotum ■ Consists of a thin pigmented skin and dartos fascia, a layer of smooth muscle fibers; when contracted, it wrinkles to regulate the temperature.
  39. 39. ■ Is innervated by genital branch of the genitofemoral, anterior scrotal branch of the ilioinguinal, posterior scrotal branch of the perineal, and perineal branch of the posterior femoral cutaneous nerves.
  40. 40. ■ Receives blood from anterior scrotal branches of the external pudendal artery and posterior scrotal branches of the internal pudendal artery and drains lymph initially into the superficial inguinal nodes.
  41. 41. D. Testes Are surrounded by the tunica vaginalis in the scrotum and produce : sperm in the seminiferous tubules and testosterone by interstitial (Leydig) cells. ■ Are innervated by the autonomic nerves, drain lymph into the deep inguinal nodes and to the lumbar and preaortic nodes, receive blood from the testicular arteries arising from the aorta, and drain venous blood by testicular veins, which empty into the inferior vena cava (IVC) on the right |and| the renal vein on the left.
  42. 42. VI. INNER SURFACE OF THE ANTERIOR ABDOMINAL WALL P189 A. Supravesical Fossa B. Medial Inguinal Fossa C. Lateral Inguinal Fossa D. Umbilical Folds or Ligaments 1. Median Umbilical Ligament or Fold 2. Medial Umbilical Ligament or Fold 3. Lateral Umbilical Fold E. Transversalis Fascia
  43. 43. A. Supravesical Fossa ■ Is a depression on the anterior abdominal wall between the median and medial umbilical folds of the peritoneum.
  44. 44. B. Medial Inguinal Fossa ■ Is a depression on the anterior abdominal wall between the medial and lateral umbilical folds of the peritoneum. It lies lateral to the supravesical fossa. ■ Is the fossa where most direct inguinal hernias* occur. An inguinal hernia occurs when soft tissue protrudes through a weak point in the abdominal muscles.
  45. 45. C. Lateral Inguinal Fossa ■ Is a depression on the anterior abdominal wall, lateral to the lateral umbilical fold of the peritoneum.
  46. 46. D. Umbilical Folds or Ligaments 1. Median Umbilical Ligament or Fold 2. Medial Umbilical Ligament or Fold 3. Lateral Umbilical Fold
  47. 47. 1. Median Umbilical Ligament or Fold ■ Is a fibrous cord, the remnant of the obliterated urachus *, which forms a median umbilical fold of the peritoneum. ■ Lies between the transversalis fascia and the peritoneum and extends from the apex of the bladder to the umbilicus. * Urachus: A canal that connects the urinary bladder to the umbilicus (bellybutton) during fetal development. The urachus is normally obliterated, so it is usually a solid cord. Failure for the urachus to fill in leaves it open. The telltale sign of an open urachus is leakage of urine through the umbilicus. An open urachus is a malformation and needs to be surgically corrected.
  48. 48. 2. Medial Umbilical Ligament or Fold ■ Is a fibrous cord, the remnant of the obliterated umbilical artery, which forms a medial umbilical fold and extends from the side of the bladder to the umbilicus.
  49. 49. 3. Lateral Umbilical Fold ■ Is a fold of the peritoneum that covers inferior epigastric vessels and extends from the medial side of the deep inguinal ring to the arcuate line.
  50. 50. E. Transversalis Fascia ■ Is the lining fascia of the entire abdominopelvic cavity between the parietal peritoneum and the inner surface of the abdominal muscles. ■ Continues with the diaphragmatic, psoas, iliac, pelvic, and quadratus lumborum fasciae.
  51. 51. ■ Forms the deep inguinal ring and gives rise to the femoral sheath and the internal spermatic fascia. ■ Is directly in contact with the rectus abdominis below the arcuate line.
  52. 52. VII. NERVES OF THE ANTERIOR ABDOMINAL WALL P191 A. Subcostal Nerve B. Iliohypogastric Nerve C. Ilioinguinal Nerve
  53. 53. A. Subcostal Nerve ■ Is the ventral ramus of the 12th thoracic nerve and innervates the muscles of the anterior abdominal wall. ■ Has a lateral cutaneous branch that innervates the skin of the side of the hip.
  54. 54. B. Iliohypogastric Nerve ■ Arises from the first lumbar nerve and innervates the internal oblique and transverse muscles of the abdomen. ■ Divides into a * lateral cutaneous branch to supply the skin of the lateral side of the buttocks and an * anterior cutaneous branch to supply the skin above the pubis.
  55. 55. C. Ilioinguinal Nerve ■ Arises from the first lumbar nerve, pierces the internal oblique muscle near the deep inguinal ring, and accompanies the spermatic cord through the inguinal canal and then through the superficial inguinal ring. ■ Innervates the internal oblique and transverse muscles. ■ Gives rise to a femoral branch, which innervates the upper and medial parts of the anterior thigh, and the anterior scrotal nerve, which innervates the skin of the root of the penis (or the skin of the mons pubis) and the anterior part of the scrotum (or the labium majus).
  56. 56. VIII. LYMPHATIC DRAINAGE OF THE ANTERIOR ABDOMINAL WALL P191 A. Lymphatics in the Region Above the Umbilicus B. Lymphatics in the Region Below the Umbilicus C. Superficial Inguinal Lymph Nodes
  57. 57. A. Lymphatics in the Region Above the Umbilicus ■ Drain into the axillary lymph nodes. B. Lymphatics in the Region Below the Umbilicus ■ Drain into the superficial inguinal nodes. C. Superficial Inguinal Lymph Nodes ■ Receive lymph from the lower abdominal wall, buttocks, penis, scrotum, labium majus, and the lower parts of the vagina and anal canal. Their efferent vessels primarily enter the external iliac nodes and, ultimately, the lumbar (aortic) nodes.
  58. 58. IX. BLOOD VESSELS OF THE ANTERIOR ABDOMINAL WALL P191 A. Superior Epigastric Artery B. Inferior Epigastric Artery C. Deep Circumflex Iliac Artery D. Superficial Epigastric Arteries E. Superficial Circumflex Iliac Artery F. Superficial (External) Pudendal Arteries G. Thoracoepigastric Veins
  59. 59. A. Superior Epigastric Artery ■ Arises from the internal thoracic artery, enters the rectus sheath, and descends on the Posterior surface of the rectus abdominis. ■ Anastomoses * with the inferior epigastric artery within the rectus abdominis. * Anastomosis : A cross-connection between adjacent channels, tubes, fibers, or other parts of a network.
  60. 60. B. Inferior Epigastric Artery ■ Arises from the external iliac artery above the inguinal ligament, enters the rectus sheath, and ascends between the rectus abdominis and the posterior layer of the rectus sheath. ■ Anastomoses with the superior epigastric artery, providing collateral circulation Between the subclavian and external iliac arteries.
  61. 61. ■ Gives rise to the cremasteric artery, which accompanies the spermatic cord.
  62. 62. C. Deep Circumflex Iliac Artery ■ Arises from the external iliac artery and runs laterally along the inguinal ligament and the iliac crest between the transverse and internal oblique muscles. ■ Forms an ascending branch that anastomoses with the musculophrenic artery.
  63. 63. D. Superficial Epigastric Arteries ■ Arise from the femoral artery and run superiorly toward the umbilicus over the inguinal ligament. ■ Anastomose with branches of the inferior epigastric artery.
  64. 64. E. Superficial Circumflex Iliac Artery ■ Arises from the femoral artery and runs laterally upward, parallel to the inguinal ligament. ■ Anastomoses with the deep circumflex iliac and lateral femoral circumflex arteries. Parallel lines
  65. 65. F. Superficial (External) Pudendal Arteries ■ Arise from the femoral artery, pierce the cribriform fascia, and run medially to supply the skin above the pubis. “The external pudendal arteries consist of a superficial vessel and a deep vessel, which originate in the femoral artery in the thigh. They course medially to enter the perineum anteriorly and supply related skin of the penis and scrotum or the clitoris and labia majora.” - Grays Anatomy 2e
  66. 66. A. Superior Epigastric Artery
  67. 67. G. Thoracoepigastric Veins ■ Are longitudinal venous connections between the lateral thoracic vein and the superficial epigastric vein. ■ Provide a collateral * route for venous return if a caval or portal ** obstruction occurs. * Collateral : Acollateral is a subordinate or accessory part. A collateral is also a side branch, as of a blood vessel or nerve. ** Caval system : the Inferior vena cava returns blood to the heart from the lower limb, pelvis, and abdomen. Portal system : portal vein carries used blood from GI Tract to the liver.
  68. 68. You Made It !

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