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What is covered by layers of abdominal wall?
- Vas deferens
- venous drainage-plexus
- testicular artery
- lymphatic autonomic n. fibers
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attachment of inguinal ligament
pubic tubercle
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what muscle is underneath inguinal ligament and lateral?
psoas muscle
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what is underneath te inguinal ligament and medial?
arteries, nerves, and veins
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Is the inguinal ligament actually a ligament?
No, it is the free edge of the external oblique muscle
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skin layer becomes what in scrotum?
stays skin layer
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Campor's Fascia (superficial fascia Membranous Fatty) becomes what in scrotum?
Dartos muscle-smooth muscle-works with cremaster muscle
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What does Scorpa's Fascia become in scrotum?
Colle's Fascia
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What does External Oblique aponeurosis become in scrotum?
External spermatic fascia
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What does Internal Oblique become in scrotum?
Cremaster muscle-works with dartos muscle
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What does Transversus Abdominis become in scrotum?
No layer in scrotum
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What does transversalis fascia become in scrotum?
Internal spermatic fascia
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What does subperitoneum fat and center become in scrotum?
center of cord
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What does peritoneum become in scrotum?
process vaginalis
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umbilical folds
median, medial, and lateral
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what are the layers of the inguinal triangle?
inferior epigastric vessels, rectus abdominus sheath, and inguinal ligament
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nerves 7-12 lie in plane between?
- internal oblique and transversus
- penetrates posterior sheath then anterior sheath and splits
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Nerves 7-12 supply?
rectus muscle
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Nerves 7-12 emerge as?
anterior cutaneous which overlap with lateral cutaneous and anterior cutaneous of other side
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Branches of L1 penetrate?
internal oblique and ASIS and lie between obliques
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T6-T8 ascend and astomose where?
in rectus abdominis
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Descent of testis
- gubernaculum-attaches undifferentiated gonad to presumptive scrotum or labium majus (before abdominal muscles are present)
- muscles migrate to surround gubernaculum
- late in embryonic life-tongue of peritoneum, processus vaginalis, invades scrotum
- testis follows preformed pathway about time of birth
- processus seals up leaving cavity in scrotum lined by tunica vaginalis
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what part is undifferentiated and is either female or male?
gonad
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gubernaculum
attach to gonads and skin
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transversus, internal oblique and external oblique
migrate (linea alba) from somite from back and surround gubernaculum-great slide for processus vagninalis
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processus vaginalis seals up and leaves?
tunica vaginalis (sac)
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without androgen processus vaginalis does what?
continutes to grow-uterus gets stuck-nothing descends through wall and canal is a remnant of gubernaculum-now round ligament of uterus
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the best surgical incision is made where?
- semihorizontal or linea alba
- semihorizontal: cut across rectus abdominis-can heal up, not much bleeding after tie off and can cut between nerves
- linea alba-easily done, overlap of nerves-cutaneous nerves, not much bleeding-downfall is tension on sutures
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apeneurosis of inguinal canal
- anterior superior iliac spine to pubic tubercle
- continuations=lacunar and pectineal ligament
- continuations attach to pectineal line
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medial and lateral crura
external oblique
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conjoined tendon
- combined fibers of internal oblique and transversus
- attaches to pectinal line
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floor of inguinal canal
- inguinal ligament
- lacunar ligament
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roof of inguinal canal
arching fibers of interior oblique and transversus
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anterior wall of inguinal canal
external oblique and internal oblique
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posterior wall of inguinal canal
- conjoined tendon
- transversalis fascia
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superficial inguinal ring
- not complete opening
- in external oblique
- surrounded by medial crus and lateral crus (door post)
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if oben external oblique muscle will see?
deep ring with spermatic cord coming out of deep ring
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deep ring=
funnel of transversalis fascia
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superfical ring=
opening in external oblique aponerosis
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coverings of cord
- external spermatic fascia
- cremaster
- internal speramtic fascia
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indirect hernia
follows pathway of processus vaginalis and testis and tends to go into scrotum
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direct hernia
- originates medial to inferior epigastric artery
- bulges posterior wall of inguinal canal and remains on anterior abdominal wall
- in medial inguinal fossa or supravesical fossa
- in supravesical fossa rub up against conjoint tendon-does not go into scrotum
- *pass through inguinal triangle and stretches conjoint tendon or transversalis fascia lateral to conjoint tendon
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if indirect hernias don't get treated what can happen?
- if untreated long enough can go into scrotum
- can cause fusion/adhesion of parietal and visceral layers-gut rotation here-occlusion of blood vessels supplying gut-3 days to live
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how hernias occur
- valsalva maneuver-weak spot
- occurs gradually-why it does not hurt
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