Lecture #56

the median plane and the trans ever umbilical plane

• from superficial to deep
• extenal oblique
• internal oblique 
• and transversealis abdominus

has anterior  ( superficial layer ) and posterior layer  ( deep )

• external blique aponeurosis , the trasnversus abdominus aponeurosusis( AP) 
• and the lamina of the internal oblique AP that has both an anterior and posterior

The rectus abdominus with the linea alba

The line of connective tissue going longitudinalto the unbilicus and in the rectus abdominus

• above and in line with the umbilicus the posterior lamina of the IO AP (in front) and the transversus abdominus are not positioned behind the rectus abdominus.
• but below it is in front

the superior and inferior epigastric arteries

• The thoracoabdomical nerves
• the intecostal nerves

betweenthe deepest layer muscle. the transversus abdominus and the middle layer the internal oblique muscles

the thoracoabdominal nerves

comes off the ventral rami of the LI spinal nerve

comes off the ventral rami of the LI spinal nerve

• the inferior epigastric traveling inferior to superior and the superior epigastric traveling vice versa 
• they anastomose

• It has to be parrallel to the tentsion lines of the skin and parralell to the muscles fiber of muscles 
• this promotes healing

Surgeon do appendectomies at this point

• the testes start out inside of the abdominal wall and their path is guided by the Gubernaculum
• as it does through the gubernaculum it becomes absorbed by the body 
• there is an out pocketing og the anterior ab wall called the processus vaginalis that the testestes eventually sit in

this creates the inguinal canal and it is found in both males and females

the Tunica vaginalis which has two layers paretial and visceral

• the processus vaginalis .
• this can make males more susceptible to hernia because content of the abdomen have a direct canal to the tested through this structure.

• skin of the abdomen/ skin of th scrotium
• scarpa's fascia
• external oblique spermatic fascia / EO aponeurosis
• IO muscle + fascia/ cremaster muscle and fascia
• transeveralis fascia / internal spermatic fascia 
• peritoneum /tunica vaginalis

bring oxygenated blood to the fetus

the ending of the inferior layer of the rectus sheath

• remnant of the urachus 
• posterior to the the median umbilical fold

• remnant of the occluded umbilical artery  
• posterior to the medial umbilical fold

The umbilican veins

the inferior apigastric artery and vein

the medial inguinal fossa

supr vesicle fossa

the lateral inguinal fossa

the lateral umbilical fold.

The medial inguinal fossa or the inguinal triangle

runs from the ASIS to the public tuberucle

• the deep inguinal vein opening 
• where contents of the inner ab could push out

there is only aponeurosis not muscles

it can be a sight of hernia because it is an opening

• oblique orientation
• it closes with increased pressure

• has both a superficial and deep rings
• larger in males because of the spermatic cord
• pressure can tear and weaken these walls

the lateral inguinal fossa go through the deep inguinal ring and exit through the superficial inguinal ring

• the medial inguinal fossa and goes through the path of exit of the supeficial inguial ring 
• these have a shorter path

physician can put their finger in the space between the superficial inguinal ring and ask the patient to cough and this should reveal how the deviating strucutre is travel and from where.

the scarpa's fascia