2.1 Surface anatomy 2.2 Anterior abdominal wall Abdomen 1 2.1 Surface anatomy 2.2 Anterior abdominal wall Albert van Schoor GNK 288 (SA4 Anatomy dissection)

2.1.1 Surface anatomy Identify and name the bony landmarks of the abdomen which are palpable on abdominal examination and state if possible their corresponding vertebral heights on the cadaver, yourself and on a radiograph Schematically illustrate and discuss the nine abdominal regions and list which organs lie approximately in each region

2.1.1 Surface Anatomy

2.1.1 Surface anatomy Identify and name in which of the nine surface anatomical regions you would expect to feel tenderness in appendicitis, cholecystitis, gastritis and cystitis Identify other surface anatomy lines e.g. transpyloric line, transumbilical line, linea alba and linea semilunaris. You should be able to say how these lines are formed and to discuss the intra-abdominal events occurring on the transpyloric line

2.1.1 Surface Anatomy Referred pain

2.1.1 Surface Anatomy

2.1.1 Surface Anatomy

2.1.1 Surface Anatomy

Transpyloric plane Hilum of the kidneys Pylorus of the stomach 2.1.1 Surface Anatomy Transpyloric plane Hilum of the kidneys Pylorus of the stomach Body of pancreas Fundus of the gall bladder

2.1.1 Surface Anatomy

2.1.1 Surface anatomy Schematically illustrate and discuss the surface anatomy of the kidneys, ureters and spleen on the posterior abdominal wall [2.5, 2.8] Discuss and identify the surface anatomy of the liver [2.4] Briefly discuss the surface anatomy of the diaphragm and the vertebral heights of its three major orifices [2.9] Identify the various dermatomes of the anterior abdominal wall Indicate whether the bladder is an abdominal organ or not. Explain

2.1.1 Surface Anatomy

2.2 Anterior abdominal wall 2.2.1 Skin and superficial fascia 2.2.2 Muscles 2.2.3 Transversalis fascia 2.2.4 Peritoneum 2.2.5 Rectus sheath 2.2.6 Inguinal area 2.2.7 Osteology

2.2.1 Skin and superficial fascia Identify the fatty superficial layer (Camper's fascia) Identify and shortly discuss the membranous superficial layer (Scarpa's fascia) according to its distribution and borders. State what this fascia is called inferior to the superficial inguinal ring

2.2.2 Muscles Identify and discuss the three major abdominal muscles as follows: Major attachments to the following points: Linea alba, crista iliaca and inguinal ligament where applicable, Direction of fibres, Nerve supply and Function Identify the neurovascular plane Identify the ilio-inguinal and iliohypogastric nerves. Also state their origin and area of supply

External oblique Origin Insertion Innervation Function Table 2.2.2 Muscles External oblique Origin Insertion Innervation Function Muscular slips from the outer surfaces of the lower eight ribs (ribs 5-12) Lateral lip of iliac crest; aponeurosis ending in midline raphe (linea alba) Anterior rami of lower six thoracic spinal nerves (T7 to T12) Compress abdominal contents; both muscles flex trunk; each muscle bends trunk to same side, turning anterior part of abdomen to opposite side Table

Internal oblique Origin Insertion Innervation Function 2.2.2 Muscles Internal oblique Origin Insertion Innervation Function Thoracolumbar fascia; iliac crest between origins of external and transversus; lateral two-thirds of inguinal ligament Inferior border of the lower three or four ribs; aponeurosis ending in linea alba; pubic crest and pectineal line Anterior rami of lower six thoracic spinal nerves (T7 to T12) and L1 See External Oblique

Transverse abdominis Origin Insertion Innervation Function 2.2.2 Muscles Transverse abdominis Origin Insertion Innervation Function Thoracolumbar fascia; medial lip of iliac crest; lateral one-third of inguinal ligament; costal cartilages lower six ribs (ribs 7-12) Aponeurosis ending in linea alba; pubic crest and pectineal line Anterior rami of lower six thoracic spinal nerves (T7 to T12) and L1 Compress abdominal contents

2.2.2 Muscles Neurovascular plane Ant Post

2.2.3 Transversalis fascia Identify the transversalis fascia

2.2.4 Peritoneum Identify the folds and associated underlying structures of the peritoneum on the posterior aspect of the anterior abdominal wall: [2.3.3] Plica umbilicalis mediana, Plica umbilicalis medialis, Plica umbilicalis lateralis, Falciform ligament

2.2.5 Rectus sheath Identify the rectus sheath and how it is formed on the following levels: Superior to the arcuate line Inferior to the arcuate line  Identify and briefly discuss rectus abdominis as follows: major attachments, nerve supply and function Name and identify the structures on the posterior wall of the rectus sheath

2.2.5 Rectus sheath

Rectus abdominis Origin Insertion Innervation Function 2.2.5 Rectus sheath Rectus abdominis Origin Insertion Innervation Function Pubic crest, pubic tubercle, and pubic symphysis Costal cartilages of ribs 5-7; xiphoid process Anterior rami of lower seven thoracic spinal nerves (T7 to T12) Compress abdominal contents; flex vertebral column; tense abdominal wall

2.2.6 Inguinal area Identify and briefly discuss the inguinal canal as follows: Surface anatomy, Borders, Openings

Inguinal canal Surface anatomy 2.2.6 Inguinal area Inguinal canal Surface anatomy

Indirect inguinal hernia 2.2.6 Inguinal area Indirect inguinal hernia

Inguinal canal Borders 2.2.6 Inguinal area Inguinal canal Borders 491-8

2.2.6 Inguinal area Know the positions of the superficial and deep inguinal rings and femoral canal. Identify the inguinal ligament and the structures posterior to it from lateral to medial.

2.2.6 Inguinal area Femoral canal Ant Post

2.2.6 Inguinal area Femoral hernia

N.A.V.E.L N A V E L Contents N.A.V.E.L (lat. - med.) Femoral nerve 2.2.6 Inguinal area N.A.V.E.L Contents N.A.V.E.L (lat. - med.) Femoral nerve Femoral artery Femoral vein Empty space (femoral canal) Lacunar ligament N A V E L

2.2.6 Inguinal area List the contents of the spermatic cord. Compare the content in males and females Identify the inferior epigastric artery and its relation to the deep inguinal ring Identify and list the borders of the inguinal triangle (Hesselbach's triangle) Name and identify the inguinal falx (conjoint tendon)

Spermatic cord 3 Fascia layers 3 Arteries 3 Nerves 3 Other structures 2.2.6 Inguinal area Spermatic cord 3 Fascia layers External spermatic fascia Cremasteric fascia Internal speratic fascia 3 Arteries Testicular artery Cremasteric artery Artery to ductus deferens 3 Nerves Genito-femoral nerve Ilio-inguinal nerve Sympathetic autonomic plexus 3 Other structures Lymphatic vessels Ductus deferens Pampiniform venous plexus

2.2.6 Inguinal area Spermatic cord

Hesselbach’s triangle 2.2.6 Inguinal area Hesselbach’s triangle

Direct inguinal hernia 2.2.6 Inguinal area Direct inguinal hernia

2.2.6 Inguinal area Conjoint tendon

2.2.7 Osteology Identify the following bony points of the os coxa: Anterior superior iliac spine (ASIS) Anterior inferior iliac spine (AIIS) Crista iliaca Posterior superior iliac spine (PIIS) Pubic tubercle Pubic crest Symphysis pubis

2.2.7 Osteology