External oblique, Internal oblique, Transversus abdominis
Lower 6 costal cartilages, Thoracolumbar fascia, Iliac crest (anterior 2/3rd), Inguinal ligament (lateral 1/3rd)
Femoral hernia
The cartilages of the 7th to 10th ribs.
Right upper quadrant, left upper quadrant, right lower quadrant, and left lower quadrant.
The abdomen is the part of the trunk between the thorax and the pelvis.
The anterior abdominal wall is often used for clinical examination and surgical access to various intra-abdominal organs.
The superficial fatty layer (of Camper) and the deep membranous layer (of Scarpa).
The linea alba passes in the median line to the symphysis pubis. It is formed by the fusion of the rectus sheath of both sides.
The inguinal ligament and pelvis.
The subcostal plane cuts through the inferior border of the 10th costal cartilage and the body of the L3 vertebra.
Downward and forward (inferomedially)
Sternum & xiphoid process, costal margin & costal cartilages, iliac crest, iliac fossa & anterior superior iliac spine (ASIS), pubic tubercle, pubic symphysis, thoracic, lumbar vertebrae and sacrum.
Subcutaneous tissue
Between the internal oblique and transversus abdominis muscle layers
The costal margin is formed by the costal cartilages.
The pubic symphysis is located at the midline of the pelvis, where the two pubic bones meet.
Midpoint of the inguinal ligament
The neurovascular plane is located between the internal oblique and the transversus abdominis muscles.
The muscles shown are the transversus abdominis, internal oblique, external oblique, erector spinae, and psoas.
Conjoint tendon
4 cm long.
The ilio-inguinal nerve and the spermatic cord pass through the Superficial Inguinal Ring.
Indirect inguinal hernia
Younger adults and children
An indirect path
If the ring admits the finger without causing pain.
Causes the least amount of nerve damage, the muscular segments can be rejoined, and they are incredibly useful for dissection above the level of the umbilicus.
A hernia where the sac returns to the containing cavity.
The pylorus of the stomach, the tips of the 9th costal cartilages, and the lower border of the L1 vertebra.
L1 vertebra.
The intertubercular plane lies between the iliac tubercles and the L5 vertebra.
Investing (deep) fascia
Xiphoid process, Linea alba (rectus sheath), Symphysis pubis, Conjoint tendon
External oblique, internal oblique, and transversus abdominis.
The xiphoid process is located at the lower part of the sternum.
It is commonly used for exploratory operations.
Mid-inguinal point
It is used as a reference point for the femoral artery.
The thoracolumbar fascia does not attach to the external oblique, hence it has a free edge.
A direct inguinal hernia occurs through the posterior wall, often in older people with conditions that predispose to increased intra-abdominal pressure, such as cough or constipation.
The components of a hernia are the sac (e.g., peritoneum), the defect (the hole through which the hernia has occurred), and the contents of the sac (e.g., bowel).
The sac in the context of a hernia is typically the peritoneum.
The aponeurosis of the transversus abdominis is behind the rectus abdominis above the umbilicus.
The internal oblique aponeurosis encloses the rectus abdominis above the umbilicus.
Transumbilical Plane
Above and lateral to the pubic tubercle.
Liver, Gallbladder, Diaphragm, Costal margin
Spleen, Stomach
This transverse, slightly convex cut transects the linea alba and anterior layer of the rectus sheath at the pubic hairline. Separate the underlying rectus muscles via the tendons and identify the surrounding nerves.
The aim is to minimize damage to nerves and muscles to preserve the functional integrity of the abdominal wall and prevent hernia.
Paired vertical rectus abdominis muscles
Post vertebral muscles (erector spinae group), Psoas major, quadratus lumborum, and iliacus muscles
The transversalis fascia.
Around the tip of the right 9th costal cartilage.
In the flanks.
A femoral hernia occurs when abdominal contents pass through the femoral canal, which is located just below the inguinal ligament.
The upper part of the abdominal cavity extends beneath the thoracic cage.
The rectus sheaths meet in the midline at the linea alba.
Femoral hernias tend to be irreducible, and hot and painful if they are strangulated.
Transversalis fascia
An oblique passageway in the lower part of the anterior abdominal wall.
The Deep Inguinal Ring is located in the transversalis fascia, about 1.5 cm above the midpoint of the inguinal ligament.
No, it does not enter the scrotum.
The inferior epigastric vessels are associated with the transversalis fascia.
Avoids nerves, frees the rectus abdominal muscle which decreases tension to the muscle, and gives access to the peritoneal cavity.
Incision of the external oblique aponeurosis in the direction of its fibers. The internal oblique and transversus abdominis are then incised and split in the direction of their fibers which are then retracted.
The anterior wall is formed by the external oblique aponeurosis (whole length) and the internal oblique muscle reinforcing the lateral third.
The Mid Inguinal Point is located using the Anterior Superior Iliac Spine (ASIS) and the Pubic Symphysis.
Indirect inguinal hernia.
The upper gastrointestinal tract, including the esophagus, stomach, and duodenum.
The transumbilical plane and the median plane.
The subcostal plane aligns with the L3 vertebra.
Immediately above and lateral to the pubic tubercle
Extraperitoneal fat
Yes, the abdominal and pelvic cavities are continuous.
The ASIS serves as an attachment point for the inguinal ligament and several muscles.
The anterior wall of the rectus sheath is complete and extends from the xiphoid process and costal cartilages above to the pubic symphysis and pubic crest below.
An indirect inguinal hernia occurs through the deep inguinal ring, often in young males.
Above the umbilicus, the internal oblique aponeurosis splits and encloses the rectus abdominis. The aponeuroses of the external oblique is in front and the transversus abdominis is behind the rectus abdominis muscle.
External and internal obliques of both sides.
The aponeurosis of the external oblique is in front of the rectus abdominis above the umbilicus.
It is the terminal branch of the internal thoracic (mammary) artery.
It is a branch of the external iliac artery.
Stomach, duodenum, small and large intestines.
Liver, pancreas, and spleen.
The blood supply to the abdominal wall includes the superior epigastric artery, inferior epigastric artery, and the deep circumflex iliac artery.
Through the inguinal canal and into the scrotum
The Mid Inguinal Point is located halfway between the Anterior Superior Iliac Spine (ASIS) and the Pubic Symphysis. It is a landmark for the femoral artery in the groin.
The Midpoint of the Inguinal Ligament is a landmark for the deep inguinal ring and is used to differentiate between direct and indirect inguinal hernias.
The deep inguinal ring is an opening in the transversalis fascia.
T7 - T9
No, the visceral peritoneum has no somatic sensory innervation
To guide surgical procedures and ensure accurate incisions and interventions.
There are two lineae semilunares, which pass along the lateral border of the rectus abdominis and cross the costal margin at the tip of the 9th costal cartilage.
Superficial fatty layer and deep membranous layer
The rectus sheath
The superficial inguinal ring
The deep fascia invests the muscles of the abdominal wall.
The incision that allows adequate exposure and, secondarily, the best possible cosmetic effect is chosen.
Groin
It is used for various abdominal surgeries.
The rectus abdominis muscle is divided into segments by tendinous intersections.
Compress the abdominal content and increase the intra-abdominal pressure to aid expiration, evacuation of urine, faeces, parturition, heavy lifting; helps to maintain posture; supports viscera (mainly the intestines); flex and rotate the trunk.
Costal margin, xiphoid process, umbilicus, transpyloric plane (L1), subcostal plane, anterior superior iliac spine, iliac tubercle, pubic tubercle, and pubic symphysis.
Below the umbilicus, all three aponeurotic layers are anterior to the rectus muscle.
External oblique, internal oblique, transversus abdominis, and rectus abdominis.
The inferior attachment of the rectus abdominis muscle includes the symphysis pubis and the pubic crest.
The rectus abdominis muscle is enclosed in the rectus sheath.
The linea semilunaris is a curved tendinous line on the lateral aspect of the rectus abdominis muscle.
The motor and sensory nerves to the abdominal wall and diaphragm are derived from the lower six thoracic nerves and the first lumbar nerve.
Deep veins bearing the same names as the arteries.
The hernia produces an impulse against the finger.
Used for most gynecologic surgeries.
A hernia where the sac contains blocked bowel.
Direct inguinal hernia.
L1 (iliohypogastric nerve, ilio-inguinal nerve)
They terminate by supplying the skin
The lowest fibres of internal oblique and transverse abdominis.
It is continuous with the superficial fat of the rest of the body.
The inferior margin curls under to form the inguinal ligament.
Indirect inguinal hernia and Direct inguinal hernia
Thoracic, lumbar vertebrae and sacrum.
Aponeurotic sheets.
It is used for various abdominal surgeries.
The pelvic inlet (pelvic brim) arbitrarily separates the abdominal cavity from the pelvic cavity.
It is used for gallbladder removal.
The rectus abdominis muscle is supplied by segmental nerves from T7 to T12.
Downward and backward
During a paramedian incision, the rectus abdominis muscle is displaced laterally because the nerve supply comes from the lateral side.
The superior attachment of the rectus abdominis muscle includes the 5-7 costal cartilages and the xiphoid process.
Minimal blood loss, avoids major nerves, and easy access for exploration.
From the deep inguinal ring (a hole in transversalis fascia) to the superficial inguinal ring (a hole in external oblique aponeurosis).
They form a potential bypass to the abdominal aorta.
Intercostal arteries 7-11, subcostal artery, lumbar arteries, and deep circumflex iliac arteries.
A dilated deep ring
Abdominal vessels.
The Mid Inguinal Point is used as a landmark for locating the femoral artery in the groin, which is important for lower limb pulses and cardiovascular examination.
The Midpoint of the Inguinal Ligament is located using the Anterior Superior Iliac Spine (ASIS) and the Pubic Tubercle.
A direct inguinal hernia occurs through a defect in the posterior wall of the inguinal canal.
Anterior rami of T7 - T12 and L1 spinal nerves
It blends with the deep fascia of the upper thigh, the penis and scrotum (or labia majora), and into the perineum as Colles' fascia.
External surface of lower 8 ribs
The intertubercular plane aligns with the L5 vertebra.
The transition between the posterior rectus sheath covering the superior three quarters of the rectus abdominis and the transversalis fascia covering the inferior quarter.
Inguinal canal and Femoral canal
The rectus sheath.
It is typically used for appendectomy.
It is used for hysterectomy.
The tendinous intersections are attached to the anterior wall of the rectus sheath.
Aponeurosis of the external oblique, Internal oblique
Femoral hernias appear below and lateral to the pubic tubercle, while inguinal hernias are above and medial to the pubic tubercle.
The transversalis fascia is the lining fascia of the anterolateral abdominal wall, located between the transversus abdominis muscle and the peritoneum.
Medial to the inferior epigastric vessels.
The contents of the sac in a hernia can be organs such as the bowel.
To the right or left of the midline.
The ilio-inguinal nerve is associated with the inguinal region.
The femoral artery and vein are major blood vessels located near the inguinal region.
No, one cannot distinguish whether it is direct or indirect by palpation alone.
The posterior wall is formed by the transversalis fascia and the medially conjoint tendon.
A hernia where the sac has contents with a compromised blood supply.
The nine regions of the abdomen are delineated by the subcostal plane, intertubercular plane, and two midclavicular planes.
The midclavicular planes pass from the midpoint of the clavicles to the mid-inguinal points.
Skin, subcutaneous tissue, superficial fascia (superficial fatty layer and deep membranous layer), investing (deep) fascia, muscles and their aponeurosis, deep fascia, extraperitoneal fat, parietal peritoneum
Superficial and deep inguinal rings, pubic tubercle, pubic symphysis, scrotum, testis, spermatic cord (testicular vessels and ductus deferens), and round ligament of the uterus.
The mid-inguinal point is halfway between the anterior superior iliac spine and the pubic symphysis, while the midpoint of the inguinal ligament is halfway between the anterior superior iliac spine and the pubic tubercle.
Between the ASIS (anterior superior iliac spine) and the pubic tubercle
Understanding the abdominal region/quadrant is crucial for accurately diagnosing and treating conditions, guiding imaging techniques, and planning surgical interventions.
Weakness of the inguinal region
It is used as a reference point for the deep inguinal ring.
Lower 3 ribs and costal cartilages, linea alba (rectus sheath), xiphoid process, pubic crest
A hematoma of the rectus muscle is localized due to the segmental nerve supply.
They are used to divide the anterior abdominal wall into descriptive regions.
Superior epigastric artery and inferior epigastric artery.
Above the medial half of the inguinal ligament.
The linea alba is a fibrous structure that runs down the midline of the abdomen.
Spermatic cord, ilioinguinal nerve, blood and lymphatic vessels.
Round ligament, ilioinguinal nerve, blood and lymphatic vessels.
Provides good access with almost no muscle damage and avoids damage to local nerves.
Appendix, Inguinal ligament, McBurney's point, Anterior superior iliac spine, Pubic tubercle
The roof is made up of the arching fibers of the internal oblique (whole length) and the medially conjoint tendon (with transverse abdominis).
Oblique passage, posterior wall reinforced by the conjoint tendon, and compression of the canal contents against the floor when intra-abdominal pressure is increased.
Indirect inguinal hernia.
Acquired defect in the posterior wall of the inguinal canal
Fans out to attach to xiphoid process, linea alba, pubic crest & tubercle, anterior half of iliac crest
Below the umbilicus at the arcuate line.
Horizontally
The inguinal ligament
The diaphragm separates the thoracic and abdominal cavities.
Between the ASIS (Anterior Superior Iliac Spine) and the pubic tubercle (PT)
Males
Thoracolumbar fascia, iliac crest (anterior 2/3rd), inguinal ligament (lateral half)
A hernia is an abnormal protrusion of an organ through the structure that usually contains the organ.
Conditions that predispose to increased intra-abdominal pressure, such as cough or constipation, can lead to a direct inguinal hernia.
Inguinal ligament, Lacunar ligament
The 'defect' in a hernia is the hole through which the hernia has occurred.
Right Upper Quadrant (RUQ), Left Upper Quadrant (LUQ), Right Lower Quadrant (RLQ), Left Lower Quadrant (LLQ)
Lateral to the inferior epigastric vessels.
Yes, it can pass into the scrotum or labia majora.
By invaginating the scrotal skin with the finger and following the spermatic cord to the superficial ring.
Reproductive organs.
Descending colon, Sigmoid colon
The Midpoint of the Inguinal Ligament is located halfway between the ASIS and the Pubic Tubercle.
An indirect inguinal hernia is lateral to the inferior epigastric vessels.
Somatic sensory supply from the same segmental nerves of the body wall
Abdomen x-ray
Epigastric hernia, Umbilical hernia, Incisional hernia, Spigelian hernia, Inguinal hernia, Femoral hernia.
The hernia’s path is straight through the posterior wall of the inguinal canal but it doesn't enter the scrotum.
Direct inguinal hernias protrude through the abdominal wall directly into the inguinal canal, while indirect inguinal hernias follow the pathway of the inguinal canal, often entering the scrotum.
The iliac crest is the upper border of the ilium, an important landmark for muscle attachment and surgical incisions.
The rectus sheath is formed by the aponeuroses of the external oblique, internal oblique, and transversus abdominis muscles.
Transversalis fascia, Internal oblique, Transversus abdominus
Rectus abdominis.
Between the internal oblique and transversus abdominis.
The walls often need to be strengthened to prevent the recurrence of a hernia after repair.
The rectus sheath includes the rectus abdominis muscle, the transversalis fascia, and the parietal peritoneum.
Stomach, duodenum, small and large intestines; liver, pancreas, spleen; kidneys, ureters, urinary bladder; reproductive organs; abdominal vessels.
Below the umbilicus, the anterior wall of the rectus sheath is composed of all three aponeuroses.
Median Plane
Kidneys, ureters, and urinary bladder.
The anterior rectus sheath and the rectus abdominis.
The floor is formed by the rolled inferior edge (gutter-like) of the external oblique aponeurosis, known as the inguinal ligament.
The conjoint tendon is formed by the lowest fibers of the internal oblique and similar fibers of the transversus abdominis aponeuroses. It is attached medially to the linea alba.
T10
Anterior rami of T7 - T11 spinal nerves
The large intestine (colon) and rectum.
Chronic straining and weak musculature
A hernia where the sac cannot be returned to the containing cavity.
Direct inguinal hernia.
Older age group
The superficial inguinal ring is an opening in the aponeurosis of the external oblique.
Lump in the groin, may come and go, there all the time, painful, vomiting, constipation, associated conditions.
An indirect inguinal hernia traverses the inguinal canal, enters the inguinal canal at the deep inguinal ring, and can pass into the scrotum or labia majora.
A direct inguinal hernia is medial to the inferior epigastric vessels.
T11 - T12
Anterior rami of T7 - T12 spinal nerves (no L1)
In the posterior wall of the inguinal canal medial to the Inferior epigastric vessels
