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James Cook MD2012 GIMN Week 1 IS notes.pptx
- 1. MD2012 Dr Monika Zimanyi Senior Lecturer Department of Anatomy and Pathology School of Medicine and Dentistry James Cook University monika.zimanyi@jcu.edu.au The Inguinal Canal and Posterior Abdominal Wall
- 2. Housekeeping • Files provided on LearnJCU: • Weekly Overview • Pre-Lecture notes and Videos • Lecture notes for IS • GLS notes • Lecture notes for SS (posted last minute) • Send me Qs (if you have any) • I will look at your Qs and As on Camtasia
- 3. Descent of the Testes • Gonads begin development in the abdomen • Gubernaculum guides gonadal descent to the labioscrotal swelling
- 4. Descent of the Testes • Processus vaginalis is a peritoneal outpouching that protrudes through the anterior abdominal wall: • Transversalis fascia • Internal oblique muscle • External oblique aponeurosis
- 5. Descent of the Testes • The neurovascular supply pass through the canal • In females, gubernaculum is still attached to the labioscrotal swelling, but the ovaries only descend to the uterus • The processus vaginalis obliterates in both sexes
- 6. Inguinal Canal • Inguinal canal is ~4 cm long • Lies above the inguinal ligament • Starts at deep inguinal ring and ends at superficial inguinal ring • Contains the spermatid cord/round ligament of uterus, genitofemoral nerve and ilio-inguinal nerve
- 7. The Inguinal Canal • Deep inguinal ring • Lies lateral to inferior epigastric vessels and superior to inguinal ligament
- 8. Mid-Inguinal Point vs Midpoint of the Inguinal Ligament • Mid-inguinal point is halfway between ASIS and pubic symphysis • Femoral artery • Midpoint of the inguinal ligament is halfway between ASIS and pubic tubercle • Femoral nerve
- 9. The Inguinal Canal • Superficial inguinal ring • Formed by the external oblique aponeurosis, superior and lateral to the pubic tubercle
- 10. The Inguinal Canal • Boundaries: it has anterior and posterior walls, a roof and a floor • Anterior wall – external oblique • Posterior wall – transversalis fascia • Roof – all anterolateral layers contribute • Floor – iliopubic tract, inguinal ligament and lacunar ligament • The canal is normally collapsed
- 11. The Spermatic Cord • Testes descend from posterior abdominal wall through the deep inguinal ring, internal oblique muscle and external oblique aponeurosis.
- 12. Spermatic Cord • Ductus deferens and it’s artery • Testicular artery • Pampiniform plexus of veins • Cremasteric artery & vein • Genitofemoral nerve • Nerves • Lymphatics • Processus vaginalis remnants
- 13. The Dartos Muscle • Thin • In subcutaneous tissue • Wrinkles skin of scrotum
- 14. Inguinal Hernia (direct and indirect)
- 15. Summary of Previous Slide • Hernia is a protrusion of a peritoneal sac • This may occur because the peritoneal sac enters thru the posterior wall of the inguinal canal (direct) OR deep inguinal ring (indirect). • Direct • Less common • Acquired • Bulging is medial to inferior epigastric vessels • Indirect • More common • Congenital • Bulging is lateral to inferior epigastric vessels • Occurs because the embryonic processus vaginalis remains patent. Extent of excursion of gut down the inguinal canal depends on the amount of processus vaginalis that is patent
- 16. Nerves • Two types: • Somatic nerves • Visceral nerves • Somatic Nerves • Spinal nerves pass thru psoas major muscle • Lumbar plexus (obturator & femoral nerves) • Lumbosacral plexus (sciatic nerve)
- 17. Nerves • Visceral Nerves • Sympathetic • Parasympathetic
- 18. Abdominal Aorta • Continuation of thoracic aorta • Begins at T12 (aortic hiatus) • Ends at L4 (forms common iliac arteries) • Branches: • Unpaired visceral (3) • Unpaired parietal (1) • Paired visceral (3) • Paired parietal (3)
- 19. Inferior Vena Cava • Largest vein • No valves • Begins anterior to L5 (union of common iliac veins) • Ends at caval foramen at T8 • Enters right atrium of heart • Lies posterior anterior to aorta
- 20. Lymphatics of the Post. Abdo. Wall • Lymphatics lie along the aorta, IVC and iliac vessels • Cisterna Chyli • At the inferior end of thoracic duct • Thoracic duct • Main lymphatic duct • Ascends in thorax • Drains into left brachiocephalic vein
- 21. Lymphatics of the Post. Abdo. Wall • Lymphatics lie along the aorta, IVC and iliac vessels • Cisterna Chyli • At the inferior end of thoracic duct • Thoracic duct • Main lymphatic duct • Ascends in thorax • Drains into left brachiocephalic vein
- 22. Organs • Kidneys • Ureters • Suprarenal glands
- 23. Peritoneum & Peritoneal Cavity • Terms used to describe peritoneum & peritoneal cavity: • Greater and lesser sacs of peritoneum • Omentum • Ligament • Mesentery • Fold • Recess http://arbl.cvmbs.colostate.edu/hbooks/pathphys/misc_topics/peritoneum.html
- 24. Intraperitoneal vs. Retroperitoneal Eizenberg et al. 2008 General Anatomy: Principles & applications. McGraw-Hill • Mobility vs fixation • Free – intraperitoneal – mobile & distensible • Fixed – retroperitoneal - stable
- 25. Torsion • A viscus suspended by a mesentery is in potential danger of twisting (torsion) • This may subsequently cut off its blood supply & lead to obstruction
- 26. Salphingogram
- 27. Basic Structure • Four basic layers: • Mucosa: • Epithelium • Lamina propria • Muscularis mucosa (muscularis interna) • Submucosa • Contains neurovascular structures • Muscularis externa (2 layers) • Inner circular and outer longitudinal • Serosa/adventitia Marieb & Hoehn (9th Ed.) Human Anatomy & Physiology. Pearson
- 28. Peristalsis Eizenberg et al. (2008) General Anatomy: Principles and applications. McGraw Hill. • Alternate contractions of longitudinal and circular muscles to propel contents along
- 29. Basic Structure • Four basic layers: • Mucosa • Submucosa • Muscularis externa • Serosa/adventitia Marieb & Hoehn (9th Ed.) Human Anatomy & Physiology. Pearson
- 30. Things to Consider: • Obstruction (impaired passage of contents): • Extramural (external factor) • Intramural (within the wall) • Intraluminal (inside the lumen) …resulting in distention proximal to obstruction, pain and increased peristaltic activity Eizenberg et al. (2008) General Anatomy: Principles and applications. McGraw Hill.
Editor's Notes
- Files provided: Weekly Overview – outlines what will be covered that week. Includes learning outcomes, key words, how to prepare for the IS, the GLS and SS. Learning Materials focuses on materials that will be covered, by you, outside of class, prior to coming to the IS. Please come prepared because I will not go over this material. What I will cover in the IS is… Lecture notes for IS – more difficult concepts and so this is a face to face lecture. I’ve reworked these with more notes. GLS notes – print these and bring them with all other notes you have. A timetable is provided in the overview document and is the same every week (for my weeks). The first activity is always in the anatomy lab and allows you to see the wet specimens, models, posters, bones & skeletons, white boards etc to study the gross anatomy of each organ we cover in that week. This is setup like a checklist. Go through it one by one to make sure you see everything there is to see and understand everything you need to understand. Tutors and I are there to help you. Try to work in groups. The second activity is always in the reef lab on the computers. I will ask you to get onto the virtual slide collection of the Uni of Iowa and study the histology of the organs of the abdomen. This will be on the exam! The third activity allows you to answer questions which I provide from time to time, and to review the anatomy and histology in your own time at your own pace. The GLS learning outcomes are not necessarily the same as the L.O.s for the week, but the weekly L.O.s will encompass them. Lecture notes for SS – this will/will not be provided… Please provide questions via email (if you have any) about content you did not understand. If you find an error or omission, please let me know! If you have suggestions, I’d be happy to hear them, though it is unlikely that I will make changes before next year.
- Peritoneum closed in males but open in females.