Weak places of the abdominal

cavity. Topography of the limbs

Professor Elena Chernomortseva

Weak places of the
abdominal cavity
 Abdominal cavity
a top wall
a bottom wall
a rear wall
a front wall
two side walls

And almost all the walls, except for the

side ones, have their weak points
Hernia – is a protrusion of the internal
organs of the abdomen, along with the
parietal piece of peritoneum through the
“weak points” of the abdominal wall

1) THE HERNIAL
GATES (orifice)
2) HERNIAL SAC
(parietal peritoneum)
3) CONTENTS OF THE
SAC (organs)

Causes - high intraabdominal pressure -

due to heavy lifting, obesity, pregnancy, straining,
coughing…
Hernias are caused by combination of muscle
weakness
and strain

Hernias are
not fatal but
they cannot
disappear by
themselves.
Surgery has
to be done.

anything that causes the increase in pressure in the abdomen, can cause hernia
 General features of the abdominal
walls weak places
 Few layers
 Natural foramens
 There are hernial gates
 Weak places of the
posterior abdominal wall
Trigonum lumbale
Pty’s triangle, Petit’s triangle

m. latissimus dorsi

m. obliquus externus
abdominis

m. obliquus internus
abdominis (floor)

crista illiaca
Weak places of the posterior
abdominal wall
Spatium lumbale
(Lesgaft-Grynfeltt’s space)

m. serratus
posterior inferior

XII rib
m. obliquus
abdominis internus
m. erector spinae
Diaphragm. Weak places of the upper
wall
Trigonum
sternocostale
(the right one – triangle
of Morgagni, the left one-
Larrey’s )

hiatus
esophageus

Trigonum
lumbocostale
(Bochdalek’s)
 Weak places of the anterior wall
1. Umbilical ring
(functioned in the embryonic period
it was part of the umbilical cord (the
navel. artery and vein)
To the right and to the bottom the ring
is thicker (due to: round ligament of
the liver)
 Weak places of the anterior wall
White line of the
abdomen
 It is a fibrous plate extending
from the xiphoid process up
to the pubic symphysis
 In the upper sections the
white line is up to 2.5 cm,
because the medial edges of
rectus muscles are distant
from the midline.
 It narrows down to 0.4 cm,
but its thickness in the
sagittal plane is growing.
 Weak places of the anterior wall
1.Arched line –
Spigelian hernia
 Weak places of the anterior wall

Inguinal canal
Inguinal canal

♂ - spermatic cord
(funiculus
spermaticus)

♀ - round ligament
of uterus
(lig. teres uteri)
 Walls of the inguinal
canal
Anterior: aponeurosis
of the external
obliqual abdominal
muscle

Inferior: ligamentum
inguinale
 Walls of the inguinal canal
Superior: free
lower margins of
the m. obliquus
abdominis
internus, m.
tansversus
abdominis
Posterior: fascia
transversalis
 Inguinal canal`s walls
Internal oblique and
transversus abdominis muscles (superiorly)

External oblique
aponeurosis
(anteriorly)

Transversalis fascia
Inguinal ligament (posteriorly)
(inferiorly)
 Annulus inguinalis
superficialis

Superior – crus
medialis (lig.
inguinale)
Lateral – fibrae
intercruralis
(superficial abdominal
facsia)
 Annulus inguinalis
superficialis
Inferior – crus
lateralis (lig. inguinale)

Medial –
ligamentum
reflexum
(aponeurosis of
the contralateral
side)
 Inguinal canal
Umbilical folds
Umbilical
fossae
Deep ring
 Annulus inguinalis
profundus
Walls:
1. Fascia transversalis
2. Falx inguinalis
3. Ligamentum
interfoveolare
 Inguinal hernia
1. Acquired: a) indirect b) direct 2. Congenital
 Weak places of the inferior wall

Suprapiriform
foramen

Infrapiriform
foramen
Canalis obturatorius
 The Thigh. Lacunae
Lacuna musculorum
(m. iliopsoas, n. femoralis,
Lateral cutaneous nerve of
thigh)

Lacuna vasorum
(a. femoralis, v. femoralis,
femoral branch of
genitofemoral nerve)
 Annulus femoralis
 Anteriorly, superiorly–
ligamentum inguinale
 Medialy – ligamentum
lacunare
 Inferiorly, posteriorly–
ligamentum
pectineale
 Lateraly – vena
femoralis
 Femoral hernia
 If a loop of intestine is
forced into the femoral
ring, it expands to form a
swelling in the upper part
of the thigh.
Such a condition is known
as a femoral hernia

 A femoral hernia is more

common in women than in
men (possibly because
their wider pelvis)
 Femoral canal –Patology!!!

1. Anterior:
ligamentum
inguinale,
cornu superius
2. Posterior:
fascia lata
(deep lamina)
3. Lateral: vena
femoralis
 Femoral canal
Superficial ring
 Margo falciformis
Cornu superius
Cornu inferius

 Hiatus saphenus
Topography of the
limbs
 Topography of the Upper limb
Axillary fossa

m. Pectoralis
major

m. Latissiumus
dorsi
Topography of the Upper limb
Cavitas axillaris
• Boundaries
– Ventral - pectoral muscles
– Dorsal = m.latissimus dorsi,
m.teres major
m.subscapularis
– Medial = m.serratus anterior
– Lateral = humerus,
m. coracobrachialis,
short head of biceps brachii m.
• Contents
– Loose fat, Axillary lymph nodes, Axillary vessels
– Brachial Plexus
Topography of the Upper limb
Openings
Foramen trilaterum
Btw. - m. subscapularis
- m. teres major
- long head of
triceps brachii m.
Transmits: a. circumflexa scapulae
Foramen quadrilaterum
Btw. - m. subscapularis
- m. teres major
- long head of
triceps brachii m.
- humeral neck
Transmits: n. axillaris,
a. circumflexa humeri posterior
 Topography of the Upper limb

I trigonum claviopectorale
II trigonum pectorale
III trigonum subpectorale
 Topography of the Upper limb
Upper arm
Sulcus bicipitalis medialis
-m. brachialis
-medial border of m. biceps
brachii
Contents: neurovascular bundle of the
arm
Sulcus bicipitalis lateralis
-m. brachialis
-lateral border of
m. biceps brachii
Contents: v. cephalica
Canalis humeromuscularis
-sulcus radialis
-triceps brachii m.
Contents: n. radialis, a., v. profunda brachii
 Topography of the Upper limb
Cubital Fossa
Boundaries
• Medial= Pronator teres
• Lateral= Brachioradialis
• Superior= Line between
epicondyles

Contents
• Median Cubital Vein
• Brachial Artery
• Median Nerve
 Topography of the Upper limb
Forearm
1. Sulcus n. ulnaris
-m. f. carpi ulnaris
-m. f. digitorum
superficialis
Transmits: a., v., n. ulnaris

2. Sulcus n. radialis
-m. brachioradialis
-m. f. carpi radialis
Transmits: a., v., n. radialis

3. Sulcus medianus
-m. f. carpi radialis
-m. f. digitorum superficialis
Transmits: n. medianus
Topography of the Upper limb
Canalis carpalis (tunnel)

 Eminentia carpi ulnaris

 Eminentia carpi radialis
 Retinaculum flexorum covers it
Contains: long tendons of flexors,
Synovial sheets, median nerve

Canalis carpalis

Can. carpi radialis Can. carpi

ulnaris
 The Carpal Tunnel and its Contents
This is a narrow enclosed space
If anything in here swells, the
median nerve will get
compressed~
- The lateral three and a half
digits will get diminished
sensation
- Sensation on the thenar
eminence will be spared
-
The movement of the thenar
muscles is controlled by a
terminal motor branch of the
median nerve, and so the thenar
muscles will atrophy in carpal
tunnel syndrome
 Forearm space of Pirogov - Parona

Anteriorly- deep flexor

digitorum & flexor
pollicis longus
Superiorly- pronator
quadratus
Posteriorly-interosseous
membrane
3
Inferiorly » to canalis 2
carpi 1
Topography of the Lower limb
Gluteal region Suprapiriform
foramen is gap
between the greater
sciatic notch and the
upper edge of the
piriformis muscle

Infrapiriform
foramen is gap
between the lower
edge of the
piriformis m.&
sacrospinous lig.
Topography of the Lower limb The Thigh
Lacuna musculorum
Borders:
• Superiorly-
inguinal ligament
• Medially –
iliopectineal arch
• Inferolaterally –
hip bone

Contents:
• Lateral cutaneal
femoral n.
• Femoral n.
• Iliopsoas muscle
Topography of the Lower limb The Thigh
Lacuna vasorum
Borders:
• Anteriorly- inguinal
ligament
• Medially – lacunar
ligament
• Posteromedially -
pectineal luigament
• Posterolaterally –
iliopectineal arch

Contents:
• Femoral sheath
• Femoral a. and v.
• Genital branch of
genitofemoral n.
• Lymphatic vessels
• Femoral ring
 Femoral Triangle The Thigh
Boundaries:
• Superiorly: The inguinal ligament
• Laterally: The sartorius muscle
• Medially: The adductor longus muscle
Its floor is formed by the fossa iliopectinea
(iliopsoas m.(laterally) and m. pectineus
(medially))

Contents:
• femoral n., a., v. and their branches
• femoral sheath
• deep inguinal lymph nodes
 The Thigh
Sulcus iliopectineus:
Laterally – iliopsoas m.
Medially – pectineus m.

Sulcus
Continuous with
femoralis anterior:
Laterally – vastus medialis
Medially – adductor longus and
magnus

Continuous with Adductor canal:

(Subsartorial/Hunter’s canal)
• Anteriorly – lamina
vastoadductoria
• Medially - adductor magnus
• Laterally - vastus medialis
 The Popliteal fossa
Boundaries:
• Biceps femoris
• Semimembranosus and
semitendinosus
• The lateral head of
gastrocnemius
• The medial head of
gastrocnemius
Floor of the popliteal fossa:
• The popliteal surface of the
femur
• The oblique popliteal ligament
• Capsule of the knee joint
• The popliteus muscle
The roof - popliteal fascia
 Cruropopliteal
canal

Posteriorly:
- soleus

Anteriolry:
-tibialis posterior
-flexor hallucis longus
 Superior
musculoperoneal
canal
is bounded

Medially:
upper third of fibula

Laterally:
peroneus longus
Contains:

Common peroneal nerve

 Inferior
musculoperoneal
canal
is bounded

Anteriorly:
lower third of fibula

Posteriorly:
flexor hallucis longus
and tibialis posterior
Contains:

Peroneal artery and veins

 Foot
Medial Lateral
plantar plantar
groove groove

Abductor
digiti minimi

Abductor
hallucis
Flexor digitorum
brevis
Hernia
Hernia
Hernia
Thank you for attention!