‫السالم عليكم ورحمة هللا وبركاته‬

‫يج عليها سؤال كبي‬

‫الدكتور ركز عىل هذه النقطة وأحتمال ي‬

‫الدكتور سحب عىل هذا النقطة‬

‫مستوى صعوبة المحاضة من ‪: 10‬‬

‫‪5‬‬ ‫مستوى زخم المحاضة من ‪: 10‬‬

‫أسئلة السنوات للمحاضة اخر التفري غ‬

‫‪ANATOMY LEC 3‬‬

‫‪1‬‬
 ‫ وكما ورد معنا في‬deep fascia ‫الـ‬
parotid gland ‫المحاضرة السابقة يحيط بـ‬
‫ وبالتالي يعيق حركة الغدة‬capsule ‫ويشكل‬
capsule ‫وتبقى محصورة في الـ‬
Anterior abdominal wall
Anterior ‫ في الـ‬deep fascia ‫ال يوجد‬
‫ لذلك سيكون هنالك حرية في‬abdominal wall
‫ وتمدده خالل فترة الحمل‬abdominal wall ‫حركة الـ‬
‫أو بعد الوجبات الدسمة‬

- There no deep fascia in anterior abdominal wall to allow extension of

the abdomen during heavy meals and pregnancy.
- Superficial fascia: a variable amount of fat.
- It is divided below the umbilicus into two layers; superficial fatty
layer and deep membranous layer called Scarp’s fascia.
anterior abdominal ‫لدينا في الـ‬
Superficial - ‫ طبقة تسمى‬wall
‫ وتحتوي على كميات متغيرة‬fascia
‫بحسب العمق من الدهون‬

‫ الى‬Superficial fascia ‫تنقسم الـ‬

‫طبقتين من الدهون‬
superficial fatty layer -1 ‫ أرسم‬: ‫نصيحة الدكتور لتعلم االناتومي‬
‫تخيل أكثر من رؤية الصور‬
2- deep membranous layer
‫الطبقة الثانية ستسمح بالتمدد ألنها‬
elastic not like the deep fascia

- The linea alba (linea= line, alba = white or bloodless): a fibrous cord
in the median plane of the anterior abdominal wall extending from
the xiphoid process to the upper border of the symphysis pubis. It is
formed by interlacing of the aponeurosis of the three muscles of
lateral abdominal
‫ من خالل‬linea alba ‫تكونت الـ‬
An aponeurosis is a thin sheath of CT aponeurosis of the three muscles
2
that helps connect your muscles to of lateral abdominal wall
your bones. Aponeuroses are similar
to tendons.
 Anterior ‫ طبقات للـ‬9 ‫عنا‬
abdominal wall
wall. The umbilicus lies slightly below its middle. It is wider above
the umbilicus than below it.

- Layers of anterior abdominal wall:

‫حفظ‬
1- Skin.
2- Superficial fascia:
a. Superficial fatty layer.
b. Deep membranous layer. 3- Muscles.
4- Fascia transversalis.
5- Extraperitoneal fatty tissue.
6- Parietal peritoneum.

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 internal ‫ هي أكثر طبقة‬transversus abdominis M ‫الـ‬
abdominal internal oblique muscle ‫وليس الـ‬

Membranous ‫راح تسمح بالتمدد‬

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 ‫ عند الجنين عبارة عن حلقة الوصل بين الجنين‬umbilicus ‫الـ‬
urine , blood ,faeces ‫واألم وكان يعبر من خاللها الـ‬
‫ تتصل بالسرة‬ligament’s ‫لذلك راح نشوف كثير‬
‫السرة‬ The umbilicus
- A fibrous structure situated slightly below the middle of the linea
alba. ‫ الطبيعي انها تسكر وتختفي في اخر مراحل الحمل وبعد والدة الطفل‬ducts ‫هذه الـ‬
- The deep surface of the umbilicus gives attachment to:
1- Median umbilical ligament: it represents the obliterated urachus.
It connects the apex of the urinary bladder with the umbilicus.
This ligament if patent the umbilicus discharge urine.
2- Medial umbilical ligaments: these are two ligaments (right and
left). It is the obliterated umbilical artery, extends from the side
of the urinary bladder to the umbilicus. If patent the umbilicus
discharges arterial blood. Anterior ‫ بدون الـ‬posterior view
abdominal wall

The urachus is a
fibrous remnant
of the allantois,
a canal that
drains the
urinary bladder
of the fetus that
joins and runs
within the
umbilical cord.

Median umbilical ligament:

‫ فاتح وسالك باتجاه الرسة‬duct ‫اذا كان ال‬
‫ ممكن يصي‬urinary bladder ‫قادم من‬
5 ‫ بنعرف ان هذه‬urine ‫يف افراز خفيف لل‬
‫ من خالل فحص المختي‬urine ‫االفراز‬
‫للالفرازات ألن الكمية صغية بتكون‬
 ‫ اذا‬Remnant of vitellointestinal duc ‫ال‬ ‫ اذا‬ligamentum teres ‫ال‬
faeces ‫االفراز راح يكون‬patent ‫كاننت‬ ‫ االفراز راح‬patent ‫كانت‬
venous blood ‫يكون‬
3- Ligamentum teres: it connects the umbilicus with the liver. It is
the remnant of obliterated left umbilical vein. If patent the
umbilicus discharges venous blood.
4- Remnant of vitellointestinal duct: this duct connects the gut with
the definitive yolk sac during fetal development. Normally it
disappears. Sometimes it persists as a fibrous cord connecting the
umbilicus to the terminal part of the ileum. This ligament if
remains patent the umbilicus discharge faeces.
5- Paraumbilical veins: these veins connect the umbilicus with the
left branch of portal vein. In case of portal hypertension they
become engorged with blood to form a pathological condition
called Caput Medusa.

Muscles of the anterior abdominal wall

- These are divided into two groups:

A) Muscles of the anterolateral part of the anterior abdominal wall:
1- External abdominal oblique.
2- Internal abdominal oblique.
3- 3- Transverses abdominis.
B) Muscles of the medial part of the anterior abdominal wall:
4- Rectus abdominis.
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 5- Pyramidalis.

- External abdominal oblique:

Its fibers are directed downwards, forwards and
medially - Internal abdominal oblique:
- Its fibers are directed upwards, forwards and medially.

- Transverses abdominis muscle:

The muscle fibers are directed medially and transverse.

‫ الدكتور يف العملية الجراحية الزم يقطع العضالت بنفس اتجاههم‬: ‫معلومة مهمة‬
- Rectus abdominis:
Origin: from the upper border of symphysis pubis and the pubic
crest.
Insertion: into the xiphoid process, and the 5th, 6th and 7th costal
cartilages.
Special characters of the rectus abdominis muscle:
- The breadth of the muscle increases as it ascends from its origin to
its insertion. The breadth of the origin is one third of the insertion.
- The muscles of the two sides are separated from each other by the
linea alba.
- The lateral border of the muscle is demarcated by a line called linea
semilunaris which is apparent in athletes. So each muscle is limited
medially by the linea alba and limited laterally by the linea
semilunaris.
- The muscle has three tendinous intersections as it developed from
several mytomes.

8
- The muscle is enveloped by a sheath called rectus sheath formed by
the aponeurosis of the three muscles of the lateral abdominal wall.
- Pyramidalis muscle: small triangular muscle infront of the lower
part of the rectus abdominis muscle. It may be absent.
Origin: from the front of the symphysis pubis and the pubic crest.
Insertion: into the lower part of the linea aspera.

‫ممكن ما تكون موجوده‬

‫عند بعض الناس‬

9
 The rectus sheath
- It is an envelope which surrounds the rectus abdominis muscle.
- It is formed by the aponeurosis of the three muscles of the lateral
abdominal wall.

- Contents of the rectus

sheath:
1- Two muscles: a- Rectus
abdominis.
b- Pyramidalis.
2- Two vessels: a- Superior
epigastric vessels.
b- Inferior epigastric
vessels.
3- Lower five intercostal
and subcostal nerves
and vessels.
- N.B.: the rectus abdominis
muscle is adherent to the
anterior wall of the rectus
sheath at its tendineous
intersections so the
contents of the sheath lie
behind the rectus
abdominis muscle

- Actions of the muscles of anterior abdominal wall:

10
 1- By their tone they support and protect the abdominal organs and
viscera.
2- They assist the diaphragm during inspiration as they relax during
contraction of the diaphragm to enhance its descent.
3- They increase the intraabdominal pressure to help in expiratory
acts as sneezing, coughing, micturition, defecation, vomiting, and
parturition.
4- The oblique muscles flex and flex the trunk laterally.
5- The rectus abdominis flexes the trunk forwards and stabilizes the
pelvis 6- The pyramidalis muscle tightens the linea alba.

- Fascia transversalis:
This is a layer of deep
fascia which lines the
deep surface of the
transverses abdominis
muscle. It is separated
from the parietal
peritoneum by
extraperitoneal fatty
tissue.

- Inguinal ligament:
- The aponeurosis of the external abdominal oblique between the
pubic tubercle and the anterior superior iliac spine is free (has no
attachment) and form the inguinal ligament.

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Mid point of the inguinal ligament : Mid inguinal point : at the mid
at the mid of ASIS – Pubic tubercle of ASIS – Pubic symphysis

- Mid-inguinal point: point on the inguinal ligament midway between

the symphysis pubis and the anterior superior iliac spine. The
femoral artery passes deep to it.

- Mid- point of the inguinal ligament: point on the inguinal ligament

midway between the pubic tubercle and the anterior superior iliac
spine. It lies half an inch lateral to the mid-inguinal point.

- Relations of the inguinal ligament:

1- Superficial: the superficial branches of the femoral artery and
their accompanying veins pass infront of inguinal ligament.
2- Deep: muscles, vessels and nerves passing from the abdomen to
the thigh and the reverse.

‫ حلقة الوصل‬inguinal ligament ‫يمر تحت الـ‬

mid ‫ اعلى من‬mid inguinal point ‫الـ‬ abdomen & lower limps ‫بين الـ‬
‫بـ‬point of the inguinal ligament 12 FA & FV
‫ تقربيا‬2cm
- The deep inguinal ring: a rounded opening in the fascia transversalis
lying half an inch above the mid-inguinal point.
- The margins of the ring extend around the spermatic cord to form a
covering for it called internal spermatic fascia.

- Superficial inguinal ring: Triangular opening in the aponeurosis of

external abdominal oblique muscle just above and lateral to the
pubic tubercle.
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 It has an apex, base and two crura; medial and lateral.
Apex: directed upwards and laterally.
Base: formed by the pubic crest.
- Structures passing through the superficial inguinal ring:
1. The spermatic cord in males or the round ligament of uterus in
females.
2. The ilioinguinal nerve in both sexes.

- The deep inguinal ring: a rounded opening in the fascia transversalis

lying half an inch above the mid-inguinal point.
- The margins of the ring extend around the spermatic cord to form a
covering for it called internal spermatic fascia.

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 The inguinal canal
- It is an oblique passage about 4 cm in length between the deep and
the superficial inguinal rings just above and parallel to the medial
half of the inguinal ligament.
. - Contents:
1- Spermatic cord in male or round ligament of uterus in females.
2- Ilioinguinal nerve in both sexes.

15
16
 superficial inguinal ring ‫من االسفل ب‬inguinal canal ‫تبدأ ال‬

aponeurosis of external ‫ يف‬superficial inguinal ring ‫تفتح الـ‬

abdominal oblique muscle just above and lateral to the pubic
tubercle.

‫ لل‬Triangular opening ‫ عبارة عن‬superficial inguinal ring ‫هذه ال‬

inguinal canal

‫اخرى‬ring ‫وتنته ب‬
‫ي‬ upward, deep & lateral , ‫ اىل‬canal ‫تتجه هذه ال‬
deep inguinal ring ‫تسىم‬

Fascia transversalis ‫ يف ال‬deep inguinal ring ‫تفتح ال‬

‫بكافة أجزائها‬canal ‫يمر خالل هذه ال‬

scrotum ‫ قادم من ال‬The spermatic cord in males -1

2- round ligament of uterus in female

testis of the female ‫قادم من ال‬
3- The ilioinguinal nerve in both sexes.

‫والتي بدورها‬deep inguinal ring ‫ طريقه داخل الـ‬spermatic cord ‫يكمل الـ‬
internal spermatic ‫تلتف حوله وتحيط فيه لتحميه وتكون طبقة جديدة تسمى‬
fascia.

superficial ring ‫اعلى من الـ‬deep ring ‫الـ‬

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 ‫الفتق‬
Hernia
- Definition: Abnormal protrusion of intra-abdominal contents
through a defect in the abdominal wall.
- Hernias are:
a) Inguinal Region
b) Incisional (ventral hernia)
c) Umbilical Hernias.
Causes:
1. Congenital defects
2. Loss of tissue elasticity (from aging)
3. Operative Trauma
4. Increased abdominal pressure (lifting heavy objects, cough,
constipation) - Complications of hernia
1. Pain.
2. Obstruction.
3. Bowel necrosis.
4. Perforation.
- Descriptive terms:
1. Reducible hernia: can be pushed back into the abdomen
2. Incarcerated hernia: cannot be reduced.
3. Strangulated hernia: the tissue in the hernia is ischemic and will
necrosis due to damage of its blood supply
4. Sliding hernia: the wall of the hernia sac is part formed by a
retroperitoneal structure
5. Richter hernia: only one side of the bowel wall involved in the
hernia can necrosis without signs of obstruction

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 Inguinal
hernia - Classified into:
1) Indirect
2) Direct

Indirect inguinal ‫الـ‬

‫ عبارة عن دخول‬hernia
deep ‫أعضاء اىل داخل ال‬
‫ويمكن تصل‬inguinal ring
scrotum ‫هذه األعضاء اىل ال‬

Indirect inguinal hernia:

- These are the most common type of hernia in both men and
women. The hernia enters the deep inguinal ring lateral to the

19
 inferior epigastric artery and passes through the inguinal canal to the
superficial inguinal ring. It may enter the scrotum.
- Cause: persistence of all or part of the embryonic processus
vaginalis.
- Direct inguinal hernia occurs when hernial sac pushed directly in
Hasselbach ’ s triangle through the floor of the inguinal canal medial
to the inferior epigastric vessels.
It never enters the scrotum.
- Boundaries of Hasselbach's Triangle

‫االغشية الضعيفة‬
Hasselbach ’ s
triangle

1. Medial boundary: Rectus abdominis ‫ما بتدخل في الـ‬direct inguinal hernia ‫الـ‬
canal ‫أو الـ‬deep inguinal ring
2. Lateral boundary: Inferior epigastric vessels
3. Inferior boundary: Inguinal ligament ‫ال مباشرة بتعمل شق في االغشية الضعيفة‬
‫وبتخترقها وبتخرج عن محلها الطبيعي‬
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Lec#3 Anatomy abdominal wall and inguinal region
1) Insertion of External muscle in :
iliac crest and pubic tubercle.
2)direct inguinal herniation is always in female . <wrong>
3- All of the following are correct EXCEPT :
a- Deep inguinal ring is an oval opening in the fascia transversalis
b- Superficial inguinal ring is an triangle-shaped defect in the
aponeurosis of internal oblique
muscle✔️
4)which of the following is NOT found inside spermatic cord...
- vas deferens
- testicular artery
- papiniform plexus
- genital branch of genitofemoral nerve
- cremastic fascia
ANS:E
5)All of the following are true regarding to inguinal canal except ;
- The anterior wall is consist of aponeurosis of internal oblique muscle
6) Transverse abdominal muscle originates from:
costal cartilage 7-12, thoracoabdominal, iliac crest and
inguinal ligament

21
7) The correct order for the layers of the anterolateral abdominal wall
is (externally to internally):
- skin/ camper's superficial fascia/scarpa's superficial fascia/muscles
and associated fascia/endoaddominale fascia/extraperitoneal fascia-
peritoneum
8)Which is NOT an anatomical feature of the inguinal canal:
a- the superficial inguinal ring is a triangular aperture in the external
oblique aponeurosis
b- the posterior wall of the inguinal canal is formed by inguinal ligament
c- indirect inguinal hernia is referred to as being congenital in origin
d- the deep inguinal ring is an oval opening in the fascia transversalis
e- the direct inguinal hernia passes medial to the deep inguinal ring
* The answer: (B)

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