37. Transversus Abdominis Conjoint Tendon Transversalis Fascia Deep Inguinal Ring Inferior Epigastric Artery Inguinal Ligament
38. HERNIAS Inguinal A. Indirect- Most common type of hernia 1. Enters deep to inguinal ring – lateral to the inferior epigastric artery
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40. HERNIAS Inguinal A. Indirect- Most common type of hernia 1. Enters deep inguinal ring – lateral to the inferior epigastric artery. B. Direct – Bulges anteriorly through posterior wall of the canal 1. Medial to inferior epigastric artery 2. About 15% of inguinal hernias
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43. HERNIAS Inguinal A. Indirect- Most common type of hernia 1. Enters deep inguinal ring – lateral to the inferior epigastric artery B. Direct – Bulges anteriorly through posterior wall of the canal 1. Medial to inferior epigastric artery 2. About 15% of inguinal hernias. Femoral A. Passes posterior to the inguinal ligament B. In the femoral canal C. Most frequent in women
46. HERNIAS Umbilical A. Congenital B. Acquired Epigastric A. Widest part of the linea alba B. Xiphoid to umbilicus
47. HERNIAS Umbilical A. Congenital B. Acquired Epigastric A. Widest part of the linea alba B. Xiphoid to umbilicus Divarication of the Recti Abdominis A. Old women with weak muscles B. Hernial sac bulges between medial margins of recti
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49. Sports Hernia a. Athletic Pubalgia, Gilmores’s Groin or Sportsman’s Groin b. tear in the conjoined tendon due to inability to oppose the effect of the thigh adductor muscles on the pubis. c. Characterized by pain in the inguinal and pubic areas. Conjoined Tendon Pubic Tubercle Pubic Body Inferior Pubic Ramus
56. Anomalies of the Midgut 1. Congenital Omphalocele – viscera do not go back in from umbilicus 2. Umbilcal hernia – viscera or fat herniate into a weakend umbilicus after intestines have gone back in. Hernia appears upon straining. 3. Gastrochisis – hernias in the abdominal wall other than in the umbilicus formation
57. 4. Malrotation of the gut a. Nonrotation - intestine does not rotate upon returning – causes the small intestines to be on the right and the large intestine on the left. b. Mixed rotation and volvulus – cecum lies posterior to the pyloris and is fixed to the posterior wall by peritoneal bands that pass over the duodenum –cause duodenal obstruction c. Reversed rotation - midgut loop rotates clockwise – duodenum lies anterior to the SMA and the transverse colon lies posterior to it which can cause the transverse colon to become occluded. d. Subhepatic cecum and appendix – cecum becomes attached to liver –complicates the diagnosis of appendicitis e. Mobile cecum – incomplete fixation of ascending colon – complcates diagnosis of appendicitis f. Internal hernia – through intestinal mesentery g. Midgut volvulus - failure of midgut loop to return properly – causing disruption of mesentery
58. 5. Stenosis and atresia of intestine – 25% duodenum and 50% ileum a. insufficient recanalization b. diaphragm c. blood supply disruption 6. Ileal diverticulum and other yolk stalk anomalies – Meckels 7. Duplication of intestine – usually incomplete recanalization
86. Abnormalities of Sexual Differentiation Turner’s Syndrome – XO – streak ovaries but normal female genitalia. True Hemaphrodism – both ovaries and testicular tissue – external genitalia female with hypertrophied clitoris. Female Pseudohermaphroditism – Genetically female (46XX) – external genitalia masculinized – CAH a cause. Male Pseudohermphroditism – (46 XY) – hypoplasia of phalus and persistence of paramesonephric duct – inadequate production of testosterone. Testicular Feminization Syndrome – androgen insensitivity due to lack of receptors – normal appearing female but has an internalized testes – characterized by amenorrhea .
