Anterolateral Muscles
Peritoneum
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middle) then give off the lateral cutaneous branch and end
as an anterior cutaneous branch.
Intercostal nerves (T7 to T11) pass deep to the costal
cartilages and continue onto the anterolateral abdominal
wall between the internal oblique and trasnversus
abdominis muscles. They enter the rectus sheath and
pass to the posterior aspect of the rectus abdominis
muscle approaching the midline, an anterior cutaneous
branch passes through the rectus abdominis muscle and
the anterior wall of the rectus sheath to supply the skin.
Spinal nerve T12 (subcostal nerve) follows similar course.
Branches of L1 (iliohypogastric and ilio-inguinal nerve)
originate from the lumbar plexus follow a similar course
but deviate from this patern near their final destination.
All nerves terminate by supplying the skin
Nerves T7-79: skin from the xiphoid process to just above
the umbilicus
T10: skin around the umbilicus
T11,T12,L1: below umbilicus to the pubic region (inclusive)
Ilioinguinal nerve: supplies the anterior surface of the
scrotum or labia majora, and sends a small cutaneous
branch to the thigh
Lymphatic drainage
Groin
The junction between the abdominal wall and the thigh quite
susceptible to inguinal hernia
Peritoneal outpunching in abdominal wall eventually forms
testes/ovaries, protruding through the various layers of the
anterior abdominal wall and acquiring coverings from each
o The transversalis fascia forms its deepes covering, followed
by musculature of internal oblique and the most external
covering is the aponeurosis of the external oblique
o This structure forms into a tubular structure knows as the
inguinal canal.
Processus vaginalis
In men, the accompanying vessels, ducts, and nerves pass
through the inguinal canal and are therefore surrounded by the
same fascial layers of the abdominal wall, forming the spermatic
cord
In women, the overaies descend into the pelvic caity and become
associated with the developing uterus therefore the only
relevant structure passing through the inguinal canal is the
round ligament of uterus.
Inguinal Canal
Ends of the triangle are the medial and lateral crus and are
attached to the pubic symphysis and the pubic tubercle,
respectively; prevent widening of the superficial ring.
Spermatic Cord
Passes from the uterus to the deep inguinal ring where it enteres
the iguinal canal
Exists through the superficial inguinal ring
As it traversus through the inguinal canal, it acquires the same
coverings as the spermatic cord in men.
Continues to the ovary as the ligament of the overy.
Clinical Note: cremaster muscle and fascia form the middle
covering of the spermatic cord (supplied by genitofermoral
nerve)
o Cremaster reflex: gentle touch at and around the skin of
the medial aspect of the superior part of the thigh
stimulates the sensory fibers of the ilio-inguinal nerve
sensory fibers to L1 response from motor fibers of
genital branch of the genitofemoral nerve
Clinical note:
o Indirect Inguinal Hernia: peritoneal sac enters the
inguinal canal by passing through the deep inguinal ring
just lateral to the inferior epigastric vessels
Congenital in origin
o Indirect Inguinal Hernia: peritoneal sac enters the
medial end of the inguinal canal directly through a
weakened posterior wall
Does not traverse the entire length of the inguinal
canal
Peritoneum
Peritoneal Cavity