Lab Manual of Regional Anatomy
(for Chinese Students)
Department of Regional Anatomy & Operative Surgery
The 1st Affiliated Hospital of China Medical University
NOTICE
? Try to find the answers to the questions before practice class.
? Preview the cases before practice class. Don’t pay much attention on disease. Try to find corresponding anatomical points in the cases and study on them. In the practice class, the cases will be discussed in English. Every student will get a score according to their appearance in discussion.
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Assignments:
Complete the learning module entitled abdominal wall, inguinal region and peritoneal cavity.
Objectives:
1. Recognize and define the abdominal cavity, peritoneal cavity. Describe the divisions of the anterolateral abdominal wall and abdominal cavity. answer：the division of the anterolateral abdominal wall (腹前外侧壁)
(1)
right hypochondriac epigastric region region right lumbar region umbilical region right inguinal region hypogastric region
(2) Median plane
Right upper abdomen area left upper abdomen area Right lower abdomen a left lower abdomen area
left hypochondriac
left lumbar region
left inguinal region
Answer:
2. Describe the general layers of the anterolateral abdominal wall and the relationships of the layers, partitions划分 and compartments分割 one encounters when dissecting from superficial to deep in any particular region.
1---skin
2---superficial fascia (Camper’s fascia –fatty ,superficially浅层，脂肪较多) （Scarpa’s fascia---membranous，deep 深层，膜性） 3---muscles rectus abdominis muscle腹直肌
External oblique muscle 腹外斜肌 Internal oblique muscle 腹内斜肌 Transverse abdominis 腹横肌 4-transversalis fascia 腹横筋膜 5.extraperitoneal fascia 腹膜外筋膜
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6.parietal peritoneal壁腹膜
Answer:
3. Describe the blood supply and innervations of the anterolateral abdominal wall.
(1) superfacial layer
lateral wall: the branch of posterior intercostals arteries , subcostal artery , lumbar arteries. nearby the median line: superior epigastric artery, inferior epigastric artery lower half: superficial epigastric artery, superficial iliac circumflex artery (2) deep layer
posterior intercostal artery, subcostal artery, lumbar artery, superior epigastric artery, inferior epigastric artery, superficial iliac circumflex artery 腹侧壁：
肋间后动脉、肋下动脉和腰动脉的分支 正中线附近：
腹壁上动脉、腹壁下动脉的分支 下半部：
腹壁浅动脉 旋髂浅动脉
下5对肋间后动脉、肋下动脉及4对腰动脉,腹壁上动脉（胸廓内动脉的终支之一 ）, 腹壁下动脉及旋髂深动脉 Nerve
肋间神经，肋下神经，髂腹下神经，髂腹股沟神经，生殖股神经
Intercostal nerves, subcostal nerve, iliohypogastric nerve, ilioinguinal nerve.
Trigone formed by the lateral borderof rectus abdominis, inguinal ligament and the horizontal line
4. Recognize the anatomical structures related to incisions on anterolateral abdominal wall.
5. Recognize and define the inguinal region. Describe the general layers of the inguinal region and ligaments in this region.
between anterior superior iliac spine and lateral border of rectus abdominis.It’s a weak region of abdominal wall skin
Superficialfascia:camper layer and Scarpa layer
Muscle layer: obliquus externus abdominis, inguinal ligament ,lacunar ligament, superficial inguinal ring.
Ligaments: injuinal ligament, lacunar ligament.
Inguinal canal: it is an oblique passage,4-5cm long, through the abdominal wall. It passed
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6. Recognize and define the inguinal canal and the 4 walls and 2 openings of it.
downwards and medially from the deep to superficial inguinal rings and lines parallel to, and immediately above, the inguinal ligament. The inguinal canal is occupied in male by the cord and in female by the round ligament of uterus. It has 4 walls and 2 openings. That is:
The anterior wall: aponeurosis of obliquus externus abdominis in the superficial layer, reinforced by muscle fibers of obliquus internus abdominis in the deep layer at the outer 1/3 of the canal
The posterior wall: transverse fascia, reinforced by the conjoined tendon at the inner 1/3 of the canal The superior wall: arched fibers formed by the and the transversus abdominis The inferior wall: inguinal ligament
The inner opening: deep inguinal ring, which is about 1cm above the middle point of inguinal ligament The outer opening: superficial inguinal ring
7. Recognize and define the inguinal triangle.
It’s surrounded by inferior epigastric artery , the inguinal ligament and the lateral border of rectus Abdominis. This area is easy to have direct inguinal hernia.
Questions:
1. Try to describe the differences of the abdomen, abdominal cavity and peritoneal cavity. Answer:
Abdomen: a part of body between thorax (胸部)and pelvis（盆部）
Abdominal cavity:the cavity between diaphragm and superior pelvic aperture(骨盆上口)
Peritoneal cavity: the irregular cavity surrounded by parietal peritoneum(壁腹膜) and visceral peritoneum（脏腹膜）
Answer：
2. How to locate the pyloric level? What important structures at this level? 3. Which layers will you meet when you choose a McBurney’s incision? How about transrectal incision?
(1) Mcburney’s incision
皮肤-浅筋膜-腹外斜肌腱膜-腹内斜肌-腹横肌-腹横筋膜-腹膜外筋膜-壁腹膜
Skin-superfacial fascia-aponeurosis of obliquus externus abdominis-internal oblique muscle of abdomen-transversus abdominis muscle-transverse fascia-extraperitoneal fascia-parietal (2) Transcrectal incision
It’s a weak region of abdominal wall. ⑴the obliquus externus abdominis change into aponeurosis of
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4. Try to describe the distribution of superficial blood vessels, lymphatic vessels and cutaneous nerves of anterolateral abdominal wall.
5. Try to describe the blood vessels and nerves in the deep layers of anterolateral abdominal wall.
6. Why do hernias occur in inguinal region?
obliquus externus abdominis;⑵there is no mucle over the region;⑶male: spermatic cord, male: round