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anatomy

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hernia

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Superficial inguinal ring

Definiton: The superficial inguinal ring (subcutaneous inguinal ring or external inguinal ring) is an anatomical structure in the anterior wall of the human abdomen.

Shape: It is a triangular opening that forms the exit of the inguinal canal

Houses:: the ilioinguinal nerve, the genital branch of the genitofemoral nerve, and the spermatic cord (in men) or the round ligament (in women).

Boundaries: bounded below by the crest of the pubis; on either side by the margins of the opening in the aponeurosis, which are called the crura of the ring(It is at the layer of the aponeurosis of the obliquus externus abdominis) ; and above, by a series of curved intercrural fibers.

  • The inferior crus (or lateral, or external pillar) is the stronger and is formed by that portion of the inguinal ligament which is inserted into the pubic tubercle; it is curved so as to form a kind of groove, upon which, in the male, the spermatic cord rests.
  • The superior crus (or medial, or internal pillar) is a broad, thin, flat band, attached to the front of the pubic symphysis and interlacing with its fellow of the opposite side.
  • The Intercrural fibres these fibers across horizontally between the two crura, and prevent the divergence of the crura from one another. As they pass across the subcutaneous inguinal ring, they are connected together by delicate fibrous tissue, forming a fascia, called the intercrural fascia. This intercrural fascia is continued down as a tubular prolongation around the spermatic cord and testis, and encloses them in a sheath; hence it is also called the external spermatic fascia.

Site:It is found within the aponeurosis of the external oblique, immediately above the crest of the pubis, 1 centimeter above and medial to the pubic tubercle.

Clinical significance: The superficial ring is palpable under normal conditions. It becomes dilated in a condition called athletic pubalgia. Abdominal contents may protrude through the ring in inguinal hernia.

Deep inguinal ring

Definition:The deep inguinal ring (internal or deep abdominal ring, abdominal inguinal ring, internal inguinal ring) is the entrance to the inguinal canal. it form due to deficiency of transversalis fascia.

Location:The surface marking of the deep inguinal ring is classically described as immediately above the midpoint of the inguinal ligament (midway between the anterior superior iliac spine and the pubic tubercle).

However, the surface anatomy of the point is disputed. In a recent study it was found to be in a region between the mid-inguinal point (situated midway between the anterior superior iliac spine and the pubic symphysis) and the midpoint of the inguinal ligament (i.e. midway between the anterior superior iliac spine and the pubic tubercle). Traditionally, either one of these 2 sites was claimed as its location. However, this claim is based upon the study's dissection of 52 cadavers, and may not reflect the live in vivo anatomy.

Some sources state that it is at the layer of the transversalis fascia.

Shape: It is of an oval form, the long axis of the oval being vertical; it varies in size in different subjects, and is much larger in the male than in the female.

Boundaries: It is bounded, above and laterally, by the arched lower margin of the transversalis fascia; below and medially, by the inferior epigastric vessels.

Transmission: It transmits the spermatic cord in the male and the round ligament of the uterus in the female.

Extensions: From its circumference a thin funnel-shaped membrane, the infundibuliform fascia, is continued around the cord and testis, enclosing them in a distinct covering.

Inguinal Canal

Definition: The inguinal canal is a semi-muscular canal between deep and superficial inguinal ring. it's a passage in the anterior (toward the front of the body) abdominal wall which in men conveys the spermatic cord and in women the round ligament. The inguinal canal is larger and more prominent in men. Each person has two, on the left and right sides of the abdomen.

Site: The inguinal canal is situated just above (parallel) the medial half of the inguinal ligament. In both sexes the canal transmits the ilioinguinal nerve.

Length: Approximately 3.75 to 4 cm.

Direction: It is obliquely directed anteroinferiorly and medially.

Boundaries: A first-order approximation is to visualize the canal as a cylinder, To help define the boundaries, the canal is often further approximated as a box with six sides. Not including the two rings, the remaining four sides are usually called the "anterior wall", "posterior wall", "roof", and "floor". These consist of the following:

superior wall (roof):
Medial crus of aponeurosis of external oblique
Musculoaponeurotic arches of internal oblique and transverse abdominal
Transversalis fascia
anterior wall:
1)aponeurosis of external oblique
2)fleshy part of internal oblique (lateral third of canal only)
superficial inguinal ring (medial third of canal only)
(inguinal canal) posterior wall:
transversalis fascia
conjoint tendon (Inguinal falx,reflected part of inguinal ligament, medial third of canal only)
deep inguinal ring (lateral third of canal only)
inferior wall (floor):
inguinal ligament
lacunar ligament (medial third of canal only)
iliopubic tract (lateral third of canal only)

Contents:

The classic description of the contents of spermatic cord in the male are:

Note that the ilioinguinal nerve passes through the superficial ring to descend into the scrotum, but does not formally run through the canal.

Development: During development gonads (ovaries or testes) descend from their starting point on the posterior abdominal wall (para-aortically) from labioscrotal swelling near the kidneys down the abdomen and through the inguinal canal to reach the scrotum. The testis then descends through the abdominal wall into the scrotum, behind the processus vaginalis (which later obliterates). Thus lymphatic spread from a testicular tumour is to the para-aortic nodes first, and not the inguinal nodes.

Disorders: Abdominal contents (potentially including intestine) can be abnormally displaced from the abdominal cavity. Where these contents exit through the inguinal canal the condition is known as an indirect or oblique inguinal hernia. This can also cause infertility. This condition is far more common in men than in women, owing to the inguinal canal's small size in women. A hernia that exits the abdominal cavity directly through the deep layers of the abdominal wall, thereby bypassing the inguinal canal, is known as a direct inguinal hernia.

Spermatic Cord

Definition: The spermatic cord is the name given to the cord-like structure in males formed by the vas deferens and surrounding tissue that run from the deep inguinal ring down to each testicle.

Contents of spermatic cord:

Note That:

  • The pampiniform plexus, testicular artery, artery of the ductus deferens, lymphatic vessels, testicular nerves, and ductus deferens all run deep to the internal spermatic fascia.
  • The genital branch of the genitofemoral nerve, cremasteric artery, and ilioinguinal nerve all run on the superficial surface of the external spermatic fascia.

Coverings: The spermatic cord is ensheathed in three layers of tissue:

Clinical significance:

  • The spermatic cord is sensitive to torsion, in which the testicle rotates within its sac and blocks its own blood supply. Testicular torsion may result in irreversible damage to the testicle within hours. A collection of serous fluid in the spermatic cord is named 'funiculocele'.
  • The contents of the abdominal cavity may protrude into the inguinal canal, producing an indirect inguinal hernia.

celiac trunk

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celiac trunk, or truncus coeliacus, is the first major branch of the abdominal aorta (the others are the superior and inferior mesenteric arteries). It is 1.25 cm in length, at T12

Structure: There are three main divisions of the celiac artery, and each in turn has its own named branches.

Artery Branches
left gastric artery esophageal branch, hepatic branch
common hepatic artery proper hepatic artery, right gastric artery, gastroduodenal artery
splenic artery dorsal pancreatic artery, short gastric arteries, left gastro-omental artery, greater pancreatic artery

The celiac artery may also give rise to the inferior phrenic arteries.

brsnches:

one piece arcs

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Sea of Survival: Super Rookies Saga

East Blue Alabasta Sky Island Water 7 Thriller Bark Summit War
Romance Dawn Arc Reverse Mountain Arc Goat Island Arc* Long Ring Long Land Arc Lovely Land Arc* Sabaody Archipelago Arc
  • Chapters 1 to 7 (Vol. 1)
  • Episodes 1 to 3
Orange Town Arc Whiskey Peak Arc Ruluka Island Arc* Ocean's Dream Arc* Thriller Bark Arc Boss Luffy Historical Special*
  • Chapters 8 to 21 (Vol. 1 - 3)
  • Episodes 4 to 8
  • Chapters 106 to 114 (Vol. 12 & 13)
  • Episodes 64 to 67
Syrup Village Arc Diary of Coby-Meppo|Coby/Helmeppo Side Story** Jaya Arc Foxy's Return Arc* Spa Island Arc* Amazon Lily Arc
  • Chapters 22 to 41 (Vol. 3 - 5)
  • Episodes 9 to 17
Baratie Arc Little Garden Arc Skypiea Arc Water 7 Arc Brook Side Story Arc* Impel Down Arc
  • Chapters 42 to 68 (Vol. 5 - 8)
  • Episodes 18 to 30
  • Chapters 115 to 129 (Vol. 13 - 15)
  • Episodes 70 to 77
Arlong Park Arc Drum Island Arc G-8 Arc* Enies Lobby Arc Straw Hat's Separation Serial**
  • Chapters 69 to 95 (Vol. 8 - 11)
  • Episodes 31 to 45
  • Chapters 130 to 154 (Vol. 15 - 17)
  • Episodes 78 to 91
Buggy's Crew: After the Battle!|Buggy Side Story** Alabasta Arc Post-Enies Lobby Arc Marineford Arc
Loguetown Arc Post-Alabasta Arc* Post-War Arc
  • Chapters 96 to 100 (Vol. 11 & 12)
  • Episodes 48 to 53
  • Chapters 581 to 597 (Vol. 59 - 61)
  • Episodes 490 to 516
  • Episode 492 = TorikoxOnePiece
Warship Island Arc*
The Final Sea: The New World Saga
Fishman Island Pirate Alliance Placeholder for title Placeholder for title Placeholder for title Placeholder for title
Return to Sabaody Arc Z's Ambition Arc*
Fishman Island Arc Punk Hazard Arc
  • Chapters 654 to 699 (Vol. 66-70)
  • Episodes 579 to 625
  • Episode 590 = TorikoxOnePiecexDragonBall
Caesar Retrieval Arc*
Dressrosa Arc
  • Chapters 700 to current (Vol. 70-current)
  • Episodes 629 to current

Arcs with * are not in the manga but are fillers in the anime.
Arcs with ** are Cover Stories from the manga adapted into episodes.

conan

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Detective Conan: The Fist of Blue Sapphire
Japanese名探偵コナン: 紺青の拳
Based onCase ClosedGosho Aoyama
Starring
Production
company
Distributed byToho Company, Ltd.
Release date
  • April 12, 2019 (2019-04-12)
CountryJapan
LanguageJapanese

Detective Conan: The Fist of Blue Sapphire (名探偵コナン: 紺青の拳) |Meitantei Konan: konjō no kobushi}} is a 2019 Japanese animated film. It is the twenty-third installment of the Case Closed film series based on the manga series of the same name by Gosho Aoyama, following the 2018 film Detective Conan: Zero the Enforcer. The film will be released on April 12, 2019.[1]

Cast

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References

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Category:Japanese films Category:2019 films Category:2019 anime films Category:Case Closed films Category:TMS Entertainment