anatomy edit
hernia edit
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:
- in males : the spermatic cord and its coverings + the ilioinguinal nerve.
- in females : the round ligament of the uterus + the ilioinguinal nerve.
The classic description of the contents of spermatic cord in the male are:
- 3 arteries: artery to vas deferens (or ductus deferens), testicular artery, cremasteric artery;
- 3 fascial layers: external spermatic, cremasteric, and internal spermatic fascia;
- 3 other structures: pampiniform plexus, vas deferens (ductus deferens), testicular lymphatics;
- 3 nerves: genital branch of the genitofemoral nerve (L1/2), sympathetic and visceral afferent fibres, ilioinguinal nerve (N.B. outside spermatic cord but travels next to it)
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:
- Arteries: testicular artery, deferential artery
- Nerves: nerve to (genital branch of the genitofemoral nerve), testicular nerves (sympathetic nerves)
- Vas deferens (ductus deferens)
- Pampiniform plexus
- Lymphatic vessels
- Tunica vaginalis (it is an extension of the peritoneum passing through this slit in the trasversalis fascia. and considered as remains of the processus vaginalis)
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:
- external spermatic fascia, an extension of the innominate fascia that overlies the aponeurosis of the external oblique muscle
- cremasteric muscle and fascia, formed from a continuation of the internal oblique muscle and its fascia
- internal spermatic fascia, continuous with the transversalis fascia
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 edit
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:
- left gastric artery
- hepatic branch
- esophageal branch
- common hepatic artery
- hepatic artery proper: supplies the gallbladder via the cystic artery and the liver via the left and right hepatic arteries
- gastroduodenal artery: branches into right gastroepiploic artery and superior pancreaticoduodenal artery
- Right gastric artery: branches to supply the lesser curvature of the stomach inferiorly
- splenic artery
- branch to the pancreas: Multiple branches serving the pancreas. The largest is the arteria pancreatica magna
- short gastric: upper part of greater curvature of the stomach
- left gastroepiploic: middle of greater curvature of the stomach
- posterior gastric: posterior of stomach, gastric region superior to the splenic artery
one piece arcs edit
| 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 | ||||
| Caesar Retrieval Arc* | |||||
| Dressrosa Arc | |||||
|
Arcs with * are not in the manga but are fillers in the anime. |
conan edit
| Detective Conan: The Fist of Blue Sapphire | |
|---|---|
| Japanese | 名探偵コナン: 紺青の拳 |
| Based on | Case ClosedGosho Aoyama |
| Starring | |
Production company | |
| Distributed by | Toho Company, Ltd. |
Release date |
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| Country | Japan |
| Language | Japanese |
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 edit
- Minami Takayama as Conan Edogawa[2]
- Wakana Yamazaki as Ran Mōri
- Rikiya Koyama as Kogorō Mōri
- Tohru Furuya as Rei Furuya
- Megumi Hayashibara as Ai Haibara
- Yukiko Iwai as Ayumi Yoshida
- Ikue Otani as Mitsuhiko Tsuburaya
- Wataru Takagi as Genta Kojima
- Yamaguchi kappei as Kaito Kid
References edit
External links edit
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Category:Japanese films Category:2019 films Category:2019 anime films Category:Case Closed films Category:TMS Entertainment
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