Abdominal wall

Learning outcomes Describe the extent of the abdominal wall, its divisions and important surface land marks
Discuss the arrangement of the different layers of the abdominal wall Apply the anatomical knowledge in some clinical situations

abdominal wall anterolateral & posterior

Anterolateral abdominal wall

Extent From costal margin to inguinal line One flank to other

Anterior superior iliac spine

Pubic tubercle

Anterolateral abdominal wall

Quadrants (9)

Right & left hypochondrium

Right & left lumbar regions Right & left iliac fosse

Epigastrium
Umbilical region Suprapubic region

Anterolateral abdominal wall

Organs related to regions

Right hypochondrium
Right lobe of liver & gall gall bladder Left hypochondrium Spleen & funds of stomach

Anterolateral abdominal wall

Organs related to regions

Right lumbar region

Right kidney & ascending colon Left lumbar region Left kidney & descending colon

Anterolateral abdominal wall

Organs related to regions Right iliac fossa
Caecum, appendix, right
ovary & right fallopian tube Left iliac fossa Pelvic colon, left ovary & left fallopian tube

Anterolateral abdominal wall

Organs related to regions

Epigastric region
left lobe of liver & stomach

Umbilical region
Coils of small intestine Suprpubic region Urinary bladder

Surface Anatomy

Murphys point Mc Burnys point

Linea alba
Linea semilunars

Surface Anatomy

Renal angle

Anterior abdominal wall Layers

1. Skin
2. Superficial fascia 3. Muscle layer

4. Transvesalis fascia
5. Extraperitoneal fat

6. Perietal peritoneum

Superficail fascia below the umbilicus

Two layers
Superficial fatty layer Deep membranous layer

Muscle layer
Single muscle at the centre
Rectus abdominis Laterally three muscles External oblique

Internal oblique
Transversus abdominis

External oblique muscle

Origin 5th -12 ribs

Fibers pass downwards and medially

Insertion linea alba, pubic tubercle & iliac crest

External oblique M.
Infolded free edge extending from the pubic tubercle to anterior superior iliac spine

Inguinal ligament

External oblique M.
From the medial end of inguinal ligament few fibers extend to the pectineal line

Lacunar ligament

External oblique M.
Superior & lateral to the pubic tubercle aponeurotic fibers separate thus forming a triangular gap

Superficial inguinal ring

Internal oblique muscle

Origin lumbar fascia, iliac crest & lateral 2/3 of inguinal ligament Fibers pass upwards & medially

Insertion 10 -12th ribs, linea alba & pectineal line

Transversus abdominal muscle Origin 7-12 costal cartilages, lumbar fascia, Iliac crest & lateral of inguinal ligament
Fibers pass transversely to midline

Insertion linea alba & pectineal line

Rectus abdominis Origin pubic symphysis & pubic crest Fibers run vertically from below upwards

Insertion xiphoid process & 5th-7th costal

cartilages

Enclosed by the
rectus sheath

Rectus sheath
Two layers Anterior rectus sheath

Posterior rectus sheath

Midway between umbilicus & pubic symphysis

Single layer Anterior rectus sheath Thus posterior rectus sheath has a free margin arcuate line

Rectus sheath formed by the decussating

aponeurotic fibers of the ext. oblique, int. oblique & transversus abdominis muscles

Rectus sheath
Anterior rectus sheath is anchored to the rectus muscle at constant sites

Tendinous intersections

No attachment of the posterior rectus sheath to the rectus abdominis muscle

Transversalis fascia
Thin layer of fascia beneath the transversus abdominis muscle.

It crosses the mid line ( not attached to linea alba)

Extraperitoneal fascia
Fascia between the transversalis fascia and peritoneum

Contains varying amount of fat.

Peritoneum Lies deep to the extraperitoneal fascia

Blood supply of the anterior Abdominal wall A good anastomoses exists

Subclavian artery

Intercostal arteries

Externa iliac artery

Lymph drainage

Venous drainage

Axillary nodes

Axillary vein

Superficial inguinal nodes

Long saphenous vein

Nerve supply of the anterior abdominal wall

Skin & muscles are supplied by the anterior rami of T7 to T12 & L1 spinal nerves

Surgical incisions
Median incision quick access. Takes more time to heal. Scar is weak Gridiron incision (apendicectomy) Suprpubic incision- In bladder/obstetric surgery

Surgical incisions
Paramedian incision Takes time to access Healing is quick Forms a strong scar Subcostal in cholecystectomy

Posterior abdominal wall

Bones & muscles of the posterior abdominal wall 11th & 12th ribs Five lumbar vertebrae iliac fossa of the ilium

Four muscles fill this bony framework

Psoas major & iliacus Quadratus lumborum Diaphragm

Psoas muscle from lumbar vertebrae to lesser trochanter of the femur

Covered with psoas fascia Psoas abscess can appear below the groin

Psoas major

Iliacus muscle from iliac fossa to lesser trochanter of the femur

Runs with the psoas major muscle Covered with thick fascia - iliac fascia

iliacus

Quadratus lumborum from iliac crest to lumbar vertebrae & 12th rib Covered by lumbar fascia Quadratus lumborum

Diaphragam most posterior fibers arising from the crura & arcuate ligaments forms the upper part of the posterior abdominal wall

Structures related to posterior abdominal wall Lumbar plexus is formed within the psoas major muscle. Its branches emerge from both sides and from the front of the muscle

 Kidneys, ureters & adrenal glands Abdominal aorta & inferior vena cava

Duodenum & pancreas

Ascending & descending colon Peritoneum lies in front of all the above structures Retroperitoneal structures