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ANTERIOR ABDOMINAL WALL

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Formed by fusion of fascia of other three layers of abdominal muscles ... liver, stomach, pancreas Right and left lateral (lumbar): Right contains ascending colon. – PowerPoint PPT presentation

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Title: ANTERIOR ABDOMINAL WALL


1
ANTERIOR ABDOMINAL WALL
2
Borders of the Abdomen
  • Superior
  • Costal cartilages 7-12.
  • Xiphoid process
  • Level of 10th cartilage L3
  • Inferior
  • Pubic bone and iliac crest
  • Level of L4.
  • Umbilicus
  • Level of IV disc L3-4

3
Lines of the Anterior Abdominal Wall
  • Linea alba
  • Located along the midline.
  • connective tissue raphe.
  • Linea semilunaris
  • Along each lateral border of rectus abdominis.
  • Linea transversa
  • Tendinous bands of rectus abdominis.

4
Abdominal Quadrants
  • Formed by two intersecting lines
  • Intersect at umbilicus.
  • Quadrants
  • Upper left.
  • Upper right.
  • Lower left.
  • Lower right.

5
Abdominal Regions
  • Divided into 9 regions by two pairs of planes
  • Vertical Planes
  • Left and right lateral planes
  • midclavicular planes
  • Horizontal Planes
  • Transpyloric plane
  • Midway between jugular notch and pubic
    symphysis (between xiphoid and umbilicus).
  • Intertubercular plane
  • Through tubercles of iliac crests.

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7
Abdominal Regions
  • Right and left hypochondriac
  • Contain liver
  • Epigastric
  • Contains liver, stomach, pancreas
  • Right and left lateral (lumbar)
  • Right contains ascending colon.
  • Left contains descending colon.

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9
Abdominal Regions
  • Umbilical
  • Contains small intestine and transverse colon.
  • Right and left inguinal
  • Right contains ileocecal junction and appendix.
  • Left contains sigmoid colon.
  • Hypogastric
  • Contains small intestine, urinary bladder
    (full), pregnant uterus.

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12
Cutaneous Nerves
  • Derived from ventral rami of T7 through L1.
  • Pass inferiorly and medially in plane between
    transverse and internal oblique muscles.
  • Motor innervation
  • To abdominal muscles.
  • Cutaneous innervation
  • Lateral cutaneous branches.
  • Anterior cutaneous branches
  • Penetrate rectus sheath.

13
Cutaneous Nerves
  • Ventral rami of T7 through T11
  • thoracoabdominal nerves.
  • T7 to dermatome over xiphoid process.
  • T10 at level of umbilicus.
  • Subcostal nerve
  • Ventral ramus of L1
  • Gives rise to
  • iliohypogastric nerve.
  • ilioinguinal nerve.

14
Fascia
  • Superficial
  • Campers fascia
  • Continuous with fascia over thorax and thigh.
  • Fatty layer.

15
Fascia
  • Deep Superficial
  • Scarpas fascia
  • Membranous layer.
  • Continues into perineum as
  • Superficial perineal fascia Colles fascia.
  • Deep
  • Thin layer covering abdominal muscles.

16
Arterial Supply Above Umbilicus
  • Posterior intercostal arteries 10-11.
  • Subcostal artery.
  • Lumbar arteries 1-4.
  • Musculophrenic arteries.
  • Superior epigastric arteries.
  • Inferior epigastric arteries.

17
Arterial Supply Below Umbilicus
  • Superficial epigastric arteries.
  • Superficial circumflex iliac arteries.
  • Superficial external pudendal arteries.

18
Venous Drainage
  • Superficial veins are paired with arteries.
  • Above the umbilicus
  • Drain into the azygos venous system.
  • Below the umbilicus
  • Drain into the femoral system (via great
    saphenous).

19
Lymphatic Drainage
  • Above the umbilicus
  • Drain into the axillary and sternal nodes.
  • Below the umbilicus
  • Drain into the superficial inguinal nodes.

20
Anterior Abdominal Wall Arteries
  • Superior epigastric
  • Terminal branch of internal thoracic.
  • Descends in rectus sheath posterior to muscle.
  • Anastomoses with inferior epigastric.

21
Anterior Abdominal Wall Arteries
  • Inferior epigastric
  • Arises from external iliac artery.
  • Enters rectus sheath at arcuate line.
  • Branches
  • Cremasteric artery.
  • Pubic branch.

22
Anterior Abdominal Wall Arteries
  • Deep circumflex iliac artery
  • Branch of external iliac.
  • Superficial epigastric artery
  • Arises from femoral artery.
  • Superficial circumflex iliac artery
  • Arises from femoral artery.
  • Superficial external pudendal artery
  • Arises from femoral artery.

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Anterior Abdominal Wall Veins
  • External iliac vein
  • Receives from epigastric and deep circumflex
    iliac veins.
  • Femoral vein
  • Receives superficial circumflex iliac vein,
  • Superficial epigastric vein,
  • Superficial external pudendal vein.
  • Superior epigastric vein
  • Drains to brachiocephalic vein.

25
Muscle Layers
  • General Characteristics
  • Three large flat sheets connecting rib cage to
    hip bone.
  • Muscular posteriorly and laterally.
  • Aponeurotic anteriorly and medially.

26
Muscle Layers
  • Include
  • External oblique.
  • Internal oblique.
  • Transversus abdominus.
  • Rectus abdominus.

27
Muscle Layers Innervations
  • Lower intercostal spinal nerve.
  • Subcostal spinal nerve.
  • First lumbar spinal nerve.

28
Linea Alba
  • Median raphe
  • Extends from xiphoid to pubic symphysis.
  • Lies between paired rectus abdominus muscles.
  • fusion of aponeuroses of transversus abdominus,
    internal oblique, and external oblique.

29
Surface Features
  • Linea semilunaris
  • Along lateral margin of rectus abdominus.
  • Crosses costal margin near tip of 9th costal
    cartilage.
  • Arcuate line
  • Lower free edge of posterior lamina.
  • Lies midway between umbilicus and pubis.

30
Inguinal Ligament
  • Inguinal ligament
  • Thickened lower border of external oblique
    aponeurosis.
  • From anterior superior iliac spine to pubic
    tubercle.

31
Muscle Layers
  • Rectus sheath
  • Encloses rectus abdominus.
  • Formed by fusion of fascia of other three
    layers of abdominal muscles.
  • Anterior and posterior laminae. (layers)
  • Arcuate line is the lower free edge of the
    posterior lamina
  • Lies midway between umbilicus and pubis.

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Inguinal Region
  • Inguinal Canal
  • Oblique passage through lower abdominal wall.
  • Site of potential weakness.
  • Transmits
  • Spermatic cord in males.
  • Round ligament of uterus in females.
  • Extends between superficial and deep inguinal
    rings.

34
Inguinal Region
  • Inguinal Canal
  • Superficial inguinal ring
  • Triangular defect in the aponeurosis of the
    external oblique muscle layer.
  • Superficial opening of the inguinal canal.
  • Lies above and lateral to pubic tubercle.
  • Larger in males
  • Transmits spermatic cord in males.
  • Transmits round ligament of uterus in
    females.

35
Inguinal Region
  • Inguinal Canal
  • Deep inguinal ring
  • Opening of the evagination of the
    transversalis fascia.
  • Lies above inguinal ligament midway between
    anterior iliac spine and pubic tubercle.

36
Inguinal Region
  • Inguinal Canal
  • Male spermatic cord
  • Vas deferens.
  • Ilioinguinal nerve.
  • Genital branch of genitofemoral nerve.
  • Testicular arteries and veins.
  • Pampiniform plexus
  • Lymph vessels.
  • Cremaster muscle.

37
Inguinal Region
  • Inguinal Canal
  • Female
  • Round ligament.
  • Ilioinguinal nerve.
  • Lymph vessels.

38
Inguinal Region
  • Hernias
  • Direct inguinal
  • Occurs in older men (rarely women).
  • Due to weakness in abdominal wall behind or
    lateral to superficial inguinal ring.
  • Passes directly through abdominal wall to
    superficial inguinal ring.
  • Does not extend into scrotum.
  • Has sac formed by peritoneum.

39
Inguinal Region
  • Hernias
  • Indirect inguinal
  • Traverses deep and superficial inguinal rings
    and inguinal canal.
  • Lies within coverings of spermatic cord.
  • May descend into scrotum.
  • More common than a direct inguinal hernia.
  • More common in boys and young men.
  • May be congenital.

40
Inguinal Region
  • Hernias
  • Femoral
  • Occurs within femoral canal.
  • More common in females.
  • Umbilical
  • Occurs at site where umbilical cord
    penetrates between muscles and fascia of
    anterior abdominal wall.

41
Folds on Posterior Surface (of anterior wall)
  • Median umbilical fold
  • Midline peritoneal fold on inner abdominal wall
    above bladder.
  • Contains median umbilical ligament
  • Remnant of embryonic urachus.
  • Medial umbilical fold
  • Paired peritoneal folds on either side of
    median fold.
  • Contain medial umbilical ligaments
  • Remnants of umbilical arteries.

42
Folds on Posterior Surface (of anterior wall)
  • Lateral umbilical fold
  • Paired peritoneal folds lateral to medial
    folds.
  • Contain inferior epigastric vessels
  • From deep inguinal ring to arcuate line.

43
Folds on Posterior Surface (of anterior wall)
  • Falciform ligament
  • Double layer of peritoneum.
  • Attaches liver to anterior abdominal wall and
    to inferior surface of diaphragm.
  • Contains ligamentum teres hepatis (round
    ligament of liver)
  • Remnant of left umbilical vein.
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