ABDOMEN IN

GENERAL
Ma. Cristina Elma-Zulueta, MD, MSPH, FPOGS

ANYTHING WRONG?

GENERAL OBJECTIVE
Understand the gross anatomy of the
anterior and posterior abdominal wall
including the inguinal region

SPECIFIC OBJECTIVE
ANTERIOR ABDOMINAL WALL
Identify anatomical landmarks(skeleton,
cadaver, living subject) used in the study
of the surface anatomy of the abdomen.
Describe how abdomen is divided into
quadrants and regions and the clinical
application of such.
Name and define extent of
layers/musculature from outwards to
inwards.

SPECIFIC OBJECTIVE
ANTERIOR ABDOMINAL WALL
Describe the formation of the rectus sheath
at various levels.
Name the contents of the rectus sheath.
Describe the innervation.
Describe the internal aspect.
Describe the disposition of the peritoneum.
Name the corresponding layers of
musculature in the scrotum.

SPECIFIC OBJECTIVE
INGUINAL REGION
Define the deep fascia in the inguinal
region.
State the extent and boundaries of the
inguinal canal.
Locate the superficial and deep inguinal
ring.
Differentiate the types of inguinal hernia.
Describe other forms of hernia in the
abdomen.

SPECIFIC OBJECTIVE
POSTERIOR ABDOMINAL WALL
Name the musculature of the posterior
abdominal wall.

THE ABDOMEN
Part of the trunk bet.
the thorax and pelvis
Enclose & protect its
contents
Anterior and posterior
abdominal wall
Abdominal viscera
Peritoneum
Peritoneal cavity

THE ABDOMINAL CAVITY

The major part of the abdominopelvic
cavity.
Located between the diaphragm and
the pelvic inlet.
Separated from the thoracic cavity by
the thoracic diaphragm.
Continuous inferiorly with the pelvic
cavity.
Enclosed anterolaterally by multilayered, musculoaponeurotic,
abdominal walls.
The location of most digestive organs,
parts of the urogenital system (kidneys
and most of the ureters), and the
spleen.

ABDOMINAL PLANES
Used to locate
abdominal organs,
pains or pathologies
Subcostal,
transtubercular,
transpyloric,
transumbilical
interspinous

ABDOMINAL PLANES
Transpyloric plane
extrapolated midway between the
superior borders of the manubrium
of the sternum and the pubic
symphysis (typically the L1
vertebral level)
Landmark for:
- the fundus of the gallbladder
- neck of the pancreas
- Origin of the superior mesenteric
artery (SMA)
- Origin of portal vein,
- root of the transverse mesocolon
- duodenojejunal junction
- hila of the kidneys

SUBDIVISIONS

LAYERS OF ANTEROLATERAL
ABDOMINAL WALL
Skin
Superficial fascia
Campers & Scarpas
Deep (investing) fascia
Muscles external and
internal oblique, transversus
and rectus abdominis,
pyramidalis
Transversalis fascia (part of
endoabdl fascia)
Extra/preperitoneal fat
Parietal peritoneum

INTERNAL ASPECT
Median umbilical fold: fr.
The apex of the bladder,
covers median umbilical
ligament
Medial umbilical
folds:lateral to median
umbilical fold, cover
medial umbilical
ligaments
Lateral umbilical
folds:lateral to medial
umbilical folds, cover the
inferior epigastric vessels

PANNICULI

PERITONEAL FOSSAE
Supravesical: between median
and the medial umbilical folds
Medial inguinal: bet. Medial
and lateral umbilical folds, also
called inguinal
triangles(Hesselbach
triangles), potential sites of
direct hernia
Lateral inguinal fossae: lateral
to the lateral umbilical fold,
include the deep inguinal ring,
site of indirect hernia

SUBCUTANEOUS TISSUE &

FASCIAL LAYER
Variable amount of fat
Males susceptible to
fat accumulation
Superficial fatty layerCampers fascia
Deep membranous
layer(Scarpas fascia)

MUSCLES OF ANT. ABDOMINAL

WALL
Form a strong expandable
support for the anterolateral
abdominal wall.
Protect the abdominal viscera
from injury.
Compress the abdominal
contents to maintain or
increase the intra-abdominal
pressure and, in so doing,
oppose the diaphragm
(increased intra-abdominal
pressure facilitates expulsion).
Move the trunk and help
maintain posture.

MUSCLES OF ANT. ABDOMINAL

WALL
1.
2.
3.

1.
2.

Three flat muscles

External oblique
Internal oblique
Transversus
abdominis
Two vertical muscles
Rectus abdominis
Pyramidalis

EXTERNAL OBLIQUE
Largest and most
superficial
Does not originate
posteriorly fr the
thoracolumbar fascia
Fleshy fibers run
inferomedially

INTERNAL OBLIQUE &

TRANSVERSUS ABDOMINIS
Internal Oblique
Thin muscular sheet
Fleshy fibers run
superomedially
Transversus Abdominis
Innermost
Run more or less
transversally
Orientation is ideal for
compressing abdominal
contents
Neurovascular plane?

LAYERS OF ANT. ABDOMINAL WALL:

SCROTAL LAYER/COVERING

RECTUS ABDOMINIS
Long, broad and strap
like muscle
Principal vertical
muscle
3X as wide superiorly
than inferiorly
Broad and thin
superiorly but narrow
and thick inferiorly

TENDINOUS INTERSECTIONS
Produced by the
attachment of the
rectus muscle to the
ant layer of rectus
sheath
When tensed in
muscular people,
stretches of muscle
bulge outward

PYRAMIDALIS
Small triangular muscle
Absent in 20% of people
Lies anterior to the
inferior part of rectus
abdominis
Ends in the linea alba
Tenses the linea alba
Used as a landmark for
accurate median
umbilical incision

RECTUS SHEATH
Strong and
incomplete fibrous
compartment of the
rectus abdominis and
pyramidalis ms.

FORMATION OF RECTUS
SHEATH

ARCUATE LINE
Demarcates the
transition between the
aponeurotic posterior
wall of the sheath
covering the superior
three quarters of the
rectus and the
transversalis fascia
covering the inferior
quarter.

CONTENTS OF THE RECTUS

SHEATH
rectus abdominis
pyramidalis
anterior rami of T7T12 spinal nerves
superior & inferior
epigastric vessels
lymph vessels

LANDMARKS

INNERVATION: ANTERIOR
ABDOMINAL WALL
Thoracoabdominal nerves:
the distal, abdominal parts of
the anterior rami of the inferior
six thoracic spinal nerves
Lateral (thoracic) cutaneous
branches: of the thoracic
spinal nerves T7,T9 or T10.
Subcostal nerve: the large
anterior ramus of spinal nerve
T12.
Iliohypogastric and
ilioinguinal nerves: terminal
branches of the anterior ramus
of spinal nerve L1.

INNERVATION: ANTERIOR
ABDOMINAL WALL
T7-T9 supply the skin
superior to the umbilicus.
T10 innervates the skin
around the umbilicus.
T11, plus the cutaneous
branches of the subcostal
(T12), iliohypogastric, and
ilioinguinal (L1), supply
the skin inferior to the
umbilicus.

BLOOD SUPPLY
Superior epigastric artery
- direct continuation of the
internal thoracic artery
- enters the rectus sheath
superiorly through its posterior
layer
- supplies the superior part of
the rectus abdominis and
anastomoses with the inferior
epigastric artery approximately
in the umbilical region

BLOOD SUPPLY
Inferior epigastric artery
arises from the external iliac
artery just superior to the
inguinal ligament
runs superiorly in the
transversalis fascia to enter
the rectus sheath below the
arcuate line
enters the lower rectus
abdominis and anastomoses
with the superior epigastric
artery.

VENOUS DRAINAGE

VENOUS DRAINAGE
-

Superficial lymphatic vessels

accompany the subcutaneous
veins
superior to the transumbilical
plane drain mainly to the axillary
lymph nodes few to the
parasternal lymph nodes.
inferior to the transumbilical plane
drain to the superficial inguinal
lymph nodes.
Deep lymphatic vessels
accompany the deep veins of the
abdominal wall and drain to the
external iliac, common iliac, and
right and left lumbar (caval and
aortic) lymph nodes.

INGUINAL REGION
Extends between the
ASIS & pubic tubercle
Anatomically impt: region
where structures exit and
enter the abdominal
cavity
Clinically impt: pathways
of exit and entrance are
potential sites of
herniation

INGUINAL LIGAMENT
Extends fr. the ASIS to the
pubic tubercle
Thickened inferolateral most
portions of the external oblique
aponeurosis
Lacunar ligament(Gimbernat):
deeper fibers that attach
posteriorly to the superior
pubic ramus
Pectineal ligament(Cooper):
lateral fibers that continue to
run along the pecten pubis

INGUINAL CANAL
An oblique passage
approximately 4 cm long
directed inferomedially
through the inferior part of
the anterolateral
abdominal wall
Main occupant: spermatic
cord(males)/round
ligament of the
uterus(females)
Openings: superficial &
deep inguinal ring

BOUNDARIES OF THE INGUINAL

CANAL
Ant. Wall: external oblique
aponeurosis & ms. Fibers of
internal oblique
Posterior wall: transversalis
fascia
Roof: transversalis fascia,
internal oblique and
transversus abdominis, medial
crus of ext. oblique
Floor:iliotibial tract, inguinal
ligament, lacunar ligament

SUPERFICIAL AND DEEP

INGUINAL RING
Deep inguinal ring
- Entrance to inguinal
canal
- Superior to middle of
inguinal ligament
- Lateral to inferior
epigastric artery

SUPERFICIAL AND DEEP

INGUINAL RING
Superficial inguinal
ring
- Exit by which the
spermatic cord or
round ligament
emerges fr. The
inguinal canal
- A diagonal split
- Lateral and medial
crus

INGUINAL HERNIA: DIRECT &

INDIRECT

OTHER FORMS OF ABDOMINAL

HERNIA

PERITONEUM
Parietal peritoneum
Visceral peritoneum
Intraperitoneal vs
extraperitoneal/retro
peritoneal organs
Peritoneal cavity

PERITONEAL
FORMATIONS(Mesentery)
is a double layer of peritoneum
that occurs as a result of the
invagination of the peritoneum
by an organ and constitutes a
continuity of the visceral and
parietal peritoneum
provides a means for
neurovascular communication
between the organ and the body
wall
connects an intraperitoneal
organ to the body wall usually
the posterior abdominal wall
(e.g., the mesentery of the small
intestine)

PERITONEAL
FORMATIONS(Omentum)
a double-layered
extension or fold of
peritoneum that passes
from the stomach and
proximal part of the
duodenum to adjacent
organs in the abdominal
cavity
Greater omentum VS
Lesser omentum

PERITONEAL
FORMATIONS(Ligaments)

POSTERIOR ABDOMINAL WALL

Five lumbar vertebrae and
associated IV discs (centrally).
Posterior abdominal wall muscles,
including the psoas, quadratus
lumborum, iliacus, transverse
abdominal, and oblique muscles
(laterally).
Diaphragm, which contributes to the
superior part of the posterior wall.
Fascia, including the thoracolumbar
fascia.
Lumbar plexus, composed of the
anterior rami of lumbar spinal
nerves.
Fat, nerves, vessels (e.g., aorta and
IVC), and lymph nodes.

THANK YOU!!!!!!