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Anterior abdominal wall

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Seemi Shah

The document describes the anatomy of the anterior abdominal wall. It is divided into nine quadrants and contains skin, superficial fascia with fatty and membranous layers, deep fascia, three muscle layers (external oblique, internal oblique, transversus abdominis), rectus abdominis muscles, pyramidalis muscle, extraperitoneal fascia, and parietal peritoneum from external to internal. Key nerves are branches of thoracic and lumbar nerves, and arteries include the superior and inferior epigastric arteries. Lymphatic drainage is to axillary nodes above the umbilicus and inguinal nodes below.

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ANTERIOR ABDOMINAL WALL
The abdomen is the region of the body that is located between the diaphragm above and the pelvic inlet below. It is divided into nine quadrants, by: Two vertical lines at the level of: ? Midclavicular point superiorly ? Midinguinal point inferiorly Two horizontal lines at the level of: ? Subcostal edges superiorly ? Right and left iliac tubercles inferiorly
Anterior abdominal wall
The structures of the abdominal wall from out side to inside. 1. Skin. 2. Superficial fascia. 3. Deep fascia 4. Muscles. 5. Extraperitoneal fascia 6. Parietal peritoneum.
SKIN Skin is loosely attached to the underlining structures except the umbilicus. The umbilicus is a scar representing the site of attachment of the umbilical cord in the fetus; it is situated in the linea alba.
SUPERFICIAL FASCIA The superficial fascia is divided into: ? Superficial fatty layer (fascia of Camper) ? Deep membranous layer (Scarpa's fascia) SUPERFICIAL FATTY LAYER (CAMPER¨S FASCIA). It¨s continuous with superficial fat over the rest of the body. In the scrotum is modified as a thin smooth muscular layer called dartos muscle.
Deep membranous layer.(Scarpa¨s fascia). ? In the midline inferiorly, the membranous layer of fascia is not attached to the pubis but forms a tubular sheath for the penis (or clitoris). ? Below in the perineum, it enters the wall of the scrotum (or labia majora). ? From there it passes to be attached on each side to the margins of the pubic arch; it is here referred to as Colles' fascia.
Anterior abdominal wall
DEEP FASCIA Is a thin layer of connective tissue covering the muscles, it lies immediately deep to the membranous layer of superficial fascia.
MUSCLES The muscles of the anterior abdominal wall consist of three broad thin sheets that are aponeurotic in front; from exterior to interior they are : ? The external oblique ? The internal oblique ? The transversus
On either side of the midline anteriorly is, in addition, a wide vertical muscle, the rectus abdominis. As the aponeuroses of the three sheets pass forward, they enclose the rectus abdominis to form the rectus sheath.
ORIGIN Lower eight ribs (5-12) INSERTION NERVE SUPPLY lower six thoracic nerves (T7-T12) iliohypogastric and ilioinguinal nerves (L1) ACTION Supports abdominal contents; compresses abdominal contents assists in flexing and rotation of trunk assists in forced expiration, micturition, defecation, parturition, and vomiting Xiphoid process linea alba pubic crest pubic tubercle iliac crest EXTERNAL OBLIQUE MUSCLE Broad, thin, muscular sheet.
There is a triangular-shaped defect in the external oblique aponeurosis that lies immediately above and medial to the pubic tubercle known as superficial inguinal ring The spermatic cord (or round ligament of the uterus) passes through this opening and carries the external spermatic fascia (or the external covering of the round ligament of the uterus) from the margins of the ring
Between the anterior superior iliac spine and the pubic tubercle, the lower border of the aponeurosis is folded backward on itself, forming the inguinal ligament .
From the medial end of the ligament, the lacunar ligament extends backward and upward to the pectineal line on the superior ramus of the pubis
ORIGIN Lumbar fascia, iliac crest, lateral two thirds of the inguinal ligament. INSERTION NERVE SUPPLY lower six thoracic nerves (T7-T12) iliohypogastric and ilioinguinal nerves (L1) ACTION Supports abdominal contents; compresses abdominal contents assists in flexing and rotation of trunk assists inforced expiration, micturition, defecation, parturition, and vomiting lower three ribs and their costal cartilages xiphoid process. linea alba. symphysis pubis. INTERNAL OBLIQUE MUSCLE The internal oblique muscle is also a broad, thin, muscular sheet that lies deep to the external oblique
Lower fibres of internal oblique are joined by similar fibers from the transversus to form the conjoint tendon . As the spermatic cord (or round ligament of the uterus) passes under the lower border of the internal oblique, it carries with it some of the muscle fibers that are called the cremaster muscle .
TRANSVERSUS MUSCLE Thin sheet of muscle that lies deep to the internal oblique ORIGIN Lower six costal cartilages Lumbar fascia, iliac crest, lateral two thirds of the inguinal ligament. INSERTION NERVE SUPPLY lower six thoracic nerves (T7-T12) iliohypogastric and ilioinguinal nerves (L1) ACTION compresses abdominal contents xiphoid process. linea alba. Symphysis pubis.
RECTUS ABDOMINIS The rectus abdominis is a long strap muscle that extends along the whole length of the anterior abdominal wall. It is broader above and lies close to the midline, being separated from its fellow by the linea alba.
ORIGIN symphysis pubis pubic crest. INSERTION NERVE SUPPLY lower six thoracic nerves (T7-T12) ACTION compresses abdominal contents; flexes vertebral column; accessory muscle of expiration fifth, sixth, and seventh costal cartilages xiphoid process RECTUS ABDOMINIS
When it contracts, its lateral margin forms a curved ridge that can be palpated and often seen and is termed the linea semilunaris, this extends from the tip of the ninth costal cartilage to the pubic tubercle. The rectus abdominis muscle is divided into distinct segments by three transverse tendinous intersections at the level of: ? xiphoid process. ? umbilicus. ? halfway between these two.
PYRAMIDALIS ORIGIN anterior surface of the pubis. INSERTION NERVE SUPPLY Twelvth thoracic nerve T12 ACTION Tenses the linea alba Linea alba
EXTRAPERITONEAL FASCIA The extraperitoneal fat is a thin layer of connective tissue that contains a variable amount of fat and lies between the fascia transversalis and the parietal peritoneum PARIETAL PERITONEUM The walls of the abdomen are lined with parietal peritoneum. This is a thin serous membrane and is continuous below with the parietal peritoneum lining the pelvis.
NERVE SUPPLY ? The nerves of the anterior abdominal wall are the anterior rami of the lower six thoracic and the first lumbar nerves. ? The thoracic nerves are the lower five intercostal nerves and the subcostal nerves ? First lumbar nerve is represented by the iliohypogastric and ilioinguinal nerves, branches of the lumbar plexus They supply the skin of the anterior abdominal wall, the muscles, and the parietal peritoneum. ? The lower six thoracic nerves pierce the posterior wall of the rectus sheath to supply the rectus muscle and the pyramidalis (T12 only).
? The oblique and transversus abdominis muscles are supplied by the lower six thoracic nerves and the iliohypogastric and ilioinguinal nerves (L1). ? The rectus muscle is supplied by the lower six thoracic nerves. ? The pyramidalis is supplied by the 12th thoracic nerve. ? Dermatomes of the abdominal wall. ? The xiphoid process: T7 ? The umbilicus: T10 ? The pubis: L1
BLOOD SUPPLY The skin near the midline is supplied by branches of the superior and the inferior epigastric arteries. ? The skin of the flanks is supplied by branches of the ? Intercostal arteries ? Lumbar arteries ? Deep circumflex iliac arteries
The superior epigastric artery, one of the terminal branches of the internal thoracic artery, enters the upper part of the rectus sheath It descends behind the rectus muscle, supplying the upper central part of the anterior abdominal wall, and anastomoses with the inferior epigastric artery. The inferior epigastric artery is a branch of the external iliac artery just above the inguinal ligament. the rectus muscle, supplying the lower central part of the anterior abdominal wall, and anastomoses with the superior epigastric artery. The deep circumflex iliac artery is a branch of the external iliac artery just above the inguinal ligament. It supplies the lower lateral part of the abdominal wall. The lower two posterior intercostal arteries, branches of the descending thoracic aorta, and the four lumbar arteries, branches of the abdominal aorta, pass forward between the muscle layers and supply the lateral part of the abdominal wall
VENOUS DRAINAGE SUPERFICIAL VEINS ? The superficial veins form a network that radiates out from the umbilicus. ? Above, the network is drained into the axillary vein via the lateral thoracic vein. ? Below, into the femoral vein via the superficial epigastric and great saphenous veins. DEEP VEINS ? The deep veins of the abdominal wall, the superior epigastric, inferior epigastric, and deep circumflex iliac veins, follow the arteries of the same name and drain into the internal thoracic and external iliac veins.
? superficial ? Lymphatics in the region above the umbilicus Drain into the axillary lymph nodes which can be palpated just beneath the lower border of the pectoralis major muscle ? Lymphatics in the region below the umbilicus Drain into the superficial inguinal nodes ? The deep lymph vessels follow the arteries and drain into the internal thoracic, external iliac, posterior mediastinal, and para-aortic (lumbar) nodes.

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Anterior abdominal wall

  • 2. The abdomen is the region of the body that is located between the diaphragm above and the pelvic inlet below. It is divided into nine quadrants, by: Two vertical lines at the level of: ? Midclavicular point superiorly ? Midinguinal point inferiorly Two horizontal lines at the level of: ? Subcostal edges superiorly ? Right and left iliac tubercles inferiorly
  • 4. The structures of the abdominal wall from out side to inside. 1. Skin. 2. Superficial fascia. 3. Deep fascia 4. Muscles. 5. Extraperitoneal fascia 6. Parietal peritoneum.
  • 5. SKIN Skin is loosely attached to the underlining structures except the umbilicus. The umbilicus is a scar representing the site of attachment of the umbilical cord in the fetus; it is situated in the linea alba.
  • 6. SUPERFICIAL FASCIA The superficial fascia is divided into: ? Superficial fatty layer (fascia of Camper) ? Deep membranous layer (Scarpa's fascia) SUPERFICIAL FATTY LAYER (CAMPER¨S FASCIA). It¨s continuous with superficial fat over the rest of the body. In the scrotum is modified as a thin smooth muscular layer called dartos muscle.
  • 7. Deep membranous layer.(Scarpa¨s fascia). ? In the midline inferiorly, the membranous layer of fascia is not attached to the pubis but forms a tubular sheath for the penis (or clitoris). ? Below in the perineum, it enters the wall of the scrotum (or labia majora). ? From there it passes to be attached on each side to the margins of the pubic arch; it is here referred to as Colles' fascia.
  • 9. DEEP FASCIA Is a thin layer of connective tissue covering the muscles, it lies immediately deep to the membranous layer of superficial fascia.
  • 10. MUSCLES The muscles of the anterior abdominal wall consist of three broad thin sheets that are aponeurotic in front; from exterior to interior they are : ? The external oblique ? The internal oblique ? The transversus
  • 11. On either side of the midline anteriorly is, in addition, a wide vertical muscle, the rectus abdominis. As the aponeuroses of the three sheets pass forward, they enclose the rectus abdominis to form the rectus sheath.
  • 12. ORIGIN Lower eight ribs (5-12) INSERTION NERVE SUPPLY lower six thoracic nerves (T7-T12) iliohypogastric and ilioinguinal nerves (L1) ACTION Supports abdominal contents; compresses abdominal contents assists in flexing and rotation of trunk assists in forced expiration, micturition, defecation, parturition, and vomiting Xiphoid process linea alba pubic crest pubic tubercle iliac crest EXTERNAL OBLIQUE MUSCLE Broad, thin, muscular sheet.
  • 13. There is a triangular-shaped defect in the external oblique aponeurosis that lies immediately above and medial to the pubic tubercle known as superficial inguinal ring The spermatic cord (or round ligament of the uterus) passes through this opening and carries the external spermatic fascia (or the external covering of the round ligament of the uterus) from the margins of the ring
  • 14. Between the anterior superior iliac spine and the pubic tubercle, the lower border of the aponeurosis is folded backward on itself, forming the inguinal ligament .
  • 15. From the medial end of the ligament, the lacunar ligament extends backward and upward to the pectineal line on the superior ramus of the pubis
  • 16. ORIGIN Lumbar fascia, iliac crest, lateral two thirds of the inguinal ligament. INSERTION NERVE SUPPLY lower six thoracic nerves (T7-T12) iliohypogastric and ilioinguinal nerves (L1) ACTION Supports abdominal contents; compresses abdominal contents assists in flexing and rotation of trunk assists inforced expiration, micturition, defecation, parturition, and vomiting lower three ribs and their costal cartilages xiphoid process. linea alba. symphysis pubis. INTERNAL OBLIQUE MUSCLE The internal oblique muscle is also a broad, thin, muscular sheet that lies deep to the external oblique
  • 17. Lower fibres of internal oblique are joined by similar fibers from the transversus to form the conjoint tendon . As the spermatic cord (or round ligament of the uterus) passes under the lower border of the internal oblique, it carries with it some of the muscle fibers that are called the cremaster muscle .
  • 18. TRANSVERSUS MUSCLE Thin sheet of muscle that lies deep to the internal oblique ORIGIN Lower six costal cartilages Lumbar fascia, iliac crest, lateral two thirds of the inguinal ligament. INSERTION NERVE SUPPLY lower six thoracic nerves (T7-T12) iliohypogastric and ilioinguinal nerves (L1) ACTION compresses abdominal contents xiphoid process. linea alba. Symphysis pubis.
  • 19. RECTUS ABDOMINIS The rectus abdominis is a long strap muscle that extends along the whole length of the anterior abdominal wall. It is broader above and lies close to the midline, being separated from its fellow by the linea alba.
  • 20. ORIGIN symphysis pubis pubic crest. INSERTION NERVE SUPPLY lower six thoracic nerves (T7-T12) ACTION compresses abdominal contents; flexes vertebral column; accessory muscle of expiration fifth, sixth, and seventh costal cartilages xiphoid process RECTUS ABDOMINIS
  • 21. When it contracts, its lateral margin forms a curved ridge that can be palpated and often seen and is termed the linea semilunaris, this extends from the tip of the ninth costal cartilage to the pubic tubercle. The rectus abdominis muscle is divided into distinct segments by three transverse tendinous intersections at the level of: ? xiphoid process. ? umbilicus. ? halfway between these two.
  • 22. PYRAMIDALIS ORIGIN anterior surface of the pubis. INSERTION NERVE SUPPLY Twelvth thoracic nerve T12 ACTION Tenses the linea alba Linea alba
  • 23. EXTRAPERITONEAL FASCIA The extraperitoneal fat is a thin layer of connective tissue that contains a variable amount of fat and lies between the fascia transversalis and the parietal peritoneum PARIETAL PERITONEUM The walls of the abdomen are lined with parietal peritoneum. This is a thin serous membrane and is continuous below with the parietal peritoneum lining the pelvis.
  • 24. NERVE SUPPLY ? The nerves of the anterior abdominal wall are the anterior rami of the lower six thoracic and the first lumbar nerves. ? The thoracic nerves are the lower five intercostal nerves and the subcostal nerves ? First lumbar nerve is represented by the iliohypogastric and ilioinguinal nerves, branches of the lumbar plexus They supply the skin of the anterior abdominal wall, the muscles, and the parietal peritoneum. ? The lower six thoracic nerves pierce the posterior wall of the rectus sheath to supply the rectus muscle and the pyramidalis (T12 only).
  • 25. ? The oblique and transversus abdominis muscles are supplied by the lower six thoracic nerves and the iliohypogastric and ilioinguinal nerves (L1). ? The rectus muscle is supplied by the lower six thoracic nerves. ? The pyramidalis is supplied by the 12th thoracic nerve. ? Dermatomes of the abdominal wall. ? The xiphoid process: T7 ? The umbilicus: T10 ? The pubis: L1
  • 26. BLOOD SUPPLY The skin near the midline is supplied by branches of the superior and the inferior epigastric arteries. ? The skin of the flanks is supplied by branches of the ? Intercostal arteries ? Lumbar arteries ? Deep circumflex iliac arteries
  • 27. The superior epigastric artery, one of the terminal branches of the internal thoracic artery, enters the upper part of the rectus sheath It descends behind the rectus muscle, supplying the upper central part of the anterior abdominal wall, and anastomoses with the inferior epigastric artery. The inferior epigastric artery is a branch of the external iliac artery just above the inguinal ligament. the rectus muscle, supplying the lower central part of the anterior abdominal wall, and anastomoses with the superior epigastric artery. The deep circumflex iliac artery is a branch of the external iliac artery just above the inguinal ligament. It supplies the lower lateral part of the abdominal wall. The lower two posterior intercostal arteries, branches of the descending thoracic aorta, and the four lumbar arteries, branches of the abdominal aorta, pass forward between the muscle layers and supply the lateral part of the abdominal wall
  • 28. VENOUS DRAINAGE SUPERFICIAL VEINS ? The superficial veins form a network that radiates out from the umbilicus. ? Above, the network is drained into the axillary vein via the lateral thoracic vein. ? Below, into the femoral vein via the superficial epigastric and great saphenous veins. DEEP VEINS ? The deep veins of the abdominal wall, the superior epigastric, inferior epigastric, and deep circumflex iliac veins, follow the arteries of the same name and drain into the internal thoracic and external iliac veins.
  • 29. ? superficial ? Lymphatics in the region above the umbilicus Drain into the axillary lymph nodes which can be palpated just beneath the lower border of the pectoralis major muscle ? Lymphatics in the region below the umbilicus Drain into the superficial inguinal nodes ? The deep lymph vessels follow the arteries and drain into the internal thoracic, external iliac, posterior mediastinal, and para-aortic (lumbar) nodes.