Abdominal Wall

and Cavity

Irwan
Indri Seta Septadina
Content: Surface Anatomy ►
Muscular Wall ►
Review vascularisation and
innervation ►
Inguinal region ►
Peritoneum and Peritoneal Cavity ►
Bony Landmarks
around Abdomen
 xiphoid process X
 costal cartilages (ribs 7-10)
 tips of ribs 11 and 12
 vertebrae L1-L5
 iliac crests IC
 tubercle of the crest TC
 anterior superior iliac spine ASIS
 anterior inferior iliac spine AIIS
 inguinal ligament IL
 pubic tubercle PT
 pubic crest PC
 pubic symphysis PS
Surface Anatomy
1. Transpyloric plane
Garis transversal antara
incissura jugularis dan
symphisis pubis.
Setinggi cartilago costae IX
(anterior) dan bagian bawah
vertebrae lumbalis I
(posterior)
 Surface Anatomy
(2) Transtubercular
plane
Garis transversal
setinggi tuberculum
iliaca (anterior)
dan vertebrae
lumbalis V (posterior)
Surface Anatomy
4 quadrants of abdomen:
• upper left quadrant
ULQ
• lower left quadrant LLQ
• upper right quadrant
URQ
• lower right quadrant
LRQ
9 regions of abdomen
Abdominal Regions
Right and left hypochondriac:
Contain liver, gaster, pancreas
Epigastric:
Contains: liver, stomach,
pancreas
Right and left lateral (lumbar):
Right contains ascending colon.
Left contains descending colon.
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.
 Abdominal Wall from surface
Rectus
abdominis
Linea alba
Linea arcuata
Linea
semilunaris
Iliac crest
Lig.inguinale
Abdominal Wall from surface
Linea Alba
 Berada di garis tengah
 Terbentang dari proc. Xyphoideus sampai
ke symphisi pubis
 Memisahkan m. rectus abdominus
 Gabungan dari = aponeuroses of transversus
abdominus, internal oblique, and external
oblique muscle
Abdominal Wall from surface
 Linea
semilunaris:
Sepanjang lateral dari M. rectus abdominis.

 Linea arcuata
bagian bawah dari lamina posterior
terletak di antara umbilicus dan pubis
Abdominal Wall from surface
Inguinal ligament:
Batas bawah dari apponeurosis M. obliquus
externus yg menebal

Mulai dari anterior superior iliac spine sampai ke

pubic tubercle.
 Abdominal wall divided into:

1. Anteriolateral abdominal wall

➢ Anterior wall
➢ Right lateral wall (Right Flank)
➢ Left lateral wall (Left Flank)

2. Posterior abdominal wall

1. Anteriolateral Abdominal Wall
This extended from the thoracic cage to the
pelvis and bounded :
Superiorly
7th through 10th costal cartilages and and
xiphoid process
Inferiorly
Inguinal ligaments, iliac crest and the pelvic
bones.

The wall consists of skin, subcutaneous tissues

(fat), muscles, deep fascia and parietal
peritoneum.
LAYERS OF ABDOMINAL WALL
 The layers of the
abdominal wall vary,
depending on where it is
you are looking. For
instance, it is somewhat
different along the lateral
sides of the abdomen than
it is at the anterior side. It is
also somewhat different at
its lower regions.
LATERAL
 skin
 superficial
fascia
 deep fascia
 muscle
 subserous
fascia
 peritoneum
ANTERIOR
WALL
 superficial fascia
 deep fascia (in
this case a
thickened area
of deep fascia
called the linea
alba)
 subserous fascia
 peritoneum
Wall inferior (umbilicus)
1. Lapisan lemak superficial yg akan
berlanjut dengan lapisan tubuh lain
(Camper's fascia)
2. Lapisan membranosa yg akan berlanjut
ke bawah menuju perineum utk melapisi
penis dan scrotum (Scarpa's fascia)
Superficial perineal fascia = Colle’s
1. Anteriolateral Abdominal Wall
Muscles→Fig. 4 & Fig. 5
➢3 Flat Muscles with strong sheet like
aponeuroses
▪External Oblique (“hands-in-pocket”)
▪Internal Oblique (fibers perpendicular to
external)
▪Transversus Abdominis (wraps around)
➢2 Vertical Muscles
▪Rectus Abdominis - vertical midline
▪Pyramidalis --
Pyramidalis arises from the pubic crest and
inserts into the linea alba. Its function is to
External obliquus muscle


External oblique is the most superficial of

the three flat muscles.
 It arises from the middle and lower 5th –
12th ribs and passes inferomedially to
insert into the linea alba, pubic tubercle
and the iliac crest.
Internal Oblique muscle

Internal oblique has fibres arising from the
inguinal ligament and iliac crest that fan
out from the anterior superior iliac spine to
insert into the linea alba, conjoint tendon
and the lower 3 ribs. It is innervated by the
thoracoabdominal and lumbar nerves.
Transversus abdominis

Transversalis is the deepest of the flat
abdominal muscles that arises from the
costal cartilages, iliac crest and inguinal
ligament. The fibres run transversomedially
to insert into the linea alba, pubic crest
and conjoint tendon
Rectus Abdominis

Rectus abdominus arises from the pubic
symphysis and pubic crest, and inserts into
the xiphoid process and costal cartilages.
Pyramidalis muscle

Pyramidalis arises from the pubic crest
and inserts into the linea alba. Its function
is to tense the linea alba.
Rectus sheath:
Encloses rectus abdominis.
Formed by fusion of fascia of other three
layers of abdominal muscles.
Anterior and posterior laminae. (layers)
 Anteriolateral Abdominal Wall
Functions

▪ Melindungi viscera abdomen dari trauma

▪ Menekan isi dari cavum abdomen
▪ Menjaga tekanan intraabdomen
▪ Menggerakkan batang tubuh dan memberi
bentuk tubuh
Posterior Abdominal Wall
• Lumbar vertebrae and IV discs.
• Muscles
• Psoas, quadratus lumborum, iliacus
• Lumbar plexus
• Ventral rami of lumbar spinal nerves.
• Fascia
• Diaphragm
• Contributing to the superior part of the
posterior wall
• Fat, nerves, vessels (IVC, aorta) and
lymph nodes.
Posterior Abdominal Wall
Between the parietal peritoneum and the muscles
(retroperitoneal space) →Fig. 6
• The psoas fascia or psoas sheath.

• The quadratus lumborum fascia.

• The thoracolumbar fascia.

Posterior Abdominal Wall
Muscles
Three paired muscles

 Psoas major

 Iliacus

 Quadratus Lumborum
Applied Anatomy
Posterior abdominal pain:

 Ilio-psoas
has relationship to kidney, ureters,
caecum, appendix, colon, pancreas….etc.

 When
any of these structures is diseased
movement of the ilio psoas usually causes pain.

 When intra abdominal inflammation is

suspected the Ilio Psoas Test performed by
moving ileopsoas muscle and if positive if it
causes pain.
Psoas Abscess
Hematogenous spread
to the lumbar
vertebrae may form
an abscess which
may spread from the
vertebrae into the
Psoas sheath
producing a Psoas
abscess.
 To be continue
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.-→ Fig. 2
Cutaneous Nerves
 Ventral rami of T7 through T11: →Fig. 3
= thoracoabdominal nerves.
T7 to dermatome over xiphoid process.
T10 at level of umbilicus.
 Subcostal nerve
 Ventral ramus of L1: → Fig. 2

Gives rise to:

iliohypogastric nerve.
ilioinguinal nerve.
Posterior Abdominal Wall
Nerves
Somatic nerves
The sub costal nerves
The lumbar nerves
The lumbar plexus of nerves branches are:
(a) The obturator nerves (L2 – L4)
(b) The femoral nerves (L2 – through L4)
(c) Ilio inguinal and ilio hypogastric nerves
(L1)
(d) Gentio femoral (L1 – L2)
(e) Lateral femoral cutaneous nerves (L2 –
L3)
Posterior Abdominal Wall
Nerves
Autonomic nerves

▪ One cranial nerve (the vagus)

▪ Several different splanchnic
nerves that deliver presynaptic
sympathizer and parasympathetic
fibers to the plexus and
sympathetic ganglia.
Posterior Abdominal Wall
Nerves
Sympathetic Nerves
Abdomino-pelvic splanchic N. from the thoracic and
abdominal sympathetic trunks
Prevertebral sympathetic ganglia
Periarterial plexus
Abdominal autonomic plexus
Celiac plexus
Superior mensentric plexus
Inferior mensentric plexus.
Celiac plexus
Superior hypogastric plexus
Inferior hypogastric plexus
Posterior Abdominal Wall
Blood Vessels
 Aorta and its branches

 IVC and its tributeries

Applied Anatomy
Some important skin areas involved in referred visceral pain.
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.
Inguinal Canal

Its boundaries are:

1) Anterior wall – aponeurosis of external
oblique
2) Posterior wall – transversalis fascia
3) Roof – internal oblique and transverse
abdominus
4) Floor – inguinal ligament (superior
surface)
Inguinal Region
The two openings of inguinal canal are :
1. Superficial inguinal ring:

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.
Inguinal Region
2. Deep inguinal ring:
Opening of the evagination of the
transversalis fascia.

Lies above inguinal ligament midway

between anterior iliac spine and
pubic tubercle.
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.
Inguinal Region
Inguinal Canal:
* Female:
Round ligament.
Ilioinguinal nerve.
Lymph vessels.
Inguinal Region
Inguinal Canal:
* Female:
Round ligament.
Ilioinguinal nerve.
Lymph vessels.
Hesselbach’s Triangle

Hesselbach’s (Inguinal) Triangle is an

important structure as it is the site for direct
hernias. The triangle has the following
borders:
1) Medial border of rectus abdominus
2) Inguinal ligament (inferiorly)
3) Inferior epigastric vessels
Abdominal Hernia Orifices
Hernia is defined as the protrusion of an organ
through it’s containing wall. It can occur because of

Normal weakness found in everyone and related to

anatomy of the area e.g., place where vessel or
viscus enters or leaves the abdomen, muscles fail to
overlap or there is only scar tissue (Umbilicus)

Abnormal weakness caused by congenital

abnormality or acquired as result of trauma or
diseases.

High intraabdominal pressure from

Coughing / Abdominal distention
Common Sites →Fig. 7
1. Inguinal Hernia
2. Umbilical Hernia
3. Femoral Hernia
4. Incisional Hernia

Less common Hernia

▪ EpigastricHernia
▪ Recurrent Hernia
 PERITONEUM LIAT DI DIKTAT
PERITONEUM
 Peritoneum merupakan membrana
serosa tipis yang melapisi dinding cavitas
abdominalis dan pelvis, dan
membungkus viscera abdominalis dan
pelvis.
 dianggap seperti balon membungkus
organ yang ditekan dari luar ke dalam
balon.
 Peritoneum parietale melapisi dinding cavitas
abdominalis dan pelvis, dan peritoneum
viscerale menutupi organ
 Cavitas peritonealis merupakan ruang
potensial antara peritoneum parietale dan
viscerale.
 Pada pria cavitas peritonealis merupakan
rongga tertutup, tetapi pada wanita
mempunyai hubungan dengan bagian luar
melalui tuba uterina, uterus dan vagina.
 Cavitasperitonealis dapat dibagi menjadi
dua bagian, yaitu greater sac dan lesser
sac (bursa omentalis).
 Greater sac merupakan kompartemen
utama dari cavitas peritonealis dan
membentang dari diaphragma ke
bawah ke dalam pelvis. Lesser sac (bursa
omentalis) lebih kecil dan terletak di
belakang gaster.
 Peritoneum menyekresi sedikit cairan
serosa, yang melumasi permukaan
peritoneum dan memudahkan gerakan
bebas di antara organ viscera.
Intraperitonealis dan
extraperitonealis
 Istilah intraperitonealis dan extraperitonealis
digunakan untuk menggambarkan hubungan
organ dengan bungkus peritoneumnya. Sebuah
organ disebut intraperitonealis jika ia dibungkus
hampir seluruhnya ( lebih dari 2/3 bagian ) oleh
peritoneum viscerale. Contoh organ
intraperitonealis adalah gaster, jejunum, ileum,
dan lien. Organ retroperitonalis adalah organ
yang terletak di belakang dan hanya sebagian
ditutupi oleh peritoneum viscerale. Contoh organ
retroperitonealis adalah pancreas, colon
ascendens dan descendens.
 Peritoneal Lining of the Abdominal
Walls
The walls of the abdomen are lined
with parietal peritoneum.→Fig. 9
This is a thin serous membrane
consisting of a layer of
mesothelium resting on
connective tissue. It is continuous
below with the parietal
peritoneum lining the pelvis.
 Peritoneal Lining of the Abdominal
Walls
The peritoneum can be regarded as a balloon.
The parietal peritoneum lines the walls of the
abdominal and pelvic cavities, and the visceral
peritoneum covers the organs.
The potential space between the parietal and
visceral layers is called the peritoneal cavity.
In males, this is a closed cavity, but in females, there is
communication with the exterior through the
uterine tubes, the uterus, and the vagina.
 Peritoneal Lining of the Abdominal
Walls
Between the parietal peritoneum and the fascial
lining of the abdominal and pelvic walls is a layer of
connective tissue called the extraperitoneal tissue;
in the area of the kidneys this tissue contains a large
amount of fat, which supports the kidneys
 Peritoneal Lining of the Abdominal
Walls
Between the parietal peritoneum and the fascial
lining of the abdominal and pelvic walls is a layer of
connective tissue called the extraperitoneal tissue;
in the area of the kidneys this tissue contains a large
amount of fat, which supports the kidneys
 Peritoneal Lining of the Abdominal
Walls
The peritoneal cavity is the largest cavity in the
body and is divided into two parts:
the greater sac and
the lesser sac.
The greater and lesser sacs are in free
communication with one another through an
oval window called the opening of the lesser
sac, or the epiploic foramen.
The peritoneum secretes a small amount of
serous fluid, the peritoneal fluid, which
lubricates the surfaces of the peritoneum and
allows free movement between the viscera.
 Peritoneal Lining of the Abdominal
Walls
Intraperitoneal and Retroperitoneal Relationships.
Intraperitoneal when it is almost totally covered with
visceral peritoneum.
Retroperitoneal organs lie behind the peritoneum
and are only partially covered with visceral
peritoneum.
Pancreas
The ascending and descending parts of the colon
 Peritoneal Lining of the Abdominal
Walls
Peritoneal Ligaments
Peritoneal ligaments are two-layered folds of
peritoneum that connect solid viscera to the
abdominal walls.
The liver, for example, is connected to the diaphragm
by the falciform ligament, the coronary ligament,
and the right and left triangular ligaments.
 Peritoneal Lining of the Abdominal
Walls
Omenta are two-layered folds of peritoneum that
connect the stomach to another viscus.
The greater omentum connects the greater curvature
of the stomach to the transverse colon.
The lesser omentum suspends the lesser curvature of
the stomach from the fissure of the ligamentum
venosum and the porta hepatis on the
undersurface of the liver
 Peritoneal Lining of the Abdominal
Walls
Mesenteries are two-layered folds of peritoneum
connecting parts of the intestines to the posterior
abdominal wall, for example, the mesentery of the
small intestine, the transverse mesocolon, and the
sigmoid mesocolon.
The peritoneal ligaments, omenta, and mesenteries
permit blood, lymph vessels, and nerves to reach
the viscera.
Peritoneal Pouches, Recesses, Spaces, and
Gutters.
The lesser sac lies behind the stomach and the lesser
omentum.
The opening into the lesser sac (epiploic foramen).
Duodenal Recesses
Close to the duodenojejunal junction, there may be four
small pocketlike pouches of peritoneum called the
superior duodenal, inferior duodenal, paraduodenal,
and retroduodenal recesses
Peritoneal Pouches, Recesses, Spaces, and
Gutters.
Cecal Recesses
Folds of peritoneum close to the
cecum produce three peritoneal
recesses called the superior
ileocecal, the inferior ileocecal, and
the retrocecal recesses.
Intersigmoid Recess
The intersigmoid recess is situated at
the apex of the inverted, V-shaped
root of the sigmoid mesocolon.
 Peritoneal Pouches, Recesses, Spaces, and
Gutters.
 Subphrenic Spaces
 The right and left anterior subphrenic spaces
lie between the diaphragm and the liver, on
each side of the falciform ligament.
 The right posterior subphrenic space lies
between the right lobe of the liver, the right
kidney, and the right colic flexure.
 The right extraperitoneal space lies between
the layers of the coronary ligament and is
therefore situated between the liver and the
diaphragm
Peritoneal Pouches, Recesses, Spaces, and
Gutters.
Paracolic Gutters
 The paracolic gutters lie on the lateral and medial
sides of the ascending and descending colons.
The subphrenic spaces and the paracolic gutters are
clinically important because they may be sites for
the collection and movement of infected
peritoneal fluid
Peritoneum
Nerve Supply of the Peritoneum
Parietal peritoneum is sensitive to
pain, temperature, touch, and
pressure.
Visceral peritoneum is sensitive
only to stretch and tearing and is
not sensitive to touch, pressure, or
temperature.
Peritoneum
Nerve Supply of the Peritoneum
Parietal peritoneum is sensitive to
pain, temperature, touch, and
pressure.
Visceral peritoneum is sensitive
only to stretch and tearing and is
not sensitive to touch, pressure, or
temperature.
 Functions of the Peritoneum
▪ Peritoneal fluid ensures that the mobile viscera
glide easily on one another.
▪ The peritoneal coverings of the intestine tend to
stick together in the presence of infection. In this
manner, many of the intraperitoneal infections
are sealed off and remain localized. greater
omentum is often referred abdominal
policeman.
 Functions of the Peritoneum
 The peritoneal folds play an important part in
suspending the various organs within the
peritoneal cavity and serve as a means of
conveying the blood vessels, lymphatics, and
nerves to these organs.
 Large amounts of fat are stored in the peritoneal
ligaments and mesenteries, and especially large
amounts can be found in the greater omentum.
Applied Anatomy
Some important skin areas involved in referred visceral pain.
 Created by:
dr. Irwan
dr. Indri Seta Septadina, M.Kes.
Bagian Anatomi
FK Unsri
Palembang
Fig. 1 Regio abdomen
Fig. 2 Nerves
Fig. 3 Thoracoabdominal nerve
Fig. 4 Anterolateral abdominal muscles
Fig. 5 Anterolateral abdominal muscles
Fig. 6 posterior abdominal muscles
Fig. 7 Site of hernia
Fig. 8
Fig. 9 Sagittal section of the abdomen