ABDOMINAL

ABDOMINAL WALL &

INGUINAL
INGUINAL REGION
1
ABDOMINAL WALL
BOUNDARIES, QUADRANTS
REGIONS
 Abdominal Wall
Boundaries:

• Superior: Diaphragm
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• Inferior: Pelvic Brim

• Anterior: Lower part of the thoracic cage and the abdominal

muscles (rectus abdominis, external & internal oblique, and
transversus abdominis)

• Posterior: Five lumbar vertebrae (L1-L5)

 Abdominal Wall
4 Abdominal quadrants

• Vertical and horizontal line intersecting at the umbilicus

(L3/L4)

• Upper and lower right, Upper and lower left quadrants

 Abdominal Wall
• Nine Regions

• Vertical lines of division:

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right and left mid-
clavicular lines

• Horizontal lines of division:

• Subcostal plane -
upper plane, passes
through the inferior
 Abdominal Wall
• Horizontal lines of
division:

• Transpyloric plane -
Sometimes used,
halfway between
the jugular notch
and pubic bone (9th
costal cartilage; L1)

• Structures passing
the transpyloric
 Right
Epigastric
Hypochondriac Left
Stomach, Liver,
Liver, Hypochondriac
Pancreas,
Gallbladder, Spleen, Colon,
Duodenum,
Right kidney, Left Kidney
Kidney
Small intestine

Left Lumbar
Right Lumbar Umbilical
Descending
Ascending Jejunum, Ileum,
colon, Small
colon, Liver, Stomach,
intestine, Left
Right kidney Kidneys
kidney

Right Inguinal
Hypogastric Left Inguinal
Appendix,
Urinary bladder, Descending and
Cecum,
Ureters, Sigmoid sigmoid colon,
Ascending
colon, Rectum Ovary
colon, Ovary
2
ANTERIOR ABDOMINAL W
NEUROVASCULAR SUPPLY
LYMPHATIC VENOUS
DRAINAGE
Skin
•Loosely attached to underlying structures except at t
umbilicus
•Umbilicus
•scar representing site of attachment of umbilical
cord in the fetus
•situated in the linea alba
Nerve Supply
•Cutaneous nerve supply – anterior
rami of lower 6 thoracic nerves and
1st lumber nerve
•Thoracic nerves – lower five
intercostal & subcostal nerves
•1st Lumbar nerve – represented
by iliohypogastric & ilioinguinal
nerves
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Nerve Supply
•T7 Dermatome – loacated
in the epigastrium over the
xiphoid process
•T10 Dermatome – includes
umbilicus & L1
Arterial Blood Supply
•Skin near Midline – branches
of superior & inferior
epigastric arteries
•Skin of Flanks – circumflex
iliac arteries (intercostal,
lumbar, deep branches)
Arterial Blood Supply
•Skin in the Inguinal Region
•superficial epigastric
•Superficial circumflex iliac
•Superficial external
pudendal arteries
•Branches of femoral artery
Venous Drainage
•ABOVE: Axillary vein via
Lateral thoracic vein

•BELOW: Femoral vein via

Superficial epigastric vein
& Great saphenous vein
Superficial Fascia
•Fascia of Camper – superficial fatty layer
•Scrotum –represented as a thin layer of smooth
muscle: Dartos muscle
Superficial Fascia
•Scarpa’s Fascia – deep membranous layer
•Thin and fades out laterally and above (becomes
continuous with the superficial fascia of the back an
thorax respectively)
•Inferior – passes in front of the thigh; fuses with the
deep fascia below the inguinal ligament
Superficial Fascia
•Scarpa’s Fascia – deep membranous layer
•In midline inferiorly – not attached to pubis; forms a
tubular sheath for the penis or clitoris
•Colle’s fascia – attached on each side to the pubic ar
margins; below the perineum entering scrotum of la
majora wall
Lymphatic Drainage
Superficial Lymph Vessels
•Above the umbilicus – drains upward to the anterior
axillary (pectoral) group of nodes
•Below the umbilicus – drains downward and laterall
to the superficial inguinal nodes
Lymphatic Drainage
Deep Lymph Vessels
•Follow the arteries; drain into the internal thoracic,
external iliac, posterior mediastinal, & para-aortic
(lumbar) nodes
3
MUSCLES OF THE ANTERI
ABDOMINAL WALL
 MUSCLES OF THE ABDOMINAL WALL
Origin Insertion Innervation Action

EXTERNAL Lower 8 ribs Xiphoid process - Supports

OBLIQUE Linea alba abdominal contents
Pubic crest - Compresses
Pubic tubercle abdominal contents
Iliac crest - Assists in the
flexing and rotation
INTERNAL Lumbar fascia Lower 3 ribs and of trunk
OBLIQUE Iliac crest costal cartilages Lower 6 thoracic - Assists in forced
Lateral 2/3 of Xiphoid process nerves, expiration,
the inguinal Linea alba Iliohypogastric micturition,
ligament Symphysis pubis and ilioinguinal defecation,
nerves (L1) parturition, and
vomiting

TRANSVERSUS Lower 6 costal Xiphoid process Compresses

cartilages Linea alba abdominal contents
Lumbar fascia Symphysis pubis
Iliac crest
Lateral third of
inguinal
ligament
 RECTUS Symphysis 5th, 6th, 7th Lower 6 thoracic - Compresses
ABDOMINIS pubis costal cartilages nerves abdominal contents
Pubic crest Xiphoid process - Flexes vertebral
column
- Accessory muscle
of expiration

PYRAMIDILIS Anterior surface Linea alba 12th thoracic Tenses the linea alba
of pubis nerve
4
RECTUS SHEATH
Rectus Sheath

• Long fibrous sheath enclosing

the rectus abdominis and
pyrimidalis
• Contains anterior rami of lower
6 thoracic nerves and the
superior and inferior epigastric
vessels and lymph vessels
• Considered in 3 levels:
a. Above the costal margin
• Anterior - External oblique
aponeuroses
• Posterior – thoracic wall (5th – 7th
costal cartilages)
b. Between costal margin and level
of the ASIS
• Anterior – External and internal
oblique aponeuroses
• Posterior – Internal oblique and
Transversus aponeuroses
c. Between the ASIS and the pubis
5
INCISIONS:
MIDLINE, PARARECTUS,
ROCKY DAVIS
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Midline Incision
• Layers of abdominal wall traversed
• Skin
• Fascia (Camper’s and Scarpa’s)
• Linea alba
• Fascia transversalis
• Extraperitoneal fat
• Parietal peritoneum
Pararectus Incision
• Layers of abdominal wall traversed
• Skin
• Fascia (Camper’s and Scarpa’s)
• Rectus Sheath (AP)
• Fascia transversalis
• Extraperitoneal fat
• Parietal peritoneum
Rocky Davis Incision
• Layers of abdominal wall traversed
• Skin
• Fascia (Camper’s and Scarpa’s)
• External oblique
• Internal oblique
• Transversus abdominus
• Transversalis fascia
• Extraperitoneal fat
• Parietal peritoneum
6
INGUINAL CANAL
 INGUINAL CANAL
- Oblique passage through the lower part of anterior abdominal wall
Males: allows structures to pass to and from the testis to abdomen
Females: allows round ligament of uterus to pass from the uterus to labium m
- Canal is about 1.5 inches long in adult
- Extends from deep inguinal ring, a hole in fascia transversalis
- Extends downward and medially to superficial inguinal ring, a hole in th
aponeurosis of external oblique muscle
- Lies parallel to and above the inguinal ligament
- Deep ring moves laterally with age
- Also transmits ilioinguinal nerve
 INGUINAL CANAL (Walls)

Anterior: external oblique aponeurosis

○ Strongest where it lies opposite the weakest part of posterior wall: the de
inguinal ring
Posterior: conjoint tendon medially, fascia transversalis laterally
○ Strongest where it lies opposite the weakest part of anterior wall: the sup
inguinal ring
Roof/ Superior: internal oblique and transversus abdominus muscles
Floor/ Inferior: lower edge of inguinal ligament and lacunar ligament
DEEP INGUINAL RING

Oval opening in fascia transversalis, lies about 0.5 inch above inguinal
ligament midway between anterior superior iliac spine and symphysis pu
Medially to it are inferior epigastric vessels
Margins of the ring give attachment to internal spermatic fascia/ interna
covering of round ligament of uterus
SUPERFICIAL INGUINAL RING

Triangular-shaped defect in aponeurosis of external oblique

Lies above and medial to pubic tubercle
Margins of the ring give attachment to external spermatic fascia
 Clinical Significance

Inguinal canal is site of potential weakness in both sexes

- Canal is oblique passage with the weakest areas lying some distance apa
- Anterior wall is reinforced by fibers of internal oblique in front of deep r
- Posterior wall is reinforced by strong conjoint tendon behind superficial
- During coughing and straining, lowest fibers of internal oblique and tran
contract, flattening out arched roof so it’s lowered
 Clinical Significance

- When great straining efforts are necessary, person assumes squatting pos
- Flexed hip joints
- Anterior surfaces of thigh are brought up against anterior abdominal wal
- This way, lower part of anterior abdominal wall is protected by thighs
7
SPERMATIC CORD
What is the spermatic cord?
• Collection of structures that pass through the inguinal canal
• Landmarks:
• Beginning– deep inquinal canal lateral to the inferior epigastric artery
• Ends – at the testis
Structures of the spermatic cord
• Vas Deferens (Ductus Deferens)
• Testicular Artery
• Testicular Veins
• Lymph Vessels
• Autonomic nerves
• Processus Vaginalis
• Genital Branch of the Genitofermoral nerve
Vas deferens
• Muscular cordlike duct
• Transports spermatozoa from epididymis to urethra
• Palpated between finger and thumb in the upper part of scrotum
Testicular artery and veins

Artery Vein
• Branch of the abdominal aorta • Pampaniform plexus – leaves
• level of the 2nd lumbar vertebra posterior border of testis
• Traverses inguinal canal • At level of deep inguinal ring
• Structures it supplies: single testicular vein is forme
• Testis • Drains into:
• epididymis • Left side – left renal vein
• Right side - IVC
Lymph Vessels
• Ascends through the inguinal canal
• Pass over to posterior abdominal wall
• Reaches lumbar (para-aortic) lymph nodes
• On the aortic side
• Level of 1st lumbar vertebra
Autonomic Nerves
• Sympathetic fibers that run with the testicular artery
• Originate from renal/aortic sympathetic plexuses
• Afferent accompany efferent
Processus Vaginalis
• Fibrous thread in the anterior part of the spermatic cord
• Extends between abdominal peritoneum and tunica vaginalis
• May not be detectable
Genital branch of the genitofemoral nerve
• Supplies the cremaster muscle
Coverings of the spermatic cord and their
derivations
Covering Derived from
Internal Spermatic Fascia Fascia Transversalis
Cremasteric Fascia Internal Oblique Aponeurosis
External Spermatic Fascia External Oblique Aponeurosis
8
INGUINAL TRIANGLE
Inguinal triangle/ Hasselbach triangle
• Contains depression
referred to as the
medial inguinal fossa,
through which direct
inguinal hernias
protrude through the
abdominal wall.
 Boundaries:

– Medial: linea semilunaris

– Superolateral: inferior
epigastric vessels
– Inferior: inguinal ligament
END