ANTERIOR ABDOMINAL WALL

1. Skin
- Umbilicus – site of attachment of the umbilical cord, at the linea alba (midline)
- Nerve supply:
o Anterior: anterior Rami, lower 6 thoracic(lower 5 intercostal + subcostal nerve) and 1st lumbar
(iliohypogastric and ilioinguinal nerves)
- Dermatomes:
o T7: epigastrium at the xiphoid process
o T10: Umbilicus
o L1: inguinal ligament and symphysis pubis
- Blood Supply:
o Midline: Sup+Inferior epigastric artery
o Flanks: intercostal, lumbar, deep circumflex iliac artery
o Inguinal region: superficial epigastric, superficial circumflex iliac, superficial external pudendal artery
(branch of femoral art)
- Venous drainage:
o Lateral thoracic  axillary vein (upper)
o Superficial epigastric vein + great saphenous  femoral vein (lower)
2. Superficial Fascia
- Camper’s fascia – superficial fatty layer, fat accumulation
- Scarpa’s fascia – deep membranous layer
o Continuous with the superficial fascia of the back
o Forms the tubular sheath for the penis/clitoris
o Enters the perineum as the Colles’ fascia
o Dartos muscle: thin layer of smooth muscle in the scrotum
3. Deep Fascia
- Covers the muscles
- Deep to the membranous layer of superficial fascia
4. Muscles
- External oblique
o O: lower 8 ribs
o I: xiphoid process, linea alba, pubic crest and tubercle, iliac creast
o N: lower 6 thoracic and first lumbar (iliohypogastric and ilioinguinal)
o Down, forward, medial
o Superficial inguinal ring: triangular shaped defect where spermatic cord/round ligament of uterus
pass through
o Inguinal ligament: folding back of aponeurosis between the ASIS and pubis tubercle
o Lacunar ligament: medial continuation of the inguinal ligament, forms the femoral ring
o Pectineal ligament: continuous with the lacunar ligament, thickening of periosteum
o Fascia lata: deep fascia of the thigh continuous with the inferior border of the inguinal ligament
- Internal oblique
o Conjoint tendon: joined with the tendons of the transversus abdominis, attached medially to the
linea alba with a lateral free border
o Cremaster muscle: @ the level of the entry of spermatic cord/round ligament of uterus, under the
lower border of internal oblique
o O: lumbar fascia, iliac crest, lateral 2/3 of inguinal ligament
o I: lower 3 ribs, xiphoid process, linea alba, symphysis pubis
o N: SAME AS EXTERNAL AND TRANSVERSE
o Up, Forward, Medial
- Transversus abdominis
o Horizontal
o O: lateral 1/3 of inguinal ligament, lower 6 costal cartilage, lumbar fascia
 o I: xiphoid process, linea alba, symphysis pubis
o N: SAME AS EXTERNAL AND INTERNAL
- Rectus Abdominis (ABS)
o O: symphysis pubis and pubic crest
o I: 5,6,7th costal cartilage and xiphoid process
o N: lower 6 thoracic nerves
o Tendinous intersections: constrictions at the level of xiphoid process, umbilicus, and one in
between, makes the 6-pack
o Linea semilunaris: lateral margin palpated when the muscle contracts
- Pyramidalis
o O: anterior surface of pubis
o I: linea alba
o N: 12th thoracic nerve
o OFTEN ABSENT
- Rectus sheath
o Long fibrous sheath that encloses the rectus abdominis and pyramidalis
o Contains the anterior rami of the lower 6 thoracic nerves, superior and inferior epigastric vessels,
and lymph vessels
5. Blood Supply
- Superior Epigastric Artery
o Terminal branch of internal thoracic
o Upper part of rectus sheath
o Descends behind the rectus muscle
o Supplies the upper part of the anterior wall
- Inferior Epigastric Artery
o Branch of internal iliac artery
o Above the inguinal ligament
o Supplies the lower central part of the anterior wall
o ANASTOMOSES W/ THE SUP EPIGASTRIC
- Deep Circumflex Iliac Artery
o Branch of External Iliac artery
o Supplies the lower lateral part of anterior wall
o Runs upward and medial to ASIS
6. Venous Drainage
- Lateral thoracic vein
o Drains to the axillary vein
o Upper part of anterior wall
- Superficial epigastric and great saphenous vein
o Drains to the femoral vein
o Lower part of anterior wall
- Deep veins:
o Follows the corresponding artery
o Drains to the corresponding vein
o Posterior intercostal vein: drains to the azygos vein
o Lumbar vein: drains to the inferior vena cava
7. Inguinal Canal
- Allows the passage of testes/round ligament to the perineum
- Superficial inguinal ring: Crura – attachment of the external spermatic fascia
- Walls of the inguinal canal:
o Anterior: external oblique aponeurosis
o Posterior: conjoint tendon (medially), fascia transversalis (laterally)
o Roof: lowest fibers of internal oblique and transversus abdominis
 o Floor: lower edge of inguinal ligament and lacunar ligament (medially)

POSTERIOR ABDOMINAL WALL

- Formed by the five lumbar vertebrae and its discs
- Lateral border: 12th ribs
- Floor: upper part of bony pelvis / ilium
Muscles of the Posterior Wall:
1. Psoas Major
- O: T12, L1-L5
- I: Lesser Trochanter
- N: lumbar plexus
- Medial arcuate ligament – thickened sheath of the psoas derived from lumbar fascia
2. Iliacus
- O: iliac fossa
- I: lesser trochanter
- N: lumbar plexus
3. Quadratus lumborum
- O: iliolumbar ligament, iliac crest, and lower lumbar vertebrae
- I: 12th rib
- N: lumbar plexus
- Lateral arcuate ligament - above
- Iliolumbar ligament - below

FASCIA OF THE ABDOMINAL WALLS:

- Present in:
o Diaphragm (diaphragmatic)
o Transverse abdominis (transversalis)
o Psoas
o Quadratus
o iliacus