ABDOMINAL

WALL
Wahyuni Atmodjo

03/03/15

Objectives
To define boundaries, quadrant and

regions of abdomen
To describe the abdominal wall
To define layers of anterior abdominal wall
To define organization of the muscles
To describe innervation and vascularisation

of the abdominal wall

Wahyuni Atmodjo

03/03/15

 Superior
Diaphragm

Inferior

Pelvic inlet

Anterior and

lateral

Muscles

Posterior
Lumbal vertebra
Muscles
03/03/15

Wahyuni Atmodjo

Layers of abdominal
wall
Skin

Fat / Campers fasc

Scarpas fasc
M. OAE
M. OAI
M. Transversus
abdominis
Transversal Fascia
Peritoneum parietale
Wahyuni Atmodjo

03/03/15

Muscles of anterior abdominal

wall
EOM:

4th 12th riblinea alba

IOM:
Inquinale lig, crista iliaca, fasc. Thoracolumbal
9th-12th ribs, linea alba, os pubis, linea pectinea
Transversus abdominis
Inquinale lig, crista iliaca, fasc. Thoracolumbal
linea alba, os pubis, linea pectinea
Rectus abdominis
Os pubis, interpubic lig cartilago 5th-7th ribs,
proc. xiphoideus
Pyramidalis
Os pubis, ant pubic lig linea alba
Wahyuni Atmodjo

03/03/15

Function
Compress abdominal contents
Protect abdominal injury
Increase intra-abdominal

pressure
Support respiration
Flexion the trunk
Rotate the trunk

Wahyuni Atmodjo

03/03/15

Muscles of post abdominal

wall
Iliopsoas mayor
Psoas head : Proc. Transversus VT12- L4

trochanter
minor femur
Iliac head : illiac fossa trochanter minor femur

Diaphragm
Costal margin VL1-L4 central tendon

Quadratus lumborum
Iliolumbar lig, crista iliaca posterior 12th rib,

proc transversus VL1-4

Wahyuni Atmodjo

03/03/15

Action
M. quadratus lumborum:
Abduction coll vert
Fixation 12th rib during inspiration
Depression 12th rib during forced

expiration

M. iliopsoas:
Flexion coll vert, the thigh when the leg is

not planted, flexion hip joint when the leg

is planted
Wahyuni Atmodjo

03/03/15

 Iliopsoas mayor
Diaphragm
Quadratus lumborum

External Obligus Abdominis

Internal Obligus Abdominis
Transversus abdominis
Rectus abdominis
Pyramidalis

03/03/15

Wahyuni Atmodjo

Blood supply of abdominal

wall
Epigastric arteries
A. epigastrica superior (thoracica interna)
A. epigastrica inferior (iliaca externa)
Intercostal arteries (aorta thoracalis)
Deep circumflex iliac artery (iliaca

externa)
Superficial epigastric artery (femoral)

Wahyuni Atmodjo

03/03/15

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Blood supply
a. epigastrica sup
a. epigastrica inf
a. epigastrica
superf
a. circumflexa
iliaca profundus
a. circumflexa
iliaca superfc
03/03/15

Wahyuni Atmodjo

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Veins
Deep drainage
Paralel to the arterial supply

Superficial drainage
Superior and inferior epigastric

veins
Axillary vein
Femoral vein
Hepatic portal vein
Wahyuni Atmodjo

03/03/15

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Nerves of abdominal
wall

Rami ventralis N. spinalis

Nn. Intercostalis inferior (T7 - T12)
Lateral cutaneous branch
Anterior cutaneous branch

Plexus lumbalis (L1-L2)

Anterior division
N. iliohypogastricus
N. ilioinquinalis
N. genitofemoralis

Posterior division
Lateral femoral cutaneous
Wahyuni Atmodjo

03/03/15

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DIGESTIVE
SYSTEM
Wahyuni Atmodjo

03/03/15

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DIGESTIVE SYSTEM
Mouth
Pharynx
Esophagus
Stomach
Small intestine : duodenum, jejenum, ileum
Cecum and appendix
Large intestine: colon ascendens, transversus,

descendens
Sigmoid, Rectum, Anal canal, Anus
Accessory organ: Liver, Pancreas, Spleen
Wahyuni Atmodjo

03/03/15

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Localized the part of the

abdomen
Describe the location of pain
Indicating the location of viscera
General localisation (quadrant)
Specific localisation (regio)

Wahyuni Atmodjo

03/03/15

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Quadrant
RUQ (Right upper quadrant)
Right lobe of liver, gallbladder, pylorus, duodenum,

pancreas, right supraren, right kidney

LUQ (Left upper quadrant)

Left lobe of liver, spleen, stomach, jejenum and ileum,

pancreas, left supraren, left colic, transverse colon,

descending colon

RLQ (Right lower quadrant)

Cecum, appendix, ileum, ascending colon, r-ovary, r-

uterine tube, r-ureter, uterus, urinary bladder, rspermatic cord

LLQ (Left lower quadrant)

Sigmoid colon, descending colon, l-ovary, l-uterine tube,

l-ureter, l-spermatic cord, urinary bladder, uterine

Wahyuni Atmodjo

03/03/15

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Plane

Vertical : Median plane

Horizontal:
Transumbilical plane

Quadrant
Upper left
Upper right
Lower left
Lower right

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Regions
For specific localisation of a finding,
abdomen is devided into 9 regions

Epigastric/epigastrium
RH
: right hypochondriaca
LH
: left hypochondriaca
Umbilical
RL
: right lumbar
LL
: left lumbar
Hypogastric/hypogastrium
RI
: right inquinal
LI
: left inquinal
Wahyuni Atmodjo

03/03/15

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Plane of the
Regions

Vertical
Right
midclavicular
Left midclavicular
Horizontal:
Subcostal
Transtubercular

Wahyuni Atmodjo

03/03/15

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 Length 25 cm,

diameter 2 cm
Behind the trachea
Passes through
diaphragm at VT X
Continue as cardia of
the stomach
Has cardiac sphincter
Function: transport of
food

03/03/15

Wahyuni Atmodjo

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 Position: left hypochondriaca - epigastric

03/03/15

Wahyuni Atmodjo

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Structure of gaster

greater curvature
lesser curvature,
cardiac sphincter,
fundus,
corpus,
anthrum pyloricum
pyloric sphincter
rugae, gastric sulci,
gastric glands
Wahyuni Atmodjo

03/03/15

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 Length: 25 cm
Secondary retroperitoneal
C shape

Division

Superior (L1),
Descending (L2-L3),
Transverse (L3)
Ascending (L3-L2)

03/03/15

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 Location: umbilical

Location : hypogastric

region
Length : 2.4 m
diameter : 2-4cm
Thicker wall
Vasa recta tall
Arcades fewer
Plica circularis tall
Peyer patches few

03/03/15

region
Length: 3.6 m
diameter: 2-3cm
Thiner wall
Vasa recta short
Arcades many
Plica circularis short
Peyer patches many

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26

03/03/15

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Atmodjo

 Blind pouch
Location:

below ileocecal junction

right iliac fossa, above inq
lig.
Ileocecal junction
Ileal papilla:projection at

the point of entry

Ileocecal valve:border
ileocecal ostium

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03/03/15

Wahyuni
Atmodjo

Retrocecal
fossa: 65%
Iliac fossa:
31%

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Length : 8-9 cm
Position: 2-3 cm
Intraperitoneal,
supported by mesoappendix
03/03/15

Right
paracolic
recess: 2%
Sup iliocolic
fossa: 1%
Inf iliocolicWahyuni
fossa: 1% Atmodjo

Blood supply of
esophagus
Arteries

A.
A.
A.
A.

thyreoidea inferior
esophageal
bronchialis
gastrica sinistra

Veins
Azygos and hemiazygos vein
Left gastric vein portal vein
Esophageal venous
Wahyuni Atmodjo

03/03/15

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 Arteries

Right gastric a : pylorus

Gastroduodenal a : pylorus, corpus
Left gastric a : fundus, cardi, corpus
Short gastric a: fundus, corpus
Gastroepiploic a: left corpus

Wahyuni Atmodjo

03/03/15

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VASCULATURE
Superior mesenteric a.
Inferior

Pancreaticoduodenal
Right gastric a.
Gastroduodenal a.
Supraduodenal a.
Retroduodenal a.
Superior
pancreaticoduodena
l a.

Wahyuni Atmodjo

03/03/15

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Innervations of GI
tract
Parasymphatetic
Vagus
Celiac plexus

Symphatetic
Greater splanchnic nn.
Celiac ganglia
Celiac plexus

Afferent
Sensory
Referred pain
Wahyuni Atmodjo

03/03/15

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Innervation
Parasymphatis: left and right vagus

esophageal plexus
Symphatis
: thoracic splanchnic n
Afferent
Sensory thoracic and greater
splanchnic nerves

Referred pain epigastria region

Wahyuni Atmodjo

03/03/15

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Clinical problems
Esophagitis
gastric contents reflux into esophagus

heartburn

Esophageal varices
portal hypertension

Hiatus hernia
herniation of stomach through

esophageal hiatus at diaphragm

Wahyuni Atmodjo

03/03/15

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Clinical problems
Gastritis: excessive HCl
Peptic ulcer
Location : Duodenum
Complication: bleeding, peritonitis,

hematemesis
Treatment: antacid, selective vagotomy

Malignant metastases

Wahyuni Atmodjo

03/03/15

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Abdominal pain
Gastritis
Epigastric pain

Appendicitis
A generalized pain epigastric region

umbilicus Right Lumbar quadrant

Peritoneitis
Inflammation of the peritoneum
Severe pain everywhere

Wahyuni Atmodjo

03/03/15

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