ANTERIOR ABDOMINAL

WALL

GUIDED BY-DR. BISHRITA SWAIN(LECTURER ,

DEPARTMENT OF SHARIRA RACHANA(ANATOMY)
PRESENTED BY-MISS SONALI SWAIN(1ST YEAR BAMS
STUDENT 2019-20)
 REGIONS AND QUADRANTS

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
 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.
The skin of the anterior abdominal wall is capable of undergoing enormous stretching as seen in
pregnancy ; with accumulation of fat , called obesity or of fluid called ascites , and with growth
of large intra-abdominal tumours . Undue stretching may result in the formation of whitish
streaks in the skin of the lower part of the anterior abdominal wall ;these are known as lineae
albicantes.
 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.
 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 abdominis
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.
EXTERNAL OBLIQUE MUSCLE
 EXTERNAL OBLIQUE MUSCLE
BROAD, THIN, MUSCULAR SHEET.

ORIGIN
INSERTION
NERVE SUPPLY
Xiphoid process
linea alba ACTION
Lower eight ribs lower six
pubic crest
(5-12) thoracic nerves
pubic tubercle Supports abdominal contents;
iliac crest (T7-T12) compresses abdominal contents
iliohypogastric assists in flexing and rotation
and ilioinguinal of trunk
nerves (L1) assists in forced expiration,
micturition, defecation,
parturition, and vomiting
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
INTERNAL OBLIQUE MUSCLE
 INTERNAL OBLIQUE MUSCLE
The internal oblique muscle is also a broad, thin, muscular sheet that lies deep to the
external oblique

ORIGIN
Lumbar fascia, INSERTION NERVE SUPPLY
iliac crest,
lower three ribs ACTION
lateral two and their costal lower six
thirds of the cartilages thoracic nerves Supports abdominal contents;
inguinal xiphoid process. (T6-T12) compresses abdominal contents
ligament. linea alba. iliohypogastric assists in flexing and rotation
symphysis pubis. and ilioinguinal of trunk
nerves (L1) assists inforced expiration,
micturition, defecation,
parturition, and vomiting
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 ABDOMINIS
 TRANSVERSUS MUSCLE
Thin sheet of muscle that lies deep to the internal
oblique.

ORIGIN
Lower six 7-7- INSERTION
NERVE SUPPLY
12 costal xiphoid process,
cartilages ACTION
linea alba,
Lumbar fascia, Symphysis lower six
compresses abdominal
iliac crest, lateral pubis. thoracic nerves
contents
two thirds of the (T6-T12)
inguinal iliohypogastric
ligament. and ilioinguinal
nerves (L1)
RECTUS ABDOMINIS
 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.
 RECTUS ABDOMINIS

ORIGIN
INSERTION
NERVE SUPPLY
symphysis
pubis fifth, sixth, ACTION
pubic and seventh lower six
crest. costal thoracic compresses abdominal
cartilages and nerves (T6- contents; flexes vertebral
xiphoid T12) column; accessory muscle
process of expiration
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
INSERTION
anterior NERVE SUPPLY
surface of the Linea ACTION
pubis. alba Twelvth thoracic
nerve Tenses the linea
T12 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 , which supply the lower part of anterior abdominal wall.
 The thoracic nerves 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 is supplied by 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.
 INGUINAL HERNIA

Indirect Inguinal hernia: piece of organ passes through deep ing. ring- courses
• * in inguinal canal – passes through superficial inguinal ring- protrudes
outwards.

Direct inguinal hernia: piece of organ pushes directly ant. Abd. wall passes
through supeficial inguinal ring – protrudes outwards.

How to differentiate direct and indirect ingunal hernia?

If it is lateral to this a. :Indirect inguinal hernia

If it is medial to this a.: Direct inguinal hernia.
THANK YOU