Abdominal wall

Basic anatomy

• The abdomen is the region of the trunk that lies between the
diaphragm above and the inlet of the pelvis below.

• Anterior Abdominal Wall

• Made up of skin, superficial fascia, deep fascia,
muscles, extraperitoneal fascia, and
parietal peritoneum
.
1 ) Skin
• skin loosely attached to the underlying structures except at the
umbilicus, where it is tethered to the scar tissue.
• umbilicus is a scar 🡪 site of attachment of the
umbilical cord in the fetus; it is situated in the
linea alba.
• lines of cleavage in skin run downward and forward
almost horizontally around the trunk.
Contin..
Blood supply of skin
⮚ branches of the superior and inferior epigastric arteries 🡪 skin near
midline
⮚branches of the intercostal, lumbar, and deep circumflex iliac
arteries 🡪 flanks skin
⮚ branches of the femoral artery 🡪 skin of inguinal area

⮚(base of aorta- common iliac – external iliac – branches of epigastric

 Contin..
Nerve Supply of skin of anterior A-wall
⮚derived from the anterior branches of the lower 6 thoracic nerves
(lower five intercostal and the subcostal nerves) and the 1st lumbar
nerves.
⮚1st lumbar nerve is represented by the iliohypogastric and the
ilioinguinal nerves
Contin..
Veins
• above into the axillary vein via lateral thoracic vein
• below into the femoral vein via the superficial epigastric and the great
saphenous veins
Superficial Fascia
• The superficial fascia is divided into
1. superficial fatty layer (fascia of Camper)
2. deep membranous layer (Scarpa’s fascia
 .
• The fatty layer is continuous with the superficial fat over the rest of
the body
• The membranous layer is thin and fades out laterally and above,
where it becomes continuous with the superficial fascia of the back
and the thorax, respectively.
• Inferiorly, the membranous layer passes onto the
front of the thigh, where it fuses with
the deep fascia one
fingerbreadth below the inguinal ligament.
Contin..
• In the midline inferiorly, the membranous layer of fascia is not
attached to the pubis but forms a tubular sheath for the
reproductive organs.
• Below ; 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
• thin layer of connective tissue covering the A-muscles
• Lies under membranous layer of superficial fascia.
Muscles of the Anterior Abdominal Wall
• 3 broad thin sheets of muscles
• external oblique, internal oblique, and transversus
• 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
• The lower part of the rectus sheath might contain a
small muscle called the pyramidalis.
.
 External oblique muscle
• broad, thin, muscular sheet that arises from the outer surfaces of the
lower eight ribs and inserted into the xiphoid process, the linea alba,
the pubic crest, the pubic tubercle, and the anterior half of the iliac
crest.
Contin..
• A triangular-shaped defect in the external oblique aponeurosis lies
immediately above and medial to the pubic tubercle. This is known as
the superficial inguinal 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
Internal Oblique
• Also a broad, thin, muscular sheet that lies deep to the external
oblique
• fibers run at right angles to those of the external oblique
• Muscle fibers 🡪 upward and forward
• arises from the lumbar fascia, the anterior two thirds of the iliac crest,
and the lateral two thirds of the inguinal ligament.
• inserted into the lower borders of the lower three ribs and their
costal cartilages, the xiphoid process, the linea alba, and the
symphysis pubis
Internal Oblique
Transversus
• thin sheet of muscle
• lies deep to the internal oblique
• fibers run horizontally forward
• Origin; deep surface of the lower six costal cartilage, the lumbar
fascia, the anterior two thirds of the iliac crest, and the lateral third of
the inguinal ligament.
• inserted into the xiphoid process, the linea alba, and the symphysis
pubis.
• posterior border of the external oblique muscle is free, whereas the
posterior borders of the internal oblique and the transversus muscles
are attached to the lumbar vertebrae by the lumbar fascia
Rectus Abdominis
• 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.
• The rectus abdominis muscle arises by two heads, from the front of
the symphysis pubis and from the pubic crest
• inserted into the 5th, 6th, and 7th costal cartilages and the xiphoid
process
Rectus abdominus
Contin..
• The rectus abdominis muscle is divided into distinct segments by
three transverse tendinous intersections:
1. one at the level of the xiphoid process,
2. one at the level of the umbilicus,
3. one halfway between these two
• These intersections are strongly attached to
the anterior wall of the rectus sheath
Contin..
• The rectus abdominis is enclosed between the aponeuroses of the
external oblique, internal oblique, and transversus, which form the
rectus sheath.
Pyramidalis
• The pyramidalis muscle is often absent.
• It arises by its base from the anterior surface of the pubis and is
inserted into the linea alba .
• It lies in front of the lower part of the rectus abdominis.
Rectus sheath
• long fibrous sheath that encloses the rectus abdominis muscle and
pyramidalis muscle (if present)
• formed mainly by the aponeuroses of the three lateral abdominal
muscles .
• contains the anterior rami of the lower six thoracic nerves and the
superior and inferior epigastric vessels and lymph vessels.
Contin..
• rectus sheath is considered at three levels
• Above the costal margin, the anterior wall is formed by the
aponeurosis of the external oblique. The posterior wall is formed by
the thoracic wall that is, the 5th, 6th and 7th costal cartilages and the
intercostal spaces.
• Between the costal margin and the level of the anterior superior iliac
spine, the aponeurosis of the internal oblique splits to enclose the
rectus muscle; the external oblique aponeurosis is directed in front of
the muscle, and the transversus aponeurosis is directed behind the
muscle.
Contin..
• Between the level of the anterosuperior iliac spine and the pubis,
the aponeuroses of all three muscles form the anterior wall. The
posterior wall is absent, and the rectus muscle lies in contact with the
fascia transversalis.
.
 Linea alba
• The rectus sheath is separated from its fellow on the opposite side by
a fibrous band called the linea alba .
• This extends from the xiphoid process down to the
symphysis pubis and is formed by the fusion of
the aponeuroses of the lateral
muscles of the two sides.
• Wider above the umbilicus, it narrows down
below the umbilicus to be attached to the
symphysis pubis.
Function of the Anterior Abdominal wall
muscles
1. supporting and protecting the abdominal viscera.
2. help in micturition, defecation, vomiting, and parturition
3. Oblique muscles 🡪 leteral flexion + rotation of trunk
4. rectus abdominis flexes the trunk + stabilize the pelvic
5. By relaxing these muscles assist the diaphragm during inspiration
6. Assist during coughing and sneezing by pulling down the ribs and
sternum
Nerve Supply of Anterior Abdominal Wall
Muscles
• oblique and transversus abdominis 🡪 lower six thoracic nerves and
the iliohypogastric and ilioinguinal nerves (L1).
• rectus muscle 🡪 lower six thoracic nerves .
• pyramidalis 🡪 12th thoracic nerve
Fascia Transversalis
• thin layer of fascia
• lines the transversus abdominis muscle
Extraperitoneal Fat
• thin layer of connective tissue
• contains a variable amount of fat
• lies between the fascia transversalis and the parietal peritoneum
Parietal Peritoneum
• Peritoneum consist of

1. Parietal peritoneum lines the abdominal and pelvic cavities.

2. Visceral peritoneum covers the external surfaces of most
abdominal organs, including the intestinal tract.
Arteries of the Anterior Abdominal Wall
• superior epigastric artery 🡪 upper central part of the anterior
abdominal wal
• inferior epigastric artery 🡪 lower central part of the anterior
abdominal wall
• deep circumflex iliac artery 🡪 lower lateral part of the abdominal wall
• posterior intercostal arteries 🡪 lateral part of the abdominal wall
• lumbar arteries 🡪 lateral part of the abdominal wall
 Veins of the Anterior Abdominal Wall
Superficial Veins
• above into the axillary vein via lateral thoracic vein
• below into the femoral vein via the superficial epigastric and the great
saphenous veins

Deep veins
• The deep veins ; superior epigastric, inferior epigastric, and deep circumflex
iliac veins drain into the internal thoracic and external iliac veins.
• posterior intercostal veins drain into the azygos veins
• lumbar veins drain into the inferior vena cava.
Nerves of the Anterior Abdominal Wall
• anterior rami of the lower six thoracic (lower five intercostal and the
subcostal nerves) and the 1st lumbar nerves.
• 1st lumbar nerve is represented by the iliohypogastric and the
ilioinguinal nerves (branches of the lumbar plexus)
• They supply the skin of the anterior abdominal wall, the muscles, and
the parietal peritoneum.
Lymph Drainage of the Anterior Abdominal
Wal
superficial lymph vessels
• lymph drainage of the skin of the anterior abdominal wall above the
umbilicus 🡪 upward to anterior axillary (pectoral) group of nodes,
• Below umbilicus, the lymph drains downward and laterally to the
superficial inguinal nodes
• Skin above the level of the iliac crests is drained upward to the
posterior axillary group of nodes
• below the level of the iliac crests, it drains downward to the
superficial inguinal nodes
Contin..
Deep lymph vessels
• drain into the internal thoracic, external iliac, posterior mediastinal,
and para-aortic (lumbar) nodes

(Para-aortic lymph nodes lie between the renal veins and the bifurcation of the aorta into the common iliac arteries, including the aortocaval
area and paravertebral plane).
Inguinal Canal
• oblique passage through the lower part of the anterior abdominal
wall.
• 1.5 in. (4 cm) long
• lies parallel to and immediately above the inguinal ligament
• extends from the deep inguinal ring, a hole in the fascia transversalis ,
downward and medially to the superficial inguinal ring, a hole in the
aponeurosis of the external oblique muscle
Contin..
• deep inguinal ring,*
• oval opening in the fascia transversalis,
• lies about 0.5 in. (1.3 cm) above the inguinal ligament midway
between the anterior superior iliac spine and the symphysis pubis.
• superficial inguinal ring*
• triangular-shaped defect in the aponeurosis of the external oblique
muscle
• lies immediately above and medial to the pubic tubercle
Contin…
Function
• In the males, it allows structures to pass to and from the testis to the
abdomen. spermatic cord
• In females, it allows the round ligament of the uterus to pass from the
uterus to the labium majus.
.
Walls of the Inguinal Canal
• Anterior wall : External oblique aponeurosis, reinforced laterally by
the origin of the internal oblique from the inguinal ligament
• This wall is therefore strongest where it lies opposite the weakest part
of the posterior wall, namely, the deep inguinal ring.
• Posterior wall : Conjoint tendon medially, fascia transversalis laterally.
This wall is therefore strongest where it lies opposite the weakest part
of the anterior wall, namely, the superficial inguinal ring
Contin…
• Roof or superior wall : Arching lowest fibers of the internal oblique
and transversus abdominis muscles.
• Floor or inferior wall : Upturned lower edge of the inguinal ligament
and, at its medial end, the lacunar ligament
.

Posterior abdominal wall

contents
• posterior abdominal wall midline formed by the 5 lumbar vertebrae
and their intervertebral discs.
• laterally 🡪
⮚12th ribs
⮚upper part of the bony pelvis
⮚psoas muscles
⮚the quadratus lumborum muscles
⮚aponeuroses of origin of the transversus abdominis muscles.
Lumbar Vertebrae
• Massive body and kidney shaped having thicker intervertebral disc
than other regions
• wedge shaped intervertebral disc 🡪 makes the curvature of back
(lordosis)
• 5th lumbar vertebra articulates with the base of the sacrum at the
lumbosacral joint.
.
Twelfth Pair of Ribs
• head of the 12th rib has a single facet for articulation with the body of
the 12th thoracic vertebra.
• The anterior end is pointed and has a small costal cartilage, which is
embedded in the musculature of the anterior abdominal wall
 Ilium
• The ilium, together with the ischium and pubis, forms the hip bone
they meet one another at the acetabulum.
Muscles
• 3 muscles makes the posterior abdominal wall
1) Psoas muscle
2) Quadratus lumborum
3) Iliacus muscle
4) Transversus abdominus
Psoas muscle
• origin: transverse processes, vertebral bodies, and
intervertebral discs, 12th thoracic to 5th lumbar vertebrae
• Insertion: lesser trochanter of the femur
Iliacus
• fan shaped
• origin : upper part of the iliac fossa
• insertion: lesser trochanter of the femur.
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