Download abdominal walls

Anatomy of anterior
abdominal wall
By
Dr. Muslim Kandel
2015
MOB TCD
Anterior Abdominal Wall
Functions of ant. Abd. wall
1--The muscles of the anterior abdominal
wall play a major role in movements of the
trunk
2--Protecting the abdominal organs
3--Increase the intra-abdominal pressure, aid
in expiration and all straining activities such
as micturition, coughing and vomiting
MOB TCD
Anterior Abdominal Muscles
4- stabilise the trunk
--Support the spine
--They flex and rotate the trunk
--Acting with the adductors and
abductors of the hip
5- stabilise the pelvis during
walking and running
ABDOMINAL WALLS
• Superior – diaphragm
• Posterior – m. psoas major, m. quadratus
lumborum
• Inferior – pelvic floor (m. levator ani, m.
coccygeus)
• Anterior and lateral – oblique muscles and m.
rectus abdominis
Internal surface of muscles – covered by
transversal fascia and by peritoneum
anterior &lateral abdominal wall
Structure
1-skin
2-superfecial facia
3-Abd. Muscle
4-facia transversalis
5-extraperitoneal fatty tissues
6-pariatal layer of peritoneum
1-skin of abd
wall
-thin
-Pubic hair –Female limited in pubic area
umbilicus
-site of umbilical cord
-lies in linea alba
-N . Supply by T10
-water shed line of the body(marks direction of veins
, lymphatics
-porto-caval anastomosis
-Anastomosis bet. Sup & inf epigasteric vv
-Meeeting 4 peritoneal folds(leg teres,median umbilical
leg.,Rt, Lt umbilical leg.)
2-Superficial fascia
Differentiates below umbilicus into 2 layers:A-superf. Fatty layer(Campers F)
B-deep membranous L (Scarpas F) its lower
border attached as follow:1 -lat. to pubic tubercle F . Lata (1 finger breadth
below ing leg
2-med. To pubic tuberclepubic arch &tubercle
3-in median plaintubular like envelope around
penis &scrotum forming (Colle s F)
Cotenous Nerve supply of ant abd. wall
- T 7,8,9 Xiphoid P—umb
-T10 umb
- T11,12 , L1  umb --inguinal
Muscles of
Abdominal wall
Tow paramedian
-Rectus abd.m
-Pyramidalis m
Three anterolateral flat m
-ext . Abd. Oblique m
- int. Abd. Oblique m
-transversus abd. m
Muscles of abdominal wall
Muscles of abdominal wall--details
.
External abd oblique
Origin:- outer surface of lower ribs
Direction of of fibers downward medially
Insertion :-1-aponeurosis ito Xiphoid P, L .
Alba , pubic creast, pubic tubercle & ant. Sup
iliac spines.
2-fleshy fibers into ant. 1\2 of lower lip of ilac
crest
N supply :- lower 6 thoracic nn
Internal abd. Oblique m
Origin:Lumber origin from lumber fascia
Ilio-inguinal origin ant 2\3 of iliac crest& lat 2\3 of
inguinal leg
Direction of fiber pass upward , forward and
medially
Insertion
- fleshy f into last 3 ribs and carteligen
-broad apponeurosis into7th , 8th , 9th ribs costal
cartlage , xiphoid P, L . Alba , pubic crest & pecteneal
line
N supply lower 6 thorasic and L1
Transversus abdominis m
Origin:Costal- inner surface of lower 6 ribes
Lumber –lumber fascia
Ilioinguinal – 2\3 of inner lip of iliac crest&lat.
1\3 inguinal leg
Direction of fibershorizontal
Insertion
-broad aponeurosis from Xiphoid P to L . Alba
-conjoin tendon
N . Supply– lower 6 thoracic & L1
Rectus abdominis m
Longitudinal paramedial m
Origin:- lower end 2 heads
Med- head  symphysis pubis
Lat. head  pubic crest
Insertion:- upper end
Front of 5,6,7th costal cartilage & Xiphoid P
N supply lower thoracic n
tendenous intersection 3,4 transvers bands
(xiphoid P, umbilicus, midway bet. Xiphoid &umb,
below umb.)
Linea similunaris –shalow curved groove along
lat.border of muscle
Pyramidalis m
Small triangular m at the lower end of
rectus m, some time abscent
Origin –pubic crest
Insertion-- lower part of L alba
N . Supply –subcostal n
Action -- streches L . alba
4-Fascia transversalis
Extension& attachment
- ant adherent to L alba above umbilicus
-post.  renal Facia
-sup.diaphragmaic facia
- inf. 
* lat to iliac v-iliac crest& lat. 1\2 of ing . leg
*over ext. iliac v (prolongation to thigh)
*med. to ext. iliac vpectineal line& pubic crest
Openings of transversalis facia
Deep ing. Ring
Oval shap opening 1\2 inch above midinguinal
point, just lat to inf. Epigasteric a.
Transmitspermatic cord(male) round leg (female)
Prolongation of F transversalis
1-internal spermatic facia
2-ant. Wall of femoral sheath
Particlar strectures in ant. Abd wall
1-inguinal ligament
2-rectus sheath
3-conjoin tendon
4-cremasteric muscle
5-Linea alba
6-inguinal canal
7-femoral canal
inguinal ligament
Attachment
lat :- ASIS
Med:- pubic tubercle
The ligament serves to contain soft tissues as they course
anteriorly from the trunk to the lower extremity.
Deep relation
1-femoral sheath
2-iliacus &Psoas m
3-femoral n, femoral br. of genitofemral n & lat. cut n of thigh
Superfecial relation superfecial epigasteric , superfecial
circumflex iliac vessels
Extension
1-lacuner leg
2-reflected part of ing. leg
Cremastric muscle
Its a slender muscle which suspends the
spermatic cord & testis, covered by
cremasteric facia
Origin– middle of ing. Leg
Insertion – fiber form U shaped loop around
spermatic cord & testis then inserted into
pubic tubercle
N supply – genetal br of genitofemoral n
Action--- elevate testis during ejaculation
Conjoin tendon
The lower most fibers of int. oblique fuse
with lowermost arching fibers of transversus
abdominus to form conjoin tendon
Rectus sheath
Formation:-Splitting of int oblique into :ant. Lamella enforced by ext oblique and
post. lamella which enforced by transvesus
abd
Parts of sheath
1st part above costal margin
2nd part from costal margin to arcute line
(midway between umb. & symphysis pubis)
3rd part lower part below arcute line
The Rectus Sheath, Anterior View
& Transverse Section
1-Rectus abdominis
2-Tendinous intersections
3-Anterior wall of rectus sheath
4-Posterior wall of rectus sheath
5-Transversalis fascia
6-Peritoneum
7-Costal margin
8-Linea alba
9-Umbilicus
10-Muscular part of external oblique
11-Muscular part of internal oblique
12-Muscular part of transversus
abdominis
13-Superficial fascia
14-Costal cartilage
15-Extraperitoneal fat
16-Intercostal muscles
17-Pectoralis major
Contents of rectus sheath
2 muscles (rectus abd , pyramidalis )
4 vessles
sup . Epigasteric a &v  int . Mammery a&v
inf. Epigastric a&v  ext. iliac a&v
6 nerves (5lower intercosatal & subcostal)
Lymphatic vv
LINEA ALBA
Linea alba
Strong tendenous raphe in the middle line
of ant abd wall between 2 recti
Attached above at Xophoid P and below at
symphysis pubis
• Aponeurotic parts of oblique muscles
attache to the linea alba at the midline
• One of the surgical approaches to the
peritoneal cavity (midline incision)
Arterial supply of abd. wall
1-sup . Epigasteric a
2-musclo-phrenic a
int mammery a
3-inf epigasteric a
int iliac a
4-10th, 11th, post. intercostal a
5- subcostal art.
thoracic aorta
6- deep circumflex art
ext. iliac a
7- superfecial circumflex artery
8- superfecial eigasteric art
femoral art
Venous drainage of abd. wall
A- above umbilicus
1-sup. Epigasteric v int mammery v
2-Lat. Thoracic v  axillary v
B-below umbilicus
1-inf. Epigasteric v  ext. iliac v
2- superfecial circumflex v  femoral v
3- superfecial eigasteric v femoral v
Venous anastomosis of ant. Abd. wal
A-between SVC & IVC
1-sup . Epigasteric & inf epigasteric vv(rectus sh)
2-lat. thoracic &superfecial epigasteric(superfecial
facia of side of trank
B- porto-systemic anstomosis
Veins of ant abd wall &paraumbilical v
(Caput Medosa)
Lymphatic drainage of ant.
Abd. wall
Above umbilicus
--superfecial lymphatics fellow veinsant. pectoria
LN
--deep lymphatics fellow arteries parasternal LN
Below umbilicus
-- superfecial lymphatics  superfecial inguinal LN
-- deep lymphatics  ext. iliac LN
Nerve supply of ant. Abd. wall
A-lower intercostal n(T7- T11)
B-subcostal n (T12)
C- iliohypogasteric (L1)
D- ilioinguinal n(L1)
inguinal canal
* Attachment where scrotum “pooches out”--carries all 3 layers of abdominal
wall through successive holes
* spermatic cord to testicles
-VAN
inguinal canal
Its oblique intramuscular passage in the lower
part of ant. Abd. Wall transmit spermatic cord
or round leg., lies just above med1\2 if ing.
Legement about 4 cm length
Deep ing. Ring –oval . at fecia. Transversalis
Superfecialing. Ring– triangular at ext oblique
Bounderies of canal:Ant.wall of canalext. oblique& fleshy int. oblique
Post.wall of canal facia transversalis
Rooflower arched fiber of int. oblique
Floor inguinal leg
Structures pass through ing. canal
1-in male  spermatic cord , its
covering + ilioinguinal n
2-In female round leg of uterus
+ilioinguinal n
The Coverings of the Inguinal Canal, External & Internal Oblique &
Transversus Abdominis Removed
1-Inguinal ligament
2-Deep inguinal ring
3-Transversalis fascia
4-Internal spermatic
fascia forming
innermost coating of
the spermatic cord
5-Pubic tubercle
Inguinal(Hasselbach s) triangle
Its triangular area in inner aspect of lower
abd. Wall may be a site of hernia
Bounderies
Medially—lat border of rectus sheath
Laterally– inf. Epigasteric art.
Inferiorly– medial 1\2 of ing. Leg
Hernia
It s abnormal protrusion of any abdominal
viscus(commonly loop of bowel or omentum)
through week part of abd . Wall
Types:- internal & external
Inguinal , Femoral ,umbilical ,paraumbilical,
epigasteric, incisional and other rare types
Structure of hernia
- Sac
-neck
-coverings
-containt
Abdominal muscular wall
pressurizes abdomen
When? 
Cough
Sneeze
Urinate
Defecate
Birth
Lifting
–
–
–
–
–
–
Inguinal hernia results because pressure
finds weak spot at inguinal canal
Inguinal hernia
Indirect
Direct
Process veginalis
Conjoin tendon
Young
old
Deep ing . ring
Ing triangle
Oblique to scrotum
Postero-anterial not
reach scrotum
Infront of spermatic cord Behind cord
Femoral hernia
Femoral hernia
Inguinal H
Femoral H
male
female
Deep ing. ring
Femoral ring
Above ing. leg
Below ing . Leg.
Above pubic tubercle
below
Umilical &paraumbilical hernias
Through weak point of scar of umbilicus
Epigasteric hernia
Through defects appearing due to fail of
fusion of linea alba
Epigasteric hernia
Incisional hernia
Male external genital organ
1-Spermatic cord ,2- scrotum ,3-testis , 4-penis
1-Spermatic cord
Its cord of several structures including vas
deference and its covering and its vessles
Extend from deep ing. Ring to the lower end
of testis
Covering spermatic cord
1-Internal spermatic facia F transversalis
2- cremasteric m and f  int. oblique+transversalis abd
3- External spermatic f -ext. oblique
Constituent of spermatic cord
A-3 structures 1-vas deference,
2-pampiniform plexus,
3-lymphatic
B-3 arteries1-testicular a  aorta
2-art. to vas inf vasical a
3-cremasteric a inf epigasteric a
C-3 nerves 1-genital br. of genitofemoral n
2-ilioinguinal n(L1)
3-sympathetic n fibers
D-vestigue of processus veginalis
Vas defferens
Its firm cord like structure 45 cm in
length , have thick muscular wall , narrow
lumen
Begin in the scrotum as a continuation
to the tail of epididymis, then join duct of
the seminal vesicle to form ejaculatory duct
which opens into prostatic urethra
Pampiniform plexus
Formed by several veins that drain testis &
epididymis, at deep ring the veins unite to
form testicular vein
Rt. Testicular v end to inf. Vena cava
Lt. testticular v end to Lt renal v varicocele
Lymphatic vessele
Drain testis and epididymis, accompany
testicular vesseles , end to para aortic LN
Testicular artery
Arise from abd. Aorta L3
Run in the spermatic cord
Supply testis anastomosis with cremasteric a
and art. to vas
Artery to vas deferens
Arise from vesical a  int. Iliac a
Supply vas & epididymis
Cremasteric a
Arise from inf. Epigasteric a
Supply covering of cord
Cremasteric nerve
Genetal br. Of genetofemoral n
Supply cremasteric m and skin of ant 2\3 of
scrotum
Sympathetic fibers
Arise from renal and aortic plexus
Iloinguinal n
Arise from lumber plexus L1
Supply the skin of ext. genitelia
2-Scrotum
Its cutaneous bag containing :-- 2 testis,
-- epididymis
--lower part of spermatic cord
( its correspond to labia majora in female)
Its divided into Rt& Lt portions by median
raphe, Lt hangs lower than Rt
Layers of sacrotum
Skin :- brown , thin , rugose
Dartos m:-  fatty layer of superfecial. facia
Form suptum between 2 testis
Supply by sympathetic f
Memberenous layer of superfecial. facia
Ext, spermatic f ext oblique
Cremasteric m&f  int. oblique+ transversalis abd.
Internal layer of spermatic f transversalis f
Parietal layer of tunica veginalis
Nerve supply
Ant. 1\3  L1( ilioinguinal n, genital br. Of
genetofemoral N)
Post. 2\3  S3( post scrotal br of perienial
n,perieneal br of post cut. N of thigh
Blood supply
1-Superfecial &deep ext. pudendal a femoral art
2-Post.pudendal br. Of int. pudendal a int iliac a
3-Cremasteric art. Inf . Epigasteric a
3-Testis
Its male primary organ, located in scrotum, oval
in shape ,
2 poles upper & lower(spermatic cord
attached to upper pole)
2 borders ant. & post(post. surface related to
epididymis by groove sinus of epididymis)
2 Surface med. & lat.
its mixed gland produce:- exocrine sperm
-endocrine testesteron
Covering of testis
3 special coats
1-tunica albugenea( fibrous capsul)
2-visceral layer of tunica vaginalis
3-parietal layer of tunica vaginalis
3 Coats from abd. wall
1-int. spermatic f  transvers abd
2-cremasteric M& F  int oblique
3-ext. Spermatic F ext oblique
3 cutenous & subcutenous coats
1-Membernous layer of superfecial F
2-dartus muscle
3-skin
Epididymis
Its comma shape body attached to posterolateral
aspect of testis , its highly coiled single tube 6
meters
3parts
-head expanded upper end which connect to
upper pole of testis by efferent duct
- body central part
- Tail lower pointed end attached to lower pole
of testis , its continuous with vas
Abdominal cavity
Planes of abdomen
1-transpyloric plane-----L1
2- subcostal plane ------L3
3-inter tubercular plane----L5
4-tow lateral vertical plane (Rt,& Lt)
Regions of abdomen
9 regions
Anterior Abdominal Wall,
Dissection
1-External oblique muscle
2-Anterior wall of rectus sheath
3-Tendinous intersections of rectus
sheath
4-Rectus abdominis
5-Posterior wall of rectus sheath
6-Intercostal nerve
7-Linea alba
8-Umbilicus
9-Mammary disc