Anatomy

of the

Anterolateral
Abdominal Wall

Global Objectives: Abdomen

Understand the basic structure and organization of organs in the

abdominal cavity and how they relate to normal body function and
the physical exam
Acquire a basic understanding of the embryologic development of
the intra-abdominal organs
Comprehend the nature of the peritoneum and the peritoneal
cavity, know the various peritoneal spaces as they relate to the
major organs and how they act to contain infections in the
abdomen
Identify normal major abdominal structures in cross-sectional
views as well as be able to identify basic structures on plain
radiographic films, barium contrast studies, and digital images
(Computerized Tomography and Magnetic Resonance Imaging
and Ultrasound)
Dissect and identify the important abdominal structures in the
cadaver
Understand the concept of the abdominal wall hernia, know which
types are congenital and acquired, know the anatomic boundaries
of the common inguinal hernial defects

Global Objectives: Abdomen

Know the definitions of the following terms:

Ligament
Fascia
Hernia
Aponeurosis
Mesentery
Intraperitoneal organ
Retroperitoneal organ
Understand the neural pathways involved in the expression of
somatic pain from inflammation of the parietal peritoneum and
visceral abdominal pain from activation of nerve endings in the
viscera and visceral peritoneum
Understand the importance of arterial blood supply, venous
drainage, lymphatic drainage, and innervation of organs as they
relate to common clinical problems as arterial occlusion, portal
hypertension, abdominal malignancy, and expression of
abdominal pain

Lecture objectives: Abdominal wall

Understand the basic musculotendinous
structure of the abdominal wall and its functions
Know the regions of the abd wall that assist
description of findings in the physical exam
Understand abdominal wall innervation and its
relevance to clinical medicine
Understand the vascular anatomy of the
abdominal wall and its relevance to clinical
medicine
Become familiar with the umbilical folds and their
embryologic origins

Why do all clinicians need to

understand anatomy?
A patients symptoms and signs are all
dependent on the location of the
structures involved by a disease
process as well as the innervation and
blood supply
Imaging studies can only be interpreted
when one has a background in
anatomy of the region of the body
being studied

Why do all clinicians need to

understand anatomy?
Interventional forms of treatment
(surgical, interventional radiology, and
radiation therapy) depend heavily on
visualizing the location, relations and
blood supply of a diseased
organ/organs

Abdominal wall

Muscle

Aponeurosis

Abdominopelvic cavity

Abdomen
Major portion of Abdominopelvic cavity
Enclosed in a musculo-tendinous wall on all
sides has limited capacity for expansion
Divided from thorax by diaphragm
Extends up to 4th intercostal space
Lined by serous mesothelial peritoneum (as are
all intra-peritoneal viscera)
Contains digestive and excretory viscera
Continuous with pelvic cavity inferiorly
Upper portion protected by ribs of thoracic cage

Divisions of Anterolateral
Abdomen

Visual and palpable external landmarks

Xiphoid process of
sternum
Costal margins
Umbilicus

Anterior superior iliac

spines
Inguinal ligament
Pubic symphysis
Mc Burneys point

Important definitions
Fascia sheet of fibrous tissue which
envelops the body and encloses muscles
or groups of muscles [Latin. fascia a band
or fillet]
Aponeurosis the end of a muscle as it
becomes a fibrous sheet of tendon [Grk.
apo, from,+ neuron, sinew or tendon]

Anterolateral Abdominal Wall

Most is musculo-aponeurotic
Striated voluntary muscle situated laterally
continue anteriorly as aponeurosis - a strong
fibrous continuation of the muscle layers
Muscles assist in forced expiration and flexion,
extension and rotation of torso
Increase intra-abdominal pressure for respiration,
coughing, sneezing, urination, defecation and
emesis
Significant protection of abdominal viscera

Cross-sectional
view of abdomen

Anterolateral Abdominal Wall

Superficial fascia subcutaneous tissue
composed of outer fatty layer (Campers
fascia) and deeper membranous layer
(Scarpas fascia) neither are true fascia
Three layers of flat musculature which
become aponeurotic medially
External Oblique
Internal Oblique
Transversus Abdominus

Layers of
abdominal
wall

Anterolateral Abdominal Wall

Medially the Rectus Abdominus muscle is
encased within the aponeuroses of the
above muscles

Transversalis fascia which underlies the

musculature

Properitoneal fat

Peritoneum

 External oblique fibers run at a downward angle as they

pass medially
Internal oblique fibers run at a right angle
Both become aponeurotic (tendonous), as they approach
midline

 Transversus abdominus fibers run in an axial plane and becomes

aponeurotic (tendonous) as they approach midline
Rectus Abdominus Muscles pair of vertically oriented strap
shaped muscles running from costal margin to pubic symphysis,
interrupted by multiple tendinous intersections

Rectus sheath
contents

Rectus sheath

Rectus sheath

Rectus sheath

Rectus sheath
Anterior layer : external oblique
aponeurosis + part of the internal oblique
aponeurosis
Posterior layer : portion of internal
oblique aponeurosis and transverse
abdominal aponeurosis
Arcuate line limit of aponeurotic post
rectus sheath, only transversalis fascia
covers the posterior Rectus below this le

Linea alba
intersection of aponeurosis in the midline
runs from xiphoid to pubic symphysis
Fibers decussate (cross) in midline due to
overlapping of internal and external
oblique aponeuroses at right angles
Midline incision stronger than paramedian
incision due to this decussation

Formation of rectus sheath

Below arcuate line

Rectus sheath CT scan @ level of umbilicus

Rectus sheath - level of umbilicus

linea alba

rectus abdominus m.
aponeuroses
external oblique m.
internal oblique m.

transversus abdominus m.

CT abdomen with soft tissue windows allowing

visualization of adipose

Innervation of abdominal wall

Innervation - both motor and sensory via

ventral rami of intercostal nerves T5-T12/L1

Innervation of the
abdominal wall

 Ilioinguinal and Iliohypogastric nerves are L1 origin

Innervation of the abdominal wall

Innervation of the abdominal

wall: remember
teat pore - T4
Belly butT10

1nguinal Ligament L1

Blood supply and

lymphatic drainage of
abdominal wall
Continuation of
intercostal arteries
supply abd wall
Lymphatic drainage
is generally to axillary
nodes for sites above
umbilicus
Inguinal nodes drain
tissues below
umbilicus

The lower abdominal wall viewed

from posterior (inside)

Internal Surface of Anterior

Abdominal Wall

Five umbilical folds

median umbilical fold covers median umbilical
ligament- remnant of urachus which joined fetal
bladder to umbilicus
2 medial umbilical folds cover medial umbilical
ligaments - remnants of umbilical arteries which
carried fetal blood to placenta via umbilical cord
2 lateral umbilical folds cover inferior epigastric
arteries

Exposed anterolateral
abdominal wall
musculature

External oblique m.

Rectus abdominus m.

Matrix of tissue densities solved by computer

Computerized tomography image of

abdomen in axial plane

 Spermatic cord in the and round ligament of ovary in emerge

from the abdominal cavity in the inguinal region making this a
common site of herniation of the abdominal wall
The superficial inguinal ring is a opening in the external oblique
aponeurosis just above and lateral to the pubic tubercle