Abdominal

Anatomy
 Learning objective :
Abdominal Wall
- Anterolateral wall
- Posterior wall
Abdomen Cavity
- Intraperitoneal organ
- Retroperitoneal organ
Abdomen
 Structure of Abdominal Cavity
Superiorly diaphragm
Inferiorly pelvic cavity
Anteriorly lower part
of the thoracic cage,
external & internal
oblique, transversus
abdominis muscles and
fasciae
Posterior lumbal,
costae XII, pelvic, muscle
(psoas, quadratus
lumborum, aponeurosis
origo transversus
abdominis, iliacus)
It is customary to relate pains, swellings, or the positions of organs to one of
these regions.
 Anterior Abdominal Wall
The anterior abdominal wall is
clearly defined by anatomical
borders.

The superior border is marked

by the costal margins,

the inferior border is the pubic

symphysis
 Anterior Abdominal Wall
Generally, the anatomical layers of the abdominal wall (deep to
superficial) are as follows:
peritoneum,
extraperitoneal fascia (deep fascia),
muscle
superficial fascia (Camper and Scarpa fascia)
skin.
The presence or absence of various layers is location dependent

These distinct tissue types necessary for consideration when

closing the surgical abdomen.
 Skin
The abdominal skin is
transgressed by Langer lines,
also called cleavage lines. In
the anterior abdominal wall
transversely.
So, vertical skin incisions
increased lateral tension,
wider scars, wound
dehiscence and hernia
formation.
low transverse incisions(e.g
Pfannenstiel) superior
cosmetic results.
 Nerve supply
The abdominal skin the anterior
rami of the T7-L1 thoracoabdominal
nerves.

T7-T9 thoracoabdominal nerves

innervate the skin above the
umbilicus;
T10 thoracoabdominal nerves
innervates the skin around the
umbilicus
T11 thoracoabdominal nerves plus
cutaneous branches of the
subcostal (T12), iliohypogastric,
and ilioinguinal (L1) nerves supply
the skin inferior to the umbilicus.
 Blood Supply
Skin near the midline is
supplied by
branches of the superior
epigastric artery (br. of int.
thoracic artery) and
the inferior epigastric
artery ( br. of external iliac
artery)

Skin of the flanks

branches from the
intercostal, lumbar, and deep
circumflex arteries
 Venous Blood
The venous blood is
collected into a network
of veins that radiate out
from the umbilicus.

Network drained above

into Axilary veins via
lateralis thorasics veins

Below into femoralis vein

via the superficial
epigastrics and great
saphenos vein.
Lymph drainage
The cutaneus lymph vessel above the umbilicus upward
into the anterior axilary lymph nodes.
Below umbilicus downward into the superficial inguinal
nodes.
SUPERFICIAL FASCIAE

Camper and Scarpa fasciae

Superior to the umbilicus
single layer
Inferior to the umbilicus
2 layers.
The more superficial and fatty
layer is the Camper fascia.
The deeper, more fibrous layer
is the Scarpa fascia.
very little fat
fascia lata : superficial fascia
of the thigh
Colles fascia: perineum
 Deep Fascia
Deep fascia in the anterior abdominal wall is merely a thin
layer of connective tissue covering the muscles

It lies immediately deep to the membranous layer of the

superficial fascia
 Muscle
From exterior to interior they are:
(flat)
External Oblique Muscle
Internal Oblique Muscle
Transversus Abdominis
Aponeurotic

A wide vertical muscle:

Rectus Abdominis
Pyramidalis Muscle
External Oblique Muscle
Origin: Lower 8 ribs

Insertion: Xiphoid process,

linea alba, pubic tubercle,
iliac crest

Action: Supports
abdominal contents, assist
in forced expiration,
micturition, defecation,
parturition, vomiting
Internal Oblique Muscle
Origin: Lumbar fascia, iliac
crest, lateral two-thirds of
inguinal ligament

Insertion: Lower three ribs

and costal cartilages, xiphoid
process, linea alba, symphysis
pubis

Action: Supports abdominal

contents, assist in forced
expiration, micturition,
defecation, parturition,
vomiting
Transversus Abdominis
Origin: Lower six costal
cartilages, lumbar fascia,
iliac crest, lateral third of
inguinal ligament

Insertion: Xiphoid process,

linea alba, symphysis pubis

Action: Compresses
abdominal contents
Rectus Abdominis
Origin: Symphysis pubis and
pubic crest

Insertion: 5th, 6th and 7th costal

cartilages and xiphoid process

Action: Compresses
abdominal contents, flexes
vertebral column, accessory
muscle of expiration
 RECTUS SHEATH
Is a long fibrous sheath

Encloses the rectus

abdominis and pyramidalis
muscle (if present)

Formed mainly by
aponeurosis of three
lateral abdominal muscles
For description it is considered at three levels:

1. Above the costal margin the anterior wall is formed by the

aponeurosis of the external oblique and posterior wall is
formed by the thoracic wall

That is the 5th , 6th and 7th costal cartilages and the intercostal
spaces
2. Between the costal margin and the level of the anterosuperior
iliac spine, the aponeurosis of the internal oblique splits to
enclose the rectus muscle

The anterior layer of the internal oblique blends with the

aponeurosis of the external oblique.

Posterior to the rectus muscle , this aponeurosis blends with

the aponeurosis of the transversus abdominis to form a
portion of the posterior rectus sheath.
3. Between the level of the anterosuperior iliac spine
and the pubis, the aponeurosis of all three muscles
form the anterior wall

The posterior wall is absent

The rectus muscle lies in contact with the fascia

transversalis
ARCUATE LINE (of Douglas)
the aponeuroses forming the
posterior wall pass in front of
the rectus abdominis at the
level of ant.sup. Iliac spine, the
posterior wall has a free,
curved lower border.

LINEA ALBA
The rectus sheath is separated
from its fellow on the opposite
side by a fibrous band called
the linea alba

Extends from the xiphoid

process to the symphysis pubis
 Nerve Supply of Ant. Abdominal Wall Muscle

Oblique & transversus

abdominis muscle :
The lower 6 thoracics
nerves
The iliohipogastric &
ilioinguinal nerves (L1)
Rectus muscle
- The lower 6 thorasics
nerves
Pyramidalis muscle
- Twelfth thorasic nerve
Fascia Transversalis
Thin layer of fascia that lines the
transversus abdominis muscle
With diapraghmatic fascia, the iliacus
fascia, and the pelvic fascia. form
one continuous lining to the
abdominal and pelvic cavities

Extraperitoneal Fat
Thin layer of connective tissue
Contains a variable amount of fat
Lies between fascia transversalis and
the parietal peritoneum

Parietal Peritoneum
Thin serous membrane
Lines the walls of the abdomen
Continuous below parietal
peritoneum lining the pelvis
 Arteries of the Anterior Abdominal Wall
Subcutaneous
The superficial epigastric
artery
The superficial external
pudendal arteries
The superficial circumflex iliac
artery
Muscle and their aponeurosis
The inferior epigastric arteries
The superior epigastric
arteries
The deep circumflex arteries
The musculophrenic arteries
 Location of deep and
superficial vessels of
the anterior abdominal
wall. Blue circles
indicate recommended
locations for trocar
placement.
 Veins of the Anterior
Abdominal Wall

The inferior epigastric , the

superior epigastric, and the
deep circumflex drain into
the internal thoracic and
external iliac veins

The posterior intercostal

into the azygos veins

The lumbar veins into the

inferior vena cava

.
Posterior abdominal
wall
Formed by:

Midline
The five lumbar vertebrae and
their intervertebral discs

Laterally
The twelfth ribs
The upper part of the bony
pelvis
The psoas muscle
The quadratus lumborum
muscle
The aponeurosisi of origin of the
transversus abdominis muscles.
 Psoas mayor et minor
Origin :
The roots of the transverse
processes
The sides of the vertebral
bodies
The intervert Th XII to L V
Insertion : throchanter minor
Inervation : lumbar plexus
Action :
o flexes the thigh
o If the thigh is fixed; flexes the
trunk ( sitting up from a lying
position )
 Quadratus lumborum
Origin : crista iliaca
Insertion : proc. Ttranversus
vert. L1-4
Innervation : n. Lumbalis
Action :
o Fixes or depresses the
twelfth rib during
respiration
o Laterally flexes the
vertebral column to the
same side
 Iliacus
Origin : fossa iliaca
Insertion : trochanter
minor
Innervasi : femoral
nerve
Action : similar with
psoas muscle
 Abdominal Cavity
Many vital organs
Gastrointestinal tract, liver, biliary ducts, pancreas,
spleen, and parts of the urinary system
Aorta and its branches
The inferior vena cava
The important portal vein
 Peritoneum
The serous membrane that forms the lining of the abdominal cavity
Support the abdominal organs
Serves as a conduit for their blood and lymph vessels and nerves

The parietal peritoneum

Outer layer Line the walls of the abdominal and pelvic cavities
The visceral peritoneum
Inner layer Covers the organs

Space between peritoneal cavity

Peritoneal cavity
Contains small amount of fluid ( about 50ml) that serves as a lubricant and has
antiinflammatory properties
In females communicates with exterior of body via uterine tubes, uterus and
vagina
 Intraperitoneal & Retroperitoneal
Intraperitoneal organs
Nearly totally covered by visceral peritoneum
Attached to body wall by mesenteries and ligaments
Liver, spleen, stomach, jejunum, ileum, transverse & sigmoid
colon, superior rectum

Retroperitoneal organs
Only partially covered with visceral peritoneum
Primary : kidney
Secondary : adrenal glands, pancreas, ascenden & descenden
colon
 Horizontal sections through the
abdomen. In A, the liver, right and
left kidneys (R.K., L.K.), pancreas
(P.), spleen (Sp.), and stomach
(St.) are shown, as well as the
aorta (Ao.) and splenic artery,
inferior vena cava (I.V.C.), portal
vein (P. V.), bile duct, and hepatic
artery. The greater sac of the
peritoneal cavity (around the liver,
for example) can be traced
through the epiploic foramen
(arrow) into the lesser sac
between the stomach and
pancreas. L. V., lumbar vertebra.
(After Symington.) B represents
the principle of the arrangement
of the peritoneum and its
mesenteries
Parts of peritoneum :
Mesentry :
The double layer of peritoneum that suspends the jejunum
and ileum from the posterior wall of the abdomen
Mesocolon
Double layer of peritoneum connects large intestine to
posterior abdominal wall
Omentum
Broad, double layered sheet of peritoneum that connects
stomach to another abdominal organ
2 parts ;
Greater omentum
Lesser omentum
 At the level of the twelfth
thoracic Vertebra
Falciform ligament : connect ant.surface of liver to
ant.abdominal wall above the umbilicus and to the
diapraghm. lies slightly to the right of the midline
Ligamentum teres obliterated umbilical vein of the fetus
which passes upward to enter the groove between the
quadrate lobe and the left lobe of the liver
Celiac axis (trunk, artery)
a. First unpaired branch off
abdominal aorta (~ L-1)
b. Originates from ventral
surface
c. Gives rise to splenic,
common hepatic, & left
gastric arteries
Superior Mesenteric Artery
a. Second, unpaired branch
of abdominal aorta
b. Originates ~ lower L-1
body
c. 1 2 cm below celiac axis
d. Supplies small intestines,
pancreas, omentum,
ascending and transverse
colon
Inferior Mesenteric Artery

a. Arises just above the

bifurcation of the aorta
(~L-3/4)
b. Last unpaired branch
of aorta
c. Supplies jejunum,
descending and
sigmoid colon, rectum
Renal arteries
a. First major paired
branches from
aorta
b. Arise opposite each
other 1-2 cm below
SMA (~L-2)
c. Multiple renal
arteries occur in 20%
of patients
Common Hepatic
Artery
a. Right branch of
celiac a.
b. Continues to GDA,
then

Proper Hepatic Artery

a. Branches within liver
b. Begin at ~porta
hepatis
Inferior Vena Cava
a. Formed at ~ L-5
b. by union of Common
Iliac Veins
c. Largest vein in body
d. Dilation may be due to:
1. right-sided CHF
2. Portal hypertension
Veins of Portal Circulation
a. SMV: joins with splenic
vein
1. runs parallel to SMA
2. On right side of
abdomen
b. IMV: terminates in
splenic vein
c. Portal Vein: enters liver
Renal Veins run parallel to renal arteries
Major Veins of the Abdomen

Figure 19.21