INTRODUCTION

• Bony landmarks
- Superiorly –costal margins
-xiphoid process
- Inferiorly –pubis
-pubic symphysis
Four Quadrants
Regions of abdomen
Regions and planes of abdomen

Midclavicular plane

Transpyloric plane (L1)

Transtubercular plane (L5)

 ANTERIOR ABDOMINAL WALL

Layers
1. Skin
2. Superficial fascia
3. Muscles
4. Fascia transversalis
5. Extra peritoneal tissue
6. Parietal peritoneum
7. Peritoneal cavity
8. Visceral peritoneum
9. Viscera
 Skin

- Thin
- Umbilicus

- Midline furrow/ groove

linea alba – xiphoid
process to pubic
symphysis

Linea semilunaris –
extends from tip of 9th
costal cartilage to pubic
tubercle
• Umbilicus

- Cicatricial tissue

- L3-4 ( vary )

- T10 spinal nerves

- Watershed line for venous

and lymphatic drainage

- Portocaval anastomosis
 ANTERIOR ABDOMINAL WALL

• Superficial fascia
1. Superficial layer (Campers)
2. Deep layer (Scarpas)

• Contents:-
1. Cut nerves
2. Arteries
3. Veins
4. lymphatics
Camper’s fascia
- Thick, areolar

- Lies superficial to superficial

inguinal ring and continuous
with superficial fascia of
thigh
Scarpa’s fascia
- Membranous layer
- Attachments
- Midline :- to linea alba,
symphysis pubis

- Extension
a. males -buck’s fascia –fascia
over penis
-colle’s fascia –
superficial fascia over perineum

b. Females ???
 ANTERIOR ABDOMINAL WALL

• Cutaneous nerves
- Lower 5 intercostal nerves
(T7 - T11)
- Subcostal nerve (T12)
- Iliohypogastric and ilioinguinal
nerve (L1)
• Cutaneous arteries
- Superior and inferior
epigastric
- Posterior intercostal
- Musculophrenic
- Deep Cx iliac
- Superficial branches of
femoral artery
 Cutaneous veins

- Above umbilicus –drain

into axillary via lateral
thoracic vein
- Below umbilicus –drain into
femoral via superficial
epigastric vein
- Superficial veins of AAW
• Cutaneous lymph vessels
- Above umbilicus- axillary lymph
nodes

- Below umbilicus- superficial inguinal

lymph nodes
 MUSCLES OF ANTERIOR ABDOMINAL WALL

• Lateral
– External oblique
– Internal oblique
– Transversus
abdominis

• Midline
– Rectus Abdominis
– Pyrimidalis
 External oblique

• Broad, thin & quadrilateral muscle

• Attachments -8 fleshy digitations from 5-12 ribs,
• lowest fibers insert on iliac crest (outer lip, ant 2/3rd)
• Middle and upper fibers end in aponeurosis on linea alba
• Innervation T7-T11 intercostal nerve and Subcostal(T12) nerve
????
 INGUINAL LIGAMENT OF POUPART

- Definition –thick, fibrous

band formed by lower free
border of aponeurosis of
external oblique
- Attachment –ASIS to pubic
tubercle
- Parts : -Lacunar
-Pectineal
-Reflected part
-Ilioinguinal lig
1. Lacunar ligament
- Gimbernat’s ligament –
extension of fibres of
inguinal ligament on
pecten pubis
- Triangular

2. Pectineal ligament
- Ligament of cooper
- Extension of the lacunar
ligament along pecten
pubis upto iliopectineal
eminence
3. Reflected part of inguinal
ligament
- Upward and medial
expansion of inguinal
ligament
- Lies behind superficial
inguinal ring

4. Ilioinguinal ligament

- Extension of Inguinal ligament

to iliopectineal eminence
 Internal oblique
- Attachment
-lateral 2/3 of inguinal lig,
-Ant 2/3 of iliac crest
-Thoracolumbar fascia

- Insertion 10, 11, 12th rib,

linea alba
- Innervations T7-T11 and
Subcostal nerve(T12) , L1
 Transversus abdominis

- Attachments
lateral 1/3 of inguinal lig,
Ant 2/3 iliac crest,
12 th rib
lower 6 CC,
thoracolumbar fascia

- Insertion –linea alba

- Innervation - T6-T11 and

Subcostal nerve (T12), L1
 Conjoint tendon

- Formation –lower fibres

of IO and TA
- Attachment –pubic crest
and pecten pubis
- Function –strengthen
medial portion of
posterior wall of inguinal
canal
 Fascia transversalis

- General layer of fascia

- Location between TA and extra peritoneal fat
- Attached to iliac crest
- Opening in FT Deep inguinal ring passage for spermatic cord
and round ligament of uterus
 Actions of AAW muscles

• Protection –protect viscera from external injury

• Retention –muscles retain viscera in position, maintained by
tone of muscles
• Compression –increase intra-abdominal pressure and
compress viscera in act of vomiting, micturition, defecation
• Action on vertebral column
- Muscles of both sides act –flex lumbar vertebrae
- Unilateral action –lateral flexion
- Contraction of EO of one side with IO of other side –rotation
of trunk
• Most imp role :- Assist in breathing
– Relaxes:- during inspiration
– Contracts:- during expiration
 Rectus abdominis

- Long flat strap muscle

- Paired, separated by linea alba
• Attachments
Inferiorly -crest of pubis, pubic
symphysis
Superiorly -5,6,7th ribs, xiphoid
process
• Innervation –T7-11 and Subcostal
nerve
• Action:- flexion of the trunk
 Tendinous intersections of RA
1. At the level of umbilicus
2. Free end of Xiphoid
process
3. Another in bet 1 & 2.
• Pyramidalis

- Attachment :- Symphysis
Pubis & Pubic crest
- Inserted into linea alba
- Innervation :- Subcostal Nv
(T12)
- Tenses the linea alba
 LINEA ALBA
- Tendinous raphe –extending
from xiphoid process to pubis
symphysis
- Location –between 2 recti
- Formation –decussating
aponeurotic fibres of EO, IO, TA
- 1cm wide above umbilicus
 APPLIED

• DIVARICATION OF RECTI
- Thinning and widening
- Widely separated recti
- Disrupts the
arrangement of
aponeurosis
- Broad midline bulge 
hernia
Abdominal hernia
RECTUS SHEATH
 RECTUS SHEATH

• Definition – fibro-aponeurotic sheath

enclosing RA and pyrimidalis with their
nerves and vessels

• Formation –aponeurosis of EO, IO, TA

 Rectus sheath formation
• Formed differently at different
levels
• Aponeurosis of IO splits into
anterior and posterior laminae to
enclose rectus muscle and
pyramidalis

• Anterior layer of rectus sheath –

EO aponeurosis and anterior
lamina of IO
• Posterior layer of rectus sheath –
TA aponeurosis and posterior
lamina of IO

• Little below umbilicus this

arrangement ceases, all 3
aponeurosis pass in front of RA
 Arcuate line

• formed because posterior

wall of rectus sheath ends
in a curved margin
• present midway between
umbilicus & pubic
symphysis
• concave downwards
• aka linea semicircularis or
fold of Douglas
• inferior epigastric vessels
perforate the rectus
abdominis below this line
 Posterior layer of rectus sheath

Transversus abdominis
Arcuate line
Inferior epigastric vessels
Rectus abdominis
Fascia transversalis

Posterior layer of rectus sheath

 FORMATION AT DIFFERENT LEVELS

• Above costal margin:

– Ant wall : Aponeurosis of EO
– Post wall: Deficient; Rectus lies directly on costal
cartilages (5-7)
• Between the costal margin and arcuate line:
– Ant wall: EO and ant lamina of IO
– Post wall: post lamina of IO
Aponeurosis of TA
• Below arcuate line:
– Anterior wall - Aponeurosis of all three flat muscles of
abdomen
– Posterior wall - is deficient;
• rectus muscle rests on fascia transversalis
 RECTUS SHEATH

Anterior lamina Posterior lamina

 RECTUS SHEATH
Ant wall Posterior wall
Extend Complete Incomplete
Relation to tendinous Adherent at the level Free from RA
intersections of Xiphoid process, muscle
Umbilicus & Midway
between them
Above costal margin Thin & formed by Absent
Aponeurosis of EO
Between costal Thicker, EO + Ant lyr Tr Abd + post
margin & Arcuate line of IO lyr of IO
Below arcuate line Thickest, EO+ IO+TA Absent
 CONTENTS

• MUSCLES
– Rectus abdominis
– pyrimidalis
• ARTERIES
– Superior epigastric
– Inferior epigastric
• VEINS
• NERVES
– Lower five intercostal
and subcostal (T7 –T12)