1.the Abdomen

The abdomen
Mr UN Kadumbo
20/16/2016
The abdominal cavity.
• Borders:
• Thoracic diaphragm superiorly.
• Pelvic diaphragm inferiorly.
• Anterior abdominal wall.
• Posterior abdominal wall.
Anterior abdominal wall.
• Surface anatomy.
• 4 quadrants.
• 9 regions.
Layers of the anterior abdominal wall.
• The 9 layers.
• Skin.
• Superficial fascia(fatty & membranous).
• Deep fascia.
• External oblique m.
• Internal oblique m.
• Transversus abdominis m.
• Transversalis fascia.
• Extraperitoneal pad of fat.
• Peritoneum.
• The skin.
• Is thin skin and loosely attached to the subcutaneous fascia except at the
umbilicus.
• Lines of cleavage run downwards and forwards.
• Fasciae.
• Superficial – fatty(Camper’s fascia) and membranous (Scarpa’s fascia).
• Deep fascia.
Muscles of the anterior abdominal wall.
• Antero-laterally are 3 aponeurotic mm.

- external oblique.
- internal oblique.
- transversus abdominis.
• Anteriorly are 3 muscles.

- the 2 rectus abdominis mm.
- pyramidalis( absent in < 20% of cases).
External oblique.
• Arises from the lower 8 ribs.
• Fans out antero- inferiorly.
• Inserts into:
Xiphoid process.
Linear alba.
Pubic crest.
Pubic tubercle.
Anterior half of iliac crest.
• Posterior fibres form a free border.
• Has a triangular defect anteriorly.
• Gives rise to external spermatic fascia
• Inferior border forms:
inguinal ligament (Paupart)
lacunar ligament (Gimbernat)
Internal oblique.
• Lies deep to the EO.
• Most of its fibers run at right angles to those of the EO.
• Arises from:
Lumbar fascia.
Anterior two thirds of the iliac crest.
Lateral two thirds of the inguinal lig.
• Fans out superiorly and anteriorly.
• Inserts into:
Lower 3 ribs and their costal cartilages.
Xiphoid process.
Linea alba.
Symphysis pubis.
• Has a lower free border anteriorly.
• The arching fibers give rise to the cremaster m and cremasteric fascia.
Transversus abdominis.
• Lies deep to the IO.
• Its fibres run horizontally.
• Arises from:
Lower 6 costal cartilages.
Lumbar fascia.
Anterior two thirds of the iliac crest.
Lateral third of the Paupart ligament.
• Inserts into:
Xiphoid process.
Linea alba.
Symphysis pubis.
• Together with IO, forms cojoint tendon wich is fixed to the pubic
crest.
Rectus abdominis.
• 2 strap mm separated by linea alba..
• Broad and thinner superiorly.
• Separation is wider superiorly.
• Has 2 heads of origin- symphysis pubis and pubic crest.
• Insertion:
5th to 7th costal cartilages.
Xiphoid process.
• Laterally has linea semilunaris.
• Has 3 transverse tendinous intersections.
• Both mm are enclosed in the rectus sheath.
Pyramidalis.
• Is often absent.
• Origin: symphysis pubis.
• Insertion: linea alba.
• Linea alba.
• Separates rectus sheath.
• Attachments:
-Xiphoid process.
-Symphysis pubis.
Rectus sheath.
• Is a fibrous sheath formed from the apponeurosis of
the 3 anterolateral mm.
• Ensheaths:
• The rectus abdominis m.
• Pyramidalis m.
• Anterior rami of power 6 thoracic nn.
• SEA.
• IEA.
• Considered at 3 levels.
Rectus sheath.
Functions of the anterior abdominal wall
muscles.
• Lateral flexion and rotation of trunk by oblique mm.
• Anterior flexion by the rectus mm.
• Accessory muscles of respiration.
• Assist in forced expiration as in coughing and sneezing.
• Increase in intra-abdominal pressure.
Micturition.
Defecation.
Parturition.
Vomiting.
Nerve supply of the anterior abdominal wall
mm.
• Obliques and transversus abdominis.
Lower 6 thoracic nn.
Iliohypogastric n.
Ilioinguinal n.
• Rectus m.
Lower six thoracic nn.
• Pyramidalis m.
Twelfth thoracic nerve.
The thoracic nerves pass between IO and transversus mm to then enter the rectus sheath from
its posterior.
The first lumbar n has a similar course but does not enter the rectus sheath.
Anterior abdominal wall arteries.
• SEA.
• IEA.
• Deep circumflex a.
• Lumbar aa.
• Lower intercostal aa.
Veins of the anterior abdominal wall.
SEV drains into the internal thoracic vein.
IEV and deep circumflex vein drain into the EIV.
Posterior ICV drain into the azygos veins.
Lumbar veins drain into the IVC.
Lymphatics of the anterior abdominal wall.
• Cutaneous and above umbilicus drain into the

anterior axillary LNs.
• Cutaneous and below the umbilicus drain into
the superficial inguinal LNs.
• Deep lymphatic vessels drain into:
• Internal thoracic.
• External iliac.
• Posterior mediastinal.
• Para aortic.
Lymphatics.
Other layers of the anterior abdominal wall.
• Fascia transversalis.
• Extra peritoneal pad of fat.
• Parietal peritoneum.

1.the Abdomen

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1.the Abdomen

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The abdomen

• Antero-laterally are 3 aponeurotic mm.

• Anteriorly are 3 muscles.

• Cutaneous and above umbilicus drain into the

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