Anterior Abdominal Wall First Half

Front 1

Where is the abdomen located?

Back 1

lies between the diaphragm above and the inlet of the pelvis below

Front 2

Walls of abdominal cavity - Superiorly

Back 2

diaphragm - separates the abdominal cavity from the thoracic cavity

Front 3

Walls of abdominal cavity - Inferiorly

Back 3

continuous to the pelvic cavity through the pelvic inlet

Front 4

Anterior walls of abdominal cavity

Back 4

above: lower part of thoracic cage

below: muscles (rectus abdomens, external oblique, internal oblique, & transverse abdominis) and fasciae

Front 5

Posterior walls of abdominal cavity

Back 5

midline: lumbar spine
laterally: XII rib and muscle (psoas major & quadratus lumborum)

Front 6

Reference Points

Back 6

Linea alba, rectus abdominis muscles, linea semilunaris, umbilicus, arcuate line

Front 7

REGIONS of anterior abdominal wall - Vertical lines

Back 7

right and left Midclavicular lines

Front 8

REGIONS of anterior abdominal wall - Horizontal planes

Back 8

subcostal plane (lower points of costal arches)

intertubercular plane (between sup. ant. iliac spines)

Front 9

9 REGIONS of the anterior abdominal wall

Back 9

1) Right hypochondrium
2) Left hypochondrium
3) Epigastric
4) Right lumbar
5) Left lumbar
6) Umbilical
7) Right iliac (inguinal)
8) Left iliac (inguinal)
9) Hypogastric

Front 10

QUADRANTS of abdominal wall - contents in right upper quadrant

Back 10

liver and gallbladder

Front 11

QUADRANTS of abdominal wall - contents in left upper quadrant

Back 11

stomach and spleen

Front 12

QUADRANTS of abdominal wall - contents in right lower quadrant

Back 12

cecum and appendix

Front 13

QUADRANTS of abdominal wall - contents in left lower quadrant

Back 13

end of the descending colon and sigmoid colon

Front 14

Referred Abdominal Pain - epigastric region

Back 14

Pain arising out of the foregut derived structures

Front 15

Referred Abdominal Pain - umbilical region

Back 15

Pain arising out of the midgut derived structures

Front 16

Referred Abdominal Pain - hypogastric region

Back 16

Pain arising out of the hindgut derived structures

Front 17

Layers of the Anterior Abdominal Wall

Back 17

1) Skin
2) Superficial fascia (Camper & Scarpa)
3) Deep fascia
4) Muscles
5) Transversalis fascia
6) Extraperitoneal fat
7) Parietal peritoneum

Front 18

Superficial Fascia - Camper's (fatty layer) Fascia

Back 18

-continuous with superficial fat over the rest of the body

- may be extremely thick (8 cm or more in obese patients)

-continues over inguinal ligament to merge with the superficial fascia of the thigh

-continues over pubis as the superficial layer of superficial perineal fascia

Front 19

Superficial Fascia - Scarpa's (membranous) Fascia

Back 19

-deeper layer of superficial fascia with no fat

-attached to the fascia lata just below of inguinal ligament and continues over the pubis as membranous later (Colles fascia) of the superficial perineal fascia

Front 20

External Oblique (ORIAN)

Back 20

Origin: Muscular slips from outer surfaces of the lower eight ribs (V to XII)

Insertion: Lateral lip of iliac crest; aponeurosis ending in midline raphe (linea alba)

Innervation: Anterior rami of lower six thoracic spinal nerves (T7-T12)

Function: Compress abdominal contents; both muscles flex trunk; each muscle bends trunk to same side, turning anterior part of abdomen to opposite side

Front 21

Internal Oblique (ORIAN)

Back 21

Origin: Thoracolumbar fascia; iliac crest between origins of external and transversus; lateral two-thirds of inguinal ligament

Insertion: Inferior border of the lower three or four ribs; aponeurosis ending in linea alba; pubic crest and pectineal line

Innervation: Anterior rami of lower six thoracic spinal nerves (T7-T12) and L1

Function: Compress abdominal contents; both muscles flex trunk; each muscle bends trunk and turns anterior part of abdomen to same side

Front 22

Transversus Abdominis (ORIAN)

Back 22

Origin: Thoracolumbar fascia; medial lip of iliac crest; lateral one-third of inguinal ligament; costal cartilages lower six ribs (ribs VII to XII)

Insertion: Aponeurosis ending in linea alba; pubic crest and pectineal line

Innervation: Anterior rami of lower six thoracic spinal nerves (T7-T12) and L1

Function: Compress abdominal contents

Front 23

Rectus Abdominis (ORIAN)

Back 23

Origin: Pubic crest, pubic tubercle, pubic symphysis

Insertion: Costal cartilages of ribs V to VI; xiphoid process

Innervation: Anterior rami of lower seven thoracic spinal nerves (T7-T12)

Function: Compress abdominal contents; flex vertebral column; tense abdominal wall

Front 24

Pyramidalis (ORIAN)

Back 24

Origin: Front of pubis and pubic symphysis

Insertion: Into linea alba

Innervation: Anterior ramus of T12

Function: Tenses the linea alba

Front 25

Transversalis Fascia

Back 25

Forms a continuous lining of the entire abdominopelvic cavity

Front 26

Contributions of Transversalis Fascia

Back 26

-Deep inguinal ring
-Femoral Sheath

Front 27

Deep Inguinal Ring

Back 27

-formed by an outpouching of the transversalis fascia immediately above the midpoint of the inguinal ligament

-represents the lateral and deep opening of the inguinal canal

-inferior epigastric vessels are medial to the deep ring

Front 28

Femoral Sheath

Back 28

-inferior extension of the transversalis fascia

-deep to the inguinal ligament into the thigh containing the femoral artery and vein and the femoral canal

Front 29

Femoral Canal

Back 29

SITE OF FEMORAL HERNIA

Front 30

First structure which is crossed by any abdominal hernia

Back 30

Transversalis fascia

Front 31

Nerve Supply of Anterior Abdominal Wall

Back 31

-7 nerves total

-lower 5 intercostals

-1 subcostal and L1 (iliohypogastric and ilioinguinal)

Front 32

Which nerve can be anesthetized by injecting 1 inch superior to the ASIS?

Back 32

L1

Front 33

Neurovascular Plane

Back 33

-contains all nerves and deep blood vessels

-between internal oblique and transversus muscles

Front 34

Arterial Supply of Anterior Abdominal Wall – Important Superficial Arteries

Back 34

-supply skin
-superfical epigastric
-superficial circumflex iliac

Front 35

Arterial Supply of Anterior Abdominal Wall – Important Deep Arteries

Back 35

-lie in neurovascular plane
-superior epigastric
-posterior intercostal arteries
-lumbar arteries
-deep circumflex iliac artery
-inferior epigastric

Front 36

Deep Veins

Back 36

-superior epigastric
-inferior epigastric
-deep circumflex iliac veins
-posterior intercostal veins
-lumbar veins

Front 37

Superficial Veins – Lateral Thoracic Vein

Back 37

Network is drained above the umbilicus into the axillary vein via the lateral thoracic vein

Front 38

Superficial Veins – Superficial Epigastric

Back 38

Network is drained below into the femoral vein via the superficial epigastric and great saphenous veins

Front 39

Superficial Veins – Paraumbilical Veins, Portal Vein

Back 39

Connect the network through the umbilicus and along the ligamentum teres in falciform ligament to the portal vein

Front 40

Lymph Drainage of Anterior Abdominal Wall – Anterior Axillary Lymph Nodes

Back 40

Where the cutaneous lymph vessels above the level of the umbilicus drain upward

Front 41

Lymph Drainage of Anterior Abdominal Wall – Superficial Inguinal Nodes

Back 41

Where vessels below the level of the umbilicus drain downward

Front 42

Rectus Sheath

Back 42

-space which encloses the rectus abdominis muscle

-formed by fusion of the aponeurosis of the external oblique, internal oblique, and transverse muscles of the abdomen

Front 43

Rectus Sheath - Arcuate Line

Back 43

-Free margin of the lower part of the posterior wall of the rectus sheath

-all 3 aponeurosis come to anterior wall of rectus sheath