Lecture - One: Anatomy of The Anterior Abdominal Wall

Lecture - one
Anatomy of the anterior

abdominal wall
Dr. Raya Abdul Ameer
CABHS-RAD , MBCHB
The abdominal wall represents the boundaries of the
abdominal cavity which located between the diaphragm
above and the pelvic inlet below
Boundaries
The anterior abdominal wall represent a hexagonal area :
Superiorly
xiphoid process ,
costal cartilage of 7th , 8th ,9th ,and 10th ribs
Laterally
Mid axillary line
Inferiorly
iliac crest , pubis and symphysis pubis .
Structures ( layers ) of the anterior abdominal wall
From out side to inside :
1-Skin
2-Superfiacial fascia
3-Deep fascia
4-Muscles
5-Transversalis fascia
6-Extra peritoneal fascia
7-Paraietal peritoneum
1-skin of the abdominal wall
The most important characters of skin of
abdomen are :-
-Thin , loosely attaches to the underlying structures

except the umbilicus
The umbilicus is a scar representing the
site of attachment of the umbilical cord
in the fetus , it is situated in lines alba .

2) Superficial Fascia
The superficial fascia is divided into two layers:
1-Superficial fatty layer (Camper's fascia)
Continue with fascia over thorax and thigh
In the scrotum, the fatty layer of the superficial fascia
exists as a thin layer of smooth muscle, the dartos
muscle
2- Deeper membranous layer (Scarpa's fascia)
*Continue in the perineum as
surpefacial perineal fascai ..called Colles fascia
*And continues inferiorly to the fascia of the
lower limbs and called fascia lata
3 - Deep Fascia
A thin layer of connective tissue covering the

muscles. It lies immediately deep to the
membranous layer of superficial fascia
4- Muscles
The muscular layers include five bilaterally paired muscles :
1 ) Three antero latreral muscles ….
three broad thin sheets of muscle that are most pronounced
( muscular ) posteriorly and laterally and become
aponeurotic anteriorly and medially . From exterior (
superficial ) to interior ( deep ):
1) External oblique
2) internal oblique
3) Transverse abdominis muscle
2) Two Anterior ( para median muscles ) include :

1 ) Rectus abdominis muscles form wide vertical straps
on either side of the anterior midline
2) Pyramidalis
Muscles of abdominal wall
1) External oblique muscle
Origin:- outer surface and inferior border of the lower eight ribs ( 5-12 )
Direction of fibers downward , for wards and medially
Insertion :-Xiphoid Process , Linea alba , pubic crest, pubic tubercle &
iliac crest
N supply :-
1- lower 6 thoracic nerves (T7 –T12 )
2- ilio-hypogastric and ilioinguinal nerves ( L1 )
Actions
-Supports abdominal contents
-Compress abdominal contents
-Assists in flexing and rotation of trunk
-Assists in forced expiration, micturition ,defecation , parturition, and
and vomiting
-* A triangular-shaped defect in the external oblique
aponeurosis lies Immediately above and medial to
the pubic tubercle. Called …superficial inguinal
ring .
The spermatic cord (or round ligament of the uterus)
passes through this opening
* The lower border of the aponeurosis is folded
backward on itself between the anterior superior iliac
spine and the pubic tubercle, forming the inguinal
ligament
*The lacunar ligament extends backward and

upward from the medial end of the inguinal ligament
to the pectineal line on the superior ramus of the
pubis , its sharp free edge formed the medial margin
of femoral ring .
2) Internal oblique muscle
1 ) Origin :
Lumbar fascia, iliac crest, lateral 2/3 of inguinal ligament
-Direction : up wards and forward

2) Insertion
Lower three ribs and costal cartilages , xiphoid process, linea alba,
symphysis pubis
3 ) NN supply :
-lower 6 thoracic nn (T7 –T12) ,
-Ilio hypogastric and ilio inguinal nn ( L1 )
4 ) Action :
-Supports abdominal contents
-compresses abdominal contents;
-Assists in flexing and Rotation of trunk
-Assists in forced expiration, micturition, defecation
, parturition, and vomiting
*Near their Insertion, the lowest tendinous fibers are
joined by similar fibers from the transversus abdominis
to form the conjoint tendon( attach medially to
linea alba and has free lateral border )
* As the spermatic cord passes under the lower border
of the internal oblique, it carries some muscle fibers
that are derived from the internal oblique. These fibers
that surround the spermatic cord constitute the
cremaster muscle
3)Transversus abdominis muscle
Origin:-
Lower six costal cartilages, lumbar fascia, iliac crest,
lateral third of inguinal ligament
Direction of fibers → horizontally and forwards
Insertion
-Xiphoid process, linea alba, symphysis pubis
N . Supply–
lower 6 thoracic nn &
iliohypogastric and ilioinguinal nnL1
Action :
Compresses abdominal contents
4) Rectus abdominis muscle
Longitudinal paramedial m
Origin:- lower end 2 heads
Med- head → symphysis pubis
Lat. head → pubic crest
Insertion:- upper end Front of 5,6,7th costal cartilage & Xiphoid
Process
N supply lower six thoracic n (T7-T12)
Action :
-Compresses abdominal contents
-Flex vertebral column
-Accessory muscle of expiration
*tendenous intersection s 3,4 transvers bands
(xiphoid P, umbilicus, midway bet. Xiphoid &umb, below umb.)
*Linea semilunaris –shallow curved groove along lateral. border
of muscle
The rectus abdominis is enclosed between the
aponeuroses of the external oblique, internal
oblique, and transversus abdominis, which form
the rectus sheath
Pyramidalis m
Small triangular m at the lower end

of rectus muscle ,some time absent
Origin –Anterior surface of pubis
Insertion-- lower part of L alba
N . Supply –12th thoracic nerve
Action -- Tenses the linea alba
5)The transversalis fascia
*Is a component of an extensive thin layer of fascia that
lies between the muscle layer of the abdominal wall and
the parietal Peritoneum (It lines the inner surface of
transversus abdominis muscle )
*At the midpoint between the anterior superior iliac spine
and the symphysis pubis, the spermatic cord pierces the
transversalis fascia to form the deep
Inguinal ring
6) Extra peritoneal Fascia
The extra peritoneal fascia is a thin layer of connective
tissue that contains a variable amount of fat. It lies
between the transversalis fascia and the parietal
peritoneum
7) Parietal Peritoneum
It lines the internal surface of the abdominal wall .It is a thin
serous membrane and is continuous below with the parietal
peritoneum lining the pelvis.
Arterial supply of the anterior abdominal wall
1- from above central part supplied by

Superior epigasteric artery and musculophrenic artery , branches
from internal thoracic artery a ( internal mammary a )
2- from above and laterally →
--10th, 11th posterior intercostal a & subcostal arteries all are
branches from thoracic aorta
3- from below →
-- central part by inferior epigastric artery branch from
external iliac artery
-- laterally deep circumflex iliac artery br. from ext. iliac a
-- inguinal region supplied by superficial circumflex iliac a
& superficial epigastric a , branches from femoral artery
Venous drainage of the anterior abdominal wall
Superfacial vein :
Form a net work that radiate out from the umbilicus
Above the umbilicus
Drain to the axillary vein via lateral thoracic vein
Below the umbilicus
Drain to femoral vein by superficial epigastric vein and great
saphenous vein
Deep veins
-Superior epigastrtic vv ..→ internal thoracic vv
-Inferior epigatric and deep circumflex iliac vein →
external iliac vv
-Posterior intercostal vv → azygos vv
Lymphatic drainage of ant. Abd. Wall
Superficial lymphatic vessels

Above the umbilicus ……axillary lymph nodes
Below the umbilicus …superficial inguinal lymph nodes
Deep lymphatic vessels

Follow the arteries and drain to
1-thoracic LN
2-external iliac LN
3-Posterior mediastinal LN
4-para oartic LN
Nerve supply of ant abd. wall
Derived from the ventral rami of T7 to L1

1-lower intercostal n(T7- T11)
2-subcostal n (T12)
3-iliohypogasteric (L1)
4-ilioinguinal n(L1)
Useful landmarks of The dermatomes of the anterolateral abdominal wall

are :
Superior to umbilicus ( T7,8,T9)
Around umbilicus T10
Inferior to umbilicus T11, T12, L1
• Dermatome T7: xiphoid process
• Dermatome Tl0: umbilicus
• Dermatome L1: pubis

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Lecture - one

Anatomy of the anterior

-Thin , loosely attaches to the underlying structures

The umbilicus is a scar representing the

site of attachment of the umbilical cord

in the fetus , it is situated in lines alba .

A thin layer of connective tissue covering the

2) Two Anterior ( para median muscles ) include :

*The lacunar ligament extends backward and

-Direction : up wards and forward

Small triangular m at the lower end

1- from above central part supplied by

Superficial lymphatic vessels

Deep lymphatic vessels

Derived from the ventral rami of T7 to L1

Useful landmarks of The dermatomes of the anterolateral abdominal wall

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