By :

Dr. BAHADUR KANWER (DPT)

 ABDOMEN
 The abdomen is the part of the trunk between the thorax and
the pelvis
 The abdomen is the region of the body that is located between
the diaphragm above and the pelvic inlet below.
 It is a flexible, dynamic container, housing most of the organs
of the digestive system and part of the urogenital
system.
The principal viscera of the abdomen are:
• The terminal part of the esophagus
• The stomach
• Intestines
• Spleen
• Pancreas
• Liver
• Gallbladder
• Kidneys
• Suprarenal glands
ABDOMINAL REGIONS
• Two sagittal (vertical) and Two transverse
(horizontal) planes divided the abdomen into 9
regions
• Describes the location of abdominal organs,
pains, or pathologies
It is divided into NINE quadrants, by:

Two vertical lines at the level of:

 Midclavicular point superiorly
 Midinguinal point inferiorly
Two horizontal lines at the level of:
 Subcostal edges superiorly
 Right and left iliac tubercles inferiorly
 QUADRANTS OF THE ABDOMINAL
CAVITY
 Four quadrants of the abdominal cavity (right and
left upper and lower quadrants) are defined by two
readily defined planes:
• The transverse transumbilical plane passing
through the umbilicus (and the intervertebral [IV] disc
between the L3 and L4 vertebrae), dividing it into
upper and lower halves,
• The vertical median plane passing longitudinally
through the body, dividing it into right and left halves
ANTEROLATERAL
ABDOMINAL WALL
 The Anterolateral abdominal wall
extends from the thoracic cage to
the pelvis
 Bounded superiorly by the
cartilages of the 7thto10th ribs and
the xiphoid process of the sternum
and inferiorly by the inguinal
ligament and the superior margins
of the anterolateral aspects of the
pelvic girdle (iliac crests, pubic
crests, and pubic symphysis)
 The structures of the
Anterolateral abdominal wall
from out side to inside:
1. Skin.
2. Superficial fascia.
3. Deep fascia
4. Muscles.
5. Extraperitoneal fascia
6. Parietal peritoneum.
• Skin is loosely attached to the underlining 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 the linea alba.
The superficial fascia is divided into:
 Superficial fatty layer (fascia of Camper)
 Deep membranous layer (Scarpa's fascia)

SUPERFICIAL FATTY LAYER (CAMPER’S FASCIA)

• It’s continuous with superficial fat over the rest of the body.
• In the scrotum is modified as a thin smooth muscular layer called dartos muscle.
 DEEP MEMBRANOUS LAYER (SCARPA’S FASCIA)
Anterolateral
 In the midline inferiorly, the membranous layer of fascia is not
attached to the pubis but forms a tubular sheath for the penis (or
clitoris).

 Below in the perineum, it enters the wall of the scrotum (or labia
majora).
 From there it passes to be attached on each side to the margins of
the pubic arch;
it is here referred to as Colles' fascia.
 Is a thin layer of connective tissue covering the muscles, it lies
immediately deep to the membranous layer of superficial fascia.
Muscles of Anterior Abdominal Wall

 External oblique
 Internal oblique
 Transvers abdominus
 Rectus abdominal
 Pyramidal
External oblique
• Origin : external surfaces of 5th to
12th
ribs.
• Insertion: linea and alba, pubic tubercle, and
anterior half of iliac crest.
• Nerve supply: thoracoabdominal nerves
(inferior 5 [T7 to T11] thoracic nerves) and
subcostal nerve.
• Action: compress and support abdominal
viscera, flex and rotate trunk
•There is a triangular-shaped defect in the external
oblique aponeurosis that lies immediately above and
medial to the pubic tubercle known as superficial
inguinal ring

•The spermatic cord (or round ligament of the uterus)

passes through this opening and carries the external
spermatic fascia (or the external covering of the round
ligament of the uterus) from the margins of the ring
Between the anterior superior iliac spine and the pubic
tubercle, the lower border of the aponeurosis is folded
backward on itself, forming The Inguinal Ligament .
From the medial end of the ligament, the
lacunar ligament extends backward and
upward to the pectineal line on the superior
ramus of the pubis
INTERNAL OBLIQUE MUSCLE
• Origin : thoracolumbar fascia, anterior two-
thirds of iliac crest, and lateral half of
inguinal ligament.
• Insertion: Inferior borders of 10th -
12th
ribs, linea alba, and pecten pubis via
conjoint tendon.
• Nerve supply: thoracoabdominal nerves
(anterior rami of inferior 6 thoracic nerves)
and first lumbar nerves
• Action: compress and support
abdominal viscera, flex and rotate trunk.
•Lower fibres of internal oblique are
joined by similar fibers from the
transversus to form the conjoint
tendon .

•As the spermatic cord (or round ligament of

the uterus) passes under the lower border of
the internal oblique, it carries with it some of
the muscle fibers that are called the
cremaster muscle .
TRANSVERSUS MUSCLE
• Origin : Internal surfaces of 7th - 12th
costal cartilages, thoracolumbar
fascia, iliac crest, and lateral third of
inguinal ligament .
• Insertion: Linea alba with
aponeurosis of internal oblique,
pubic crest, and pecten pubis via
conjoint tendon.
• Nerve supply: thoracoabdominal
nerves (anterior rami of inferior 6
thoracic nerves) and first lumbar
nerves
• Action: compress and support
abdominal viscera.
 RECTUS ABDOMINIS
•On either side of the midline anteriorly is, in
addition, a wide vertical muscle, the rectus
abdominis.

•As the aponeuroses of the three sheets pass

forward, they enclose the rectus abdominis to
form the rectus sheath.

•It is broader above and lies close to the

midline, being separated from its fellow by the
linea alba.
RECTUS ABDOMINIS
• Origin : pubic symphysis and pubic crest.
• Insertion: xiphoid process and 5thto 7th
costal cartilages.
• Nerve supply: thoracoabdominal nerves
(anterior rami of inferior 6 thoracic nerves).
• Action: flexes trunk, compresses abdominal
viscera; stabilizes and controls tilt of pelvis
(antilordosis)
PYRAMIDALIS
• Approximately 80% of people have an insignificant muscle,
the pyramidalis which is located in the rectus sheath
anterior to the most inferior part of the rectus abdominis.
• It extends from the pubic crest of the hip bone to the
linea alba.
• This small muscle draws down on the linea alba.
PYRAMIDALIS
• Origin : anterior surface of the
pubis.
• Insertion: Linea alba
• Nerve supply: Linea alba
• Action: Tenses the linea alba
•The extraperitoneal fat is a thin layer of connective tissue that contains a variable amount of fat and
lies between the fascia transversalis and the parietal peritoneum.

•The walls of the abdomen are lined with parietal peritoneum.

•This is a thin serous membrane and is continuous below with the parietal
peritoneum lining the pelvis.
ABDOMINAL INCISIONS
 When possible, the incisions follow the
cleavage lines (Langer lines) in the skin.
 Longitudinal incisions are used centrally
in the abdomen, because muscle and
vasculature are primarily longitudinally
oriented here and the nerves, which have
been approaching circumferentially or
transversely, diminish in size and
significance near the midline.
 Longitudinal incisions, such as median and
paramedian incisions, are preferred for
exploratory operations because they offer
good exposure of and access to the
viscera and can be extended as
necessary with minimal complication.
 Median or midline incisions can be made
rapidly without cutting muscle, major blood
vessels, or nerves.
 They cut through the fibrous tissue of the linea
alba, superior and/or inferior to the umbilicus.
 Because the linea alba transmits only small vessels
and nerves to the skin, a midline incision is relatively
bloodless and avoids major nerves
 Oblique and transverse incisions are used most
commonly on one side of the midline and
especially in the more peripheral abdomen where
their direction is related to muscle fiber orientation,
nearby hard tissue (costal margin or iliac or pubic
crest), or minimizing potential nerve damage
• The nerves of the anterior abdominal wall are the
anterior rami of the lower six thoracic and the first
lumbar nerves.
• The thoracic nerves are the lower five intercostal nerves
and the subcostal nerves
• First lumbar nerve is represented by the iliohypogastric
and ilioinguinal nerves, branches of the lumbar plexus
•They supply the skin of the anterior abdominal wall, the
muscles, and the parietal peritoneum.
• The lower six thoracic nerves pierce the posterior wall of
the rectus sheath to supply the rectus muscle and the
pyramidalis (T12 only).
• The oblique and transversus abdominis muscles are
supplied by the lower six thoracic nerves and the
iliohypogastric and ilioinguinal nerves (L1).
• The rectus muscle is supplied by the lower six
thoracic nerves.
• The pyramidalis is supplied by the 12th thoracic
nerve.

Dermatomes of the abdominal wall:

• The xiphoid process: T7
• The umbilicus: T10
• The pubis: L1
The skin near the midline is supplied by branches
of the
superior and the inferior epigastric arteries.

The skin of the flanks is supplied by branches

of the
 Intercostal arteries
 Lumbar arteries
 Deep circumflex iliac arteries
 The superior epigastric artery, one of the terminal
branches of the internal thoracic artery, enters the upper
part of the rectus sheath
 It descends behind the rectus muscle, supplying the
upper central part of the anterior abdominal wall, and
anastomoses with the inferior epigastric artery.

 The inferior epigastric artery is a branch of the

external iliac artery just above the inguinal ligament. The
rectus muscle, supplying the lower central part of the
anterior abdominal wall, and anastomoses with the superior
epigastric artery.
 The deep circumflex iliac artery is a branch of the
external iliac artery just above the inguinal ligament. It supplies the lower lateral part
of the abdominal wall.

 The lower two posterior intercostal arteries, branches of the descending thoracic
aorta, and the four lumbar arteries, branches of the abdominal aorta, pass forward
between the muscle layers and supply the lateral part of the abdominal wall
SUPERFICIAL VEINS
• The superficial veins form a network that radiates out from the
umbilicus.
• Above, the network is drained into the axillary vein via the
lateral thoracic vein.
• Below, into the femoral vein via the superficial epigastric and
great saphenous veins.
DEEP VEINS
• The deep veins of the abdominal wall, the superior epigastric,
inferior epigastric, and deep circumflex iliac veins, follow the
arteries of the same name and drain into the internal thoracic
and external iliac veins.
•Lymphatics in the region above the umbilicus drain
into the axillary lymph nodes which can be palpated just
beneath the lower border of the pectoralis major muscle
• Lymphatics in the region below the umbilicus
drain into the superficial inguinal nodes

• The deep lymph vessels follow the arteries and

drain into the internal thoracic, external iliac,
posterior mediastinal, and para-aortic (lumbar)
nodes.
REFERENCES
• Moore, Keith L.; Dalley, Arthur F, Clinically Oriented
Anatomy, 5th Ed. Lippincott Williams & Wilkins;
2006.
• Harold Ellis, Clinical Anatomy, Applied anatomy
for students and junior doctors, 11th Ed, Blackwell
Publishing Ltd, 2006
• Richard S.Snell, Clinical Anatomy by Regions, 8th
Ed. Lippincott Williams & Wilkins.