General Anaphy

Abdomen

is the region of the trunk that lies between the diaphragm above and the inlet of the pelvis below.

Skin

is loosely attached to the underlying structures

umbilicus

where it is tethered to the scar tissue.

linea alba

site of attachment of the umbilical cord in the fetus; it is situated in

anterior abdominal wall

supplied by the anterior rami of lower 6th thoracic and 1st lumbar nerves

iliohypogastric and the ilioinguinal nerves.

1st lumbar nerve is represented by

Arteries

Skin near the midline supplied by: Superior and inferior epigastric arteries

Veins

Above drains into the axillary vein via the lateral thoracic vein

Superficial Fascia

• Fatty layer (fascia Camper)

• Membranous layer (Scarpa’s fascia)

superficial part

deep layer

muscle of the anterior abdominal wall

External oblique

• Internal oblique

• Transversus

Rectus abdominis

A wide vertical muscle at the either side of the midline

Rectus sheath

Formed by the aponeurosis of the 3 sheets pass forward

Pyramidalis

A small muscle at the lower part of the rectus sheath

External Oblique

Is a broad, thin, muscular shee

arises

from the outer surfaces of the lower right ribs

Inserted

to the xiphoid process, lines alba, pubic crest, pubic tubercle and anterior half of the iliac crest

Superficial inguinal ring

A triangular-shaped defect in the external oblique aponeurosis lies immediately above and medial to the pubic tubercle

External spermatic fascia

a thin membrane, continuation of the superficial fascia of the abdominal wall and the aponeurosis of the oblique externe muscle of the abdomen

Inguinal Ligament

Formed between the anterior iliac spine and pubic tubercle

Inguinal Ligament

Formed between the anterior iliac spine and pubic tubercle

Lacunar ligament (Gimbernat’s)

• extends backward and upward to the pectineal line on the superior ramus of the pubis

Femoral Ring

A sharp, free crescentric edge

Lacunar ligament (Gimbernat’s)

extends backward and upward to the pectineal line on the superior ramus of the pubis

Pectineal ligament

Lacunar ligament becomes continuous with a thickening of the periosteum

Fascia Lata

the inferior rounded border of the inguinal ligament is attached the deep fascia of the thigh

Internal Oblique Muscle

is also a broad, thin, muscular sheet that lies deep to the external oblique

Cremaster muscle

As the spermatic cord (or round ligament of the uterus) passes under the lower border of the internal oblique

Transversus Muslce

thin sheet of muscle that lies deep to the internal oblique

Rectus Abdominis

s a long strap muscle that extends along the whole length of the anterior abdominal wall

Tendinous intersection

Divides the muscle into distinct segments

Rectus sheath

• At the intersection of the muscle • Strongly attaches to the anterior wall

Pyramidalis

• Often absent

• It lies in front of the lower part of the rectus abdominis

Rectus Sheath

• Arcuate line

is an area of demarcation visible from the peritoneal surface of the abdominal wall, residing one-third the distance between the umbilicus and the pubis

Rectus sheath

• Linea alba

A fibrous band that separates the rectus sheath

Functions of the Anterior Abdominal Wall Muscles

• Oblique muscles

• Laterally flex and rotate the trunk

Functions of the Anterior Abdominal Wall Muscles

• Rectus Abdominis

Flexes the trunk and stabilizes the pelvis

Muscles of Anterior and Lateral abdominal walls

Assist the diaphragm during inspiration

Oblique and transversus abdominis muscles

are supplied by

the lower six thoracic

nerves and the

iliohypogastric and

ilioinguinal nerves

Rectus muscle

e is supplied by the lower six thoracic nerves

• Pyramidalis

s supplied by the 12th thoracic nerve

Fascia Transversalis

is a thin layer of fascia that lines the transversus abdominis muscle

Fascia Iliaca

Covers the iliacus muscle

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

Parietal Peritoneum

Lines the walls of the abdomen

Nerves of the Anterior Abdominal Wall

are the anterior rami of the lower six thoracic and the 1st lumbar nerves

lower six thoracic nerves

pierce the posterior wall of the rectus sheath to supply the rectus muscle and the pyramidalis (T12 only)

iliohypogastric

nerve, which pierces the external oblique aponeurosis above the superficial inguinal ring

ilioinguinal nerve

which emerges through the ring

1st lumbar nerve

• Supplying

the skin just above the inguinal ligament and symphysis pubis

Superior epigastric artery

Terminal branch of internal thoracic

Inferior Epigastric Artery

• Supplies

the lower central part of the anterior abdominal wall

Deep Circumflex Iliac Artery

a branch of the external iliac artery just above the inguinal ligament

Deep Circumflex Iliac Artery

• Supplies

the lower lateral part of the abdominal wall

• Lower two posterior intercostal arteries

branches of the descending thoracic aorta

Four lumbar arteries

branches of the abdominal aorta

Supply

the lateral part of the abdominal wall

Veins of The Anterior Abdominal Wall

Superficial Veins

form a network that radiates out from the umbilicus

Veins of The Anterior Abdominal Wall

• Superficial Veins

• Drains the upper area

Superficial Veins • Femoral vein via superficial epigastric and great saphenous vein

Drains the lower area

Deep Veins

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

Deep Veins

• Posterior intercostal veins

drain into the azygos veins, and the lumbar veins drain into the inferior vena cava.

Superficial Lymph Vessels

Anterior axillary group of nodes lymph drainage of the skin of the anterior abdominal wall above the level of the umbilibus

Superficial Lymph Vessels

Superficial inguinal nodes lymph drains downward and laterally below the level of the umbilibus

Deep Lymph Vessels

follow the arteries and drain into the internal thoracic, external iliac, posterior mediastinal, and para-aortic (lumbar) nodes

Inguinal Canal

is an oblique passage through the lowerpart of the anterior abdominal wall

testis

In the males, it allows structures to pass to and from the testis to the abdomen

uterus

In females, it allows the round ligament of the uterus to pass from the uterus to the labium majus.

Superficial inguinal ring

is a triangular-shaped defect in the aponeurosis of the external oblique muscle

cura

Margins of the ring, sometimes called

Internal spermatic fascia (or the Internal covering of the round ligament of the uterus)

Margins if the deep inguinal ring gives attachment to it

Anterior wall

• External oblique aponeurosis

Reinforced laterally by the origin of internal oblique

Posterior wall

Conjoint tendon medially, fascia transversalis laterally

Roof or Superior wall

Arching lowest fibers of the internal oblique and transversus abdominis muscles

Floor or Inferior wall

Upturned lower edge of the inguinal ligament and, at its medial end, the lacunar ligament

Spermatic Cord

a collection of structures that pass through the inguinal canal to and from the testis

Vas Deferens (Ductus Deferens)

cordlike structure • It is a thick-walled muscular duct that transports spermatozoa from the epididymis to the urethra

Lymph Vessels

ascend through the inguinal canal and pass up over the posterior abdominal wall to reach the lumbar (para-aortic)

Sympathetic fibers

run with the testicular artery from the renal or aortic sympathetic plexuses

run with the testicular artery from the renal or aortic sympathetic plexuses

accompany the efferent sympathetic fibers

Processes Vaginalis

The remains of the processus vaginalis are present within the cord

Genital Branch of the Genitofemoral Nerve

This nerve supplies the cremaster muscle

Coverings of the Spermatic Cord (Spermatic Fasciae)

The coverings of the spermatic cord are three concentric layers of fascia

External spermatic fascia

derived from the external oblique aponeurosis and attached to the margins of the superficial inguinal ring

Cremasteric fascia

derived from the internal oblique muscle

Internal spermatic fascia

derived from the fascia transversalis and attached to the margins of the deep inguinal ring

Scrotum

is an outpouching of the lower part of the anterior abdominal wall.

Layers of wall of the scrotum:

• Skin

is thin, wrinkled, and pigmented and forms a single pouch.

• Superficial Fascia

s continuous with the fatty and membranous layers of the anterior abdominal wall

dartos muscle.

the fat is replaced by smooth muscle called the

Spermatic fasciae

External spermatic fascia

is derived from the aponeurosis of the external oblique muscle

Cremasteric fascia

is derived from the internal oblique muscle

Internal spermatic fascia

is derived from the fascia transversalis

Tunica Vaginalis

lies within the spermatic fasciae and covers the anterior, medial, and lateral surfaces of each testis.

Testis

s a firm, mobile organ lying within the scrotum • Left testis usually lies at a lower level than the right.

Epididymis

• is a firm structure lying posterior to the testis, with the vas deferens lying on its medial side.

testicular artery

s a branch of the abdominal aorta.

testicular veins

emerge from the testis and the epididymis as a venous network, the pampiniform plexus

Labia Majora

are prominent, hair-bearing folds of skin formed by the enlargement of the genital swellings in the fetus

Posterior abdominal wall is formed

• Midline

by the five lumbar vertebrae and their intervertebral discs

Laterally

by the 12th ribs, the upper part of the bony­ pelvis, the psoas muscles, the quadratus lumborum muscles, and the aponeuroses of origin of the transversus abdominis muscles