ABDOMINAL WALL AND INGUINAL REGION:

1. Determine the boundaries of the abdominal wall and abdominal region

Boundaries:
o Superiorly: formed by the diaphragm
! Diaphragm separates the abdominal cavity from the thoracic cavity
o Inferiorly: continuous with the pelvic cavity through the pelvic inlet
o Anteriorly: the abdominal wall is formed from above by the lower part of the thoracic
cage and below from the rectus abdominis, external oblique, internal oblique and
transverses abdominis muscle and fascia
o Posteriorly: formed in the midline by the five lumbar vertebrae and their IV discs
o Laterally: formed by the 12th rib, upper part of the bony pelvis, psoas muscle,
quadrates lumborum and aponeurosis of origin of the tranversus abdominis muscle
2. Define and illustrate the quadrants and regions of the abdominal wall

Horizontal Planes:
Xiphisternal
Transpyloric plane -9th costal cartilage, L1, between jugular notch and pubic symphysis
Supracristal
Transtubercular tubercles of iliac crest
Subcostal -10th costal cartilage
Interspinous spines of ilium
3. Describe the fascial lining of the abdominal walls
Skin
o Loosely attached to the underlying structures except the umbilicus
Superficial Fascia
o Can be divided into:
!
superficial fatty layer Campers fascia
Continuous with the superficial fat over the rest of the body
! deep membranous layer Scarpas fascia
Thin and fades out laterally and above where it becomes continuous
with the superficial fascia of the back and thorax
Inferiorly, it fuses with the deep fascia below the inguinal ligament.
In the midline inferiorly, it is not attached to the pubis but forms a
tubular sheath for the penis or clitoris
Below the perineum, it enters the wall of the scrotum or labia
majora and is attached on each side to the margins of the pubic
arch

o Now referred to as Colles fascia

Posteriorly, it fuses with the perineal body and the posterior margn
of the perineal membrane

Deep fascia
o Merely a thin layer of connective tissue covering the muscles
o It lies immediately deep to the membranous layer of the superficial fascia
Muscular Layer
o Consists of 3 broad thin sheets that are aponeurotic in front
! External Oblique
! Internal Oblique
! Transversus abdominis
o On either side of the midline anteriorly is a wide vertical muscle rectus abdominis
! The rectus abdominis is enclosed by the aponeuroses of the external
oblique, internal oblique and transversus abdominis, and this is referred to
as the rectus sheath
Fasica Transversalis
o Thin layer of fascia that lines the transversus abdominis muscle
o Continuous with a similar layer lining the diaphragm and iliacus muscle
Extraperitoneal Fat
o Thin layer of connective tissue that contains variable amount of fat between the
fascia transversalis and parietal peritoneum
Parietal peritoneu,
o Thin serous membrane and is continuous below with the parietal peritoneum lining
the pelvis
4. Give the cutaneous NVS of the anterior abdominal wall
Nerves of the Anterior Abdominal Wall:
Anterior rami of the lower 6 and 1st lumbar nerves
Pass forward in the interval between the internal oblique and transversus muscle
Thoracic nerves are the lower 5 intercostal nerves and subcostal nerves
o Lower 6 thoracic nerves pierce the posterior wall of the rectus sheath to supply the
rectus muscle and the pyrimidalis
! Pyrimidalis is innervated by T12 only
First lumbar nerve " iliohypogstric and ilioinguinal nerves
o Branches of the lumbar plexus
o Does not enter the rectus sheath
o The iliohypogastric nerve pierces the external oblique aponeurosis above the
superficial inguinal ring
o The ilioinguinal nerve emerges through the ring
Supply the skin of the anterior abdominal wall, muscles and parietal peritoneum
Arteries of the Anterior Abdominal Wall:
Superior Epigastric Artery
o One of the terminal branches of the internal thoracic artery
o Enters the upper part of the rectus sheath between the sternal and costal origins of
the diaphragm
o Descends behind the rectus muscle supplying the upper central part of the anterior
abdominal wall
o Anastomoses with the inferior epigastric vessels
Inferior Epigastric Artery
o Branch of the external iliac artery just above the inguinal ligament
o Runs upward and medially along the medial side of the deep inguinal ring
o Pierces the fascia transversalis to enter the rectus sheath anterior to the arcuate line
o Ascends behind the rectus muscle to supply the lower central part of the anterior
abdominal wall
Deep circumflex iliac artery
o Branch of the external iliac artery just above the inguinal ligament
o Runs upward and laterally towad the ASIS and then continues along the iliac crest

o Supplies the lower lateral part of the abdominal wall

Lower two posterior intercostals arteries
o Branches of the descending thoracic aorta and 4 limbar arteies
Veins of the Anterior Abdominal Wall
Superficial veins
o Forms a network that radiates out from the umbilicus
o Above, the network is drained into the axillary vein via the lateral thoracic vein
o Below, drained into the fermoral vein via superficial epigastric veins and great
saphenous vein
o Paraumbilical veins connect the network through the umbilicas and along the
ligamentum teres to the portal vein
5. Differentiate the muscles of the anterior abdominal wall giving its origin, insertion, NVS
External Oblique
o A broad thin muscular sheet that arises from the outer surfaces of the lower 8 ribs
and fans out to be inserted into the xiphoid process, linea alba, pubic crest and
anterior half of the iliac crest
o A triangular shaped defect lies in the external oblique aponeurosis and lies
immediately aboveand medial to the pubic tubercle known as the superficial
inguinal ring
o Between the ASIS and pubic tubercle, the lower border of the aponeurosis is folded
backward on itself to form the inguinal ligament
! From the medial end of the ligament, it extends backward and upward to the
pectineal line on the superior ramus of the pubis lacunar ligament
o Its sharp free crescentic edge forms the medial boundary of the femoral ring
Internal Oblique
o Broad thin muscular sheet that lies deep to the external oblique
o Most of its fibers run at right angles to those of the external oblique
o Arises from the lumbar fascia, anterior 2/3 of the iliac crest and lateral 2/3 of the
inguinal ligament
o Inserted into the lower borders of the lower 3 ribs and their costal cartilages, xiphoid
process, linea alba and symphysis pubis
Transversus
o A thin sheet of muscle that lies deep to the internal oblique
o Its fibers run horizontally forward
o It arises from the deep surface of the lower 6 costal cartilages, lumbar fascia,
anterior 2/3 of the iliac crest and lateral third of the inguinal ligament
o Inserted into the xiphoid process, linea alba and symphysis pubis
Rectus Abdominis
o Long strap muscle that extends along the whole length of the anterior abdominal wall
o Lies close to the midline, being separated from its fellow by the linea alba
o Arises by two heads, from the front of the symphysis pubis and from the pubic crest
o Inesertedinto the 5th ,6th and 7th costal cartilages and xiphoid process
o When it contracts, its lateral margins form a curved ridge linea semilunaris
ORIGIN
INSERTION
ACTION
INNERVATION

External Oblique

Lower 8 ribs

Internal Oblique

Lumbar
fascia,
iliac crest, later
2/3 of inguinal
ligament

Transversus

Lower six costal

cartilages, lumbar
fascia, iliac crest,

Xiphoid
process,
linea alba, pubic
crest,
pubic
tubercle, iliac crest
Lower 3 ribs and
costal cartilages,
xiphoid
process,
linea
alba,
symphysis pubis
Xiphoid
process,linea alba,
symphysis pubis

Supports abdominal
contents, compresses
abdominal contents,
assists in flexing and
rotation
of
trunk;
assists
in
forced
expiration, micturation
defecation, parturition
and vomiting
Compresses
abdominal contents

Lower six thoracic

nerves
and
iliohypogastric and
ilioinguinal nerves
(L1)

Rectus Abdominis

Pyrimidalis

lateral third of
inguinal ligament
Symphysis pubis
and pubic crest

Anterior surface of
pubis

5th, 6th and 7th

costal
cartilages
and
xiphoid
process
Linea alba

Compressesabdominal
contents and flexes
vertebral
column;
accessory muscle of
expiration
Tenses linea alba

Lower 6 thoracic
nerves

12th thoracic nerve

6. Describe and illustrate the formation of the rectus sheath at the following levels: costal margins,
between the costal margins and ASIS, below the ASIS and above the pubis
Rectus Sheath:
Long fibrous sheath that encloses the rectus abdominis muscle and pyrimidalis muscle
Contains the anterior rami of the lower 6 thoracic nerves and the superior and inferior
epigastric vessels and lymph vessels
Formed mainly by the aponeurosis of the 3 lateral abdominal muscles
3 levels:
o Above the costal margin
! Anterior wall is formed by the aponeurosis of the external oblique
! Posterior wall is formed by the:
thoracic wall (5th, 6th and 7th costal cartilages and intercostals
space)
o Between the costal margin and the level of the ASIS:
! The aponeurosis of the internal oblique splits to enclose the rectus muscle
! The external oblique is directed in front of the muscle
! Transversus aponeurosis os directed is directed behind the muscle
o Between the level of the ASIS and pubis
! The aponeuroses of all three muscles form the anterior wall
! Posterior wall is absent and the rectus muscle lies in contact with the fascia
transversalis
Arcuate line at the level of the ASIS, the aponeurosis forming the posterior wall in fron of
the recuts has a free, cruved lower border
o At this level, the inferior epigastric vessels enter the rectus sheath and pass upward
to anastomose with the superior epigastric vessels
7. Describe the inguinal canal as to its location, boundaries or walls openings, contents and clinical
importance
Inguinal Canal
1.5in long (4cm)
An oblique passage through the lower part of the anterior abdominal wall
Allows structures to pass to and from the testis to the abdomen in males
o In females, it permits the passage of the round ligament of the utersus from the
uterus to the labium majus
Also transmits the ilioinguinal nerve
Extends from the deep inguinal ring, a hole in the fascia transversalis , downward and
medially to the superficial inguinal ring, a hole in the aponeurosis of the external oblique
o Deep Inguinal Ring
! Oval opening in the fascia transversalis
! About 0.5 in (1.3 cm) above the inguinal ligament midway between the ASIS
and symphysis pubis
! Related medially are the:
Inferior epigastric vessels

! Margins of the ring give attachment of the internal spermatic fascia

Superficial Inguinal Ring
! Triangular shaped defect in the aponeurosis of the external oblique muscle
! Lies immediately above and medial to the pubic tubercle
! Margins of the rings are called crura and give attachment to the external
spermatic fascia

8. Describe the spermatic cord as to its structures/compositions and layers/coverings

Spermatic Cord:
A collection of structures that pass through the inguinal canal to and from the testis
Covered with 3 concentric layers of fascia derived from the layers of the anterior abdominal
wall
Begins at the deep inguinal ring lateral to the inferior epigastric arteries and end in the testis
Structures/ Composition:
o Vas deferens
o Testicular artery
o Testicular veins
o Testicular lymph nodes
o Autonomic nerves
o Processus vaginalis
o Cremasteric artery
o Artery of the vas deferens
o Genital branch of the genitofemoral nerve
Coverings of the Spermatic cord:
Covering of the spermatic cord:
Derived from:
Internal Spermatic Fascia
Fascia Transversalis
Cremasteric fasica
Internal Oblique Aponeurosis
External Spermatic fascia
External Oblique Aponeurosis
**mnemonic: ICE TIE
9. Describe and illustrate the inguinal triangle
Inguinal Triangle:
Boundaries:
o Medial border: linea semilunaris
o Superolateral border: inferior epigastric vessels
o Inferior border: inguinal ligament