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INTRODUCTION
ANATOMY OF ABDOMEN
• The abdomen is the lower part of the trunk and lies below
the diaphragm.
• It is divided by the plane of the pelvis inlet into a larger
upper part, the abdomen proper and a smaller lower part,
the true pelvis.
B. ARUN, MPT,CMPT,COHS.
• The abdomen is bounded to a large extent by muscles,
PROFESSOR IN PHYSIOTHERAPY
which can easily adjust themselves to periodic changes in
the capacity of abdominal cavity.

• The abdominal wall is made up of the

MUSCLES OF THE ANTERIOR
following six layers
ABDOMINAL WALL
1. Skin

2. Superficial fascia

3. Muscles

4. A continuous layer of fascia

5. Extra peritoneal connective tissue

6. Peritoneum.

Muscles of the Abdominal Wall

Introduction
• The anterior abdominal wall is made up mainly of
muscles.
• On either side of the midline there are four large
muscles.
• These are
1. External oblique,
2. Internal oblique
3. Transverse abdmonins
4. Rectus abdominis

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• Apart from it two small muscles also present

1) Cremaster
2) Pyramidalis • It is enclosed in a sheath formed by the
• The Ext.oblique, Int.oblique, TA are large flat muscles
aponeuroses of flat muscles named above.
placed in the antero-lateral part of abdominal wall.
• Ends in an extensive aponeuroses that reaches the • The various muscles are considered one by one
midline. below.
• The aponeuroses of the right and left sides decussate to
form a median band called the linea alba.
• The rectus abdominis runs vertically on either side of the
linea alba.

Nerve supply:
Origin: • Lower six thoracic nerves
– the muscle arises by eight fleshy slips from the lower eight ribs,
– The fibres run downwards, forward and medially.

Insertion:
– Most of the fibres of the muscles end in a broad aponeuroses
through which they are inserted into the Xiphoid process, the linea
alba, the pubic symphysis, the pubic crest and the pectineal line of
the pubis.
– The lower fibres of the muscle are inserted directly into the
anterior two third of the outer lip of the illiac crest.

Nerve supply:
Origin:
• Lower six thoracic nerves & first lumbars
– Lateral two third of the inguinal ligament
– The anterior two third of the intermediate area of illiac crest
– The thoracolumbar fascia.
Insertion:
– The upper most fibres inserted directly into lower three or
four ribs and cartilages.
– Greater part of the muscles ends in an aponeurosis through
which it is inserted into 7th,8th, &9th costal cartilage, Xiphoid,
linea alba, pubic crest and pectineal line of pubis.

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Nerve supply:
Origin:
– Lateral two third of the inguinal ligament
• Lower six thoracic nerves & first lumbars
– The anterior two third of the inner lip of illiac crest
– The thoracolumbar fascia.
– Inner surfaces of the lower six costal cartilages.
Insertion:
– The fibres end in a broad aponeurosis which is inserted into
the xiphiod process, linea alba, pubic crest, and pectineal line
of the pubis.
– Internal oblique to form co-joined tendon.

Nerve supply:
Origin: • Lower six or seven thoracic nerves
– Lateral head from the lateral part of the pubic crest
– Medial head from the anterior pubic ligament
– The fibres run vertically upward

Insertion:
– On the front of the wall of throax, along a horizontal
line passing laterally from xiphoid process and
cutting the 7th ,6th &5th Coastal cartilage.

Actions of the main muscles of the

anterior abdominal wall MUSCLES OF THE POSTERIOR
• Support for abdominal viscera.
ABDOMINAL WALL
• Expulsive acts.

• Forceful expiratory acts.

• Movement of trunk.

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Psoas major
Introduction
• This is a fusiform muscle placed on the side of
• These are
the lumbar spine, & along the brim of the
1. Psoas major
pelvis. The psoas and the illiacus are together
2. Illiacus known as iliopsoas, due to their common
3. Quadratus lumborum insertion and action.

Origin:
Insertion
• From ant. Surfaces and lower border of transverse • The muscle passes behind the inguinal ligament

process of all lumbar vertebra. and in front of the hip joint to entre the thigh.

• By 5 slips one from the bodies of two adjacent
vertebra & IV disk from T12 to L5.
• From 4 tendinous arches extending across the
constricted parts of the bodies of lumbar vertebrae,
the origin is continuous from T12 to L5.
• It ends on a tendon which receives the fibres of
the iliacus on its lateral side.
• It is inserted into the tip and medial part of the
anterior surface of the lesser trochanter of the
femur.

Nerve supply Action

• With the iliacus, it acts as a powerful hip flexor
• Branches from L2, L3 & L4
• Maintaining stability at hip

• Balances trunk when sitting

• Lateral flexion of trunk ( act on one side)

• Lateral rotator of hip

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Psoas minor
Origin:
• This is a small muscle which lies in front of the
• Sides of the bodies of vertebrae
psoas major
• T12 & L1 and disc between them
• It is frequently absent.

Insertion Nerve supply

• The muscle ends in a long, flat tendon which is
inserted into the pecten pubis and the iliopubic • Branches from L1

eminence.

Action ILIACUS
• Triangular Muscle
• Weak flexors of trunk

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Origin:
Insertion
• Lateral part of anterior surface of lesser
• Upper two third of illac fossa
trochanter
• Inner lip of the iliac crest and the ventral
• The insertion extends for 2.5 cms below
sacroliac and iliolumbar ligaments
trochanter.
• Upper surface of the lateral part of the sacrum

Nerve supply Action

• With Psoas it flexes the hip joint
• Branches from femoral nerve

QUADRATUS LUMBORUM
Origin:
• This is a Quadrate muscle lying in the lumbar
• Transverse process of vertebrae L5
region.
• Iliolumbar ligament
• Its origin lies below and insertion above.
• Adjoining 2 inches of the inner lip of the iliac
crest

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Insertion
• Transverse process of the upper four lumbar
vertebra
• Medial half of the lower border of the last rib
(12)
Action
• Fixes the last rib during inspiration so that the
contraction of the diaphragm takes place more
effectively
• When the pelvis is fixed. It may cause lateral
flexion of the vertebral column
• The muscles of both side act together can extend
the lumbar vertebral column
EXTENT
• The posterior layer covers the loin and is
continued upwards on the back of the thorax
and neck
• The middle and anterior layer are confined to
the lumbar region.
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Nerve supply
• Ventral rami of spinal nerves T12 to L4
THORACO LUMBAR FASCIA
• This is the fascia enclosing the deep muscles of
back
• It is made up of three layers Posterior, Middle &
Anterior.
• The posterior layer is thickest and the anterior
layer is thinner.
ATTACHMENTS
A) Posterior layer
• Medially is attached to the tips of the lumbar and sacral
spines & interspinous ligaments.
• Laterally it blends with the middle layer at the lateral
border of erector spinae.
• Superiorly it continuous on to the back of the thorax
where it is attached to the vertebral spines
• Inferiorly it is attached to the posterior one fourth of the
outer lip of the iliac crest.
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MIDDLE LAYER
• Medially it is attached to the tips of the lumbar
transverse process and the intertransverse ligament
• Laterally it blends with the anterior layer at the
lateral border of the quadratus lumborum
• Superiorly it is attached to the lower border of the
12th rib and to the lumbocostal ligament
• Inferiorly it is attached to the posterior part of the
intermediate area of the iliac crest.
Rectus sheath
• This is an Aponeurotic sheath covering the
rectus abdominis muscle.
• It has two walls, Anterior & Posterior
Posterior Wall
• Incomplete, being deficinet above the coastal
margin and below the arcuate line
• Its composition is uniform
• It is free from Rectus muscle.
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Anterior layer
• Medially it is attached to the vertical ridges on the
anterior surface of the lumbar transverse processes
• Laterally it blends with the middle layer at the
lateral border of the Quadratus lumborum
• Superiorly it forms the lateral arcurate ligament
extending from the tip of the first lumbar
transverse process to the 12th rib.
• Inferiorly it is attached to the inner lip of the iliac
crest and the iliolumbar ligament.
Anterior Wall
• It is complete covering the muscle from end to
end.
• Its composition is variable
• It firmly adherent to the tendinous
intersection of the rectus muscle.
Details of walls
Above the Costal margin.
• Anterior wall: External oblique aponeurosis
• Posterior wall: It is deficient, the rectus rest directly
on coastal cartilage.
Below the Costal margin & Arcuate line.
• Ant: External oblique aponeurosis, Ant. Lamina of
aponeurosis of Internal oblique
• Post: Post. Lamina of the aponeurosis of internal
oblique., Aponeurosis of transverse muscle.
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• Midway between the umbilicus & the pubic Contents of rectus sheath
symphysis, the posterior wall of the rectus sheath
Muscles:
ends in the arcurate line.
Below the arcuate line:
• Rectus Abdominis is the chief & largest content

• Ant: Aponeuroses of all the three flat muscles of • Pyramidalis lies in front of the lower part of
abdomen, the aponeuroses of the transverses and Rectus
internal oblique are fused, but ext oblique is spared.
• Post: it is deficient, the rectus muscle rest on the
fascia transversalis.

Contents of rectus sheath Contents of rectus sheath

Arteries:
Veins:
• Superior Epigastric artery enters the sheath by passing
between the cosatal & xiphoid origin of the diaphragm. • Superior epigastric vein accompanies its artery
• It crosses the upper border of the transverse abdominis & joins the internal thoracic vein.
behind the 7th Costal cartilage.
• Inferior epigastric vein also accompanies its
• Supplies to Rectus muscle
artery & joins the external ilian vein
• Anastomoses with inferior epigastric artery
• Inferior Epigastric artery enters the sheath by passing in
front of arcurate line.

Contents of rectus sheath

Nerves:

• Lower six thoracic nerves

• Including lower 5 intercostal nerves and the

subcostal nerves.

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• This is an oblique passage in the lower part of the anterior
abdominal wall, situated just above the medial half of the
inguinal ligament
• It is about 4cm long
• It directed downwards, forward & medially.
• These margins are referred to as Curra.
• At and beyond, the apex of the triangle the two
crura are united by intercrural fibres.
Boundaries
Posterior wall is formed by the
a)Whole extent Fascia transversalis, Extraperitoneal
tissue & parietal peritoneum
b) Medial 2/3 by cojoint tendon, inguinal ligament
and over its lateral 1/3 by interfoveolar ligament.
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• Inguinal canal extends from the deep inguinal ring to the
superficial inguinal ring.
• The deep inguinal ring is an oval shape opening in the
fascia transversalis, situated half an inch above the mid-
inguinal point.
• Superficial inguinal ring is a traingular gap in the external
oblique aponeurosis.
• It is shaped like an Obtuse angled triangle.
• The Base of Triangle is formed by Pubic crest and two
sides from lateral and medial margins of the opening.
Boundaries
A) Anterior wall is formed by the following:
a) skin, superficial fascia & external oblique aponeurosis
b) lateral 1/3 the fleshy fibres of the internal oblique muscles
Int. Oblique
Ext. Oblique
Superficial fascia
ROOF
• Formed by arched fibres of the internal
oblique and transverse abdominis muscles
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FLOOR
• Formed by the grooved upper surface of the
inguinal ligament and at the medial end by the
lacunar ligament
• The inguinal canal is larger in males than in
Females.
Spermatic cord
Round Ligament
Obliquity of the inguinal canal
• The two inguinal rings do not lie opposite each
other.
• Therefore , when the intra-abdominal pressure
rises the anterior and posterior walls of the
canal are approximated,
• Thus obliterating the passage.
• This is known as Flap valve mechanism
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STRUCTURES PASSING THROUGH CANAL
1) Spermatic cord in males or
round ligament of uterus in females
It enters the inguinal canal through the deep inguinal
ring and passes out through the superficial inguinal ring.
2) Ilioinguinal nerve enters the canal through the interval
between the external and internal oblique muscles and
passes out through the superficial inguinal ring.
MECHANISM OF INGUINAL CANAL
• Presence of inguinal canal cause weakness in
the lower part of the anterior abdominal wall.
• This weakness is compensated by following.
• Superficial inguinal ring is guarded from behind the cojoint
tendon and by the reflected part of the inguinal ligament.
• Deep inguinal ring is guarded from the front by the fleshy
fibres of the internal oblique.
• Shutter mechanism of the internal oblique. This muscle has
triple relation to the inguinal canal. It forms the anterior wall,
the roof, & post wall of the canal. When it contracts roof
approximated to floor, like shutter.
• The arching fibres of the transversus also take part in shutter
mechanism.
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• Contraction of the cremaster helps the spermatic cord to plug the

superficial inguinal ring.
INGUINAL HERNIA
• Contraction of the external oblique results in approximation of the • Abnormal protrusion of abdominal contents into
two crura of the superficial inguinal ring. The integrity of the superficial the inguinal canal is known as inguinal hernia.
inguinal ring is greatly increased by the intercrural fibers.
• This is more likely to occur in persons in whom
• Hormones play a role in maintaining the tone of the inguinal
intra-abdominal pressure is frequently increased.
musculatures.
(e.g) chronic cough by work involving frequent
• When ever there is a rise in intra-abdominal pressure ( coughing,
sneezing, & lifting) all these mechanisms come into play , so that the lifting of heavy weights ect..
inguinal canal is obliterated, its openings are closed, and herniation of • Types Direct or Indirect hernia.
abdominal viscera is prevented.

INDIRECT INGUINAL HEINIA AND DIRECET

INGUINAL HEINIA

Abdominal Aorta Relation

• The abdominal aorta begins in the midline at the aortic Anteriorly : aorta related to

opening of the diaphragm, opposite the lower border of
vertebra T12.
• It runs downwards & slightly to the left in front of the lumbar
vertebrae, & ends infront of the lower part of the body of
vertebrae L4, about half an inch to the left of the median
plane, by dividing into the right & left common iliac arteries.
• Due to forward convexity of the lumbar vertebral column,
aortic pulsation can be felt in the region of the umbilicus,
particularly in slim persons.
1) Coeliac & aortic plexus
2) body of the pancreas with the splenic vein
embedded in its posterior surface.
3) Left renal vein clamped to aorta by the
origin of the superior mesenteric artery
4) The uncinate process of the pancreas
5) Third part of the duodenum
6) Parietal peritoneum separating it from
coils of small intestine.

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Posteriorly : aorta related to Right side of aorta there are

1. The bodies of the upper four lumbar vertebrae & IV 1) IVC

disc 2) Right crus of the diaphragm which separated aorta

2. Anterior longitudinal ligament from IVC above the level of the renal veins

3. Left lumbar veins 3) Cisterna chyil & azygos vein in the upper part

4. Beginning of lumbar arteries. 4) Lumbar lymph nodes.

Left side of aorta there are Branches

1) Left crus of the diaphragm
A ventral braches which develop from ventral
2) Pancreas
splanchnic arteries and supply the gut, these are.
3) Fourth part of the duodenum

4) Lumbar lymph nodes. • Coeliac trunk

5) Left sympathetic chain • Superior mesenteric artery

• Inferior mesenteric artery

Lateral braches which develop from lateral splanchnic

Dorsal braches represent the somatic
arteries and supply the viscera derived from the
intersegmental arteries and are distributed to
intermediate meseoderm these are the right & left.
the body wall. these are.
• Inferior phrenic arteries
• Lumbar arteries
• Middle suprarenal arteries
• Median sacral artery
• Renal arteries

• Testicular or ovarian arteries

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Terminal branches are a pair of common iliac

arteries.

They supply the pelvic & lower limbs.

INFERIOR VENA CAVA

Relations
Anteriorly: from above downwards. It is related to
• Formed by the union of the right & left common
1. Posterior surface of the liver
iliac veins on the right side of the body of the
2. Epipolic foramen
vertebra L5.
3. First part of duodenum & portal vein
• It ascends in front of the vertebral column on the rt
4. Head of pancreas along with bile duct
side of the aorta, grooves the posterior surface of
5. Third part of duodenum & gonadal vein
the live pierces the central tendon of the
6. Posterior parietal peritoneum & root of mesentery
diaphragm at the level of vertebra T8 & opens into
7. Right common iliac artery
the lower and posterior part of the rt atrium.

• Posteriorly : TRIBUTARIES
• Above the right crus of the diaphragm is separated
from the IVC by right renal , middle suprarenal & • Common iliac veins

inferior phrenic arteries, the right coeliac ganglion, (formed by the union of the external &
and the medial part of the right suprarenal gland, internal iliac veins) unite to from the IVC.

• Below, it is related to the right sympathetic chain Each vein receives an iliolumbar vein, the
and to the medial border of the right psoas. medial sacral vein joins the left common
iliac vein.

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• Third & Fourth lumbar veins:

• Right testicular vein,
run along with the corresponding arteries and
open into the posterior aspect of the IVC. opens into the IVC just below the entrance

The vein of the left side cross behind the aorta of the renal veins. The left gonadal vein
to reach the vena cava. drains into the left renal vein.
The 1st & 2nd lumbar veins may end in the 3rd
lumbar vein, the ascending vein, the azygos
vein to the hemiazygos vein.

• Right Suprerenal vein

• Hepatic veins
is extremely short, it emerges
from the hilum of the Three large and many small opens directly
gland and soon opens into
the IVC.
into the anterior surface of the IVC just
the left suprarenal vein opens before it pierces the diaphragm.
into the left renal vein.

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