Abdominal

Anatomy
Learning objective :
Abdominal Wall
- Anterolateral wall
- Posterior wall
Abdomen Cavity
- Intraperitoneal organ
- Retroperitoneal organ
Abdomen
 Structure of Abdominal Cavity
Superiorly diaphragm
Inferiorly pelvic
cavity
Anteriorly lower part
of the thoracic cage,
external & internal
oblique, transversus
abdominis muscles and
fasciae
Posterior lumbal,
costae XII, pelvic,
muscle (psoas,
quadratus lumborum,
aponeurosis origo
transversus abdominis,
iliacus)
It is customary to relate pains, swellings, or the positions of
organs to one of these regions.
 Anterior Abdominal Wall
The anterior abdominal
wall is clearly defined by
anatomical borders.

The superior border is

marked by the costal
margins,

the inferior border is the

pubic symphysis
 Anterior Abdominal Wall
Generally, the anatomical layers of the abdominal
wall (deep to superficial) are as follows:
peritoneum,
extraperitoneal fascia (deep fascia),
muscle
superficial fascia (Camper and Scarpa
fascia)
skin.
The presence or absence of various layers is
location dependent

These distinct tissue types necessary for

consideration when closing the surgical abdomen.
 Skin
The abdominal skin is
transgressed by Langer
lines, also called
cleavage lines. In the
anterior abdominal wall
transversely.
So, vertical skin incisions
increased lateral
tension, wider scars,
wound dehiscence and
hernia formation.
low transverse
incisions(e.g
Pfannenstiel) superior
cosmetic results.
 Nerve supply
The abdominal skin the
anterior rami of the T7-L1
thoracoabdominal nerves.

T7-T9 thoracoabdominal
nerves innervate the skin
above the umbilicus;
T10 thoracoabdominal nerves
innervates the skin around the
umbilicus
T11 thoracoabdominal nerves
plus cutaneous branches of
the subcostal (T12),
iliohypogastric, and ilioinguinal
(L1) nerves supply the skin
inferior to the umbilicus.
 Blood Supply
Skin near the midline is
supplied by
branches of the
superior epigastric
artery (br. of int.
thoracic artery) and
the inferior epigastric
artery ( br. of
external iliac artery)

Skin of the flanks

branches from the
intercostal, lumbar,
and deep circumflex
arteries
 Venous Blood
The venous blood is
collected into a
network of veins that
radiate out from the
umbilicus.

Network drained above

into Axilary veins via
lateralis thorasics veins

Below into femoralis

vein via the superficial
epigastrics and great
saphenos vein.
Lymph drainage
The cutaneus lymph vessel above the umbilicus
upward into the anterior axilary lymph nodes.
Below umbilicus downward into the superficial
inguinal nodes.
SUPERFICIAL FASCIAE

Camper and Scarpa

fasciae
Superior to the umbilicus
single layer
Inferior to the umbilicus
2 layers.
The more superficial and
fatty layer is the Camper
fascia.
The deeper, more fibrous
layer is the Scarpa fascia.
very little fat
fascia lata : superficial
fascia of the thigh
Colles fascia: perineum
 Deep Fascia
Deep fascia in the anterior abdominal wall is
merely a thin layer of connective tissue covering
the muscles

It lies immediately deep to the membranous

layer of the superficial fascia
 Muscle
From exterior to interior
they are: (flat)
External Oblique
Muscle
Internal Oblique
Muscle
Transversus Abdominis
Aponeurotic

A wide vertical muscle:

Rectus Abdominis
Pyramidalis Muscle
External Oblique Muscle
Origin: Lower 8 ribs

Insertion: Xiphoid
process, linea alba,
pubic tubercle, iliac
crest

Action: Supports
abdominal contents,
assist in forced
expiration,
micturition,
defecation,
parturition, vomiting
Internal Oblique Muscle
Origin: Lumbar fascia,
iliac crest, lateral two-
thirds of inguinal
ligament

Insertion: Lower three

ribs and costal cartilages,
xiphoid process, linea
alba, symphysis pubis

Action: Supports
abdominal contents,
assist in forced
expiration, micturition,
defecation, parturition,
vomiting
Transversus Abdominis
Origin: Lower six costal
cartilages, lumbar
fascia, iliac crest,
lateral third of inguinal
ligament

Insertion: Xiphoid
process, linea alba,
symphysis pubis

Action: Compresses
abdominal contents
Rectus Abdominis
Origin: Symphysis pubis
and pubic crest

Insertion: 5th, 6th and 7th

costal cartilages and
xiphoid process

Action: Compresses
abdominal contents,
flexes vertebral column,
accessory muscle of
expiration
 RECTUS SHEATH
Is a long fibrous sheath

Encloses the rectus

abdominis and
pyramidalis muscle (if
present)

Formed mainly by
aponeurosis of three
lateral abdominal
muscles
For description it is considered at three levels:

1. Above the costal margin the anterior wall is

formed by the aponeurosis of the external
oblique and posterior wall is formed by the
thoracic wall

That is the 5th , 6th and 7th costal cartilages and

the intercostal spaces
2. Between the costal margin and the level of the
anterosuperior iliac spine, the aponeurosis of the
internal oblique splits to enclose the rectus
muscle

The anterior layer of the internal oblique blends

with the aponeurosis of the external oblique.

Posterior to the rectus muscle , this aponeurosis

blends with the aponeurosis of the transversus
abdominis to form a portion of the posterior
rectus sheath.
3. Between the level of the anterosuperior
iliac spine and the pubis, the aponeurosis
of all three muscles form the anterior wall

The posterior wall is absent

The rectus muscle lies in contact with the

fascia transversalis
ARCUATE LINE (of Douglas)
the aponeuroses forming the
posterior wall pass in front
of the rectus abdominis at
the level of ant.sup. Iliac
spine, the posterior wall has
a free, curved lower border.

LINEA ALBA
The rectus sheath is
separated from its fellow on
the opposite side by a
fibrous band called the linea
alba

Extends from the xiphoid

process to the symphysis
pubis
 Nerve Supply of Ant. Abdominal Wall
Muscle

Oblique & transversus

abdominis muscle :
The lower 6 thoracics
nerves
The iliohipogastric &
ilioinguinal nerves
(L1)
Rectus muscle
- The lower 6 thorasics
nerves
Pyramidalis muscle
- Twelfth thorasic nerve
Fascia Transversalis
Thin layer of fascia that lines the
transversus abdominis muscle
With diapraghmatic fascia, the
iliacus fascia, and the pelvic
fascia. form one continuous
lining to the abdominal and
pelvic cavities

Extraperitoneal Fat
Thin layer of connective tissue
Contains a variable amount of fat
Lies between fascia transversalis
and the parietal peritoneum

Parietal Peritoneum
Thin serous membrane
Lines the walls of the abdomen
Continuous below parietal
peritoneum lining the pelvis
 Arteries of the Anterior
Abdominal Wall
Subcutaneous
The superficial epigastric
artery
The superficial external
pudendal arteries
The superficial circumflex
iliac artery
Muscle and their aponeurosis
The inferior epigastric
arteries
The superior epigastric
arteries
The deep circumflex
arteries
The musculophrenic
arteries
 Location of deep
and superficial
vessels of the
anterior
abdominal wall.
Blue circles
indicate
recommended
locations for
trocar placement.
 Veins of the
Anterior Abdominal
Wall

The inferior epigastric , the

superior epigastric, and the
deep circumflex drain
into the internal thoracic
and external iliac veins

The posterior intercostal

into the azygos veins

The lumbar veins into

the inferior vena cava

.
Posterior
abdominal wall
Formed by:

Midline
The five lumbar vertebrae
and their intervertebral discs

Laterally
The twelfth ribs
The upper part of the bony
pelvis
The psoas muscle
The quadratus lumborum
muscle
The aponeurosisi of origin
of the transversus
abdominis muscles.
 Psoas mayor et minor
Origin :
The roots of the
transverse processes
The sides of the vertebral
bodies
The intervert Th XII to L V
Insertion : throchanter minor
Inervation : lumbar plexus
Action :
o flexes the thigh
o If the thigh is fixed; flexes
the trunk ( sitting up from
a lying position )
 Quadratus lumborum
Origin : crista iliaca
Insertion : proc.
Ttranversus vert. L1-4
Innervation : n.
Lumbalis
Action :
o Fixes or depresses
the twelfth rib during
respiration
o Laterally flexes the
vertebral column to
the same side
 Iliacus
Origin : fossa iliaca
Insertion :
trochanter minor
Innervasi : femoral
nerve
Action : similar
with psoas muscle
 Abdominal Cavity
Many vital organs
Gastrointestinal tract, liver, biliary ducts,
pancreas, spleen, and parts of the urinary
system
Aorta and its branches
The inferior vena cava
The important portal vein
 Peritoneum
The serous membrane that forms the lining of the abdominal cavity
Support the abdominal organs
Serves as a conduit for their blood and lymph vessels and nerves

The parietal peritoneum

Outer layer Line the walls of the abdominal and pelvic cavities
The visceral peritoneum
Inner layer Covers the organs

Space between peritoneal cavity

Peritoneal cavity
Contains small amount of fluid ( about 50ml) that serves as a
lubricant and has antiinflammatory properties
In females communicates with exterior of body via uterine tubes,
uterus and vagina
 Intraperitoneal &
Retroperitoneal
Intraperitoneal organs
Nearly totally covered by visceral peritoneum
Attached to body wall by mesenteries and
ligaments
Liver, spleen, stomach, jejunum, ileum,
transverse & sigmoid colon, superior rectum

Retroperitoneal organs
Only partially covered with visceral peritoneum
Primary : kidney
Secondary : adrenal glands, pancreas, ascenden
& descenden colon
(R.K., L.K.), pancreas (P.),
spleen (Sp.), and stomach
(St.) are shown, as well as
the aorta (Ao.) and splenic
artery, inferior vena cava
(I.V.C.), portal vein (P. V.),
bile duct, and hepatic
artery. The greater sac of
the peritoneal cavity
(around the liver, for
example) can be traced
through the epiploic
foramen (arrow) into the
lesser sac between the
stomach and pancreas. L.
V., lumbar vertebra. (After
Symington.) B represents
the principle of the
arrangement of the
peritoneum and its
mesenteries
Parts of peritoneum :
Mesentry :
The double layer of peritoneum that suspends
the jejunum and ileum from the posterior wall of
the abdomen
Mesocolon
Double layer of peritoneum connects large
intestine to posterior abdominal wall
Omentum
Broad, double layered sheet of peritoneum that
connects stomach to another abdominal organ
2 parts ;
Greater omentum
Lesser omentum
 twelfth thoracic
Vertebra
Falciform ligament : connect ant.surface of liver
to ant.abdominal wall above the umbilicus and to
the diapraghm. lies slightly to the right of the
midline
Ligamentum teres obliterated umbilical vein of
the fetus which passes upward to enter the
groove between the quadrate lobe and the left
lobe of the liver
Celiac axis (trunk,
artery)
a. First unpaired
branch off
abdominal aorta (~
L-1)
b. Originates from
ventral surface
c. Gives rise to splenic,
common hepatic, &
left gastric arteries
Superior Mesenteric
Artery
a. Second, unpaired
branch of abdominal
aorta
b. Originates ~ lower
L-1 body
c. 1 2 cm below
celiac axis
d. Supplies small
intestines, pancreas,
omentum, ascending
and transverse colon
Inferior Mesenteric
Artery

a. Arises just above

the bifurcation of
the aorta (~L-3/4)
b. Last unpaired
branch of aorta
c. Supplies jejunum,
descending and
sigmoid colon,
rectum
Renal arteries
a. First major
paired branches
from aorta
b. Arise opposite
each other 1-2
cm below SMA
(~L-2)
c. Multiple renal
arteries occur in
20% of patients
Common Hepatic
Artery
a. Right branch of
celiac a.
b. Continues to
GDA, then

Proper Hepatic
Artery
a. Branches within
liver
b. Begin at ~porta
hepatis
Inferior Vena Cava
a. Formed at ~ L-5
b. by union of
Common Iliac Veins
c. Largest vein in body
d. Dilation may be due
to:
1. right-sided CHF
2. Portal
hypertension
Veins of Portal
Circulation
a. SMV: joins with
splenic vein
1. runs parallel to
SMA
2. On right side of
abdomen
b. IMV: terminates in
splenic vein
c. Portal Vein: enters
liver
Renal Veins run parallel to renal
arteries
Major Veins of the Abdomen

Figure 19.21