Abdomen 1

2.1 Surface anatomy

2.2 Anterior abdominal wall

Albert van Schoor

GNK 288 (SA4 Anatomy dissection)
 2.1.1 Surface anatomy
• Identify and name the bony landmarks of
the abdomen which are palpable on
abdominal examination and state if
possible their corresponding vertebral
heights on the cadaver, yourself and on a
radiograph
• Schematically illustrate and discuss the
nine abdominal regions and list which
organs lie approximately in each region
2.1.1 Surface Anatomy
 2.1.1 Surface anatomy

• Identify and name in which of the nine surface

anatomical regions you would expect to feel
tenderness in appendicitis, cholecystitis,
gastritis and cystitis
• Identify other surface anatomy lines e.g.
transpyloric line, transumbilical line, linea alba
and linea semilunaris. You should be able to
say how these lines are formed and to discuss
the intra-abdominal events occurring on the
transpyloric line
 2.1.1 Surface Anatomy

Referred pain
2.1.1 Surface Anatomy
2.1.1 Surface Anatomy
2.1.1 Surface Anatomy
 2.1.1 Surface Anatomy

• Transpyloric
plane
– Hilum of the
kidneys
– Pylorus of the
stomach
– Body of
pancreas
– Fundus of the
gall bladder
2.1.1 Surface Anatomy
 2.1.1 Surface anatomy
• Schematically illustrate and discuss the surface
anatomy of the kidneys, ureters and spleen on
the posterior abdominal wall [2.5, 2.8]
• Discuss and identify the surface anatomy of the
liver [2.4]
• Briefly discuss the surface anatomy of the
diaphragm and the vertebral heights of its three
major orifices [2.9]
• Identify the various dermatomes of the anterior
abdominal wall
• Indicate whether the bladder is an abdominal
organ or not. Explain
2.1.1 Surface Anatomy
2.2 Anterior abdominal wall

2.2.1 Skin and superficial fascia

2.2.2 Muscles
2.2.3 Transversalis fascia
2.2.4 Peritoneum
2.2.5 Rectus sheath
2.2.6 Inguinal area
2.2.7 Osteology
2.2.1 Skin and superficial fascia

• Identify the fatty superficial layer

(Camper's fascia)
• Identify and shortly discuss the
membranous superficial layer (Scarpa's
fascia) according to its distribution and
borders. State what this fascia is called
inferior to the superficial inguinal ring
 2.2.2 Muscles
• Identify and discuss the three major abdominal
muscles as follows:
– Major attachments to the following points: Linea
alba, crista iliaca and inguinal ligament where
applicable,
– Direction of fibres,
– Nerve supply and
– Function
• Identify the neurovascular plane
• Identify the ilio-inguinal and iliohypogastric
nerves. Also state their origin and area of supply
 2.2.2 Muscles

External oblique

Origin Insertion Innervation Function

Muscular slips Lateral lip of Anterior rami of Compress

from the outer iliac crest; lower six abdominal
surfaces of aponeurosis thoracic spinal contents; both
Table
the lower ending in nerves (T7 to muscles flex
eight ribs (ribs midline raphe T12) trunk; each
5-12) (linea alba) muscle bends
trunk to same
side, turning
anterior part
of abdomen to
opposite side
 2.2.2 Muscles

Internal oblique

Origin Insertion Innervation Function

Thoracolumbar Inferior border of Anterior rami of See External
fascia; iliac the lower three or lower six thoracic Oblique
crest between four ribs; spinal nerves (T7
origins of aponeurosis to T12) and L1
external and ending in linea
transversus; alba; pubic crest
lateral two- and pectineal line
thirds of
inguinal
ligament
 2.2.2 Muscles

Transverse abdominis

Origin Insertion Innervation Function

Thoracolumbar Aponeurosis Anterior rami of Compress
fascia; medial ending in linea lower six thoracic abdominal
lip of iliac crest; alba; pubic crest spinal nerves (T7 contents
lateral one-third and pectineal line to T12) and L1
of inguinal
ligament; costal
cartilages lower
six ribs (ribs 7-
12)
 2.2.2 Muscles

Neurovascular plane

Ant Post
2.2.3 Transversalis fascia

• Identify the transversalis fascia

 2.2.4 Peritoneum

• Identify the folds and associated underlying

structures of the peritoneum on the posterior
aspect of the anterior abdominal wall: [2.3.3]
– Plica umbilicalis mediana,
– Plica umbilicalis medialis,
– Plica umbilicalis lateralis,
– Falciform ligament
 2.2.5 Rectus sheath
• Identify the rectus sheath and how it is formed
on the following levels:
– Superior to the arcuate line
– Inferior to the arcuate line 
• Identify and briefly discuss rectus abdominis
as follows:
– major attachments,
– nerve supply and
– function
• Name and identify the structures on the
posterior wall of the rectus sheath
2.2.5 Rectus sheath
 2.2.5 Rectus sheath

Rectus abdominis

Origin Insertion Innervation Function

Pubic crest, Costal cartilages Anterior rami of Compress
pubic tubercle, of ribs 5-7; lower seven abdominal
and pubic xiphoid process thoracic spinal contents; flex
symphysis nerves (T7 to T12) vertebral
column; tense
abdominal wall
 2.2.6 Inguinal area

• Identify and briefly discuss the inguinal canal

as follows:
– Surface anatomy,
– Borders,
– Openings
 2.2.6 Inguinal area
Inguinal canal
Surface anatomy
 2.2.6 Inguinal area

Indirect inguinal hernia

 2.2.6 Inguinal area
Inguinal canal
Borders

491-8
 2.2.6 Inguinal area

• Know the positions of the superficial and deep

inguinal rings and femoral canal.
• Identify the inguinal ligament and the
structures posterior to it from lateral to medial.
 2.2.6 Inguinal area

Femoral canal

Ant

Post
 2.2.6 Inguinal area

Femoral hernia
 2.2.6 Inguinal area

N.A.V.E.L
Contents

• N.A.V.E.L (lat. - med.)

– Femoral nerve
– Femoral artery
– Femoral vein N
AV
– Empty space (femoral E
canal) L
– Lacunar ligament
 2.2.6 Inguinal area

• List the contents of the spermatic cord.

Compare the content in males and females
• Identify the inferior epigastric artery and its
relation to the deep inguinal ring
• Identify and list the borders of the inguinal
triangle (Hesselbach's triangle)
• Name and identify the inguinal falx (conjoint
tendon)
 2.2.6 Inguinal area

Spermatic cord
• 3 Fascia layers
– External spermatic fascia
– Cremasteric fascia
– Internal speratic fascia
• 3 Arteries
– Testicular artery
– Cremasteric artery
– Artery to ductus deferens
• 3 Nerves
– Genito-femoral nerve
– Ilio-inguinal nerve
– Sympathetic autonomic plexus
• 3 Other structures
– Lymphatic vessels
– Ductus deferens
– Pampiniform venous plexus
 2.2.6 Inguinal area

Spermatic cord
 2.2.6 Inguinal area

Hesselbach’s triangle
 2.2.6 Inguinal area

Direct inguinal hernia

 2.2.6 Inguinal area

Conjoint tendon
 2.2.7 Osteology

• Identify the following bony points of the os

coxa:
– Anterior superior iliac spine (ASIS)
– Anterior inferior iliac spine (AIIS)
– Crista iliaca
– Posterior superior iliac spine (PIIS)
– Pubic tubercle
– Pubic crest
– Symphysis pubis
2.2.7 Osteology