Abdominal Wall

Lecture one Anatomy of anterior abdominal wall

ABDOMINAL WALLS
the abdominal walls represents the boundaries of the abdominal cavity
• Superior – diaphragm
• Inferior – pelvic floor (m. levator ani, m. coccygeus)
• Posterior – m. psoas major, m. quadratus lumborium
• Anterior and lateral – oblique muscles and m. rectus abdominis
Internal surface of muscles – covered by transversal fascia and by peritoneum
Structure

1 - skin

2- superfecial facia
3- Abd. Muscles
4- facia transversalis
5- pariatal layer of peritoneum



1-skin of abd wall
The most important characters of skin of abdomen are :-
-thin , have scattered hair ( but in Female limited in pubic area
umbilicus
-site of umbilical cord in emberyo , lies in linea alb
its regared as water shed line of the body(marks direction of veins , lymphatics and site of porto-caval anastomosis
2-Superficial fascia
Its single layer but differentiates below umbilicus into 2 layers:-
A-superfetial Fatty layer(Campers F)
B-deep membranous L (Scarpas F) its lower border attached as follow:-
1 -lat. to F . Lata (1 finger breadth below ing leg
2-med. to pubic arch &tubercle
3-in median plain envelope around penis &scrotum forming (Colle s F)

3-Muscles of Abdominal wall

Tow paramedian
-Rectus abd.m
-Pyramidalis m
Three anterolateral flat m
-ext . Abd. Oblique m
- int. Abd. Oblique m
-transversus abd. m


Muscles of abdominal wall
External abd oblique
Origin:- outer surface of lower ribs
Direction of of fibers downward medially
Insertion :-1-aponeurosis to Xiphoid P, L . Alba , pubic creast, pubic tubercle & ant. Sup iliac spines.
2-fleshy fibers into ant. 1\2 of lower lip of ilac crest
N supply :- lower 6 thoracic nn

Internal abd. Oblique m

Origin:- Lumber origin from lumber fascia
Ilio-inguinal origin ant 2\3 of iliac crest& lat 2\3 of inguinal leg
Direction of fiber pass upward , forward and medially
Insertion - fleshy f into last 3 ribs and carteligen
-broad apponeurosis into7th , 8th , 9th ribs costal cartlage , xiphoid P, L . Alba , pubic crest & pecteneal line
N supply lower 6 thorasic and L1

Transversus abdominis m

Origin:-
Costal- inner surface of lower 6 ribes
Lumber –lumber fascia
Ilioinguinal – 2\3 of inner lip of iliac crest&lat. 1\3 inguinal leg
Direction of fibers horizontal
Insertion
-broad aponeurosis from Xiphoid P to L . Alba
-conjoin tendon
N . Supply– lower 6 thoracic & L1

Rectus abdominis m

Longitudinal paramedial m
Origin:- lower end 2 heads
Med- head symphysis pubis
Lat. head pubic crest
Insertion:- upper end Front of 5,6,7th costal cartilage & Xiphoid P
N supply lower thoracic n
tendenous intersection 3,4 transvers bands
(xiphoid P, umbilicus, midway bet. Xiphoid &umb, below umb.)
Linea similunaris –shallow curved groove along lat. border of muscle

Pyramidalis m

Small triangular m at the lower end of rectus m, some time abscent
Origin –pubic crest
Insertion-- lower part of L alba
N . Supply –subcostal n
Action -- stretches L . alba


4-Fascia transversalis
Extension& attachment
ant adherent to L alba above umbilicus -post. renal Fascia( f around kidney)
-sup.diaphragmaic fascia -inf. inguinal leg & femoral sheath
Openings of transversalis fascia
Deep inguinal Ring
Transmit spermatic cord(male) round leg (female)

Arterial supply of abd. wall

1- from above sup . Epigasteric a br. from int mammery a

2- from laterally
--10th, 11th, post. intercostal a & subcostal a all are br. from thoracic aorta
3- from below
--inf epigastric a br. from int iliac a
-- deep circumflex art br. from ext. iliac a
-- superficial circumflex a & superficial epigastric a are br. from femoral art


Venous drainage of abd. wall
A- above umbilicus 1-sup. Epigastric v int mammary v
2-Lat. Thoracic v axillary v
B-below umbilicus 1-inf. Epigastric v ext. iliac v
2- superficial circumflex v femoral v
3- superficial epigastric v femoral v

Venous anastomosis of ant. Abd. wall

A-between SVC & IVC
1-sup . Epigasteric & inf epigasteric vv( with in rectus sh)
2-lat. thoracic v &superfecial epigasteric v ( below (superfecial facia of side of trank
porto-systemic anstomosis
Veins of ant abd wall & paraumbilical v (Caput Medosa)

Lymphatic drainage of ant. Abd. Wall

Above umbilicus --superfecial lymphatics fellow veins anterior pectorial LN
--deep lymphatics fellow arteries parasternal LN
Below umbilicus --superfecial lymphatics superfecial inguinal LN
--deep lymphatics ext. iliac LN
Nerve supply of ant abd. wall
Nerve roots
from Xiphoid P to umb T 7,8,9
umbilical & periumbilical area T10
from umb to inguinal area T11,12 , L1
nerves
1-lower intercostal n(T7- T11)
2-subcostal n (T12)
3-iliohypogasteric (L1)
4-ilioinguinal n(L1)


lecture tow Particular structures in ant. Abd wall
1-inguinal ligament 2-rectus sheath 3-conjoin tendon
4-Linea alba 5-inguinal canal 6-femoral canal
inguinal ligament

Relation :- Behind this ligament the soft tissues (muscles , vessels nerves pass from the trunk to the lower extremity.)
Deep relation 1-femoral sheath 2-iliacus &Psoas m
3-femoral n, 4-femoral br. of genitofemral n
5- lat. cut n of thigh
Superfecial relation superficial epigastric , superficial circumflex iliac vessels
This ligament extended from ( ant. Sup. Iliac spine ASIS) laterally to pubic tubercle medially
Attachment
Its formed from lower aponeurosis of ext oblique
From lower border F lata
From above lat 2\3 int bolique
lat. 1\3 transvers oblique
med part cremastric m

Conjoin tendon

Its formed from fusion of the lower most fibers of int. oblique with transversus abdomens (lowermost fibers ) its part of ing. canal wall
Rectus sheath
2 Longitudinal Sheaths Rt & Lt enclose of rectus muscles with there nerve & blood supply in the paramedian
Parts of rectus sheath
1st part above costal margin . the post wall of sheath formed from thoracic wall and ribs, ant wall formed from ext aponeurosis


2nd part from costal margin to arcute line (midway between umb. & symphysis pubis)
Splitting of int oblique into :-
ant. Lamella enforced by ext oblique ant R. sheath
post. lamella which enforced by
transversus abd post R. sheath
3rd part lower part below arcute line
The 3 aponeurosis become ant.

Contents of rectus sheath

2 muscles (rectus abd , pyramidalis )
4 vessles sup . Epigasteric a &v br from int . Mammery a&v inf. Epigastric a&v br from ext. iliac a&v
6 nerves (5 lower intercosatal & subcostal)
Lymphatic vv
Linea alba
Strong tendenous raphe in the middle line of ant abd wall between 2 recti
Attached above at Xophoid P and below at symphysis pubis
Aponeurotic parts of oblique muscles attaché to the linea alba at the midline
One of the surgical approaches to the peritoneal cavity (midline incision)
inguinal canal
Its oblique intramuscular passage in the lower part of ant. Abd. Wall transmit spermatic cord or round leg., lies just above med1\2 if ing. Legement about 4 cm length

Deep ing. Ring –oval . at fascia. Transversalis

Superfecialing. Ring– triangular at ext oblique
Boundaries of canal:-
Ant. wall of canalext. oblique & fleshy int. oblique
Post.wall of canal facia transversalis
Roof lower arched fiber of int. oblique
Floor inguinal leg

Structures pass through inguinal. canal

1-in male spermatic cord , its covering& ilioinguinal n
2-In female round leg of uterus +ilioinguinal n
Spermatic cord

Its part of male external genital organ , Extend from deep inguinal. Ring to the lower end of testis including
i- vas deference
ii- its vessles1-testicular a br from aorta
2-art. to vas br from inf vasical a
3-cremasteric a br from inf epigasteric
4-pampiniform plexus, testicular vein
iii- nerves 1-genital br. of genitofemoral n
2-ilioinguinal n(L1
iv-its covering
1-Internal spermatic fascia drived from F transversalis
2- Cremastric muscle and fescia derived from int. oblique + transversalis abd
3- External spermatic f -ext. oblique


Cremastric muscle
Its a slender muscle which suspends the spermatic cord & testis, covered by cremasteric facia
Origin– middle of ing. Leg
Insertion – fiber form U shaped loop around spermatic cord & testis then inserted into pubic tubercle
N supply – genetal br of genitofemoral n
Action--- elevate testis during ejaculation
The femoral sheath



is formed by a prolongation downward, of the abdominal fascia, behind the inguinal ligament
The sheath is divided by two vertical partitions 3 compartments
--lateral contains the femoral artery
--the intermediate the femoral vein,
--the medial and smallest one is named the femoral canal, and contains some lymphatic vessels
and a lymph gland embedded in a small amount of areolar tissue
Vas defferens



Its firm cord like structure 45 cm in length , have thick muscular wall , narrow lumen
Begin in the scrotum as a continuation to the tail of epididymis, then join duct of the seminal vesicle to form ejaculatory duct which opens into prostatic urethra


Hernia

It s abnormal protrusion of any abdominal viscus(commonly loop of bowel or omentum) through week part of abdominal wall i.e ( umbilicus , inguinal & femoral or surgical incision)
inguinal hernia May be
Indirect protrusion of abdominal viscus through weak deep ring of inguinal canal
direct protrusion of abdominal viscus through weak transversalis f at post . Wall of inguinal canal
Femoral hernias
occur just below the inguinal ligament, when abdominal contents pass through femoral canal.
Scrotum

Its cutaneous bag containing

2 testis, epididymis & lower part of spermatic cord
Its divided into Rt& Lt portions by median raphe,
Lt hangs lower than Rt to avoid compression in the
event of impact

Layers of scrotum

Extension from layers of abdominal wall
Skin :- brown , thin , rogues
Dartos m:- fatty layer of superfecial. facia
Membranous layer of superficial fascia
Ext, spermatic f ext oblique
Cremasteric m&f int. oblique + transversalis abd.
Internal layer of spermatic f transversalis f
Parietal layer of tunica veginalis

Nerve supply of scrotum

Ant. 1\3 supply by L1( ilioinguinal n, genital br. of genetofemoral N) while Post. 2\3 S3( post scrotal br of perienial n, perieneal br of post cut. N of thigh
Blood supply
1-Superfecial &deep ext. pudendal a branch from femoral art
2-Post.pudendal br. of int. pudendal a branch from int iliac a
3-Cremasteric art. branch from Inf . Epigasteric a
Testis
Its male primary organ, located in scrotum, oval in shape ,
Two poles upper & lower(spermatic cord attached to upper pole)
Two borders ant. & post (post. surface related to epididymis by groove sinus of epididymis)
Two Surface med. & lat.


its function :-
spermatogenesis production of sperms
- Hormonal production testesteron

Testicular Compartments

There is septum between 2 testis

Each testis subdevided into several lobules by septa ,
inside each lobule there is coiled tube known as seminiferous tubules ( its location of spermatogenesis, or formation of new sperm.) And, inside each tubule, there are sperm in all different stages of development,
rete testis is an anastomosing network that carries sperm from the seminiferous tubules to the efferent ducts. before entering epididymis.

Covering of testis 3 special coats

1-tunica albugenea( fibrous capsul)
2-visceral layer of tunica vaginalis
3-parietal layer of tunica vaginalis


Abdominal cavity Planes of abdomen

1-transpyloric plane-----L1

2- subcostal plane ------L3
3-inter tubercular plane----L5
4-tow lateral vertical plane (Rt,& Lt)
Regions of abdomen 9 regions