1. Abdominal wall 腹壁
山东大学医学院解剖教研室
李振华

2. Boundaries of the abdomen
Superiorly－ xiphoid process, lower border of costal arch, 11th and 12th ribs, vertebra T12
Inferiorly－superior border of pubic symphysis, pubic crest, pubic tubercle, fold of inguinal canal, anterior superior iliac spine, iliac crest, spinous process of L5

3. The abdominal regions 腹部分区 ——Nine regions
Epigastric region 腹上区
R. hypochondriac region 右季肋区
L. hypochondriac region
左季肋区
R. lateral regions 右外区
L. lateral regions
左外侧区
R. inguinal region右腹股沟区
Umbilical region 脐区
L. inguinal region
左腹股沟区
Pubic region 耻区

4. The abdominal regions 腹部分区 ——Four quadrants
Left and right upper quadrants
Left and right lower quadrants

5. Landmarks of abdomen Pubic symphysis Pubic tubercle Iliac crest
Umbiicus
Linea semilunaris
Transpyloric plane

8. Anterolateral abdominal wall
Layers ( from superficial to deep)
Skin
Superficial fascia
Anterolateral muscles
Transverse fascia 腹横筋膜
Extraperitoneal fascia 腹膜下筋膜
Parietal peritoneum 壁腹膜

9. Anterolateral abdominal wall
Superficial fascia －divisions below umbilicus
Fatty layer (Camper’s fascia) continuous with the superficial fascia over the rest of the body.
Membranous layer (Scarpa’s fascia) passes over the inguinal ligament to fuse the deep fascia of the thigh (fascia lata) approximately one fingerbreadth below the inguinal ligament. In the midline, it is not attached to the pubis but instead from a tubular sheath for the penis (clitoris). In the perineum, it is attaches on each side to the margins of the pubic arch and is know as Colles’ fascia.

10. Superficial vessels and cutaneous nerves
Arteries
Superficial epigastric a.
Superficial iliac circumflex a.
Veins
Thoracoepigastric v.
Superficial epigastric v.
Cutaneous nerves
Anterior and lateral cutaneous n. of lower six thoracic
Iliohypogastric n. (first lumb nerves)

11. Superficial vessels and cutaneous nerves
Lymph drainge
Superficial lymph vessels above the level of the umbilicus grain upward into the pectoral Ln.
The vessels below this level drain downward into the superficial inguinal Ln.

12. Muscles of abdomen

13. Muscles of abdomen Anterolateral group
Obliquus externus abdominis 腹外斜肌
Obliquus internus abdominis 腹内斜肌
Transversus abdominis 腹横肌
Rectus abdominis 腹直肌

14. Muscles of abdomen Posterior group Quadratus lumborum 腰方肌
Psoas major 腰大肌

15. Obliquus externus absominis 腹外斜肌
General direction of fibers: downward, forward and medially (run down and inward)

16. Obliquus externus absominis 腹外斜肌
Structures
Inguinal ligament 腹股沟韧带
Lacunar ligament 腔隙韧带
Superficial inguinal ring 腹股沟管浅环 －triangular-shaped defect in aponeurosis of obliquus externus abdominis above pubic tubercle

17. Superficial inguinal ring

18. Obliquus internus abdominis 腹内斜肌
Deep to obliquus externus abdominis
General direction of fibres: upwards, forwards and medially

19. Transversus abdominis 腹横肌
Deep to obliquus internus
General direction of fibers: run horizontally forward.

20. Transversus abdominis 腹横肌
Inguinal falx 腹股沟镰
Obliquus internus abdominis has a lower, free border that arches over spermatic cord
Inserted with transversus abdominis fiber into medial part of pecten of pubis
Cremaster 提睾肌
Dirived from the lower fibers of the obliquus internus abdominis and transversus abdominis
Around the spermatic cord and testis

21. Rectus abdominis 腹直肌 Position: lie on to either of midline
Origin: pubic crest and symphysis
Insertion: xiphoid and 5th-7th costal cartilages
Tendinous intersections 腱划 3-4
linea semiluaris 半月线

22. Similar functions for above four pairs of muscles
Support and compress the abdominal viscera
Increase intra-abdominal pressure, aid in expulsive efforts-vomiting, coughing, sneezing, defecation, urination and childbirth.
Depress ribs, assist in (the act of force(4)expiration.
Flex, lateral flex, and rotate vertebral column

23. Sheath of rectus abdominis 腹直肌鞘
Anterior layer
Formed by fusion of aponeurosis of obliquus externus abdominis and anterior leaf of aponeurosis of obliquus internus abdominis

24. Sheath of rectus abdominis 腹直肌鞘
Posterior layer
Formed by fusion of posterion leaf of aponeurosis of obliquus internus abdominis and aponeurosis of transversus abdominis
Absent in about 4-5cm below the umbilicus, where aponeuroses of all three muscles form anterior layer the lower free border named arcuate line 弓状线
Below this line rectus abdominis in contact with transverse fascia

25. Muscles of abdomen Linea alba 白线
－tendinous raphe between right and left recti from xiphoid to pubic symphysis

26. Deep vessels of abdomen
Arteries
Superior and inferior epigastric arteris
Lower posterior intercostal aa.
Subcostal a.
Deep iliac circumflex a.
Four lumbar a.

27. Deep nerves of abdomen Lower five intercostals nerves Subcostal nerve
Run between obliquus internus and tranversus abdominis.

28. Deep nerves of abdomen Iliohypogastric n. 髂腹下神经
Arises from lumbar plexus
Passes forward in the interval between obliquus internus and tranversus abdominis
Pieces obliquus internus abdominis 2.5 cm medial to anterior superior iliac spine
Pieces aponeurosis of obliquus externus abdominisabout 2.5 cm above superficial inguinal ring

29. Deep nerves of abdomen Ilioinguinal n. 髂腹股沟神经
Arises from lumbar plexus
Runs parallel with iliohypogastric n. at a lower level
Enters inguinal canal and exits through superficial inguinal ring
Supplies the transversus abdominis, obliquus internus, and obliquuse externus abdiminis. It also supplies the skin just above the symphysis pubis and the scrotum or greater lip of pudendum.

30. Deep nerves of abdomen Genitofemoral n. 生殖股神经
Arises from lumbar plexus
Emerges through superficial inguinal ring and supplies the cremaster muscle

31. Inguinal region 腹股沟区 Boundaries Inguinal ligament
Lateral margin of rectus abdominis
A horizontal line stretching from anterior iliac spine to lateral margin of rectus abdominis

32. Inguinal canal 腹股沟管
Position: oblique passage, 4cm long, located 1.5cm above medial half of inguinal ligament

33. Boundaries of inguinal canal
Anterior wall
Aponeurosis of obliquus externus abdominis
Obliquus internus abdominis (lateral third of wall)
Posterior wall
Transverse fascia
Inguinal flax medially
Roof－arching fibers of obliquus internus and transversus abdominis
Floor－inguinal ligament

34. Boundaries of inguinal canal
Two openings
Superficial inguinal ring 腹股沟管浅环 －a triangular-shaped defect in the aponeurosis of the obliquus externus abdominis and lies immediately above and medial to the pubic tubercle

35. Boundaries of inguinal canal
Two openings
Deep inguinal ring 腹股沟管深环 －an oval opening in transverse fascia and lies approximately 1.5cm above midpoint of inguinal ligament

36. Mechanics of the inguinal canal
The inguinal canal is a site of potential weakness in both sexes.
On coughing and straining (as in micturition, defecation, and parturition), the arching lowers fibers of the obliquus internus and transversus abdominis contract and flatten the arch.
In turn, this lowers the roof of the canal toward the floor and virtually closes the canal.

37. Structures passing through the inguinal canal
In males
Spermatic cord 精索
Ilioinguinal nerve 髂腹股沟神经
In females
Round ligament of uterus 子宫圆韧带

38. Descent of testes Seven-week embryo showing the
testis before its descent from the
dorsal abdominal wall

39. Descent of testes Fetus at 28 week the testis passing
through the inguinal canal

40. Descent of testes
Newborn

41. Inguinal Triangle (of Hesselbach) 腹股沟三角
Boundaries
Medially: Lateral border of rectus abdominis
Laterally: Inferior epigastric artery
Inferiorly: Inguinal ligament

42. Indirect inguinal hernia and direct inguinal hernia

43. Anterior abdominal wall
Transverse fascia 腹横筋膜
Extraperitoneal fascia 腹膜外筋膜
Parietal peritoneum 壁腹膜

44. Landmarks and surface anatomy
Xiphoid process
Costal arch
Anterior superior iliac spine
Iliac crest
Superior border of pubic symphysis
Pubic tubercle

45. Landmarks and surface anatomy
Linea alba
Rectus abdominis
Tendinous intersections
Linea semilunaris
Umbilicus: at the level of L3 ~ L4
Inguinal ligament

46. Layer ? Median or midline incision Subcostal incision
Muscle-splitting incision
Left paramedian incision
Transverse incision
Suprapubic incision

47. ★You must identify follow structures！
Obliquus externus abdominis
Inguinal ligament
Superficial inguinal ring
Obliquus internus abdominis
Transversus abdominis
Inguinal falx
Rectus abdominis
Tendinous intersections
Sheath of rectus abdominis
arcuate line
inferior epigastric artery
Posterior intercostal a.
Intercostals nerve
Iliohypogastric n.
Ilioinguinal n.
Spermatic cord