Antero-Lateral Abdominal Wall

Skin  Fascia  Muscle  Special fascia (Transversalis) Abdominal Wall Skin  Fascia  Muscle  Special fascia (Transversalis) Anterior Lateral (Rt. & Lf.) Posterior Ant & Lat walls boundary is: Linea Semilunaris Muscle fascia & nerves are continuous within lat. & ant. Walls  Antero-lateral abdominal wall

Linea Semilunaris

Antero-Lateral Wall Boundaries: Superior Xiphoid process & costal margin (7th-10th CC) Inferior Inguinal Ligament: C.T. ligament extends from ant. sup. iliac spine  pubic tubercle

Fascia of Abdominal Wall Superficial fatty layer (Camper’s fascia) membranous (Scarpa’s fascia) Deep enclosing the muscles (muscle fascia) divided into: superf., intermediate & deep layers Transversalis continuous with endothoracic fascia in the thorax Extra peritoneal fat

Linea Semilunaris & Linea Alba

Layers of Abdominal Wall

Muscles of Antero-Lateral Wall Read The Table in Your Textbook 5 muscles 3 lateral: (flat broad m) Named by layer & fibers direction external oblique internal oblique transversus abdominis 2 anterior: (vertical m) Named by shape Rectus Abdominis Pyramidalis

Read The Table in your textbook outer surfaces of lower ribs (??) External Oblique Read The Table in your textbook From: outer surfaces of lower ribs (??)  Inferomedially Inserted to: Linea alba Pubic crest & tubercle Ant. ½ of iliac crest Inferior free border is thickened to become: Inguinal Ligament

Inguinal Ligament & Superficial Ring

Inguinal Lig.: Thickened backward reflection of the inferior border of external oblique aponeurosis that extends from anterior superior iliac spine to pubic tubercle

Superficial Inguinal Ring: a triangular split (opening) in the aponeurosis of external oblique muscle, above pubic crest & medial to inguinal lig. Structure passing through: Spermatic cord in male or ? In female

Internal Oblique Muscle Read your textbook Main Origin: lumbar fascia ant. 2/3 of iliac crest ?? Insertion lower 3 ribs & Costal margin xiphoid process Linea alba symphysis pubis

Transversus Abdominis Runs horizontally Main origin ?? Main Insertion: Linea alba Read Your Textbook

Rectus Abdominis Long strap like muscle Extends vertically over ant. Wall 4 Fleshy parts run between 3 tendinous intersections: xiphoid umbilicus halfway between ? Enclosed by rectus sheath (deep fascia)

Pyramidalis NOT always present Base from pubis Apex inserted into linea alba Anterior to rectus abdominis & within Rectus sheath Function ??

Rectus Sheath Long fibrous sheath that encloses rectus abdominis m. It is formed by the three lat. Muscles aponeuroses Starts from linea semilunaris in both sides Splits into 2 parts: - Ant. to rectus abdominis ext. oblique + ½ of internal oblique - Post. to rectus abdominis transversus + ½ of internal oblique Merges in midline as ???

Exception At level of ant. sup. Iliac spine (midway between umbilicus and ?)  All aponeuroses go anterior  NO posterior part - Rectus abdominis become lined by transversalis fascia The infero-posterior disappearance is marked by: arcuate line

Contents of Rectus Sheath 2 muscles ?? 4 bld. Vessels Sup. & Inf. epigastric arteries Sup. & Inf. epigastric veins 6 nerves T7 –T11 intercostals (5 nerves) Subcostal n. (T12) 2 – 4 - 6

Blood Vessels of Abdominal Wall Superior epigastric a. continuation of ?? posterior to rectus abdominis m. Inferior epigastric a. from external iliac artery Route & location ? 10th & 11th Post. intercostals & Subcostal a. (12th) Lumbar arteries (between which layers?) Deep Circumflex iliac (origin?)

Nerves of Abdominal Wall Lower intercostal nerves: T7 – T11 Subcostal n. T12 1st lumbar nerve: 2 divisions: iliohypogastric n. ilioinguinal n. does NOT enter the rectus sheath

9 regions classification Surface Anatomy 9 regions classification Subcostal plane: lowest costal margin, 10 cc, L3 Transtubercular plane: iliac tubercles what vertebral level? Midclavicular planes: mid clavicle  mid inguinal lig.

9 Regions Rt. & Lf. Hypochondriac Rt. & Lf. Lumbar Rt. & Lf. Inguinal Epigastric Umbilical Hypogastric (pubic)

4 Regions classification Transumbilical plane IV disc L3-L4 Midsagittal line symphesis menti  symphesis pubis

Abdominal Surgical Incisions Surgeons use various incisions to gain access to abd. cavity Rules: 1. Provide adequate exposure 2. avoid damage to major vital str. (van) 3. best possible cosmetic effect Common surgical incisions: 1. Median (Midline) Incisions: common 3 types 2. Paramedian Incision: 2-5 cm lat. To midline spleen or kidney

3. Kocher’s (Subcostal) Incision:  oblique incision runs parallel & below (2.5cm) the Rt. costal margin  cholecystectomy 4. McBurney’s Incision: Parallel to ext. obliq. M. fibers at Mcburney’s point (??)  Appendectomy

McBurney’s Point On a straight line : 1/3 from ant. sup. iliac spine 2/3 from the umbilicus Corresponds to the base of the appendix The incision site during appendectomy (removal of the appendix)

5. Pfannenstiel (Suprapubic) Incision:  transverse, slightly curved incision (Smile Incision)  5cm above pubic symphysis * most frequent incision used by urologists & gynecologists  c-section, hystrectomy urinary bladder & prostate surgeries