1. Anatomy of anterior abdominal wallBy
Dr. Muslim Kandel
2015

2. Anterior Abdominal Wall
MOB TCD
Anterior Abdominal Wall
Functions of ant. Abd. wall
1--The muscles of the anterior abdominal wall play a major role in movements of the trunk
2--Protecting the abdominal organs
3--Increase the intra-abdominal pressure, aid in expiration and all straining activities such as micturition, coughing and vomiting

3. Anterior Abdominal Muscles
MOB TCD
Anterior Abdominal Muscles
4- stabilise the trunk
--Support the spine
--They flex and rotate the trunk
--Acting with the adductors and abductors of the hip
5- stabilise the pelvis during walking and running

4. ABDOMINAL WALLS • Superior – diaphragm
• Posterior – m. psoas major, m. quadratus
lumborum
• Inferior – pelvic floor (m. levator ani, m.
coccygeus)
• Anterior and lateral – oblique muscles and m.
rectus abdominis
Internal surface of muscles – covered by
transversal fascia and by peritoneum

5. anterior &lateral abdominal wall
Structure
1-skin
2-superfecial facia
3-Abd. Muscle
4-facia transversalis
5-extraperitoneal fatty tissues
6-pariatal layer of peritoneum

6. 1-skin of abd wall umbilicus -thin
-Pubic hair –Female limited in pubic area
umbilicus
-site of umbilical cord
-lies in linea alba
-N . Supply by T10
-water shed line of the body(marks direction of veins , lymphatics
-porto-caval anastomosis
-Anastomosis bet. Sup & inf epigasteric vv
-Meeeting 4 peritoneal folds(leg teres,median umbilical leg.,Rt, Lt umbilical leg.)

8. 2-Superficial fascia Differentiates below umbilicus into 2 layers:-
A-superf. Fatty layer(Campers F)
B-deep membranous L (Scarpas F) its lower border attached as follow:-
1 -lat. to pubic tubercle F . Lata (1 finger breadth below ing leg
2-med. To pubic tuberclepubic arch &tubercle
3-in median plaintubular like envelope around penis &scrotum forming (Colle s F)

9. Cotenous Nerve supply of ant abd. wall
- T 7,8,9 Xiphoid P—umb
-T10 umb
- T11,12 , L1  umb --inguinal

11. 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

12. Muscles of abdominal wall

13. Muscles of abdominal wall--details.

15. External abd oblique Origin:- outer surface of lower ribs
Direction of of fibers downward medially
Insertion :-1-aponeurosis ito 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

17. 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 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

19. 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

20. 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 –shalow curved groove along lat.border of muscle

21. 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 -- streches L . alba

22. 4-Fascia transversalis
Extension& attachment
- ant adherent to L alba above umbilicus
-post.  renal Facia
-sup.diaphragmaic facia
- inf. 
* lat to iliac v-iliac crest& lat. 1\2 of ing . leg
*over ext. iliac v (prolongation to thigh)
*med. to ext. iliac vpectineal line& pubic crest

23. Openings of transversalis facia
Deep ing. Ring
Oval shap opening 1\2 inch above midinguinal point, just lat to inf. Epigasteric a.
Transmitspermatic cord(male) round leg (female)
Prolongation of F transversalis
1-internal spermatic facia
2-ant. Wall of femoral sheath

24. Particlar strectures in ant. Abd wall
1-inguinal ligament 2-rectus sheath 3-conjoin tendon 4-cremasteric muscle 5-Linea alba 6-inguinal canal 7-femoral canal

25. inguinal ligament Attachment lat :- ASIS Med:- pubic tubercle
The ligament serves to contain soft tissues as they course anteriorly from the trunk to the lower extremity.
Deep relation
1-femoral sheath
2-iliacus &Psoas m
3-femoral n, femoral br. of genitofemral n & lat. cut n of thigh
Superfecial relation superfecial epigasteric , superfecial circumflex iliac vessels
Extension
1-lacuner leg
2-reflected part of ing. leg

27. 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

28. Conjoin tendon
The lower most fibers of int. oblique fuse with lowermost arching fibers of transversus abdominus to form conjoin tendon

29. Rectus sheath Formation:-Splitting of int oblique into :-
ant. Lamella enforced by ext oblique and
post. lamella which enforced by transvesus abd
Parts of sheath
1st part above costal margin
2nd part from costal margin to arcute line (midway between umb. & symphysis pubis)
3rd part lower part below arcute line

30. The Rectus Sheath, Anterior View & Transverse Section
1-Rectus abdominis
2-Tendinous intersections
3-Anterior wall of rectus sheath
4-Posterior wall of rectus sheath
5-Transversalis fascia
6-Peritoneum
7-Costal margin
8-Linea alba
9-Umbilicus
10-Muscular part of external oblique
11-Muscular part of internal oblique
12-Muscular part of transversus abdominis
13-Superficial fascia
14-Costal cartilage
15-Extraperitoneal fat
16-Intercostal muscles
17-Pectoralis major

31. Contents of rectus sheath
2 muscles (rectus abd , pyramidalis )
4 vessles
sup . Epigasteric a &v  int . Mammery a&v
inf. Epigastric a&v  ext. iliac a&v
6 nerves (5lower intercosatal & subcostal)
Lymphatic vv

33. LINEA ALBA
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
attache to the linea alba at the midline
• One of the surgical approaches to the
peritoneal cavity (midline incision)

34. Arterial supply of abd. wall
1-sup . Epigasteric a
2-musclo-phrenic a int mammery a
3-inf epigasteric a int iliac a
4-10th, 11th, post. intercostal a
5- subcostal art thoracic aorta
6- deep circumflex art ext. iliac a
7- superfecial circumflex artery
8- superfecial eigasteric art femoral art

35. Venous drainage of abd. wall
A- above umbilicus
1-sup. Epigasteric v int mammery v
2-Lat. Thoracic v  axillary v
B-below umbilicus
1-inf. Epigasteric v  ext. iliac v
2- superfecial circumflex v  femoral v
3- superfecial eigasteric v femoral v

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

39. Lymphatic drainage of ant. Abd. wall
Above umbilicus --superfecial lymphatics fellow veinsant. pectorial LN --deep lymphatics fellow arteries parasternal LN Below umbilicus -- superfecial lymphatics  superfecial inguinal LN -- deep lymphatics  ext. iliac LN

40. Nerve supply of ant. Abd. wall
A-lower intercostal n(T7- T11)
B-subcostal n (T12)
C- iliohypogasteric (L1)
D- ilioinguinal n(L1)

41. inguinal canal
* Attachment where scrotum “pooches out”--carries all 3 layers of abdominal wall through successive holes
* spermatic cord to testicles
-VAN
-Vas Deferens

42. 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 fecia. Transversalis
Superfecialing. Ring– triangular at ext oblique
Bounderies of canal:-
Ant.wall of canalext. oblique& fleshy int. oblique
Post.wall of canal facia transversalis
Rooflower arched fiber of int. oblique
Floor inguinal leg

43. Structures pass through ing. canal
1-in male  spermatic cord , its covering + ilioinguinal n
2-In female round leg of uterus +ilioinguinal n

44. The Coverings of the Inguinal Canal, External & Internal Oblique & Transversus Abdominis Removed
1-Inguinal ligament
2-Deep inguinal ring
3-Transversalis fascia
4-Internal spermatic fascia forming innermost coating of the spermatic cord
5-Pubic tubercle

45. Inguinal(Hasselbach s) triangle
Its triangular area in inner aspect of lower abd. Wall may be a site of hernia
Bounderies
Medially—lat border of rectus sheath
Laterally– inf. Epigasteric art.
Inferiorly– medial 1\2 of ing. Leg

48. Hernia
It s abnormal protrusion of any abdominal viscus(commonly loop of bowel or omentum) through week part of abd . Wall
Types:- internal & external
Inguinal , Femoral ,umbilical ,paraumbilical, epigasteric, incisional and other rare types
Structure of hernia
- Sac
-neck
-coverings
-containt

50. Abdominal muscular wall pressurizes abdomen
When?
Cough
Sneeze
Urinate
Defecate
Birth
Lifting

51. Inguinal hernia results because pressure finds weak spot at inguinal canal

52. Inguinal hernia Direct Indirect Conjoin tendon Process veginalis old
Young
Ing triangle
Deep ing . ring
Postero-anterial not reach scrotum
Oblique to scrotum
Behind cord
Infront of spermatic cord

54. Femoral hernia

56. Femoral hernia Femoral H Inguinal H female male Femoral ring
Deep ing. ring
Below ing . Leg.
Above ing. leg
below
Above pubic tubercle

57. Umilical ¶umbilical hernias
Through weak point of scar of umbilicus
Epigasteric hernia
Through defects appearing due to fail of fusion of linea alba

58. Epigasteric hernia

59. Incisional hernia

60. Male external genital organ
1-Spermatic cord ,2- scrotum ,3-testis , 4-penis
1-Spermatic cord
Its cord of several structures including vas deference and its covering and its vessles Extend from deep ing. Ring to the lower end of testis
Covering spermatic cord
1-Internal spermatic facia F transversalis
2- cremasteric m and f  int. oblique+transversalis abd
3- External spermatic f -ext. oblique

62. Constituent of spermatic cord
A-3 structures 1-vas deference,
2-pampiniform plexus,
3-lymphatic
B-3 arteries1-testicular a  aorta
2-art. to vas inf vasical a
3-cremasteric a inf epigasteric a
C-3 nerves 1-genital br. of genitofemoral n
2-ilioinguinal n(L1)
3-sympathetic n fibers
D-vestigue of processus veginalis

63. 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

65. Pampiniform plexus Lymphatic vessele
Formed by several veins that drain testis & epididymis, at deep ring the veins unite to form testicular vein
Rt. Testicular v end to inf. Vena cava
Lt. testticular v end to Lt renal v varicocele
Lymphatic vessele
Drain testis and epididymis, accompany testicular vesseles , end to para aortic LN

66. Testicular artery Arise from abd. Aorta L3 Run in the spermatic cord
Supply testis anastomosis with cremasteric a and art. to vas
Artery to vas deferens
Arise from vesical a  int. Iliac a
Supply vas & epididymis
Cremasteric a
Arise from inf. Epigasteric a
Supply covering of cord

67. Cremasteric nerve Genetal br. Of genetofemoral n
Supply cremasteric m and skin of ant 2\3 of scrotum
Sympathetic fibers
Arise from renal and aortic plexus
Iloinguinal n
Arise from lumber plexus L1
Supply the skin of ext. genitelia

68. 2-Scrotum Its cutaneous bag containing :- -- 2 testis, -- epididymis
--lower part of spermatic cord
( its correspond to labia majora in female)
Its divided into Rt& Lt portions by median raphe, Lt hangs lower than Rt

69. Layers of sacrotum
Skin :- brown , thin , rugose Dartos m:-  fatty layer of superfecial. facia Form suptum between 2 testis Supply by sympathetic f Memberenous layer of superfecial. facia Ext, spermatic f ext oblique Cremasteric m&f  int. oblique+ transversalis abd. Internal layer of spermatic f transversalis f Parietal layer of tunica veginalis

70. Nerve supply
Ant. 1\3  L1( ilioinguinal n, genital br. Of genetofemoral N) 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 femoral art 2-Post.pudendal br. Of int. pudendal a int iliac a 3-Cremasteric art. Inf . Epigasteric a

71. 3-Testis Its male primary organ, located in scrotum, oval in shape ,
2 poles upper & lower(spermatic cord attached to upper pole)
2 borders ant. & post(post. surface related to epididymis by groove sinus of epididymis)
2 Surface med. & lat.
its mixed gland produce:-
- exocrine sperm
-endocrine testesteron

72. Covering of testis 3 special coats 1-tunica albugenea( fibrous capsul)
2-visceral layer of tunica vaginalis
3-parietal layer of tunica vaginalis
3 Coats from abd. wall
1-int. spermatic f  transvers abd
2-cremasteric M& F  int oblique
3-ext. Spermatic F ext oblique
3 cutenous & subcutenous coats
1-Membernous layer of superfecial F
2-dartus muscle
3-skin

74. Epididymis
Its comma shape body attached to posterolateral aspect of testis , its highly coiled single tube 6 meters
3parts
-head expanded upper end which connect to upper pole of testis by efferent duct
- body central part
- Tail lower pointed end attached to lower pole of testis , its continuous with vas

75. 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

77. Anterior Abdominal Wall, Dissection
1-External oblique muscle
2-Anterior wall of rectus sheath
3-Tendinous intersections of rectus sheath
4-Rectus abdominis
5-Posterior wall of rectus sheath
6-Intercostal nerve
7-Linea alba
8-Umbilicus
9-Mammary disc