abdomen anatomy
TRANSCRIPT
Surgical anatomy of
Anterior abdominal wall
by Wichien Sirithanaphol
Anterior abdominal wall
• Anterolateral part– External oblique muscle– Internal oblique muscle– Transverse abdominis muscle
• Middle part (or midline)– Rectus abdominis muscle– Pyramidal muscle– Rectus sheath
External Oblique Muscle
• Origin : inferior border of lower 8th rib
• Insertion : linea alba , iliac crest , ASIS
• Fibers pass inferiorly and medially" Hands in the front pockets "
• The external oblique fascia – Innominate Fascia of Gallaudet– Inguinal ligament– spermatic cord : external spermatic fascia
External oblique m.
Aponeurosis of external oblique
Internal Oblique Muscle
• Origin : thoracolumbar fascia and the iliac crest
• Insertion : Lower border of ribs 9-12 , linea alba
• Fiber pass upward and medially " Hands in the back pockets "
• The lowest fibers arch– spermatic cord or round ligament : cremasteric layer
Internal oblique m.
Cremaster m.
Transversus Abdominis Muscle
• Origin : Iliac crest , thoracolumbar fascia , lower ribs
• Insertion : linea alba , pecten pubis
• The deepest of the three flat anterior abdominal muscles
• Fibers pass medially
• Transversalis fascia
• Extraperitoneal fat
Transversus
Abdominis m.
Transversalis fascia
Transversus abdominis aponeurosis
Inferior fiber of
internal oblique
Pyramidalis m.
Rectus abdominis m.
Transversalis
fascia
Lateral border of rectus
Rectus Abdominis muscle• Origin : pubis and pubic symphysis
• Insertion : Cartilages of ribs 5-7th , xiphoid process
• 3 tendinous lines – the xiphoid process – the umbilicus– halfway between these points
Pyramidalis muscle
• inserts into the linea alba 3-4 cm above pubic creast• its insertion into the linea alba : landmark for an accurate midline incision
Linea semicircularis
Tendinous line
Rectus sheath
• Anterior rectus sheath
• Posterior rectus sheath
• The semicircular line of Douglas (linea semilunalis)
A above arcuate line
B below arcuate line
Umbilical Area
• A midline fusion of the medial borders of both rectus abdominis aponeurosis around the umbilical cord
• This fusion may take place around the 10th week
• Structures associated with the Umbilical Cord and Umbilicus
– umbilical vein → round ligament of the liver
– 2 umbilical arteries → medial umbilical ligaments
– Urachus → median umbilical ligament
Umbilical a & v.
Falciform lig
Umbilical v.
Umbilical a.
Round ligament
(obliterated umbilical v.)
Medial umbilical ligament
(obliterated umbilical a.)
Median umbilical ligament
(obliterated urachus)
Artery of the Anterior Abdominal Wall
• Superior epigastric artery (internal thorasic artery)• Inferior epigastric artery (ext.illiac artery)• Deep circumflex illiac artery (ext.illiac artery)• 3 branches of Femoral artery
– superficial circumflex iliac artery– superficial epigastric artery– superficial external pudendal artery
Superior epigastric a.
Deep circumflex iliac a.
Inferior epigastric a.
Superficial inferior epigastric a.
Superficial circumflex iliac a.
External oblique
perforators
Superficial inferior
epigastric a.
Superficial
circumflexiliac a.
superficial external pudendal artery
Lymphatic of anterior abdominal wall
Nerve Supply to
the Anterior Abdominal Wall
• Intercostal n.
• Subcostal n.• Iliohypogastric n.
• Ilioinguinal n.
A: Seventh to twelfth thoracic n.
B: First lumbar n.
Surgical anatomy of
Posterior abdominal wall
Posterior abdominal wall
• Lumbar vertebrae
• Paravertebral gutters– Psoas major – Quadratus lumborum– Iliacus– Erectoe spinae
• Fascia of posterior abdominal wall– Thoracolumbar fascia (lumbodorsal fascia)
Thoracolumbar fascia
Thoracolumbar fascia
• 3 layers of connective tissue– Anterior lamella– Middle lamella– Posterior lamella
Muscle Origin Insertion
External oblique • Inf border of lower 8 ribs • linea alba• iliac crest
• ASIS
Internal oblique • Iliac fascia
• Anterior iliac crest
• Lumbar aponeurosis
• Lower border of ribs 9-12
• linea alba
• Pecten pubis
Transversus abdominis
• Iliac crest
• Lumbodorsal fascia
• Cartilages of lower ribs
• linea alba
• Pecten pubis
Rectus abdominis • pubis and pubic symphysis • Cartilages of ribs 5-7
• Xiphoid process
Pyramidal • Pubis
• Anterior pubic ligament
• Linea alba
Muscle Origin Insertion
Quadratus lumborum • Iliolumbar ligament
• Posterior iliac crest
• 12th rib
• Transverse processes L1-4
Internal oblique • Transverse processes L1-5
• Bodies/fibrocartilages T12-L5
• Lesser trochanter
Iliacus • Upper ⅔ of iliac fossa
• Inner lip of iliac crest
• Ant sacroiliac ligament
• Base of sacrum
• lesser trochanter