the abdomen

The Abdomen

The objectives:1.To get knowledge about the normal anatomy of the abdomen (abd. Wall, digestive system, spleen,….).2.Understanding the normal location of structures and their anatomical relationships is necessary in practicing surgery.3.Knowing the anatomical basis is very important in solving the clinical problems.

Pectineal line or pecten

Symphysis pubis
Pubic tubercle
Pubic crest
Sup. ramus of pubis
Ant. Sup. Iliac spine
Iliac crest tubercle

The abdomenal wallSurface anatomy

Umbilicus (L3-L4)
Linea alba
Linea semilunaris

Vertical lines

Intertubercular line
Subcostal plane
(L5)
(L3)
Transpyloric plane LI

umbilical

epigastric
Vertical lines
hypogastric
iliac
lumbar
hypochondrium
Intertubercular line
Subcostal plane
(L5)
(L3)
Transpyloric plane LI

Superficial fascia

Muscles of abd. wall
Anterolateral: -ext. oblique. & -Int. oblique. & -Transvesus abdominis & -cremaster muscle. Anterior: -rects abdominis & -pyramidalis. Posterior: -quadratus lamborum & -psoas muscles

Ext. oblique

Lumbar triangle

Origin: Lower 8 ribs

Derivatives of Ext. oblique aponeurosis

Reflected ing. Lig.

Ext. spermatic fascia
Intercrural fibers
Med. crus
Lat crus
lacunar Lig.
Ing. Lig.
Rectus sheath

Int. oblique

origin: Lumbar fascia Iliacus fascia 2/3 ing. Lig. 2/3 iliac crest
Insertion: lin. Alba Xiph. Process Pubic symphysis Lower 3 ribs & C.C. Pubic crest Pectineal line

Int. oblique

Lower fibers
Cremaster muscle
Conjoint tendon

Transversus abdominis

origin: Lowe 6 ribs Lumbar fascia 1/3 ing. Lig. 3/4 iliac crest
Insertion: lin. Alba Xiph. Process Pubic symphysis Pubic crest Pectineal line

Action of Muscles of abd. wall

Support and compress abd. contents Flexion ,rotation, and bending of trunk Assist in expiration, micturation, defecation, parturition

Tendinous intersection

Linea semilunaris
Rectus abdominis
pyramidalis
insertion 5,6,7 CC & X.P.
origin Sup. Ramus & lig. PS


Rectus sheath
Rectus sheath
content: Rectus abd. m. pyramidalis Sup. $ inf. Epig. Art. Lower 6 thoracic n

Arcuate line

Post. Abd. wall
Quadratus lumborum
Psoas m.

Transversalis fascia

Quadratus lumborum
Psoas m.

Transversalis fascia

Deep ing. ring
Femoral sheath

Nerve supply of anterolateral abd. wall

L1
T12
T10
T7
L1
T7
T10
L1

Nerve supply of anterolateral abd. wall

Blood supply of anterolateral abd. wall
musculophrenic
1. (Int. thorc. Art.)
3. (femoral Art.)
2. (abd. Aorta)
4. (ext. iliac. Art.)
5. (Int. iliac. Art.) → iliolumbar art.


Blood supply of anterolateral abd. wall
3. (femoral Art.)
4. (ext. iliac. Art.)
5. (Int. iliac. Art.) → iliolumbar art. 1. (Int. thorc. Art.)
2. (abd. Aorta)
Veins 1.Internal thoracic vein 2.Inferior vena cava 3.Femoral vein 4.External iliac vein 5.Internal iliac vein

Lymphatic drainage

Deep lymphatics
Superficial lymphatics
Sternal nodes

Inguinal canal

Descent of testis

Descent of testis

8 months
5 months
3 months

Cryptochidism

Incomplete descent
maldescent

Descent of ovary

Inguinal canal
Ing. Lig.
Deep ing. ring
Superf.ing. ring
Ing. Lig.
Ant. wall

Boundaries of Inguinal canal

lacunar Lig.
Transversalis fascia
Conjoint tendon
Ing. Lig.
Transv. abdominis
(floor)
(roof)
Pos. wall

Structures pass through Inguinal canal

Cremasteric art.
Ilioiguinal nerve

Structures pass through Inguinal canal in female

Round lig. Of uterus. Art. And vein of round lig. Cremaster m. Genital branch. Ilioinguinal n.

Abdominal Hernia

Abd. cavity

Abdominal hernia

Inguinal hernia (direct and indirect) Femoral hernia Umbilical hernia

Abdominal hernia

Lumbar hernia Incisional hernia Epigastric hernia


Indirect Inguinal hernia

Direct Inguinal hernia

Hasselback’s triangle lacunar Lig.

Inf. epigastric artery

Direct Inguinal hernia
Indirect Inguinal hernia


indirect Inguinal hernia (hernia is through deep ing. Ring) narrow hernial sac neck. Lat. To inf. Epigastric. Art. Usually extend to scrotum. Most common. Covering same as sp. Cord
direct Inguinal hernia (hernia is through post. wall of in. canal) wider hernial sac neck. Med. To inf. Epigastric. Art. Rarely extend to scrotum. Less common. Tran.fasci.+conjoint tendon

Inguinal hernia

supravesical
Med.Ing. Fossa (direct hernia)
Lat.umb. fold
Median umb. Lig.
Inf.epig.vess.
Medial umb. Lig.
Median umb. fold
Medial umb. fold
lat. Ing. Fossa (indirect hernia)