ANTERIOR ABDOMINAL WALL

Learning objectives
At the end of the lecture the student should be able to:

Know the details of anterior abdominal wall.

Identify the layers of abdominal wall.

Identify the fascia, muscles of wall.

Abdominal wall
Abdominal wall represents the boundaries of the abdominal cavity.

Abdominal wall is split into:

Posterior (back)

Lateral (sides)

Anterior (front).
Borders of the Abdomen
Superior:

Costal cartilages 7-12.

Xiphoid process: Level of 10th cartilage = L3

Inferior:

Pubic bone and iliac crest: Level of L4.

Umbilicus:

Level of IV disc L3-4

Lines of the Anterior Abdominal Wall

Linea alba:

Located along the midline = connective tissue raphe.

Linea semilunaris:

Along each lateral border of rectus abdominis.

Linea transversa:

Tendinous bands of rectus abdominis

Linea Alba
Median raphe

Extends from xiphoid to pubic

symphysis.

Lies between paired rectus abdominus

muscles.

Fusion of aponeuroses of transversus

abdominus, internal oblique, and
external oblique.

Surface Features
Linea semilunaris:

o Along lateral margin of rectus abdominus.

o Crosses costal margin near tip of 9th costal cartilage.

Arcuate line:
o Lower free edge of posterior lamina.
o Lies midway between umbilicus and pubis.
Layers of abdominal wall

Layers of the abdominal wall are (from

superficial to deep):
Skin
Fascia
Camper's fascia - fatty superficial layer.
Scarpa's fascia - deep fibrous layer.

Muscle
Three large flat sheets connecting rib
cage to hip bone.
Muscles posteriorly and laterally.
Aponeurosis anteriorly and medially
Rectus abdominis
External oblique muscle
Internal oblique muscle
Transverse abdominal muscle

Fascia transversalis
Peritoneum
Fascia
Superficial:

o Campers fascia
o Continuous with fascia over thorax and thigh.
o Fatty layer.
o It is areolar in texture, and contains in its
meshes a varying quantity of adipose tissue.

In men, this superficial layer continues over the

penis and, after losing its fat and fusing with the
deeper layer of superficial fascia, continues into
the scrotum where it forms a specialized fascial
layer (the dartos fascia).

In women, this superficial layer retains some fat

and is a component of the labia majora.

Fascia
Deep Superficial:

Scarpas fascia

Membranous layer.

It continues into the anterior part of the

perineum where it is firmly attached to the
ischiopubic rami and to the posterior margin
of the perineal membrane. Here, it is referred
to as the superficial perineal fascia (Colles'
fascia).

Deep:
Thin layer covering abdominal muscles.
Muscle Layers
5 muscles

3 horizontal

External oblique.
Internal oblique.
Transversus abdominus.

2 vertical
Rectus abdominus.

Rectus sheath
Rectus sheath:

Encloses rectus abdominus.

Formed by fusion of fascia of other three layers of

abdominal muscles.

Anterior and posterior laminae. (layers)

Arcuate line is the lower free edge of the posterior

lamina

Lies midway between umbilicus and

Rectus abdominis muscle
Two parallel muscles

Separated by a midline band of connective tissue

called the linea alba

Attachment

Pubic crest,
Pubic tubercle
Pubic symphysis
Costal cartilages of ribs V to VII;
xiphoid process
Anterior rami of lower seven
thoracic spinal nerves (T7 to T12)

Functions
Compresses abdominal contents;
Flexes vertebral column & tense
abdominal wall.
Pyramidalis

Attachment
Front of pubis and pubic symphysis Into linea alba.
Anterior ramus of T12 Tenses the linea alba

External oblique

Most superficial of the three flat muscles

Immediately deep to the superficial fascia.
Large aponeurotic component covers the anterior part of the abdominal wall
to the midline.
Extensions of external oblique

The lower border of the external oblique

aponeurosis forms the inguinal
ligament on each side.
This thickened reinforced free edge of
the external oblique aponeurosis passes
between the anterior superior iliac spine
laterally and the pubic tubercle
medially.
Lacunar ligament is a crescent-shaped
extension of fibers at the medial end of
the inguinal ligament that pass
backward to attach to the pecten pubis
on the superior ramus of the pubic bone.
Additional fibers extend from the
lacunar ligament along the pecten pubis
of the pelvic brim to form the pectineal
(Cooper's) ligament.

Internal oblique muscle

Deep to the external oblique muscle is the internal oblique muscle

This muscle is smaller and thinner than the external oblique, with most of its
muscle fibers passing in a superomedial direction.
Its lateral muscular components end anteriorly as an aponeurosis that blends
into the linea alba at the midline.
Transversus abdominis
Deep to the internal oblique muscle is the transversus abdominis muscle.

So-named because of the direction of most of its muscle fibers.

It ends in an anterior aponeurosis, which blends with the linea alba at the
midline.

Transversalis fascia
Each of the three flat muscles is covered on its anterior and posterior
surfaces by a layer of investing abdominal fascia.

These layers are unremarkable except for the layer deep to the transversus
abdominis muscle (the transversalis fascia), which is better developed.
 Deep to the transversalis fascia is a layer of connective tissue, the
extraperitoneal fascia, which separates the transversalis fascia from the
peritoneum

Peritoneum
Deep to the extraperitoneal fascia is the peritoneum. This thin serous
membrane lines the walls of the abdominal cavity and, at various points,
reflects onto the abdominal viscera, providing either a complete or a partial
covering.

Cutaneous Nerves
The skin and muscles of the anterolateral abdominal wall
are supplied by T7 to T12 and L1 spinal nerves.

The intercostal nerves (T7 to T11) leave their

intercostal spaces, passing deep to the costal
cartilages, and continue onto the anterolateral
abdominal wall between the internal oblique and
transversus abdominis muscles.
Cutaneous Nerves
Ventral rami of T7 through T11:= thoracoabdominal
nerves.

T7 to dermatome over xiphoid process.

T10 at level of umbilicus.

Subcostal nerve

Ventral ramus of L1:

Gives rise to:

iliohypogastric nerve.

ilioinguinal nerve.

Arterial supply
Superior part of the wall

Musculophrenic artery, a terminal

branch of the internal thoracic
artery.

Inferior part of the wall

Superficial epigastric artery

Superficial circumflex iliac artery,

both branches of the femoral artery

Lateral part of the wall

10th and 11th intercostal arteries

Subcostal artery
Lymphatic Drainage
Superficial lymphatics:

Above the umbilicus:

Drain into the axillary and sternal nodes.

Below the umbilicus:

Drain into the superficial inguinal nodes.

Deep lymphatic drainage

Follows the deep arteries back to

parasternal nodes along the internal
thoracic artery,
lumbar nodes along the abdominal aorta
external iliac nodes along the external
iliac artery.

Venous Drainage
Superficial veins are paired with arteries.

Above the umbilicus:

Drain into the azygos venous system.

Below the umbilicus:

Drain into the femoral system (via great saphenous).

Folds on Posterior Surface (of anterior wall)
Median umbilical fold:
Midline peritoneal fold on inner abdominal wall above bladder.
Contains median umbilical ligament:
Remnant of embryonic urachus.

Medial umbilical fold:

Paired peritoneal folds on either side of median fold.
Contain medial umbilical ligaments:
Remnants of umbilical arteries.

Lateral umbilical fold:

Paired peritoneal folds lateral to medial folds.
Contain inferior epigastric vessels:
From deep inguinal ring to arcuate line.