ABDOMEN PART 1

ANTERIOR ABDOMINAL WALL

Skin
o Lines of Cleavage
Run downward and forward almost horizontally around the trunk
o Umbilicus
Scar representing the site of attachment of the umbilical cord in the fetus
Situated in the linea alba
o Nerve Supply
Cutaneous nerve supply = Anterior rami of the:
Lower 5 intercostal n.
Subcostal n.
Iliohypogastric n
Ilioinguinal n.
Dermatomes:
T7 = epigastrium over the xiphoid process
T10 = umbilicus
L1 = above the inguinal ligament and the symphysis pubis
o Blood supply
Arteries (skin)
Near the midline = br. of superior and inferior epigastric a.
Flanks = br. of the intercostal, lumbar and deep circumflex iliac a.
Inguinal region = superficial epigastric, circumflex iliac and external pudendal a., and br. of
femoral a.
Veins
Above: Axillary vein via the Lateral thoracic vein
Below: Femoral vein via the Superficial epigastric and Great Saphenous veins
Superficial fascia
o Fascia of Camper: superficial and fatty layer
Continuous w/ the superficial fat over the rest of the body (> 3 inches in obese)
Dartos muscle: thin layer of smooth muscle in the scrotum
o Scarpas fascia: deep and membranous layer
Thin and fades out laterally and above, continuous w/ the superficial fascia of the back and thorax
Inferior = continuous w/ the deep fascia
Midline inferior = forms a tubular sheath for the penis or clitoris
Colles fascia: attached on each side to the margins of the pubic arch
Deep Fascia
o Thin layer of connective tissue covering the muscles
o Lies immediately deep to the membranous layer of superficial fascia
Muscles
o External Oblique
Posterior fibers passing down to the iliac crest from a posterior free border
Superficial Inguinal Ring: triangular-shaped defect in the external oblique that lies above and medial to
the pubic tubercle
Spermatic cord passes through this opening and carries the external spermatic fascia from the
margins of the ring
Inguinal Ligament
Lacunar ligament
Pectineal ligament: lacunar ligament becomes continuous w/ a thickening of the periosteum
Fascia lata: deep fascia of the thigh
o Internal Oblique
Fibers run at right angles to those of the external oblique
Conjoint tendon: attached medially to the linea alba, and has lateral free border
Cremaster muscle: as the spermatic cord passes under the lower border of the int. oblique, it carries this
muscle
o Transversus
Deep to the internal oblique
Fibers run horizontally forward
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 Posterior border of the External Oblique is FREE
Posterior border of the Internal Oblique and Transversus muscles are attached to the LUMBAR vertebra by
lumbar fascia
o Rectus Abdominis
Long strap muscle that extends along the whole length of the ant. Abdominal wall
Two heads:
Front of the symphysis pubis
Pubic crest
Inserted into the 5th-7th costal cartilages and the xiphoid process
Linea semilunaris: when it contracts, lateral margin forms a curved ridge
Extends from the tip of the 9th costal cartilage to the pubic tubercle
Divided into Segments by 3 transverse tendinous intersections:
Level of the xiphoid process
Umbilicus
Halfway between these two
o Pyramidalis muscle
Often absent
Lies in front of the lower part of the rectus abdominis
Rectus Sheath: encloses the rectus abdominis muscle and pyramidalis muscle, and contains the anterior rami of the
lower 6 thoracic nerves, and superior and inferior epigastric vessels and lymph vessels
Formed by the aponeuroses of the 3 lateral abdominal muscles
Arcuate line: posterior wall has a free curved lower border
In this site, the inferior epigastric vessels enter the rectus sheath and pass upward to anastomose
w/ superior epigastric vessels
Linea Alba: separates the rectus sheath from its fellow on the opposite side
The posterior wall of the rectus sheath is not attached to the rectus abdominis muscle
o FUNCTION OF THE ANTERIOR ABDOMINAL WALL MUSCLES:
Oblique muscles: laterally flex and rotate the trunk
Rectus abdominis: flexes the trunk and stabilizes the pelvis
Pyramidalis: keeps linea alba taut
o TABLE 4.1 page124
Fascia Transversalis
o Lines the transversus abdominis muscle
o Continuous w/ a similar layer lining the diaphragm and iliacus muscle
o Femoral sheath: Fascia transversalis + Fascia iliaca
Extraperitoneal Fascia
o Contains a variable amount of fat and lies between the fascia transversalis and the parietal peritoneum
Parietal Peritoneum
o Thin serous membrane

Nerves of the Anterior Abdominal Wall

Between the internal oblique and transversus muscles
Anterior rami of the lower 6 thoracic nerves
o Lower 5 intercostal nerves (Rectus muscle)
o Subcostal nerve (Pyramidalis muscle)
Anterior rami of the 1st lumbar nerve
o Iliohypogastric nerve
Pierces the external oblique aponeurosis above the superficial inguinal ring
o Ilioinguinal nerve
Emerges through the ring
o Supply the skin above the inguinal ligament and symphysis pubis

Arteries of the Anterior Abdominal Wall

Superior Epigastric Artery
o Br. of Internal Thoracic Artery
o Supply UPPER central part of the Anterior Abdominal Wall
Inferior Epigastric Artery
o Br. of the External Iliac Artery
o Supply LOWER central part of the anterior abdominal wall
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 Deep Circumflex Iliac Artery
o Br. of the External Iliac Artery
o Supplies the LOWER part of the abdominal wall
Lower 2 posterior intercostal arteries
o Br. of the Descending Thoracic Aorta
o Supply the LATERAL part of the abdominal wall
4 Lumbar arteries
o Br. of Abdominal Aorta
o Supply the LATERAL part of the abdominal wall

Veins of the Anterior Abdominal Wall

Superficial Veins
o Radiates out from the umbilicus
o Drain into the Axillary vein via Lateral Thoracic Vein (ABOVE)
o Drain into the Femoral vein via the Superficial epigastric and Great Saphenous Veins (BELOW)
o Paraumbilical veins
Connect the network through the umbilicus and along the ligamentum teres to the portal vein
Forms a Portal-Systemic Venous Anastomoses
Deep Veins
o Superior and Inferior Epigastric Veins
o Deep Circumflex Iliac Veins
Drain into the Internal Thoracic and External Iliac Veins
o Posterior Intercostal Veins
Drain into the Azygos Veins
o Lumbar Veins
Drain into the Inferior Vena Cava

Lymph Drainage of the Anterior Abdominal Wall

Superficial Lymph Vessels
o Above the level of the Umbilicus: Anterior axillary (pectoral) group of nodes
o Below the level of the umbilicus and Iliac Crest: Superficial Inguinal nodes
o Above the level of the Iliac Crest: Posterior Axillary group of nodes
Deep Lymph Vessels
o Follow the arteries and drain into the:
Internal Thoracic nodes
External Iliac nodes
Posterior Mediastinal nodes
Para-aortic (lumbar) nodes

INGUINAL CANAL
Oblique passage through the lower part of the abdominal wall
Allows structures to pass to and from the testis to the abdomen (MALE)
Allows the round ligament of the uterus to pass from the uterus to the labium majorus (FEMALE)
Deep Inguinal Ring
o Oval opening in the fascia transversalis
o Margins of the ring give attachment to the internal spermatic fascia
o Weakest part of the posterior wall
Superficial Inguinal Ring
o Triangular-shaped defect in the apneurosis of the external oblique muscle
o Margins (Crura) gives attachment to the external spermatic fascia
o Weakest part of the anterior wall
Walls of the Inguinal Canal
o Anterior: External Oblique aponeurosis
o Posterior: Conjoint tendon (medial), Fascia transversalis (lateral)
o Roof: Lowest fibers of the oblique and transversus abdominis muscles
o Floor: lower edge of the inguinal ligament, Lacunar ligament (medial end)

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SPERMATIC CORD
Collection of structures that pass through the inguinal canal to and from the testis
Begins at the deep inguinal ring lateral to the inferior epigastric artery
Ends at the testis
Structures of the Spermatic Cord:
o Vas Deferens (Ductus Deferens)
Thick-walled muscular duct that transports spermatozoa from the epididymis to the urethra
o Testicular Artery
Br. of the Abdominal Aorta (level of L2)
Descends on the post. abdominal wall
Supplies the testis and epididymis
o Testicular Veins
from the Pampiniform plexus
runs up on the post. abdominal wall
drains into the Left Renal Vein (left) and Inferior Vena Cava (right)
o Lymph Vessels
Lumbar (para-Aortic) lymph nodes on the side of the Aorta
Level of L1
o Autonomic Nerves
Sympathetic fibers from Renal or Aortic Sympathetic Plexuses
o Processus Vaginalis
o Genital Br. of the Genitofemoral Nerve
Supplies the Cremaster Muscle
Coverings of the Spermatic Cord (Spermatic Fascia)
o External Spermatic Fascia
Derived from the External Oblique Aponeurosis
Attached to the margins of the Superficial Inguinal Ring
o Cremasteric Fascia
Derived from the Internal Oblique Muscle
o Internal Spermatic Fascia
Derived from the Fascia Transversalis
Attached to the margins of the deep inguinal ring
Development of the Inguinal Canal
o Processus Vaginalis
Peritoneal diverticulum
Passes through the layers of the lower part of the anterior abdominal wall

SCROTUM
Outpouching of the lower part of the anterior abdominal wall
Contains the testes, epididymides, and lower ends of the spermatic cords
LAYERS of the wall of the Scrotum:
o Skin
Thin, wrinkled, and pigmented
Forms a SINGLE pouch
Raised ridge in the midline: line of fusion of the two lateral labioscrotal swellings
Swellings (Female): forms the Labia Majora
o Superficial Fascia
Continuous w/ the Fatty and Membranous layers of the anterior abdominal wall
Dartos Muslce: smooth muscle that replaces the fat
Innervated by the sympathetic fibers
Responsible for the wrinkling of the overlying skin
Colles fascia: membranous layer of the superficial fascia
o Spermatic Fascia
Derived from the three layers of the anterior abdominal wall
Three layers:
External Spermatic Fascia
Cremasteric Fascia
Internal Spermatic Fascia

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 Cremasteric reflex
Cremaster muscle is made to contract by stroking the skin on the medial aspect of the thigh
Afferent fibers: femoral br. of the Genitofemoral nerve
Efferent fibers: genital br. of the Genitofemoral nerve
Cremaster muscle
Raise the testis and scrotum upward for warmth and protection against injury
o Tunica Vaginalis
Lies w/in the spermatic fascia
Covers the anterior, medial and lateral surfaces of each testis
Lower expanded part of the Processus Vaginalis
Closed sac invaginated from behind by the testis
Lymph Drainage of the Scrotum
o Superficial Inguinal Lymph Nodes
Testis
o Firm, mobile organ lying within the scrotum
o LEFT testis lies at a lower level than the right
o Tunica albuginea: fibrous capsule that surrounds each testis
Fibrous septa: divide the interior of the organ into lobules
Each lobule = 1-3 seminiferous tubules
Rete testis: tubule open into a network of channels
Efferent Ductules: connect the rete testis to the upper end of the epididymis
o Normal Spermatogenesis:
Happens if testes are at a temperature lower than that of the abdominal cavity
Scrotum = 30C lower than the abdominal temperature
Stabilize the temperature of the testes by counterconcurrent heat exchange mechanism:
Testicular veins
Testicular arteries
Epididymis
o Firm structure lying posterior to the testis, vas deferens lying on its medial side
o Sinus of the epididymis: inner visceral layer of the tunica vaginalis
o Coiled tube nearly 20 ft. long
o Long length of the duct
provides storage space for the spermatozoa
allows them to mature
o MAIN FUNCTION: absorption of fluid
Addition of substances to the seminal fluid to nourish maturing sperm
Blood Supply (Testis and Epididymis)
o Testicular Artery
Br. of Abdominal Aorta
o Testicular Veins Pampiniform Plexus
Right Testicular Veins: drains into the Inferior Vena Cava
Left Testicular Veins: drains into the Left Renal Vein
Lymph Drainage (Testis and Epididymis)
o Ascends in the spermatic cord and end in the Para-aortic or Lumbar nodes (level of L1 transpyloric plane)

LABIA MAJORA
Prominent, hair-bearing folds of the skin formed by the enlargement of the genital swellings in the fetus
w/in are a large amount of adipose tissue and the terminal strands of the round ligaments of the uterus

POSTERIOR ABDOMINAL WALL

formed in the midline by:
o 5 lumbar vertebra and IVDs
o 12th rib (lateral)
o Upper part of the Bony Pelvis
Iliacus muscle lie here
o Psoas Muscles
o Quadratus Lumborum muscles
o Aponeurosis of origin of the transversus abdominis muscles

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 Lumbar Vertebra
o Body = massive and kidney-shaped
Bear the greater part of the body weight
o Lumbosacral joint = where L5 articulates w/ the base of the sacrum
o Intervertebral Discs = thicker than in other regions of the VC
Wedge-shaped
Responsible for the Lordosis in the Lumbar region
12th pair of Rib
o Head has a single facet for the articulation w/ the body of T12 vertebra
o Costal cartilage is embedded in the musculature of the Anterior Abdominal Wall
Ilium
o + Ischium + Pubis = Hip Bone
o Meet one another at the Acetabulum
o Arcuate line = divides the medial surface of the ilium into two
Forms the posterior part of the iliopectineal line
Pectineal line = forms the anterior part of the iliopectineal line
Muscles of the Posterior Abdominal Wall = TABLE 4.2 (page 137)

FASCIAL LINING OF THE ABDOMINAL WALLS

Diaphragmatic Fascia
Transversalis Fascia
Psoas Fascia
Quadratus Lumborum Fascia
Iliaca Fascia

Abdominal Blood and Lymph Vessels = lie within its fascial lining
Principal nerves = lie outside the fascia
Femoral Sheath
o Downward prolongation of the fascial lining around the femoral vessels and lymphatics
o Femoral nerve lies outside the fascial envelope = It has no Sheath

PERITONEAL LINING OF THE ABDOMINAL WALLS

Parietal Peritoneum
o Thin serous membrane consisting of a layer of mesothelium resting on connective tissue
Nerve supply:
o Central part of the Diaphragmatic Peritoneum = Phrenic Nerve
o Peripheral part of the Diaphragmatic Peritoneum = Lower Intercostal Nerves
o Peritoneum lining the anterior and posterior Abdominal Walls = Intercostal and Lumbar Nerves

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