Abdominal wall

Objectives: To know the anatomy of abdominal wall( ant& post). Blood supply nerve supply and lymph drainage To understand the anatomy of the inguinal canal To list common types of hernia

Abdomen is a closed cylinder with a musculo-skeletal wall.

Inside are the wall are the liver, intestines, kidneys, etc.

Abdominal Muscles Increase Intra-abdominal pressure

Remember Valsava?

Abdomen defined by diaphragm above, pelvic brim below, and vertebral bodies ribs and muscles posteriorly, and laterally.

To get in the abdominal cavity you must go through skin, 2 superficial fascias (fatty and membraneous). 3 muscles layers (or one), transversalis fascia, parietal peritoneum.

MUSCLES OF THE ANTEROLATERAL ABDOMINAL WALL

LINEA ALBA TENDINOUS INTERSECTION TRANSVERSUS ABDOMINIS INTERNAL OBLIQUE EXTERNAL OBLIQUE RECTUS ABDOMINIS

APONEUROSIS OF EXTERNAL OBLIQUE SUPERFICIAL INGUINAL RING

INGUINAL LIGAMENT

MUSCLES OF THE ANTEROLATERAL ABDOMINAL WALL RECTUS SHEATH

TA IO EO
APONEUROSES

ABOVE THE ARCUATE LINE THE APONEUROSIS OF THE INTERNAL OBLIQUE SPLITS TO ENCLOSE THE RECTUS ABDOMINIS BELOW THE ARCUATE LINE ALL APONEUROSES PASS IN FRONT OF THE RECTUS ABDOMINIS

Vessels of the Anterolateral Abdominal Wall

Internal thoracic vessels Superior epigastric vessels

Inferior epigastric vessels

Nerves of the Abdominal Wall Ventral Rami of T6 to L2

MUSCLES OF THE ANTEROLATERAL ABDOMINAL WALL

EXTERNAL OBLIQUE INTERNAL OBLIQUE

BILATERAL ACTION: ASSISTS RECTUS ABDOMINIS IN FLEXING VERTEBRAL COLUMN, COMPRESSING ABDOMINAL WALL, AND INCREASING INTRAABDOMINAL PRESSURE UNILATERAL ACTION: AID BACK MUSCLES IN ROTATION AND LATERAL FLEXION

NN. = T7-T12

NN. = T7-T12, L1

MUSCLES OF THE ANTEROLATERAL ABDOMINAL WALL RECTUS ABDOMINIS

RECTUS ABDOMINIS

BILATERAL: FLEXION OF VERTEBRAL COLUMN, COMPRESSION OF ABDOMEN, INCREASE IN INTRA-ABDOMINAL PRESSURE

UNILATERAL: ASSISTS BACK MUSCLES IN LATERAL FLEXION AND ROTATION

NN. = T7-T12, L1

Psoas and quadratus lumborum form posterior wall.

Psoas + Iliacus = IliopsoasMost Major Hip FlexorCrosses under Inguinal Ligament with Femoral Nerve, and External Iliacs (become Femoral a and v.

Inguinal Ligamentinferior border of aponeurosis of

external oblique muscleattaches to ASIS and pubic tubercle

* Superficial Inguinal ring, a weak spot through which abdominal contents may extrude-direct inguinal hernia.

Deep Inguinal RingPushes through transversalis facia Inginal Canal from deep ring (under ext. oblique) to superfical inguinal ring (where hernias puch out)

Whats indeed the parietal peritoneum? Liver Gall Bladder Stomach Ascending Colon

Small intestines
Greater Omentum an apron from the stomach to the transvers colon.

MESENTERIES

The Abdominal Cavity

DOUBLE-LAYERED FOLDS OF PERITONEUM THAT SUSPEND THE VISCERAL ORGANS.

PROVIDE A NEUROVASCULAR CONNECTION BETWEEN THE ORGANS AND THE BODY WALL

The Mesentery

The Mesentery
Greater omentum and transverse colon reflectedpulled up.

Figure 22.6c

Duodenum begins

DuoduodnalJejunal junct

The Mesentery attaches to the posterior wall.

Ileo-Colic junction

Intraperitoneal Abdominal Organs derived from foregut (B) have a dorsal and ventral mesentery. Midgut derived organs (A) lack a ventral mesentery.

B A B A

Parietal peritoneum serous membrane lining the abdominal cavity (space between) Visceral peritoneum serous membrane covering the internal organs

Right and Left Colic Flexures

Some Organs Lose Their Mesentery and Become Retroperitoneal

INTRAPERITONEAL VS. RETROPERITONEAL

INTRAPERITONEAL ORGANS ARE ALMOST COMPLETELY
COVERED WITH VISCERAL PERITONEUM THEY are

suspended or protrude in into the peritoneal cavity, but are not actually in it. RETROPERITONEAL ORGANS ARE LOCATED between the paeietal perinoneum and the body wall itself. -They may be partially covered by parietal peritoneum

Subperitonealsome organs lie below the peritoneum in the pelvis, e.g. The uterus and bladder.

PARIETAL PERITONEUMBlue area

The Adult Mesenteries

TRANSVERSE MESOCOLON

MESENTERY PROPER

NOT SHOWN: MESOAPPENDIX, SIGMOID MESOCOLON

GREATER AND LESSER OMENTA

LESSER OMENTUM A double layer of peritoneum extending from the porta hepatis of the liver to the lesser curvature of the stomach and the beginning of the duodenum

GREATER OMENTUM a double layer of peritoneum attached to the greater curvature of the stomach superiorly and the transverse colon inferiorly; it hangs down like a fatty apron over the abdominal viscera

TWO PERITONEAL SACS

LESSER SAC OR OMENTAL BURSA

GREATER SAC SUPRACOLIC

TRANSVERSE MESOCOLON

GREATER SAC INFRACOLIC

Rotation of the Stomach Forms the Lesser Sac of the Peritoneal Cavity and Starts to Form the Greater Omentum

LOCATION OF THE SPLEEN

SPLEEN

The Peritoneum

The Peritoneum

The parietal peritoneum

The visceral peritoneum

The peritoneal cavity

The retroperitoneal space kidneys suprarenal glands ureters duodenum pancreas aorta inferior vena cava

nerves
ascending colon descending colon

The Peritoneum

The parietal peritoneum

The visceral peritoneum

The peritoneal cavity

The visceral peritoneum The peritoneal cavity

2 layer folds of the peritoneum 1. The peritoneal ligaments 2. Lesser and Greater Omenta 3. The mesenteries

1. The peritoneal ligaments falciform ligament ligamentum teres median umbilical ligament medial umbilical ligaments lateral umbilical ligaments

2. Lesser and Greater Omenta

Lesser and Greater Omenta

hepatogastric ligament hepatoduodenal ligament

the epiploic foramen (of Winslow)

Lesser Omentum

Greater Omentum

3. The mesenteries

The mesenteries

Contents ?

mesentery of the small intestine transverse mesocolon sigmoid mesocolon

Lesser Sac

Other Ligaments falciform ligament ligamentum teres Lesser Omentum

hepatogastric ligament hepatoduodenal ligament.

gastrophrenic ligament gastrosplenic ligament

Lienorenal ligament

phrenicocolic ligament

gastrocolic ligament

Greater Omentum

Lesser Sac

Lesser Sac

Lesser Sac
(Omental Bursa)

Lesser Sac epiploic foramen (of Winslow)

Superior recess left subhepatic space Vestibule

Morisons pouch

Epiploic foramen (of Winslow) Ant: hepatoduodenal ligament

Post: inferior vena cava

Sup: caudate lobe

Inf: first part of the duodenum

Peritoneal cavity Greater sac

The supra-colic compartment

Rt. anterior subphrenic space

Lt. anterior subphrenic space

Rt. posterior subphrenic (Rt. Subhepatic)

Superior recess Vestibule

left subhepatic Space

(Lt. posterior subphre

Morisons pouch