Abdominal Wall

and Cavity
Dr.Yulia Anggraini
Content:
Surface Anatomy
Muscular Wall
Review vascularisation and
innervation
Inguinal region
Peritoneum and Peritoneal Cavity

Surface Anatomy
1. Planum transpyloricum
Garis transversal antara
incissura jugularis dan
symphisis pubis.
Setinggi cartilago costae IX
(anterior) dan bagian bawah
vertebrae lumbalis I
(posterior)
Surface Anatomy
(2) Planum
transtubercular
Garis transversal
setinggi tuberculum
iliaca (anterior)
dan vertebrae
lumbalis V (posterior)
Surface Anatomy
4 quadrants of abdomen:
upper left quadrant ULQ
lower left quadrant LLQ
upper right quadrant URQ
lower right quadrant LRQ
9 regions of abdomen
Abdominal Regions
Hipocondrium dextra
Hepar
Hipocondrium sinistra
Gaster, pankreas
Epigastrium
Hepar, gaster, pankreas
Lumbalis
Right contains ascending colon.
Left contains descending colon.
Ren
Abdominal Regions
Umbilicalis
Intestinum tenue dan colon transversum
Inguinalis
Right ileocecal junction, appendix.
Left colon sigmoideum
Hypogastrium
Intestinum tenue, vesica urinaria, uterus
Bony Landmarks
around Abdomen

xiphoid process X
costal cartilages (ribs 7-10)
tips of ribs 11 and 12
vertebrae L1-L5
iliac crests IC
tubercle of the crest TC
anterior superior iliac spine ASIS
anterior inferior iliac spine AIIS
inguinal ligament IL
pubic tubercle PT
pubic crest PC
pubic symphysis PS
Abdominal Wall from surface
Rectus abdominis
Linea alba
Linea arcuata
Linea semilunaris
Iliac crest
Lig.inguinale

Abdominal Wall from surface
Linea Alba
Berada di garis tengah
Terbentang dari proc. Xyphoideus sampai ke
symphisi pubis
Memisahkan m. rectus abdominus
Gabungan dari = aponeuroses of transversus
abdominus, internal oblique, and external oblique
muscle
Abdominal Wall from surface
Linea semilunaris:
Sepanjang lateral dari M. rectus abdominis.

Linea arcuata
bagian bawah dari lamina posterior
terletak di antara umbilicus dan pubis
Abdominal Wall from surface
Inguinal ligament:
Batas bawah dari apponeurosis M. obliquus
externus yg menebal

Mulai dari anterior superior iliac spine
sampai ke pubic tubercle.
Abdominal wall divided
into:

1. Anteriolateral abdominal wall
Anterior wall
Right lateral wall (Right Flank)
Left lateral wall (Left Flank)

2. Posterior abdominal wall

1. Anteriolateral Abdominal Wall
This extended from the thoracic cage to the pelvis and
bounded :
Superiorly
7th through 10th costal cartilages and and xiphoid
process
Inferiorly
Inguinal ligaments and the pelvic bones.

The wall consists of skin, subcutaneous tissues (fat),
muscles, deep fascia and parietal peritoneum.

LAYERS OF ABDOMINAL WALL
The layers of the
abdominal wall vary,
depending on where it is
you are looking. For
instance, it is somewhat
different along the lateral
sides of the abdomen than
it is at the anterior side. It
is also somewhat different
at its lower regions.
LATERAL
skin
superficial
fascia
deep fascia
muscle
subserous
fascia
peritoneum

ANTERIOR
WALL
superficial fascia
deep fascia (in
this case a
thickened area of
deep fascia
called the linea
alba)
subserous fascia
peritoneum

Wall inferior (umbilicus)
1. Lapisan lemak superficial yg akan berlanjut
dengan lapisan tubuh lain (Camper's fascia)
2. Lapisan membranosa yg akan berlanjut ke
bawah menuju perineum utk melapisi penis
dan scrotum (Scarpa's fascia)
Superficial perineal fascia = Colles



1. Anteriolateral Abdominal Wall
MusclesFig. 4 & Fig. 5
3 Flat Muscles with strong sheet like aponeuroses
External Oblique (hands-in-pocket)
Internal Oblique (fibers perpendicular to external)
Transversus Abdominis (wraps around)
2 Vertical Muscles
Rectus Abdominis - vertical midline
Pyramidalis --
Pyramidalis arises from the pubic crest and inserts into
the linea alba. Its function is to tense the linea alba.
External obliquus muscle


External oblique is the most superficial of the
three flat muscles.
It arises from the middle and lower 5th 12th
ribs and passes inferomedially to insert into the
linea alba, pubic tubercle and the iliac crest.


Internal Oblique muscle

Internal oblique has fibres arising from the
inguinal ligament and iliac crest that fan out
from the anterior superior iliac spine to insert
into the linea alba, conjoint tendon and the
lower 3 ribs. It is innervated by the
thoracoabdominal and lumbar nerves.


Transversus abdominis

Transversalis is the deepest of the flat
abdominal muscles that arises from the costal
cartilages, iliac crest and inguinal ligament.
The fibres run transversomedially to insert
into the linea alba, pubic crest and conjoint
tendon



Rectus Abdominis

Rectus abdominus arises from the pubic
symphysis and pubic crest, and inserts into the
xiphoid process and costal cartilages.
Pyramidalis muscle

Pyramidalis arises from the pubic crest and
inserts into the linea alba. Its function is to
tense the linea alba.


Rectus sheath:
Encloses rectus abdominis.
Formed by fusion of fascia of other three
layers of abdominal muscles.
Anterior and posterior laminae. (layers)
Anteriolateral Abdominal Wall
Functions


Melindungi viscera abdomen dari trauma
Menekan isi dari cavum abdomen
Menjaga tekanan intraabdomen
Menggerakkan batang tubuh dan memberi
bentuk tubuh
Posterior Abdominal Wall
Lumbar vertebrae and IV discs.
Muscles
Psoas, quadratus lumborum, iliacus
Lumbar plexus
Ventral rami of lumbar spinal nerves.
Fascia
Diaphragm
Contributing to the superior part of the posterior wall
Fat, nerves, vessels (IVC, aorta) and lymph nodes.
Posterior Abdominal Wall
Between the parietal peritoneum and the
muscles (retroperitoneal space) Fig. 6
The psoas fascia or psoas sheath.

The quadratus lumborum fascia.

The thoracolumbar fascia.
Posterior Abdominal Wall
Muscles
Three paired muscles

Psoas major

Iliacus

Quadratus Lumborum
Applied Anatomy
Posterior abdominal pain:

Ilio-psoas has relationship to kidney, ureters,
caecum, appendix, colon, pancreas.etc.

When any of these structures is diseased movement
of the ilio psoas usually causes pain.

When intra abdominal inflammation is suspected
the Ilio Psoas Test performed by moving ileopsoas
muscle and if positive if it causes pain.

Psoas Abscess
Hematogenous
spread to the
lumbar vertebrae
may form an
abscess which may
spread from the
vertebrae into the
Psoas sheath
producing a Psoas
abscess.
Inguinal Region
Inguinal Canal:
Oblique passage through lower
abdominal wall.
Site of potential weakness.
Transmits:
Spermatic cord in males.
Round ligament of uterus in
females.
Extends between superficial and deep
inguinal rings.
Inguinal Canal
Its boundaries are:
1) Anterior wall aponeurosis of
external oblique
2) Posterior wall transversalis fascia
3) Roof internal oblique and transverse
abdominus
4) Floor inguinal ligament (superior
surface)
Inguinal Region
The two openings of inguinal canal are :
1. Superficial inguinal ring:

Superficial opening of the inguinal canal.
Lies above and lateral to pubic tubercle.
Larger in males:
Transmits spermatic cord in males.
Transmits round ligament of uterus
in females.
Inguinal Region
2. Deep inguinal ring:
Opening of the evagination of the
transversalis fascia.

Lies above inguinal ligament
midway between anterior iliac
spine and pubic tubercle.

Inguinal Region
Inguinal Canal:
* Male: spermatic cord:
Vas deferens.
Ilioinguinal nerve.
Genital branch of genitofemoral
nerve.
Testicular arteries and veins.
Pampiniform plexus
Lymph vessels.
Cremaster muscle.
Inguinal Region
Inguinal Canal:
* Female:
Round ligament.
Ilioinguinal nerve.
Lymph vessels.
Inguinal Region
Inguinal Canal:
* Female:
Round ligament.
Ilioinguinal nerve.
Lymph vessels.
Hesselbachs Triangle

Hesselbachs (Inguinal) Triangle is an important
structure as it is the site for direct hernias. The
triangle has the following borders:
1) Medial border of rectus abdominus
2) Inguinal ligament (inferiorly)
3) Inferior epigastric vessels
Abdominal Hernia Orifices
Hernia is defined as the protrusion of an organ through its
containing wall. It can occur because of

Normal weakness found in everyone and related to
anatomy of the area e.g., place where vessel or viscus
enters or leaves the abdomen, muscles fail to overlap or
there is only scar tissue (Umbilicus)

Abnormal weakness caused by congenital abnormality or
acquired as result of trauma or diseases.

High intraabdominal pressure from
Coughing / Abdominal distention
Common Sites Fig. 7
1. Inguinal Hernia
2. Umbilical Hernia
3. Femoral Hernia
4. Incisional Hernia

Less common Hernia
Epigastric Hernia
Recurrent Hernia

Peritoneal Lining of the Abdominal Walls
The walls of the abdomen are lined with
parietal peritoneum.Fig. 9
This is a thin serous membrane consisting
of a layer of mesothelium resting on
connective tissue. It is continuous below
with the parietal peritoneum lining the
pelvis.
Peritoneal Lining of the Abdominal Walls
The peritoneum can be regarded as a balloon.
The parietal peritoneum lines the walls of the
abdominal and pelvic cavities, and the visceral
peritoneum covers the organs.
The potential space between the parietal and
visceral layers is called the peritoneal cavity.
In males, this is a closed cavity, but in females,
there is communication with the exterior
through the uterine tubes, the uterus, and the
vagina.
Peritoneal Lining of the Abdominal Walls
Between the parietal peritoneum and the fascial
lining of the abdominal and pelvic walls is a
layer of connective tissue called the
extraperitoneal tissue; in the area of the
kidneys this tissue contains a large amount of
fat, which supports the kidneys
Peritoneal Lining of the Abdominal Walls
Between the parietal peritoneum and the fascial
lining of the abdominal and pelvic walls is a
layer of connective tissue called the
extraperitoneal tissue; in the area of the
kidneys this tissue contains a large amount of
fat, which supports the kidneys
Peritoneal Lining of the Abdominal Walls
The peritoneal cavity is the largest cavity in the body
and is divided into two parts:
the greater sac and
the lesser sac.
The greater and lesser sacs are in free communication
with one another through an oval window called the
opening of the lesser sac, or the epiploic foramen.
The peritoneum secretes a small amount of serous
fluid, the peritoneal fluid, which lubricates the
surfaces of the peritoneum and allows free
movement between the viscera.
Peritoneal Lining of the Abdominal Walls
Intraperitoneal and Retroperitoneal
Relationships.
Intraperitoneal when it is almost totally covered
with visceral peritoneum.
Retroperitoneal organs lie behind the
peritoneum and are only partially covered
with visceral peritoneum.
Pancreas
The ascending and descending parts of the colon
Peritoneal Lining of the Abdominal Walls
Peritoneal Ligaments
Peritoneal ligaments are two-layered folds of
peritoneum that connect solid viscera to the
abdominal walls.
The liver, for example, is connected to the
diaphragm by the falciform ligament, the
coronary ligament, and the right and left
triangular ligaments.
Peritoneal Lining of the Abdominal Walls
Omenta are two-layered folds of peritoneum
that connect the stomach to another viscus.
The greater omentum connects the greater
curvature of the stomach to the transverse
colon.
The lesser omentum suspends the lesser
curvature of the stomach from the fissure of
the ligamentum venosum and the porta
hepatis on the undersurface of the liver
Peritoneal Lining of the Abdominal Walls
Mesenteries are two-layered folds of
peritoneum connecting parts of the intestines
to the posterior abdominal wall, for example,
the mesentery of the small intestine, the
transverse mesocolon, and the sigmoid
mesocolon.
The peritoneal ligaments, omenta, and
mesenteries permit blood, lymph vessels, and
nerves to reach the viscera.
Peritoneal Pouches, Recesses, Spaces, and Gutters.
The lesser sac lies behind the stomach and the
lesser omentum.
The opening into the lesser sac (epiploic
foramen).
Duodenal Recesses
Close to the duodenojejunal junction, there may be
four small pocketlike pouches of peritoneum
called the superior duodenal, inferior duodenal,
paraduodenal, and retroduodenal recesses
Peritoneal Pouches, Recesses, Spaces, and Gutters.
Cecal Recesses
Folds of peritoneum close to the cecum
produce three peritoneal recesses called
the superior ileocecal, the inferior ileocecal,
and the retrocecal recesses.
Intersigmoid Recess
The intersigmoid recess is situated at the
apex of the inverted, V-shaped root of the
sigmoid mesocolon.
Peritoneal Pouches, Recesses, Spaces, and Gutters.
Subphrenic Spaces
The right and left anterior subphrenic spaces
lie between the diaphragm and the liver, on
each side of the falciform ligament.
The right posterior subphrenic space lies
between the right lobe of the liver, the right
kidney, and the right colic flexure.
The right extraperitoneal space lies between
the layers of the coronary ligament and is
therefore situated between the liver and the
diaphragm
Peritoneal Pouches, Recesses, Spaces, and Gutters.
Paracolic Gutters
The paracolic gutters lie on the lateral and
medial sides of the ascending and descending
colons.
The subphrenic spaces and the paracolic gutters
are clinically important because they may be
sites for the collection and movement of
infected peritoneal fluid
Peritoneum
Nerve Supply of the Peritoneum
Parietal peritoneum is sensitive to pain,
temperature, touch, and pressure.
Visceral peritoneum is sensitive only to
stretch and tearing and is not sensitive to
touch, pressure, or temperature.
Peritoneum
Nerve Supply of the Peritoneum
Parietal peritoneum is sensitive to pain,
temperature, touch, and pressure.
Visceral peritoneum is sensitive only to
stretch and tearing and is not sensitive to
touch, pressure, or temperature.
Functions of the Peritoneum
Peritoneal fluid ensures that the mobile
viscera glide easily on one another.
The peritoneal coverings of the intestine
tend to stick together in the presence of
infection. In this manner, many of the
intraperitoneal infections are sealed off and
remain localized. greater omentum is often
referred abdominal policeman.

Functions of the Peritoneum
The peritoneal folds play an important part
in suspending the various organs within the
peritoneal cavity and serve as a means of
conveying the blood vessels, lymphatics,
and nerves to these organs.
Large amounts of fat are stored in the
peritoneal ligaments and mesenteries, and
especially large amounts can be found in
the greater omentum.
Applied Anatomy
Some important skin areas involved in referred visceral pain.
Created by:
dr. Irwan
dr. Indri Seta Septadina, M.Kes.
Bagian Anatomi
FK Unsri
Palembang
Fig. 1 Regio abdomen
Fig. 2 Nerves
Fig. 3 Thoracoabdominal nerve
Fig. 4 Anterolateral abdominal muscles
Fig. 5 Anterolateral abdominal muscles
Fig. 6 posterior abdominal muscles
Fig. 7 Site of hernia
Fig. 8
Fig. 9 Sagittal section of the abdomen