ABDOMINAL WALL ANATOMY

by
Hassaan Ali Gad
Assistant lecturer of urology and Andrology
Aswan University,Egypt

OUTLINE:
 ABDOMINAL REGIONS
 ABDOMINAL WALL LAYERS
 ABDOMINAL WALL FACIA
 ABDOMINAL WALL MUSCULATURE
 ABDOMINAL WALL CIRCULATION
 ABDOMINAL WALL INNERVATION
 ABDOMINAL WALL LYMPHATICS
Aswan urology department
hassaan.ali@aswu.edu.eg

 ABDOMINAL WALL FACIA
 ABDOMINAL WALL MUSCULATURE
 ABDOMINAL WALL CIRCULATION
 ABDOMINAL WALL LYMPHATICS

• Divided into 9 regions by two pairs of planes:
Vertical Planes:
Left and right lateral planes
midclavicular planes
Horizontal Planes:
Transpyloric plane:
Midway between jugular notch and
pubic symphysis (between xiphoid
andumbilicus).
Intertubercular plane:
Through tubercles of iliac crests.

• Formed by two intersecting lines:
Intersect at umbilicus.
• Quadrants:
Upper left.
Upper right.
Lower left.
Lower right.

Layers Posterior Abdominal Wall

 ABDOMINAL WALL FACIA Anterior
• Scarpa fascia forms a distinct layer deep to Camper fascia, although
Superiorly and laterally, it blends with Camper fascia. Inferiorly, it fuses
with the deep fascia of the thigh 1 cm below the inguinal ligament along a line
from the anterior superior iliac spine to the pubic tubercle.
• Medially, it is continuous with Colles fascia of the perineum
• Colles fascia attaches to the posterior edge of the urogenital diaphragm and
the inferior ischiopubic rami. It is continuous with the dartos fascia of the
penis and scrotum.
• These fasciae can limit both the spread of infection in and the extent of urinary
extravasation in an anterior urethral injury. For therefore butterfly
shaped.
• Because of these fasciae, bleeding, infection, or urinary extravasation will not
extend down the leg or into the buttock but can freely travel up the anterior
abdominal wall deep to Scarpa fascia to the clavicles and around the flank to
the back

ABDOMINAL WALL FACIA posterior
• The lumbodorsal fascia surrounds the sacrospinalis and quadratus lumborum,
which together comprise the posterior abdominal wall.
• The lumbodorsal fascia originates from the spinous processes of the lumbar
vertebrae and extends anteriorly and cranially. As it progresses upward, it
separates into three layers: posterior, middle, and anterior.
• The posterior layer provides the posterior covering for
• the sacrospinalis muscle and is the origin of the latissimus
• dorsi muscle.
• The middle layer forms the fascial layer separating the anterior aspect of
the sacrospinalis muscle from the posterior aspect of the quadratus
lumborum.
• The anterior layer of the lumbodorsal fascia provides the anterior
covering to the quadratus lumborum muscle and forms the posterior
margin of the retroperitoneum.
• As one moves laterally away from the sacrospinalis and quadratus lumborum
muscles, the lumbodorsal fascial layers fuse together and then connect with
the transversus abdominis muscl

ABDOMINAL WALL MUSCULATURE
• Anterior Group
Rectus Abdominis
Pyramidalis
• Lateral Group
External Oblique
Internal Oblique
Transversus

Posterior group
A. SUPERFICIAL LAYER - move upper extremity
Trapezius.
Latissimus dorsi.
Levator scapulae.
Rhomboideus major.
Rhomboideus minor.
B. INTERMEDIATELAYER- Respiratory muscles
levator costrum
Serratus posterior superior.
Serratus posterior inferior
C. DEEP LAYER - movetrunk and back
psoas major
psoas minor
quadratus lumborum
iliacus

THE ARCUATE LINE is the inferior margin of the posterior leaflet of the rectus
sheath within the abdomen.
The posterior leaflet of the sheath is formed, the posterior part of the internal
oblique aponeurosis transversus abdominis aponeurosis transversalis fascia
Below the arcuate line, there is a transition so that all but the transversalis fascia
pass anterior to rectus abdominis.
It is roughly positioned half way between the umbilicus and the pubic crest.
Clinically, important as the:
site of entry of the inferior epigastric artery into the rectus shea
Th site of weakness: site of Spigelian hernia
• SEMILUNAR LINE an anatomical feature of the anterior abdominal wall; the
lateral edge of the rectus abdominis m
• the linea alba is fibrous band Extends from the xiphoid process to the
symphysis pubis
it separated the rectus sheath from its fellow on the opposite side .

• Serratus posterior superior -
Origin: Vertebrae(cervical and upper thoracic spines)
Insert: Ribs
Action: Raise ribs inspiration
• Serratus posterior inferior -
Origin: Vertebrae lumbar and lower thoracic spines;
Insert: Ribs
Action: Lower ribs in expiration
Innervation: both muscles by Inter-costal Nerves
• latissimus dorsi
• Origin: vertebral spines from T7 to the sacrum, posterior third of
the iliac crest, lower 3 or 4 ribs, sometimes from the inferior angle
of the scapula
• Insert: floor of the intertubercular groove
• Action: extends the arm and rotates the arm medially
Innervation thoracodorsal nerve (C7,8)

 Psoas major
Origin: inter vertebral discs T12/L1 to L4,5 bodies of L1-5
transverse prossesL1-5
Insertion: lesser trochanter
Action: flexes the thigh; flexes & laterally bends the lumbar
vertebral column
Nerve supply: L1 ,2,3
 Psoas minor
Origin: bodies of T12/L1
Insertion: fascia over Psoas major behind inguinal ligament
Action: flexes & laterally bends the lumbar vertebral column
Nerve supply: L1

Quadrates lumborum
Origin: transverse prossesL5, iliolumber ligament & posterior
1/3 iliac crest
Insertion : medial ½ of 12th rib, transverse prossesL1-4
Action: laterally bends the trunk, fixes the 12th rib
Nerve supply: T12/L4
iliacus
Origin : hollow of iliac fossa
Insertion :psoas tendon below lesser trochanter
Action: flexes the thigh; if the thigh is fixed it flexes the pelvis on
the thigh
Nerve supply : femoral(L1,2,3)

ABDOMINAL WALL CIRCULATION
Three groups of arteries :
= The branches of intercostal, subcostal,
and lumbar arteries.
= Superior and inferior epigastric arteries.
= Superficial epigastric and superfical iliac
circumflex arteries.

Arterial Supply Above Umbilicus
• Posterior intercostal arteries 10-11.
• Subcostal artery.
• Lumbar arteries 1-4.
• Musculophrenic arteries.
• Superior epigastric arteries.
• Inferior epigastric arteries.

Arterial Supply below Umbilicus
• Superficial epigastric arteries.
• Superficial circumflex iliac arteries.
• Superficial external pudendal arteries.

Arterial Supply of the back
• the 4 lumbar arteries on each side arise
from the posterior surface of the aorta at
the level of vertebrae L1-L4.
• Supply to psoas major m., psoas minor m.,
quadratus lumborum m., spinal cord and
vertebral column, deep back muscles

Superior epigastric:
Terminal branch of internal thoracic.
Descends in rectus sheath posterior to
muscle.
Anastomoses with inferior epigastric.
Inferior epigastric:
Arises from external iliac artery.
Enters rectus sheath at arcuate line.
Branches:
Cremasteric artery.
Pubic branch.

• superficial circumflex iliac a. Branche of
femoral a crosses the upper thigh parallel to
the inguinal ligament Supply to superficial
fascia of lower abdomen and thigh
• superficial epigastric a. is one of three
superficial arteries that arise from the femoral
a. (superficial circumflex iliac a. and superficial
external pudendal a.) Supply to superficial
fascia and skin of the lower abdominal wall
• superficial external pudendal a. is one of
three superficial branches of the femoral a.
near the inguinal ligament Supply to skin and
superficial fascia of the upper medial thigh,
skin of the pubic region

• Musculophrenic a branch of internal thoracic
a. supply to anterior diaphragm, anterior
aspects of intercostal spaces 7-10 or 11
• Subcostal a. is equivalent to a posterior
intercostal a., but is named subcostal because it
courses inferior to the 12th rib branch of
descending thoracic aorta supply to vertebrae,
spinal cord; muscles, skin & fascia of the upper
abdominal wall

Venous Drainage
• Venous blood is collected into a network of veins that
radiate from the umbilicus
• The network is drained above into the axillary vein via
the lateral thoracic vein
• Below into the femoral vein via the superficial
epigastric and the great saphenous veins
• Few small veins, the paraumbilical veins form a
clinically important portal-system venous anastomosis

Venous drainage of the back
• ascending lumbar v drainedposterior
abdominal wall into :
• right: azygos v.
• left: hemiazygos v.

• Nerves of the anterior abdominal wall supply
the skin, muscles and the parietal peritoneum
• They are derived from the anterior rami of
lower six thoracic and the first lumbar nerves
• Inflammation of parietal peritoneum causes
pain in the overlying skin and also a reflex
increase in tone of the abdominal musculature
in the same area

• Iliohypogastric L1 Motor supply to internal oblique, transversus muscles,
sensation over lower anterior abdominal wall
• Ilioinguinal L1 Sensation over anterior pubis (mons) and anterior scrotum
or labia
• Genitofemoral L1, L2
Genital branch: motor supply to cremaster muscle sensation to anterior
scrotum
Femoral branch: sensation to anterior thigh
• Femoral L2, L3, L4 Motor supply to extensors of the knee sensory to anterior
thigh
• Obturator L2, L3, L4 Motor supply to adductors of the thigh, sensation to
medial thigh
• Lumbosacral trunk L4, L5 Joins the sacral nerves to form the lumbosacral
plexus that supplies motor and sensory innervation to the lower extremities
• Posterior femoral cutaneous S2, S3 Sensation to perineum, posterior
scrotum, and posterior thigh
• Pudendal S2, S3, S4 Motor to levator ani, muscles of the urogenital
diaphragm, anal and striated urethral sphincter, sensation to the perineum,
scrotum, penis
• Pelvic somatic efferents S2, S3, S4 Motor supply to levator ani and striated
urethral sphincter
• Nervi erigentes S2, S3, S4 Parasympathetic fibers from the sacral cord supply
the pelvic viscera

ABDOMINAL WALL LYMPHATICS
• Above the umbilicus:
Drain into the axillary and sternal nodes.
• Below the umbilicus:
Drain into the superficial inguinal nodes.

THANK YOU

ABDOMINAL WALL ANATOMY

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