just awareness

1. Farwa Fiaz
DPT-II
Presented to:
Dr.Assadullah Awan
TOPIC:
ANTERIOR ABDOMINAL WALL

2. SURFACE ANATOMY
EXTENT:
oXIPHOID PROCESS
oCOSTAL MARGIN
oMID AXILLARY LINE
oILIAC CREST
oINGUINAL LIGAMENT
oPUBIC TUBERCLE
oPUBIC SYMPHYSIS

3. 3 GROOVES:
LINEA ALBA , RIGHT & LEFT LINEA SEMILUNARIS.
DIVIDED INTO 9 REGIONS BY 4 IMAGINARY PLANES.
Planes:
• 2 mid clavicular plane • Subcostal plane • Trans tubercular
plane
Regions:
• Epigastric • Umbilical • Suprapubic • Right & left hypochondria
• Right & left lumbar • Right & left iliac

4. LAYERS OF ANTERIOR ABDOMINAL WALL
1. Skin 2. Superficial fascia 2a. Camper’s fatty layer
2b. Scarpa’s membranous layer
3. External oblique muscle
4. Internal oblique muscle
5. Transverse abdominis muscle
6. Rectus abdominis muscle [ medial ]
7. Fascia transversalis
8. Preperitoneal pad of fat
9. Parietal peritoneum

5. SKIN OF ANTERIOR ABDOMINAL WALL
 Smooth,
stretchable,
undue stretching causes linea nigra,
lineae albicantes.

6. UMBILICUS
Physiological scar formed by remnants of the root of umbilical
cord.
Forms watershed line for venous and lymphatic drainage.
Area of porto-caval anastomosis.
Embryological importance:
Meeting point of 4 folds of embryonic plate: 2 lateral, cranial and
caudal.
Meeting point of 3 systems: vitalointestinal duct, urachus, umbilical
vessels.

7. SUPERFICIAL FASCIA
Fatty Camper’s :
• Continuous with adjacent superficial fascia of the body.
• In penis it is devoid of fat.
• In scrotum it forms Dartos muscle.
Membranous Scarpa’s layer:
• Continues as Colle’s fascia of perineum.
• Prevents extravasation of urine backwards [ischeo-rectal
fossa] and downwards [thigh].

8. EXTERNAL OBLIQUE
Origin
As fleshy strips from middle of shaft of lower 8 ribs.
Insertion
Mostly as aponeurosis which attaches to xiphoid, linea alba,
pubic crest, tubercle and iliac crest. Lower fibers directly on outer
lip of iliac crest.
Nerve supply
Lower 6 thoracic nerves, iliohypogastric and ilioinguinal nerves.
 Action
Supports abdominal wall, assists in forced expiration, assists in
flexion and rotation, assists in defecation.

9. LIGAMENTS OF EXTERNAL OBLIQUE

10. INTERNAL OBLIQUE
Origin: Lumbar fascia, iliac crest, lateral 2/3 of inguinal
ligament.
Insertion: Lower 3 ribs and costal cartilages, as aponeurosis
attached to xiphoid, linea alba , pubic symphysis.
Nerve supply: Lower 6 thoracic nerves, iliohypogastric and
ilioinguinal nerves.
Action: Supports abdominal wall, assists in forced expiration,
assists in flexion .
Some fibers continue as cremaster into the pelvis.
Fibers run upward, medially and forward.

11. TRANSVERSUS ABDOMINIS
Origin: Inner surface of lower six ribs, thoraco
lumbar fascia, iliac crest, lateral 2/3 of inguinal
ligament.
Insertion: As aponeurosis inserted to xiphoid, linea
alba, pubic crest, and pectineal line. Lower fibres
fuse with lower fibres of internal oblique forming
conjoint tendon.
Nerve supply: lower 6 thoracic nerves and first
lumbar nerve.
Action: Supports abdominal wall.

12. RECTUS ABDOMINIS & PYRAMIDALIS
Rectus abdominis:
Origin: lateral head: lateral part of pubic crest
Medial head : anterior pubic ligament.
Insertion: 5, 6 7 costal cartilages, xiphoid process
Nerve supply: lower 6 thoracic nerves.
Action: compresses abdominal contents, flexes
vertebral column, acc. Muscle of expiration.

13. RECTUS ABDOMINIS & PYRAMIDALIS
Pyramidalis:
Origin: anterior pubis.
Insertion: linea alba.
Nerve supply: 12th thoracic nerve.
Action: tenses linea alba.

14. Aponeurotic sheath covering
rectus muscle.
Arcuate line :
Semilunar line mid point between
umbilicus and pubic symphysis.
Deficient of posterior rectus
sheath.
RECTUS SHEATH

15. POSTERIOR ASPECT
•Falciform ligament.
•Ligamentum teres [round ligament of liver]:
remnant of umbilical vein.
•Median umbilical ligament : remnant of urachus.
•Medial umbilical ligaments: remnants of umbilical
arteries.
•Lateral umbilical ligaments: overlies inf. Epigastric
vessels.

16. BLOOD SUPPLY
Superficial arteries:
Cutaneous branches of superior and inferior
epigastric arteries.
Lateral cutaneous branches of intercostal arteries.
Superficial epigastric artery
Superficial external pudendal artery.
Superficial circumflex iliac artery.

17. BLOOD SUPPLY
Deeper arteries:
Superficial epigastric artery.
Musculophrenic artery.
Inferior epigastric artery
Deep circumflex iliac artery.
Small lateral branches .

18. NERVE SUPPLY
Lower 5 to 6 intercostal and
subcostal nerves, through
their anterior and lateral
cutaneous branches.
Iliohypogastric and
ilioinguinal nerves of first
lumbar nerve.

19. Lymphatics
Lymphatics respect the water shed line
Above umbilicus drain into axillary
lymph nodes.
Below the umbilicus drain into
superficial inguinal lymph nodes
[horizontal group]