The document provides an overview of the surface anatomy of the abdomen and peritoneal relations. It describes the layers of the abdominal wall including the external oblique, internal oblique, and transverse abdominal muscles. It also details the peritoneal folds and relations of intra-abdominal organs such as the liver, stomach, intestines and bladder. Key planes used as anatomical landmarks are defined including the subcostal, transpyloric, and intercristal planes. Common physical exam findings like abdominal guarding are also explained.

1. Surface Anatomy of the
Abdomen, Peritoneal
Relations
Department of Anatomy, Histology and Embryology
Semmelweis University
March 5, 2019
Dr. Ágoston Szél

2. Abdominal wall

3. External oblique abdominal muscle

4. Internal oblique abdominal muscle

5. Transverse abdominal muscle

6. 6
ext.obl.
abd. m.
int. obl.
abd. m.
transv.
abd. m.
inguinal lig.
inguinal
lig.
The broad
abdominal muscles
iliac crest
lumbar
fascia
pubic
tubercle
(v)
(v) lumbar
fascia
inguinal lig.

7. Rectus abdominal muscle
Pyramidalis
muscle

8. 8
ext. obl. abd. m.
int. obl. abd. m.
transv. abd.m.
ext. obl. abd. m.
obl. abd. m. int.
transv. abd. m.
transversalis fascia
peritoneum
linea alba
skin superficial fascia
rectus abd. m.
intercostal muscles
pectoralis major m.
extraperitoneal fat
aponeurosis of
ext. obl. abd.
xyphoid process
Structure of the abdominal wall
rectus abd. m.
transversalis fascia

9. urinary bladder
vagina
rectum
rectus abdominis
muscle
inferior epigastric
a&v.
lateral
abdominal
muscles
external iliac
artery.
Rectus sheath

10. superficial fascia
fatty layer (Camper’s
fascia)
position of penis
spermatic cord
position of scrotum
fascia lata
line of fusion
membranous layer
(Scarpa’s fascia)
aponeurosis of external
oblique muscle
Arrangement of the fatty and membranous layers of the
superficial fascia of the abdominal wall

11. *fatty layer
(Camper’s fascia)
*membranous layer
(Scarpa’s fascia)
perineal
membrane
dartos muscle
symphysis
urethra
Arrangement of fasciae in the lower abdominal wall
*superficial fascia
**Colles’s fascia
**membranous layer of
the superficial fascia
external spermatic,
cremasteric, internal
spermatic fasciae

12. 12
Ext. obl. Abd.
Adductors
Rhomboideus
Serratus ant.
Pectoralis major
Int. obl. abd.
Gluteus maximus
Sartorius
Insertion of abdominal muscles in the
loop system of the body musculature

13. 13
Functions of the abdominal muscles
Movements of the trunk
Bending of the trunk (forwards, sideways), rotation of the
trunk – in collaboration with the muscles of the back.
Stiffening the abdominal wall
Fixation of internal organs in position – according to the
variation of the content of the stomach, urinary bladder
and bowels.
Maintaining the abdominal pressure
Expiration, urination, defecation, coughing, sneezing,
vomiting, exertion of high muscular force, birth.
Breathing
Diaphragm + abdominal muscles.

14. Visceral
topography

15. Transverse colon
Urinary bladder
Descending colon
Ileum
Jejunum
Stomach
Pancreas, body
Spleen
Left lung
Clavicle
Cecum
Ascending colon
Right lobe of liver
Gall bladder
Pylorus
Duodenum, desc.
Ant. inf. iliac spine
Apex of right lung
Diaphragm
Left lobe of liver
Visceral topography

16. Medioinguinal plane
Transpyloric plane (L1)
Subcostal plane (L2-3)
Supracristal plane (L4)
Intercristal distance (L5)
Symphysis
Jugular notch
Interspinal line
Medioclavicular
(pararectal) plane
Topographical
coordinate
system for
surface anatomy
(from in front)
1/2
1/2

17. Medioinguinal plane
Transpyloric plane (L1)
Supracristal plane (L4)
Intercristal distance (L5)
Vertebra prominens
Subcostal plane (L2-3)
Interspinal line
Topographical
coordinate
system for
surface anatomy
(from behind)

18. EPIGASTRIUM
HYPOGASTRIUM
Medioclavicular
(pararectal) plane
Subcostal plane
Interspinal plane
Hypochondriac region
Epigastric region
Lateral abd. region
Umbilical region
Inguinal region
Pubic region
umb.
McBurney (1/2-1/3)
Lanz (1/3)
Abdominal regions for physical examinantion
MESOGASTRIUM
Ant. sup. iliac spine

19. Subcostal
Interspinal
Mediclavicular (pararectal) plane
Diaphragm Hypochondriac r.
Epigastric r.
Lat. abd. r.
Umbilical r.
Inguinal r.
Pubic r.
Abdominal regions for physical examination

20. Interspinal l.
Monroe-line
Medioclavicular
(pararectal) line
Anterior
axillary fold –
navel line
Murphy
McBurney (1/3)
Lanz (1/3)
9th rib
Abdominal regions for physical examination
Morris (2/3)
Sonnenburg: crossing of interspinal
line & lateral edge of rectus

21. Medioinguinal plane
Transpyloric plane (L1)
Supracristal plane (L4)
Intercristal distance (L5)
Subcostal plane (L2-3)
Location of visceral
organs in the
coordinate system

22. pylorus
pylorus
10th rib
10th rib
cardia cardia
xyphoid proc.
fornix
fornix
body
body
ant. sup.
iliac spine
hook-shaped
(letter J) stomach
ptotic (atonic)
stomach
Variations of the topography of stomach
projected onto the anterior abdominal wall
ant. sup.
iliac spine
xyphoid proc.

23. Tp
Sc
Scr
Dcr
Variations of the topography of stomach
projected onto the anterior abdominal wall
hook-shaped
(letter J) stomach
ptotic (atonic)
stomach

24. Cecum
Liver
Gall bladder
Lung
Heart
Stomach
Descending colon
Ascending colon
Duodenum
Projection of
internal organs

25. 25
Diaphragm (C4)
Heart (T3-4)
Esophagus (T4-5)
Stomach (T8)
Liver, gall bladder (T8-11)
Small intestines (T10)
Large intestines T11)
Urinary bladder (T11-L1)
Testis, kidney (T10-L1)
Head-zones: irradiation of visceral pain

26. Tensing (hardening) of the abdominal wall muscles is a reflex mechanism.
To protect inflamed organs from the pain of pressure upon them.
The tensing is detected when the abdominal wall is pressed.
Guarding is a characteristic finding in the physical examination for an
abruptly painful abdomen (an acute abdomen).
It accompanies the inflammation of the inner abdominal (visceral and
parietal peritoneal) surface due to appendicitis or diverticulitis.
The tensed muscles of the abdominal wall automatically go into spasm to
keep the tender underlying tissues from being disturbed.
Abdominal guarding, „défense musculaire”

27. spine-navel
(Monroe’s) line
McBurney’s point
(1/2-1/3), Morris (2/3)
Lanz’s point (1/3)
ant. sup.
iliac spine
interspinal line
inguinal lig.
pelvic position (a)
anteroparietal position (b)
Ilioinguinal position (c)
lumbar position (d)
retrocecal position (e)
Position of appendix

28. Pelvic
position (a)
Ilioinguinal
position (c)
Lumbar position (d)
Anteroparietal
position (b)
Retrocecal
position (e)
Position of appendix

29. Change of
position of
appendix during
pregnancy

30. Tipical pressure
points in
appendicitis

31. Rovsing-signal:
upon vigorously
pressing the
abdomen counter-
clockwise,
the pain felt on
the appendix
region becomes
more intensive.

32. internal iliac artery
external iliac artery
median sacral artery
bifurcation of aorta (L4)
inf. mesenteric artery
psoas major muscle
gonadal arteries
left crus
aortic hiatus (Th12-L1)
inf. phrenic artery
esophageal hiatus (Th11)
median arcuate ligament
common iliac artery
bifurcation
(sacroiliac joint)
coeliac trunk
suprarenal artery
sup. mesenteric artery
renal artery
lumbar arteries
Branches of abdominal aorta

33. inferior vena cava
(Th12) coeliac trunk
(L1) superior
mesenteric artery
(L3) inferior
mesenteric artery
abdominal aorta
external iliac a.&v.
common iliac a&v.
anterior superior
iliac spine
The prjection of the abdominal aorta and branches
internal iliac a.&v.

34. Projection of colon
transverse colon
left colic flexure
right colic flexure
ascending colon descending colon
colon sigmoideum
rectum
appendix
cecum
ileum
medioinguinal plane
distantia cristarum
medioclavicular plane
cecum

35. Left lobe
Right lobe
Gall bladder
5th rib
8th rib
Medioinguinal plane
Transpyloric plane
Projection of liver and gall bladder
Gall bladder

36. Superior part (L1)
Descending part (L1-3)
Inferior part (L3) Ascending part (L3-2)
Duodenojejunal flexure (L1-2)
Tail (L1)
Body (L1-2)
Head (L2)
Projection of duodenum and pancreas

37. Jejunum: rather
vertical, in the upper
left quadrant
Ileum: rather
horizontal, in the
lower right
quadrant
Duodenum: horse-
shoe shaped, in
the upper right
quadrant
Position of small intestine

38. Skeletotopy of the spleen (from in front)
ribs

39. spleen (rib
8/9th-11th)
left lung
liver
stomach
transverse colon
diaphragm
costo-diaphrag-
matic recess
Topography of spleen (as seen from the left)

40. transpyloric plane (L1)
supracristal plane (L4)
intercristal plane (L5)
subcostal plane (L2-3)
medioinguinal plane
Topography of
the lung,
pleura, kidney
and spleen
left: 12th rib:
1/3-2/3
right: 12th rib:
upper pole

41. crista iliaca
post. sup. iliac spine
right kidney
12th rib
11th rib
left kidney
Posterior projection of kidneys

42. The peritoneum

43. Bibliography
• Lippert H: Lehrbuch Anatomie, Urban & Fischer, München, 2000
• Mac Kinnon P, Morris J: Oxford Lehrbuch der klinischen Anatomie,
Hans Huber, Bern, 1997
• Moore KL, Dalley AF: Clinically Oriented Anatomy, Lippincott, 1999
• Putz R, Pabst R: Sobotta. Alliter, Budapest, 2004.
• Patel R: Applied Peritoneal Anatomy, www.myESRorg.
• Renz-Polster H, Krautzig S, Braun J: Innere Medizin, Urban &
Fischer, München, 2004
• Snell RS, Clinical Anatomy, Little, Brown & Co, Boston, 1995
• Tirkes T et al: Peritoneal Anatomy. Gastrointestinal Imaging,
https://doi.org/10.1148/rg.322115032.
• https://www.kenhub.com/en/start/anatomy.