Introduction to Abdomen Abdominal Wall

The Human Abdomen

 

Between the pelvis and the thorax. From the thorax (at the thoracic diaphragm) to the pelvis at the pelvic brim.


The pelvic brim stretches from the lumbosacral angle (the intervertebral disk between L5 and S1) to the pubic symphysis and is the edge of the pelvic inlet.

Functionally, the human abdomen is where most of the alimentary tract is placed.

Regions of the Abdomen



Transpyloric line


Half-way between the suprasternal notch and the top of the symphysis pubis. Hilum of each kidney is below it, while its left end approximately touches the lower limit of the spleen. Ffirst lumbar vertebra behind.

Subcostal line


Lowest point of the subcostal arch (tenth rib). Upper part of the third lumbar vertebra, and it is an inch or so above the umbilicus. It indicates roughly the transverse colon, the lower ends of the kidneys.

Intertubercular line


Across between the two rough tubercles. Body of the fifth lumbar vertebra. Passes through or just above the ileo-caecal valve.

What are the 4 horizontal planes in the abdomen and what are their vertebral levels?
Transpyloric: T1 Subcostal: L2/L3 Transumbilical: L3/L4 Transtubercular: L4/L5

What are the nine zones and the planes that delineate them?
The two horizontal planes are the subcostal (L1) and the transtuburcular (L4) and the two vertical planes are the midclavicular lines. Hypochondrium, Epigastrium Lumbar, Umbilicus Inguinal, Illiac (Inguinal)

Abdominal Cavity


The abdominal cavity is lined with a protective membrane termed the peritoneum. The kidneys are located in the abdominal cavity behind the peritoneum, in the retroperitoneum. The viscera are also covered, in the front, with a layer of peritoneum called the greater omentum (or omental apron).

Anterior Abdominal Wall

Layers of the abdominal wall are (from superficial to deep):


Skin Fascia


Camper's fascia - fatty superficial layer. Scarpa's fascia - deep fibrous layer.

Muscle


Rectus abdominis External oblique muscle Internal oblique muscle Transverse abdominal muscle

Fascia transversalis Peritoneum

Fascia


Superficial:
  

Campers fascia Continuous with fascia over thorax and thigh. Fatty layer. Scarpas fascia Membranous layer. Continues into perineum as: Superficial perineal fascia = Colles fascia. Thin layer covering abdominal muscles.

Deep Superficial:
   

Deep:


Muscles


5 muscles attachments of the anterior abdominal wall:

    

External oblique, the internal oblique, transversus abdominus, rectus abdominus, and the pyramidalis.

External Oblique


Proximal:


Outer surface of ribs 5-12 Illiac crest apponeurosis: linea alba Compresses abdominal contents, bilateral bending of trunk, unilateral flexion of trunk to same side, rotation of anterior abdomen to opposite side. Anterior rami of spinal nerves T7-T12

Distal:
 

Action:


Innervation:


Internal Oblique


Proximal:


Thoracolumbar fascia, illiac crest and inguinal ligament. Inf. border of ribs 9-12, Aponeorosis ends at linea alba, pubic crest and pectineal line. Rotates abdomen to the same side. L1

Distal:
 

Action:


Innervation:


Transversus Abdominus


Proximal:


Thoracolumbar fascia, illiac crest, lateral 2/3 of inguinal ligament, costal cartilages of ribs 7-12. Pubic crest , pectineal line, Apponeurses end at linea alba Compresses abdomen. L1

Distal:
 

Actions:


Innervation:


Rectus Abdominus


Proximal:


Pubic crest, pubic tubercle, and pubic symphysis Costal cartilages of ribs 5-7, xiphiod process. Compress abdominal contents, flex vertebral column, tense abdominal wall. t7-t12

Distal:


Actions:


Innervations:


Pyramidalis


Proximal:


pubis, pubic symphysis linea alba tenses linea alba Anterior ramus of spinal nerve T12

Distal:


Action:


Innervation:


Rectus Sheath


Formed by the aponeuroses of the Obliqui and Transversus. Contains the Rectus abdominis and Pyramidalis muscles.
Above the arcuate line At the lateral margin of the Rectus, the aponeurosis of the Obliquus internus divides into two lamellae: One passes in front of the Rectus, blending with the aponeurosis of the Obliquus externus. the other, behind it, blending with the aponeurosis of the Transversus, and these, join at the medial border of the Rectus, are inserted into the linea alba. Below the arcuate line: Below this level, the aponeuroses of all three muscles (including the internus) pass in front of the Rectus

Arcuate line


Also known as Linea semicircularis or Douglas' line

Horizontal line that demarcates the lower limit of the posterior layer of the rectus sheath.


Also where the inferior epigastric vessels perforate the rectus abdominus.


Occurs about 1/3 of the distance from the umbilicus to the pubic crest, but this varies from person to person

Transversalis Fascia
Thin aponeurotic membrane which lies between the inner surface of the Transversus abdominis and the extraperitoneal fascia.


Directly continuous with the iliac and pelvic fasciae.



In the inguinal region, the transversalis fascia is thick and dense in structure and is joined by fibers from the aponeurosis of the Transversus, but


It becomes thin as it ascends to the diaphragm, and blends with the fascia covering the under surface of this muscle.


Behind Fat which covers the posterior surfaces of the kidneys. Below Posteriorly, to the whole length of the iliac crest, between the attachments of the Transversus and Iliacus; Between the anterior superior iliac spine and the femoral vessels it is connected to the posterior margin of the inguinal ligament, and is there continuous with the iliac fascia. Medial to the femoral vessels it is thin and attached to the pubis and pectineal line, behind the inguinal falx, with which it is united; it descends in front of the femoral vessels to form the anterior wall of the femoral sheath. Beneath the inguinal ligament it is strengthened by a band of fibrous tissue, which is only loosely connected to the ligament, and is specialized as the iliopubic tract.

Other Fascia
Fascia of Camper A thick superficial layer of the anterior abdominal wall.


Fascia of Scarpa A layer of the anterior abdominal wall.

 

It is areolar in texture, and contains in its meshes a varying quantity of adipose tissue.


It is found deep to the Camper Fascia and superficial to the External Oblique muscle. Thinner and more membranous


It is found superficial to Scarpa's fascia.



Connected to the aponeurosis of the Obliquus externus abdominis In mid-line: Adherent to the linea alba and to the symphysis pubis Extends to the dorsum of the penis, forming the fundiform ligament; Continuous with the superficial fascia over the rest of the trunk Blends with the fascia lata of the thigh, below the inguinal ligament


Continued over the penis and spermatic cord to the scrotum. From the scrotum it may be traced backward into continuity with the deep layer of the superficial fascia of the perineum In the female, it is continued into the labia majora and from there to the fascia of Colles.

The umbilicus.

Review

The linea alba is a median fibrous white line or band.



The linea semilunaris is a curved line that extends from the 9th costal cartilage to the pubic tubercle. This indicates the lateral border of the rectus abdominis muscle. The superficial fascia just above the inguinal ligament can be divided into two layers:


There is a fatty superficial layer (Camper's fascia) There is also a membranous deep layer (Scarpa's fascia)

The superficial vessels and nerves run between these two layers. The membranous deep layer is continuous with the superficial fascia of the thigh, the fascia lata.


This layer is also continuous with the superficial fascia of the perineum (Colles' fascia) and with that investing the scrotum and penis and the labia majora.

Inguinal Ligament


Band running from the pubic tubercle to the anterior superior iliac spine. It is formed by the external abdominal oblique aponeurosis and is continuous with the fascia lata of the thigh.

Lacunar Ligament


The lacunar ligament is that part of the aponeurosis of the Obliqus externus which is reflected backward and laterally, and is attached to the pectineal line. Its base is concave, thin, and sharp, and forms the medial boundary of the femoral ring. Its apex corresponds to the pubic tubercle. Its posterior margin is attached to the pectineal line, and is continuous with the pectineal fascia. Its anterior margin is attached to the inguinal ligament. Its surfaces are directed upward and downward.

Ligament of Cooper


This is a strong fibrous band. It extends lateralward from the base of the lacunar ligament along the pectineal line, to which it is attached. It is strengthened by the pectineal fascia, and by a lateral expansion from the lower attachment of the linea alba.

Posterior Abdominal Wall



The posterior abdominal wall is composed principally of muscles and fascia attached to the vertebrae, hip bones, and ribs. Muscles of the Post. Wall:
  

psoas major, iliacus, and quadratus lumborum.

Quadratus Lumborum Muscle It lies adjacent to the transverse processes of the lumbar vertebrae and is broader inferiorly. Superior attachments: medial half of inferior border of 12th rib and tips of lumbar transverse processes. Inferior attachments: iliolumbar ligament and internal lip of the iliac crest. Innervation: Ventral branches of T12 and L1 to L4 Functionv: Extends and laterally flexes the vertebral column, and fixes the 12th rib during inspiration.

Psoas Major Muscle Passes from the abdomen to the thigh deep to the inguinal ligament. The lumbar plexus is imbedded in this muscle.

The Iliacus Muscle Large triangular or fan-shaped muscle lies along the lateral side of the psoas major in the pelvis. Proximal attachments are: iliac crest, iliac fossa, ala of sacrum, and anterior sacroiliac ligaments.

Proximal attachments are: sides of T12 to L5 vertebrae and intervertebral Distal attachments are: tendon of discs between them. psoas major and body of Distal attachment is: lesser femur, inferior to lesser trochanter of femur trochanter. Innervation: ventral rami of Innervation: femoral nerve (L2 lumbar nerves (L1, L2, and and L3) L3)