Abdominal wall Contents I. Boundaries of the Abdomen 2. Layers of the Anterior Abdominal Wall and 9 regions 3.

Muscles of Anterior Abdominal Wall. 4. Blood and nerve supply of nerve supply of anterior abdominal wall 5. The Rectus Sheath 6. Inguinal canal 7. Posterior abdominal wall 8. Abdominal incisions

Abdomen cavity includes Abdomen proper and pelvic cavity. Its the region between the diaphragm above and the inlet of the pelvis below. DIG Pelvic cavity is divided into true or lesser pelvis. Boundaries of the abdomen Superiorly: Diaphragm Inferiorly: Continuous with pelvic cavity Anteriorly: Above = Lower part of thoracic cage (7th thru 10th ribs, xiphoid process of sternum) Below = Anterolateral abdominal muscles Posteriorly: Midline = 5 lumbar vertebrae and intervertebral discs Laterally =12th ribs, upper part of bony pelvis, & muscles of the posteriorabdominalwall DIG of 9regions explain

Layers of the anterior abdominal wall DIG. Superficial fatty layer is continuous with fat over the body. Membranous layer fuses with deep fascia of the thigh one inch below the inguinal ligament. Extends into the genitalia and perineum as Colless Fascia. DIG in the phone

The tranversalis fascia is a continuous layer of deep fascia that lines the abdominal cavityand continues into the pelvic cavity.in some areas its thick/thin, attached or free and participates in the formation of specialized structures. Extraperitoneal fascia Is deep to the tranversalis fascia, it separates the tranversalis fascia from the peritoneum. Lines abdominal cavity and is continuous with a layer lining the pelvic cavity. Its abundant on the posterior abdominal wall especially around the kidney, continues over organs covered by peritoneal reflections and extends into mesentries with blood vessels( as vasculature is located in this layer). Viscera in the extrpritoneal fascia are refered to as retroperitoneal. In surgical procedures the fascia toward the anterior side of the body are described as preperitoneal and the fascia towards the posterior side are described as retroperitoneal.DIG ON PHONE PERITONEUMis deep to the extraperitoneal fascia. This thin serous membrane lines the walls of the abdominal cavity and at various points, reflects onto the abdominal viscera providing either a partial or a complete covering. The peritoneum linng the walls is the parietal peritoneum while the peritoneum covering the viscera is the visceral peritoneum.

Muscles of the anterolateral abdominal wall (i) EXTERNAL OBLIQUE-Muscle fibers are directed downwards, forwards and medially (ii) INTERNAL OBLIQUE- Muscle fibers are directed upwards, forwards and medially (iii) TRANSVERSUS ABDOMINIS- Muscle fibers are directed transversely The above are three flat muscles whose fibers begin posterolaterally, pass anteriorly and are replaced by an aponeurosis as the muscle continues towards the midline. (iv) RECTUS ABDOMINISvertical muscles are enclosed within a tendinous sheath formed by aponeuroses of flat muscles. (v) PYRAMIDALIS- Anterior to rectus abdominis at its inferior end. 80% of the time it is insignificant and small. (O): Pubic crest and pubic symphisis (I): Linea alba Shown in DIG N/B linea alba-The linea alba is associated with the rectus sheath. It is formed by the tendons of all three flat abdominal muscles, inserting from both sides on the midline of Raphe. Ligaments contributed by E.O. 1. Lacunar ligament-Medial end of inguinal ligament 2. Pectineal ligament-Continuation of lacunar lig on pectineal line 3. Inguinal ligament-Inrolled lower border of aponeurosis of E.O m/s between A.S..I.S and pubic tubercle FIND PICTURE

ACTION OF THE MUSCLES Oblique ms: Lateral flexion and rotation of thetrunk Rectus Abdominis: Flexes the trunk and stabilizes thepelvis Pyramidalis: Keeps linea alba taut ====All muscles assist during respiration, supports abdominal contents and increase intra-abdominal pressure in act of defecation, micturation, parturation, forced expiration and vomiting. Innervation the skin, muscles and parietal peritoneum of the anterolateral abdominal wall are supplied by T7 to T12 and L1 spinal nerves. DIG on phone ..right-xiphoid process, lateral cutaneous branches T7 to T12( double arrow), external oblique muscle and aponeurosis, iliohypogastric nerve L1, ilio inguinal nerve L1..left top- anterior cutaneous branches T7 to t12, iliac crest dermatome pic in the phone the nerves all terminate by supplying the skin;-nerves T7 to T9 supply the skin from the xiphoid process to just above the umbilicus -T10 supplies the skin around the umbilicus -T11, T12 and L1 supply the skin from just below the umbilicus to, and including, the pubic region. -additionally the ilio-inguinal nerve supplies the anterior surface of the scrotum or labia majora and sends a small cutaneous branch to the thigh. Blood supply of anterolateral abdominal wall Look for extraperitoneal fascia showing the pre and retroperitoneal Innervation check phone Blood supply of abdo wall-musculophrenic artery,internal thoracic aretery, superficial epigastric artery, superficial circumflex iliac artery,10 th and 11th intercostal arteries, subcostal artery,inferior epigastric artery and deep circumflex iliac artery both branches of externl iliac artery.

Lymphatic

Superficial lymphatics above the umbilicus pass superiorly to axillary nodes while drainage below the umbilicus passes in an inferior direction to superficial inguinal nodes. Deep lymphatics drainage follows the deep arteries back to parasternal nodes along the internal thoracic artery, lumber nodes along the abdominal aorta and external iliac nodes along the external iliac artery.