Anatomy sheet : abdominal wall and

inguinal region .

Done by : Sara al-zoubi .

edited by : Tala samour .

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Abdominal borders :

xiphoid process superiorly / iliac crest and Pubic symphysis inferiorly

costal margin(cartilage of (7-10)ribs) laterally .

* The anterior abdominal wall is made up of skin , superficial fascia(underneath the

skin) , muscles , deep( investing) fascia which surround the indivisual muscle .

*Superficial fascia composed of two layer *:

1-fatty superficial layer .

2-membranous deep layer : this layer is thin and become thicker below the umbilicus (it

is more prominent in the lower aspect of the abd.wall below the level of the umbilicus ) ,

it insert in the iliac crest , this layer attach to the fascia lata (deep fascia of the lower

limb), it unite with the pubic arch in both right and left side.

**Any urethra defect that blocks the flow of urine cause trapping of the urine under the

membranous layer of the superficial fascia.

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Blood supply of the anterior abdominal wall :

1- superior epigastric artery which arise from internal thoracic artery (mammary

artery(from subclavian artery)), it supply the breast and runs inferiorly passing the

diaphragm to the abdominal wall as epigastric artery .

2- inferior epigastric artery which arise from the external iliac artery .

* Sup. epigastric artery anastomoses with the inf. epigastric artery at the umbilicus and

supply the anterior abdominal wall.

3- intercostal arteries

4- lumber arteries which arise from abdominal aorta .

5- branches from femoral artery supply the lower part of the abdomen

Lymphatic drainage of the anterior abdominal wall

Lymphatics in the upper part drain into the axillary lymph nodes deep to the liver .

Lymphatics in the lower part drain into the inguinal lymph nodes .

*The abdominal muscles form the anterior and lateral abdominal wall and consist of

external and internal oblique muscles , the rectus abdominis muscle and the

Transverses Abdominis

Nerve supply of the anterior abdominal wall :

Note …intercostals nerves are arise from the spinal nerves from T1-T11.

...Subcostal nerve is anterior division of the 12th thoracic nerve

Anterior abdominal wall supplied by (T6-T12),L1(ilioinguinal nerve)and

iliohypogastric nerve.

T6 supply the epigastric region / T10 supply the umbilical region.

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* Origin :

costal cartilage of (5 th-7 th) ribs and xiphoid process .

* Insertion : iliac crest and pubic symphysis

* The rectus abdominis muscle is crossed by three fibrous lines (مكان ملتحم في العضلة)

called the tendinous intersections خطوط مستعرضة , this mean that rectus muscle formed

by 4 pieces .

* this muscles are wide at the top, and tapering to a more narrow attachment at the

bottom.

* The linea alba (white line) is a single fibrous line which formed by the fusion of the

aponeuroses of the abdominal muscles, and it separates the left and right rectus

abdominis muscles (this alba is extend from the xiphoid process to pubic symphysis ), it

appears on the abdomen as abrown dark line in pregnant women.

*the rectus abdominis is surrounded by an anterior and posterior layer of the rectus

sheath .

((anterior rectus sheath is complete septum (extend along the muscle) and the posterior

rectus sheath end by arcuate line (midway b/w the umbilicus and pubis ))

so The arcuate line of the abdomen is a horizontal line under the posterior rectus sheath

** look at page 10&11 to understand this point .

T12-erve supply : T7*n

1-rectus abdominis muscle (very long muscle):

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* origin: outer surface of the lower eight ribs .

*insertion : anterior half of the iliac crest , xiphoid process superiorly , linea alba and

the body of the pubic bone and pubic crest.

** the posterior part of this muscle is free .

* This muscle interdigitate with serratus anterior muscle and latissimus dorsi تتشابك

muscle.

* Its fiber directed medially and downward.

*medially –EAO muscle gradually becomes aponeurotic غشائية (strong membranous

structure) , which attach to the anterior superior iliac spine inferiorly (lower part of this

muscle inserted to the anterior superior iliac spine.

* There is a triangular shaped defect in the aponeurosis of the external oblique muscle

called the superficial inguinal ring above the iliac crest , *spermatic cord in male and

the round ligament in female passes through this ring.*

*Contents of the rectus sheath ;

1-Blood vessels :sup & inf epigastric arteries

2- Rectus abdominis muscles

3-All nerves that supply the rectus abdominis muscle (T7-T12)4-Lymphatic vessels and

veins

2- External abdominal Oblique muscle(EAO)

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* the lower border of the aponeurosis is folded backward and medially on itself forming

the inguinal ligament (which extend from the anterior superior iliac spine to pubic

tubercle), from this point * internal abdominal oblique and transverses abdomins

form*

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lumbar fascia. The thoraco : origin*

Lower fibers originate from 1-The lateral two-thirds of the inguinal ligaments.

2-The anterior two-thirds of the the iliac crest.

.and medially ibers run upwardsF*

* medially -- The muscle gradually becomes aponeurotic (strong membranous structure)

, this aponerouses inserted medially into the lenia alba.

The uppermost fibers are inserted directly into the lower .costal margin (: *insertion

medially into linea alba .) & three or four ribs and their cartilages

posterior rectus & contribute in the formation of the anteriorthe aponeurosis of the IAO *

sheath

* the aponeurosis of the internal abdominal oblique splits around the two sides of the (

)rectus abdominis muscle

muscle(IAO) Internal abdominal Oblique-3

transverse and just above the external abdominal oblique located beneath the it *

. abdominal muscles

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* Lower fibers of IAO that originate from the lateral two-thirds of the inguinal ligaments

inserted whichconjoint tendon e arch above the spermatic cord , this arch is called mak

Abdominis muscle Transversus the pubic bone ,, also of into the iliac crest in front

contribute to the formation of this arch

aponeurosis unite internal oblique forms when the fibers of the conjoint tendon SO))

aponeurosis.** transversus abdominis with the deeper fibers of the

that form when the fibers of is a ligament in the inguinal region lacunar ligament

in another the inguinal ligament extend medially along the pectineal ligament ,

pectineal ligament to the inguinal ligament connects the words lacunar ligament

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* Its fibers running transversely

*lower fiber join with the fibers of IOA to form conjoint tendon.

Origin : thoraco lumber fascia and inner side of the costal cartilage from ( 5th -8th )ribs

*the aponeurosis of this muscle contribute in the formation of the posterior rectus

sheath(above the arcuate line) & anterior rectus sheath (below the arcuate line).

*. The muscle gradually becomes aponeurotic (strong membranous structure) that end

medially into the lenia alba.

*Inferiorly transversus abdominis inserted the anterior half of the iliac crest and lateral

half of the inguinal ligament .

Transversalis fascia deep to the transversous abdominis .

Transversus Abdominis -4

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^^ Above the costal margins/ xiphoid process (cartialage of (7th -10th) ribs

There is only an anterior sheath made up of the openeurotic fibers of the external

abdominal oblique .

^^ Between the costal margin/xiphoid process and the arcuate line(above the

arcuate line)

* the aponeurosis of the internal abdominal oblique splits around the two sides of

the rectus abdominis muscle *

Anterior sheath is made up of a combination of the aponeurosis of the external

abdominal oblique and the internal abdominal oblique .

. posterior sheath is made up of a combination of the aponeuroses of the internal

abdominal oblique and the transversus abdominis muscles

^^ below the arcuate line

there is no posterior sheath below the arcuate line

** The arcuate line is located half way between the umbilicus and the pubic crest .

** The anterior abdominal wall has a layered configuration that changes depending

on whether the approach is proximal or distal to the arcuate line.

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the anterior sheath is made up of the aponeuroses of all three abdominal

muscles (EAO, IAO, and TA).

.

is a cylindrical shaped The inguinal canaltube 4 cm long located just above the inguinal

ligament

There are two openings to the inguinal canal

:The deep & superficial inguinal ring , it has

anterior and posterior wall(floor) and roof ,

its floor is made up by inguinal and lacunar

ligament ,anterior wall is formed by conjoint

tendon

extend from

the anterior

superior iliac

spine to pubic

tubercle)

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