Abdominal Wall & Stomach
Dr. Nimir
Dr. Safaa
Objectives
Define the abdominal wall. Enlist the layers.. Give its blood and nerve supply. Applied anatomy Discuss stomach in terms of its parts and musculature. Enlist the peritoneal relations of the stomach. Enlist the structures forming stomach bed. Discuss the blood supply of the stomach.
Abdominal wall divided into:- Anteriolateral abdominal wall
Anterior wall Right lateral wall (Right Flank) Left lateral wall (Left Flank)
Posterior abdominal wall
Abdominal wall divided into:- Anteriolateral abdominal wall
Anterior wall Right lateral wall (Right Flank) Left lateral wall (Left Flank)
Posterior abdominal wall
Anterolateral Abdominal Wall
This extended from the thoracic cage to the pelvis and bounded : Superiorly
7th through 10th costal cartilages and and xiphoid process
Inferiorly Inguinal ligaments and the pelvic bones.
The wall consists of skin, subcutaneous
tissues (fat), muscles, deep fascia and parietal peritoneum.
Antrolateral Abdominal Wall Fascia & Subcutaneous Tissues
The subcutaneous tissues over most of the wall consists of layer of connective tissues that contains a variable amount of fat.
In the inferior part of the wall , the subcutaneous tissue is composed of two layers
Fatty superficial layer (Camper’s fascia) Membranous deep layer (Scarpa’s fascia)
Antrolateral Abdominal Wall Muscles
3 Flat Muscles with strong sheet like aponeuroses External Oblique Internal Oblique Transversus Abdominus
2 Vertical Muscles Rectus Abdomius Pyramidalis
Anterolateral Abdominal Wall Nerves
T7 – T11 Thoracoabdominal Nerves
T12 Sub-costal nerve
L1 ilio-hypogastric Nerve ilio inguinal Nerves
Antrolateral Abdominal Wall Arteries
Internal Thoracic Artery Superior Epigastric Artery
External Iliac Artery Inferior Epigastric Artery Deep Circumflex Iliac Artery
Femoral Artery Superfecial Epigastric Artery Superfecial Circumflex Artery
Applied Anatomy
Abdomen is divided into 9 regions via four planes: Two horizontal [sub-costal (10th) and trans
tubercules plane] (L5). Two vertical (midclavicular planes).
They help in localization of abdominal signs and symptoms
The nine abdominal regions:-
Anterior Abdominal WallFunctions
Form strong expandable support. Protect the abdominal viscera from
injury such as low blow in boxing Compress the abdominal content Helps to maintain or increase the
intraabdominal pressure. Move the trunk and help to maintain
posture.
Protuberance of the abdomen. The five common causes (5F) Fat, Faeces, Fetus, Flatus And Fluid
Abdominal Hernias Anteriolateral abdominal wall may be
the site of hernias Inguinal, umbilical and epigastric
regions
Posterior Abdominal Wall
Lumbar vertebrae and IV discs. Muscles
Psoas, quadratus lumborum, iliacus, transverse, abdominal wall oblique muscles.
Lumbar plexus Ventral rami of lumbar spinal nerves.
Fascia Diaphragm
Contributing to the superior part of the posterior wall
Fat, nerves, vessels (IVC, aorta) and lymph nodes.
Posterior Abdominal WallFascia
Between the parital peritoneum and the muscles
The psoas fascia or psoas sheath.
The quadratus lumborum fascia.
The thoracolumbar fascia.
Posterior Abdominal WallMuscles
Three paired muscles
Psoas major
Iliacus
Quadratus Lumborum
Posterior Abdominal WallNerves
The sub costal nervesThe lumbar nervesThe lumbar plexus of nerves branchus
are: (a) The obturator nerves (L2 – L4)
(b) The femoral nerves (L2 – through L4) (c) Ilio inguinal and ilio hypogastric nerves (L1)
(d) Gentio femoral (L1 – L2) (e) Lateral femoral cutaneous nerves (L2 – L3)
Posterior Abdominal WallBlood Vessels
Aorta and its branches
IVC and its tributeries
Applied Anatomy
Posterior abdominal pain:
Ilio-psoas has relationship to kidney, ureters, caecum, appendix, colon, pancreas….etc.
When any of these structures is diseasedmovement of the ilio psoas usually causes pain.
When intra abdominal inflammation is suspected the Ilio Psoas Test performed by moving ileopsoas muscle and if positive it causes pain.
Psoas Abscess
Hematogenous spread to the lumbar vertebrae may form an abscess which may spread from the vertebrae into the Psoas sheath producing a Psoas abscess.
Stomach
The muscular wall
The outer longitudinal layer
The intermediate circular layer
The innermost oblique layer
Stomach Musculature
mucous membrane
rugae
Stomach
Stomach bed:-
Transverse colon Transverse mesocolon Pancreas Spleen& splenic artery Left kidney Left suprarenal Left crus of the diaphragm
Arterial supply of the stomach:-
Venous drainage:-
left and right gastric, left and right gastroepiploic, and the short gastric arteries.
Arteries of the stomach
Veins of the stomach
left and right gastric veins --> portal vein
left gastroepiploic and the short gastric veins--> splenic vein
The right gastroepiploic vein --> superior mesenteric vein.
Thank you