Anterior abdominal wall Video

 

Thorax

External oblique muscle seen through skin

Abdomen

Tendinous intersections of rectus abdominis

 

 

 

ANTERIOR ABDOMINAL WALL

The anterior abdominal wall is the gateway to the abdominal cavity. It is utilized by surgeons who wish to operate on intraperitoneal structures and by clinicians who may wish to examine the abdomen to obtain information about the state of health of abdominal viscera. It has skin, superficial fascia, (no deep fascia), muscles, transversalis fascia and parietal peritoneum.

Skin:

The skin of the anterior abdominal wall is lax. It is distensible also to accommodate the ever increasing abdominal cavity. It has Langerís lines running transversely and incision made on those lines (e.g. Pfannenstiel) heals with minimum of scar tissue formation.

Superficial fascia:

Superficial fascia of the anterior abdominal wall is divided into two and this is best seen below the umbilicus. It has no deep fascia.

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Superficial Camperís fascia is fatty. It contains loose areolar tissue.

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Deeper Scarpa's fascia is membranous. It extends to the perineum as the Colles fascia, and it is attached to the fascia lata of the anterior aspect of thigh, to the dartos  muscle of scrotum, to the sides of the pubic bones, and to the suspensory ligament of penis or clitoris.

 
Anterior abdominal wall from back Anterior abdominal wall from front
1 innermost intercostal muscle 2 rectus sheath (posterior wall and parietal peritoneum together with transversalis fascia 3 internal thoracic vessels 4 intercostal vessels and nerves 1 pectoralis major 2 anterior wall of rectus sheath with aponeurosis of external oblique in front 3 external oblique muscle of abdomen 4 innermost intercostal muscle 5 external intercostal muscles 6 internal intercostal muscle with intercostal vessels and nerve

Anterior abdominal wall seen from back

 

Muscles:

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Superficial- External oblique muscle of the abdomen, which runs downwards and forwards to its insertion on the linea alba and beyond

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Intermediate- Internal oblique muscle, which runs upwards and forwards to reach the linea semilunaris where it splits into duality to enclose the rectus sheath and gain its attachment to the linea alba.

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Deep- transversus abdominis, which runs transversely to the linea alba behind the rectus

Other muscles

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Rectus abdominis- parallel muscles on the sides of the line alba. They are enclosed in aponeurotic sheath called the rectus sheath

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Pyramidalis

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Cremaster

Rectus sheath

This sheath has varying boundaries and hence will be described in three different planes-

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1. Plane above  the costal margin.

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2. Plane between the costal margin and midway between umbilicus and the symphysis pubis (arcuate line)

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3. Plane below the arcuate line.

Arteries of anterior abdominal wall

Rectus sheath is supplied by 

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Superior epigastric artery

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Inferior epigastric artery

The flanks are supplied by

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Intercostal arteries

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Lumbar arteries

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Part of internal thoracic artery

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Musculophrenic artery

Veins:

The veins do not follow the artery. The veins that drain the anterior abdominal wall pass from the umbilicus in a radiate manner, resembling the spokes of bicycle wheel. They pass to the great saphenous vein below the umbilicus and to the lateral thoracic vein  from where they reach the axillary vein above the umbilicus. Some drain via the ligamentum teres to the portal vein and hence may become distended in portal obstruction leading to formation of the so-called caput medusae and also a distended thoraco-epigastric vein (inguino-axillary vein) at the mid-clavicular line.

Nerves:

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T7 nerve ventral ramus

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T8 nerve ventral ramus

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T9 nerve ventral ramus

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T10 nerve ventral ramus

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T11 nerve ventral ramus

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T12 nerve ventral ramus, especially for pyramidalis

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L1 nerve ventral ramus, especially for conjoint tendon of internal oblique and transversus abdominis at the roof of inguinal canal. The L1 nerve is divided into

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Ilioinguinal nerve

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Iliohypogastric nerve

Ligaments

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Inguinal ligament: This separates the anterior abdominal wall from the thigh

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Lacunar ligament

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Reflected inguinal ligament.

Others:

Rizk description of muscular attachment

Inguinal canal

Anatomy of abdominal incisions

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(Gridiron incision for appendicectomy)

Lymphatics.

  

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Embryology

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Histology

 

 QUIZ

  There is nothing in anatomy not found in this website

 

 

 

Exposure of peritoneal cavity

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Skin

1 External oblique muscle of abdomen 2 Rectus abdominis and tendinous intersections

1 Camper's and Scarpa's fasciae 2 External oblique aponeurosis

Rectus sheath

Muscles of anterior wall

1 Rectus abdominis 2 Linea alba 3 Tendinous intersection 4 Transversus abdominis 5 Inguinal ligament 6 Spermatic cord

 

1 Internal oblique muscle

Cremasteric muscle

Pyramidalis