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

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 Wall Functions 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 Wall Fascia Between the parital peritoneum and the muscles The psoas fascia or psoas sheath. The quadratus lumborum fascia. The thoracolumbar fascia.

Posterior Abdominal Wall Muscles Three paired muscles Psoas major Iliacus Quadratus Lumborum

Posterior Abdominal Wall Nerves The sub costal nerves The lumbar nerves The 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 Wall Blood 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 diseased movement 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:-

Arteries of the stomach left and right gastric, left and right gastroepiploic, and the short gastric arteries.

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