1. Anatomy of Abdomen and Pelvis

2. Areas/Organs Abdominal wall – anterior Inguinal region
Abdominal wall - posterior
Bowel
Biliary system
Genital tract
Liver
Pancreas
Peritoneum
Pelvis
Pelvic bones
Perineum
Sacrum
Spleen
Suprarenal (adrenal) glands
Urinary tract

3. Anatomy of Abdomen and Pelvis
Surface anatomy
Surface marking
Xiphoid
Iliac crest
Pubic tubercle
Vas deference

6. Anatomy of Abdomen and Pelvis
Vertebral Levels
T9 __ The xiphoid
L1 __ Transpyloric plane of addison
L3 __ The subcostal plane
L4 __ The plane of iliac crest
The Umbilicus __ at the junction between L3 __ L4

16. Anatomy of Abdomen and Pelvis
Nerve supply of the abdominal wall
Abdominal Muscles
Overlaying Skin
From T7 __ L1
The Umiblicus T10
The Groin and Scrotum L1

19. Anatomy of Abdomen and Pelvis
Surface Marking
Abdominal Vescera are inconstant in their position
Liver
Spleen
Gallbladder
Pancrease
Aorta
Kidneys
In thin people (women) you may palpate caecum sigmoid colon

21. Anatomy of Abdomen and Pelvis
The fascia and muscles of the abdominal wall
No deep Fascia
Super fecial Fascia
Camper __ Faty layer
Scarpas __ fibrous
Colles __ Extinction of scarpas to the perineum

23. Anatomy of Abdomen and Pelvis
The muscles of the anterior abdominal wall of considerable practical importance.
The Rectus abdominis
(origin) arises- Horizontal line from the 5th, 6th, and 7th costal cartilage.
Insertion____ into the crest of pubis
Transverse tendinous intersections 3 or 4

26. Abdominal wall muscle

28. Anatomy of Abdomen and Pelvis
Rectus sheath- aponeurotic expansion of lateral abdominal muscles.
Above the costal margin
From the costal margin to a point half way between the umbilicus and the pubis
Below the previous point
The arcuate line of douglas

32. Anatomy of Abdomen and Pelvis
The oblique Externus abdominis (External oblique)
Origin: Anterior surface of lower 8th ribs.
Insertion: xiphoid, pubic crest and pubic tubercle and anterior part of iliac crest.
Inguinal ligament of poupart’s from pubic tubercle to the anterior superior iliac spine
Fibers: downwards, forwards, mediall
Posterior wall – Free

35. Anatomy of Abdomen and Pelvis
The oblique internus abdominis ( internal oblique)
Origin – lumber fascia, Anterior two third of iliac crest, and lateral two third of inguinal ligament.
Insertion: lower 6th costal cartilage linea alba and pubic crest.
Fibers: upwards, forwords
Posterior wall – arise from lumber fascia

39. Anatomy of Abdomen and Pelvis
The transversus abdominis:
Origin: lumber fascia, lower 6th costal cartilage, anterior two third of iliac crest and the lateral two third of inguinal ligament.
Insertion: linea alba – pubic crest
Fibers: transversely
Posterior border – arise from lumber fascia.

43. Anatomy of Abdomen and Pelvis
The anatomy of abdominal incisions
Midline incision
Through linea alba
Wide fibrous structure above the umbilicus
Narrow hair line below the umbilicus
Bloodless line
Through it the abdomen can be opened rapidly
Gives wide exposure.

44. Anatomy of Abdomen and Pelvis
Paramedian incisions:
1in {2.5cm -1.5in (4cm)} parallel to ML
Anterior rectus sheath opened
Rectus muscle retracted
Posterior rectus sheath and peritoneum opened
Posterior rectus sheath and peritoneum become thin and fatty below a point half way between umbilicus and pubis

45. Anatomy of Abdomen and Pelvis
Transrectus incision:
Best avoided
The rectus muscle is split in the line of paramedian incision
The nerve supply of rectus muscle lies laterally
The medial part of the muscle become atrophic
Pararectal incision (Battle)
Rectus sheath opened
Rectus muscle retracted medially
Extending of this incision may damage the segmental nerve supply to the rectus muscle

46. Anatomy of Abdomen and Pelvis
Subcostal incision (Kocher)
Right side ___ used in Biliary Surgery
Left side ___ to expose the spleen
Starts at midline and extends parallel to and 1in (2.5cm) below costal margin
Anterior rectus sheath is opened
Rectus muscle is cut
Posterior rectus sheath and peritonerm is incised
The 8th 9th intercostal nerves might be injured
Is valuable in wide costal angle’s patient.

47. Anatomy of Abdomen and Pelvis
Gridiron Incision ( muscle splitting to the appendix)
Centered at Mac Burney's point ( two third of the way laterally along the line from the umbilicus to the anterior superior iliac spine
Transverse incision ( to the appendix)
Skin crease forwards from, and 1in (2.5cm) above the anterior spine

48. Anatomy of Abdomen and Pelvis
Transverse and oblique incisions
Cutting incisions through the lateral abdominal muscles
Do not damage their nerve supply
Used to expose lower abdominal intraperitoneal and extra peritoneal structure. ie sigmoid colon, caecum, ureter, blood vessels

49. Anatomy of Abdomen and Pelvis
Throco abdominal Incision
Upper Para median or oblique abdominal incision through 8th and 9th inter costal space.
Used to expose upper stomach, lower esophagus, right lobe & liver

50. Anatomy of Abdomen and Pelvis
Paracentesis abdominis
To evacuate intraperitoneal abdominal fluid
Through a cannula inserted through abdominal wall
Through linea alba (mid lines)
Lateral to Mac Burney's point

51. Anatomy of Abdomen and Pelvis
The inguinal canal
Is 1.5in (4cm) long
Passes downwards medially from external to internal inguinal ring
Parallel to and immediately above the inguinal ligament
Relations
Anteriorly skin, superficial fascia, external oblique, internal oblique
Posteriorly, conjoind tendon, fascia transversalis

53. Anatomy of Abdomen and Pelvis
Above – internal oblique and transversus abdominis
Below – The inguinal ligament
Deep ring (internal ring) – the point at which the spermatic cord pushes through the T.F.
External Ring ( superficial ring) – A defect in external oblique
The I.C. Transmit – spermatic cord and ilioinguinal nerve – in male
Round ligament and ilioinguinal nerve in female

59. Anatomy of Abdomen and Pelvis
The spermatic cord
3 layers of fascia – E.S.F., I.S.F.C.F
3 arteries – T.A., C.A. and artery to Vas.
3 nerves – G.N.,S.F.I.I.N.
3 other structure:
Pampiniform plexus of veins draining the right testis (R.T) to inferior vena ceva ( I.V.C.) and the left testis (Lt) to the renal vein (R.v.)
Vas deferens
Lymphatics drain the testis to Aortic lymph nods (L.N.)

61. Anatomy of Abdomen and Pelvis
Indirect inguinal Hernia passes through
Internal ring – along the inguinal canal – external ring – scrotum
If reducible controlled by direct pressure on the internal ring
The internal ring: lies 0.5in (12mm) above the midian point of inguinal ligament above the pulsation of femoral artery

64. Anatomy of Abdomen and Pelvis
Direct inguinal hernia
Pushes directly the posterior wall of the inguinal canal ( I.C.)
Lies medial to inferior epigastric artery
May protrude through the external inguinal ring (E.I.R.)
Notice
The diagnosis of inguinal hernia wither direct or indirect sometimes is difficult and can only made during surgery

65. Anatomy of Abdomen and Pelvis
Inguinal Hernia – is felt to lie above and medial to pubic tubercle (p.T.)
The femoral hernia – is felt to lie below and lateral to the P.T.
The inferior epigastric vessels ( I.E.V.) demarcate the medial border of the internal ring so
An indirect hernia sac – lies lateral to IEV
A direct hernia sac – lies medial to IEV
Pantaloons hernia - both direct and indirect hernia coexist and bulge through on each side of the IEV