1. Antero-Lateral Abdominal Wall

2. Skin  Fascia  Muscle  Special fascia (Transversalis)
Abdominal Wall
Skin  Fascia  Muscle  Special fascia (Transversalis)
Anterior
Lateral (Rt. & Lf.)
Posterior
Ant & Lat walls boundary is:
Linea Semilunaris
Muscle fascia & nerves are continuous within lat. & ant. Walls
 Antero-lateral abdominal wall

3. Linea Semilunaris

5. Antero-Lateral Wall Boundaries: Superior Xiphoid process
& costal margin
(7th-10th CC)
Inferior
Inguinal Ligament:
C.T. ligament extends from
ant. sup. iliac spine  pubic tubercle

6. Fascia of Abdominal Wall
Superficial
fatty layer (Camper’s fascia)
membranous (Scarpa’s fascia)
Deep
enclosing the muscles
(muscle fascia)
divided into:
superf., intermediate & deep layers
Transversalis
continuous with endothoracic
fascia in the thorax
Extra peritoneal fat

7. Linea Semilunaris & Linea Alba

8. Layers of Abdominal Wall

9. Muscles of Antero-Lateral Wall
Read The Table in Your Textbook
5 muscles
3 lateral: (flat broad m)
Named by layer & fibers direction
external oblique
internal oblique
transversus abdominis
2 anterior: (vertical m)
Named by shape
Rectus Abdominis
Pyramidalis

10. Read The Table in your textbook outer surfaces of lower ribs (??)
External Oblique
Read The Table in your textbook
From:
outer surfaces of lower ribs (??) 
Inferomedially
Inserted to:
Linea alba
Pubic crest & tubercle
Ant. ½ of iliac crest
Inferior free border is thickened to become: Inguinal Ligament

11. Inguinal Ligament & Superficial Ring

12. Inguinal Lig.: Thickened backward reflection of the inferior border of external oblique aponeurosis that extends from anterior superior iliac spine to pubic tubercle

13. Superficial Inguinal Ring: a triangular split (opening) in the aponeurosis of external oblique muscle, above pubic crest & medial to inguinal lig.
Structure passing through:
Spermatic cord in male or ? In female

14. Internal Oblique Muscle
Read your textbook
Main Origin:
lumbar fascia
ant. 2/3 of iliac crest ??
Insertion
lower 3 ribs & Costal margin
xiphoid process
Linea alba
symphysis pubis

15. Transversus Abdominis
Runs horizontally
Main origin ??
Main Insertion:
Linea alba
Read Your Textbook

16. Rectus Abdominis Long strap like muscle
Extends vertically over ant. Wall
4 Fleshy parts run between
3 tendinous intersections:
xiphoid
umbilicus
halfway between ?
Enclosed by rectus sheath
(deep fascia)

17. Pyramidalis NOT always present Base from pubis
Apex inserted into linea alba
Anterior to rectus abdominis
& within Rectus sheath
Function ??

18. Rectus Sheath Long fibrous sheath that encloses rectus abdominis m.
It is formed by the three lat. Muscles aponeuroses
Starts from linea semilunaris
in both sides
Splits into 2 parts:
- Ant. to rectus abdominis
ext. oblique + ½ of internal oblique
- Post. to rectus abdominis
transversus + ½ of internal oblique
Merges in midline as ???

20. Exception At level of ant. sup. Iliac spine
(midway between umbilicus and ?)
 All aponeuroses go anterior
 NO posterior part
- Rectus abdominis become lined by transversalis fascia
The infero-posterior disappearance is marked by: arcuate line

23. Contents of Rectus Sheath
2 muscles ??
4 bld. Vessels
Sup. & Inf. epigastric arteries
Sup. & Inf. epigastric veins
6 nerves
T7 –T11 intercostals (5 nerves)
Subcostal n. (T12)
2 – 4 - 6

24. Blood Vessels of Abdominal Wall
Superior epigastric a.
continuation of ??
posterior to rectus abdominis m.
Inferior epigastric a.
from external iliac artery
Route & location ?
10th & 11th Post. intercostals & Subcostal a. (12th)
Lumbar arteries (between which layers?)
Deep Circumflex iliac (origin?)

26. Nerves of Abdominal Wall
Lower intercostal nerves:
T7 – T11
Subcostal n.
T12
1st lumbar nerve:
2 divisions:
iliohypogastric n.
ilioinguinal n.
does NOT enter the rectus sheath

27. 9 regions classification
Surface Anatomy
9 regions classification
Subcostal plane:
lowest costal margin,
10 cc, L3
Transtubercular plane:
iliac tubercles
what vertebral level?
Midclavicular planes:
mid clavicle 
mid inguinal lig.

28. 9 Regions
Rt. & Lf. Hypochondriac
Rt. & Lf. Lumbar
Rt. & Lf. Inguinal
Epigastric
Umbilical
Hypogastric (pubic)

29. 4 Regions classification
Transumbilical plane
IV disc L3-L4
Midsagittal line
symphesis menti 
symphesis pubis

30. Abdominal Surgical Incisions
Surgeons use various incisions to gain access to abd. cavity Rules: 1. Provide adequate exposure 2. avoid damage to major vital str. (van) 3. best possible cosmetic effect Common surgical incisions: 1. Median (Midline) Incisions: common 3 types 2. Paramedian Incision: 2-5 cm lat. To midline spleen or kidney

31. 3. Kocher’s (Subcostal) Incision:  oblique incision runs parallel & below (2.5cm) the Rt. costal margin  cholecystectomy 4. McBurney’s Incision: Parallel to ext. obliq. M. fibers at Mcburney’s point (??)  Appendectomy

32. McBurney’s Point On a straight line : 1/3 from ant. sup. iliac spine
2/3 from the umbilicus
Corresponds to the base of the appendix
The incision site during appendectomy (removal of the appendix)

33. 5. Pfannenstiel (Suprapubic) Incision:  transverse, slightly curved incision (Smile Incision)  5cm above pubic symphysis * most frequent incision used by urologists & gynecologists  c-section, hystrectomy urinary bladder & prostate surgeries