1. Surface Anatomy, Vessels, Muscles, and Peritoneum
The Abdomen
Surface Anatomy, Vessels, Muscles, and Peritoneum

2. Surface Anatomy
Anterior abdominal wall extends from costal margin to inferior boundaries:
Iliac crest
Anterior superior iliac spine
Inguinal ligament
Pubic crest
Superior boundary
Diaphragm
Central landmark
Umbilicus
Linea alba (white line)
Tendinous line
Extends from xiphoid process to pubic symphysis

3. Abdominal Quadrants 9 regions 4 quadrants Draw “line” through navel
Right upper quadrant
Left upper quadrant
Left lower quadrant
Right lower quadrant

4. Muscles Function: Abdominal wall Help contain abdominal organs
Move trunk
Forced breathing
Increase intra-abdominal pressure
Abdominal wall
Anterior (4)
Innervated by intercostal nerves
Continuous with layers of intercostal muscles
Fibers of layers run in different directions for strength
Ends in aponeurosis which contains rectus abdominis muscle
Posterior (3)

5. Anterior Abdominal Wall Muscles
Rectus Abdominis
Origin
Pubic crest, symphysis
Insertion
Xiphoid process, costal cartilages of ribs 5-7
Function
Flex, rotate trunk, fix and depress ribs, stabilize pelvis, compress abdomen
Internal oblique
Lumbar fascia, iliac crest, inguinal ligament
Linea alba, pubic crest, last 3-4 ribs, costal margin
Same for external obliques

6. Anterior Abdominal Wall
External oblique
Origin
Lower 8 ribs
Insertion
Aponeurosis to linea alba, pubic and iliac crest
Function
Flex trunk, compress abdominal wall (together), Rotate trunk (separate sides)
Transversus abdominis
Inguinal ligament, lumbar fascia, cartilage of last 6 ribs, iliac crest
Linea alba, pubic crest
Compress abdominal contents

7. Posterior Abdominal Wall
Iliopsoas
Psoas major
Origin
Lumbar vertebrae, T12
Insertion
Lesser trochanter of femur via iliopsoas tendon
Function
Thigh flexion, trunk flexion, lateral flexion
Innervation
Ventral rami L1-L3
Iliacus
Iliac fossa, ala of sacrum
Thigh flexion, trunk flexion
Femoral nerve (L2 and L3)
Psoas minor – variable (40-60% do not have)

8. Posterior Abdominal Wall
Quadratus lumborum
Origin
Iliac crest and lumbar fascia
Insertion
Transverse process of upper lumbar vertebrae, lower margin of rib 12
Function
Flex vertebral column, maintains upright posture, assists in inspiration
Innervation:
T12 and upper lumbar spinal nerves (ventral rami)

9. Abdominopelvic Cavity
Ventral body cavity
Thoracic
Abdominopelvic
Abdominal
Liver
Stomach
Kidneys
Pelvic cavity
Bladder
Some reproductive organs
Rectum

10. Abdominal cavity The space bounded by: Anterolateral abdominal wall
Posterior abdominal wall
Diaphragm
Pelvic walls and pelvic floor.
Subdivided into:
True abdominal cavity (from diaphragm to linea terminalis)
Pelvic cavity (below linea terminalis).

11. Peritoneum and peritoneal compartment
Peritoneum is a continuous serous membrane, composed of two layers:
Parietal peritoneum, lines abdominal and pelvic wall
Visceral peritoneum, lines abdominal and pelvic organs.
Peritoneal compartment is part of the abdominal cavity enclosed within the parietal peritoneum. Contains organs covered with peritoneum and peritoneal structures.
Outside the parietal peritoneum is the extraperitoneal compartment of the abdominal cavity.

12. Peritoneal cavity
Peritoneal cavity (PC) - the space between the two peritoneal layers, is a potential space, into which the organs are tightly packed against each other.
PC contains thin layer of fluid, which lubricates the peritoneal surfaces and allows movement of the organs without friction.
PC is closed in males, but communicates with the external environment in females through the uterine tubes, uterus and vagina.
Peritoneum, peritoneal cavity and all the organs are situated in the abdominal cavity.

13. Development of the peritoneum

14. Relationship between the organs and peritoneum
Due to intraembryonal processes the organs have different relationship with the peritoneum.
1. Intraperitoneal organs are entirely covered with peritoneum. They are connected to the abdominal wall with ligaments or meso, which ensures greater mobility.
2. Extraperitoneal organs are partially or entirely devoid of peritoneum. They are slightly movable or immovable. According to their position these are:
а) retroperitoneal – on the posterior abdominal wall
b) subperitoneal – in the lesser pelvis
c) preperitoneal – at the anterior abdominal wall.

15. Vertical layout of the peritoneum

16. Horizontal layout of the peritoneum

17. Passage of the parietal into visceral peritoneum

18. Peritoneal structures
1. Mesentery – double peritoneal layer, representing elongation of the visceral peritoneum.
М. connects the corresponding organ with the abdominal wall (e.g., mesentery of the small intestine).
М. contains connective tissue in which are embedded blood vessels, nerves and lymph nodes.
М. ensures mobility of the organs.

19. 2. Omentum – double layered structure of visceral peritoneal, extending from the stomach to neighbouring organs.
Lesser omentum (оmentum minus) connects the lesser curvature of the stomach and intitial portion of pars superior duodeni with liver.
Greater omentum (оmentum majus) descends from the greater curvature of the stomach and intitial portion of pars superior duodeni, covers the intestines, and then ascends back to attache to the transverse colon. Contains great amount of fat tissue.

20. 3. Peritoneal ligaments – double layered structures of visceral peritoneum, between neighbouring organs or between organ and abdominal wall (e.g., lig. falciforme, lig. gastrophrenicum, lig. gastrolienale, lig. gastrocolicum).
4. Peritoneal folds (plicae) formed over underlying structures (e.g., plica iliocecalis superior, plica umbilicalis mediana).
5. Peritoneal recessuses – spaces in the peritoneal cavity заградени between peritoneal structures and abdominal organs or abdominal wall (e.g., bursa omentalis, recessus subphrenicus, fossa retrocecalis).

21. Divisions of the peritoneal cavity
By mesocolon transversum the peritoneal compartment divites into:
1. Supracolic compartment – between diaphragm and mesocolon transversum with its mesentery.
2. Infracolic compartment - between mesocolon transversum and linea terminalis.
3. Pelvic compartment - below linea terminalis in the pelvi cavity.

22. Supracolic compartment
Organs:
1. Esophagus, pars abdominalis - intraperitoneal
2. Stomach - intraperitoneal
3. Liver - intraperitoneal
4. Gall bladder - intraperitoneal
5. Spleen - intraperitoneal

23. Supracolic compartment. Projections of organs

24. Supracolic compartment
Peritoneal structures:
1. Lig. falciforme hepatis
lig. teres hepatis
2. Lig. coronarium hepatis (dextum et sinistrum)
area nuda
3. Lig. triangulare (dextum et sinistrum)

25. Supracolic compartment
4. Omentum minus
lig. hepatogastricum
lig. hepatoduodenale
5. Omentum majus
lig. gastrocolicum
lig. gastrolienale
lig. gastrophrenicum
6. Lig. phrenicolienale

26. Supracolic compartment
Peritoneal spaces:
1. Recessus subphrenicus dexter - bursa hepatica
2. Recessus subphrenicus sinister - bursa pregastrica
3. Perilienal space
4. Recessus subhepaticus
а) anterior part
b) posterior part - recessus hepatorenalis
5. Bursa omentalis

27. Supracolic compartment
Bursa omentalis. Opened thru lig. hepatogastricum
Bursa omentalis. Opened thru lig. gastrocolicum

28. Infracolic compartment
Organs:
1. Small intestine
duodenum (pars superior, descendens, horizontalis, ascendens) - retroperitoneal, pars superior intraperitoneal
Jejunum and ileum - intraperitoneal
2. Large intestine
cecum - intraperitoneal
appendix vermiformis - intraperitoneal
colon (ascendens, transversum, descendens, sigmoideum) - intraperitoneal /mesoperitoneal
rectum – most extraperitoneal

29. Organs and projections

30. Peritoneal structures
1. Omentum majus - pars libera
2. Mesenterium
3. Mesocolon transversum
4. Mesocolon sigmoideum
5. Mesoappendix

31. Peritoneal structures
1. Plicae duodenalis superior/inferior
- recessus duodenalis superior/inferior
2. Plicae ileocecalis superior/inferior
- recessus ileocecalis superior/inferior

32. Peritoneal spaces 1. Canalis lateralis dexter
2. Sinus mesentericus dexter
3. Sinus mesentericus sinister
4. Canalis lateralis sinister
5. Recessus intersigmoideus
6. Recessus retrocecalis

33. Appendix vermiformis

34. Supracolic compartment. Blood supply
Truncus celiacus
1. A. gastrica sisnistra
- r. esophageus
2. A. hepatica communis
- a. hepatica propria
- a. hepatica dextra/sinistra
- a. gastroduodenalis
- a. gastroepiploica dextra
- aa. pancreaticoduodenales superiores (anterior/posterior)
- a. gastrica dextra
3. A. lienalis
- aa. gastricae breves
- a. gastroepiploica sinistra

35. Supracolic compartment. Blood supply

36. Arteriogram of truncus celiacus

37. Infracolic compartment. Blood supply
A. mesenterica superior
1. A. pancreaticoduodenalis inferior
2. Aa. intestinales (15-18)
3. A. iliocolica
4. A. colica dextra
5. A. colica media

38. Infracolic compartment. Blood supply
A. mesenterica inferior
1. A. colica sinistra
2. Aa. sigmoideae (3-4)
3. A. rectalis superior