1. Abdominal Wall & Stomach
Dr. Nimir
Dr. Safaa

2. 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.

3. Abdominal wall divided into:-  Anteriolateral abdominal wall
Anterior wall
Right lateral wall (Right Flank)
Left lateral wall (Left Flank)
 Posterior abdominal wall

4. 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.

5. 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)

6. Antrolateral Abdominal Wall Muscles
3 Flat Muscles with strong sheet like aponeuroses
External Oblique
Internal Oblique
Transversus Abdominus
2 Vertical Muscles
Rectus Abdomius
Pyramidalis

10. Anterolateral Abdominal Wall Nerves
T7 – T11 Thoracoabdominal Nerves
T12 Sub-costal nerve
L1 ilio-hypogastric Nerve ilio inguinal Nerves

11. 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

12. 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

13. The nine abdominal regions:-

14. 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.

15. 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

16. 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.

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

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

19. 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)

20. Posterior Abdominal Wall Blood Vessels
Aorta and its branches
IVC and its tributeries

21. 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.

22. 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.

23. Stomach

24. The muscular wall
The outer
longitudinal layer
The intermediate
circular layer
The innermost
oblique layer

26. Stomach Musculature

27. mucous membrane
rugae

28. Stomach

29. Stomach bed:- Transverse colon Transverse mesocolon Pancreas
Spleen& splenic artery
Left kidney
Left suprarenal
Left crus of the diaphragm

30. Arterial supply of the stomach:-

32. Venous drainage:-

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

35. 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.

38. Thank you