Anatomy 4.

November 3, 2011
Dr. Zulueta

Abdomen in General
OUTLINE
I. The Abdomen
II. Abdominal Cavity
III. Abdominal Regions, Planes and Quadrants
IV. Subdivisions of the Abdomen
V. Layers of Anterolateral Abdominal Wall
VI. Internal Aspect of The Abdomen
VII. Peritoneal Fossae
VIII. Subcutaneous Tissue and Fascial Layer
IX. Muscles of Anterior Abdominal Wall
X. Rectus Sheath
XI. Innervation of the Anterior Abdominal Wall
XII. Blood Supply
XIII. Venous and Lymphatic Drainage
XIV. Inguinal Region
XV. Peritoneal Region
XVI. Posterior Abdominal Wall

General Objective:
Understand the gross anatomy of the anterior and posterior abdominal
wall, including the inguinal region.
Specific Objectives:
Anterior Abdominal Wall
o Identify anatomical landmarks (skeleton, cadaver, living subject) used in
the study
o Describe how the abdomen is divided into quadrants and regions and
its clinical applications
o Name and define extent of layers/musculature from outwards to
inwards
o Describe the formation of rectus sheath and various levels.
o Name the contents of the rectus sheath
o Describe the internal aspect
o Describe the disposition of the peritoneum.
o Name the corresponding layers of musculature in the scrotum.
Inguinal Region
o Define the deep fascia in the inguinal region.
o State the extent and boundaries of the inguinal canal.
o Locate the superficial and deep inguinal ring.
o Differentiate the types of inguinal hernia.
o Describe other forms of hernia in the abdomen.
Posterior Abdominal Wall
o Name the musculature of the posterior abdominal wall.
*Arial Narrow- information mentioned by Dr. Zulueta
*Times New Roman- information lifted from the book and from Lansang

accommodating expansions caused by ingestions, pregnancy, fat

deposition or pathology.
o The anterolateral abdominal wall and several organs lying
against the posterior wall are covered on their internal aspects
with serous membrane or peritoneum (serosa) that reflects onto
the abdominal viscera.
Abdominal viscera - include soft parts and internal organs such as
the stomach, intestine, liver and spleen.
Peritoneum (serous membrane) reflects onto the abdominal
viscera
Peritoneal cavity
o A bursal sac or lined potential space (peritoneal cavity) is
formed between the walls and the viscera that normally contain
only enough extracellular (parietal) fluid to lubricate the
membrane covering most of the surfaces of the structures
forming the abdominal cavity.

II. THE ABDOMINAL CAVITY

The major part of the abdominopelvic cavity.

Located between the diaphragm and the pelvic inlet.
Separated from the thoracic cavity by the thoracic diaphragm.
Continuous inferiorly with the pelvic cavity.
Enclosed anterolaterally by multi-layered, musculoaponeurotic,
abdominal walls.
The location of most digestive organs, parts of the urogenital
system (kidneys and most of the ureters), and the spleen.
Has no floor of its own because it is continuous with the pelvic
cavity. The plane of the pelvic inlet (superior pelvic aperture)
arbitrarily, but not physically, separates the abdominal and pelvic
cavities.

I. THE ABDOMEN
Part of the trunk between the thorax and pelvis.
Enclose & protect its contents
It is flexible, dynamic container, housing most of the organs of the
alimentary system and part of the urogenital system.
Contain abdominal organs and their contents is provided by
musculoaponeurotic walls anterolaterally, the diaphragm,
superiorly, and the muscles of the pelvis inferiorly.
The anterolateral musculoaponeurotic walls are suspended
between and supported by two bony rings (the inferior margin of
the thoracic skeleton superiorly and pelvic girdle inferiorly) linked
by a semi rigid lumbar vertebral column in the posterior abdominal
wall.
Interposed between the more rigid thorax and pelvis
o arrangement enables the abdomen to enclose and protect its
contents while providing the flexibility required by respiration,
posture, and locomotion.
Anterior and posterior abdominal wall
o The muscoloaponeurotic abdominal walls not only contract to
increase intrabdominal pressure but also distend considerably,
Group 1 | Abainza, Abante, Ablaza, Abong, Abuel, Agero, Agustin A.

Figure 1. The Abdomen

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III. ABDOMINAL REGIONS, PLANES AND QUADRANTS

Figure 2. The Abdominal Region, Planes and Quadrants

A. Abdominal Regions
The region is delineated by four planes:
o 2 Sagittal (vertical) planes
This are usually the midclavicular planes that pass from
the midpoint of the clavicles (approximately 9 cm from the
midline) to the midinguinal points, midpoints of the lines
joining the anterior superior iliac spine (ASIS) and the
superior edge of the pubic symphysis on each side.
o 2 Transverse (horizontal) planes
The subcostal plane, passing through the inferior border of
the 10th costal cartilage on each side.
The transtubecular plane, passing through the iliac
tubercles (approximately 5 cm posterior to the ASIS on
each side) and the body of the L5 vertebra. Both of these
planes have the advantage of intersecting palpable
structures.
9 Regions:
o RH-Right hypochondrium
o RL-Right flank (lateral region)
o RI-Right inguinal (groin)
o E-Epigastric
o U- Umbilical
o P-Pubic
o LH- Left hypochondriac
o LL-Left flank (lateral region)
o LI- Left inguinal (groin)

Group 1 | Abainza, Abante, Ablaza, Abong, Abuel, Agero, Agustin A.

B. Abdominal Planes
Used to locate abdominal organs, pains or pathologies
Subcostal,
transtubercular,
transpyloric,
transumbilical,
interspinous
o Subcostal plane
Passes through inferior border of 10th costal cartilage
o Transtubercular plane
Passes through iliac tubercles and body of L5 vertebra
o Transpyloric plane
Extrapolated midway between the superior borders of the
manubrium of the sternum and the pubic symphysis
(typically the L1 vertebral level)
Landmark for:
- fundus of the gallbladder
- neck of the pancreas
- origin of the superior mesenteric artery (SMA)
- origin of portal vein
- root of the transverse mesocolon
- duodenojejunal junction
- hila of the kidneys
o Transumbilical plane
Passes through the umbilicus (and the IV disc between L3 and
L4 vertebrae)
o Interspinous plane
Passes through the easily palpated ASIS on each side.
C. Abdominal Quadrants
This is more commonly used in clinics.
Four quadrants of the abdominal cavity (right and left upper and
lower quadrants) are defined by two readily defined planes:
o The transverse transumbilical plane, passing through the
umbilicus, dividing it into upper and lower halves
o The vertical median plane, passing longitudinally through the
body, dividing it into right and left halves.
It is important to know what organs are located in each abdominal
region or quadrant so that one knows where to auscultate,
percuss, and palpate them, and to record the locations of finding
during a physical examination. Refer to Figure 2 for the organs in
every quadrant.

Figure 3. Different incisions done on the abdomen

McBurneys Point
o 2.5 cm medial to anterior superior iliac spine (ASIS) along a line
between umbilicus and ASIS (spinoumbilical line).
o Guide for open surgery

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IV. SUBDIVISIONS OF THE ABDOMEN

Figure 4. Subdivisions of the abdominal wall. A transverse section of the

abdomen demonstrates various aspects of the wall and its components.

Subdivisions:
o Anterior wall
o Right Lateral Wall
o Left Lateral Wall
o Posterior Wall
All have musculoaponeurotic wall except for posterior wall
(lumbar region of the vertebral column)
The term anterolateral abdominal wall is used because the
boundary between the anterior and the lateral walls is indefinite; it
extends from the thoracic cage to the pelvis
o bounded superiorly by cartilages of the 7th-10th ribs and the
xiphoid process and inferiorly by the inguinal ligament and the
superior margins of the anterolateral aspects of the pelvic girdle
(iliac crests, pubic crests and pubic symphysis)

V. LAYERS OF ANTEROLATERAL ABDOMINAL WALL

Skin- attaches loosely to the subcutaneous tissue, except at the
umbilicus where it adheres firmly
Superficial fascia Campers (superficial fatty layer) & Scarpas
(deep membranous layer)
Deep (investing) fascia- covers the external aspects of the three
muscle layers of the anterolateral abdominal wall and their
aponeuroses (flat expanded tendon)
*investing fascia- extremely thin, respresented mostly by the
epimysium (outer fibrous CT layer surrounding all muscles)
Muscles external and internal oblique, transversus and rectus
abdominis, pyramidalis
Transversalis fascia (part of endoabdominal fascia)- portion lining
the deep surface of the transversus abdominis muscle and its
aponeurosis
o Endoabdominal Fascia- lines the internal aspect of the
abdominal wall
Extra/preperitoneal fat
o Parietal peritoneum - glistening lining of the abdominal
cavity; internal to the transversalis fascia

Figure 5. Layers of the Abdominal Wall

VI. INTERNAL ASPECT OF THE ABDOMEN

Presents 5 longitudinal ridges of the peritoneum
Median umbilical fold (1)- from the apex of the bladder, covers
median umbilical ligament
Median umbilical ligament-remnant of URACHUS

Medial umbilical folds (2)- lateral to median umbilical fold, cover

medial umbilical ligaments;
Medial umbilical ligament- formed by obliterated umbilical arteries

Lateral umbilical folds (2)- lateral to medial umbilical folds, cover

the inferior epigastric vessels; formed by inferior epigastric
arteries and veins

VII. PERITONEAL FOSSAE

Figure 6. Internal aspect of the Abdomen

Group 1 | Abainza, Abante, Ablaza, Abong, Abuel, Agero, Agustin A.

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 Supravesical fossae- between median and the medial umbilical folds

Medial inguinal fossae- between medial and lateral umbilical

folds; also called inguinal triangles (Hesselbach triangles),
potential sites of direct hernia
Lateral inguinal fossae- lateral to the lateral umbilical fold,
include the deep inguinal ring, site of indirect hernia

VIII. SUBCUTANEOUS TISSUE AND FASCIAL LAYER

Subcutaneous tissue of the wall major site of fat storage
PANNICULI- one or more sagging fat folds bilbil
(L.PANNICULI; singular=panniculus, apron )
Variable amount of fat
Males susceptible to fat accumulation
Superficial Fascia
o Superficial fatty layer- Campers fascia
o Deep membranous layer - Scarpas fascia
Continuation over pubis as deep layer Colles fascia
o Forms fundiform ligament of penis
Deep Fascia (Lansang)
o Over pubis and perineum as deep perineal fascia- Gallaudets
o Over penis as deep penile fascia- Bucks

Figure 7. Subcutaneous and Fascial layers of the Abdomen

IX. MUSCLES OF ANTERIOR ABDOMINAL WALL

Form a strong expandable support for the anterolateral
abdominal wall.
Protect abdominal viscera from injury
Compress abdominal contents to maintain/increase intraabdominal pressure and oppose diaphragm
o Increased intra-abdominal pressure facilitates expulsion
Maintains posture; moves the trunk
A. Flat Muscles (3)
o Their aponeuroses form the rectus sheath which encloses the
rectus abdominis.
o Aponeuroses also interweave with their fellows in the opposite
side forming the linea alba
Interweaving of aponeuroses are also present between the
superficial, intermediate and deep layers.
1. External Oblique
o Largest and most superficial
o Does not originate posteriorly from thoracolumbar fascia
Posteriormost fibers (thickest part of muscle) have a free
edge and span between its costal origin and the iliac crest
Group 1 | Abainza, Abante, Ablaza, Abong, Abuel, Agero, Agustin A.

o Fleshy fibers run inferomedially (like putting hand in pocket)

Become aponeurotic at midclavicular line and inferiorly at
spinoumbilical line
o Posterior ext. oblique aponeurosis attaches to pubic crest
medial to pubic tubercle
o Inferior margin of ext. oblique aponeurosis is thickened and
spans between ASIS and pubic tubercle as the inguinal
ligament (Poupart ligament)
o Forms digastric muscle (2-bellied muscle sharing common
tendon and working as 1 unit) w/ contralateral internal
oblique
2. Internal Oblique
o Thin muscular sheath
o Fleshy fibers run superomedially (like putting hand on chest)
o Aponeurotic at MCL and forms part of rectus sheath
o Torsion of the body possible due to joint aponeurosis of both ext.
and int. oblique muscles
3. Transversus Abdominis
o Innermost layer
o Run more or less transversally
o Transverse circumferential orientation ideal for compressing
abdominal contents
o NEUROVASCULAR PLANE between int. oblique and transverses
abdominis
Contains nerves and arteries supplying anterolateral
abdominal wall (mostly in the subcutaneous tissue)
Scrotal Layer/Covering
o Subcutaneous tissue dartos muscle and fascia
dartos muscle causes scrotum to wrinkle when cold
o Ext. oblique aponeurosis ext. spermatic fascia
o Int. oblique aponeurosis cremasteric muscle and fascia
Cremasteric muscle can be detected by stroking the inner aspect of
the thigh ipsilateral scrotum alone elevates
Stroke with caution, you might be stroking a different anatomical site
o Transversalis fascia int. spermatic fascia
B. Vertical Muscles (2)
1. Rectus Abdominis
o long, broad and strap-like muscle
o principal vertical muscle
o 3x wider superiorly than inferiorly
o Broad and thin superiorly, narrow and thick inferiorly
o Tendinous insertions - produced by the attachment of the
muscle to the anterior layer of the rectus sheath
When tensed in muscular people, stretches of muscle
bulge outward.
o Linea alba in between 2 rectus abdominis and has a defect on the
umbilical ring
2. Pyramidalis
o Small, triangular muscle which is absent in 20% of people
o Lies anterior to the inferior part of rectus abdominis muscle
o Ends in the linea alba and tenses it
o Landmark for accurate median umbilical/abdominal incision
(seen in between the 2 pyramidalis muscle)

X. RECTUS SHEATH
Strong, incomplete fibrous compartment of rectus abdominis and
pyramidalis muscle
Formation of the rectus sheath
o At the level of the SUPERIOR 3 QUARTERS OF RECTUS
ABDOMINIS MUSCLE (above the arcuate line)
Anterior layer of the sheath is formed by the ff:
External oblique muscle aponeurosis
Anterior laminae of internal oblique

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 Posterior layer of the sheath is formed by the ff:

Posterior laminae of internal oblique
Transversus abdominis aponeurosis
o At the level of the INFERIOR QUARTER OF RECTUS ABDOMINIS
MUSCLE (below the arcuate line)
Anterior layer formed by the aponeuroses of the 3 flat muscles
Posterior layer formed by the transversalis fascia
Arcuate Line (aka Semicircular line of Douglas)
o Demarcates the transition between the aponeurotic posterior
wall of the sheath covering the superior three quarters of the
rectus abdominis, and the transversalis fascia that covers the
inferior quarter.
Contents of the rectus sheath:
o Rectus abdominis
o Pyramidalis
o Anterior rami of T7-T12 spinal nerves
o Superior and inferior epigastric vessels
o Lymph vessels
Landmarks
o Linea alba middle
o Linea semilunaris sides

XI. INNERVATION OF THE ANTERIOR ABDOMINAL WALL

Figure 8. Nerves in the anterior abdominal wall and their branches

Thoracoabdominal nerves (T7-T11) - distal, abdominal parts of

anterior rami of the inferior 6 thoracic spinal nerves
o Innervates muscles of anterolateral abdominal wall and
overlying skin
Lateral (thoracic) cutaneous branches - of the thoracic spinal
nerves T7-T9 or T10
o Innervates skin of right and left hypochondriac regions
Subcostal nerve - large anterior ramus of spinal nerve T12;
o Innervates muscles of anterolateral abdominal wall and
overlying skin, superior to iliac crest and inferior to umbilicus
Iliohypogastric and ilioinguinal nerves - terminal branches of the
anterior ramus of spinal nerve L1
T7-T9 - skin superior to the umbilicus
T10 - skin around the umbilicus
T11, plus the branches of the subcostal (T12), iliohypogastric,
and ilioinguinal (L1) - skin inferior to the umbilicus

Group 1 | Abainza, Abante, Ablaza, Abong, Abuel, Agero, Agustin A.

XII. BLOOD SUPPLY

Superior epigastric artery
o Direct continuation of the internal thoracic artery
o Enters the rectus sheath superiorly through its posterior layer
o Supplies the superior part of the rectus abdominis and
anastomoses w/ the inferior epigastric artery approximately in
the umbilical region
Inferior epigastric artery
o Arises from the external iliac artery just superior to the inguinal
ligament
o Runs superiorly in the transversalis fascia to enter the rectus
sheath below the arcuate line
o Enters the lower rectus abdominis and anastomoses with the
superior epigastric artery

XIII. VENOUS AND LYMPHATIC DRAINAGE

Venous drainage
o Drain superiorly internal thoracic vein medially, lateral thoracic vein
laterally
o Inferiorly drain through superficial epigastric vein (from femoral vein)
and inferior epigastric vein (from external iliac vein)
o Medial & Deep venous drainage: between inferior and superior
epigastric vein
o Collateral drainage: superficial epigastric vein + lateral thoracic vein =
thoracoepigastric vein
o Dilation of thoracoepigastric vein : seen in liver cirrhosis/ blockage of
portal vein; called caput medusa
o Deep set of veins follow arterial supply (venae commitantes)
Lymphatic Drainage
o Superficial lymphatic vessels accompany the subcutaneous
veins
o superior to the transumbilical plane drain mainly to the axillary
lymph nodes, a few drain to the parasternal lymph nodes.
o inferior to the transumbilical plane drain to the superficial
inguinal lymph nodes.
Infection at umbilicus Lymph enlargement at parasternal area
Infection below umbilicus Lymph enlargement at inguinal region
o Deep lymphatic vessels accompany deep veins
Drain to the external iliac, common iliac, right and left lumbar (caval
and aortic) lymph nodes

XIV. INGUINAL REGION

Extends between the ASIS & pubic tubercle
Anatomically important: region where structures exit and enter
the abdominal cavity
Inguinal ligament
o Extends fr. the ASIS to the pubic tubercle flexor retinaculum
of the hip joint, spanning the subinguinal space
o Thickened inferolateral most portions of the external oblique
aponeurosis
o Dense band constituting the inferiormost part of the external oblique
aponeurosis
o Lacunar ligament (Gimbernat): deeper fibers that attach
posteriorly to the superior pubic ramus; medial boundary of
subinguinal space
o Pectineal ligament (Cooper): lateral fibers that continue to run
along the pecten pubis
Inguinal Canal
o An oblique passage approximately 4 cm long directed
inferomedially through the inferior part of the anterolateral
abdominal wall

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o Parallel and superior to the medial half of the inguinal ligament

o Main occupant: spermatic cord (males)/round ligament of the
uterus (females)
o Openings:
Deep (internal) inguinal ring
Entrance to the inguinal canal
Located superior to the middle of the inguinal ligament
and lateral to the inferior epigastric artery
Beginning of evagination in the transversalis fascia that
forms the opening letting extraperitoneal ductus deferens,
and testicular vessels (male) or round ligament of the
uterus (females) pass through
Superficial (external) inguinal ring
Exit by which the spermatic cord in males or round
ligament in females emerges from the inguinal canal
Diagonal split of external oblique aponeurosis
With lateral and medial crus
- Lateral crus attaches to pubic tubercle
- Medial crus attaches to pubic crest
o Boundaries of the inguinal canal
Anterior Wall: external oblique aponeurosis & internal
oblique ms. fibers
Posterior wall: transversalis fascia
- reinforced medially by internal oblique and transversus
abdominis aponeurosis that merge into a common tendon
(inguinal falx) and reflected inguinal ligament
Roof: transversalis fascia, internal oblique and transversus
abdominis, medial crus of ext. oblique
Floor: iliopubic tract, inguinal ligament, lacunar ligament

Figure 9. Inguinal Canal and Spermatic Cord

Figure 10. Different Parts of Hernia

Table 1. Differences between Direct and Indirect Inguinal Hernia

Characteristic
Predisposing
factors

Frequency

Direct (Acquired)
Weakness of anterior
abdominal wall in
inguinal triangle (e.g.,
owing to distended
superficial ring, narrow
inguinal falx, or
attenuation of
aponeurosis in males
>40 years of age)
Less common (one third
to one quarter of
inguinal hernias)

Exit from
abdominal
cavity

Peritoneum plus
transversalis fascia (lies
outside inner one or two
fascial coverings of cord)

Course

Passes through or
around inguinal canal,
usually traversing only
medial third of canal,
external and parallel to
vestige of
processusvaginalis
Via superficial ring,
lateral to cord; rarely
enters scrotum

Exit from
anterior
abdominal
wall

Indirect (Congenital)
Patency of processus
vaginalis (complete or
at least superior part)
in younger persons,
the great majority of
which are males

More common (two

thirds to three
quarters) of inguinal
hernias
Peritoneum of
persistent
processusvaginalis
plus all three fascial
coverings of
cord/round ligament
Traverses inguinal
canal (entire canal if it
is of sufficient size)
within
processusvaginalis

Via superficial ring

inside cord, commonly
passing into
scrotum/labium majus

CLINICAL CORRELATON
Pathways of entrance and exit are potential sites of herniation in
the INGUINAL REGION.
Inguinal Hernia
o A protrusion of parietal peritoneum and viscera, such as the
small intestine, through a normal or abnormal opening from the
cavity in which they belong.
o Most hernias are reducible, meaning that they can be returned
to their normal place in the peritoneal cavity by appropriate
manipulation.
o Direct
o Indirect
Group 1 | Abainza, Abante, Ablaza, Abong, Abuel, Agero, Agustin A.

Figure 11. Other Forms of Abdominal Hernia

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CLINICAL CORRELATON
Abdominal Hernias mostly occurs in the inguinal , umbilical,
and epigastric regions
Congenical Umbilical Hernia (exomphalos/omphalocele) newborns
Acquired Umbilical Hernia women and obese people,
consequence of surgical or traumatic wounds or weakness of the
scar of the umbilicus in the linea alba
Spigelian Hernia- obese people older than 40 years old
-uncommon hernia of the lineasemilunaris occurs through the
aponeurosis of the transversusabdominis just lateral to the lateral
edge of the rectus sheath.
Femoral Hernia -descends through the femoral canal within the
femoral sheath, creating a femoral hernia.
Congenital umbilical hernia, or exomphalos (omphalocele)
-caused by a failure of part of the midgut to return to the
abdominal cavity from the extraembryonic coelom during fetal
life.
Acquired infantile umbilical hernia
-small hernia that sometimes occurs in children and is caused by a
weakness in the scar of the umbilicus in the linea alba. Mostly
become smaller and disappear without treatment as the abdominal
cavity enlarges.
Acquired umbilical hernia of adults
- paraumbilical hernia The hernial sac does not protrude
through the umbilical scar, but through the linea alba in the region
of the umbilicus

XV. PERITONEAL REGION

Peritoneum
o continuous, glistening and slippery transparent serous
membrane
o lines the abdominopelvic cavity and invests the viscera

o Intraperitoneal VS Extraperitoneal/Retroperitoneal organs

The peritoneum and viscera are in the abdominopelvic cavity. The
relationship of the viscera to the peritoneum is as follows:
Intraperitoneal organs are almost completely covered with
visceral peritoneum.
- Intraperitoneal in this case does not mean inside the
peritoneal cavity (although the term is used clinically for
substances injected into this cavity).
- Ex: Stomach, Spleen
Extraperitoneal, retroperitoneal, and subperitoneal organs
are also outside the peritoneal cavity external, posterior, or
inferior to the parietal peritoneum and are only partially
covered with peritoneum (usually on just one surface).
-ex: Kidney (retroperitoneal), Urinary Bladder (subperitoneal)
Peritoneal cavity -within the abdominal cavity and continues
inferiorly into the pelvic cavity.
a potential space of capillary thinness between the parietal
and visceral layers of peritoneum.
PERITONEAL FORMATIONS(Mesentery)
o a double layer of peritoneum that occurs as a result of the
invagination of the peritoneum by an organ and constitutes a
continuity of the visceral and parietal peritoneum
o provides a means for neurovascular communication between
the organ and the body wall
o connects an intraperitoneal organ to the body wall usually the
posterior abdominal wall (e.g., the mesentery of the small
intestine)
PERITONEAL FORMATIONS (Omentum)
o double-layered extension or fold of peritoneum that passes
from the stomach and proximal part of the duodenum to
adjacent organs in the abdominal cavity

Figure 13. Sagittal section of the female abdomen showing the arrangement
of the peritoneum

Figure 12. The Peritoneum

o Parietal peritoneum- lines the walls of the abdominal and pelvic

cavities
o Visceral peritoneum- covers the organs

Group 1 | Abainza, Abante, Ablaza, Abong, Abuel, Agero, Agustin A.

Greater omentum VS Lesser omentum

The greater omentum is a prominent peritoneal fold that

hangs down like an apron from the greater curvature of the
stomach and the proximal part of the duodenum. After
descending, it folds back and attaches to the anterior
surface of the transverse colon and its mesentery.

The lesser omentum connects the lesser curvature of the

stomach and the proximal part of the duodenum to the liver
it also connects the stomach to a triad of structures that run
between the duodenum and liver in the free edge of the
lesser omentum

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XVI. POSTERIOR ABDOMINAL WALL

o Composed of:

Five lumbar vertebrae and associated IV discs (centrally).

Posterior abdominal wall muscles, including the psoas,

quadratus lumborum, iliacus, transverse abdominal and
oblique muscles (laterally).

Diaphragm, which contributes to the superior part of the

posterior wall.

Fascia, including the thoracolumbar fascia.

Lumbar plexus, composed of the anterior rami of lumbar

spinal nerves.

Fat, nerves, vessels (e.g., aorta and IVC), and lymph nodes.

Figure 14. Parts of Greater and Lesser Omenta

PERITONEAL FORMATIONS(Ligaments)

Figure 16. Posterior view of thoracic and abdominal viscera

***

Figure 15. The Peritoneal Ligaments

o Peritoneal ligament consists of a double layer of peritoneum

that connects an organ with another organ or to the abdominal
wall.
o The liver is connected to the:
Anterior abdominal wall by the falciform ligament
Stomach by the hepatogastric ligament, the membranous
portion of the lesser omentum.
Duodenum by the hepatoduodenal ligament, the
thickened free edge of the lesser omentum, which conducts
the portal triad: portal vein, hepatic artery, and bile duct
o The stomach is connected to the:
Inferior surface of the diaphragm by the gastrophrenic
ligament.
Spleen by the gastrosplenic ligament (gastrolienal ligament),
which reflects to the hilum of the spleen.
Transverse colon by the gastrocolic ligament, the apron-like
part of the greater omentum, descends from the greater
curvature, turns under, and then ascends to the transverse
colon.

Shoutouts: Hello Old and New Classmates! Welcome to Section A!

Happy Studying on our first trans for Second Sem! God bless.
Group 1 | Abainza, Abante, Ablaza, Abong, Abuel, Agero, Agustin A.

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