Professional Documents
Culture Documents
Cavity
Irwan
Content:
Surface Anatomy
Muscular Wall
Review vascularisation and
innervation
Inguinal region
Peritoneum and Peritoneal Cavity
Surface Anatomy
Bony Landmarks
around
Abdomen
Iliac crest
Anterior superior iliac
spine (ASIS)
Pubic crest
Inguinal ligament
Costal margin
Xiphoid process
Rectus
abdominis
Linea alba
Iliac crest
Linea Alba
Median raphe
Extends from xiphoid to pubic
symphysis.
Lies between paired rectus
abdominus muscles.
= fusion of aponeuroses of
transversus abdominus, internal
oblique, and external oblique.
Linea semilunaris:
Along lateral margin of rectus
abdominus.
Crosses costal margin near tip of
9th costal cartilage.
Arcuate line:
Lower free edge of posterior
lamina.
Lies midway between umbilicus
and pubis.
Inguinal ligament:
Inferior:
Pubic bone and iliac crest:
Level of L4.
Umbilicus:
Level of IV disc L3-4
Abdominal Quadrants
Formed by two intersecting lines:
Intersect at umbilicus.
Quadrants:
Upper left.
Upper right.
Lower left.
Lower right.
Abdominal Regions
Right and left
hypochondriac:
Contain liver -Fig. 1
Epigastric:
Contains: liver, stomach,
pancreas
Abdominal Regions
Umbilical:
Contains small intestine and transverse
colon.
Right and left inguinal:
Right contains ileocecal junction and
appendix.
Left contains sigmoid colon.
Hypogastric:
Contains small intestine, urinary bladder
(full), pregnant uterus.
Cutaneous Nerves
Derived from ventral rami of T7
through L1.
Pass inferiorly and medially in plane
between transverse and internal
oblique muscles.
Motor innervation:
To abdominal muscles.
Cutaneous innervation:
Lateral cutaneous branches.
Anterior cutaneous branches:
Penetrate rectus sheath.- Fig. 2
Cutaneous Nerves
Ventral rami of T7 through T11: Fig. 3
= thoracoabdominal nerves.
T7 to dermatome over xiphoid process.
T10 at level of umbilicus.
Subcostal nerve
Ventral ramus of L1: Fig. 2
Fig. 2 Nerves
Fascia
Superficial:
Campers fascia
Continuous with fascia over thorax
and thigh.
Fatty layer.
Fascia
Deep Superficial:
Scarpas fascia
Membranous layer.
Continues into perineum as:
Superficial perineal fascia = Colles
fascia.
Deep:
Thin layer covering abdominal
muscles.
external)
Transversus Abdominis (wraps around)
2 Vertical Muscles
Rectus Abdominis - vertical midline
Pyramidalis
Rectus sheath:
Encloses rectus abdominis.
Formed by fusion of fascia of other three layers
of abdominal muscles.
Anterior and posterior laminae. (layers)
Arcuate line is the lower free edge of the
posterior lamina
Lies midway between umbilicus and pubis.
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 if it
causes pain.
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.
IVC Obstruction
Three collateral routs formed by
valveless veins of the trunk are
available for venus blood to
return to the heart.
the
Inguinal Region
Inguinal Canal:
Oblique passage through lower
abdominal wall.
Site of potential weakness.
Transmits:
Spermatic cord in males.
Round ligament of uterus in
females.
Extends between superficial and
deep inguinal rings.
Inguinal Region
Inguinal Canal:
1. Superficial inguinal ring:
Triangular defect in the
aponeurosis of the external oblique
muscle layer.
Superficial opening of the inguinal
canal.
Lies above and lateral to pubic
tubercle.
Larger in males:
Transmits spermatic cord in
males.
Inguinal Region
Inguinal Canal:
2. Deep inguinal ring:
Opening of the evagination of
the transversalis fascia.
Lies above inguinal ligament
midway between anterior iliac
spine and pubic tubercle.
Inguinal Region
Inguinal Canal:
* Male: spermatic cord:
Vas deferens.
Ilioinguinal nerve.
Genital branch of genitofemoral
nerve.
Testicular arteries and veins.
Pampiniform plexus
Lymph vessels.
Cremaster muscle.
Inguinal Region
Inguinal Canal:
* Female:
Round ligament.
Ilioinguinal nerve.
Lymph vessels.
Inguinal Region
Inguinal Canal:
* Female:
Round ligament.
Ilioinguinal nerve.
Lymph vessels.
Abdominal Hernia
Orifices
Hernia is defined as the protrusion of an organ
through its containing wall. It can occur because of
Normal weakness found in everyone and related to
anatomy of the area e.g., place where vessel or
viscus enters or leaves the abdomen, muscles fail to
overlap or there is only scar tissue (Umbilicus)
Abnormal weakness caused by congenital
abnormality or acquired as result of trauma or
diseases.
High intraabdominal pressure from Coughing /
Strains / Abdominal distention
Inguinal Hernia
Umbilical Hernia
Femoral Hernia
Incisional Hernia
Less common Hernia
Epigastric Hernia
Recurrent Hernia
Common Clinical
Features
Inguinal Hernia
Types
Treatment
Clinical aspect
Fig. 8
Inguinal Region
Hernias:
Femoral:
Occurs within femoral canal.
More common in females.
Umbilical:
Occurs at site where umbilical
cord
penetrates between
muscles and
fascia of anterior
abdominal wall.
Cecal Recesses
Folds of peritoneum close to the
cecum produce three peritoneal
recesses called the superior
ileocecal, the inferior ileocecal, and
the retrocecal recesses.
Intersigmoid Recess
The intersigmoid recess is situated
at the apex of the inverted, Vshaped root of the sigmoid
mesocolon.
Subphrenic Spaces
The right and left anterior subphrenic
spaces lie between the diaphragm and
the liver, on each side of the falciform
ligament.
The right posterior subphrenic space
lies between the right lobe of the liver,
the right kidney, and the right colic
flexure.
The right extraperitoneal space lies
between the layers of the coronary
ligament and is therefore situated
Paracolic Gutters
The paracolic gutters lie on the
lateral and medial sides of the
ascending and descending colons.
The subphrenic spaces and the
paracolic gutters are clinically
important because they may be sites
for the collection and movement of
infected peritoneal fluid
Peritoneum
Nerve Supply of the
Peritoneum
Parietal peritoneum is sensitive
to pain, temperature, touch, and
pressure.
Visceral peritoneum is sensitive
only to stretch and tearing and is
not sensitive to touch, pressure,
or temperature.
Peritoneum
Nerve Supply of the
Peritoneum
Parietal peritoneum is sensitive
to pain, temperature, touch, and
pressure.
Visceral peritoneum is sensitive
only to stretch and tearing and is
not sensitive to touch, pressure,
or temperature.
Applied Anatomy
Some important skin areas involved in referred visceral pain.