Dr. Reynaldo V.

Lopez
Senior Lecturer
Department of Anatomy
Learning Objectives:
At the end of the lecture, the student should be
able to:

1. Define the region of the abdomen.

2. Enumerate its boundaries.
3. Delineate the abdominal quadrants & regions.
4. Describe the abdominal cavities & peritoneum.
5. Describe the structure of the abdominal walls, both
anterior & posterior.
6. Describe the surface landmarks of the abdominal
walls.
Definition
 Abdomen

– defined as the region of

the trunk that lies
between the diaphragm
above & the inlet of the
pelvis below
 Boundaries of the Abdomen

 Superior Boundary:
- diaphragm which separates the abdominal
cavity from the thoracic cavity .

 Inferior Boundary:
- continous with the pelvic cavity thru the pelvic
inlet or the pelvic brim
 Diaphragm

 Vena Caval Foramen: Hole for the Inferior Vena

Cava, where it passes to the liver.
 Around T8
 It is located in the central tendon (superior most
part) of the diaphragm.
 Eosphageal Hiatus: Opening that admits the
esophagus, guarded by two muscles left crus
and right crus.
 Left Gastric Artery and Left Gastric Vein also pass
through the eosphageal hiatus.
 Passes through at T10.
 Diaphragm

 Aortic Hiatus: Is actually posterior to the

diaphragm -- not really a hole in the diaphragm.
 Thoracic Duct goes posterior through this opening
as well as aorta.
 About Level 12, at lower most part of diaphragm.
 Lumbocostal Arches: Transversalis Fascia on
the posterior wall of the diaphragm.
Sympathetic Ganglia come through along these
arches.
Muscles
Diaphragm
of the Thorax
Openings

Caval
Esophageal

Aortic
 Pelvic Brim
 It consists of the Right and
Left Coxal Bones.
 Each coxal bone is made up of
an ilium, ischium, and pubic
bone.
 Iliac Crest: The superior
portion of the iliac bone. The
Iliac Tubercles are bony
prominences on the iliac
crest.
 Anterior Superior Iliac Spine
(ASIS): The anterior most
feature on the iliac crest.
 Pubic Tubercle: Lateral edge
of pubic bone.
 Pelvic Brim
 Inguinal Ligament: Found between the ASIS and the
pubic tubercle, running in the same direction as the
ASIS.
 Formed from aponeurosis part of the external abdominal
oblique.
 The femoral vessels and the inguinal canal are both related
to the inguinal ligament.
 Boundaries of the Abdomen
 Anterolateral Boundary:
- above by the lower part of the thoracic cage
- below by the muscles of abdominal wall:
rectus abdominis, transversus abdominis, and
internal & external abdominal oblique.

 Posterior Boundary:
- lumbar vertebrae & discs, 12th rib & upper part of
bony pelvis
- psoas, quadratus lumborum and transversus
abdominis & iliacus muscles.
Quadrants &
Regions
 Abdominal Quadrants
 Abdomen is divided
into quadrants by
using a vertical &
horizontal line that
intersect at the
umbilicus
 Epigastrium: area
between the xiphoid
process & above the
umbilicus
 Periumbilical: area
around the umbilicus
Abdominal Quadrants
 Abdominal Regions
 Vertical lines of division:
(L) and (R) mid-clavicular
lines
 Horizontal lines of
division:
 Transpyloric Plane:
Sometimes used. It is
halfway between the jugular
notch and the pubic bone.
 Subcostal Plane: Upper
plane, passing through the
inferior-most margin of the
ribs.
 Transtubercular Plane: The
line transversing the pubic
tubercle.
Abdominal Regions

Figure 22.4b
Abdominal Cavity
 Abdominal Cavity
 Abdominal Cavity:
- Everything but the
lateral, posterior,
and anterior body
walls of the
abdomen, including
both the peritoneal
cavity and the
retroperitoneal
space.
 Abdominal Cavity
 Peritoneal Cavity:
- That part of the abdomen invaginated by
peritoneum
 Retroperitoneal Space: The area behind
(posterior to) the peritoneum.
 Peritoneum
 Peritoneal layers
 Visceral Peritoneum:
Surrounds the
digestive organs.
 Parietal Peritoneum:
Lines the abdominal
wall.
 Peritoneum

 MALES: The peritoneal cavity is CLOSED.

 FEMALES: The peritoneal cavity is OPEN. It
opens out into the cervix and vagina, making it a
potential space for pathogens to enter.
 Peritoneum should be considered a potential
space for pathogens and fluids to build up.
 Peritoneum
 Mesentery – a double layer of peritoneum
 Holds organs
in place
 Sites of fat
storage
 Provides a
route for
circulatory
vessels and
nerves
 Abdominal Contents

 Intra-Peritoneal Organs: Organs

completely or almost completely
enclosed by peritoneum.
 Stomach
 Liver
 Gall Bladder
 Transverse Colon: completely
 Jejunum
 Ileum
 Cecum (very start of ascending
colon)
 Abdominal Contents
 Retro-Peritoneal Organs: Organs located mostly
or completely behind the posterior parietal
peritoneum.
 Duodenum
 Ascending Colon (only 25-50% covered)
 Descending Colon (only 25-50% covered)
 Sigmoid Colon
 Pancreas
 Kidneys
 Great Vessels and their primary branches: Abdominal
Aorta and Inferior Vena Cava, Celiac Trunk, and
Superior and Inferior Mesenteric arteries and veins.
Abdominal Walls
 Anterior Abdominal Wall
Layers:
1. Skin
2. Superficial Fascia -- Connective tissue that is not
aponeurosis, tendon, or ligament. This is the same
thing as the hypodermis.
1. Camper's Fascia: Fatty layer, first of the two layers. It
is found throughout.
2. Scarpa's Fascia: Lower layer, found in the lower 1/3 of
the anterior abdominal wall.
 Anterior Abdominal Wall

Limits of superficial fascia :

 The area is restricted to the anterior abdominal wall.
 Lateral Limit: Basically the inguinal ligament, where it
intersects with fascia lata, so that fluid does not pass
into the thigh.
 Inferior Limit = the base of the scrotum.
 Posterior Limit = it goes back to the anus, and fills the
pelvis in between.
 Anterior Abdominal Wall

 The outlined region is called the superficial perineal

space.
 It is called different fascia at different places: Dartos Fascia
in scrotum / labia majora, and Colles Fascia around
perineum.
3. Fundiform Ligament: The false suspensory ligament
of the penis or clitoris. It is an extension of superficial
fascia.
 Anterior Abdominal Wall

3. Deep Fascia
 A true suspensory ligament occurs in the deep fascia
layer, which extends into the penis / clitoris. So, we have
both a true suspensory ligament (deep fascia) and a
false one (fundiform ligament / superficial fascia).
 Deep fascia encompasses all muscles of the entire body.
 Anterior Abdominal Wall
4. Muscles
1. External Abdominal Oblique
- muscle fiber direction is
antero-inferior
 Originate at border of Thoracic
ribs T5 - T12
 Extends to midline and
attaches on linea alba & iliac
crest.
 Aponeurosis portion form the
inguinal ligaments &
superficial inguinal ring, which
allows passage of the
spermatic cord (male) or round
ligament (female).
 Anterior Abdominal Wall
4. Muscles
2. Internal Abdominal Oblique
 Fibers attach along the inguinal
ligament to the pubic crest.
 Direction of fibers tends to go
outward, from medial to lateral
and a little bit inferiorly
(inferolaterally).
 Borders on ribs 7 - 12.
 The aponeurosis splits and goes
both anteriorly (to merge with
external aponeurosis) and
posteriorly (to merge with
transversus aponeurosis)
 Anterior Abdominal Wall
4. Muscles
3. Transversus Abdominis -
deep most layer of flat
muscles.
 Borders on ribs 7 - 12. Extends
down to the pubic crest and
medially to the linea alba.
 Creates a diagonal pathway for
the spermatic cord or round
ligament to pass through.
 Fibers run transversely! --
horizontally from lateral to
medial.
 Anterior Abdominal Wall
4. Muscles
4. Rectus Abdominis: -
Straight muscle.
 Passes from xiphoid process
inferiorly to pubic symphysis
(inferior center of pubic bone).
 Rectus Sheath holds this rectus
muscle in place. It is directly
shallow to it, formed by the
aponeuroses of the three flat
muscles. It has a posterior and
anterior layer, formed from the
aponeuroses of the three flat
muscles.
 Anterior Abdominal Wall
4. Muscles
 Upper 3/4 of Abdominal Wall: All three muscle layers converge
on rectus sheath, and pass both anteriorly (external
aponeurosis) and posteriorly (transversus aponeurosis).
 Lower 1/4 of abdominal wall is transversalis fascia. Here, all
three muscle layers pass anteriorly. Here it is called
transversalis fascia.
 Anterior Abdominal Wall
 NERVOUS SUPPLY : Ventral rami of T7 - T12, & L1.

 ARTERIAL SUPPLY :
 Superior Epigastric Artery -- Runs directly over rectus
abdominis muscle.
 Inferior Epigastric Artery
 Superficial Epigastric Artery

 VENOUS SUPPLY : The same as the arteries

above.
 Posterior Abdominal Wall
Layers:
1. Thoracolumbar Fascia: an extension of the
aponeuroses of the transversus abdominis and
external abdominal oblique muscles.
 Divides into an anterior plane and posterior plane that
compartmentalize the muscles, which lies in between
the two planes.
 Anterior plane attaches to the transverse process of the
lumbar vertebrae.
 Posterior plane attaches to join with the other muscles in
the back.
 Posterior Abdominal Wall
2. Muscles
1. Psoas Major Muscle: Chief
flexor of the thigh and trunk
 Passes all along vertebral
column starting at T12.
 Passes deep to the inguinal
ligament and attaches to the
lesser trochanter of the femur.
 Innervated by L2-L4.
 Contraction: Pulls the body
toward the leg, or the thigh
toward the body.
 Posterior Abdominal Wall
2. Muscles
2. Iliacus Muscle: Aids the psoas
major in flexing the thigh and
trunk
 Attaches to the iliac fossa
(anterior surface of the iliac
bone).
 Inserts into psoas tendon, and
hence the two muscles
together are often called the
iliopsoas muscle.
 Posterior Abdominal Wall
2. Muscles
3. Quadratus Lumborum:
Stabilizes the 12th
(floating) rib during
inspiration. Inserts on the
12th rib.
 Posterior Abdominal Wall
Vessels
1. Abdominal aorta
 The abdominal aorta
passes through the
diaphragm at the level
of T12 vertebra.
 It passes inferiorly on
the bodies of the
lumbar vertebrae. In
front of the body of
L4, it divides into the
common iliac arteries.
 Posterior Abdominal Wall
Vessels
2. Inferior vena cava
 This vessel is formed on
the right side of the
aortic bifurcation, at
the level of the L5
vertebra, by the union
of the two common
iliac veins.
 It ascends to the right
of the aorta and passes
behind the liver to
pierce the diaphragm at
the level of T8 vertebra
& almost immediately
enters the heart.
 Posterior Abdominal Wall
Nerves
 The nerves of the posterior abdominal wall
are branches of the lumbosacral plexus.
 The roots of the plexus are:
 L1
 L2
 L3
 L4
 L5
 Posterior Abdominal Wall
 L1 gives rise to the
iliohypogastric and
ilioinguinal nerves.
 L1 + L2 gives rise
to the
genitofemoral
nerve
 L2 + L3 gives rise
to the lateral
femoral cutaneous
nerve
 Posterior Abdominal Wall
 L2 + L3 + L4 give
rise to the femoral
and obturator
nerves
 L4 + L5 give rise to
the lumbosacral
trunk which joins
sacral nerves to
form the sacral
plexus.
Surface Landmarks
 Surface Landmarks
 The linea alba is a midline depression running
from the xiphisternum to the pubis.
 The linea semilunaris is a smooth, curved line,
representing the lateral margin of the rectus
abdominis.
 Surface Landmarks
 The inguinal ligament runs from the anterior
superior iliac spine to the pubic tubercle.
 The deep inguinal ring lies at the midinguinal
point (halfway between the anterior superior
iliac spine and the pubic tubercle).
 Surface Landmarks

 The arcuate line is the line that divides the

upper 3/4 of abdomen from lower 1/4, by the
differences in the aponeurotic layers.
 Surface Landmarks

 McBurney's Point:
The point of surgical incision
for an appendectomy.
 Is located on a line along the
ASIS.
Surface Landmarks
 Surface Landmarks
Liver
 The inferior border
extends from the (R) 10th
costal cartilage in the
midclavicular line to the
(L) 5th rib in the
midclavicular line.
 The upper border runs
between the (L) & (R) 5th
ribs; both points are in the
midclavicular line.
 The right border runs from
the 5th (R) rib to the 10th
 Surface Landmarks
Fundus of the gall bladder
 This lies deep to the
intersection of the linea
semilunaris with the
costal margin in the
transpyloric plane.
 At this point the fundus
of the gall bladder lies
behind the 9th costal
cartilage
 Surface Landmarks
Spleen
 Lies deep to the 9th,
10th, and 11th ribs on the
left behind the
midaxillary line.
 It is not palpable unless it
is enlarged, at which
point the spleen extends
inferiorly and anteriorly
along the 10th rib to
below the costal margin.
 Surface Landmarks
Pancreas
 The head of the pancreas
lies in the ‘C’ shaped
concavity of the duodenum
at the level of the L2
vertebra.
 The neck of the pancreas
lies anterior to the L1
vertebra in the transpyloric
plane.
 The pancreas continues to
the left, curving upwards
towards the hilum of the
spleen.
THANK
YOU