ANTERIOR ABDOMINAL WALL
RIDA HAJRA
ABDOMEN
Is divided topographically by two transverse and two longitudinal planes into nine (9) regions:
right and left Hypochondriac
Epigastric
right and left Lumbar
Umbilical
right and left Inguinal (iliac)
Hypogastric (pubic)
ABDOMEN (CONT.)
Is also divided by vertical and horizontal planes through the umbilicus into four (4) quadrants:
right and left upper quadrants
right and left lower quadrants
Umbilicus lies at the level of the intervertebral disk between the third and fourth lumbar
vertebrae.
Its region is innervated by the 10th thoracic nerve.
ANTERIOR ABDOMINAL WALL:
Muscles, Fascia Blood supply, Lymphatics, Veins
STRUCTURE INGUINAL REGION SUPPLY
INGUINAL REGION
ANTERIOR ABDOMINAL WALL
The anterior abdominal wall is made up of:
Skin
Superficial fascia
Deep fascia
Muscles
Extra-peritoneal fascia
Parietal peritoneum
MUSCLES OF ANTERIOR ABDOMINAL WALL
FASCIAE & LIGAMENTS OF ANTERIOR ABDOMINAL WALL
Linea Alba
Is a tendinous median raphe between the two rectus abdominis muscles, formed by the fusion of the
aponeuroses of the external oblique, internal oblique, and transverse abdominal muscles.
Extends from xiphoid process to pubic symphysis.
Linea Semilunaris
Is a curved line along the lateral border of rectus abdominis.
Linea Semicircularis (Arcuate Line)
Is a crescent-shaped line marking the inferior limit of the posterior layer of the rectus sheath just
below the level of the iliac crest.
RECTUS SHEATH
Is formed by fusion of the aponeuroses of external oblique, internal oblique, and transverse
muscles of abdomen.
Encloses the rectus abdominis and sometimes the pyramidal muscle.
Also contains the superior and inferior epigastric vessels and the ventral primary rami of thoracic
nerves 7 to 12.
FASCIAE & LIGAMENTS OF ANTERIOR ABDOMINAL WALL
Are organized into superficial (tela subcutanea) and deep layers.
The superficial layer has two layers; the superficial fatty layer (Camper’s fascia), and the
deep membranous layer (Scarpa’s fascia)
Superficial Fascia
1. Superficial (Fatty) Layer of Superficial Fascia (Camper’s Fascia)
Continues over the inguinal ligament to merge with the superficial fascia of the thigh.
Continues over the pubis and perineum as the superficial layer of the superficial perineal
fascia.
FASCIAE & LIGAMENTS OF ANTERIOR ABDOMINAL WALL
(CONT.)
2. Deep (Membranous) Layer of Superficial Fascia (Scarpa’s Fascia)
Continues over the pubis and perineum as the membranous layer (Colles’s fascia) of
superficial perineal fascia.
Deep Fascia
Covers muscles and continues over the spermatic cord at the superficial inguinal ring as the
external spermatic fascia.
Continues over the penis as the deep fascia of the penis (Buck’s fascia) and over the pubis
and perineum as the deep perineal fascia.
INGUINAL REGION
Inguinal (Hesselbach’s) Triangle
Is bounded medially by the linea semilunaris (lateral edge of the rectus abdominis), laterally by the
inferior epigastric vessels, and interiorly by the inguinal ligament.
Is an area of potential weakness and hence is a common site of a direct inguinal hernia.
Inguinal Rings
1. Superficial Inguinal Ring
Is a triangular opening in the aponeurosis of the external oblique muscle that lies just lateral to the
pubic tubercle.
2. Deep Inguinal Ring
Lies in the transversalis fascia, just lateral to the inferior epigastric vessels.
INGUINAL REGION (CONT.)
Inguinal Canal
Begins at the deep inguinal ring and
terminates at the superficial ring.
Transmits the spermatic cord or the round
ligament of the uterus and the genital branch
of the genitofemoral nerve
INNER SURFACE OF THE ANTERIOR ABDOMINAL WALL
Supravesical Fossa
Is a depression on the anterior abdominal wall between the median and medial umbilical folds of the
peritoneum.
Medial Inguinal Fossa
Is a depression on the anterior abdominal wall between the medial and lateral umbilical folds of the
peritoneum. It lies lateral to the supravesical fossa.
Is the fossa where most direct inguinal hernias occur.
Lateral Inguinal Fossa
Is a depression on the anterior abdominal wall, lateral to the lateral umbilical fold of the peritoneum.
TRANSVERSALIS FASCIA
Is the lining fascia of the entire
abdominopelvic cavity between the parietal
peritoneum and the inner surface of the
abdominal muscles
Forms the deep inguinal ring and gives rise to
the femoral sheath and the internal spermatic
fascia
Is directly in contact with the rectus abdominis
below the arcuate line
NERVES OF THE ANTERIOR ABDOMINAL WALL
Subcostal Nerve
Is the ventral ramus of the 12th thoracic nerve and innervates the muscles of the anterior abdominal
wall
Iliohypogastric Nerve
Arises from the first lumbar nerve and innervates the internal oblique and transverse muscles of
abdomen.
Ilioinguinal Nerve
Arises from the first lumbar nerve
Innervates the internal oblique and transverse muscles.
LYMPHATIC DRAINAGE OF THE ANTERIOR ABDOMINAL WALL
Lymphatics in the Region Above the Umbilicus
Drain into the axillary lymph nodes
Lymphatics in the Region Below the Umbilicus
Drain into the superficial inguinal nodes
Superficial Inguinal Lymph Nodes
Receive lymph from the lower abdominal wall, buttocks, penis, scrotum, labium majus, and the lower
parts of the vagina and anal canal. Their efferent vessels primarily enter the external iliac nodes and,
ultimately, the lumbar (aortic) nodes.
BLOOD VESSELS OF THE ANTERIOR ABDOMINAL WALL
Superior Epigastric Artery
Arises from the internal thoracic artery, enters the rectus sheath, and descends on the posterior
surface of the rectus abdominis.
Anastomoses with the inferior epigastric artery within the rectus abdominis.
Inferior Epigastric Artery
Arises from the external iliac artery above the inguinal ligament, enters the rectus sheath, and
ascends between the rectus abdominis and the posterior layer of the rectus sheath.
Anastomoses with the superior epigastric artery,
Deep Circumflex Iliac Artery
Arises from the external iliac artery and runs laterally along the inguinal ligament and the iliac crest
between the transverse and internal oblique muscles.
BLOOD VESSELS OF THE ANTERIOR ABDOMINAL WALL
Superficial Epigastric Arteries
Arise from the femoral artery and run superiorly toward umbilicus over the inguinal ligament.
Anastomose with branches of the inferior epigastric artery.
Superficial Circumflex Iliac Artery
Arises from the femoral artery and runs laterally upward, parallel to the inguinal ligament.
Superficial (External) Pudendal Arteries
Arise from the femoral artery, run medially to supply the skin above the pubis.
Thoracoepigastric Veins
Are longitudinal venous connections between the lateral thoracic vein and the superficial
epigastric vein.
Provide a collateral route for venous return if a caval or portal obstruction occurs.
ANY QUESTIONS?
THANK YOU!
