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Abdominal Wall

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									Abdominal Wall
      Landmarks: bony & soft
• costal arch: formed by #7-10 costal
  cartilages
  – a. infrasternal angle - sharp upward angle at
    midline, xiphoid process at the apex
  – b. epigastric fossa - depression just inferior to
    xiphoid
              Coxal bones
• Three bones fused together
• ilium: anterior superior iliac spine; iliac
  crest
• ischium
• pubis: pubic symphysis,
• inguinal ligament (below): indicated at
  surface by depression separating leg from
  abdomen
            Abdominal wall
• Linea alba: midline from xiphoid to pubic
  bone, umbilicus - at level of L4
• Linea semilunaris: parallels linea alba on
  each side; marks lateral border of rectus
  abdominis
• Tendinous intersections: 3 horizontal
  divisions of rectus abdominis between
  linea semilunaris
Regions
          Superficial vessels
• thoracoepigastric veins: drain laterally
  from umbilical level up
• anterior perforating veins: closer to midline
• umbilical venous plexus (caput medusae
  may seen in portal hypertension)
• superficial epigastric artery, vein
• superficial circumflex iliac artery vein
                       Nerves
• Thoracoabdominal nerve: continuations of
  intercostals 7-11 & subcostal from thorax to
  abdomen, between internal oblique & transverse
  abdominis
• Anterior, lateral cutaneous nerve: terminal
  branches of thoracoabdominal nerve to the
  surface
   – T7-9 to skin superior to umbilicus
   – T10 to skin surrounding umbilicus
   – T11-12, L1 to skin inferior to umbilicus
• Iliohypogastric nerve: to skin over inguinal region
• Ilioinguinal nerve: just inferior to iliohypogastric to
  skin of superior, medial thigh
                  Muscles
•   External oblique muscle
•   Internal oblique muscle
•   Transversus abdominis
•   Rectus abdominis
          EXTERNAL ABDOMINAL OBLIQUE
• Origin
   – Anterior fibers: external surfaces of ribs five
     through eight interdigitating with serratus anterior
   – lateral fibers: external surface of ninth rib,
     interdigitating with serratus anterior; and external
     surfaces of 10th, 11 th ans 12th ribs, interdigitating
     with latissnus dorsi
• Insertion
   – Anterior fibers: into a board, flat aponeurosis,
     terminating in the linea alba, which is a tendinous
     rephe which extends from the xiphoid
   – Lateral fibers: as the inguinal ligament, into
     anterior superior spine and public tubercle, and
     into the external lip of anterior one half of iliac
     crest.
        EXTERNAL ABDOMINAL OBLIQUE
• Action
  – Anterior fibers: acting bilaterally, the anterior
    fibers flex the vertebral column approximating
    the thorax and pelvis anteriorly, support and
    compress the abdominal viscera, depress the
    thorax, and assist in respiration. Acting
    unilaterally with the anterior fibers of the
    Internal Oblique on the opposite site, the
    anterior fibers of External Oblique rotate the
    vertebral column, bring the thorax forward
    (when the pelvis is fixed), or the pelvis
    backward (when the thorax is fixed). For
    example, with the pelvis fixed, the right
    external oblique rotates the thorax
    counterclockwise, and the left external oblique
    rotates the thorax clockwise.
        EXTERNAL ABDOMINAL OBLIQUE
• Action
  – Lateral fibers: acting bilaterally, the lateral
    fibers of the external oblique flex the vertebral
    column, with major influence on the lumbar
    spine, titling the pelvis posteriorly. Acting
    unilaterally with the lateral fibers of the internal
    oblique on the same side, these fibers of the
    external oblique laterally flex the vertebral
    column, approximating the thorax and iliac
    crest. These external oblique fibers also act
    with the internal oblique on the opposite side
    to rotate the vertebral column. The external
    oblique, in its action on the thorax, is
    comparable to the sternocleidomastoid in its
    action on the head.
  EXTERNAL ABDOMINAL OBLIQUE
• Nerve
  – Anterior fibers: T5, 6, T7-T12
  – Lateral fibers: T5, 6, T7-T12
• Direction of the fibers:
  – Anterior fibers: the fibers extend
    obliquely downward and medialward
    with the uppermost fibers from the
    xiphoid
  – Lateral fibers: fibers extend obliquely
    downward and medialward, more
    downward than the anterior fibers
   INTERNAL ABDOMINAL OBLIQUE
• Origin
   – Lower anterior fibers: middle one third of
     intermediate line of iliac crest, and
     thoracolumbar fascia
   – Upper anterior fibers: anterior one third of
     intermediate line of iliac crest
   – Lateral fibers: middle one third of intermediate
     line of iliac crest, and thoracolumbar fascia
• Insertion
   – Lower anterior fibers: inferior borders of 10th,
     11th, and 12th ribs and linea alba by means of
     aponeurosis
   – Upper anterior fibers: linea alba by means of
     aponeurosis
   – Lateral fibers: inferior borders of 10th, 11th,
     and 12th ribs and linea alba by means of
     aponeurosis
  INTERNAL ABDOMINAL OBLIQUE
• Action
  – Lower anterior fibers: acting
    bilaterally, the lateral fibers flex the
    veterbral column, approximating the
    thorax and pelvis anteriorly, and
    depress the thorax. Acting unilaterally
    with the lateral fibers of the external
    oblique on the same side, these fibers
    of the internal oblique laterally flex the
    vertebral column, approximating the
    thorax and pelvis. These fibers also act
    with the external oblique on the
    opposite side to rotate the vertebral
    column.
  INTERNAL ABDOMINAL OBLIQUE
• Action
  – Upper anterior fibers: acting bilaterally, the
    upper anterior fibers flex the vertebral column,
    approximating the thorax and pelvis anteriorly,
    support and compress the abdominal viscera,
    depress the thorax, and assist in respiration.
    Acting unilaterally, in conjuction with the
    anterior fibers of the external oblique on te
    oppisite side, the ipper anterior fibers of the
    internal oblique rotate the vertebral column,
    bringing the thorax backward (when the pelvis
    is fixed), or the pelvis forward (when the thorax
    is fixed). For example, the right internal
    oblique rotates the thorax clockwise and the
    left internal oblique rotates the thorax
    couinterclockwise on a fixed pelvis.
  INTERNAL ABDOMINAL OBLIQUE
• Action
  – Lateral fibers: acting bilaterally, the
    lateral fibers flex the veterbral column,
    approximating the thorax and pelvis
    anteriorly, and depress the thorax.
    Acting unilaterally with the lateral
    fibers of the external oblique on the
    same side, these fibers of the internal
    oblique laterally flex the vertebral
    column, approximating the thorax and
    pelvis. These fibers also act with the
    external oblique on the opposite side
    to rotate the vertebral column.
    INTERNAL ABDOMINAL OBLIQUE
• Nerve
    – Lower anterior fibers: T7-11, T12,
      iliohypogastric and ilioinguinal, ventral rami
    – Upper anterior fibers: T7-11, T12,
      iliohypogastric and ilioinguinal, ventral
    – Lateral fibers: T7-11, T12, iliohypogastric and
      ilioinguinal, ventral rami
• Direction of fibers:
    – Lower anterior fibers: fibers extend obliquely
      upward and medialward, more upward than the
      anterior fibers
    – Upper anterior fibers: fibers extend obliquely
      medialward and upward
    – Lateral fibers: fibers extend obliquely upward
      and medialward, more upward than the
      anterior fibers
•
        TRANSVERSUS ABDOMINIS
• Origin
   – inner surfaces of cartilages of lower six ribs,
     interdigitating with the diaphragm; thoracolumbar
     fascia; anterior three fourths of internal lip of iliac
     crest; and lateral one third of inguinal ligament
• Action
   – Acts likes a girdle to flatten the abdominal wall and
     compress the abdominal viscera; upper portion
     helps to decrease the infrasternal angle of the ribs
     as in expiration. This muscle has no action in
     lateral trunk flexion except that it acts to compress
     the viscera and stabilize the linea alba, thereby
     permiting better action by anteriolateral trunk
     muscles
• Insertion
   – linea alba by means of a board aponeurosis, pubic
     crest and pectin publis
• Nerve
   – T7-T12, iliohypogastric, ilioinguinal, ventral
     divisions Direction of fibers: transverse (horizontal)
                 RECTUS ABDOMINIS

• Origin
   – pubic crest and symphysis
• Action
   – flexes the vertebral column by approximating the
     thorax and pelvis anteriorly. With the pelvis fixed,
     the thorax will move toward the pelvis; with the
     thorax fixed, the pelvis will move toward the
     thorax.
• Insertion
   – costal cartilages of fifth, sixth, and seventh ribs,
     and xiphiod process of sternum
• Nerve
   – T5-T12, ventral rami
            Inguinal triangle

• bounded by
  – lateral border of rectus abdominis muscle
    medially
  – inguinal ligament inferiorly
  – inferior epigastric artery laterally

								
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