Lecture Abdominal Wall

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					Lecture 5. Abdominal Wall




 Lecture5. Abdominal Wall
 G. C. Bennett
 NOTE
•      In order to save time on your part, all of the information in these notes is cross-referenced to
       Moore’s Testbook (5th ed.). Since these lecture notes contain all of the necessary information
       for examination purposes, it is not necessary to read the textbook, but the accompanying
       diagrams are often useful.
•      All of the diagrams shown in lectures are referenced in these notes. These diagrams come
       from three sources:
     1)    Plates in Netter’s atlas
     2)    Figures included in these notes
     3)    Figures in Moore’s textbook
•      Typical cross-references in the notes are as follows:

 (p244-245)                  =       pages 244-245 of Moore’s textbook (5th ed.)
 [320, 321]                  =       plates 320 and 321 in Netter’s atlas (4th ed.)
 (f16)                       =       figure 16 in these notes
 (2.51:292)                  =       figure 2.51 on page 292 of Moore’s textbook


 Note: Since some students may own a 3rd edition of Netter’s Atlas, I have made up a conversion
 table of corresponding plates in the 3rd and 4th editions.

•      Photographs of specimens shown in lectures are from:
     1)    Human Anatomy Color Atlas and Text, 4th edit., Gosling, Harris, Whitmore, and Willan,
           pub. by Mosby, 2002.
     2)    McMinn’s Color Altas of Human Anatomy, 5th edit., Abrahams, Marks and Hutchings,
           pub. by Mosby, 2003.
•      References are also made to abdomen specimens in our Anatomy Museum.
•      Self Study Programs:
     1)    the Atlas of Video Anatomy by Robert Acland especially to DVD 3 (Abdominal Walls)
           and DVD 6 (Abdominal Organs).
     2)    the videotape on the abdomen by Harvey. This videotape, originally made by Carl Harvey
           and myself at McGill in the 1970’s, was redone at Bayler University by Dr. Harvey and
           made available to us. While less sophisticated than the Acland tapes, it is made using our
           own laboratory specimens, and is therefore valuable in preparing for the laboratory
           examination.
     3)    In addition, a self-study computer program (Anatomedia) on the Abdomen is installed on
           our Anatomy Web Site, and is accessible through our on-campus computers.




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 1.Oblique Section of Abdomen




 Figure 2. Superficial Fascia of Anterior Abdominal Wall and Perineum




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 2b




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 3a Anterior Abdominal Wall




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 3b




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 3c




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 4




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 4b




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 4c




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 5 Parasagittal Section of Abdomen (arrow)




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 5b




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 6a Inguinal canal and Spermatic Cord




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 6b




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 7. Transverse Sections of Spermatic Cord and Testis




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Figure 7b




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 LAYERS OF ABDOMINAL WALL
 (p 196-198) [249,349] (F 1, 2, 3ab) (2.4:197)
    •     Thorax has bony walls
    •     Pelvis has bony walls
    •     Abdomen has bony posterior wall but muscular anterolateral wall (2.2:194)
    •     flexibility of abdominal wall
            o      adjustable living girdle (muscle instead of strong deep fascia)
            o      to accommodate: food, feces, fluid, flatus, fat, fetus
    •     support of abdominal viscera; local weakness may lead to hernia
    •     protection (especially rectus abdominis when contracted)

 Skin
     •        skin [249]

 Superficial fascia
          o      Camper’s fascia (fatty superficial layer of superficial fascia)
          o      Scarpa’s fascia (membranous deep layer of superficial fascia)
                   ▪     continuous inferiorly with fascia lata of thigh, and Colles’ fascia of perineum
                         [361, 378]
                   ▪     used for holding sutures during closure of abdominal skin incisions
                   ▪     urine may pass from rupture of membranous urethra up into space between
                         Scarpa’s fascia and underlying deep fascia of abdominal wall (p441-442)
                         (B3.25:442)

 Deep fascia
     •        deep fascia [249]
     •        muscles [249, 250]

 Anterolateral Wall Muscles
 (p 198-206)
    (a) External Oblique Muscle [249,252, 253, 254, 263, 349] (f 1, 3ab, 4) (Table 2.2:199,
         2.6:201)
     •    equivalent to external intercostal in thorax [189] ; not interrupted by bones
     •    from: external surface of 5th-12th ribs
     •    to: linea alba, pubic tubercle, pubic crest, pecten pubis (lacunar ligament), anterior 1/2 of
          iliac crest
     •    features:
        o      fleshy part
                  ▪    fibers run inferomedially




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall



          o   aponeurosis
          o   posterior free edge
          o   linea alba
          o   inguinal ligament ( "free" edge attached to fascia lata) (2.6:201, 2.11:215)(p214)
          o   curved inwards to form floor of inguinal canal (2.12:216)
          o   lacunar ligament (2.11:215)
          o   superficial inguinal ring
     •    nerve supply: T7-T12,L1 [257] (f1)
     •    actions:
        o     acting on both sides:
                 ▪     support and protection of abdominal viscera
                 ▪     abdominothoracic rhythm:
                     Ø      relaxes to make room for abdominal viscera when thoracic diaphragm
                            descends during inspiration
                     Ø      contracts during expiration
                 ▪     if diaphragm is contracted and glottis closed, contraction increases intra-
                       abdominal pressure; used in:
                     Ø      defecation
                     Ø      urination
                     Ø      vomiting
                     Ø      parturition
                     Ø      coughing (glottis temporarily remains closed; then suddenly opened to
                            allow expulsion of forceful jet of air)
                 ▪     if pelvis is fixed: flex trunk
                 ▪     if thorax is fixed: tilt anterior part of pelvis superiorly
        o     acting on one side:
                 ▪     if pelvis is fixed: laterally flex trunk and rotate it to opposite side
        (b) Internal Oblique Muscle [250, 252, 253,263, 349] (f, 1, 2, 3ab, 4) (Table 2.2:199,
              2.6:201)
     •    equivalent to inner intercostal in thorax [189,191]
     •    from: thoracolumbar fascia, anterior 2/3 iliac crest, lateral 1/2 inguinal ligament
     •    to: inferior borders of 10th-12th ribs, linea alba, pubic crest, pecten pubis
     •    features:
        o     fleshy part
                 ▪     fibers run superomedially (above level of umbilicus)
        o     (cremasteric muscle and fascia)
        o     aponeurosis
        o     conjoint tendon (with transversus abdominis muscle) (2.12:216)
     •    nerve supply: T7-T12, L1 [257] (f1)
     •    actions:
        o     acting on both sides: see external oblique
        o     acting on one side:
                 ▪     if pelvis is fixed: laterally flex trunk and rotate it same side
                 ▪     if thorax is fixed: rotate pelvis to opposite side
    (c) Transversus Abdominis Muscle [251, 252, 253, 263, 349] (f1, 3b, 4) (Table
         2.2 :199,2.8 :203)




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall



     •      equivalent to transversus thoracis in thorax [191]
     •      from: internal surfaces of 7th-12th costal cartilages, thoracolumbar fascia, iliac crest,
            lateral 1/3 inguinal ligament
     •      to: linea alba, pubic crest, pecten pubis
     •      features:
          o     fleshy part
                   ▪      fibers horizontal (above level of  umbilicus)
          o     aponeurosis
          o     conjoint tendon (with internal oblique muscle)
     •      nerve supply: T7-T12, L1 [257] (f1)
     •      actions:
          o     acting on both sides: see external oblique
          (d) Rectus Abdominis Muscle and Rectus Sheath

 (p 182-184)

 Rectus Abdominis Muscle [247, 250, 251, 252, 253, 255, 258, 348, 349] (f 1,
 3ab, 5) (2.6:201)
     •      equivalent to sternalis muscle in thorax [188]
     •      from: pubic symphysis, pubic crest
     •      to: xiphoid process, 5th-7th costal cartilage
     •      tendinous intersections from muscle to anterior wall of rectus sheath
     •      at xiphoid process, umbilicus, and 1/2 way in between
     •      nerve supply: T7-T12 [257] (f1)
     •      action:
          o     see external oblique
          o     depresses ribs
          o     stabilizes pelvis during walking
          o     protection of viscera

 Rectus Sheath [249, 250, 251, 252, 253, 255, 257, 258, 348, 349] (f 1,
 3ab,5)(2.8:203,2.10:213)
     •      anterior layer
          o     superior to arcuate line:
                  ▪      aponeurosis of external oblique
                  ▪      anterior layer of aponeurosis of internal oblique
          o     inferior to arcuate line:
                  ▪      aponeuroses of external and internal oblique and transversus abdominis
     •      posterior layer of rectus sheath
          o     superior to costal margin:
                  ▪      none (rectus muscle lies against sternum and costal cartilages)
          o     costal margin to arcuate line:
                  ▪      posterior layer of aponeurosis of internal oblique
                  ▪      aponeurosis of transversus abdominis
          o     inferior to arcuate line
                  ▪      none (rectus muscle lies against transversalis fascia)


Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




 Endoabdominal (Transversalis) Fascia
 (p 197, 331-332) [251, 252, 253, 260, 348, 349] (f 1, 3b, 5)(2.4:197)
    •     named according to region it lines:
        o     diaphragmatic fascia
        o     iliac fascia
        o     psoas fascia
        o     quadratus lumborum fascia
        o     pelvic fascia
    •     deep inguinal ring [260]
    •     internal spermatic fascia [260]

 Extraperitoneal Fatty Tissue (2.4:197)

 Parietal Peritoneum

 Nerves and Vessels of Anterolateral Abdominal Wall
 (p 206-210 [257, 258, 267] (f 1)(Table 2.3:207)
 T7-T11 (thoracoabdominal)
   •     these are at first “intercostal” nerves in thorax wall
       o     they travel in neurovascular plane between the internal intercostal and innermost
             intercostal muscles [258]
               ▪      motor to intercostal muscles
               ▪      sensory to skin and parietal pleura
       o     they then leave the costal margin to enter the abdominal wall
       o     they travel in the neurovascular plane between the internal oblique and transverses
             abdominis muscles; then enter the rectus sheath [258] (2.8.203)
               ▪      motor to anterolateral wall muscles and rectus abdominis muscle
               ▪      sensory to skin and parietal peritoneum
                    Ø      T10 supplies anterior wall at umbilicus [257]
                    Ø      T7-T9 supply wall above umbilicus
                    Ø      T11-L1 supply wall below umbilicus
 T12 (subcostal)
   •      travels in the neurovascular plane between the internal oblique and transverses abdominis
          muscles; then enters the rectus sheath
        o     motor to anterolateral wall muscles and rectus abdominis muscle
        o     sensory to skin and parietal peritoneum
 L1 – divides into two branches, iliohypogastric and ilioinguinal [257]
    •     they travel in the neurovascular plane between the internal oblique and transverses
          abdominis muscles, and then between the internal and external oblique muscles; do not
          enter the rectus sheath [257] (2.7:202,2.8:203)
        o     motor to anterolateral wall muscles but not rectus abdominis muscle




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall



     •      superior epigastric artery (from internal thoracic) [251, 255] (f 3b, 5)(2.8:203)
     •      inferior epigastric artery (from external iliac) [251, 253, 255] (f 3b, 5)(2.8:203,2.10:213)
     •      deep circumflex artery (from external iliac) [264]
     •      subcostal artery [264]
     •      lumbar arteries [264]
     •      superficial epigastric vein [256]
     •      Thoracoepigastric vein
     •      lateral thoracic vein [256]
          o     collateral pathways of venus flow (p212) (B2.2:212)
     •      superior epigastric vein (drains to internal thoracic) [256]
     •      inferior epigastric vein (drains to external iliac) [256]
     •      superficial lymph vessels from wall superior to umbilicus drain to axillary lymph nodes
            [184]
     •      superficial lymph vessels from wall inferior to umbilicus drain to superficial inguinal
            lymph nodes [546]




Lecture 5. Abdominal Wall
Lecture 5. Abdominal Wall




Lecture 5. Abdominal Wall

				
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