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Superficial Fascia 3- Deep Fascia and Muscles (3+1) (Transverse Fascia) a Plane 4- Subperitoneal Fascia (Or Extraperitoneal Fascia) 5- Parietal Peritoneum BA Plane

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Superficial Fascia 3- Deep Fascia and Muscles (3+1) (Transverse Fascia) a Plane 4- Subperitoneal Fascia (Or Extraperitoneal Fascia) 5- Parietal Peritoneum BA Plane Chapter 5 The Abdomen Section 1 Introduction Section 2 The anterolateral abdominal wall Section 3 The peritoneum and peritoneal cavity Section 4 The organs which are related with peritoneal cavity Section 5 The retroperitoneal space Section 1 Introduction The abdomen is location between the thorax and perineum. It includes the abdomen wall, abdomen cavity and the organs of abdomenal cavity. Section 1 Introduction Ⅰ. Boundaries 1. Superior border It is formed by the xiphoid process, costal archs, anterior ends of 11th ribs, lowers of 12th ribs and the 12th thorax vertebra. 2. Inferior border It is formed by the upper border pubis symphysis, pubic crests, pubic tubercles, inguinal ligaments, iliac crests and the border of 5th lumber vertebra. Section 1 Introduction Ⅱ. The abdominal cavity 1. Formation It is a cavity surrounded by diaphragm, pelvic diaphragm, the posterior and anterior walls of cavity. 2. Division It is divided into following two parts by inlet of lesser pelvic cavity. (1) Proper abdominal cavity - abdominal cavity: The cavity is above the inlet of lesser pelvic cavity. (2) Pelvic cavity: The cavity is below the inlet of the lesser pelvic cavity. Section 1 Introduction Ⅲ. The division of the abdominal wall and abdomen 1. The division of the abdominal wall (1) Anterior abdominal wall (or anterolateral abdominal wall): It is anterior to the posterior axillary line. (2) Posterior abdominal wall: The wall is posterior to the posterior axillary line. 2. The division of abdomen Section 1 Introduction Ⅲ. The division of the abdominal wall and abdomen 2. The division of abdomen Two methods are used to divide the abdomen into different regions. (1) Four lines - nine divisions methods (2) Two lines - four divisions method Section 1 Introduction (1) Four lines - nine divisions methods: It uses four lines—two transverse and two vertical lines to divide the abdomen into 9 regions. Four lines ① Two transverse lines Superior transverse line (or subcostal line): It is drawn between the lower limits of costal arch. Inferior transverse line (or transtubercular line): The Superior abdominal part line is drawn between right and left tubercles on the iliac crests. middle abdominal part Two transverse lines divide the abdomen into three parts i.e. superior, middle and inferior. inferior abdominal part Section 1 Introduction (1) Four lines - 9 regions. Four lines ① Two transverse lines ② Two vertical lines: Right & Left vertical lines. Two vertical lines pass through the midpoint of inguinal ligaments. Two vertical lines together Superior abdominal part with transverse lines divide abdomen into Nine regions. middle abdominal part inferior abdominal part Section 1 Introduction Nine regions ① Superior abdominal part: Epigastric region, Right & Left hypochondriac regions. ② Middle abdominal part: Umbilical region, Right & Left lateral (or lumber) regions. Superior abdominal part ③ Inferior abdominal part: Hypogastric (or pubic, supropubic) region, Right & Left iliac (or inguinal) middle abdominal part regions . inferior abdominal part Section 1 Introduction Four quadrants (2) Two lines four divisions method: passes through the umbilicus. Vertical line Transverse line RUQ RLQ LUQ LLQ Landmark (Two lines) • The linea alba: it is a linear depression in the median plane extending from the xipoid process to the pubic symphsis. The umbilicus is interposed in the linea alba at the level between the 3rd and 4th lumbar. • The linea semilunaris: it indicated border of the rectus abdominais and its sheath. The point where this line meets the right 9th costal cartilarge indicates the position of the fundus of the gallbladder. Chapter 5 The Abdomen Section 1 Introduction Section 2 The anterolateral abdominal wall Section 3 The peritoneum and peritoneal cavity Section 4 The organs which are related with peritoneal cavity Section 5 The retroperitoneal space Section 2 The anterolateral abdominal wall Position: anterior to the posterior maxillary line. Arrangement (from superficial to deep layer): 1- The skin 2- superficial fascia 3- Deep fascia and muscles (3+1) (transverse fascia) A plane 4- subperitoneal fascia (or extraperitoneal fascia) 5- parietal peritoneum BA plane B Section 2 The anterolateral abdominal wall Position: anterior to the posterior maxillary line. Arrangement (from superficial to deep layer): 1- The skin 2- superficial fascia 3- Deep fascia and muscles (3+1) (transverse fascia) 4- subperitoneal fascia (or extraperitoneal fascia) 5- parietal peritoneum 2- Superficial fasica 1- Skin Camper’s fascia Scarpa’s fascia bbbbb bbbbb3- Deep fascia bbbband muscle layer (3) external obliques muscle internal obliques muscle transverse muscle abdominis 4- subperitoneal fascia Transversalis fascia (or extraperitoneal fascia) 5- parietal peritoneum. Section 2 The anterolateral abdominal wall Superficial fascia ① Formation: It is formed by adipose tissue and loose connective tissue. ② The superficial fascia below the umbilicus can be divided into two layers superficial and deep. Superficial layer: is a fatty layer, also called Camper’s fascia. Deep layer: is a membranous layer, also called Scarpa’s fascia. 1. Skin: thinner and more elastic 薄而富有弹性 2.The superficial fascia below the umbilicus can be divided into two layers superficial and deep. ① Superficial layer: is a fatty layer, also called Camper’s fascia. The superficial fascia below the umbilicus can be divided into two layers superficial and deep. ① Superficial layer: is a fatty layer, also called Camper’s fascia. ① Superficial fascia is a fatty layer, also called Camper’s fascia. ②Deep layer is Scarpa’s fascia，is a membranous layer. It lies immediatedly superficial to the aponeurosis of the external oblique muscle. It is more membranous and continues with superficial fascia of penis, dartos of scrotum and superficial fascia of perineum (or Colle’s fascia) inferiorly. Deep layer is Scarpa’s fascia，is a membranous layer. It lies immediatedly superficial to the aponeurosis of the external oblique muscle. It is more membranous and continues with superficial fascia of penis, dartos of scrotum and superficial fascia of perineum (or Colle’s fascia) inferiorly. Deep layer is Scarpa’s fascia，is a membranous layer. It lies immediatedly superficial to the aponeurosis of the external oblique muscle. It is more membranous and continues with superficial fascia of penis, dartos of scrotum and superficial fascia of perineum (or Colle’s fascia) inferiorly. The contents of superficial fascia The superficial fascia contains superficial blood vessels, lymphatic vessels and cutaneous nerves. ⑴Superficial arteries The branches of posterior intercostals arteries, subcostal arteries and lumber arteries: They distribute to the lateral abdomen wall. The branches of superior and inferior epigastric arteries: They distribute the part of anterior abdominal wall which is near to the median line. The superficial epigastric artery and circumflex artery: They distribute to the lower part of the anterior abdominal wall. ⑵Superficial veins The veins above the level of umbilicus to the thoracoepigastric veins which drain to the axillary vein. The veins below the level of umbilicus to the superficial epigastric veins which drain to the great saphenous vein. The venous plexus around the umbilicus drain to the paraumbilical veins which drain to the hepatic portal vein. The contents of superficial fascia ⑶Superficial lymphatic vessels The lymph above the level of umbilicus drain to the axillary lymph nodes. The lymph below the level of umbilicus drain to the superficial inguinal lymph nodes. ⑷The cutaneous nerves The skin of anterior abdominal wall is supplied by the anterior and lateral branches of 7th to 11th intercostals nerves and subcostal nerves and iliohypogastric nerve (first lumbar nerve). They are aranged in following serial order. 7th intercostal nerve (T7) →distributes to the skin near the xiphoid process. 10th intercostal nerve (T10) →distributes to the skin at the level of the umbilicus. Iliohypogastric nerve (L1) →distributes to the skin above the inguinal ligament (or an inch above the superficial inguinal ring and other at propotionate distance between them). Clinical correlates Deep layer is a membranous layer, also called Scarpa’s fascia. It ends by being attached to the fascia lata (i.e., deep fascia of the thigh) along a line 2 cm below the inguinal ligament. Medially, it ends by being attached to the linea alba. Between pubic symphysis and pubic tubercle, it is continues with superficial fascia of penis, dartos of scrotum and superficial fascia of perineum (or Colle’s fascia). There is a potential space between Scarpa’s fascia and the aponeurosis of the external oblique. • If the penile urethra is injured (perineal injuries in car accidents; falling astride onto sharp objucts such as fence poles, etc.), urine may escape from the urethra into the scrotum. From there it may readily spread superiorly into the lower abdominal wall between Scarpa’s fascia and the aponeurosis of the external oblique. This is called urinary extravasation. • The urinary extravasation may be dramatic with extensive, red edematous swelling of the scrotum, penis, and lower abdominal wall. Of course, urinary extravasation into the thigh and the opposite side do not occur. Section 2 The anterolateral abdominal wall Deep fascia and muscles (3+1) (transverse fascia) The three flat muscles are the: – external oblique muscle – internal oblique muscle – transversus abdominis And one is the – rectus abdominis Specimen of abdominal muscle
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