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Introduction to abdomen Cylindrical chamber extending from A diaphragm to the base of the pelvis, comprising of abdomen proper & the lesser pelvis -+------- Lower limb • Abdomen proper & lesser pelvis communicate with each other at the plane of inlet into lesser pelvis (upper border of pubic symphysis,pubic crests, arcuate line of innominate bones,sacral promontary) pelvis Pelvic inlet Inguinal ligament • Contents of Abdomen proper:- Most of the digestive tube, Liver, pancreas, spleen, kidneys, ureters (in part), supra renal gland & various blood &lymph vessels lymph nodes &nerves • Contents of lesser pelvis:- Terminal parts of ureters, urinary bladders, the sigmoid colon, rectum some coils of ileum, internal genitalia, blood & lymph vesels, lymph nodes & nerves Functions • Houses & protects major viscera Rib cage Assists in breathing of Relaxation of diaphragm diaphragm Relaxation of abdominal muscles Contraction of abdominal muscles Expiration Inspiration Changes in the intra abdominal pressure Laryngeai cav'ity c·1os 1erd Cr0ntrac ion of abdominal wal I ncrease in intra- abdominal pressure _..l,....._ Mictu ·ition Child birth Defecation Component parts ony Frame,vork of Abdomen • Wall- Skeletal elements Muscles • Muscles:- Superficial fascia • Anteriorly a Fatty layer Membranous layer (Camper's) (Scarpa's) segmented Transversalis fascia muscle Rectus [=E<trapedtoceru..; abdominis Parietal peritoneum Visceral peritoneum • Anterolateraly External oblique, internal oblique & trasversus abdominis ~.34 Transverse section showing the layers of the abdominal wa ll. Po~ t ei·i 01· .--\. lJcl 0111in a] \,-a]] • Posteriorly- Quadratus lumborum, psoas major & iliacus Abdominal regions Subcostal plane Midclavicular planes ,7 I I Left lowe ( I. _ quadr;mt Transumbilical plane Median plane Transtubercular plane Regions on anterior abdominal wall vertic~I plane Left ve rtical p,lane ' Hypochondriac Hypochondriac L / ' / ' ,/ '' / ' ✓ ' Subcostal plane ,-.;;'-~_,,:;.....,,,___ --i--------------~+-----'_ ......;;_..,,___. Lateral Umbilical Lateral, 0 Transtubercu lar -----,1 1c-~--------+-------------;--- plane , I \ I \ \ I I / / \ \ Jnguinaf Pubic nguinal f 1 "\' ~ ,. I ' "\ I "\ , ,. ' ' , ,. / ' / / ' ' ,,, ' ' I I • Transpyloric plane- planes midway between Subcostal plane Midclavicular suprasternal notch & symphysis pubis, cuts the tip of ninth costal cartilage, vertebral level L1 lower border • Trans tubercular plane- Passes from 5TH Lumber vertebra near its upper border Transtubercular plane pattern. Fig.4.23 Nine- region organizational Transpyloric plane Pyloric orifice between stomach and duodenum margin Jugular notch ·I • ,. LI (transpyloric Right - --+----'­ ,kidney plane Position of umbilicus Pubic symphysis Some other lines and planes Subcostal plane Midclavicular planes • Subcostal plane- Lower margin of rib cage, passes thru upper border of L3 • Supracristal plane- joins the highest point of iliac crest, passes thru body of L5th Transtubercular plane pattern. Fig.4.23 Nine-region organizational Vertical planes • Midline Subcostal plane Midclavicular planes • Midclavicular line: passes thru the midpoint of the clavicle, crosses the costal margin just lateral to the tip of ninth costal cartilage & passes thru a point midway between the anterior superior iliac spine & the pubic symphysis Transtubercular plane pattern. Fig. 4.23 Nine-region organizational Abdominal cavity • Cavity is lined by Peritoneum- Parietal peritoneum Visceral peritoneum Abdominal viscera can be Intraperitoneal structures Retroperitoneal structures Anterior abdominal wall • Includes both the fasci? Fatty layer Membranous layer front and side of the (Camper's) (Scarpa's) wall Transversal is fascia Extraperitoneal fascia • Made up of the skin, Parietal peritoneum superficial fascia, Visceral peritoneum muscles , fascia transversalis, extra peritoneal connective tissue & parietal layer of peritoneum U4 Transverse section showing the layers of the abdominal wall. • Skin- highly strechable, show following feature • A midline verticle furrow • Umbilicus • Linea semilunaris • Three transverse furrows Umbilicus • Normal scar • Normally lies at the junction between the third & fourth vertebra • Supplied by T10 segment • Marks the water shed line of the body • Important site of portocaval anastomosis • Meeting point of four folds in embryo • Meeting point of three systems Superficial fascia • A layer of fatty connective tissue • Single layer up to umbilicus • Below umbilicus splits in to superficial fatty layer deep membranous layer • Superficial layer • Contains fat & varies in thickness • Continues over inguinal ligament with the superficial fascia fascia of thigh Aponeuros is of external oblique • In men continues over penis, Fatty layer looses fat & fuses with deeper (Camper's fascia) layer & forms dartos fascia of Membranous layer scrotam (Scarpa's fascia)-- • In women, it retains fat & Inguinal ligament becomes content of labia Skin majora ~ -Fascia lata of thigh Pubic symphysis Scrotum Dartos fascia uperficial fascia. • Deep membranous layer • Contains fat • continues into thigh • In men in midline forms fundiform ligament of penis • continues inferiorly with superficial fascia of perineum. The line of attachment pass over holden’s line, pubic tubercle, body of pubis, margins of pubic arch & posterior border of perineal membrane ______...______ Membranous layer of superficial fascia External oblique muscle (Scarpa's fascia) and aponeurosis ontinuity with superficial ~ - - ---,-+-- Attachment to fascia lata penile fascia Attachment to ___ ___,___ ____ _ ;-;------ ----__,_.......-__ Superficial perinea! ischiopubic rami fascia (Colles 1 fascia) Continuity with dartos fascia .4.26 Continuity of membranous layer of superficial fascia into other areas. Cutaneous nerves • Lower six thoracic & first lumbar nerves Anterior cutaneous branches T7 to T1 2 Lateral cutaneous branches T7 to T12 External oblique muscle and aponeurosis Innervation of the anterolateral abdominal wall. Cutaneous vessels of ~-\.nterior ~-\.bdon1ina] ,,·a11 • Anterior cutaneous art are branches of Superior & inferior epigastric artery • Lateral cutaneous art are branches of posterior intercostal artery • Below umbilicus supply is from three suprficial branches of femoral artery Superficial epigastric Superficial external pudendal Superficial circumflex iliac Cutaneous veins of Anterior all eios Abdominal \\l"' • Accompany arteries • Below the umbilicus they drain in to great saphenous vein, eventually into inferior vena cava • Above umbilicus they pass to axilla & in to superior vena cava • Both group anastomose thru small veins, which open up in case of obstruction in liver, giving a appearance called caput medusae • Lymphatics also respect water shed line Anterolateral muscles • 5muscles • Three flat muscles whose fiber icial fascia begin posterolaterally, are Fatty layer Membranous layer replaced anteriorly by an (Camper's) (Scarpa's) aponeurosis as they continue Transversalis fascia towards midline. These are Apo neuroses '---- Extraperitoneal fascia external oblique, internal Parietal periton eum oblique & transversus External oblique muscle 1-------Visceral peritoneum abdominis muscle • Two vertical muscles, enclosed within tendinous sheath, rectus abdominis & Pyramidalis U4 Transverse section showing the layers of the abdominal wal l. External oblique muscle----- - ..-.-- - - ---+--+-- ---Arcuate line ---,,..;...:;..- --~ --\------Transversalis fascia :m--- 'll"---'-~ "'--""',-:A,,-- - -------11-------Linea alba Pyramidalis muscle --- - -1---- ..J:,.J,.,~ ~~~ 1,.- O Fig. 4.32 Rectus abdominis and pyramidal is muscles. External oblique (EO) Origin from: 5th to 12th ribs OBLIQUUS EXTERNUS ABDOMINIS (external surface & lower border) (External Oblique) l Insertion: - Through an aponeurosis into: __ xiphoid a process . Linea . : -- alba Pubic -symphysis -crest -tubercle (See below) Inguinal lig. is lower border of aponeurosis Posterior fibres are inserted Trunk-lateral view directly into iliac crest Fig. 39.7. La teral view of the trunk to show the attachments of the external oblique muscle of the abdomen. • Nerve supply – lower 6 thoracic nerves • Has three free Anterior cutaneous branches T? to T1 2 La teral cutaneous borders. Inferior branches T? to T12 free border forms inguinal ligament • Has one opening External oblique muscle and aponeurosis superficial inguinal ring nnervation of the anterolateral abdominal wall. Inguinal ligament --- - - -, • Lower border of Anterior superior iliac spine external oblique Pectineal ligament aponeurosis which is Inguinal ligament rolled backwards on Pectineal line itself • Fascia lata is attached inferiorly to give it convexity • Gives origin to IO & TA from its superior Pubic tubercle surface Pubic symphysis Lacunar ligament Fig. 4.29 Ligaments of the inguinal region. • Upper grooved Anterior superior iliac spine --~--~ surface in medial half forms inguinal canal Pectineal ligame nt Inguinal ligament Pectineal line Pubic tubercle Pubic symphysis Lacunar li gament Fig. 4.29 Ligaments of the inguinal region. Extensions of inguinal ligament Anterior superior iliac spine --~--~ • Lacunar ligament Pectineal ligament • Pectineal ligament or Inguinal ligament ligament of cooper Pectineal line • Reflected part of inguinal ligament Pubic tubercle Pubic symphysis Lacunar ligament Fig. 4.29 Ligaments of the inguinal region. Internal oblique (IO) OBLIQUUS INTERNUS ABD (Internal Oblique) OMINIS )rigin from : Thoraco­ lumbar­ fascia Iliaccrest Trunk-lateral
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