The AbdomenThe Abdomen

Department of Human Anatom School of Medicine of Zhejiang University

Xiaoming Zhang

IntroductionIntroduction

Formation: Abdominal wall, Abdominal cavity and contentsBoundaries

Superior boundary Inferior boundary

Abdominal wall Anterior Abdominal Wall posterior abdominal wall

Abdominal cavity Division

4 abdominal quadrants4 abdominal quadrants

right epigastric region

left epigastric region

right hypogastric region

left hypogastric region

9 abdominal regions9 abdominal regions

hypogastric region

Abdominal WallAbdominal Wall

Anterior Abdominal Wall

Ⅲ.The abdominal wall

The layers of the anterior abdominal wall:

skin superficial fascia muscles transverse fascia extraperitoneal fascia

parietal peritoneum

II Anterior Abdominal Wall Anterior Abdominal Wall

Layers and structures

Superficial structures1.skin

2.superficial fascia superficial layer — Camper‘s fascia deep layer — Scarpa‘s fascia, Colles’ fascia

3.superficial vessels and cutaneous nerves

Superficial structuresSuperficial structures

superficial arteries ： three groups

• The branches of posterior intercostal A., sub

costal A., and lumbar A. ；• Superior and inferior epigastric A. ；• Superficial epigastric A. and superfical iliac

circumflex.

Superficial structuresSuperficial structuresthe superficial veins:

—umbilical venous network above the umbilicus below the umbilicus

Superficial lymphatic vessels:

upper→axillary lymph nodes lower→superficial inguinal lymph nodes anastomise with the lymphatics of the liver

the cutaneous nerves

II Anterior Abdominal Anterior Abdominal WallWallDeep Structures

Deep fasciaMuscular layersrectus abdominis the sheath of rectus abdominis

anterior layer of the sheath is formed

by the aponeurosis of the obliquus exter-

nus and the ant. layer of the aponeurosis

of the obliquus internus.

The linea alba is extending between the xiphoid process and the pubic symphysis,

formed by the decussating of the aponeu-

roses of the three flat muscles.

The posterior layer of the

sheath is formed by the

aponeurosis of the trans-

versus and the post. Layer

of the aponeurosis of the

obliquus internus.

The posterior layer of the

sheath is lack of at the

arcuate line(about 4cm

below the omphalo)

II Anterior Abdominal Wall Anterior Abdominal Wall

Deep Structures Muscular layers obliquus externus abdominis linea alba) superficial inguinal ring reflected ligament external spermatic fascia Inguinal ligament lacunar ligament pectineal ligament(Cooper ）

(3) The internus abdominis

—arises from the lateral 2/3 of the inguinal lig.,the iliac crest and the

thoracolumbar fascia.The

muscular fibers is replace

by the aponeurosis(ant. And

post. layers) at the lateral

margin of the rectus.

—cremaster

—inguinal falx

(4) The transverse abdominis

—arises from the lateral 1/3 of the inguinal lig.,the iliac crest and the

thoracolumbar fascia and

internal aspect of lower 6

costal cartilage.

—cremaster

—inguinal falx

——inguinal canalinguinal canal1. position —parallel to,and above the inguinal lig. I1. position —parallel to,and above the inguinal lig. Immediately.mmediately. About 4cm long. About 4cm long.2. Structures — two orifices (1) the deep inguinal ring lies a transverse finger breadth(2cm)above the midpoint of inguinal lig. formed by the transverse fascia. (2)(2)sup. Inguinal ringsup. Inguinal ring formed by the aponeurosis of the obliquus exter formed by the aponeurosis of the obliquus externus.nus. triangular defect in shape. triangular defect in shape. medial and lateral crus medial and lateral crus

—four walls

(1) ant. wall is mainly formed by aponeurosis of the obliquus ext.,and laterally is reinforced by the beginning part of the obliquus internus. (2) inf. wall is formed by the inguinal ligament (3) Post.wall is formed by the transverse fascia, inguinal falx and the reflected lig.. (4) Sup. wall is formed by the arched fibers of the obliquus internus and transverse abdominis

The contents male spermetic cord, ilioinguinal nerve

female round ligament and ilioinguinal nerve

The inguinal triangle —boundaries inf. boundary medial half of the inguinal ligament medial boundary lateral border of the rectus abdominis lateral boundary inf. epigastric a..**direct inguinal hernia

I Anterior Abdominal WallI Anterior Abdominal WallDeep Structures

extraperitoneal fascia parietal peritoneum Five longitudinal folds Median umbilical fold

Medial umbilical fold

Lateral umbilical fold

inguinal medial fossa and inguinal lateral fossa

Summary of anterior abdominal Summary of anterior abdominal wallwall

Superficial structures skin superficial fascia :Camper and Scarpa superficial vessels and cutaneous nerves

Deep Structures Deep fascia Muscular layers The vessels and nerves transversalis fascia extraperitoneal fascia parietal peritoneum

II Inguinal regionII Inguinal region

Boundaries Superior boundary—from anterior iliac spine to lat

eral margin of rectus Medial boundary—lateral margin of rectus Inferior boundary—inguinal ligament inguinal trangle(Hesselbach trangle ） laterally —inferior epigastric A. medially —the lateral border of the rectus abdomini

s inferiorly —medial half of the inguinal ligament

III III The incisions of anterolateral wall of abdomen

Rectus incision

Median incision

Inferior median incision

McBurney’s incision