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STUDY OF HUMAN ANATOMY
ANATOMY OF THE ABDOMENANATOMY OF THE ABDOMEN
DEFINITION OF ABDOMENDEFINITION OF ABDOMEN
• A region of the body bounded A region of the body bounded by the following regions:-by the following regions:-– Superiorly – thoraxSuperiorly – thorax
– Inferiorly – pelvis/perineumInferiorly – pelvis/perineum
– Posteroinferiorly – backPosteroinferiorly – back
– Inferolaterally – lower limbsInferolaterally – lower limbs
BONY LANDMARKS OF THE ABDOMENBONY LANDMARKS OF THE ABDOMEN
• Xiphoid processXiphoid process
• Costal margin – 7Costal margin – 7thth – 11 – 11thth costal costal cartilagescartilages
• Pelvic bonesPelvic bones
• L1 – L5 Lumbar vertebraeL1 – L5 Lumbar vertebrae
ABDOMINAL CAVITYABDOMINAL CAVITY
• extends btw thoracic extends btw thoracic diaphragm & pelvic diaphragm & pelvic diaphragm – diaphragm – abdominopelvic cavityabdominopelvic cavity
• upper part is under cover of upper part is under cover of the osteocartilagenous the osteocartilagenous thoracic cagethoracic cage
• occupied by organs of the occupied by organs of the digestive, urogenital, digestive, urogenital, endocrine & vascular endocrine & vascular structures.structures.
CONTENTS OF THE ABDOMINAL CAVITYCONTENTS OF THE ABDOMINAL CAVITY
CONTENTS OF THE ABDOMINAL CAVITYCONTENTS OF THE ABDOMINAL CAVITY
ABDOMINAL WALLABDOMINAL WALL
PLANES OF THE ABDOMENPLANES OF THE ABDOMEN
• 4 planes divide the abdominal cavity into 9 regions4 planes divide the abdominal cavity into 9 regions– 2 vertical (midclavicular), midclavicular to midinguinal2 vertical (midclavicular), midclavicular to midinguinal– 2 transverse – ( subcostal & transtubercular) 2 transverse – ( subcostal & transtubercular)
• Subcostal – pass through 10Subcostal – pass through 10thth costal cartilage costal cartilage• Transtubercular – pass through iliac tubercleTranstubercular – pass through iliac tubercle
REGIONS OF THE ABDOMENREGIONS OF THE ABDOMEN
REGIONS OF THE ABDOMENREGIONS OF THE ABDOMEN
QUADRANTS OF THE ABDOMENQUADRANTS OF THE ABDOMEN
• 2 planes delineate the abdominal cavity into 4 quadrants2 planes delineate the abdominal cavity into 4 quadrants• 1 vertical – median1 vertical – median• 1 transverse – transumbilical 1 transverse – transumbilical
POSITIONS OF THE ABDOMINAL ORGANSPOSITIONS OF THE ABDOMINAL ORGANS
ANTEROLATERAL ABDOMINAL WALLANTEROLATERAL ABDOMINAL WALL
• Anterior & lateral walls Anterior & lateral walls extending from the thorax to extending from the thorax to pelvispelvis
• Consists of the Consists of the – (1) Skin(1) Skin– (2) Fascia - (2) Fascia -
Subcutaneous & deepSubcutaneous & deep– (3) Muscles(3) Muscles– (4) Transversalis fascia(4) Transversalis fascia– (5) Extraperitoenal fat (5) Extraperitoenal fat – (6) Peritoneum(6) Peritoneum
ANTEROLATERAL ABDOMINAL WALLANTEROLATERAL ABDOMINAL WALL
• Anterior & lateral walls Anterior & lateral walls extending from the thorax to extending from the thorax to pelvispelvis
• Consists of the Consists of the – (1) Skin(1) Skin– (2) Fascia - (2) Fascia -
Subcutaneous & deepSubcutaneous & deep– (3) Muscles(3) Muscles– (4) Transversalis fascia(4) Transversalis fascia– (5) Extraperitoenal fat (5) Extraperitoenal fat – (6) Peritoneum(6) Peritoneum
SKINSKIN
• Loosely attaches to the Loosely attaches to the superficial fascia, except at the superficial fascia, except at the umbilicus.umbilicus.
• Varies in texture - wrinkle, Varies in texture - wrinkle, rough, smooth, scars.rough, smooth, scars.
• Thin in front and thick at the Thin in front and thick at the backback
• Distribution of hair varies with Distribution of hair varies with sex, age and race.sex, age and race.
• Natural tension lines run Natural tension lines run horizontally around the body horizontally around the body wall.wall.
FASCIAFASCIA• (L. (L. panniculi – panniculi – apron)apron)
• Composed of fatty tissues and Composed of fatty tissues and fibrous connective tissuefibrous connective tissue
• Divided into two layersDivided into two layers– (1) Superficial(1) Superficial– (2) Deep – covers (2) Deep – covers
abdominal musclesabdominal muscles
• (1) Same as elsewhere and (1) Same as elsewhere and varies in amount of fat.varies in amount of fat.
• (1) Major site of fat storage.(1) Major site of fat storage.
• (1) Excessive fat deposition in (1) Excessive fat deposition in the lower anterior abdominal the lower anterior abdominal wall – wall – morbid obesitymorbid obesity
SUPERFICILA FASCIA/TISSUESUPERFICILA FASCIA/TISSUE
• Superior to umbilicusSuperior to umbilicus
– Consistent with other regionsConsistent with other regions
• Inferior to umbilicusInferior to umbilicus
– Reinforced by collagen and Reinforced by collagen and elastic fiberselastic fibers
– Thus 2 layers –Thus 2 layers –
• (1) Superficial fatty layer (1) Superficial fatty layer (Camper’s fascia)(Camper’s fascia)
• Same elsewhereSame elsewhere
• (2) Deep membranous layer (2) Deep membranous layer (Scarpa’s fascia)(Scarpa’s fascia)
• Membranous continues to the Membranous continues to the perineum – Colles’s fascia, not to perineum – Colles’s fascia, not to the thigh.the thigh.
SUPERFICIAL FASCIASUPERFICIAL FASCIA
SUPERFICIAL FASCIASUPERFICIAL FASCIA
MUSCLES OF THE ANTEROLATERAL ABDOMINAL WALLMUSCLES OF THE ANTEROLATERAL ABDOMINAL WALL
• 5 pairs of muscles bilaterally – 3 5 pairs of muscles bilaterally – 3 flat, 2 verticalflat, 2 vertical
• (1) External oblique(1) External oblique• (2) Internal oblique(2) Internal oblique• (3) Transversus abdominis(3) Transversus abdominis• (4) Rectus abdominis(4) Rectus abdominis• (5) Pyramidalis(5) Pyramidalis
EXTERNAL OBLIQUE MUSCLEEXTERNAL OBLIQUE MUSCLE
• O: O: external surfaces of 5external surfaces of 5thth – 12 – 12thth ribs ribs
• I: I: linea alba, pubic tubercle, ant ½ of iliac crestlinea alba, pubic tubercle, ant ½ of iliac crest
• N: N: thoracoabdominal nerves (T7-T11 spinal nerves), subcostal nerve.thoracoabdominal nerves (T7-T11 spinal nerves), subcostal nerve.
• A: A: compresses the abdomen to provide support for abdominal organs.compresses the abdomen to provide support for abdominal organs.
INTERNAL OBLIQUE MUSCLEINTERNAL OBLIQUE MUSCLE
• O: O: thoracolumbar fascia, ant 2/3 of iliac crest, lat 1/3 of inguinal ligament.thoracolumbar fascia, ant 2/3 of iliac crest, lat 1/3 of inguinal ligament.
• I: I: inferior borders of 10inferior borders of 10thth – 12 – 12thth ribs, linea alba, pecten pubis, conjoint tendon. ribs, linea alba, pecten pubis, conjoint tendon.
• N: N: thoracoabdominal nerves (T6-T12 spinal nerves), L1 nervethoracoabdominal nerves (T6-T12 spinal nerves), L1 nerve
• A: A: compresses and supports abdominal visceracompresses and supports abdominal viscera
TRANSVERSUS ABDOMINIS MUSCLETRANSVERSUS ABDOMINIS MUSCLE
• O: O: thoracolumbar fascia, internal surfaces of 7thoracolumbar fascia, internal surfaces of 7thth-12-12thth costal cartilages, iliac crest, costal cartilages, iliac crest, lat 1/3 of inguinal ligament.lat 1/3 of inguinal ligament.
• I: I: linea alba, pubic crest, pecten pubis, conjoint tendon.linea alba, pubic crest, pecten pubis, conjoint tendon.
• N: N: thoracoabdominal nerves (T6-T12 anterior rami of spinal nerves), L1 nervethoracoabdominal nerves (T6-T12 anterior rami of spinal nerves), L1 nerve
• A: A: compresses and supports abdominal visceracompresses and supports abdominal viscera
RECTUS ABDOMINIS MUSCLERECTUS ABDOMINIS MUSCLE
• O: O: pubic symphysis & pubic crestpubic symphysis & pubic crest
• I: I: xiphoid process & 5xiphoid process & 5thth-7-7thth costal cartilages costal cartilages
• N: N: thoracoabdominal nerves (T6-T12 spinal nerves)thoracoabdominal nerves (T6-T12 spinal nerves)
• A: A: flexes trunk, compresses and supports abdominal organs, prevents pelvic flexes trunk, compresses and supports abdominal organs, prevents pelvic tiltingtilting
ABDOMINAL MUSCLESABDOMINAL MUSCLES
ABDOMINAL MUSCLESABDOMINAL MUSCLES
DEEP FASCIADEEP FASCIA
• Dense connective tissue layer , devoid of fat, that covers the muscles Dense connective tissue layer , devoid of fat, that covers the muscles and their aponeurosis.and their aponeurosis.
• 3 layers – superficial, intermediate & deep.3 layers – superficial, intermediate & deep.
DEEP FASCIADEEP FASCIA
PYRAMIDALIS MUSCLEPYRAMIDALIS MUSCLE
• Small, insignificant muscle.Small, insignificant muscle.
• Absent in 20% of peopleAbsent in 20% of people
• O: O: pubic crest, pubic symphysispubic crest, pubic symphysis• I: I: linea albalinea alba• N: N: subcostal nerve (T12)subcostal nerve (T12)• A: A: tenses the abdomentenses the abdomen
RECTUS SHEATHRECTUS SHEATH
• A strong incomplete fibrous A strong incomplete fibrous compartmentcompartment
• Formed by decussation and Formed by decussation and interweaving of the flat interweaving of the flat abdominal muscles.abdominal muscles.
• Internal oblique Internal oblique aponeurosis splits into two aponeurosis splits into two layers: layers: anterioranterior & & posterior posterior and invest the rectus and invest the rectus abdominis muscle.abdominis muscle.
RECTUS SHEATHRECTUS SHEATH
• Anterior wall – external oblique, Anterior wall – external oblique, anterior layer of internal obliqueanterior layer of internal oblique
• Posterior wall – transversus Posterior wall – transversus abdominis and posterior layer of abdominis and posterior layer of internal oblique.internal oblique.
• All aponeuroses fuse in the All aponeuroses fuse in the midline – midline – linea alba.linea alba.
• In the midline, it contains the In the midline, it contains the umbilical ring. A defect where umbilical ring. A defect where fetal umbilical vessels pass to fetal umbilical vessels pass to the placenta. the placenta.
• Splitting of internal oblique, Splitting of internal oblique, lateral to rectus abdominis – lateral to rectus abdominis – semilunar line.semilunar line.
RECTUS SHEATHRECTUS SHEATH
• Posterior wall ends slightly below the umbilicus – Posterior wall ends slightly below the umbilicus – arcuate line of arcuate line of Douglas.Douglas.
• The rectus abdominis is covered by the transversalis fascia posteriorly.The rectus abdominis is covered by the transversalis fascia posteriorly.
CONTENTS OF THE RECTUS SHEATHCONTENTS OF THE RECTUS SHEATH
• Contents of the Rectus Contents of the Rectus Sheath.Sheath.– Rectus abdominis Rectus abdominis
musclemuscle– PyramidalisPyramidalis– Superior & inferior Superior & inferior
epigastric vesselsepigastric vessels– Intercostal nerves Intercostal nerves
(T7-T11)(T7-T11)
RECTUS SHEATHRECTUS SHEATH
ENDOABDOMINAL FASCIAENDOABDOMINAL FASCIA
• A membranous and areolar sheets.A membranous and areolar sheets.
• Named according to muscle or Named according to muscle or aponeurosis it lines.aponeurosis it lines.
• Transversalis fascia as it lines the Transversalis fascia as it lines the transversus abdominis muscle.transversus abdominis muscle.
• A variable amount of fat separates the A variable amount of fat separates the fascia above from the peritoneum – fascia above from the peritoneum – extraperitoneal fat.extraperitoneal fat.
• Peritoneum – a single layer of Peritoneum – a single layer of epithelial cells and connective tissue.epithelial cells and connective tissue.
NERVES OF THE ANTEROLATERAL ABDOMINAL WALLNERVES OF THE ANTEROLATERAL ABDOMINAL WALL
• (1) thoracoabdominal (1) thoracoabdominal nerves (T7 – T11)nerves (T7 – T11)
• (2) Subcostal nerve (2) Subcostal nerve (anterior ramus of T12)(anterior ramus of T12)
• (3) Iliohypogastric(3) Iliohypogastric
• (4) Ilioinguinal(4) Ilioinguinal
VESSELS OF THE ANTEROLATERAL ABDOMINAL WALLVESSELS OF THE ANTEROLATERAL ABDOMINAL WALL
• (1) superior epigastric artery (1) superior epigastric artery
• (2) musculophrenic artery (2) musculophrenic artery
• (3) 10(3) 10thth & 11 & 11thth post intercostal post intercostal arteriesarteries
• (4) subcostal artery(4) subcostal artery
• (5) inferior epigastric(5) inferior epigastric
• (6) deep circumflex iliac(6) deep circumflex iliac
• (7) superficial circumflex iliac(7) superficial circumflex iliac
• (8) superficial epigastric (8) superficial epigastric
VEINS & LYMPHATICS OF THE ANTEROLATERAL ABDOMINAL WALLVEINS & LYMPHATICS OF THE ANTEROLATERAL ABDOMINAL WALL
• (1) Subcutaneous venous plexus(1) Subcutaneous venous plexus
• (2) Paraumbilical veins(2) Paraumbilical veins
• (3) Lateral thoracic vein(3) Lateral thoracic vein
• (4) Superficial epigastric veins(4) Superficial epigastric veins
• (5) superficial circumflex iliac(5) superficial circumflex iliac
• (6) superior & inferior epigastric(6) superior & inferior epigastric
• (7) deep circumflex iliac (7) deep circumflex iliac
• (8) posterior interocstal (11th) & (8) posterior interocstal (11th) & subcostal veinssubcostal veins
FUNCTIONS OF THE ABDOMINAL MUSCLESFUNCTIONS OF THE ABDOMINAL MUSCLES
• Form a strong expandible Form a strong expandible support for the wallsupport for the wall
• Support organs from injuriesSupport organs from injuries
• Compress to increase Compress to increase intraabdominal pressure to intraabdominal pressure to facilitate expulsionfacilitate expulsion
• Move trunk to maintain postureMove trunk to maintain posture
• Assists in breathingAssists in breathing
FINIS