Name : Muhammad Ramdhani

NPM : 130110110118
Group : E5

Anatomy of Abdominal Wall

Although the abdominal
wall is continuous, it is
subdivided into the anterior
wall, right and left lateral
walls, and posterior wall
for descriptive purposes.
The
wall
is
musculoaponeurotic, except
for the posterior wall, which
includes the lumbar region
of the vertebral column. The
boundary
between
the
anterior and the lateral walls
is indefinite, therefore the
term
anterolateral
abdominal wall is often
used.
The
anterolateral
abdominal wall extends from the thoracic cage to the pelvis.
The anterolateral abdominal wall is bounded superiorly by
the cartilages of the 7th-10th ribs and the xiphoid process of the
sternum, and inferiorly by the inguinal ligament and the superior
margins of the anterolateral aspects of the pelvic girdle (iliac
crests, pubic crests, and pubic symphysis).
The anterolateral abdominal wall consists of skin and
subcutaneous tissue (superficial fascia) composed mainly of fat,
muscles and their aponeuroses and deep fascia,
extraperitoneal fat, and parietal peritoneum. The skin
attaches loosely to the subcutaneous tissue, except at the

umbilicus, where it adheres firmly. Most of the anterolateral wall

includes three musculotendinous layers; the fiber bundles of each
layer run in different directions.
Fascia of the Anterolateral Abdominal Wall
The subcutaneous tissue over most of the wall includes a
variable amount of fat. It is a major site of fat storage.
Superior to the umbilicus, the subcutaneous tissue is
consistent with that found in most regions. Inferior to the
umbilicus, the deepest part of the subcutaneous tissue is
reinforced by many elastic
and collagen fibers, so it
has
two
layers:
the
superficial
fatty
layer
(Camper fascia) and the
deep membranous layer
(Scarpa
fascia)
of
subcutaneous tissue. The
membranous
layer
continues inferiorly into the
perineal region as the
superficial perineal fascia
(Colles fascia).
Superficial, intermediate, and deep layers of
investing fascia cover the external aspects of the three muscle
layers of the anterolateral abdominal wall and their aponeuroses
(flat expanded tendons) and cannot be easily separated from
them. The investing fascias here are extremely thin, being
represented mostly by the epimysium (outer fibrous connective
tissue layer surrounding all muscles) superficial to or between
muscles. The internal aspect of the abdominal wall is lined with
membranous and areolar sheets of varying thickness called the
endoabdominal fascia. The glistening lining of the abdominal
cavity, the parietal peritoneum, is formed by a single layer of
epithelial cells and supporting connective tissue. The parietal

peritoneum is internal to the transversalis fascia and is separated

from it by a variable amount of extraperitoneal fat.
Muscles of Anterolateral Abdominal Wall
There are five (bilaterally paired) muscles in the
anterolateral abdominal wall: three flat muscles and two
vertical muscles. The three flat muscles are the external
oblique, internal oblique, and transversus abdominis. All
three flat muscles are continued anteriorly and medially as
strong, sheet-like aponeuroses. Between the midclavicular line
(MCL) and the midline, the aponeuroses form the tough,
aponeurotic, tendinous rectus sheath enclosing the rectus
abdominis muscle. The aponeuroses then interweave with their
fellows of the opposite side, forming a midline raphe (G. rhaphe,
suture, seam), the linea alba (L. white line), which extends from
the xiphoid process to the pubic symphysis. The
two
vertical
muscles of the anterolateral abdominal wall, contained within the
rectus sheath, are the large rectus abdominis and the small
pyramidalis.

FUNCTIONS
AND
ACTIONS
OF
ANTEROLATERAL
ABDOMINAL MUSCLES
The muscles of the anterolateral abdominal wall:
Form a strong expandable support for the anterolateral
abdominal wall.

Support the abdominal viscera and protect them from most

injuries.

Compress the abdominal contents to maintain or increase

the intra-abdominal pressure and, in so doing, oppose the
diaphragm (increased intra-abdominal pressure facilitates
expulsion).

Move the trunk and help to maintain posture.

The combined actions of the anterolateral muscles also

produce the force required for defecation (discharge of feces),
micturition (urination), vomiting, and parturition (childbirth).
Increased intra-abdominal (and intrathoracic) pressure is also
involved in heavy lifting, the resulting force sometimes producing
a hernia.
Neurovasculature of Anterolateral Abdominal Wall


DERMATOMES
OF
ANTEROLATERAL
ABDOMINAL WALL
The map of dermatomes
of
the
anterolateral
abdominal wall is almost
identical to the map of
peripheral
nerve
distribution.
This
is
because the anterior rami
of spinal nerves T7-T12,
which supply most of the
abdominal wall, do not
participate in plexus formation. Each dermatome begins
posteriorly overlying the intervertebral foramen by which the
spinal nerve exits the vertebral column and follows the slope of
the ribs around the trunk. Dermatome T10 includes the umbilicus,
whereas dermatome L1 includes the inguinal fold.

NERVES OF ANTEROLATERAL ABDOMINAL WALL

The skin and muscles of the anterolateral abdominal wall
are supplied mainly by the following nerves:
Thoracoabdominal nerves: these are the distal, abdominal
parts of the anterior rami of the inferior six thoracic
spinal nerves (T7-T11); they are the former inferior
intercostal nerves distal to the costal margin.

Lateral (thoracic) cutaneous branches: of the thoracic

spinal nerves T7-T9 or T10.

Subcostal nerve: the large anterior ramus of spinal nerve

T12.

Iliohypogastric and ilioinguinal nerves: terminal branches of

the anterior ramus of spinal nerve L1.

VESSELS OF ANTEROLATERAL ABDOMINAL WALL

The
primary
blood
vessels (arteries and veins) of
the anterolateral abdominal wall
are the
Superior epigastric vessels
and branches of the
musculophrenic
vessels
from the internal thoracic
vessels.

Inferior
epigastric
and
deep
circumflex
iliac
vessels from the external
iliac vessels.

Superficial circumflex iliac and superficial epigastric vessels

from the femoral artery and greater saphenous vein,
respectively.

Posterior intercostal vessels of the 11th intercostal space

and the anterior branches of subcostal vessels.

Lymphatic drainage of the anterolateral abdominal wall follows

the following patterns:
Superficial lymphatic vessels accompany the subcutaneous
veins; those superior to the transumbilical plane drain
mainly to the axillary lymph nodes; however, a few drain to
the parasternal lymph nodes. Superficial lymphatic vessels
inferior to the transumbilical plane drain to the superficial
inguinal lymph nodes.

Deep
lymphatic
vessels
accompany the deep veins of
the abdominal wall and drain to
the external iliac, common iliac,
and right and left lumbar (caval
and aortic) lymph nodes.

Abdominal Hernias
The anterolateral abdominal
wall may be the site of hernias. Most
hernias
occur
in
the
inguinal,
umbilical, and epigastric regions
Umbilical hernias are common in
newborns
because
the
anterior
abdominal wall is relatively weak in
the umbilical ring, especially in lowbirth-weight infants. Umbilical hernias
are usually small and result from
increased intra-abdominal pressure in
the presence of weakness and
incomplete closure of the anterior
abdominal wall after ligation of the umbilical cord at birth.
Herniation occurs through the umbilical ring. Acquired umbilical
hernias occur most commonly in women and obese people.
Extraperitoneal fat and/or peritoneum protrude into the hernial
sac. The lines along which the fibers of the abdominal
aponeuroses interlace are also potential sites of herniation (see
Fig. 2.6B). Occasionally, gaps exist where these fiber exchanges
occurfor example, in the midline or in the transition from
aponeurosis to rectus sheath. These gaps may be congenital, the
result of the stresses of obesity and aging, or the consequence of
surgical or traumatic wounds.

An epigastric hernia, a hernia in the epigastric region

through the linea alba, occurs in the midline between the xiphoid
process and the umbilicus. Spigelian hernias are those occurring
along the semilunar lines (see Table 2.1B). These types of hernia
tend to occur in people older than 40 years and are usually
associated with obesity. The hernial sac, composed of peritoneum,
is covered with only skin and fatty subcutaneous tissue.