The Abdominal Wall

Lectured by Bien Eli Nillos, MD

PRE-TEST: Identify
Where is the
Abdomen?
The region of the trunk that lies
between the diaphragm above and
the inlet of the pelvis below
Xiphoid Process
• Thin cartilaginous lower part of the
sternum
• Easily palpated in the depression
where the costal margins meet in the
upper part of the anterior abdominal
wall
• Xiphisternal junction – lies opposite
the body of the ninth thoracic
vertebra.
Costal Margin
• The curved lower margin of the
thoracic wall, formed in front by the
cartilages of the seventh, eighth,
ninth and tenth ribs and behind by
the cartilages of the eleventh and
twelfth ribs
• Reaches its lowest level at the tenth
costal cartilage, which lies opposite
the body of the third lumbar vertebra
Iliac Crest
• May be felt along its entire length
and ends in front at the Anterior
Superior Iliac Spine (ASIS).
• Its highest point lies opposite the
body of the fourth lumbar vertebra.
• About 2 inches posterior to the ASIS,
the outer margin projects to form the
tubercle of the crest – lies at the
level of the body of 5th Lumbar
Vertebra.
Inguinal Ligament
• Rolled-under inferior
margin of the external
oblique muscle
• Attached laterally to the
ASIS, curves downward
and medially to be
attached to the pubic
tubercle
Symphysis Pubis
• Cartilaginous joint that lies in the
midline between the bodies of the
pubic bones
• Felt as a solid structure beneath the
skin in the midline at the lower
extremity of the anterior abdominal
wall
• Pubic crest – ridge on the superior
surface of the pubic bones medial to
the pubic tubercle
Superficial Inguinal Ring
• Triangular aperture in the
aponeurosis of the external oblique
muscle situated above and medial to
the pubic tubercle
• In males – the margins can be felt by
invaginating the skin of the upper
part of the scrotum with the tip of
the little finger
• In females – smaller and difficult to
palpate
Scrotum
• Pouch of skin containing the testes,
the epididymides, lower ends of the
spermatic cord.
• Testis on each side is a firm ovoid
body surrounded on its lateral,
anterior and medial surfaces by two
layers of tunica vaginalis.
• Testis should lie free and not
tethered to the skin or subcutaneous
tissue.
Linea Alba
• Fibrous band that extends from
symphysis pubis to the xiphoid
process and lies in the midline.
• Fusion of the aponeuroses of the
muscles of the anterior abdominal
wall and is represented on the
surface by a slight median groove
Umbilicus
• Lies in the linea alba and is
inconstant in position
• Puckered scar and is the site of
attachment of the umbilical cord in
the fetus
Linea Semilunaris
• Lateral edge of the rectus abdominis
muscle, crosses the costal margin at
the tip of the ninth costal cartilage
• To accentuate, the patient is asked
to lie on his back and raise his
shoulders off the couch without using
his arms
Abdominal Regions
The Superficial Fascia
• Divided into: superficial fatty layer and
deep membranous layer
• Fatty layer – continuous with the
superficial fat over the rest of the body
and may be extremely thick in obese
patients.
• Membranous layer – fades out over the
thoracic wall above and along the
midaxillary line laterally, inferiorly it
passes onto the front of the thigh where it
fuses with the deep fascia
Clinical Notes
• Camper’s Fascia – a.k.a. Superficial
fatty layer
• Scarpa’s Fascia – a.k.a. deep
membranous layer
• Colles fascia – extension of the
Scarpa’s in the perineum
External Oblique
• Origin – lower eight ribs
• Insertion – xiphoid process, linea
alba, pubic crest, pubic tubercle, iliac
crest
• Nerve supply – lower 6 thoracic
nerves
• Action – supports abdominal
contents, assists in forced expiration,
micturition, defecation, partuition,
Clinical Notes
• Triangular shaped defect in the
external oblique aponeurosis, lies
immediately above and medial to the
pubic tubercle (hmmm….sounds familiar?)
• The lower border of the aponeurosis
is folded backward on itself, forming
the inguinal ligament.
Internal Oblique
• Origin – lumbar fascia, iliac crest,
lateral two thirds of the inguinal
ligament
• Insertion – Lower three ribs and
costal cartilages, xiphoid process,
linea alba, symphysis pubis
• Nerve supply – lower six thoracic
nerves
• Action – same with external obliques
1. Inguinal ligament
2. Muscular part of transversus abdominis
3. Transversus abdominis aponeurosis
4. Muscular part of internal oblique
5. Internal oblique aponeurosis
6. Transversalis fascia
7. Cremasteric fascia forming middle coating of spermatic cord
8. Pubic tubercle
Transversus Abdominis
• Origin – lower six costal cartilages,
lumbar fascia, iliac crest, lateral third
of inguinal ligament
• Insertion – xiphoid process, linea
alba, symphysis pubis
• Nerve supply – lower six thoracic
nerves
• Action – compresses abdominal
contents
Rectus Abdominis
• Origin – symphysis pubis and pubic
crest
• Insertion – fifth, sixth and seventh
costal cartilages and xiphoid process
• Nerve supply – lower six thoracic
nerves
• Action – compresses abdominal
contents and flexes vertebral column
• When it contracts, its lateral margin
forms a curved ridge that can be
palpated and often seen (hmmm…sounds
familiar again)
• It is enclosed between the
aponeuroses of the external oblique,
the internal oblique and the
transversus, which form the rectus
sheath.
Pyramidalis
• Origin – anterior surface of pubis
• Insertion – Linea alba
• Nerve supply – Twelfth thoracic
nerve
• Action – tenses the linea alba

It is often absent
Rectus Sheath
Arteries of the Anterior and
Lateral Abdominal Walls
• Superior epigastric artery – terminal
branch of the internal thoracic artery;
supplies the upper central part of the
anterior abdominal wall
• Inferior epigastric artery – branch of
the external iliac artery, just above
the inguinal ligament; supplies the
lower central part of the anterior
abdominal wall
• Deep circumflex iliac artery – branch
of the external iliac artery; supplies
the lower lateral part of the
abdominal wall.
• Posterior Intercostal arteries – 2,
branches of the descending thoracic
aorta; supply the lateral part of the
abdominal wall.