Anterior abdominal wall

Has 6 muscles on each side of midline: Rectus abdominis External oblique Internal oblique Transversus abdominis Cremasteric Pyramidalis

Anterior abdominal wall is firm & elastic & consists of eight layers Skin Superficial fascia- Fascia of Camper Fascia of Scarpa External Oblique Muscles Internal Oblique muscles Transverse Abdominis muscles Fascia Transversalis Extraperitoneal Tissue Parietal Peritoneum

Superficial Fascia of the Anterior Abdominal Wall Above the Umbilicus Single Layer Below the Umbilicus Two Layers Superficial Fatty layer (Fascia Camper) Deep Membranous Layer (Fascia of scarpa)

Linea Alba Linea Semilunaris Arcuate line

External Oblique Muscle Origin: External surfaces of lower 8 ribs ribs. Direction Downwards, forwards and medially (shape of pocket.) Insertion: Xiphoid Process, linea alba, pubic symphysis, pubic crest and anterior half iliac crest Nerve supply: lower six thoracic nerve &1st lumbar nerve

Inguinal Ligament Infolding of the lower border of external Oblique Aponeurosis Attachment Laterally - Anterior superior iliac spine to Medially - Pubic tubercle Lacunar Ligament Triangular piece of fascia connecting median end of inguinal ligament to pectinate line Ligament of Cooper/ Pectineal ligament: Ligament joining base of lacunar lig to pectineal line and pubic tubercle

Internal Oblique Origin: Iliac crest, and lateral 2/3rd inguinal ligament, Direction Run upward, forward & medially Insertion: Uppermost fibers insert into lower 3 or 4 ribs and costal cartilage, Xiphoid process, linea alba, Symphysis pubis Nerved Supply: inferior six thoracic and first lumbar nerves.

Transversus Abdominis Origin: lateral 1/3rd of inguinal ligament, iliac crest, lumbar fascia, internal surfaces of lower 6 costal cartilages Insertion: Xiphoid Process, linea Alba, pubic sympysis Direction Run horizontally forward Innervation: Lower six thoracic and first lumbar nerve.

Conjoint Tendon It is formed by fusion of lower aponeurosis of internal oblique & transverse abdominis muscles Is attached to pubic tubercle and pectineal line Internal oblique has a lower free border that arches to be attached to pubic crest & pectinate line Similar fibers from transverse abdominis join it to form conjoint tendon Strengthens the anterior abdominal wall at site of sup inguinal ring

Rectus Abdominis This is a long, broad, strap-like muscle is the principle vertical muscle of the anterior abdominal wall. Origin: Pubic Symphysis & pubic crest. Insertion: xiphoid process and 5th to 7th costal cartilages. Direction Run vertically upwards innervation: Lower six thoracic nerves. Muscle is enclosed in a sheath formed by the aponeurosis of three flat muscles Tendinous intersection 3 transverse fibrous bands divide the muscle into smaller parts

Rectus Sheath Rectus sheath is a long sheath enclosing the rectus abdominis muscles It has 2 walls anterior & Posterior Anterior wall It is complete covering whole muscle Posterior wall Is incomplete being deficient above costal margin & below arcuate line The posterior wall of rectus sheath end in a free curved margin with convexity upwards called arcuate line

Components It is formed by the aponeuroses of the 3 lateral abdominal muscles External oblique Internal oblique Tranverse abdominis

Formation It is considered at 3 levels Above the costal margin Ant Wall - aponeurosis of external oblique Post Wall - Absent directly rests on costal cartilage

 2. Btw costal margin & Arcuate line Ant Wall aponeurosis of ext oblique anterior lamina of internal oblique Post Wall post lamina of internal oblique & tranversus abdominis

Below the level of Arcuate line Ant Wall aponeuroses of all 3 muscles Post Wall rectus muscle lies in contact with fascia transversalis

Contents of Rectus sheath Rectus abdominis & pyramidis Anterior rami of lower 6 thoracic n & artery Superior & inferior epigastric vessels Lymphatics

Fascia Transversalis Fascia lining the inner surface of transverses abdominis

Hasselbach's Triangle Clinical importance in hernia Direct hernia comes out through it Boundaries of Hasselbach's Triangle Medial boundary: Rectus abdominis Lateral boundary: Inferior epigastric vessels Inferior boundary: Inguinal ligament

 Cremaster Muscle:
Origin from: Inguinal ligament Insertion: around scrotum as cremasteric fascia Well developed in male In female, only few fibers are seen Protective muscle for testes

 Pyramidalis muscle: a small and triangular muscle, anterior to the Rectus abdominis, and contained in the rectus sheath Origin: pubic symphysis and pubic crest, from two sides Insertion: run upwards and medially to get inserted to linea alba, midway between umbilicus and pubic symphysis May be absent in 20% cases Used to identify the midline

Deep inguinal ring Deep inguinal ring is oval opening in fascia transversalis situated 1.2cm above midinguinal point Superficial inguinal ring Superficial inguinal ring is triangular opening in external oblique aponeurosis Immediately above & medial to pubic tubercle

Inguinal Canal Oblique passage in lower part of anterior wall situated just above medial half of inguinal ligament 4 cm long Run downward, forward & medially It extends from deep inguinal ring to superficial inguinal ring

Boundaries of Inguinal Canal Anterior Wall Whole Extent-Formed by apooneurosis of external oblique Lateral 1/3rd Internal Oblique Posterior Whole extend -Formed by fascia transversalis, Wall Medial 2/3rd Conjoint tendon, reflected part of inguinal ligament Floor Formed by inguinal ligament & lacunar ligament medially Roof Formed by the arching lowest fibres of internal oblique & transversus abd muscles

Structures passing through inguinal canal Spermatic cord in male or round ligament in female It 1st passes through deep inguinal ring transverses canal & again comes out of superficial inguinal ring Ilioinguinal nerve

Blood supply of anterior abdominal wall: Superior epigastric artery: from Internal thoracic artery Inferior epigastric artery: from external iliac artery Deep circumflex iliac artery: from external iliac artery Superficial epigastric arteries : from femoral artery Deep circumflex iliac artery :from external iliac artery

Nerve supply: Lower six thoracic nerves, subcostal nerve and L1 nerve through Ilioiguinal and iliohypogastric nerves