ANTEROLATERALABDOMINAL WALL

of the

Gross Anatomy

M1 Gross and Developmental Anatomy8:00 AM, November 11, 2008

Dr. Milton M. SholleyProfessor of Anatomy and Neurobiology

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Bony Landmarks of the Abdomen

Costal margin

Rib 10

Rib 7

L5

L1

Arcuate line

Sacral promontory

Pectineal line

Anterior superioriliac spine (ASIS)

Pubic tubercle

Xiphoid process

Pubic symphysis

Iliac crest

Rib 10

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Soft tissues fill the bony gap and form the

Anterolateral Abdominal Wall

Examples of soft tissues

Skin

Superficial fascia

Muscle

Aponeurosis

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Soft Tissue Landmarkson the Anterolateral Abdominal Wall

Linea semilunaris(lateral rectus plane) Umbilicus

(at vertebral levelL4 in non-obesepersons)

Inguinal ligament(attached at ASISand pubic tubercle)

Linea alba(midline interdigitationof aponeuroses)

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Quadrantssubdivide the anterolateral abdominal wall

and allow more precise localization of clinical findings.

Upper rightquadrant

Upper leftquadrant

Lower leftquadrant

Lower rightquadrant

Transumbilical line crossesumbilicus (if not obese) andvertebral body L4

Midline

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Nine Regionsmay be used to subdivide the anterolateral abdominal wall,

to make the localization of clinical findings even more precise.

Mid-clavicular lines

Transpyloric line

Intertubercular line

E

U

H Nine regions

right hypochondriac epigastric left hypochondriacright lumbar umbilical left lumbarright inguinal hypogastric left inguinal

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Langer’s lines - Cleavage lines of the skin

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The superficial fascia of the anterolateral abdominal wall has

Two Layers - Camper’s and Scarpa’s.

Skin

Camper’s layer(the fat-containingsuperficial layer ofthe superficial fascia)

Scarpa’s layer(the membranous layerof the superficial fascia -lies on the deep surfaceof the fatty layer)

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Nerves and Dermatomes

T10

T11

T12

L1

T9T8

T7T7

T8

T9

T10

T11

L1

T10 crosses the umbilicus

T12

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Inferiorepigastricartery

Superiorepigastricartery

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Cutaneous Lymphatic DrainageThe watershed crosses the umbilicus

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Superficial Inguinal Lymph Nodes

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External oblique

muscle

aponeurosis

Internal oblique

muscle

aponeurosis

External and InternalAbdominal Oblique Muscles

(ply 1) (ply 2)

Inguinalligament

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Internal oblique

muscle

aponeurosis

Transversus abdominis

muscle

aponeurosis

Transversus Abdominis Musclelies deep to the internal oblique

(ply 2) (ply 3)

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Tendinousintersection

Rectusabdominismuscle

Anterior layerof rectus sheath

Rectus Abdominis Muscleis enclosed in the Rectus Sheath

Posterior layersof rectus sheaths

Arcuate line

Transversalisfascia

Peritoneum

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Posterior layerof rectus sheath

Arcuate line

Transversalisfascia

A

B

Rectus Sheath Formationsuperior (A) and inferior (B) to the arcuate line

Linea alba

Anterior layerof rectus sheath

Linea alba

Posterior layer

Anterior layerof rectus sheath

Transversalisfascia

Peritoneum

Extraperitonealfat

Transversalisfascia

Peritoneum

Extraperitonealfat

1. Aponeurosis of externaloblique muscle

2. Aponeurosis of internaloblique muscle

3. Aponeurosis of transversusabdominis muscle

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3

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Skin Superficialfascia

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Inguinal ligament

Spermatic cord