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Ragad Alhawi & Marah Aldarawsheh

Maher Alhadidi

ABDUL AZIZ ALSHAMALI

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"Abdomen"

The abdominal wall covers a large Area , It`s bounded superiorly by

the xiphoid process and costal margins , posteriorly by the vertebral

column , and inferiorly by the upper parts of the pelvic bones , it`s

layers consists of skin , superficial fascia (subcutaneous Tissue ) ,

muscles and their associated deep facias , extraperitoneal fascia and

parietal peritoneum .

*it`s Part of the body extending below diaphragm and above pelvics.

Has Borders bounded :

Anteriorly: anteroabdominal wall

Posteriorly: posteroabdominal wall

Superiorly: diagram ( Roof)

Inferiorly: pelvic inlet ( Floor)

Note : floor -→

imaginary part .

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Anteroabdominal wall forms 9 layers : 1- skin.

2- superficial fascia which contains fat / artery / vein / Nerve 3-Deep fascia, and below it there are 3 muscles in the anteroabdominal wall.

- three flat muscles whose fibers begin posteriorly pass anteriorly and replaced by an aponeurosis as the muscle continues toward the midline.

Additional information : Also we have 2 vertical muscles which are enclosed within a tendinous sheath .

Therefore, the total No. of muscles in the anterolateral group of the abdominal wall is 5 muscles in number (3 deep muscles , 2 vertical muscles)

External oblique

Internal oblique

Transversus ab.

*external oblique: the most superficial of the 3 fat muscle as it`s immediately deep to the superficial facia . *internal oblique: Deep to the external oblique muscle & it is the 2nd of the three muscles + it`s smaller and thinner than the external oblique with most of its muscles fibers passing in a superomedial direction. *transversus (inner most) : Deep to the internal oblique , it ends in an . anterior aponeurosis , which blends with the linea alba at the midline .

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Below it we have the following layers:

Transvers fascia ( fascia of

transvers)

Extra peritonal fat

Peritoneum

*each of these muscles has its own action BUT they`re important for

the maintenance of many normal physiological functions such as: 1- keeping the abdominal viscera within the abdominal cavity. 2- protection of the viscera from injury. 3- Helping maintain the position of viscera .

- Linea alba :

1) It is a ”white line “ that runs down the midline of the abdomen

2) The linea alba is a fibrous line that splits the rectus abdominis into two.

3) It is visible as a vertical groove extending inferiorly from the xiphoid process to

the pubic symphysis.

4) It is traversed by the umbilicus.

- Function: adheres right and left part of body with each other + it separate abdominal wall to right and left

NOTE: The doctor said

that the origin and insertion of these muscles are excluded

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Clinical applications:

1) Inguinal(umbilical ) herni (فتاق): is common in premature newborn infant which is born at th 7th or 8th month.

- Treatment ? by surgery repair . why ? because linea alba didn't fuse at htat time.

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2) Jaundice occurs because baby's body "after birth "didn`t adapt with

the milk`s protein , Jaundice is a yellow tint to a newborn's skin and the white part of the eyes, 1 or 2 weeks later the liver will accept this nutrition

We have to discover the veins , arteries and nerves of this area for common surgical Vermiform appendix (الدودية الزائدة)

The skin , muscles , and parietal peritonume of the

antero-lateral abdominal wall are supplied by T7 to T12 and L1 spinal nerve .

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Artery supply:

- Central part (upper) by internal thoracic A. Extension of subclavian A. & Continue as superior epigastric A .

- Lower part (inferior) by epigastric A. (extension of fumeral A. that is

an extension of external eliac A).

Both of them meet each other at umbilicus

epigastric area stomach ulcer - Peripheral part (lateral) عند الخصر :

supplied by 6:

Lower 2 intercostal A.

lumber A .4 ----------------------------------------------------------

Nerve supply:

The intercostal nerves (T7:T11) leave their intercostal spaces passing deep to the cartilages and continue onto the antero-lateral abdominal wall between ( internal oblique and transversus abdominis muscle ).

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Lower 6 thoracic (intercostal) N. + L1 from lumber plexus. Supply from skin to peritoneum

T7 >>> epigastric

T8-T12 >>> supply structure between epicastric and pelvic

T10---> lumblicus

L1 N ( has 2 branches) as the " pelvic inlet " inguinal ligament above L1 N"

Begins >> T7

Lower part >> L1

Central >> T10 ----------------------------------------------------------

Veins supply: Numerous blood vessels supply antero-lateral abdominal

wall.

Superficial vein >>> moves from umblicus

above the level of umbilicus >>> drain up into axillary vein them through lateral thoracic vein

Below the level of umbilicus >>> femoral vein

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Lymph:

- superficial lymphatics above the umbilicus pass in a superior direction to the axillary nodes while drain age below the umbilicus passes at the inferior direction to the superficial inguinal nodes.

- above the level of umbilicus >>> anterior axillary lymph nodes

- Below the level of umbilicus >>> superficial " inguinal "lymph node

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Muscles :

"1 central , 3 peripheral"

Peripheral (flat) muscles are:

1-external oblique.

2- internal oblique.

3- Transverse.

Origion of peripheral muscles is flishy "لـحـمي" and their insertion is abnirotic .

All of their insertion is in linea alba >>> aponerousis of

muscle ((flatten tendon " dense CT thin but very strong ")

Right and left side of aponerousis is fused to form linea alba

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Caesarean section ( C section) :

- is the use of surgery to deliver one or more babies. - is it limited ? Yes about 3 times only . why ? because it separates the abdomen muscle , at the third time there won`t be healing so the scar appears ugly .

. 1- Skin 2-superficial fascia 3-deep fascia 4- linea alba 5-aponorosis of external 6- aponorosis of internal

" In the middle found central muscle " rectus abdominis "

Abdominal viscera :

- peritoneum : IS a thin membrane lines the walls of the abdominal cavity and covers much of the viscera .

visceral peritoneum covers the viscera .

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Rectus abdominis :

The rectus abdominis muscle has 3-4 horizontal tendinous intersections

Between the rectus abdominis muscles there is a thick mass of white fibrous

connective tissue called the linea alba

that unites the abdominal muscles

of the left and right sides

- It is narrow below and wide up.

- Action : compress the ribs and viscera + providing thoracic and

pelvic stability,Flex vertebral column (additional info )

- Nerve supply : Lower 6 intercostal nerves.

Sources : Gray`s Anatomy P.280,282,284,286-289,292.

Record sec. 2

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