Department of Anatomy,

Faculty of Basic Medical Sciences,

College of Health Sciences,
Osun State University, Osogbo, Osun State.

ANA 204 (Gross Anatomy of the Abdomen)

(2 Units)

ADELEKE Opeyemi Samson.

Surface and Radiological Anatomy of the Abdomen

FIFTH (5TH) WEEK LECTURE

 INTRODUCTION
 Surface Anatomy can be define as the study of the structural relationships of the
external features of the body to the internal organs and parts.

 Surface anatomy provide knowledge of what lies under the skin and what
structures are perceptible to touch (palpable) in the living body at rest and in
action.

 For instance someone that has stab wounds, Physician with the knowledge of
Surface Anatomy must be able to visualize the deep structures that might be
injured.
 Surface Anatomy of the Abdomen
 Visualization of the position of abdominal viscera is fundamental to a physical
examination.

 Some of these viscera or their parts can be felt by palpating through the
abdominal wall.

 Dividing anterior abdominal surface into regions and Quadrants can help to
establish the positions of deep structures and locate any pathological structures.

 By means of two vertical (Right & Left Midclavicular planes) and two
horizontal (Transpyloric plane & Transtubercular plane) lines, abdomen will be
divided into Nine regions.
 Surface Anatomy of the Abdomen
 By means of one vertical (Median plane) and one horizontal lines
(Transumbilical plane), abdomen will be divided into Four Quadrants.

 The 9 Abdominal regions are:

 Right & Left Hypochondria
 Right & Left Lumbar
 Right & Left Inguinal (Iliac Fossa)
 Epigastrum
 Umbilical
 Hypogastrium

 The 4 Abdominal Quadrants are:

 Right Upper Quadrant
 Right Lower Quadrant
 Left Upper Quadrant
 Left Lower Quadrant
 Surface Anatomy of the Abdomen
 The lines/planes that divide the abdomen into regions and quadrants can be define in
relation to the vertebral column L1,L2,L3,L4 and L5

 The Transpyloric plane: Is an imaginary horizontal line, located halfway between

the suprasternal notch of the manubrium and the upper border of the pubis
symphysis. It lies roughly a hand's breadth beneath the xiphisternum

 Transpyloric plane passes through the pylorus, body of the L1 Vertebra, pancreatic
neck, the duodenojejunal flexure, the fundus of the gall-bladder, the tip of the 9th
costal cartilage, Hila of the kidneys, level of termination of the spinal cord portal
vein and root of the transverse mesocolon.

 The Subcostal plane: Imaginary line joining the lowest point of the thoracic cage
on each side, usually the inferior margin of the 10th rib

 Subcostal plane It passes via body of the L3 Vertebra, the origin of the inferior
rd
 Surface Anatomy of the Abdomen
 Transtubercular plane: Imaginary line uniting the 2 tubercles of the iliac crests.

 Transtubercular plane passes through the upper border of the L5 vertebra and the
confluence of the common iliac veins (IVC).

 The Transumbilical plane: Imaginary line drawn through the umbilicus and passes
via the intervertebral [IV] disc between the L3 and L4 vertebrae.

 The Median plane: Imaginary line drawn longitudinally at the middle of the body,
dividing the body into right and left halves.

 The Midclavicular planes: Imaginary lines drawn from the midpoint of the
clavicles to the midinguinal points.

 Midclavicular planes roughly corresponds to the lateral border of the rectus

abdominis muscle.
 Surface Anatomy of the Abdomen
• Structures located in each quadrant
Abdomino-thorax.
Organs and their locations.
 Surface Marking of some Abdominal organs
 Liver: The lower border of the liver extends along a line from the tip of the
right 10th rib to the left 5th intercostal space in the mid clavicular line.
 The upper border follows a line passing through the 5th intercostal space on each
side and It maybe palpable during deep inspiration.

 Spleen: Spleen underlies the 9th, 10th and 11th ribs posteriorly on the left side 5
cm from the midline (median plane).

 Gall-bladder: The fundus of the gall-bladder corresponds to the point where the
lateral border of the rectus abdominis cuts the costal margin.
 It can also be located at the tip of the 9th costal cartilage, easily detected as a
distinct ‘step’ when the fingers are run along the costal margin.
 Surface Marking of some Abdominal organs
 Aorta Bifurcation: Terminates just to the left of the midline at the level of the iliac
crest at L4 vertebra.
 Pulsatile swelling below this level may thus be an iliac, but cannot be an aortic,
aneurysm.

 Pancreas: The transpyloric plane defines the level of the neck of the pancreas
which overlies the vertebral column.
 From this landmark, the head can be imagined passing downward and to the right,
the body and tail passing upwards and to the left.

 Kidneys: The lower pole of the normal right kidney may sometimes be felt in
the thin human on deep inspiration.
 Anteriorly, the hilum of the kidney lies on the transpyloric plane four finger breadths
from the midline.
 Posteriorly, the upper pole of the kidney lies deep to the 12th rib.
 The right kidney normally extends about 2.5 cm lower than the left.
 Surface Marking of some Abdominal organs

Development of the spinal cord

 Appendix: Appendix can be located by drawn

imaginary line from right ASIS to the
Umbilicus and locate a point(called McBurney’s
point) which is one-third 1/3rd of the imaginary
line from ASIS.
Plain x-ray of abdomen.
Gross Anatomy of the Spleen and Pancreas

SIXTH (6TH) WEEK LECTURE

 INTRODUCTION
 The spleen is an ovoid, usually purplish, pulpy, soft, vascular, lymphatic organ
which is about the size and shape of one's fist.

 The spleen is 1inch thick, 3inches wide, 5inches long, and weighs 7ounces.

 The Primary function of the Spleen is to help in the body's defense system and also
in immune surveillance and response.

 Prenatally, Spleen is a hematopoietic (blood-forming) organ, but after birth is

involved primarily in identifying, removing, and destroying expended red blood
cells and broken-down platelets, and in recycling iron and globin.

 It serves as a blood reservoir and, to a limited degree, can provide a sort of self-
transfusion in response to the stress imposed by hemorrhage.
 Location of Spleen
• Spleen is located in the left hypochondrium, lies just beneath the left half of the
diaphragm close to the 9th, 10th, and 11th ribs.

• The long axis lies along the shaft of the 10th rib, and extends forward only as far
as the midaxillary line.
Coverings of Spleen
• The spleen is covered by fibroelastic capsule and is surrounded by peritoneum
except at the splenic hilum.

Important relations of Spleen

Anteriorly: The stomach, and tail of pancreas
Posteriorly: The left part of the diaphragm which separates it from the pleura,
lung, and ribs 9th, 10th and 11th.
Inferiorly: The left colic flexure.
Medially: The left kidney.
 Presenting parts of Spleen
• Spleen has two Surfaces
(Diaphragmatic and Visceral surface)
• Two borders (Superior and Inferior
border)
• Two ends (Anterior or lateral and
Posterior or medial end)

• The diaphragmatic surface of the

spleen is convexly curved to fit the
concavity of the diaphragm.
• The anterior and superior borders of
the spleen are sharp and often notched
• Posterior (medial) end and inferior
border are rounded
  Spleen Ligaments
 Gastrosplenic ligament: It is the fold of peritoneum that connects spleen at the
hilum with greater curvature of stomach.

 Splenorenal/lienorenal ligament: It is the fold of peritoneum that connects

spleen at the hilum to the left kidney. This Ligament carries splenic vessels and
sometimes tail of pancreas

 Phrenicocolic ligament: It is attached to the left colic flexure (colon) and

diaphragm. This ligament supports the spleen from below.
 Arteries of Spleen
 The large splenic artery convey blood out of the spleen.
 Splenic artery is the largest branch of the celiac artery.
 It has a tortuous course as it runs along the upper border of the pancreas.
 The splenic artery then divides into about six branches, which enter the spleen at the
hilum.
Veins of Spleen
 The splenic vein leaves the hilum and runs behind the tail and the body of the
pancreas.
 Behind the neck of the pancreas, the splenic vein joins the superior mesenteric vein to
form the portal vein.
Lymph Drainage of Spleen
 The lymph vessels emerge from the hilum and pass through a few lymph nodes along
the course of the splenic artery and then drain into the celiac nodes
Nerve Supply of Spleen
 The nerves accompany the splenic artery and are derived from the celiac plexus
PANCREAS
 Pancreas
 The pancreas is an oblong-shaped abdominal glandular organ with both
digestive (exocrine) and hormonal (endocrine) functions.

 Pancreas is positioned at the level of the transpyloric plane

 It is a retroperitoneal organ, located deep within the upper abdomen in

the epigastrium and left hypochodrium regions with the exception of the tail of the
pancreas which is intraperitoneal.
Important Relations of the Pancreas
Anterioly: Stomach (Separated from the pancreas by the lesser sac); First part
of the Duodenum; Transverse mesocolon

Posterioly: Common bile duct, aorta and inferior vena cava (Descends behind the
head of the pancreas); Spleen (Connects to tail of the pancreas by
Lienorenal Ligament); Superior mesenteric artery, the splenic and
superior mesenteric veins (Descends behind the neck of the pancreas).
Laterally: Second part of the Duodenum and Spleen
 Pancreas parts
 Head: This is the widest part of the pancreas. It lies within the C-shaped curve
created by the duodenum, and is connected to it by connective tissue.

 Uncinate process: It’s a projection arising from the lower part of the head and
extending medially to lie beneath the body of the pancreas. It
lies posterior to the superior mesenteric vessels.

 Neck: Located between the head and the body of the pancreas. It overlies the
superior mesenteric vessels which form a groove in its posterior aspect.

 Body: Centrally located, crossing the midline of the human body to

lie behind the stomach and to the left of the superior mesenteric vessels.

 Tail: The left end of the pancreas that lies within close proximity to the
hilum of the spleen. It’s lie within the splenorenal ligament and the
splenic vessels and it’s the only part of the pancreas that is intraperitoneal.
 Pancreatic Ducts
 Histologically; Pancreas composed of clusters of cells called acini, connected by
short intercalated ducts.

 The intercalated ducts unite with one another and drain into a network of intralobular
collecting ducts, which in turn drain into the main pancreatic duct.

 The pancreatic duct runs through the length of the pancreas and unites with
the common bile duct of the Liver to form the hepatopancreatic ampulla of Vater.

 Hepatopancreatic ampulla of Vater then opens into the duodenum via the major
duodenal papilla

 Muscular valve called Sphincter of Oddi that surrounds the ampulla of Vater controls
secretions via ampulla of vater into the duodenum.
 Pancreas Vasculature
 The pancreas is supplied by the pancreatic branches of the splenic artery.

 The head is additionally supplied by the superior and inferior pancreaticoduodenal

arteries which are branches of the gastroduodenal and superior mesenteric arteries
respectively.

 Venous drainage of the head of the pancreas is into the superior mesenteric
branches of the hepatic portal vein.

 The pancreatic veins draining the rest of the pancreas do so via the splenic vein.
Lymphatics Drainage
 The pancreas is drained by lymphatic vessels that follow the arterial supply.

 They empty into the pancreaticosplenal nodes and the pyloric nodes, which in turn
drain into the superior mesenteric and coeliac lymph nodes.
 Clinical Significance
Pancreatitis:
• Pancreatitis refers to inflammation of the pancreas which
can be acute or persist over an extended period (chronic
pancreatitis).

• The causes of pancreatitis can be Gall stones, Alcohol,

Trauma, Steroids, Mumps, Autoimmune etc.
Gross Anatomy of the Liver, gall bladder and
bile ducts

SEVENTH (7TH) WEEK LECTURE

 INTRODUCTION
 The liver is the largest wedge shaped of the abdominal gland and occupies a
substantial portion of the upper abdominal cavity.

 It weighs approximately 1500 g and accounts for approximately 2.5% of adult body
weight.

 It is an essential organ that performs a wide range of metabolic activities required for
homeostasis, nutrition and immunity.

 The functional unit of liver is called hepatocytes which originate from the endoderm of
primitive foregut.

Location of the Liver

 The greater part of the liver is situated undercover of the right costal margin and also
extends to the left to reach the left hemidiaphragm.
Location of the Liver Contd..
 Liver occupies most of the right hypochondrium and epigastrium and also a small
portion extends into the left hypochondrium.
 The diaphragm separates liver from pleura, lungs, pericardium and heart.
Presenting parts of Liver
 The liver has a convex diaphragmatic surface (anterior, superior, and Right surfaces)
and a relatively flat visceral surface (posteroinferior).
(Diaphragmatic surface) Superior surface: Features and Relations
 It is the largest surface, convex in shape and is molded to the undersurface of the
domes of the diaphragm.
 This surface is covered by peritoneum except for a small triangular area between the
two diverging layers of falciform ligament.
 Centrally there is a shallow cardiac impression corresponding to the position of the
heart above the central tendon of the diaphragm and is related to the pericardium.
(Diaphragmatic surface) Anterior surface: Features and Relations
 Triangular and convex in shape, the anterior surface is covered by peritoneum except
at the attachment of the falciform ligament.
 The anterior surface is related on the right with the pleura and 6th to 10th ribs and their
cartilages and with 7th and 8th costal cartilages on the left.
 The midline area of the anterior surface lies behind the xiphoid process and the
anterior abdominal wall in the infracostal angle.
Right Surface: Features and Relations
 The right surface lies adjacent to the right dome of the diaphragm which separates it
from the right lung and pleura and the 7th to 11th ribs.
 The right lung and basal pleura between the diaphragm and the 7th and 8th ribs lie
above and lateral to upper third of this surface.
 The diaphragm, the costodiaphragmatic recess, and the 9th and 10th ribs are related
lateral to the middle third of the right surface.
 In the lower third, the diaphragm and thoracic wall are in direct contact.
Visceral surface: Features and Relations
 Visceral surface of the liver consist of posterior and inferior surfaces which are
together called posteroinferior surface.
 Posterior surface
 The posterior surface is convex, wide on the right, but narrow on the left.
 Much of the posterior surface is attached to the diaphragm by loose connective tissue
in the region of the 'bare area'.
 Posterior surface over the left lobe presents a shallow oesophageal impression which is
related to the abdominal part of the oesophagus.
 The posterior surface of the left lobe to the left of this impression is related to part of
the fundus of the stomach.
 A deep median concavity near the attachment of ligamentum venosum is related to
vertebral column.
 Fissure for ligamentum venosusm separates the caudate lobe of liver from the left lobe.
Posterior surface Contd…
 The lips of the fissure give attachment to the two layers of the lesser omentum.
 The floor of the fissure lodges the ligamentum venosum.
 Groove for inferior vena-cava lies in the medial end of the ‘bare area’ and to the left it
is related to the caudate lobe.
 The ‘bare area’ of the liver is devoid of peritoneum and is connected to the diaphragm
by loose areolar tissue.
 Inferolateral angle of the 'bare area' presents suprarenal impression that is related with
the upper pole of the right suprarenal gland.
Inferior surface
 The inferior surface is irregular and bounded separated from the anterior and right
surface by inferior border.
 Inferior surface of the left lobe of liver presents gastric impression which is related
inferiorly with the fundus of stomach and upper lesser omentum.
Inferior surface Contd…
 Fissure for ligamentum teres lodges the ligamentum teres.
 Quadrate lobe is related to pylorus, first part of duodenum and lower part of lesser
omentum.
 Fossa for gallbladder that lodges the gallbladder is located on the inferior surface.
 To the right of the fossa for the gall bladder, inferior surface of liver is related with the
first part of duodenum, the hepatic flexure of colon, the right kidney and right
suprarenal gland.
Liver Lobes
 Liver has a larger right and smaller left lobes.
 Falciform ligament, fissure for ligamentus venosum and fissure for ligamentum teres
separate the two lobes.
Right Lobe
 The right lobe also presents quadrate lobe and caudate lobe.

 Bulge of tissue seen at the inferior border of the right lobe, to the right of the
gallbladder is referred to as Riedel's lobe.

Quadrate lobe
 Present in the inferior surface of the Liver
 Anatomically is the part of right lobe and functionally belongs to left lobe

Boundaries
 Above - porta hepatis
 Below – Inferior border of the liver
 To the right – fossa for the gallbladder
 To the left – fissure for ligamentum teres

Relations:
 Pylorus and first part of duodenum
 Caudate lobe
 Present in the posterior surface of the liver
 Anatomically is the part of right lobe and functionally belongs to left lobe

Boundaries
 Above continuous with superior surface
 Below porta hepatis
 To the right groove for inferior vencava
 To the left fissure for ligamentum venosum

Caudate process
 Below and to the right, caudate lobe present a narrow strip called the caudate
process.
 Caudate process bounds porta hepatis posteriorly and forms the upper boundary of
epiploic foramen.
Left lobe
 The left lobe is smaller & ends in a thin apex pointing into the left upper quadrant.
 Since it is substantially thinner than the right lobe it is more flexible.
 Ligaments of the liver
Falciform ligament
o Falciform ligament is a two-layered fold of peritoneum that ascends from the umbilicus
to attach the liver to the posterior surface of anterior abdominal wall.
o At the superior surface of the liver, the ligament splits into right and left layers.
o The right layer turns laterally and forms the upper layer of the coronary ligament (the
extreme of which is called the right triangular ligament)
o The left layer turns medially to form the anterior layer of left triangular ligament.
o Falciform ligament has a sickle shaped free margin that contains ligamentum teres
hepatis or round ligament of liver.
Lesser Omentum
 The lesser omentum is also the peritoneal fold that is attached on the margin of the
porta hepatis and the fissure for the ligamentum venosum and passes down to the
lesser curvature of the stomach and proximal part of duodenum.
 Thus lesser omentum has two components- hepatogastric and hepatoduodenal.
 Ligaments of the liver
Coronary Ligament
• The coronary ligament attaches posterior surfaces of the right lobe of the liver to the
diaphragm.
• It consists of the upper and lower layers.
• Between the two layers of this ligament bounded laterally by groove for inferior vena
cava and also a large triangular area of liver devoid of peritoneum
• This triangular area in the liver is called the 'bare area' of the liver.
• This part of liver is attached to the diaphragm by areolar tissue.
• The two layers of coronary ligament meet on the right to form the right triangular
ligament.
Porta Hepatis
• The porta hepatis is hilum of the liver present in the inferior surface.
• It provides a passageway to the neurovascular and biliary structures, except the hepatic
veins.
• It is anteriorly bounded by the quadrate lobe and the caudate process posteriorly
Neurovascular supply of liver
 The portal vein and hepatic artery ascend in the lesser omentum and enter the liver at
the porta hepatis where each bifurcates into right and left branches.
 The hepatic bile duct and lymphatic vessels leave the liver at porta hepatis and descend
through lesser omentum.
 The hepatic veins directly drain into the inferior vena cava after leaving the liver
through it posterior surface.
Hepatic Artery
 It arises from the coeliac trunk of abdominal aorta.
 The artery may be subdivided into the common hepatic artery (from the coeliac trunk
to the origin of the gastroduodenal artery) and the hepatic artery proper
 Major Hepatic Artery Branches are: (Right Gastric artery, Gastroduodenal artery
and Cystic artery from right hepatic artery)

Veins
 The liver has two venous systems:
1. The portal venous system (Portal vein) that conveys venous blood from the majority of the
gastrointestinal tract and its associated organs to the liver

2. The hepatic venous system that drains blood from the liver parenchyma into the inferior vena cava
Hepatic Veins
 The hepatic veins convey blood from the liver to the inferior vena cava.
 Hepatic veins are arranged in upper and lower groups.
 The veins in upper group are usually large and commonly referred to as the right,
middle and left hepatic veins.
 The lower groups vein vary in number and extent of distribution

Nerve supply

• The liver parenchyma is supplied by hepatic nerves, which arise from the hepatic
plexus and contain sympathetic and parasympathetic (vagal) fibres.
• Hepatic nerve enter the liver at the porta hepatis and largely accompany the hepatic
arteries and bile ducts.
• The liver capsule is innervated by branches of the lower intercostal nerves.
 Lymphatic drainage
The lymphatic from the liver are arranged into two sets:
1. Superficial lymphatics run in subserous areolar tissue and drain into:
i. Subdiaphragmatic lymph nodes (most of the posterior surface, surface of caudate lobe and
posterior part of inferior surface)
ii. Hepatic lymph nodes (most of inferior surface, anterior and most of the superior surface)
iii. Coeliac lymph nodes (few lymphatics from right surface)
iv. Paracardiac lymph nodes (few lymphatics from posterior surface of left lobe)

2. Deep lymphatics
 Deep lymphatics vessels drain the liver parenchyma.
 The lymph vessels partly accompany the hepatic veins and portal vein and drain into
i. Supra-diaphragmatic lymphnodes
ii. Hepatic lymph nodes.
 Ducts of liver
Bile ducts of the liver:
 The ducts of the liver consist of right and left hepatic ducts, the common hepatic
duct, the bile duct, the gall bladder and the cystic duct.
 The Intrahepatic bile ducts at porta hepatis of the liver form the right and left hepatic
ducts.
Hepatic Duct
 The right hepatic duct drains the right lobe of the liver whereas the left hepatic duct
drains the left, caudate and quadrate lobe of the liver.
 After the short course the right and left hepatic ducts unite to form common hepatic
duct which is about 4cm long and descends within the free margin of lesser omentum.
 Common hepatic duct joined on its right side by the cystic duct to form the common
bile duct.
Bile duct
 The bile duct or Common bile duct is about 3 inches (8cm) long.
 Bile duct courses (journey) through four different parts:
 First part of its course: it lies in the right free margin of the lesser omentum
 Second part of its course: it lies behind the first part of the duodenum
 Third part of its course: it lies in a groove on the posterior surface of the head of the
pancreas.
 Fourth part of its course which is the final course: the bile duct ends by piercing the wall
of the second part of the duodenum where it is usually joined by main pancreatic duct and
together they open into the ampulla of Vater.
Gall Bladder
 It is a pear shaped sac lying on the inferior surface of the liver.
 It has a capacity of about 30-50 ml and stores bile.
 Gall bladder parts are Fundus, body and neck
 Fundus is rounded and comes in contact with the anterior abdominal wall at the level
of tip of the ninth costal cartilage.
 The body lies in contact with the liver surface and is directed upward, backward and
to the left.
 The neck becomes continuous with the cystic duct which turns into the lesser
omentum to join the right side of the common hepatic duct to form the bile duct.
Gall Bladder Vasculature
 The cystic duct connects the neck of the gallbladder to the common hepatic duct
 The cystic artery which is a branch from right hepatic artery supplying the
gallbladder and cystic duct
 The cystic veins, draining the neck of the gallbladder and cystic duct, enter the liver
directly or drain through the portal vein to the liver, after joining the veins draining the
hepatic ducts and upper bile duct
 The lymphatic drainage of the gallbladder is to the hepatic lymph nodes often
through cystic lymph nodes located near the neck of the gallbladder.
 Efferent lymphatic vessels from these nodes pass to the celiac lymph nodes
 The nerves to the gallbladder and cystic duct are celiac nerve plexus, the vagus nerve
and the right phrenic nerve.
Posterior Abdominal Wall

EIGHTH (8TH) WEEK LECTURE

 Introduction
 The posterior abdominal wall mainly composed the following:
 Lumbar vertebrae and its associated vertebrae discs.
 Muscles which include: Psoas, quadratus lumborum, iliacus, transverse, abdominal
wall oblique muscles.
 Lumbar plexus composed of Ventral rami of lumbar spinal nerves.
 Fascia (Psoas fascia, Quadratus lumborum fascia, Thoracolumber fascia)
 Diaphragm which contributing to the superior part of the posterior wall
 Fat, nerves, vessels (IVC, aorta) and lymph nodes
 Posterior abdominal Fascia
 Posterior abdominal fascia lies between the parietal peritoneum and the muscles.
 The psoas fascia or psoas sheath: Covers the psoas muscle and attached medially to
the lumbar vertebrae and pelvic brim.

 The quadratus lumborum fascia: Covers the quadratus lumborum muscle

 Thoracolumber fascia: It’s thin and transparent where it covers the thoracic parts of
the deep muscles but is thick and strong in the lumbar region.

 In the lumbar region, thoracolumber fascia consists of three layers:

1. Posterior layer is thick and is attached to the spinous processes of the lumbar and
sacral vertebrae, and the supraspinous ligament-from these attachments, it extends
laterally to cover the erector spinae
Thoracolumber fascia layer Contd..
2. Middle layer is attached medially to the tips of the transverse
processes of the lumbar vertebrae and intertransverse ligaments-inferiorly, it is
attached to the iliac crest and, superiorly, to the lower border of rib XII

3. Anterior layer covers the anterior surface of the quadratus lumborum

muscle and is attached medially to the transverse processes of the lumbar vertebrae
inferiorly, it is attached to the iliac crest and, superiorly, it forms the lateral arcuate
ligament for attachment of the diaphragm.

Muscles of the Posterior Abdominal Wall

Iliacus
Origin: Iliac fossa
Insertion: Lesser trochanter of femur
Action: Flexes the thigh at the hip
Nerve: Femoral Nerve
 Muscles of the Posterior Abdominal Wall Contd…
Psoas major
Origin: Lumbar transverse processes, intervertebral discs, and
adjacent bodies from TXII to L
Insertion: Lesser trochanter of femur via iliopsoas tendon
Nerve: Anterior rami of L1 to L3
Action: Thigh flexion, trunk flexion, lateral flexion

Quadratus lumborum
Origin: iliac crest, lumbar fascia
Insertion: transverse processes of upper lumbar vertebrae
Nerve: Anterior rami of T12 and L1 to L4
Action: Flexes the vertebral column
 Nerves of the Posterior Abdominal Wall
 Components of both the somatic and the autonomic (visceral) nervous systems are
associated with the posterior abdominal wall.
Somatic Nerves of Posterior Abdominal Wall
o Obturator (L2 - L4)
o Femoral (L2- L4)
o Lumbosacral trunk
o Ilioinguinal (L1)
o Iliohypogastric (L1)
o Genitofemoral (L1, L2)
o Lateral femoral cutaneous (L2, L3)
Autonomic nerves
o Vagus nerve
o Several different splanchnic nerves that deliver presynaptic sympathizer and
parasympathetic fibers to the plexus and sympathetic ganglia.
Abdominal autonomic plexus
o Celiac plexus
o Superior mesentric plexus
o Inferior mesentric plexus.
o Celiac plexus
o Superior hypogastric plexus
o Inferior hypogastric plexus
 Posterior Abdominal Wall Blood Vessels
Abdominal Aorta
 Begins at the aortic hiatus of the diaphragm as a midline structure at approximately the
lower level of T12 vertebra.

 Passes downward on the anterior surface of the bodies of L1-L4 vertebrae, ending just
to the left of midline at the lower level of L4 vertebra.

 Divides into the right and left common iliac arteries.

 Covered on the anterior surface by the prevertebral plexus of nerves and ganglia

 Abdominal aorta broadly divided into Visceral branches supplying organs, Posterior
branches supplying the diaphragm or body wall and Terminal branches
 Posterior Abdominal Wall Blood Vessels
Abdominal Aorta
 Visceral branches are (Celiac trunk,
superior mesenteric artery, Inferior
mesenteric artery, Middle suprarenal
arteries-small, Renal arteries and
Testicular or ovarian arteries).

 Posterior branches are (Inferior phrenic

arteries, Lumber arteries and Median
sacral artery).

 Terminal branches are Right and left

Common Iliac Arteries which are the
terminal bifurcation from the
abdominal aorta
 Posterior Abdominal Wall Blood Vessels
Inferior vena cava
 Drains blood from all structures below the diaphragm to the right atrium of the heart.

 Formed when the two common iliac veins come together at the level of the 5th lumbar
vertebra just to the right of midline.

 It ascends through the posterior abdominal region anterior to the vertebral column
immediately to the right of the abdominal aorta and leaves the abdomen by piercing
the central tendon of the diaphragm at the level of the 8th thoracic vertebra.

 Inferior vena cava tributaries from below up are (the common iliac veins; Lumbar
veins; Right testicular or ovarian vein; Renal veins; Right suprarenal vein; Inferior
phrenic veins and the hepatic veins).
 Posterior Abdominal Wall Blood Vessels
Inferior vena cava Contd…
 NOTE; There are no tributaries from the abdominal part of the
gastrointestinal tract, spleen, pancreas, or gallbladder because
veins from these structures are components of the portal venous
system, which first passes through the liver.

 If the inferior vena cava becomes blocked the ascending lumbar

veins become important collateral channels between the lower
and upper parts of the body.

 The 5th lumbar vein generally drains into the iliolumbar vein

 The 3rd and 4th lumbar veins usually drain into the inferior vena
cava

 The 1st and 2nd lumbar veins may drain into the ascending
lumbar veins