Abdominal Wall

Dr Natasha Bhuto
PPDPT,BS PT
Lecturer@IPRS SMBBMU
Structure of the Anterior
Abdominal Wall
• Abdomen is the region of the trunk that lies between the
diaphragm above and the inlet of pelvis below
• The anterior abdominal wall is made up of :
• Skin
• Superficial fascia
• Deep fascia
• Muscles
• Extraperitoneal fascia
• Parietal peritoneum
 Skin
• The skin is loosely attached to the underlying structures
except at the umbilicus where it is tethered to the scar
tissue
• The umbilicus is a scar representing the site of
attachment of the umbilical cord in the fetus, it is
situated in the linea alba
 Nerve Supply to Skin
• The cutaneous nerve supply to the anterior abdominal
wall is derived from the anterior rami of the lower six
thoracic and the first lumbar nerves
• The dermatome of T7 is located Over the xiphoid process
• The dermatome of T10 includes the umbilicus
• That of L1 lies just above the inguinal ligament and
symphysis pubis
 Blood Supply of Skin
• The skin near the midline is supplied by branches of the
superior and inferior epigastric arteries
• The skin of the flanks is supplied by branches of the
• 1).Intercostal arteries
• 2.)Lumber arteries
• 3.)Deep circumflex iliac arteries
 Veins
• The venous drainage passes above mainly into the
axillary vein via the lateral thoracic vein
Below
Into the femoral vein via the superficial epigastric and the
great saphenous veins
 Superficial Fascia
• The superficial fascia is divided into:
• 1. Superficial fatty layer (fascia of Camper)
• 2 .Deep membranous layer (Scarpa’s fascia)
• The fatty layer is continuous with the superficial fat over
the rest of the body and may be extremely thick (8cm) or
more in obese patients
• The membranous layer is thin and fades out laterally and
obove , when it becomes continuous with the superficial
fascia of the back and the thorax respectivey
 Deep Fascia
• It lies immediately deep to the membranous layer of
superficial fascia.
 Muscles
• The muscles of the anterior abdominal wall consist of
three broad thin sheets
• From exterior to interior they are the
• 1. External oblique
• 2.Internal oblique
• 3.Transversus Abdominis
• On either side of the midline anteriorly is in addition a
wide vertical muscle, the rectus abdominis
• As the aponeurosis of the three sheets pass forward ,
they enclose the rectus abdominis to form the rectus
sheath
• The lower part of the rectus sheath might contain a small
muscle called the pyramidalis
 External Oblique
• Origin: the outer surface of the lower eight ribs and fans
out to be
• Insertion: the xiphoid process, the linea alba, the pubic
crest, the pubic tubercle and the anterior half of the iliac
crest
• Most of the fibers are inserted by means of a broad
aponeurosis
• A triangular-shaped defect in the external obique
aponeurosis lies immediately above and medial to the
pubic tubercle
• This is known as the superficial inguinal ring
• The spermatic cord or (round ligament of the uterus)
passes through this opening and carries the external
spermatic fascia (or the external covering of the round
ligament of the uterus) from the margins of the ring
• Between the anterior superior iliac spine and the pubic
tubercle, the lower border of the aponeurosis is folded
backward on itself, forming the inguinal ligament
 Internal Oblique
• Origin: lumber fascia,the anterior two thirds of the iliac
crest , and the lateral two thirds of the inguinal ligament
• Insertion: the lower borders of the lower three ribs and
their costal cartilages, the xiphoid process, the linea alba
and the symphysis pubis
 Transversus
• Origin: the deep surface of the lower six costal cartilages,
the lumber fascia, the anterior two thirds of the iliac
crest,and the lateral third of the inguinal ligament.
• Insertion: the xiphoid process,the linea alba and the
symphysis pubis
 Rectus Abdominis
• The rectus abdominis is a long strap muscle that extends
along the whole length of the anterior wall
• It is broader above and lies close to the midline, being
seperated from its fellow by the linea alba
• The rectus abdominis muscle is divided into distinct
segments by three transverse tendinous intersetions
• 1. One at the level of the xiphoid process
• 2. One at the level of the umbilicus
• 3. one halfway between these two
• These intersections are strongly attached to the anterior
wall of the rectus sheath
 Pyramidalis
• The pyramidals muscle is often absent
• Origin: anterior surface of the pubis
• Insertion: linea alba
• It lies in front of the lower part of the rectus abdominis
 Rectus Sheath
• The rectus sheath is a long fibrous sheath that encloses
the rectus abdominis muscle and pyramidals muscle ( if
present)
• It is formed mainly by the aponeurosis of the three
abdominal muscles
• Between the coastal margin and the level of the anterior
superior iliac spine, the aponeurosis of the internal
oblique splits to enclose the rectus muscle, the external
oblique aponeurosis is directed in front of the muscle
and the transversus aponeurosis is directed behind the
muscle
Functions of the Anterior
Abdominal Wall Muscles
• The oblique muscles laterally flex and rotate the trunk
• The rectus abdominis flexes the trunk and stablizes the
pelvis
• The pyramidalis keeps the linea alba taut during the
process
• The muscles of the anterior and lateral abdominal walls
assist the diaphragm during inspiration by relaxing as
the diaphragm descends so that abdominal viscera can
be accommodated
• The muscles assist in the act of the forced expiration that
occurs during coughing and sneezing by pulling down the
ribs and the sternum.
• The tone plays an important part in supporting and
protecting the abdominal viscera
• By contracting simultaneously wih the diaphragm, with
the glottis of the larynx closed, they increase the intra-
abdominal pressure and help in
• 1. Micturition
• 2. Defecation
• 3. Vomiting
• 4.Parturition
Nerve Supply of Anterior
Abdominal Wall Muscles
• The oblique and transversus abdominis muscles are
supplied by the lower six thoracic nerves and the
iliohypogastric and ilioinguinal nerves (L1)
• The rectus muscle is supplied by the lower six thoracic
nerves.
• The pyramidalis is supplied by the 12th thoracic nerves.
 Fascia Transversalis
• It is a thin layer of fascia that lines the transversus
abdominis muscle
 Extraperitoneal Fat
• It is a thin layer of connective tissue that contains a
variable amount of the fat and lies between the fascia
transversalis and the parietal peritoneum
 Parietal Peritoneum
• The walls of the abdomen are lined with parietal
peritoneum
• This is a thin serous membrane annd is continous below
with the parietal peritoneum lining the pelvis