1. abdominal wall: surface anatomy

• Landmarks:– Xiphoid process

– Costal margin

– Semilunar line

– Umbilicus

– Linea alba

– Iliac crest

– Ant sup iliac spine

– Inguinal lig

– Pubic tubercle

– Pubic symhysis

2. Abdominal wall: Subdivisions of abdomen and reference planes

• Clinicians subdivide the abdominal cavity into nine regions to locate abdominal organs or pain sites:

– right hypochondriac, right lateral (lumbar), right inguinal (groin), – epigastric, umbilical, pubic (hypogastric),– left hypochondriac, left lateral (lumbar), and left inguinal (groin).

• For general clinical descriptions, clinicians use four quadrants of the abdominal cavity: right upper, right lower, left upper, and left lower. The four quadrants are defined by two planes:

– Transumbilical plane, passing through the umbilicus and IV disc – Median plane

3. Abdominal wall: muscles

A. the external oblique, rectus s

heath & rectus.

B. the external oblique

C. internal oblique

D. transverse abdominal

Vessels & Nerves of Anterolateral Abdominal Wall

• Superior epigastric vessels and branches of the musculophrenic vessels from the internal thoracic vessels.

• Inferior epigastric and deep circumflex iliac vessels from the external iliac vessels.• Superficial circumflex iliac and superficial epigastric vessels from the femoral artery a

nd great saphenous vein.• Posterior intercostal vessels in the 11th intercostal space and anterior branches of sub

costal vessels.

Internal Surface of Anterolateral Abdominal Wall

• The internal surface of the a

nterolateral abdominal wall i

s covered with transversalis

fascia, a variable amount of

extraperitoneal fat, and pari

etal peritoneum.

• The infraumbilical part of thi

s surface of the wall exhibits

several peritoneal folds, so

me of which contain remnan

ts of vessels that carried blo

od to and from the fetus.

• A. The anterior abdominal wall has b

een cut away. Note the relationship o

f the abdominal wall and the superfici

al abdominal contents. Most of the int

estine is covered by the greater ome

ntum.

• B. This section shows the layers of th

e inferior part of the wall

Abdominal contents and layers of anterolateral abdominal wall.

Abdominal Surgical Incisions

What layers and structure are cut through?

Inguinal Area• The inguinal canal is formed in relation

to the descent of the gonad (testes or ovary) during fetal development. The inguinal canal in adults is an approximately 4-cm-long, inferomedially directed oblique passage

• The main occupant of the inguinal canal is the spermatic cord in males and the round ligament of the uterus in females. The inguinal canal also contains blood and lymphatic vessels and the ilioinguinal nerve in both sexes. The inguinal canal has an opening at each end.

– The deep (internal) ring – The superficial (external) inguin

al ring• The inguinal canal has two walls (anteri

or and posterior), a roof, and a floor:– Anterior wall: formed by external obliqu

e aponeurosis throughout the length of the canal

– Posterior wall: formed by transversalis fascia;

– Roof: formed laterally by transversalis fascia, centrally by the musculoaponeurotic arches of internal oblique and transverse abdominal muscles,

– Floor: formed laterally by the iliopubic tract, centrally by the superior surface of the inguinal ligament

Characteristics of Inguinal Hernias

• A hernia occurs when the abdominal wall weakens and the inner lining of the abdomen pushes through the weakened area, forming a sac. To correct this problem, the surgeon's goal is to patch the abdominal wall in a way that will permanently strengthen it, precluding the possibility of another hernia later.

TRADITIONAL ANTERIOR SURGERY AND LAPAROSCOPIC SURGERY FO

R INGUINAL-HERNIA PEPAIR

The repair consisted of (1) a reduction of the hernia, (2) ligation of the hernial sac, (3) reconstruction of the inguinal floor with a mesh patch to secure the repair and promote healing

What layers to pass through to reach the hernial sac?

Cavities