Abdominal Wall & Stomach

Dr. NimirDr. Safaa

Objectives

Define the abdominal wall. Enlist the layers.. Give its blood and nerve supply. Applied anatomy Discuss stomach in terms of its parts and musculature. Enlist the peritoneal relations of the stomach. Enlist the structures forming stomach bed. Discuss the blood supply of the stomach.

Abdominal wall divided into:- Anteriolateral abdominal wall

Anterior wall Right lateral wall (Right Flank) Left lateral wall (Left Flank)

Posterior abdominal wall

Anterolateral Abdominal Wall

This extended from the thoracic cage to the pelvis and bounded : Superiorly

7th through 10th costal cartilages and and xiphoid process

Inferiorly Inguinal ligaments and the pelvic bones.

The wall consists of skin, subcutaneous

tissues (fat), muscles, deep fascia and parietal peritoneum.

Antrolateral Abdominal Wall Fascia & Subcutaneous Tissues

The subcutaneous tissues over most of the wall consists of layer of connective tissues that contains a variable amount of fat.

In the inferior part of the wall , the subcutaneous tissue is composed of two layers Fatty superficial layer (Camper’s fascia) Membranous deep layer (Scarpa’s fascia)

Antrolateral Abdominal Wall Muscles

3 Flat Muscles with strong sheet like aponeuroses External Oblique Internal Oblique Transversus Abdominus

2 Vertical Muscles Rectus Abdomius Pyramidalis

Anterolateral Abdominal Wall Nerves

T7 – T11 Thoracoabdominal Nerves

T12 Sub-costal nerve

L1 ilio-hypogastric Nerve ilio inguinal Nerves

Antrolateral Abdominal Wall Arteries

Internal Thoracic Artery Superior Epigastric Artery

External Iliac Artery Inferior Epigastric Artery Deep Circumflex Iliac Artery

Femoral Artery Superfecial Epigastric Artery Superfecial Circumflex Artery

Applied Anatomy Abdomen is divided into 9 regions via

four planes: Two horizontal [sub-costal (10th) and trans

tubercules plane] (L5). Two vertical (midclavicular planes).

They help in localization of abdominal signs and symptoms

The nine abdominal regions:-

Anterior Abdominal WallFunctions

Form strong expandable support. Protect the abdominal viscera from

injury such as low blow in boxing Compress the abdominal content Helps to maintain or increase the

intraabdominal pressure. Move the trunk and help to maintain

posture.

Protuberance of the abdomen. The five common causes (5F) Fat, Faeces, Fetus, Flatus And Fluid

Abdominal Hernias Anteriolateral abdominal wall may be

the site of hernias Inguinal, umbilical and epigastric

regions

Posterior Abdominal Wall Lumbar vertebrae and IV discs. Muscles

Psoas, quadratus lumborum, iliacus, transverse, abdominal wall oblique muscles.

Lumbar plexus Ventral rami of lumbar spinal nerves.

Fascia Diaphragm

Contributing to the superior part of the posterior wall

Fat, nerves, vessels (IVC, aorta) and lymph nodes.

Posterior Abdominal WallFascia

Between the parital peritoneum and the muscles

The psoas fascia or psoas sheath.

The quadratus lumborum fascia.

The thoracolumbar fascia.

Posterior Abdominal WallMuscles

Three paired muscles

Psoas major

Iliacus

Quadratus Lumborum

Posterior Abdominal WallNerves

The sub costal nervesThe lumbar nervesThe lumbar plexus of nerves branchus

are: (a) The obturator nerves (L2 – L4) (b) The femoral nerves (L2 – through L4) (c) Ilio inguinal and ilio hypogastric nerves (L1)

(d) Gentio femoral (L1 – L2) (e) Lateral femoral cutaneous nerves (L2 – L3)

Posterior Abdominal WallBlood Vessels

Aorta and its branches

IVC and its tributeries

Applied AnatomyPosterior abdominal pain:

Ilio-psoas has relationship to kidney, ureters, caecum, appendix, colon, pancreas….etc.

When any of these structures is diseasedmovement of the ilio psoas usually causes pain.

When intra abdominal inflammation is suspected the Ilio Psoas Test performed by moving ileopsoas muscle and if positive it causes pain.

Psoas AbscessHematogenous spread to the lumbar vertebrae may form an abscess which may spread from the vertebrae into the Psoas sheath producing a Psoas abscess.

Stomach

The muscular wall

The outer longitudinal layerThe intermediate circular layer

The innermost oblique layer

Stomach Musculature

mucous membrane

rugae

Stomach

Stomach bed:- Transverse colon Transverse mesocolon Pancreas Spleen& splenic artery Left kidney Left suprarenal Left crus of the diaphragm

Arterial supply of the stomach:-

Venous drainage:-

left and right gastric, left and right gastroepiploic, and the short gastric arteries.

Arteries of the stomach

Veins of the stomach

left and right gastric veins --> portal vein

left gastroepiploic and the short gastric veins--> splenic vein

The right gastroepiploic vein --> superior mesenteric vein.

Thank you