External Oblique (\\ or // striations) Muscles of the abdominal wall, anterior view (superficial)
Anterior abdominal muscles
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Transcript of Anterior abdominal muscles
ANTERIOR ABDOMINAL MUSCLES(Complete Info. & Presentation)(Complete Info. & Presentation)
By- Dr. Armaan SinghBy- Dr. Armaan Singh
Anterior Abdominal Wall• The muscles of the anterior
abdominal wall play a major role in movements of the trunk
• Protecting the abdominal organs
• Increase the intra-abdominal pressure, aid in expiration and all straining activities such as micturition, coughing and vomiting
• Supplied by lower five intercostal and subcostal nerves
Anterior Abdominal Muscles• Strong abdominals are important in
helping to stabilise the trunk
• Support the spine
• They flex and rotate the trunk
• Acting with the adductors and abductors of the hip
• They help to stabilise the pelvis during walking and running
Anterior Abdominal Wall• Superficial fatty layer
• Membranous layer of superficial fascia
• Below umbilicus
• Continuous with Colles’ fascia in the perineum
Skin of Anterior Abdominal Wall
• Lower five intercostal nerves
• Subcostal nerve T12
• 10th intercostal nerve is at the level of the umbilicus
• Iliohypogastric nerve L1
• Ilioinguinal nerve L1
Blood Supply and Lymphatics
• Intercostal vessels
• Skin above umbilicus superficial veins and lymphatics drain to axilla
• Skin below umbilicus superficial veins and lymphatics drain to long saphenous vein
• Superficial inguinal glands
Inguinal Glands• Proximal group parallel to
inguinal ligament
• Enlarged tender inguinal glands
• Part of a generalised lymphadenopathy
• Secondaries
Inguinal Glands• Proximal group
• Lesions in local structures
• Skin of lower anterior abdominal wall
• Gluteal region
• Skin of scrotum or labia Distal superficial glands
• Skin of leg area drained by long saphenous vein
• All drain to deep inguinal glands along femoral vein
Abdominal Muscles• External oblique
• Internal oblique
• Transversus
• Rectus abdominus
• Pyramidalis
• Nerves and vessels
• Lie between internal oblique and transversus
External Oblique• Origin
• Outer surfaces lower borders lower eight ribs
• Interdigitating with serratus anterior and latissimus dorsi
• Fibres pass medially and inferiorly
External Oblique Insertion• Inserted into anterior half of
anterior two thirds outer lip of iliac crest
• Aponeurosis in the inguinal region passes anterior to rectus muscle
• Forms the inguinal ligament
• Lacunar ligament
• Reflected portion of inguinal ligament
Inguinal and Lacunar Ligaments
• Inguinal ligament aponeurosis is folded back from anterior superior iliac spine to pubic tubercle to form inguinal ligament
• Lacunar ligament triangular, attached to pectineal line. lateral free border medial margin of femoral ring
Insertion External Oblique• Pubic crest
• Gap for superficial inguinal ring
• Pubic bone
• Linea alba
• Anterior wall of the rectus sheath
• Zyphoid process
External Oblique• Acting separately
• The external oblique flexes the vertebral column laterally and rotates it to the opposite side
• If the thorax is fixed by contracting both external obliques, you can tilt the symphysis pubis superiorly and flex the trunk, posterior pelvic tilt
• Movement of the iliac crests determines the direction of the tilt
Internal Oblique• Muscular origin lateral two
thirds of inguinal ligament
• Anterior two thirds intermediate lip of iliac crest
• Lumbar fascia
• Muscular fibres arch over contents of inguinal canal anterior to rectus muscle
• Fibres pass medially and superiorly
Insertion Internal Oblique• Into coastal margin, upper three as
fleshy fibres
• Next three as aponeurotic
• Inserted into linea alba
• Between zyphoid and half way between umbilicus and pubic symphysis aponeurosis splits
• Anterior layer fuses with external oblique
• Posterior layer fuses with transversus
Internal Oblique Conjoint Tendon
• Half way between umbilicus and pubic symphysis
• Aponeurosis of the internal oblique and transversus fuse to form conjoint tendon
• Anterior portion of rectus sheath
• Inserted into pectineal line behind superficial inguinal ring
Internal Oblique
• The right side of the muscle twists to the right and the left side twists to the left
• The lower six intercostals nerve
• Subcostal nerve
• Iliohypogastric nerves
Transversus Abdominus• Origin
• Lateral one third of inguinal ligament
• Anterior two thirds of inner lip of iliac crest
• Lumbar fascia
• Lower border and inner surfaces lower six ribs interdigitating with diaphragm
Insertion Transversus Abdominus
• Into zyphoid, linea alba
• Half way between umbilicus and pubic symphysis
• Fuses with posterior lamella of internal oblique
• Below forms conjoint tendon
• Inserted into pectineal line behind superficial inguinal ring
Transversus Abdominus• The transversus abdominus helps
to support the abdominal viscera
• Maintain intra-abdominal pressure
• Stabilises the lumbar spine
• It is supplied by the lower six intercostals nerves
• Subcostal nerves
• Iliohypogastric nerves
Rectus Abdominus• Segmental muscle
• Two heads
• Anterior pubic symphysis
• Pubic crest
• Inserted anterior aspect of 5, 6, 7th costal cartilages
• Adhesions anterior surface
• Segmental blood and nerve
supply from Intercostals
• The rectus abdominus flexes the trunk
Rectus Abdominus• The rectus muscles (recti)
are the most powerful flexors of the vertebral column
• When raising the head from a supine position
• A movement often used to strengthen the abdominals
• It is the recti that contract first
• When the shoulders start to rise upwards, the obliques start to contract
MOB TCD
Rectus Sheath• Above zyphoid
• Anterior wall is the external oblique
• Posterior, costal cartilages
• From ziphoid and half way between umbilicus and pubic symphysis
• Anterior is external oblique and anterior lamella of internal oblique
• Posterior lamella internal oblique and transversus
Rectus Sheath• Below half way between
umbilicus and pubic symphysis
• The aponeurosis of the external oblique, internal oblique and transversus (conjoint tendon) pass anterior to the rectus
• Posterior lies the transversalis fascia
Rectus Sheath• Contents
• Rectus muscle
• Pyramidalis
• Superior and inferior epigastric vessels
• Lower five intercostal vessels and nerves
Transversalis Fascia• Lines deep aspect of
transversus abdominus
• Fuses with inguinal ligament
• Continuous with iliac fascia
• Except in the region of the femoral vessels
• Forms anterior wall of femoral sheath
Extraperitoneal Tissue• Extraperitoneal connective
tissue
• If fatty, it separates the
transversalis fascia from
the peritoneum
• If thin, they are in close contact with one another
Peritoneal Pouches• Peritoneal pouches are
found in the region of the deep inguinal ring
• Medial portion of the posterior wall
Posterior aspect anterior abdominal wall
Inguinal Canal• Intra muscular canal
• Lower portion of anterior abdominal wall
From
• Deep inguinal ring
• Superficial inguinal ring
• Transmits spermatic cord in male
• Round ligament in female
Superficial Inguinal Ring• Triangular opening in
aponeurosis of external oblique
• Base, pubic crest
• Superior crus attached to the pubic crest
• Inferior attached to pubic tubercle
• External spermatic fascia arises from its margins
Deep Inguinal Ring• Oval opening 2.5 cm
• Above the middle of inguinal ligament
• Inferior epigastric artery passes medial to the deep ring
Interfoveolar Ligament• The interfoveolar ligament is
an inconstant band
• Medial to deep inguinal ring
• Anterior to inferior epigastric vessels
• From lower margin of transversus abdominus
• To pectineal lineMcVay & Anson, 1949
Inguinal Canal• Anterior Wall
• External oblique forms
• Whole anterior wall
• Internal oblique forms
• Lateral half only
Inguinal Canal• Posterior Wall
• Transversalis fascia
• Whole of wall
• Medial half conjoint tendon
• Medial quarter reflected portion of inguinal ligament
Roof of Inguinal Canal
• Roof
• Arching fibres of internal oblique
• Transversus as they both arise from the inguinal ligament
Floor of Inguinal Canal• Floor
• Inguinal ligament forms whole of floor
• Medial half by the lacunar ligament
• Reflected part of inguinal ligament forms medial quarter
Passing Through Deep Ring Male
• Vas Deferens
• Testicular artery
• Pampiniform plexus of veins
• Remains of processus vaginalis
• Genital branch of genitofemoral nerve
• Lymphatics from testes
• Cremaster artery
Passing through Superficial Ring Male
• Everything that went through deep ring
• Plus
• Ilioinguinal nerve
• Internal spermatic fascia from margins of the deep ring
• Cremaster muscle and fascia
Passing through Deep Ring Female
• Round ligament of uterus
• Remains of processus vaginalis
• Genital branch of genitofemoral nerve
• Lymphatics from uterus, region of cornu
Passing through Superficial Ring Female
• Everything that went through deep ring
• Plus ilioinguinal nerve
Inguinal Canal• Contraction of the
abdominal muscles increases the obliquity of the inguinal canal
• Protecting the two ringsLytle, 1945
Increase in Intra-Abdominal Pressure
• Pain aggravated by an increase in intra- abdominal pressure
• Hernia
• Inguinal or femoral hernia
• Entrapment of the ilioinguinal nerve
Inguinal Hernia• Sudden severe pain in
lower abdomen
• Associated with lifting a heavy object
• Common history of a direct inguinal hernia
Indirect Inguinal Hernia• Passes through
• Deep inguinal ring
• May extend to pass through the superficial ring into the scrotum
• Congenital or acquired
• Congenital inside the tunica vaginalis (serous membrane, covers part of testes)
• Acquired outside
Direct Inguinal Hernia• Enters through posterior wall of
the inguinal canal
• Leaves through superficial inguinal ring
• Above and medial to the pubic tubercle
Inguinal Versus Femoral Hernia• Inguinal hernia above and
medial to pubic tubercle
• Femoral hernia below and lateral to the tubercle
• More common in females and more likely to strangulate
Femoral Hernia• Enters through femoral ring
• Enters femoral canal
• Medial compartment of femoral sheath
• More common in women
Saphenous Varix• Swelling is soft and
diffuse
• Empties on minimal pressure
• Refills on release
• Cough impulse is present
Gilmore’s Groin• Common cause of chronic groin
pain in field sports
• Particularly soccer players
• Pain on any sudden change of movement, sneezing, coughing
Gilmore’s Groin• Trying to sprint
• Will increase the pain
• Pain is worse getting out of bed
• The day after a match or a training session
Gilmore’s Groin• Pain is increased by
external rotation
• Or hyperextension of hip
• Pain is localised to lower anterior abdominal wall
• Adductor or perineal region
Gilmore’s Groin• Torn external oblique
aponeurosis
• Torn conjoint tendon
• A dehiscence between conjoint tendon and the inguinal ligament
• The absence of a hernial sac
• Superficial inguinal ring on the affected side is dilated and tender
• Cough impulse
Gilmore’s Groin Surgery• Treatment is surgical
• 90% return to sport
• Strengthen lower abdominal muscles
1.Plication of the transversalis fascia in “Shouldice hernia repair”
2.Repair of torn conjoint tendon