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Wall
Dr.
Bea/September
2,
2013
Prepared
by:
Katrina
Kabigting
Abdominal
wall
lower
part
of
the
torso
Divided
into
9
regions
by
drawing:
2
vertical
lines
along
the
side
of
the
neck
2
imaginary
lines
at
the
level
of
the
subcostal
margin
and
at
the
level
of
the
anterior
superior
iliac
spine
RH
Right
Hypochondriac
E
Epigastric
LH
Left
Hypochondriac
RL
-
Right
Lumbar
U
-
Umbilical
LL
Left
Lumbar
RI
Right
Inguinal
P
Pubic/Hypogastric
LI
Left
Inguinal
These
quadrants
give
us
an
idea
about
the
positions
of
the
different
organs.
However,
nowadays
we
divide
the
abdomen
into
four
quadrants
by
drawing:
1
vertical
line
exactly
in
the
middle,
passing
through
the
umbilicus
1
horizontal
line
at
the
level
of
the
umbilicus
Figure
2.
Four
quadrants
of
the
abdomen
MUSCLES:
External Oblique
Internal Oblique
Transverse abdominis
Rectus abdominis
Pyramidalis
2
types
of
muscles
in
the
abdominal
wall:
Muscles
found
in
the
middle,
fibers
oriented
vertically
(i.e.
rectus)
Muscles
found
at
the
side,
fibers
oriented
obliquely
or
transverse
(i.e.
obliques)
Rectus
abdominis
muscle
occupying
the
midline
or
the
middle
part
of
the
abdominal
wall
(rectus
straight,
i.e.
straight,
vertical
fibers)
Rectus
abdominis
fibers
are
vertical
but
are
not
continuous.
At
some
point,
along
the
length
of
the
muscle,
they
have
these
fibrous
or
tendinous
insertions.
This
is
the
reason
why
the
rectus
abdominis
is
divided
into
segments.
Pyramidalis
not
always
present,
present
at
the
midline,
tenses
the
linea
alba
Oblique
muscles
(external,
internal,
and
transverse
abdominis)
are
examples
of
flat
muscles.
Flat
muscles
muscles
that
attach
via
aponeurosis
The
rectus
sheath
is
a
sheath
of
fibrous
tissue
that
covers
the
rectus
abdominis.
This
is
derived
from
the
aponeurosis
of
the
oblique
muscles.
As
the
oblique
muscles
insert
themselves
by
means
of
aponeurosis,
they
also
create
a
covering
for
the
rectus
abdominis.
2
Layers:
The
posterior
rectus
sheath
does
not
extend
up
to
the
symphysis
pubis.
The
arcuate
line
or
the
semilunar
line
of
Douglas
is
the
point
of
termination
of
the
posterior
rectus
sheath.
What
covers
the
area
between
the
umbilicus
and
symphysis
pubis
now
is
the
transversalis
fascia.
Figure
3.
Cross-section
of
the
anterior
abdominal
wall
above
the
arcuate
line.
The
anterior
rectus
sheath
is
formed
by
the
aponeurosis
of
the
external
oblique
and
partly
by
the
aponeurosis
of
the
internal
oblique.
Posterior
rectus
sheath
is
formed
partly
by
the
aponeurosis
of
the
internal
oblique
and
that
of
the
transverse
abdominis.
Below
the
posterior
rectus
sheath
is
the
transversalis
fascia.
Figure
4.
Cross-section
of
the
anterior
abdominal
wall
below
the
arcuate
line.
The
posterior
rectus
sheath
is
absent
in
the
region
below
the
arcuate
line.
Three
ligaments
are
found
in
this
region.
The
one
in
the
middle
is
called
the
median
umbilical
ligament,
while
the
two
at
its
side
are
called
medial
umbilical
ligaments.
In
patent
urachus,
there
is
discharge
coming
out
of
the
umbilicus
because
there
is
still
a
connection
between
the
umbilicus
and
the
urinary
bladder.
Medial
umbilical
ligament
obliterated
umbilical
artery.
The
three
ligaments
only
extend
up
to
the
level
of
the
umbilicus.
At
this
point,
the
ligament
that
extends
up
beyond
the
umbilicus
is
called
the
ligamentum
teres
hepatis,
a
remnant
of
the
umbilical
vein.
As
the
transversalis
fascia
goes
over
the
inferior
epigastric
vessel,
it
also
creates
the
lateral
umbilical
ligament.
In
the
area
between
the
inferior
epigastric
vessel
(lateral
border),
lateral
border
of
the
rectus
abdominis
(medial
border),
and
the
inguinal
ligament
(inferior
border),
we
have
now
what
we
call
Hesselbachss
triangle.
This
triangle
is
a
point
of
weakness
in
the
lower
abdominal
wall.
This
is
a
potential
site
for
direct
inguinal
hernia.
Constant
stretching
of
the
abdominal
walls,
thereby
increasing
the
intraabdominal
pressure,
may
cause
this
hernia.
Direct
hernia
does
not
go
the
scrotal
area,
medial
to
the
inferior
epigastric
vessels
Indirect
hernia
manifests
lateral
to
the
inferior
epigastric
vessels.
BLOOD SUPPLY
4
lumbar
arteries
VENOUS
DRAINAGE
use
the
umbilicus
as
the
central
point:
venous
drainage
will
either
be
going
up
to
the
superior
epigastric
vein
or
down
towards
the
external
iliac
vein
Venae commitantes
&
4 &
:&
'
:
*
4
0"
%
Sensory
component
will
innervate
the
skin
covering
"
$ &: *
4
the
abdominal
wall.
Sensory
innervation
is
also
by
dermatomal
level.