Words in bold
The Abdomen:
Superficial epigastric arteries and veins: the superior epigastric vein anastomoses with lateral thoracic
vein in the superficial fascia collateral venous channel from the femoral vein to the axillary . If
obstruction of inferior vena cava or hepatic portal vein caput medusae.
Anterior cutaneous nerves : are branchings of the intercostal nerves :T7(below 7 and 8
rib),subcostal(T12),iliohypogastric L1(below L1 )
Lateral cutaneous nerves: from the intercostal and subcostal nerves
T6 innervates the skin superficial to the xiphoid process
T10 innervates the skin of the umbilicus
T12 innervates the skin superior to the pubic symphysis
L1 innervates the skin overlying the pubic symphysis
External Oblique : superolateral to inferomedial
Insertions: proximal : 5-12 rib
distal: linea alba, pubic crest and tubercle anterior half of the iliac crest
Innervation : Thoracoabdominal nerves (T7-T11)+ subcostal nerve (T12)
compresses and supports the abdominal viscera , flexes and rotates the trunk
External spermatic Fascia and superficial inguinal ring are made by the aponeurosis of the External
oblique muscle .
ilioinguinal nerve is anterior to the spermatic cord : sensory sensation to the anterior of the external
genitalia and medial thigh . It is between the external and internal oblique . Inferior and parallel to
iliohypogastric.
Inguinal canal has a medial and a lateral crus +intercrural fibers
(prevent the crura from spreading apart )
Inguinal ligament: from the ASIS to the pubic tubercle
Lacunar ligament : form at the medial end of the inguinal ligament , with fibers that turn posteriorly
and attach to the pecten pubis
Internal Oblique Muscle: superomedial to inferolateral
Proximal attachment :Iliac crest , thoracolumbar fascia , lateral half of the inguinal ligament
Distal attachment: linea alba , ribs 10-12, pubic crest and pecten pubic via conjoint tendon
Innervation:T17-T11 + subcostal and L1
Action: Compresses and supports the abdominal viscera + flexes and rotates the abdominal trunk
Aponeurosisconjoint tendon posterior to inguinal canal
Arching fibers  roof of inguinal canal
Cremaster muscle: from the internal oblique to the spermatic cord
Ilioinguinal nerve: between the internal and external oblique , parallel and inferior to the
iliohypogastric
The conjoint tendon :aponeurosis of the internal oblique and transvers abdominis
Transversus abdominus: horizontal
Proximal attachment: Thoracolumbar fascia, Iliac crest internal surface of costal cartilage(7 to 12)
Distal attachment: linea alba ,pubic crest ,pecten pubis via conjoint tendon
Innervation:T7-T11,T12,L1
Action: compresses and supports the abdominal viscera, flexes and rotates the abdominal trunk
The arching fibers of the transversus abdominis forms the roof of the inguinal canal and its aponeurosis
forms part of the posterior abdominal wall
Inguinal hernias: the inguinal canal is a weak point in which the abdominal viscera can protrude
Direct: through the hesselbach triangle , medial to the inferior epigastric artery
Indirect (congenital): through the deep inguinal canal , lateral to the inferior epigastric artery
Hesselbach’s triangle:
Bound :
Laterally by : the inferior epigastric vessel
Medially by : the rectus abdominis
Inferiorly by: the inguinal ligament
The Rectus Sheath : Rectus abdominus ,superior and inferior epigastric vessels(on the posterior side of
the rectus abdominus, within the extraperitoneal fascia) , pyramidalis muscle , ventral terminal of rami
of T7-T11anterior cutaneous nerves
Rectus abdominus : from the fifth rib to pubic symphysis
Proximal attachment : Xiphoid process , costal cartilage 5 to 7
Distal attachment: pubic symphysis and pubic crest
Innervation:T7-T11 and subcostal T12
Action: compresses abdominal viscera , flexes trunk , pelvic tilt
Has tendinous intersections
Pyramidalis muscle: attaches to the anterior surface of the pubis and linea alba tension on the linea
alba
Linea Alba: because there are no bones in the anterior abdominal wall , the linea alba serves as a muscle
attachment
Rectus Sheath:
Above arcuate line : anteriorly and posteriorly : aponeurosis of the three muscles
Below arcuate line: only anteriorly
The inferior epigastric vessels are much larger than the posterior , they enter the rectus sheath at the
level of the arcuate line
Epigastric anastomosis: The superior and inferior epigastric anastomosis together , if the IVC is
obstructed they go to the PVC. If the aorta is obstructed, they take its place.
External iliac and internal thoracic
Transversalis fascia: lines the inner surface of the transverse abdominus.
The deep inguinal ring : the point at which the gubernaculum passed through the transversalis fascia
during development .
Inguinal canal :
Anterior: External Oblique
Posterior: Transversalis fascia laterally and conjoint tendon medially
Superior: the arching of the oblique and transvers
Inferior: Inguinal ligament and lacunar ligament
Falciform ligament : connects the anterior wall to the anterior surface of the liver
Umbilical folds:
Medial: remnant of the umbilical artery
Median: urachus(remnant of the allantois)
Lateral: epigastric vessels
The lesser omentum :composed of the hepatogastric ligament and hepatoduodenal ligament .
The Greater omentum: composed of the gastrophrenic gastrosplenic and gastrocolic ligaments. Made of
two double layers of peritoneum . Continuous with the lesser omentum which links the liver to the
stomach.
The rectum is located partly in the abdomen , partly in the pelvis
The round ligament at the inferior edge of the falciform ligament , contains remnant of left umbilical
veins from development .
The coronary ligament is around the liver and joins at left and right triangular ligaments.
Omental bursa=lesser sac
The transverse mesocolon: attaches from the transverse colon to the anterior surface of the duodenum
and pancreas
Phrenicocolic ligament : attaches the left colic flexure to the diaphragm
Mesentery: suspends the ileum and jejunum to the posterior abdominal wall
Mesoappendix: Attaches the appendix to the distal ileum and cecum and contains the appendicular
artery
Sigmoid mesocolon: Suspends the sigmoid to the posterior abdominal wall
Omental foramen lies posterior to the hepatoduodenal ligament
Boundaries of omental foramen:
Anterior: hepatoduodenal ligament
Posterior: The parietal peritoneum overlying the IVC and the right crus of the diaphragm
Superior: liver
Inferiorly : first part of duodenum
Superior and inferior recesses of the lesser peritoneal sac
Intraperitoneal organs: Stomach , liver , spleen , rectum(1/3),sigmoid colon , tail of pancreas , first part
of duodenum , ileum, jejunum , cecum the transverse colon
Retroperitoneal organs:
Suprarenal glands, aorta and IVC ,duodenum(except first part) secondary ,Pancreas (except tail)
secondary ,ureters, colon(ascending descending)secondary ,kidneys,esophagus,rectum(2/3)
Liver in the right upper quadrant (the ligaments are made of peritoneum) right kidney lower than left
The spleen is in the upper left , next tol the stomach
The stomach is deep to the liver
Gastrosphrenic ligament :greater curvature of the stomach to diaphragm
Gastrosplenic: greater curvature of the stomach to the spleen
Splenorenal: spleen to the wall anterior to the left kidney