Landmarks of Abdomen
Pubic tubercle: Small bony projection can be felt at medial end of fold of groin Pubic crest: Short bony ridge between pubic tubercle and pubic symphysis Pubic symphysis: Lies in median plane at level of tip of coccyx
Dr. Praveen Kurrey
08-09-2025
Arterial Supply of Abdominal Wall
Anterior cutaneous branches of superior and inferior epigastric arteries Lateral cutaneous branches of posterior intercostal arteries Three superficial branches of femoral artery Superficial external pudendal artery Superficial epigastric artery Superficial circumflex iliac artery Deep circumflex iliac artery (branch of external iliac artery)
Dr. Praveen Kurrey
08-09-2025
Nerves of Abdominal Wall
Supplied by lower six thoracic nerves and first lumbar nerves-PKK
Dr. Praveen Kurrey
08-09-2025
Superficial Fascia Of Abdomen
Fascia of Camper (superficial fatty layer) This layer – continuous with subcutaneous fat of adjoining areas In penis – devoid of fat; in scrotum, replaced by involuntary dartos muscle-PKK
Dr. Praveen Kurrey
08-09-2025
Bony Cavity of Abdomen
Bounded as follows Superiorly by xiphoid process and right and left costal margins Inferiorly by iliac crest, fold of groin, pubic tubercle,pubic crest, and pubic symphysis On each side, extends up to midaxillary line and continues with posterior abdominal wall-PKK
Dr. Praveen Kurrey
08-09-2025
Holdens Line- Abdomen
Holden’s line: Extends 8 cm laterally from pubic tubercle in horizontal plane-PKK
Dr. Praveen Kurrey
08-09-2025
Extravasated Urine Flow- Abdomen
Due to attachment of fascia of Scarpa, extravasated urine in ruptured urethra gets accumulated in superficial perineal pouch in thigh up to Holden’s line and in anterior abdominal wall inferior to umbilicus
Dr. Praveen Kurrey
08-09-2025
Cutaneous Nerves-Abdomen
Supplied by lower six thoracic nerves and first lumbar nerves
Dr. Praveen Kurrey
08-09-2025
Superficial Veins- Abdomen
Above umbilicus: These veins run toward axilla and drain into axillary vein and finally to superior vena cava Below umbilicus: Cutaneous veins run toward groin and drain into great saphenous vein and finally to inferior vena cava Small veins (paraumbilical veins) from umbilicus run along ligamentum teres drain into portal vein
Dr. Praveen Kurrey
08-09-2025
Superficial Lymphatics -Abdomen
axillary and superficial inguinal nodes and follow water-shed line at level of umbilicus as follows -- 1. Above umbilicus, lymphatic vessels run upward to drain into the axillary lymph nodes 2. Below umbilicus, lymphatic vessels run downward to drain into superficial inguinal nodes
Dr. Praveen Kurrey
08-09-2025
Dermatomes- Abdomen
Lower six thoracic nerves (T7–T12) Two lateral intercostal nerves are derived from lower two intercostal nerves (T10, T11) pierce external intercostal muscle Divided into anterior and posterior divisions to supply skin on side of abdomen
Dr. Praveen Kurrey
08-09-2025
External Oblique Muscle -Abdomen
Origin-- Originates by eight fleshy slips from outer surfaces of middle of shafts of lower eight ribs Direction of fibers-- Run downward, forward, and medially (similar to direction of fingers when one keeps hand in Trousers’ pocket)
Dr. Praveen Kurrey
08-09-2025
External and Internal Oblique Muscle
External Oblique-- Insertion Posterior most fibers insert on outer lip of anterior 2/3rd of iliac crest Posterior border of muscle extends from 12th rib to iliac crest Forms anterior boundary of lumbar triangle of petit
Dr. Praveen Kurrey
08-09-2025
Internal Oblique Muscle
Origin-- 1. Lateral 2/3rds of upper surface of inguinal ligament 2. Intermediate area of anterior 2/3rd of iliac crest 3. Thoracolumbar fascia
Dr. Praveen Kurrey
08-09-2025
Transversus Abdominis
Origin-- Lateral 1/3rd of upper surface of inguinal ligament Inner lip of anterior 2/3rd of iliac crest Thoracolumbar fascia Inner surfaces of lower six ribs and their costal cartilages
Dr. Praveen Kurrey
08-09-2025
Rectus and Transversus Abdominis muscle
Rectus Abdominis-- Long, flat strap muscle supports anterior abdominal wall (rectus = straight in Latin) Origin Originates by two tendons or heads Medial head originates from anterior surface of pubic symphysis and anterior pubic ligament Lateral head originates from lateral part of pubic crest Insertion Inserts on horizontal line passing laterally from xiphoid process Intersecting 5th, 6th, and 7th costal cartilages Innervation Ventral primary rami of lower six or seven nerves (T7–T12) Actions Maintains anterior abdominal wall tone during standing Flexion of trunk on pelvis Protects abdominal viscera
Dr. Praveen Kurrey
09-09-2025
Pyramidalis Muscle
Origin-- Front pubic crest and anterior pubic ligament Direction of fibers--Run upward and medially Insertion--Inserts into linea alba, midway between umbilicus and pubic symphysis Innervation--Subcostal nerve (T12) Action--Tenses linea alba
Dr. Praveen Kurrey
09-09-2025
Cremaster Muscle
Origin-- Superficial fibers – originate from middle 1/3rd of upper surface of inguinal ligament Deep fibers – originate from pubic crest and conjoint tendon Insertion Superficial fibers extend along spermatic cord and reach scrotum Superficial and deep fibers – connected with each other around spermatic cord and upper part of scrotum In females, few fibers of cremaster muscle accompany round ligament of uterus, Innervation---Genital branch of genitofemoral nerve (L1–L2) Mostly these fibers carry sympathetic innervation Cremaster muscle – not under voluntary control, Actions--- Pulls testis upward toward superficial inguinal ring helps in closing superficial inguinal ring and controlling temperature of testis
Dr. Praveen Kurrey
09-09-2025
Iliohypogastric and Ilioinguinal Nerve
Iliohypogastric Nerve--Branch of 1st lumbar nerve Close to iliac crest, nerve divides into Lateral branch – pierces external and internal oblique muscle, passes posteriorly to supply skin of gluteal region Anterior branch – pierces internal oblique at 2.5 cm medial to anterior superior iliac spine Pierces external oblique about 3 cm above superficial inguinal ring
Dr. Praveen Kurrey
09-09-2025
Fascia Transversalis
Thin layer of areolar membrane lines deeper surface of transverse abdominis muscle Extent-- Superiorly, continuous with ill-defined subdiaphragmatic fascia Inferiorly -- continuous with fascia iliaca (fascia covering iliacus muscle) Extent Attached to iliac crest, inguinal ligament, pecten pubis, and pubic crest Continuous with pelvic fascia
Dr. Praveen Kurrey
09-09-2025
8 Layers of Anterior Abdominal Wall
Consists of eight layers from superficial to deep as follows Skin Superficial fascia External oblique muscle and aponeurosis Internal oblique muscle and aponeurosis Transverse abdominis muscle and aponeurosis Fascia transversalis Extra peritoneal connective tissue Parietal layer of peritoneum
Dr. Praveen Kurrey
09-09-2025
Muscles of Anterior Abdominal Wall
External oblique Internal oblique Transverse abdominis Rectus abdominis Pyramidalis External oblique, internal oblique, and transverse abdominis – large, broad, flat muscles
Dr. Praveen Kurrey
09-09-2025
27. Conjoint Tendon
Internal Oblique + Transversus Abdominis- Conjoint tendon (FALX INGUINALIS-) -It inserts into the pubic crest and pectineal line, strengthening the posterior wall of the inguinal canal, and its weakness can lead to direct inguinal hernias.
Dr. Praveen Kurrey
02-05-2026
27. Rectus Sheath
The rectus sheath is a durable, multi-layered fibrous compartment (aponeurosis) that surrounds the rectus abdominis and pyramidalis muscles in the anterior abdomen. It acts as a protective sleeve, providing structural integrity, abdominal wall strength, and preventing muscle bowing during contraction. It is formed by the fused aponeuroses of the external oblique, internal oblique, and transversus abdominis muscles.
Dr. Praveen Kurrey
02-05-2026
28. Boundaries of Rectus sheath
The rectus sheath is a fibrous compartment enclosing the rectus abdominis and pyramidalis muscles, formed by the aponeuroses of the oblique and transversus abdominis muscles. Its boundaries consist of the medial linea alba (where sheaths meet) and lateral linea semilunaris (where fascia splits), extending from the pubic symphysis inferiorly to the costal cartilages (5th-7th) superiorly-PKK
Dr. Praveen Kurrey
02-05-2026
29. Abdominal Wall- Anterior and Posterior
-The abdominal wall consists of anterolateral and posterior components, providing structural integrity, visceral protection, and movement, layered from superficial to deep as skin, fascia, muscles, and parietal peritoneum. The anterior wall is formed by muscles like the rectus abdominis, whereas the posterior wall is built upon the lumbar spine, featuring muscles like the psoas major and quadratus lumborum
Dr. Praveen Kurrey
02-05-2026
30. Remnants of Umblicus
[Urachal Remnants]: These occur when the urachus—a tube that channels urine from the fetus to the allantois—fails to close and turn into a ligament. They can manifest as a [patent urachus], [urachal cyst], or [sinus]. [Omphalomesenteric Duct Remnants]: These are remnants of the connection between the yolk sac and the gut, which can appear as polyps or fistula .[Umbilical Granuloma]: A small piece of red tissue that remains at the belly button after the umbilical cord separates
Dr. Praveen Kurrey
02-05-2026
31. Superficial Fascia of Abdominal Wall
It is the subcutaneous connective tissue layer located between the skin and the deep abdominal muscles. Inferior to the umbilicus, it divides into two layers: the fatty superficial Camper’s fascia and the deeper membranous Scarpa’s fascia, which is significant in preventing deep abdominal infections from spreading to the thigh
Dr. Praveen Kurrey
02-05-2026
32. Inguinal Canal -Boundaries
Anterior Wall (A): Aponeurosis of the external oblique muscle (along its entire length) and the lateral third of the internal oblique muscle. Posterior Wall (T): Transversalis fascia throughout, reinforced medially by the conjoint tendon (fused internal oblique and transversus abdominis aponeuroses). Roof/Superior Wall (M): Arched fibers of the internal oblique and transversus abdominis muscles. Floor/Inferior Wall (L): Inguinal ligament (a "rolled" edge of the external oblique aponeurosis) and the lacunar ligament medially.
Dr. Praveen Kurrey
02-05-2026
33. Inguinal Rings- Superficial and Deep
. The deep inguinal ring acts as the internal opening, formed by the transversalis fascia, while the superficial inguinal ring serves as the external, triangle-shaped opening in the aponeurosis of the external oblique muscle.
Dr. Praveen Kurrey
02-05-2026
34. Inguinal Canal -Walls
Anterior Wall (Front)Main Component: Aponeurosis of the external oblique muscle along its entire length. Lateral Reinforcement: Internal oblique muscle (lateral third). Superficial Ring: The aponeurosis forms the superficial inguinal ring medially. Posterior Wall (Back)Main Component: Transversalis fascia throughotu. Medial Reinforcement: Conjoint tendon (fused aponeuroses of internal oblique and transversus abdominis) and the reflected inguinal ligament. Deep Ring: The deep inguinal ring is a defect in the transversalis fascia lateral to the inferior epigastric vessels
Dr. Praveen Kurrey
02-05-2026
35. Inguinal Canal Location and Structure
The inguinal canal is a 4-5 cm long, oblique passage located in the lower anterior abdominal wall on both sides, just superior to the medial half of the inguinal ligament. It extends from the deep inguinal ring (midpoint of the inguinal ligament) to the superficial inguinal ring (above the pubic tubercle)
Dr. Praveen Kurrey
02-05-2026
36. Inguinal Hernia- Indirect
An indirect inguinal hernia is a common congenital hernia caused by a failure of the abdominal wall to close properly before birth, causing a bulge in the groin or scrotum. It often requires surgery to repair. Symptoms include pain or a visible bulge, while risk factors include being male, chronic cough, and heavy lifting.
Dr. Praveen Kurrey
02-05-2026
37. Direct Inguinal Hernia- Medial and Lateral
A direct inguinal hernia is an acquired abdominal wall defect where intestinal tissue pushes through a weakened area of the abdominal muscle (Hesselbach’s triangle) in the groin. Common in older men due to aging, it causes a visible bulge that is often painless, yet painful or enlarged when coughing, lifting, or straining. Surgery (often mesh repair) is the primary treatment.
Dr. Praveen Kurrey
02-05-2026
38. Direct and Indirect Inguinal Hernia
Direct inguinal hernias are acquired weaknesses in the abdominal wall, typically affecting older men, Indirect inguinal hernias are usually congenital (present from birth) and more common in children. Direct hernias protrude directly forward through Hesselbach's triangle, while indirect hernias pass through the inguinal canal, lateral to the epigastric vessels
Dr. Praveen Kurrey
02-05-2026
39. Inguinal Hernia
Anatomical Position (Medial vs. Lateral): The most reliable way to differentiate them surgically is their relation to the inferior epigastric vessels. Direct hernias are medial (closer to the belly button), and indirect are lateral (closer to the hip).Causes: Direct hernias occur over time due to chronic strain or weak muscles, whereas indirect hernias result from a tube-like structure (processus vaginalis) failing to close during development.Presentation: Both appear as bulges in the groin that may worsen with coughing or standing. However, indirect hernias are more likely to descend into the scrotum.Physical Exam (Zieman's test):Index finger: Suggests indirect.Middle finger: Suggests direct.Ring finger: Suggests femoral hernia.
Dr. Praveen Kurrey
02-05-2026
40. Inguinal Canal
Contents Males: Spermatic cord, gonadal vessels, and ilioinguinal nerve. Females: Round ligament of the uterus and ilioinguinal
Dr. Praveen Kurrey
02-05-2026
41. Inguinal Hernia
Location: Indirect occurs lateral to the inferior epigastric vessels, frequently descending into the scrotum. Direct occurs medial to these vessels, usually not reaching the scrotum. Cause: Indirect is usually due to a birth defect (persistent process vaginalis). Direct is acquired over time from weakened abdominal muscles and chronic pressure. Path: Indirect enters the deep inguinal ring, while direct pushes through the posterior wall of the inguinal canal.
Dr. Praveen Kurrey
13-05-2026