HEAD(Station 1-10)
NECK(Station 1-10)
THORAX(Station 1-11)
ABDOMEN(Station 1-10)
UPPER LIMB (Station 1-10)
LOWER LIMB(Station 1-11)

ABDOMEN

OSCE
Station 4

Anterior Abdominal Wall

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The anterior abdominal wall can be devided into 9 regions.

The 9 regions are formed by 2 horizontal and 2 vertical lines:

  • 1st horizontal line - Transpyloric plane- corresponds to the 9th costal cartilages bilaterally and the lower border of L1 vertebra.
  • 2nd horizontal line - Transtubercular plane- the line joining the iliac tubercles. Corresponds to the level of the lower border of L4 / upper border of L5 vertebral bodies.
  • 2 vertical lines: Midclavicular planes - drawn from the mid-inguinal points (midway between anterior superior iliac spine and pubic symphysis) superiorly to the midpoint of the clavicles (approximately 9 cm from the midline)

Note: The point where the right vertical line intersects the transtubercular line is the approximate location of the ileocaecal valve.

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"In a flat and muscular abdomen, the umbilicus lies at the level of L4 vertebra. This can vary in a pendulous abdomen. "
"The transpyloric plane lies midway between the suprasternal (jugular) notch and the pubic symphysis (superior edge). It usually corresponds to the level of the lower border of L1 vertebra. "
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The structures that lie on the level of the transpyloric plane include the: 

  • The pylorus of the stomach
  • Fundus of the gallbladder
  • Head of the pancreas
  • Formation of the portal vein by the joining of the superior mesenteric and splenic veins
  • 2nd part of the duodenum
  • Duodeno-jejunal flexure
  • Origin of the superior mesenteric artery from the aorta
  • Right and left colic flexures
  • Hilum of the spleen
  • Upper pole of right kidney
  • Hilum of left kidney
  • The linea semilunaris crossing the costal margin
  • End of the spinal cord in adults
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  • Skin
  • Subcutaneous fat
  • Superficial layer of superficial fascia (Camper’s)
  • Deep layer of superficial fascia (Scarpa’s)
  • External oblique muscle
  • Internal oblique muscle
  • Transverse abdominal muscle
  • Transversalis fascia
  • Pre-peritoneal fat
  • Peritoneum
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  • Skin
  • Subcutaneous fat
  • Scarpa’s fascia (below the umbilicus)
  • Linea alba
  • Transversalis fascia
  • Pre-peritoneal fat
  • Peritoneum
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The two vertical muscles of the anterior abdominal wall are both contained within the rectus sheath. They are:

  • Rectus abdominis
  • Pyramidalis
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  • Rectus abdominis
  • Pyramidalis
  • Superior and inferior epigastric arteries and veins
  • Lymphatics
  • Ventral ramin of T7-T12 nerves
  • Fibro-fatty connective tissue
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 The arterial supply to the anterolateral abdominal wall arises from the:

  • Superior epigastric artery: arising from the internal thoracic artery.
  • Inferior epigastric artery and deep circumflex iliac artery: arising from the external iliac artery.
  • Superficial circumflex iliac artery and superficial epigastric artery: arising from the femoral artery.
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"A Spigelian hernia, also known as the lateral ventral hernia, is herniation through the aponeurotic layer between the rectus abdominis muscle medially and the semilunar line laterally (this aponeurotic layer is called the Spigelian fascia). "