The abdominal wall encloses the abdominal cavity, and can be divided into anterolateral and posterior sections. Its key functions include:
Superficial FasciaThe superficial fascia consists of fatty connective tissue. The composition of this layer depends on its location:
Fig 1 – The layers of the anterolateral abdominal wall. Below the umbilicus, there are two layers of superficial fascia – Camper’s and Scarpa’s.
Muscles of the Abdominal WallThe muscles of the anterolateral abdominal wall can be divided into two main groups:
In the anteromedial aspect of the abdominal wall, each flat muscle forms an aponeurosis(a broad, flat tendon), which covers the vertical rectus abdominis muscle. The aponeuroses of all the flat muscles become entwined in the midline, forming the linea alba (a fibrous structure that extends from the xiphoid process of the sternum to the pubic symphysis).
The external oblique is the largest and most superficial flat muscle in the abdominal wall. Its fibres run inferomedially.
The internal oblique lies deep to the external oblique. It is smaller and thinner in structure, with its fibres running superomedially (perpendicular to the fibres of the external oblique).
Picture: The muscles of the anterolateral abdominal wall. Note how the flat muscles form aponeuroses medially.
The transversus abdominis is the deepest of the flat muscles, with transversely running fibres. Deep to this muscle is a well-formed layer of fascia, known as the transversalis fascia.
The rectus abdominis is long, paired muscle, found either side of the midline in the abdominal wall. It is split into two by the linea alba. The lateral border of the two muscles create a surface marking, known as the linea semilunaris.
At several places, the muscle is intersected by fibrous strips, known as tendinous intersections. The tendinous intersections and the linea alba give rise to the ‘six pack’ seen in individuals with a well-developed rectus abdominis.
This is a small triangular muscle, found superficially to the rectus abdominis. It is located inferiorly, with its base on the pubis bone, and the apex of the triangle attached to the linea alba.
Clinical Relevance: Surgical Incisions in Abdominal Wall
Vertical Incisions Median
An incision that is made through the linea alba. It can be extended the whole length of the abdomen, by curving around the umbilicus. The linea alba is poorly vascularised, so blood loss is minimal, and major nerves are avoided. All can be used in any procedure that requires access to the abdominal cavity.
Similar to the median incision, but is performed laterally to the linea alba, providing access to more lateral structures (kidney, spleen and adrenals). This method ligates the blood and nerve supply to muscles medial to the incision, resulting in their atrophy.
Transverse Incisions Transverse
This incision is made just inferior and laterally to the umbilicus. This is a commonly used procedure, as it causes least damage to the nerve supply to the abdominal muscles, and heals well. The incised rectus abdominis heals producing a new tendinous intersection. It is used in operations on the colon, duodenum and pancreas.
Suprapubic incisions are made 5cm superior to the pubis symphysis. They are used when access to the pelvic organs is needed. When performing this incision, care must be taken not the perforate the bladder (especially if it is not catheterised), as the fascia thins around the bladder area.
This incision starts inferior to the xiphoid process, and extends inferior parallel to the costal margin. It is mainly used on the right side to operate on the gall bladder, and on the left to operate on the spleen.
This is a ‘grid iron’ incision, because it consists of two perpendicular lines, splitting the fibres of the muscles without cutting them – this allows for excellent healing. McBurney incision is performed at McBurney’s point (1/3 of the distance between the ASIS and the umbilicus). It is mostly used in appendectomies.
Surface AnatomyThe abdominal cavity contains numerous organs – many of which can be palpated through the abdominal wall, or their position can be visualised by surface markings.
The umbilicus is the most visible structure of the abdominal wall, and is the scar of the site of attachment of the umbilical cord. It is usually located midway between the xiphoid process and the pubis symphysis.
The rectus abdominis muscle gives rise to abdominal markings. The lateral border of this muscle is indicated by the linea semilunaris, a curved line running from the 9th rib to the pubic tubercle. The linea alba is a fibrous line that splits the rectus abdominis into two. It is visible as a vertical groove extending inferiorly from the xiphoid process.
The abdomen is a large area, and so it split into nine regions – these are useful clinically for describing the location of pain, location of viscera and describing surgical procedures. The nine regions are formed by two horizontal and two vertical planes:
The water with ginger is really effective in the stimulation of burning fat in the body and it is helping you to get slimmer and fit on a totally natural way. This potion is really useful to stimulate the burning of the fat on the arms, belly, thighs, hips which are the most difficult areas for losing weight. Ginger water, not only will help you lose weight, it also has a lot of benefits for your health. Some of these are:
Lowers the blood pressure that is high – drink ginger water regularly and that will help you in the reduction of the high blood pressure and it will help you stop the forming of blood clots.
Antioxidant – ginger water has a power to kill the free radical in the body and it will prevent them from damaging the tissue and the organ.
It is reducing the levels of cholesterol – this potion reduces the high levels of cholesterol and it is preventing diseases connected to high cholesterol.
Effective for infection- It is very effective for a lot of diseases that are infectious and it is good to fight the inflammation. Actually, it reduces the risk of pain in the joint.
Anti –inflammatory properties – It stops the inflammations and it is helps you to fight cancer of all types.
Other positive effects from ginger water:
ภimproves the circulation
Zinc and magnesium are present in ginger and they are crucial for a good circulation and blood flow. Ginger also stops the accumulation of the cholesterol in the liver and protects it from many diseases. It makes you sweat less and it lowers high fever.
-Improve the absorption of the nutrients
If you drink ginger water regularly the body will have the necessary nutrients and it is improving the absorption of the nutrients. That is because it is stimulating the production of the stomach bile. If you are losing your appetite, all you need to do is to chew ginger before you eat and this will help you.
Help with the flu
Because of its expectorant property, which is very useful, it offers protection from flu and common cold. Ginger water is helping your immune system and helps you to stop coughing and reduces the inflammations.
Improves the digestion
Ginger is improving the absorption of the nutrient thus is improving the digestion. It is calming the irritated stomach and it is eliminating the indigestion and the flatulence.
It is boosting the immune system
As it was mentioned, the ginger is improving the immune system and it is protecting your organism from different chronic diseases and infections. It is giving excellent results in the fight against common cold and flu and it is protecting you from bacteria. Ginger water is also reducing the risk of having a stroke.
It is alleviating the pain in the joints
The ginger is soothing the pain in the joints and it is reducing the inflammations because it has anti-inflammatory properties.
Recipe for ginger water:
• Lemon juice
• 1.5 ltrs Water
Boil the water and put the ginger in it. Leave the mixture to simmer about fifteen minutes and then put it somewhere to cool it off. You should strain the mixture and put it in a glass. Then you can put the lemon and Honey your choice.
Q & A
Contraindication for a postnatal / postpartum massage?
A massage will not be performed with:
video of Abdominal Wall