Anatomy of the Abdominal Wall

       Know the surface anatomy:
Identify
 The sternal angle of Louis (Manubriosternal junction)  (T4 5 IV disc, 2nd costal cartilage)

 Xiphisternal joint (T9 Verebra) and subcostal angle

 Costal margin with it's lowest point being the 10th costal cartilage

 Central tendon of diaphragm is at the level of xiphisternal junction
    Right cupula- upper border of 5th rib
    Left cupula- lower border of 5th rib

Umbilicus - approx L3 vertebra

Iliac crest - ends anteriorly at ASIS. 
Inguinal ligament: ASIS to pubic tubercle

Midline groove overlies linea alba. Outer border of rectus - linea semilunaris. Intersects subcostal margin at 9th costal cartilage

ZONES - USING BONY LANDMARKS

SUBCOSTAL PLANE (Across 10th costal cartilage. 3rd Lumbar Vertebra)
INTERTUBERCULAR PLANE (Across Iliac Tubercles which are 2 inches behind ASIS)(L5)
RIGHT AND LEFT VERTICAL PLANES (At midpoint of inguinal lig i.e., midpt of ASIS and midline)

REGIONS:
EPIGASTRIC (Stomach) , UMBILICAL, HYPOGASTRIC
HYPOCHONDRIUM (Spleen) , LUMBAR (Asc colon) , ILIAC (Appendix)

TRANSPYLORIC PLANE - 9th costal cartilage (Ask patient to raise shoulders to get the lateral margin of rectus or the linea semilunaris, Where this crosses the costal margin is 9th costal cartilage) (Goes thru Pylorus, Duodenojejunal junction, neck of pancreas, hila of kidneys)

Intercristal plane- Highest plane of iliac crest --- L4 (Above intertubercular)

Organs
Fundus of Gall bladder: 9th costal cartilage

Lower pole Right kidney can be felt normally

REFERRAL
VISCERA------>   SPLANCHNIC NERVES ---- >   REFERRED VIA INTERCOSTAL NERVES TO ANTERIOR ABDOMINAL WALL (SKIN, MUSCLES AND PERITONEUM)

INTERCOSTAL NERVE- T7,T8, T8, T10 (umbilicus), T11, SUBCOSTAL NERVE T12, AND TWO NERVES FROM ANT RAMUS OF L1- Ilioinguinal and Iliohypogastric

Stomach- epigastric
Appendix- Umbilical
Bladder pain- referred to hypogastric region
Arterial supply to follow