Surface
Landmarks of the Abdominal Wall
The linea alba is a vertically running fibrous band that extends
from the symphysis pubis to the xiphoid process and lies in the midline . It is
formed by the fusion of the aponeuroses of the muscles of the anterior abdominal
wall and is represented on the surface by a slight median groove.
Umbilicus
The umbilicus lies in the linea alba and is inconstant in position.
It is a puckered scar and is the site of attachment of the umbilical cord in
the fetus.
Iliac Crest
The iliac crest can be felt along its entire length and ends
in front at the anterior superior iliac spine
and behind at the posterior superior iliac spine. Its highest point lies
opposite the body of the4th lumbar vertebra.
About 2 in. (5 cm) posterior to the anterior superior iliac
spine, the outer margin projects to form the tubercle of the crest . The
tubercle lies at the level of the body of the 5th lumbar vertebra.
Pubic Tubercle
The pubic tubercle is an important surface landmark. It may
be identified as a small protuberance along the superior surface of the pubis.
Symphysis Pubis
The symphysis pubis is the cartilaginous joint that lies in the
midline between the bodies of the pubic bones . It is felt as a solid structure
beneath the skin in the midline at the lower extremity of the anterior
abdominal wall. The pubic crest is the name given to the ridge on the superior
surface of the pubic bones medial to the pubic tubercle.
Rectus Abdominis
The rectus muscle lie on both side of the linea alba and run
vertically in the abdominal wall; they can be made prominent by asking the
patient to raise the shoulders while in the supine position without using the
arms.
Tendinous Intersections of the Rectus Abdominis
The tendinous intersections are three in number and run across
the rectus abdominis muscle. In muscular individuals, they can be palpated as
transverse depressions at the level of the tip of the xiphoid process, at the
umbilicus, and halfway between the two (see Fig. 4.11).
Linea Semilunaris
The linea semilunaris is the lateral edge of the rectus abdominis
muscle and crosses the costal margin at the tip of the ninth costal cartilage.
To accentuate the semilunar lines, the patient is asked to lie on the back and
raise the shoulders off the couch without using the arms. To accomplish this,
the patient contracts the rectus abdominis muscles so that their lateral edges stand
out
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