PRACTICAL GUIDE FOR THE ANTEROLATERAL ABODOMINAL WALL AND
THE GASTROINTESTINAL TRACT
THEME (WEEK7-11)
Systemic anatomy I (ATM 3512)
Author: Albertina Shatri
Year: 2021
Practical Instructor
Mrs A. Shatri
Prof O.Azu
Dr K.van Niekerk
Prof Q. Wesseles
Mr. J. van der Merwe
Dr A. Duplessis
Mrs A. Poolman
Ms D. Bouman
Mr J. Lakanemo
General instructions
Hands on dissections will start on Tuesday 31 August 2021.
1. The practical slots will run according to the time table in the study guide (Table 1).
2. The groups have been divided into A and B and then subdivided into smaller groups
allowing for 2-hour practical access per week for this block (Table 1).
3. All students are expected to be on time and to come prepared.
4. Carefully read the instructions for your group dissection as well as for the group before
your dissection.
5. Every group should have a grant’s dissector manual, and an atlas.
6. New instructions will be provided for each week of dissection.
7. Each group will be given 15-20 minutes to familiarize themselves with the dissections done
by the previous group before starting dissecting.
8. Do not forget to consult your grant dissector for clinical relevance.
9. If you are not sure ask!
Table 1: Practical slots
TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
07:30-08:30
ANATOMY LECTURES (LH)
08:30-09:30
09:30-10:30
ANATOMY LECTURE
10:30-11:30 (LH)
Anatomy Dissection
11:30-12:30 GROUP A2 Anatomy Dissection
12:30-13:30 GROUP B2
13:30-14:30 LUNCH
14:30-15:30 Anatomy Dissection Anatomy Dissection
15:30-16:30 GROUP A1 GROUP B1
16:30-17:30
Table 2 shows the cadavers allocated for this theme.
Cadaver
number SEX
10042 M
7667 F
7669 F
7656 M
7663 F
DISSECTION INSTRUCTIONS
WEEK 7: ANTEROLATERAL ABDOMINAL WALL (ALL GROUPS)
For each group, familiarize yourself with the following:
1. Osteology of the anterior abdominal wall: Xiphoid process, Coastal margins, pubic
symphysis Pubic crest, pubic tubercle, ASIS, Inguinal ligament, Tubercle of the iliac crest
2. The nine abdominal regions (Planes and division lines)
3. NB: Only carry out dissection tasks allocated to your group and do not dissect further
unless when you are asked to do so by the instructors.
4. However, you are expected to understand the dissection instructions for the whole week.
5. Familiarize yourself with different dissection instruments and their functions as
shown in figure 1(Page 1-3, 13th edition on the grant’s dissector manual).
D E F G
A B
C H
Figure 1. A. Teaser needle straight. B. Small forceps. C. large forceps. D. Small scissors.
E. Large scissors. F. removable blade. G. Scalpel handle. H. Scalpel
INSTRUCTORS/ LECTURERS:
Mark out skin incisions as shown on FIGURE 2 before students dissect (Page 65, 13th
edition, grant’ dissector).
Figure 2: Skin incisions
GROUP A1:
Part 1. Completing skin incisions (Page 65, Grant’s dissector 13th edition)
Refer to FIGURE 2 of this document.
1. Make a midline skin incision from the xiphisternal junction (C) to the pubic symphysis (E),
encircling the umbilicus.
2. Make an incision from the xiphoid process (C) along the costal margin to a point on the
mid-axillary line (V).
3. Make a skin incision beginning 2-3 cm below the pubic crest (E).
a. Extend this incision laterally, 3 cm inferior to the inguinal ligament to a point 3 cm
below the anterior superior iliac spine.
b. Continue the incision posteriorly, 3 cm below the iliac crest to a point on the
midaxillary line (F).
4. NB: DO NOT make a vertical skin incision along the midaxillary line from point V to
point F leave this part intact.
5. Make a transverse skin incision from the umbilicus to the midaxillary line.
6. Reflect the skin from medial to lateral, BUT DO NOT detach it along the midaxillary line.
Part 2. Superficial fascia (Page 65-66 Grant’s dissector 13th edition),
Follow figure 2 when tearing through the superficial fascia
Figure 3: Removing he abdominal superficial fascia (Campus)
NB:
Note: The superficial epigastric artery and vein are located in the superficial fascia in
this area, however, do not make a special effort to find/ preserve them.
Identify the Scarpa’s fascia (Membrenous)
Identify the Camper’s fascia (fatty & superficial).
Note that the abdominal anterior cutaneous nerves are branches of:
o thoracoabdominal nerves (T7 to T11)
o the subcostal nerve (T12),
o iliohypogastric and ilioinguinal nerves (L1).
Figure 4a: Layers of the anterolateral abdominal wall
Your dissection aim is to obtain a clear muscle view as in figure 4b!!
Figure 4b: Anterolateral abdominal wall
GROUP A2: muscles of the anterolateral abdominal wall (External oblique and Internal
oblique)
1.Part 1: External oblique (Page 67, Grant’s dissector 13th edition)
1. NB: Identify and understand: the following features of the external oblique
aponeurosis:
Lateral (inferior) crus – forms the lateral margin of the superficial inguinal
ring. These fibers attach to the pubic tubercle.
Medial (superior) crus – forms the medial margin of the superficial
inguinal ring. These fibers attach to the pubic crest.
Intercrural fibers – delicate fibers that span across the crura super lateral
to the superfi cial inguinal ring. They prevent the crura from spreading
apart.
Inguinal ligament – the inferior border of the aponeurosis of the external
oblique muscle. It spans from the anterior superior iliac spine to the pubic
tubercle. Vessels and nerves exit the abdominal cavity and enter the lower
limb by passing posterior to the inguinal ligament.
The external oblique aponeurosis forms the anterior wall of the inguinal
canal, and the inguinal ligament forms its floor.
Observe the differences in muscle fiber directions for internal and external
oblique muscles.
Part2: Internal Oblique Muscle (page 67, Grant’s dissector 9th edition)
NB: Try to find the ilioinguinal, iliohypogastric nerves and the conjoint tendon (Figure 5)
Figure 5: Dissection of left groin region showing the unusual path of branches of the ilioinguinal
nerve (IIN). (Ba, Bb and Bc: branches of the IIN; SC: spermatic cord; CT: conjoint tendon; EOA:
external oblique aponeurosis; IO: internal oblique muscle)
Group B1: Transversus abdominis muscles and Inguinal canal
Part 1: Transversus abdominis and Inguinal rings (page 69, Grant’s dissector 13th edition)
NB: Locate and identify the deep inguinal ring (Figure 6)
Inferior epigastric vessels
Boundaries of the inguinal canal
Understand the difference between direct and indirect inguinal hernia based on the
courses that viscera take to protrude through the abdominal wall.
Figure 6: Layers of the anterolateral abdominal wall
Group B2: Rectus sheath and rectus abdominis muscles
Part 1: Rectus abdominis (page 70, Grant’s dissector 13th edition)
Figure 7 shows all the structures you need to identify
Figure 7: Rectus sheath and other structures
Refer to figure 8 on where to cut (cut1-Cut 3). When opening the rectus sheath.
NB: Identify: tendinous intersections, rectus abdominis muscles, anterior and
posterior wall of the rectus sheath, Superior and inferior epigastric vessels,
pyramidalis muscle (when available), linea alba, transversalis fascia, parietal
peritoneum.
Understand and confirm the content of the rectus sheath above the coastal margin,
between the coastal margin and acuate line and below the acuate line (figure 7b).
a b
Figure 7: Rectus sheath and other structures
By the end of week 7 you should have a clean dissection as shown in figure 8.
Figure 8: Muscles of the anterolateral abdominal wall
Clinical knowledge (All groups)
1. Inguinal hernia
2. Epigastric anastomoses
3. Caput medusa
