The superficial fascia of the anterior abdominal wall consists of two layers: an external layer of adipose tissue (Camper's fascia) and an internal layer of dense collagenous connective tissue (Scarpa's fascia). Camper's fascia is absent in the perineum. In contrast, Scarpa's fascia continues into the perineum, but the nomenclature is changed relative to the region in which it is located. For example, Scarpa's fascia becomes Colles' fascia when surrounding the roots of the penis and clitoris; it becomes superficial penile (or clitoral) fascia when it surrounds the shaft of the penis (or clitoris); and it becomes dartos fascia in the scrotum.
Embedded in the adipose tissue of Camper's fascia are the superficial epigastric veins, which drain the anterior abdominal wall. These cutaneous veins drain into the femoral and paraumbilical veins.
Blood pressure within the portal vein increases because of the inability of blood to filter through the diseased (cirrhotic) liver. In an attempt to return blood to the heart, small collateral (paraumbilical veins) veins expand at and around the obliterated umbilical vein to bypass the hepatic portal system. These paraumbilical veins form tributaries with the veins of the anterior abdominal wall, forming a portal-caval anastomosis, and drain into the femoral or axillary veins. In patients with chronic cirrhosis, the paraumbilical veins on the anterior abdominal wall may swell and distend as they radiate from the umbilicus and are termed caput medusae because the veins appear similar to the head of the Medusa from Greek mythology. ▼
Sagittal midline plane
Sagittal midline plane
Transpyloric plane ■ Subcostal plane
Two layers — of superficial fascia
Muscles and fascia
Extraperitoneal fat Parietal peritoneum
Figure 7-1: A. Quadrant partitioning: right upper quadrant (RUQ); left upper quadrant (LUQ); right lower quadrant (RLQ); and left lower quadrant (LLQ). B. Regional partitioning: right hypochondriac (RH); right lumbar (RL); right iliac (RI); epigastrium (E); umbilical (U); hypogastrium (H); left hypochondriac (LH); left lumbar (LL); and left iliac (LI). C. Surface anatomy and dermatome levels. D. Fascial layers of the anterior abdominal wall.
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