11-7 Abdomen III Flashcards
A: What are the 5 Layers of the POST Abd Wall? (Front to back)
B: Where is the Lumbar plexus in the POST Abd Wall and why is it there?
- < FRONT >= Partial Peritoneal layer
- Visceral layer [contains Retroperitoneal structures]
- 3 Fascia [ Psoas / iliac / thoracolumbar Fascia ]
- 4 Muscles[ Psoas Major vs. psoas minor, Quadratus lumborum & ILiacus]
- ## < backk >= bony layerB: Lumbar plexus is formed INSIDE Psoas Major = its branches innervate POST abd wall m.
The 4 POST abd wall muscles include the ILiacus, Psoas MAJor, ____ ______ and Quadratus lumborum.
- Describe the ILiacus
1. Origin [2]
2. Insertion [2]
3. nerve innervation
4. Purpose
4 POST abd wall m.= [ILiacus, Psoas MAJor, psoas minor & Quadratus lumborum]
- *ILiacus**
1. ILiac fossa & Sacrum
2. Femur & Psoas MAJor tendon
3. Femoral nerve
4. Flexes hip with Psoas MAJor
The 4 POST abd wall muscles include the ILiacus, Psoas MAJor, psoas minor and _______ ______.
- Describe the Psoas MAJor
1. Origin
2. Insertion
3. nerve innervation
4. Purpose [3]
4 POST abd wall m.= [ILiacus, Psoas MAJor, psoas minor & Quadratus lumborum]
- *Psoas MAJor**
1. lumbar vertebrae transverse process
2. Femur
3. [ 1st FOUR lumbar nerves >ventral Rami]
- ºFlexes HIP with ILiacus SUPERIORLY
ºFlexes trunk with ILiacus inferiorly = Balances trunk when sitting
ºLaterally Flexes vertebral column inferiorly
The 4 POST abd wall muscles include the ILiacus, ____ ______ , psoas minor and Quadratus lumborum.
- Describe the psoas minor
1. Origin
2. Insertion
3. nerve innervation
4. Purpose
B: What’s special about this muscle?
4 POST abd wall m.= [ILiacus, Psoas MAJor, psoas minor & Quadratus lumborum]
- *psoas minor**
1. Vertebral margins of T12-L1
2. Pectineal line
3. [First Lumbar nerve>ventral Rami]
4. Flexes pelvis on vertebral column
B: psoas minor MAY BE ABSENT IN SOME PEOPLE
The 4 POST abd wall muscles include the _____, Psoas MAJor, psoas minor and Quadratus lumborum.
- Describe the Quadratus lumborum
1. Origin [2]
2. Insertion [2]
3. nerve innervation [2]
4. Purpose [2]
4 POST abd wall m.= [ILiacus, Psoas MAJor, psoas minor & Quadratus lumborum]
- *Quadratus lumborum**
1. 12th rib & lumbar transverse process
2. iliolumbar ligament & iliac crest
3. [ 1st FOUR lumbar nerves >ventral Rami] & [T12 ventral rami]
4. Extends/Laterally flexes vertebral column & fixes 12th rib during inhalation
A: Describe the Shape and Structure of the Diaphragm [3]
B: What nerve is the Diaphragm innervated by?
- fibromuscular partition between thorax & abdomen
- Has R & L Lateral copula regions [which R copula is Higher due to Liver]
- Central area = [central tendon] =
*diaphragms insertion point tht all m.fibers converge to form non-contracting aponeurosis
* [protects Aortic hiatus from being squished during diaphragm contraction ]
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B: [phrenic n. (C3, C4, C5)] “keeps diaphragm alive”
A: Diaphragm has 3 origin points. What are they?
B: Describe the Diaphragm R and L crus. What do they form together?
C: Describe the 3 arcuate ligaments of the Diaphragm
D: Explain how the R crus is related to the esophageal hiatus and [Duodenal suspensory ligament]
A: Origin points
- Sternal = Xiphoid process
- lower 6 costal cartilages
- ## Lumbar Vertebral = 2 Crura & [1 Median, 2, medial, 2 Lateral Arcuate Ligaments]B: R & L crus
ºR Crus=Longer/Stronger & arises from upper 3 lumbar BODIES
ºl crus= smaller & arises from upper 2 lumbar BODIES
C: *Median Arcuate= combines crura across aorta–>forms [arctic hiatus]
**Medial Arcuate= Arch formed by the muscle thickening fascia of [Psoas MAJor m.]
D: R crus fibers ascend upward & encircle esophagus to form [Esophageal hiatus]. Other fibers run DOWN R crus and form [Duodenal suspensory ligament]
List Location and what each transmits [#]
1. Caval hiatus [transmits 2]
- Esophageal hiatus [transmits 2]
- Aortic hiatus [transmits 4]
” i 8 ..10 Eggs..At 12 “
1) Caval hiatus lies in < Diaphragm central tendon at T8 > and transmits [iVC & R phrenic n.]
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2) Esophageal hiatus Lies at level T10 & transmits [ESOPHAGUS & Vagus n.]
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3. Aortic hiatus lies behind 2 crura at level T12 and transmits [AORTA, Thoracic duct, Azygos vein & Greatr Splanchnic n.]
A: Describe [Lumbar plexus L1-4] formation. Where is this in close proximity to?
B: Name the 7 nerves that make up this plexus
C: Which nerves Run as a group IN FRONT of Quadratus lumborum & pierces [transverse abdominal m.]?
D: Which nerves pierce [internal oblique m.]?
E: Which nerve pierces the Psoas Major m.??
A: [Lumbar plexus L1-4] forms INSIDE Psoas MAJor by combining [upper 3 lumbar nerves] + [part 4th lumbar n.]
–>All Close to POST abd wall m.
Lumbar Plexus = "S i i G - LFO " B: 1. [Subcostal n. T12] 2. [ILiohypogastric n. L1] 3. [ILioinguinal n. L1] **THESE "RUNner nerves" RUN in front of [Quadratus Lumborum m.] & pierce [transverse abd m.] to RUN between it & [Internal Oblique] but.......
D: The ILio’s (2&3) pierce [transverse abd m.] AND [Internal Oblique] traveling between it & [EXTernal Oblique]
- [Genitofemoral n.] = PIERCES PSOAS MAJOR m.
- [Lateral femoral cutaneous n.] –>on top of [ Iliacus m. ]
- [Femoral n. L2-L4]
- [Obturator n. L2-L4]
A: What’s specifically special about the [ILioinguinal n. L1]
B: What’s its PARENT nerve?
C: what type of sensory innervation does it do? [4]
D: What Motor Innervation does it do? [2]
A:[ ILioinguinal n. L1] is the only LUMBAR PLEXUS daughter that rides with [Male spermatic cord]/[feMale round uterus ligament] into inguinal canal –>emerges thru superficial inguinal ring
B: LUMBAR PLEXUS
C: sensory= Skin of upper medial thigh, & [feMale labium majus]
D: Motor= [transversus abdominis] & [Internal Oblique] (becuz those are the m. it pierces)
[Genitofemoral n. L_/_]
A: Route of Passage [3]
B: What is its PARENT nerve?
C: Motor innervates
D: sensory Innervates [3]
[Genitofemoral n. L1/2]
A:
1st. emerges in front of Psoas muscle & descends down
2nd. Divides into {genital branch} which enters inguinal canal thru deep inguinal ring
3rd. {genital branch} reaches spermatic cord & innervates cremaster muscle + {femoral branch}=femoral triangle
B: PARENT = LUMBAR PLEXUS
C: Motor= Male Cremaster muscle<——{genital branch}
D: sensory = Skin of femoral triangle{femoral branch}, scrotum & [feMale labium majus]
Describe Route of Passage for these 3 daughter nerves of the _____ ______
- [Lateral femoral cutaneous n. L2/3]
- [Femoral n. L2-4]
- [Obturator n. L2-4]
LUMBAR PLEXUS daughter nerves
(F) 2. emerges from lateral Psoas MAJor & descends into groove between Psoas & iliacus–>into femoral triangle, deep to inguinal ligament
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(O) 3. descends along [medial Psoas] muscle & then runs forward on [lateral pelvis] to enter thigh thru [obturator foramen]
**[Femoral n. L2-4]
A: Motor innervation [3]
B: sensory innervation [2]
C: PARENT NERVE
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What nerve innervates the [MEDIAL thigh muscles]?
**[Femoral n. L2-4]
A: Motor (muscles innervated)= iliacus, Pectineus, [ANT thigh muscles]
B: sensory = Skin of [ANT thigh] & medial leg
Motor innervation to [MEDIAL thigh muscles] = [Obturator n. L2-4] –>also does Pectineus & [Obturator externus]
1) The KIDNEY is a _____ organ that lies Erect on the _____ ____ ____ opposite __ to ___ vertebrae.
2) Which Kidney is lower than the other and Why? Also, Describe their location to the ribs
3) Describe the Kidney Hilum
4) List the 4 Major Kidney components. Which one contains [1-2 million nephron units]?
1) KIDNEY is a retroperitoneal organ that lies Erect on POST abd wall opposite T12 to L3 vertebrae
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2) RIGHT KIDNEY IS LOWER & related to rib 12 because [R LIVER lobe] is HUGE –> presses down on R KIDNEY
3) Found on medial border, this is place where Renal VAP(Vein/ Artery/ Pelvis of Ureter) & nerves enter/leave organ
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4)
A. Cortex
B. Medulla
C. minor Calyces
D. MAJor Calyces
“In order to LIVE (liver), you have to kick the R KIDney DOWN and life ur R Diaphragm UP”
Renal Arterial Supply
3 Major things about Renal ARTERIES
1) Which Renal artery is longer and what does it pass behind?
B: What 3 arteries supply the Suprarenal gland
Renal ARTERIES
- Arise from side of abd Aorta
- R Renal artery is LONGER & passes behind IVC
- ## Gives off [inf suprarenal a.] which enters kidney hilum & divides into [5 segmental “end” arteries]B: Suprarenal Gland Arteries !
1) [inf. phrenic a.>SUP suprarenal a.]
2) [Aorta>middle suprarenal a.]
3) [Renal artery > inf. suprarenal artery]
Renal Venous Supply
1) Which RENAL VEINS open DIRECTLY into the IVC?
2) Which renal vein is longer and describe what 2 structures it passes in FRONT of before reaching kidney?
3) Which Renal vein receives 3 tributaries and what are they?
4) Where does the Azygous vein and R hemiazygous vein drain into?
5) At what vertebrae does all of this Riff Raff occur?
Renal VEINS
1. Both R & L renal veins open directly into IVC but R is shorter!
- L renal VEIN is LONGER and passes in front of the Aorta AND L renal a.
- L renal vein receives [L suprarenal v., L gonadal vein & L hemiazygous v. ]
{L renal vein then dumps into the IVC} - Azygous vein and [R hemiazygous vein] both Drain DIRECTLY into IVC as well!
- L2
B: Describe Renal MEDULLA
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C: Describe Renal [minor Calyx]
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D: List the 7 Step Passage of Urine from Outer Kidney to the Ureters
B: MEDULLA= inner prt of kidney made of 8-12 [renal pyramids].
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C: minor Calyx= receives urine from collecting tubes and empties into 3 MAJOR Calyces
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D:
Renal CORTEX—>Renal Medulla/Pyramids—->papilla —->
minor calyx —> MAJor Calyx —>Renal Pelvis —->Ureters
Ureters are _____ ______ tubes that starts at the ____ _____ and then extends from _____ to _________. Explain its route of passage
B: Ureters may be obstructed by ____ ____(Kidney stones) in 3 areas of constriction. What are they?
Ureters are RETROPERITONEAL MUSCULAR tubes tht start at RENAL PELVIS and extend from KIDNEYS to URINARY BLADDER.
B: Ureters can be obstructed by RENAL CALCULI (Kidney Stones) in 3 areas.
- Ureteropelvic junction= where it joins renal pelvis
- Pelvic inlet= Area in front of the Common iliac a. bifurcation = L4
- Ureterovesicular jnction= MOST NARROW PRT OF URETER—>and is where it enters bladder wall.
A: Suprarenal gland is a _____ ____ that lies on the ____ ____ of the kidney. The R Suprarenal gland is ___ shaped while the L Suprarenal gland is _____ shaped.
B: What does its Cortex do?
C: What does its Medulla do? Embryologically where does its Medulla come from?
D: List the 3 arteries that perfuse it and THEIR PARENTS
E: Describe its venous system
F: Suprarenal glands are AKA “____ ______”
A: Suprarenal gland is a RETROPERITONEAL ORGAN that lies on SUPEROMEDIAL POLE of Kidney. [R Suprarenal gland = pyRamidal shaped] and [L Suprarenal gland = semiLunar shaped]
B: Suprarenal gland CORTEX= makes 3 types of steroid hormones
D: 1. [SUP Suprarenal a.] (from [inf. phrenic a.])
2. [Middle Suprarenal a.] (from abd aorta)
3. [inf Suprarenal a.] (from renal artery]
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E: Suprarenal gland is drained via [Suprarenal vein]
–> which empties into R IVC{R Kidney} and [L renal vein]{L Kidney}
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F: Suprarenal Glands = “Adrenal Glands”
A: The Abdominal Aorta is nothing but an inferior continuation of the _____ _____. Describe its Route of Passage. [3]
B: Name and Describe the single UNpaired branches stemming from the Abdominal Aorta [3]
C: Describe the [Median sacral a.]
A: Abd Aorta = inferior continuation of THORACIC AORTA. ººIt passes thru AORTIC HIATUS into diaphragm at T12
–>then descends in front of vertebral bodies —>to finally bifurcate into R and L [common iliac arteries] @ L4
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B:
1. [Celiac / SMA / iMA]
Celiac trunk (T12) = Foregut
SMA (L1) = midgut
iMA (L3 = Hindgut
- [Median sacral a.] = arise from back of Aorta –>travels in front of Sacrum—>supplies rectum & anal canal AND gives off [5th pair of lumbar arteries]
A: The Abdominal Aorta is nothing but an inferior continuation of the _____ _____. Describe its Route of Passage. [3]
B: Describe the 4 Paired Branches
- [Inferior phrenic a.] [4]
- Gonadal a.
- Lumbar a.
- [Common iliac a.]
C: Which artery gives Suprarenal Adrenal gland its blood?
A: Abd Aorta = inferior continuation of THORACIC AORTA. ººIt passes thru AORTIC HIATUS of diaphragm at T12
—>to finally bifurcate into R and L [common iliac arteries] L4 Pelvic Inlet
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B: 1. [Inferior phrenic a.]= supplies Diaphragm, [Suprarenal Adrenal gland], middle suprarenal a. and renal a.
- Gonadal a. = runs laterally on Psoas MAJor & across ureter
- Lumbar a. = Comprised of 5 a. pairs that come from POST Aorta
- ## [Common iliac a. ]= terminal branches of Abd Aorta tht end up opposite lumbosacral disc & divide into EXTernal & internal iliac arteriesC: [Inferior phrenic a.] perfuses Suprarenal Adrenal gland
Which Abdominal Artery branches stem FROM the…..
ANT midline Aorta [3]
Lateral [3]
[Posterolateral / Diaphragm Body Wall] [3]
Abd Aorta Daughter Arteries stemming from…
ANT midline Abd Aorta
ºCeliac º[SUP Mesenteric a. ] º[inf Mesenteric a.] -------------------------------------------------------------------------------------- *Lateral Abd Aorta* º[Suprarenal a.] ºRenal a. ºGonadal a. -------------------------------------------------------------------------------------- *[Posterolateral Abd Aorta / Diaphragm Body Wall]* ºSubcostal a. T12 º[inf. phrenic a.] ºLumbar a.
1) The Inferior Vena Cava is formed __[R/L] of ___ vertebrae by combining _________. Is this vessel than Abdominal Aorta?
2) Describe its route of passage
1) inf. Vena Cava is formed R of L5 vertebrae by combining EXTernal and internal iliac veins. This vessel is LONGER than ABD AORTA
2) ascends along R side of Aorta–> thru IVC opening in central tendon of diaphragm at level T8—>then enters R heart atrium
A: Name All of the Tributary veins that the IVC receives [6]
B: What are the 2 ways the [Azygos vein] is formed?
C: Which 2 veins drain into the L Renal vein on the Left side only?
D: Where could you find the L renal vein?
A: Tributaries of IVC (dump their mess into the IVC)
1. R gonadal veins
2. R suprarenal veins
3. hepatic veins
4.
5. 3rd/4th Lumbar veins
6. [inf phrenic veins]
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B: [Azygos vein] is formed by
1) arising from L2 POST IVC as daughter
2) union between [ascending lumbar v.] + [subcostal v. ]
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C: R gonadal & R suprarenal drain into L renal vein on L side
D: L renal vein runs behind [SUP mesenteric a.] but in FRont of Abdominal Aorta
