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GIGU - Week 2 > 13- Posterior Abdominal Wall > Flashcards

13- Posterior Abdominal Wall Flashcards

1
Q

What is the origin of the Psoas Major and Minor Ms.?

A

Transverse processes and sides of vertebral bodies and intervertebral discs of T12-L5

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2
Q

What is the insertion of the Psoas Major M.?

A

Tendon to the Lesser Trochanter of Femur

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3
Q

What is the innervation of the Psoas Major and Minor Ms.?

A

Anterior Rami of L1-L3

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4
Q

What is the origin of the Iliacus M.?

A

Superior 2/3’s of Iliac Fossa
Ala
Anterior Sacroiliac Ligaments

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5
Q

What is the insertion of the Iliacus M.?

A

Lesser Trochanter and shaft below

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6
Q

What is the innervation of the Iliacus M.?

A

Femoral N. (L2-4)

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7
Q

What is the origin of the Quadratus Lumborum M.?

A

Iliolumbar Ligament

Lip of Iliac Crest

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8
Q

What is the insertion of the Quadratus Lumborum M.?

A

Medial half of inferior surface of 12th rib

Tips of lumbar Transverse processes

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9
Q

What is the innervation of the Quadratus Lumborum M.?

A

Anterior Rami T12-L4

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10
Q

What are the muscles of the posterior abdominal wall?

A

Psoas Major and Minor Ms.
Iliacus M.
Quadratus Lumborum M.
Diaphragm

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11
Q

This can present as back or flank pain, fever, limp, and an inguinal mass. Causes include disease of organs (i.e., TB spread into abdomen), cancers (i.e., adenocarcinomas), or infections deep to psoas fascia.

A

Psoas Abscess

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12
Q

Psoas abscess has a hallmark called the “Psoas Sign”. What is this?

A

Lower abdominal pain exacerbated by extending thigh

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13
Q

What are the ligaments of the posterior abdominal wall?

A

Median Arcuate Ligament
Medial Arcuate Ligament
Lateral Arcuate Ligament

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14
Q

This ligament is a tendinous arch of the crura of the diaphragm. It unites the right and left crura.

A

Median Arcuate Ligament

***Crosses Aorta!

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15
Q

This ligament is a fascial thickening of the psoas fascia, spanning the lumbar body and tip of L1 transverse process.

A

Medial Arcuate Ligament

***This is lateral to Median Arcuate Ligament!

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16
Q

This ligament is a fascial thickening of the Quadratus Lumborum M. running from L1 transverse process to the tip of the 12th rib.

A

Lateral Arcuate Ligament

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17
Q

What are the paired arteries of the posterior abdominal wall?

A 
Subcostal As.
Inferior Phrenic As.
Suprarenal As.
Renal As. (L2)
Gonadal As. (L2)
Lumbar As.
Deep Circumflex Iliac As.
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18
Q

What are the unpaired arteries of the posterior abdominal wall?

A

Celiac Trunk (T12)
Superior Mesenteric A. (L1)
Inferior Mesenteric A. (L3)
Median Sacral A.

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19
Q

This vein begins anterior to L5 and right of medial plane. It passes through the caval hiatus of the diaphragm.

A

Inferior Vena Cava (IVC)

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20
Q

Tributaries of the IVC are corresponding veins of paired visceral and parietal branches of the aorta. What are these branches?

A

Paired Visceral = Suprarenal V., Renal V., Gonadal V.

Paired Parietal = Inferior Phrenic V., 3rd and 4th Lumbar V., Common Iliac V.

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21
Q

Ascending ______ ______ and _______ _______ connect the SVC and IVC, either directly or indirectly.

A

Lumbar V.

Azygos V.

22
Q

Venous return from abdominal viscera returns via the…

A

Portal Venous System (Hepatic Portal V.)

23
Q

What is the diaphragm opening of the level of T8? What passes through it?

A

Caval Opening – IVC and right Phrenic N.

24
Q

What is the diaphragm opening of the level of T10? What passes through it?

A

Esophageal Hiatus – Esophagus and Anterior/Posterior Vagal Trunks

25
Q

What is the diaphragm opening of the level of T12? What passes through it?

A

Aortic Hiatus – Aorta, Thoracic Duct, and sometimes Azygos and Hemiazygos Vs.

26
Q

The muscular portion of the diaphragm contains a _______ part that attaches to the xiphoid (may or may not be present), and a _______ part that attaches to the inferior 6 costal cartilages.

A

Sternal

Costal

27
Q

The diaphragm has a central tendon, and crura. The (LEFT/RIGHT) crus is larger and longer (L3-L4 vertebral bodies) and has some fibers that run along the left side of the aortic hiatus. The (LEFT/RIGHT) crus is L2-L3 vertebral bodies.

A

Right

Left

28
Q

What arteries are on the superior side of the diaphragm?

A

Musculophrenic A. (off Internal Thoracic A.)
Pericardiophrenic A. (off Internal Thoracic A.)
Superior Phrenic A. (off thoracic aorta)

29
Q

What arteries are on the inferior side of the diaphragm?

A

Inferior Phrenic A. (off abdominal aorta)

Intercostal branches for peripheral diaphragm

30
Q

This type of hernia occurs when the pouch of peritoneum and stomach fundus extend through the esophageal hiatus, usually anterior to the esophagus. Gastric regurgitation usually does not occur as the cardiac portion is normal.

A

Para-esophageal Hiatal Hernia

31
Q

This type of hernia occurs when part of the abdominal esophagus, cardiac, and portion of the fundus of stomach extends through the esophageal hiatus. Regurgitation of stomach contents is possible.

A

Sliding Hiatal Hernia

32
Q

These organs are retroperitoneal lying at about T12-L3 levels. Suprarenal glands lie above them.

A

Kidneys

33
Q

The (LEFT/RIGHT) kidney is lower.

A

Right

***Because of liver!

34
Q

This is the entrance to the renal sinus, and is the area in the kidney where blood vessels, renal pelvis, and nerves are located.

A

Renal Hilum

35
Q

Posteriorly, the superior parts of the kidneys lie deep to the ______ and ______ ribs.

A

11th (left kidney)

12th (right kidney)

36
Q

The left kidney hilum and superior pole or right kidney lies near the _______ _______.

A

Transpyloric Plane (T12)

37
Q

The inferior pole of the right kidney is approximately an index fingers breath superior to the…

A

Iliac Crest

38
Q

This muscle lies posterior to the largest parts of the kidney, with intervening fat.

A

Quadratus Lumborum M.

39
Q

What nerves pass posterior to the kidney?

A

Subcostal N. (protected by 12th rib)
Iliohypogastric N. (L1)
Ilioinguinal N. (L1)

40
Q

There is a _______ fat-adjacent kidney capsule that extends into the renal pelvis. Renal fascia covers the fat enveloping the kidney and suprarenal gland, which blends and ensheaths renal vessels. Superiorly the fascia is continuous with inferior diaphragmatic fascia. _________ fat lies external to the renal fascia.

A

Perinephric

Paranephric

41
Q

This runs inferiorly from the Renal Pelvis, passing over the pelvic brim and along the lateral pelvic wall and running posterior to the Ductus Deferens (males) and Uterine A. (females).

A

Ureter

42
Q

Where are possible sites of obstruction for the ureter?

A
    • Junction of ureter with renal pelvis
    • Crossing pelvic brim
    • Entering bladder wall
43
Q

This is an x-ray of the ureter enhanced with contrast media.

A

Pyelogram

44
Q

What does the right Suprarenal Gland lie near?

A

Right crus
Right kidney
IVC

45
Q

What does the left Suprarenal Gland lie near?

A 
Left crus
Spleen
Stomach
Pancreas
Left kidney
46
Q

What is the blood supply to the Suprarenal Glands?

A

Superior Suprarenal A.
Middle Suprarenal A.
Inferior Suprarenal A.

47
Q

What innervates the Suprarenal Glands?

A

Preganglionic Sympathetics from T10-L1

Celiac Plexus and Abdominopelvic Splanchnic Ns.

48
Q

These LNs are from the External/Internal Iliac LNs and drain into the Lumbar LNs.

A

Common Iliac LNs

49
Q

These LNs run along both sides of the IVC and aorta. They receive from the posterior wall and posterior pelvic wall and organs. They form the lumbar lymphatic trunks.

A

Lumbar LNs

50
Q

These LNs form intestinal lymphatic trunks draining from alimentary tract, liver, spleen, and pancreas.

A

Pre-aortic LNs

51
Q

All lymphatics of the posterior abdominal wall collect into the _______ _______ (beginning of thoracic duct).

A

Cisterni Chyli

52
Q

The lumbar plexus is composed of the anterior rami of lumbar spinal nerves, revealed by the removal of the psoas muscle. What nerves are included in this plexus?

A 
Iliohypogastric N. (L1)
Ilioinguinal N. (L1)
Genitofemoral N. (L1-L2)
Lateral Femoral Cutaneous N. (L2-L3)
Obturator N. (L2-L4)
Femoral N. (L2-L4)

***These are all nerves of the posterior wall, two other nerves included are the Subcostal N. (T12) and the Lumbosacral Trunk (L4-L5). These are NOT part of the plexus!

GIGU - Week 2 (10 decks)

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