9 Posterior Abdominal Wall Flashcards by Brett Niles

What is the origin of the psoas mm

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

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What is the insertion of the psoas

Tendon to the lesser trochanter of femur

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What is the innervation of the psoas mm

Anterior rami of L1-3

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What is the origin of the illiacus

Superior 2/3s of iliac fossa, ala, anterior sacro-iliac ligaments

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What is the insertion of the iliacus

Lesser trochanter and shaft below

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What is the innervation of the iliacus

Femoral n (L2-4)

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What is the origin of the quadratus lumborum

Medial half of inferior surface of 12th rib plus tips of lumbar ptp

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What is the insertion of quadratus lumborum

Iliolumbar ligament and lip of iliac crest

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What is the function of the quadratus lumborum

Helps fix 12th rib during deep inspiration

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What is the innvervation of the quadratus lumborum

Anterior T12, L1-4

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What does a psoas abscess cause

Back or flank pain, fever, limp, inguinal mass

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What is the cause of a psoas abscess

Disease of organs (TB spread into abdomen)
Cancer
Infections deep to psoas fascia

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How do you determine psoas abscesses

Lower abdominal pain exacerbated by extending thigh (psoas sign)

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What is the median arcuate ligament

Tendinous arch of the crura of the diaphragm; unites R and L crura (where aorta pierces diaphram)

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What is the medial arcuate ligament

Fascial thickening of psoas fascia; spanning lumbar body and tip of L1 transverse process

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What is the lateral acruate ligament

Fascial thickening of quadratus lumborum m running from L1 tp to the tip of the 12th rib

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What pierces through the diaphragm m

Esophagus and aorta

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What are the unpaired A of the abdominal aorta

Celiac trunk (T12)
SMA (L1)
IMA (L3)
Medial sacral A

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What are the paired A of the abdominal aorta

Subcostal A
Inferior phrenic A
Suprarenal A
Renal A (L2)
Gonadal A (L2)
Lumbar A
Deep circumflex iliac A

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Where does the IVC begin inferiorly

Anterior to L5 and right of midline

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What are the paired tributaries of the IVC

Suprarenal V, renal V, gonadal V, inferior phrenic V, 3rd and 4th lumbar V, common iliac V

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What goes through the diaphragm at T8

IVC and right phrenic N

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What does through the diaphragm at T10

Esophagus and ant/post vagal trunks

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What goes through the diaphragm at T12

Aorta
Thoracic duct
Sometimes azygos and hemiazygos V

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Where is the R crus of the diaphragm

Larger and longer (L3-4 vertebral bodies)

Where is the L crus of the diaphragm

L2-3

What are the arteries superior to the diaphragm

- Superior phrenic A (off thoracic aorta) | - Musculophrenic and pericardicophrenic A (off internal thoracic A)

What are the arteries inferior to the diaphragm

- Inferior phrenic A (off abdominal aorta) | - intercostal branches for peripheral diaphragm

What are the types of hiatal hernias

Para-esophageal hiatal hernia | Sliding hiatal hernia

What is a para-esophageal hiatal hernia

Portion of the fundus of the stomach herniates through the diaphragm

With what hiatal hernia does regurgitation of the stomach occur

Sliding

What is a sliding hiatal hernia

The cardia and part of the fundus slide superiorly through the esophageal hiatus

Why are hiatal hernias thought to happen

Weakening of muscular diaphragm

Where are the kidneys (level)

T12-L3, right kidney is lower

What is the renal hilum

Entrance to renal sinus (where the A, V, N, and ureters come out)

The left kidney hilum is near what plane

Transpyloric

The transpyloric plane runs through what part of the right kidney

Superior pole

Where is the inferior pole of the right kidney

Approximately index finger breadth superior to iliac crest

What lies posterior to the largest part of the kidney

Quadratus lumborum m

What nerves are posterior to the kidney

Subcostal (protected by 12th rib) Iliohypogastric (L1) (superior to ilioinguinal) Ilioinguinal (L1)

What does the renal fascia surround

Kidney, adrenal gland, and perirenal fat

What are the types of renal fat

Perinephric (perirenal) - covers kidney and suprarenal Paranephric (pararenal) - external to renal fascia

What is the renal fascia continuous with

Inferior diaphragmatic fascia

What are the points of constriction of the ureter

- Junction of urerter with renal pelvis - Crossing pelvic brim - Entering bladder wall

What is an xray of the ureter

Pyelogram

What supplies the kidney

Renal A which branch into segmental A

What supplies the ureter

- renal branches - gonadal branches - iliac branches - superior vesicular branches - pelvic branches

Where is the right suprarenal gland

Lies near right crus of diaphragm, right kidney and IVC

Where is the L suprarenal gland

Lies near L crus of diaphragm, spleen, stomach, pancreas, L renal

What is the supply of the suprarenal gland

Superior, middle, inferior suprarenal A

What is the innervation of the suprarenal gland

Preganglioninc sympathetic for T10-11

What does the inferior suprarenal come off? Middle? Superior?

Inferior - Renal A Middle - aorta Superior - inferior phrenic A

What path does lymph follow from the lower parts of the abdomen

Common iliac nodes (from external/internal iliac nodes) —> lumbar lymph nodes (runs along both sides of IVC and aorta) —> lumbar lymphatic trunks —> pre-aortic lymph nodes —> cisterni chyli (beginning of thoracic duct)

What level is the subcostal N

T12; runs along margin of 12th rib

What level are the iliohypogastric N and ilioinguinal N

L1; they can come out divided or divide shortly after

What level is the genitofemoral N

L1,2; comes out on the psoas mm and runs medially

What level is the lateral femoral cutaneous N

L2,3; beneath inguinal ligament and medial to ASIS

What level is the femoral N

L2-4, it is the largest

What level is the obturator N

L2-4

What level is the lumbosacral trunk

L4,5

What does the subcostal N innervate

What does the iliohypogastric N innervate

IO, TA, and posterolateral gluteal skin and skin in pubic region

What does the ilioinguinal innervate

IO, TA, and skin in the upper medial thigh, and either the skin over the root of the penis and anterior scrotum or the mons pubis and labium majus

What does the genitofemoral inneravate

Male cremasteric m Genital branch - skin of anterior scrotum or skin of mons pubis and labium majus Femoral branch - skin of upper anterior thigh

What does the lateral cutaneous nerve of thigh innervate

Skin on anterior and lateral thigh to the knee

What does the obturator n innervate

Obturator externus, pectineus, mm in the medial compartment of thigh Skin on medial aspect of thigh

What does the femoral n innervate

Iliacus, pectineus, mm in anterior compartment of thigh Skin on anterior thigh and medial surface of leg