Abdomen III Flashcards
What are the layers of the posterior abdominal wall, starting w/the deepest?
- Bony layer
- Muscles
- Fascia
- Visceral layer
- Partial peritoneal layer
What bones form the bony layer of the post abd wall?
- Iliac bone (iliac fossa + crest)
- Lumbar vertebrae
- Last 2 ribs
What mm. form the m. layer of the post abd wall?
Psoas major, psoas minor (may be absent), iliacus & quadratus lumborum mm.
What organs lie retroperitoneally at the post abd wall’s visceral layer?
- Suprarenal glands
- Abd aorta + IVC
- Ureters
- Kidneys
(basically kidney stuff + aorta)
What n. plexus is formed in the area of the post abd wall?
Lumbar plexus
What fascia are at the post abd wall?
- Psoas fascia
- Iliac fascia
- thoracolumbar fascia
Iliacus m: OIIA?
O: Sup 2/3 iliac fossa, ala of sacrum, ant sacro-iliac ligaments
I: Lesser trochanter of femur and shaft inf to it, and to psoas major tendon
I: Femoral n.
A: Flexes hip and stablizes hip joint; acts w/psoas major m.
Psoas major m: OIIA?
O: Transverse process of lumbar vertebrae, sides of bodies of T12-L5 + intervening discs
I: Lesser trochanter of femur
I: Ventral rami of first 4 lumbar nn.
A: Acting superiorly w/iliacus, flexes hip; acting inferiorly, flexes vertebral column laterally; used to balance trunk in sitting position; acting inferiorly w/iliacus, flexes trunk
Psoas minor m: OIIA?
O: Vertebral margins of T12-L1 + their intervertebral discs
I: Pectineal line, iliopectineal eminence
I: Ventral rami of 1st lumbar n.
A: Flexes pelvis on vertebral column
Quadratus lumborum m: OIIA?
O: Medial half of inf border of 12th rib, tips of lumbar transverse processes
I: Iliolumbar ligament, internal lip of iliac crest
I: Ventral rami of T12 and first 4 lumbar nerves
A: Extends and laterally flexes vertebral column, fixes 12th rib during inspiration
Diaphragm: OIIA?
O: Xiphoid process (sternal part), lower 6 costal cartilages (costal part), L1-L3 vertebrae (lumbar part)
I: *Central tendon (converges at midline)
I: Phrenic n.
A: Chief m. of resp, draws central tendon down and forwards
What are the elevated right and left regions of the diaphragm called?
Which is higher?
Right and left copula
- right is higher
What is the insertion of the diaphgram?
Central tendon (converging aponeuroses)
The right crus of the diaphragm runs up to partially form the _________ and runs down to form the _________.
- esophageal hiatus
- suspensory ligament of duodenum
Where does the left crus of the diaphragm arise from?
Bodies of upper 2 L-vertebrae.
Where does the right crus of the diaphragm arise from?
Upper 3 lumbar vertebrae
larger, stronger, longer than left
The median arcuate ligament forms the __________ by uniting crossing crura
Aortic hiatus
The medial arcuate ligaments run across the upper portion of what?
Psoas major m.
The lateral arcuate ligaments run across the upper portion of what?
Quadratus lumborum m.
What else comes thru the esophageal hiatus w/the esophagus?
2 vagus nn.
What travels through the aortic hiatus?
ATA
Aorta
Thoracic duct
Azygos v.
What vertebral nn. makeup the lumbar plexus?
Where is it formed?
T12/L1/L2/L3/L4/(L5), ventral rami
- Inside psoas major m.
What supplies the subcostal n?
T12
What supplies the iliohypogastric n?
L1
What supplies the ilioinguinal n?
*What does this nerve run though?
L1
*Superficial inguinal ring
What supplies the femoral n?
L2, L3, L4
What supplies the obturator n?
L2, L3, L4
What’s common b/w the subcostal, iliohypogastric, ilioinguinal, and lateral femoral cutaneous nn. initial locations?
All run in front of quadratus lumborum m.
*Which n. accompanies the spermatic cord/round ligament of uterus, continues thru inguinal canal, and emerges thru the superficial inguinal ring?
Ilioinguinal n.
*What’s the physical location of the genitofemoral n?
Emerges in the front of psoas m. by piercing it and descends on its anterior surface
What does the genitofemoral n. divide into? *What do each of them do?
- Genital branch (supplies cremaster m.)
- Femoral branch (supplies skin of femoral triangle)
*Where can you find the lateral femoral cutaneous n.?
On top of Iliacus m.
*What’s the location of the femoral n?
Descends in-b/w psoas major and iliacus
What’s the location of the obturator n?
Descends along medial border of psoas m.
What vertebrae does the kidney span from?
T12-L3 in erect position
Posteriorly, what ribs do the right and left kidney each reach?
Right: 12th
Left: 11th
What comes into the hilum of the renal pelvis, anterior to posterior?
VAP:
renal Vein
renal Artery
Pelvis of ureter
Explain the drainage from the renal pyramid.
- Renal pyramid
- > renal papilla
- > minor calyx
- > major calyx
- > renal pelvis
- > ureter
What do the renal aa. arise from?
At what level?
- Abdominal aorta
- L2
What’s unique about the left renal a?
Longer than the right and passes posterior to the IVC
Describe what happens along the path of the renal a.
- Gives the inferior suprarenal a.
- Enters the hilum of the kidney and divides into 5 segmental aa. (end aa.)
What do right and left renal vv. dump into?
IVC
What is unique about the left renal v?
Longer than the right and passes anterior to the abdominal aorta (below origin of the SMA)
What vv. does the left renal v. receive?
- Left suprarenal v.
- Left gonadal (testicular or ovarian) v.
- May give rise to inferior hemiazygos v.
What are the 3 sites of constriction of the ureter?
- Ureto-pelvic junction (where it joins renal pelvis)
- Pelvic inlet (where it crosses pelvic brim)
- Uretovesicular junction (at wall of urinary bladder–narrowest point)
What aa. supply the suprarenal gland (and what do they come off of?)
- Superior suprarenal a. (from inferior phrenic a., which comes off aorta)
- Middle suprarenal a. (from abdominal aorta)
- Inferior suprarenal a. (from renal a.)
Where does the suprarenal v. drain on the right and on the left?
- Right: IVC
- Left: left renal v.
At what vertebral level does the abd aorta bifurcate?
Into what aa. does it bifurcate?
- L4
- Right and left common iliac aa.
What are the single and paired branches of the abdominal aorta, sup to inf?
T12: celiac a. (single visceral); subcostal (paired parietal), inferior phrenic (paired parietal)
L1: SMA (single); suprarenal (paired visceral), renal (paired visceral)
L2: Gonadal a. (paired visceral)
L3: IMA (single visceral)
L1-L4: lumbar a. (paired parietal)
Where does median sacral a. arise?
From aorta, just above bifurcation (supplies rectum + anal canal)
What is the right gonadal vein a tributary too? What about the left?
Right: IVC
Left: renal v.
At what vertebral level does the IVC form? What 2 veins come together to form it?
- L5
- Common iliac vv. (right and left)
What vv. drain into the IVC in the abd? (just review it)
- Right gonadal (drains into left renal on left, usually)
- Right suprarenal (drains into left renal on left, usually)
- Hepatic vv.
- Right and left renal vv.
- 3rd and 4th lumbar vv.
- Inferior phrenic vv.
- May receive azygos v.
What is a cisterna chyli? Where is it? What is it formed by?
- A dilated lymphatic sac (at the bottom end of the thoracic duct)
- Lies just to the right and posterior to the aorta.
- Formed by the intestinal and lumbar lymph trunks.
(narrows superiorly to give the thoracic duct)
Where does the thoacic duct drain into, specifically?
Junction b/w left subclavian and IJV (“jugular subclavian junction”)
