Abdomen III

Question 1

Arrange the layers of the posterior abdominal wall in order from posterior to anterior:

fascia, muscles, partial peritoneal layer, visceral layer, bony layer

Answer 1

bony layer
muscles
fascia
visceral layer
partial peritoneal layer

Question 2

Describe the bony layer of the posterior abdominal wall.

Answer 2

Layer 1
iliac bone (iliac fossa, iliac crest, lumbar vertebras, last 2 ribs)

Question 3

Describe the muscles of the posterior abdominal wall from medial to lateral.

Answer 3

Layer 2

psoas major, psoas minor, quadratus lumborum, iliacus

Question 4

Describe the psoas major:

Answer 4

the muscle descends and enters the thigh behind the inguinal ligament to be inserted in lesser trochanter together with the iliacus tendon - iliopsoas tendon

innervated by ventral rami of first four lumbar nerves
flexes hip, flexes trunk

Question 5

Describe the fibers of the right crus of the diaphragm.

Answer 5

some fibers run up to form the esophageal hiatus by encircling the esophagus

some run down to form suspensory ligament of duodenum

Question 6

Describe the diaphragm openings.

Answer 6

I 8 (ate) 10 Eggs At 12 (noon)
T8- IVC (caval hiatus)… also sometimes right phrenic n
T10- esophagus (right crus) …also anterior and posterior trunks of Vagus
T12- aorta /Aortic hiatus (behind or between two crura) …also thoracic duct, azygos vein, occasionally greater splanchnic

Question 7

Describe the relation of the diaphragm to posterior abdominal muscles.
median arcuate ligament:
medial arcuate ligament:
lateral arcuate ligament:

Answer 7

median arcuate ligament: unites crura across aorta, forming aortic hiatus*

medial arcuate ligament: tendinous arch across the upper part of psoas major*

lateral arcuate ligament - tendinous arch across quadratus lumborum*

Question 8

Describe how the lumbar plexus is related to muscles of the posterior abdominal wall.

Answer 8

T12 - subcostal
L1- ilioinguinal, iliohypogastric
L1, L2- genitofemoral
L2, L3- lateral cutaneous of the thigh
L2, 3, 4- femoral, obturator

Question 9

What is significant about the subcostal nerve (T12) iliohypogastric nerve (L1) and ilioinguinal nerve (L1)?

Answer 9

all run in front of quadratus lumborum muscle and pierce transverse abdominal muscle to run between it and internal oblique muscle

but iliohypogastric and ilioinguinal pierce internal oblique to run between it and external oblique

Question 10

Which nerve is the only one that accompanies the spermatic cord (or round ligament of uterus), continues through the inguinal canal and emerges through superficial inguinal ring?

Answer 10

ilioinguinal nerve

Question 11

What is significant about the genitofemoral nerve (L1, L2)

Answer 11

emerges on the front of the psoas muscle and descends on its anterior surface

Question 12

What is significant about the lateral femoral cutaneous nerve (L2,3)?

Answer 12

emerges from lateral side of psoas muscle and runs in FRONT of iliacus

Question 13

What is significant about the femoral nerve (L2,3,4)?

Answer 13

emerges from the lateral border of the psoas major and descends in the groove between the psoas and iliacus

Question 14

What is significant about the obturator nerve (L2,3,4)?

Answer 14

descends along the medial border of the psoas muscle

Question 15

Describe the viscera layer of the posterior abdominal wall.

Answer 15

Layer 3

retroperitoneal structures
kidneys, ureters, suprarenal glands, abdominal aorta and IVC

Question 16

Describe the basic structure of the kidney.

Answer 16

medulla (inner region, pyramids) , cortex (outer region, columns) , 1-2 million nephrons in each kidney (anatomic and functional units of kidney)

minor calyces receive urine from collecting tubules and empty two or three major calyces which in turn empty into the renal pelvis of ureter

Question 17

Describe the suprarenal gland of the kidneys.

Answer 17

retroperitoneal organ
lies on superomedial pole of kidney
has cortex that produces 3 types of steroid hormones and medula that secretes epi and nor-epi

Question 18

Describe the blood supply of the suprarenal glands.

Answer 18

receives arteries from three sources:
superior suprarenal artery from the inferior phrenic artery

middle suprarenal artery from the abdominal aorta

inferior suprarenal artery from the renal artery

Question 19

Describe the three sites of constriction of the ureter.

Which is the narrowest point?

Answer 19

ureto-pelvic junction - where it joins the renal pelvis

pelvic inlet- where it crosses the pelvic brim

ureto-vesicular junction - where it enters the wall of the urinary bladder. NARROWEST point of the whole ureter

Question 20

What will cross the abdominal aorta?

Answer 20

Left renal vein

Question 21

What are the single branches of the abdominal aorta?

Answer 21

celiac (T12) SMA (L1) and IMA (L3)
(anterior midline)
median sacral artery

Question 22

What are the paired visceral branches of the abdominal aorta?

Answer 22

lateral

suprarenal (L1) , renal (L1) , gonadal (L2)

Question 23

What are the paired parietal/segmental branches of the abdominal aorta?

Answer 23

postero-lateral
subcostal (T12)
inferior phrenic (T12)
lumbar (L1-L4)

Question 24

Describe the abdominal aorta:
T12
L1
L2
L3
L4

Answer 24

T12- celiac trunk
L1- SMA
L2- renal arteries
L3- IMA
L4- ends by divinding into right and left common iliac arteries

Question 25

What nerve is on the psoas major?

Answer 25

genitofemoral

Question 26

What nerve is lateral to psoas major between psoas and iliacus?

Answer 26

femoral nerve

Question 27

What nerve is medial to psoas major going to the adductor compartment of the thigh?

Answer 27

obturator nerve (round white and glistening)

Question 28

What are the nerves in order on the quadratus lumborum?

Answer 28

subcostal, iliohypogastric and ilioinguinal nerves

Question 29

What nerve is on the iliacus?

Answer 29

lateral femoral cutaneous nerve

Question 30

Describe the cisterna chyli
What is it?
Where does it lie?
How is it formed?
What does it give?

Answer 30

lower dilated lymphatic sac

is at the end of thoracic duct and lies to the right and posterior to aorta

formed by intestinal and lumbar lymph trunks

narrows superiorly and gives the thoracic duct

Question 31

Where does the kidney lie?
Which kidney is lower and why?
What is on medial border of kidney?

Answer 31

posterior abdominal wall opposite T12 to L3 in erect position

right kidney lies a little lower because of large size of right lobe of liver so right kidney is related to rib 12 and then left kidney related to ribs 11 and 12

on medial border is hilum.. VAP - renal Vein, renal Artery, and Pelvis of ureter

Question 32

Describe the blood supply of the kidney.

Where do the renal arteries arise from?
Which renal artery is longer?
What does the renal artery give off?
Where do the right and left renal veins open into?
Which renal vein is longer? Where does it pass?

Answer 32

renal arteries arise from side of abdominal aorta opposite upper border of L2

right renal artery is longer than left and passes posterior to IVC

renal artery gives inferior suprarenal artery then enters hilum of kidney and divides into 5 segmental arteries

both right and left renal veins open directly into IVC

Left renal vein is longer than the right renal vein and passes anterior to aorta below origin of SMA

Question 33

What 3 veins does the left renal vein receive?

Answer 33

left suprarenal vein
left gonadal (testicular or ovarian) vein
may give rise to inferior hemiazygos vein

Question 34

Where do the right and left gonadal veins drain?

Answer 34

Right gonadal vein drains in IVC

left gonadal drains in left renal vein