Abdomen III Flashcards
Arrange the layers of the posterior abdominal wall in order from posterior to anterior:
fascia, muscles, partial peritoneal layer, visceral layer, bony layer
bony layer muscles fascia visceral layer partial peritoneal layer
Describe the bony layer of the posterior abdominal wall.
Layer 1 iliac bone (iliac fossa, iliac crest, lumbar vertebras, last 2 ribs)
Describe the muscles of the posterior abdominal wall from medial to lateral.
Layer 2
psoas major, psoas minor, quadratus lumborum, iliacus
Describe the psoas major:
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
Describe the fibers of the right crus of the diaphragm.
some fibers run up to form the esophageal hiatus by encircling the esophagus
some run down to form suspensory ligament of duodenum
Describe the diaphragm openings.
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
Describe the relation of the diaphragm to posterior abdominal muscles.
median arcuate ligament:
medial arcuate ligament:
lateral arcuate ligament:
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*
Describe how the lumbar plexus is related to muscles of the posterior abdominal wall.
T12 - subcostal L1- ilioinguinal, iliohypogastric L1, L2- genitofemoral L2, L3- lateral cutaneous of the thigh L2, 3, 4- femoral, obturator
What is significant about the subcostal nerve (T12) iliohypogastric nerve (L1) and ilioinguinal nerve (L1)?
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
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?
ilioinguinal nerve
What is significant about the genitofemoral nerve (L1, L2)
emerges on the front of the psoas muscle and descends on its anterior surface
What is significant about the lateral femoral cutaneous nerve (L2,3)?
emerges from lateral side of psoas muscle and runs in FRONT of iliacus
What is significant about the femoral nerve (L2,3,4)?
emerges from the lateral border of the psoas major and descends in the groove between the psoas and iliacus
What is significant about the obturator nerve (L2,3,4)?
descends along the medial border of the psoas muscle
Describe the viscera layer of the posterior abdominal wall.
Layer 3
retroperitoneal structures
kidneys, ureters, suprarenal glands, abdominal aorta and IVC
Describe the basic structure of the kidney.
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
Describe the suprarenal gland of the kidneys.
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
Describe the blood supply of the suprarenal glands.
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
Describe the three sites of constriction of the ureter.
Which is the narrowest point?
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
What will cross the abdominal aorta?
Left renal vein
What are the single branches of the abdominal aorta?
celiac (T12) SMA (L1) and IMA (L3)
(anterior midline)
median sacral artery
What are the paired visceral branches of the abdominal aorta?
lateral
suprarenal (L1) , renal (L1) , gonadal (L2)
What are the paired parietal/segmental branches of the abdominal aorta?
postero-lateral
subcostal (T12)
inferior phrenic (T12)
lumbar (L1-L4)
Describe the abdominal aorta: T12 L1 L2 L3 L4
T12- celiac trunk L1- SMA L2- renal arteries L3- IMA L4- ends by divinding into right and left common iliac arteries
What nerve is on the psoas major?
genitofemoral
What nerve is lateral to psoas major between psoas and iliacus?
femoral nerve
What nerve is medial to psoas major going to the adductor compartment of the thigh?
obturator nerve (round white and glistening)
What are the nerves in order on the quadratus lumborum?
subcostal, iliohypogastric and ilioinguinal nerves
What nerve is on the iliacus?
lateral femoral cutaneous nerve
Describe the cisterna chyli What is it? Where does it lie? How is it formed? What does it give?
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
Where does the kidney lie?
Which kidney is lower and why?
What is on medial border of kidney?
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
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?
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
What 3 veins does the left renal vein receive?
left suprarenal vein
left gonadal (testicular or ovarian) vein
may give rise to inferior hemiazygos vein
Where do the right and left gonadal veins drain?
Right gonadal vein drains in IVC
left gonadal drains in left renal vein
