abdominal wall 2 Flashcards
what structures are you going to find in the posterior wall of the abdomen?
- lumbar vertebrae and IV discs
- muscles
- diapghram (contributes to the superior part of the wall)
- fascia
- lumbar plexus
- kidneys, fat, nerves and vessels
what muscles are found on the posterior abdominal wall?
- psoas
- quadratus lumborum
- iliacus
- transversus abdominis and oblique muscles laterally
innervation and function of quadratus lumborum?
wat does its fascia contribute towards?
function:
- fixes and depresses the 12th rib during inspiration and flexes/laterally flexes the trunk
innervation:
- T12-L4 anterior rami
the fascia contributes to forming the lateral arcuate ligament.
psoas major function and innervation?
what does it fascia create?
function:
- flexes the thigh, trunk and laterally flexes the trunk
innervation:
- L1-L3 spinal nerves
fascia creates the medial arcuate ligament
psoas minor function and innervation
innervation:
L1
this muscle is often not present in around 60% of people
it is merely an extension of psoas major
iliacus innervation and function?
innervation:
- femoral nerve (L1,2,3)
function:
- merges with psoas major acting to flex the trunk and thigh
what does the lumbar plexus supply?
- abdominal muscles
- extensor compartment of the thigh
- adductor compartment of the thigh
where will you find the lumbar plexus?
what branches is it made from?
- formed within psoas major
- brnaches will be visible on the posterior abdominal and pelvic walls
- made up by L1-3 and most of L4
where will you find the muscular and vascular compartment of the thigh?
deep to the inguinal ligament
- it is divided by the femoral sheath
what is the femoral sheath continous with?
transversalis and iliac fascia
what will you find within the muscular comparmtnet?
- psoas major
- iliacus muscle
- femoral nerve
- lateral cutaneous nerve of the thigh (sometimes it perices the inguinal ligament directly)
what will you find within the vascular compartment ?
transmits femoral vessels and femoral branch of the genitofemoral nerve
what 2 arteries is the posterior abdominla wall supplied by?
- thoracic aorta
- abdominal aorta
these arteries will continue anteriorly to anastomose with the anterior abdominal wall arteries
branches of the thoracic aorta?
10th and 11th posterior intercostal arteries
branches of the abdominal aorta?
- subcostal
- lumbar arteries (4 pairs)
what 3 arteries supply the anterolateral abdominal wall?
- internal thoracic
- external iliac
- femoral
branches of the internal thoracic artery
- musculophrenic
- superior epigastric
brnaches of the external iliac artery
- inferior epigastric
- deep circumflex iliac
branches of the femoral artery
- superficial epigastric
- superficial circumflex iliac
inferiorly and superiorly, what vessels does the venous blood drain to?
- femoral and external iliac veins inferiorly
- internal thoracic and axillary veins superioly
veins accompany arteries
iwhere will the superficial epigastric and superficial circumflex iliac drain into?
- they can drain into the prximal end of the great saphenous vein rther than the femoral vein
where do the veins radiate from?
how is the venous system connected?
- veins radiate out from the umbilicus
- para umbilical veins connect the venous system through the umbilicus to the portal veins in the liver
what is caput medusae in cirrohosis of the liver?
- in port systemic hypertension
anterior lymphatic drainage:
- above umbilicus
- below umbilicus
superficial
above umbilicus = anterior axillary nodes
below umbilicus= superficial inguinal nodes
posterior lymphatic drainage:
- above iliac crest
- below iliac crest
superficial
above iliac crest = posterior axillary nodes
below iliac crest = superficial inguinal nodes
what vessels are involved in deep lymphatic drainage:
- superiorly
- inferiorly
(lymph from the deeper abdominal wall accompanies epigastric vessels)
superiorly:
- parasternal nodes then medistinal nodes
inferiorly:
- external iliac then para aortic nodes
what are the boundries of the femoral ring/canal?
anterior = inguinal ligament
medial = lacunar ligament
posterior = pectineus or pectineal ligament
lateral = femoral vein
closed by the extraperitoneal tissue
where will you find the femoral ring/ canal?
medial to the vascular compartment in the femoral canal
what is a femoral hernia?
(the femoral ring is a weak area- this is where hernias can happen)
- it is an abnormal portusion of the abdominal organs into the femoral canal
how can you differentiate between an inguinal and a femoral hernia?
- the pubic tubercle is a useful landmark to differentiate between them both
- a femoral hernia will ppear below and lateral to the pubic tubercle
how do you get a psoas abcess?
because the psoas muscle and its sheath arises from not only the lumbar vertebrae but alos from the intervertebral disc between each vertebraa,
so if you get tuberculosis or salmonella discitis (for example)…
the infection can spread into the psoas muscle sheath, which will then spread into the muscle
it may appear below the inguinal ligament as a mass.
where would you see a femoral hernia in relation to the pubic tubercle?
infero-lateral
what is the most medial branch of the lumbar plexus?
obturator
L1
lumbar plexus
iliohypogastric
&
ilioinguinal
L1 and L2
genitofemoral
L2 and L3
lateral femoral cutaneus
L2,3,4
obturator
&
femoral
where will reffered pain from the stomach and oesophagus be felt?
T6-7 in the epigastrium
where will reffered pain from the appendix, gonad and small intestine?
T10 - umbilicus
where will reffered pain from the lower colon, bladder and uterus be felt?
T12- pubic region
what nerves are sensory and cutaneus supply for the anterior abdominal wall?
what is the course for these nerves?
T7-L1
- these nerves pass between the internal oblique and transversus abdominis and supplies them at the same time
- it will then enter the rectus sheath to supply rectus abdominus
what is herpes zoster (shingles)
- Varicella Zoster virus (chiken pox) it may remain inactive in nerve cells
- reactivation will cause shingles
- the rash can form along the course of a nerve (dermatome)
- unilateral
- the skin remains sore after the rash goes away
