Ach: Kidney, Posterior Abdominal Wall, Diaphragm Flashcards
What are the muscles that line the posterior abdominal wall?
Psoas major Psoas minor iliacus quadratus lumborum transverse abdominus
Psoas major
O:
I:
O: lumbar vertebral bodies
I: joins iliacus muscle after tapering at L5
What does the iliopsoas pass beneath and where does it insert?
inguinal ligament
lesser trochanter of the femur
Action of iliopsoas?
Flexes vertebral column
Action of iliacus?
flexes hip joint
Psoas minor
Antererior to psoas major
T12/L1—> pectineal line and iliacus fascia
Weak FLEXOR of the vertebral column
Iliacus
Superior part of the iliac fossa–> joins psoas to insert on the lesser trochanter
Flexion of the iliacus and psoas will…
flex the thigh at the hip joint
Movements of the iliopsoas may be accompanied by pain if…
There is disease in the: ureters kidneys cecum appendix sigmoid colon pancreas lumbar LN nerves on posterior abdominal wall
Quadratus lumborum
Iliac crest/2-4 lumbar transverse processes–> 12 rib
What does the quadratus lumborum in relation to the diaphragm and the trunk?
Holds 12th rib down against traction exerted by the diaphragm
Alone–flexes the trunk
together both sides can EXTEND the trunk
What is the third and innermost of the 3 flat muscles of the anterior abdominal wall?
Transverse abdominus
What is the transversalis fascia?
The fascia that covers the posterior abdominal muscles. Each has it’s own name, but this is the general term for all of it.
The muscular portion of the diaphragm that surrounds the periphery is derived from what mesoderm?
somatic
What is the sternal portion of the diaphragm derived form?
xiphoid process of sternum and the
adjacent aponeurosis of the transversus abdominus
What is the costal portion of the diaphragm derived from?
cartilage and bony surfaces of ribs 7-12
What are the sternocostal triangles?
Gaps between the sternal and costal portions through which the SUPERIOR EPIGASTRIC VESSELS continue into the abdomen
What does the lumbar portion of the diaphragm arise from?
vertebral column in the form of 2 crura
What is the difference between the left and right crus?
Right- longer, better developed, form V1-3
Left- from L1-2
What forms the esophageal hiatus and the suspensory ligament of the duodenum?
Right crus
What is the median arcuate ligament and what does it form?
the tendinous arch that unites the two crura in the midline forming the AORTIC HIATUS
What does the mediaN arcuate ligament pass over?
the anterior surface of hte aorta
What are the mediaL arcuate ligaments?
thickenings of fascia ARCHING over the PSOAS MAJOR
attach to L1 and vertebral body of L1-2
The thickening of fascia that arches over the superior part of hte QUADRATUS LUMBORUM is? What is it’s O and I?
lateral arcuate ligament
Transverse process of the FIRST lumbar vertebrae to the 12th rib
What is the central tendon?
a strong aponeurosis upon which all the muscle fibers of the diaphragm insert on
Where does a CDH usually occur?
periphery of diaphragm in the lumbocostal triangle
5 x more likely on the LEFT side
What causes a CDH?
POSTEROLATERAL DEFECT
Failure of fusion of the pleuroperitoneal membrane w/ the septum transversum–> weak area that organs/intestines can herniate through
What is a hiatal hernia?
when adominal viscera herniate through the ESOPHAGEAL HIATUS
What passes through the hiatus for the IVC? What level?
RIGHT T8
IVC
Right phrenic nere
What passes through the esophageal hiatus? WHat level?
Left at T10
Esophagus
Vagal trunks
anastomotic vessels between esophagus and stomach
What passes through the aortic hiatus? What level?
T12 (R and L crura, Median AL, vertebral column)
Aorta
thoracic duct
azygos and hemiazygos veins
Minor openings in the diaphragm are for…
Splanchnic nerves in the R and L crus
superior epigastric vessels at sternocostal triangle
What a. supplies the posterior aspect of the diaphragm?
thoracic aorta> SUPERIOR PHRENIC ARTERIES
What a. supplies the central area of the diaphragm?
internal thoracic arteries > PERICARDIOPHRENIC ARTERIES (accompany phrenic nerves)
What a. supplies the periphery of the diaphragm?
(terminal branch) internal thoracic a. –> MUSCULOPHRENIC ARTERY
What arteries that supply the diaphragm arise superior to it?
SUPERIOR PHRENIC A.
PERICARDIOPHRENIC A.
MUSCULOPHRENIC A.
What arteries that supply the diaphragm arise inferior to it (from the 1st branches of the aorta in the abdomen)?
branch from abdominal aorta inferior to the hiatus> INFERIOR PHRENIC A.
What is the major source of blood to the diaphragm?
inferior phrenic a.
Venous drainage of the diaphragm parallels the arteries, so the chief route is through what vein?
INFERIOR PHRENIC VEIN> L. suprarenal v. > L renal vein
What is the motor supply to the diaphragm?
SOMATIC efferents in the PHRENIC nerves
C3,4,5 keep the diaphragm alive!
What are the two somatic afferent sources to the diaphragm?
PHRENIC = central area of diaphragm
INTERCOSTAL= peripheral inch of diaphragm
What causes referred pain to the shoulder?
Irritation to the peritoneum covering the diaphragm > phrenic nerve C3,4,5 (same as shoulder–supraclavicular nerves C3,C4 from cervical plexus)> wrongly interpreted at higher centers.
What causes parietal referred pain?
Peripheral irritation of the peritoneum> afferents in intercostal nerves> pain in thoracic wall
What causes hiccups?
Irritation of aff or eff endings in the phrenic nerves> involuntary spasm of diaphragm and glottis
What causes abdominal straining?
Diaphragm contracting increases the intraabdominal pressure that is needed to poop and shit.
What is the cisterna chyli?
Sac like structure between the aorta and right crus of the diaphragm that passes behind the median AL to empty into the THORACIC DUCT.
Lymph nodes in the posterior abdominal wall are where?
surrounding the aorta
What tributary of the cisterna chyli drains the lumbar lymph nodes and organs supplied by systemic circulation?
Lumbar lymph trunks
(lower extremity, viscera of pelvis, kidney, body wall
What tributary of the cisterna chyli drains the organs supplied by PORTAL circulation?
Intestinal lymph trunk
intestine, stomach, spleen, pancreas, liver
What forms the somatic nerves of the lumbar plexus?
L1-L5 exit the intervertebral foramina and divide into the dorsal and ventral rami
What supplies the muscle and skin of the back?
dorsal rami
What forms the lumbar plexus?
ventral rami of L1-3 and upper 1/2 of L4
What nerves sometimes sends a branch to L1?
subcostal nerve (T12)
What forms the lumbosacral trunk which ultimately joins the sacral plexus in the pelvis?
Lower 1/2 of L4 and L5
ilioinguinal and iliohypogastric
L1
genitofemoral
L1-L2
Lateral femoral cutaneous nerve
L2-3
Obturator nere
L2-4
Femoral nerve
L2-4
Lumbosacral trunk
1/2 of L4, L5
descents into pelvis to join the 1st sacral nerve
