Diaphragm and Posterior Abdominal Wall

Question 1

Where does the diaphragm attach most anteriorly?

Answer 1

The Xiphoid of the sternum

Question 2

What structure passes just lateral of the xiphoid attachment of the diaphragm?

Answer 2

the superior epigastric artery

Question 3

What costal cartliages are attached to the diaphragm?

Answer 3

CC [7,8,9,10,11,12]

Question 4

What is the tendon in the center of the diaphragm called?

Answer 4

central tendon

Question 5

What is the innervation of the diaphragm?

Answer 5

C3,4,5 keeps the diaphragm alive

motor to the diaphragm and sensory to the parietal peritoneum = referred pain to the shoulder

Question 6

What are the nerves of the lumbar plexus?

Answer 6

Subcostal nerve (T12)

Iliohypogastric nerve (L1)

ilio-inguinal nerve (L1)

Genitofemoral nerve (L1, 2)

lateral cutaneous nerve of thigh (L2,3)

Femoral nerve (L2,3,4)

Obturator nerve (L2,3,4)

“I insist on letting flow go out”

Question 7

Why is the ilioinguinal nerve clinically important?

Answer 7

when you’re doing surgery at McBurney’s point fo an appendix you could damage it and lose sensory innervation fo the medial thigh and lateral genitalia. These patients would also be subject to hernias b/c of weaking of the the motor funciton of the wall

Question 8

What does the genitofemoral nerve supply?

Answer 8

It supplies the chromasteric muscle responsible for raising the testes and it also supplies the skin covering the femoral triangle

Question 10

Where does the abdominal aorta enter the abdomen?

Answer 10

behind the median arcuate ligament at T12

Question 11

Describe the Abdominal Aorta

Answer 11

enters abdomen behind median arcuate ligament

ends by bifurcating at L4

4 unpaired brances CSIM

Question 12

What general area does the Ceoliac trunk supply?

Answer 12

The foregut and the gut tube (eosophagus to the ampulla vader?)

Question 13

Which artery supplies the mid gut?

Answer 13

The superior mesenteric supplies the ampulla vader down to the second half of the colon

Question 14

Which artery supplies the hind gut?

Answer 14

The inferior mesenteric artery supplies the distal half of the transverse colon down to the anal canal.

Question 15

Where is pain referred from the foregut, mid gut, and hindgut?

Answer 15

foregut = epigastric region

midgut = umbilicus

hindbut = suprapubic region

Question 16

Where do the adrenal arteries come from?

Answer 16

There are three

1) superior suprarenal artery stems from inferior phrenic artery
2) middle suprarenal artery stems from the AA
3) the inferior suprarenal artery stems from the renal artery

Question 17

Why are varicose veins more common on the left side in women?

Answer 17

Because during pregnancy, the left iliac vein is directly below the uterus, where the right iliac artery is just below it as well - the left vein causes pressure in the venous system below

Question 18

Where do the left testicular vein and left adrenal vein drain into on the left side?

Answer 18

they do not drain directly into the IVC, they actually drain into the renal vein before entering the IVC

Question 19

what are the embryological origins of the central tendon?

Answer 19

They are derived from the septum transversum which originally matures around the liver cords

Question 20

Where might we see herniation in the diaphragm?

Answer 20

We could see it through the aortic hiatus,

through an absence of the pleuroperitoneal membrane or through the opening for the esophagus?

Question 22

What is a morgagni hernia?

Answer 22

Morgagni hernia is where part of the transverse colon ascends into the thorax - this is anterior and more to the right side (90%)- it is a congenital condiiton

Question 23

What is a bochdalek hernia?

Answer 23

A Bochdalek hernia is a form of congenital diaphragmatic hernia. They occur posteriorly and are due to a defect in the posterior attachment of the diaphragm when there is a failure of pleuroperitoneal membrane closure in utero.