Diaphragm and Posterior Abdominal Wall

Question 1

What is the nerve supply to Diaphragm?

Answer 1

Phrenic Nerve from roots C3,4,5

Question 2

What does the Diaphragm consist of?

Answer 2

1. Central Tendon
2. Peripheral Muscle Structure
3. Arcuate Ligaments

Question 3

What are the Arcuate Ligaments of the Diaphragm?

Answer 3

1. Median Arcuate Ligament
2. Medial Arcuate Ligament
3. Lateral Arcuate Ligament

Question 4

What goes through the Central Tendon of the Diaphragm and which vertebral level do they go through?

Answer 4

Inferior Vena Cava and Right Phrenic Nerve go through at level T8

Question 5

What goes through the Peripheral Muscular Structure of the Diaphragm and which vertebral level do they go through?

Answer 5

Oesophagus and Vagal Nerve at level T10

Question 6

What goes through the Diaphragm behind the Median Arcuate Ligament and which vertebral level do they go through?

Answer 6

Aorta, Thoracic duct and Azygos Vein at level T12

Question 7

What are the muscles of the Posterior Abdominal Wall?

Answer 7

1. Psoas Major
2. Trasversus Abdominis
3. Quadratus Lumborum

Question 8

What nerve roots make up the Lumbar Plexus?

Answer 8

L1 to L4 with a small contribution from T12

Question 9

Which root of the Lumbar Plexus does the Subcostal Nerve come off?

Answer 9

T12

Question 10

What are the Nerves coming off the Lumbar Plexus?

Answer 10

1. Subcostal Nerve
2. iliohypogastric Nevre
3. Ilioinguinal Nerve
4. Genitofemoral Nerve
5. Femoral Nerve
6. Obturator Nerve
7. Lateral Cutaneous of Thigh

Question 11

Which root of the Lumbar Plexus does the Iliohypogastric Nerve come off?

Answer 11

L1

Question 12

Which root of the Lumbar Plexus does the Ilioinguinal Nerve come off?

Answer 12

L1

Question 13

Which root of the Lumbar Plexus does the Genitofemoral Nerve come off?

Answer 13

L1 , L2

Question 14

Which root of the Lumbar Plexus does the Femoral Nerve come off?

Answer 14

L2,L3,L4

Question 15

Which root of the Lumbar Plexus does the Obturator Nerve come off?

Answer 15

L2,L3,L4

Question 16

Which root of the Lumbar Plexus does the Lateral Cutaneous Nerve of Thigh come off?

Answer 16

L2, L3

Question 17

Which of the Lumbar Plexus Nerves are Medial to Psoas Major?

Answer 17

Obturator Nerve and Lumbosacral trunk

Question 18

Which of the Lumbar Plexus Nerve are Anterior to Psoas Major?

Answer 18

Genitofemoral Nerve

Question 19

Which of the Lumbar Plexus Nerves are Lateral to Psoas Major?

Answer 19

Femoral Nerve, Iliohypogastric Nerve, Ilioinguial Nerve, Lateral Cutaneous Nerve of thigh, Subcostal Nerve

Question 20

Where does the Abdominal Aorta enter the abdomen?

Answer 20

Behind the Median Arcuate Ligament at T12

Question 21

What are the branches of the Abdominal Aorta in general terms (4,4,4)?

Answer 21

4 Unpaired Branches
4 Paired Branches
4 Pairs of Lumbar Arteries

Question 22

What are the 4 Unpaired Branches of the Abdominal Aorta and what vertebral level do they come off?

Answer 22

T12–> Coeliac Trunk
L1–> Superior Mesenteric
L3–> Inferior Mesenteric
L4–. Median Sacral

Question 23

What are the 4 Paired Branches of the Abdominal Aorta and what vertebral level do they come off?

Answer 23

T12–> Inferior Phrenic
L1–> Middle Supra Renal
L1–> Renal
L2–> Gonadal

Question 24

What artery gives off the Superior Suprarenal Artery?

Answer 24

Inferior Phrenic Arteries

Question 25

What artery gives off the Inferior Suprarenal Artery?

Answer 25

Renal Arteries

Question 26

Where is Cisterna Chyli located?

Answer 26

Posterior to the aorta on L1/L2 vertebral body, then ascends as the thoracic duct together with the aorta and azygos vein at T12

Question 27

Describe the Embryological Formation of the Diaphragm

Answer 27

The Septum Transversum fuses with Pleuroperitoneal Membrane to form primitive diaphragm that partitions thoracic from abdominal contents

Question 28

What happens if there is a defect in the fusion of the Pleuroperitoneal Membrane (normal in the left posterolateral aspect)?

Answer 28

Congenital Hernia of Bochdalek--> Abdominal organs can herniate up into the thorax if the Pleuroperitoneal membrane fails to close

Question 29

What is an Abdominal Aortic Aneurysm?

Answer 29

Dilation in the Abdominal Aorta--> need to know if it is below or above the renal arteries

Question 30

What is Pneumoperitoneum?

Answer 30

Free air under the diaphragm that can be caused by perforation of the lung and diaphragm

Question 31

Why can diaphragmatic pain be referred to the shoulder?

Answer 31

Nerve Supply C3,4,5 also gives off cutaneous supply to the shoulder