Diaphragm & Post Abdominal Wall

Question 1

Diaphragm

Answer 1

Question 2

Abdominal Aspect of Diaphragm

Answer 2

Question 3

Diphragmatic Hiatuses

Answer 3

IVC: T8, R phrenic, lymphatic vessels, IVC

Esoph: T10, Esoph, vagus, L gastric esoph br.

Aortic: T12, Abdominal Aorta, thoracic duct, azygos v.

Question 4

Superior Diaphragm

Answer 4

Thoracic aorta–> sup phrenic a.

Internal thoracic a. –> musculophrenic & pericardiophrenic a.

Sup phrenic v. (R)–> IVC

Musculophrenic & pericardiocphrenic v.–> internal thoracic v.

Dipahragmatic LN–> phrenic LN–> parasternal & post mediastinal nodes

Phrenic n. C3-5–> motor

Intercostal T5-11 & subcostal T12–> sensory

Question 5

Inf Diaphragm

Answer 5

Abdominal aorta–> inf phrenic a.

Inf phrenic v. –> R to IVC, L to IVC & suprarenal v .

Sup lumbar LN

Same innervation as superior

Question 6

Congenital Diaphragmatic Hernia

Answer 6

On L oppsite IVC

Foramne of Bochdalek:

• lung hypoplasia
• oligohydramnios
• resp distress

Loops of intestine occupying L pulm cavity

Question 7

Peritoneal Recesses (gutters)

Answer 7

Question 8

Primary Retroperitoneal

Answer 8

Kidney

Ureter

Suprarenal

Uterine

Cervix

Question 9

Secondary Retroperitoneal

Answer 9

Duodenum-descding, horizontal, ascending

Colon- ascend & descend

Rectum upper 2/3

Question 10

Post Abdominal Wall

Answer 10

1 central region: 5 lumbar vert, IV discs

2 lateral regions: paravertebral gutters

3 m.: iliacus, psoas (major & minor), quadratus lumborum

3 arcuate lig: median, medial, lateral

Question 11

Fascia

Answer 11

1. Transversalis Fascia
2. Renal Fascia
3. Psoas fascia - medial arcuate ligament
4. Thoracolumbar fascia:

• layer (quasratus lumborum) - lateral arcuate ligament
• middle
• post

Question 12

Psoas Sign

Answer 12

Patient supine instruct him to move flexed R leg against your hand for + R psoas sign

W/ patient on L side, instruct to push his R leg up from hip against your hand

INFLAMED APPENDIX!

Question 13

Abdominal Aorta

Answer 13

T12-L4

Bifurcates to give R & L common iliac a.

Aneurysm

Tumors of pancreas & stomach may mimick aneurysm; transmit their pulsations to aorta.

Compression= Against L4, over umbilicus, stop bleeding.

Question 14

Ascending Lumbar v..

Answer 14

Leave abdomen under medial arcuate ligament

Join subcostal v.

Become azygos v. on R & hemiazygos v. on L

Question 15

Collateral Circulation

Answer 15

IVC–> common iliac v.–> external iliac v.

Superficial pathway:

Femoral v. –>

Great saphenous–>

superficial epigastric v.–>

thoracic epigastric v.–>

lateral thoracic v. –>

axillary v.

Deep pathway:

inf epigastric v.–>

sup epigastric v.–>

internal thoracic v.

Both:

subclavian–>

braciocephalic–>

SVC

Question 16

Gut Lymphatics

Answer 16

Foregut–> celiac nodes

midgut–> sup mesenteric nodes

hindgut–> inf mesenteric nodes

Question 17

Cisterna Chyli

Answer 17

All gut nodes to cisternal chyli

all para-aortic nodes to cisternal chyli

Drains into Thoracic Duct