Diaphragm, Posterolateral Abdominal Wall and Kidneys

Question 1

What is attached to the central tendon superiorly?

Answer 1

Fibrous pericardium

Question 2

What are the 3 muscular components of the diaphragm? and where do they arise from?

Answer 2

Sternal- xiphoid process
Costal- ribs 7-12
Crura (lumbar)- anterior aspects of the L1-L3 vertebrae

Question 3

Where does the right crus of the diaphragm arise and what runs through its apertures? Is the right larger or smaller than left?

Answer 3

Arises from L1-L3

Has 2 apertures– one for greater and 1 for lesser right splanchnic nerves

Larger and longer than left

Question 4

Where does the left crus of the diaphragm arise and what runes through its apertures?

Answer 4

Arises from L1-L2

Has three apertures- one for greater, one for lesser left splanchnic nerves and one for hemiazygous vein

Shorter and smaller than right

Question 5

Where does the central portion of the diaphragm receive motor and sensory innervation from? Where will referred pain be felt from this region?

Answer 5

Phrenic formed by C3-C5 ventral rami

Over the shoulder

Question 6

Where does the diaphragm receive sensory innervation from the peripheral portion? Where will referred pain be felt from this region?

Answer 6

T6-T9/10- intercostal and subcostal(T12) nerve

skin over the ribs of anterolateral abdominal wall

Question 7

What are the 3 vessels for blood supply to the diaphragm?

Answer 7

Musculophrenic
pericardiophrenic
superior/inferior phrenic

Question 8

Medial and lateral arcuate ligaments travel over the anterior portion of what two muscles and what is their purpose?

Answer 8

Psoas muscle and quadratus lumborum, respectively

Provide addition attachment for the diaphragm

Question 9

How is the median arcuate ligament formed and where does it pass?

Answer 9

Joining of the right and left crura of the diaphragm

Passes anteriorly over the aorta

Question 10

Where is the caval aperture located and what passes through it?

Answer 10

T8
IVC/right phrenic nerve branches/lymphatics from the liver

(I 8) 10 Eggs at 12

Question 11

Where is the Esophageal Hiatus located and what passes through it?

Answer 11

T10
Esophagus/Vagus/esophageal branches of left gastric artery and vein

Site of Hiatal Hernias!!!!

I 8 (10 Eggs) at 12

Question 12

Where is the Aortic Hiatus located and what passes through it?

Answer 12

T12
NOT within the diaphragm–runs BEHIND it–posterior to the median arcuate ligament
Aorta/thoracic duct/sometimes azygos vein

I 8 10 Eggs (at 12)

Question 13

What are the superior/lateral/inferior boundaries of the posterolateral abdominal wall?

Answer 13

Superiorly- 10-12 ribs
Inferiorly- superior margin of the iliac crests
Laterally- midaxillary line

Question 14

What are some important aspects of the posterolateral abdominal wall?

Answer 14

site of surgical incisions to each organs in the retroperitoneum
common site of blunt and penetrating wounds
common site of muscle strains and vertebral fractures

Question 15

What forms the costovertebral angle and what is its significants?

Answer 15

formed by the incomplete 12th rib and the vertebral column

tenderness in this area= Lloyd’s sign–kidney punches/renal/perirenal/subdiaphragmatic dz

Swelling= abscess/tumor of a retroperitoneal organ

Question 16

What are the 3 hip flexor muscles and what are there origins and insertions?

Answer 16

Psoas major- T12 and All Lumbar/lesser trochanter on femur
Psoas minor- T12 and L1/ pectineal line of pubic bone
Iliacus- iliac fossa, iliac crest, base of sacrum/tendon of psoas major onto lesser trochanter of femur

Question 17

What is the function of the Quadratus Lumborum and what is its origin and insertion?

Answer 17

Depresses the 12th rib during respiration and flexes the vertebral column ipsilaterally

Origin and insertion- iliac crest/inferior surface of 12th rib and transverse process of L1-L4

Question 18

What fibers do the Splanchnic nerves carry?

Answer 18

Preganglionic sympathetic info to the viscera

Also contain visceral Afferents-pain fibers

Question 19

What are the 4 splanchnic nerves and where do they arise and synapse?

Answer 19

Greater-T5-T9–celiac ganglion
Lesser- T10-11–superior mesenteric ganglia
Least- T12–aorticorenal ganglia
Lumbar- L1-2– near Inferior mesenteric artery

Question 20

What fibers do the Vagus nerve branches carry?

Answer 20

Preganglionic parasympathetic –anterior and posterior gastric branches

Question 21

What nerve supplies SENSORY info from the skin of lower abdomen and lateral glut region and MOTOR info to the transverse/oblique/and rectus abdomens muscles?

Answer 21

Subcostal Nerve (T12)

Question 22

What nerve supplies SENSORY info from skin of suprapubic and inguinal regions and MOTOR to the 3 abdominal muscles?

Answer 22

Iliohypogastric Nerve (L1)

Question 23

What nerve supplies SENSORY to the skin of the pubic region,root of the penis/clitoris and anterior walls of the scrotum/labia major and MOTOR to the 3 abdominal muscles?

Answer 23

Ilioinguinal Nerve (L1)

Question 24

What nerve supplies SENSORY from the parietal peritoneum of the iliac fossa/skin on the anterior and lateral thigh and patellar plexus?

Answer 24

Lateral Cutaneous Nerve (L2-3)

Question 25

What nerve supplies MOTOR and SENSORY to the lower extremities?

Answer 25

Femoral Nerve (L2-4)

Question 26

What are the two branches of the Geniofemoral Nerve (L1-2) and what do they supply?

Answer 26

Genital- MOTOR to cremastor muscle

Femoral- SENSORY from anterior thigh

Question 27

What nerve supplies SENSORY to the upper medial thigh and MOTOR to many of the adductor muscles of the lower extremity and also innervates the hip and knee joints?

Answer 27

Obturator Nerve (L2-4)

Question 28

What is contained within the renal columns of the cortex of the kidneys?

Answer 28

Glomeruli and portions of the renal tubules

Question 29

What is contained within the pyramids of the medulla of the kidneys?

Answer 29

portions of the renal tubules and collecting ducts and the tips form the papillae

Question 30

What is the consequence of the inferior renal fascia not fusing inferiorly around the ureters?

Answer 30

Kidney infections may spread down into the pelvis and/or pelvic infections may spread up to the kidneys

Question 31

What is Nephroptosis?

Answer 31

inferior displacement of the kidney–due to loss of perirenal fat (extreme emaciation) or a kidney punch/blow to the lower lumbar region

Question 32

What is the difference btwn the left and right renal arteries?

Answer 32

Left is higher and shorter than the right

Question 33

What is the consequence of occlusion of one of the end renal arteries?

Answer 33

Due to no communication btwn segmental arteries occlusion results in an infarction of the area of renal tissue it supplies–no anastomoses to take over flow!!

Question 34

What are the differences btwn the right and left renal veins?

Answer 34

Left renal vein–longer and higher than the right also receives blood from the left gonadal/upper left ureteric/ left suprarenal/inferior phrenic veins

Right renal vein– shorter and only has upper right ureteric vein

Question 35

What is nutcracker syndrome?

Answer 35

B/c the left renal vein runs btwn the SMA and the AA it can be compressed btwn the two and can cause

• Left flank abdominal pain
• Hematuria
• Testicular pain/LLQ pain, since left gonad drains via the left renal v.

Question 36

Where are the 3 common places for constriction to occur in the ureters?

Answer 36

Uretero-pelvic junction
where ureter passes over the iliac vessels–brim of the pelvis
junction with the urinary bladder

Question 37

What does the cortex of the Adrenal gland synthesize?

Answer 37

Cortisol and hormones that regulate the 3 S’s- salt/sugar/sex

Question 38

What does the medulla of the adrenal gland secrete?

Answer 38

Epi and NE–essential for fight and flight