Exam IV: Abdomen IV Flashcards
Psoas Major
Attachments:
Lateral surface of T12 and L1 to L5 vertebral bodies
Transverse process of lumbar vertebrae
Intervertebral disks between T12 and L1 to L5
Lesser trochanter of femur (underneath the inguinal ligament)
Innervation: anterior rami of L1 to L3
Functions: flexion of thigh at hip joint
Psoas Minor
Attachments:
Lateral surface of T12 to L1 vertebrae and intervertebral disk
Pectineal line of the pelvic brim
Iliopubic eminence
Innervation: anterior rami of L1
Functions: weak flexion of lumbar vertebral column
It passes anteriorly on top of the psoas major
Quadratus Lumborum
Attachments:
Transverse process of L5 vertebrae
Iliolumbar ligament comes across the iliac crest and attaches to it, and to the inferior border of rib 12
Transverse process of L1 to L4 vertebrae
Innervation: anterior rami of T12 and L1 to L4
Functions: depress and stabilize rib 12 with some lateral bending of trunk
Iliacus
Attachments: Upper 2/3 of iliac fossa Anterior sacro-iliac Iliolumbar ligaments Upper lateral surface of sacrum Similar to psoas major- passes over inguinal ligament to lesser trochanter of femur
Innervation: femoral nerve (L2 – L4)
Functions: flexion of thigh at hip joint
Musculature: Diaphragm Parts and Ligaments
Parts
1. Sternal head – xiphoid process → central tendon
2. Costal – costal cartilage 7-12 → central tendon
3. Lumbar – lumbar vertebrae 2 and 3 → central tendon
Right crus- attaches to L2 and L3; much larger and comes over the hiatus for aorta goes up to loop over the esophageal hiatus and then comes back down
Left crus- attaches to L2
Ligaments:
- Medium arcuate: goes over aorta
- Medial arcuate: psoas major
- Lateral arcuate: quadratus laborum; hopping from transverse process to rib 12
Diaphragm: Esophageal and Aortic Hiatus & Vena Caval Foramen
Vena caval foramen: contain IVC, right phrenic nerve at level T8; need to get blood from liver back to the heart; left phrenic nerve does not have a specific opening, but still goes through diaphragm
Esophageal hiatus: contains esophagus and right and left vagal trunks, esophageal artery from left gastric artery at level T10
Aortic hiatus: contains aorta, thoracic duct, azygos vein at level – T12
Sometimes the azygos vein goes through the right crus and hemiazygos goes through left crus
Diaphragm: Splanchnic Nerves, Azygos System, Sympathetic Chain, and Superior Epigastric
Greater, lesser and least splanchnic: pass through the crura
Azygous and Hemiazygous: pass through the crura
Sympathetic trunks: pass through medial arcuate ligament and psoas
Superior epigastric: pass anterior to diaphragm
Diaphragm: Blood Supply and Innervation
Blood supply:
- Superior: internal thoracic artery divides into musclophrenic and superior epigastric; pericardiophrenic comes off internal thoracic alongside the heart with the phrenic nerve; aorta, and superior phrenic artery
- Inferior: abdominal aorta and inferior phrenic artery
Innervation: C3, 4, and 5 “keeps you alive”
Motor and sensory to central part
Intercostal nerves
Sensory on peripheral areas
Question: cardiothoracic surgery, open pericardium, periocardial phrenic arteries cut on accident, pick another artery that supplies the diaphragm as well (antastomoses with phrenic)= superior phrenic artery
Domes of the Diaphragm
Right side ~ rib V
Liver- pushes diaphragm upwards
Right kidney
Right suprarenal gland
Left side ~ 5th intercostal space between ribs 5 and 6 Stomach Spleen Left kidney Left suprarenal gland
Location of Kidneys
Right KidneyDescending part of duodenum sits over right hilum, right colic flexure on top, and small intestine, liver
Left Kidney: stomach at superior border, spleen on superior border, pancreas coming apart (when we take off pancreas we take off peritoneum because kidney is retroperitoneal as well), stomach
If someone is having a GI scope, what if we rupture the colon, we need to be aware of the kidney and make sure we don’t damage that too
Posterior wall of left splenic flexure cut on accident: kidney could be damage-QUESTION
Posterior View of Kidneys
Posterior view: kidneys are somewhat well protected because ribs are only covering the kidneys somewhat= ribs 11 and 12
Muscles of deep back (psoas, quadratus luborum, and transversus abdominus)
Why aren’t the kidneys at the same level: during development kidneys start in pelvic and then need to ascend; Left side moves first and right moves up next and they stop at the same time
Horseshoe kidney where it sits on lower abdomen because gets stuck
Secondary Support of Kidneys: Fascia and Fat
Renal fat and fascia- secondary protection of kidneys
Perirenal fat (perinephric fat)- innermost layer
Renal fascia- middle layer
Pararenal fat (paranephric fat)- outermost layer
Both fatty layers + fascia = ½ inch in width to provide support
Kidney Structures
- Hilum of kidney where blood flow comes in and renal pelvis comes out
- Outside = cortex
- Inner layer = renal medulla with columns (lighter areas) and the pyramids (triangles)
- Renal Papilla: where pyramid and minor calyx meet
Urine passes into the minor calyx, 2-3 minor calyxes come together to make major calyx, then urine goes to pelvis through the ureters to bladder
Renal Vasculature and Lymphatics
Renal artery- width of pinky because it filters ALL blood; comes directly from the aorta to the renal arteries
Renal veins- brings blood to the IVC
Lateral aortic (lumbar) nodes: on both sides of vertebral column that drain lymphatics
Superior mesenteric pass on top of left renal vein (makes a sandwich)
Say aortic ayneurysm- apply pressure to left renal vein… want good blood flow to kidneys, but this would impede it
Ureters
Points of constriction:
1. ureteropelvic junction
2. pelvic inlet: ureter passes through abdomen, bifurcation at L4
3. entrance to the bladder
causes a chain reaction of problems, but prevent stones from coming through
Ureteric vasculature: renal arteries, aorta, testicular/ ovarian, common iliac, and internal iliac
Ureteric and lymphatics: lateral aortic (lumbar)nodes, common iliac, external and internal iliac; wherever it got blood supply from lymph will go back there
Ureteric innervation: parasympathetic and sympathetic innervation because hollow organ it will get autonomics
