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Anatomy Renal > Lecture 1 - Posterior Abdominal Wall > Flashcards

Lecture 1 - Posterior Abdominal Wall Flashcards

1
Q

What is the diaphragm?

A

It is a musculotendinous structure that separates the thoracic cavity from the abdominal cavity. It is double domed.

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2
Q

What does the level of the diaphragm depend on?

A
  1. ) phase of respiration
  2. ) posture
  3. ) size and position of the abdominal viscera (especially in pregnancy)
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3
Q

The diaphragm is a …….. of inspiration

A

chief muscle

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4
Q

What is the action of the diaphragm?

A

The muscular part contracts which:

  • the domes are pulled inferiorly and so thee diaphragm flattens
  • abdominal viscera is pushed down and that increases the thoracic volume
  • this decreases intrathoracic pressure which increases air flow to the lungs
  • this also increases abdominal pressure which increases venous blood flow towards the heart
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5
Q

Where does the base of the pericardial sac sit on the diaphragm?

A

Sits on the central tendon

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6
Q

In what direction do the fibres of the central tendinous part go in?

A

They go in the direction towards their peripheral attachments.

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7
Q

What are the muscular parts of the diaphragm?

A
  1. ) Sternal part
  2. ) Costal part
  3. ) Lumbar part
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8
Q

What is the costal muscular part of the diaphragm?

A

Wide muscular slips that attach to the internal surface of the lower 6 costal cartilages and their adjoining ribs.

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9
Q

What is the sternal muscular part of the diaphragm?

A

two muscular slips that come from the xyphoid process

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10
Q

What is the lumbar muscular part of the diaphragm?

A

arises from the medial and lateral arcuate ligaments and they form the right an left crura

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11
Q

The right and left crura are musculotendinous arise from?

A
  1. ) Anterior surface of the bodies L1-L3
  2. ) Anterior longitudinal ligaments
  3. ) Intervertebral discs
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12
Q

What is the difference between there right and left crus of the diaphragm?

A

right:
- longer and larger
- spans from L1-L3

left:
- shorter and smaller
- spans from L1-L2

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13
Q

What are the arcuate ligaments?

A
  1. ) median
  2. ) medial
  3. ) lateral
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14
Q

Where is the median arcuate ligament and what does it do?

A
  • Only one of them, and it is located at the midline.
  • It unites the crura in front of the aorta
  • it forms the aortic hiatus
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15
Q

Where is the medial arcuate ligament and what does it do?

A
  • 2 of them and they are close to the vertebral columns
  • on the sides of the median
  • between the lumbar vertebral bodies and the tip of the transverse process of L1.
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16
Q

The medial arcuate ligament is the thickening of what fascia?

A

Thickening of the poses major muscle fascia.

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17
Q

Where is the lateral arcuate ligament and what does it do?

A
  • 2 of them and it is closer to the midclavicular lines
  • located at the tip of the 12th rib.
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18
Q

The lateral arcuate ligament is the thickening of what fascia?

A

The thickening of the fascia of the quadratus lumborum muscle.

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19
Q

What are the apertures of the diaphragm and what is the acronym for it?

A
  • Caval opening at T8
  • Esophageal hiatus at T10
  • Aortic hiatus at T12

I 8, 10 EGGS, At 12

I = IVC
E - Esophagus
A = Aorta

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20
Q

Where is the caval opening?

A

Central tendinous part of the diaphragm at the level of the intervertebral disc between T8 and T9.

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21
Q

What happens to the caval opening during inspiration and what does that do?

A
  • It dilates which widens the IVC
  • Facilitates increased blood flow from abdomen to the thoracic cavity
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22
Q

What structures pass through the caval opening ?

A
  1. ) IVC
  2. ) Right phrenic nerve
  3. ) lymphatic vessels from the liver
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23
Q

Where is the esophageal opening?

A
  • oval shaped opening in the muscular part of the diaphragm
  • level of T10
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24
Q

How is the muscular sphincter of the oesophagus formed ?

A

The muscular fibres of the right crus decussate (intersect) inferior to the hiatus to form the muscular sphincter and so the oesophagus contracts with the diaphragm.

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25
Q

What structures pass through the esophageal opening ?

A
  1. ) esophagus
  2. ) Vagus nerves
  3. ) Esophageal vessels (branches from the left gastric)
26
Q

Where is the aortic hiatus?

A
  • between the right and left crura of the diaphragm
  • posterior to the median arcuate ligament
  • at level of T12
  • does not pierce the diaphragm, hence movements of the diaphragm do not effect arterial blood flow
27
Q

What structures pass through the aortic hiatus?

A
  1. ) aorta (descending)
  2. ) Thoracic duct
  3. ) Azygos and hemiazygos veins
28
Q

What are the small apertures?

A
  1. ) sternocostal triangle
  2. ) Left and right crura
  3. ) medial arcuate ligament (deep to)
29
Q

What passes through the sternocostal triangle?

A

Superior epigastric vessels

30
Q

What passes through the left and right crura?

A

greater and lesser splanchnic nerves

31
Q

What passes through the medial arcuate ligament?

A

least splanchnic nerves and the sympathetic trunk

32
Q

What is the arterial supply to the diaphragm?

A

thoracic surface:

  1. ) pericardiacophrenic arteries which branch from the internal thoracic artery
  2. ) musculophrenic artery which is a terminal branch of the internal thoracic artery
  3. ) Superior phrenic arteries which is a branch of the thoracic aorta

Abdominal Surface:

4.) inferior phrenic arteries which is a branch of the abdominal aorta

33
Q

What is the venous drainage of the diaphragm?

A

Thoracic surface:

  1. pericardiacophrenic veins
  2. ) musculophrenic veins goes to internal thoracic
  3. ) superior phrenic goes to IVC or azygos

Abdominal Surface:

4.) inferior phrenic veins which goes to IVC

34
Q

Origin of the psoas major muscle?

A
  • transverse processes of lumber vertebrae
  • sides of the bodies of T12-L5 vertebrae
35
Q

Insertion of the psoas major muscle?

A

-lesser trochanter of the femur

36
Q

innervation of the psoas major muscle?

A

-anterior rami of L1-L3

37
Q

Actions of the psoas major muscle?

A
  • flexes the thigh at the hip joint
  • flexes the vertebral column laterally
  • balances the trunk
  • acts with the iliacus to flex the trunk (when sitting)
38
Q

Origin of the iliacus muscle?

A
  • supeiror 2/3 of the iliac fossa
  • sacrum
  • anterior sacroiliac ligament
39
Q

Insertion of the iliacus muscle?

A
  • lesser trochanter of the femur
  • psoas major tendon
  • shaft of the femur
40
Q

Innervation of the iliacus muscle?

A

-femoral nerve (L2-L4)

41
Q

Actions of the iliacus muscle?

A
  1. ) flexes thigh at the hip joint
  2. ) Stabilises the hip joint
  3. ) Acts with the psoas major to flex the trunk (when sitting)
42
Q

Origin of the quadratus lumborum muscle?

A
  • medial half of the inferior border of rib 12
  • tips of the transverse processes of the lumbar vertebrae
43
Q

insertion of the quadratus lumborum muscle?

A
  • internal lip of the iliac crest
  • iliolumbar ligament
44
Q

innervation of the quadratus lumborum muscle?

A

-anterior branches of T12-L4

45
Q

action of the quadratus lumborum muscle?

A
  • extends and laterally flexes the vertebral column
  • fixes the 12th rib during inspiration so helps to stabilise the lower diaphragm attachments
46
Q

What is the thoracocolumbar fascia and where does it attach to?

A
  • covers the deep back muscles and the posterior sheath is thick
  • the lumbar part of the posterior sheath extends from 12th rib and iliac crest to the internal oblique and the transverses abdominis muscles.
47
Q

Where is the quadratus lumborum fascia?

A
  • covers the anterior surface of the quadratus lumborum muscle
  • attaches to the transverse processes of lumbar vertebrae, iliac crest and the 12th rib.
  • inferiorly attaches to the iliolumbar ligaments
  • superiorly it thickens to form the lateral arcuate ligament
48
Q

What is the psoas fascia?

A
  • covers the psoas major muscle
  • fuses laterally with the quadratus lumborum fascia
  • continuous with the iliac fascia
  • thickens superiorly to form the medial arcuate ligament
49
Q

What are the nerves of the posterior abdominal wall?

A

subcostal nerve:

  • anterior rami of T12
  • supplies the external oblique and skin of the anterior abdominal wall

Lumbar spinal nerves:

  • L1-L5
  • posterior rami supply deep muscles of the back
  • anterior rami (lumbar plexus) supply the skin and muscles of the inferior aspects of the trunk. Also part of the lower limb.
50
Q

List the nerves of the lumbar plexus and their origin?

A
51
Q

From where does the abdmonial aorta extend and till where?

A

Frrom T12 (aortic hiatus) vertebrae till L4 vertebrae (site of bifurcation of the aorta)

52
Q

What are the psoterior abdominal arteries?

A

Paired parital arteries (supply muscles and branch posterolaterally):

  1. ) inferior phrenic which comes from abdominal aorta at T12
  2. ) Subcostal which comes from thoracic aorta and visible at L2
  3. ) Lumbar which come out from L1-L4 and from the abdominal aorta

Paired visceral arteries (supply organs and branch laterally):

  1. ) middle suprarenal
  2. ) renal artery at L1
  3. ) Gonadal artery at L2
53
Q

The veins of the abdominal wall are tributaries to …..?

A

The IVC

54
Q

Where does the IVC start and how does it make it’s way up?

A
  1. ) starts at L5 at the union of the common iliac veins, 2.5 cm from the median plane and inferior to the aortic bifurcation
  2. ) ascends to the right side of the vertebral bodies of L3-L5 and the right psoas major muscle
  3. ) leaves abdomen at T8 via Caval opening
  4. ) on the way it colelcts blood from lower limbs and non portal blood from pelvis and abdomen.
55
Q

What is the cisterna chyli?

A

dilated lymphatic channel that lies anterior to the second lumbar vertebrae and marks the begining of the thoracic duct.

56
Q

What is a congenital diaphragmatic hernia?

A
  • When the pleuroperitoneal folds fail to form properly, more often on the left side
  • so loops of the small intestine (also other GIT elements) enter the thoracic cavity through the incompletee seperation of the plerual and periotneal cavities by the congenital defect
  • presence of abdominal viscera in the thorax can hinder lung formation and lead to pulmonary hypoplasia and decrease alveolar surface area for gas exhange
  • degree of it determines survival (50 % mortality rate)
57
Q

Until when are alveoli developed?

A

Until the age of 8 and thats why kids shouldnt be exposed to polluted air because they still developing their alveoli.

58
Q

What is psoas sign?

A

Medical indication of irrritation to the iliopsoas muscle (hip flexors) in the abdomen.

59
Q

How to do psoas test?

A
  1. ) patient is asked to lie on their unaffected side
  2. ) extend the thigh on the affected side against resistance, ask patient to flex
  3. ) if there is pain than postive psoas sign
  4. ) low specificity
60
Q

If the psoas sign is positive and patient feels relief in the fetal postition, then what can it be?

A

can be inflammation of apendix

61
Q

What is an abdominal aortic aneurysm?

A
  • ballooning og the wall of the aorta
  • abdominal aorta closely related to the pancreas, stoamch, and ascending duodenum
  • may feel pulsations of a large aortic aneurysm on the left of tehmidline between L2 and L4
  • surgical repair will involve - either open repair method or endovascular aneurysm rerpair/stent graft

Anatomy Renal (2 decks)

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