Lecture 12: Posterior Abdominal Wall Flashcards
What are the attachments of the Psoas major ms.; main action; innervation?
- TP’s and bodies of T12-L5
- Lesser Trochanter
- Main hip flexor
- Anterior rami of L1-L3
What are the attachments of the iliacus m; innervated by?
- Iliac crest to Greater trochanter
- Femoral nerve (L2-4)
What are the attachments of the Quadratus Lumborum m.; innervation?
- 12th rib - lliac crest
- Anterior T12, L1-L4
Where is a Psoas infection found (tissue wise)?
Deep to psoas fascia, between the fascia and muscle
Signs and symptoms of a Psoas Abscess?
Back or flank pain, inguinal mass, fever, limp, anorexia, and weight loss
What can elicit a positive psoas sign?
- Psoas abscess
- Retro-cecal appendix (appendicitis)
- Kidney and ureter pathologies
- Pathologies of the sigmoid colon
What pathology is this?
Psoas Abscess
What are the landmarks for the median, medial, and lateral arcuate ligaments; which have attachements to the diaphragm?
Median - superior to aorta
Medial - thickening of Psoas fascia (diaphragm attachment)
Lateral - thickening of fascia lining Quadratus lumborum (diaphragm attachment)
What nerve is found just inferior to the lateral arcuate ligament?
Subcostal n. (T12)
What are the 3 parts of the diaphragm and their attachment?
Sternal part: may NOT be present. Attaches to Xiphoid
Costal part: attahces to inferior 6 costal cartilages
Lumbar part: attaches to medial and lateral arcuate ligs.
What are the spinal levels of the right and left crus of diaphragm?
Right: (larger and longer) - L3-L4
Left: L2-L3
What comes thru Caval opening?
IVC and Rt. Phrenic n
What comes through the Esophageal Hiatus?
Esophagus, ant. and post. Vagal trunks, and Esophageal branches
What comes through the Aortic Hiatus?
Aorta, Thoracic duct, and sometimes Azygous/Hemi-azygos veins
What spinal level is the body of the pancreas at?
L1
What spinal level is the horizontal part of the duodenum at?
L3
What is found anteriorly, superiorly and inferior to the Lf. Adrenal gland?
Superiorly: Lf. crus of diaphragm
Anteriorly: Stomach, spleen, and pancreas
Inferiorly: Left kidney
How do the veins of the suprarenals differ?
Right: drains directly into IVC
Left: drains into L. Renal V.
What is the innervation of the adrenal glands (plexus and nerve)?
- Preganglionic sympathetics from T6-L1
- Celiac plexus and splanchnic nerves
What is found anterior to the Rt. and Lf. Kidneys?
Right: liver, duodenum, ascending colon
Left: stomach, spleen, pancreas, jejunum, and descending colon
Which spinal levels do the kidneys sit between?
T11-L3
*The left kidney is higher due to the liver
What is the best point of incision for removing kidney; why?
- Posterolateral
- Will only require transection of transversalis fascia
What are layers immediately external to renal capsule; where will a perinephric abscess form?
- Perinephric fat (abscess forms here)
- Renal Fascia
What is the most anterior structure in the renal hilum?
- Renal vein (most anterior)
- Renal artery (middle)
- Renal pelvis (posterior)
