Lecture 12: Posterior Abdominal Wall

Question 1

Psoas Major and Minor

OINA

Answer 1

O: T12-L5
I: lesser trochanter
N: anterior rami of L1-3
A: flex the thigh and trunk with ilacus, laterally flex vertebral column

Question 2

Iliacus M.

OINA

Answer 2

O: iliac fossa, ala, ASI l.
I: lesser trochanter
N: Femoral N. (L2-4)
A: flex thigh and stabilize hip joint, with psoas major

Question 3

Quadratus lumborum M.

OINA

Answer 3

O: inferior 12th rib
I: iliolumbar l., iliac crest
N: T12, L1-4
A: extend and laterally flex vertebral column, fix 12th rib during respiration

Question 4

Psoas Abscess
Cause
Clinical

Answer 4

• organ disease spreading infection into abdomen

- lower AP worse with extension of thigh (psoas sign), fever, limp, inguinal mass

Question 5

What are the ligaments of the posterior abdominal wall?

Answer 5

Median arcuate ligament
Medial arcuate ligament
Lateral arcuate ligament

*attaches thoracic diaphragm to the posterior abdominal wall

Question 6

What are the unpaired arteries of the posterior abdominal wall?

Answer 6

SMA
IMA
Celiac Trunk
Median Sacral A.

*Everything else is paired

Question 7

Be able to draw the arteries and veins of the posterior abdominal wall

Answer 7

Ok

Question 8

What are the paired parietal veins?

What are the paired visceral veins?

Answer 8

• inferior phrenic v, 3rd/4th lumbar v, and common iliac v.

- suprarenal v., renal v., gonadal v.

Question 9

Where are the diaphragm openings and what passes through?

Answer 9

Caval - T8; IVC, R phrenic
Esophageal hiatus - T10; esophagus, a/p vagal trunks
Aortic hiatus - T12; aorta, thoracic duct, azygous and hemiazygous v.

Question 10

Where does the muscular portion of the diaphragm attach to?

Answer 10

Sternal portion attaches to xiphoid

Costal portion attaches to inferior 6 costal cartilages

Question 11

Where does the crura of the diaphragm attach to?

Answer 11

Right crus - larger crus at L3-L4 v-bodies, run beside the aortic hiatus
Left crus - L2-3 v-bodies

Question 12

What arteries feed the diaphragm (include where they come from)?

Answer 12

Superior side: Musculophrenic and pericardiophrenic a. (from Internal thoracic a.), superior phrenic a. (from thoracic aorta)

Inferior side: Inferior phrenic a (abdominal aorta), intercostal branches for peripheral diapgragm

Question 13

Where is the kidney located anteriorly?

Where is the kidney located posteriorly?

Answer 13

Retroperitoneal T12-L3

superior parts deep to Rib 11-12, Transpyloric plane has left hilum and superior pole of right kidney; inferior pole of right kidney a bit above the iliac crest

*right kidney is lower

Question 14

What muscle lies posterior to the largest part of the kidney?

What nerves serve the kidney?

Answer 14

• QL

- Subcostal, iliohypogastric and ilioinguinal n.

Question 15

What are the layers of renal fat (superficial to deep)?

Answer 15

Paranephric
Renal fascia (posterior part)
Perinephric

Question 16

Be able to label parts of the kidney on the image

Answer 16

Ok

Question 17

Where is the ureter located?

Answer 17

inferior to renal pelvis, posterior to vas deferens/uterine artery

Question 18

Where the constriction/obstruction points of the ureter?

How do you diagnostically image the ureter?

Answer 18

Junction of ureter with renal pelvis
Crossing pelvic brim
Entering bladder wall

-use pyelogram

Question 19

What do arterial pathway of the blood from body to kidney?

What is the venous pathway of blood from kidney and back to body?

Answer 19

Descending aorta > Renal Artery > Segmental Artery –> Interlobar Artery –> Arcuate Artery –> Interlobular Artery –> Afferent Arteriole > Glomerulus > Peritubular capillaries/Vesa Recta

Vesa recta > efferent arteriole > Cortical radiate V. > Arcuate V. > Interlobar V. > Renal V. > Inferior vena cava

Question 20

What arteries do ureters “leech” off of?

Answer 20

branches of renal, gonadal, abdominal, iliac, superior vesicular and pelvic/perineal arteries

Question 21

Right suprarenal gland associated structures

Left suprarenal gland associated structure

Answer 21

• IVC, right crus, right kidney

- stomach, pancreas, left crus and left renal

Question 22

what arteries feed the suprarenal glands?

What nerves serve the suprarenal glands?

Answer 22

Superior, middle and inferior suprarenal arteries

Preganglionic sympathetic (T10-L1), celiac plexus and abdominopelvic splanchnic ns.

Question 23

what does the lumbar nodes drain?

Answer 23

posterior wall and posterior pelvic wall

Question 24

What do the pre-aortic lymph nodes drain?

Answer 24

alimentary tract, liver, spleen, pancreas

Question 25

Describe the pathway of lymph drainage from the posterior abdominal wall

Answer 25

Ext/Int Iliac Nodes > Common Iliac Nodes > Lumbar Nodes >Lumbar Lymphatic trunks > cisterna chyli

Pre-aortic nodes > intestinal lymphatic trunks > cisterna chylli