posterior ab wall Flashcards
what are the 4 muscles that make up the muscular floor of the posterior ab wall?
- psoas minor and major (T12 –> lesser trochanter)
- iliacus (iliac crest —> greater trochanter)
- quadratus lumborum (rib 12–>iliac crest)
- diaphragm
function of the 4 muscles of the posterior ab wall
- psoas = hip flexor, lumbar flexion, lateral sidebending
- iliacus = hip flexor, hip stabilizer
- quadratus lumborum = posture, and sidebending
- diaphragm (inspiration)
what is a psoas abscess
- infection deep to psoas fascia
- signs: back/flank pain, fever, inguinal mass, limp (bc keeping hip flexed), anorexia, wt. loss
- can be caused by TB
- psoas sign = lower ab pain exacerbated by leg extension
describe the median, medial, and lateral arcuate ligaments
- median
- runs over aorta
- tendonous arch of the crura of the diaphragm - medial
- runs over psoas major
- fascial thickening of psoas fascia
- attachment pt for lumbar diaphragm - lateral
- runs over quadratus lumbordum
- fascial thickening of the quadratus lumborum fascia
- attachment for lumbar diaphragm
describe the anatomy of the diaphragm
- muscular part (hypomere)
- sternal part-attaches to xiphid process
- costal part- attaches to lower 6 costal cartilages
- lumbar part- attaches to medial and lateral arcuate L. - central tendon (from septum transversum)
- crura from dorsal messentary of esophagus
- right crus - larger and longer (L3-L4). circles esophagus
- left crus (L2-L3) - apertures- openings for vessels
describe the apertures of the diaphragm
- cavil opening
- T8
- IVC and R. Phrenic n. - esophageal hiatus
- T10
- esophagus, both vagal trunks, esophageal n.s - aortic hiatus
- T12
- aorta, thoracic duct, sometimes azygous and hemiazygous veins
which nerves pierces the diaphragm without an opening
Left phrenic n.
splanchnic n.s
what level is the body of the pancreas and splenic vein
L1 - L2 (transpyloric plane)
what level does the Left renal vein come off the aorta and why is it significant
L2
- posterior to SMA and anterior to aorta
- drains left gonadal vein and left suprarenal vein
describe the anatomy of the adrenal (suprarenal) glands
- both are covered in renal fascia
1. right - Rt. crus, Rt. kidney, IVC (medial)
- under the liver and diaphragm
2. Left - Lf. crus, spleen, (behind) stomach, pancreas (below), Lf. kidney
- superior and posterior is the diapraghm
blood supply: superior/middle/inferior suprarenal arteries. left and right suprarenal veins
innervation: preganglioninc sympathetic from T6-L2, celiac plexus, splanchnic nerves
where does the superior, middle, and inferior suprarenal gland arteries come from? and left and right suprarenal veins drain?
superior A. - off inferior phrenic A. middle A. - aorta inferior A. - Renal A.'s Rt vein- drain into IVC Lt. vein- drains into left renal vein
anatomical relationship of the kidneys
*right is half an inch lower than left
Right
-posterior: muscular floor, nerve branches of L1, and subcostal n.
-anterior: liver, duodenum, ascending colon
-Medial : IVC
Left (T12-L3)
-posterior: muscular floor, nerve branches of L1, and subcostal n.
-anterior: stomach, spleen, pancreas, jejunum, descending colon
-medial: aorta
the renal hilum is comprised off what renal vessels
In order of anterior to posterior (VAP)
- renal vein
- renal artery
- renal pelvis (opening to ureter)
What are the ureters posterior to that is important for surgery
anterior: vas deferens in males and uterine artery in females
what are the constriction points of the ureters
- ureteropelvic junction
- crossing over the external iliac artery or pelvic brim
- ureter enters bladder wall
