Posterior Abdomen Flashcards by Lucas Bracero

Quadratus Lumborum (origin, insertion, action, innervation)

O: lumbar ligament, posterior part of iliac crest
I: Lower border 12th rib, transverse processes of upper 4th lumbar vertebrae
A: Bends trunk laterally, fixes 12th rib during inspiration
N: T12, L1-L4

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Psoas Major (origin, insertion, action, innervation)

O: lumbar vertebrae- transverse processe, sides of bodies, and intervertebral discs
I: lesser trochanter of femur (as iliopsoas tendon)
A: flexes thigh and trunk
N: L2-L4 via lumbar plexus

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Psoas Minor (origin, insertion, action, innervation)

O: T12 and L1- transverse processes, sides of bodies, and intervertebral discs
I: iliopubic eminemce
A: weak flexor of trunk
N: L1

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Iliacus (origin, insertion, action, innervation)

O: iliac fossa
I: lesser trochanter (iliapsoas tendon)
A: flexes trunk
N: L2-L4 (femoral n.)

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Diaphragm (what is it)

musculotendinous sheath that separates abdominal and thoracic cavities

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were does the diaphragm insert?

central tendon

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what is the central tendon (whats it derived from)

aponeurosis of muscle

derived from the embryonic septum transversum

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sternal origin of the diaphragm

two small muscular slips off xiphoid process

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costal origin of diaphragm

lower 6 rips (major part of diaphragm)

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lumber origin of the diaphragm

right and left crura (legs)

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right and left crura (legs) of diaphragm (what are they where do they each originate)

musculotendinous band that originates from the anterior surface of:
right crus- the upper three vertebrae
left crus- upper two vertebrae

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the right crus gives rise to what?

suspensory muscle of the duodenum (ligament of Treitz)

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what crus is longer?

right crus is longer than the left crus

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what unites the crura and where

median arcuate ligament

anterior to aorta

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lateral arcuate ligament (what is it)

superior thickening of quadrates lumborum fascia that overlies quadrates lumborum muscle

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the arcuate ligaments are continuations of what fascia?

transversalis fascia

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the opening for the inferior vena cava pierces the diaphragm at what level and where?

central tendon

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during inspiration what happens to the inferior vena cava

diaphragm conracts and dilates the vena canva

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the inferior vena cava foramen contains what?

inferior vena cava and branches of right phrenic nerve

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esophageal hiatus is at what spinal level and where in the diaphragm?

T10

encircled by right crus

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Aortic hiatus is located at what spinal level and where

T12

posterior to diaphragm

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what passes through the esophageal hiatus

esophagus
anterior and posterior vagal trunks
esophageal branches of left gastric vessels

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what passes through the aortic hiatus

aorta
thoracic duct
azygous vein

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The diaphragm gets its blood supply from what arteries (and where do they branch from)

musculophrenic- internal thoracic
pericardiacophrenic- internal thoracic
superior phrenic- thoracic aorta
inferior phrenic- abdominal aorta

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retroperitoneal organs in posterior abdomen are positioned between what spinal levels

T12-L3

the hilum of the kidneys lie in what plane

transpyloric

kidney coverings (name them from superficial to deep)

``` Paranephric fat Renal Fascia (extraperitoneal fascia) Perinephric fat (perirenal fat) ```

Paranephric fat (what is it)

large amount of fat found only posterior to the kidney

Renal Fascia

later of fascia that encloses the kidneys and suprarenal glands

Perinephric Fat (what is it)

completely surrounds the kidney and allows for slight vertical moment during respiration

renal capsule (what is it)

fibrous capsule covering that invests the kidney (but not suprarenal glands)

the left gonadal vein empties where

left renal vein

right gonadal vein empties into what

inferior vena cava

Hilum of kidney (what enters through it, from anterior to posterior)

renal vein renal artery renal pelvis autonomic nerves and lymph also enter at the hilum

shape of right suprarenal gland

shaped like a pyramid

shape of left suprarenal gland

semilunar shape, larger than right

suprarenal glands get blood from where (and what are those branches from

superior suprarenal artery- from inferior phrenic middle suprarenal artery- from aorta inferior suprarenal artery- from renal artery

right suprarenal vein drains into what

inferior vena cava

left suprarenal vein drains in into what

left renal vein

branches of the abdominal aorta can be classified into what three categories (and what do they supply)

``` unpaired visceral (to GI tract) paired visceral (to UG and endocrine organs) Paired Parietal (to diaphragm and body wall) ```

Unpaired visceral branches of aorta (name them and the level at which branching)

Celiac trunk- T12 Superior Mesenteric- L1 Inferior Mesenteric- L3

Paired visceral branches of aorta (name them and their source)

Middle Suprarenal- L1 Renal- L1 Gonadal (testicular/ovarian)- L2

Paired parietal branches of aorta (name them and their source)

Inferior phrenic- T12 Subcostal- T12 Lumbar- L1-L4

Tributaries to IVC include (name them

``` common iliac veins lumbar veins right testicular or ovarian veins renal venis right suprarenal veins inferior phrenic veins hepatic veins ```

the ivc's location is what compared to midline

offset to right

which renal vein is longer

left, goes over aorta

lymph from the posterior abdominal region is collected where?

pre-aortic (anterior to aorta) trunk | para-aortic/ lumbar (lateral to aorta) trunk

cisterna chyli (what is it)

confluence of pre and parametric trucks

cisterna chyli (what does it mark)

bringing of thoracic dust posterior to abdominal aorta at L1-L2

the subcostal nerve is from where?

ventral rams of T12 just below diaphragm

the lumbar plexus arises from where

ventral rami of L1-L4

lumbar plexus (named nerves and where they arise)

``` iliohypogastric (L1) ilioinguinal (L1) Genitofemoral (L1, L2) Lateral Femoral Cutaneous (L2, L3) Femoral (L2-L4) Obturator (L2-L4) Accessory Obtruator (10% of people -L3, L4) ```

lumbrosacral trunk arise from where

L4-L5

lumbosacral trunk joins the sacral plexus where?

in pelvis

abdominal sympathetic trunk carries what kind of fibers?

presynaptic fivers that synapse at ganglia at various spinal levels

subcostal nerve supplies what

skin and muscles of anterolateral abdominal wall

iliohypogastric nerve supplies what

skin of upper inguinal and suprapubic region | internal oblique and transverus abdominis muscle

ilioinguinal nerve supplies what

skin of lower inguinal region, groin, and medial thigh | internal oblique and transverus abdominis muscle

Genitogemoral Nerve supplies what

genital branch: motor to cremaster muscle | femoral branch: skin of medial thigh

lateral femoral cutaneous nerve supplies what

skin of lateral and anterior thigh

femoral nerve supplies what

anterior thigh muscles

obturator nerve supplies what

medial thigh muscles

the splanchnic nerves (describe their course)

pierce muscle of diaphragm and enter celiac ganglion or plusses in thorax

the subcostal courses how

passes under arcuate ligament and course laterally

what nerves of the lumbar plexus emerge lateral to psoas muscle

iliohypogastric ilioinguinal cutaneous nerve of thigh femoral

what nerves of the lumbar plexus emerge medial to psoas muscle

obtruator | lumbosacral trunk

what nerves of the lumbar plexus emerge anterior to psoas muscle

genitofemoral

what nerves can be damaged in a lumbar approach to the kidney

subcostal, iliohypogastri, ilioinguinal

genitofemoral nerve (course)

pierces psoas fascia courses anteriorly on the anterior surface of psoas and then divides into its two terminal branches: genital branch and femoral branch

lateral femoral cutaneous nerve (course)

inferolaterally on iliacus

Femoral nerve (course)

decending in interval b/w iliacus and psoas

Iliopsoas test (what is it)

patient flexes thigh against resistance of the examiner’s hand painful response indicates inflammation involving psoas muscle

right positive psoas sign may suggest what?

appendicits

Abdominal aortic aneurysm (what is it)

a balloon-like swelling in wall of the abdominal aorta | may be due to degenerative disease or a congenital deficiency that weakens the muscular wall

Real calculus (kidney stone)

crystals (stones) formed in the kidney when excess calcium forms a mass with other waste or mineral such as oxalate, magnesium, or uric acid

Pelvic kidney (what is it)

kidneys fail to ascend and remain at brim of pelvis | may be asymptomatic

Horseshoe kidney (what is it, what might it cause)

fusion of lower poles of the two kidneys | may impinge on ureters, blocking the passage of urine

Unilateral double kidney (what is it and what might it cause)

double kidney with separate ureters/vessels on one side | this may cause the ureters to enter the bladder at an abnormal angle, blocking urine

Rosette kidney

fusion of kidneys at their hila | usually remain in pelvis

Bifid ureter

ureters may join in the lower third of their course, open through a common orifice, or open independently into bladder this anomaly has an increased potential for infection or calculus formation