Posterior Abdomen Flashcards
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
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
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
Iliacus (origin, insertion, action, innervation)
O: iliac fossa
I: lesser trochanter (iliapsoas tendon)
A: flexes trunk
N: L2-L4 (femoral n.)
Diaphragm (what is it)
musculotendinous sheath that separates abdominal and thoracic cavities
were does the diaphragm insert?
central tendon
what is the central tendon (whats it derived from)
aponeurosis of muscle
derived from the embryonic septum transversum
sternal origin of the diaphragm
two small muscular slips off xiphoid process
costal origin of diaphragm
lower 6 rips (major part of diaphragm)
lumber origin of the diaphragm
right and left crura (legs)
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
the right crus gives rise to what?
suspensory muscle of the duodenum (ligament of Treitz)
what crus is longer?
right crus is longer than the left crus
what unites the crura and where
median arcuate ligament
anterior to aorta
lateral arcuate ligament (what is it)
superior thickening of quadrates lumborum fascia that overlies quadrates lumborum muscle
the arcuate ligaments are continuations of what fascia?
transversalis fascia
the opening for the inferior vena cava pierces the diaphragm at what level and where?
T8
central tendon
during inspiration what happens to the inferior vena cava
diaphragm conracts and dilates the vena canva
the inferior vena cava foramen contains what?
inferior vena cava and branches of right phrenic nerve
esophageal hiatus is at what spinal level and where in the diaphragm?
T10
encircled by right crus
Aortic hiatus is located at what spinal level and where
T12
posterior to diaphragm
what passes through the esophageal hiatus
esophagus
anterior and posterior vagal trunks
esophageal branches of left gastric vessels
what passes through the aortic hiatus
aorta
thoracic duct
azygous vein
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
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
