POSTERIOR ABDOMINAL WALL Flashcards
What is the posterior abdominal wall composed of?
5 lumbar vertebrae (L1 - L5) and their associated IV Disks
What are the 3 main muscles in the posterior abdominal wall?
ILIACUS
PSOAS MAJOR
QUADRATES LUMBORUM
What are the special features of the LUMBAR VERTEBREA?
What do the lower couple ribs do?
BIG BODY
LONG/SLENDER TRANSVERCE PROCESSES
short/thick spinous process (hatched-shaped)
NO DEMIFACETS OR TRANSVERSE COSTAL FACTS
LOWER COUPLE RIBS PROVIDE PROTECTION TO THE KIDNEYS
What is the strongest hip flexure in the body?
What forms this structure (2 other muscles)
ILIOPSOAS
Illiacus muscle
PSOAS MAJOR
What is the function of the PSOAS MAJOR?
What innervates the PSOAS MAJOR?
ACTS INFERIORLY W/ ILIACUS to flex thigh
ACTS INFERIORLY W/ ILIACUS TO FLEX TRUNK (when sitting)
Acts superiorly to flex vertebral column laterally
VENTRAL RAMI OF L1-L4
What innervates the ILIACUS MUSCLE?
What is the ILLIACUS MUSCLE FUNCTION?
FEMORAL NERVE L2-L4
FLEXES THIGH
STABALIZES HIP JOINT
(ACTS W/ the inferior portion of the PSOAS MAJOR)
What innervates the QUADRATUS LUMBORUM?
What is the function of QUADRATUS LUMBORUM?
Ventral rami of T12-L4
EXTENDS VERTEBRAL COLUMN
LATERALLY FLEXES VERTEBRAL COLUMN
fixes 12th rib during inspiration
What 4 types of vessels does the ABDOMINAL AORTA give off? (these are 4 categories of vessels)
UNPAIRED VISCERAL BRANCHES
PAIRED VISCERAL BRANCHES
UNPAIRED PARIETAL BRANCHES
PAIRED PARIETAL BRANCHES
What branches off of the unpaired visceral branches?
Celiac trunk (T12)
SUPERIOR MESENTERIC Artery (L1)
INFERIOR MESENTERIC Artery (L3)
What branches off of the paired visceral branches?
MIDDLE SUPRARENAL Artery (L1)
RENAL Artery (L1)
GONADAL Artery (L2)
What branches off of the unpaired parietal branch ?
Median Sacral Artery (L4)
What are the branches off of the paired parietal branch?
INFERIOR PHRENIC Artery (T12)
LUMBAR ARTERIES (4 pairs)
What does the abdominal aorta bifurcate into?
What level does the abdominal aorta bifurcate at?
LEFT COMMON ILIAC Artery
RIGHT COMMON ILIAC ARTERY
L4
The localized enlargement of the aorta inferior to the level of the renal arteries is called? (BELOW L1)
(Normally this is fine.. unless it has ruptured.. 90% mortality rate)
Abdominal Aortic Aneurysm (AAA)
What size diameter of the abdominal aorta is surgery recommended?
5 cm
If the abdominal aorta diameter/width is 5cm or bigger, what procedure is it called?
Explain the procedure?
ENDOVASCULAR ANEURYSM REPAIR
You place an expandable stent graft SO THAT BLOOD CAN BE SHUNTED TOWARDS the left and right common iliac.
DON’T ACTUALLY OPERATE ON THE AORTA ITSELF
What forms the IVC?
What vertebral level does it form at?
LEFT AND RIGHT COMMON ILIAC VEINS
L5
What sends blood to the IVC (VEINS)?
LEFT AND RIGHT COMMON ILIAC VEINS
3 HEPATIC VEINS (LEFT, RIGHT, MIDDLE)
LEFT AND RIGHT INFERIOR PHRENIC VEINS
LEFT AND RIGHT RENAL VEINS
3rd and 4th LUMBAR VEINS
RIGHT GONADAL VEIN
RIGHT SUPRARENAL VEIN
Where does the Left suprarenal vein and Left gonadal vein dump blood to?
Left Renal Vein –> IVC
What spinal nerves form the lumbar plexus?
Ventral rami of L1-L4 Spinal Nerves
What are 6 major branches of the lumbar plexus?
(REMEMBER.. first nerve you will see will be SUBCOSTAL NERVE) for orientation purposes
ILLIOHYPOGASTRIC NERVE (L1)
ILLIOINGUINAL NERVE (L1)
LATERAL FEMORAL CUTANOUES NERVE (L2-L3) - sits on top of iliacus muscle
FEMORAL NERVE (L2-L4)
GENITOFEMORAL NERVE (L1-L2) - sits on top of the psoas major muscle)
OBTURATOR NERVE (L2 - L4) - medial side of psoas muscle
What sits on top of the kidneys?
SUPRARENAL GLAND (ADRENAL GLAND)
Are the kidneys retro or intraperitoneal?
RETROPERITONEAL
Where is urine produced?
What structure does the urine go through to get to the bladder?
Produced in the kidneys and goes to the bladder via the URETERS.
What level does the left kidney lie?
What level does the right kidney lie?
LEFT KIDNEY –> T12-L3
RIGHT KIDNEY –> L1-L4
Describe the urinary pathway?
Urine released into the RENAL PAPILLA –> MINOR CALYX –> MAJOR CALYX –> RENAL PELVIS –> URETUR
What supplies blood to the kidneys?
RENAL ARTERIES
What syndrome is associated when the SMA compresses the LEFT RENAL VEIN?
NUTCRACKER SYNDROME
What does the renal arteries divide into? (Hint: 5 of them)
These are “end” arteries because they do not form an anastomosis.
5 SEGMENTAL ARTERIES
SUPERIOR (APICAL) ARTERY
ANTEROSUPERIOR ARTERY
ANTERINFERIOR ARTERY
INFERIOR ARTERY
POSTERIOR ARTERY
What are the KIDNEY FASCIAL LAYERS?
(outermost –> innermost)
PARANEPHRIC FAT –> RENAL FASCIA –> PERINEPHRIC FAT
Is the ureter retro or intraperitoneal?
RETROPERITONEAL
What supplies the ureter with blood?
RENAL ARTERIES
GONADAL ARTERIES
SUPERIOR VESICAL ARTERIES
What are the 3 URETER CONSTRICTIONS?
URETEROPELVIC JUNCTION (where it starts)
As the ureter cross the pelvic brim and/or
crosses the external iliac (lower)
As ureter traverses the bladder wall (lower)
What are the 2 structures of the suprarenal gland (adrenal gland)?
SUPRARENAL CORTEX (ADRENAL CORTEX)
SUPRARENAL MEDULA (ADRENAL MEDULLA)
What does the ADRENAL CORTEX (SUPRARENAL CORTEX) SECRETE?
Corticosteroids and Androgens
What does the ADRENAL MEDULA (SUPRARENAL MEDULA) secrete?
Contain chromaffin cells which secrete catecholamines (mostly epi 80%)
What is CUSHING SYNDROME?
What are some of the symptoms?
TOO MUCH CORTISOL (HYPOcortosolism)
MOON FACE (ROUND FACE)
BUFFALO HUMP
Purple striae (REDDISH too)
High blood pressure
Rapid weight gain (PHAT BODY and SKINNY legs)
What is ADDISON SYNDROME (PRIMARY ADRENAL INSUFFICIENCY)?
What are some of the symptoms?
What is the treatment?
DESTRUCTION of suprarenal cortex (adrenal cortex) –> LOW CORTISOL (HYPOcortisolism)
chronic diarrhea
mouth lesions
dizziness when standing up
salt cravings
Hyperpigmentation of skin
Corticosteroid shots
hydrocortisone
What is CONN SYNDROME?
What are they symptoms?
What is the treatment?
Small tumor that produce HELLA aldosterone. Usually it has to do with a pituitary adenoma that produces ACTH causing adrenal cortex (zone glomerulosa) to produce lot of aldosterone.
hypernatremia and hypokalemia –> HIGH BP (hypertension)
LAPROSCOPIC ADRENALECTOMY (remove adrenal gland + tumor)
Carcinomas of the CHROMAFFIN CELLS WITHIN THE SUPRERENAL MEDULLA (ADRENAL MEDULLA) are called?
PHAEOCHROMOCYTOMA
What are Phaeochromocytomas?
What can phaeochromocytomas cause/
Tumor of the chromaffin cells within the adrenal medula –> cause episodic release of catecholamines
Can cause hyperglycemia and hypertension
What is the treatment of phaechromocytomas?
ADRENERGIC ALPHA-BLOCKADES (give before surgery)
What supplies blood to the SUPRARENAL GLAND (ADRENAL GLAND)?
SUPERIOR SUPRARENAL artery (comes of inferior phrenic artery)
MIDDLE SUPRARENAL artery (comes of aorta)
INFERIOR SUPRARENAL artery (comes of renal artery)
Where does lymph from the SUPRARENAL glands (Adrenal glands), kidney, ureter drain into?
LUMBAR LYMPH NODES
What 2 cavities the diaphragm separate?
THORACIC CAVITY and ABDOMINAL CAVITY
What is the main function of the diaphragm?
CHIEF MUSCLE OF INSPIRATION
What nerves innervates the diaphragm?
PHRENIC NERVES
What are the 3 parts of the diaphragm?
Central tendon is in the middle.
STERNAL PART
COSTAL PART
LUMBAR PART
What are the musculotendinous bundles that arise in the diaphragm?
Where verterbral levels can they reach down to?
Right and Left crus (crura)
Right crus can run down to L3.
Left crus can run down to L2
What are the fibrous ligaments (5) that help anchor the diaphragm to the posterior abdominal wall?
Median arcuate ligament (made up mostly of right crus)
2 Medial arcuate ligaments (made up of mostly psoas muscle fascia)
2 Lateral arcuate ligaments (made up of mostly quadratus lumborum fascia)
What is the only part of the diaphragm that moves?
During inspiration, what happens to the diaphragm?
Central Tendon
Inspiration –> diaphragm DESCENDS
Expiration –> diaphragm ASCENDS
What are the 3 DIAPHRAGMATIC APERTURES?
CAVAL OPENING (IVC passes through) (T8 - at the central tendon specifically)
ESOPHAGEAL HIATUS (esophagus passes through at T10) (right crus form this)
AORTIC HIATUS (T12) (Aorta doesn’t technically pierce the diaphragm)
What nerves innervates the diaphragm? (takes care of somato-motor innervation)
PHRENIC NERVE (ventral rami of C3-C5)
What takes care of somatosensory innervation of the diaphragm?
PHRENIC and INTERCOSTAL NERVES
What arteries supply blood to the SUPERIOR PORTION of the diaphragm?
SUPERIOR PHRENIC ARTERY
PERICARDIOCOPHRENIC ARTERY
MUSCULOPHRENIC ARTERY
What supplies blood to the INFERIOR PORTION of the diaphragm?
This is the primary blood supply to the diaphragm.
INFERIOR PHRENIC ARTERIES
