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Posterior abdominal wall Flashcards

1
Q

what is posterior abdominal wall ?

A

Osseo-musculo fascial extension from the last rib to the pelvic brim ( cuz its made out of bone , muscle , fascia )

from the floating ribs to the pelvic brim

anterior abdominal wall was from xiphoid process and costa margin then to the pubic symphysis and iliac crests

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2
Q

what is the anterior to the posterior abdominal wall?

A

Retroperitoneal organs

Parietal peritoneum

so in order to see the posterior wall you gotta remove these

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3
Q

what is the content of the posterior abdominal wall?

A

Bones : Lumbar vertebrae , pelvic bone, 11, 12 ribs

Muscle of the posterior abdominal wall and the facia covering them

Abdominal aorta

Inferior vena cava

Nerves of posterior abdominal

lymphatic drainage

Viscera

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4
Q

what are the bones of the Posterior abdominal wall ?

A

Lumbar vertebrae : 5 –> project into them midline of the posterior abdominal wall - bodies of the five lumbar vertebrae - lumbar lordosis ( curvature of lumbar bones )

Pelvic bone : ilia attach laterally to the sacrum at the sacroiliac joint , medial side of the iliac fossa is part of posterior abdominal wall

Ribs : 11th 12th

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5
Q

what type of joint is sacroiliac joint ?

A

Diarthrodial synovial joint

Surrounded by fibrous capsule containing joint space filled with synovia fluid

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6
Q

what is iliac fossa?

A

depression in the ilium

main site of origin of the iliacus fossa

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7
Q

what are the muscles of posterior abdominal wall ?

A

Psoas major and minor —> MEDAILLY

Quadratus lumborum ( Quadrangular in shape ) —> LATERALLY

iliacus —-> MEDIALLY

Diaphragm —-> SUPERIORLY

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8
Q

where do the psoas major and iliacus run ?

A

Run together to attach to the LESSER TROCHANTER

called iliopsoas

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9
Q

what is psoas minor ?

A

smaller psoas major

More medially located

has different attachments

Not found in all individuals

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10
Q

what is the origin of psoas major ?

A

Body of T12

body of L1-L5

transverse processes of lumbar vertebrae

Slip from transverse process of T12

+ Intervertebral disc

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11
Q

what is the insertion of psoas major?

A

Lesser trochanter

via combined tendon with iliacus muscle

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12
Q

what is the nerve supply of psoas major ?

A

Ventral rami of L2 and L3

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13
Q

What is the action psoas major ?

A

Flexion of of thigh at hip joint

helped by iliacus

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14
Q

what covers the psoas major ?

A

Psoas fascia

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15
Q

what happens to the psoas major in cases of IV disc disease ?

A

psoas major has origin from IV discs

in case of IV disease for example tuberculosis , infection can spread underneath the psoas fascia and into lower limb cuz the attachment of the muscle and its fascia is the lesser trochanter

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16
Q

what is the origin of psoas minor ?

A

Two slips :

One from body of T12

One from body of L1

and their intervertebral Disk

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17
Q

what is the insertion of psoas minor?

A

Pectineal line of the pelvic brim

iliopubic eminence

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18
Q

what is the nerve supply of Psoas minor ?

A

Ventral rami of L1

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19
Q

what is the action of psoas minor?

A

Weak flexion of lumbar column

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20
Q

what are the differences between psoas major and minor ?

A

Psoas minor doesnt attach to Transverse processes in the origins

only limited to T12 AND L1 vertebrae as it is smaller

Minor is shorter and attach to the pectineal line of pelvic brim and iliopubic eminence

doesnt go to lower limb SO NO EFFECT ON THE HIP JOINT –> it works on the vertebral column

Different nerve supply

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21
Q

what is the origin of lumborum muscle ?

A

transverse process of L5 vertebra

Iliolumbar ligament ( Between ilium and lumbar vertebrae )

Iliac crest

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22
Q

what is the insertion of quadratus lumborum muscle ?

A

transverse processes of L1 to L5

Inferior border of 12 rib

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23
Q

what is the nerve supply of quadratus lumborum ?

A

Ventral rami of T12

Ventral rami of L1 to L4

nearly all lumbar plexus except L5

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24
Q

what is the action of quadratus lumborum ?

A

Depress and stabilize 12th Rib

little lateral bending trunk

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25
what is the origin of iliacus muscle ?
upper 2/3 of iliac fossa (Majority of origin ) anterior sacro iliac ligaments ( spread over ala from sacrum to ilium ) iliolumbar ligament ( parts of the origin of quadratus lumborum ) Upper lateral surface of sacrum
26
what is the insertion of ilacus muscle?
Lesser trochanter ( With the psoas major )
27
what is the nerve supply of iliacus muscle ?
Femoral nerve : L2 , L3
28
what is the action of iliacus ?
Flexion of thigh at hip joint
29
what are the relations of the muscles in posterior abdominal wall?
Psoas major --> medial to the quadratus lumborum Quadratus lumborum ---> MOST LATERAL
30
what forms medial arcuate ligament ?
Psoas fascia ---> Fascia of the most medial muscle
31
what forms the lateral arcuate ligament ?
Thickening of the QUADRATUS LUMBORUM FASCIA ---> fascia of the lateral most muscle
32
what is ligament of trietz?
ligamentous structure consisting of muscle and fascia continues from the RIGHT CRUS of DIAPHRAGM and attach to duodenojejunal flexure
33
what is thoracolumbar fascia?
Strong sheet of deep fascia which binds the deep muscles of the back to the sides of the vertebral column
34
what does Thoracolumbar fascia enclose ?
Quadratus lumborum --> anterior Erector spinae muscle ---> Posterior
35
what are 3 layers of thoracolumbar fascia?
anterior Middle Posterior
36
what does anterior layer of thoracolumbar fascia cover?
anterior surface of quadratus lumborum
37
what does the anterior layer of thoracolumbar fascia attaches to medially ?
Lumbar transverse process
38
what does the anterior layer of thoracolumbar fascia attaches to LATERALLy?
aponeurotic origin of transversus abdominis
39
what does the middle layer of thoraco lumbar fascia cover?
Back of quadratus lumborum
40
what does the middle layer of thoracic fascia attaches to MEDIALLY?
Lumbar transverse process
41
what does the middle layer of thoracolumbar fascia attaches to laterally?
units with the anterior layer also attaches to the transversus abdominis aponeurosis
42
what does the posterior layer of thoracolumbar fascia located?
Posterior to erector spinae
43
what does the posterior layer of thoraco lumbar fascia attaches to medially?
it is the strongest layer Tips of lumbar spines
44
what does the posterior layer of thoracolumbar fascia attaches to laterally?
fuses with with middle layer at the lateral margin of erector spinae
45
describe psoas fascia ?
thick connective tissue Extends into the thigh ( so in cases of psoas abscess extends into femoral triangle Thickened superiorly to form MEDIAL ARCUATE LIGAMENT OF DIAPHRAGM
46
psoas fascia is at the same level as what?
renal hilum which is at transpyloric plane Vertebrae L1
47
what is the clinical significance of psoas muscle abscess ?
Psoas muscle and its sheath not only arise from lumbar vertebrae but also from INTERVERTEBRAL DISCS BETWEEN EACH VERTEBRAE in certain type of infections ,the intervertebral disc is affected and has abscess ---> Tuberculosis , salmonella discitis As the infection of the disc develops, the infection spread anteriorly and antero laterally in anterolateral position, the infection passes into the psoas muscle sheath and spreads within the muscle and sheath may appear below the INGUINAL LIGAMENT AS MASS
48
what are the PAIRED VISCERAL branches of the aorta?
Visceral branches --> supply organs/viscera Paired --->bilateral Renal ( 2 kidneys ) Middle suprarenal ( 2 adrenal glands ) Gonadal ( 2 gonads )
49
what are the UNPAIRED visceral branches of the abdominal aorta?
Celiac ---> foregut Superior mesenteric ---> midgut Inferior mesenteric ----> hindgut
50
we mentioned middle suprarenal artery for adrenal glands what are the other branches for the adrenal glands ?
indirect branches: Superior suprarenal artery ----> Inferior phrenic artery Inferior suprarenal artery ---> Renal artery
51
what are the PAIRED POSTERIOR/PARIETAL of the abdominal aorta ?
Paired ---> bilateral Posterior/parietal ---> go to the posterior abdominal wall to supply muscles and tissue Inferior phrenic artery ( which give raise to Superior suprarenal gland ) Lumbar Inferior phrenic we have a single pair ( one in each side ) Lumbar we have 4 pairs ---> 4 ON EACH SIDE so 8
52
what are the UNPAIRED posterior/parietal branches of abdominal aorta?
Median sacral 1 small tail like artery descending to supply the tissue of the posterior abdominal wall
53
what are the terminal branches of abdominal aorta?
Common iliac arteries
54
what is the level that median sacral artery arise from ?
L4 posterior to the bifurcation of the aorta into its terminal branches , the 2 common iliac arteries )
55
describe the blood supply of suprarenal gland ?
middle suprarenal artery from the abdominal aorta Superior suprarenal artery from the inferior phrenic artery Inferior suprarenal artery from the renal artery the adrenal gland is an endocrine gland which naturally has richer blood supply to accommodate its function hence why it has 3 branches supplying it
56
at what location does the gondal artery arise?
below renal artery and superior mesenteric above inferior mesenteric artery ( at lvl L3)
57
at what vertebral level does the renal artery arise from?
IV disk between L1 and L2 ( superior mesenteric artery at L1 ) at the right angles with abdominal aorta
58
describe the difference between Right renal artery and left renal artery?
The right one is longer because it has to travel longer to the right kidney pass behind the inferior vena cava
59
what is the significance of left gonadal vein ?
drain into the left renal vein whereas the right gonadal vein drain directly to IVC cuz the IVC is on the right left renal vein longer than the right one cuz it has to travel for longer distance as the IVC is more to the right
60
at what level do the VISCERAL UNPAIRED branches of the abdominal aorta?
Celiac artery ---> Superior border of L1 Superior mesenteric artery ---> Inferior border of L1 ---> Behind pancreatic head and anterior to the uncinate process Inferior mesenteric artery ---> L3 ( inferior to the head of pancreas )
61
describe inferior phrenic ?
1st branch of the aorta Supply diaphragm and suprarenal gland ( superior suprarenal artery )
62
describe lumbar arteries?
4 pairs ( 8, 4 in each side ) Pass deep to psoas Supply : vertebral column, spinal cord, abdominal wall
63
describe median sacral artery?
arise from the posterior of the abdominal aorta js superior to bifurcation Descends into the pelvis in front of the sacrum
64
at what level does the inferior vena cava form?
L5 vertebrae by the union of two common iliac veins
65
describe inferior vena cava course ?
Ascends on the posterior abdominal wall to the RIGHT OF THE MIDDLINE ( aorta at left ) Pass through the caval opening in the central tendon of diaphragm AT THE LEVLE OF T8
66
what are the tributaries of IVC?
i like to rise so high I --> COMMON ILIAC VEINS AND INFERIONR PHRENIC VEIN L ----> lumbar veins ( lower 2 ) T---> right testicular/gonadal vein ( no left cuz it drains to the left renal vein which will drain into IVC ) R----> renal veins ( both left and right ) S ---> Right suprarenal vein ( no left cuz it will drain directly to left renal vein ) H---> hepatic veins ( both and right and left )
67
where do the renal veins lie ?
Anterior to the renal arteries
68
compare the the left renal to the right renal artery?
Left is longer than the right Receives from Left suprarenal and left gonadal cuz they dont directly empty to IVC
69
describe the autonomic innervation of GI tract?
Sympathetic : T5 TO L2 nerves via the sympathetic chain or splanchnic Parasympathetic --> CRANIOSACRAL ---> from vagus nerve and plevic splanchnic nerves S2-S4 Sympathetic splanchnic : Greater : T5-T9 --> celiac ganglion ---> foregut Lesser splanchnic --->T10-T1---> Superior mesenteric ganglion ---> Midgut Least splanchnic ----> T12 ---> superior mesenteric ganglion + AORTICORENAL ---> midgut Lumbar splanchnic ---> L1-L2 ---> inferior mesenteric ganglion ----> hindgut Sacral splanchnic ---> L1-L2 ----> supply part of the pelvis, posterior thigh , most lower leg, entire foot
70
what are the nerves of the posterior abdominal wall?
Lumbar part of the sympathetic trunk Celiac plexus Aortic plexus ( infront of the aorta ) Hypogastric plexus ( both superior/presacral and inferior/pelvic ) Lumbar plexus nerves
71
describe lumar part of sympathetic plexus ?
Lumbar trunk consists of 4 pairs of sympathetic ganglia Sympathetic trunk reaches the abdomen by passing BEHIND the medial arcuate ligament The RIGHT chain descends behind IVC Left chain descends to the LEFT of abdominal aorta
72
describe celiac plexus ?
2 celiac ganglia ( left and right ) lying on the crus of the DIAPHRAGM on both sides of the celiac trunk Celiac ganglia send sympathetic branches surrounding the upper part of abdominal aorta, the celiac trunk and celiac branches , forming celiac plexus The plexus receive parasympathetic branches from the left gastric nerves ( VAGUS NERVE )
73
describe aortic plexus ?
aortic plexus of nerves is continued above with CELIAC PLEXUS AND BELOW with the HYPOGASTRIC plexus Aortic plexus is present along the FRONT and sides of the AORTA Hypogastric plexus lies below the bifurcation of the aorta Divides into right and left inferior hypogastric plexus AROUND the internal iliac arteries
74
describe lumbar plexus of nerve?
Formed by : Subcostal nerve and ANTERIOR primary RAMI of L1-L4 is formed in the substances of PSOAS Branches of the plexus arise from PSOAS MUSCLE
75
what are the nerves lateral to the PSOAS ?
iliohypogastric ( T12-L1) its collateral ilioinguinal ( T12-L1) Lateral femoral cutaneous (L2-L3 ) Femoral ( L2,L3,L4 )
76
what are the lumbar plexus anterior the psoas ?
Genitofemoral ( L1, L2)
77
what are the lumbar plexus MEDIAL to the psoas major ?
Obturator ( L2,L3,L4 ) Lumbosacral trunk

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