Posterior Abdominal Wall Flashcards
what spaces is the retroperitoneal space continuous with
pelvic cavity
diaphragm
subserous fascia
what nerves are associated with the posterior abdominal wall
T12-L5
what areas drain lymph through the retroperitoneal space
GI tract
pelvis
reproductive organs
what forms the esophageal hiatus
right crus of the diaphragm
what for the aortic hiatus
right and left crura of the diaphragm
what forms the median arcuate ligament?
right and left crura of diaphragm
tendinous arches of the diaphragm
meidan, medial and lateral form as thickenings of transferals fascia
what is the blood supply to the diaphragm
superior- pericardiacophrenic, musculophrenic
inferior- inferior phrenic from aorta
what is the innervation of the diaphragm
motor and sensory- phrenic (C3,4,5)
intercostals- sensory
where is the referred pain location for the diaphragm
shoulder
where are the 3 openings in the diaphragm and what goes through them
T8- IVC
T10- esophagus
T12- aorta
where is the median arcuate ligament
aortic hiatus
where is the medial arcuate ligament
over psoas major
where is the lateral arcuate ligament
over quadratus lumborum
what main structures pass through the diaphragm and where do they go through
IVC- T8
esophagus- T10
aorta- T12
what passes through the esophageal hiatus
esophagus
vagus trunks
what passes through the aortic hiatus
aorta
thoracic duct
sometimes the asecending lumbar veins
what passes through the crura of the diaphragm
greater and lesser splanchnic nerves
sometimes the ascending lumbar veins
what are the 4 muscles of the posterior abdominal wall
quardatus lumborum
posts major
psoas minor (sometimes)
iliacus
where is the quadratus lumborum muscle and what does it form
superior to the iliac crest
forms lateral arcuate ligament
function of the quadrates lumborum muscle
flex trunk
where is the posterior major muscle and what does it form
next to spine
forms medial arcuate ligament
function of posts major
hip flexor
where is the posterior minor muscle and what does it form
tendon on top of psoas major
may be missing
forms medial arcuate ligament
function of psoas minor
hip flexor
where is the iliac muscle
in the iliac fossa
function of iliac muscle
hip flexor
what does the subcostal nerve supply
T12- hypogastric region
where is the iliohypogastric nerve
L1- lowest cutaneous nerve on the abdomen
where is the ilioinguinal nerve and what does it supply
L1- in the inguinal canal
skin of scrotum and medial thigh
sensory aspect of cremaster reflex
where is the genitofemoral nerve and what does it supplly
L1-2 on the surface of the psoas muscle
splits into 2 nerves- genital and femoral branches
where is the genital branch of the genitofemoral nerve and what does it do
medial branch of genitofemoral nerve
in the spermatic cord
supplies the cremaster reflex
where is the femoral branch of genitofemoral nerve
lateral branch of genitofemoral nerve
goes to medial thigh to assist in cremaster reflex
what does the lateral femoral cutaneous nerve supply
L3-4, anterior superior iliac spine
where is the femoral nerve and what does it supply
L2-4 posteiror and lateral to psoas
hip flexors and knee extensors
where is the obturator nerve and what does it supply
L2-4, exits obturator foramen and supplies the adductors
where is the lumbosacral trunk
L4-5 on the surface of the sacrum
gives off sciatic nerve
what is Gerota’s fascia
surrounds the kidneys
closed superiorly and laterally, but opened inferiorly and medially so blood and urine can move between left and right and drain into the pelvic cavity
what covers kidneys
periphrenic fat and Gerona’s fascia
where is the right kidney
T12-L3 (due to liver)
where is the left kidney
T11-L2
why are the right renal artery and left renal vein longer than their partners
aorta is on left
IVC is on right
nutcracker relationship
the left renal vein is between the SMA and the aorta
can increase the pressure in the left gonadal vein and cause a varicocele
what is the right kidney in contact with
liver ascending colon ileum duodenum suprarenal gland
what is the left kidney in contact with
stomach spleen pancreas transverse mesocolon descending colon jejunum suprarenal gland
what are the 5 segmental branches of the renal artery
apical- top most anteriorly anterior superior- second anteriorly anterior inferior- third anteriorly inferior- last anteirorly posterior- goes to posterior side
what is the order of vessels from the renal artery
segmental–> interlobar–> arcuate–> interlobular–> afferent arteriole–> glomerulus–> efferent arteriole
what is the innervation of the kidney
least splanchnic nerve
where does the ureter exit the kidney
at the hilum, most posterior structure
why does compression of the left renal vein cause a varicocele
the left gonadal vein drains into the left renal vein before reaching the IVC
compression of the left renal vein backs up the blood into the left gonadal vein
describe the path of the ureter
passes posteriorly to the gonadal vessels
passes anteriorly to common iliac vessels, lateral to the internal iliac vessels to enter the pelvis
what is the blood supply of the ureters while they are in the retroperitoneum and from where does the blood supply originate (significance?)
renal artery
gonadal artery
aorta
originates medially- reflect the ureters medially here
what is the blood supply of the ureters while they are in the pelvis and from where does the blood supply originate (significance?)
vesicle artery
uterine artery
middle rectal artery
originates laterally- reflect ureters laterally here
what are the 3 points where kidney stones are most likely to get stuck
ureteropelvic junction
crossing iliac vessels
ureterovesicle junction
what is the arterial supply to the suprarenal gland
branches of inferior phrenic, aorta, renal
what is the venous supply draining the suprarenal galnd
1 vein
right- IVC
left- drains to renal vein
what is the innervation of the suprarenal glands
preganglionic fibers (lesser and least splanchnic T10-T12) that do not synapse at the ganglion but go directly to chromatin cells of medulla
what is the name for kidney stones
renal calculi
what is the innervation to the ureter
T11-L2
where is referred pain for the kidney/ureter
starts on side and then goes inferiorly down around back
path of metastasis of left bladder cancer
left iliac–> paraaortic–> aortic-> interaorticocaval
path of metastasis for right bladder cancer
right paracaval-> interaorticocaval-> aortic-> left para-aortic
drainage path of things superior to umbilicus
superior to parasternal and axillary nodes
drainage path of things inferior to umbilicus
skin and superficial fascia- inferior to inguinal nodes
muscle- exteral iliac nodes via inferior epigastric and deep iliac circumflex
