Posterior Abdominal Wall Flashcards
Posterior Abdominal Wall Components (6)
- Lumbar Vertebrae and IV discs
- Wall muscles
- diaphragm
- fascia
- Lumbar plexus
- fat, nerves, vessels
Muscular Floor
- Psoas Major and Minor
- Iliacus
- Quadratus Lumborum
- Diaphragm
Psoas Abscess
- describe
- symptoms
Infection deep to psoas fascia
Symptoms
- back or flank pain
- fever
- inguinal mass
- limp
- anorexia
- weight loss
- lower abdominal pain exacerbated by extending limb
- “psoas sign”
Fascia (3)
1) Median arcuate ligament
2) Medial arcuate ligament
3) lateral arcuate ligament
Median arcuate ligament
tendonous arch of the crura of the diaphragm
Medial arcuate ligament
fascial thickening of the psoas fascia
-lateral to the median arcuate ligament
Lateral arcuate ligament
thickening of fascia lining the quadratus lumborum
Diaphragm components
- Muscular part
- Central tendon
- Crura
- Apertures
Muscular part of Diaphragm
- components (3)
1) Sternal part: may not be present, attaches to xiphoid
2) Costal Part: attached to inferior 6 costal cartilages
3) Lumbar part: attaches to medial and lateral arcuate ligament
Crura of diaphragm
- components
Right Crus
- larger and longer (L3-L4)
Left Crus
- L2-L3
Apertures of diaphragm
- components (3)
1) Cavil Opening
- located at T8
- IVC and R. phrenic N.
2) Esophageal Hiatus
- located at T10
- esophagus
- anterior and posterior vagal trunks
3) Aortic Hiatus
- located at T12
- aorta, thoracic duct, and sometimes the azygos and hemi-azygos veins
Aorta Vertebral Level
T12-L4
Celiac Vertebral Level
T12
SMA Vertebral Level
L1
Renal Vertebral Level
L1/L2
Gonadal Vertebral Level
L2
IMA Vertebral Level
L3
Bifurcation Vertebral Level
L4
Body of pancreas and splenic vein Vertebral Level
L1 and L2
Left renal vein Vertebral Level
L2
Horizontal part of duodenum Vertebral Level
L3
Coils of the intestine Vertebral Level
Lower than L3
Adrenal Glands
- Component
- Relationship to what’s around it
Right Adrenal Gland
- inferior to right crus, superior to right kidney, lateral to IVC, posterior and lateral to liver
Left Adrenal Gland
- inferior to left crus, posterior to spleen, posterior to stomach, posterior to pancreas, and superior to left kidney
Adrenal Glands
- blood suplly
Superior (from inferior phrenic A), middle (from aorta), inferior (from renal) suprarenal arteries
Veins
- right suprarenal vein to IVC
- left suprarenal vein to left renal vein to IVC
Adrenal Glands
- innervation
Preganglionic sympathetics from T6-L2
Celiac plexus and splanchnic nerves
Kidney Relationships
Posterior: Muscular floor
- diaphragm
- psoas major m
- quadratus lumborum m
- transversus abdominis m
Anterior:
- Right Kidney (1/2 inch below left kidney)
- liver duodenum, ascending colon - Left Kidney (T12-L3)
- stomach, spleen, pancreas, jejunum, descending
Ureter Relationships
Posterior to ductus deferens (males)
posterior to uterine artery ( female)
Ureter Constriction points
1) ureteropelvic junction
2) crossing external iliac artery and/or pelvic brim
3) Ureter enters bladder wall
Renal Pelvis
flattened, funnel shaped, expansion of ureter
- receives 2-3 major calices, each of which divides into 2-3 minor calices
- each minor calyx is indented by renal papilla, the apex of the renal pyramid
Posterior Abdominal Wall Lymphatics
1) Celiac, superior and inferior mesenteric nodes: lymph from alimentary tract, liver, spleen, and pancrease
2. Lumbar lymph nodes (caval and aortic) posterior abdominal wall, kidneys, ureters, testes or ovaries, uterus and uterine tubes
Lumbar Plexus components
1) Iliohypogastric
2) Ilioinguinal
3) Genitofemoral
4) Lateral cutaneous nerve of thigh
5) Obturator
6) Femoral
Iliohypogastric nerve
- spinal segment
- motor function
- sensory function
L1
Motor
- IO and TA
Sensory
- skin of pubis
- posterolateral gluteal skin
Ilioinguinal nerve
- spinal segment
- motor function
- sensory function
L1
Motor
-IO and TA
Sensory
-skin in upper medial thigh, penis, scrotum , mons pubis, labium majus
Genitofemoral Nerve
- spinal segment
- motor function
- sensory function
L1, L2
Motor
- Genital branch of male
- cremasteric muscle
Sensory
- Genital branch- skin of scrotum, mons pubis, labium majus
- Femoral branch- skin of upper anterior thigh
Lateral cutaneous nerve of thigh
- spinal segment
- motor function
- sensory function
L2, L3
Motor: N/A
Sensory
- skin of anterior and lateral thigh to the knee
Obturator nerve
- spinal segment
- motor function
- sensory function
L2-L4
Motor:
- obturator externus
- pectineus
- muscles in medial compartment of thigh
Sensory:
-skin of medial aspect of thigh
Femoral Nerve
- spinal segment
- motor function
- sensory function
L2-L4
Motor:
- Iliacus
- Pectineus
- muscles in anterior compartment of thigh
Sensory
- skin of anterior thigh and medial surface of leg
