Posterior Abdominal Wall Flashcards
The posterior abdominal wall consist of?
fascia, muscles and their vessels and spinal nerves
The overlying skin is continuoys with that of the back
The psoas majors contains which plexus?
Lumbar plexus
What are the problems caused by the psoas?
lower back pain, sacroiliac pain, sciatica, disc problems, spindylolysis, scoliosis, hip degeneration, knee pain, menstruation pain, infertility, and digestive problems
Biomechanical problems = pelvic tilt, leg length discrepancies, kyphosis, and lumbar lordosis
Blood supply and innervation to the diaphragm?
blood supply: infereior phrenic arteries
innervation: phrenic nerves (C3-C5) - sensory and motor
What is the origin of the diaphragm?
Sternal = xiphoid process
Costal = at the lower six ribs
Describe the diaphragm
dome shaped swptum that seperates the thoracic cavity from the abdominal cavity.
Convex upper surface forms floor of thoracic cavity
concave under surface forms roof of abdominal cavity.
Peripheral parts consist of muscularis fibers that take origin from the circumference of the inferior thoracic aperture and converge to be inserted into a central tendon.
How many lumbosacral arches are contained in the diaphragm?
2 (on either side)
Medial
Lateral
The muscles of the diaphragm arise from?
Somite level 3-5
(this also correspinds tot he levels of segmental nerves providing inntervation of the diaphragm)
How are the muscular fibers of the diaphragm grouped?
They are grouped acording to their origin (sternal, costal, and lumbar)
Sphincter like arrangement of the righ crus of the diaphragm acts like?
acts as a lower esophagel sphincter
Lateral arcuate ligament is located where?
runs from L1 transverse process to rib 12
Medial arcuate ligament is located where?
runs from L! transverse process to L1 vertebral body (crus of diaphragm)
What is the purpose of the median arcuate ligament?
unites left and right crura of diaphragm insertion : central tendon
The left and right crura end at which vertebral level?
Right crus = LIII
Left crus = LII
The passing of the inferior vena cava through the diaphragm occurs at which vertebral level?
T8, through the central tendon
The esophageal hiatus is at which vertebral level?
T10
usually in the muscles of the right crus
The aortic hiatus is located at which vertebral level?
T12
posterior to the diaphragm (median arcuate liagment)
The adrenal glands are covered by?
Renal fascia
What is produced in the cortex and the medulla of the adrenal glands?
Cortex - mineral corticocoids, glucocorticoids, sex hormones
Medulla - epinephrine and norepinephrine
Although variations of the blood supply to the adrenal glands are common, there are usually three arteries that supply each adrenal gland. What are they?
Right and left Superior Suprarenal arteries (branch of right and left inferior phrenic arteries)
Rght and left middle suprarenal arteries (branch from abdominal aorta)
Right and left inferior suprarenal arteries (branch of renal artery)
Which two organs have the greatest blood supply per gram of tissue?
Adrenal glands and thyroid gland
Up to 60 arterioles may enter each adrenal gland
Venous drainaige of the adrenal glands is achieved via the?
suprarenal veins
(these anastamose with the infrior phrenic veins)
What are the layers surrounding the kidneys?
Periphrenic fat
renal fascia/transverse fascia
periphrenic fat
Anterior abdominal wall muscles/quadratus lumborum muscles/psoas major muscle
another layer of fat
Peritoneum
What are the constrictions in the ureters?
- first constriction = ureteropelvic junction
- Second constriction = pelvic inlet
- Third constriction = entrance to bladder
Blood supply to the ureters
branches of renal artery, testicular/ovarian arteries, abdominal aorta, common iliac, internal iliac
Somatic nervous system
Lumbar plexus
Includes:
Iliohypogastic nerve
Ilioingunal nerve
Genitofemoral nerve
Lateral femoral cutaneou nerve
Femoral nerve
Obtrurator nerve
Lumbosacral trunk
Branches of the sympathetic trunk (R&L)
Lumbar splanchnic nerve.
Celiac plexus
Superior mesenteric plexus
renal plexus
inferior mesenteric plexus
aortic plexus
Hypogastric plexus
Lumbar Plexus
T12, L1-5
Subcostal (T12)
Iliohypogastic (L1 main nerve)
Ilioinguinal (L1 collateral branch)
Genitofemoral (L1, 2)
Lateral femoral cutaneous (L2, L3)
Femoral (posterior division L2, 3, 4)
Obturator (anterior division L2, 3.4)
Lumbosacral trunk (L4,5)
Circulation of the posterior abdominal wall comes from which three main arteries?
Abdominal aorta
Inferior vena cava
Portal vein
Branches of the abdominal aorta
Unpaired branches
Celiac trunk
superior mesenteric artery
inferior mesenteric artery
median sacral artery
paired branches
inferior phrenic arteries
suprarenal arteries
Gonadal arteries
Common iliac arteries
renal arteries
lumbar arteries
Branches of the inferior vena cava?
Hepatic veins
renal veins
lumbar veins
common iliac veins
The azygous vein connects to which two systems?
To the systems of superior vena cava and inferior vena cava
This vein provides an alternate path for blood to the right atrium when either of the vena cavae is blocked
Azygous vein
What is cystic fibrosis?
An inherited condition that affects the cells that produce mucous, sweat, and digestive juices. These secreted fluids are normally thin and slippery but in cystic fibrosis they become thick and sticky, which causes them to plug tubes, ducts and passageways especially in the lungs and pancreas
What is the funciton of the kidneys?
Maintain blood purity by removing nitrogen compounds (urea, uric acid, creatinine), excessive ions to maintain electrolyte balance (K+, H+), and remove toxins
The kidneys are intraperitoneal or retroperitoneal?
REtroperitoneal
Which kidney sits lower in the posterior abdominal wall?
Right
At which level of the vertebra would you find the hilum of the kidney?
L1
This is the transpyloric plane
The kidneys are located between which two vertebral levels?
T12 and L3
The posterior surface of the kidney relates to which muscle?
Quadratus lumborum muscle
What are the three layers that surround the kidney?
Renal capsule
Adipose capsule
renal fascia (anterior and posterior)
There are three nerves that cross the kidney, what are they?
Subcostal n.
Iliohypogastic n.
Ilioinguinal n.
Paralysis of the lower abdominal wall and hernia may be caused by?
Damage to the subcostal, ilioinguinal, and iliohypogastric nerves during kidney transplant.
The upper pole of the kidneys rest upon what?
The diaphragm and they move with each breath
Which muscles surround the kidney?
Psoas major (medial, posterior)
Quadratus lumborum (lateral, posterior)
Anterolateral abdominal wall muscles
Which structures provide support and protection of the kidney?
Perineal fat
Renal fascia
The renal fascia is the condensation of what?
Condensation of sub-serous connective tissue
Blood supply of the kidney
Renal artery branches into
segmental arterires -> lobar artery -> interlobar artery -> arcuate artery
Nerves to the ureters aris from which plexus?
Renal plexus
Consist of sympathetic and parasympathetic fibers.
The renal plexus is supplied by which nerves?
Thorasic splanchnic n.. mostly least splanchnic n.
What is the direction the urethers run?
posteriorinferiorly on the lateral wall of the pelvis, external to the parietal peritoneum, and anterior to the internal iliac aa., then they curve anteromedially to enter the posterior superior angle of the bladder
Where are the potential sites for calculi distress in the ureters?
Where the constrictors are located (in the beginning, where it crosses the pelvic brin, and where it enters the bladder)
What affects does a stone have on the ureter?
Smooth muscle of the ureter feels intense peristaltic contraction which produces ureteric pain
Urine is backed up and causes dilation of the renal pelvis and calyces.
Congenital Pelviureteric Obstruction causes what to teh kidney?
Hyronephrosis
(pressure atrophy of the kidney)
This is marked by dilation of the renal pelvis
Patient may present with abdominal pain
The kidney is usually placed in the which fossa?
Iliac fossa
Renal Transplant
A transplant kidney is not usually placed in the same location (iliac fossa) of the original kidney therefor a alternate blood supply is used for reconnection.
Renal a, previously branching from the abdominal aorta in the donor, is often coonected to the external iliac artery in the recipient
Renal vein, previously draining to the IVC in the donor, is often connected to the external iliac vein in the recipient.
The muscle that makes up the bladder is know as the?
Detrusor muscle
In females where is the bladder located?
anterior and inferior to the uterus
An enormous uterus limits the expansion of the bladder = urinary frequency and urgency i.e pregnancy
On there way tot he bladder, as the ureter pass in proximity to the lateral fornices of the _____, they cross _______ to the uterine arteries
vagina
inferior
During surgical procedures on the uterus and ovaries what is a great risk?
The ureters
Must be identified before ligating or cutting any tissue in the region of the pelvis
The internal urethral spinchter is made of _________ _________ muscle and is _________.
Circular Smooth muscle
Involuntary
Where is the internal urethral sphincter located?
located at the bladder’s inferior end and the urethra’s proximal end at the junction of the urethra with the urinary bladder
Where is the external urethral sphincter located?
at the bladder’s distal inferior end in females and inferior to the prostate (at the level of the membranous urethra) in males is a secondary sphincter to control flow of urine through the urethra.
The external urethral sphincter is made of ______ muscle and is _____.
Skeletal muscles
Voluntary
In males the urethra passes through what?
The prostate gland
Prostate cancer will grow into the ?
bladder, ectum, and peritoneum
Tumors may occlude the urethra
What is BPH?
Benign Prostate hypertrophy
Enlargement of inner part of prostate gland, most median lobe, by action of testosterone
What are the side effects of BPH?
swelling of the uvula compresses the internal urethral orifice causing intermitent retention of urin
BPH occurs mainly in?
aged men
they have urinary frequency but cant expell urine
WHy are females more prone to UTI?
Because the urethra is located in close proximity to the Vagina
and
the urethra is short
