Posterior Abdominal Wall

Question 1

Thoracolumbar fascia

Answer 1

1. Encloses deep back muscles
2. Fuses internal oblique and transversus abdominus fascias laterally
3. Associated w/ vertebrae => not distensible

Question 2

Psoas major

Answer 2

1. Prox: transverse process T12-L5
2. Distal: lesser trochanter
3. Fxn:
   A. Unilateral: flex trunk same side
   B. Bilateral: flex and externally rotate hip, raise trunk from supine
4. Innervation: ventral rami L2-L4
5. Supply: lumbar, renal, common iliac, deep circumflex

Question 3

Iliacus

Answer 3

1. Prox: iliac fossa
2. Distal: lesser trochanter
3. Fxn:
   A. Unilateral: flex trunk same side
   B. Bilateral: flex and externally rotate hip, raise trunk from supine
4. Innervation: femoral n. (L2-L4)
5. Supply: lumbar, renal, common iliac, deep circumflex

Question 4

Quadratus lumborum

Answer 4

1. Prox: iliac crest
2. Distal: 12th rib, transverse processes L1-L4
3. Fxn:
   A. Stabilizes 12th rib
   B. Unilateral: flexes trunk same side
4. Innervation:
   A. Subcostal (T12)
   B. Iliohypogastric (L1)
   C. Ilio-inguinal (L1)
   D. Ventral rami L2-L4
5. Supply:
   A. Lumbar a
   B. Iliolumbar a.
   C. Subcostal a

Question 5

Diaphragm

Answer 5

1. Primary respiratory muscle
2. Double-domed
3. Musculoteninous partition between thoracic and abdominal cavity
4. Muscular leaves
   A. Sternal
   B. Costal
   C. Lumbar
5. Insertion: central tendon
6. Innervation:
   A. Motor: phrenic n. (C3-C5)
   B. Sensory: phrenic, intercostal (T5-T11), subcostal (T12)
7. Supply:
   A. Thoracic surface:
   
   1. Pericardiacophrenic a. And v.
   2. Musculophrenic a. And v.
   3. Superior phrenic a. And v.
      B. Abdominal surface
   4. Inferior right and left phrenic a. And v.

Question 6

Median artucate

Answer 6

Midline union of right and left crura

Question 7

Medial arcuate

Answer 7

Between lumbar bodies and transverse processes

1. Passage of psoas major and lumbar sympathetic trunk

Question 8

Lateral arcuate

Answer 8

From T12 transverse process to rib 12 over quadratus lumborum

Question 9

Caval opening

Answer 9

Opening for IVC thru the diaphragm

1. T8 level

Question 10

Esophageal hiatus

Answer 10

Opening for esophagus thru diaphragm

1. Right crus formation for passage of esophagus, vagal trunks, gastric vessels, and few lymphatic
2. T10 level

Question 11

Aortic hiatus

Answer 11

Aperture between right and left crura for passage of aorta

Question 12

Abdominal aorta

Answer 12

1. Begins T12, enters aortic hiatus
2. Retroperitoneal
3. Ends L4 -> divides right and left common iliac a.
4. Visceral branches
   A. Unpaired
   
   1. Celiac trunk
   2. Superior mesenteric artery (SMA)
   3. Inferior mesenteric artery (IMA)
      B. Paired
   4. Right and left middle suprarenal a.
   5. Right and left renal a.
   6. Right and left testicular/ovarian a.
5. Parietal branches
   A. Unpaired median sacral a.
   B. Paired right and left inferior phrenic
   
   1. Right and left lumbar a.

Question 13

Celiac ganglion and plexus

Answer 13

Surrounding celiac trunk

1. Connects superior mesenteric plexus and 2 aorticorenal ganglia

Question 14

Superior mesenteric plexus

Answer 14

Surrounding SMA

Question 15

Inferior mesenteric plexus

Answer 15

Connected to IMP via intermesenteric plexus

1. Right and left sides divide -> hypogastric n.

Question 16

Inferior hypogastric plexus

Answer 16

Hypogastric n. From superior hypogastric plexus

Question 17

Visceral referred pain

Answer 17

Pain associated w/ actual or potential damage referred to somatic structures supplied by same sensory ganglia and spinal cord segments
1. Visceral and somatic afferent enter spinal cord at same level cross-talk and brain interprets pain as tho in somatic region