Posterior Abdominal Wall Flashcards
What is the origin, insertion, and innervation of the psoas major and minor?
O: TP and sides of vertebral bodies and IV disks of T12-L5
I: tendon to lesser trochanter of femur (major)
N: anterior rami L1-3
What is the origin, insertion, and innervation of the iliacus?
O: superior 2/3’s iliac fossa, ala, ant. sacro-iliac lig
I: lesser trochanter and shaft below
N: femoral n. (L2-4)
What is the origin, insertion, and innervation of the quadratus lumborum?
O: iliolumbar lig and lip of iliac crest
I: medial half of inf surface of 12th rib plus tips of lumbar TPs
N: ant T12, L1-L4
What is a psoas abscess?
back or flank pain, fever, limp, inguinal mass, pain exaggerated by extending thigh (psoas sign)
Causes= disease of organs (ex. TB spread into abdomen), cancers, infections deep to fascia
What is the median arcuate ligament and where is it found?
tendinous arch of the crura of diaphragm, unites right and left crura
What is the medial arcuate ligament and where is it found?
fascial thickening of psoas fascia, spanning lumbar body and tip of L1 TP, lateral to median
What is the lateral arcuate ligament and where is it found?
fascial thickening of quadratus lumborum running from L1 TP to tip of 12th rib
What paired arteries are found in the posterior abdominal wall?
subcostal, inferior phrenic, suprarenal, renal (L2), gonadal (L2), lumbar, deep circumflex iliac
What unpaired arteries are found in the posterior abdominal wall?
Unpaired: celiac trunk (T12), SMA (L1), IMA (3), median sacral
What is the path of the IVC?
begins ant to L5 and right of medial plane, passes through caval hiatus of diaphragm
What does it mean if something is a tributary?
Corresponding veins of paired visceral and parietal branches of aorta
Visceral= suprarenal, renal and gonadal Parietal= inf phrenic, L3 and L4, and common iliac
Where does the right gonadal vein drain vs the left?
right gonadal –> IVC
left –> renal –> IVC
What are the 3 openings of the diaphragm and where are they?
Caval opening= T8 level, IVC, and right phrenic
Esophageal hiatus= T10 level, esophagus, ant pot vagal trunks
Aortic hiatus= T12 level, aorta thoracic duct sometimes azy and hemiazy
What are the parts of the muscular diaphragm?
Sternal part- attaches to xiphoid
Costal= attaches to inf 6 costal cartilages
Central tendon
Crura: Right crus= larger and longer L3-4 bodies, some fibers run along left side of aortic hiatus, Left= L2-3 bodies
What are the superior arteries of the diaphragm?
musculophrenic and pericadiophrenic off of internal thoracic and superior phrenic off thoracic aorta
What are the inferior arteries of the diaphragm?
inferior phrenic off abdominal aorta and intercostal branches for peripheral
What is a para-esophageal histal hernia?
pouch of peritoneum and stomach fundus extends through esophageal hiatus ant to esophagus, gastric regurg does not occur bc cardiac portion normal
What is a sliding histal hernia?
abdominal esophagus, cardiac, and portion of fundus through esophageal hiatus, regurg
What is the anterior location of the kidney?
retroperitoneal T12-L3, lower on right, 10 cm long 5 cm wide 2 cm thick, hilum entrance to renal sinus
What is the posterior portion of the kidney?
superior lies deep to 11th and 12th ribs, left hilum near transpyloric plane which runs through superior pole of right kidney, quadratus lumborum lies post
What nerves are associated with the kidneys?
subcostal, iliohypogastric, ilioinguinal
What are the layers of fat and fascia of the kidney?
Prephrenic= adjacent to capsule extends into renal pelvis
Renal fascia= covers fat enveloping kidney and suprarenal gland, blends and ensheaths renal vessels, sup continuous with in diaphragmatic fascia
Paranephric fat= external to renal fascia
What makes up the internal anatomy of the kidney?
hilum, sinus (filled with fat), pelvis, calices, cortex, medulla, pyramids, columns, papilla, segmental a and v
Where do we find ureters?
inf from renal pelvis passing over pelvic brim and along lat pelvic wall and running post to ductus deferens and uterine a.
What are the constrictions of the ureter?
junction of ureter with renal pelvis
crossing pelvic brim
entering bladder wall
Where do we find the right suprarenal glands?
near right crus right kidney and IVC
Where do we find left suprarenal glands?
near left crus, spleen, stomach, pancreas, and left renal
What is the blood supply of the suprarenal glands?
sup, middle, and inf suprarenal arteries
What is the innervation of the suprarenal glands?
pregang symp from T10-L1, celiac plexus and abdominopelvic splanchnic
What drains into the common iliac LNs? What does it drain into?
from external/internal iliac nodes, drain into lumbar LNs
Where are the lumbar LNs found? Where do they receive lymph from?
run along both sides of IVC and aorta
post wall and post pelvic wall and organs, from lumbar lymphatic trunks
What do the pre-aortic LNs arise from and what do they drain?
intestinal lymphatic trunks
alimentary tract, liver, spleen, pancreas
What level is the ilihypogastric? What does it innervate?
L1
internal oblique and transversus abdominis, posterolateral gluteal skin and skin in pubic region
What level is the ilioinguinal? What does it innervate?
L1
internal oblique and transversus abdominis
skin in upper medial thigh, skin over root of penis and ant scrotum, mons pubis and labium majus
What level is the Genitofemoral? What does it innervate?
L1, L2
male cremasteric muscle (genital branch)
genital= skin of ant scrotum moms pubis and labium majus
femoral= skin of upper ant thigh
What level is the lateral femoral cutaneous? What does it innervate?
L2, L3, L4
iliacus, pectineus, and muscles in ant. thigh, skin on ant thigh and medial leg
What level is the obtruator? What does it innervate?
L2, L3, L4
obturator externus, pectineus, muscles in med thigh compartment, skin on medial thigh
What levels are the lumboscral trunk?
L4 and L5
