Posterior Abdominal Wall Flashcards
Psoas abscess
Back pain, fever, limp, inguinal mass
Can be caused by diseases of organs (e.g., TB spread into abdomen), cancers (adenocarcinomas), infections deep to psoas fascia
Lower abdominal pain exacerbated by extending thigh - psoas sign
Median arcuate ligament
Tendinous arch of crura of diaphragm, unites right and left crura, crosses aorta
Medial arcuate ligament
Fascial thickening of the psoas fascia; spanning lumbar body and tip of L1 TP
Lateral to median arcuate ligament
Lateral arcuate ligament
Fascial thickening of quadratus lumborum running from L1 TP to tip of 12th rib
Inferior vena cava
Begins anterior to L5 and right of medial plane, passes through caval hiatus of diaphragm
Ascending lumbar and azygos veins connect the SVC and IVC, either directly or indirectly
Venous return from abdominal viscera returns via portal venous system/hepatic vein
Paired visceral tributaries of IVC
Suprarenal v., renal v., gonadal v.
Paired parietal tributaries of IVC
Inferior phrenic v., 3rd/4th lumbar v., common iliac v.
Caval opening of diaphragm location/contents
T8
IVC
Right phrenic nerve
Esophageal hiatus location/contents
T10
Esophagus
Anterior/posterior vagal trunks
Aortic hiatus location/contents
T12 Aorta Thoracic duct Sometimes azygos and hemiazygos veins Opens up b/w right/left crus
Arteries on superior side of diaphragm
Musculophrenic and pericardiophrenic (from internal thoracic aorta)
Superior phrenic
Arteries on inferior side of diaphragm
Inferior phrenic artery (off abdominal aorta)
Intercostal branches for peripheral diaphragm
Psoas major and minor OIN
O- TP and sides of vertebral bodies of T12-L5
I- Tendon to lesser trochanter of femur
N- anterior rami of L1-L3
Iliacus OIN
O- superior 2/3rds iliac fossa, anterior sacro-iliac ligaments
I- lesser trochanter and shaft below
N- femoral nerve
Quadratus lumborum OIN
O- medial half of inferior surface of 12th rib, tips of lumbar TPs
I- iliolumbar ligament and lip of iliac crest
N- anterior T12, L1-L4
Para-esophageal hiatal hernia
Pouch of peritoneum and stomach fundus extends through esophageal hiatus usually anterior to esophagus
Gastric regurgitation usually does not occur as cardiac portion is normal
-Can be caused by weakening of muscular diaphragm
Sliding hiatal hernia
Abdominal esophagus, cardiac, and portion of fundus extends through esophageal hiatus
Regurgitation of stomach contents possible
-Can be caused by weakening of muscular diaphragm
Kidney location - anterior aspect
Retroperitoneal lying about T12-L3
Kidney lower on right
Kidney location- posterior aspect
Posteriorly, superior parts lie deep to 11th and 12th ribs
Left kidney hilum near transpyloric plane
TP plane runs through superior pole of right kidney
Inferior pole of right kidney is approximately index fingers breadth superior to iliac crest
Nerves running posterior to kidney
Subcostal- protected by 12th rib
Iliohypogastric
Ilioinguinal
Periphrenic fat
Adjacent kidney capsule (perirenal fat capsule)
Extends into renal pelvis
Renal fascia
Covers fat enveloping kidney and suprarenal gland
Blends and ensheaths renal vessels
Superiorly continuous with inferior diaphragmatic fascia
Paraphrenic fat
External to renal fascia
Ureter location
Run inferiorly from renal pelvis passing over pelvic brim and along lateral pelvic wall and running posterior to ductus deferens (male) and uterine artery (female)
