Posterior Abdominal Wall

Question 1

What is the psoas sign?

Answer 1

Lower abdominal pain exacerbated by EXTENDING THIGH

Question 2

What sx does a psoas abscess cause?

Answer 2

back/flank pain, fever, limp, inguinal mass

Question 3

What causes a psoas abscess?

Answer 3

Diseases of organs (TB into abd)

Cancers

Infections deep to psoas fascia

Question 4

What innervates the psoas major and minor Ms?

Answer 4

L1-L3 ventral rami

Question 5

What is the O/I of psoas Ms?

Answer 5

TP, sides of VB and IV discs of T12-L5——–> tendon to lesser trochanter of femur

Question 6

What is the O/I of Iliacus M?

Answer 6

iliac fossa, ala and anterior SI Ls–> lesser trochanter and shaft of femur

Question 7

What innervates the iliacus M?

Answer 7

Femoral N (L2-4)

Question 8

What is the O/I of quadratus lumborum M?

Answer 8

Iliolumbar L, lip of iliac crest–> medial inferior 12th rib, tips of lumbar TPs

Question 9

What innervates the quadratus lumborum M?

Answer 9

anterior rami of T12-L4

Question 10

What unites left and right crura?

Answer 10

median arcuate L

Question 11

What is the tendinous arch of the crura of the diaphragm that makes the space for the aorta?

Answer 11

median arcuate L

Question 12

What is the fascial thickening of the psoas fascia b/t lumbar body and L1 TP?

Answer 12

medial arcuate L

Question 13

What is the fascial thickening of the quadratus lumborum from L1 to 12th rib?

Answer 13

lateral arcuate L

Question 14

What are the unpaired arteries of the posterior abdominal wall?

Answer 14

Celiac trunk (T12)
SMA (L1)
IMA (L3)
Median sacral A

Question 15

What are the paired arteries of the posterior abdominal wall?

Answer 15

Subcostal A
Inferior Phrenic A
Suprarenal A
Renal A (L2)
Gonadal A (L2)
Lumbar A
Deep circumfle iliac A

Question 16

What are the veins of the posterior abdominal wall?

Answer 16

IVC (L5) through caval hiatus of diaphragm

Question 17

What are the paired visceral branches of IVC?

Answer 17

Suprarenal V
Renal G
Gonadal V

Question 18

What are the parietal branches of IVC?

Answer 18

Inferior phrenic V
3rd and 4th lumbar V
Common iliac V

Question 19

What connect the SVC and IVC?

Answer 19

ascending lumbar V

azygous V

Question 20

What diaphragm opening is at T8?

Answer 20

caval opening

–>IVC, R phrenic N

Question 21

What diaphragm opening is at T10?

Answer 21

Esophageal hiatus

–>esophagus, vagal trunks

Question 22

What diaphragm opening is at T12?

Answer 22

Aortic hiatus

—> aorta, thoracic duct, azygus/hemiazygos Vs

Question 23

What passes through the caval opening of the diaphragm?

Answer 23

IVC

R phrenic N

Question 24

What passes through the esophageal hiatus?

Answer 24

esophagus

vagal trunks

Question 25

What passes through the aortic hiatus?

Answer 25

aorta throacic duct sometimes azyg/hemiazyg Vs

Question 26

What makes up the muscular diaphragm?

Answer 26

Sternal part ----> to xiphoid ----> inferior 6 costal cartilages Costal Part

Question 27

What makes up the diaphragm?

Answer 27

Muscular part Central Tendon Crura

Question 28

Which diaphragm crus is larger and longer?

Answer 28

Right crus

Question 29

Is the right crus purely on the R side of the body?

Answer 29

No- some run along L side of aortic hiatus

Question 30

What crus is at L2-3 VBs?

Answer 30

Left crus

Question 31

What crus is at L3-L4 VBs?

Answer 31

Right

Question 32

What unites right and left crus?

Answer 32

median arcutate L

Question 33

What arteries run on the superior diaphragm?

Answer 33

Musculophrenic Pericardiophrenic -->both off ITA Superior phrenic A --->off thoracic aorta

Question 34

What arteries run on the inferior side of the diaphragm?

Answer 34

Inferior phrenic A -----> off abd aorta Intercostal branches

Question 35

Does gastric regurgitation occur in para-esophageal hiatal hernias?

Answer 35

NO d/t cardiac portion of stomach nml position

Question 36

What type of hernia extends anterior to esophagus that includes peritoneum and the stomach fundus?

Answer 36

para-esophageal hiatal hernia

Question 37

Does gastric regurgitation occur in a sliding hiatal hernia?

Answer 37

Yes

Question 38

What type of hernia occurs when the esophagus, cardiac and fundus of stomach go through the esophageal hiatus?

Answer 38

Sliding hiatal hernia

Question 39

What is thought to be the cause of hiatal hernias?

Answer 39

weakening of muscular diaphragm

Question 40

What level are the kidneys located?

Answer 40

T12-L3

Question 41

Which kidney is lower?

Answer 41

right d/t liver

Question 42

Dimensions of kidney

Answer 42

10cm long 5cm wide 2cm thick

Question 43

Where do the superior parts of the kidneys lie?

Answer 43

deep to 11 and 12 ribs

Question 44

Which kidney hilum is near the transpyloric plane?

Answer 44

left kidney hilum

Question 45

The superior pole of which kidney does the transpyloric plane run through?

Answer 45

Right kidney

Question 46

What muscle lies posterior to the largest part of the kidney?

Answer 46

quadratus lumborum M

Question 47

What nerves are behind the kidney?

Answer 47

Subcostal Iliohypogastric Ilioinguinal

Question 48

What fat is adjacent to the kidney capsule that extends into renal pelvis?

Answer 48

Perinephric fat

Question 49

What covers fat enveloping the kidney and adrenal gland?

Answer 49

Renal fascia | -->continuous with inferior diaphragmatic fascia and renal vessels

Question 50

What fat is external to renal fascia?

Answer 50

paranephric fat

Question 51

What type of x-ray is used to see the ureter?

Answer 51

pyelogram

Question 52

What runs inferiorly from renal pelvis, over pelvic brim, along pelvic wall and posterior to vas deferens and uterine A?

Answer 52

ureter

Question 53

What are potential contriction points of the ureter?

Answer 53

jxn of ureter with renal pelvis crossing pelvic brim entering bladder wall

Question 54

What innervates the adrenal glands?

Answer 54

Preganglionic sympathetic (T10-L1) Celiac Plexus Abdominopelvic splanchnic Ns

Question 55

What lies near right crus, right kidney and IVC?

Answer 55

Right suprarenal gland

Question 56

What lies near left crus, spleen, stomach, pancreas and left kidney?

Answer 56

Left suprarenal gland

Question 57

What LN drain into lumbar LN?

Answer 57

common iliac LN from external/internal iliac nodes

Question 58

What LN run along both sides of IVC and aorta and receive lymph from posterior wall/organs?

Answer 58

lumbar LNs

Question 59

What LN form intestinal lymphatic trunks that drain GI, liver, spleen and pancreas?

Answer 59

Pre-aortic LNs

Question 60

Where do all the LN drain into?

Answer 60

cisterni chyli

Question 61

What plexus can be revealed by removing the psoas muscle?

Answer 61

lumbar plexus

Question 62

What are the nerves of the posterior wall?

Answer 62

- Subcostal (T12) - Iliohypogastric - Ilioinguinal - -> both L1 - Genitofemoral (L1-2) - Lateral femoral cutanous N (L2-3) - Femoral N (L2-4) - Obturator N (L2-4) - Lumbosacral trunk (L4-5)

Question 63

What nerves make up the lumbar plexus?

Answer 63

``` Iliohypogastric (L1) lioinguinal (L1) Genitofemoral (L1-2) Lateral cutaneous N (L2-3) Obturator (L2-4) Femoral (L2-4) ```