Posterior Abdominal Wall Flashcards
What is the psoas sign?
Lower abdominal pain exacerbated by EXTENDING THIGH
What sx does a psoas abscess cause?
back/flank pain, fever, limp, inguinal mass
What causes a psoas abscess?
Diseases of organs (TB into abd)
Cancers
Infections deep to psoas fascia
What innervates the psoas major and minor Ms?
L1-L3 ventral rami
What is the O/I of psoas Ms?
TP, sides of VB and IV discs of T12-L5——–> tendon to lesser trochanter of femur
What is the O/I of Iliacus M?
iliac fossa, ala and anterior SI Ls–> lesser trochanter and shaft of femur
What innervates the iliacus M?
Femoral N (L2-4)
What is the O/I of quadratus lumborum M?
Iliolumbar L, lip of iliac crest–> medial inferior 12th rib, tips of lumbar TPs
What innervates the quadratus lumborum M?
anterior rami of T12-L4
What unites left and right crura?
median arcuate L
What is the tendinous arch of the crura of the diaphragm that makes the space for the aorta?
median arcuate L
What is the fascial thickening of the psoas fascia b/t lumbar body and L1 TP?
medial arcuate L
What is the fascial thickening of the quadratus lumborum from L1 to 12th rib?
lateral arcuate L
What are the unpaired arteries of the posterior abdominal wall?
Celiac trunk (T12)
SMA (L1)
IMA (L3)
Median sacral A
What are the paired arteries of the posterior abdominal wall?
Subcostal A Inferior Phrenic A Suprarenal A Renal A (L2) Gonadal A (L2) Lumbar A Deep circumfle iliac A
What are the veins of the posterior abdominal wall?
IVC (L5) through caval hiatus of diaphragm
What are the paired visceral branches of IVC?
Suprarenal V
Renal G
Gonadal V
What are the parietal branches of IVC?
Inferior phrenic V
3rd and 4th lumbar V
Common iliac V
What connect the SVC and IVC?
ascending lumbar V
azygous V
What diaphragm opening is at T8?
caval opening
–>IVC, R phrenic N
What diaphragm opening is at T10?
Esophageal hiatus
–>esophagus, vagal trunks
What diaphragm opening is at T12?
Aortic hiatus
—> aorta, thoracic duct, azygus/hemiazygos Vs
What passes through the caval opening of the diaphragm?
IVC
R phrenic N
What passes through the esophageal hiatus?
esophagus
vagal trunks
What passes through the aortic hiatus?
aorta
throacic duct
sometimes azyg/hemiazyg Vs
What makes up the muscular diaphragm?
Sternal part
—-> to xiphoid
—-> inferior 6 costal cartilages
Costal Part
What makes up the diaphragm?
Muscular part
Central Tendon
Crura
Which diaphragm crus is larger and longer?
Right crus
Is the right crus purely on the R side of the body?
No- some run along L side of aortic hiatus
What crus is at L2-3 VBs?
Left crus
What crus is at L3-L4 VBs?
Right
What unites right and left crus?
median arcutate L
What arteries run on the superior diaphragm?
Musculophrenic
Pericardiophrenic
–>both off ITA
Superior phrenic A
—>off thoracic aorta
What arteries run on the inferior side of the diaphragm?
Inferior phrenic A
—–> off abd aorta
Intercostal branches
Does gastric regurgitation occur in para-esophageal hiatal hernias?
NO d/t cardiac portion of stomach nml position
What type of hernia extends anterior to esophagus that includes peritoneum and the stomach fundus?
para-esophageal hiatal hernia
Does gastric regurgitation occur in a sliding hiatal hernia?
Yes
What type of hernia occurs when the esophagus, cardiac and fundus of stomach go through the esophageal hiatus?
Sliding hiatal hernia
What is thought to be the cause of hiatal hernias?
weakening of muscular diaphragm
What level are the kidneys located?
T12-L3
Which kidney is lower?
right d/t liver
Dimensions of kidney
10cm long
5cm wide
2cm thick
Where do the superior parts of the kidneys lie?
deep to 11 and 12 ribs
Which kidney hilum is near the transpyloric plane?
left kidney hilum
The superior pole of which kidney does the transpyloric plane run through?
Right kidney
What muscle lies posterior to the largest part of the kidney?
quadratus lumborum M
What nerves are behind the kidney?
Subcostal
Iliohypogastric
Ilioinguinal
What fat is adjacent to the kidney capsule that extends into renal pelvis?
Perinephric fat
What covers fat enveloping the kidney and adrenal gland?
Renal fascia
–>continuous with inferior diaphragmatic fascia and renal vessels
What fat is external to renal fascia?
paranephric fat
What type of x-ray is used to see the ureter?
pyelogram
What runs inferiorly from renal pelvis, over pelvic brim, along pelvic wall and posterior to vas deferens and uterine A?
ureter
What are potential contriction points of the ureter?
jxn of ureter with renal pelvis
crossing pelvic brim
entering bladder wall
What innervates the adrenal glands?
Preganglionic sympathetic (T10-L1)
Celiac Plexus
Abdominopelvic splanchnic Ns
What lies near right crus, right kidney and IVC?
Right suprarenal gland
What lies near left crus, spleen, stomach, pancreas and left kidney?
Left suprarenal gland
What LN drain into lumbar LN?
common iliac LN from external/internal iliac nodes
What LN run along both sides of IVC and aorta and receive lymph from posterior wall/organs?
lumbar LNs
What LN form intestinal lymphatic trunks that drain GI, liver, spleen and pancreas?
Pre-aortic LNs
Where do all the LN drain into?
cisterni chyli
What plexus can be revealed by removing the psoas muscle?
lumbar plexus
What are the nerves of the posterior wall?
- 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)
What nerves make up the lumbar plexus?
Iliohypogastric (L1) lioinguinal (L1) Genitofemoral (L1-2) Lateral cutaneous N (L2-3) Obturator (L2-4) Femoral (L2-4)
