Posterior Abdominal Wall Flashcards
1
Q
What are the muscles of the posterior abdominal wall
A
psoas major
psoas minor
iliacus
quadratus lumborum
2
Q
Where is the iliacus located?
A
Large triangular muscle located lateral to the inferior part of psoas major
3
Q
What is the origin of the iliacus?
A
Ala of sacrum, iliac fossa and anterior sacroiliac l.
4
Q
What is the insertion of the iliacus?
A
Lesser trochanter of femur with psoas major m.
5
Q
What is the innervation of the iliacus?
A
Femoral n. (L2-4)
6
Q
What is the action of the iliacus?
A
Flexes thigh and stabilizes hip joint
7
Q
What and where is the quadratus lumborum located?
A
Quadrilateral shaped muscle forming a sheet on posterior abdominal wall
8
Q
What crosses superiorly over the quadratus lumborum?
A
Lateral arcuate ligament
9
Q
What nerves cross the quadratus lumborum?
A
Subcostal n. and branches of lumbar plexus cross this m.
10
Q
What is the origin of the quadratus lumborum?
A
12th rib and lumbar TPs
11
Q
What is the insertion of the quadratus lumborum?
A
Iliolumbar l. and iliac crest
12
Q
What is the innervation of the quadratus lumborum?
A
VPR of T12-L4
13
Q
What is the action of the quadratus lumborum?
A
Depresses/stabilizes 12th rib for respiratory muscles (thoracic diaphragm
contracts against it during inspiration); laterally flexes vertebral column
14
Q
What lines the posterior abdominal wall?
A
Lined internally by parietal peritoneum
15
Q
Where is endoabdominal fascia found?
A
Between parietal peritoneum and musculature
16
Q
What is the endoabdominal fascia continuous with?
A
Continuous anteriorly with transversalis fascia on anterolateral abdominal wall
17
Q
What and where is the thoracolumbar fascia found?
A
Thin and transparent in thoracic region
Thick and strong in lumbar region
- Attached to vertebrae and spans between 12th rib and iliac crest
18
Q
How is the thoracolumbar fascia found in regards to the deep back mm.?
A
Anterior, middle and posterior layers split to enclose deep back mm
19
Q
Between which layers of the thoracolumbar fascia are the quadratus lumborum located and what muscles attach laterally?
A
Quadratus lumborum m. located between anterior and middle layers
- Internal abdominal oblique and transversus abdominis mm. attach laterally
20
Q
Between which layers of the thoracolumbar fascia are the erector spinae mm. located and what muscles attach posteriorly?
A
located between middle and posterior layers
- Comparable to rectus sheath, but stronger due to vertebrae
- Latissimus dorsi m. attaches to lateral aspect of posterior layer
21
Q
What are fascial abscesses?
A
Vertebral disease or infection may spread though psoas sheath
- Fascial compartment surrounding psoas major m.
22
Q
What do fascial abcesses do to the fascia?
A
Psoas abscess causes this fascia to thicken and become very taut
23
Q
Where does pus from fascial abcesses travel and via what?
A
Pus will spread through this compartment to the superior thigh
-Via lacuna musculorum
24
Q
What will pus from fascial abcesses do to the muscle?
A
Pus accumulation will compress this muscle and cause pain
25
What are the somatic nerves of the posterior abdominal wall?
```
subcostal
lumbar spinal
lumbar plexus of nerves
- iliohypogastric
- ilioinguinal
- lateral femoral cutaneous
- femoral
- genitofemoral
- obturator
- lumbosacral trunk
```
26
What is the nerve root of subcostal n?
VPR of T12
27
where is the subcostal nerve found?
- Located just inferior to 12th rib
- Laterally located between transversus abdominis and internal oblique mm.
- Passes posterior to lateral arcuate l. and crosses quadratus lumborum m.
28
What does the subcostal nerve innervate?
Innervates anterolateral abdominal wall mm. and T12 dermatome
29
What do the dorsal rami of lumbar spinal nerves supply?
Dorsal rami supply mm. and skin of back
30
What do the ventral rami of lumbar spinal nerves pass through and form?
Ventral rami pass into psoas major m. and form lumbar plexus of nerves
31
What nerve roots make up the lumbar plexus of nerves?
Consists of VPR from L1-L4
32
What nervous autonomics do the lumbar plexus of nerves receive and via what?
Each receives postsynaptic sympathetics via gray rami communicantes
33
Is the quadratus lumborum retroperitoneal or intraperitoneal?
Retroperitoneal
34
What does the VPR of L1 split into?
Iliohypogastric and ilioinguinal nn
35
Where does the VPR of L1 split?
May split proximally in psoas major m., midway through pass on posterior abdominal wall or distally near ASIS
36
Where do the Iliohypogastric and ilioinguinal nn pass?
- Pass posterior to medial arcuate l. and cross quadratus lumborum m.
- Parallel iliac crest and pierce transversus abdominis m. near ASIS
37
What do the Iliohypogastric and ilioinguinal nn innervate?
Innervate abdominal oblique and transversus abdominis mm. and L1 dermatome anteriorly
38
What nerve roots make up the lateral femoral cutaneous nerve?
VPR of L2-3
39
Where does the lateral femoral cutaneous nerve pass?
- Pass inferolaterally across ilacus m.
| - Enters thigh deep to inguinal l. and medial to ASIS
40
What does the lateral femoral cutaneous n. innervate?
Sensory to anterolateral skin of thigh
41
What nerve roots make up the femoral nerve?
VPR of posterior divisions of L2-4
42
Where does the femoral nerve pass?
- Emerges from the lateral border of psoas major m (iliacus innervation)
- Passes deep to inguinal l. and then to anterior thigh (hip flexor and knee extensor innervation)
43
What does the femoral n. innervate?
Innervates iliacus m. and hip flexors and knee extensors
44
What nerve roots make up the genitofemoral nerve?
VPR of L1-L2
45
Where does the genitofemoral nerve pass?
Sits on anterior surface of psoas major m.
46
What does the genital branch of the genitofemoral nerve supply?
- Sensory to anterolateral skin of scrotum/labia majora
| - Motor to cremaster m.
47
Where does the genital branch of the genitofemoral nerve pass?
Genital branch passes through deep inguinal ring
48
Where does the femoral branch of the genitofemoral nerve pass?
Femoral branch passes along external iliac a.
49
What does the femoral branch of the genitofemoral nerve supply?
Sensory innervation over femoral triangle
50
What nerve roots make up the obturator nerve?
VPR of L2-4
51
Where does the obturator nerve pass?
- Runs along medial border of psoas major m. (lateral to iliac vessels)
- Passes through obturator canal
52
What does the obturator nerve supply?
Innervates medial thigh mm.
53
What nerve roots make up the lumbosacral trunk?
VPR L4-5
54
Where does the lumbosacral trunk pass?
Medial to psoas major m. where it passes over ala of sacrum
55
What does the lumbosacral trunk supply?
Participates with S1-4 in forming sacral plexus
56
What supplies sympathetic innervation in the posterior abdominal wall?
Lumbar sympathetic trunk
Abdominopelvic splanchnic nn
Lumbar splanchnic nn
57
What is the lumbar sympathetic trunk?
4 paravertebral ganglia and associated interganglionic segments
58
Is the lumbar sympathetic trunk continuous with the thoracic and sacral sympathetic trunk?
Yes
59
Where is the lumbar sympathetic trunk located?
Located anterolaterally to lumbar vertebral bodies
60
Between what levels do the presynaptic sympathics originate?
Presynaptic sympathetics originate from lateral horn of T1 to as low as L2
61
How do presynaptic sympathetics enter the sympathetic trunk?
Enter trunk via white rami communicantes
62
How do postsynaptic sympathetics exit the lumbar ventral rami?
via gray rami
63
Where do the presynaptic sympathetics of the abdominopelvic splanchnic nerves originate from?
Presynaptic sympathetics originate from lateral horn between T5-L2
64
How do presynaptic sympathetics enter the adominopelvic splanchnic nerves?
Enter sympathetic trunk via white rami communicantes
65
Where do postsynaptic sympathetics of adominopelvic splanchnic nerves travel?
Postsynaptic Sympathetics pass through sympathetic trunk without synapsing
66
At what levels does the greater splanchnic nerve arise from?
T5-9
67
At what levels does the lesser splanchnic nerve arise from?
T10-11
68
At what levels does the least splanchnic nerve arise from?
T12
69
Where do the thoracic splanchnic synapse?
Synapse in either celiac, superior mesenteric or aorticorenal ganglia
70
Where do the lumbar splanchnic nerves arise from?
Arise from L1-2 or 3
71
Where do the lumbar splanchnic synapse?
Synapse in inferior mesenteric ganglion
72
Where do postsynaptic sympathetics exit from the chain?
Exit from the respective prevertebral ganglia
73
How do the sympathetics of the posterior abdominal wall enter the abdominal viscera?
Following the periarterial plexuses
74
What do the sympathetics of the posterior abdominal wall do?
Vasoconstriction in abdominal viscera
| - Inhibits GI activity
75
What do visceral afferents of the posterior abdominal wall travel with?
Accompany sympathetics retrograde through splanchnic nn.
76
What do visceral afferents and their accompaniment of sympathetics do in regards to pain?
Referred pain is to dermatomes associated with segmental levels where presynaptic sympathetics originate
77
What provide parasympathetic innervation to the posterior abdominal wall?
Anterior/posterior vagal trunks
| Pelvic splanchnic nn.
78
Where are the anterior/posterior vagal trunks found in the posterior abdominal wall?
Emerge from esophageal plexus and pass through esophageal hiatus
79
What autonomic innervation do the Anterior/posterior vagal trunks carry?
Contain presynaptic parasympathetics
80
What plexuses do the Anterior/posterior vagal trunks contribute to?
Contribute to same plexuses as splanchnic nn.
81
What do the Anterior/posterior vagal trunks innervate?
Innervate lower esophagus to splenic flexure of colon and most viscera
- Carry visceral afferents for reflex superior to middle of sigmoid colon
82
Do the pelvic splachnic nerves associate with sympathetic innervation?
no, Have nothing to do with sympathetic innervation
| - Do not attach to sympathetic trunk
83
What nerve roots make up the pelvic splanchnic nerves?
VPR of S2-4
84
Where do the pelvic splanchnic nerves convey presynaptic parasympathetics to?
Presynaptic parasympathetics to hypogastric plexuses
85
What do the pelvic splanchnic nerves innervate?
Innervate from splenic flexure of colon to rectum and pelvic viscera
- Carry visceral afferents for reflex and pain inferior to middle of sigmoid colon
86
Where do presynaptic parasympathetics of the posterior abdominal wall synapse and what do they do?
Presynaptics synapse on postsynaptic cells in intrinsic ganglia
- Stimulates GI activity
87
List the autonomic plexuses of the posterior abdominal wall
```
Celiac plexus
Superior mesenteric plexus
Inferior mesenteric plexus
Superior hypogastric plexus
Inferior hypogastric plexus
```
88
What autonomic innervations do the autonomic plexuses of the posterior abdominal wall contain?
Contain both sympathetic and parasympathetic neurons
89
Where are the autonomic plexuses of the posterior abdominal wall found?
Surround abdominal aorta and/or its major arterial branches
90
Where is the parasympathetic intrinsic ganglia found?
In wall of gut or viscera (i.e. Auerbach’s myenteric plexus)
91
What autonomics contribute to the celiac plexus?
- Sympathetic contribution via greater and lesser splanchnic nn.
- Parasympathetic contribution via posterior vagal trunk
92
Where does the celiac plexus supply?
Primarily to foregut derivatives
93
What autonomics contribute to the superior mesenteric plexus?
1) Sympathetic contribution via lesser and least splanchnic nn.
2) Parasympathetic contribution via posterior vagal trunk
94
Where does the superior mesenteric plexus supply?
Primarily to midgut derivatives
95
What autonomics contribute to the Inferior mesenteric plexus?
1) Sympathetic contribution from lumbar splanchnic nn
| 2) Parasympathetic contribution via pelvic splanchnic nn.
96
Where does the inferior mesenteric plexus supply?
Primarily to hindgut derivatives
97
What autonomics contribute to the Superior hypogastric plexus?
Sympathetic contribution from lumbar splanchnic nn.
98
Where is the Superior hypogastric plexus located?
Anterior to bifurcation of abdominal aorta
99
Where does the Superior hypogastric plexus supply?
Innervates ureteric and gonadal plexuses
100
What autonomics contribute to the inferior hypogastric plexus?
1) Sympathetic contribution via lumbar splanchnic nn. (and to a small extent sacral splanchnic nn.)
2) Parasympathetic contribution via pelvic splanchnic nn.
101
Where is the inferior hypogastric plexus located?
Connected to superior hypogastric plexus via hypogastric nn
102
What does the inferior hypogastric plexus supply?
Supplies pelvic viscera
103
Between what levels is the abdominal aorta found?
Anterior to T12-L4 vertebrae
104
What are the unpaired anterior visceral branches of the abdominal aorta?
o Celiac trunk (T12)
o Superior mesenteric a. (L1)
o Inferior mesenteric a. (L3)
105
What are the paired lateral visceral branches of the abdominal aorta?
o Middle suprarenal a. (L1)
o Renal a. (L1)
o Gonadal a. (testicular or ovarian aa.) (L2)
106
List the lumbar plexus of nerves in order from lateral (and superior) to medial
```
Iliohypogastric
Ilioinguinal
lateral femoral cutaneous
femoral
genitofemoral
obturator
lumbosacral trunk
```
107
What are the paired parietal branches of the abdominal aorta?
o Subcostal a. (T12)
o Inferior phrenic a. (T12)
o Lumbar aa. (L1-4)
108
Where does the abdominal aorta bifurcate and into what?
At L4 it bifurcates into common iliac aa.
109
Where does the median sacral artery originate from?
Median sacral a. originates at bifurcation of abdominal aorta
110
Where does the common iliac arteries travel?
Follow medial border of psoas major m. to pelvic brim
111
What does the common iliac artery bifurcate into?
Bifurcate to form external and internal iliac aa.
112
What do the internal iliac arteries supply?
Supplies pelvis, perineum and gluteal region
113
Where does the external iliac arteries travel?
Follows psoas major m. deep to inguinal l. where it becomes femoral a.
114
What does the external iliac artery give rise to?
Gives rise to inferior epigastric and deep circumflex iliac aa. just before inguinal l.
115
What is an Abdominal Aortic Aneurysm?
Enlargement of abdominal aorta due to congenital or acquired weakness of wall
116
Where are Abdominal Aortic Aneurysms most commonly found?
Most commonly occur where inferior mesenteric a. branches off
117
Are Abdominal Aortic Aneurysms palpable?
yes, Pulsatile mass is palpable left of midline and easily moveable side to side
118
What symptoms does an acute rupture of an Abdominal Aortic Aneurysm provide?
Acute rupture produces severe abdominal and back pain
119
What is the mortality rate of an Abdominal Aortic Aneurysm ?
Mortality rate is >90% due to rapid and severe blood loss
120
How are Abdominal Aortic Aneurysm repaired?
Aneurysm may be surgically repaired using a prosthetic graft
121
What artery compensates for a loss of inferior mesenteric artery?
Marginal a. (of Drummond) will usually compensate for loss of IMA
122
What is the largest vein of the body?
Inferior vena cava
123
Are valves found in the Inferior vena cava?
No valves except the nonfunctional one at orifice of right atrium
124
What does the Inferior vena cava do?
Venous return from lower limbs, back, abdominal walls and pelvic viscera
125
Where does the venous return from the abdominal viscera travel?
Through the hepatic portal vein and then drains into the IVC via hepatic veins
126
At what level is the IVC formed and by what?
At L5 by common iliac veins
127
Where is the IVC located?
- Slightly inferior and to the right of the aortic bifurcation
- Ascends along right sides of vertebrae to caval hiatus in diaphragm
128
What vessels are tributaries to the IVC?
1) Common iliac vv.
2) Lumbar vv.
3) Right gonadal v.
4) Renal vv.
5) Right suprarenal v.
6) Right inferior phrenic v.
7) Hepatic vv.
8) Azygos/hemiazygos vv.
- Connect IVC to SVC (directly or indirectly)
129
What are the 3 ways the IVC drains if it is obstructed?
1) External iliac v. to inferior epigastric v. to superior epigastric v. to internal thoracic v. to brachiocephalic v. to SVC
2) Femoral v. to superficial epigastric v. to lateral thoracic v. to axillary v. to subclavian v. to brachiocephalic v. to SVC
3) Lumbar v. to epidural venous plexus of vertebral column to azygos system to SVC
130
Which collateral circulation would create a conspicuous subcutaneous thoracoepigastric vein?
Collateral from femoral to brachiocephalic via the lateral thoracic
131
What forms the cisterna chyli?
Lymphatics of lower limbs and abdomen
132
Where are the lymph nodes of the posterior abdominal wall found?
Nodes are located along abdominal aorta and its main branches
133
What are inguinal nodes primary for?
o Lower limbs
o Perineum
o Buttock
o Anterior abdominal wall below umbilicus
o Drain secondarily through external and common iliac nodes
134
What are the internal iliac nodes primary for?
o Pelvic urinary organs
o Pelvic genital organs
o Pelvic portion of rectum
o Drain secondarily through common iliac or lumbar nodes
135
What do lumbar nodes receive lymph from?
o Common iliac, inferior mesenteric, superior mesenteric and celiac nodes
o Posterior body wall
o Kidneys and suprarenal glands
o Gonads
136
What is the cisterna chyli an extension of?
Lower expanded beginning of thoracic duct
137
What is the cisterna chyli?
Convergence of all lymphatic drainage trunks below thoracic diaphragm
138
how does the cisterna chyli appear?
Often appears as a plexus rather than a dilated sac
139
At what level and between what structures is the cisterna chyli found?
Located at L1 between right crus of diaphragm and abdominal aorta
140
Where is the iliacus located?
Large triangular muscle located lateral to the inferior part of psoas major
141
What is the origin of the iliacus?
Ala of sacrum, iliac fossa and anterior sacroiliac l.
142
What is the insertion of the iliacus?
Lesser trochanter of femur with psoas major m.
143
What is the innervation of the iliacus?
Femoral n. (L2-4)
144
What is the action of the iliacus?
Flexes thigh and stabilizes hip joint
145
What and where is the quadratus lumborum located?
Quadrilateral shaped muscle forming a sheet on posterior abdominal wall
146
What crosses superiorly over the quadratus lumborum?
Lateral arcuate ligament
147
What nerves cross the quadratus lumborum?
Subcostal n. and branches of lumbar plexus cross this m.
148
What is the origin of the quadratus lumborum?
12th rib and lumbar TPs
149
What is the insertion of the quadratus lumborum?
Iliolumbar l. and iliac crest
150
What is the innervation of the quadratus lumborum?
VPR of T12-L4
151
What is the action of the quadratus lumborum?
Depresses/stabilizes 12th rib for respiratory muscles (thoracic diaphragm
contracts against it during inspiration); laterally flexes vertebral column
152
What lines the posterior abdominal wall?
Lined internally by parietal peritoneum
153
Where is endoabdominal fascia found?
Between parietal peritoneum and musculature
154
What is the endoabdominal fascia continuous with?
Continuous anteriorly with transversalis fascia on anterolateral abdominal wall
155
What and where is the thoracolumbar fascia found?
Thin and transparent in thoracic region
Thick and strong in lumbar region
- Attached to vertebrae and spans between 12th rib and iliac crest
156
How is the thoracolumbar fascia found in regards to the deep back mm.?
Anterior, middle and posterior layers split to enclose deep back mm
157
Between which layers of the thoracolumbar fascia are the quadratus lumborum located and what muscles attach laterally?
Quadratus lumborum m. located between anterior and middle layers
- Internal abdominal oblique and transversus abdominis mm. attach laterally
158
Between which layers of the thoracolumbar fascia are the erector spinae mm. located and what muscles attach posteriorly?
located between middle and posterior layers
- Comparable to rectus sheath, but stronger due to vertebrae
- Latissimus dorsi m. attaches to lateral aspect of posterior layer
159
What are fascial abscesses?
Vertebral disease or infection may spread though psoas sheath
- Fascial compartment surrounding psoas major m.
160
What do fascial abcesses do to the fascia?
Psoas abscess causes this fascia to thicken and become very taut
161
Where does pus from fascial abcesses travel and via what?
Pus will spread through this compartment to the superior thigh
-Via lacuna musculorum
162
What will pus from fascial abcesses do to the muscle?
Pus accumulation will compress this muscle and cause pain
163
What are the somatic nerves of the posterior abdominal wall?
```
subcostal
lumbar spinal
lumbar plexus of nerves
- iliohypogastric
- ilioinguinal
- lateral femoral cutaneous
- femoral
- genitofemoral
- obturator
- lumbosacral trunk
```
164
What is the nerve root of subcostal n?
VPR of T12
165
where is the subcostal nerve found?
- Located just inferior to 12th rib
- Laterally located between transversus abdominis and internal oblique mm.
- Passes posterior to lateral arcuate l. and crosses quadratus lumborum m.
166
What does the subcostal nerve innervate?
Innervates anterolateral abdominal wall mm. and T12 dermatome
167
What do the dorsal rami of lumbar spinal nerves supply?
Dorsal rami supply mm. and skin of back
168
What do the ventral rami of lumbar spinal nerves pass through and form?
Ventral rami pass into psoas major m. and form lumbar plexus of nerves
169
What nerve roots make up the lumbar plexus of nerves?
Consists of VPR from L1-L4
170
What nervous autonomics do the lumbar plexus of nerves receive and via what?
Each receives postsynaptic sympathetics via gray rami communicantes
171
Is the quadratus lumborum retroperitoneal or intraperitoneal?
Retroperitoneal
172
What does the VPR of L1 split into?
Iliohypogastric and ilioinguinal nn
173
Where does the VPR of L1 split?
May split proximally in psoas major m., midway through pass on posterior abdominal wall or distally near ASIS
174
Where do the Iliohypogastric and ilioinguinal nn pass?
- Pass posterior to medial arcuate l. and cross quadratus lumborum m.
- Parallel iliac crest and pierce transversus abdominis m. near ASIS
175
What do the Iliohypogastric and ilioinguinal nn innervate?
Innervate abdominal oblique and transversus abdominis mm. and L1 dermatome anteriorly
176
What nerve roots make up the lateral femoral cutaneous nerve?
VPR of L2-3
177
Where does the lateral femoral cutaneous nerve pass?
- Pass inferolaterally across ilacus m.
| - Enters thigh deep to inguinal l. and medial to ASIS
178
What does the lateral femoral cutaneous n. innervate?
Sensory to anterolateral skin of thigh
179
What nerve roots make up the femoral nerve?
VPR of posterior divisions of L2-4
180
Where does the femoral nerve pass?
- Emerges from the lateral border of psoas major m (iliacus innervation)
- Passes deep to inguinal l. and then to anterior thigh (hip flexor and knee extensor innervation)
181
What does the femoral n. innervate?
Innervates iliacus m. and hip flexors and knee extensors
182
What nerve roots make up the genitofemoral nerve?
VPR of L1-L2
183
Where does the genitofemoral nerve pass?
Sits on anterior surface of psoas major m.
184
What does the genital branch of the genitofemoral nerve supply?
- Sensory to anterolateral skin of scrotum/labia majora
| - Motor to cremaster m.
185
Where does the genital branch of the genitofemoral nerve pass?
Genital branch passes through deep inguinal ring
186
Where does the femoral branch of the genitofemoral nerve pass?
Femoral branch passes along external iliac a.
187
What does the femoral branch of the genitofemoral nerve supply?
Sensory innervation over femoral triangle
188
What nerve roots make up the obturator nerve?
VPR of L2-4
189
Where does the obturator nerve pass?
- Runs along medial border of psoas major m. (lateral to iliac vessels)
- Passes through obturator canal
190
What does the obturator nerve supply?
Innervates medial thigh mm.
191
What nerve roots make up the lumbosacral trunk?
VPR L4-5
192
Where does the lumbosacral trunk pass?
Medial to psoas major m. where it passes over ala of sacrum
193
What does the lumbosacral trunk supply?
Participates with S1-4 in forming sacral plexus
194
What supplies sympathetic innervation in the posterior abdominal wall?
Lumbar sympathetic trunk
Abdominopelvic splanchnic nn
Lumbar splanchnic nn
195
What is the lumbar sympathetic trunk?
4 paravertebral ganglia and associated interganglionic segments
196
Is the lumbar sympathetic trunk continuous with the thoracic and sacral sympathetic trunk?
Yes
197
Where is the lumbar sympathetic trunk located?
Located anterolaterally to lumbar vertebral bodies
198
Between what levels do the presynaptic sympathics originate?
Presynaptic sympathetics originate from lateral horn of T1 to as low as L2
199
How do presynaptic sympathetics enter the sympathetic trunk?
Enter trunk via white rami communicantes
200
How do postsynaptic sympathetics exit the lumbar ventral rami?
via gray rami
201
Where do the presynaptic sympathetics of the abdominopelvic splanchnic nerves originate from?
Presynaptic sympathetics originate from lateral horn between T5-L2
202
How do presynaptic sympathetics enter the adominopelvic splanchnic nerves?
Enter sympathetic trunk via white rami communicantes
203
Where do postsynaptic sympathetics of adominopelvic splanchnic nerves travel?
Presynaptic Sympathetics pass through sympathetic trunk without synapsing
204
At what levels does the greater splanchnic nerve arise from?
T5-9
205
At what levels does the lesser splanchnic nerve arise from?
T10-11
206
At what levels does the least splanchnic nerve arise from?
T12
207
Where do the thoracic splanchnic synapse?
Synapse in either celiac, superior mesenteric or aorticorenal ganglia
208
Where do the lumbar splanchnic nerves arise from?
Arise from L1-2 or 3
209
Where do the lumbar splanchnic synapse?
Synapse in inferior mesenteric ganglion
210
Where do postsynaptic sympathetics splanchnics from?
Exit from the respective prevertebral ganglia
211
How do the sympathetics of the posterior abdominal wall enter the abdominal viscera?
Following the periarterial plexuses
212
What do the sympathetics of the posterior abdominal wall do?
Vasoconstriction in abdominal viscera
| - Inhibits GI activity
213
What do visceral afferents of the posterior abdominal wall travel with?
Accompany sympathetics retrograde through splanchnic nn.
214
What do visceral afferents and their accompaniment of sympathetics do in regards to pain?
Referred pain is to dermatomes associated with segmental levels where presynaptic sympathetics originate
215
What provide parasympathetic innervation to the posterior abdominal wall?
Anterior/posterior vagal trunks
| Pelvic splanchnic nn.
216
Where are the anterior/posterior vagal trunks found in the posterior abdominal wall?
Emerge from esophageal plexus and pass through esophageal hiatus
217
What autonomic innervation do the Anterior/posterior vagal trunks carry?
Contain presynaptic parasympathetics
218
What plexuses do the Anterior/posterior vagal trunks contribute to?
Contribute to same plexuses as splanchnic nn.
219
What do the Anterior/posterior vagal trunks innervate?
Innervate lower esophagus to splenic flexure of colon and most viscera
- Carry visceral afferents for reflex superior to middle of sigmoid colon
220
Do the pelvic splachnic nerves associate with sympathetic innervation?
no, Have nothing to do with sympathetic innervation
| - Do not attach to sympathetic trunk
221
What nerve roots make up the pelvic splanchnic nerves?
VPR of S2-4
222
Where do the pelvic splanchnic nerves convey presynaptic parasympathetics to?
Presynaptic parasympathetics to hypogastric plexuses
223
What do the pelvic splanchnic nerves innervate?
Innervate from splenic flexure of colon to rectum and pelvic viscera
- Carry visceral afferents for reflex and pain inferior to middle of sigmoid colon
224
Where do presynaptic parasympathetics of the posterior abdominal wall synapse and what do they do?
Presynaptics synapse on postsynaptic cells in intrinsic ganglia
- Stimulates GI activity
225
List the autonomic plexuses of the posterior abdominal wall
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Celiac plexus
Superior mesenteric plexus
Inferior mesenteric plexus
Superior hypogastric plexus
Inferior hypogastric plexus
```
226
What autonomic innervations do the autonomic plexuses of the posterior abdominal wall contain?
Contain both sympathetic and parasympathetic neurons
227
Where are the autonomic plexuses of the posterior abdominal wall found?
Surround abdominal aorta and/or its major arterial branches
228
Where is the parasympathetic intrinsic ganglia found?
In wall of gut or viscera (i.e. Auerbach’s myenteric plexus)
229
What autonomics contribute to the celiac plexus?
- Sympathetic contribution via greater and lesser splanchnic nn.
- Parasympathetic contribution via posterior vagal trunk
230
Where does the celiac plexus supply?
Primarily to foregut derivatives
231
What autonomics contribute to the superior mesenteric plexus?
1) Sympathetic contribution via lesser and least splanchnic nn.
2) Parasympathetic contribution via posterior vagal trunk
232
Where does the superior mesenteric plexus supply?
Primarily to midgut derivatives
233
What autonomics contribute to the Inferior mesenteric plexus?
1) Sympathetic contribution from lumbar splanchnic nn
| 2) Parasympathetic contribution via pelvic splanchnic nn.
234
Where does the inferior mesenteric plexus supply?
Primarily to hindgut derivatives
235
What autonomics contribute to the Superior hypogastric plexus?
Sympathetic contribution from lumbar splanchnic nn.
236
Where is the Superior hypogastric plexus located?
Anterior to bifurcation of abdominal aorta
237
Where does the Superior hypogastric plexus supply?
Innervates ureteric and gonadal plexuses
238
What autonomics contribute to the inferior hypogastric plexus?
1) Sympathetic contribution via lumbar splanchnic nn. (and to a small extent sacral splanchnic nn.)
2) Parasympathetic contribution via pelvic splanchnic nn.
239
Where is the inferior hypogastric plexus located?
Connected to superior hypogastric plexus via hypogastric nn
240
What does the inferior hypogastric plexus supply?
Supplies pelvic viscera
241
Between what levels is the abdominal aorta found?
Anterior to T12-L4 vertebrae
242
What are the unpaired anterior visceral branches of the abdominal aorta?
o Celiac trunk (T12)
o Superior mesenteric a. (L1)
o Inferior mesenteric a. (L3)
243
What are the paired lateral visceral branches of the abdominal aorta?
o Middle suprarenal a. (L1)
o Renal a. (L1)
o Gonadal a. (testicular or ovarian aa.) (L2)
244
List the lumbar plexus of nerves in order from lateral (and superior) to medial
```
Iliohypogastric
Ilioinguinal
lateral femoral cutaneous
femoral
genitofemoral
obturator
lumbosacral trunk
```
245
What are the paired parietal branches of the abdominal aorta?
o Subcostal a. (T12)
o Inferior phrenic a. (T12)
o Lumbar aa. (L1-4)
246
Where does the abdominal aorta bifurcate and into what?
At L4 it bifurcates into common iliac aa.
247
Where does the median sacral artery originate from?
Median sacral a. originates at bifurcation of abdominal aorta
248
Where does the common iliac arteries travel?
Follow medial border of psoas major m. to pelvic brim
249
What does the common iliac artery bifurcate into?
Bifurcate to form external and internal iliac aa.
250
What do the internal iliac arteries supply?
Supplies pelvis, perineum and gluteal region
251
Where does the external iliac arteries travel?
Follows psoas major m. deep to inguinal l. where it becomes femoral a.
252
What does the external iliac artery give rise to?
Gives rise to inferior epigastric and deep circumflex iliac aa. just before inguinal l.
253
What is an Abdominal Aortic Aneurysm?
Enlargement of abdominal aorta due to congenital or acquired weakness of wall
254
Where are Abdominal Aortic Aneurysms most commonly found?
Most commonly occur where inferior mesenteric a. branches off
255
Are Abdominal Aortic Aneurysms palpable?
yes, Pulsatile mass is palpable left of midline and easily moveable side to side
256
What symptoms does an acute rupture of an Abdominal Aortic Aneurysm provide?
Acute rupture produces severe abdominal and back pain
257
What is the mortality rate of an Abdominal Aortic Aneurysm ?
Mortality rate is >90% due to rapid and severe blood loss
258
How are Abdominal Aortic Aneurysm repaired?
Aneurysm may be surgically repaired using a prosthetic graft
259
What artery compensates for a loss of inferior mesenteric artery?
Marginal a. (of Drummond) will usually compensate for loss of IMA
260
What is the largest vein of the body?
Inferior vena cava
261
Are valves found in the Inferior vena cava?
No valves except the nonfunctional one at orifice of right atrium
262
What does the Inferior vena cava do?
Venous return from lower limbs, back, abdominal walls and pelvic viscera
263
Where does the venous return from the abdominal viscera travel?
Through the hepatic portal vein and then drains into the IVC via hepatic veins
264
At what level is the IVC formed and by what?
At L5 by common iliac veins
265
Where is the IVC located?
- Slightly inferior and to the right of the aortic bifurcation
- Ascends along right sides of vertebrae to caval hiatus in diaphragm
266
What vessels are tributaries to the IVC?
1) Common iliac vv.
2) Lumbar vv.
3) Right gonadal v.
4) Renal vv.
5) Right suprarenal v.
6) Right inferior phrenic v.
7) Hepatic vv.
8) Azygos/hemiazygos vv.
- Connect IVC to SVC (directly or indirectly)
267
What are the 3 ways the IVC drains if it is obstructed?
1) External iliac v. to inferior epigastric v. to superior epigastric v. to internal thoracic v. to brachiocephalic v. to SVC
2) Femoral v. to superficial epigastric v. to lateral thoracic v. to axillary v. to subclavian v. to brachiocephalic v. to SVC
3) Lumbar v. to epidural venous plexus of vertebral column to azygos system to SVC
268
Which collateral circulation would create a conspicuous subcutaneous thoracoepigastric vein?
Collateral from femoral to brachiocephalic via the lateral thoracic
269
What forms the cisterna chyli?
Lymphatics of lower limbs and abdomen
270
Where are the lymph nodes of the posterior abdominal wall found?
Nodes are located along abdominal aorta and its main branches
271
What are inguinal nodes primary for?
o Lower limbs
o Perineum
o Buttock
o Anterior abdominal wall below umbilicus
o Drain secondarily through external and common iliac nodes
272
What are the internal iliac nodes primary for?
o Pelvic urinary organs
o Pelvic genital organs
o Pelvic portion of rectum
o Drain secondarily through common iliac or lumbar nodes
273
What do lumbar nodes receive lymph from?
o Common iliac, inferior mesenteric, superior mesenteric and celiac nodes
o Posterior body wall
o Kidneys and suprarenal glands
o Gonads
274
What is the cisterna chyli an extension of?
Lower expanded beginning of thoracic duct
275
What is the cisterna chyli?
Convergence of all lymphatic drainage trunks below thoracic diaphragm
276
how does the cisterna chyli appear?
Often appears as a plexus rather than a dilated sac
277
At what level and between what structures is the cisterna chyli found?
Located at L1 between right crus of diaphragm and abdominal aorta
