Posterior abdominal wall Flashcards
1
Q
describe the fascia of the abdominal wall
A
- continuous with that of pelvis
- lies between the peritoneum and the muscles of abdominal wall
- named after muscles it overlies
2
Q
in the inguinal region, the fascia extends to form what
A
femoral sheath that surrounds the femoral artery and vein
3
Q
does the femoral nerve lie within the femoral sheath
A
no: vessels inside, nerve outside
4
Q
the transversalis fascia continues as what layer of the spermatic cord and scrotum
A
internal spermatic fascia
5
Q
after the arcuate line, what lies behind the rectus abdominis
A
transversalis fascia
6
Q
what is the name of the quadrangular muscle that lies in the lumbar region
A
quadratus lumborum
7
Q
what are the attachments of quadratus lumborum
A
iliac crest to 12th rib and L1-4 transverse processes
8
Q
what is the function of quadratus lumborum
A
bends trunk to same side (one used) - lateral flexion
supports abdominal wall (both) - pressure, forced expiration and support for 12th rib
9
Q
what is the nerve supply of quadratus lumborum
A
T12 - L4 anterior rami
10
Q
the fascia over quadratus lumborum is thickened near the diaphragm to form what ligament
A
lateral arcuate ligament
11
Q
what are the attachments of iliacus
A
iliac fossa of the pelvis and then joins with psoas muscle to become iliopsoas and attach to lesser trochanter of femur
12
Q
what is the attachment of the iliopsoas
A
lesser trochanter of femur
13
Q
what is the function of iliopsoas
A
flex hip
14
Q
what is the innervation of iliacus
A
femoral nerve (L2-4)
15
Q
what are the roots of the femoral nerve
A
L2-4
16
Q
what are the attachments of psoas
A
superficial: T12-L4 vertebral bodies and IVDs
deep: L1-L5
to join iliacus as iliopsoas and attach to lesser trochanter of femur
17
Q
what is the function of psoas
A
as iliopsoas: flex hip
superiorly - bend trunk laterally (one) or raise trunk from supine (both)
18
Q
what is the innervation of psoas
A
direct branches of L2 - L4 anterior rami
19
Q
what is the psoas minor
A
long tendon anterior to psoas major
20
Q
the fascia over the psoas is thickened near the diaphragm to form what ligament
A
medial arcuate ligament
21
Q
what other muscles contribute to the posterior abdominal wall
A
transversus abdominis
crura of diaphragm
22
Q
what is the attachments of the right crus of the diaphragm
A
vertebral bodies L1 - L3
23
Q
what is the attachments of the left crus of the diaphragm
A
vertebral bodies L1 and L2
24
Q
when does the aorta enter the abdomen
A
T12 through aortic hiatus
25
level of celiac axis
T12
26
level of SMA
L1
27
level of IMA
L3
28
what level does the aorta bifurcate and into what
L4
| into right and left common iliac arteries
29
what branches of the abdominal aorta supply the body wall
lumbar (L1-4)
| median sacral
30
the abdominal aorta gives what branch to the diaphragm
inferior phrenic
31
lateral sacral arteries are a branch of what
internal iliac arteries
32
when do the common iliac arteries divide into internal and external
at pelvic brim
33
where does the internal iliac artery go
enters the pelvis
34
the common iliac artery follows what muscle after the bifurcation of the aorta
follows the medial border of the psoas muscle to the pelvic brim
35
what muscle does the external iliac artery follow
iliopsoas muscle
36
just before leaving the abdominal cavity the external iliac artery gives rise to what
inferior epigastric artery and deep circumflex artery which supply anterolateral abdominal wall
37
level of renal artery
L1
38
level of suprarenal artery
L1
39
level of gonadal artery
anterolateral surface at L2
40
at what level does the inferior vena cava form and from what
L5 from union of right and left common iliac veins
| slightly to right of median plane
41
the IVC drains blood from where
posterior abdominal wall, kidneys and suprarenal glands (+ hepatic veins)
42
the IVC drains blood to where
right atrium
43
blood from the gut drains where
portal system
44
how does blood from the gut get to the IVC
blood from portal system passes through the liver before entering IVC via hepatic veins
45
where does the IVC peirce the diaphragm
T8
46
where does the left gonadal vein drain
left renal vein
47
where does the right gonadal vein drain
IVC
48
where does the IVC form
- L5 level
- slightly to right of median plane
- inferior to aortic bifurcation
- Posterior to right common iliac artery
49
the left suprarenal vein drains where
into left renal vein
50
the right suprarenal vein drains where
into IVC
51
how many lumbar veins are there
5
52
how many hepatic veins are there
3 - right, middle and left
53
what veins drain the posterior abdominal wall
lumbar veins
54
(some variation of pattern of lumbar veins)
typically, lumbar veins 1 and 2 drain where
ascending lumbar veins
55
typically, lumbar veins 3 and 4 drains where
IVC
56
typically, lumbar vein 5 drains where
iliolumbar vein (into common iliac)
57
ascending lumbar veins connect what
external iliac and lumbar veins to azygous and hemiazygous veins
58
what does the connection of the lumbar veins to iliac veins and azygous system allow
pathway for venous return from abdomen that does not use IVC
59
why might someone have a swollen ascending lumbar vein
if they have a variation called an interrupted IVC where part of IVC doesnt form
60
what lymph nodes drain the gut tube
pre-aortic lymph nodes assoc. with the large anterior branches of the abdominal aorta that supply the foregut, midgut and hindgut
61
what nodes drain the foregut
coeliac pre-aortic nodes at T12
62
what nodes drain the midgut
superior mesenteric pre-aortic nodes at L1
63
what nodes drain the hindgut
inferior mesenteric pre-aortic nodes at L3
64
what nodes drain the kidneys
para-aortic renal nodes at L1
65
where is the start of the thoracic duct and what is found here
```
cisterna chyli (in some)
L1 vertebral level
```
66
lymph from intestines drains where
intestinal trunk which then passes into end of thoracic duct
67
internal and external iliac nodes drain where
common iliac lymph nodes
68
lymph from common iliac lymph nodes drains where
to right and left lumbar nodes
69
how are the intestinal lymphatic trunks formed
efferent vessels from pre-aortic lymph nodes
70
how are the lumbar lymphatic trunks formed
efferent vessels from large lumbar nodes
71
describe the sympathetic supply of the abdominal viscera
fibres from splanchnic nerves join to form plexuses around aorta and its branches
72
where does the greater splanchnic nerve come from
sympathetic chain in thorax
73
where do lumbar splanchnic nerves come from
sympathetic chain in the abdomen
74
the greater and lumbar splanchnic nerves add fibres to what
coeliac, superior mesenteric and inferior mesenteric plexuses
75
parasympathetic fibres for the plexuses come from
```
vagus nerve (CN X)
pelvic splanchnic nerves (S2 3 4)
```
76
where is the superior hypogastric plexus
bifurcation of the aorta
77
where is the inferior hypogastric plexus
both lateral walls of pelvis
78
what do the superior and inferior hypogastric plexuses carry
sympathetic and parasympathetic fibres
79
the vagus nerve carries parasympathetic innervation to
foregut and midgut
80
the pelvic splanchnic nerves supply parasympathetic innervation to
hindgut - distal transverse colon to anal canal
81
the inferior hypogastric plexuses also carry autonomic fibres to
pelvic organs
82
the lumbar plexus is formed by what
somatic nerves from anterior rami of L1 - L4
83
where does the lumbar plexus lie
under psoas - branches form within psoas
84
what does the lumbar plexus carry
some sensory branches to skin of pelvis but mostly motor and sensory supply to lower limb
85
name the nerves of the lumbar plexus
```
iliohypogastric
ilioinguinal
genitofemoral
lateral femoral cutaneous
femoral
obturator
```
86
the lumbar plexus also forms what
lumbosacral trunk to carry L4 and L5 fibres into pelvis to join with sacral nerve roots
87
what is the name of the large nerve that lies immediately inferior to rib 12
subcostal
88
what is the root of the subcostal nerve
anterior rami of T12
89
why is it useful to identify the subcostal nerve
guide you to iliohypogastric and ilioinguinal nerves that form from L1 nerve roots
90
describe the course of the subcostal nerve
arises in thorax
passes posterior to lateral arcuate ligament into abdomen
runs inferolaterally on anterior surface of quadratus lumborum
91
what does the subcostal nerve pass through to supply what
passes through transversus abdominis and internal oblique muscles to supply the external oblique and skin of anterolateral abdominal wall
92
what are the 2 nerves from L1 in lumbar plexus
iliohypogastric
| ilioinguinal
93
iliohypogastric nerve supplies sensory innervation to what
lateral gluteal and pubic skin
94
the iliohypogastric nerve supplies motor innervation to what
internal oblique and transversus abdominis
95
the ilioinguinal nerve supplies sensory innervation to
skin on medial thigh and perineum - root of penis/scrotum or mons pubis/labium majus
96
the ilioinguinal nerve supplies motor innervation to
internal oblique and transversus abdominis
97
root of iliohypogastric and ilioinguinal nerves
anterior ramus L1
98
what nerve passes through the posterior wall of the inguinal canal and exits through the superficial inguinal ring to supply cutaneous innervation to medial thigh and perineum
ilioinguinal nerve
99
what is the root of the genitofemoral nerve
L1 and L2 anterior rami
100
describe the course of the genitofemoral nerve
pierces psoas and runs along the anterior surface and divides into a femoral and genital branch
101
the femoral branch of the genitofemoral nerve supplies what
sensory to skin of upper part of anterior surface of thigh
102
the genital branch of the genitofemoral nerve supplies what
sensory to perineum (scrotum/mons pubis)
| motor to cremasteric muscle
103
the genital branch of the genitofemoral nerve is found where
enters deep inguinal ring to join spermatic cord
104
what are the roots of the lateral cutaneous nerve of the thigh (aka lateral femoral cutaneous nerve
anterior rami L2-L3
105
where does the lateral cutaneous nerve of the thigh run
on the iliacus
106
what does the lateral cutaneous nerve of the thigh supply
sensory to skin on anterior and lateral thigh (above knee)
107
what is the largest nerve from the lumbar plexus
femoral nerve
108
what are the roots of the femoral nerve
anterior rami L2 3 4
109
the femoral nerve gives sensory innervation where
anterior thigh and via its saphenous branch to the medial side of the leg
110
the femoral nerve gives motor innervation where
pectineus and iliacus muscles and anterior compartment of the thigh e.g. quads
(flexors of hip, extensors of knee)
111
how does the femoral nerve reach the anterior compartment of the thigh
passes under the inguinal ligament and into femoral triangle
112
what are the roots of the obturator nerve
anterior rami L2 3 4
113
describe the course of the obturator nerve
passes close to sacrum and into pelvis where it passes through the obturator muscles and membrane of obturator foramen to the medial compartment of the thigh
114
the obturator nerve supplies sensory innervation where
skin on medial thigh
115
the obturator nerve supplies motor to what
adductor muscles
obturator externus
medial compartment of thigh e.g. gracilis
may supply pectineus
116
what nerve supplies posterior compartment of thigh
sciatic nerve
117
what are the roots of the sciatic nerve
L4 - S3
