Posterior Abdominal Wall Flashcards
What are the four muscles of the posterior abdominal wall?
psoas major/minor, iliacus, quadratus lumborum, diaphragm
where does the psoas major/minor and iliacus insert onto?
lesser trochanter of the femur
what is the innervation of the psoas major/minor muscle?
anterior rami of L1-L3
what is the innervation of the iliacus muscle?
femoral nerve (L2-L4)
what is the origin of the quadratus lumborum muscle?
the iliolumbar ligament and the lip of the iliac crest
what is the insertion of the quadratus lumborum muscle?
the medial half of the inferior surface of the 12th rib
what is the innervation of the quadratus lumborum muscle?
anterior rami of T12, L1-L4
what is the common presentation of a psoas abscess?
back or flank pain, fever, limp, inguinal mass; lower abdominal pain that is exacerbated by extending the thigh (psoas sign)
what are some causes of a psoas abscess?
disease of organs (TB spread into the abdomen), cancers, or infections deep to psoas fascia
what are the three ligaments of the posterior abdominal wall?
medial arcuate ligament, lateral arcuate ligament, median arcuate ligament
what is the medial arcuate ligament?
fascial thickening of the psoas fascia
what is the lateral arcuate ligament?
fascial thickening of the quadratus lumborum muscle
what is the median arcuate ligament?
the tendinous arch of the crura of the diaphragm-crosses the aorta
what are the unpaired arteries of the posterior abdominal wall?
celiac trunk, superior mesenteric artery, inferior mesenteric artery, median sacral artery
where does the IVC begin?
anterior to L5 and to the right
what are tributaries?
corresponding veins of paired visceral and parietal branches of the aorta
where does the left gonadal vein empty into?
the left renal vein, which then empties into the IVC
what are the three openings of the diaphragm?
the caval opening, the esophageal hiatus, and the aortic hiatus
where is the caval opening located?
T8 level
what goes through the caval opening?
the IVC and the right phrenic nerve
where is the esophageal hiatus?
T10 level
what goes through the esophageal hiatus?
the esophagus and the anterior and posterior vagal trunks
where is the aortic hiatus?
T12 level
what passes through the aortic hiatus?
aorta, thoracic duct, and sometimes the azygos and hemiazygos veins
What are the three parts of the muscular diaphragm?
muscular portion, central tendon, and the crura
what are the parts of the muscular portion of the diaphragm?
the sternal part, the costal part, and the lumbar (crural) part
where does the costal part of the diaphragm attach?
to the inferior 6 costal cartilages- this is the largest portion
which crura of the diaphragm is larger?
the right crus
what arteries supply the superior side of the diaphragm?
the musculophrenic and the pericardiophrenic artery and the superior phrenic artery
what do the musculophrenic and pericardiophrenic arteries branch off of?
the internal thoracic artery
what does the superior phrenic artery branch off of?
the thoracic aorta
what arteries supply the inferior side of the diaphragm?
the inferior phrenic artery and the intercostal branches for the peripheral diaphragm
what does the inferior phrenic artery branch off of?
the abdominal aorta
what causes a hiatal hernia?
weakening of the muscular diaphragm
where are the kidneys located?
retroperitoneally- lying about T12-L3 level
which kidney is lower?
the right one
what is the renal hilum?
it is the entrance to the renal sinus
posteriorly , where do the superior parts of the kidney lie?
deep to the 11th and 12th ribs
posteriorly, where is the left kidney hilum located?
near the transpyloric plane
posteriorly, where does the transpyloric plane run through the right kidney?
the superior pole of the right kidney
posteriorly, where is the inferior pole of the right kidney located?
an index finger superior to the iliac crest
what muscle lies posterior to the largest part of the kidney?
the quadratus lumborum
what nerves are susceptible to damage if you are resecting the kidney?
the iliohypogastric nerve and the ilioinguinal nerve
what is the layer of fat that is surrounding the kidney?
perinephric fat
what is just outside of the perinephric fat?
the renal fascia
what is just outside of the renal fascia?
paranephric fat
what is found in the renal hilum?
the renal artery and the renal vein
what is the space in the kidney that is filled with some of the perinephric fat called?
the renal sinus
what is it called where the ureter expands into a funnel-like shape?
renal pelvis
where does the renal pelvis collect urine from?
The major calyx
what makes up the renal medulla?
renal pyramids
what sits between the renal pyramids and makes up the renal cortex?
the renal columns
what is found at the tips of the renal pyramids?
the renal papilla
what does the ureter connect?
the renal pelvis to the bladder
where are common potential sites of obstruction in the ureter?
the junction of the ureter with the renal pelvis, at the point of the crossing of the pelvic brim, and the point where the ureter enters the bladder wall
what can be used to detect an obstruction of the ureter?
a pyelogram
what is the blood supply to the suprarenal glands?
superior, middle, and inferior suprarenal arteries
where are all the lymphatics of the posterior abdominal wall collected into?
the cisterni chyli
what is the cisterni chyli the beginning of?
the thoracic duct
where does the subcostal nerve come from?
the anterior rami of T12
where does the iliohypogastric nerve come from?
the anterior rami of L1
where does the ilioinguinal nerve come from?
the anterior rami of L1
where does the genitofemoral nerve come from?
the anterior rami of L1 and L2
where does the lateral femoral cutaneous nerve come from?
the anterior rami of L2 and L3
where does the femoral nerve come from?
the anterior rami of L2, L3, and L4
where does the obturator nerve come from?
the anterior rami of L2, L3, and L4
where does the lumbosacral trunk come from?
L4 and L5
what is the innervation of the suprarenal glands?
preganglionic sympathetic from T10-L1; celiac plexus and abdominopelvic splanchnic nerves
