Posterior Abdominal Wall and Lumbar Plexus Flashcards by Matthew Archer

What are the three layers of the Thoracolumbar Fascia? Which is the layer that covers the quadratus lumborum?

Anterior, Middle and Posterior layer.

It is the anterior layer that covers the quadratus lumborum

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Which layer of fascia covers the Psoas Major muscle? What is it’s clinical correlation

Psoas fascia

Can get inflammatory collections from spinal cord and track down to groin where it is thinnest

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What is the fascia that is continuous with the Psoas fascia?

Iliac Fascia

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What is the fascia that covers the kidney and associated areas? Name the exact areas that it covers.

Peri-renal fascia

Bi-laminated fascia over:
Kidneys
Suprarenal gland
Upper ureter
Fat

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Which is the fascia in the thoracolumbar region that fuses with the Transversalis Fascia?

Lateroconal fascia (this is the lateral aspect of peri-renal fascia)

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Which are the two muscles that form the conjoined tendon?

Psoas Major and Iliacus

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What is the origin and insertion of the Psoas Major

Origin: Transverse processes of T12-L5

Insertion: Lesser trochanter of femr (along with Iliacus

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What are the major relations of the psoas Major?

Lies anterior to lumbar plexus

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What is the innervation of the Psoas Major

Femoral Nerve (anterior br. of L2-L4)

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What are the relations of the Psoas Minor

Inferolateral to sides of T12-L5 bodies

Anterior to Psoas Major

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What is the origin and insertion of the Psoas Minor

Origin: Bodies of T12 and L1

Insertion: Pectineal Line (Pectin Pubis)

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What is the innervation of the Psoas Minor

Anterior rami of L1

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What are the relations of the Iliacus Muscle

Lateral to the inferior part of the Psoas Major

In the Iliac Fossa

Forms conjoined tendon along with Psoas Major - which is deep to Inguinal Ligament

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What is the innervation of the Iliacus

Femoral Nerve (L2-L4)

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What is the origin of the Quadratus Lumborum

From the Transverse processes of the Lumbar vertebrae and 12th rib

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What are the relations of the Quadratus Lumborum

Lateral to superior part of Psoas Major

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What is the innervation of the Quadratus Lumborum

Anterior branches of T12-L4

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What is the action of the Psoas Major

Flexes the thigh

Flexes vertebral column laterally

Helps to balance the trunk

Helps to flex trunk when sitting

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What is the action of the Iliacus

Flexes thigh

Stabilises hip joint

What is the action of Quadratus Lumborum

Extends and laterally flexes vertebral column

Fixes 12th rib during inspiration

At what level does the abdominal aorta bifurcate into left and right common iliac arteries?

What are the branches of the adominal aorta in the anterior midline? What are the levels?

Celiac (T12)
Superior Mesenteric (L1)
Inferior Mesenteric (L3)

What are the branches of the abdominal aorta laterally? What are their levels?

Suprarenal (L1)
Renal (L1)
Gonadal - Testicular or Ovarian (L2)

What are the branches of the abdominal aorta in the posterolateral plane? What are their levels?

Middle Sacral (L4)
Inferior Phrenic (T12)
Lumbar (L1-L4)

At what level is the union of the common iliac veins? What do they form?

L5 | Form Inferior vena cava

Where does the median sacral vein drain?

Into the left iliac vein

What are the plexuses that ANS travel through to get to the Abdominal Viscera

Coeliac Plexus Superior and Inferior Mesenteric Plexuses Hypogastric Plexus

What are the relations of the Hypogastric Plexus

Travels with the Internal Iliac artery and Inferior Mesenteric Artery

What are the nerves that supply the Hypogastric Plexus

Sympathetic verves from T10-L2 Parasympathetic Plevic Splanchnic nerves from S2-S4

What are the main nerves supplying the parasympathetic and sympathetic components of the Abdominal Viscera

Sympathetic: - Thoracic Splanchnic (Greater, Lesser and Least) - Lumbar Trunk Parasympathetic: - Vagus (ant. and post. trunks) - Pelvic splanchnic nerves

Describe the main visceral plexus of the Abdomen

Lumbar plexus From ant. primary rami of L1-L4 Deep to and within Psoas Major

What are the branches of the Lumbar Plexus and what forms them?

Iliohypogastric - L1 Ilioinguinal - L1 Genitofemoral -L1 and L2 Lateral cutaneous n. of the thigh - Post. div. of L2-L3 Obturator - ant. div. of L2-L4 Femoral - post. div. of L2-L4

Which branch of the Lumbar plexus communicates with the lumbosacral trunk

What are the Ligaments of the Posterior part of the diaphragm and their respective relations?

Median arcuate Ligament: - T12 - Fibro-osseous tunnel Medial arcuate ligament: - Arch over Pdoas Major - From median lig. to tip of L1 Transverse Process Lateral arcuate ligament: - Over quadratus lumborum - From tip of L1 transverse process to tip of 12th rib

What are the levels of the crura of the diaphragm

Rt. crus: L1-L3 | Lt. crus: L1-L2

What passes through the aortic opening of the diaphragm? What level is this

T12 Aorta Thoracic duct Left and right ascending Lumbar Vessels

What passes through the oesophageal opening? What level is this?

T10 Oesophagus Anterior and Posterior Vagal Trunks

What passes through the Caval Opening? What level is this?

T8 IVC Rt. Phrenic Nerve

How do the Thoracic Splanchnic nerves pass through the diaphragm?

Through crura

How do the Sympathic trunks pass through the diaphragm

Through medial arcuate ligament.

How do the subcostal nerves pass through the diaphragm

Through the Later arcuate lig.

How do the branches of the left phrenic nerve pass through the diaphragm?

Through the left dome of the diaphragm

How do the sup. epigastric vessels and lymphatics pass through the diaphragm?

Between diaphragmic attachments to the Xiphoid and 7th costal cartilage

How do the Intercostal neurovascular bundles pass through the diaphragm? Which ones are they?

7th - 12th neurovascular bundles Pass between costal slips of origin of diaphragm

What is the arterial supply to the diaphragm?

Superior surface: - Pericardiacophrenic aa - Musculophrenic aa. - ----Both are branches of the Internal thoracic artery----- Inferior surface: - Inferior Phrenic arteries - ----First branches of the Abdominal Aorta-----

What is the venous drainage of the diaphragm?

Superior surface: - Pericardiacophrenic vv - Musculophrenic vv - ----Both are branches of the Internal thoracic vein----- - Superior phrenic v. on right (drains into SVC) Inferior surface: -Inferior Phrenic vv.