Posterior Abdominal Wall and Respiratory Diaphragm Lecture (Test 1) Flashcards
Posterior Abdominal Wall Muscles
- Psoas Major
- Psoas Minor
- Quadrates Lumborum
- Iliacus
Posts Major Muscle
PROXIMAL ATTACHMENT:
- Lateral aspects and Transverse processes of Vertebral Bodies of T12 - L5!!!!!
DISTAL ATTACHMENT:
- LESSER TROCHANTER of Femur (Via Common Tendon with Iliacus Muscle)
INNERVATION:
- L2, L3, L4 (Via Lumbar Plexus)
ACTIONS:
a) Bilaterally: Flexes Thigh at the Hip
b) Unilaterally: Side Bends trunk to the same side
Iliascus Muscle
PROXIMAL ATTACHMENT:
- ILIAC FOSSA of Pelvis
DISTAL ATTACHMENT:
- LESSER TROCHANTER of Femur (Via common Tendon with Psoas Major Muscle)
INNERVATION:
- FEMORAL Nerve
ACTIONS:
- Flexes thigh at Hip
Psoas Minor Muscle
PROXIMAL ATTACHMENT:
- LATERAL aspects of Vertebral Bodies of T12 and L1
DISTAL ATTACHMENT:
- PECTINEAL LINE (Superior Pubic Ramus)
INNERVATION:
- L1 and L2
ACTIONS:
- DEPRESSES 12th RIB
- FIXES 12th RIB (DURING DEEP INSPIRATION)!!!!!!!!!
a) Bilaterally: Assists with Trunk Extension
b) Unilaterally: Side Bends Trunk to Same Side
Quadrates Lumborum Muscle
PROXIMAL ATTACHMENT:
- ILIAC CREST and ILIOLUMBAR Ligament
DISTAL ATTACHMENT:
- Medial half of INFERIOR Border of the 12th Rib
- Tops of LUMBAR TRANSVERSE Processes
INNERVATION:
- T12 to L4
ACTIONS:
- Extends and Laterally FELXES Vertebral Column
- FIXES RIB 12 DURING INSPIRATION!!!!!
Posterior Abdominal Pain
- Psoas Major and Iliac Muscle have close relationships with many Abdominal Structures
a) Kidneys, Ureters, Cecum, Sigmoid Colon, Pancreas, Posterior Abdominal Nerves - Disease or Injury of these structures can be associated with ILIOPSOAS Pain
a) Iliopsoas Test is performed to HELP with Differential Diagnosis
Ex: Patient lies on UNAFFECTED Side and EXTEND OPPOSITE THIGH Against Resistance
Psoas Syndrome
PRESENTATION:
- Lumbosacral Pain
- Difficulty Standing up Stright
- Pain in the CONTRALATERAL GLUTEAL REGION
- Radiation of Pain down the LOWER EXTREMITY (Usually stops at the Knee)
May MIMIC Herniated Disk*
DIFFERENTIAL DIAGNOSIS:
- Appendicitis, Colon Cancer, Diverticulitis, Hip Dysfunction, Salpingitis, ect
Blood Supply of the Abdomen
T12:
- Inferior Phrenic Artery
- Superior Suprarenal Artery
- Middle Suprarenal Artery
L1:
- First Lumbar Artery
- Inferior Suprarenal Artery
- Renal Artery (Right Renal goes BEHIND IVC)
L2:
- Gonadal Artery
- Second Lumbar Artery
L3:
- Third Lumbar Artery
L4:
- Fourth Lumbar Artery
L5:
- Common Iliac
- External and Internal Iliac
- Median Sacral
Respiratory Diaphragm
BORDERS (Peripheral Origins):
- Xiphisternal Joint
- Costal Margin
- Vertebral Body of T12
PARTS:
- Right and Left Dome
- Superior Surface can extend to 5th RIB!!!!!
Respiratory Diaphragm Cont
A) 3 Peripheral Origins Inserts on the Central Tendon:
- Sternal Origin
- Costal Origin
- Vertebral Origin
B) Right an Left Crus (Meet at Aortic Hiatus)
1) RIGHT CRUS
- Longer (forms the MUSCULAR Esophageal Hiatus)
2) LEFT CRUS
- Shorter, More Lateral
Caval Opening
Vertebral Level:
- T8
What is Coming out:
- Inferior Vena Cava
- PHRENIC NERVE!!!!
- Lymphatic from Liver
Esophageal Hiatus
Vertebral Level:
- T10
What is Coming out:
- Esophagus
- ANTERIOR and POSTEIROR VAGAL TRUNKS!!!!!!
- Esophageal Branches of Left Gastric Artery
Aortic Hiatus
Vertebral Level:
- T12
What is Coming out:
- Aorta
- THORACIC DUCT!!!!!
- AZYGOUS VEIN!!!!
Sternocostal Hiatus
- SUPERIOR EPIGASTRIC VESSELS!!!!
Arcuate Ligaments
- Posterior Origins of the DIAPHRAGM from ARCUATE LIGAMENTS:
a) Medina Arcuate Ligament
b) Medial Arcuate Ligament
c) Lateral Arcuate Ligament - Arcuate Ligaments form Openings for Posterior Abdominal Wall Structures:
1) Median Arcuate Ligament = AORTIC HAITUS
2) Medial Arcuate Ligament = GAP FOR PSOA MAJOR MUSCLE
3) Lateral Arcuate Ligament = GAP FOR QUADRATUS LUMBORUM MUSCLE
Potential Sites for Diaphragmatic Hernias
- Occur when attachments becomes stretched or Ligament become LOOSE
- Commonly occur on the LEFT SIDE, due to protection of the Right Hemidraphragm by the Liver
PARASTERNAL HERNIAS:
- STERNOCOSTAL TRIANGLE!!!!!!
- Located Between the Sternal and Costal Parts of the Diaphragm
PLEUROPERITONEAL HERNIAS:
- LUMBOCOSTAL TRIANGLE
- Located between the 12th Rib and the Diaphragm
Congenital Diaphragmatic Hernia
- 1 in 2,500 Live Births
ETIOLOGY:
- Failure of Plemroperitoneal Membranes to FUSE with other components of the Diaphragm
PRESENTATION:
- Respiratory Distress and Cyanosis in the FIRST MINUTES or HOURS OF LIFE
- Later Presentation is possible
- Respiratory Distress may be SEVERE and can be associated with CIRCULATORY INSUFFICIENCY
***UNUSUALLY FLAT ABDOMEN!!!!
Hiatal Hernia
- Protrusion of Part of the STOMACH into the MEDIASTINUM through the ESOPHAGEAL HIATUS
- Occurs MOST OFTEN after MIDDLE AGE, possible due to WEAKENING of the MUSCULAR PORTION of the Diaphragm
Two Main Types:
1) PARAESOPHAGEAL:
- Cardia reamins in position
- Usually NO REGURGITATION of GASTRIC Contents
- FUNDUS EXTENDS THROUGH THE HIATUS!!!!!!!!!
2) SLIDING:
- ABDOMINAL ESOPHAGUS, Cardia, and Funds of the Stomach SLIDE SUPERIORLY into the Thorax
- SOME REGURGITATION of Gastric Contents may occur
Blood Supply of the Diaphragm
SUPERIOR SURFACE:
- Pericardiacophrenic Artery
- Musculophrenic Artery
- SUPERIOR PHRENIC Artery
INFERIOR SURFACE:
- INFERIOR PHRENIC Artery
a) Right: Passes Posterior to IVC
b) Left: Passes Posterior to Esophagus
Innervation of the Diaphragm
MOTOR:
- PHRENIC NERVE!!!!!!!
- C3, C4, C5
- Some Branches run with Inferior Phrenic Artery
- ONLY MOTOR INNERVATION!!!!!**
SENSORY:
1) Central Portion (Central Tendon):
- PHRENIC Nerve
2) Peripheral Portion:
- INTERCOSTAL Nerve
Lymphatics of the Diaphragm
SUPERIOR SURFACE:
a) Anterior Diaphragm
- PARASTERNAL NODES
b) Posterior Diaphragm
- MEDIASTINAL NODES
INFERIOR SURFACE:
- CELIAC NODES
- SUPERIOR LUMBAR NODES
Lymphatics
THORACIC DUCT (Forms L1-L2):
1) Lower Extremity, Perineum, Gluteal Region
- Travel through Abdomen
2) Body Wall
- Lumbar Lymph trunks
3) GI Tract
- Enters Intestinal Lymph Trunks
Visceral Lymphatics: Drainage from GI Tract and Glands
INTESTINAL LYMPHATIC TRUNK:
1) Celiac Nodes
2) Superior Mesenteric Nodes
3) Lumbar Nodes
4) Inferior Mesenteric Nodes
Cisterna Chyli
- Dilation at the end of the Thoracic Duct
- Collects Lymph from INTESTINAL Lymphatic Trunks and LUMBAR Lymphatic Trunks
RETROPERITONEAL STRUCTURE!!!!**
- Lies POSTERIOR to the Aorta around Vertebral Levels L1 to L2!!!!!!!!!
Celiac Lymph Node Cluster
AREA DRAINED:
- Liver
- Stomach
- Spleen
- Pancreas
- Upper Duodenum
Superior Mesenteric Lymph Node Cluster
AREA DRAINED:
- Lower Duodenum
- Jejunum
- Ileum
- Colon (Up to the Splenic Flexure)
Inferior Mesenteric Lymph Node Cluster
AREA DRAINED:
- Colon (From Splenic Flexure to Upper Rectum)
Internal Iliac Lymph Node Cluster
AREA DRAINED:
- Lower Rectus to Anal Canal (Above PECTINATE Line)
- Bladder
- Vagina (Middle 3rd)
- Prostate
Para- Aortic Lymph Node Cluster
AREA DRAINED:
- TESTES
- Ovaries
- Kidneys
- Uterus
Superficial Inguinal Lymph Node Cluster
AREA DRAINED:
- Anal Canal (Below PECTINATE Line)
- Most skin below Umbilicus
- Scrotum
Deep Inguinal Lymph Node Cluster
AREA DRAINED:
- Lower Extremity
Subdivision of Peritoneal Cavity
1) Greater and Lesser Sac:
a) GREATER SAC
- Accessed by incision to the Anterior Abdominal Wall
b) LESSER SAC (Aka Mental Bursa)
- Posterior to Stomach and Lesser Momentum
2) Suprecolic and Infracolic Compartments
- Divided by TRANSVERSE MESOCOLON
a) SUPRACOLIC COMPARTMENT
- Stomach
- Liver
- Spleen
b) INFRACOLIC COMPARTMENT
- Small Intestine
- Ascending and Descending Colon
- Further divided by the Mesentery of the Small Intestine into RIGHT and LEFT Infracolic Spaces
Parabolic Gutters
- Area between Lateral aspects of Ascending and Descending Colon and the Posterior Abdominal Wall
- Allows for FREE COMMUNICATION between the SUPRACOLIC and INFRACOLIC Compartments
PHRENICOCOLIC Ligament:
- Prevents the SPREAD of Fluid SUPERIORLY
