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GastroIntestinal > Posterior Abdominal Wall and Respiratory Diaphragm Lecture (Test 1) > Flashcards

Posterior Abdominal Wall and Respiratory Diaphragm Lecture (Test 1) Flashcards

1
Q

Posterior Abdominal Wall Muscles

A
  • Psoas Major
  • Psoas Minor
  • Quadrates Lumborum
  • Iliacus
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2
Q

Posts Major Muscle

A

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

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3
Q

Iliascus Muscle

A

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

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4
Q

Psoas Minor Muscle

A

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
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5
Q

Quadrates Lumborum Muscle

A

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!!!!!
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6
Q

Posterior Abdominal Pain

A
  • 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
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7
Q

Psoas Syndrome

A

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

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8
Q

Blood Supply of the Abdomen

A

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
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9
Q

Respiratory Diaphragm

A

BORDERS (Peripheral Origins):

  • Xiphisternal Joint
  • Costal Margin
  • Vertebral Body of T12

PARTS:

  • Right and Left Dome
  • Superior Surface can extend to 5th RIB!!!!!
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10
Q

Respiratory Diaphragm Cont

A

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

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11
Q

Caval Opening

A

Vertebral Level:
- T8

What is Coming out:

  • Inferior Vena Cava
  • PHRENIC NERVE!!!!
  • Lymphatic from Liver
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12
Q

Esophageal Hiatus

A

Vertebral Level:
- T10

What is Coming out:

  • Esophagus
  • ANTERIOR and POSTEIROR VAGAL TRUNKS!!!!!!
  • Esophageal Branches of Left Gastric Artery
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13
Q

Aortic Hiatus

A

Vertebral Level:
- T12

What is Coming out:

  • Aorta
  • THORACIC DUCT!!!!!
  • AZYGOUS VEIN!!!!
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14
Q

Sternocostal Hiatus

A
  • SUPERIOR EPIGASTRIC VESSELS!!!!
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15
Q

Arcuate Ligaments

A
  • 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

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16
Q

Potential Sites for Diaphragmatic Hernias

A
  • 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
17
Q

Congenital Diaphragmatic Hernia

A
  • 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!!!!

18
Q

Hiatal Hernia

A
  • 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
19
Q

Blood Supply of the Diaphragm

A

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
20
Q

Innervation of the Diaphragm

A

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

21
Q

Lymphatics of the Diaphragm

A

SUPERIOR SURFACE:

a) Anterior Diaphragm
- PARASTERNAL NODES

b) Posterior Diaphragm
- MEDIASTINAL NODES

INFERIOR SURFACE:

  • CELIAC NODES
  • SUPERIOR LUMBAR NODES
22
Q

Lymphatics

A

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

23
Q

Visceral Lymphatics: Drainage from GI Tract and Glands

A

INTESTINAL LYMPHATIC TRUNK:

1) Celiac Nodes
2) Superior Mesenteric Nodes
3) Lumbar Nodes
4) Inferior Mesenteric Nodes

24
Q

Cisterna Chyli

A
  • 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!!!!!!!!!
25
Q

Celiac Lymph Node Cluster

A

AREA DRAINED:

  • Liver
  • Stomach
  • Spleen
  • Pancreas
  • Upper Duodenum
26
Q

Superior Mesenteric Lymph Node Cluster

A

AREA DRAINED:

  • Lower Duodenum
  • Jejunum
  • Ileum
  • Colon (Up to the Splenic Flexure)
27
Q

Inferior Mesenteric Lymph Node Cluster

A

AREA DRAINED:

- Colon (From Splenic Flexure to Upper Rectum)

28
Q

Internal Iliac Lymph Node Cluster

A

AREA DRAINED:

  • Lower Rectus to Anal Canal (Above PECTINATE Line)
  • Bladder
  • Vagina (Middle 3rd)
  • Prostate
29
Q

Para- Aortic Lymph Node Cluster

A

AREA DRAINED:

  • TESTES
  • Ovaries
  • Kidneys
  • Uterus
30
Q

Superficial Inguinal Lymph Node Cluster

A

AREA DRAINED:

  • Anal Canal (Below PECTINATE Line)
  • Most skin below Umbilicus
  • Scrotum
31
Q

Deep Inguinal Lymph Node Cluster

A

AREA DRAINED:

- Lower Extremity

32
Q

Subdivision of Peritoneal Cavity

A

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

33
Q

Parabolic Gutters

A
  • 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

GastroIntestinal (21 decks)

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