Posterior Abdominal Wall LO's

Question 1

Explain the three layers of the thoracolumbar fascia including what attaches to each

Answer 1

Posterior: Attaches to the latissimus dorsi
Between posterior and middle layers lies Erector spinae
Middle layer: attaches to TrA Ext Oblique and Int Oblique
Between middle and anterior layers like QL

Question 2

Name the attachment sites of each muscle of the posterior abdominal wall

Answer 2

Psoas major: from transverse processes of T12-L4 to lesser trochanter of femur
QL: from 12th rib & transverse processes of L1-4 to iliolumbar ligament & iliac crest
Iliacus: from iliac fossa to lesser trochanter of femur

Question 3

Name the openings in the diaphragm and the structures that pass through them

Answer 3

Median Arcuate Ligament: Descending Aorta
Medial Arcuate Ligaments (bil): Psoas mm
Lateral Arcuate Ligaments (bil): QL m

Question 4

Summarize the lumbar plexus using a drawing

Answer 4

Draw

Question 5

Describe the arterial supply of the posterior abdominal wall

Answer 5

Draw Celiac trunk, SMA and IMA

Question 6

Review the retroperitoneal structures and their relation to the posterior abdominal wall

Answer 6

Primary retroperitoneal: Kidneys and suprarenal glands

Secondary retroperitoneal: ascending/descending colon, pancreas, duodenum (desc, horiz, ascend), rectum (upper 2/3)

Question 7

Describe the external and internal features of the kidneys

Answer 7

Exterior–>Interior: Fibrous capsule, renal cortex, renal columns and renal pyramids, papillae, minor calyx, major calyx, renal sinus, renal pelvis.–>ureter

Question 8

Explain the autonomic innervation of the kidneys

Answer 8

Parasympathetic: CN X –>esophageal plexus>post vagal trunk>celiac ganglion & plexus>renal nerve plexus>kidney (synapse)

Sympathetic: Lesser Splanchnic (T10-11) or least splanchnic (T12)–>aorticorenal ganglion (synapse)>renal nerve plexus>kidney

Question 9

Explain the autonomic innervation of the urinary bladder

Answer 9

Sympathetic: T10-L2–>lumbar splanchnic>superior/inferior hypogastric plexus>inferior hypogastric plexus (synapse)>wall causing relaxation and filling

Parasympathetic: S2-4–>pelvic splanchnic>inferior hypogastric plexus>wall (synapse; contraction and voiding)

Question 10

Explain the relation between the ureter and the testicular artery

Answer 10

The testicular/ovarian artery passes anterior to the ureter of the same side

Question 11

Define the trigone of the urinary bladder

Answer 11

The trigone is located posterior inferior w/in the bladder and is made up of the 2 ureteric orifices and the urethral orifice.

Question 12

Contrast the anatomy of the male and female urethra

Answer 12

Male: 20cm long, 4 sections (pre-prostatic, prostatic, membranous, and spongy)
Female: 4cm

Question 13

Describe the venous drainage of the posterior abdominal wall

Answer 13

Draw IVC tributaries

Question 14

Draw the portal system

Answer 14

Draw

Question 15

Draw the Abdominal lymphatic drainage

Answer 15

Draw

Question 16

Explain the venous pathways involved in each of the four primary portal hypertension scenarios

Answer 16

A. HTN leads to back up in the L gastric v. >esophageal v. >azygos v. >IVC

B. HTN leads to backup in the splenic v >IMV >superior rectal v. >middle and inferior rectal vv. >internal iliac v. >common iliac >IVC

D. HTN leads to backup in the splenic v. >L. colic v. >lumbar vv. >IVC

C. HTN leads to backup in the paraumbilical v. > superficial/inferior epigastric vv > external iliac >common iliac > IVC