Posterior abdominal wall week 2 Flashcards
The posterior abdominal wall is
a. peritoneal
b. retroperitoneal
retroperitoneal
The posterior abdominal wall is bounded by bones and muscles.
What bones are associated with the posterior abdominal wall?
What muscles are in the posterior abdominal wall?
Bones associated with the posterior abdominal wall include the 11th and 12th ribs, iliac crests and the T12-L5 vertebrae.
Muscles with attachments to the 12th rib, vertebrae T12-L5, the iliac crest and the femur include:
• Quadratus lumborum
• Iliacus
• Psoas Major and Minor
• Diaphragm.
o upper limit of the abdominopelvic cavity.
o structures travel through or behind the diaphragm to gain access to the abdomen or thorax.
____ ligaments mark attachment sites of the diaphragm and are associated with specific structures.
Arcuate
State where the following ligaments are located and what structures they are associated with:
median arcuate ligament
medial arcuate ligament
lateral arcuate ligament
Median arcuate ligament
• located at T12
• associated with the aorta and aortic hiatus
Medial arcuate ligament
• associated with the psoas major and minor muscles
Lateral arcuate ligament
• associated with the quadratus lumborum muscles
What diaphragmatic hiatus do hiatal hernias occur?
What are the 2 forms of hiatal hernias?
What are the risk factors for hiatal hernias?
Hiatal hernia - the “great mimic” due to a variety of presenting symptoms.
Occur at the level of esophageal hiatus
2 forms:
• Sliding hiatal hernia - most common; gastroesophageal junction moves above the diaphragm
together with some of the stomach.
• Rolling hiatal hernia - (a.k.a. paraesophageal); part of the stomach herniates through the
esophageal hiatus without movement of the gastroesophageal junction.
Risk factors (anything accompanied by increased pressure within the abdominal cavity):
• Heavy lifting or bending over
• Frequent or hard coughing
• pregnancy
• straining with constipation
• obesity
What organs lie in the posterior abdominal wall? (just list)
kidneys
suprarenal glands
Which kidney is more superior to the other and why?
What layers do the kidneys reside btwn?
What fascia covers the suprarenal glands?
Kidneys (key features):
• Retroperitoneal
• right kidney generally lies slightly inferior to the left
(pushed down by the liver.)
• reside between the endoabdominal fascia and
posterior parietal peritoneum.
• surrounded and protected by perinephric fat,
surrounded by renal fascia and more perinephric fat.
Suprarenal Glands (key features):
• Retroperitoneal
• Positioned on the upper poles of the kidney are also
enclosed by renal fascia
Identify the labeled structures.
What ribs do the left and right kidneys project to?
- left projects to the middle of rib 11
- right projects to the middle of the 11th intercostal space.
T or F: The ureters are surrounded by numerous small arterial branches as they descend into the pelvis.
What are the 3 constriction sites of the ureters? What may cause constrictions?
True: The ureters are surrounded by numerous small arterial branches as they descend into the pelvis. This arrangement comes into clinical importance during the replacement of a kidney.
Urinary stones, for example, can cause constrictions of the ureters as they come out of the kidney, at the pelvinc inlet as they cross the common iliacs, and as they enter the bladder. see attached
Why may a male with a kidney stone experience scrotal pain?
Why may a person with a kidney stone experience infrascapular pain? Why do kidney stones cause pain as they pass?
At what spinal cord levels do visceral afferent nerve fibers from the ureter enter the spinal cord?
Pain caused by a kidney stone may be reffered to cutaneous regions (somatic afferent fibers) by nerves from what spinal cord levels?
- As the stone goes down the ureter, crosses it genitofemoral nerve which innervates scrotum and can cause pain. scrotal pain subsides when the stone passes.
- Infrascapular pain, which moved to the groin, relates to passage of the stone along the ureter.
• origin of the pain relates to ureteral distension.
• peristaltic waves distend the ureter resulting in an exacerbation of the pain and periods of relief. - Visceral afferent (sensory) nerve fibers from the ureter pass into the spinal cord levels T8 to L2.
- Pain is referred to cutaneous regions innervated by somatic sensory nerves from T11 to L2.
Identify the labeled arteries.
What is an abdominal aortic aneursym (AAA)? Where do they most commonly occur?
What is the most common site of athersclerotic plaques?
An abdominal aortic aneurysm is a dilatation of the aorta (in excess of 4 cm in diameter) can occur anywhere. Without surgical or endovascular intervention, the dilated artery usually continues to enlarge and may subsequently rupture.
The most common site for an abdominal aneurysm is in the area between the renal arteries and the bifurcation of the abdominal aorta. Signs include decreased circulation to the lower limbs and pain radiating down the back of the lower limbs. The most common site of atherosclerotic plaques is at the bifurcation of the abdominal aorta.
Which renal artery is longer than the other? Why?
What structures do the left and right renal arteries lie posterior to ?
What arteries supply the suprarenal glands? Indicate what arteries they branch from if applicable.
Kidneys
• Right renal artery is longer and passes deep to the inferior vena cava.
• Left renal artery is shorter and passes deep to left renal vein.
Suprarenal glands
• abundant supply
• 3 sources.
• superior suprarenal arteries (from the inferior
phrenic arteries.)
• left and right middle suprarenal arteries (from the
abdominal aorta.)
• left inferior suprarenal artery (from the left renal
artery.)
• right inferior suprarenal artery (from the right renal artery)
What paired veins empty directly into the IVC?
What are the differences (between the right and left sides) of the drainage of suprarenal and testicular/ovarian veins?
Paired veins that empty directly into the inferior vena cava:
• Hepatic veins
• Inferior phrenic veins
• Renal veins
• Lumbar veins (more than just one!)
• Common iliac veins
Paired veins that are a little different:
• Suprarenal veins:
• Right drains directly into the inferior vena cava
• Left drains into the left renal vein (and then into the inferior vena
cava)
• Testicular/ovarian veins:
• Right testicular/ovarian vein drains directly into the inferior cava
• Left testicular/ovarian vein drains directly into the left renal vein
(and then into the inferior vena cava)
What is the lumbar plexus formed by?
The lumbar plexus is formed by anterior rami of L1-L4.
Identify the labeled nerves. Give both the common name and the vertebral level name (L1, L2, etc.)
Identify the labeled nerves.
What structures do para-aortic nodes drain? What do they form?
Para-aortic nodes:
• Right and left lateral aortic or lumbar nodes (a.k.a. para-aortic nodes) lie on either side of the aorta.
• receive lymph from the abdominal body wall, kidneys, suprarenal glands and testes/ovaries.)
• form the right and left lumbar trunks.
Cisterna Chyli and the Thoracic Duct.
The right and left lumbar trunks and intestinal trunk eventually coalesce to form the cisterna chyli which empties into the
thoracic duct.
