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NME > The posterior abdominal wall > Flashcards

The posterior abdominal wall Flashcards

1
Q

What are the bones associated with the posterior abdominal region?

A

Lumbar vertebrae (L1-5), Iliac crest, Ribs 11-12, Iliac fossa, Sacral ala, and promontory.

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2
Q

What are the muscles present in the posterior abdominal region?

A

Psoas major, Psoas minor (if present), Quadratus lumborum, Diaphragm, Iliacus.

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3
Q

What is the significance of the psoas muscle in the posterior abdominal region?

A

The psoas muscle is the deepest muscle in this region and can be involved in conditions such as psoas abscess or tuberculosis (TB) infection, as it can serve as a site of transmitted infection.

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4
Q

What is the role of the iliacus muscle in the posterior abdominal region?

A

The iliacus muscle is located in the iliac fossa and is involved in flexing and stabilizing the hip joint.

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5
Q

What are the structures associated with the diaphragm in the posterior abdominal region?

A

The diaphragm has various associations:

T8: Inferior vena cava (IVC), right phrenic nerve.
T10: Esophagus, vagal trunks.
T12: Aorta, thoracic duct, azygos vein.
Medial arcuate ligament: Sympathetic trunks.
Crura: Splanchnic nerves, hemiazygos vein.

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6
Q

Psoas major

A

Origin: Lateral surface of bodies of T12 and L1-L5 vertebrae, transverse processes of the lumbar vertebrae, and the intervertebral discs between T12 and L1-L5 vertebrae.
Insertion: Lesser trochanter of the femur.
Innervation: Anterior rami of L1 to L3.
Action: Flexion of thigh at the hip joint.

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7
Q

Psoas minor

A

Origin: Lateral surface of bodies of T12 and L1 vertebrae and the intervening intervertebral disc.
Insertion: Pectineal line of the pelvic brim and iliopubic eminence.
Innervation: Anterior rami of L1.
Action: Weak flexion of the lumbar vertebral column.

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8
Q

Quadratus lumborum

A

Origin: Transverse process of L1-L4 vertebrae, iliolumbar ligament, and iliac crest.
Insertion: Transverse processes of LI-LIV vertebrae and the inferior border of rib XII.
Innervation: Anterior rami of T12 and L1-L4.
Action: Depress and stabilize rib XII and contribute to some lateral bending of the trunk.

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9
Q

Iliacus

A

Origin: Upper two-thirds of the iliac fossa, anterior sacroiliac and iliolumbar ligaments, and the upper lateral surface of the sacrum.
Insertion: Lesser trochanter of the femur.
Innervation: Femoral nerve (L2-L4).
Action: Flexion of thigh at the hip joint.

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10
Q

Diaphragm

A

Origin: Xiphoid process, costal margin, ribs XI and XII, and vertebrae LI-LIII.
Insertion: Central tendon.
Innervation: Phrenic nerve (C3-C5), Intercostal nerves (T5-T12).
Action: Respiration - active during inspiration, passive during expiration.

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11
Q

What are the three layers of the thoracolumbar fascia?

A

The three layers of the thoracolumbar fascia are the anterior layer, middle layer, and posterior layer.

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12
Q

What forms the medial arcuate ligaments?

A

The psoas fascia thickens superiorly to form the medial arcuate ligaments.

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13
Q

Which muscle does the iliac fascia overlay?

A

The iliac fascia overlays the iliacus muscle.

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14
Q

What muscle is covered by the middle layer of the thoracolumbar fascia?

A

The middle layer of the thoracolumbar fascia covers the erector spinae muscles.

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15
Q

What is the superficial covering of the erector spinae muscles?

A

The posterior layer of the thoracolumbar fascia is the superficial covering of the erector spinae muscles.

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16
Q

What is the pathway of the ureters in relation to the Psoas major muscle?

A

The ureters travel over the anterior surface of the Psoas major muscle, from lateral to medial.

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17
Q

What is the role of the diaphragm in the posterior abdominal region?

A

The diaphragm, which separates the thoracic and abdominal cavities, is an important muscle involved in respiration. It contributes to the boundary of the posterior abdominal region.

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17
Q

What is the pathway of the ureters in relation to the Psoas major muscle?

A

The ureters travel over the anterior surface of the Psoas major muscle, from lateral to medial.

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18
Q

What are the three constrictions along the course of the ureters?

A

The three constrictions along the course of the ureters are the pelviureteric junction (PUJ), pelvic brim (passes over common iliac vessel bifurcation), and vesicoureteric junction (VUJ) through the detrusor muscle of the bladder.

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19
Q

What potential constrictions can occur in males and females along the ureter pathway?

A

In males, the ureter may be constricted by the crossing ductus deferens (superior to the ureter). In females, the crossing uterine artery can potentially cause constriction of the ureter in the true pelvic cavity.

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20
Q

What is the clinical significance of the ureter obstruction?

A

Obstruction of the ureter, often caused by renal calculi (kidney stones), can lead to various clinical issues and symptoms.

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21
Q

What is the location of the aortic hiatus?

A

The aortic hiatus is located at the level of the 12th thoracic vertebra (T12).

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22
Q

Name the three unpaired visceral branches arising from the abdominal aorta.

A

The three unpaired visceral branches arising from the abdominal aorta are the coeliac trunk, superior mesenteric artery, and inferior mesenteric artery.

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23
Q

Which arteries are considered as paired visceral branches of the abdominal aorta?

A

The paired visceral branches of the abdominal aorta include the renal arteries, gonadal arteries, and middle adrenal arteries.

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24
Q

What are the paired somatic branches originating from the abdominal aorta?

A

The paired somatic branches originating from the abdominal aorta are the inferior phrenic arteries and lumbar arteries (four in number).

25
Q

What is the terminal branch or bifurcation point of the abdominal aorta?

A

The terminal branch or bifurcation point of the abdominal aorta is the common iliac arteries, which typically occurs at the level of the fourth lumbar vertebra (L4).

26
Q

What is the clinical relevance of the abdominal aortic aneurysm?

A

Abdominal aortic aneurysm refers to the dilation or bulging of the abdominal aorta, which can lead to serious complications if the aneurysm ruptures. It is an important clinical consideration and may require medical intervention or surgical repair.

27
Q

Where is the celiac trunk located in relation to the aortic hiatus?

A

The celiac trunk originates immediately inferior to the aortic hiatus of the diaphragm.

28
Q

Which part of the gastrointestinal tract does the celiac trunk supply blood to?

A

The celiac trunk supplies blood to the abdominal foregut.

29
Q

Where does the superior mesenteric artery originate in relation to the celiac trunk?

A

The superior mesenteric artery originates immediately inferior to the celiac trunk.

30
Q

Which part of the gastrointestinal tract does the superior mesenteric artery supply blood to?

A

The superior mesenteric artery supplies blood to the abdominal midgut.

31
Q

Where does the inferior mesenteric artery originate in relation to the renal arteries?

A

The inferior mesenteric artery originates anteriorly, inferior to the renal arteries.

32
Q

Which part of the gastrointestinal tract does the inferior mesenteric artery supply blood to?

A

The inferior mesenteric artery supplies blood to the abdominal hindgut.

33
Q

What structures are supplied by the middle suprarenal arteries?

A

The middle suprarenal arteries supply blood to the suprarenal glands.

34
Q

Where do the renal arteries arise in relation to the superior mesenteric artery?

A

The renal arteries arise laterally, immediately inferior to the superior mesenteric artery

35
Q

What organs do the testicular or ovarian arteries supply blood to?

A

The testicular arteries supply blood to the testes in males, and the ovarian arteries supply blood to the ovaries in females.

36
Q

Which part of the diaphragm is supplied by the inferior phrenic arteries?

A

The inferior phrenic arteries supply blood to the diaphragm.

37
Q

How many pairs of lumbar arteries are usually present?

A

Usually, there are four pairs of lumbar arteries.

38
Q

Which structures are supplied by the median sacral artery?

A

The median sacral artery supplies blood to the lumbar vertebrae, sacrum, and coccyx.

39
Q

Where does the common iliac artery bifurcate?

A

The common iliac artery typically bifurcates at the level of the fourth lumbar vertebra (L4).

40
Q

Where is the caval hiatus located?

A

The caval hiatus is located at the level of the eighth thoracic vertebra (T8).

41
Q

What is the formation of the inferior vena cava?

A

The inferior vena cava is formed by the union of the common iliac veins at the level of the fifth lumbar vertebra (L5).

42
Q

Name the tributaries that directly drain into the inferior vena cava.

A

The suprarenal veins (right side directly into IVC, left side into left renal vein) directly drain into the inferior vena cava.

43
Q

Which veins drain into the renal veins before entering the inferior vena cava?

A

The renal veins (right and left) drain into the inferior vena cava.

44
Q

How do the gonadal veins contribute to the venous drainage?

A

The right gonadal vein directly drains into the inferior vena cava, while the left gonadal vein drains into the left renal vein before entering the inferior vena cava.

45
Q

Which nerves are part of the lumbar plexus and innervate the abdominal walls?

A

The nerves of the lumbar plexus that innervate the abdominal walls are:

Iliohypogastric nerve (L1)
Ilioinguinal nerve (L1)
Genitofemoral nerve (L1-2)
Lateral cutaneous nerve of thigh (L2-3)
Obturator nerve (L2-4)
Femoral nerve (L2-4)

46
Q

What type of innervation is associated with the autonomic nervous system?

A

The autonomic nervous system provides involuntary innervation to smooth muscles, glands, and cardiac muscle.

47
Q

Name the sympathetic nerves involved in the extrinsic sympathetic innervation of abdominal viscera.

A

The sympathetic nerves involved in the extrinsic sympathetic innervation of abdominal viscera are:

Greater splanchnic nerves (T5-9)
Lesser splanchnic nerves (T10-11)
Least splanchnic nerve (T12)
Lumbar splanchnic nerves (L2-4)
Sacral splanchnic nerves (S2-4)

48
Q

Which cranial nerve is associated with parasympathetic innervation of abdominal viscera?

A

The vagus nerve (CNX) is associated with parasympathetic innervation of abdominal viscera.

49
Q

What are the nerves of the parasympathetic pelvic splanchnic nerves?

A

The pelvic splanchnic nerves (S2-4) provide parasympathetic innervation to abdominal viscera.

50
Q

What is the enteric nervous system?

A

The enteric nervous system is an intrinsic network of nerves located within the walls of the gastrointestinal tract. It controls the gastrointestinal functions, including motility and secretion, independently of the central and peripheral nervous systems.

51
Q

What types of tissues are associated with somatic pain?

A

Somatic pain is associated with skeletal muscles, bones, and connective tissues.

52
Q

How would you describe the characteristics of somatic pain?

A

Somatic pain is typically sharp and localized.

53
Q

How does somatic pain follow the body??

A

Somatic pain follows dermatomes or cutaneous mapping, which means it is experienced in specific areas of the body associated with particular spinal nerve distributions.

54
Q

Which types of structures are associated with visceral pain?

A

Visceral pain is associated with the organs of body cavities and vessels.

55
Q

How would you describe the characteristics of visceral pain?

A

Visceral pain is often described as dull and poorly localized.

56
Q

How is visceral pain usually referred to in terms of dermatome?

A

Visceral pain is often referred to a dermatome, meaning it is felt in an area of the skin that is innervated by a specific spinal nerve, although the source of pain is from an internal organ.

57
Q

What are some common causes of visceral pain?

A

Visceral pain is typically caused by stretch, ischemia (lack of blood supply), or chemical irritation.

58
Q

What is referred pain?

A

Referred pain refers to pain that originates from visceral organs but is perceived in a more distant area of the body that shares the same spinal segment or dermatome.

59
Q

Can you provide examples of referred pain from specific organs and their corresponding referral areas?

A
  • Foregut (supplied by celiac trunk): Referred pain is felt in the lower thorax and epigastric region.

Midgut (supplied by superior mesenteric artery): Referred pain is felt in the umbilical region.
Kidneys and upper ureter: Referred pain is felt in the flanks (lateral regions).
Hindgut (supplied by inferior mesenteric artery) and lower ureter: Referred pain is felt in the pubic region, lateral and anterior thighs, and groin.

NME (49 decks)

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