The posterior abdominal wall Flashcards
Bones
Lumbar vertebrae
Ribs 11/12
Ilia
Sacrum
Musculature
Diaphragm
Quadratus lumborum
Iliacus
Psoas
Diaphragm
Anchored by crura
Central tendon
Hiatus
- T8: IVC
- T10: oesophagus
- T12- aorta
Quadratus lumborum
Posterior to kidneys
Rib 12- iliac crest
Transverse abd-lat attachment
Abdominal stability/ lateral flexion
Iliacus and psoas
Iliacus: iliac blade
Psoas: lumbar vertebrae
Lesser trochanter femur
Hip flexors
Vein/ arteries
Diaphragm- superior and inferior phrenic
Quadratus lumborum- lumbar
Iliopsoas- lumbar
Nerves
Diaphragm- phrenic (C3-5), intercostal (T5-11), subcostal (T12)
Quadratus lumborum- lumbar (T12-L4)
Iliopsoas- femoral (L2-L4)
Aorta
3 midline vessels
Paired parietal
Paired visceral
Aneurysm- more common below renal arteries
Cause: atherosclerosis
Occlusion aortic bifurcation- claudication
Impotence
Innervation
Somatic: voluntary muscle control and sensation
Autonomic: outside out control
Autonomic system
- in segmented structures
- in viscera
Innervation in the abdomen
Somatic
- muscles of ant/ pos abdominal wall, joints, skin
Autonomic
- in segmented structures
- in viscera
Somatic nerves
Lumbar plexus (L1-L4)
Motor and sensory
Autonomic sympathetic
Segmented- sympathetic chain
Viscera- celiac, sup and inf mesenteric
Autonomic parasympathetic
Vagus
Pelvic splanchnic
Nerves to kidneys and adrenals
Suprarenals innervated by greater, lesser and least sp n
Celiac and aorticorenal ganglia
Kidneys innervated mostly by fibres from the least sp n
Somatic abdominal pain
Arises from
- skin
- fascia
- muscle
- parietal peritoneum
Precisely localised and severe
When occurring on one side from midline- lateralised
Visceral abdominal pain
Arises from
- abdominal organs
- mesenteries
- visceral peritoneum
Causes
- stretching viscus or mesentery
- impaired blood supply to viscus
- chemical damage to viscus
Dull and poorly localised
Pain is referred to midline
Colic pain is a form of visceral pain
Referred pain
Pain at location other than side of origin stimulus but supplied by sam or adjacent segments of spinal cord
Both somatic and visceral structures may produce referred pain
Referred visceral pain from stomach
T5-9
Referred visceral pain from appendix
T10
Referred visceral pain from gall bladder
T7-9
With parietal peritoneum involvement C3/4
