The Posterior Abdominal Wall and Diaphragm

Question 1

What is the order from anterior to posterior of structures in the hilum of the kidney?

Answer 1

Renal vein (anterior)
Renal artery
Ureter (posterior)

VAU (high yield)

Question 2

What are the four muscles of the posterior abdominal wall?

Answer 2

Psoas major
iliacus
psoas minor
quadratus lumborum

Question 3

What are the 3 portions of the diaphragm according to its musculature?

Answer 3

Sternal portion (from posterior surface of xiphoid)
Costal portion (from ribs 7-12 and costal cartilages)
Lumbar portion (from crura and arcuate ligaments)

Question 4

What are the two arcuate ligaments? What do they cover the upper surface of?

Answer 4

Medial arcuate ligament - covers upper margin of psoas major (extend from body of L2 to transverse process of L1)
Lateral arcuate ligament - cover upper surface of quadratus lumborum (extend from transverse process of L1 to lower border of 12th rib)
(high yield)

Question 5

What are the openings of the diaphragm? What level are they at, and what passes through?

Answer 5

Aortic hiatus (T12) - aorta, thoracic duct, azygous vein
Esophageal hiatus (T10) - esophagus, esophageal branches of left gastric vessels, right and left vagus nerves
Caval opening (T8) - inferior vena cava, branches of right phrenic
Sternocostal triangle (small gap between sternal and costal origins of diaphragm) allow superior epigastric vessels to pass

Question 6

Which arcuate ligaments do the sympathetic trunks pass through the diaphragm? Which for the subcostal nerves?

Answer 6

Sympathetic trunks descend behind medial arcuate ligaments

Subcostal nerves descend behind lateral arcuate ligaments

Question 7

What supplies the superior and inferior surface of the diaphragm with blood?

Answer 7

Superior - pericardiophrenic arteries (from internal thoracic artery), musculophrenic arteries (from internal thoracic artery), superior phrenic arteries (from thoracic aorta)
Inferior - inferior phrenic arteries (usually from abdominal aorta)

Question 8

What is the motor and sensory nerve supply of diaphragm?

Answer 8

All of motor supply is from the phrenic nerves

Sensory supply is: Central portion - phrenic nerves, peripheral portions from lower intercostal and subcostal nerves

Question 9

What forms the lumbar plexus?

Answer 9

Iliohypogasrtic (L1) 
Ilioinguinal (L1)
Lateral cutaneous nerve of the thigh (L2-L3)
Femoral Nerve (L2-L4)
Genitofemoral nerve (L1, L2)
Obturator nerve (L2-L4)

Question 10

What are the main nerves of the posterior abdominal wall?

Answer 10

Subcostal nerve
Lumbar plexus (formed within psoas major from ventral rami of L1-L4)
Lumbosacral trunk (desceding portion of ventral ramus of L4 and all of ventral ramus of L5)
Lumbar sympathetic trunks