The Posterior Abdominal Wall & Diaphragm

Question 1

the kidneys are located ___ on the ___ wall in the paravertebral gutters between the vertebrae levels ___

Answer 1

retroperitoneally (primary)
posterior abdominal
T12 - L3

Question 2

the right kidney lies slightly ___ than the left kidney because of the ___

Answer 2

lower

large size of the right lobe of the liver

Question 3

with contraction of the diaphragm during respiration, both kidneys move vertically ___ as much as ___ cm

Answer 3

downwards

2.5

Question 4

each kidney has dimensions which are approximately ___ cm x ___ cm x ___ cm

Answer 4

12
6
3

Question 5

each kidney’s lateral sides are ___ in shape

their medial sides are ___ in shape & contain a vertical slit called the ___ which leads into a large space called the ___

this space contains 4 things: ___

Answer 5

convex

concave
hilum
renal sinus

renal pelvis
calyces
renal vessels
fat

Question 6

the usual order of structures within the hilum from anterior to posterior are: ___

Answer 6

renal vein
renal artery
ureter
(VAU)

Question 7

coverings of the kidney:
fibrous capsule:

closely applied to the ___ & passes over the ___ to line the ___

Answer 7

kidney
edges of the hilum
renal sinus

Question 8

coverings of the kidney:
perirenal fat:

encloses both the ___ & the ___

continuous at the ___ w/ the ___ in the ___

Answer 8

kidneys
suprarenal glands

hilum
fat
renal sinus

Question 9

coverings of the kidney:
renal fascia:

the most ___ layer

encloses ___

Answer 9

important

everything else (kidneys, suprarenal glands, & perirenal fat)

Question 10

coverings of the kidney:
pararenal fat:

lies ___

thicker ___ to the kidneys

Answer 10

external to the renal fascia

posterior

Question 11

the suprarenal glands lie between the ___ & the ___

right suprarenal gland - ___ shaped

left suprarenal gland - ___ shaped

Answer 11

superomedial aspects of the kidneys
diaphragm

triangular

semilunar

Question 12

the ureters descend ___ on the surface of the ___ msucles

they cross into the ___ over the bifurcation of the ___ arteries in front of the ___ joints

Answer 12

retroperitoneally
psoas major

pelvis
common iliac
sacroiliac

Question 13

muscles of the posterior abdominal wall:
psoas major:

a ___ muscle located on the side of the ___ region of the ___

Answer 13

long
lumbar
vertebral column

Question 14

muscles of the posterior abdominal wall:
iliacus:

a ___ muscle inferior to the ___

Answer 14

flat, triangular

quadratus lumborum muscle

Question 15

muscles of the posterior abdominal wall:
psoas minor:

a ___ muscle which is located anterior to the ___

Answer 15

long, slender

psoas major muscle

Question 16

muscles of the posterior abdominal wall:
quadratus lumborum:

a ___ muscle superior to the ___ & posterior to the ___

Answer 16

quadrilateral shaped
iliacus muscle
psoas major muscle

Question 17

diaphragm:

a ___ sheet intervening between the ___ & ___

its muscles are arranged around a ___

it is divided into three portions according to the origins of its ___: ___

Answer 17

fibromuscular
thoracic & abdominal cavities

central tendon

musculature

• sternal portion
• costal portion
• lumbar portion

Question 18

diaphragm:

sternal portion

Answer 18

from the posterior surface of the xiphoid process

Question 19

diaphragm:

costal portion

Answer 19

from ribs 7-12 & their costal cartilages

Question 20

diaphragm:

lumbar portoin

Answer 20

from the crura & arcuate ligaments

Question 21

crura:
right crus:

arises from the ___ & ___ from levels ___

its ___ fibers usually from a sling around the ___ at the ___

Answer 21

sides of the bodies
intervertebral discs
L1 - L3

muscular
esophagus
esophageal hiatus

Question 22

crura:
left crus:

arises from the ___ of levels ___ & the ___

it usually does not contribute to the ___

Answer 22

sides of the bodies
L1 & L2
intervening disc

sling around the esophagus

Question 23

the arcuate ligaments:

the medial arcuate ligaments are actually ___ covering the ___ of the ___ muscles

they extend from the ___ to the ___

Answer 23

thickened fascia
upper margin
psoas major

body of L2
transverse processes of L1

Question 24

the arcuate ligaments:

the lateral arcuate ligaments are ___ covering the ___ of the ___ muscle

they extend from the ___ to the ___

Answer 24

thickened fascia
upper surfae
quadratus lumborum

transverse process of L1
lower border of the 12th rib

Question 25

the main openings of the diaphragm & corresponding spinal cord levels (3)

permit structures to pass between the ___ & the ___

Answer 25

caval openings (T8)
esophageal hiatus (T10)
aortic hiatus (T12)

thorax
abdomen

Question 26

openings of the diaphragm:
aortic hiatus (3)*

Answer 26

aorta
thoracic duct
azygous vein

Question 27

openings of the diaphragm:
esophageal hiatus (3)

Answer 27

esophagus
right & left vagus nerves (vagal trunks)
esophageal branches of the left gastric vessels & lymphatics

Question 28

openings of the diaphragm:
caval opening (2)

Answer 28

inferior vena cava

branches of the right phrenic nerve

Question 29

openings of the diaphragm:
superior epigastric vessels:

descend through the ___, which is a small gap b/n the ___ & ___ origins of the diaphragm

Answer 29

sternocostal triangle
sternal
costal

Question 30

openings of the diaphragm:
thoracic splanchnic nerves:

pierce the ___ of the diaphragm

Answer 30

crura

Question 31

openings of the diaphragm:
left phrenic nerve:

pierces the ___ of the diaphragm

Answer 31

left dome

Question 32

openings of the diaphragm:
sympathetic trunks:

descend behind the ___

Answer 32

medial arcuate ligaments

Question 33

openings of the diaphragm:
subcostal nerves:

descend behind the ___

Answer 33

lateral arcuate ligaments

Question 34

openings of the diaphragm:
other openings (5)

Answer 34

superior epigastric vessels
thoracic splanchnic nerves
left phrenic nerve
sympathetic trunks
subcostal nerves

Question 35

blood supply of the diaphragm:
superior surface (3)

Answer 35

pericardiophrenic arteries (from internal thoracic artery)
musculophrenic arteries (from internal thoracic artery)
superior phrenic arteries (from thoracic aorta)

Question 36

blood supply of the diaphragm:
inferior surface (1)*

Answer 36

inferior phrenic arteries (usually from abdominal aorta)

Question 37

nerve supply of the diaphragm:

motor - the entire motor supply is from the ___ nerves (levels ___)

sensory (___ & ___):

• central portion - ___ nerves
• peripheral portions - ___ nerves

Answer 37

phrenic
C3, C4, C5

pain & proprioception

• phrenic
• lower intercostal & subcostal

Question 38

referred pain from the diaphragm radiates to ___ different areas

pain from the ___ or ___, which is innervated by the ___ nerves, is referred to the shoulder region supplied by segments ___ of the spinal cord (the same levels of the cord giving origin to the ___ nerves)

irritation of the ___ regions of the diaphragm, which are innervated by the ___ nerves, radiates to the skin over the ___ margins of the ___ wall

Answer 38

central diaphragmatic pleura
diaphragmatic peritoneum
phrenic
C3 - C5
phrenic

peripheral
intercostal & subcostal
costal
anterolateral abdominal

Question 39

the fascia of the posterior abdominal wall is part of a ___ layer of ___ fascia lying between the ___ & the ___

it is customary to name the fascia according to the ___

Answer 39

continuous
endoabdominal
parietal pertioneum
musculature of the abdominal wall

underlying muscles

Question 40

examples of underlying muscles of fascia of posterior abdominal wall (4)

Answer 40

diaphragm - diaphragmatic fascia
transversus abdominus - transversalis fascia
psoas major - psoas fascia
quadratus lumborum - qudaratus lumborum fascia

Question 41

nerves of the posterior abdominal wall:
the subcostal nerve:

___ nerve

the subcostal nerve is the ___ ramus of ___, which descends posterior to the ___ approximately 1cm inferior to the ___

Answer 41

landmark

ventral
T12
lateral arcuate ligament
12th rib

Question 42

nerves of the posterior abdominal wall:
lumbar plexus:

the lumbar plexus is formed within the substance of the ___ muscle from the ___ rami of ___

its major branches & corresponding spinal cord levels(6)

Answer 42

psoas
ventral
L1 - L4

iliohypotastric (L1)
ilioinguinal (L1)
lateral cutaneous nerve of the thigh (L2, L3)
femoral nerve (L2 - L4)
genitofemoral nerve (L1, L2)
obturator nerve (L2 - L4)

Question 43

nerves of the posterior abdominal wall:
lumbar plexus:
iliohypogastric:

motor to the ___

sensor to the ___ & ___

Answer 43

abdominal muscles

upper buttocks
lower abdomen

Question 44

nerves of the posterior abdominal wall:
lumbar plexus:
ilioinguinal:

passes out of the ___ but not the ___

motor to the ___

sensory to the ___ & ___

Answer 44

superficial inguinal ring
deep inguinal ring

abdominal muscles

labia majora or scrotum
adjacent medial thigh

Question 45

nerves of the posterior abdominal wall:
lumbar plexus:
lateral cutaneous nerve of the thigh:

passes under the ___ near the ___

sensory to the ___

Answer 45

inguinal ligament
ASIS

lateral thigh

Question 46

nerves of the posterior abdominal wall:
lumbar plexus:
femoral nerve:

the ___ branch of the lumbar plexus

runs ___ in a groove b/n the ___ & the ___

enters the ___ beneath the ___ & lateral to the ___

Answer 46

largest

downward
psoas major
iliacus muscle

thigh
inguinal ligament
femoral sheath

Question 47

nerves of the posterior abdominal wall:
lumbar plexus:
genitofemoral nerve:

emerges on the surface of the ___

its genital branch joins the ___ & is motor to the ___ & sensory to the ___

its femoral branch passes onto the ___ beneath the ___ on the surface of the ___ & is sensory to the ___ over the ___

Answer 47

psoas major muscle

spermatic cord or round ligament
cremaster muscle
scrotum or labia majora

thigh
inguinal ligament
femoral artery
skin
femoral triangle

Question 48

nerves of the posterior abdominal wall:
lumbar plexus:
obturator nerve:

appears at the medial border of the ___ superficial to the ___

it passes over the ___ into the ___ & courses toward the ___

Answer 48

psoas major muscle
lumbosacral trunk

pelvic brim
pelvis
obturator canal

Question 49

the lumbosacral trunk is composed of the ___ portion of the ___ ramus of level ___ & all of the ___ ramus of level ___

it appears on the medial side of the ___ deep to the ___

it enters the ___ & joins the ___ ramus of level ___ in the formation of the ___

Answer 49

descending
ventral
L4
ventral
L5

psoas major muscle
obturator nerve

pelvis
ventral
S1
sacral plexus

Question 50

the sympathetic trunks pass into the ___ beneath the ___ & descend along the medial borders of the ___ on the sides of the ___

the right sympathetic trunk lies posterior to the ___

the left trunk lies just to the left of the ___

Answer 50

abdomen
medial arcuate ligaments
psoas major muscles
vertebral bodies

IVC

abdominal aorta

Question 51

the great vessels in the abdomen:

the abdominal aorta pierces the diaphragm at the level of ___ & bifurcates into the ___ at the level of ___

the level of the bifurcation is approximately 2-3cm inferior & to the left of the ___

the IVC begins by the union of the ___ beneath the ___ & ascends on the ___ to the right of the ___

Answer 51

T12
two common iliac arteries
L4

umbilicus

common iliac veins
right common iliac artery
posterior abdominal wall
aorta