The Posterior Abdominal Wall & Diaphragm Flashcards
the kidneys are located ___ on the ___ wall in the paravertebral gutters between the vertebrae levels ___
retroperitoneally (primary)
posterior abdominal
T12 - L3
the right kidney lies slightly ___ than the left kidney because of the ___
lower
large size of the right lobe of the liver
with contraction of the diaphragm during respiration, both kidneys move vertically ___ as much as ___ cm
downwards
2.5
each kidney has dimensions which are approximately ___ cm x ___ cm x ___ cm
12
6
3
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: ___
convex
concave
hilum
renal sinus
renal pelvis
calyces
renal vessels
fat
the usual order of structures within the hilum from anterior to posterior are: ___
renal vein
renal artery
ureter
(VAU)
coverings of the kidney:
fibrous capsule:
closely applied to the ___ & passes over the ___ to line the ___
kidney
edges of the hilum
renal sinus
coverings of the kidney:
perirenal fat:
encloses both the ___ & the ___
continuous at the ___ w/ the ___ in the ___
kidneys
suprarenal glands
hilum
fat
renal sinus
coverings of the kidney:
renal fascia:
the most ___ layer
encloses ___
important
everything else (kidneys, suprarenal glands, & perirenal fat)
coverings of the kidney:
pararenal fat:
lies ___
thicker ___ to the kidneys
external to the renal fascia
posterior
the suprarenal glands lie between the ___ & the ___
right suprarenal gland - ___ shaped
left suprarenal gland - ___ shaped
superomedial aspects of the kidneys
diaphragm
triangular
semilunar
the ureters descend ___ on the surface of the ___ msucles
they cross into the ___ over the bifurcation of the ___ arteries in front of the ___ joints
retroperitoneally
psoas major
pelvis
common iliac
sacroiliac
muscles of the posterior abdominal wall:
psoas major:
a ___ muscle located on the side of the ___ region of the ___
long
lumbar
vertebral column
muscles of the posterior abdominal wall:
iliacus:
a ___ muscle inferior to the ___
flat, triangular
quadratus lumborum muscle
muscles of the posterior abdominal wall:
psoas minor:
a ___ muscle which is located anterior to the ___
long, slender
psoas major muscle
muscles of the posterior abdominal wall:
quadratus lumborum:
a ___ muscle superior to the ___ & posterior to the ___
quadrilateral shaped
iliacus muscle
psoas major muscle
diaphragm:
a ___ sheet intervening between the ___ & ___
its muscles are arranged around a ___
it is divided into three portions according to the origins of its ___: ___
fibromuscular
thoracic & abdominal cavities
central tendon
musculature
- sternal portion
- costal portion
- lumbar portion
diaphragm:
sternal portion
from the posterior surface of the xiphoid process
diaphragm:
costal portion
from ribs 7-12 & their costal cartilages
diaphragm:
lumbar portoin
from the crura & arcuate ligaments
crura:
right crus:
arises from the ___ & ___ from levels ___
its ___ fibers usually from a sling around the ___ at the ___
sides of the bodies
intervertebral discs
L1 - L3
muscular
esophagus
esophageal hiatus
crura:
left crus:
arises from the ___ of levels ___ & the ___
it usually does not contribute to the ___
sides of the bodies
L1 & L2
intervening disc
sling around the esophagus
the arcuate ligaments:
the medial arcuate ligaments are actually ___ covering the ___ of the ___ muscles
they extend from the ___ to the ___
thickened fascia
upper margin
psoas major
body of L2
transverse processes of L1
the arcuate ligaments:
the lateral arcuate ligaments are ___ covering the ___ of the ___ muscle
they extend from the ___ to the ___
thickened fascia
upper surfae
quadratus lumborum
transverse process of L1
lower border of the 12th rib
the main openings of the diaphragm & corresponding spinal cord levels (3)
permit structures to pass between the ___ & the ___
caval openings (T8) esophageal hiatus (T10) aortic hiatus (T12)
thorax
abdomen
openings of the diaphragm: aortic hiatus (3)*
aorta
thoracic duct
azygous vein
openings of the diaphragm: esophageal hiatus (3)
esophagus
right & left vagus nerves (vagal trunks)
esophageal branches of the left gastric vessels & lymphatics
openings of the diaphragm: caval opening (2)
inferior vena cava
branches of the right phrenic nerve
openings of the diaphragm:
superior epigastric vessels:
descend through the ___, which is a small gap b/n the ___ & ___ origins of the diaphragm
sternocostal triangle
sternal
costal
openings of the diaphragm:
thoracic splanchnic nerves:
pierce the ___ of the diaphragm
crura
openings of the diaphragm:
left phrenic nerve:
pierces the ___ of the diaphragm
left dome
openings of the diaphragm:
sympathetic trunks:
descend behind the ___
medial arcuate ligaments
openings of the diaphragm:
subcostal nerves:
descend behind the ___
lateral arcuate ligaments
openings of the diaphragm: other openings (5)
superior epigastric vessels thoracic splanchnic nerves left phrenic nerve sympathetic trunks subcostal nerves
blood supply of the diaphragm: superior surface (3)
pericardiophrenic arteries (from internal thoracic artery) musculophrenic arteries (from internal thoracic artery) superior phrenic arteries (from thoracic aorta)
blood supply of the diaphragm: inferior surface (1)*
inferior phrenic arteries (usually from abdominal aorta)
nerve supply of the diaphragm:
motor - the entire motor supply is from the ___ nerves (levels ___)
sensory (___ & ___):
- central portion - ___ nerves
- peripheral portions - ___ nerves
phrenic
C3, C4, C5
pain & proprioception
- phrenic
- lower intercostal & subcostal
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
central diaphragmatic pleura diaphragmatic peritoneum phrenic C3 - C5 phrenic
peripheral
intercostal & subcostal
costal
anterolateral abdominal
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 ___
continuous
endoabdominal
parietal pertioneum
musculature of the abdominal wall
underlying muscles
examples of underlying muscles of fascia of posterior abdominal wall (4)
diaphragm - diaphragmatic fascia
transversus abdominus - transversalis fascia
psoas major - psoas fascia
quadratus lumborum - qudaratus lumborum fascia
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 ___
landmark
ventral
T12
lateral arcuate ligament
12th rib
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)
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)
nerves of the posterior abdominal wall:
lumbar plexus:
iliohypogastric:
motor to the ___
sensor to the ___ & ___
abdominal muscles
upper buttocks
lower abdomen
nerves of the posterior abdominal wall:
lumbar plexus:
ilioinguinal:
passes out of the ___ but not the ___
motor to the ___
sensory to the ___ & ___
superficial inguinal ring
deep inguinal ring
abdominal muscles
labia majora or scrotum
adjacent medial thigh
nerves of the posterior abdominal wall:
lumbar plexus:
lateral cutaneous nerve of the thigh:
passes under the ___ near the ___
sensory to the ___
inguinal ligament
ASIS
lateral thigh
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 ___
largest
downward
psoas major
iliacus muscle
thigh
inguinal ligament
femoral sheath
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 ___
psoas major muscle
spermatic cord or round ligament
cremaster muscle
scrotum or labia majora
thigh inguinal ligament femoral artery skin femoral triangle
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 ___
psoas major muscle
lumbosacral trunk
pelvic brim
pelvis
obturator canal
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 ___
descending ventral L4 ventral L5
psoas major muscle
obturator nerve
pelvis
ventral
S1
sacral plexus
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 ___
abdomen
medial arcuate ligaments
psoas major muscles
vertebral bodies
IVC
abdominal aorta
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 ___
T12
two common iliac arteries
L4
umbilicus
common iliac veins
right common iliac artery
posterior abdominal wall
aorta
