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Post. Abdom. Wall

The posterior abdominal wall and diaphragm

* Where are the kidneys located (General position, vertebral landmarks)? Difference between left and right? Retroperitoneally in paravertebral gutters between T12 and L3; right is slightly lower (due to right lobe of liver)
* The usual order of structures (vessels) within the hilum from ANTERIOR TO POSTERIOR are the following: _____, ______, _____. Renal vein, renal artery, ureter
* The medial sides of the kidneys are concave in shape and contain a vertical slit called the ___. This leads into a large space called the ___ ____. This space contains the ____ _____, ____, ______ vessels, and ____. renal sinus, renal pelvis, calyces, renal vessels, fat
* What are the (4) coverings of the kidney (deep to superficial)? Fibrous capsule, perirenal fat, renal fascia, pararenal fat
* Identify the covering of the kidney: closely applied to the surface of the kidney and passes over the edges of the hilum to the line of the renal sinus Fibrous capsule
* Identify the covering of the kidney: encloses both the kidneys and the suprarenal glands. It is continous at the hilum with the fat in the renal sinus. Perirenal fat
* Identify the covering of the kidney: MOST IMPORTANT LAYER. Encloses everything else Renal fascia
* Identify the covering of the kidney: lies external to the renal fascia and is thicker posterior to the kidneys Pararenal fat
* Where are the suprarenal glands located? What are their shapes? between the supromedial aspects of the kidneys and the diaphragm. Right: triangular shaped; Left: semilunar
Describe the path of the ureters prior to entering the pelvic cavity Descend retroperitoneally on the surface of the psoas major muscles; cross into the pelvis over the bifurcation of the common iliac arteries IN FRONT of the sacroiliac joints
Describe the innervation and major action of the psoas major Ventral rami L2-L4; illiopsoas is the chief flexor of the thigh; it flexes and balances the trunk while sitting
Describe the innervation and major action of the iliacus Femoral nerve; iliopsoas chief flexor of the thigh; flexes and balances he trunk while sitting
Describe the innervation and major action of the psoas minor Ventral ramus of L1; flexes the pelvis
Describe the innervation and major action of the quadratus lumborum Ventral rami T12-L4; respiratory movement, one side alone laterally bends the trunk
Describe how the diaphragm is subdivided into various regions Sternal portion (from posterior surface of the xiphoid process), costal portion (from ribs 7-12 and their costal cartilages), lumbar portion (from the crura and arcuate ligaments)
* Describe the crura of the diaphragm. Right crus: arises from sides of brodies and intervertebral discs from L1-L3, forms sling around esophagus at esophageal hiatus; Left crus: from sides of bodies of L1, L2 and intervening disc, usually doesn't contribute to the sling around the esophagus
What are the arcuate ligaments? Medial arcuate ligaments: fascia covering upper margin of psoas major m. from L2 to transverse process of L1. Lateral arcuate lig: same, covering upper surf. of quadratus lamborum from L1 to 12th rib
* List the major openings of the diaphragm. What passes through each? 1. Aortic hiatus (T12): aorta, thoracic duct, azygous vein. 2. Esophageal hiatus (T10): esophagus, vagal trunks (L and R), esophageal branch of left gastric vessels and lymphatics. 3. Caval opening (T8): IVC, right phrenic nerve branches
Identify the minor openings in the diaphragm through which the following structures pass: superior epigastric vessels, thoracic splanchinic nerves, left phrenic nerve, sympathetic trunks, subcostal nerves sternocostal triangle (small gap between sternal and costal origins of diaphragm), crura of diaphragm, left dome of diaphragm, behind medial arcuate ligaments, behind lateral arcuate ligaments
What supplies the superior surface of the diaphragm? The inferior surface? Where do each of these usually branch from? Sup: pericadriphrenic arts. (Internal thoracic), musculophrenic arts. (internal thoracic), superior phrenic arts. (thoracic aorta). Inf: inferior phrenic arts. (abdominal aorta)
* Describe the nerve supply to the diaphragm Motor: solely from phrenic nerves C3, C4, C5. Sensory: central portion--phrenic nerves, peripheral portions (lower intercostal and subcostal nerves)
Where does referred pain to the diaphragm refer to? Area supplied by C3-C5 (central diaphragmatic pleura): shoulder region; peripheral regions innervated by intercostal and subcoastal nerves radiate over skin of costal margins of the anterolateral abdominal wall
How is the fascia of the posterior abdominal wall named? Named after underlying muscles (e.g. diaphragmatic fascia, transversalis gascia, psoas fascia, quadratus lumborum fascia; this continous fascia between parietal peritoneum and musculature of abdominal wall
The ____ nerve (landmark nerve) is the ventral ramus of T12 which descends posterior to the lateral arcuate ligament approximately 1 cm inferior to the 12th rib subcoastal
What is the lumbar plexus? What nerves comprise the lumbar plexus? Formed within the psoas major muscle from ventral rami of L1-L4; includes iliohypogastric, ilioinguinal, lateral cutaneous nerve of thigh, femoral nerve, genitofemoral nerve, obturator nerve
Describe the spinal cord segment and area supplied by the iliohypogastric nerve L1: motor to abdominal muscles and sensory to lower buttocks and lower abdomen
Describe the spinal cord segment and area supplied by the ilioinguinal nerve L1: passes out of superficial inguinal ring (not deep to it, though); motor to abdominal muscles and sensory to labia majora or scrotum and adjacent medial thigh
Describe the spinal cord segment and area supplied by the lateral cutaneous nerve of the thigh (L2, L3) L2-L4: Largest branch of the lumbar plexus; runs down in groove between psoas major and iliacus muscle; enters thigh beneath inguinal ligament and lateral to femoral sheath
Describe the spinal cord segment, anatomical position, and area supplied by the genitofemoral nerve L1,L2: from surface of psoas major, GENITAL br. : in sperm. cord/r. lig., motor to cremaster and sensory to scrotum/labia majora; FEMORAL br: passes onto thigh beneath inguinal ligament on surface of femoral artery; sensory to skin over femoral triangle
Describe the spinal cord segment and anatomical position L2-L4: appears on medial border of psoas major superficial to lumbosacral trunk; passes over pelvic brim into pelvis and courses towards obturator canal
The lumbosacral trunk is composed of the ___ portion of the v. ramus of ___ and all of the v. ramus of ____. It appears on the ___ side of the ____ muscle _____ to the obturator nerve. It enters the pelvis and joins the v. ramus of ____ to form the _____. descending; L4, L5; medial, psoas major deep; S1, sacral plexus
Describe the position relative to other structures in the abdomen of the lumbar sympathetic trunks Pass into abdomen beneath the medial arcuate ligaments; descend along medial borders of psoas major m. on sides of vertebral bodies; right sympathetic trunk lies post. to IVC; left trunk just to left of abdominal aorta
* At what level does the abdominal aorta pierce the diaphragm? Where does it bifurcate into the common iliac arteries? T12; L4, approximately 2-3 cm inferior and to the left of the umbilicus
* Where does the IVC form? How does it travel relative to the aorta once it forms? Begins as the union of the common iliac veins beneath the right common iliac artery; ascends on the posterior abdominal wall to the right of the aorta
Created by: karkis77



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