abdominal wall 2

Question 1

what structures are you going to find in the posterior wall of the abdomen?

Answer 1

• lumbar vertebrae and IV discs
• muscles
• diapghram (contributes to the superior part of the wall)
• fascia
• lumbar plexus
• kidneys, fat, nerves and vessels

Question 2

what muscles are found on the posterior abdominal wall?

Answer 2

• psoas
• quadratus lumborum
• iliacus
• transversus abdominis and oblique muscles laterally

Question 3

innervation and function of quadratus lumborum?

wat does its fascia contribute towards?

Answer 3

function:
- fixes and depresses the 12th rib during inspiration and flexes/laterally flexes the trunk

innervation:
- T12-L4 anterior rami

the fascia contributes to forming the lateral arcuate ligament.

Question 4

psoas major function and innervation?

what does it fascia create?

Answer 4

function:
- flexes the thigh, trunk and laterally flexes the trunk

innervation:
- L1-L3 spinal nerves

fascia creates the medial arcuate ligament

Question 6

psoas minor function and innervation

Answer 6

innervation:
L1

this muscle is often not present in around 60% of people
it is merely an extension of psoas major

Question 7

iliacus innervation and function?

Answer 7

innervation:
- femoral nerve (L1,2,3)

function:
- merges with psoas major acting to flex the trunk and thigh

Question 8

what does the lumbar plexus supply?

Answer 8

• abdominal muscles
• extensor compartment of the thigh
• adductor compartment of the thigh

Question 9

where will you find the lumbar plexus?
what branches is it made from?

Answer 9

• formed within psoas major
• brnaches will be visible on the posterior abdominal and pelvic walls
• made up by L1-3 and most of L4

Question 10

where will you find the muscular and vascular compartment of the thigh?

Answer 10

deep to the inguinal ligament
- it is divided by the femoral sheath

Question 11

what is the femoral sheath continous with?

Answer 11

transversalis and iliac fascia

Question 12

what will you find within the muscular comparmtnet?

Answer 12

• psoas major
• iliacus muscle
• femoral nerve
• lateral cutaneous nerve of the thigh (sometimes it perices the inguinal ligament directly)

Question 13

what will you find within the vascular compartment ?

Answer 13

transmits femoral vessels and femoral branch of the genitofemoral nerve

Question 14

what 2 arteries is the posterior abdominla wall supplied by?

Answer 14

• thoracic aorta
• abdominal aorta

these arteries will continue anteriorly to anastomose with the anterior abdominal wall arteries

Question 15

branches of the thoracic aorta?

Answer 15

10th and 11th posterior intercostal arteries

Question 16

branches of the abdominal aorta?

Answer 16

• subcostal
• lumbar arteries (4 pairs)

Question 17

what 3 arteries supply the anterolateral abdominal wall?

Answer 17

• internal thoracic
• external iliac
• femoral

Question 18

branches of the internal thoracic artery

Answer 18

• musculophrenic
• superior epigastric

Question 19

brnaches of the external iliac artery

Answer 19

• inferior epigastric
• deep circumflex iliac

Question 20

branches of the femoral artery

Answer 20

• superficial epigastric
• superficial circumflex iliac

Question 21

inferiorly and superiorly, what vessels does the venous blood drain to?

Answer 21

• femoral and external iliac veins inferiorly
• internal thoracic and axillary veins superioly

veins accompany arteries

Question 22

iwhere will the superficial epigastric and superficial circumflex iliac drain into?

Answer 22

• they can drain into the prximal end of the great saphenous vein rther than the femoral vein

Question 23

where do the veins radiate from?

how is the venous system connected?

Answer 23

• veins radiate out from the umbilicus
• para umbilical veins connect the venous system through the umbilicus to the portal veins in the liver

Question 24

what is caput medusae in cirrohosis of the liver?

Answer 24

• in port systemic hypertension

Question 25

anterior lymphatic drainage: - above umbilicus - below umbilicus | superficial

Answer 25

above umbilicus = anterior axillary nodes below umbilicus= superficial inguinal nodes

Question 26

posterior lymphatic drainage: - above iliac crest - below iliac crest | superficial

Answer 26

above iliac crest = posterior axillary nodes below iliac crest = superficial inguinal nodes

Question 27

what vessels are involved in deep lymphatic drainage: - superiorly - inferiorly

Answer 27

(lymph from the deeper abdominal wall accompanies epigastric vessels) superiorly: - parasternal nodes then medistinal nodes inferiorly: - external iliac then para aortic nodes

Question 28

what are the boundries of the femoral ring/canal?

Answer 28

anterior = inguinal ligament medial = lacunar ligament posterior = pectineus or pectineal ligament lateral = femoral vein closed by the extraperitoneal tissue

Question 29

where will you find the femoral ring/ canal?

Answer 29

medial to the vascular compartment in the femoral canal

Question 30

what is a femoral hernia?

Answer 30

(the femoral ring is a weak area- this is where hernias can happen) - it is an abnormal portusion of the abdominal organs into the femoral canal

Question 31

how can you differentiate between an inguinal and a femoral hernia?

Answer 31

- the pubic tubercle is a useful landmark to differentiate between them both - a femoral hernia will ppear below and lateral to the pubic tubercle

Question 32

how do you get a psoas abcess?

Answer 32

because the psoas muscle and its sheath arises from not only the lumbar vertebrae but alos from the intervertebral disc between each vertebraa, so if you get tuberculosis or salmonella discitis (for example)... the infection can spread into the psoas muscle sheath, which will then spread into the muscle it may appear below the inguinal ligament as a mass.

Question 33

where would you see a femoral hernia in relation to the pubic tubercle?

Answer 33

infero-lateral

Question 34

what is the most medial branch of the lumbar plexus?

Answer 34

obturator

Question 35

L1 | lumbar plexus

Answer 35

iliohypogastric & ilioinguinal

Question 36

L1 and L2

Answer 36

genitofemoral

Question 37

L2 and L3

Answer 37

lateral femoral cutaneus

Question 38

L2,3,4

Answer 38

obturator & femoral

Question 39

where will reffered pain from the stomach and oesophagus be felt?

Answer 39

T6-7 in the epigastrium

Question 40

where will reffered pain from the appendix, gonad and small intestine?

Answer 40

T10 - umbilicus

Question 41

where will reffered pain from the lower colon, bladder and uterus be felt?

Answer 41

T12- pubic region

Question 42

what nerves are sensory and cutaneus supply for the anterior abdominal wall? what is the course for these nerves?

Answer 42

T7-L1 - these nerves pass between the internal oblique and transversus abdominis and supplies them at the same time - it will then enter the rectus sheath to supply rectus abdominus

Question 43

what is herpes zoster (shingles)

Answer 43

- Varicella Zoster virus (chiken pox) it may remain inactive in nerve cells - reactivation will cause shingles - the rash can form along the course of a nerve (dermatome) - unilateral - the skin remains sore after the rash goes away