Lecture 11-Posterior Abdominal Wall

Question 1

Psoas major

-Insertion?

Answer 1

Lesser trochanter of femur via common tendon with iliacus (iliopsoas tendon)

Question 2

Psoas major

-Innervation?

Answer 2

L2-L4 via lumbar plexus

Question 3

Psoas major

-Action?

Answer 3

• Flexes thigh at the hip
• With feet fixed flexes trunk on thigh (at the hip joint)
• Acting unilaterally side-bends trunk to same side

Question 4

Psoas minor

-Innervation?

Answer 4

L1, (L2)

Question 5

Psoas minor

-Action?

Answer 5

• Depresses rib 12, fixes 12th rib during deep inspiration
• Assists in extension of trunk
• Acting unilaterally side-bends trunk to same side

Question 6

Quadratus lumborum

-Innervation?

Answer 6

T12-L4

Question 7

Quadratus lumborum

-Action?

Answer 7

• Extends and laterally flexes vertebral column

- Fixes rib 12 during inspiration

Question 8

Iliacus

-Innervation?

Answer 8

Femoral n (L2-L4)

Question 9

Iliacus

-Action?

Answer 9

• Flexes thigh at hip

- With lower limb fixed, flexes pelvis on thigh

Question 10

Psoas Syndrome

-Presentation??

Answer 10

• Lumbosacral pain
• Difficulty standing up straight
• Pain in the contralateral gluteal region
• Radiation of pain down the lower extremity (usually stopping at knee)
• May mimic herniated disc

Question 11

Blood supply of the abdomen picture

Answer 11

Slide 12

Question 12

Abdominal openings

-Caval opening-what comes out?

Answer 12

IVC, branches of right phrenic nerve, and lymphatics from liver

Question 13

Esophageal hiatus-what comes out?

Answer 13

Esophagus, anterior and posterior vagal trunks, esophageal branches of left gastric artery

Question 14

Aortic hiatus-What comes out?

Answer 14

Aorta, thoracic duct, and azygous vein

Question 15

Sternocostal hiatus-What comes out?

Answer 15

Superior epigastric vessels

Question 16

Posterior abdominal wall muscles

Answer 16

Psoas major/minor, quadratus lumborum, iliacus

Question 21

Posterior origins of the diaphragm form?

Answer 21

Arcuate ligaments

Question 23

Respiratory diaphragm

-Superior surface extends upward as far as what rib?

Answer 23

Superior surface extends upward as far as the 5th rib

Question 24

Respiratory diaphragm

-Three peripheral origins insert on central tendon?

Answer 24

-Sternal, costal, and lumbar origins

Question 25

Respiratory diaphragm-Arcuate ligaments form openings for posterior wall abdominal structures
-Lateral arcuate ligament?

Answer 25

Gap for quadratus lumborum m.

Question 26

Potential sites for diaphragmatic hernias

• When do they occur?
• Commonly occur on which side? Why?

Answer 26

• Occur when attachments become stretched or ligaments become loose
• Commonly occur on the left side due to protection of the right hemidiaphragm by the liver

Question 27

Parasternal hernias

-Where do they occur?

Answer 27

Sternocostal triangle

-Located between the sternal and costal parts of the diaphragm

Question 28

Pleuroperitoneal hernias

-Where do they occur?

Answer 28

Lumbocostal triangle-located between the 12th rib and the diaphragm

Question 29

Congenital diaphragmatic hernia

-Etiology?

Answer 29

Failure of the pleuroperitoneal membranes to fuse with other components of the diaphragm

Question 30

Congenital diaphragmatic hernia | -presentation?

Answer 30

- Respiratory distress and cyanosis in the first mins/hours of life - Unusually flat abdomen

Question 31

Respiratory diaphragm | -Right crus compared to left crus?

Answer 31

- Right crus is longer | - Left crus is short and lateral

Question 32

Respiratory diaphragm | -The muscular esophageal hiatus is formed by which crus?

Answer 32

Right crus

Question 33

Respiratory diaphragm | -The right and left crus join to form?

Answer 33

The aortic hiatus

Question 35

Respiratory diaphragm - Posterior origins of the lumbar part of the diaphragm form arcuate ligaments over posterior wall structures - 3 arcuate ligaments?

Answer 35

- Median arcuate ligament - Medial arcuate ligaments - Lateral arcuate ligaments

Question 36

Respiratory diaphragm-Arcuate ligaments form openings for posterior wall abdominal structures -Median arcuate ligament?

Answer 36

Aortic hiatus

Question 37

Respiratory diaphragm-Arcuate ligaments form openings for posterior wall abdominal structures -Medial arcuate ligament?

Answer 37

Gap for psoas major m.

Question 38

Blood supply of the diaphragm | -Superior surface?

Answer 38

Pericardiacophrenic, musculophrenic, and superior phrenic

Question 39

Blood supply of the diaphragm | -Inferior surface?

Answer 39

Inferior phrenic a | -right passes posterior to IVC, left passes posterior to esophagus

Question 40

Innervation of the diaphragm | -Motor?

Answer 40

C3, 4, 5 keeps the diaphragm alive **only motor innervation!**

Question 41

Innervation of the diaphragm | -Sensory-central portion?

Answer 41

Phrenic nerve

Question 42

Innervation of the diaphragm | -Sensory-peripheral portion?

Answer 42

Intercostal n

Question 43

Lymphatics of the diaphragm | -Superior surface-anterior diaphragm?

Answer 43

Anterior diaphragmatic nodes-->parasternal nodes

Question 44

Lymphatics of the diaphragm | -Superior surface-posterior diaphragm?

Answer 44

Posterior diaphragmatic nodes-->mediastinal nodes

Question 45

Lymphatics of the diaphragm | -Inferior surface?

Answer 45

Celiac nodes, superior lumbar nodes

Question 46

Lymphatics | -Body wall

Answer 46

Lumbar lymph trunks

Question 47

Lymphatics | -Lower extremity, perineum, gluteal region-travel through?

Answer 47

Abdomen

Question 48

Lymphatics | -GI tract-enters?

Answer 48

Enters intestinal lymph trunks

Question 49

Lymphatics | -Body wall, lower extremity, perineum, gluteal region, and GI tract all contribute to?

Answer 49

Thoracic duct (forms L1-L2)

Question 50

Intestinal Lymphatic Trunk | -4 components?

Answer 50

-Celiac nodes, superior mesenteric nodes, lumbar nodes, and inferior mesenteric nodes

Question 51

Cisterna Chyli | -What is it and where is it found?

Answer 51

- Dilation found at the end of the thoracic duct | - Retroperitoneal structure lies posterior to the aorta around LV1-2

Question 52

Cisterna chyli | -Function?

Answer 52

Collects lymph from intestinal lymphatic trunks and lumbar lymphatic trunks

Question 53

* *Abdominal lymphatics** | - Para-aortic-area drained?

Answer 53

**Testes**, ovaries, kidneys, uterus

Question 54

* *Abdominal lymphatics** | - Superficial inguinal-area drained?

Answer 54

**Scrotum and anal canal below pectinate line**, labium majora

Question 55

* *Abdominal lymphatics** | - Internal iliac-area drained?

Answer 55

**Anal canal above pectinate line**

Question 56

Subdivisions of peritoneal cavity | -Greater sac-Accessed by?

Answer 56

Incision to anterior abdominal wall

Question 57

Lesser sac-where is it located?

Answer 57

Posterior to stomach and lesser omentum

Question 58

Supracolic and infracolic compartments | -**Divided by?**

Answer 58

Transverse mesocolon

Question 59

Organs within supracolic compartment?

Answer 59

Stomach, liver spleen

Question 60

Organs within the infracolic compartment?

Answer 60

Small intestine and ascending/descending colon

Question 61

Infracolic compartment-Further subdivided into right and left infracolic spaces by?

Answer 61

THE mesentery

Question 62

Paracolic gutters

Answer 62

Areas between lateral aspects of ascending and descending colon and the posterior abdominal wall

Question 63

Paracolic gutters | -The spread of fluid superiorly is prevented by?

Answer 63

Phrenicocolic ligament