Posterior Abdominal Wall

Question 1

Be able to label a diagram of the various vessels arising from the abdominal aorta.

Answer 1

Important, bottom diagram page 207.

Question 2

Which of these vessels are directly associated with the abdominal autonomic plexuses?

Answer 2

Celiac trunk, superior and inferior mesenteric aa.

Question 3

From which vertebral levels does the sympathetic input to these plexuses arise?

Answer 3

T5 through L4.

Question 4

What specific structures deliver the sympathetic input into these plexuses?

Answer 4

Thoracic and lumbar splanchnic nn.

Question 5

By what structure(s) does the parasympathetic input to these plexuses arrive?

Answer 5

The vagus (for celiac and superior mesenteric plexuses) and the pelvic splanchnic nn. For the inferior mesenteric plexus.

Question 6

How far does parasympathetic input from the vagus extend along the G.I.T.?

Answer 6

To the mid transverse colon.

Question 7

Where does parasympathetic input for pelvic organs arise?

Answer 7

S2 through S4.

Question 8

Be able to label a diagram of the gross sagittal section through a kidney.

Answer 8

A diagram similar to the one on top of page 209 has been used on the exam before - as well as the structures tested in the lab.

Question 9

How many lobes are there in each kidney?

Answer 9

Five lobes (segments) per kidney.

Question 10

How many segmental branches are there from each renal artery?

Answer 10

Five segmental aa. (one per kidney lobe/segment).

Question 11

Trace the pathway of blood from the renal a. through to the arcuate a.

Answer 11

Renal a., lobar (segmental) a., interlobar a., arcuate a.

Question 12

Name the 3 sites where kidney stones are likely to become impaled and cause pain
along the length of the ureter.

Answer 12

1. Where pelvis narrows to ureter proper; 2. where ureter bends over common iliac into pelvis; 3. where ureter pierces the bladder wall.

Question 13

At what point does the ureter cross into the pelvis?

Answer 13

At the pelvic brim (entrance into true pelvis).

Question 14

Name a specific anatomical relationship the ureter has with the common iliac a.

Answer 14

At the bifurcation of the common iliac into the external and internal iliac aa.

Question 15

Where are the suprarenal glands located?

Answer 15

On the superior pole of each kidney (retorperitoneal).

Question 16

How can they be identified on the basis of shape?

Answer 16

The left is semilunar in shape while the right is more pyramidal.

Question 17

Why are the suprarenal glands so richly vascularized?

Answer 17

They are endocrine glands.

Question 18

What is unusual about the sympathetic innervation of these organs?

Answer 18

The preganglionic sympathetic fibers extend into the organ and synapse in the medulla (central core). Generally preganglionic sympathetic fibers synapse in a distant (paravertebral/prevertebral) ganglion.

Question 19

List the muscles that comprise the posterior abdominal wall.

Answer 19

Quadratus lumorum, iliacus and psoas major.

Question 20

What is the innervation of each muscle?

Answer 20

Psoas and quadratus lumborum = ventral rami of L1-3; iliacis = femoral n.

Question 21

What is the function of each muscle?

Answer 21

Quadratus lumborum: stabilizes R12 during inspiration as well as laterally flexing the trunk; the combined iliopsoas: flexes the hip on the trunk.

Question 22

Which two ligaments of the diaphragm are formed by thickenings of the fascia over the
musculature of the posterior abdominal wall.

Answer 22

The medial and lateral arcuate ligaments.

Question 23

Identify the muscles involved in each ligament.

Answer 23

Fascia over the psoas major thickens to form the medial arcuate ligament; facsia of the quadratus lumborum thickens to form the lateral arcuate ligament.

Question 24

Which part of the 3 parts of the diaphragm arise from these ligaments?

Answer 24

The lumbar portions of the diaphragm.

Question 25

What are the other two components comprising the diaphragm.

Answer 25

The sternal and costal portions.

Question 26

Identify two triangles formed by muscle deficiency in the diaphragm.

Answer 26

The sternocostal and lumbocostal triangles.

Question 27

Which triangle allows a structure to traverse it?

Answer 27

The sternocostal - the superior epigastric a. passes through it.

Question 28

Which of the two diaphragmatic crura is longest?

Answer 28

The right crus.

Question 29

To which vertebral levels does each diaphragmatic crus extend inferiorly?

Answer 29

The left drus extends to L1/2; the right crus extends to L3/4

Question 30

Which crus of the diaphragm forms a sling around the esophagus?

Answer 30

The right crus.

Question 31

List the various openings in the diaphragm, their vertebral level, and what traverses them.

Answer 31

Caval: T8 - inferior vena cava; esophageal: T10 - esophagus & vagus nn.; and aortic: T12 - aorta.

Question 32

Which ventral rami contribute to the lumbar plexus?

Answer 32

L1 through L4.

Question 33

What nerves are formed by the lumbar plexus?

Answer 33

Iliohypogastic, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, obturator, lumbosacral trunk.

Question 34

What is the function of each nerve formed by the plexus?

Answer 34

Iliohypogastic, ilioinguinal, genitofemoral, lateral femoral cutaneous: sensory to cutneous regions named; femoral: motor to the muscles of the anterior compartment of the thigh; obturator: motor to the muscles of the medial compartment of the thigh; lumbosacral trunk: takes innervation from lumbar plexus down into the sacral plexus.

Question 35

Be able to correctly orient the various branches of the lumbar plexus with its landmark - the psoas major muscle.

Answer 35

Lateral to the psoas major: iliohypogastic, ilioinguinal, lateral femoral cutaneous and femoral on surface of the psoas: genitofemoral; medial to the psoas: obturator, and lumbosacral trunk.

Question 36

Know the 9 regions of the abdomen and those which contain specific clinically relevant organs.

Answer 36

Right hypochondriac: liver; epigastric: stomach; left hypochondriac: spleen; right lateral: asecnding colon; umbilical; left lateral: descending colon; right iliac (inguinal): appendix; hypogastric; left iliac (inguinal): sigmoid colon.