Posterior Abdominal Wall

Question 1

Posterior Abdominal Wall Components (6)

Answer 1

• Lumbar Vertebrae and IV discs
• Wall muscles
• diaphragm
• fascia
• Lumbar plexus
• fat, nerves, vessels

Question 2

Muscular Floor

Answer 2

1. Psoas Major and Minor
2. Iliacus
3. Quadratus Lumborum
4. Diaphragm

Question 3

Psoas Abscess

• describe
• symptoms

Answer 3

Infection deep to psoas fascia

Symptoms

• back or flank pain
• fever
• inguinal mass
• limp
• anorexia
• weight loss
• lower abdominal pain exacerbated by extending limb
  
  • “psoas sign”

Question 4

Fascia (3)

Answer 4

1) Median arcuate ligament
2) Medial arcuate ligament
3) lateral arcuate ligament

Question 5

Median arcuate ligament

Answer 5

tendonous arch of the crura of the diaphragm

Question 6

Medial arcuate ligament

Answer 6

fascial thickening of the psoas fascia

-lateral to the median arcuate ligament

Question 7

Lateral arcuate ligament

Answer 7

thickening of fascia lining the quadratus lumborum

Question 8

Diaphragm components

Answer 8

• Muscular part
• Central tendon
• Crura
• Apertures

Question 9

Muscular part of Diaphragm

- components (3)

Answer 9

1) Sternal part: may not be present, attaches to xiphoid
2) Costal Part: attached to inferior 6 costal cartilages
3) Lumbar part: attaches to medial and lateral arcuate ligament

Question 10

Crura of diaphragm

- components

Answer 10

Right Crus
- larger and longer (L3-L4)

Left Crus
- L2-L3

Question 11

Apertures of diaphragm

- components (3)

Answer 11

1) Cavil Opening
- located at T8
- IVC and R. phrenic N.
2) Esophageal Hiatus
- located at T10
- esophagus
- anterior and posterior vagal trunks
3) Aortic Hiatus
- located at T12
- aorta, thoracic duct, and sometimes the azygos and hemi-azygos veins

Question 12

Aorta Vertebral Level

Answer 12

T12-L4

Question 13

Celiac Vertebral Level

Answer 13

T12

Question 14

SMA Vertebral Level

Answer 14

L1

Question 15

Renal Vertebral Level

Answer 15

L1/L2

Question 16

Gonadal Vertebral Level

Answer 16

L2

Question 17

IMA Vertebral Level

Answer 17

L3

Question 18

Bifurcation Vertebral Level

Answer 18

L4

Question 19

Body of pancreas and splenic vein Vertebral Level

Answer 19

L1 and L2

Question 20

Left renal vein Vertebral Level

Answer 20

L2

Question 21

Horizontal part of duodenum Vertebral Level

Answer 21

L3

Question 22

Coils of the intestine Vertebral Level

Answer 22

Lower than L3

Question 23

Adrenal Glands

• Component
• Relationship to what’s around it

Answer 23

Right Adrenal Gland
- inferior to right crus, superior to right kidney, lateral to IVC, posterior and lateral to liver

Left Adrenal Gland
- inferior to left crus, posterior to spleen, posterior to stomach, posterior to pancreas, and superior to left kidney

Question 24

Adrenal Glands

- blood suplly

Answer 24

Superior (from inferior phrenic A), middle (from aorta), inferior (from renal) suprarenal arteries

Veins

• right suprarenal vein to IVC
• left suprarenal vein to left renal vein to IVC

Question 25

Adrenal Glands | - innervation

Answer 25

Preganglionic sympathetics from T6-L2 Celiac plexus and splanchnic nerves

Question 26

Kidney Relationships

Answer 26

Posterior: Muscular floor 1. diaphragm 2. psoas major m 3. quadratus lumborum m 4. transversus abdominis m Anterior: 1. Right Kidney (1/2 inch below left kidney) - liver duodenum, ascending colon 2. Left Kidney (T12-L3) - stomach, spleen, pancreas, jejunum, descending

Question 27

Ureter Relationships

Answer 27

Posterior to ductus deferens (males) posterior to uterine artery ( female)

Question 28

Ureter Constriction points

Answer 28

1) ureteropelvic junction 2) crossing external iliac artery and/or pelvic brim 3) Ureter enters bladder wall

Question 29

Renal Pelvis

Answer 29

flattened, funnel shaped, expansion of ureter - receives 2-3 major calices, each of which divides into 2-3 minor calices - each minor calyx is indented by renal papilla, the apex of the renal pyramid

Question 30

Posterior Abdominal Wall Lymphatics

Answer 30

1) Celiac, superior and inferior mesenteric nodes: lymph from alimentary tract, liver, spleen, and pancrease 2. Lumbar lymph nodes (caval and aortic) posterior abdominal wall, kidneys, ureters, testes or ovaries, uterus and uterine tubes

Question 31

Lumbar Plexus components

Answer 31

1) Iliohypogastric 2) Ilioinguinal 3) Genitofemoral 4) Lateral cutaneous nerve of thigh 5) Obturator 6) Femoral

Question 32

Iliohypogastric nerve - spinal segment - motor function - sensory function

Answer 32

L1 Motor - IO and TA Sensory - skin of pubis - posterolateral gluteal skin

Question 33

Ilioinguinal nerve - spinal segment - motor function - sensory function

Answer 33

L1 Motor -IO and TA Sensory -skin in upper medial thigh, penis, scrotum , mons pubis, labium majus

Question 34

Genitofemoral Nerve - spinal segment - motor function - sensory function

Answer 34

L1, L2 Motor - Genital branch of male - cremasteric muscle Sensory - Genital branch- skin of scrotum, mons pubis, labium majus - Femoral branch- skin of upper anterior thigh

Question 35

Lateral cutaneous nerve of thigh - spinal segment - motor function - sensory function

Answer 35

L2, L3 Motor: N/A Sensory - skin of anterior and lateral thigh to the knee

Question 36

Obturator nerve - spinal segment - motor function - sensory function

Answer 36

L2-L4 Motor: - obturator externus - pectineus - muscles in medial compartment of thigh Sensory: -skin of medial aspect of thigh

Question 37

Femoral Nerve - spinal segment - motor function - sensory function

Answer 37

L2-L4 Motor: - Iliacus - Pectineus - muscles in anterior compartment of thigh Sensory - skin of anterior thigh and medial surface of leg