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GI Week 2 > Posterior Abdominal Wall and Diaphragm > Flashcards

Posterior Abdominal Wall and Diaphragm Flashcards

1
Q

What long fusiform muscle lies lateral to the lumbar vertebral column?

A

Psoas major

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2
Q

Where does the psoas major originate?

A

originates on the lumbar vertebral bodies

then tapers at L5 to join the ilacus muscle and form the iliopsoas

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3
Q

Where does the combined ilipsoas muscle insert?

A

it passes beneath the inguinal ligament to insert on the lesser trocanter of the femur

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4
Q

What does the psoas major do? WHat does the iliopsoas do?

A

psoas major flexes the vertebral column

the iliopsoas also flexes the hip joint

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5
Q

Where does the psoas minor muscle lie in relation to the psoas major?

A

it;s a slender muscle that lies just anterior to it (only present in 50% of the population)

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6
Q

Where does the iliacus originate?

A

from the superior part of the iliac fossa

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7
Q

Why is the iliopsoas muscle important clinically?

A

If the ureters, kidneys, cecum, appendix, sigmoid colon, pancreas, lumbar LNs or nerves on the posterior abdominal wall are diseased, movement of the iliopsoas muscle may be accompanied by pain

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8
Q

What is the thick muscle sheet originating on the iliac crest and 2-4 lumbar transverse processes and inserting on the 12th rib?

A

the quadratus lumborum

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9
Q

What does the quadratus lumborum do?

A

fixes the 12th rib in relation to the pelvis.Acting alone, one side flexes the trunk, but together both muscle extend the trunk

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10
Q

What is the third and innermost of the 3 flat muscles of the anterior abdominal wall?

A

transverse abdominis

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11
Q

IN general, the posterior abdominal muscles are covered by deep fascia named according to the muscle. But what’s the general term for all of it?

A

transversalis fascia

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12
Q

Where is the muscular portion of the diaphragm located?

A

all around the periphery

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13
Q

What are the 3 portions of the muscular portion?

A

Sternal portion (from xiphoid process and adjacent aponeurosis of the transversus abdominis)

Costal portion (cartilage and bony surface of ribs 7-12_

Lumbar portion (arising from vertebral column)

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14
Q

What divides the sternal and costal portions?

A

they’re separated by small gaps called the sternocostal triangles through which the superior epigastric vessels continue into the abdomen

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15
Q

What are the two parts of the lumbar portion?

A

the right and left crura

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16
Q

Which crus is longer and better developed?

A

the right crus

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17
Q

The right crus contributes to the muscular porion of the dipahragm between what two structures?

A

between the aortic and esophageal hiatuses

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18
Q

What does the right crus form in relation to the duodenum?

A

the ligament of Treitz (suspensory ligament or muscle)

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19
Q

WHere do the right and left crura arise form?

A

right: vertebral bodies of L1-L3

left from L1-L2

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20
Q

What unites the two crura? What does this form?

A

united by the median arcuate ligament, which forms the aortic hiatus

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21
Q

What are the three arcuate (lumbocostal) ligaments?

A

the median arcuate ligament
the medial arcuate ligaments
lateral arcuate ligaments

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22
Q

What do the medial arcuate ligaments arch over?

A

the psoas major muscle

23
Q

What do the lateral arcuate ligaments arch over?

A

the superior part of the quadratus lumborum

24
Q

All muscle fibers of the diaphragm converge and insert on what?

A

the central tendon - it’s a strong aponeurosis with interlacing tendinous fibers

NO bony attachments

25
Q

What are the 4 hiatuses in the diaphragm?

A
  1. hiatus for the IVC
  2. Esophageal hiaus
  3. Aortic hiatus
  4. minor openins for splanchnic nerves in the R and L crus and for sueprior epigastric vessels at the sternocostal triangles
26
Q

At what level is the hiatus for the IVC?

A

T8

27
Q

What passes through the IVC hiatus besides the IVC?

A

branches of the right phrenic nerve

28
Q

At what level is the esophageal hiatus?

A

slightly to the left of midline at T10

29
Q

What passes through the esophageal hiatus besides the esophagus?

A

vagal trunks (anterior and posterior)

anastomotic vessels connecting the vessels of the trhoacic esophagus with those of the stomach (left gastric branches)

30
Q

At what level is the aortic hiatus?

A

it’s immediately anterior to the vertebral column at the level of T12

31
Q

What passes thorugh the aortic hiatus besides the aorta?

A

thoracic duct

elements of the azygos and hemiazygos system of veins

32
Q

What superior arteries supply the diaphragm from above (3 sets)…

A

superior phrenic arteries
pericardiacophrenic arteries
musculophrenic arteries

33
Q

Where do the superior phrenic arteries branch from? WHat part do they supply?

A

direct branches off the trhoacic aorta

supply posterior aspect

34
Q

Where do the pericardiacophrenic arteries come from and what part do they supply?

A

they’re branches of the internal thoracic arteries accompanying the phrenic nergves

supply the central area

35
Q

Where do the musculophrenic arteries come from? What part do they supply?

A

one of the terminal branches of the internal thoracic arteries

supply the periphery of the diaphragm

36
Q

What set of arteries supplies the diaphragm from below?

A

inferior phrenic arteries - this is hte major source of blood to the diaphragm.

37
Q

Where do the inferior phrenic arteries come from?

A

branches of the abdominal aorta just inferior to the hiatus

38
Q

What’s the chief route of venous drainage from the diaphragm?

A

parallels the arteries, but mostly follows inferior phrenic veins…

L inferior phrenic vein drains to left suprarenal then left renal

39
Q

What supplies motor innervation to the diaphragm?

A

phrenic nerves
C3, 4, 5 keeps the diaphragm alive

(somatic efferents)

40
Q

Somatic afferents from the dipahragm are derived from what two sources?

A

phrenic nerve (central area) and intercostal nerves (peripheral inch)

41
Q

When the peritoneum covering the diaphragm is irritated, pain is referred where? Why?

A

to the shoulder region

this is the area of the periteonum supplied by the phrenic nerve, the same segments providing innervation to the skin of the shoulder region (via supraclavicular nerves C3 and C4 from cervical plexus)

42
Q

What if it’s only the periteoneum that covers the peripheral part of the diaphragm supplied by intercostal nerves?

A

it will be referred to the thoracic wall

43
Q

What are hiccups?

A

due to irritation of afferent or efferent nerve endings of the phrenic

or of medullary centers in the brainstem causing involuntary spasms of the diaphragm and glottis

44
Q

What are the two main actions of the diaphragm?

A

it’s the chief muscle of inspiration

also important in abdominal straining

45
Q

Where is the cisternal chyli located?

A

between the aorta and the right crus of the diaphragm

46
Q

What are the three main tributaries of the cisternal chyli?

A

right and left lumbar lymph trunks and a single intestinal lymph trunk

47
Q

What do the lumbar lymph trunks drain?

A

they drain the lumbar LNs alongside the lumbar vertebrae which in turn receive lymph from the lower extremity via external and common iliac chains of nodes, the pelvis, kidney, suprarenal glands and body wall

48
Q

What does the intestinal lymph trunk drain?

A

receives lymph from intestine, stomach, spleen, pancreas and liver

49
Q

What branches of the lumbar plexus supply the muscles and skin of the back?

A

the dorsal rami of L1-L5 lumbar nerves

50
Q

What two plexi are formed by the ventral rami after they extend into the posterior aspect of the psoas muscle?

A

L1-3 and upper half of L4 form the lumbar plexus

lower half of L4 and L5 form the lubosacral trunk, which joins the sacral plexus in the pelvis

51
Q

What are the 7 branches of the lumbar plexus?

A
  1. ilioinguinal
  2. iliohypogastric
  3. genitofemoral (femoral and genital branches)
  4. lateral femoral cutaneous nerve
  5. obturator nerve
  6. femoral nerve
  7. lumbosacral trunk
52
Q

WHere does the femoral branch of the genitofemoral nerve pass?

A

passes beneath the inbuinal ligament within the femoral sheath to supply the skin over the femoral truangle

53
Q

Where does the genital branch of the genitofemoral nerve pass?

A

runs to the deep inguinal ring and traverses the inguinal canal to supply the cremaster muscle

54
Q

What does the lateral femoral cutaneous nerve supply?

A

skin over lateral and anterior thigh

GI Week 2 (11 decks)

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