Posterior Abdominal Wall and Respiratory Diaphragm

Question 1

What are the proximal and distal attachments of Psoas major m?

Answer 1

proximal: lateral aspects and transverse processes of vertebral bodies of T12-L5
Distal: lesser trochanter of femur

Question 2

What is the innervation of Psoaas major m?

Answer 2

L2, L3, L4 via lumbar plexus

Question 3

What are the actions of psoas major m?

Answer 3

Bilaterally: flexes thigh at hip
Unilaterally: side-bends trunk to same side

Question 4

What are the proximal and distal attachments of the iliacus m?

Answer 4

Proximal: illiac fossa of pelvis
Distal: lesser trochanter of femur

Question 5

What is the innervation of iliacus m?

Answer 5

Femoral n

Question 6

What are the actions of iliacus M?

Answer 6

flexes thigh at hip

Question 7

What are the proximal and distal attachments of psoas minor m?

Answer 7

Proximal: lateral aspects of vertebral bodies of T12 and L1
Distal: pectineal line

Question 8

What is the innervation of psoas minor m?

Answer 8

L1 and L2

Question 9

What are the actions of Psoas minor m?

Answer 9

Depresses 12th rib
fixes 12th rib during deep inspiration
Bilateral: assists with trunk extension
Unilaterally: side-bends trunk to same side

Question 10

What are the proximal and distal attachments of Quadratus lumborum M

Answer 10

Proximal: iliac crest and iliolumbar ligament
Distal: medial half of inferior border of the 12th rib and tips of lumbar transverse processes

Question 11

What is the innervation of quadratus lumborum m?

Answer 11

T12-L4

Question 12

What are the actions of quadratus lumborum M?

Answer 12

Extends and laterally flexes vertebral column

Fixes 12 rib during inspiration

Question 13

What are the presentation of psoas syndrome?

Answer 13

lumbosacral pain 
difficulty standing up straight 
pain in contralateral gluteal region 
radiation of pain down the lower extremity: usually stops at knee
Mimic herniated disk

Question 14

What are the differential diagnosis of psoas syndrome?

Answer 14

appendicitis, colon cancer, diverticulitis, hip dysfunction, salpingitis

Question 15

The diaphragm can extend to what rib?

Answer 15

5th

Question 16

What are the 3 peripheral origins of the central tendon of diaphragm?

Answer 16

sternal origin: right and left muscular slips that originate on posterior surface of xiphoid
costal origin: originate from deep surfaces of lower 6th ribs
and vertebral origin: lumbar - arise from crura and arcuate ligaments

Question 17

Which crus is longer and forms the muscular esophageal hiatus?

Answer 17

right crus

Question 18

What comes out of caval opening?

Answer 18

At T8, IVC, branches of right phrenic nerve and lympatics from liver come out

Question 19

What comes out of esophageal hiatus?

Answer 19

T10
esophagus
anterior and posterior vagal trunks
esophageal branches of left gastric a

Question 20

What comes out of Aortic hiatus

Answer 20

T12
aorta, thoracic duct
azygous vein

Question 21

What comes out of sternocostal hiatus?

Answer 21

superior epigastric vessels

Question 22

What do posterior origins of the diaphragm form?

Answer 22

arcuate ligaments

Question 23

What is at the median arcuate ligament?

Answer 23

aortic hiatus

Question 24

What is at the medial arcuate ligament?

Answer 24

gap for psoas major m

Question 25

What is at the lateral arcuate ligament?

Answer 25

gap for quadratus lumborum m

Question 26

When do diaphragmatic hernias occur?

Answer 26

when attachment become stretched or ligaments become loose

Question 27

Where do diaphragmatic hernias commonly occur?

Answer 27

on the left side, due to protection of the right hemi diaphragm by the liver

Question 28

Where are Parasternal hernias located?

Answer 28

sternocostal triangle; located between the sternal and costal parts of the diaphragm

Question 29

where are pleuroperitoneal hernias located?

Answer 29

lumbocostal triangle located between 12th rib and diaphragm

Question 30

What are the presentations of congenital diaphragmatic hernia?

Answer 30

respiratory distress, cyanosis, unusually flat abdomen

Question 31

What aa supply the superior surface of the diaphragm?

Answer 31

pericardiacophrenic a
musculophrenic a
superior phrenic a

Question 32

What aa supply the inferior surface of the diaphragm?

Answer 32

Inferior phrenic a

Question 33

The right inferior phrenic a passes _______ to IVC

Answer 33

posterior

Question 34

The left inferior phrenic a passes ______ to esophagus

Answer 34

posterior

Question 35

What is the motor innervation of the diaphragm?

Answer 35

phrenic N

Question 36

What is the sensory innervation of the diaphragm?

Answer 36

Central portion: phrenic N

Peripheral portion: intercostal

Question 37

What are the lymphatics of the anterior diaphragm ?

Answer 37

anterior diaphragmatic nodes -> parasternal nodes

Question 38

what are the lymphatics of the posterior diaphragm?

Answer 38

Posterior diaphragmatic nodes -> mediastinal nodes

Question 39

Inferior surface of the diaphragm has what type of lympatic nodes?

Answer 39

celiac nodes

superior lumbar nodes

Question 40

What does the cisterna chyli collect?

Answer 40

lymph from intestinal lympahtic trunks and lumbar lymphatic trunks
LIes posterior to aorta around L1-2

Question 41

Internal iliac nodes drain what areas?

Answer 41

lower rectum to anal canal above pectinate line

Bladder, vagina and prostate

Question 42

What does the para-aortic nodes drain?

Answer 42

testes, ovaries, kidneys, uterus

Question 43

What does the superficial inguinal node drain?

Answer 43

anal canal below pectinate line, most skin below umbilicus and scrotum

Question 44

What does the deep inguinal node drain?

Answer 44

lower extremity

Question 45

What does right inferior phrenic v empty into?

Answer 45

IVC

Question 46

what does left inferior phrenic v empty into?

Answer 46

left renal vein