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Arterial supply to diaphragm Superior Branches off internal thoracic aa ? Pericardiophrenic aa. Musculophrenic aa. Arterial supply to diaphragm Superior Branches off aorta ? Superior phrenic aa. Arterial supply to diaphragm Inferior Branches off aorta ? Inferior phrenic aa Venous drainage of diaphragm Superior Drains into internal thoracic vv ? Pericardiophrenic vv. Musculophrenic vv. Venous drainage of diaphragm Superior Drains into IVC ? Superior phrenic v. (right side only) Venous drainage of diaphragm Inferior Drains into the IVC ? Right inferior phrenic v. Left inferior phrenic v. Venous drainage of diaphragm Inferior Drains into the left suprarenal v. ? Left inferior phrenic v. Venous drainage of diaphragm Inferior Usually double branched ? Left inferior phrenic v. The lymphatic drainage of the diaphragm? Anterior & posterior diaphragmatic lymph nodes. Innervation of the diaphragm motor ? Right and left phrenic nerves From anterior rami of C3-C5 segments of spinal cord Innervation of the diaphragm Sensory Central portion ? Right and left phrenic nerves Innervation of the diaphragm Sensory Periphery ? Intercostal nerves (~5-11) and subcostal nerve Muscles of the Posterior Abdominal Wall ? Diaphragm Quadratus lumborum Psoas major Psoas minor Iliacus These 3 fuse after passing under inguinal canal and insert on the femur as the Iliopsoas complex. Psoas major Psoas minor Iliacus These muscles are covered on their anterior surfaces by transversalis fascia. Muscles of the Posterior Abdominal Wall Formed by ventral rami of spinal nerves L1-4 ? Lumbar Plexus Portion of T12, not actually part of plexus ? Subcostal n T12 + L1 common trunk with ilioinguinal n ? Iliohypogastric n T12 + L1 common trunk with iliohypogastric n Ilioinguinal n L1 + L2 ? Genitofemoral n Enters deep inguinal ring Innervates cremaster muscle ? Genital branch of Genitofemoral n Passes deep to inguinal ligament Cutaneous sensation to proximal anterior thigh Femoral branch of Genitofemoral n Posterior components of L2-L3 Passes under inguinal ligament Lateral femoral cutaneous n. Posterior components of L2-L4 Passes under inguinal ligament Femoral n. Anterior components L2-L4 Exists through obturator foramen Obturator n Anterior components L4-L5 Contributes to sciatic nerve from sacral plexus Lumbosacral trunk On each side of vertebral column Pair of ganglia for each body segment (spinal nerve) Paravertebral ganglia or chain ganglia Only from T12-L2 spinal nerves Preganglionics enter sympathetic trunk White rami communicantes Fibers exit sympathetic trunk Join ALL spinal nerves Grey rami communicantes Preganglionic fibers entering the trunk may ... 1. Synapse immediately and exit as postganglionic fiber 2. Travel up/down one or more vertebral levels, synapse, then exit as postganglionic fiber 3. Pass through the sympathetic trunk without synapsing, travel to the abdominopelvic cavity in a splanchnic nerve, and travel to the target organ as a plexus around an artery Collateral ganglia ... Celiac Superior mesenteric Inferior mesenteric Aorticorenal Nerve plexuses ... Celiac Superior mesenteric Aorticorenal Inferior mesenteric Superior hypogastric Inferior hypogastric Consists of mixture of preganglionic parasympathetic fibers, pre- & postganglionic sympathetic fibers, and associated collateral ganglia ? Nerve plexuses 1. Preganglionic sympathetic fibers from thoracic levels of the sympathetic trunk 2. Synapse to postganglionic sympathetic neurons of celiac, superior mesenteric and aorticorenal ganglia Greater, lesser, & least splanchnic nn. 1. Preganglionic sympathetic fibers from upper lumbar sympathetic trunk 2. Synapse to postganglionic sympathetic fibers of inferior mesenteric ganglion Lumbar splanchnic n. 1. Preganglionic parasympathetic fibers from Vagus nn. 2. Vagal fibers enter abdominal cavity running on esophagus 3. Pass through w/o synapsing celiac, superior mesenteric, aorticorenal, inferior mesenteric and superior hypogastric plexuses Vagal nerve fibers 1. Preganglionic parasympathetic fibers from S2-S4 spinal cord 2. Pass through inferior hypogastric plexus 3. Continue on to supply pelvic organs. Pelvic splanchnic nerves Preganglionic parasympathetic fibers _____ synapse in plexus. do NOT Exiting from plexus are _____ sympathetic and _____ parasympathetic fibers that distribute with arteries to target organs. postganglionic preganglionic Nerve fibers run w/ branches of celiac trunk to stomach, liver, spleen, duodenum and pancreas. Celiac plexus Via superior mesenteric artery to small intestine, cecum, ascending colon, and first part of transverse colon. Superior mesenteric plexus Via renal arteries to kidneys. Aorticorenal plexus Via inferior mesenteric artery to second part of transverse colon, descending colon, sigmoid colon and rectum. Inferior mesenteric plexus Via internal iliac artery to bladder, anal canal, uterus, vagina and prostate gland. Inferior hypogastric plexus also called pelvic plexus. Superior and inferior hypogastric plexus Preganglionic parasympathetic fibers synapse onto postganglionic parasympathetic fibers in ... terminal ganglia (in or near target organ) Adrenal medulla receives direct preganglionic sympathetic innervation from ... greater splanchnic nerve Adrenal medulla cells are modified _____ neurons. postganglionic sympathetic Sympathetic Nerve: Origin: ... Sympathetic Nerve: Origin: ... Sympathetic Nerve: Origin: ... Sympathetic Nerve: Origin: ... Sympathetic Nerve: Origin: ...