Posterior Abdominal Wall
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73 terms
Terms | Definitions |
|---|---|
 quadratus lumborum attachments | superiorly - rib 12, medially = TP's L1=L4, inferiorly - iliolumbar ligament, iliac crest |
| quadratus lumborum: action and innervation | Inn: T12-L4 ventral rami action: unilateral - lateral bending, bilateral - extension of trunk |
| psoas major attachments | superiorly - lateral 12th vertebrae, inferiorly - lesser trochanter of the femur (travels under the inguinal ligament) = ROUTE FOR SPREAD OF INFECTION -> ABSCESS OF THIGH b/c crosses hip joint |
| psoas major: innervation and action | Inn: L1-L3 ventral rami Action: flexes the hip joint |
| iliacus attachments | superiorly - superior 2/3 iliac fossa, ala of sacrum, sacroiliac ligaments, inferiorly - lesser trochanter of femur |
| iliacus: action and innervation | Inn: femoral nerve (L2-L4 ventral rami) Action: flexes the thigh |
| iliopsoas muscle | chief flexor of thigh |
| psoas minor attachments | superiorly - lateral sides of T12-L1 vertebrae, inferiorly - superior pubic ramus of pectineal line (DOESN'T cross hip joint) |
| psoas minor action | weak anterior flexion of trunk |
| iliopsoas test | tests for inflammation of muscle by extending leg and hip back; tension of the deep fascial covering produces pain = positive sign of TB or appendicitis |
| median arcuate ligament | formed by fibers of L and R crus of the diaphragm; forms the gap through which the aorta runs |
| medial arcuate ligament (of the posterior abdominal wall) | superior thickening of the deep fascia of psoas major; runs from lumbar v. to T.P of L1 |
| lateral arcuate ligament (of the posterior abdominal wall) | superior thickening of the deep fascia of quadratus lumborum; runs from T.P of L1 to 12th rib |
| sternocostal hiatus | passageway for superior epigastric artery |
| esophageal hiatus | formed by the R crus of the diaphragm |
| R crus of diaphragm | larger and lower origin (L1-L3/4) |
| L crus of diaphragm | smaller and higher origin (L1-L2/3); forms the suspensory ligament of the duodenum (Treitz) |
| lumbocostal triangle | diaphragmatic area lacking muscle fibers; only made of CT so considered a weak spot; lateral and just above rib 12; site of traumatic diaphragmatic hernias |
| morgagni hernia | rare; parasternal or rectosternal; likely due to septum transversum defect (= anterior diaphragm) |
| bochdalek hernia | more common and along P/L diaphragm; likely due to defect in pleuroperitoneal folds |
| passing the diaphragm: T8, T10, T12 | T8= IVC, T10= esophagus, vagal trunks, T12= aorta, azygos, hemiazygos, thoracic duct |
| motor innervation to diaphragm | C3,4,5 = phrenic nerve innervates the muscle fibers; therefore, irritated diaphragm refers pain to shoulder |
| sensory innervation to diaphragm | phrenic nerve (C3-5) innervates central tendon vs. intercostal and subcostal nerves T5-12) innervate peripheral portion |
| hiccup | irritated diaphragm or phrenic nerve causes spastic contractions of the diaphragm as air's suddenly drawn in |
| lesion of phrenic nerve | causes paralysis of a hemidiaphragm and paradoxial (opposite) mvmt of the deinnervated diaphragm |
| pericardiacophrenic a + v | branches from internal thoracic a; supplies pericardial sac and central tendon of diaphragm |
| musculophrenic a + v | branches from internal thoracic a; supplies ribs, intercostal spaces, anterior diaphragm |
| superior phrenic a + v | branches from thoracic aorta before crossing diaphragm; supplies posterior diaphragm |
| inferior phrenic a + v | branches form abdominal aorta after crossing diaphragm; supplies posterior diaphragm |
| aortic aneurysm | weakened abdominal aorta walls due to increased P causes walls to inc. in diameter with 90% mortality with rupture; pulse of aneurysm can be transferred to the anterior abdominal wall; TX = stent to handle P |
| L renal vein | long because located to R of aorta therefore receives blood from L suprarenal, and L gonadal veins; can be compressed by SMA |
| R gonadal vein | drains directly into IVC |
| flow of abdominal lymphatics | visceral nodes > parietal nodes > cisterna chyli (posterior to IVC at L1/2 v.) > thoracic duct |
| visceral abdominal lymph nodes | associated with abdominal organs and mesenteries |
| parietal abdominal lymph nodes | retroperitoneal; in close association with large BVs |
| lumbar plexus | ventral rami if L1-L5 that supply the abdominal wall and lower extremities (NO viscera!_ |
| subcostal nerve (T12) | nerve on the posterior abdominal wall but NOT a part of the lumbar plexus |
| iliohypogastric nerve (L1) | SENSORY to skin along the iliac crest |
| ilioinguinal neve (L1) | SENSORY to skin along scrotum/labia majora by dropping into the inguinal canal |
| genitofemoral nerve (L1 &L2) | femoral branch: sensory to skin of anterior thigh genital branch: M = motor to cremaster muscle and sensory to scrotal skin vs. F= sensory to labia majora |
| lateral femoral cutaneous nerve (L2 & L3) | SENSORY to skin of lateral thigh |
| femoral nerve (L2-4) | 1st 2 branches supply iliacus muscle, then gives off anterior branches to supply SKIN of thigh and posterior branches to supply quadriceps muscle |
| obturator nerve (L2-4) | SENSORY to skin on medial aspect of thigh MOTOR to ADDuctors of thigh |
| lumbrosacral trunk (L4 & L5) | drops into pelvis to join the sacral plexus and contribute to sciatic nerve (supplies back and posterior aspect of the lower extremity) |
| kidney | retroperitoneal organ that removes water, salts, and nitrogenous wastes from blood to maintain homeostasis and produce urine |
| location of kidneys | T12-L3 vertebral levels with hilum of L kidney at L1 and hilum of R kidney at L2 |
| 3 narrowings where kidney stones (caliculi) can cause blockage | -where renal pelvis narrows to form ureter -where ureter crosses iliac vessels -where ureter is in wall of bladder |
| renal and ureteric caliculi | SM of ureter doesnt readily expand so kidney stones 3 mm or larger can block the ureteric passageway |
| loin to groin pain | kidney stones irritate the extensively innervated ureter; T11-L2 afferents = loin pain vs. L1 and L2 = groin pain in scrotal / labia / ant. thigh areas |
| renal vein entrapment (nutcracker syndrome) | narrowed L renal vein due to SMA entrapment causes backing up of venous blood into kidney; SX= blood in urine (hematuria), abdominal pain, testicular pain, LLQ pain in females; TX= lay down |
| renal columns and cortex | contain glomeruli |
| renal glomeruli | capillary tufts where initial filtration begins via fluid leakage |
| renal papillae | collecting points for urine located at the apex of renal pyramids |
| minor calyx | caps each renal papillae at the apex of the renal pyramid and collects urine from the ducts opening up into the apex |
| major calyx | 1 or more minor calices |
| renal pelvis | 2 or more major calices; runs out of hilum of kidney and narrows down to form the ureter |
| renal sinus | cavity withing the kidney continuous with the hilum; contains fat, calices, renal pelvis, renal vessels, autonomics |
| renal calicul "kidney stones" | very concentrated salt solution released at the renal papilla precipitates out as stones; can lead to 'loin to groin' pain |
| flow of urine | apex > minor calyx > major calyx > renal pelvis > ureter |
| getting to the inside of a kidney | parietal peritoneum > PARAnephric fat > renal fascia > PERInephric fat > fibrous capsule > kidney |
| paranephric fat | 1st layer of fat under the parietal peritoneum; ends at the renal fascia |
| renal fascia "Gerota's capsule" | thin membrane that splits around the kidney; posteriorly attached to psoas major fascia and laterally continues as transversalis fascia |
| perinephric fat | 2nd layer of fat between the renal fascia and fibrous capsule of the kidney; continuous with the fat in the renal sinus |
| floating kidney | loosened kidney due to poor vertical anchorage hand and stress the renal vessels; kidney transplant puts kidneys in iliac fossa on iliacus muscle which can support the kidney |
| suprarenal cortex | produces and secretes corticosteriods and androgens to regulate salts and carbohydrates in blood |
| suprarenal medulla | chromaffin cells produce and secrete catocholamines (E and NE); innervated by preganglionic sympathetic greater splanchnic nerves |
| suprarenal gland | retroperitoneal organ along the posterior abdominal wall at T11; surrounded by its own fibrous capsule, peri/pararenal fat and renal fasica |
| superior suprarenal artery | suprarenal branch off of inferior phrenic artery |
| middle suprarenal artery | suprarenal branch off of abdominal aorta |
| inferior suprarenal artery | suprarenal branch off of renal artery |
| L suprarenal vein | suprarenal vein that drains into L renal vein |
| R suprarenal vein | suprarenal vein that drains into IVC |
| preganglionic sympathetic greater splanchnics | innervated the chromaffin cells in the medulla of the suprarenal glands |
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