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86 Cards in this Set
- Front
- Back
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Bony areas of abdominal cavity
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1. 5 lumbar vertebrae
2. iliac crest 3. sacrum and ala 4. lower costal angle |
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Muscles of abdominal cavity
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1. Diaphragm
2. Quadratus Lumborum 3. Psoas major 4. Psoas minor 5. Iliacus 6. Iliopsoas (compound muscle of PM w/ iliacus) |
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Quadratus Lumborum (QL)
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-rectangular muscle
-cephalad attachment to 12th rib -caudal attachments to iliac crests -continuous w/ in same plane as transversus abdominis muscle -helps extend back -innvervated by ventral rami of lowest thoracic and upper 3 lumbar nerves (T12-L3) -lies adjacent to transverse processes of lumbar vertebrae and lateral to superior part of psoas major |
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Psoas Major
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-tenderloin
-strongest flexor of hip (bringing knee up to hip) -innervated by L1-L3 ventral rami -very deeply placed muscle--some therapists try to massage this muscle -combines w/ iliacus to attach to lesser trochanter of femur as ileopsoas muscle -extends somewhat inferiorly at oblique trajectory (lateral) from lumbar spine and inserts on lesser trochanter |
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Ileopsoas Muscle
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-combination of Psoas Major and Iliacus
-attaches directly to lesser trochanter of femur for powerful flexion of hip -helps form part of femoral triangle (lateral 1/2 of floor) |
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Psoas minor
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-seen in about 50% of people with ethnic differences
-atavistic muscle like palmaris longus (not found in everyone) -innervated by L1 -arises primarily from transverse processes of lumbar vertebrae -runs superficial to psoas major -attaches to iliopubic eminence |
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Where does the abdominal aorta bifurcate?
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-L4
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What does the abdominal aorta bifurcate into?
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-right and left common iliac arteries
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What do the right and left common iliac arteries branch into?
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-right and left external and interal iliac arteries
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Iliacus muscle
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-other half of iliopsoas
-fills iliac fossa -corresponding muscle to infraspinatus in lower extremity -innervated by femoral nerve -acts w/ psoas major to flex thigh and stabalize hip joint |
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Diaphragm
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-IVC pierces central tendon of diaphragm
-esophageal hiatus -right crufa sternocostal foramen -underside supplied by inferior phrenic arteries -innervated by phrenic nerves |
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Central tendon of diaphragm
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-IVC pierces this
-central tendon does not compress IVC but opens up and holds IVC taught acting as a siphon to bring venous return from lower torso to right atrium of heart -IVC pierces diaphragm at T8 |
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Esophageal hiatus
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-T10
-contributed to primarily by right crura -2-3 inches to left of midline -carries anterior and posterior vagal trunks and esophageal branch of left gastric artery |
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Aortic hiatus
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-T12
-opening posterior to diaphragm -transmits aorta, azygos vein, and thoracic duct -aorta passes between crura of diaphragm posterior to the median acruate ligament |
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Crura of diaphragm
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-the little lets on the midline anterior to the vertebral bodies in lumbar region
-get pierced by different structures |
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Left crus of diaphragm
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-gets pierced by hemiazygos
-arises from only the first two or three lumbar vertebrae |
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Right crus of diaphragm
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-attached to Treitz ligament
-larger and longer than left crus -arises from first three or four lumbar vertebrae |
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Arcuate Ligaments
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-thickenings of fascia near the posterior inferior attachment of the diaphragm
-laterial, medial, and median arcuate ligaments |
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Median Arcuate Ligament
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-unites left and right crura
-passes over the anterior surface of aorta |
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Medial arcuate ligaments
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-thickening of fascia covering psoas muscles
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Lateral arcuate ligaments
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-thickenings of fascia covering quadratus lumborum muscles
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Sternocostal foramen
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-anterior, just lateral to xiphoid process
-point where internal thoracic a. sends off superior epigastric that then gains access to anterior abdominal wall -site of Morgagni herniation -between sternal and costal attachments of diaphragm |
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Vertebrocostal trigone
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-site of Bochdalek herniations
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What does the right phrenic nerve travel with through the diaphragm?
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IVC
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Left phrenic nerve
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-directly pierces diaphragm wher eit aborizes on inferior surface
-supplies the entire diaphragm with motor fibers -supplies central portion of diaphragm w/ sensory fibers |
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Inferior phrenic arteries
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-usually the first branches of descending abdominal aorta
-occasionally branches of celiac trunk -run off to form a tentacular vessel to supply underside of diaphragm |
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Dunbar's syndrome
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-inadequate distribution of bloodflow, especially to celiac trunk
-can be caused by compression of aorta by median arcuate ligament |
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Does the aorta pierce the diaphragm?
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-no, it runs behind it
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What are the unpaired vessels of the abdominal region?
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-celiac trunk
-SMA -IMA |
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Artery of Adamkiewicz
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-left side, uper lumbar artery region
-very important in supplying distal spinal cord -**if you have an abdominal aortic aneurism, you should make sure that the patient can move lower extremities after operation |
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Paired visceral branches of abdominal arteries
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-Suprarenal aa.
-Renal aa. -Gonadal aa. (ovarian or testicular) |
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Paired somatic/parietal branches of abdominal arteries
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-Lumbar aa. (pass around the sides of superior 4 lumbar vertebrae to supply posterior abdominal wall)
-Inferior phrenic arteries (supply inferior surface of diaphragm and suprarenal glands) |
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Unpaired parietal branch of abdominal arteries
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-Median sacral artery
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Median sacral artery
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-arises from aorta at its bifurcation and descends into lesser pelvis
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Ascending lumbar vein
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-connects common iliac veins to lumbar veins
-has connections to left renal vein -communicates perpendicularly w/ subcostal vein to form azygos on right and hemiazygos on left |
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Cisterna chyli
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-dilated proximal portion of thoracic duct as it ascends through aortic hiatus
-located just deep to right crus of diaphragm |
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Lumbar plexus
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-collection of ventral rami L1-L4
-located w/in psoas major anterior to lumbar transverse processes -largest branch is femoral nerve -Consists of: 1. Obtruator nerve (L2-L4) 2. Femoral nerve (L2-L4) 3. Lumbrosacral trunk (L4-L5) 4. Ilioinguinal and Iliohypogastric nerves (L1) 5. Genitofemoral nerve (L1-L2) 6. Lateral cutaneous nerve of thigh (L2,L3) |
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Intercostal/Subcostal nerve
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-may or may not be considered part of lumbar plexus
-called subcostal nerve (T12) because it doesn't have a rib underneath it -ventral ramus of T12 -runs over surface of quadratus lumborum -arise in thorax and pass posterior to lateral arcuate ligaments into abdomen -run inferolaterally -pass through transverse abdominal and interal oblique muscles -supply external oblique and skin of anterolateral abdominal wall |
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Iliohypogastric and Ilioinguinal nerves
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-L1
-arise from anterior ramus of L1 -enter abdomen posterior to medial arcuate ligaments -pass inerolaterally, anterior to quadratus lumborum -pierce transverse abdominal muscles near anterior superior iliac spines -pass through internal and external oblique muscles -supply abdominal muscles and skin of pubic and inguinal regions |
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Ilioinguinal nerve
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-often thought to be a component of iliohypogastric nerve
-innervates patch of skin on anterior thigh -travels out with spermatic cord -superficial to spermatic cord or round ligament of uterus -L1 |
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Iliohypogastric nerve
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-innervates the muscles it traverses
-ends and supplies skin over pubic bone -L1 -innervates pyramidalis |
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Lateral femoral cutaneous nerve
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-travels over iliacus muscle
-exits medial to ASIS -innervates a patch of skin down lateral thigh -entrapment of this nerve can lead to neuralgia parastetica -L2, L3 |
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Neuralgia parastetica
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-results from entrapment of lateral femoral cutaneous nerve
-most commonly seen in new army recruits due to long days of marching |
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Femoral nerve
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-L2-L4
-largest nerve of lumbar plexus -emerges from lateral border or psoas major -innervates iliacus -passes deep to inguinal ligament to anterior thigh -supplies flexors of hip and extensors of knee -innervates most muscles of anterior thigh -has cutaneous branches that supply skin over anterior thigh and medial thigh and leg regions -comes out of lumbar plexus just lateral to psoas major |
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Opterator nerve
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-L2-L4
-emerges from medial border of psoas major -passes through pelvis to medial thigh -supplies adductor muscles -travels medial to psoas major through obturator foamen -supplies medial thigh muscles and skin |
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Obturator foramen
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-large hole through pelvic bone through which obturator nerve passes
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Lumbrosacral trunk
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-L4-L5
-passes over ala of sacrum -descends into peovis -participates in formation of sacral plexus along w/ anterior rami of S1-S4 |
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T10 cutaneous branch of ilioinguinal nerve
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-travels down spermatic cord or round ligament
-changes name to anterior scrotal or anterior labial nerve -supplies 1/3 skin to scrotum or labia |
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Does the ilioinguinal have a lateral cutaneous branch?
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no
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Genitofemoral nerve
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-L1-L2
-pierces anterior surface of psoas major -runs inferiorly on psoas major deep to psoas fascia -divides laterally to common and external iliac arteries into femoral and genital branches |
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Genital branch of genitofemoral nerve
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-enters ilioinguinal canl through deep ring and leaves through superficial ring
-runs out to supply cremaster muscle and sking of scrotum/labia -motor arm of cremaster reflex (ilioinguinal nerve is sensory arm) |
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Femoral branch of genitofemoral nerve
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-runs out to skin over femoral triangle
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What does the cremaster reflex test for?
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-intergrity of L1
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Preaortic plexus
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-rich plexus network on anterior aorta
-nerves strand down midline, extended from thorax down into abdomen -various ganglia associated w/ this plexus -reinforced by sympathetic trunk in lumbar region -plexus leaves association w/ anterior aorta and runs down into pelvis |
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Splanchnic nerves
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-pierce crura of diaphragm
-presynaptic fibers extending off thoracic sympathetic trunk -pierce diaphragm and run out and synapse in ganglia associated w/ major vessels of proximal aorta (celiac trunk, SMA, aorticorenal ganglia) -postganglionic fibers continue down anterior aorta, some passing out to various structures such as ureter |
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Superior hypogastric plexus
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-plexus inferior to bifurcation of aorta at L4
-primarily sympathetic plexus -carries motor and sensory fibers, which are not by definition included in autonomic nervous system -in the pelvis, S2-S4 merge w/ descending superior hypogastric plexus |
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Inferior Hypogastric plexus
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-occurs once S2-S4 parasympathetic fibers merge w/ descending superior hypogastric plexus and disseminate to viscera of pelvis
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Lumbar sympathectomy
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-cutting the lumbar sympathetic trunk
-done for different reasons -used to be done for hypertension to create more of a reservoir for blood of body to reduce BP but not done much now b/c we have good drugs for this -also done for lower extremity disease -interferes w/ ejaculation in men |
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Vagus nerve
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-anterior and posterior vagal trunks supply parasympathetic innervation of abdominopelvic region up to splenic flexure
-after splenic flexure, parasympathetics brought by S2-S4 |
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What is the primary contributor to celiac plexus?
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-posterior vagal trunk
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Presacral neurectomy
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-cut superior hypogastric plexus near promontory of sacrum
-done for intractable pain coming from a pelvic organ -cuts inflow into spinal cord -problem is that not all viscera of pelvis have pain fibers that travel in sympathetic system, but most do |
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Parts of Kidney
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-cortex
-inner medula -renal pelvis -ureter -major calices -minor calices -renal pyramid -hilum |
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Major calices
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-1-3 per kidney
-large tributaries into renal pelvis -formed by merging of 2-3 minor calices |
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Minor calices
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-7-14 per kidney
-one drop of urine enters per heart beat -merge to empty into major calices |
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Where are the kidneys located?
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-retroperitoneal
-posterior abdominal wall at level of T12-L3 vertebrae -right kidney lies slightly lower than left due to relationship to liver -11th and 12th rib associated w/ left kidney -only 12th rib associated w/ right kidney -enveloped by renal fascia |
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Renal pyramid/renal papilla
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-indents each minor calyx
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What has an anterior relationship to right kidney?
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-duodenum
-liver -ascending colon |
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What has an anterior relationship to left kidney?
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-stomach
-spleen -pancreas -jejunum -descending colon |
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Renal pelvis
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-funnel shaped end of ureter that lies w/ in renal sinus
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Renal sinus
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-space within kidney that is occupied by renal pelvis, calices, vessels, nerves, and fat
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Renal capsule
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-fibrous capsule that can be stripped off surface of kidney
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Renal cortex
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-outer zone of kidney
-approx. 1/3 of depth |
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Renal medulla
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-inner zone of kidney
-consists of renal pyramids and renal columns -approx. 2/3 of depth |
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Renal papilla
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-apex of renal pyramid that projects into minor calyx
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Minor calyx
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-cup like chamber that is beginning of extrarenal duct system
-several combine to form a major calyx |
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Gerota's (renal) fascia
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-Anterior part = Tolt's fascia
-Posterior part = Zuckerkandt layer |
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Left renal vein
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-receives adrenal vein, inferior phrenic vein, left gonadal vein, ascending lumbar vein
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Right renal vein
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-receives just adrenal vein
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What should you look for if someone presents w/ huge swollen left testicle?
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-compression of renal vein
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5 branches of renal artery
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1. apical
2. inferior 3. posterior 4. anterior superior 5. anterior inferior |
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Are the branches of the renal artery terminal or do they anastamose?
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-terminal
-if you were to clip a branch, that part of the kidney would necrose |
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Brodel's white line
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-watershed area of kidney
-located between anterior superior and posterior branches or renal artery -avascular area |
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Ureters
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-25 cm long
-blood supply mainly from renal artery -innervated by splanchnic nerves -3 common areas of constriction 1. pelvic rim whre ureter joins bladder 2. beginning of ureter 3. where ureters cross bring of pelvic inlet |
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Common places for kidney stone to become trapped
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1. junction of ureters w/ renal pelves
2. where ureters cross brim of pelvic inlet 3. during passage of ureters through wall of urinary bladder |
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Right Adrenal Gland
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-pyramidal shaped
-lies anterior to the diaphragm -makes contact w/ IVC anteromedially and liver anterolaterally |
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Left Adrenal Gland
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-semilunar shaped
-related to spleen, stomach, pancreas, and left crus of diaphragm |
