Posterior Abdominal Wall

Front 1

Which is outside? Abdominal or peritoneal cavity?

Back 1

Abdominal

Front 2

Peritoneal cavity

Back 2

Around the organs

Front 3

Primary retroperitoneal structures are innervated by:

Back 3

Ventral primary rami: will feel sharp, localized pain

Front 4

Examples of primary retroperitoneal structure

Back 4

Two major muscles of the posterior wall; vertebral body; aorta, SVC, kidneys

Front 5

Innervation of the intraperitoneal structures

Back 5

Vagus nerve and splanchnic nerves

(diffuse/referred pain)

Front 6

Secondary retroperitoneal examples

Back 6

Descending and ascending colon

Front 7

Secondary retroperitoneal innervation

Back 7

Similar to intraperitoneal- diffuse, referred pain

Front 8

Aponeuroses of internal abdominal oblique and transversus abdominus do this, posteriorly

Back 8

Split to connect to spinous process (posteriorly-- the thoracolumbar fascial sheath) and transverse process (anteriorly)

Front 9

Abdominal muscles inside the abdominal cavity

Back 9

Psoas major, psoas minor, quadratus lumborum

Front 10

Psoas major origin and insertion

Back 10

Origin: transverse processes of lumbar vertebrae, sides of bodie (lateral vertebral bodies) of T12-L5 vertebrae, intervening intervertebral discs

Insertion: lesser trochanter of femur (slides down deep to the inguinal ligament)

Front 11

Psoas minor origin and insertion

Back 11

Origin: Vertebral margins of T12-L1 vertebrae, corresponding intervertebral discs

Insertion: Pectineal line, ileopectinealeminence

Front 12

Contract that psoas major and this happens

Back 12

Thigh is flexed (you can lift your thigh)

Injured? One will go into fetal position-- will minimize abdominal pain

Front 13

How many people have psoas minor?

Back 13

50% of people have it; weak flexor of the spine

Will be slip of muscle directly on top of psoas major

Front 14

Illiacus m. origin and insertion

Back 14

Origin: superior 2/3 iliac fossa, ala of sacrum, anterior sacro-iliac ligaments

Insertion: Lesser trochanter of femur and shaft inferior to it, and to psoas major tendon

Front 15

Big fan-like muscle

Back 15

Illiacus m.

Front 16

When you get inferior toward the trochanter of the femur, this happens with the muscle.

Back 16

Fibers start to blend together (psoas major and illiacus)

Front 17

Action of the iliacus muscle (hint: same as psoas major)

Back 17

Flexor of the thigh

Front 18

Quadratus Lumborum origin and insertion

Back 18

Origin: Medial half of inferior border of 12th rib, tips of lumbar transverse processes

Insertion: Iliolumbar ligament, internal lip of iliac crest

Front 19

Function of the quadratus lumborum

Back 19

Lateral flexion of the vertebral column

Front 20

Medial arcuate ligament

Back 20

Arches over psoas major

Front 21

Lateral arcuate ligament

Back 21

Arches over quadratus lumborum

Front 22

Median arcuate ligament

Back 22

MEANS MIDLINE

Will pass the aorta through this

Will not compress when we breathe

Front 23

Three holes in the diaphragm

Back 23

Caval foramen (T8), Esophageal hiatus (T10), Aortic hiatus (T12)

Front 24

"Legs" of the median arcuate ligament

Back 24

Left and right crus of the diaphragm

Front 25

Lumbar plexus is (somatic/autonomic/mixed)

Back 25

MIXED

Front 26

Nerve below Rib 12 and what it innervates

Back 26

Subcostal nerve

- innervates abdominal dermatome

Front 27

Lumbar plexus

Back 27

Communication between the lumbar ventral primary rami (INSIDE of psoas major m.)

Front 28

Name the nerves coming off of the lumbar plexus

Back 28

Subcostal nerve

Iliohypogastric nerve

Ilioinguinal nerve

Lateral cutaneous nerve of the thigh

Femoral nerve

Genitofemoral nerve

Obturator nerve

Front 29

Iliohypogastric nerve: where does it go?

Back 29

-innervates abdomen superior to inguinal ligament but ends in the hypogastric region

Front 30

Ilioinguinal nerve

Back 30

-innervates inguinal region and tissue around the pubic symphysis

Front 31

Lateral cutaneous nerve of the thigh

Back 31

-innervates the anterolateral skin regions of the thigh

Front 32

Femoral nerve

Back 32

-innervates muscles of the anterior compartment of the thigh (travels with the femoral artery and vein)

Front 33

Genitofemoral nerve

Back 33

-innervates the skin of the genitals and femoral region

-pierces through the anterior surface of the psoas major muscle

Front 34

Obturator nerve

Back 34

-sneaks out along the midline

-innervates the muscles of the medial compartment of the thigh

Front 35

Sympathetic chain in the abdomen

Back 35

Will continue in the lumbar region (thoracolumbar)

Sympathetics will hitchhike to innervate vascular elements and sweat glands in the skin

Front 36

Parasympathetics will hitchike with which lumbar ventral primary rami branches?

Back 36

NONE-- parasympathetics do not innervate the body wall.

All will contain sympathetics, however.

Front 37

Moment the aorta passes through the diaphragm it is called...

Back 37

Abdominal aorta (starting at T12)

Front 38

Aorta bifurcates to become the common iliac arteries at this level

Back 38

L4

Front 39

The three categories of arteries off of the aorta

Back 39

-unpaired anteriorly directed to viscera

-paired laterally directed to organs

-paired posteriorly directed to body wall

Front 40

Unpaired arteries directed anteriorly to viscera

Back 40

-Celiac

-Superior mesenteric

-Inferior mesenteric

Front 41

Level at which the superior mesenteric artery comes off the aorta

Back 41

L1

Front 42

Celiac trunk vetebral level

Back 42

T12

Front 43

Gives rise to esophageal branches

Back 43

Left gastric artery

Front 44

Anastomose along the lesser curvature of the stomach

Back 44

Right and left gastric artery

Front 45

Short Gastric Arteries

Back 45

Off of the splenic artery

Front 46

Marginal artery

Back 46

Connecting (anastomosing) artery allowing passage of blood from superior mesenteric supply regions to inferior mesenteric supply regions

Front 47

Critical point

Back 47

Region between the last sigmoidal artery and the superior rectal artery fields

-beyond this, no anastomosing supply is available for the rectum

Front 48

If rectal artery is snipped during surgery, what will happen?

Back 48

This is a problem because critical point is just prior to this and there is no remaining alternate blood supply.

Front 49

Paired lateral arteries (3 pairs)

Back 49

Middle suprarenal arteries (to adrenal glands), renal arteries, gonadal arteries (testicular or ovarian arteries)

Front 50

The gonadal arteries: where do they come off of the aorta?

Back 50

They rarely come off at the same location. Usually the left comes off higher than the right.

Front 51

Segmental arteries

Back 51

Inferior phrenic arteries, lumbar arteries (analogous to intercostal arteries), median sacral artery

Front 52

Inferior phrenic arteries: what do they supply?

Back 52

-supply to the inferior surface of the diaphragm, arising immediately at the aortic hiatus

Front 53

Lumbar arteries: what do they supply?

Back 53

-arise at each vertebral level

-supply the posterior wall

-analogous to the intercostal arteries

-supplies the body wall

Front 54

Median sacral artery: what does it supply?

Back 54

-arises posterior at the iliac bifurcation point

-supplies the sacrum

*unpaired

Front 55

Pelvic hemorrhage therapeutic response

Back 55

Compression where the abdominal aorta is and restrict blood flow into the pelvis

This compressed the abdominal aorta against the vertebral column

Front 56

Decrease of elastin where? And what is the consequence?

Back 56

Aorta from kidneys to bifuraction into iliacs

Consequence is that this region is more susceptible to aneurysm (abdominal aortic aneurysm AAA)

Front 57

Classical portal system

Back 57

intestinal capillaries>small veins>larger veins>portal vein>liver (portal vein branches)>intrahepatic veins>smaller veins>liver capillaries (sinusoids)>small veins (central veins)>large veins (hepatic veins)>IVC>Right side of heart

Front 58

Posterior wall venous return

Back 58

Renal veins, gonadal veins, suprarenal veins (posterior retroperitoneal regions)

Drain back to IVC directly OR azygous/hemiazygous

Front 59

How does the blood that goes to the intestines get back to the heart?

Back 59

Through the portal venous system

Front 60

If you have a blockage in the IVC in the abdomen, what will happen?

Back 60

Blood is rerouted by azygous or hemiazygous to bypass the blockage

Front 61

If you have blockage in liver region, what will happen?

Back 61

Portal hypertension

-spleen will swell

-back pressure of blood and venous swelling

-Varices around the rectum

Front 62

Umbilical vein reopens. Why?

Back 62

Blockage in portal vein system, causes the old umbilical vein to open and swell around the umbilicus

Front 63

Lymphatics (inferior to the diaphragm) will dump here

Back 63

Cisterna chyli: base of the lymphatic duct

Front 64

Where does the cisterna chyli empty into?

Back 64

Thoracic duct

Front 65

Where does the thoracic duct return lymph to?

Back 65

Left venous angle in the thorax

Front 66

Kidney locations

Back 66

Between T12 and L3; located anterior to the psoas major muscle and inferior part of the diaphragm

Front 67

Surprarenal glands

Back 67

Located anterior to the inferior part of the diaphragm