Posterior Abdominal Wall & Diaphragm Anatomy
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Questions and Answers

Which muscle is primarily responsible for trunk extension in the posterior abdominal wall?

  • Quadratus lumborum
  • Erector spinae group (correct)
  • Psoas major
  • Illicus

    • What is a potential symptom of a psoas abscess?

  • Lower back stiffness
  • Increased appetite
  • Severe pain during thigh flexion (correct)
  • Enhanced mobility

    • At which vertebral level does the esophagus pass through the diaphragm?

  • TV8
  • TV12
  • LV1
  • TV10 (correct)

    • Which of the following arteries emerges near the superior mesenteric artery (SMA)?

    <p>Middle suprarenal artery (B)</p> Signup and view all the answers

    What results from a failure of the pleuroperitoneal fold to close the canal?

    <p>Congenital diaphragm hernia (C)</p> Signup and view all the answers

    Which structure is associated with the lateral arcuate ligament?

    <p>Quadratus lumborum (A)</p> Signup and view all the answers

    Which of these is an unpaired branch of the abdominal aorta?

    <p>Celiac trunk (C)</p> Signup and view all the answers

    What complication arises from the weakness of the diaphragm near the esophageal hiatus?

    <p>Hiatal hernia (B)</p> Signup and view all the answers

    What connects the two crura of the diaphragm?

    <p>Tendinous arches (C)</p> Signup and view all the answers

    Which condition involves the compression of the left renal vein?

    <p>Nutcracker syndrome (D)</p> Signup and view all the answers

    What condition results from the compression of the third part of the duodenum between the SMA and aorta?

    <p>SMA syndrome (C)</p> Signup and view all the answers

    Which structure lies to the right of the abdominal aorta?

    <p>Inferior vena cava (C)</p> Signup and view all the answers

    Which option describes the clinical significance of IVC filters?

    <p>Block the passage of DVT clots to the heart/lungs (B)</p> Signup and view all the answers

    In May-Thurner syndrome, which vessels are primarily involved in the compression?

    <p>L common iliac vein and R common iliac artery (A)</p> Signup and view all the answers

    Which lumbar plexus nerve provides cutaneous innervation to the anterior thigh?

    <p>Femoral nerve (A)</p> Signup and view all the answers

    What is the primary anatomical landmark marking the beginning of the thoracic duct?

    <p>Cisterna chyli (A)</p> Signup and view all the answers

    What complication is associated with abdominal aortic aneurysm (AAA) if not addressed?

    <p>Rupture leading to fatality (A)</p> Signup and view all the answers

    Which channel receives lymph from the GI tract and accessory organs?

    <p>Pre-aortic channel (A)</p> Signup and view all the answers

    What surgical procedure is indicated for clearing cancerous retroperitoneal lymph nodes?

    <p>Retroperitoneal lymph node dissection (RPLND) (B)</p> Signup and view all the answers

    What effect does compression in the lumbar sympathetic trunk primarily have?

    <p>Sympathetic nervous response alteration (C)</p> Signup and view all the answers

    What is the primary function of the quadratus lumborum muscle in the posterior abdominal wall?

    <p>Lateral flexion of the trunk (B)</p> Signup and view all the answers

    Which structure is associated with the development of the diaphragm?

    <p>Septum transversum (D)</p> Signup and view all the answers

    What anatomical structure passes through the caval opening at T8?

    <p>Inferior vena cava (B)</p> Signup and view all the answers

    Which artery is paired and emerges near the superior mesenteric artery (SMA)?

    <p>Renal arteries (D)</p> Signup and view all the answers

    What is a common clinical symptom associated with a psoas abscess?

    <p>Severe pain during thigh flexion (D)</p> Signup and view all the answers

    Which of the following ligaments contains the thoracic duct?

    <p>Median arcuate ligament (B)</p> Signup and view all the answers

    Which branch of the abdominal aorta is unpaired and emerges at the level of TV12?

    <p>Celiac trunk (D)</p> Signup and view all the answers

    What condition arises from a failure of the pleuroperitoneal fold to close?

    <p>Congenital diaphragm hernia (A)</p> Signup and view all the answers

    Which structure carries the anterior and posterior vagal trunks as it passes through the diaphragm?

    <p>Esophageal hiatus (D)</p> Signup and view all the answers

    Which entity primarily experiences compression in Nutcracker syndrome?

    <p>Left renal vein (B)</p> Signup and view all the answers

    What condition is characterized by flank pain and blood in urine (hematuria) due to compression between specific structures?

    <p>Superior mesenteric artery syndrome (C)</p> Signup and view all the answers

    Which lymphatic channel is specifically associated with receiving lymph from the kidneys and suprarenal glands?

    <p>Para-aortic channel (D)</p> Signup and view all the answers

    Which nerve is responsible for providing innervation to the cremasteric muscle?

    <p>Genitofemoral nerve (A)</p> Signup and view all the answers

    What is the primary consequence of untreated abdominal aortic aneurysm (AAA)?

    <p>Rupture leading to life-threatening hemorrhage (B)</p> Signup and view all the answers

    In May-Thurner syndrome, which vein is compressed, leading to pain and swelling in the lower limb?

    <p>Left common iliac vein (D)</p> Signup and view all the answers

    What anatomical structure marks the beginning of the thoracic duct?

    <p>Cisterna chyli (B)</p> Signup and view all the answers

    Which nerve from the L2-L3 levels provides cutaneous innervation to the lateral thigh?

    <p>Lateral femoral cutaneous nerve (C)</p> Signup and view all the answers

    What is a potential complication of retroperitoneal lymph node dissection (RPLND)?

    <p>Formation of lymphatic leaks (D)</p> Signup and view all the answers

    The ascending lumbar veins are important for providing which of the following?

    <p>Collateral circulation if IVC is blocked (C)</p> Signup and view all the answers

    What role do IVC filters play in clinical practice?

    <p>Avoid passage of DVT clots into the heart/lungs (C)</p> Signup and view all the answers

    Flashcards

    Psoas Major Muscle Function

    Flexes the trunk and thigh.

    Quadratus Lumborum Muscle Function

    Assists in lateral flexion of the trunk.

    Diaphragm Anatomy - Crura

    Two parts of the diaphragm attached to the lumbar vertebrae. Right attaches to L1-L3, Left to L1-L2.

    Diaphragm - Esophageal Hiatus Location

    Located at T10, allows the esophagus to pass through the diaphragm with vagal nerves and blood vessels.

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    Diaphragm - Caval Opening Location

    Located at T8, allows the inferior vena cava to pass through the diaphragm.

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    Abdominal Aorta - Celiac Trunk

    Unpaired branch, supplying blood to the stomach, liver, and spleen - originates at TV12.

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    Abdominal Aorta - Superior Mesenteric Artery (SMA)

    Unpaired branch supplying blood to the small intestine, originates at LV1.

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    Congenital Diaphragm Hernia Cause

    Failure of pleuroperitoneal fold to close.

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    Psoas Abscess Symptoms

    Severe pain during thigh flexion, fever, weight loss, and malaise.

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    Diaphragm's Developmental Origin

    Develops from septum transversum, pleuroperitoneal folds, and posterior esophageal mesentery.

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    SMA syndrome

    Compression of the third part of the duodenum between the superior mesenteric artery (SMA) and the aorta.

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    Abdominal aortic aneurysm (AAA)

    A bulge or swelling in the abdominal aorta.

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    IVC

    Inferior vena cava. Major vein carrying deoxygenated blood from the lower body back to the heart.

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    Ascending lumbar veins

    Long veins providing alternative blood flow paths if the inferior vena cava is blocked.

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    May-Thurner syndrome

    Compression of the left common iliac vein by the right common iliac artery against the body of vertebra L5.

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    Cisterna chyli

    The beginning of the thoracic duct, formed from the convergence of abdominal lymphatic trunks.

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    Retroperitoneal lymph node dissection (RPLND)

    Surgery to remove cancerous lymph nodes in the retroperitoneal space.

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    Lumbar plexus nerves

    Nerves that supply sensory and motor innervation to the lower abdominal wall, groin, and thigh.

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    Subcostal nerve

    Nerve from T12 associated with the 12th rib and quadratus lumborum muscle, impacting sensation in the suprapubic area.

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    Prevertebral plexus

    Network of nerves surrounding the abdominal aorta and its major branches, continuing to the hypogastric plexus.

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    Inferior Vena Cava (IVC)

    Major vein in the abdomen that carries deoxygenated blood from the lower body back to the heart.

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    Posterior Abdominal Wall Muscles

    Muscles located behind the abdominal organs, supporting the trunk and moving the lower limbs. They include the erector spinae group, psoas minor, psoas major, iliacus, and quadratus lumborum.

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    Psoas Major Muscle

    A long muscle extending from the lumbar vertebrae to the femur, responsible for flexing the trunk and thigh.

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    Iliacus Muscle

    A deep muscle located in the iliac fossa of the pelvis, working together with the Psoas Major to flex the hip.

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    Quadratus Lumborum Muscle

    A muscle located in the lower back, connecting the last rib to the pelvis, responsible for lateral trunk flexion.

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    Diaphragm: Crura

    Two tendinous arms of the diaphragm, anchored to the lumbar vertebrae. The right crura connects to L1-L3, and the left crura connects to L1-L2.

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    Diaphragm: Esophageal Hiatus

    An opening in the diaphragm at T10, allowing the esophagus to pass through with nerves and blood vessels.

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    Diaphragm: Caval Opening

    An opening in the diaphragm at T8, allowing the inferior vena cava to pass through with the right phrenic nerve.

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    Diaphragm Development

    Forms from the septum transversum, pleuroperitoneal folds, posterior esophageal mesentery, and peripheral rim.

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    Abdominal Aorta: Unpaired Branches

    These branches supply blood to the digestive system and surrounding organs. They include the celiac trunk (TV12), SMA (LV1), and IMA (LV3).

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    Abdominal Aorta: Paired Branches

    These branches supply blood to specific organs, including the adrenal glands, kidneys, gonads, and muscle of the back. They include the inferior phrenic, middle suprarenal, renal, gonadal, and lumbar arteries.

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    Study Notes

    Posterior Abdominal Wall & Diaphragm

    • Musculoskeletal framework supports abdominal structures, including Gl tract, liver, pancreas, & spleen. Muscles move trunk & limbs, constrained superiorly by diaphragm.
    • Bones involved: ribs XI & XII, iliac crest & fossa, LV1-LV5 vertebral bodies & transverse processes, ala of sacrum.
    • Muscles:
      • Erector spinae group: trunk extension
      • Psoas minor: TV12-LV1, iliopubic eminence, trunk flexion
      • Psoas major: TV12-LV4, lesser trochanter, trunk & thigh flexion
      • Iliacus: iliac fossa, lesser trochanter, trunk & thigh flexion
      • Quadratus lumborum: rib 12 & TV12-LV5, iliac crest, lateral flexion.
    • Clinical correlation: psoas abscess: pus accumulating between psoas muscle & fascia, causing thigh pain, fever, weight loss, malaise.

    Diaphragm

    • Anatomy: two crura (R: LV1-LV3, L: LV1-LV2) joined at midline by 3 arches:
      • Median arcuate: contains aorta & thoracic duct
      • Medial arcuate: contains psoas major & sympathetic trunk
      • Lateral arcuate: contains quadratus lumborum.
    • Esophageal hiatus: TV10, esophagus, anterior/posterior vagal trunks, esophageal branches
    • Caval opening: T8, IVC, R phrenic nerve, L phrenic nerve, azygos & hemiazygos veins, thoracic splanchnics.
    • Developmental considerations: diaphragm's components, their origins (septum transversum, pleuroperitoneal folds, etc.).
    • Clinical correlation: hiatal hernia: weak diaphragm allows stomach to enter thorax.
    • Congenital diaphragm hernia: failure of pleuroperitoneal folds closing leads to gut entry.

    Abdominal Aorta

    • Unpaired branches: celiac trunk (TV12), SMA (LV1), IMA (LV3)
    • Paired branches: inferior phrenic, middle suprarenal & renal, gonadal (~LV2), lumbar (4 pairs LV1-LV4).
    • Clinical correlations: Nutcracker syndrome: L renal vein compression, flank pain, hematuria, & varicocele.
    • SMA syndrome: 3rd part of duodenum compression, intermittent intestinal pain, after meals.

    Abdominal Aortic Aneurysm (AAA)

    • Bulge/swelling in abdominal aorta, often ruptures.

    Inferior Vena Cava (IVC)

    • Located R of abdominal aorta
    • Tributaries: common iliac vv., lumbar vv., R gonadal, renal, R suprarenal, inferior phrenic, hepatic veins.
    • Clinical correlations: IVC filters: prevent blood clots from traveling to the heart/lungs.
    • May-Thurner syndrome: L common iliac vein compression by R common iliac artery, resulting in L lower limb pain & swelling.

    Abdominal Lymphatics

    • 2 channels converge at R posterior surface of aorta near LV1-LV2, forming cisterna chyli.
    • Pre-aortic channel: abdominal aorta nodes (Gl tract, accessory organs).
    • Para-aortic channel: lateral to aorta/IVC, (body wall, kidneys, suprarenals, testes/ovaries).

    Nerves

    • Subcostal n: T12, quadratus lumborum muscle.
    • Iliohypogastric & ilioinguinal nn: L1 (anterior abdominal wall, scrotum).
    • Genitofemoral n: L1-L2 (genitals, upper thigh).
    • Femoral n: L2-L4 (lateral thigh).
    • Obturator n: L2-L4 (medial thigh)
    • Review lumbar plexus nerves for their location, function, and clinical correlation

    Clinical Correlations (continued)

    • Retroperitoneal lymph node dissection (RPLND): removing cancerous nodes (open or laparoscopic).

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    Lecture 75: Gross Anatomy - Posterior Abdominal Wall & Diaphragm PDF

    Description

    This quiz explores the anatomy and functions of the posterior abdominal wall and diaphragm. It covers the musculoskeletal framework, key muscles, and clinical correlations related to abdominal structures. Test your knowledge on the critical components and functions of this region.

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