The posterior abdominal wall and diaphragm
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| * Where are the kidneys located (General position, vertebral landmarks)? Difference between left and right? | Retroperitoneally in paravertebral gutters between T12 and L3; right is slightly lower (due to right lobe of liver)
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| * The usual order of structures (vessels) within the hilum from ANTERIOR TO POSTERIOR are the following: _____, ______, _____. | Renal vein, renal artery, ureter
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| * The medial sides of the kidneys are concave in shape and contain a vertical slit called the ___. This leads into a large space called the ___ ____. This space contains the ____ _____, ____, ______ vessels, and ____. | renal sinus, renal pelvis, calyces, renal vessels, fat
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| * What are the (4) coverings of the kidney (deep to superficial)? | Fibrous capsule, perirenal fat, renal fascia, pararenal fat
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| * Identify the covering of the kidney: closely applied to the surface of the kidney and passes over the edges of the hilum to the line of the renal sinus | Fibrous capsule
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| * Identify the covering of the kidney: encloses both the kidneys and the suprarenal glands. It is continous at the hilum with the fat in the renal sinus. | Perirenal fat
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| * Identify the covering of the kidney: MOST IMPORTANT LAYER. Encloses everything else | Renal fascia
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| * Identify the covering of the kidney: lies external to the renal fascia and is thicker posterior to the kidneys | Pararenal fat
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| * Where are the suprarenal glands located? What are their shapes? | between the supromedial aspects of the kidneys and the diaphragm. Right: triangular shaped; Left: semilunar
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| Describe the path of the ureters prior to entering the pelvic cavity | Descend retroperitoneally on the surface of the psoas major muscles; cross into the pelvis over the bifurcation of the common iliac arteries IN FRONT of the sacroiliac joints
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| Describe the innervation and major action of the psoas major | Ventral rami L2-L4; illiopsoas is the chief flexor of the thigh; it flexes and balances the trunk while sitting
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| Describe the innervation and major action of the iliacus | Femoral nerve; iliopsoas chief flexor of the thigh; flexes and balances he trunk while sitting
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| Describe the innervation and major action of the psoas minor | Ventral ramus of L1; flexes the pelvis
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| Describe the innervation and major action of the quadratus lumborum | Ventral rami T12-L4; respiratory movement, one side alone laterally bends the trunk
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| Describe how the diaphragm is subdivided into various regions | Sternal portion (from posterior surface of the xiphoid process), costal portion (from ribs 7-12 and their costal cartilages), lumbar portion (from the crura and arcuate ligaments)
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| * Describe the crura of the diaphragm. | Right crus: arises from sides of brodies and intervertebral discs from L1-L3, forms sling around esophagus at esophageal hiatus; Left crus: from sides of bodies of L1, L2 and intervening disc, usually doesn't contribute to the sling around the esophagus
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| What are the arcuate ligaments? | Medial arcuate ligaments: fascia covering upper margin of psoas major m. from L2 to transverse process of L1. Lateral arcuate lig: same, covering upper surf. of quadratus lamborum from L1 to 12th rib
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| * List the major openings of the diaphragm. What passes through each? | 1. Aortic hiatus (T12): aorta, thoracic duct, azygous vein. 2. Esophageal hiatus (T10): esophagus, vagal trunks (L and R), esophageal branch of left gastric vessels and lymphatics. 3. Caval opening (T8): IVC, right phrenic nerve branches
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| Identify the minor openings in the diaphragm through which the following structures pass: superior epigastric vessels, thoracic splanchinic nerves, left phrenic nerve, sympathetic trunks, subcostal nerves | sternocostal triangle (small gap between sternal and costal origins of diaphragm), crura of diaphragm, left dome of diaphragm, behind medial arcuate ligaments, behind lateral arcuate ligaments
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| What supplies the superior surface of the diaphragm? The inferior surface? Where do each of these usually branch from? | Sup: pericadriphrenic arts. (Internal thoracic), musculophrenic arts. (internal thoracic), superior phrenic arts. (thoracic aorta). Inf: inferior phrenic arts. (abdominal aorta)
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| * Describe the nerve supply to the diaphragm | Motor: solely from phrenic nerves C3, C4, C5. Sensory: central portion--phrenic nerves, peripheral portions (lower intercostal and subcostal nerves)
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| Where does referred pain to the diaphragm refer to? | Area supplied by C3-C5 (central diaphragmatic pleura): shoulder region; peripheral regions innervated by intercostal and subcoastal nerves radiate over skin of costal margins of the anterolateral abdominal wall
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| How is the fascia of the posterior abdominal wall named? | Named after underlying muscles (e.g. diaphragmatic fascia, transversalis gascia, psoas fascia, quadratus lumborum fascia; this continous fascia between parietal peritoneum and musculature of abdominal wall
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| The ____ nerve (landmark nerve) is the ventral ramus of T12 which descends posterior to the lateral arcuate ligament approximately 1 cm inferior to the 12th rib | subcoastal
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| What is the lumbar plexus? What nerves comprise the lumbar plexus? | Formed within the psoas major muscle from ventral rami of L1-L4; includes iliohypogastric, ilioinguinal, lateral cutaneous nerve of thigh, femoral nerve, genitofemoral nerve, obturator nerve
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| Describe the spinal cord segment and area supplied by the iliohypogastric nerve | L1: motor to abdominal muscles and sensory to lower buttocks and lower abdomen
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| Describe the spinal cord segment and area supplied by the ilioinguinal nerve | L1: passes out of superficial inguinal ring (not deep to it, though); motor to abdominal muscles and sensory to labia majora or scrotum and adjacent medial thigh
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| Describe the spinal cord segment and area supplied by the lateral cutaneous nerve of the thigh (L2, L3) | L2-L4: Largest branch of the lumbar plexus; runs down in groove between psoas major and iliacus muscle; enters thigh beneath inguinal ligament and lateral to femoral sheath
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| Describe the spinal cord segment, anatomical position, and area supplied by the genitofemoral nerve | L1,L2: from surface of psoas major, GENITAL br. : in sperm. cord/r. lig., motor to cremaster and sensory to scrotum/labia majora; FEMORAL br: passes onto thigh beneath inguinal ligament on surface of femoral artery; sensory to skin over femoral triangle
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| Describe the spinal cord segment and anatomical position | L2-L4: appears on medial border of psoas major superficial to lumbosacral trunk; passes over pelvic brim into pelvis and courses towards obturator canal
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| The lumbosacral trunk is composed of the ___ portion of the v. ramus of ___ and all of the v. ramus of ____. It appears on the ___ side of the ____ muscle _____ to the obturator nerve. It enters the pelvis and joins the v. ramus of ____ to form the _____. | descending; L4, L5; medial, psoas major deep; S1, sacral plexus
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| Describe the position relative to other structures in the abdomen of the lumbar sympathetic trunks | Pass into abdomen beneath the medial arcuate ligaments; descend along medial borders of psoas major m. on sides of vertebral bodies; right sympathetic trunk lies post. to IVC; left trunk just to left of abdominal aorta
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| * At what level does the abdominal aorta pierce the diaphragm? Where does it bifurcate into the common iliac arteries? | T12; L4, approximately 2-3 cm inferior and to the left of the umbilicus
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| * Where does the IVC form? How does it travel relative to the aorta once it forms? | Begins as the union of the common iliac veins beneath the right common iliac artery; ascends on the posterior abdominal wall to the right of the aorta
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