The Posterior Abdominal Wall & Diaphragm

Question 1

the kidneys are located ___ on the ___ wall in the paravertebral gutters between the vertebrae levels ___

Answer 1

retroperitoneally (primary)
posterior abdominal
T12 - L3

Question 2

the right kidney lies slightly ___ than the left kidney because of the ___

Answer 2

lower

large size of the right lobe of the liver

Question 3

with contraction of the diaphragm during respiration, both kidneys move vertically ___ as much as ___ cm

Answer 3

downwards

2.5

Question 4

each kidney has dimensions which are approximately ___ cm x ___ cm x ___ cm

Answer 4

12
6
3

Question 5

each kidney’s lateral sides are ___ in shape

their medial sides are ___ in shape & contain a vertical slit called the ___ which leads into a large space called the ___

this space contains 4 things: ___

Answer 5

convex

concave
hilum
renal sinus

renal pelvis
calyces
renal vessels
fat

Question 6

the usual order of structures within the hilum from anterior to posterior are: ___

Answer 6

renal vein
renal artery
ureter
(VAU)

Question 7

coverings of the kidney:
fibrous capsule:

closely applied to the ___ & passes over the ___ to line the ___

Answer 7

kidney
edges of the hilum
renal sinus

Question 8

coverings of the kidney:
perirenal fat:

encloses both the ___ & the ___

continuous at the ___ w/ the ___ in the ___

Answer 8

kidneys
suprarenal glands

hilum
fat
renal sinus

Question 9

coverings of the kidney:
renal fascia:

the most ___ layer

encloses ___

Answer 9

important

everything else (kidneys, suprarenal glands, & perirenal fat)

Question 10

coverings of the kidney:
pararenal fat:

lies ___

thicker ___ to the kidneys

Answer 10

external to the renal fascia

posterior

Question 11

the suprarenal glands lie between the ___ & the ___

right suprarenal gland - ___ shaped

left suprarenal gland - ___ shaped

Answer 11

superomedial aspects of the kidneys
diaphragm

triangular

semilunar

Question 12

the ureters descend ___ on the surface of the ___ msucles

they cross into the ___ over the bifurcation of the ___ arteries in front of the ___ joints

Answer 12

retroperitoneally
psoas major

pelvis
common iliac
sacroiliac

Question 13

muscles of the posterior abdominal wall:
psoas major:

a ___ muscle located on the side of the ___ region of the ___

Answer 13

long
lumbar
vertebral column

Question 14

muscles of the posterior abdominal wall:
iliacus:

a ___ muscle inferior to the ___

Answer 14

flat, triangular

quadratus lumborum muscle

Question 15

muscles of the posterior abdominal wall:
psoas minor:

a ___ muscle which is located anterior to the ___

Answer 15

long, slender

psoas major muscle

Question 16

muscles of the posterior abdominal wall:
quadratus lumborum:

a ___ muscle superior to the ___ & posterior to the ___

Answer 16

quadrilateral shaped
iliacus muscle
psoas major muscle

Question 17

diaphragm:

a ___ sheet intervening between the ___ & ___

its muscles are arranged around a ___

it is divided into three portions according to the origins of its ___: ___

Answer 17

fibromuscular
thoracic & abdominal cavities

central tendon

musculature

• sternal portion
• costal portion
• lumbar portion

Question 18

diaphragm:

sternal portion

Answer 18

from the posterior surface of the xiphoid process

Question 19

diaphragm:

costal portion

Answer 19

from ribs 7-12 & their costal cartilages

Question 20

diaphragm:

lumbar portoin

Answer 20

from the crura & arcuate ligaments

Question 21

crura:
right crus:

arises from the ___ & ___ from levels ___

its ___ fibers usually from a sling around the ___ at the ___

Answer 21

sides of the bodies
intervertebral discs
L1 - L3

muscular
esophagus
esophageal hiatus

Question 22

crura:
left crus:

arises from the ___ of levels ___ & the ___

it usually does not contribute to the ___

Answer 22

sides of the bodies
L1 & L2
intervening disc

sling around the esophagus

Question 23

the arcuate ligaments:

the medial arcuate ligaments are actually ___ covering the ___ of the ___ muscles

they extend from the ___ to the ___

Answer 23

thickened fascia
upper margin
psoas major

body of L2
transverse processes of L1

Question 24

the arcuate ligaments:

the lateral arcuate ligaments are ___ covering the ___ of the ___ muscle

they extend from the ___ to the ___

Answer 24

thickened fascia
upper surfae
quadratus lumborum

transverse process of L1
lower border of the 12th rib

Question 25

the main openings of the diaphragm & corresponding spinal cord levels (3) permit structures to pass between the ___ & the ___

Answer 25

``` caval openings (T8) esophageal hiatus (T10) aortic hiatus (T12) ``` thorax abdomen

Question 26

``` openings of the diaphragm: aortic hiatus (3)* ```

Answer 26

aorta thoracic duct azygous vein

Question 27

``` openings of the diaphragm: esophageal hiatus (3) ```

Answer 27

esophagus right & left vagus nerves (vagal trunks) esophageal branches of the left gastric vessels & lymphatics

Question 28

``` openings of the diaphragm: caval opening (2) ```

Answer 28

inferior vena cava | branches of the right phrenic nerve

Question 29

openings of the diaphragm: superior epigastric vessels: descend through the ___, which is a small gap b/n the ___ & ___ origins of the diaphragm

Answer 29

sternocostal triangle sternal costal

Question 30

openings of the diaphragm: thoracic splanchnic nerves: pierce the ___ of the diaphragm

Answer 30

crura

Question 31

openings of the diaphragm: left phrenic nerve: pierces the ___ of the diaphragm

Answer 31

left dome

Question 32

openings of the diaphragm: sympathetic trunks: descend behind the ___

Answer 32

medial arcuate ligaments

Question 33

openings of the diaphragm: subcostal nerves: descend behind the ___

Answer 33

lateral arcuate ligaments

Question 34

``` openings of the diaphragm: other openings (5) ```

Answer 34

``` superior epigastric vessels thoracic splanchnic nerves left phrenic nerve sympathetic trunks subcostal nerves ```

Question 35

``` blood supply of the diaphragm: superior surface (3) ```

Answer 35

``` pericardiophrenic arteries (from internal thoracic artery) musculophrenic arteries (from internal thoracic artery) superior phrenic arteries (from thoracic aorta) ```

Question 36

``` blood supply of the diaphragm: inferior surface (1)* ```

Answer 36

inferior phrenic arteries (usually from abdominal aorta)

Question 37

nerve supply of the diaphragm: motor - the entire motor supply is from the ___ nerves (levels ___) sensory (___ & ___): - central portion - ___ nerves - peripheral portions - ___ nerves

Answer 37

phrenic C3, C4, C5 pain & proprioception - phrenic - lower intercostal & subcostal

Question 38

referred pain from the diaphragm radiates to ___ different areas pain from the ___ or ___, which is innervated by the ___ nerves, is referred to the shoulder region supplied by segments ___ of the spinal cord (the same levels of the cord giving origin to the ___ nerves) irritation of the ___ regions of the diaphragm, which are innervated by the ___ nerves, radiates to the skin over the ___ margins of the ___ wall

Answer 38

``` central diaphragmatic pleura diaphragmatic peritoneum phrenic C3 - C5 phrenic ``` peripheral intercostal & subcostal costal anterolateral abdominal

Question 39

the fascia of the posterior abdominal wall is part of a ___ layer of ___ fascia lying between the ___ & the ___ it is customary to name the fascia according to the ___

Answer 39

continuous endoabdominal parietal pertioneum musculature of the abdominal wall underlying muscles

Question 40

examples of underlying muscles of fascia of posterior abdominal wall (4)

Answer 40

diaphragm - diaphragmatic fascia transversus abdominus - transversalis fascia psoas major - psoas fascia quadratus lumborum - qudaratus lumborum fascia

Question 41

nerves of the posterior abdominal wall: the subcostal nerve: ___ nerve the subcostal nerve is the ___ ramus of ___, which descends posterior to the ___ approximately 1cm inferior to the ___

Answer 41

landmark ventral T12 lateral arcuate ligament 12th rib

Question 42

nerves of the posterior abdominal wall: lumbar plexus: the lumbar plexus is formed within the substance of the ___ muscle from the ___ rami of ___ its major branches & corresponding spinal cord levels(6)

Answer 42

psoas ventral L1 - L4 ``` iliohypotastric (L1) ilioinguinal (L1) lateral cutaneous nerve of the thigh (L2, L3) femoral nerve (L2 - L4) genitofemoral nerve (L1, L2) obturator nerve (L2 - L4) ```

Question 43

nerves of the posterior abdominal wall: lumbar plexus: iliohypogastric: motor to the ___ sensor to the ___ & ___

Answer 43

abdominal muscles upper buttocks lower abdomen

Question 44

nerves of the posterior abdominal wall: lumbar plexus: ilioinguinal: passes out of the ___ but not the ___ motor to the ___ sensory to the ___ & ___

Answer 44

superficial inguinal ring deep inguinal ring abdominal muscles labia majora or scrotum adjacent medial thigh

Question 45

nerves of the posterior abdominal wall: lumbar plexus: lateral cutaneous nerve of the thigh: passes under the ___ near the ___ sensory to the ___

Answer 45

inguinal ligament ASIS lateral thigh

Question 46

nerves of the posterior abdominal wall: lumbar plexus: femoral nerve: the ___ branch of the lumbar plexus runs ___ in a groove b/n the ___ & the ___ enters the ___ beneath the ___ & lateral to the ___

Answer 46

largest downward psoas major iliacus muscle thigh inguinal ligament femoral sheath

Question 47

nerves of the posterior abdominal wall: lumbar plexus: genitofemoral nerve: emerges on the surface of the ___ its genital branch joins the ___ & is motor to the ___ & sensory to the ___ its femoral branch passes onto the ___ beneath the ___ on the surface of the ___ & is sensory to the ___ over the ___

Answer 47

psoas major muscle spermatic cord or round ligament cremaster muscle scrotum or labia majora ``` thigh inguinal ligament femoral artery skin femoral triangle ```

Question 48

nerves of the posterior abdominal wall: lumbar plexus: obturator nerve: appears at the medial border of the ___ superficial to the ___ it passes over the ___ into the ___ & courses toward the ___

Answer 48

psoas major muscle lumbosacral trunk pelvic brim pelvis obturator canal

Question 49

the lumbosacral trunk is composed of the ___ portion of the ___ ramus of level ___ & all of the ___ ramus of level ___ it appears on the medial side of the ___ deep to the ___ it enters the ___ & joins the ___ ramus of level ___ in the formation of the ___

Answer 49

``` descending ventral L4 ventral L5 ``` psoas major muscle obturator nerve pelvis ventral S1 sacral plexus

Question 50

the sympathetic trunks pass into the ___ beneath the ___ & descend along the medial borders of the ___ on the sides of the ___ the right sympathetic trunk lies posterior to the ___ the left trunk lies just to the left of the ___

Answer 50

abdomen medial arcuate ligaments psoas major muscles vertebral bodies IVC abdominal aorta

Question 51

the great vessels in the abdomen: the abdominal aorta pierces the diaphragm at the level of ___ & bifurcates into the ___ at the level of ___ the level of the bifurcation is approximately 2-3cm inferior & to the left of the ___ the IVC begins by the union of the ___ beneath the ___ & ascends on the ___ to the right of the ___

Answer 51

T12 two common iliac arteries L4 umbilicus common iliac veins right common iliac artery posterior abdominal wall aorta