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Abdomen part 4
- 1. Abdomen Part 4 (POSTERIOR ABDOMINAL REGION) Themba Hospital FCOG(SA) Part 1 Tutorials By Dr N.E Manana
- 2. โข 4.140
- 3. Bones Lumbar vertebrae and the sacrum โข Projecting into the midline of the posterior abdominal area are the bodies of the five lumbar vertebrae โข The prominence of these structures in this region is due to the secondary curvature (a forward convexity) โข The lumbar vertebrae can be distinguished from cervical and thoracic vertebrae because of their size
- 4. Bones Ribs โข Superiorly, ribs XI and XII complete the bony framework of the posterior abdominal wall โข These ribs are unique in that they do not articulate with the sternum or other ribs โข They have a single articular facets on their heads, and they do not have necks or tubercles โข Rib XI is posterior to the superior part of the left kidney, and rib XII is posterior to the superior part of both kidneys
- 5. โข 4.141
- 6. Muscles โข Muscles forming the medial, lateral, inferior, and superior boundaries of the posterior abdominal region โข Medially are the psoas major and minor muscles, laterally is the quadratus lumborum muscle, inferiorly is the iliacus muscle, and superiorly is the diaphragm Psoas major and minor โข Cover the anterolateral surface of the bodies of the lumbar vertebrae, โข Each of these muscles arises from the bodies of vertebra TXII and all five lumbar vertebrae
- 7. Muscles โข Associated with the psoas major muscle is the psoas minor muscle, which is sometimes absent โข Lying on the surface of the psoas major, this slender muscle arises from vertebrae TXII and LI and the intervening intervertebral disc โข Its long tendon inserts into the pectineal line of the pelvic brim and the iliopubic eminence. Quadratus lumborum โข Fill the space between rib XII and the iliac crest โข They are overlapped medially by the psoas major muscles โข Along their lateral borders are the transversus abdominis muscles
- 8. โข 4.142
- 9. Muscles โข Each quadratus lumborum muscle arises from the transverse process of vertebra LV โข The muscle attaches superiorly to the transverse process of the first four lumbar vertebrae and the inferior border of rib XII. Iliacus โข Inferiorly, an iliacus muscle fills the iliac fossa on each side โข The muscle passes inferiorly, joins with the psoas major muscle, and attaches to the lesser trochanter of the femur โข As they pass into the thigh, these combined muscles are referred to as the iliopsoas muscle
- 10. โข Table 4.2
- 11. โข 4.143
- 12. Viscera Suprarenal glands โข Associated with the superior pole of each kidney โข They consist of an outer cortex and an inner medulla. โข The right gland is shaped like a pyramid, whereas the left gland is semilunar in shape and the larger of the two. โข They are surrounded by the perinephric fat โข Enclosed in the renal fascia, though a thin septum separates each gland from its associated kidney
- 13. โข 4.163
- 14. Vasculature Abdominal aorta โข Begins at the aortic hiatus of the diaphragm as a midline structure at approximately the lower level of vertebra TXII โข At vertebra LIV it divides into the right and left common iliac arteries. โข This bifurcation can be visualized on the anterior abdominal wall as a point approximately 2.5 cm below the umbilicus or even with a line extending between the highest points of the iliac crest. โข As the abdominal aorta passes through the posterior abdominal region, the prevertebral plexus of nerves and ganglia covers its anterior surface
- 15. โข 4.164
- 16. โข Table 4.3
- 17. Inferior vena cava โข Returns blood from all structures below the diaphragm to the right atrium of the heart โข Formed when the two common iliac veins come together at the level of vertebra LV, just to the right of midline โข It ascends through the posterior abdominal region anterior to the vertebral column immediately to the right of the abdominal aorta โข Leaves the abdomen by piercing the central tendon of the diaphragm at the level of vertebra TVIII โข Tributaries include the: 1.common iliac veins, 2. lumbar veins, 3. right testicular or ovarian vein, 4. renal veins,5. right suprarenal vein, 6. inferior phrenic veins, and 7. hepatic veins
- 18. โข 4.166
- 19. โข 4.167
- 20. โข 4.168
- 21. Nervous system in the posterior abdominal region โข Several important components of the nervous system are in the posterior abdominal region. โข The sympathetic trunks and associated splanchnic nerves, โข The plexus of nerves and ganglia associated with the abdominal aorta, โข And the lumbar plexus of nerves.
- 22. โข 4.169
- 23. โข 4.170
- 24. โข 4.171
- 25. โข Table 4.5
- 26. โข 4.173
- 27. โข Table 4.6
- 28. Thank you
Editor's Notes
- The pedicles are short and stocky, the transverse processes are long and slender, and the spinous processes are large and stubby The vertebral bodies are massive and progressively increase in size from vertebra LI to LV The articular processes are large and oriented medially and laterally, which promotes flexion and extension in this part of the vertebral column Between each lumbar vertebra is an intervertebral disc, which completes this part of the midline boundary of the posterior abdominal wall
- Also, rib XII serves as a point of attachment for numerous muscles and ligaments
- Passing inferiorly along the pelvic brim, each muscle continues into the anterior thigh, under the inguinal ligament, to attach to the lesser trochanter of the femur The psoas major muscle flexes the thigh at the hip joint when the trunk is stabilized and flexes the trunk against gravity when the body is supine. It is innervated by anterior rami of nerves L1 to L3
- Diaphragm
- Superiorly, the diaphragm forms the boundary of the posterior abdominal region This musculotendinous sheet also separates the abdominal cavity from the thoracic cavity. Structurally, the diaphragm consists of a central tendinous part into which the circumferentially arranged muscle fibers attach anchored to the lumbar vertebrae by musculotendinous crura, which blend with the anterior longitudinal ligament of the vertebral column The crura are connected across the midline by a tendinous arch (the median arcuate ligament), which passes anterior to the aorta Lateral to the crura, a second tendinous arch is formed by the fascia covering the upper part of the psoas major muscle. This is the medial arcuate ligament, which is attached medially to the sides of vertebrae LI and LII and laterally to the transverse process of vertebra LI A third tendinous arch, the lateral arcuate ligament, is formed by a thickening in the fascia that covers the quadratus lumborum
- Anterior to the right suprarenal gland is part of the right lobe of the liver and the inferior vena cava, whereas anterior to the left suprarenal gland is part of the stomach, pancreas, and, on occasion, the spleen. Parts of the diaphragm are posterior to both glands
- Suprarenal vasculature The arterial supply to the suprarenal glands is extensive and arises from three primary sources As the bilateral inferior phrenic arteries pass upward from the abdominal aorta to the diaphragm, they give off multiple branches (superior suprarenal arteries) to the suprarenal glands. A middle branch (middle suprarenal artery) to the suprarenal glands usually arises directly from the abdominal aorta. Inferior branches (inferior suprarenal arteries) from the renal arteries pass upward to the suprarenal glands In contrast to this multiple arterial supply is the venous drainage, which usually consists of a single vein leaving the hilum of each gland (suprarenal vein) mainly innervated by preganglionic sympathetic fibers from spinal levels T8-L1
- Branches of the abdominal aorta can be classified as: Visceral branches supplying organs, posterior branches, or terminal branches The paired visceral branches of the abdominal aorta (Fig. 4.164) include: the middle suprarenal arteries, the renal arteries, the testicular or ovarian arteries Posterior branches: inferior phrenic arteries, the lumbar arteries, and the median sacral artery Branches of the abdominal aorta can be classified as: Visceral branches supplying organs, posterior branches, or terminal branches The paired visceral branches of the abdominal aorta (Fig. 4.164) include: the middle suprarenal arteries, the renal arteries, the testicular or ovarian arteries Posterior branches: inferior phrenic arteries, the lumbar arteries, and the median sacral artery
- During its course, the anterior surface of the inferior vena cava is crossed by the right common iliac artery, the root of the mesentery, the right testicular or ovarian artery, the inferior part of the duodenum, the head of the pancreas, the superior part of the duodenum, the bile duct, the portal vein, and the liver, which overlaps and on occasion completely surrounds the vena cava
- Lymphatic drainage from most deep structures and regions of the body below the diaphragm converges mainly on collections of lymph nodes and vessels associated with the major blood vessels of the posterior abdominal region The lymph then predominantly drains into the thoracic duct
- The sympathetic trunks pass through the posterior abdominal region anterolateral to the lumbar vertebral bodies, before continuing across the sacral promontory and into the pelvic cavity lumbar splanchnic nerves (Fig. 4.169). These components of the nervous system pass from the sympathetic trunks to the plexus of nerves and ganglia associated with the abdominal aorta Usually two to four lumbar splanchnic nerves carry preganglionic sympathetic fibers and visceral afferent fibers
- The abdominal prevertebral plexus is a network of nerve fibers surrounding the abdominal aorta. It extends from the aortic hiatus of the diaphragm to the bifurcation of the aorta into the right and left common iliac arteries. Along its route, it is subdivided into smaller, named plexuses celiac plexus the abdominal aortic plexus superior hypogastric plexus