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- 1. Muhammad Qasim Roll No:27 Jawad Khan Roll No:13 In The Name of Allah
- 2. Topic: 1.Abdominal Aorta 2.Inferior Vana Cava 3.Lumbar Plexus
- 3. Abdominal Aorta · The abdominal aorta is the continuation of descending thoracic aorta at aortic orifice in the diaphragm (inferior border of T 12) · Length-10-11 cm · Breadth:2 cm · Is retroperitoneal · On posterior abdominal wall
- 4. left inferior phrenic superior suprarenal middle suprarenal srst lumbar inferior suprarenal renal g0nadal secend lumbar a third fumbar fourth fumbar right common illac L5 right external iliac gnal Agememt right femoral … Vertebral extent 8 Ter mination Terminates at lower border of L4 vertebra to the left of midline by dividing into right and left common iliac arteries Extent -from L1 to L4 ABDOMINAL AORTA IVC L1 r na t r L2 e n e h g ri right T12 left common iliac left external iliac right internal femoral median left internal iliac m g u i n e af itiac sacral L3 L4 left BS
- 5. Lateral Group: 1. Right &Left Inferior phrenic arteries 2. Right &Left Suprarenal arteries 3. Right &Left Renal arteries 4. Right &Left Gonadal arteries Terminal Branches: 1.Right &Left Common iliac Anterior Group: 1. Celiac trunk 2.Superior mesenteric artery 3.Inferior mesenteric artery Dorsal Group: 1. Right &Left Lumbar arteries 2. Median sacral artery arteries Detailed course and distribution of these arteries will be taught with the Branches of abdominal aorta respective viscera or in the specific region
- 6. phrente Diaphragm,interior portian of esophagus Adrenal glands Kidneys Testes or ovaries Vetebrae,spinal card. bdominsl aorta Interlor arterleB Adrenal Renal arterles Len gastrle erten Splenle Commen SuPerlor mesenterle Intertor meeenterte Common iliae arteries Medlan aacral rt Stomach, d of esophagus , ach, Pancreas am leen s S n t o n r a Livwer,strmach, , m, pancreas en xkie uo allbl Pancreas,small n i s t ti tn , p - n i of s x o a s e r t abdominal wall, lumbar region Last third of large intestine large intestine ionadal arterlee Lumbar arterlee ie artary hepat arteies Celliao trunk aTtery artery artery
- 7. Name of Artery Type Number Vertebral level 1 Celiac trunk Visceral Unpaired T12 2 Superior mesenteric artery Visceral Unpaired L1 3. Inferior mesenteric artery Visceral Unpaired L3 4 Middle suprarenal arteries Visceral Paired L1 5 Renal arteries Visceral Paired L1/L2 6 Gonadal arteries Visceral Paired L2 7 Inferior phrenic arteries Parietal Paired T12 8 Lumbar arteries(L1,L2,L3,L4) Parietal Paired L1-L4 9 Median sacral artery Parietal Unpaired L4 10 Common lliac arteries Terminal Paired L4 Branches of abdo minal aorta
- 8. Name of Artery Distribution 1 Celiac trunk Derivatives of foregut 2 Superior mesenteric artery Derivatives of foregut 3. Inferior mesenteric artery Derivatives of foregut 4 Middle suprarenal arteries Suprarenal gland 5 Renal arteries Kidneys,suparenal gland,ureter 6 Gonadal arteries Testes /Ovaries 7 Inferior phrenic arteries Diaphragm,suprarenal gland 8 Lumbar arteries Abdominal wall 9 Median sacral artery Vestigial artery 10 Common liac arteries Its external &internal branches supply lower limb,pevic viscera,walls of pelvis Visceral structures supplied by the branches
- 9. Anterior · Between celiac trunk &SMA- splenicvein &body of pancreas Between SMA &IMA-left renal vein, uncinate process of pancreas and 3 part of duodenum Below the 3rd part of duodenum - covered by parietal peritoneum of floor of infracolic compartment Diagrammatic representation ofAorta as seen from the rightside Left Left sympathetic trunk Posterior -L1-L4,3&4*lumbar Right —Inferior Vena Cava Celrae thwnk Spleuevein aucneas ٠ vei ﻝ va ﻉ ? ﺗﻠﻌﺎ Uneinan aoces Supeuc mesen(eg aA Duodenum Iwlewes meeu ouag hena 0nada thind Ca Relations Tr2 L2 L3 veins meduar ﻟﻤﻌﻌﻤﮏ ﺁﻟﺪﻣﮧ level ﮦ ﺪ ﺘ ﻔ ﻌ ﻣ pP
- 10. Aneurysm -dilation of the artery to more than 1.5 times its original size. The abdominal part of aorta -common site for aneurysmal changes. Patients -may experience abdominal pulsations,abdominal pain and back pain,may also compress nerve roots causing pain/numbness in the lower limbs. Aortic aneurysm aWTO FOUNDATONFCH MEDCA EDUCATON ANE CN L HT E ●
- 11. Middie hepatic vein Interior phrenic Hemiazaygos L1 Subcostal Right Suprarenal Right Ascending lumbar L3 Right gonadal testicularlovarian vien L 4 3rd lumbar 3rd lumbar L.5 Miolumbar Median sacral · Largest vein · Drains blood from body below diaphragm · Length-20-23 cm · Breadth-2.5 cm · Formation:opposite L5 by union of right &left common iliac veins Inferior vena cava (location &formation) Right hepatievein 2nd lumbar iliac vein iliac vein renal vein vein L2
- 12. Ascends in front of vertebral column Lodges in a groove on right lobe of liver At T8 passes through diaphragm (central tendon) Pierces fibrous pericardium Opens into right atrium,opening guarded by valve(semilunar valve) Extent -right of L5-T8 Inferior vena cava (course) Longer course than aorta Right hepatic vein Middie hepatic vein Left hepatic vein Hemlazaygos L1 Subcostal Lumbar azygos —Left renal vein L2 1st Lumbar Ascending lumbar 2nd lumbar Right Suprarenal · Right renal vein 3rd lumbar 4th lumbar. Right gonadal testicularlovanian vien L4 3rd lumbar ● ● ● Interior phrenic vein Median sacral vein Right common iliac vein Left common Hliac vein 4th lumbar lliolumbar · L5 L3
- 13. Relations of IVC ANTERIOR RELATIONS: In the Infracolic compartment 1. Root of mesentery 2. Above it by 3u part of duodenum In the Supracolic compartment 1. First behind portal vein,head of pancreas &bile duct 2. Above it behind the peritoneum forming posterior wall of epiploic foramen
- 14. Relations of POSTERIOR RELATIONS: Lumbar vertebrae ■ Right psoas major ■ Right crus of diaphragm On its RIGHT Right kidney &right ureter ■ Hepatorenal pouch On its LEFT ■ Abdominal aorta ■ Omental burse ■ Caudate lobe of liver IVC contd....
- 15. Hepatic veins Inferiorphrenicvein Left suprarenal vein Left renal vein Left gonadal vein Right gonadal Second lumbar Third lumbar Fourth lumbar Left common iliacvein 1. Common iliac veins (formative tributaries) 2. Lumbar veins-3&4m 3. Inferior phrenic veins - Right & left 4. Hepatic veins (right,middle & left 5. Renal veins - Right &left 6. Gonadal vein -Right 7. Suprarenal vein -Right (ovarian or testicular vein) Right common iliacvein Tributaries Right suprarenal vein Right renal vein
- 16. ANATOMY OF LUMBAR PLEXUS
- 17. LUMBAR PLEXUS .Upper portion ofthe lumbosacral plexus. .Roots ----anterior rami ofist lumbar spinal nerve until 4h lumbar spinal nerves (Ln-L4) Some contribution from 12th thoracic spinal nerve and sh lumbar spinal nerve. Give motor and cutaneous innervations for certain area on the abdominal area,pelvic area,and thigh.
- 18. Cervical nerves (8 pairs) Cervical enlargement Thoracic nerves (12 pairs) —Medullary cone 一Lumbar nerves (5 pairs) -Cauda equina Intercostal (thoracic) nerves Lumbar enlargement- Vertebra L1— Lumbar plexus (L1-L4) Brachial plexus (C5-T1) Figur Vertebra T1— … … 5 词 气 e 周 子 心 不 Vertebra C1 (atlas)一 Cervical plexus (C1-C5)一 Copyright@The MoGraw -Hil Comparies,Ine.Permission required for reproduction or displiay. 5 6 3 3 3 Coccygeal nerves (1 pair) —Sacral nerves (5 pairs) Sacral plexus (L4-S4) Sciatic— nerve ef6 的 S s
- 19. LUMBAR PLEXUS .Anterior primary division of Li,Lz and L4 divide into upper and lower branches. The upper branch of Li forms the iliohypogastric and ilioinguinal nerves The lower branch to form the genitott nd?ansehSeyPper branch of L² The lower branch of L4 jo ns L5 to form the lumbosacral trunk.
- 20. LUMBAR PLEXUS The lower branch of L2,all ofL3 and the upper branch of L4 each split into a small anterior and a large posterior division The 3 anterior divisions unite to form the obturator nerve The 3 posterior divisions unite to form the femoral nerve,and the upper 2 posterior divisions give off twigs that form the lateral femoral cutaneous nerve.
- 21. LUMBAR PLEXUS Collatoral branches to muscles supply the quadratus lumborum and intertransversari from Li to L4 and the psoas muscle from L2 and L3.
- 22. The Lumbar Plexus Copyright e The MeGraw-Hil Companies,ine,Pemission required for feproductien or d aplay. Tibial nerve一 Common fibular nerve- Superficial fibular nerve— Deep fibular nerve— Fibula — Tibia —— Tibial nerve· Medial plantar nerve - Lateral plantar nerve一 -llioinguinal nerve -Genitofemoral nerve Obturator nerve From lumbar plexus From sacral plexus Os coxae一 Sacrum— Femoral nerve Pudendal nerve- -Femoral nr -Saphenous nerve -Obturator nerve -Lumbosacral trunk Roots Anterior divisions Posterior divisions L1 L2 L3 L4 L5 Lateral femoral cutaneous nerve Sciatic nerve一 Femur一 -liohypogastric nerve Anterior view
- 24. ILIOHYPGOSTRIC NERVE(T12,L1) Passes around the iliac crest between the internal oblique muscles and divides into an iliac(lateral) branch supplying the skin of the upper lateral part of the thigh and a hypogastric(anterior) branch descending anteriorly to the skin over the pubic symphysis.
- 25. The ilioinguinal nerve(L1)follows a course slightly inferior to iliohypogastric nerve,with it may anastomose,and is distributed to the skin of the upper medial part of the thigh and the root of the penis and scrotum(mons pubis &labium majus)
- 26. GENITOFEMORAL NERVE (L1,L2) Emerges from the anterior surface of the psoas muscles,runs obliquely downward on the surface of this muscle and divides into the external spermatic nerve,which supplies the cresmastric muscle and the skin of the scrotum or labia and the lumboinguinal nerve,which supplies the skin of the middle upper part of the thigh.
- 27. LATERAL FEMORAL CUTANEOUS NERVE(L2,L3) Passes obliquely across the iliacus muscle and under Poupart's ligament to divide into several rami distributed to the skin of the anterolateral side of the thigh.
- 28. LUMBOSACRAL TRUNK(L4,L5) Descends into the pelvis,where it becomes part of the sacral plexus.
- 29. FEMORAL (ANTERIOR CRURAL)NERVE L2-L4 .Largest branch of the lumbar plexus Arise from the 3 posterior division of the plexus which derived from L2,L3 &L4 Emerges from the lateral border of the psoas muscle just above the inguinal ligament where it divides into terminal branches.
- 30. FEMORAL (ANTERIOR CRURAL)NERVE L2-L4 Motor branch above the inguinal ligament supply the iliopsoas muscle Motor branches in the thigh supply the sartorius, pectinues and quadriceps femoris muscles Sensory branches include anterior femoral cutaneous branches to the anterior and medial surface of the thigh and the saphenous nerve to the medial side of the leg and foot.
- 31. OBTURATOR NERVE Arise from the lumbar plexus by a fusion of the 3 anterior divisions of the plexus,which are divided from the 2d,3rd,and 4th lumbar nerves. Emerges from the medial border of the psoas muscle near the brim of the pelvis,obturator nerve passes on the lateral side of the hypogastric vessels and ureter and descends through the obturator canal in the upper part of the obturator foramen to the medial side of the thigh.
- 32. OBTURATOR NERVE In the canal the obturator nerve splits into anterior and posterior branch. Motor rami from the posterior branch supply the obturator externus and adductor magnus muscles. Motor rami from the anterior branch supply the adductor longus and adductor brevis muscles and the gracilis muscles Sensory rami from the anterior branch of the nerve supply the hip joint and a small area of skin on the medial internal part of the thigh.
- 33. Tibial nerve一 Common fibular nerve 一 Superficial fibular nerve一 Deep fibular nerve— Fibula 一 Tibia —— Tibial nerve 一 Medial plantar nerve — Lateral plantar nerve一 —llioinguinal nerve Genitofemoral nerve Obturator nerve From lumbar plexus From sacral plexus Os coxae — Sacrum— Femoral nerve Pudendal nerve一 -Femoral nerve -Saphenous nerve —Obturator nerve -Lumbosacral trunk Roots Anterior divisions Posterior divisions L1 L2 L3 L4 L5 Copynight O The McGraw-Hil Companies,Ine.Pemission required for feproduction ar dispiay. Lateral femoral cutaneous nerve lliohypogastric nerve Sciatic nerve Femur - Anterior view
- 34. ·Abdominal internal oblique Ilioinguinal L1 ·Anterior scrotal nerves in males ·Anterior labial nerves in females Genitofemoral L1,L2 ·Cremaster in males ·Femoral ramus ·Genital ramus Lateral femoral cutaneous L2.L3 ·Lateral femoral cutaneous ·Obturator externus ·Adductor longus Obturator L2-L4 ·Gracilis ·Pectineus ·Adductor magnus ·lliopsoas ·Cutaneous ramus ·Pectineus ·Anterior cutaneous branches femoral L2-L4 ·Sartorius ·Quadriceps femoris ·Saphenous ·Anterior cutaneous ramus lliohypogastric T12-L1 ·Lateral cutaneous ramus ·Psoas majon ·Quadratus lumborum ·liacus ·Iumbar intertrans verse Nerves of the lumbar Segment Innervated Short,direct muscular branches T12-L4 plexus31 muscles ·Transversus abdominis Cutaneous branches Nerve