ANATOMY: Posterior Abdominal Wall

8/8/2019 ANATOMY: Posterior Abdominal Wall

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Posterior Abdominal WallPosterior Abdominal Wall

&&KidneysKidneys


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Fascia of The Posterior Abd. WallFascia of The Posterior Abd. Wall

ThoracolumbarFascia

3 layers of fascia:

ant., middle & post.

Covers the muscles

of post. abd. Wall

Continuous with

Transversalis fascia

&Deep muscle fascia

of anterolateral wall


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Muscles of Post. WallMuscles of Post. Wall

Mainly 3 muscles:

Psoas major

Iliacus

Quadratus lumborum


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*Psoas minor muscle:

small muscle

not always present (40%)

in front of psoas major

*psoas majoris the only muscle in the body to contain a

nervous plexus (network) within it


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Iliacus MuscleIliacus Muscle

Iliac fossa

Join psoas m. to form

Iliopsoas

Lesser trochanter of femur

Innervation:

femoral n. of lumbar plexus

Action: Flexes thigh on trunk


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Quadratus LumborumQuadratus Lumborum

From 12th rib

Iliac crest

Lateral to psoas major m.

Innervation:

lumbar plexus

Action:

Fixes 12th rib inspiration

Depresses 12th rib- forced

expiration


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Nerves of Post. Abd. WallNerves of Post. Abd. Wall

Subcostal n. (T12)

Lumbar nerves (L1-L5)

L1 L4: form a network inside psoas major m. Lumbar plexus

L4 & 5 S4: form network in the pelvis

LumboSacral plexus

L4 &L5 branch tolumbosacralplexusis

called:

Lumbosacraltrunk


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Branches of Lumbar PlexusBranches of Lumbar Plexus

L1: iliohypogastric & ilioinguinal n.

Genitofemoral nerve: (L1, L2)

ant. to psoas major

divide into: genital branch& femoral branch

Femoral nerve: (L2, L3, L4)

Obturator nerve (L2, L3, L4)


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Bld. Supply to Post. WallBld. Supply to Post. Wall

Arteries:

Subcostal a. (T12)

5 Lumbar a. (from abd. Aorta)

1st lumbar branch is

called?

Veins:

Subcostal vein (T12)drains into??

5 Lumbar veins (to IVC)


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KidneysKidneys


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KidneysKidneys

*Retroperitoneal

Rt. is at lowerlevel than the Lf.

Rt. Lobe of Liver

Usually at vertebral level between:

T12 L3

Convex lat. Border

&

Concave med. Border

(contains the hilum)


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Structures within The HilumStructures within The Hilum

From ant. to post.:

Renal Vein:

most ant.

Lf. is longer than Rt.

Renal Artery

Ureter:most posterior


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Coverings of the KidneysCoverings of the Kidneys

From interior to out:1. Fibrous Capsule:

strong protecting layer

2. Perirenal Fat:

3. Renal Fascia:

continue with transversalis

fascia on lateral wall

4. Pararenal Fat:

external to renal fascia

continue with post. fat layer


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Renal StructureRenal Structure

In longitudinal cross section

Outer layer = cortex

Inner renal pyramids = medullalighter in color in cadaver

2 projections:

Renal columns:??

Medullary rays:

striated projections from basesof renal pyramids into cortex


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Kidneys RelationsKidneys Relations

Lf. Kidney

Sup.:

spleen

suprarenal gland

Ant.:

pancreas

Lf. Colic flexure

Post.:diaphragm

psoas major

Quadratus lamborum


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Draining SystemDraining System

Each pyramid drains intoMinor calyx

Minorcalyces join into

Major calyx

Major calyces join into

Renal pelvis

Renal pelvis drains to

ureter


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Arterial Blood Supply To The KidneyArterial Blood Supply To The Kidney

Renal a.

Segmental a.

(5 a.)

Lobar

one for each ?

Interlobar a.

pass through ??

Arcuate a.over the bases of the pyramids

Interlobular

Between lobules of the kidney


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Renal TransplantRenal Transplant

Transfer of a kidney from a living donor or cadaver to a pt. withTransfer of a kidney from a living donor or cadaver to a pt. with

renal failurerenal failure

1- Donor kidney usually placed in

the pt. pelvis

2- Renal a. & v. : attached to iliac a. & v.

3- Ureter: attached to bladder

4- Diseased kidneys: left in place

5- Pt. receives immunosuppressive drugs for life (why?)


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HemodialysisHemodialysis

An artificial method for bld. Filtration when kidneys are in renal failure

Dialysis Solution

Selective permeable membrane

Artificial kidney machine


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UreterUreter

Muscular tube that extends from the kidneys to the urinary bladder

(b 25 cm)

3 areas of constriction:

When renal pelvis joins the ureter

Over pelvic brim

When enters the bladder

(posteriorly)

ANATOMY: Posterior Abdominal Wall

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