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29 Cards in this Set
- Front
- Back
Muscles of the posterior abdominal wall:
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Psoas minor
Psoas major Iliacus Quadratus lumborum Diaphragm |
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Psoas major Proximal attachment
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Proximal attachment is the lumbar bodies and intervertebral discs of T12 to L5;
also transverse processes of lumbar vertebrae |
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Iliacus proximal attachment
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Proximal attachment is the superior 2/3 of iliac fossa
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Iliopsoas
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Psoas major and the iliacus m. merge together to form the iliopsoas m.
Iliopsoas inserts on the lesser trochanter of the femur and is a strong flexor of the hip; performs a deep bow when insertion point remains fixed The superior portion of the psoas major muscle can laterally bend the lower vertebral column when one side acts alone; important in balancing the trunk |
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Innervations of iliopsoas
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-Innervation – posas major: anterior rami L2-L4
-Innervation – iliacus m.: femoral nerve (L2 – L4) |
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Psoas minor
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- Superior attachment to lateral aspect of T12 and L1 vertebral bodies
- Inferior attachment to iliopectineal eminence - Function: balance the trunk Innervation from L1 & L2 ventral rami |
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Iliopsoas test
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- Muscle has a close relationship to abdominal organs:
Kidneys & ureters Cecum & appendix Pancreas Sigmoid colon - Intra-abdominal inflammation + psoas movement = pain - How to test: flexion of thigh against resistance or extension of thigh while lying on unaffected side -If there is pain then the location of sensation can be used to pinpoint the affected organ. For example, appendicitis will produce pain in the lower right quadrant |
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Anterior pelvic tilt
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- Tightened iliospoas m. can cause anterior pelvic tilt because of relationship with the anterior pelvis
- Anterior tilt is countered by anterior abdominal musculature including rectus abdominis and posterior gluteus maximus and hamstring mm. |
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Quadratus lumborum
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- Superior attachment: inferior border of 12th rib and transverse processes of lumbar vertebrae
- Inferior attachment: Iliac crest & iliolumbar ligament - Lateral bending of trunk; depress rib 12 - Innervation: anterior rami of T12 – L4 |
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Layers of thoracolumbar fascia
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- Note anterior, middle and posterior layers of the thoracolumbar fascia and which muscles or groups of muscles they enclose.
- Lateral attachment of posterior layer to the internal oblique and transversus abdominis mm. - Note psoas fascia and renal fascia |
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Vertical deep back mm.
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between middle and posterior layers of thoracolumbar facia
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Quadratus lumborum
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between anterior and middle layers of thoracolumbar fascia
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Diaphragm
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Floor of thoracic cavity
Roof of abdominal cavity R & L dome – Right side is higher because of the liver |
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Innervation Diaphram
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- Motor (efferent) innervation is from phrenic nerve.
- Phrenic nerve also has general somatic afferent (proprioception and pain) fibers. - On the periphery of the diaphragm GSA fibers are located within intercostal nerves and subcostal nerves. |
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referred pain diaphram
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Referred pain from the diaphragm can felt in the supraclavicular and shoulder region
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Spinal cord injuries
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in the superior cervical region can paralyze the diaphragm
- If one phrenic nerve is accidentally severed during surgery or compromised due to infection then paralysis of half the diaphragm (hemi diaphragm) results and eventual muscular atrophy will ensue. - A paralyzed hemidiaphragm cannot contract, i.e. descend, so it will be positioned higher than normal in the thorax when viewed on a chest radiograph. - An individual can still breath in such a circumstance with half a functional diaphragm but breathing is much more difficult. |
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Fibers of the diaphram
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-Muscle fibers extend peripherally to the central tendon:
- Sternal fibers Xiphoid process - Costal fibers Inferior 6 costal cartilages and adjoining ribs - Lumbar fibers Left and right crura; medial and lateral arcuate ligs. Left (L1-L3); Right (L1-L2) |
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Arcuate ligaments
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are thickenings of fascia that serve as attachments for fibers of the diaphragm
- Lateral arcuate lig. is a superior thickening of the anterior layer of thoracolumbar fascia (around quadratus lumborum). - Medial arcuate lig. is a superior thickening of the psoas fascia. |
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Diaphragmatic apertures
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allow structures to pass from the thoracic cavity into the abdominal cavity
- Caval opening – IVC - Esophageal hiatus – esophagus and vagal trunks - Aortic hiatus – descending aorta and thoracic duct |
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Hiatal hernia
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- Lax diaphragmatic fibers at the esophageal hiatus can cause the fundus of the stomach to herniate into the thoracic cavity within the region of posterior mediastinum.
- This will typically cause an increase in acid reflux symptoms and may require surgery. |
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Superior view of diaphragm
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Greater and lesser splanchnic nerves pierce the left and right crura to reach the abdominal cavity
Sympathetic trunks and least splanchnic nerves will pass behind the medial arcuate ligament |
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Diaphragm blood supply via:
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Superior phrenic arteries (from thoracic aorta)
Pericardiophrenic arteries (from internal thoracic a.) Musculophrenic arteries (from internal thoracic a.) |
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Venous drainage:
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- Pericardiophrenic & musculophrenic veins (tributaries of internal thoracic vein)
- Superior phrenic vein (tributary of the IVC) |
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Diaphragm development
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- Septum transversum becomes the future central tendon.
- It grows dorsally from the ventrolateral body wall and forms a shelf between the developing heart and liver. - The septum transversum develops in the cervical region and descends to the lower thoracic region taking the phrenic nerves (ventral rami of C3-C5) with it. - Dorsal mesentery of the esophagus becomes the crura of the diaphragm. - Muscular ingrowth of body wall contributes to the peripheral diaphragm. - Pleuroperitoneal membrane (membrane that will separate pleural and peritoneal cavities) only has small contribution in neonate. - Fusion of various components may fail resulting in congenital hernias (most common is Bochdalek’s hernia) |
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Congenital diaphragmatic hernia
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- Note intestines projecting up into the abdominal cavity
- Lung on respective side can not develop or inflate due to limited space resulting in pulmonary hypoplasia |
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Nerves of the posterior abdominal wall
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Ventral ramus of spinal nerve T12 = Subcostal nerve (inferior to rib 12)
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Sympathetic trunks in the lumbar region
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Lumbar splanchnic nerves
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Abdominal aorta
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Lumbar arteries (4 on each side) supply posterior abdominal wall
Bifurcates at the level of L4 into R & L common iliac arteries |
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Lumbar veins drain posterior abdominal wall
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R and L iliac veins join to form the IVC
Ascending lumbar veins receive 1st and 2nd lumbar veins; 3rd and 4th drain into IVC. Ascending lumbar veins communicate with azygous and hemiazygous veins. |