Posterior abdominal wall

Sanjaya Adikari Department of Anatomy

Objectives

 Describe the arrangement of muscles and fascia in the posterior abdominal wall  Describe the structures found in the posterior abdominal wall  Describe the posterior abdominal viscera

Contents of abdominal cavity Contents removed

Posterior abdominal wall

• A musculoskeletal wall between the lower border of the rib cage and the pelvic brim • Marks the posterior boundary of the abdominal cavity • Anteriorly lie the retroperitoneal organs and the parietal peritoneum • Posteriorly lie muscles, fascia and the lumbar spine

Structures forming the posterior abdominal wall

Rib cage peritoneum cavity Fat Fascia Muscles Bones mesentery Pelvic brim

Retro-peritoneal structures

Organs Abdominal aorta IVC, Portal vein Lymphatics Nerves Peritoneum

Paravertebral gutters

lumbar lordosis Forward projection is enhanced by aorta and IVC Floor is formed by psoas and quadratus lumborum above and iliacus below the iliac crest Posterior part of the diaphragm also contributes

Psoas major and minor L1

Fibrous arches Inguinal ligament

Psoas major muscle

Psoas major

• Originates from bodies of T12 to L5, intervertebral disks and the medial end of transverse processors • Inserted into the lesser trochanter of the femur • Part above the medial arcuate ligament lies in the thoracic cavity • Flexes the hip and laterally flexes the lumbar spine • Both muscles acting together flexes the trunk

Quadratus lumborum

Quadratus lumborum Iliolumbar ligament Anterior sacroiliac ligament

Quadratus lumborum

• Originates from transverse process of L5, iliolumbar ligament and iliac crest • Inserted into the transverse processes of L4 to L1 and the 12th rib medial half

Iliacus

Iliacus

Iliacus

• Originates from upper 2/3 of iliac fossa and anterior sacroiliac ligament thereby filling the illiac fossa • Inserted into the lesser trochanter of the femur trough a common tendon with the psoas major • Flexes the hip Psoas major muscle Iliacus Common attachment

Fascia of the posterior abdominal wall

• Psoas fascia • Iliac fascia • Lumbar part of the thoracolumbar fascia

Psoas fascia

• Thick fascial sheath surrounding the psoas muscle • Arises as the muscle enters the abdominal cavity under the medial arcuate ligament • Ends at the pelvic brim as the muscle leaves the abdomen inferior to the inguinal ligament ( does not extend into the thigh )

Thoracolumbar fascia

• Extends from the back of sacrum to the neck • Binds erector spinae to vertebral column and encloses the quadratus lumborum • Very strong in the lumbar region • Laterally it gives origin to internal oblique and transversus abdominis muscles • Its lumbar part medially splits into three layers

Transversus abdominis Anterior layer Middle layer Posoas fascia Posoas major muscle Internal oblique Quadratus lumborum Posterior layer Erector spinae

Inguinal ligament

L1

Psoas abscess

• A focus of pus in the lumbar intervertebral disks can track down along the muscle and present as a lump in the groin • Tuberculosis of the spine gives rise to a psoas abscess

Skeleton of the posterior abdominal wall include A. Ischium B. 11 th rib C. 12 th vertebra D. Sacrum E. Intervertebral disks Correct: B, C, D, E

Muscles of the posterior abdominal wall include A. Iliopsoas B. Erector spinae C. Quadratus lumborum D. Diaphragm E. Transversus abdominis Correct: A, C, D

Lateral arcuate ligament Medial arcuate ligament Anterior layer of lumbar fascia Psoas fascia Iliac fascia

Arcuate ligaments

Lateral arcuate ligament Medial arcuate ligament

Median arcuate ligament

Formed by tendinous fibres from medial edges of left and right crura of the diaphragm

L1

Median arcuate ligament

Medial and Lateral arcuate ligaments

Subcostal vessels and nerve Iliohypogastric nerve Ilioinguinal nerve Sympathetic chain Abdominal aorta

Organs in the posterior abdominal wall

Duodenum 2 nd and 3 rd parts Pancreas Kidneys and ureters Suprarenal glands

Vessels

• Aorta and its branches • Inferior vena cava and its tributaries • Portal vein and its tributaries • Lymphatics and lymph nodes

Branches of abdominal aorta

Main branches are in three categories • Single ventral arteries to gut and its derivatives – Coeliac trunk, superior and inferior mesenteric • Paired arteries to other viscera – Suprarenal, renal, gonadal • Paired arteries to body wall – Inferior phrenic, lumbar

Branches of abdominal aorta

Coeliac trunk R. inferior phrenic art.

R. suprarenal art.

R. renal art.

R. gonadal art.

Superior mesenteric a.

R. 4 th lumbar art.

Inferior mesenteric a.

Median sacral artery

T.P.P

Related structures

Coeliac trunk Splenic vein Body of pancreas Superior mesenteric a.

L. renal vein Un. pro. pancreas 3 rd part duodenum Inferior mesenteric a.

Median sacral artery

Lymph nodes

Lymphatics follow arteries • Single ventral arteries Pre-aortic nodes • Paired arteries to other viscera Para-aortic nodes • Paired arteries to body wall

Lymph nodes

Thoracic duct Cisterna chyli Para-aortic nodes Common iliac nodes External iliac nodes Internal iliac nodes Pre-aortic nodes

Lumbar plexus

1 st – 4 th lumbar spinal segments Embeded in the psoas Branches related laterally, medially or anteriorly to psoas

Branches of lumbar plexus & psoas muscle