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    Posterior Abdominal Wall

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    ezekieldare91
    The document describes the muscles, nerves and vasculature of the posterior abdominal wall. It details the origins, insertions, innervation and actions of the major muscles including the psoas major, quadratus lumborum and iliacus. It also describes the lumbar plexus, including its formation and branches, as well as the sympathetic and parasympathetic innervation of the abdominal region.

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    Posterior Abdominal Wall

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    ezekieldare91
    5 views29 pages
    The document describes the muscles, nerves and vasculature of the posterior abdominal wall. It details the origins, insertions, innervation and actions of the major muscles including the psoas major, quadratus lumborum and iliacus. It also describes the lumbar plexus, including its formation and branches, as well as the sympathetic and parasympathetic innervation of the abdominal region.

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    posterior_abdominal_wall

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    The document describes the muscles, nerves and vasculature of the posterior abdominal wall. It details the origins, insertions, innervation and actions of the major muscles including the psoas major, quadratus lumborum and iliacus. It also describes the lumbar plexus, including its formation and branches, as well as the sympathetic and parasympathetic innervation of the abdominal region.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    5 views29 pages

    Posterior Abdominal Wall

    Uploaded by

    ezekieldare91
    The document describes the muscles, nerves and vasculature of the posterior abdominal wall. It details the origins, insertions, innervation and actions of the major muscles including the psoas major, quadratus lumborum and iliacus. It also describes the lumbar plexus, including its formation and branches, as well as the sympathetic and parasympathetic innervation of the abdominal region.

    Copyright:

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    of 29

    Posterior Abdominal

    wall- I
    (Muscles & nerves)
    Dr Garima Sehgal
    Associate Professor
    Department of Anatomy
    King George’s Medical University
    DISCLAIMER:
    • The presentation includes images which are either
    hand drawn or have been taken from google images
    or books.

    • They are being used in the presentation only for


    educational purpose.

    • The author of the presentation claims no personal


    ownership over images taken from books or google
    images.

    • However, the hand drawn images are the creation of


    the author of the presentation
    Learning Objectives
    By the end of this teaching session you should be able
    to-
    • Describe the muscles of posterior abdominal wall (origin,
    insertion, actions, nerve supply)

    • Enumerate the nerves of the posterior abdominal wall

    • Describe the lumbar plexus (location , formation , branches)


    Understanding the anatomical
    reconstruction Muscles of
    posterior abdominal wall
    Skeletal Background
    Ligamentous background

    Musculofascial Background

    1. T 12 vertebra 1. Iliolumbar ligament


    2. 12th rib 2. Anterior longitudnal
    3. L 1 – L5 vertebrae ligament
    4. Iliac crest and iliac 1. Psoas major muscle
    3. Ventral sacroiliac and fascia
    fossa ligament 2. Quadratus lumborum
    3. Iliacus and fascia iliaca
    4. Psoas minor
    Psoas major
    Occupies 3 regions- abdomen, false
    pelvis & upper thigh
    Origin – 14 fleshy strips
    Continous attachment from T12(lower
    border) to L5 (upper border)
    1. discs above 5 lumbar vertebrae
    2. adjoining parts of vertebral
    bodies
    3. 4 fibrous arches across the sides
    of upper 4 lumbar vertebrae
    Actions –
    i. Chief flexor of thigh at hip joint Insertion
    ii. Bilateral muscles help in flexion of •as Ilio psoas tendon
    trunk • at lesser trochanter
    iii. Medial rotator of thigh Nerve supply – ventral rami of L1 – L4
    Psoas fascia
    Covers psoas muscle
    Attachments:
    Superiorly - thickened and forms
    medial arcuate ligament (body of L1 to
    tip of L1 transverse process)
    Laterally fused with anterior layer of
    thoracolumbar fascia
    Medially – bodies of lumbar vertebrae &
    intervertebral discs
    Inferiorly – fused with fascia covering
    iliacus
    Forms a sheath around muscle – psoas
    sheath
    Psoas minor

    Origin – common origin with psoas


    major from T12 – L1

    Insertion –
    • Iliopubic eminence

    Nerve supply – ventral rami of L1


    Quadratus Lumborum
    Most lateral muscle of posterior
    abdominal wall
    Origin –
    • Iliolumbar ligament
    • Adjacent part of iliac crest
    • Lumbar vertebrae transverse process

    Insertion –
    • Medial part of inferior border of 12th
    Rib
    Actions –
    i. Helps to fix 12th rib during inspiration • slips to transverse process behind
    ii. Bilateral muscles help in extension of slips of origin
    lumbar vertebral column Nerve supply – upper lumbar nerves &
    iii. Acting singly – lateral flexion subcostal nerve
    Iliacus
    Below iliac crest
    Origin –
    • Upper 2/3 rd of iliac fossa

    Insertion –
    • as iliopsoas tendon to the lesser
    trochanter

    Nerve supply –
    Femoral nerve

    Actions:
    Flexion of thigh at hip joint
    Iliac Fascia
    • Covers the iliacus
    Fascia attachments:
    • Medially – merges with psoas
    fascia & attached to
    iliopectineal eminence
    • Inferiorly –passes deep to
    inguinal ligament & forms
    posterior layer of femoral
    sheath
    Triangle of surgical
    importance

    Triangle of Marcille /

    Lumbosacral triangle
    Lumbosacral triangle
    Boundaries:
    • Medially – body of L5
    • Laterally – medial border of
    psoas major
    • Apex – junction of medial &
    lateral margin
    • Base – Ala of sacrum
    • Floor – transverse process of L5
    & iliolumbar ligament

    Ureter crosses common iliac vessels


    at lateral angle
    Nerves of the posterior abdominal
    wall
    ➢Lumbar plexus and its branches

    ➢Abdominal part of ANS


    – Sympathetic nerves
    • Thoracic splanchnic nerves- greater, lesser & least
    • Lumbar splanchnic nerves – from Lumbar sympathetic chain
    – Parasympathetic nerves
    • Branches from right and left vagus
    Lumbar Plexus
    • Plexus of nerves on posterior abdominal wall
    • Nerves taking part –
    – Ventral rami of L1, L2, L3 & L4 (upper part)
    NOTE : Lower part of L4 does not participate in formation

    of lumbar plexus it joins L5 to form lumbosacral trunk

    The lumbar plexus innervates part of the lower abdominal wall


    But is chiefly concerned in supplying
    “ skin and muscle borrowed from the trunk by the lower limb”
    Formation & Location of lumbar plexus
    Lumbar
    ganglia
    • Anterior primary rami of L1-L4
    emerge from respective
    intervertebral foramina
    Ventral ramus • Enter the substance of psoas
    Lumbar spinal nerve • Give off branches to psoas and
    quadratus
    • After this they form a plexus –
    LUMBAR PLEXUS within
    substance of psoas major
    Branches of Lumbar plexus
    Iliohypogastric & Ilioinguinal- L1
    Genitofemoral- L1 , L2
    Lateral femoral cutaneous nerve –
    L2, L3 (posterior division)

    Femoral - L2, L3, L4 (posterior division)


    Obturator - L2, L3, L4 (Anterior division)-
    Sometimes – Accessory obturator nerve L3, L4 (posterior divisions)
    Relation of Psoas major muscle &
    branches of lumbar plexus
    Emerge from lateral border of psoas major:
    • iliohypogastric nerve
    • Ilioinguinal nerve
    • lateral femoral cutaneous nerve
    • femoral nerve
    Emerges through psoas anteriorly:
    • genitofemoral nerve
    Emerges from medial border:
    •obturator nerve
    Abdominal part of ANS
    • Receives both sympathetic and parasympathetic nerves
    • Sympathetic supply----- twofold supply provided by
    • Lumbar part of sympathetic chain
    – Gives both somatic and visceral branches
    – Somatic branches – supply lower abdominal wall & lower limb
    – Visceral branches – supply only pelvic organs
    • Thoracic part of sympathetic chain through Celiac plexus
    – Celiac plexus gives only visceral branches – supplies all abdominal
    organs including gonads
    • Parasympathetic supply ------ twofold supply provided by
    • Vagus nerve from above
    • Pelvic splancnic nerves from below
    Sympathetic supply-
    Lumbar sympathetic chain

    • Enters abdomen behind medial arcuate ligament


    • Descends in front of lumbar vertebrae
    • Along medial margin of psoas
    • Right trunk is behind IVC
    • Left trunk along left margin of aorta
    • Passes in front of lumbar vessel
    • But, behind common iliac vessels
    Sympathetic supply-
    Lumbar sympathetic chain contd…..

    • Ganglia----- usually 4 in number


    • Gives off both somatic and visceral branches
    – Somatic branches (grey rami
    communicantes)
    • Pass from ganglia to all five lumbar nerves
    • Supply body wall & lower limb
    – Visceral Branches( Lumbar splancnic
    nerves)
    • Arise from all lumbar ganglia
    • Join aortic & superior hypogastric plexus
    Sympathetic supply-
    Celiac plexus (solar plexus)

    • lies around origin of celiac trunk


    • consists of right & left celiac ganglia
    • lower detached part – aorticorenal ganglion
    • receives pre ganglionic sympathetic fibres
    through greater and lesser splanchnic nerves
    • pre- ganglionic fibres relay in celiac ganglion
    • post ganglionic fibres from ganglia ----- form celiac plexus
    • post ganglionic fibres pass along all vissceral branches of aorta to
    reach all abdominal viscera
    Actions of sympathetic supply

    • Vasomotor
    • Motor to sphincters
    • Inhibitory to peristalsis
    • Carry sensory fibres for all viscera

    Suprarenal medulla receives preganglionic fibres directly


    WITHOUT RELAY ------ cause release of adrenalin from
    adrenal medulla
    Parasympathetic part
    • Receive fibres from both vagal trunks
    • Both trunks contain fibres from right and left vagus nerves
    • Enter celiac plexus
    • Pass without relay
    • Supply viscera, gut is supplied
    • only upto transverse colon by vagus

    • Splenic flexure onwards


    • parasympathetic supply received through pelvic splanchnic
    nerves derived from S2, S3 & S4
    Actions of parasympathetic supply

    • Stimulates peristalsis
    • Inhibitory to sphincters
    • Secretomotor to the gut and its glands
    – upto transverse colon (vagus),
    – beyond splenic flexxure of colon to rectum (pelvic splanchnic
    nerves)
    Applied Anatomy
    Appendix & right psoas major
    muscle

    Retrocaecal appendix

    Inflammation of appendix

    Spasm of psoas major

    Patient keeps right thigh in flexed &


    medially rotated position

    This forms basis of PSOAS TEST


    Psoas Abscess

    Accumulation of pus in the vertebral column


    Pus trickles along psoas muscle within psoas
    sheath
    Collection of pus passes underneath inguinal
    ligament
    Presents as swelling in the groin below
    inguinal ligament
    Meralgia Paresthetica
    •Normally Lateral femoral
    cutaneous nerve passes deep to
    lateral end of inguinal ligament

    •Sometimes, it may pass through


    substance of inguinal ligament

    •Entrapment of nerve causing

    •Pain along its distribution

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