Presentation on theme: "Posterior abdominal wall 2"— Presentation transcript:
1Posterior abdominal wall 2 In the name of GodPosterior abdominal wall 2Dr. Zahiri
2VASCULAR SUPPLY AND LYMPHATIC DRAINGE Dr. Maria ZahiriVASCULAR SUPPLY AND LYMPHATIC DRAINGE
3ABDOMINAL AORTA Anterior: Coeliac trunk and its branches. Dr. Maria ZahiriABDOMINAL AORTAAnterior:Coeliac trunk and its branches.coeliac plexus and the lesser sac lie between it and the left lobe of the liver and lesser omentum.Superior mesenteric arteryleft renal vein, the body of the pancreasthe splenic veinthe gonadal arteries, and the third part of the duodenumsmall intestinal mesentery.
5Posterior relations of Aorta Dr. Maria ZahiriPosterior relations of Aortathoracolumbar intervertebral discsupper four lumbar vertebraeLumbar arteriesthird and fourth (and sometimes second) left lumbar veinsthe left psoas major.
7Right relations of Aorta Dr. Maria ZahiriRight relations of Aortacisterna chyli and thoracic ductazygos veinright crus of the diaphragm, which overlaps and separates it from the inferior vena cava and right coeliac ganglion.
9Left relations of Aorta Dr. Maria ZahiriLeft relations of Aortaleft crus of the diaphragmleft coeliac ganglionduodenojejunal flexureleft sympathetic trunkthe fourth part of the duodenuminferior mesenteric vessels.
10Branches of Aorta Anterior group Lateral group Dorsal group Dr. Maria ZahiriBranches of AortaAnterior groupLateral groupDorsal group
11Anterior group: Coeliac trunk is the first anterior branch Dr. Maria ZahiriAnterior group:Coeliac trunkis the first anterior branchat the level ofT12/LlSuperior mesenteric artery1 cm below the coeliac trunkat the level of the Ll-L2Inferior mesenteric artery3 or 4 cm above the aortic bifurcationat the level of L3
12Lateral group: Suprarenal arteries The renal arteries Dr. Maria ZahiriLateral group:Suprarenal arteriesThe renal arteriesThe gonadal arteries
13Dorsal group: Inferior phrenic arteries Lumbar arteries Dr. Maria ZahiriDorsal group:Inferior phrenic arteriesLumbar arteriesMedian sacral artery
14Dr. Maria ZahiriINFERIOR VENA CAVARelations of the abdominal part of the inferior vena cava:Anteriorly:right common iliac arteryroot of the mesenteryright gonadal arteryhead of the pancreasfirst part of the duodenumcommon bile ductportal vein
15The lower three lumbar vertebral bodies their intervertebral discs Dr. Maria Zahiriposterior :The lower three lumbar vertebral bodiestheir intervertebral discsthe anterior longitudinal ligamentright psoas majorsympathetic trunkright crus of the diaphragmthe medial part of the right suprarenal glandthe right coeliac ganglion
16Right & Left relations of IVC Dr. Maria ZahiriRight & Left relations of IVCRight :The right ureterthe second part of the duodenummedial border of the right kidneythe right lobe of the liverleft :The aortathe right crus of the diaphragmthe caudate lobe of the liver
17Inferior phrenic veins Dr. Maria ZahiriLumbar veinsAscending lumbar veinGonadal veinsRenal veinsSuprarenal veinInferior phrenic veins
18Dr. Maria ZahiriLumbar veinsFour pairs of lumbar veins collect blood by dorsal tributaries from the lumbar muscles and skin.anastomose with:lumbar origin of the azygosand hemiazygos veinsbranches of the inferiorand superior epigastric veins.
19Dr. Maria ZahiriAscending lumbar veinThe ascending lumbar vein connects the common iliac, iliolumbar and lumbar veins.
20Gonadal veins Only the right gonadal vein joins the IVC directly. Dr. Maria ZahiriGonadal veinsOnly the right gonadal veinjoins the IVC directly.
21Renal veins The left is three times longer than the right in length Dr. Maria ZahiriRenal veinsThe left is three times longerthan the right in length
22Dr. Maria ZahiriSuprarenal veinThe right suprarenal vein drains directly into the inferior vena cava
23Inferior phrenic veins Dr. Maria ZahiriInferior phrenic veinsrun on the inferior surface of the central tendon of the diaphragm.drain into the posterolateral aspect of the IVC
24LYMPHATIC DRAINAGE posterior abdominal wall: Dr. Maria ZahiriLYMPHATIC DRAINAGEposterior abdominal wall:The small upper left and upper right lateral aortic nodesThe larger lower left and lower right portions lateral and retro aortic lymph nodesOr the left and right superficial inguinal nodes.
25through the cisterna chyli and the thoracic duct Dr. Maria Zahiriabdominal viscera:through the cisterna chyli and the thoracic ductThe lymph nodes of the retroperitoneum lie around the abdominal aorta and form pre-aortic, lateral aortic and retro-aortic groups.Collectively, they are referred to as the para-aortic lymph nodes
27Cisterna chyli and abdominal lymph trunks Dr. Maria ZahiriCisterna chyli and abdominal lymph trunksThe abdominal origin of the thoracic duct:lies to the right of the midlineat the level of the lower border of the T12receives all the lymph delivered by the four main abdominal lymph trunks
28Dr. Maria ZahiriThe lumbar lymph trunks are formed by vessels draining from the lateral aortic nodes. Thus, either directly or after traversing intermediary groups, they carry lymph from:the lower limbs, the full thickness of the pelvic, perineal and infra-umbilical abdominal walls, the deep tissues of most of the supra-umbilical abdominal walls, most of the pelvic viscera, gonads, kidneys and suprarenal glands.
29Dr. Maria ZahiriThe intestinal lymph trunks receive vessels draining from coeliac nodes and, via these nodes, the superior and inferior mesenteric nodes, which are collectively the pre-aortic nodes.Either directly or via intermediary groups, they drain the entire abdominal gastrointestinal tract down to the anus.
30Dr. Maria ZahiriPre-aortic grouplie around the origins of the anterior (visceral) arteries and receive lymph from the gastrointestinal tract and its accessory structures (liver, spleen and pancreas) from the abdominal oesophagus to the level of the anus.They are divisible into coeliac, superior mesenteric and inferior mesenteric groups, being near the origins of these arteries.
31Dr. Maria ZahiriCoeliac nodesThe coeliac nodes lie anterior to the abdominal aorta around the origin of the coeliac artery.receive lymph draining from the regional lymph nodes around the branches of the coeliac artery (left gastric, hepatic and pancreaticosplenic nodes).They also receive lymph from the lower pre-aortic groups (the superior mesenteric and inferior mesenteric).
32Dr. Maria ZahiriGastric NodesThere are a great number of gastric lymph node groups. They drain the stomach, upper duodenum, abdominal oesophagus and the greater omentum.They drain to the coeliac group.
33Hepatic Nodes They vary in number and site Dr. Maria ZahiriHepatic NodesThey vary in number and sitebut almost occur at the junction of the cystic and common hepatic ducts (the cystic node), and in the anterior border of the epiploic foramen.Hepatic nodes drain the majority of the liver, gallbladder and bile ducts, but also receive drainage from some parts of the stomach, duodenum and pancreas.They drain to the coeliac nodes
34Pancreaticosplenic Nodes Dr. Maria ZahiriPancreaticosplenic NodesThe pancreaticosplenic nodes drain the spleen, pancreas and part of the stomach.Their afferents join the coeliac nodes.
35Superior mesenteric and inferior mesenteric nodes Dr. Maria ZahiriSuperior mesenteric and inferior mesenteric nodeslie anterior to the aorta near the origins of their respective arteries.They collect from outlying groups, including the mesenteric, ileocolic, …drain into the coeliac nodes.
36Dr. Maria Zahirilateral aortic groupThe lateral aortic nodes lie on either side of the abdominal aorta anterior to the medial margins of psoas major, diaphragmatic crura and sympathetic trunks.On the right, some nodes lie lateral and anterior to the inferior vena cava near the end of the right renal vein.
37Dr. Maria Zahirilateral aortic groupThe lateral aortic nodes drain the viscera and other structures supplied by the lateral and dorsal aortic branches.The upper lateral groups receive the lymph drainage directly from the suprarenal glands, kidneys, ureters, gonads, uterine tubes and upper uterus. They also receive lymph directly from the deeper tissues of the posterior abdominal wall.
38Dr. Maria ZahiriLymphatics from the pelvis, most of the pelvic viscera, the perineum and the anterolateral abdominal wall pass first to regional nodes largely related to the iliac arteries and their branches.These include the common iliac, external iliac, internal iliac and circumflex iliac nodes, in addition to the inferior epigastric and sacral nodes.
39Dr. Maria ZahiriLymph from the lower limbs passes through the pelvic lymph nodes via the iliac groups.The lateral aortic group drains into the two lumbar lymph trunks, one on each side, which terminate in the confluence of lymph trunks.A few vessels may pass to the pre-aortic and retro-aortic nodes and others cross the midline to flow into the contralateral nodes, forming a loose plexus.
40Dr. Maria ZahiriRetro-aortic groupThe retro-aortic group is the smallest of all the para-aortic lymph nodes.They have no particular areas of drainage, although they may receive some lymph directly from the paraspinal posterior abdominal wall.They effectively provide peripheral nodes of the lateral aortic groups and interconnect between surrounding groups.
55Iliohypogastric nerve Dr. Maria ZahiriIliohypogastric nerveoriginates from the L1 ventral ramuslateral border of psoas majorin front of quadratus lumborum.lateral cutaneous branches (iliac crest)Ant. cutaneous branches (ASIS)
56Dr. Maria ZahiriMotor –transversus abdominis and internal oblique, including the conjoint tendon.Sensory - The iliohypogastric nerve supplies sensory fibres to transversus abdominis, internal oblique and external oblique, and innervates the posterolateral gluteal and suprapubic skin.
57Ilioinguinal nerve originates from the L1 ventral ramus Dr. Maria ZahiriIlioinguinal nerveoriginates from the L1 ventral ramusIt is smaller than the iliohypogastric nervethe lateral border of psoas majorjust inferior to the iliohypogastric nerveIlioinguinal nerve emerges with the cordskin of the thigh and the skin over the root of the penis and upper part of the scrotum in males, or the skin covering the mons pubis and the adjoining labium majus in females.
58Ilioinguinal nerve Motor – transversus abdominis and internal oblique. Dr. Maria ZahiriIlioinguinal nerveMotor –transversus abdominis and internal oblique.Sensoryto transversus abdominis and internal obliquemedial skin of the thigh and the skin over the root of the penis and upper part of the scrotum in males or the skin covering the mons pubis and the adjoining labium majus in females.
59Genitofemoral nerve originates from the L1 and L2 ventral rami. Dr. Maria ZahiriGenitofemoral nerveoriginates from the L1 and L2 ventral rami.It is formed within the substance of psoas majorIt descends beneath the peritoneum on psoas major Crosses obliquely behind the ureter and divides above the inguinal ligament into genital and femoral branches.
60Dr. Maria ZahiriGenitofemoral nerve often divides close to its origin; its branches then emerge separately from psoas major.The genital branch crosses the lower part of the external iliac artery, enters the inguinal canal by the deep ring and supplies cremaster and the skin of the scrotum in males.In females, it accompanies the round ligament and ends in the skin of the mons pubis and labium majus.
61The femoral branch descends lateral to the external iliac artery Dr. Maria ZahiriThe femoral branch descends lateral to the external iliac arteryand sends a few filaments round it.It then crosses the deep circumflex iliac arterypasses behind the inguinal ligament and enters the femoral sheath lateral to the femoral artery.
62cremaster via the genital branch. Cutaneous – Dr. Maria ZahiriMotor –cremaster via the genital branch.Cutaneous –the skin of the scrotum in males or mons pubis and labium majus in females via the genital branch, and the anteromedial skin of the thigh via the femoral branch.
63Femoral nerve descends through psoas major Dr. Maria ZahiriFemoral nervedescends through psoas majorIt passes between psoas major and iliacus and runs posterior to the inguinal ligament into the thigh.It gives off branches, which supply iliacus and pectineus and sensory fibers to the femoral arteryPosterior to the inguinal ligament, it lies lateral to the femoral artery and is separated from it by a part of psoas major.
64Lateral femoral cutaneous nerve of the thigh Dr. Maria ZahiriThe lateral femoral cutaneous nerve of the thigh emerges from the lateral border of psoas major and crosses iliacus obliquely towards the anterior superior iliac spine.It supplies sensory fibers to the parietal peritoneum in the iliac fossa.The right nerve passes posterolateral to the caecum, separated from it by the iliac fascia and peritoneum. The left nerve passes behind the lower part of the descending colon. Both pass behind or through the inguinal ligament c.l cm medial to the anterior superior iliac spine and anterior to, or through, sartorius into the thigh.
65Dr. Maria ZahiriObturator nerveThe obturator nerve descends within the substance of psoas major to emerge from its medial border at the level of the pelvic brim.It passes posterior to the common iliac vessels and lateral to the internal iliac vessels. It then descends on the lateral wall of the pelvis attached to the fascia over obturator intern us. Here it lies anterosuperior to the obturator vessels before running into the obturator foramen to enter the thigh. It gives no branches in the abdomen or pelvis.
66Accessory obturator nerve Dr. Maria ZahiriAccessory obturator nerveWhen present, the accessory obturator nerve emerges from the medial border of psoas major and runs along this border over the posterior surface of the superior pubic ramus posterior to pectineus. It gives off branches here to supply pectineus and the hip joint, and it may join with the main obturator nerve.
67Dr. Maria ZahiriLUMBOSACRAL PLEXUSThe lumbosacral plexus provides the nerve supply to the pelvis and lower limb, in addition to part of the autonomic supply to the pelvic viscera. It gives origin to the sciatic, inferior gluteal, superior gluteal and pudendal nerves, in addition to the nerves to quadratus femoris, obturator intemus and the posterior cutaneous nerve of the thigh.