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Posterior abdominal wall

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Presentation on theme: "Posterior abdominal wall"— Presentation transcript:

1 Posterior abdominal wall
Sanjaya Adikari Department of Anatomy

2 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

3 Contents of abdominal cavity
Contents removed Contents of abdominal cavity

4 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

5 Structures forming the posterior abdominal wall
Rib cage peritoneum cavity Fat Fascia mesentery Muscles Bones Pelvic brim

6 Retro-peritoneal structures
Organs Abdominal aorta IVC, Portal vein Lymphatics Nerves Peritoneum

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

8 Psoas major and minor Fibrous arches L1 Inguinal ligament

9 Psoas major muscle

10 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

11 Quadratus lumborum Quadratus lumborum Iliolumbar ligament
Anterior sacroiliac ligament

12 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

13 Iliacus Iliacus

14 Iliacus Psoas major muscle Iliacus Common attachment 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

15 Fascia of the posterior abdominal wall
Psoas fascia Iliac fascia Lumbar part of the thoracolumbar fascia

16 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)

17 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

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

19 L1 Inguinal ligament

20 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

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

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


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

25 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 Lateral arcuate ligament Medial arcuate ligament L1

26 Medial and Lateral arcuate ligaments
Sympathetic chain Subcostal vessels and nerve Abdominal aorta Iliohypogastric nerve Ilioinguinal nerve


28 Organs in the posterior abdominal wall
Duodenum 2nd and 3rd parts Pancreas Kidneys and ureters Suprarenal glands


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

31 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

32 Branches of abdominal aorta
R. inferior phrenic art. Coeliac trunk L5 T12 R. 4th lumbar art. R. suprarenal art. Superior mesenteric a. R. renal art. R. gonadal art. Inferior mesenteric a. Median sacral artery

33 Related structures Coeliac trunk T12 Splenic vein Body of pancreas
T.P.P Superior mesenteric a. L. renal vein Un. pro. pancreas 3rd part duodenum Inferior mesenteric a. Median sacral artery


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

36 Lymph nodes

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

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

39 Branches of lumbar plexus & psoas muscle

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