. At the aortic opening in the diaphragm opposite the lower border of T12 in the
median plane behind the median arcuate ligament & between the Rt. & Lt. crura.
. lt is a continuation of the thoracic aorta.
. Aortic pulsation can be felt just to the left of the umbilicus.
. At L4 vertebra slightly to the left by dividing into 2 terminal branches (2 common
.Posterior: {F it lies directly anterior to L1 - L4.
.Structures cross anterior to aorta include:
.On its left side: ls closely related to the Lt sympathetic trunk.
.On its right side: lVC, cisterna chyli.
3 sinqle branches to GIT viscera
F Celiac trunk ) Starts at upper border of L1.
) Superior mesenteric a.) Starts at lower border of L1.
F lnferior mesenteric a.) Starts at L3.
3 paired branches to the qland
) Gonadal (testis or ovarian) lower border of L2.
5 paired branches to the walls
) Phrenic a. (to the diaphragm): one pair.
) Lumbar arteries (to abdominalwall & spinal cord): 4 pairs.
@ tf lumbar arteries are abstructed ) paraplegia due to spinat cord infarction.
. hg!gig!6 The abdominal aorta is exposed by a long midline incision
from the xiphoid process to the pubis.
. j.pgl!E!!g!!: The most common indication is for aneurysm which lies
level of the renal arteries in 95% of cases.
1)The peritoneum in Lt. para-colic gutter is incised laterally to the Lt. colon &
extended above to the diaphragm & below to the pelvic brim.
2) Left colon, left kidney, spleen, body & tail of pancreas & fundus of the
stomach are retracted upwards and to the right in the relatively avascular
plane in anterior median line.
1 cm below & to the Lt. of the
O f iq in : one of the 2 terminal branches of abdominal aorta at lower border of L4.
CO U f Sg: it descends downwards & laterally along the medial side of psoas major
End: opposite to sacro-iliac joint by dividing into external & internal iliac arteries.
O f iO i n : at the sacroiliac joint as the larger of the two terminal branches of the
EndS: at mid inguinal point where it continues as the femoral artery in the thigh.
a. Deep Circumflex lliac arterv:
It runs between internal oblique & transversus abdominis, so it can be injured
during widening the incision of appendectomy (it anastomoses with
b. I nferior Eoiaastri c arterv
- Passes upwards close to the medial margin of deep inguinal ring.
- Then it pierces fascia transversalis (posterior wall of rectus sheath) to enter the
sheath where it anastomoses with superior epigastric artery.
o Pubic branch: anastomose with pubic branch of obturator A.
o Cremaseric branch: anastomose with testicular A.
- lt ascends close to the medial margin of the deep ring, then enter the posterior
wall of rectus sheath to anastomose with superior epigastric A. at the level of
Surqical Imoortance of inferior epioastric artery:
1. lt forms the lateral border of Hasselbach's triangle.
2. Lies between direct & indirect inguinal hernias (direct medially & indirect
3. Lies between the two limbs of pantaloon hernia.
4. lt marks the neck of hernial sac during herniotomy.
5.ln Orchiopexy, if additional length is needed, this artery is cut and anastomosed
with testicular artery giving more length for the spermatic cord.
6. ln sometimes give an abnormal obturator artery (large pubic branch):
.Present in 30% of population.
fifi[ enArging the femoral ring medially to relieve strangulation of femoral
hernia sometimes ) severe hemorrhage due to tear of abnormal obturator a.
7. lt gives the cremasteric artery.
8. There is an anastomosis between subclavian & external iliac arteries, in
which the inf. epigastric a. participates (important in LERICH syndrome)
' These vessels can be approached extra-peritoneally by an oblique incision such
as the one used for the ureter.
. The incision runs obliquely fonryards from the loin in the direction of the
symphysis pubis up to the lateral border of the rectus abdominis.
. This incision exposes the whole length of iliac vessels, including the aortic
bifurcation, but the exposure afforded to the opposite iliac vessels is poor.
suface anatomv of common iliac & external iliac afteries
- 1 cm below & to the Lt. of the umbilicus.
common iliac A. while the lower 2i3 represent the external iliac A.
5. Rt. gonadalvein. (testicular or ovarian)
BeO inS: at the lower border of L5 by union of the 2 common iliac veins behind the
. lt ascends on the right side of the abdominal aorta.
. lt is closely related to the Rt. sympathetic trunk.
End: it pierces the central tendon of the diaphragm to open into the right atrium.
The diaphragm, pericardium & heart are formed in the neck, and thus obtain their
nerve supply from there. They migrate to their final sites carrying their nerve supply
It separates pericardial development (ventrally) from developing gut (dorsally). lt
moves to lie caudal to pericardial cavity. lt descends from neck to form the central
Bodv wall (transverce laver) and pleura-oeritoneal membranes:
Both grow inwards to fuse with septum transversum and give the diaphragm.
Dorsal mesentry of the esophaous:
Completes the diaphragm posteriorly.
Despite this complex development, few defects occur in the diaphragm.
Perhaps the severer ones are incompatible with life.
The important sites of hernia:
a- Sternal: back of xiphoid process.
Costal: lower 6 costal cartilages.
, Rt. crus from front of upper 3 lumbar vertebrae.
' Lt. crus from front of upper 2 lumbar vertebrae.
. 2 lateral ) bridges over quadrates lumborum muscle
. 2 medial ) bridges over psoas major muscle
The three large openings in the diaphragm are shown in table
Nerve Suoply of the DiaPhraom{F
i-phrenic nerve (C4) is the motor nerve to the diaphragm and is also sensory to
receives sensory nerves from the lower six or seven intercostal nerves.
Action: {F - It is the chief (involuntary) muscle of inspiration (contraction ) central tendon
descends & intra-thoracic pressure decreases).
- lt can also be used voluntarily to increase pressure in the abdomen.
- Contraction of diaphragm assists in venous return to the heart.
- Contraction of Rt. crus helps in preventing regurgitation of food from stomach into
the esophagus (pinch-cock mechanism).
o Relations of the Upper Surface:
- PIeura & lung on both sides.
- Base of pericardium in the middle.
. Relations of the Lower Surface:
- Liver, kidney & suprarenal gland (on both sides).
- Spleen & stomach (on the left).
Points of Surqical Imoortance:
Foramen of Morgagni or Magendi:
- Due to: persistent pleura-peritoneal canal.
- Sife. It is a triangular gap between the lat rib & the diaphragm.
- Posterior diaphragmatic hernia may develop through it.
{Fof the transverse processes of all lumbar vertebrae.
2) By 5 digitations, each of which arises from the sides of the bodies of each 2
adjacent lumbar vertebrae and the inter-vertebral discs in between.
3) From tendinous arches attached to the sides of the lumbar vertebrae. These
arches bridge over the lumbar arteries.
- The muscle descends medial to iliacus muscle & continues downwards to enter
the front of the thigh behind inguinal ligament above superior pubic ramus.
- lts tendon receives fibers of the iliacus muscle and is inserted into the lesser
Nerve SuOplv: branches from the lumbar plexus (L 1, 2, 3).
..r.-1) lt flexes the thigh and rotates it medially. But in fracture of the neck of femur, the
*' muscle rotates-the thigh laterally. ' 2)Acting from below, the muscle bends the trunk fonrvards.
I'he Psoas Majon is enveloped by the psoas fascia, whieh is thickened ln tts upper
part to form the medial arcuate ligament.
l-a,l hnrolal rFy rrd"eiE arhry ild lrnil
Common for Lt. and Rt. muscles
1) Kidney and its renal vessels.
5) Psoas minor (in G0% of population).
6) End of the ileum (on the right) and descending coton (on the left).
lVC, 2nd and 3rd parts of duodenum.
1. Transverse processes of lumbar vertebrae.
1. Quadratus lumborum (above).
5. Lateral cutaneous nerve of thigh.
6. Femoral nerve (the lower most).
1)Sympathetic trunk (along its medial margin).
2) External iliac vessels (at the brim of the pelvis).
3)2 nerves: obturator nerve and lumbosacraltrunk.
root of mesentery and superior mesenteric vessels.
Points of Surqical Importance:
- ln acute appendicitis, there.is spasm of psoas major ms. ) flexion deformity.
- Hyperextension of the rib leads to abdominal pain (psoas sign).
- Produces cross fluctuation (DD: mass in the Rt. iliac fossa & mass in the
E. Obliterated Psoas Shadow in X-Ray film:
d. In fracture neck of the femur the muscle rotates the thigh laterally (not
It is formed by ventral rami of L1, 2,3 & greater part of L4 (nervus furcalis).
It is lies within the posterior part of Psoas major muscle.
ls connected to sacral plexus by lumbo-sacral trunk
) To quadratus lumborum (T12, L1, L2, L3).
) To psoas major (L2, L3, L4).
) Lateral cutaneous nerve of the thigh (L2, L3).
) Femoral (dorsal division of L2, L3, L4).
) Obturator (venteral division of L2, L3, L4).
) Accessory obturator (venteral division of L3, L4).
To oberrator lllimus nHJEcla lii lo,Jctor anl. coogygt€HJs. End s(l6ntEl srd sptlrEt€r nuselEg
FGt€rlor rgltorel anan€ol.E nrYg Pld€ndd nsrYe
@ Esrylet Drdle et al: 6rdt','s fttabrfly &r StulellE - unvw.s[tthntcon$lt,com
The pelvis is the area of transition
between the trunk and the lower
limbs. The bony pelvis serves as the
foundation for the pelvic region and it
provides strong support for the
vertebral column upon the lower
limbs. .The pelvic cavity contains the
rectum, the urinary bladder, and the
internal genitalia. The perineum is the
region of the trunk that is located
between the thighs. The pelvic
diaphragm separates the pelvic cavity
from the perineum . The perineum
contains the anal canal, the urethrq
and the external genitalia (penis and
No comments:
Post a Comment
اكتب تعليق حول الموضوع