1. Posterior abdominal wall 2
In the name of God
Posterior abdominal wall 2
Dr. Zahiri

2. VASCULAR SUPPLY AND LYMPHATIC DRAINGE
Dr. Maria Zahiri
VASCULAR SUPPLY AND LYMPHATIC DRAINGE

3. ABDOMINAL AORTA Anterior: Coeliac trunk and its branches.
Dr. Maria Zahiri
ABDOMINAL AORTA
Anterior:
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 artery
left renal vein, the body of the pancreas
the splenic vein
the gonadal arteries, and the third part of the duodenum
small intestinal mesentery.

4. Dr. Maria Zahiri

5. Posterior relations of Aorta
Dr. Maria Zahiri
Posterior relations of Aorta
thoracolumbar intervertebral discs
upper four lumbar vertebrae
Lumbar arteries
third and fourth (and sometimes second) left lumbar veins
the left psoas major.

6. Dr. Maria Zahiri

7. Right relations of Aorta
Dr. Maria Zahiri
Right relations of Aorta
cisterna chyli and thoracic duct
azygos vein
right crus of the diaphragm, which overlaps and separates it from the inferior vena cava and right coeliac ganglion.

8. Dr. Maria Zahiri

9. Left relations of Aorta
Dr. Maria Zahiri
Left relations of Aorta
left crus of the diaphragm
left coeliac ganglion
duodenojejunal flexure
left sympathetic trunk
the fourth part of the duodenum
inferior mesenteric vessels.

10. Branches of Aorta Anterior group Lateral group Dorsal group
Dr. Maria Zahiri
Branches of Aorta
Anterior group
Lateral group
Dorsal group

11. Anterior group: Coeliac trunk is the first anterior branch
Dr. Maria Zahiri
Anterior group:
Coeliac trunk
is the first anterior branch
at the level ofT12/Ll
Superior mesenteric artery
1 cm below the coeliac trunk
at the level of the Ll-L2
Inferior mesenteric artery
3 or 4 cm above the aortic bifurcation
at the level of L3

12. Lateral group: Suprarenal arteries The renal arteries
Dr. Maria Zahiri
Lateral group:
Suprarenal arteries
The renal arteries
The gonadal arteries

13. Dorsal group: Inferior phrenic arteries Lumbar arteries
Dr. Maria Zahiri
Dorsal group:
Inferior phrenic arteries
Lumbar arteries
Median sacral artery

14. Dr. Maria Zahiri
INFERIOR VENA CAVA
Relations of the abdominal part of the inferior vena cava:
Anteriorly:
right common iliac artery
root of the mesentery
right gonadal artery
head of the pancreas
first part of the duodenum
common bile duct
portal vein

15. The lower three lumbar vertebral bodies their intervertebral discs
Dr. Maria Zahiri
posterior :
The lower three lumbar vertebral bodies
their intervertebral discs
the anterior longitudinal ligament
right psoas major
sympathetic trunk
right crus of the diaphragm
the medial part of the right suprarenal gland
the right coeliac ganglion

16. Right & Left relations of IVC
Dr. Maria Zahiri
Right & Left relations of IVC
Right :
The right ureter
the second part of the duodenum
medial border of the right kidney
the right lobe of the liver
left :
The aorta
the right crus of the diaphragm
the caudate lobe of the liver

17. Inferior phrenic veins
Dr. Maria Zahiri
Lumbar veins
Ascending lumbar vein
Gonadal veins
Renal veins
Suprarenal vein
Inferior phrenic veins

18. Dr. Maria Zahiri
Lumbar veins
Four pairs of lumbar veins collect blood by dorsal tributaries from the lumbar muscles and skin.
anastomose with:
lumbar origin of the azygos
and hemiazygos veins
branches of the inferior
and superior epigastric veins.

19. Dr. Maria Zahiri
Ascending lumbar vein
The ascending lumbar vein connects the common iliac, iliolumbar and lumbar veins.

20. Gonadal veins Only the right gonadal vein joins the IVC directly.
Dr. Maria Zahiri
Gonadal veins
Only the right gonadal vein
joins the IVC directly.

21. Renal veins The left is three times longer than the right in length
Dr. Maria Zahiri
Renal veins
The left is three times longer
than the right in length

22. Dr. Maria Zahiri
Suprarenal vein
The right suprarenal vein drains directly into the inferior vena cava

23. Inferior phrenic veins
Dr. Maria Zahiri
Inferior phrenic veins
run on the inferior surface of the central tendon of the diaphragm.
drain into the posterolateral aspect of the IVC

24. LYMPHATIC DRAINAGE posterior abdominal wall:
Dr. Maria Zahiri
LYMPHATIC DRAINAGE
posterior abdominal wall:
The small upper left and upper right lateral aortic nodes
The larger lower left and lower right portions lateral and retro aortic lymph nodes
Or the left and right superficial inguinal nodes.

25. through the cisterna chyli and the thoracic duct
Dr. Maria Zahiri
abdominal viscera:
through the cisterna chyli and the thoracic duct
The 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

26. Dr. Maria Zahiri

27. Cisterna chyli and abdominal lymph trunks
Dr. Maria Zahiri
Cisterna chyli and abdominal lymph trunks
The abdominal origin of the thoracic duct:
lies to the right of the midline
at the level of the lower border of the T12
receives all the lymph delivered by the four main abdominal lymph trunks

28. Dr. Maria Zahiri
The 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.

29. Dr. Maria Zahiri
The 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.

30. Dr. Maria Zahiri
Pre-aortic group
lie 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.

31. Dr. Maria Zahiri
Coeliac nodes
The 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).

32. Dr. Maria Zahiri
Gastric Nodes
There 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.

33. Hepatic Nodes They vary in number and site
Dr. Maria Zahiri
Hepatic Nodes
They vary in number and site
but 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

34. Pancreaticosplenic Nodes
Dr. Maria Zahiri
Pancreaticosplenic Nodes
The pancreaticosplenic nodes drain the spleen, pancreas and part of the stomach.
Their afferents join the coeliac nodes.

35. Superior mesenteric and inferior mesenteric nodes
Dr. Maria Zahiri
Superior mesenteric and inferior mesenteric nodes
lie 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.

36. Dr. Maria Zahiri
lateral aortic group
The 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.

37. Dr. Maria Zahiri
lateral aortic group
The 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.

38. Dr. Maria Zahiri
Lymphatics 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.

39. Dr. Maria Zahiri
Lymph 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.

40. Dr. Maria Zahiri
Retro-aortic group
The 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.

41. Dr. Maria Zahiri
INNERVATION

42. Dr. Maria Zahiri

43. Dr. Maria Zahiri

44. Dr. Maria Zahiri
PNS: Somatic fiber

45. Dr. Maria Zahiri
PNS: Visceral fibers

46. Dr. Maria Zahiri

47. ANS: Autonom nervous tissue
Dr. Maria Zahiri
ANS: Autonom nervous tissue
Intermediolateral columns (IMLs)

48. Dr. Maria Zahiri

49. Dr. Maria Zahiri

50. Prevertebral plexus Celiac plexus Abdominal aortic plexus
Dr. Maria Zahiri
Prevertebral plexus
Celiac plexus
Abdominal aortic plexus
Superior hypogastric plexus

51. Prevertebral ganglion
Dr. Maria Zahiri
Prevertebral ganglion
Celiac
SMG
IMG

52. Prevertebral & paravertebral plexus
Dr. Maria Zahiri

53. Dr. Maria Zahiri
Lumbar plexus

54. Dr. Maria Zahiri

55. Iliohypogastric nerve
Dr. Maria Zahiri
Iliohypogastric nerve
originates from the L1 ventral ramus
lateral border of psoas major
in front of quadratus lumborum.
lateral cutaneous branches (iliac crest)
Ant. cutaneous branches (ASIS)

56. Dr. Maria Zahiri
Motor –
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.

57. Ilioinguinal nerve originates from the L1 ventral ramus
Dr. Maria Zahiri
Ilioinguinal nerve
originates from the L1 ventral ramus
It is smaller than the iliohypogastric nerve
the lateral border of psoas major
just inferior to the iliohypogastric nerve
Ilioinguinal nerve emerges with the cord
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.

58. Ilioinguinal nerve Motor – transversus abdominis and internal oblique.
Dr. Maria Zahiri
Ilioinguinal nerve
Motor –
transversus abdominis and internal oblique.
Sensory
to transversus abdominis and internal oblique
medial 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.

59. Genitofemoral nerve originates from the L1 and L2 ventral rami.
Dr. Maria Zahiri
Genitofemoral nerve
originates from the L1 and L2 ventral rami.
It is formed within the substance of psoas major
It descends beneath the peritoneum on psoas major Crosses obliquely behind the ureter and divides above the inguinal ligament into genital and femoral branches.

60. Dr. Maria Zahiri
Genitofemoral 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.

61. The femoral branch descends lateral to the external iliac artery
Dr. Maria Zahiri
The femoral branch descends lateral to the external iliac artery
and sends a few filaments round it.
It then crosses the deep circumflex iliac artery
passes behind the inguinal ligament and enters the femoral sheath lateral to the femoral artery.

62. cremaster via the genital branch. Cutaneous –
Dr. Maria Zahiri
Motor –
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.

63. Femoral nerve descends through psoas major
Dr. Maria Zahiri
Femoral nerve
descends through psoas major
It 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 artery
Posterior to the inguinal ligament, it lies lateral to the femoral artery and is separated from it by a part of psoas major.

64. Lateral femoral cutaneous nerve of the thigh
Dr. Maria Zahiri
The 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.

65. Dr. Maria Zahiri
Obturator nerve
The 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.

66. Accessory obturator nerve
Dr. Maria Zahiri
Accessory obturator nerve
When 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.

67. Dr. Maria Zahiri
LUMBOSACRAL PLEXUS
The 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.

68. Dr. Maria Zahiri
موفق باشید