Posterior Abdominal Wall

Dr Sanjaya Kumar Shrestha

 Abdominal aorta
 Inferior vena cava
 Azygous and himiazygous veins- abdominal part
 Lymph nodes and cisterna chyli
 Muscles of posterior abdominal wall
 Thoracolumbar fascia
 Nerves- lumbar plexus and abdominal part of
autonomic nervous system
The abdominal aorta
 Midline- aortic opening
of diaphragm- level
T12- L4 – divides into
R and L iliac arteries
branches Ventral branches
- Coeliac trunk
- Sup mesentric a
- Inf mesentric a
Lateral branches
- Inf phrenic a
- Middle suprarenal a
- Renal a
- Testicular or ovarian a
Dorsal branches
- Lumbar a – 4 pairs
- Median sacral a – unpaired-
supplies rectum
Terminal branches
- R and L common iliac a
 Inferior vena cava
 Formed by union of R and L
common iliac veins
 On the R side of body of L5
 Ascends on R side of aorta
 Grooves posterior surface of
liver
 Pierces central tendon of
diaphragm – T8 level
 opens into lower and
posterior part jof strium
 1. Common iliac veins
tributaries 2. 3rd and 4th lumbar v –
posteriior aspect of IVC
(1st and 2nd lumbar v – may end in
3rd lumbar v, ascending
lumbar v, azygous v on R, or
hemiazugous v in L)
(ascending lumbar v- an
anastomotic channel- connects
lateral sacral, iliolumbar and
subcostal v.- lies within psoas
m. – on joining subcostal v it
forms- azygous v on R and
hemiazygous v in L)
3 R testicular or ovarian v-
opens into IVC just below
entrance of renal veins
 L gonadal v drains into
L renal v.
4 Renal veins- receives L
suprarenal and gonadal
veins
5 R suprarenal vein
6 Hepatic veins- 3 large
and many small veins-
open directly into the
anterior surface of IVC
just before it pierces
the diaphragm
 Clinical anatomy

Thrombosis of IVC – edema of legs

Collateral circulation
 Superficial-

- epigastric, circumflex iliac, lateral thoracic, thoracoepigastric,

intrnal thoracic, posterior intrcostal , external pdendal, and
lumbovertebral v
Deep veins-
- Azygous, hemiazygous and lumbar v, vertebral venous plexus
 Abdominal part of
azygous and
hemiazygous veins
Lymph nodes of posterior abdominal wall

 External iliac
 Common iliac
 Lumbar or aortic nodes
External iliac nodes-
8-10, lies along ext iliac
vessels
Receives afferent from
 Inguinal l n

 Deeper layer of

infraumbilical part of abd

wall
 Adductr region of thigh

 Glans penis or clitoris

 Membranous urethra

 Prostate

 Fundus of urinary bladder

 Cervix uteri

 Part of vagina
Common iliac nodes (4-6)
- Afferents from- ext and

int iliac nodes

- Efferents to – latral

aortic nodes
Lumbar or aortic nodes
- Preaortic group

- Lateral aortic gr

- Retroaortic gr
 Preaortic nodes
afferents from-
subdiaphragmatic part of GIT,
liver, pancreas, spleen
- efferents- intestinal trunks –
enter – cisterna chyli
 lateral aortic nodes
- afferents- from strs supplied
by lateral and dorsal branches
of aorta and from common iliac
nodes- efferents from lumbar
trunk- cisterna chyli
 Retroaortic nodes
no particle area of drainage
 Cisterna chyli
 An elongated lymphatic sac
(5-7cm)
 Situated in front of L1 and
L2, immediately to the R of
abd aorta
 Its upper end is continuous
with thoracic duct
 Joined by R and L lumbar
and intestinal lymph trunks
 Muscles of posterior
abd wall

 Psoas major
 Psoas minor
 Iliacus
 Quadratus lumborum
 Clinical anatomy

 Psoas abscess
Psoas enclosed in psoas
sheath- a part of lumbar
fascia-
Pus from tubercular inf of
thoracic and lumbar
vertebrae – track down
through the sheath into
the thigh – swelling of
femoral triangle
Nerves of posterior abd
wall

Lumbar plexus
 Lies in the posterior part

of the substance of
psoas major muscle
 Formed by – ventral

rami of upper 4 lumbar

nerves
Abdominal part of autonomic nervous system
Sympathetic n – derived
from 2 sources
1. Lumbar symp trunk-
supplies- somatic
branches of lower abd
wall and lower limbs
- visceral branches- pelvic
organs
2. Coeliac plexus- formed by
splanchnic nerves from
thorax- supplies-
abdominal organs,
including gonads
Parasympathetic nerves-
derived from 2 sources:
1. Vagus joins coeliac
plexus
2. Pelvic splanchnic n joins
inferior hypogastric
plexus
 Functions of ANS
 In general, sympathetic n – vasomotor, motor
to sphyncters, inhibitory to peristalsis and
sensory to all viscera supplied
 Parasympathetic- motor and secretomotor to
gut and glands associated with it
 Cliniacal anatomy
Visceral pain
 Insensitive to cutting, crushing or burning
 Visceral pain- caused by
1. Excessive distension
2. Spasmodic contraction
3. Ischemia
 Visceral pain is poorly localized- is dull in nature-
may be felt in the skin or other somatic tissues,
supplied by somatic n arising from the same spinal
segment -- referred pain