GROSS HSB – A

Post. Abd. Wall(2), Azygos Sys., Lumbar plexus Dr. Clester F. Bea (CFB) Lec # 28 - 26 Oct 2015
I. Posterior Abdominal wall Table 3.2. Muscles of the post. abd. wall and their action
 Formed in the midline by the 5 lumbar vertebrae and their IV discs Action
 Formed laterally by the 12th ribs, upper part of the bony pelvis, Quadratus Flexes thigh on trunk; if thigh is fixed, it flexes trunk
psoas muscles, quadratus lumborum muscles, and the Lumborum on thigh (as in sitting up from lying position)
aponeuroses of origin of the transversus abdominis muscles Fixes 12th rib during inspiration; depresses 12th rib
 Iliacus muscle lie in the upper part of the bony pelvis Psoas Major during forced expiration; laterally flexes vertebral
 The abdominal walls are lined by one continuous layer of column ipsilaterally
connective tissue that lies between the parietal peritoneum and Weak flexor of lumbar vertebrae / assists in flexing
Psoas Minor
muscles. the lumbar vertebrae
○ It is continuous below with a similar fascial layer lining the Flexes thigh on trunk; if thigh is fixed, it flexes trunk
Iliacus
pelvic walls. on thigh (as in sitting up from lying position)
○ It is named according to the structure it overlies, such as:
 Diaphragmatic fascia, transversalis fascia, psoas IV. Lumbar Plexus
fascia, etc. - One of the main nervous pathways supplying the lower limb, is
formed in the psoas muscle from the anterior rami of L1-L4
II. Fascial Covering of the Post Abdominal Wall  Iliohypogastric nerve (L1)
Three Layers of Thoracolumbar Fascia ○ Together with ilioinguinal nerve enter the lateral and anterior
 Posterior layer abdominal walls
○ Covers the deep muscles of the back (erector spinae ○ Supplies the skin of the lower part of the anterior abdominal
muscles) wall
 Middle later  Ilioinguinal nerve (L1)
○ Covers the posterior surface of quadratus lumborum ○ Together with cremasteric nerve enter the lateral and
 Anterior layer anterior abdominal walls
○ Cover the anterior surface of quadratus lumborum and the ○ Pass through inguinal canal to supply the skin of the groin
psoas muscle and the scrotum/ labium majus
 Lateral cutaneous nerve of the thigh (L2,L3)
Transversalis Fascia ○ Crosses iliac fossa in front of the iliacus muscle and enters
 Thin layer of fascia that lines the transversus abdominis muscle the thigh behind the lateral end of the inguinal ligament
 Continuous with a similar layer lining the diaphragm and iliacus ○ Supplies the skin over the lateral surface of the thigh
muscle  Femoral Nerve (L2,L3,L4)
 From the anterior abdominal wall also goes to the post. abd. wall ○ Is the largest branch of lumbar plexus
○ Runs downward and laterally between the psoas and the
III. Muscles of the Post Abdominal Wall iliacus muscles and enters the thigh behind the inguinal
 Quadratus lumborum ligament and lateral to the femoral vessels and the femoral
○ Flat, quadrilateral-shaped muscle sheath
○ Lie alongside the vertebral column  Obturator Nerve (L2,L3,L4)
○ Its anterior surface is covered by lumbar fascia that thickens ○ Together with the 4th lumbar root of the lumbosacral trunk
to form the lateral arcuate ligament and below to form the emerge from the medial border of the psoas at the brim of
iliolumbar ligament pelvis
○ crosses the pelvic brim in front of the sacroiliac joint and
 Psoas Major behind the common iliac vessels
○ Enclosed in a fibrous sheath that is derived from the lumbar ○ leaves the pelvis by passing through the obturator foramen
fascia that is thickened above to form the medial arcuate into the thigh
ligament  Genitofemoral Nerve (L1,L2)
 Psoas Minor ○ Emerges on the anterior surface of the psoas
○ Not always present ○ Runs downward in front of the muscle and divides into:
 Iliacus  Genital branch
○ Fan shaped muscle  Enters the spermatic cord
○ Combines with psoas as they insert to the lesser trochanter  Supplies the cremaster muscle
of the femur (referred to as the iliopsoas muscle)  Femoral branch
 Supplies a small area of the skin of the thigh
Table 3.0 Muscles of the post. abd. wall and their origin and insertion  Nervous pathway is involved in the cremasteric
Origin Insertion reflex (stimulation of skin of the thigh in males
Iliolumbar ligament, iliac result in reflex contraction of cremaster muscle,
Quadratus
crest, transverse processes 12th rib drawing upward of testis within scrotum)
Lumborum
of lower lumbar vertebrae
Transverse processes, With iliacus into
Psoas Major bodies, IV discs of T12 and 5 lesser trochanter of
lumbar vertebrae femur
Iliopectineal
Psoas Minor T12 and L1 verterbral bodies
eminence
With psoas major
Iliacus Iliac fossa into lesser trochanter
of femur

Table 3.1 Muscles of the post. abd. wall and their nerve supply
Nerve Supply
Quadratus Lumborum
Psoas Major Lumbar plexus
Psoas Minor
Iliacus Femoral nerve
Figure 4.0. The Lumbar Plexus

MCHMari MD-1C 2019 Page 1 of 3

 GROSS HSB – A
Post. Abd. Wall(2), Azygos Sys., Lumbar plexus Dr. Clester F. Bea (CFB) Lec # 28 - 26 Oct 2015

Figure 4.1 Sites for visceral referred pain

Table. Spinal Cord levels for Visceral Pain

Organ Spinal Cord Level
Stomach T5-T9
Spleen T6-T8
Duodenum T5-T8
Pancreas T7-T9
Liver or gallbladder T6-T9
Jejunum T6-T10
Ileum T7-T10
Cecum T10-T11
Appendix T10-T11 Figure 5.0 Autonomic innervation of GIT
Ascending colon T10-T12
Sigmoid colon L1-L2 Gallbladder and Biliary Ducts
Kidney T10-L1  Receives postganglionic parasympathetic and sympathetic fibers from
Ureter T11-L1 the hepatic plexus
 Parasympathetic: derived from vagus nerve
V. Autonomic Nervous Supply of the Abdomen ○ Stimulates smooth muscles of gallbladder and bile ducts
Parasympathatic Nerve Supply ○ Inhibits sphincter of Oddi
Kidney
 Preganglionic fibers enter the abdomen via anterior (left) and
 Parasympathetic
posterior (right) vagal trunks
○ Preganglionic fibers enter the renal plexus from the vagus
 Fibers that pass to the GIT terminate on postganglionic neurons ○ Synapse with postganglionic neurons at renal plexus
in the: ○ Vasodilators of renal arteries within the kidney
○ Myenteric (Auerbach) Plexus  Sympathetic
 For the peristalsis of smooth muscles, relaxation of ○ Preganglionic fibers pass through the lower thoracic part of the
sphincters sympathetic trunk and the lowest thoracic splanchnic nerve to
○ Submucosal (Meissner) Plexus join the renal plexus around the renal artery
 For the stimulation of secretion of mucosal glands ○ Synapse with postganglionic neurons in the renal plexus
○ Vasoconstrictors of renal arteries within the kidney
Sympathetic Nerve Supply Medulla of Suprarenal Gland
 Preganglionic fivers enter pass through the thoracic part of the  Parasympathetic = no parasympathetic innervation
sympathetic trunk and enter the greater and lesser splanchnic  Sympathetic fibers
nerves ○ Preganglionic descends to the gland in the greater splanchnic
 Descends into abdomen and synapse with postganglionic nerve
neurons in the celiac and superior mesenteric ganglia ○ Terminate in the secretory cells of the medulla
○ Inhibit peristalsis and cause contraction of the sphincter, ○ Stimulates secretory cells to increase output of epi and norepi
inhibit secretions of glands

Descending Colon, Pelvic Colon and Rectum

 Parasympathetic
○ Preganglionic fibers originate in the gray matter of spinal
cord from the 2nd to 4th sacral segments
○ Fibers pass through the pelvic splanchnic nerves and the
nerve plexuses around the branches of the inferior
mesenteric artery
○ Terminate on postganglionic neurons in the myenteric and
submucosal plexuses

 Sympathetic
○ Preganglionic neurons pass through the lumbar part of the
sympathetic trunk
○ Synapse with postganglionic neurons in the inferior
mesenteric plexus

Figure 5.1 Autonomic innervation of kidney and adrenal gland

MCHMari MD-1C 2019 Page 2 of 3

 GROSS HSB – A
Post. Abd. Wall(2), Azygos Sys., Lumbar plexus Dr. Clester F. Bea (CFB)
Involuntary Internal Sphincter of Anal Canal
 Sympathetic
○ Contraction of internal anal sphincter
○ Preganglionic fibers from aortic plexus, from lumbar and
pelvic parts of the sympathetic trunks
○ Postganglionic fibers from hypogastic plexus
Urinary Bladder
 Parasympathetic
○ Preganglionic fibers arise as the pelvic splanchnic nerves
from the 2nd, 3rd, 4th sacral nerves
○ They pass through the hypogastric plexus to reach the
bladder where they synapse with postganglionic neurons
 Sympathetic
○ Preganglionic fibers from first and second lumbar ganglia of
the sympathetic trunk
○ Postganglionic from hypogastric plexus
Lec # 28 - 26 Oct 2015
 Originates from the (L) ascending lumbar vein and the lower
(9th-11th) posterior intercostal veins (mirrors the inferior portion
of the azygos vein on the right)
 About midthorax, it passes in front of the vertebral column and
joins the azygos vein
Accessory Hemiazygos Vein
 Completes the venous drainage of the left (middle) thorax and
can be thought of as a superior continuation of the hemiazygos
vein
 It receives blood from the 4th-8th posterior intercostal veins and
crosses to the (R) to empty into the azygos vein.
 It receives oxygen-poor systemic blood from the bronchi of the
lungs (bronchial veins)

Figure 6.0 The azygos system

REFERENCES
 Snell, R. Et al. (2012). Clinical Anatomy by Regions (9th Ed).
USA: Philadelphia, Lippincott Williams & Wilkins, a Wolters
Kluwer Business
Figure 5.2 Autonomic innervation of sphincter of anal canal & U.B.  Snell, R. (2010) Clinical Neuroanatomy. (7th Ed). USA:
Philadelphia, Lippincott Williams & Wilkins, a Wolters Kluwer
Table 5.0 Autonomic nervous supply to GIT derivatives Business
Foregut Midgut Hindgut  Hansen, J., Netter, F. (2014). Netter’s Clinical Anatomy. (3rd
Parasympathetic Vagus Vagus Pelvic Ed). USA: Philadelphia, Elsevier Saunders
Splanchnics  Moore, K., et al. (2010). Clinically Oriented Anatomy. (6th
(S2-S4) Ed). USA: Philadelphia, Lippincott Williams & Wilkins, a
Sympathetic Thoracic Thoracic Lumbar Wolters Kluwer Business
splanchnics splanchnics Splanchnics  Personal lecture notes
(T5-T11) (T11-T12) (L1-L2)

Autonomics do not have their own nerve trunks unlike the spinal nerve
-They actually mix with the spinal nerves and some cranial nerves
- Sympathetic = Thoracolumbar spinal nerves origin
- T5-T9 = greater splanchnic nerve -> celiac ganglion
- T10-T11 = lesser splanchnic nerve
- T12 =least splanchnic nerve
- Parasympathetic = Craniosacral nerves origin
- Vagus nerve (CN10)

VI. Azygos system

Azygos Vein
 Located against the right side of the vertebral column
 Originates in the abdomen, from the (R) ascending lumbar vein
that drain most of the (R) abdominal cavity wall and from (R) This is the last trans lecture for Gross HSB A! 
posterior intercostal veins (except the first) that drain the chest
muscles EVERYTHING YOU DO NOW IS FOR YOUR FUTURE.
THINK ABOUT THAT.
 T4 vertebra level, the azygos vein arches over the great vessels
God Bless us all! 
that run to the right lung and empties into the SVC
-MC
Hemiazygos Vein
 This vessel ascends on the left side of the vertebral column.

MCHMari MD-1C 2019 Page 3 of 3