Posterior abdominal wall 2

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

2. Dr. Maria Zahiri VASCULAR SUPPLY AND LYMPHATICDRAINGE

3. Dr. Maria Zahiri ABDOMINAL AORTA Anterior: • Coeliactrunk and its branches. • coeliacplexus 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 splenicvein • the gonadal arteries, and the third part of the duodenum • small intestinal mesentery.

4. Dr. Maria Zahiri

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

6. Dr. Maria Zahiri

7. Dr. Maria Zahiri Right relations of Aorta • cisternachyli and thoracic duct • azygosvein • right crus of the diaphragm, which overlaps and separates it from the inferior vena cava and right coeliac ganglion.

8. Dr. Maria Zahiri

9. Dr. Maria Zahiri Left relations of Aorta • left crus of the diaphragm • left coeliacganglion • duodenojejunalflexure • left sympathetic trunk • the fourth part of the duodenum • inferior mesenteric vessels.

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

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

13. 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 gonadalartery • head of the pancreas • first part of the duodenum • common bile duct • portal vein

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

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

21. 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. 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. 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. Dr. Maria Zahiri abdominal viscera: through the cisternachyli 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. 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, perinealand 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. 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 coeliacnodes

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

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

48. Dr. Maria Zahiri

49. Dr. Maria Zahiri

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