Kidney, ureter and posterior abdominal wall

Question 1

What are the posterior abdominal wall muscles? (details)

Answer 1

Quadratus lumborum: iliac crest to 12th rib/ L1-4 TP
Psoas major: T12, L1-5 to the LT.
Iliacus: iliac fossa to LT. Femoral nerve
Transversus abdominis (more lateral)

Question 2

When does the aorta branch?
Renal arteries?
Gonadal vessels?

Answer 2

L4
L1 para aortically
L2

Question 3

IVC brnach occurs where?

Answer 3

L5 beneath the right common iliac artery

RCIA covers LCIV –> left leg varicose veins in preggers women

Question 4

Kidney surface anatomy
note peri (lat and ant) and para (behind) nephric fat

Answer 4

right kidney lower then the left (due to liver)
RK behind rib 12
LK behind rib 11 and 12
Ureters EXIT at L1 (TP plane)

Question 5

Kidney anatomy (hila) NB kidney poles

Answer 5

• Hilum contains RA, RV and pelvis/ureter
• Pelvis/ ureter are posterior to the vessels
• RVs are anterior to the renal arteries
• arteries branch into ant. and post. before hilum
• Right RA (post to IVC) longer than left RA; Left RV longer then right RV (left RV ant to aorta but post to SMA)

Question 6

Ureters

Answer 6

leaves at L1
vertically down psoas in line with transverse processes
crosses common iliac bifurcation (ant SI joint)
towards ischial spine
enters bladder on inferior surface at trigone

Question 7

What are the three constrictions of the ureter?

Answer 7

1- pelvi-ureteric junction (PUJ)
2- crossing of common iliac bifurcation / pelvic brim
3- enter bladder wall

sites of renal calculus obst.

Question 8

Ureter BNL

Answer 8

Arterial: RA; Gonodal (testic); superior vesical artery
Venous: “
Nervous: renal plexus to hypogastric, pain referred to suprapubic

Question 9

Bladder

Answer 9

Transitonal epi; rugae
smooth muscle called detrusor msucle
sphincter of vesicae
Arterial: 2 times superior and inferior vesical arteries from ant branch of internal iliac
Venous: vesical plexus to int iliac
Nervous: inf hypogastric plexus (sacral splachnic S2-4 (L1-2 fibres) and pelvic splachnic)

Question 10

Trigone

Answer 10

Base of bladder where the two ureters and urethra leave
smooth part
between ureter openings is inter-ureteric crest (least mobile part of bladder)

Question 11

Urethra

Answer 11

Female: short and passes through deep and superficial perineal pouches
Male: pre prostatic; prostatic (wide); membranous (thinnest, throuh deep perineal pouch); spongy

Question 12

Micturition

Answer 12

PS: pelvic splachnic for sensation and detrusor muscle contraction
S: some sphincter in urethra, more related to sex
Somatic: pudendal nerve for external urethral sphincter

Question 13

Lumbar plexus

Answer 13

T12-L4

ORDER: iliohypogastric; ilioingunal; genitofemoral ; lat. cut. of thigh; femoral; obturator

Question 14

Iliohypogastric L1

Answer 14

S: lat gluteal and pubic skin
M: Transversus abdominis and internal oblique
C: over quad L. through TA

Question 15

ilioinguinal L2

Answer 15

S: medial thigh/ root of penis and scrotum/ mons pubis/labia majora
M:TA and IO
C: over QL, through TA to IO through inguinal canal to spermatic cord

Question 16

genitofemoral L1 and L2

Answer 16

two branches genital/femoral branches of the GF nerve
S: scrotum and upper ant thigh
M: cremasteric (genital branch)
C: ON PSOAS, joins spermatic cord (genital branch)/ under IL to thigh (femoral)

Question 17

lat. cut. of thigh L2 and L3

Answer 17

S: anterior and lateral thigh
C: over iliacus, laterally (from lateral border of psoas) under the IL by the ASIS
Bernhardt Roth- compressed by IL

Question 18

femoral big mama and L2-4

Answer 18

S: and thigh and med leg
M: pectineus, iliacus and ant thigh compartment
C: lower lateral psoas under IL

Question 19

obturator L2-4

Answer 19

S: medial thigh
M: obturator externus and medial comp.
C: emerges medial to psoas behind common iliac, laterl to II and ureters, exits via obturator foramen