The Kidney and Posterior Abdominal Wall

Question 1

What can be found against the posterior abdominal wall

Answer 1

Retroperitoneal organs (kidneys, asc, desc colon, recon, duodenum, pancreas), aorta, IVS
Parietal peritoneum against posterior wall, has retroperitoneal fat

Question 2

Muscles of the posterior abdominal wall

Answer 2

Diaphragm
Quadratus lumborum
Psoas
Illiacus

Question 3

Where does the diaphragm attach to

Answer 3

Back of 12th rib, lumbar vertebrae and arcuate ligament

Question 4

Location of the arcuate ligament

Answer 4

Comes over quadrates lumborum (lateral arcuate ligament) and psoas major (medial arcuate ligament)

Question 5

Where does the quadratus lumborum attach to

Answer 5

Posterior iliac crest and 12th rib

Balances the pull of the diaphragm when breathing

Question 6

Where does the psoas major attach to

Answer 6

L1-5 and femur lesser trochanter

Receives innervation from lumbar plexus L1-3

Question 7

Where does the illiacus attach to

How does the illiacus relate to the psoas major

Answer 7

Iliac fossa

Tendons on illiacus + tendons of psoas major = illiopsoas tendon

Receives innervation from the femoral nerves L2-3

Question 8

Importance of the psoas major

Answer 8

Covered by psoas sheath
Bacteria (TB) can enter, fill it up with pus, irritate muscle
Cause swelling of sheath at inguinal ligament, looks like hernia

Muscle spasms here cause flexion at hip
Haematomas can form here (v vascular)

Question 9

Nerves of lumbar plexus and where do they originate?

Answer 9

Iliohypogastric L1
Illioinguinal L1 (branch of illiohypogastric)
Genitofemoral L1-2 (L1-femoral branch, L2-genital branch)
Lateral femoral L2-3
Femoral L2-4
Accessory obturator L3-4
Obturator L2-4
Lumbosacral L4-5

Question 10

What does the iliohypogastric innervate

Answer 10

Cutaneous for lower anterior abdominal wall and superopubic region

Question 11

What does the ilioinguinal innervate

Answer 11

Internal oblique, transversus abdominus

Cutaneous anterior innervation of scrotum/labia majora

Question 12

What does the genitofemoral innervate

Answer 12

L1, cutaneous to the top of the thigh

L2, supplies cremaster muscle

Question 13

What does the obturator innervate

Answer 13

Medial thigh compartment

Question 14

What does the femoral innervate

Answer 14

Anterior thigh

Question 15

What does the lateral femoral innervate

Answer 15

Lateral thigh

Question 16

What does the lumbosacral innervate

Answer 16

Posterior thigh and lower limbs

Question 17

Major abdominal arteries and their origin

Answer 17

Abdominal aorta continued on form descending thoracic artery emerged from behind diaphragm at rib 12

Coeliac trunk T12
Superior mesenteric L1
Inferior mesenteric L3
Bifurcation => common iliac L4

Question 18

Major abdominal veins and their origins

Answer 18

Common iliac => IVC L5

IVC passes up to top of diaphragm T8

Question 19

Structure of the abdominal aorta

Answer 19

T12, coeliac trunk, inferior phrenic
L1, middle adrenal, superior mesenteric
L1-4 4 pairs of lumbar arteries
L1-2 renal
L2 gonadal
L3 inferior mesenteric
L4 common iliac
Median sacral comes off bottom of bifurcation
Internal iliac bifurcates off external iliac

Question 20

What does the phrenic artery supply

Answer 20

Supply abdominal wall

Question 21

What does the median sacral artery supply

Answer 21

Sacrum

Question 22

What does the internal iliac artery supply

Answer 22

Pelvis, perineum

Question 23

What does the external iliac artery supply

Answer 23

Lower limbs

Question 24

What arteries are found in pairs

Answer 24

Adrenal, kidney, gonadal

Question 25

Structure of the inferior vena cava

Answer 25

T8, hepatic R, M, L, inferior phrenic
L1-4 lumbar
L1-2 R renal
L2 R gonadal
L5 bifurcation of common iliac vein

L1-2 L renal, adrenal, gonadal

Median sacral vein comes off bottom of bifurcation
Internal iliac bifurcates off external iliac

Question 26

Why do the L adrenal, gonadal veins join to to L renal before joining the IVC at L1-2

Answer 26

Easier for organs on R to access IVC

Question 27

Function of each part of the urinary system

Answer 27

Kidneys, purifies blood
Ureters, drain urine from kidney to bladder via peristalsis and gravity
Bladder, stores urine, bag of smooth muscle
Urethra, drains urine from bladder => outisde

Question 28

Position of kidneys and ureters

Answer 28

Hilium, more medial and anterior than back of kidney
R lower than L due to liver
Center of R helium below transpyloric plane

L kidney top touches R11, bottom is 2/3 between L2-3
R kidney top in 11th intercostal space, bottom is at level of L3

Ureters cross tips of lumbar vertebra

Question 29

Relations of the kidney, anterior

Answer 29

Retroperitoneal, posterior to parietal peritoneum
Cut edges of peritoneal reflection form mesenteries/ligaments

R triangular, L semilunar adrenal glands on kidneys
Duodenum in front of R
Transverse mesocolon, hepatic flexure (R), splenic flexure, pancreatic tail (L) in front

Question 30

Relations of the kidney, posterior

Answer 30

L kidney from top to bottom
Rib 11
Rib 12
Diaphragm covers ribs

From L to R
Transversus abdominis
Quadrates lumborum
Psoas

R kidney from top to bottom
Rib 12
Diaphragm covers ribs

From L to R
Psoas
Quadratus lumborum
Transversus abdominis

Question 31

Important of the psoas major next to the kidneys

Answer 31

Infection from the psoas can spread around the body and the kidneys

Question 32

Structures around the kidneys

Answer 32

Kidney and adrenal gland within kidney capsule
Capusules, aorta and VC surrounded by perirenal fat
Perirenal fat surrounded by renal fascia
Renal fascia surrounded by pararenal fat

Separated from retroperitoneal fat

Question 33

Internal structure of the kidney

Answer 33

Cortex
Renal columns between pyramids in medulla
Apex of pyramids = papilla (location of CD)
Bottom of renal columns = sinus
Ducts open up into minor calyces
Many minor calyces => major calyx => renal pelvis => ureter
Helium (whether vessels enter an organ)

Question 34

Renal and adrenal arteries

Answer 34

Superior suprarenal branches from inferior phrenic
Middle suprarenal branches from abdominal aorta
Inferior suprarenal branches from renal arteries

Question 35

Renal and adrenal veins

Answer 35

Veins infant of arteries and pelvis
R suprarenal vein drains => IVC
L suprarenal vein drains => L renal vein

Question 36

Renal and suprarenal vasculature (arteries)

Answer 36

Each kidney has several lobes during development, each lobe has its own arterial supply
Lobes disappear but arteries don’t
Arcuate arteries don’t anastomose, form end arteries
Veins freely anastomose

Arteries are polar have superior and inferior entering hilium

Question 37

Arterial supply of the ureters

Answer 37

Freely anastomotic connections around ureter
Aberrant arteries normally disappear as the arteries rise up the pelvis into the abdomen
If they remain, can press on ureters, cause problems

Question 38

Structure and relations of the ureters

Answer 38

Ureters leave the hilium at pelvicuretic junction (narrowest)
Crosses over external iliac and psoas major
Enters bladder from the back

Question 39

Renal stones and colic

Referred pain

Answer 39

Renal stones can form in the ureter
Ureter smooth muscle tries to move stones by peristalsis
Ureter spasms cause pain

Referred pain in kidneys, anterior and posterior
Around the bottom of the ribcage

Referred pain in ureters, anterior
From the top of the pelvis to the pubis on the side affected

Referred pain in ureters, posterior
Around the top of pelvis on affected side

Question 40

Structure of the suprarenal glands and functions

Answer 40

Cortex
Zona glomerulosa, controls salt and water balance
Zona fasciculata, regulates body carbohydrates
Zona reticularis, secretes precursor steroid sex hormones

Medulla
Chromaffin cells
Auguments SNS, adrenaline, noradrenaline secretion

Question 41

What is the most posterior structure at the hilum

Answer 41

Ureter