Quadratus Lumborum O: I: Innervation?
O: Iliac Crest I: 12th rib and L1-4 Transverse processes Innervation: T12, L1-L4 (anterior rami)
Iliacus O: I: Action: Innervation:
O: iliac fossa I: Lesser Trochanter (join psoas to form common tendon) Action: Hip flexion Innervation: Femoral Nerve (L2-4)
Psoas Major O: I: Action: Innervation:
O: T12, L1-L5 I: Lesser Trochanter Action: Raise body from supine position, bend trunk laterally, flex hip joint Innervation: Lumbar plexus (L1-3)
The Renal Artery comes off _______ at level ____
The Renal Artery comes off para-aortically at level L1
The Testicular Artery comes off at level ____
The Testicular Artery comes off at level L2
How many Veins and arteries supply and drain the posterior abdominal wal
5x Lumbar Veins 5x Lumbar arteries
Where do the aorta and IVC bifurcate?
Aorta: @L4 IVC: @L5
Flow diagram of the Urinary System? These are all ________
Kidney> Ureter > Bladder > Urethra These are all 'retroperitoneal'
What sits atop each kidney?
'Suprarenal Glands' NOT part of urinary system, involved in dealing with adrenaline. Also infraperitoneal
Where do the kidneys (+ suprarenal glands) sit within the abdominal cavity. Where does the ureters exit each kidney?
above 'psoas major' and 'quadratus lumborum' Ureters exit at L1 (transpyloric plane)
Each kidney sits behind and below what rib?
RK: rib 12 (lower due to liver) LK: rib 11 & 12
The Kidneys have a smooth ____________. Each Hilum contains __________ and branches of the _________, (also lymphatics and ANS). The kidneys can be divided into ______ and _______________.
The Kidneys have a smooth outer capsule. Each Hilum contains Renal veins and branches of the Renal arteries, (also lymphatics and ANS). The kidneys can be divided into upper and lower poles.
Are the ureters/renal pelvis posterior or anterior to the renal vessels?
Draw and label the kidney - internal overview structure (page 31)
Right Kidney Relations Anterior: Posterior:
A: suprarenal gland, liver, 2* duodenum, hepatic flexure of colon P: diaphragm, psoas, quad. lumborum, transversus abdominis, rib 12, subcostal nerve
Left Kidney Relations Anterior: Posterior:
A: Suprarenal gland, spleen, stomach, pancreas, jejunum, splenic flexure of colon. P: diaphragm, psoas, quad. lumborum, transversus abdominis, rib 11 & 12, subcostal nerve
Renal veins and arteries are at level ____, the ____ is slightly lower then the _____. Veins are ______ to arteries.
Renal veins and arteries are at level L1 (come off para-aortically), the RHS is slightly lower then the LHS. Veins are anterior to arteries.
Before entering the kidneys renal arteries branch into?
anterior and posterior branches > Segmental branches
Which renal artery is longest. The right renal artery runs _____ to the IVC
The right renal artery is longest and runs posterior to the IVC
Which renal vein is longest and by how much? The left renal vein runs _____
Left Renal artery is 3x longer. It runs anterior to aorta, under SMA and posterior to splenic vein/body of pancreas. *R. renal vein runs posterior to 2* duodenum
What is the nervous innervation of the kidneys? S: PS: Referred pain =
'Renal Plexus' S: complicated PS: Vagus Referred Pain = flank pain
Para-aortic nodes @L1
What are the ureters? Explain their journey
25cm SM tubes that propel urine from the kidneys via contractions (+ filtration pressure) Exit Kidney @L1, extend vertically down from hilus on surface of psoas muscle. Roughly in-line w transverse processes of lumbar spine, Cross bifurcation of common iliac artery (@ant sacro-iliac joint) Passes lateral wall of pelvis to ischial spine Enters bladder on inferior surface at the trigone.
The 3 constrictions of the Ureters are? Why are these sites important?
Junction of 'ureters & renal pelvis' (Pelvi-ureteric junction PUJ) Where ureters cross the 'Pelvic brim' As they enter 'bladder wall' This is most common areas of renal calcium obstruction
Draw the Ureter Blood, nerve and lymph diagram
How is it that the bladder doesn't fall? When it fills where does it move? What is it made of?
Has a partial peritoneum covering that is 'stuck' against pubic bones'
When it fills it rises into the suprapubic region
- Transitional epithelium and rugae
- SM coat (Detrusor muscle)
- ** SM spincter at neck of cladder (sphincter vesicae)
What is the trigone?
- Triangular smooth area at the base of the bladder, mucous membrane with no rugae.
- Ureters enter and urethra exits at the points of the triangle
- In between uteric openings is known as the inter-ureteric crest
Blood and Nerve supply of the Bladder?
Arterial: Superior (x2) and inferior vesical arteries from each side
-off of anterior branch of internal iliac a.
Venous: Vesical Plexus (drain to internal iliac v. )
Nervous: ANS inferior hypogastric plexus
S= sacral splanchnic nerves S2-4
PS= pelvic splanchnic
Pain is referred to the suprapubic region (L1/2)
Male vs female urethra?
Female: bladder ⇒ through deep and superficial Perineal pouches
Male: 4 distinct regions
- Prostatic (widest part- many ducts emptying in)
- Membranous (thinnest part- through deep perineal pouh)
- Spongy (through corpus spongiosum)
Lymphatics of the ureter, bladder and urethra?
Ureter drains to:
- common/external/internal iliac
Bladder drains to:
- Internal iliac nodes
- internal iliac nodes
Label this diagram
Course of Iliohypogastric and Ilioinguinal nerves
- Emerge at lateral border of psoas
- Run obliquely over Q.lumborum (hypo superior to inguinal)
- Pierce Transversus Abdominis
- Ilioinguinal will pierce int. oblique to enter inuinal canal and accompany spermatic cord throguh SF inguinal cord
Sensory and motor control of Iliohypogastric and Ilioinguinal
Sensory: Lateral gluteal & Pubic skin
Motor: transverse abdominis & Internal oblique
Sensory: skin of medial thigh + roots of penis/scrotum or mons pubis/labia
Motor: transversus Abdominis & internal Oblique
Level: L1 and L2
Branches: Genital and femoral
Sensory: scrotum or mons pubis, skin of upper anterior thigh
Motor: Cremasteric muscle
- Emerges throguh and runs atop psoas
- Genital branch will enter spermatic cord to innervate Cremaster muscle and give sensory to genital skin
- Femoral branch passes under inguinal lig to thigh
Lateral Femoral Cutaneous n.
Levels: L2 & L3
Sensory: Skin on Anterior & lateral thigh
- Emerges from lateral border of Psoas
- Descends obliquely across surface of Iliacus
- Passes under inguinal lig. (at lateral extremity near attachment to ASIS)
-Numbness of outer thigh due compression of the lat. femoral cut. nerve as it passes under the inguinal lig.
Many causes (eg; seat belts, exercise, tight clothing)
Levels: L2-4 (largest)
Sensory: skin on anterior thigh and medial leg
Motor: Pectineus, iliacus and ant compartment of thigh
- Emerges from lower lateral border of Psoas
- Runs between iliacus and Psoas
- Passes under inguinal lig. to thigh
Sensory: skin on medial thigh
Motor: obturator externus and medial comp. of thigh
- emerges from lower MEDIAL border of psoas
- passes behind common iliac art. then lateral to internal iliac and ureters
- Runs along along walls of pelvis cavity exit via the obturator foraen (through obturator canal)