lec17 Flashcards
(7 cards)
I. POSTERIOR ABDOMINAL WALL
A. Consists of the (4)
B. Thoracic (Respiratory) Diaphragm
- Large muscle separating the abdominal and thoracic cavities. Consists of peripheral skeletal muscle attached anteriorly to the sternum and the costal arches, and a central fibrous region—the what.
- Posteriorly, there are two muscular arches—what—that extend along the lateral sides of the lumbar vertebrae and form the aortic hiatus at T12, through which pass the (3).
- The esophagus passes through the esophageal hiatus at T10, accompanied by the vagus nerves.
- The IVC passes through the central tendon at T8, along with the phrenic nerve.
- Innervation—phrenic nerve (C3-C5).
- Clinical Conditions a. Diaphragmatic hernia b. Hiatal hernia
A. diaphragm, vertebral column, posterior wall muscles, and lumbar plexus.
B. central tendon
C. the crura; aorta, thoracic duct, and azygos vein
I. POSTERIOR ABDOMINAL WALL
C. Muscles
- Psoas major*—arises from the transverse processes and vertebral bodies of _________to ______ and inserts onto the lesser trochanter of the femur along with the iliacus muscle; innervated by the_____ _________ (ventral rami of L1, L2 and usually L3 spinal nerves).
- ____ _______—arises from the iliac crest, and inserts onto the 12th rib and transverse processes of the upper four lumbar vertebrae; innervated by the T12-L4 spinal nerves; extends and laterally flexes the vertebral column and fixes the 12th rib during inspiration.
- _________ -arises from the iliac fossa and attaches to the lesser trochanter of the femur along with the psoas major muscle; innervated by the femoral nerve. * Together, the psoas major and iliacus muscles form the iliopsoas muscle, the chief flexor of the thigh.
- T12 - L5; lumbar plexus;
- Quadratus lumborum
- Iliacus*—
I. POSTERIOR ABDOMINAL WALL
D. Lumbar Plexus
A network of nerves formed within the psoas major muscle by ventral rami of spinal nerves ___ to ___.
These provide innervation to the abdominal wall and parts of the pelvis and perineum. The course of these nerves is somewhat controversial. Thus, for the first four nerves listed, you only need to know the basic information presented below. However, the femoral and obturator nerves are important nerves of the lower limb and you will be responsible for learning the details of those.
a. _________ (L1)—motor to the internal obliques and transversus abdominis muscles; sensory to the pubic region.
2. ___ (L1)—motor to the abdominal wall; sensory to the scrotum/labia and the base of penis/clitoris; terminal branch passes through the superficial inguinal ring. 3. Genitofemoral nerve (L1-2)—formed within the psoas major muscle; genital branch to the cremaster muscle, femoral branch is sensory to the medial thigh. 4. Lateral femoral cutaneous nerve (L2-3)—runs along the lateral aspect of the iliacus muscle; passes beneath the inguinal ligament to supply sensation to lateral thigh. 5. Femoral nerve (L2-4)—major nerve to the muscles of the anterior thigh; passes beneath the inguinal ligament just lateral to the psoas major muscle. 6. Obturator nerve (L2-4)—major nerve to the adductor muscles in the medial thigh; passes medial to the psoas major muscle; leaves the pelvis via the obturator foramen.
L1 to L4
a. Iliohypogastric nerve
2. Iliohypogastric nerve
3. genitofemoral
4. lateral femoral cutaneous
5. femoral
5. oburator
II. URINARY SYSTEM
A. Kidney
- Retroperitoneal. Each kidney lies in a mass of perirenal fat posterior to the peritoneum at the L1 to L4 vertebral level; the right kidney may be lower than the left.
- The hilum of the kidney is located on its concave medial surface where the renal artery and vein, and the ureter enter the substance of the kidney. As the ureter approaches the hilum, it is dilated to form the renal pelvis. In the depths of the hilum, the pelvis divides into several major calyces (singular, calyx), which in turn divide into 7-14 minor calyces that receive urine from the largest collecting ducts. The ureter and calyces comprise a conducting system that carries urine from the kidney to the bladder. The renal pelvis and its branching calyces fit within a space called the renal sinus, along with the renal vessels.
- If a coronal cut is made through the kidney that divides it into anterior and posterior halves, the cut surface can be seen to have regions of differing texture that are functionally significant. The cortex is 1-2 cm thick and parallels the convex surface of the kidney. The medulla lies between the cortex and the hilum of the kidney and is divided into lobes consisting of the pyramids and the columns. The renal columns are similar to the cortex. The renal papilla is located at the apex of the renal pyramid, protrudes into a minor calyx, and is the site where urine is secreted into the calyx to begin its journey to the bladder
m
- Vessels—renal artery and vein
- Kidney Function a. Maintain ionic balance of blood and excrete waste products as urine. Some crystalline compounds may form in the calyx and form kidney stones. b. Regulation of blood pressure c. Renal transplantation is an established operation for the treatment of selected cases of chronic renal failure. The transplant site for the kidney is the lower abdomen
n
B. Ureter 1. Retroperitoneal throughout its course. The ureter descends from the renal pelvis to the bladder, anterior to the psoas major muscle, crossing anterior to the external iliac vessels to enter the lateral aspect of the pelvis, and proceeds to the posterosuperior aspect of the urinary bladder. Here it passes obliquely through the bladder wall, forming a functional valve to prevent the reflux of urine. 2. Blood supply from renal artery superiorly, gonadal artery during descent, and superior vesical artery near the bladder. 3. Innervation—autonomic nerves from the renal plexus 4. Clinical Conditions a. Renal stones—pain frequently results from a stone passing from the kidney to obstruct in the ureter b. Obstruction—usually occurs at three areas, and can result in hydronephrosis i. junction of ureter and pelvis (UPJ) ii. where it crosses pelvic inlet iii. its intramural portion (in the wall of the bladder)
b
Suprarenal (Adrenal) Gland 1. Relations—at the superior pole of the kidney, within the renal fascia 2. Structure and function a. Capsule—surrounding each gland b. Cortex—secretes mineralocorticoids, glucocorticoids, and sex hormones: cortisol, aldosterone, progesterone, and estradiol c. Medulla—secretes epinephrine and norepinephrine 3. Blood supply—suprarenal arteries from the aorta 4. Innervation—The nerves are mainly preganglionic sympathetic fibers that are derived from splanchnic nerves. The majority end in the medulla and help regulate epinephrine secretion. The cortex receives only a vasomotor supply. Medullary cells are homologous with sympathetic ganglion cells.
b
