Lecture 15: Posterior Body Wall, Diaphragm, and Autonomics Flashcards Preview

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Flashcards in Lecture 15: Posterior Body Wall, Diaphragm, and Autonomics Deck (188):
1

What are the major components of the excretory system

kidney

2

What is the embryological derivative of kidney tissue

Intermediate mesoderm

3

What are the names of the 3 different kidneys that are formed in the human at subsequent developmental stages?

Pronephric, mesonephric, adult kidney (metanephros)

4

Pronephros: Will it deteriorate or remain? Percursors?

Will deteriorate. Becomes past of the mesonephric duct

5

What does the mesonephric duct in the embryo become in the adult for males and females?

Males- Vas deferens and epididimus (reproductive organs)
Both sexes- Gives of ureteric bud

6

Mesonephros: Does it function?

Yes but deteriorates with age

7

What does the ureteric bud give rise to in the adult?

The ureter, collecting tubules of kidney, and calyx system

8

Where does the adult kidney form in the embryo

Pelvis

9

What does the undifferentiated metanephros form?

nephrons

10

What causes the metonephros to ascend with age

-Growth of body in the lumbar-sacral regions
-Decrease in body curvature

11

Congenital abnormality: Pelvic Kidney

Failure for kidney to ascend- may interfere with pregnancy

12

Congenital abdnormality: Horseshoe kidney

Gets stuck on inferior mesenteric a. Functions but plaques and aneurisms occur within the common iliac arteries (makes surgery difficult)

13

What is the location (vertebral level) of the adult kidney

T12-L3

14

Which kidney sits lower relative to the other and why?

The right is lower than the left due to the massive liver

15

Is the kidney retroperitoneal?

Yes, primarily retroparitoneal

16

Where does the adult kidney lie

In a mass of perirenal fat ensheathed by renal fascia

17

What is the renal fascia attached to superiorly, inferiorly, posteriorly, and medially?

Superiorly- Diaphragm
Posteriorly- psoas major m.
Medially- IVC and aorta
Inferiorly- Ureter

18

How is it that kidney infections spread to the pelvis?

Because the renal fascia blends with the ureteric fascia

19

What are the 3 muscles that come into contact with the kidneys

Psoas major, quadrates lumborum, and transversus abdominis

20

What are the boarders of the kidney that each posterior back wall muscle contacts

-Psoas major- medial surface
-Quadratus laborum- Biggest (between the medial and lateral boarders)
-Tranversus abdominis- Lateral surface

21

What are the two surfaces of the kidney

Anterior and posterior

22

What are the 2 margins of the kidneys

medial and lateral

23

Describe the medial and lateral margin of the kidney

Medial: indented or concave (where the hilus is).
Lateral: Convex

24

What is the order (anterior to posterior) that vessels leave the hilus of the kidney

Renal vein --> Renal artery --> ureter

25

What are the 2 poles of the kidney

Superior and inferior

26

What sits atop of the superior pole of the kidney

Suprarenal gland (adrenaline gland)

27

What is the outermost covering of the kidney

Renal capsule

28

What are the inner and outer regions of the kidney referred to as?

-Outer= Cortex
-Inner= Medulla

29

Within the medulla, there are triangular structures called.... which are separated by....

Renal pyramids,,,, renal columns in between each pyramid

30

Can we see structural subdivisions of the cortex?

Not without a microscope

31

The tip of each renal pyramid is called...

Renal papilla

32

Purpose of the renal papilla

Provides a route of entry for the urine into minor calyces

33

What do minor calyces unite to form

major calyces

34

Role of major calyces

Dump urine into the expanded portion of the ureter (renal pelvis)

35

Expanded portion of the ureter is called...

Renal pelvis

36

Typically, how many major calyces and minor calyces

Major- 2 or 3
Minor- 7 to 14

37

What is the superior pole of the right kidney related to?

The inferior surface of the liver

38

What part of the duodenum passes along the hills of the right kidney

descending part of duodenum

39

What structure is close to the inferior pole of the right kidney

The hepatic flexure

40

Which kidney touches more organs the right or left?

Left

41

Since the left kidney touches many organs, what can be said about cancer in the left kidney

Metastisis is common?

42

What are the organs that surround the left kidney

Suprarenal gland, stomach, spleen, pancreas, jejunum, and descending colon

43

Where does the left kidney lie

Stomach bed- region where stomach lies

44

Where do the renal arteries arise from

Abdominal aorta inferior to the superior mesenteric a.

45

Describe the morphology of the branches given to the kidneys by the renal a.

Large anterior branch and small posterior branch

46

What are the subdivisions of the anterior artery branch to the kidney

Apical (superior), upper (anteriosuperior), middle (anterioinferior), and inferior branches

47

What supplies the entire anterior surface of the kidney?

The large anterior branch

48

What region on the kidney does the posterior artery supply

The whole posterior surface, with the exception of the superior and inferior poles

49

What supplies the blood on the posterior surface of the kidney at the superior pole

The anterior apical artery

50

What supplies the blood on the posterior surface of the kidney at the inferior pole

Anterior lower artery

51

What are the sources for accessory arteries to the kidney?

The come off as branches from the aorta

52

When do these accessory renal arteries from the aorta form?

When the kidney ascends from the pelvis

53

What sorts of issues can accessory renal arteries bring about

They can obstruct the ureter

54

What drains blood out of the kidneys and into the heart?

Right and left renal veins which flow into the inferior vena cava

55

Is innervation to the kidney sympathetic or parasympathetic? Where does it come from?

Sympathetic. The lesser and least splanchnic nerves synapse at the aorticorenal gangia which supplies the kidney

56

Which kidney has a further distance to travel to reach the IVC

Left

57

Where do the suprarenal and gonal vein ever for the left kindey

The Left renal v.

58

Where do the suprarenal and gonal vein ever for the right kindey

Directly into the IVC

59

Where does the calyx system in the kidneys derive from?

Urinteric bud

60

What does the ureter derive from

Urinteric bud

61

The urinteric bud also forms collecting tubules, can we see these in lab?

no need microscope.

62

Where does the ureter start and end

Begins at the renal pelvis and ends at the urinary trigone within the urinary bladder

63

Where are ureters commonly constricted (smaller)

-Where the renal pelvis becomes the ureter
-Where the ureter crosses the common iliac a.
-Where the ureter goes into urinary bladder

64

What normally gets stuck in the constricted regions of the ureter

kidney stones (urantitic calculi)

65

What is the arterial supply to the ureters

Renal, gonadal (testicular or ovarian) and abdominal aorta

66

Where is the pain felt for a kidney stone

Loin to groin (back to groin)

67

What spinal nerves are responsible for the loin to groin pain for a kidney stone

T11-L2 due to the marked distention of the muscular wall of the ureter.

68

Where do the suprarenal glands lie in relation to the kidney?

Superior pole of each kidney

69

What shape are the left and right suprarenal glands

Left- Semilunar
Right- Hat

70

What makes up the urintary trigone

2 ureters and 1 urethra

71

What technique is used to reveal where kidney stones are

Pyelogram (Can see kidney outline, can see calyx system

72

How are bifid ureters formed

uranteric bud divides too early

73

Why can bifid ureters be an issue?

they are so narrow suceptible to clogging- there is one of these in the lab

74

Which suprarenal gland (right or left) extends more inferiorly

Left

75

What separates the kidney from the suprarenal gland

renal fascia

76

What envelopes each suprarenal gland

fat and renal fascia

77

Embryonically, what is the suprarenal gland derived from

mesoderm (cortex) and ectoderm (medulla)

78

What is the difference between the cortex and medulla of the suprarenal glands

Cortex- secretes and produces steroid hormones (cortisol and aldosterone)

Medulla- produces and secretes peptide hormones (epiephrine)

79

Why is it that the cortex and medulla produce different types of hormones

because they are derived from two different embryonic layers

80

What receives innervation from in the suprarenal gland

Medulla

81

Is the innervation to the medulla parasympathetic or sympathetic

Sympathetic

82

Describe the pathway of innervation

The medulla receives preganglionic fibers from the sympathetic truck via the greater splanchnic n. **These splanchnic nerves DO NOT go into the celiac ganglia. They go into the medulla directly. There are no postganglionic fibers**

83

What happens when the suprarenal gland is stimulated by a neuronal synapse

The organ secretes epinephrine during fight or flight

84

How many arterial branches supply the suprarenal gland

3

85

The three vessels that supply the suprarenal gland are...

Superior suprarenal a
Middle suprarenal a
Inferior suprarenal a

86

What are the superior, middle and inferior suprarenal arteries branches of?

Superior- Inferior phrenic a
Middle- Aorta
Inferior- Renal a

87

What are the veins that drain the suprarenal gland?

Right and left suprarenal v.

88

What are the tributaries of the right and left suprarenal veins

Right-IVC
Left- Renal v.

89

What are the bony attachments of the diaphragm (sternal and costal portions)

Sternal portion- Typhoid process
Costal portion- Internal surface of lower 6 ribs and costal cartilage.

90

What are the bony attachments of the diaphragm (Lumbar portion)

Lumbar portion- Arises from lumbar vertebrae by the right and left cura, which attach to L1-2 and surround aorta.

91

What ligament unites with the cura of the diaphragm

The anterior longitudinal ligament

92

Attachment to the diaphragm (central tendon)

Sheet like aponeurosis- no bony attachment

93

What gives sensory and motor innervation to the diaphragm

The phrenic nerve

94

What spinal cord levels make up the phrenic nerve

C3,4,5

95

What additional nerves provide sensory innervation to the diaphragm other than the phrenic nerve

intercostal n.

96

What are the 3 ligaments of the diaphragm

Median, Medial, and Lateral arcuate ligaments

97

Median arcuate ligament: Attachment

Unites cura opposite of T12 and L1.

98

Medial arcuate ligament: Attachment

Connects the cura of the diaphragm to transverse processes of L1

99

What goes underneath the medial arcuate ligament

Posts major m.

100

What goes under the median arcuate ligament

The aorta

101

Lateral arcuate ligament: Attachment

Attaches to the transverse process of L1 to rib 12

102

What lies superior to the lateral arcuate ligament

vertebrocostal triangle

103

What is the vertebrocostal triangle

A region where the diaphragm is so thin that it produces a potential herniation spot

104

Where do most diaphragmatic herniations occur

The vertebrocostal triangle

105

In what hole does the esophagus go through the diaphragm

Esophageal hiatus

106

In what hole does the inferior vena cava penetrate the diaphragm

The Inferior vena cala formamen

107

What muscle sits beneath the medial arcuate ligament

Posas major m.

108

What muscle sits under the lateral arcuate ligament

Quadratus laborum m.

109

What is the role of the arcuate ligaments

Anchor the diaphragm (to lumbar vertebrae)

110

At what vertebral level does the inferior vena cava go through the inferior vena naval forament

T8

111

At what vertebral levels does the esophagus penetrate the diaphragm through the esophageal hiatus?

T10

112

At what vertebral level does the aorta come off of the median arcuate ligament?

T12

113

How does the diaphragm increase the size of the thoracic cavity

Muscles pull down on the central tendon

114

What is the hole that the aorta emerges out of in the diaphragm

Aortic hiatus (again at vertebral level T12)

115

What are the arterial supplies to the diaphragm on the abdominal side

Inferior phrenic artery

116

What are the arterial supplies to the diaphragm on the thoracic side?

Pericardiophrenic a., Musculophrenic a, and branches of the thoracic aorta.

117

Where do the branches of the pericardiophrenic a that supply the diaphragm come from

internal thoracic a.

118

What is the first branch off the abdominal aorta

The inferior phrenic a.

119

What portion of the diaphragm is supplied by the arterial supplies from the thoracic and abdominal sides respectively

Thorax- superior portion
Abdominal- Inferior

120

Embryology of the diaphragm: What cells for the muscles on the periphery

Somites (muscle cells on body wall)

121

Embryology of the diaphragm- What forms the cura of the diaphragm

The dorsal mesentery of the esophagus

122

Embryology of the diaphragm- What forms the central tendon of the diaphragm

Septum transversum

123

What are the 4 posterior body all muscles

Psoas Minor
Psoas Major
Quadratus Laborum
Iliacus

124

Proximal attachment of the posts major m.

Transverse processes of lumbar vertebrae. Bodies of discs T12-L5

125

Distal attachment of Psoas major m.

Lesser trochanter of femur

126

Innervation of Psoas major m.

Vertebral branches of lumbar nerves (ventral rami)

127

Proximal attachment of Iliacus

Iliac fossa, iliac crest, sacral ala, anterior sacroiliac ligaments

128

Distal attachment of Illiacus

Lesser trochanter of femur (same as psoas major)

129

Innervation of iliacus

femoral n.

130

Action of iliacus

Flexes thigh on hip (this action is shared by psoas major m.)

131

What is the only thing different between the psoas major m and the iliacus

Innervation

132

Why do the psoas major and iliac us have different innervations?

Because they have different embryological origins

133

Proximal attachment of Psoas minor m

Sides and bodies of vertebrae T12-L1

134

Distal attachment of Psoas minor m

Pectineal line and iliopectineal eminence

135

Innervation of the Psoas minor m.

Ventral branches from L1

136

Proximal attachment of Quadrates Laborum

12th rib and lumbar transverse process

137

Distal attachment of Quadrates Laborum

Iliolumbar ligament and internal lip of iliac crest

138

Action of Quadrates laborum

extends and laterally flexes vertebral column. Fixes 12th rib during inspiration

139

Innervation of Quadratus Laborum m

Ventral branches of T12 and L1-4

140

What muscle is where the lumbar plexus forms?

The psoas major muscle

141

What are the spinal nerves that make up the lumbar plexus

Ventral rami of L1-4

142

What are the 6 nerves in the lumbar plexus

Iliohypogastric, Ilioinguinal, Gentiofemoral, Lateral femoral cutaneous n of the thigh, Femoral, and obturator

143

Iliohypogastric spinal cord level

L1

144

Iliohypogastric innervation

Sensory for skin over buttocks and anterior abdominal wall above pubic symphysis. Motor fibers to the transverses abdomens and internal obllique muscles

145

Ilioinguinal spinal cord level

L1

146

Ilioinguinal innervation

Sensory- Passes through superficial inguinal ring and supplies groin, scrotum, and labia major. Motor- transverses abdominis and internal oblique muscles

147

Genitofemoral nerve spinal cord level

L1,2

148

Genitofemoral nerve innervation

Genital branch- Supplies cremaster muscle and scrotum in males and labia majora in females. Femoral branch- sensory to skin of femoral triangle

149

Lateral femoral cutaneous nerve of thigh spinal cord level

L2-3

150

Lateral femoral cutaneous nerve of thigh innervation

Skin over the anterior and lateral aspects of the thigh

151

Femoral nerve Spinal cord level

L2,3,4

152

Femoral n innervation

anterior compartment of the thigh

153

Obturator spinal cord level

L2,3,4

154

Obturator innervation

Supplies adductor muscles of thigh

155

2 additional nerves that are NOT a part of the lumbar plexus

Subcostal n, and lumbrosacral trunk

156

Spinal cord levels of subcostal and lumbrosacral trunk

Subcostal= T12
Lumbrosacral= L4-5

157

Do the majority of organs receive sympathetic or parasympathetic fibers

both

158

Where do the majority of the nerve fibers tend to congregate in the abdomen?

Many congregate around arteries forming nerve plexuses

159

Do synapses occur in these poleax located on the arteries?

No

160

What are the 3 poleax in the abdomen

Celiac, superior mesenteric, and inferior mesenteric pelus

161

Where does the celiac plexus sit and what organs does it innervate?

Surrounds celiac artery. Innervates stomach, liver, pancreas, gallbladder, spleen, and parts of duodenum (AKA FORGUT)

162

Where does the superior mesenteric plexus sit and what organs does it innervate?

Surrounds superior mesenteric a. innervates the midgut

163

Where does the inferior mesenteric plexus sit and what organs does it innervate?

Surrounds inferior mesenteric a. innervates the hindgut

164

Are splanchnic nerves composed of pre or postganglionic fibers

preganglionic

165

Where do the greater and lesser splanchnic nerves pierce the diaphragm?

The cura

166

Where do the least and lumbar splanchnic nerves arise in relation to the diaphragm

At the level of or below the diaphragm

167

What are the spinal cord levels of the greater splanchnic n.

T(s)6-9

168

What are the spinal cord levels of the lesser splanchnic n.

T(9)10-11

169

What are the spinal cord levels of the least splanchnic n.

T12

170

Where do the preganglionic fibers in the greater splanchnic nerve synapse

celiac ganglia

171

From the celiac ganglia- what organs are supplied by the postganglionic fibers?

Forgut organs

172

Where do the lesser and least splanchnic nerves synapse

aorticorenal ganglia

173

What organ does the aorticorenal ganglia supply?

Kidney (lesser) renal arteries and ureters (least)

174

What are the spinal cord levels of the lumbar splanchnic nerves

L1,2,3

175

Where do the lumbar splanchnic nerve synapse?

inferior mesenteric ganglia

176

What organs are supplied by the inferior mesenteric ganglia

hindgut

177

For the sympathetic fibers that enter the celiac ganglia but do not synaspe there, what do they innervate?

Suprarenal gland

178

Is the aorticorenal ganglia a part of the celiac ganglia complex?

yes

179

What does the vagus nerve provide innervation to in the abdomen

Everything up to the distal 1/3 of transverse colon (mostly forgut

180

Where do the parasympathetic pelvic splanchnic nerves arise from (spinal cord levels)

S2-4

181

What plexus contains the pelvic splanchnic nerves for the parasympathetic system

Inferior mesenteric plexus

182

What do the pelvic splanchnic nerves innervate

Parasympathetic innervation to the distal 1/3 transverse colon, large intestine, rectum, and pelvic organs

183

Referred visceral pain

Brain misdiagnoses visceral pain for abdonmial pain because the pain receptors are in the same dorsal root ganglia as the somatic afferent fibers, and somatic afferent fibers carry pain better than the visceral afferent fibers

184

What are the two main lymphatics of the abdomen

Visceral lymph nodes and lumbar lymph nodes

185

Visceral lymph noses

From abdominal viscera drain into nodes situated along the unpaired visceral branches of the aorta

186

Lumbar lymph nodes

Receive drainage from the kidneys, testes, ovaries, and posterior body wall and lower limbs through the common iliac lymph nodes

187

Where do the visceral and lumbar lymph nodes unite?

At a dilation within the abdomen called the cisterna chyli to form the thoracic duct,

188

What is the largest lymph vessel in the body

the cisterna chyli