Lecture 2: Kidneys, Ureter, Bladder and Posterior Abdominal Wall

Question 1

Quadratus Lumborum O: I: Innervation?

Answer 1

O: Iliac Crest I: 12th rib and L1-4 Transverse processes Innervation: T12, L1-L4 (anterior rami)

Question 2

Iliacus O: I: Action: Innervation:

Answer 2

O: iliac fossa I: Lesser Trochanter (join psoas to form common tendon) Action: Hip flexion Innervation: Femoral Nerve (L2-4)

Question 3

Psoas Major O: I: Action: Innervation:

Answer 3

O: T12, L1-L5 I: Lesser Trochanter Action: Raise body from supine position, bend trunk laterally, flex hip joint Innervation: Lumbar plexus (L1-3)

Question 4

The Renal Artery comes off _______ at level ____

Answer 4

The Renal Artery comes off para-aortically at level L1

Question 5

The Testicular Artery comes off at level ____

Answer 5

The Testicular Artery comes off at level L2

Question 6

How many Veins and arteries supply and drain the posterior abdominal wal

Answer 6

5x Lumbar Veins 5x Lumbar arteries

Question 7

Where do the aorta and IVC bifurcate?

Answer 7

Aorta: @L4 IVC: @L5

Question 8

Flow diagram of the Urinary System? These are all ________

Answer 8

Kidney> Ureter > Bladder > Urethra These are all ‘retroperitoneal’

Question 9

What sits atop each kidney?

Answer 9

‘Suprarenal Glands’ NOT part of urinary system, involved in dealing with adrenaline. Also infraperitoneal

Question 10

Where do the kidneys (+ suprarenal glands) sit within the abdominal cavity. Where does the ureters exit each kidney?

Answer 10

above ‘psoas major’ and ‘quadratus lumborum’ Ureters exit at L1 (transpyloric plane)

Question 11

Each kidney sits behind and below what rib?

Answer 11

RK: rib 12 (lower due to liver) LK: rib 11 & 12

Question 12

The Kidneys have a smooth ____________. Each Hilum contains __________ and branches of the _________, (also lymphatics and ANS). The kidneys can be divided into ______ and _______________.

Answer 12

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.

Question 13

Are the ureters/renal pelvis posterior or anterior to the renal vessels?

Answer 13

Posterior.

Question 14

Draw and label the kidney - internal overview structure (page 31)

Answer 14

….

Question 15

Right Kidney Relations Anterior: Posterior:

Answer 15

A: suprarenal gland, liver, 2* duodenum, hepatic flexure of colon P: diaphragm, psoas, quad. lumborum, transversus abdominis, rib 12, subcostal nerve

Question 16

Left Kidney Relations Anterior: Posterior:

Answer 16

A: Suprarenal gland, spleen, stomach, pancreas, jejunum, splenic flexure of colon. P: diaphragm, psoas, quad. lumborum, transversus abdominis, rib 11 & 12, subcostal nerve

Question 17

Renal veins and arteries are at level ____, the ____ is slightly lower then the _____. Veins are ______ to arteries.

Answer 17

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.

Question 18

Before entering the kidneys renal arteries branch into?

Answer 18

anterior and posterior branches > Segmental branches

Question 19

Which renal artery is longest. The right renal artery runs _____ to the IVC

Answer 19

The right renal artery is longest and runs posterior to the IVC

Question 20

Which renal vein is longest and by how much? The left renal vein runs _____

Answer 20

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

Question 21

What is the nervous innervation of the kidneys? S: PS: Referred pain =

Answer 21

‘Renal Plexus’ S: complicated PS: Vagus Referred Pain = flank pain

Question 22

Renal lymph?

Answer 22

Para-aortic nodes @L1

Question 23

What are the ureters? Explain their journey

Answer 23

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.

Question 24

The 3 constrictions of the Ureters are? Why are these sites important?

Answer 24

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

Question 25

Draw the Ureter Blood, nerve and lymph diagram

Answer 25

Question 26

How is it that the bladder doesn't fall? When it fills where does it move? What is it made of?

Answer 26

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)

Question 27

What is the trigone?

Answer 27

* 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

Question 28

Blood and Nerve supply of the Bladder?

Answer 28

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)**

Question 29

Male vs female **urethra**?

Answer 29

Female: bladder ⇒ through **_deep and superficial Perineal pouches_** Male: 4 distinct regions 1. **Pre-prostatic** 2. **Prostatic** *(widest part- many ducts emptying in)* 3. **Membranous** *(thinnest part- through deep perineal pouh)* 4. **Spongy** *(through corpus spongiosum)*

Question 30

Lymphatics of the ureter, bladder and urethra?

Answer 30

**Ureter** drains to: * Lumbar * common/external/internal iliac **Bladder** drains to: * Internal iliac nodes **Urethra** * internal iliac nodes

Question 31

Label this diagram

Answer 31

..

Question 32

Course of Iliohypogastric and Ilioinguinal nerves

Answer 32

BOTH L1! * 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

Question 33

Sensory and motor control of Iliohypogastric and Ilioinguinal

Answer 33

_iliohypogastric_; Sensory: **Lateral gluteal & Pubic skin** Motor: **transverse abdominis & Internal oblique** _Ilioinguinal;_ Sensory: **skin of medial thigh + roots of penis/scrotum or mons pubis/labia** Motor**: transversus Abdominis & internal Oblique**

Question 34

**Genitofemoral Nerve.** Level: Branches: Sensory: Motor: Course:

Answer 34

Level**: L1 and L2** Branches**: Genital and femoral** Sensory**: scrotum or mons pubis, skin of upper anterior thigh** Motor**: Cremasteric muscle** Course: * 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

Question 35

**Lateral Femoral Cutaneous n.** Levels: Sensory: Course:

Answer 35

Levels: L2 & L3 Sensory: Skin on Anterior & lateral thigh Course: * Emerges from lateral border of Psoas * Descends obliquely across surface of Iliacus * Passes under inguinal lig. (at lateral extremity near attachment to ASIS)

Question 36

Bernhardt-Roth Syndrome

Answer 36

-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)

Question 37

Femoral Nerve Levels: Sensory: Motor: Course:

Answer 37

Levels: L2-4 (largest) Sensory: skin on anterior thigh and medial leg Motor: Pectineus, iliacus and ant compartment of thigh Course: * Emerges from lower lateral border of Psoas * Runs between iliacus and Psoas * Passes under inguinal lig. to thigh

Question 38

**Obturator Nerve** Levels: Sensory: Motor: Course:

Answer 38

Levels: L2-4 Sensory: skin on medial thigh Motor: obturator externus and medial comp. of thigh Course: * 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)