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Flashcards in Lecture 5 Deck (78):
1

What are the key bony landmarks?

1. Anterior sacro-iliac joint.
2. Ischial spine.
3. Punic symphysis.
4. Obturator foramen.
5. ASIS.
6. Iliac crest.
7. Iliac fossa.

2

What muscles make up the posterior abdominal wall?

1. Quadratus Lumborum.
2. Iliacus.
3. Psoas Major.
(4. Diaphragm).

3

What is the origin of Quadratus Lumborum?

Iliac Crest.

4

Where does Quadratus Lumborum insert?

12th rib and L1-4 Transverse Processes.

5

What is the action of Quadratus Lumborum?

Both quadratrus lumborum will help with forced expiration and 12th rib support.
One quadratrus lumborum will help to bend the trunk to the same side.

6

What nerve innervates Quadratus Lumborum?

T12 and L1-4 (anterior rami).

7

What is the origin of iliacus?

Iliac fossa.

8

Where does iliacus insert?

Lesser trochanter of femur - it joins posts to form a common tendon.

9

What is the action of iliacus?

Hip flexion.

10

What nerve innervates iliacus?

Femoral nerve (L2-4).

11

What is the origin of psoas major?

Vertebral bodies and IV discs of T12 and L1-5.

12

Where does psoas major insert?

Lesser trochanter of femur - joins iliacus to form a common tendon.

13

What is the action of psoas major?

Raise body from supine position (both posts will do this). And one will help to bend the rink laterally. Also flexion at the hip joint.

14

What nerve innervates psoas major?

Lumbar plexus (L1-3).

15

Where does the aorta come from behind?

It comes from behind the diaphragm at T12 and it bifurcates at L4.

16

Where do the renal arteries come off the aorta?

Para-aortically: this means they come off the side of the aorta at L1.

17

Where do the testicualr arteries come off?

Slightly lower down to the renal arteries at L2.

18

What arteries and veins supply and drain the posterior abdominal wall?

There are 5 lumbar arteries and veins that do this.

19

Where does the IVC bifurcate at?

L5 (slightly lower down then when the aorta bifurcates). It runs behind the aorta.

20

Why do ladies get varicose veins during childbirth?

Well the common iliac veins run behind the iliac artery - they cross over. So the left leg will get varicose veins when the arteries crush the common iliac veins.

21

What makes up the urinary system (from superior to inferior)?

1. Kidney.
2. Ureter.
3. Bladder.
4. Urethra.

All these organs are retroperitoneal.

22

What is the function of the urinary system?

1. Removal of waste.
2. Electrolyte balance.
3. pH balance.
4. Blood pressure/volume regulation.

23

What sits above the kidneys?

The suprarenal gland. It is not apart of the urinary system.

24

Describe the surface anatomy of the kidneys and the suprarenal gland?

The kidneys are located posteriorly in the abdomen. They sit on top of the Psoas and Quadratus Lumborum muscles in the abdominal cavity. The right kidney is slightly lower than the left kidney (due to position of the liver). The right kidney sits behind and below rib 12. The left kidney sits behind and below ribs 11 + 12. The ureter exits the kidney at L1 (Transpyloric plane) - basically the hila of the kidney is at L1.

25

What surrounds the kidney?

They are surrounded by a lot of fat, this is because they are at risk of trauma. There are two areas of fat:
1. Peri-nephric fat: this is fat just surrounding the kidney.
2. Para-nephric fat: this is fat sitting outside the peri-nephric fat.

A renal fascia separates the two fats and it blends with the psoas fascial compartment.

26

What are the physical characteristics of the kidneys?

They are red/brown and they have a smooth outer capsule.

27

What does each hilum of the kidneys contain?

Renal vein and branches of the renal arteries (also lymphatics and ANS).

28

What can the kidneys divide into?

Upper and lower poles.

29

What is the ureters and the renal pelvis posterior to?

The renal vessels.

30

Where are the suprarenal glands (adrenal) located?

Superiorly on top of the upper pole of the kidneys.

31

Where do the arteries sit in terms of the kidneys?

The arteries sit behind the veins.

32

Describe the internal structure of kidneys?

1. Capsule - surrounding the kidney.
2. Cortex - the outer of the kidney; smooth glandular tissue.
3. Medulla (loop of henle, collecting duct).
4. Renal papilla.
5. Minor calyces.
6. Major calyx.
7. Renal pelvis.
8. ureter.

33

Describe the anterior relationship to the right kidney?

The following structures sit anteriorly to the right kidney:
1. Suprarenal gland.
2. Liver.
3. Second part of duodenum.
4. Hepatic flexure of colon.

34

Describe the posterior relationship to the right kidney?

The following structures sit posteriorly to the right kidney:
1. Diaphragm.
2. Psoas.
3. Quadratus lumborum.
4. Transversus abdominus.
5. Ribs 12.
6. Subcostal nerve.

35

Describe the anterior relationship to the left kidney?

The following structures sit anteriorly to the left kidney:
1. Suprarenal gland.
2. Spleen.
3. Stomach.
4. Pancreas.
5. Jejunem.
6. Splenic flexure of colon.

36

Describe the posterior relationship to the left kidney?

The following structures sit posteriorly to the right kidney:
1. Diaphragm.
2. Psoas.
3. Quadratus lumborum.
4. Transversus abdominus.
5. Ribs 11-12.
6. Subcostal nerve.

37

What is the surface anomy of the renal arteries and veins?

L1.

38

How do the veins sit compared to the arteries?

They sit anterior to the arteries. You don't want veins passing behind arteries otherwise they'll get occluded.

39

How do the arteries branch?

The renal arteries branch into anterior and posterior branches before entering the kidney.

40

Where do the veins come off at L1?

They come off para-aortically.

41

Describe the arterial supply to the kidneys?

They sit L1. The right renal artery is longer than the left renal artery. The right renal artery runs posteriorly to the IVC.

42

Describe the venous drainage of the kidneys?

Renal veins drain into IVC laterally at L1. The left renal vein is three times longer than the right renal vein. The left renal vein runs anteriorly to the aorta, under the SMA and posterior to the splenic vein and pancreas body. The right renal vein runs posteriorly to the second part of the duodenum.

43

Describe the nerve supply of the kidneys?

Renal plexus:
1. Sympathetic is complicated.
2. Parasympathetic = vagus nerve [CNX].
3. Referred pain is described as "Flank" pain.

44

Describe the lymphatics of the kidney?

Para-aortic nodes at L1.

45

What are the ureters?

25cm long smooth muscle tubes that run form the kidneys to the bladder.

46

How is urine propelled from the kidney?

It is propelled from the kidney via smooth muscle contractions (and filtration pressure from the glomeruli).

47

Where do the ureters extend from?

Vertically down from the hilus on the surface of the psoas muscle.

48

What is the ureter in line with?

Transverse processes of the lumbar spine.

49

Describe the pathway of the ureters?

It crosses the bifurcation of the common iliac artery at the anterior sacroiliac joint. It passes on the lateral wall of the pelvis (ilium) towards the ischial spine. It enters the bladder on the inferior surface at the trigone.

50

What are the constrictions of the ureters?

1. Junction of the ureters and the renal pelvis - pelvic-ureteric junction (PUJ).
2. Where ureters cross the pelvic brim.
3. As the ureters enter the wall of the bladder.

N.B. Most common sites of renal calculus obstruction.

51

Describe the blood, nerve and lymph supply of the superior 1/3 of the ureter?

Arterial = Renal artery.
Venous = Renal vein.
Nerve = Renal plexus.
Lymph = Lateral aortic at L1/iliac nodes.

52

Describe the blood, nerve and lymph supply of the middle 1/3 of the ureter?

Arterial = Gonadal artery (testicular/ovarian).
Venous = Gonadal vein (testicular/ovarian).
Nerve = Renal plexus.
Lymph = Lateral aortic at L1/iliac nodes.

53

Describe the blood, nerve and lymph supply of the inferior 1/3 of the ureter?

Arterial = Superior vesical artery (from internal iliac).
Venous = Superior vesical vein (from internal iliac).
Nerve = Hypogastric plexuses (superior and inferior).
Lymph = Lateral aortic at L1/iliac nodes.

54

Where is pain referred to from the ureters?

L1/2 dermatomes (suprapubic region).

55

Describe the bladder?

it is a partial covering of peritoneum, it is 'stuck' against the pubic bones (various ligaments helping it to do so). There is transitional epithelium and rug. There is muscular coat of smooth muscle (detrusor muscle) and at the neck of the bladder there is a smooth muscle sphincter (sphincter vesicle). The apex is posterior to the pubic symphysis.

56

What happens as the bladder fills?

The bladder rises into the suprapubic region.

57

Where do the ureters enter the bladder?

Trigone.

58

Describe the Trigone?

It is a triangular smooth area at the base of the bladder - mucous membrane (no rugae). The ureters enter at the base of the triangle (top) and the urethra exit at the apex. In between the ureteric opening is the inter-ureteric crest.

59

Describe the arterial supply to the bladder?

There are two superior vesicle arteries from each side and inferior vesicle arteries - these come off an anterior branch of the internal iliac artery.

The inferior vesicle artery in males usually corresponds to the vaginal artery in females.

60

Describe the venous supply to the bladder?

Vesical plexus which drains to the internal iliac vein.

61

Describe the nervous supply to the bladder?

ANS inferior hypogastric plexus: sympathetic - sacral splanchnic nerves S2-4 (l1-2 fibres); parasympathetic - pelvic splanchnic.

62

Where is pain referred to in terms of the bladder?

Suprapubic region - l1/2 dermatomes.

63

Describe the urethra in the female?

The urethra leaves the bladder and passes through the deep and superficial perineal pouches.

64

Describe the urethra in males?

There are 4 distinct regions:
1. Pre-prostatic.
2. Prostatic - widest part, there are many ducts emptying in.
3. Membranous - thinnest part, through deep perineal pouch.
4. Spongy - through corpus spongiosum.

65

Describe the urinary tract lymphatics?

Ureter: drains to lumbar, common iliac, external iliac, and internal iliac (as they descend towards the bladder).
Urethra: main drainage is to the internal iliac nodes (some male/female variation).
Urinary bladder: main drainage is to the internal iliac nodes.

66

What nerves are apart of the lumber plexus?

T12-L4.
1. Iliohypogastric.
2. Ilioinguinal.
3. Genitofemoral.
4. Lateral femoral cutaneous.
5. Femoral.
6. Lumbrosacral trunk.
7. Obturator.
Subcostal is not part of the lumbar plexus.

67

Describe the iliohypogastric nerve?

Comes from L1.
Sensory = supplies lateral gluteal and pubic skin.
Motor = supplies the transverses abdominis and internal oblique.

68

Describe the ilioinguinal nerve?

Comes from L1.
Sensory = supplies the skin of the medial thigh and root of penis/scrotum or mons pubis/labia major.
Motor = supplies transversus abdominis and internal oblique.

69

Describe the course of the iliohypogastric and ilioinguinal nerves?

The merge at the lateral border of psoas muscle. They run obliquely over the quad.lumborum muscle (iliohypogastric is superior to ilioinguinal). They pierce the transverses abdominis. The ilioinguinal will pierce the internal oblique to enter the inguinal canal and accompany the spermatic cord through the superficial inguinal ring.

70

Describe the genitofemoral nerve?

It comes from L1-2. There are two branches:
1. Genital.
2. Femoral.
Sensory = supplies the scrotum/mons pubis and skin of upper anterior thigh.
Motor = supplies the cremasteric muscle.

71

Describe the course of the genitofemoral nerve?

It emerges through and runs on top of the psoas muscle. The genital branch will enter the spermatic cord to innervate the cremaster muscle and give sensory to genital skin. The femoral branch passes under the inguinal ligament to the thigh.

72

Describe the lateral femoral cutaneous nerve?

It comes from L2/3. It is only sensory = supplies the skin on the anterior and lateral thigh (above the knee).

73

Describe the course of the lateral femoral cutaneous nerve?

It emerges from the lateral border of psoas muscle. It descends obliquely across the surface of iliacus and it passes under the inguinal ligament (at lateral extremity near attachment to ASIS).

74

Describe Bernhardt-Roth Syndrome?

(Meralgia parasthetica). It is the numbness of the outer thigh due to compression of the nerve as it passes under the inguinal ligament. Causes: seat belts, exercise, and tight clothing.

75

Describe the femoral nerve?

Comes from L2-4. It is the largest nerve.
Sensory = supplies skin to the anterior thigh and medial leg.
Motor = supplies pectinous, iliacus and anterior compartment of the thigh.

76

Describe the course of the femoral nerve?

It emerges from the lower lateral border of psoas muscle. It runs between iliacus and psoas and passes under the inguinal ligament into the thigh.

77

Describe the obturator nerve?

Comes from L2/4.
Sensory = supplies the skin on the medial thigh.
Motor = supplies the obturator externes and medial compartment of the thigh (may also supply pectineus).

78

Describe the course of the obturator nerve?

It emerges form the lower medial border of psoas muscle. it passes behind the common iliac arteries, then lateral to the internal iliac and ureters. It runs along the walls of the pelvis cavity to exit via the obturator foramen (specifically through the obturator canal running through the obturator internus and externus).