Post. Abdominal Viscera And Wall

Question 1

Kidneys location

Answer 1

. T12 to L3 w/ right one lower than the left
. Inf. Pole may be palpable (esp. right one)
. Sup. Pole under cover of ribs
. W/in retroperitoneal fat
. Renal fascia encloses kidney and some fat
. Has fibrous capsule

Question 2

Perirenal fat

Answer 2

. Btw kidney and renal fascia

. Surrounds and helps protect kidney

Question 3

Pararenal fat

Answer 3

. Outside renal fascia

Question 4

Hilus of kidney

Answer 4

. Where vessels enter/leave

. Has sinus that is space surrounding these vessels

Question 5

Kidney parenchyma

Answer 5

. Cortex
. Medulla w/ renal pyramids (14 each, base towards cortex, apex/papilla into minor calyx) and renal column (cortical tissue extending into medulla)

Question 6

Kidney duct system

Answer 6

. Dozen large collecting ducts of each pyramid empty at papilla into minor calyx
. 1+ papilla share minor calyx
. 2+ minor calyces unite to form major calyx
. 2-3 major calyces unit to form renal pelvis that drains to ureter

Question 7

Kidney blood supply

Answer 7

. From renal a. That divides at hilus into 5 segmental branches
. Each is end artery
. Accessory renal aa. Also end arteries
. Venous drainage to IVC via renal vein

Question 8

Kidney innervation

Answer 8

. Renal (aorticorenal) plexus
. Parasympathetic from vagus nerve
. Postganglionic sympathetic fibers from aorticorenal ganglion
. Visceral sensory fibers for pain travel along-side sympathetic motor

Question 9

Ureter

Answer 9

. Muscular drainage tube from renal pelvis to post. Side of urinary bladder
. Bloackage causes severe pain when ureter contracts
. Descends vertically on psoas muscle then crosses at beginning of external iliac a. To enter pelvis

Question 10

Ureter blood supply

Answer 10

. Renal a.
. Gonadal a.
. Abdominal aorta

Question 11

Renal and ureteric calculi

Answer 11

. Calculi (pebbles) in calices of kidney, ureters, or urinary bladder
. Renal calculus pass from kidney into penal pelvis and ureter causing tube distension
. Severe rhythmic pain as it is gradually forced down ureter by waves on contractions
. Visceral afferents conveying pain to T11-L2 innervation areas (lumbar, hypogastric region, external genitalia, and testis)

Question 12

Suprarenal (adrenal) glands structure and innervation

Answer 12

. Flat endocrine gland against diaphragm on sup. Pole of each kidney
. Cortex: outer part secreting steroids (essential for life)
. Medulla: inner that secretes catecholamines (not essential for life), secretory cells are modified sympathetic postganglionic neurons synapse gets w/ preganglionic fibers from T10-L2
. Blood supply: several suprarenal aa. To reach periphery of gland, venous from single suprarenal vein

Question 13

Adrenal gland blood supply

Answer 13

. L suprarenal v. Drains into R suprarenal vein that goes to IVC

Question 14

Thoraco-abdominal diaphragm

Answer 14

. Thin, voluntary muscle partition btw thoracic and abdominal cavities
. Dome-like, R side higher then L from liver
. Central tendon: C-shaped w/ convexity ant., aponeurosis for muscle fiber insertion

Question 15

Diaphragm Origins

Answer 15

. Sternal from xiphoid process
. Costal from lower 6 costal cartilages and lower 2 bony ribs
. Vertebral: right crus (1st 3 lumbar bodies and discs, larger than L, surrounds esophageal hiatus) and left crus (1st 2 lumbar bodies/discs), arcuate ligaments

Question 16

Diaphragm innervation

Answer 16

. Phrenic n. (All motor and sensory except to periphery)

. T6-11 intercostal/subcostal nn. (Periphery, mostly sensory but some motor)

Question 17

Diaphragm superior surface blood supply

Answer 17

. Sup. Phrenic aa. Branches from aorta to post. Position
. Pericardiacophrenic and musculophrenic aa. From internal thoracic aa. To ant. And central position
. Lower 6 post. Intercostal and subcostal aa. From thoracic aorta to lat. positions

Question 18

Inf. Surface diaphragm blood supply

Answer 18

. Inf. Phrenic aa.

Question 19

Structures piercing diaphragm

Answer 19

. IVC via vena canal foramen in central tendon at T8
. Esophagus via esophageal hiatus at T10 w/ ant. And post. Vagal trunks
. Aorta via aortic hiatus under median arcuate ligament at T12
. Thoracic splanchnic nn. (Greater, lesser, least) pierce crura

Question 20

Lower esophageal sphincter

Answer 20

. Prevents regurgitation by constricting when diaphragm contracts
. Physiological, not anatomical, sphincter

Question 21

Psoas major OIA

Answer 21

. O: transverse processes of L1-5, sides of bodies T12-L5 and discs
. I: lesser trochanter via iliopsoas tendon
. A: bi/unilaterally flexes thigh, bilaterally flexes trunk if thigh stabilized, unilaterally lat. flexes vertebral column toward same side

Question 22

Psoas major N

Answer 22

N: vertebral rami of L2-4 (post. Divisions)

Question 23

Iliacus OIAN

Answer 23

. O: iliac crest and sup. 2/3 of iliac fossa, ala of sacrum, ant. Sacroiliac ligaments
. I: lesser trochanter of femur via iliopsoas tendon
. A: flexes thigh and stabilizes hip joint
. N: ventral rami of L2-4 nerves (post. Divisions)

Question 24

Iliopsoas muscle

Answer 24

. Iliacus w/ psoas major

Question 25

Psoas minor OIAN

Answer 25

``` O: T12-L1 bodies and disc I: iliopubic eminence A: weak trunk flexor N: ventral ramus of L1 . Absent in 40% people, when present it lies ant. To psoas major ```

Question 26

Quadratus lumborum OIAN

Answer 26

O: iliolumbar ligament, internal lip of iliac crest I: inf. Border 12th rib, transverse processes L1-4 A: one side contracted lat. flexes vertebral column to same side, fixes 12th rib during inspiration N: subcostal n. And L1-4 (ant. Division)

Question 27

Thoracolumbar fascia

Answer 27

. Thick, covers origin of erector spinae muscle in lumbar region . Ant. Layer: ant. Surface of quadratus lumborum . Middle layer: attached to transverse processes of lumbar vertebrae . Post layer: attached to spinous processes . Middle and post. Layers join lat. at aponeurosis of transversus abdominis muscle

Question 28

Transversalis fascia

Answer 28

. Deep surface of transversus abdominis and quadratus lumborum muscles . Part of larger fascial layer that lines deep surface of entire abdominal cavity (endoabdominal fascia)

Question 29

Abdominal aorta course

Answer 29

. Enters through aortic hiatus . Terminates at L4 by splitting into R/L common iliac aa. . Common iliac aa. Split into external and internal iliac aa.

Question 30

Abdominal aorta visceral branches

Answer 30

. Paired: suprarenal, renal, testicular/ovarian | . Unpaired: celiac a., sup. And inf. Mesenteric aa.

Question 31

Abdominal aorta parietal branches

Answer 31

Paired: inf. Phrenic aa (to inf. Diaphragm)., lumbar aa Unpaired: median sacral aa.

Question 32

Lumbar arteries

Answer 32

. Post. Abdominal wall . 4 arteries paired in segmental fashion . Arise from post. Side of aorta . Run post. To quadratus lumborum muscle

Question 33

Median sacral artery

Answer 33

. Arises from inf. Surface of aorta as it bifurcated . Runs along ant. Surface of sacrum . Final pair of lumba aa. May arise from it

Question 34

T/F IVC receives blood from GI tract

Answer 34

F, that is drained by portal v.

Question 35

IVC tributaries

Answer 35

. Paired visceral vv. (Renal vv both drain to IVC., R testicular goes to IVC, L testicular goes to L renal v., R suprarenal v. To IVC, L suprarenal v. Goes to L renal v.) . Paired parietal vv.: inf. Phrenic vv. To IVC, lumbar vv., hepatic vv. (3 branches drain liver)

Question 36

Ascending lumbar vv.

Answer 36

. Connects lumbar, IVC, and lumbar vv. On each side | . Joins azygos system of veins sup.

Question 37

Iliac lymph trunks

Answer 37

. Drain into lumbar lymph trunks alongside aorta

Question 38

lumbar lymph nodes

Answer 38

Lay alongside aorta

Question 39

Intestinal lymph trunk

Answer 39

. Drains most of abdominal digestive tract

Question 40

Cisterna chyli

Answer 40

. Dilated inf. End of thoracic duct | . Gets lumbar lymph trunks and intestinal trunk

Question 41

Lumbar plexus

Answer 41

. Ventral rami L1-4 | . Roots of plexus

Question 42

Branches of lumbar plexus

Answer 42

. Muscular branches to quadratus lumborum and psoas major muscles . Iliohypogastric and ilioinguinal nn . Genitofemoral n. . Lat. femoral cutaneous n. (Lat. cutaneous n. Of thigh) . Femoral n. . Obturator n.

Question 43

Iliohypogastric and ilioinguinal n.

Answer 43

. L1 | . To muscles of lower abdominal wall, skin of upper high, and ant. Side of scrotum/labium majus

Question 44

Genitofemoral n.

Answer 44

. L1-2 . Runs down ant. Surface of psoas muscle to reach cremaster, skin of upper thigh, and ant. Side of scrotum . Involved in cremaster reflex

Question 45

Lat. femoral cutaneous n.

Answer 45

. Post. Divisions of L2-3 | . Sensory skin to thigh and buttock

Question 46

Femoral nerve

Answer 46

``` . Post. Divisions of L2-4 . In groove btw iliacus and psoas major . Enters thigh lat. to femoral a. . Supplies skin of ant. And med. thigh . Motor to muscles in ant. Compartment of thigh and iliacus ```

Question 47

Obturator n.

Answer 47

. Ant. Division L2-4 . Emerges med. to psoas major muscle and crosses pelvic brim . Exits via obturator foramen . Motor to muscles of med. compartment of the thigh . Sensory to skin of med. thigh

Question 48

Lumbosacral trunk

Answer 48

. part of L4 and all of L5 | . Descends into pelvis where it contributes to sacral plexus