Posterior abdominal wall

Question 1

where do the kidneys lie?

Answer 1

retroperitoneally, at level of T12-L3

ant to 11th and 12th ribs

Question 2

which kidney is higher than the other?

Answer 2

right is lower than left due to liver

Question 3

what are the kidneys related to superiorly and inferiorly?

Answer 3

sup - diaphragm

inf - quadratus lumborum

Question 4

which nerves descend diagonally across the post surface of the kidneys?

Answer 4

subcostal nerves and vessels, iliohypogastric and ilioinguinal nerves

Question 5

course of the ureters?

Answer 5

run inferomedially and anterior to psoas major and tips of the lumbar vertebrae
pass over pelvic brim at bifurcation of the common iliac
crosses external iliac then runs along lateral wall of pelvis to enter the bladder

Question 6

what fat and fascia surrounds the kidney?

Answer 6

kidney is surrounded by perinephric fat, then renal fascia then paranephric fat

Question 7

when does movement of the kidneys occur and what is normal renal motility?

Answer 7

during respiration and when moving from supine to erect positions
normal renal motility 3cm

Question 8

In which three places is the ureter constricted?

Answer 8

the junction of the ureter and renal pelves
where the ureters cross the brim of the pelvic inlet
during their passage through the wall of the urinary bladder

Question 9

what shape is the right adrenal gland and what is it related to?

Answer 9

pyramid shaped

related to IVC anteromedially and liver anterolaterally

Question 10

what shape is the left adrenal gland and what is it related to?

Answer 10

crescent shaped

related to spleen, stomach, pancreas and left crus

Question 11

what are the adrenal glands composed of and what is their function?

Answer 11

suprarenal cortex - secretes corticosteroids and androgens

suprarenal medulla - secretes adrenaline and NA

Question 12

where do the renal arteries arise?

Answer 12

at the level of the IV disc between L1 and L2

Question 13

where does the blood flow in the kidneys?

Answer 13

renal artery
segmental arteries
interlobar artery
arcuate arteries
interlobular arteries
afferent arterioles
glomerular capillaries
efferent arterioles
peritubular capillaries
interlobular vein
arcuate vein
interlobar vein
renal vein

Question 14

does the renal vein or artery lie more anteriorly?

Answer 14

renal vein

Question 15

where does the hilum of the left kidney lie in relation to the median plane?

Answer 15

hilum of left kidney lies near the level of the transpyloric plane, 5cm from the median plane

Question 16

what passes through the superior pole of the right kidney?

Answer 16

transpyloric plane

Question 17

which kidney can be palpated in lean adults?

Answer 17

inferior pole of the right kidney

palpable as a rounded mass that descends during inspiration. left kidney not palpable unless enlarged/displaced

Question 18

where do the suprarenal arteries arise from?

Answer 18

superior - inferior phrenic artery
middle - aa near the origin of the SMA
inferior - renal artery

Question 19

which dome of the diaphragm is usually higher?

Answer 19

right due to liver

Question 20

during expiration, how high does each dome of the diaphragm reach?

Answer 20

right - 5th rib

left - 5th ics

Question 21

what are the three attachments of the diaphragm?

Answer 21

sternal - posterior aspect of the xiphoid process
costal - ribs 7-12 `and adjoining ribs (forms the domes of the diaphragm)
lumbar - arises from two aponeurotic arches, med and lat arcuate ligaments and 3 sup lumbar vertebrae

Question 22

what are the left and right crura?

Answer 22

right crus arises from L1-3 and IV discs. Some fibres from the right crus surround the oesophagus and act as a sphincter to prevent reflux of gastric contents into the oesophagus
left crus arises from L1, 2 and their IV discs

Question 23

what are the crura united by?

Answer 23

median arcuate ligament (goes over ant surface of the aorta)

Question 24

what are the medial and lateral arcuate ligaments made from?

Answer 24

medial - thickenings of the fascia covering psoas

lateral - thickenings of the fascia covering quadratus lumborum

Question 25

where is the caval opening and what passes through it?

Answer 25

T8 | IVC, terminal branches of right phrenic nerve, lymph (middle phrenic and mediastinal nodes)

Question 26

what happens to the IVC when the diaphragm contracts during inspiration?

Answer 26

IVC adherent to the margin of the opening so when diaphragm contracts, it widens opening and dilates IVC - facilitates blood flow

Question 27

where is the oesophageal hiatus and what passes through it?

Answer 27

T10 ant and post vagal trunks oesophageal branches of the left gastric vessel lymph vessels

Question 28

where is the aortic hiatus and what passes through it?

Answer 28

T12, posterior of diaphragm | descending aorta, azygos vein and thoracic duct

Question 29

how is the oesopohageal hiatus formed?

Answer 29

fibres of the right crus decussate inf to the hiatus forming a muscular sphincter that constricts it when the diaphragm contracts

Question 30

what is the sternocostal triangle (foramen)?

Answer 30

small opening between sternal and costal attachments of diaphragm transmits lymph vessels from diaphragmatic surface of liver and superior epigastric vessels

Question 31

where do the sympathetic trunks pass in relation to the diaphragm?

Answer 31

deep to the median arcuate ligament

Question 32

parts of the posterior abdominal wall from deep to superficial

Answer 32

``` 5 lumbar vertebrae post abdo wall mm lumbar plexus fascia inc thoracolumbar fascia diaphragm fat, nerves, vessels and ln ```

Question 33

where does the abdominal aorta start and finish?

Answer 33

T12-L4

Question 34

where do the common iliac arteries start?

Answer 34

L4

Question 35

where do the suprarenal and renal arteries originate?

Answer 35

L1

Question 36

at what vertebral level do the gonadal arteries originate?q

Answer 36

L2

Question 37

at what vertebral level does the coeliac trunk originate?

Answer 37

T12

Question 38

at what vertebral level does the SMA and IMA originate?

Answer 38

SMA - L1 | IMA - L3

Question 39

where does the left gonadal vein drain to?

Answer 39

left renal vein (not IVC)

Question 40

why is the IVC different to other veins in the body?

Answer 40

has no valves

Question 41

where does the IVC start?

Answer 41

L5 by the union of the common iliac veins