Posterior Abdominal Wall Flashcards

(24 cards)

1
Q

Kidneys

  • What type of organ?
  • Vertebrae level?
  • Which one is higher?
  • What do you have to remove to see kidneys?
  • Quadrant?
  • List layers of fat/fascia from superficial to deep
A

Kidneys

  • Primarily retroperitoneal
  • Located at T12 - L3 vertebral levels
  • RUQ and LUQ
  • Left kidney higher due to liver on right side
  • Must remove parietal peritoneum to see kidneys
  • Surrounded by layers of fat and fascia - from SF to deep:
    • Paranephric fat
    • Renal fascia
      • Prolonged inferiorly along ureters
      • Helps prevent spread of infection locally, but acts as a conduit for the spread of these fluids into the pelvis
    • Perinephric fat
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2
Q

What are the features of the kidneys?

What is anterior, middle, and posterior in renal hilum?

A

Features of the kidneys

  • Superior pole - adjacent to renal hilum
  • Inferior pole
  • Lateral border - convex
  • Medial border - concave, contains renal hilum
  • Renal capsule - very thin outer layer
  • Renal cortex - deep to the capsule and extends internally to renal columns
  • Renal medulla - renal pyramids

Renal hilum

  • Arteries enter
  • Veins and renal pelvis exit
  • Anterior - renal vein
  • Middle - renal pelvis
  • Posterior - renal pelvis
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3
Q

What is the pathway of urine to the ureter?

A

Pathway of urine to the ureter

  • Renal papillae - apices of renal pyramids
  • Minor calyx - collects urine from renal papillae
  • Major calyx - collects uring from 2-3 minor calices
  • Renal pelvis - receives urine from 2-3 major calices and delivers it to the ureter
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4
Q

What are the two anomalous kidneys?

A

Anomalous kidneys

  • Pelvic kidney
    • failure of kidney to ascend during development
  • Horsehoe kidney
    • right and left kidneys are united at inferior poles
    • ascent stopped by IMA
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5
Q

Ureters

  • What kind of organ?
  • What kind of tubes and where do they extend to?
  • How do they transport urine?
A

Ureters

  • Primarily retroperitoneal
  • Fibromuscular tubes extending from renal pelvis to bladder
  • Transport urine via peristaltic contractions
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6
Q

Adrenal (suprarenal) glands

  • What kind of organ?
  • Location?
  • Quadrant?
  • Enclosed by?
A

Adrenal (suprarenal) glands

  • Primarily retroperitoneal
  • Located on superomedial aspect of kidneys
  • RUQ or LUQ (where kidneys are)
  • Enclosed by renal fasica
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7
Q

Lymphatic drainage of the kidneys and adrenal glands

A

Lymphatic drainage of the kidneys and adrenal glands

  1. lumbar lymph nodes (along aorta)
  2. chyle cistern
  3. thoracic duct
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8
Q

Parasympathetic innervation of kidneys

A

Parasympathetic innervation of kidneys

  • Preganglionic cell bodies: brain
  • Preganglionic fibers: vagus nerve (CN X)
  • Postganglionic cell bodies: wall of kidney
  • Postganglionic fibers: wall of kidney
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9
Q

Sympathetic innervation of kidneys

A

Sympathetic innervation of kidneys

  • Preganglionic cell bodies: lateral horn of the thoracolumbar spinal cord
  • Preganglionic fibers: ventral root, spinal nerve, ventral ramus, white ramus communicans, sympathetic trunk, thoracic splanchnic nerve (usually least thoracic splanchnic nerve)
  • Postganglionic cell bodies: renal (aorticorenal) ganglia
  • Postganglionic fibers: follow arterial branches to target organ
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10
Q

Visceral pain from kidneys and ureters

  • Where do you enter spinal cord?
  • Where does pain refer to?
A

Visceral pain from kidneys and ureters

  • follow the sympathetic pathway back to the spinal cord but enter dorsal root
  • refer to back, flank, groin, and genitals
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11
Q

Sympathetic innervation of adrenal glands

A

Sympathetic innervation of adrenal glands

  • Preganglionic cell bodies: lateral horn of the thoracolumbar spinal cord
  • Preganglionic fibers: ventral root, spinal nerve, ventral ramus, white ramus communicans, sympathetic trunk, thoracic splanchnic nerve
  • Postganglionic cell bodies: secretory cells of adrenal medulla
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12
Q

Abdominal aorta

  • Where does it begin?
  • Located left or right of midline?
  • Where does it bifurcate and into what?
  • What are the unpaired branches?
A

Abdominal aorta

  • begins at aortic hiatus of diaphragm at T12
  • located left of the midline
  • bifurcates at L4 into common iliac arteries
  • unpaired branches:
    • celiac trunk
    • SMA
    • IMA
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13
Q

What are the paired branches of the abdominal aorta? Include branches if applicable

What do they supply?

A

Paired branches of abdominal aorta

Paired branches supply primarily retroperitoneal organs, gonads, and body wall

  • inferior phrenic arteries
    • supply inferior surface of diaphragm and adrenal glands via the superior suprarenal arteries
  • middle suprarenal arteries
  • renal arteries
    • ​inferior suprarenal arteries
  • gonadal (testicular or ovarian) arteries
  • subcostal arteries
  • lumbar arteries
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14
Q

Paired branches of abdominal aorta

Renal arteries

  • Which side is longer?
  • What are the (possible) branches?
A

Paired branches of abdominal aorta

Renal arteries

  • Right renal artery is longer because it courses posterior to IVC and aorta is left of midline
  • Can have accessory renal arteries, which are from a failure of embryonic arteries to degenerate
  • Inferior suprarenal branch off
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15
Q

What are the arteries to the adrenal gland and where are they from?

A

Arteries to adrenal gland

  • Superior suprarenal artery
    • via inferior phrenic artery
  • Middle suprarenal artery
    • via aorta
  • Inferior suprarenal artery
    • via renal artery
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16
Q

Abdominal aortic aneurysm

A

Abdominal aortic aneurysm

  • can rupture
  • high mortality rates (90%) if not diagnosed
17
Q

Inferior vena cava

  • Formed by union of? Vertebral level?
  • Exits abdomen through what? Vertebral level?
  • Located right or left of midline?
  • Tributaries of IVC parallel what?
  • What are the exceptions?
A

Inferior vena cava

  • formed by a union of common iliac veins at L5 vertebral level
  • exits abdomen through caval opening of diaphragm at T8 vertebral level
  • located right of the midline
  • tributaries of IVC parallel the paired branches of the aorta
  • notable exceptions:
    • Left gonadal veins - drain to left renal vein
    • Hepatic veins - have no arterial complement
18
Q

Posterior abdominal wall muscles

  • What are they?
  • Origin for each?
  • Insertion for each?
A

​Posterior abdominal wall muscles

  • Iliopsoas
    • Psoas major
      • Origin - lumbar vertebrae
    • Iliacus
      • Origin - iliac fossa
    • Psoas major and iliacus fuse to form iliopsoas, which inserts on the lesser trochanter of the femur
  • Quadratus lumborum
    • Origin - 12th rib and lumbar vertebrae
    • Insertion - iliac crest
19
Q

What are the nerves of the posterior abdominal wall

A

Nerves of the posterior abdominal wall

  • subcostal nerves
  • lumbar plexus
  • greater, lesser, and least splanchnic nerves
  • sympathetic trunks
20
Q

Nerves of the posterior abdominal wall

Subcostal nerves

  • Ventral rami of what?
  • Travel laterally across what?
  • Pierce what to enter abdominal wall?
  • What innervation to what dermatome?
  • Motor innervation to where?
A

Nerves of the posterior abdominal wall

Subcostal nerves: ventral rami of T12

  • travel laterally across quadratus lumborum
  • pierce transversus abdominis to enter abdominal wall
  • sensory innervation and sympathetic innervation to T12 dermatome
  • motor innervation to external obliques, internal obliques, and transverse abdominis
21
Q

Nerves of the posterior abdominal wall

Lumbar plexus

  • Ventral rami of what lumbar spinal nerves?
  • List the nerves and vertebral level
A

Nerves of the posterior abdominal wall

Lumbar plexus: ventral rami of L1 - L5

  • iliohypogastric nerve L1
  • ilioinguinal nerves L1
  • genitofemoral nerve L1 - L2
  • lateral cutaneous nerve of the thigh L2 - L3
  • femoral nerve L2 - L4
  • obturator nerve L2 - L4
22
Q

Nerves of the posterior abdominal wall

Greater, lesser, and least splanchnic nerves

What do they pass through?

A

Nerves of the posterior abdominal wall

Greater, lesser, and least splanchnic nerves

Pass through the diaphragm

23
Q

Nerves of the posterior abdominal wall

Sympathetic trunks

  • Continue from where?
  • Located?
A

Nerves of the posterior abdominal wall

Sympathetic trunks

  • continue from thorax
  • located lateral to the lumbar vertebral bodies along the anterior surface of the sacrum
24
Q

Diaphragm

  • What are the attachments?
  • What are the openings?
A

Diaphragm

Attachments (all peripheral):

  • xiphoid process
  • costal margin
  • ribs 11-12
  • lumbar vertebrae (via right and left crura)

Openings:

  • caval opening at T8 for IVC
  • esophageal hiatus at T10 for esophagus and vagus nerve
  • aortic hiatus at T12 for aorta, thoracic duct, and azygos vein