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Retroperitoneal Organs of PAW Flashcards

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1
Q

The retroperitoneum

A
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2
Q

Contents of the Retroperitoneum abbreviation

A

PEAR DUCKS

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3
Q

Contents of the Retroperitoneum: PEAR DUCKS:

A
  • Pancreas
  • Oesophagus
  • Aorta & IVC
  • Rectum
  • Duodenum
  • Ureter
  • Colon
  • Kidneys
  • Suprarenal glands
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4
Q

Contents of the Retroperitoneum

A
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5
Q

The kidneys lie in the

A

Paravertebral gutter formed by the angle (renal angle) between erector spinal and the quadratic lumborum muscles (psoasmuscles too)

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6
Q

Which parts of the large intestine are NOT retroperitoneal?

A
  • transverse colon is intraperitoneal
  • sigmoid colon is intraperitoneal
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7
Q

Kidney basics structure

A
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8
Q

Order of structures at the Hilum of kidney anterior to posterior

A

Renal vein, renal artery, ureter

VAU

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9
Q

Kidney function abbreviation

A

A WET BED

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10
Q

Kidney function: A WET BED:

A

I

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11
Q

Kidney structure

A

Renal pyramids ending in papilla, where collecting ducts of nephrons emerge
Minor Calyces (8-10) joint to form major calyces (4-6)
Renal sinus contains fat

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12
Q

Transpyloric plane

A

Through the lower order of L1 vertebra Posteriorly and across 9th CC anteriorly

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13
Q

Calyx is

A

Collecting duct

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14
Q

A kidney will typically have how many major calyces?

A

4-6

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15
Q

Renal columns are

A

Extensions of cortex between medulla

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16
Q

Which kidneys lies lower and why?

A

Right lies lower than left due to the presence of the liver

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17
Q

Anterior Relationships of the Right Kidney:
Anterior:
Medial:
Superior:
Posterior:

A
  • anterior: hepatic flexure of colon, liver
  • medial aspect of kidney: 2nd duodenum
  • superior: adrenal gland
  • posterior: diaphragm, adrenal gland???
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18
Q

What is the problem with using the umbilicus as a surface marking?

A

Not in a fixed position
Variable

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19
Q

Anterior Relationships of Left Kidney:

A

Anterior: splenic flexure of Large bowel
Pancreas tail over upper pole and Hilum
Left suprarenal gland lies on top
Spleen is anterior and superior

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20
Q

Kidneys posterior relationships

A
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21
Q

Posterior Relationships of the Left Kidney:

A

Left kidney sits on top of iliohypogastric nerve and ilioinguinal nerve
Psoas muscle lies on top of left kidney
Quadratus Lumborum lies on top of Psoas

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22
Q

Kidneys anterior relationships

A
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23
Q

Kidneys posterior relationships

A

Insert diagram

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24
Q

Upper pole and lower pole of kidney to midline distance

A

Upper Pole: 5cm
Lower Pole: 15cm

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25
Kidney: Fascia and Coverings:
- renal fascia envelops kidney and adrenal gland - perinephric fat is loose fatty i tissue inside renal fascia - paranephric fat is OUTSIDE gerotas fascia
26
If a surgeon approaches a kidney Posteriorly, what must be cut through T to reach blood vessels?
Renal fascia (Gerota’s fascia) and perinephric fat
27
The left renal vein is located under which artery?
The superior mesenteric artery
28
Aorta anteriorly 3 branches are
Coeliac trunk Superior mesenteric artery Inferior mesenteric artery
29
Renal arteries arise from
The lateral border of the aorta
30
In 70% of people there are three or more renal arteries. True or False?
False 30%
31
32
Kidney blood supply
33
Segmental arteries
Open down brodel line to avoid damage to major arteries
34
Segmental arteries anastomose. True or False?
False Segmental arteries are end arteries Run risk of scarring of tissue supplied by a blocked segmental artery
35
Which renal vein is shorter?
IVC more to the right of midline Right renal vein is shorter
36
gonadal veins on the right side drain directly into IVC and left side drain into renal vein. True or False?
True
37
Adrenal vein on right drains directly into the IVC and on the left drains into the left renal vein. True or False?
True
38
Why is it easier to transplant a left kidney than a right?
Renal vein on left is longer and easier to anastomose
39
Lumbar veins on the left may drain into the renal vein. Implication on surgery?
On both sides if cutting renal vein may cut into a lumbar vein which drains directly into IVC.
40
Venous drainage of the bowels is
Into separate Azygous system of veins
41
Kidney venous drainage
42
Retroperitoneal nerve supply: ——— plexus (4):
Preverterbral plexus: - coeliac plexus - aortic plexus - superior hypogastric plexus - inferior hypogastric plexus
43
Prevertebral plxus provide preganglionic and visceral afferents: - sympathetic: - parasympathetic: - preganglionic parasympathetic fibres
- sympathetic: thoracic and lumbar splanchnic nerves - parasympathetic: Vagus CNX - parasympathetic: pelvic splanchnic nerves
44
Retroperitoneal nerve supply
45
Nerve supply retroperiotneal
46
Renal and ureteric pain
Insert slide
47
Pain afferents from all abdominal viscera pass
Retrogradely back to the spinal cord through thoracic and lumbar splanchnic nerves T5-L2
48
Pain afferents from pelvic viscera follow
Pelvic splanchnic parasympathetic nerves S2-4 into the cord and largely confined to the pelvic regions
49
Lymphatics of kidneys
50
Lymphatics of Retroperitoneum:
Internal iliac nodes drain pelvis. External iliac nodes drain legs. Pre-aortic chain formed on top of aorta, para-aortic nodes on the side, all join to form cisterna chyli which drain into the thoracic duct
51
Applied anatomy of kidneys
52
Difference in shape between right and left adrenal glands?
- right is pyramidal - left is semi-lunar
53
Right renal grand location
On top of upper pole of right kidney tucked away behind IVC
54
Left renal gland location
- larger, crescent shaped, sits medial to the upper pole
55
Blood supply to renal glands
- superior branch of suprarenal arteries (branch of infraphrenic) - middle suprarenal artery (branch of aorta or renal artery) - inferior suprarenal artery is a branch of renal artery
56
Veins of renal glands
- one vein per each - right directly to IVC, left into left renal vein
57
Adrenal glands: Position and blood supply:
58
Suprarenal Gland internal structure and function:
- Cortex: - corticosteroids (cortisol, aldosterone) - adrenal androgens (sex hormones) - Medulla: - adrenaline
59
Nerve supply of suprarenal glands
Sympathetic Innervation: T8-L1 (Greater, lesser,least splanchnic)
60
Nephron structure
61
Renal cortex and Medulla
62
Ureteric anatomy
63
Ureteric blood supply
Proximal ureter = renal artery Bottom part of ureter: internal iliac branches
64
Which parts of ureter have good blood supply?
Pelvic ureter has good blood supply, as has proximal ureter but mid ureter blood supply is relatively poor
65
Bladder anatomy
66
Key features of bladder anatomy:
- urinary bladder is highly distensible - deter us or muscle forms the bulk of bladder wall - body base apex neck trigone - lining transition cell epithelium
67
Urethra
68
Innervation of lower urinary tract
69
Innervation of lower urinary tract
70
Innervation of lower urinary tract
Insert table
71
Sites of ureteric obstruction
72
Narrow points of ureter (3):
- exit out of kidney at PUJ - crossing sacral iliac joints - enters muscle wall of bladder
73
Exctraperitoneal bladder injuries are not as severe as intraperitoneal because
Intraperitoneal urine will fill pelvic cavity Extraperitoneal fat
74
Trigone of bladder
Ureter orifices where ureters pass into the bladder Posteriorly Smoother area behind orifices because comes from mesenteric duct embyologically Activation of nerve endings in trigone results in need to urinate

NME (52 decks)

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