Retroperitoneal Structures

Question 1

What are the Retroperitoneal (RP) Structures?

Answer 1

They’re SAD PUCKERS.

Suprarenal Glands
Aorta + IVC
Duodenum (2nd and 3rd segment)
Pancreas (except tail)
Ureters
Colon (Ascending/Descending)
Kidneys
Esophagus
Rectum

Question 2

What are the major muscles of the Posterior Abdominal Wall?

Answer 2

Psoas Major
Transversus Abdominus
Iliacus
Quadratus Lumborum

Psoas Minor is found in some people but not all (50/50)

Question 3

The Iliacus and Psoas join to form what muscle?

Answer 3

Iliopsoas.

Function: assist in flexion of the thigh.

Question 4

What are the nerves of the Lumbar Plexus?

Answer 4

Subcostal (T12)
Iliohypogastric (L1)
Ilioinguinal (L1)
Lateral Cutaneous nerve of Thigh (L2-3)
Femoral (L2-4)
Genitofemoral (L1-L2)
Obturator (L2-L4)

“Some Insane Interns Love Fan Girling Over” the Lumbar Plexus

Question 5

Which of the Lumbar Plexus nerves lies in front of the Psoas Major?

Answer 5

Genitofemoral ONLY.

Question 6

What vessels are located in the RP Space?

Answer 6

The AA Arteries and IVC Veins?

Need to confirm

Question 7

Where in the Renal fasciae are you likely to see rupture from a fluid buildup?

Answer 7

Inferiorly around the ureter; the fascia is weaker here, while the rest of the fasciae are very strong and would likely contain the buildup.

Question 8

Describe the topography of the Kidneys.

Answer 8

Right Kidney Anterior:
- Superior: Suprarenal glands
- Mid-Lateral: Liver
- Medial: Duodenum
- Inferior: Colon
Left Kidney Anterior:
- Slide 10 for picture with locations -_-
- Suprarenal Glands
- Spleen
- Pancreas
- Jejunem
- Colon

Posterior aspect of both Kidneys:

• Superior: Diaphragm
• Lateral: Transversus Abdominus M.
• Anterior-Inferior: Quadratus Lumborum
• Medial: Psoas

Note that anterior is organs, posterior is muscle

Question 9

Describe the orientation and number of the vascular segments of the Kidney.

Answer 9

Four vascular segments Anterolaterlly

One segment Posteriorly

Note that Renal Artery is L2

Question 10

Describe the Hilus of the kidney. What ureteric precursor is located in what structure in this region?

Answer 10

Major Calyx (which breaks off into minor calyces), which is found in the Renal Sinus.

Question 11

What is different about the Left Renal Vein from the Right Renal Vein?

Answer 11

Left has more tributaries (Suprarenal, Gonadal)

Question 12

What are the three narrowing/blockage points of the Ureter? Describe the pain associated with a kidney stone lodged at each point.

Answer 12

Pelviureteric Junction (pain the loin/flank)
Pelvic Brim (Pain in medial aspect of left thigh/inguinal region)
Urinary Bladder Entrypoint (Pain in external genitalia/posterior thigh)

Question 13

What is the basic mechanism of renal failure in Polycystic Kidney Disease?

Answer 13

Failure of linkage between excretory and collecting components.

Autosomal Recessive: failure of collecting components; renal failure in childhood

Autosomal Dominant: failure of secretory components; renal failure in adulthood

Question 14

Describe Nutcracker Syndrome and some of its symptoms. What is its other name?

Answer 14

Renal Vein Entrapment Syndrome.

The SMA and Aorta compress the left renal vein, which results in renal hypertension.

Symptoms: Hematuria, left-side flank pain that radiates to inguinal region, visible varicocele.

Question 15

What is Bilateral Renal Agenesis?

Answer 15

Kidneys fail to develop. Occurs in 1/1000 live births. (Unilateral Agenesis suspected when newborn has a single umbilical artery.)

Symptoms: Oligohydramnios (decreased amniotic fluid), Death shortly after birth, Potter Sequence (facial anomalies, club foot, pulmo hypoplasia)

Question 16

What is Patent Urachus?

Answer 16

Failure of Allantois to completely close off the Anterior abdominal wall during fetal development.

Causes a secondary medical problem:

• Umbilical Polyp (Tube extends off umbilicus)
• Urachal Cyst (cyst between bladder and umbilicus)
• Bladder Diverticulum (tube extends off the bladder)