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HAE - Quiz 5 > Retroperitoneum > Flashcards

Retroperitoneum Flashcards

1
Q

Posterior Abdominal Wall

(contents)

A
  1. Lumbar Vertebral Column
  2. Skeletal Muscle (Psoas Major and Psoas Minor, Iliacus, Quadratus Lumborum, Diaphragm)
  3. Overlying Transversalis Fascia
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2
Q

Psoas Major

A

Origin: Lumbar Vertebrae

Combines with: Iliacus Muscle (Iliopsoas)

Insertion: Lesser trochanter of the femur

Action: most powerful flexor of the thigh at the hip joint

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3
Q

Quadratus Lumborum

A
  • lateral to the psoas major

Origin: 12th Rib

Insertion: Iliac Crest

Attachments: Lumbar Vertebrae

Action: Flexes spine laterally

**stabalized 12th rib and therefore diaphragm during respiratory exersion (i.e. valsalva maneuver)

Nerve Supply: Lumbar Plexus

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4
Q

Iliacus

A

Origin: Ilium

Insertion: Lesser trochanter of the femur

**combines with psoas major to form iliopsoas

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5
Q

Diaphragm

A
  • thin dome-shaped musculo-tendinous partition separating the thoracic and abdominal contents

Action: flattens during inspiration pushing down abdominal contents

Origins: Xiphoid process, ribs, and lumbar vertebrae

** higher on right side because of the liver

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6
Q

Crura

A
  • parts of the diaphragm that arise from the vertebrae
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7
Q

Major Openings of the Diaphragm

A

T8 - IVC (Foramen of the Vena Cava)

T10 - Esophagus (Esophageal Hiatus)

T12 - Aorta (Aortic Hiatus)

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8
Q

Structures that pass through Diaphragm

(Other)

A

Pass through Crura:

  • Greater, Lesser, and Least Splanchnic Nerves
  • Azygous veins

Pass posterior to diaphragm:

  • Sympathetic trunks

Pass through the diaphragm:

  • Phrenic Nerves
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9
Q

Blood Supply to the Diaphragm

A

Two branches of the internal thoracic artery:

  1. Percardiophrenic Artery
  2. Musculophrenic Artery

Directly from the aorta:

  1. Inferior Phrenic Arteries
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10
Q

Abdominal Surface of the Diaphragm

A
  • except for bare area covered by highly sensitive serosal layer of the peritoneum
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11
Q

Diaphragm Innervation

A

Phrenic Nerve - motor (efferent) and sensory (afferent) innervation (C3, C4, C5)

Intercostal Nerves - sensory (afferent) innervation to the periphery of the diaphragm (T6-T12)

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12
Q

Properitoneal Space

A
  • ANTERIOR extraperitoneal space between the transversalis fascia and the peritoneum
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13
Q

Retroperitoneal Space

A
  • POSTERIOR extraperitoneal space between the transversalis fascia and the peritoneum
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14
Q

Viscera of the Retroperitoneal Space

A

Kidneys (primary)

Adrenal Glands (primary)

Ureters (primary)

Duodenum (Distal) (secondary)

Pancreas (secondary)

Ascending/Descending Colons (secondary)

(arteries, veins, nerves, and lymphatics)

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15
Q

Kidneys (Function)

A
  • filter 200 liters fluid/day
  • urinary output 600-1500 cc/day
  • regulate total water volume of body and osmolality
  • regulate concentration of extracellular ions
  • help regulat longer term acid-base balance
  • help eliminate drugs/toxins

**therefore complex anatomy

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16
Q

Renal Hilum

A
  • vertical cleft on the medial margin of the kidney where vessels, nerves, and lympatics enter/leave
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17
Q

Renal Sinus

A
  • fat-filled cavity at the medial border of the renal hilum
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18
Q

Renal Cortex

A
  • forms out 1/3 of renal substance
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19
Q

Renal Medulla

A
  • composed of renal pyramids
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20
Q

Renal Columns

A
  • cortical substance that extends between the renal pyramids into the medulla
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21
Q

Renal Pyramids

A
  • project from the renal sinuses towards the surface of the kidneys
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22
Q

Renal Papillae

A
  • blunted, perforated apices (area cribosa( of the pyramids projecting into the minor calyces of the renal pelvis where they discharge urine
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23
Q

Minor calyces

A
  • each receives a renal papillae
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24
Q

Major Calyces

A
  • 2 or 3 minor calyces coalesce to form the major calyx
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25
Q

Renal Pelvis

A
  • major calyces come together to form this funnel-shaped area located at the hilum of the kidney which tapers to form the ureter
26
Q

Kidney Blood Supply

A
  • Renal Arteries
  • arise just caudal to the SMA at L1

Right Renal Artery - runs posterior to the IVC

27
Q

Renal Veins

A
  • drain blood from the kidneys
  • anterior to the renal arteries and renal pelvis

Left Renal Vein - empties directly into IVC after crossing anterior to the aorta between the aorta and the SMA (superior to the duodenum)

Right Renal Vein - runs posterior to the descending duodenum and empties in the IVC

28
Q

Location of Kidneys

A

Between T12-L3

Renal Arteries - arise at L1

Superiorly - separated from costodiaphragmatic recess and 12th rib by the diaphragm

Caudally - lie against the quadratum lumborum muscles

Right Kidney - slightly more caudal because of liver

  • both kidneys cushioned by retroperitoneal fat
29
Q

Costovertebral Angle

A

CVA

  • lies on either side of the spine - where you percuss to identify tenderness in the kidneys
30
Q

Morison’s Pouch

A
  • hepatorenal fossa
31
Q

Suprarenal Gland Location

A
  • sit on top of the kidney on the superomedial aspect
  • separated from the kidney by a thin fibrous renal capsule
32
Q

Renal Fascia

A

aka Gerota’s Fascia

  • located within retroperitoneal fat

Perirenal Fat - deep to renal fascia

Pararenal Fat - superficial to renal fascia

33
Q

Layers Surrounding Kidney

A

Renal Capsule

Perirenal Fat

Renal Fascia (Gerota’s Fascia)

Pararenal Fat

34
Q

Renal Arteries

A
  • END ARTERIES (no anatomosies) - occlusion can lead to renal infarction

4 anterior segmental renal artery branches

1 posterior segmental renal artery branch

35
Q

Adrenal Glands

A
  • paired, flattened, endocrine glands that sit loosely on the superomedial aspect of the kidneys and lie within the renal fascia
36
Q

Adrenal Gland Cortex

A
  • derived from mesoderm
  • secretes corticosteroids
  • surrounds the medulla
37
Q

Adrenal Gland Medulla

A
  • derived from neural crest cells
  • secretes catecholamines (norepinephrine and epinephrine)
38
Q

Blood Supply to Adrenal Glands

A

Three Different Arteries:

Superior Suprarenal Arteries - Inferior Phrenic Artery

Middle Suprerenal Arteries - Aorta

Inferior Suprarenal Arteries - Renal Artery

39
Q

Veinous Drainage of the Adrenal Glands

A

Right Adrenal Gland - IVC

Left Adrenal Gland - Left Renal Vein

40
Q
A
41
Q

Ureter

A
  • hollow tube that conveys urine from the kidney to the bladder
  • descends into the pelvis and travels
  • Anterior -* to the bifurcation of the common iliac vessels
  • Posterior* - to the gonadal vessels
42
Q

Ureter Constriction Sites

A
  1. Uteropelvic Junction (UP) - between the renal pelvis and the ureter
  2. Pelvic Brim - where cross the common iliac vessels
  3. Ureterovesical Junction (UV) - between the ureter and the bladder entry
43
Q

Abdominal Aorta

A
  • Passes through diaphragm at T12
  • anterior to vertebral bodies and left of the IVC
  • shorter in length and smaller (2cm) than the IVC
44
Q

Aorta Bifurcation

A
  • at L4 into the Common Iliac Arteries

(level of umbilicus and T10 dermatome)

45
Q

Aortic Branches

A

6 Visceral, 3 Parietal

Ventral, Lateral, Dorsal, Terminal Branches

46
Q

Ventral Aortic Branches

A

Three Visceral Branches

  1. Celiac (supplies foregut) - T12
  2. Superior Mesenteric Artery (supplies midgut) - L1
  3. Inferior Mesenteric Artery (supplies hindgut) - L3
47
Q

Lateral Aortic Branches

A

3 Visceral Branches:

  1. Middle Suprarenal Artery - supplies adrenal gland (L1)
  2. Renal Artery - supplies kidney (L1)
  3. Ovarian/Testicular Artery - supplies gonads

1 Parietal Branch:

  1. Inferior Phrenic Artery (T12)- supplies abdominal aspect of diaphragm and gives rise to Superior Renal Artery
48
Q

Dorsal Aortic Branches

A

2 Visceral Branches:

  1. Lumbar Arteries (4) - supply musculature of the posterior abdominal wall, vetebrae, and spinal cord (important source of collateral circulation) (L1-L4)
  2. Medial Sacral Artery - vestigial vessel (supplies tail of animals) (L4)
49
Q

Terminal Aortic Branches

A

Aorta Bifurcates into the Common Iliac Arteries at L4

Common Iliac Arteries bifurcate into:

  • R/L Internal Iliac Arteries - descend into the pelvis
  • R/L External Iliac Arteries - enter the thigh deep to the inguinal ligament (halfway between the ASIS and the pubic tubercle) - gives rise to arteries that supply abdominal muscles:
    1. Inferior Epigastric Artery
    2. Circumflex Iliac Arteries
50
Q

Inferior Vena Cava

A
  • forms at the junction of the common iliac veins at L5 (just caudal to the aorta)

Receives:

  • lumbar veins
  • R gonadal vein
  • renal veins
  • R suprarenal vein
  • hepatic veins
  • inferior phrenic veins
51
Q

Deep Collateral Venous Drainage

A

Segmental lumbar veins → ascending lumbar veins → azygous and hemiazygous → SVC

52
Q

Three Lymphatic Trunks of the Abdomen

A

Right Lumbar Trunk

Left Lumbar Trunk

(legs, pelvic viscera, urogenital system, abdominal wall and abdominal viscera)

Intestinal Trunk

(celiac, superior and inferior mesenteric lymph nodes)

→ all drain into the cisterna chyli

53
Q

Major Lymph Nodes of the Abdomen

A

Celiac Nodes - abdominal foregut

Superior Mesenteric Nodes - abdominal midgut

Inferior Mesenteric Nodes - abdominal hindgut

Right and Left Lumbar Nodes - primary retroperitoneal organs and genitourinary tract

54
Q

Thoracic Splanchnic Nerves

A
  • Sympathetic nerves that supply the primarily retroperitoneal organs

**Pass through the sympathetic chaing but DO NOT synapse there

Synapse - prevertebral ganglia in the abdominal plexuses

55
Q

Parasympathetic Nerves of the Abdomen

A

Vagus Nerve - innervate kidneys and ureters

56
Q

Lumbar Plexus

A
  • formed by the ventral rami of L1-L4

Iliohypogastric

Ilioinguinal

Genitofemoral

Muscular Branches - of posterior abdominal wall

57
Q

Iliohypogastric

A

Supplies:

  • layered muscles of the abdominal wall
  • skin of the lower abdomen
58
Q

Ilioinguinal

A

Supplies:

  • layered muscles of the abdominal wall
  • skin of the medial thigh and superior portion of the scrotum/labia
59
Q

Genitofemoral

A

Supplies:

  • cremaster muscles
  • skin of the anterior scrotum/labia
60
Q
A

HAE - Quiz 5 (3 decks)

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