Retroperitoneum Flashcards Preview

HAE - Quiz 5 > Retroperitoneum > Flashcards

Flashcards in Retroperitoneum Deck (60):
1

Posterior Abdominal Wall 

(contents)

1. Lumbar Vertebral Column

2. Skeletal Muscle (Psoas Major and Psoas Minor, Iliacus, Quadratus Lumborum, Diaphragm)

3. Overlying Transversalis Fascia

2

Psoas Major

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

3

Quadratus Lumborum

- 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

4

Iliacus

Origin: Ilium

Insertion: Lesser trochanter of the femur

**combines with psoas major to form iliopsoas

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Diaphragm

- 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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Crura

- parts of the diaphragm that arise from the vertebrae

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Major Openings of the Diaphragm

T8 - IVC (Foramen of the Vena Cava)

T10 - Esophagus (Esophageal Hiatus)

T12 - Aorta (Aortic Hiatus)

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Structures that pass through Diaphragm

(Other)

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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Blood Supply to the Diaphragm

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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Abdominal Surface of the Diaphragm

except for bare area covered by highly sensitive serosal layer of the peritoneum

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Diaphragm Innervation

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

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

12

Properitoneal Space

- ANTERIOR extraperitoneal space between the transversalis fascia and the peritoneum

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Retroperitoneal Space

- POSTERIOR extraperitoneal space between the transversalis fascia and the peritoneum

 

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Viscera of the Retroperitoneal Space

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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Kidneys (Function)

- 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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Renal Hilum

- vertical cleft on the medial margin of the kidney where vessels, nerves, and lympatics enter/leave

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Renal Sinus

- fat-filled cavity at the medial border of the renal hilum

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Renal Cortex

- forms out 1/3 of renal substance

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Renal Medulla

- composed of renal pyramids

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Renal Columns

- cortical substance that extends between the renal pyramids into the medulla

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Renal Pyramids

- project from the renal sinuses towards the surface of the kidneys

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Renal Papillae

- 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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Minor calyces

- each receives a renal papillae

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Major Calyces

- 2 or 3 minor calyces coalesce to form the major calyx

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Renal Pelvis

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

26

Kidney Blood Supply

Renal Arteries

- arise just caudal to the SMA at L1

Right Renal Artery - runs posterior to the IVC

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Renal Veins

- 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

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Location of Kidneys

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

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Costovertebral Angle

CVA

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

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Morison's Pouch

- hepatorenal fossa

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Suprarenal Gland Location

- sit on top of the kidney on the superomedial aspect

- separated from the kidney by a thin fibrous renal capsule

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Renal Fascia

aka Gerota's Fascia

- located within retroperitoneal fat

Perirenal Fat - deep to renal fascia

Pararenal Fat - superficial to renal fascia

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Layers Surrounding Kidney

Renal Capsule

Perirenal Fat

Renal Fascia (Gerota's Fascia)

Pararenal Fat

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Renal Arteries

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

4 anterior segmental renal artery branches

1 posterior segmental renal artery branch

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Adrenal Glands

- paired, flattened, endocrine glands that sit loosely on the superomedial aspect of the kidneys and lie within the renal fascia

36

Adrenal Gland Cortex

- derived from mesoderm

- secretes corticosteroids

- surrounds the medulla

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Adrenal Gland Medulla

- derived from neural crest cells

- secretes catecholamines (norepinephrine and epinephrine)

 

38

Blood Supply to Adrenal Glands

Three Different Arteries:

Superior Suprarenal Arteries - Inferior Phrenic Artery

Middle Suprerenal Arteries - Aorta

Inferior Suprarenal Arteries - Renal Artery

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Veinous Drainage of the Adrenal Glands

Right Adrenal Gland - IVC

Left Adrenal Gland - Left Renal Vein

40

41

Ureter

- 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

Ureter Constriction Sites

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

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Abdominal Aorta

- Passes through diaphragm at T12

- anterior to vertebral bodies and left of the IVC

- shorter in length and smaller (2cm) than the IVC

 

44

Aorta Bifurcation

- at L4 into the Common Iliac Arteries

(level of umbilicus and T10 dermatome)

45

Aortic Branches

6 Visceral, 3 Parietal

Ventral, Lateral, Dorsal, Terminal Branches

46

Ventral Aortic Branches

Three Visceral Branches

1. Celiac (supplies foregut) - T12

2. Superior Mesenteric Artery (supplies midgut) - L1

3. Inferior Mesenteric Artery (supplies hindgut) - L3

47

Lateral Aortic Branches

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

Dorsal Aortic Branches

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

Terminal Aortic Branches

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

Inferior Vena Cava

- 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

Deep Collateral Venous Drainage

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

52

Three Lymphatic Trunks of the Abdomen

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

Major Lymph Nodes of the Abdomen

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

Thoracic Splanchnic Nerves

- 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

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Parasympathetic Nerves of the Abdomen

Vagus Nerve - innervate kidneys and ureters

56

Lumbar Plexus

- formed by the ventral rami of L1-L4

Iliohypogastric

Ilioinguinal

Genitofemoral

Muscular Branches - of posterior abdominal wall

57

Iliohypogastric

Supplies:

- layered muscles of the abdominal wall

- skin of the lower abdomen

58

Ilioinguinal

Supplies:

- layered muscles of the abdominal wall

- skin of the medial thigh and superior portion of the scrotum/labia

59

Genitofemoral

Supplies:

- cremaster muscles

- skin of the anterior scrotum/labia

60