Retroperitoneum

Question 1

describe the posterior of the abdominal wall

Answer 1

made up of vertebral column, psoas major and minor, iliacus, and quadratus lumborum. the diaphragm contributes superiorly and the transversalis fascia is also present

Question 2

what is the origin and insertion of the psoas major? what does it do?

Answer 2

lumbar vertebrae to greater trochanter of the femur. hip flexor

Question 3

what is the origin and insertion of the quadratus lumborum. what does it do?

Answer 3

12th rib to iliac crest and to the transverse lumbar vertebrae. it flexes the spin laterally and stabilizes the diaphragm

Question 4

what are the parts of the diaphragm that originate from vertebrae?

Answer 4

crura

Question 5

what are the main to branches off the internal thoracic arteries that supply the diaphragm?

Answer 5

pericardiophrenic and muscophrenic

Question 6

describe the innervation of the diaphragm

Answer 6

central diaphragm is innervated by the phrenic nerve. peripheral diaphragm is innervated by intercostal nerves.

Question 7

where is transversalis fascia found?

Answer 7

between the parietal peritoneum and the musculature surrounding the entire abdominal cavity

Question 8

what is the space that exists between the transversalis fascia and the musculature

Answer 8

anteriorly- properitoneal space. posteriorly- retroperitoneal

Question 9

what are the viscera found in the retroperitoneal space?

Answer 9

kidneys, adrenal glands, duodenum, pancreas, ascending and descending colon, ureters

Question 10

how many liters per day do the kidneys filter? what is normal urine output?

Answer 10

200 L total filtration. 600-1500 cc/day urine

Question 11

what are the following kidney parts?: renal hilum, sinus, cortex, medulla, columns, pyramids, papillae, minor calyces, major calyces, pelvis

Answer 11

hilum- where all the vessels nerves and lymphatics enter on the medial border
sinus- fat filled concavity at medial border
cortex- outer 1/3 of renal substance
medulla- composed of renal pyramids
columns- cortical substance that extends between pyramids into the medulla
pyramids- project from the renal sinuses toward the kidney surface
papillae- apices of the pyramids projecting into the minor calyces of the renal pelvis
minor calyces- each receives a papillae
major- combination of multiple minor
pelvis- major calyces come together to form this funnel shaped area located in the hilum

Question 12

where do the renal arteries branch off the aorta?

Answer 12

at L1, just caudal to the SMA.

Question 13

does the right renal artery travel anteriorly or posteriorly to the IVC?

Answer 13

posteriorly

Question 14

describe the organization of the renal vein, artery, and sinus at the hilum

Answer 14

vein is anterior to artery which is anterior to hilum

Question 15

describe the course of the renal veins back to the IVC

Answer 15

left- crosses the aorta anteriorly just under the SMA to join the IVC. right- runs posterior to the duodenum and enters IVC

Question 16

what is the CVA and why is it important?

Answer 16

costalvertertebral angle. this is where you percuss to assess kidney tenderness on exam

Question 17

what vertebrae describe the range of the kidneys?

Answer 17

t12-L3

Question 18

which kidney is more caudal? why?

Answer 18

right- liver

Question 19

describe the 4 layers of fat and fascia encompassing the kidneys

Answer 19

1. renal capsule- the outside layer of the kidney
2. perirenal fat- fat between the capsule and the renal fascia
3. renal fascia (gerotas fascia)- layer between peri and para renal fat
4. pararenal fat

Question 20

what does it mean that renal arteries are endpoint arteries

Answer 20

they have no anastomes and an occlusion will lead to infarction

Question 21

where does the aorta split into the common iliacs?

Answer 21

L4 (umbilicus)

Question 22

describe the 3 ventral aortic branches

Answer 22

supply to viscera. celiac trunk t12 (foregut), SMA l1 (midgut), and IMA l3 (hindgut)

Question 23

describe the 4 lateral aortic branches

Answer 23

inferior phrenic t12 (parietal)- abdominal side of diaphragm. middle suprarenal L1 - adrenal gland, renal artery L1, ovarian/testicular

Question 24

where does the superior suprarenal artery start

Answer 24

branches off inferior phrenic artery

Question 25

describe the dorsal aortic branches

Answer 25

lumbar arteries L1-4- supply the musculature of the abdominal wall. sacral - L4 vestigal vessel that would supply tail

Question 26

describe the bifurcation of the common iliac arteries

Answer 26

into internal and external iliacs. external will eventually supply inferior epigastric and deep circumflex arteries

Question 27

where does the IVC bifurcate?

Answer 27

L5- one level lower than aorta

Question 28

what veins drain the abdominal diaphragm?

Answer 28

inferior phrenic veins

Question 29

what veins drain the adrenal gland?

Answer 29

suprarenal veins (via the renal vein in the left side)

Question 30

name two superficial veins that drain the abdomen

Answer 30

thoracoepigastric and superficial epigastric

Question 31

describe lymph drainage from the foregut, midgut and hindgut

Answer 31

celiac, superior mesenteric, and inferior mesenteric nodes found on the aorta

Question 32

where do retroperitoneal structures drain their lymph?

Answer 32

left and right lumbar nodes on the aorta and IVC respectively

Question 33

describe the sympathetic innervation of the abdominal organs

Answer 33

thoracic splanchnic (greater, lesser, least)- celiac plexus- stomach, liver, kidneys, spleen, pancreas. thoracic splanchnics- SMA plexus- small bowel, ascending colon lumbar splanchnic- IMA plexus- descending bowel

Question 34

describe the parasympathetic innervation of the abdomen

Answer 34

vagus- stomach liver, pancreas, kidney, small bowel, ascending colon pelvic splanchnic- descending colon

Question 35

where do the pelvic splanchnics originate?

Answer 35

s2-4

Question 36

describe the lumbar plexus

Answer 36

t12- subcostal L1- iliohypogastric and ilioinguinal, genitofemoral L2- lateral femoral cutaneous nerve and obturator L3- obturator and femoral l4/5- lumbosacral trunk

Question 37

what do the unnamed lumbar branches supply?

Answer 37

quadratus lumborum, psoas major, psoas minor, iliacus

Question 38

what does the iliohypogastric innervate?

Answer 38

layered muscles of ab wall and lower ab skin

Question 39

what does the ilioinguinal innervate?

Answer 39

muscles of the ab wall, skin of the medial thigh, superior scrotum/labia

Question 40

what does the genitofemoral innervate?

Answer 40

creamaster muscle and skin of anterior scrotum