Surgical anatomy of the retroperitoneum, adrenal, kidney and ureters Flashcards Preview

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Flashcards in Surgical anatomy of the retroperitoneum, adrenal, kidney and ureters Deck (54)
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1

The dorsal lumbotomy incision to expose the kidney

Splits the lumbodorsal fascia without incising muscle,. This approach allows entrance to the retroperitoneum without violation of musculature

2

The lumbodorsal fascia originates from the

Lumbar vertebrae

3

The lumbodorsal fascia consists of how many layers

3- Posterior, middle and anterior

Posterior: covering for the sacrospinalis, latissimus dorsi origin

Middle: separates the anterior of of sacrospinalis from the posteror aspect of the quadratus lumborum,

Anterior: lumodorsal fascia probides the anterior covering to the quadratus lumborum muscle and forms the posterior margin of the retroperitoneum

4

All three layers of the lumbodorsal fascia join to form the a single thick aponeurosis lateral to the quadratus lumborum muscle before extending further anterolaterally, where they are contiguous with the aponeurosis of the ____________.

Transversus abdominis muscle

5

The psoas major joins the iliacus muscle, which originates ____, to become the _____ and insert on the _____ and _____ the thigh at the hip

1. Inner aspect of the iliac wing of the pelvis

2. iliopsoas

3. lesser trochanter

4. flex

6

What is the boundary of the retroperitoneum?

Posterior surface: lumbar vertebral bodies covered by shiny, longitudinal fibers of the anterior spinous ligament, these are flanked bilaterally by the psoas. Psoas is covered by the psoas sheath which are contiguous with the transversus abdominis muscle

LAterally: transversus abdominis

Superior: posterior insertion of the diaphragm along the lower ribs

Inferior: below the level of the iliac crest, iliopsoas forms the posterior confine

7

in a subcostal flank approach to the kidney, which of the ff may be incised to increase upward mobility of the 12th rib

the costovertebral ligament

8

What are the first abdominal branches of the aorta

the paired inferior phrenic arteries

9

which of the following arteries branches from the celiac trunk?

a. the left gastric

b. the right gastric

c. the pancreaticoduodenal

d. SMA

E. IMA

A. left gastric

The short celiac arterial trunk trifurcates into common hepatic, left gastric, and splenic branches

10

The renal arteries typically branch from the abdominal aorta at the level of the ____

2nd lumbar

11

the testicular arteries commonly originate from the

Abdominal aorta below the renal arteries

12

The inferior mesenteric artery can be sacrificed without complication

True, especially in individuals without atherosclerotic occlusive arterial disease

13

Which of the following drains directly to the IVC?

REnal veins, IMV,SMV,splenic veins

only renal vein, the rest drains into to the portal vein

14

the left gonadal vein usually enters the ____

inferior aspect of the left gonadal vein

15

left renal vein receives the ff

left adrenal, left lumbar, left gonadal

16

cysternal chyli is located

located at the 1st lumbar vertebra posterior to aorta

17

the right testis lymphatics drains into

interaortocaval region

18

the lumbar sympathetic chains

1. Run vertically in the retroperitoneum, ,medial to the psoas muscles

2. contain numerous sympathetic ganglia

3. Closely associated with the lumbar blood vessels

contain postganglionic sympathetic neurons supplying the lower ex

19

Disruption of which sympathetic nervous plexus on this anterior abdominal aorta during retrpoperioneal dissection will likely cause loss of seminal emission?

A. Celiac plexus

B. Renal plexus

C. Superior mesenteric plexus

D. Superior hypogastric plexus

E AOTA

D. superior hypogastric plexus
From book: At the lower extent of the abdominal aorta, much of the autonomic input to the pelvic urinary organs and genital tract travels through the superior hypogastric plexus. This plexus lies on the aorta anterior to its bifurcation and extends inferiorly on the anterior surface of the fifth lumbar vertebra. This plexus is contiguous bilaterally with inferior hypogastric plexuses, which extend into the pelvis. Disruption of the sympathetic nerve fibers that travel through these plexuses during retroperitoneal dissection can cause loss of seminal vesicle emission and/ or failure of bladder neck closure, resulting in retrograde ejaculation.

20

23   
In the lateral abdominal wall, the iliohypogastric nerve will be found coursing in the plane:
 
a   
deep to the transversalis fascia.
 
b   
between the transversalis fascia and the transversus abdominis muscle.
 
c   
between the transversus abdominis and internal oblique muscles.
 
d   
between the internal oblique and external oblique muscles.
 
e   
superficial to the external oblique muscle.

c. In between the transversus abdominis and internal oblique muscles.

21

The cremaster muscle is innervated by the:
 
a   
ilioinguinal nerve.
 
b   
iliohypogastric nerve.
 
c   
obturator nerve.
 
d   
genital branch of the genitofemoral nerve.

D. genital branch

 

22

In the retroperitoneum, where can the genitofemoral nerve be found?
 
a   
Posterior to the psoas muscle
 
b   
On the anterior surface of the psoas muscle
 
c   
Lateral to the psoas muscle
 
d   
Medial to the psoas muscle

B.  the genitofemoral branch lies directly atop and parallels the psoas on most of its retroperitoneal course

23

Autonomic system divided into sympathetic and parasympathetic fibers. The sympathetitic ganglion originates from ___ while the parasymphatetic originates from ____. The major autonomic plexuses are associated with the primary branches of the aorta namely: ___, ___, ___

sympathetic: thoracic and lumbar portions

PArasymphathetic: Cranial and sacral collumns

Major autonomic branches: Celiac, superior hypogastric, inferior hypogastric plexus

24

26   
The descending duodenum:
 
a   
lies within the retroperitoneum.
 
b   
receives the common bile duct.
 
c   
lies lateral to the head of the pancreas.
 
d   
lies anterior to the right renal hilum.
 
e   
does all of the above.

e. The second part of the duodenum descends vertically, directly anterior to the right renal hilum, and this is intimately related on its posterior aspect to the medial margin of the right kidney, right renal vessels, renal pelvis, UPJ, upper right ureter, the CBD also lies posterior and drains into this part

25

The posterior surface of the tail of the pancreas is closely associated with:
 
a   
the splenic artery.
 
b   
the splenic vein.
 
c   
the upper pole of the left kidney.
 
d   
the left adrenal gland.
 
e   
all of the above.

e all of the above

26

In cases of renal ectopia, the ipsilateral adrenal gland is typically:
 
a   
absent.
 
b   
found in its normal anatomic position in the upper retroperitoneum.
 
c   
found in association with the contralateral adrenal gland.
 
d   
found closely applied to the superior pole of the ectopic kidney.
 
e   
found closely associated with the ipsilateral renal artery.

B. found in its normal position in the upper retroperitoneum

27

30   
Which of the following statements is NOT true?
 
a   
The right renal vein is much shorter than the left renal vein.
 
b   
The right adrenal vein is much shorter than the left adrenal vein.
 
c   
The right kidney is typically located lower in the retroperitoneum than the left kidney.
 
d   
The right adrenal gland is typically located lower in the retroperitoneum than the left adrenal gland.
 
e   
Both c and d

d

28

s one proceeds outward from the adrenal medulla, the three separate functional layers of the adrenal cortex are, in correct order:
 
a   
zona reticularis, zona fasciculata, and zona glomerulosa.
 
b   
zona fasciculata, zona reticularis, and zona glomerulosa.
 
c   
zona glomerulosa, zona fasciculata, and zona reticularis.
 
d   
zona glomerulosa, zona reticularis, and zona fasciculata.
 
e   
zona reticularis, zona glomerulosa, and zona fasciculata.

a

29

Which of the following statements is (are) NOT true?
 
a   
The adrenal medulla produces catecholamines in response to stimulation from the sympathetic nervous system.
 
b   
The zona glomerulosa produces aldosterone in response to angiotensin II.
 
c   
The zona reticularis of the adrenal cortex produces androgens in response to luteinizing hormone (LH).
 
d   
The zona fasciculate of the adrenal cortex produces glucocorticoids in response to adrenocorticotropic hormone (ACTH).
 
e   
Both b and c

C. it is regulated by ACTH not LH

30

The adrenal arteries are branches from:
 
a   
the aorta.
 
b   
the inferior phrenic arteries.
 
c   
the renal arteries.
 
d   
the celiac arterial trunk.
 
e   
a, b, and c.

e