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CPR Week 3 > 3.3.5. ANATOMY LAB - Posterior Abdomen, Kidneys, Renal > Flashcards

3.3.5. ANATOMY LAB - Posterior Abdomen, Kidneys, Renal Flashcards

1
Q

What are the crura of the diaphragm?

A

The crura of the diaphragm are musculotendinous bands that arise from the anterior surfaces of the bodies of the three lumbar vertebrae, the anterior longitudinal ligament, and the IV discs

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2
Q

The left crus arises from where?

A

The left crus arises from the first two or three lumbar vertebrae

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3
Q

The ___ along with the ___ ___ ___ form the aortic hiatus

A

The crura along with the median arcuate ligament form the aortic hiatus

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4
Q

Compare the right crus to the left crus

A

The right crus is larger and longer than left crus and arises from the first three or four lumbar vertebrae

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5
Q

medial arcuate ligament

A

A thickening of the fascia covering the psoas major spanning between the lumbar vertebral bodies and the tip of transverse process of L1

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6
Q

lateral arcuate ligament

A

covers quadratus lumborum muscles and continues from L12 transverse process to tip of 12th rib

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7
Q

suspensory muscle of the duodenum (Ligament of Treitz)

A

A surgical landmark where the retroperitoneal duodenum ends and the intraperotoneal jejunum begins

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8
Q
A
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9
Q

What are the apertures of the diaphragm?

A

vena caval foramen (caval opening)

esophageal hiatus

aortic hiatus

muscular “gaps” for the psoas and quadratus lumborum mm

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10
Q

Discuss the vena caval foramen

A

Terminal part of IVC passes to enter the heart which perforates the central tendon of the diaphragm

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11
Q

Discuss the esophageal hiatus

A

Formed by the right crus, this is a hole in the diaphragm in which the esophagus and vagus nerve passes at the T10 level.

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12
Q

Discuss the aortic hiatus

A

The lowest and most posterior of the diaphragm apertures, this is located at the T12 level. The aorta, azygos vein, and thoracic duct pass through here. Diaphragm contractions do not affect the diameter.

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13
Q
A
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14
Q

Trace the path of the subcostal nerve.

What does it innervate?

A

Arise in thorax, pass posterior to lateral arcuate ligaments into abdomen and run inferolaterally on anterior surface of quadratus lumborum. Pass through transversus abdominis and internal oblique to innervate external oblique and skin of anterolateral abdominal wall

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15
Q

Trace the path of the obturator nerve. What does it supply?

A

emerges from medial border of psoas major and passes into pelvis passing inferior and superior to pubic ramus to medial thigh, supplying adductor muscles

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16
Q

Trace the path of the femoral nerve. What does it innervate?

A

emerges from lateral border of psoas major and innervates iliacus. Passes deep to inguinal ligament to anterior thigh to supply flexors of hip and extensors of knee.

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17
Q

Note branches of _____ and ____ are the two nerves that run with the spermatic cord structures in the inguinal canal.

A

Note branches of iloinguinal and genitofemoral are the two nerves that run with the spermatic cord structures in the inguinal canal.

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18
Q

Trace the path of the iloinguinal nerve. What does it innervate?

A

Enter abdomen posterior to medial arcuate ligament and pass inferolaterally anterior to quadratus lumborum. Then run superior and parallel to iliac crest, piercing transverse abdominis near ASIS. Pass through internal and external obliques to supply abdominal muscles and skin of inguinal and pubic regions.

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19
Q

What nerve runs along with iloinguinal and innervates the same way?

A

Illiohypogastric

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20
Q

Trace the genitofemoral nerve and what does it innervate?

A

Pierces psoas major and runs inferiorly on its anterior surface under the psoas fascia. It divides lateral to the common and external iliac arteries into femoral and genital branches.

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21
Q

Trace the lateral femoral cutaneous nerve. What does it supply?

A

Runs inferolaterally on the iliacus and enters the thigh deep to the inguinal ligament/ iliopubic tract just medial to ASIS. It supplies skin on the anterolateral surface of the thigh.

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22
Q

Where do we find the lumbosacral trunk and what does it innervate?

A

Passes over the wing of the sacrum and descends into the pelvis to participate with the sacral plexus.

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23
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24
Q
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25
Q

What and where are the supradrenal glands?

A

On the superomedial aspect of each kidney but separated from the kidney from a fascial septum, these function as part of the endocrine system separate from the kidney.

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26
Q
A
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27
Q

What is the renal capsule

A

tough fibrous tissue that surrounds the kidney

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28
Q

What is the renal medulla and what happens here?

A

The innermost part of the kidney that is split into sections known as the renal pyramids. Interlobular arteries (from the renal artery) branch into arcuate arteries and reach the glomeruli than renal tubules here. Contains nephrons reponsible for maintaining salt and water balance

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29
Q

Discuss the renal cortex

A

Outer portion of the kidney between the renal capsule and renal medulla. It extends down between the pyramids and contains the renal corpuscles and the renal tubles (except for parts of the loop of Henle)

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30
Q

What are renal pyramids

A

renal medulla is made up of 27 to 30 of these. The base of the pyramid faces the renal cortex

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31
Q

What are renal papilla?

A

The tip of each pyramid which empties urine into a minor calyx. Histologically marked by medullary collecting ducts.

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32
Q

What are renal hilium?

A

The entrance to space within the kidney, the renal sinus. The renal artery enters the kidney, the renal vein and ureter leave

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33
Q

What are renal roots?

A

vessels and structures transiting the hilum

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34
Q

What are minor and major calices?

A

Minor empties urine into a major calyces. Calyces are chambers in the kidney through which urine passes.

Major passes urine to the ureter

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35
Q

What is the renal pelvis

A

a flattened, funnel-shaped expansion of the superior end of the ureter. The apex of the renal pelvis is continuous with the ureter.

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36
Q
A
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37
Q

What is the general framework of the renal arteries and why is it done this way?

A

Renal arteries arise at the level of the IV disc between L1 and L2. The longer right renal artery passes posterior to IVC. Each artery divides close to the hilum into five segmental arteries. Having a separate blood supply allows the removal of tumors in a section without sacrificing the entire gland

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38
Q

What are the segments of the renal arteries?

A

superior (apical) segmental artery

anterosuperior segmental artery and antero-inferior segmental artery:

inferior segmental artery

posterior segmental artery

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39
Q

Where do the superior suprarenal arteries branch from?

A

inferior phrenic arteries

40
Q

Where do the middle suprarenal arteries branch from?

A

middle suprarenal arteries from the abdominal aorta near the level of SMA origin

41
Q

Where do the Inferior suprarenal arteries branch from?

A

Inferior suprarenal arteries from the renal arteries

42
Q

Where do the renal veins drain to?

A

IVC

43
Q

The right renal vein is _____ and has ___ ___ ___.

A

The right renal vein is short and has limited collateral vessels

44
Q

Venous drainage of suprarenal glands occurs through the right and left _____ veins.

A

Venous drainage of suprarenal glands occurs through the right and left suprarenal veins.

45
Q

Venous draining from the ureters occurs through the ____ and _____ veins

A

Venous draining from the ureters occurs through the renal and gonadal veins

46
Q

The renal lymphatics follow the ___ ___ and drain into the right and left ___ ___ ___.

A

The renal lymphatics follow the renal veins and drain into the right and left lumbar lymph nodes.

47
Q

Discuss the suprarenal lymphatic vessels

A

The suprarenal lymphatic vessels pass to the lumbar lymph nodes and arise from the gland itself

48
Q
A
49
Q

Where are the common iliac veins?

What makes them up and where do they go?

A

Formed by the external and internal iliac veins. The left and right common iliac veins come together in the abdomen at L5 forming the IVC draining blood from the pelvis and lower limbs.

50
Q

Discuss the right and left gonadal veins

A

Carries blood from the gonads to the heart. The left gonadal vein drains into the left renal vein. the right gonadal vein drains into the IVC

51
Q
A
52
Q

Where are the ureters and why?

A
53
Q

Like the kidneys, the ureters have a segmental blood supply which makes them vulnerable to _____.

A

Like the kidneys, the ureters have a segmental blood supply which makes them vulnerable to ischemia.

54
Q

The ureters enter the urinary bladder posteriorly between the ____ ____ and ___ ___ in males, or inferior to the ___ ___ in females.

A

The ureters enter the urinary bladder posteriorly between the seminal vesicles and ductus deferens in males, or inferior to the uterine arteries in females.

55
Q
A
56
Q
A
57
Q

Discuss the urinary bladder

A

A hollow viscus with strong muscular walls that is a temporary reservoir for urine. Located in the lesser pelvis. It lies partially superior to and partially posterior to the pubic bones when empty.

58
Q

Discuss the trigone

A

A smooth triangular region of the internal urinary bladder formed by the two ureteral orifices and the internal urethral orifice.

59
Q

Discuss the orifices of ureters

A

These along with the internal urethral orifice are at the angles of trigone of the bladder. Ureteric orifices are encircled by loops of detrusor muscculature that tightens when the bladder contracts to assist in preventing reflux of urine into the ureter.

60
Q

Discuss the internal sphincter

A

Toward the neck of the male bladder. Involuntary, and contracts during ejaculation to prevent retrograde ejaculation of semen in the bladder.

61
Q

Discuss the male urethra

A

The male urethra is a muscular tube (18-22 cm) that conveys urine from the internal urethral orifice of the urinary bladder to the external urethral orifice. Located at the tip of the glans penis. Provides exit for semen.

62
Q

Discuss the female urethra

A

The female urethra (4 cm long x 6 mm) passes antero-inferiorly from the internal urethral orifice of the urinary bladder, posterior and inferior to the pubic symphysis to the external urethral orifice.

63
Q

Discuss the internal urethral orifice as it differs between males and females

A

The opening of the urinary bladder into the urethra.

Fibers from the male internal urethral sphincter run radially to assist opening the internal urethral orifice of the male.

The musculature surrounding the internal urethral orifice of the female bladder is not organized into an internal sphincter.

64
Q

In females, where is the external urethral orifice?

A

In females, it is located at the vestibule of the vagina, the cleft between the labia minora of the external genitalia, directly anterior to the vaginal orifice.

65
Q
A
66
Q

main arteries supplying the bladder are branches of the ___ ___ ___..

A

main arteries supplying the bladder are branches of the internal iliac arteries.

67
Q

The ___ ___ arteries supply anterosuperior parts of bladder.

A

The superior vesical arteries supply anterosuperior parts of bladder.

68
Q

in males, the ___ ___ arteries supply the fundus and neck of the bladder.

A

in males, the inferior vesical arteries supply the fundus and neck of the bladder.

69
Q

Discuss female arterial supply to the bladder

A

Females - the vaginal arteries replace the inferior vesical arteries and send small branches to postero-inferior parts. The obdurator and inferior gluteal arteries also supply small branches to the bladder.

70
Q
A

Veins draining blood correspond to arteries and are tributaries of the internal iliac veins.

71
Q

Discuss venous drainage in males

A

In males, the vesical venous plexous is continuous with the prostatic venous plexus, and these combine to envelop the fundus of the bladder and prostate, seminal glands, the ductus deferentes, and inferior ends of ureters. It also receives blood from the deep dorsal vein of the penis which drains into the prostatic venous plexus.

72
Q

Discuss venous drainage of the bladder in females

A

Females - The vesical venous plexus envelops the pelvic part of the urethra and the neck of the bladder. It receives blood from the dorsal vein of the clitoris and communicates with the vaginal or uterovaginal venous plexus.

73
Q

Discuss sympathetic innervation of the bladder

A

Sympathetic fibers are conveyed from the inferior thoracic and upper lumbar spinal cord levels to the vesical plexuses through the hypogastric plexuses and nerves.

74
Q

Discuss parasympathetic innervation of the bladder

A

Parasympathetic fibers from the sacral spinal cord levels are conveyed by the pelvic splanchnic nerves and the inferior hypogastric plexus. parasympathetic fibers are motor to the detrusor muscle and inhibit the internal urethral sphincter of the male bladder.

75
Q

What stimulates urination (think nerve pathway)

A

When visceral afferent fibers are stimulated by stretching, the bladder contracts reflexively, the internal urethral sphincter relaxes and urine flows into the urethra

76
Q

How do we not constantly pee ourselves?

A

We learn to suppress this reflex with toilet training. Sympathetic innervation stimulates ejaculation and causes contraction of the internal urethral sphincter to prevent reflux of semen into the bladder. Sympathetic responce can cause the internal sphincter to contract and hamper the ability to urinate until parasympathetic inhibition.

77
Q

Discuss the all important lymphatic drainage of urinary system…

A
78
Q

What is a suprapubic cystostomy?

A

Surgically created connection between the urinary bladder and the skin which drains urine from the bladder in individuals with obstruction of normal urine flow.

79
Q

What is a cytoscopy?

A

A test that allows the physician to look inside the bladder and urethra using a thin, lighted instrument called a cystoscope.

80
Q

What is lithotripsy?

A

A procedure that uses shock waves to break up stones in the kidney, bladder, or ureter.

81
Q
A
82
Q
A
83
Q

What other pathology can be mistaken for an AAA?

A

The aorta lies posterior to the pancreas and stomach. A tumor of these organs may transmit pulsations of the aorta that could be mistaken for an abdominal aortic aneurysm, a localized enlargement of these organs

84
Q

Rectal flexures?

A

The anteroposterior curve with anterior convexity of the last portion of the rectum. this flexure (approx 80 degrees) is important in retaining fecal continance and is maintained by the puborectalis muscle sling.

85
Q

The puborectalis muscle sling is responsible for what?

A

Responsible for maintaining the anorectal angle.

86
Q

What is the rectal ampulla?

A

The dilated terminal part of the rectum. Lies superior to and supported by the pelvic diaphragm (levator ani) and anococcygeal ligament. This receives and holds an accumulating fecal mass until it is expelled during defecation.

87
Q

The superior rectal artery (from the abdominal inferior mesenteric artery) supplies what?

A

The superior rectal artery (from the abdominal inferior mesenteric artery) supplies the proximal part of the rectum

88
Q

The right and left _____ rectal arteries (from the anterior divisions of the internal iliac arteries) supply the ____ and inferior parts of the rectum

A

The right and left middle rectal arteries (from the anterior divisions of the internal iliac arteries) supply the middle and inferior parts of the rectum

89
Q

The inferior rectal arteries, from the internal pudendal arteries in the perineum, supply what?

A

The inferior rectal arteries, from the internal pudendal arteries in the perineum, supply the anal rectal junction and anal canal

90
Q

Blood from the rectum drains through what?

A

Blood from the rectum drains through the superior, middle, and inferior rectal veins.

91
Q

What is the sympathetic rectal nerve supply?

A

Sympathetic: from the lumbar spinal cord via the lumbar splanchnic nerves and hypogastric/ pelvic plexuses through the peri-arterial plexus of the inferior mesenteric and superior rectal arteries.

92
Q

Discuss the parasympathetic rectal nerve supply

A

Parasympathetic: from the S2-S4 spinal cord passing through the pelvic splanchnic nerves and the left and right inferior hypogastric plexuses to the rectal (pelvic) plexus.

93
Q

The pectinate line indicates what?

A

The pectinate line (13i) indicates the junction of the superior part of the anal canal from the inferior part.

94
Q

the anal canal superior to the pectinate line differs from the inferior part in what ways?

A

the anal canal superior to the pectinate line differs from the inferior part in arterial supply, venous drainage, lymphatic drainage, and innervation

95
Q
A
96
Q
A
97
Q
A

Right and left lumbar lymph nodes (on both sides of IVC and aorta) receive from the common iliac lymph nodes

CPR Week 3 (16 decks)

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