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Anatomy Topnotch > 9. Lumbosacral plexus and kidneys > Flashcards

9. Lumbosacral plexus and kidneys Flashcards

1
Q

network of nerve fibres that supplies the skin and muscles of the pelvis and lower limb. It is located on the surface of the posterior pelvic wall, anterior to the piriformis muscle.

A

sacral plexus

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2
Q

the sacral pelxus is formed by

A

anterior rami (divisions) of the sacral spinal nerves S1, S2, S3 and S4.

It also receives contributions from the lumbar spinal nerves L4 and L5.

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3
Q

peripheral nerves of sacral plexus

A

5 major

Some Irish Sailor Pesters Polly’.

  1. Superior Gluteal Nerve 2. Inferior Gluteal Nerve
  2. Sciatic Nerve
  3. Posterior Femoral Cutaneous
  4. Pudendal Nerve

other branches

Nerve to piriformis
Nerve to obturator internus
Nerve to quadratus femoris

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4
Q

2 main destinations the nerves of sacral plexus

A
  • Leave the pelvis via the greater sciatic foramen -> gluteal region
  • Remain in the pelvis
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5
Q

this nerve leaves the pelvis via the greater sciatic foramen, entering the gluteal region superiorly to the piriformis muscle. It is accompanied by the superior gluteal artery and vein for much of its course.

A

superior gluteal nerve

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6
Q

roots of superior gluteal nerve

A

L4,L5, S1

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7
Q

Roots of inferior gluteal nerve

A

L5,S1,S2

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8
Q

Roots of sciatic nerve

A

L4,L5,S1,S2,S3

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9
Q

roots of posterior femoral cutaneous

A

S1,S2,S3

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10
Q

roots of pundendal nerve

A

S2,S3,S4

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11
Q

fx of superior gluteal nerve

A

Motor Functions: Innervates the gluteus minimus, gluteus medius and tensor fascia lata.

Sensory Functions: None.

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12
Q

fx of inferior gluteal nerve

A

Motor Functions: Innervates gluteus maximus.

Sensory Functions: None.

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13
Q

roots of sciatic nerv

A

L4, L5, S1, S2, S3

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14
Q

motor fx of sciatic nerve

A

Tibial portion – Innervates the muscles in the posterior compartment of the thigh (apart from the short head of the biceps femoris), and the hamstring component of adductor magnus. Innervates all the muscles in the posterior compartment of the leg and sole of the foot.

Common fibular portion – Short head of biceps femoris, all muscles in the anterior and lateral compartments of the leg and extensor digitorum brevis.

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15
Q

sensory fx of sciatic nerve

A

Tibial portion: supplies the skin of the posterolateral leg, lateral foot and the sole of the foot.
Common fibular portion: supplies the skin of the lateral leg and the dorsum of the foot.

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16
Q

leaves the pelvis via the greater sciatic foramen, entering the gluteal region inferiorly to the piriformis muscle. It descends deep to the gluteus maximus and runs down the back of the thigh to the knee.

A

Posterior Femoral Cutaneous

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17
Q

fx of Posterior Femoral Cutaneous

A

Motor Functions: None

Sensory Functions: Innervates the skin on the posterior surface of the thigh and leg. Also innervates the skin of the perineum.

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18
Q

This nerve leaves the pelvis via the greater sciatic foramen, then re-enters via the lesser sciatic foramen. It moves anterosuperiorly along the lateral wall of the ischiorectal fossa, and terminates by dividing into several branches.

A

Pudendal Nerve

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19
Q

fx of pudendal nerve

A

Motor Functions: Innervates the skeletal muscles in the perineum, the external urethral sphincter, the external anal sphincter, levator ani.

Sensory Functions: Innervates the penis and the clitoris and most of the skin of the perineum.

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20
Q

intramuscular injection into the gluteal region must be given in the

A

upper lateral quadrant to avoid sciatic nerve (which passess through the lower media quadrant )

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21
Q

refers to compression of the sciatic nerve by the piriformis muscle.

A

Piriformis syndrome/ deep gluteal syndrome

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22
Q

Clinical features include radicular pain, numbness, muscle weakness and buttock tenderness. The pain can occasionally be exacerbated by internal rotation of the lower limb at the hip.

A

Piriformis syndrome

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23
Q

Lab findings of piriformis syndrome

A

X-ray and MRI imaging is usually unremarkable but can exclude other pathology such as spinal compression of the sciatic nerve.

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24
Q

The treatment of piriformis syndrome can be divided into non-operative and operative:

A

Non-operative – analgesia, physiotherapy and corticosteroid injections
Operative – piriformis muscle release

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25
Q

bilateral bean-shaped organs, reddish-brown in colour and located in the posterior abdomen.

A

Kidneys

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26
Q

main fx of kidneys

A

filter and excrete waste products from the blood. They are also responsible for water and electrolyte balance in the body.

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27
Q

level of kidneys

A

T12-L3

right kidney is slightly lower due to the presence of the liver

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28
Q

Kidney is covered

deep to superficial

A

renal capsule
perirenal fat
fenal fascia / Gerota’s fascia
Pararenal fat

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29
Q

the renal parenchyma are divided into

A

cortex

medulla

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30
Q

The cortex extends into the medulla, dividing it into triangular shapes – these are known as

A

renal pyramids

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31
Q

The apex of a renal pyramid is called a

A

renal papilla

32
Q

Each renal papilla is associated with a structure known as the____, which collects urine from the pyramids

A

minor calyx

33
Q

encloses the kidneys and the suprarenal glands.

A

renal fascia

34
Q

Several minor calices merge to form a

A

major calyx

35
Q

Urine passes through the major calices into the

A

renal pelvis

36
Q

The medial margin of each kidney is marked by a deep fissure, known as the

A

renal hilum

37
Q

The kidneys are supplied with blood via the

A

renal arteries

38
Q

this renal artery is longer, and crosses the vena cava posteriorly.

A

Due to the anatomical position of the abdominal aorta (slightly to the left of the midline), the right renal artery is longer

39
Q

carry 75% of blood supply to the kidney

A

anterior division of the renal artery

40
Q

25% of the blood supply to the kidney

A

posterior division of the renal artery

41
Q

avascular plane of the kidney

aka

A

line of brodel

42
Q

is an imaginary line along the lateral and slightly posterior border of the kidney, which delineates the segments of the kidney supplied by the anterior and posterior divisions.

A

avascular plane of the kidney (line of Brodel)

43
Q

It is an important access route for both open and endoscopic surgical access of the kidney, as it minimises the risk of damage to major arterial branches.

A

avascular plane of the kidney (line of Brodel)

44
Q

Each segmental artery divides to form

A

interlobar arteries

45
Q

urine flow from renal papilla to bladder

A

renal papilla -> minor calyx -> major calyx ->major calyx -> renal pelvis -> ureter -> bladder

46
Q

This acts as a gateway to the kidney – normally the renal vessels and ureter enter/exit the kidney via this structure.

A

renal hilum

47
Q

segmental artery to efferent arterioles

A

segmental artery -> interlobar arteries -> arcuate arteris -> interlobular arteries -> afferent arterioles (cortex) - form glomerulus -> efferent arterioles

48
Q

a At 90 degrees to the arcuate arteries, these arteries arise

A

interlobular arteries

49
Q

supplies the nephron tubules with oxygen and nutrients.

A

peritubular network

50
Q

peritubular network is formed by

A

efferent arterioles in the outer 2/3 of the renal cortex

51
Q

The inner third of the cortex and the medulla are supplied by

A

long, straight arteries called vasa recta.

52
Q

accessory arteries of the kidneys are common in ___ % of patients

A

25%

53
Q

If a supernumerary artery does not enter the kidney through the hilum, it is called

A

aberrant

54
Q

venous drainage of the kidneys

A

left and right renal veins.

55
Q

left and right renal veins drain into

A

IVC

56
Q

this renal vein is longer

A

As the vena cava lies slightly to the right, the left renal vein is longer

57
Q

this renal artery lies posterior to the inferior vena cava.

A

right renal artery

58
Q

Lymph from the kidney drains into the

A

lateral aortic (or para-aortic) lymph nodes

59
Q

In utero, the kidneys develop in the pelvic region and ascend to the lumbar retroperitoneal area. Occasionally, one of the kidneys can fail to ascend and remains in the pelvis – usually at the level of the

A

common iliac artery

60
Q

failure of kidneys to ascend in utero

A

pelvic kidney

61
Q

is where the two developing kidneys fuse into a single horseshoe-shaped structure.

A

horseshoe kidney (also known as a cake kidney or fused kidney)

62
Q

This occurs if the kidneys become too close together during their ascent and rotation from the pelvis to the abdomen – they become fused at their lower poles (the isthmus) and consequently become ‘stuck’ underneath this artery

A

inferior mesenteric artery

63
Q

Horseshoe kidney presentation

A

asymptomatic, although it can be prone to obstruction

64
Q

most common tumor of the kidneys

A

renal cell carcinoma

65
Q

kidneys is closely in contact with this muscle

A

psoas major

66
Q

3 structures that enter/ leave at renal hilum

A
  1. renal vein - anterior
  2. renal artery
  3. renal pelvis - posterior
67
Q

T/F

fibrous capsule of the kidneys is a true capsule

A

true

68
Q

Gerota’s fascia is continuous laterally with

A

fascia tranversalis

69
Q

how many renal pyramids

A

12 pyramids

70
Q

nerve supply of kidneys

A

renal sympathetic plexus

T10-12

71
Q

renal transplantation

usual site

A

iliac fossa on the posterior abdominal wall

72
Q

for renal transplantation, renal artery is anastomosed to

A

internal iliac artery

73
Q

for renal transplantation, renal vein is anastomosed to

A

external iliac vein

74
Q

rare vein compression disorder. It occurs when arteries, most often the abdomen’s aorta and superior mesenteric artery, squeeze the left renal (kidney) vein.

A

nutcracker syndrome

75
Q

if left renal vein is compressed by SMA as the vein crosses anterior to the aorta
this results

A

renal and adrenal hypertension on the Left

in males: varicocele on the left

Anatomy Topnotch (26 decks)

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