9. Posterior Ab Wall Flashcards by Alixandria Keller

Retroperitoneal Space

Between parietal peritoneum and muscles of ab wall

Contains fat, blood vessels, organs

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Kidneys

Primarily retroperitoneal

~T12-L3 vertebral levels

R slightly inferior than L

Surrounded by:
-paranephric (pararenal) fat
-renal fascia
perinephric (perirenal) fat

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Renal Fascia

Helps prevent spread of infection/blood locally

Conduit for spread of fluids into pelvis

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Kidneys: External Structures

Superior, inferior pole
Lateral, medial border

Renal hilum on medial border

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Renal Hilum

A–>P
Renal vein
Renal artery
Renal pelvis

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Kidneys: Internal Structures

Renal capsule
Renal cortex
Renal columns
Renal medulla

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Pathway of Urine

Renal papillae
Minor calices
Major calices
Renal pelvis 
Ureter

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Pelvic Kidney

Anomalous kidney

Failure of kidney to ascend during development

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Horseshoe Kidney

Anomalous kidney

Fused inferior poles

Ascent stopped by IMA

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Ureters

Primarily retroperitoneal

Fibromuscular tubes extend from renal pelvis to bladder

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Peristalsis

Transport of urine

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Adrenal Glands

Primarily retroperitoneal

Superomedial to kidneys

Enclosed by renal fascia

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Lymphatics of Kidneys/Adrenal Glands

Lumbar lymph nodes (along aorta) –> chyle cistern –> thoracic duct

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Kidney Innervation: Parasympathetic

PreG CB: brain
PreG fibers: vagus nerves
PostG CB, fibers: wall of kidney

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Kidney Innervation: Sympathetic

Lateral horn of thoracolumbar spinal cord
Ventral root
Spinal nerve
Ventral ramus
White ramus communicans
Sympathetic trunk
Thoracic splanchnic nerves (esp least)
Renal (aorticorenal) ganglion
Kidney

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Visceral Pain from Kidneys and Ureters

Follows sympathetic pathway - enters dorsal root

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Referred Pain

Back, flank, genitals

Along L1 dermatome

Adrenal Innervation: Sympathetic

Lateral horn of thoracolumbar spinal cord
Ventral root
Spinal nerve
Ventral ramus
White ramus communicans
Sympathetic trunk
Thoracic splanchnic nerves (greater, lesser, least)
Secretory cells of adrenal medulla

Adrenal Gland and the Sympathetic NS

Adrenal gland is an extension of the sympathetic NS

Release epinephrine and norepinephrine

Abdominal Aorta

T12-L4

Bifurcation at L4 into common iliac arteries

L of midline

Abdominal Aorta: Unpaired Branches

Celiac trunk
SMA
IMA

Abdominal Aorta: Paired Branches (Supply)

Primarily retroperitoneal organs
Gonads
Body wall

Abdominal Aorta: Paired Branches

Inferior phrenic arteries
-superior suprarenal arteries
Middle suprarenal arteries
Renal arteries
Inferior suprarenal arteries
Gonadal arteries (ovarian/testicular)
Subcostal arteries
Lumbar arteries

Inferior Phrenic Arteries

Supply inferior surface of diaphragm

and adrenal glands (via superior suprarenal arteries)

Renal Arteries

R renal is longer and courses posterior to IVC

Accessory Renal Arteries

Can happen Failure of embryonic arteries to degenerate

Abdominal Aortic Aneurysm

Can rupture High mortality rates if not diagnosed (~90%) Happens pretty close to bifurcation Common

Inferior Vena Cava

T8-L5 L5: union of common iliac veins R of midline Exits abdomen through caval opening

IVC Tributaries

Parallel paired aortic branches Except: L gonadal vein Hepatic veins (no arterial component)

Left Gonadal Vein

Drains to L renal vein Root of mesentery blocks path to IVC

Posterior Ab Wall Muscles: Iliopsoas

Psoas major + Iliacus Hip flexor

Psoas Major

Origin: lumbar vertebrae Fuses with iliacus Insertion: Lesser trochanter of femur

Iliacus

Origin: iliac fossa Fuses with psoas major Insertion: Lesser trochanter of femur

Muscles of Posterior Ab Wall: Quadratus Lumborum

Origin: 12th rib and lumbar vertebrae Insertion: Iliac crest Lateral to psoas major

Nerves (List)

``` Subcostal (T12) Iliohypogastric (L1) Ilioinguinal (L1) Genitofemoral (L1-L2) Lateral cutaneous nerve of the thigh (L2-L3) Femoral nerve (L2-L4) Obturator nerve (L2-L4) ``` Greater, lesser, least splanchnic nerves Sympathetic Trunks

Nerves (Notes)

Ventral rami carry somatic motor, somatic sensory, sympathetic fibers Everything but subcostal = lumbar plexus

Subcostal Nerves

Ventral rami T12 T12 dermatome Motor innervation to external and internal obliques, transversus abdominis

Lumbar Plexus

Formed of ventral rami of lumbar spinal nerves (L1-L5)

Diaphragm: Attachments

Xiphoid process Costal margin Ribs 11,12 Lumbar vertebrae (R/L crura)

Diaphragm: Openings

Caval (IVC) opening: T8 (IVC) Esophageal hiatus: T10 (esophagus, vagus nerves) Aortic hiatus: T12 (aorta, bile duct, azygos vein)