Abdomen 3 Flashcards
Retroperitoneum
Located in the posterior abdominal cavity
Not suspended in the mesentery
Between the parietal peritoneum and the muscular fascia:
Diaphragmatic fascia (supriorly)
Psoas, quadratus lumborum(posteriorly)
Transversalis fascia (laterally)
Split into the borders, visceral and vascular contents
ANTERIOR PARARENAL
Head, neck, and body of the pancreas (not the tail)
Ascending and descending colon
Duodenum
PERIRENAL
Kidneys
Adrenals
Ureters
Renal Vessels
POSTERIOR PARARENAL
No major organs
Fat, vasculature and lymphatics
Pancreas
Head- lies within the C-shaped curve of duodenum Uncinate process- posterior to SMA/SMV Neck- anterior to SMA/SMV Body- lies behind stomach Tail- Intraperitoneal
Pancreas blood supply
The pancreas is supplied by numerous arteries.
Each artery supplies a specific part of the pancreas
Pancreatic branches of the splenic artery
Pancreaticoduodenal artery
Gastroduodenal artery
Kidneys surface anatomy
VERTEBRAE: Extends from T12-L3
RIBS:
Superior pole of right kidney anterior to 12th rib
Superior pole of left kidney anterior to 11th/12 rib
Kidneys enclosed by
Renal Capsule- fibrous capsule
Perinephric fat
Renal Fascia- membranous fascia which encloses the kidneys and adrenal glands and fuses with the transversalis fascia laterally and the diaphragmatic fascia superiorly
Paranephric fat- posterolateral to kidneys (forms the posterior paranephric space)
Kidney structure
Outermost layer - Renal Cortex
Renal Medulla- segregated into triangles (renal pyramids)
Apex of renal pyramids form the papillae
Papillae - Minor calyces - Major calyces - Renal pelvis - Ureter
Renal Vasculature
Arterial Supply: Renal arteries (anterior and posterior)
Left renal artery is higher
Right renal artery is longer + posterior to IVC
Line of Brodel - supplied by both anterior and posterior - surgical access
Venous Supply: Renal veins
Lymphatic drainage: Para-aortic nodes
Ureters
3 constrictions of the ureters:
Pelviureteric junction (PUJ)
Pelvic brim- common iliac vessels cross the ureter
Vesicoureteric junction
Spleen surface anatomy
LEFT SIDE
Follows the contour of rib X Superior border: Rib IX Inferior border: Rib XI Medial border: Lateral border of psoas Lateral border: Just posterior to MAL
Spleen
Location in the LUQ under the diaphragm + ribcage
Connected to the stomach and kidney by the greater omentum
Gastrosplenic ligament - Short gastric vessels and left gastroepiploic
Splenorenal ligament - Splenic artery, Splenic vein, Tail of pancreas
Spleen structure
The outer surface is divided into two: Diaphragmatic surface (smooth) Visceral surface (has notches)
Hilum of Spleen on visceral surface- entry point for splenic vessels
ARTERIAL SUPPLY: splenic artery which arises from the coeliac trunk
VENOUS SUPPLY: splenic vein
Abdominal Aorta
3 Unpaired arteries: Coeliac Trunk, SMA, IMA
5 Paired arteries: Inferior Phrenic, Adrenal, Renal, Gonadal and Lumbar arteries
3 Terminal arteries: Right and Left common iliac arteries, median sacral artery
Pelvic Vasculature
At L4 the abdominal aorta BiFOURcates to the form the common iliac arteries
The common iliac artery divides into the:
Internal Iliac artery: supplies the pelvis and perineum
External Iliac artery: supplies the lower limbs
Internal iliac artery branches
Anterior trunk: Inferior Gluteal artery Internal Pudendal artery Inferior + superior vesical artery Middle rectal artery Vaginal artery Obturator artery Umbilical artery + Uterine artery
Posterior trunk:
Iliolumbar artery
Lateral Sacral
Superior Gluteal Artery
Other:
Median Sacral artery (terminal)
Gonadal arteries
The systemic venous system
returns blood to the heart via the IVC
Common iliac veins Gonadal veins Renal Veins Suprarenal veins Hepatic Veins
Lymphatics
RETROPERITONEAL LYMPH NODES:
PRE-AORTIC: drains lymph from midline structures (pancreas and liver)
PARA-AORTIC: drains lymph from bilateral structures (kidneys, adrenals, gonads)
Both drain into the cisterna chyli
ILIAC LYMPH NODES
Internal Iliac nodes
External Iliac nodes
INGUINAL LYMPH NODES
Deep inguinal nodes
Superficial inguinal nodes
Nerves of pancreas
Vagus and abdominopelvic splanchnic nerves.
Nerves of spleen
Coeliac trunk
Nerves of kidney, ureter and suprarenal glands
Renal nerve plexus
The rich nerve supply of the suprarenal glands is from the celiac plexus and abdominopelvic (greater, lesser, and least) splanchnic nerves.