Abdomen 5 Flashcards
What are the suprarenal glands? what surrounds them?
Paired endocrine glands (adrenoglands) - produce hormones
Lie in upper pole of kidney
surrounded by renal fascia
What is the difference in shape between the left and right adrenal gland?
Right kidney = Pyramidal shape
Left Kidney = Crescent shape
2 components of the suprarenal glands
Yellow cortex (outer)
Brown medulla (inner)
2 features of the yellow cortex
Derived from mesoderm
Secretes corticosteroids and androgens ie, cortisol
2 features of the brown medulla
Derived from the neural crest
Main source of catecholamines (adrenaline and noradrenaline)
importance of renal fascia
covering of suprarenal glands, and is seperate to kidneys -
so if kidney is affected, surparenal glands stay protected
What is the arterial supply to the suprarenal gland? (3)
3-
1. Superior suprarenal artery - comes from Inferior phrenic artery
- Middle suprarenal artery - comes from Aorta
- Inferior suprarenal artery - comes from Renal artery
Venous drainage of the suprarenal glands? (2) and clin significance of L
only 2
right and left suprarenal veins (r = drain into IVC) (l = drain into L renal vein)
Drainage is different on the left side as the aorta is in the way, so it is safer for the vessel to not cross over the aorta
L = preffered site for donor , may get compressed by anurism. is longer
4 functions of the kidneys
Kidney and peritoneum
- Excretes most of waste products of metabolism.
- Controls water and electrolyte balance of body.
- Maintains acid-base balance of body.
Secretes hormones and renin into the blood stream
Primary retroperitoneal
At what vertebral level would we find the kidneys?
Where do we find the hila of the kidneys?
Which kidney is higher?
*Located between T12 – L3 vertebrae.
*Hila of kidney: L1.
- Between rib 11 and 12 (floating
they move w diaphragm bc of close relation
Left
Right is lower (due to liver)
What are the anterior relations of the right kidney? 5
7 anterior left kidney relations
What are the posterior bony and muscular relations of the kidneys?
Muscular Transversus abdominis
Superior poles of L+ R kidney related to diaphragm
Medially = psoas major
Laterally = quadratus lumborum
Identify the coverings of the kidneys on the diagram and function
REPI REPA
- Renal capsule
- Perinephric Fat
- Renal Fascia (continuous with transversalis fascia)
- Paranephric fat
What is the purpose of the paranephric fat?
Insulates and protects the kidneys
Which covering on the kidney is continous with the transversalis fascia and fascia over the diaphragm
renal fascia
Label the kidneys
Contents of hilum of kidney
*Transmits, from anterior to posterior, the renal vein, renal artery & the ureter (VAU). ant to post
Lymph vessels & sympathetic fibers also pass through the hilum
what is the Calyx muscles
Smooth muscle in calyces propels urine through renal pelvis into ureters to the bladder
What is the renal sinus?
Will contain the renal pelvis (upper expanded part of ureter)
(perinephric fat will also continue here)
What is the arterial supply of the kidneys? (v similar to bronchus tree)
Abdominal aorta —> Renal arteries —> Segmental arteries —> Lobar arteries —> Interlobar arteries —> Arcuate arteries —> Interlobular arteries
The segmental arteries of the kidneys will divide the kidney into 5 vascular segments
Determine these segments
What is the venous drainage of the kidneys?
- Venous drainage will follow arterial drainage
- Interlobular veins will receive efferent glomerular veins from Bowmann’s Capsule and drain into the arcuate veins
- Arcuate veins and interlobar veins
- They drain into the multiple renal veins which will not align to the segmental artery
- These will flow into the left and right renal vein
efferent glomelular veins –> interlobular –> arcuate –> interlobar –> renal veins –> L + R renal vein
L renal vein is 3x longer than right, so preffered for renal donation
Which renal vein is longer and why?
What is the clinical significance of this?
Left is longer because inferior vena cava is a right side structure and needs to travel over the aorta
1) means if there is an aneurysm in the aorta/ SMA and may compress renal vein
2) Longer vein means left kidney is more likely to be used for transplantation
3 veins to the left renal vein
*Receives left gonada (testicular or ovarian) vein, inferior phrenic and left suprarenal vein.
What is the renal lymphatic drainage?
Will follow the renal veins
Drain into right and left lumbar nodes (caval and aortic) near Renal artery
What is the difference in what the left and right renal vein receive?
Left = receives left gonadal and inferior phrenic and suprarenal then to IVC
Right drains directly into IVC
What is the nerve supply to kidneys?
Mainly regulated by hormones (no evidence of parasymp supply)
Sympathetic
= Vasomotor regulating BF and renin secretion
Come from renal plexus
Post-ganglionic (T10-L2)
What is a staghorn calculus?
Build up of struvite
Solid mass will take up kidney itself
Occur in recurrent UTI’s
Is renal function dependent on innervation?
**Renal function not dependant on innervation as shown with renal transplantation (complete transection of innervation).
Renal function regulated by hormones.
Contractions in ureter
Peristaltic
What is the course of the ureter in the abdomen ? and what peritenom?
retroperitineal
· They run inferiorly (down), anterior to the psoas major muscle.
- Cross anterior to genitofemoral nerve
- Obliquely crossed by gonadal vessels
· Enter the pelvis anterior to the bifurcation of the common iliac arteries (L4/L5)
What is the course of the ureter in the pelvis?
· Turn medially opposite the ischial spine to enter the base of the bladder.
· In males, the ureter is crossed by the vas deferens.
· In females the ureter is crossed by the uterine artery.
Hint: Water under the bridge.
What are kidney stones?
where are they mainly found?
where is pain reffered?
They are formed from excess calcium or oxylates. They may cause painful blockage in the ureters
found mainly in:
1. uteropelvic junction
2. crossing of common iliac artery
3. site of entrance to bladder
pain reffered below ‘loin to groin’ - bc of contractions in ureter
where will pain from kidney stones be felt
Pain depending on site of obstruction can be referred to the lumbar, hypogastric, external genitalia or testes
Pain can also be referred to cutaneous areas (innervated by spinal cord segments and sensory ganglia) also supplying the ureter (T11-L2) ‘Pain from loin to groin)
what is uteric colic pain
Ureteric colic is severe intermittent pain due to contraction of ureteric muscles to overcome an obstruction, usually due to stone or clot formation.
What are the ureteric constrictions?
(These can be sites of obstruction and stone impaction
1) Ureteropelvic junction
2) Crossing of common iliac artery
3) Site of entrance to bladder
Arterial supply of ureter
Renal artery
Gonadal
Common iliac
Internal iliac
(venous drains into corresponding veins)
Bladder volume and peritineom
Position of bladder dependent on volume
1L and sub peritineol
*Empty: lesser pelvis
*Full: Extends into abdominal cavity
What are the anatomical relations of the bladder in females?
What are the anatomical relations of the bladder in males?
Identify these features on the external surface of the urinary bladder
Superior surface
· Infero-lateral surface (X2)
· Base
· Neck (important bc allows continence)
· Apex (Gives attachment to median umbilical ligament)
Attachment of bladder (1)
*Attachment to median umbilical ligament from apex of bladder, Running to umbilicus
it is a Remnant of urachus: fibrous remnant of allantosis, Functioned to drains foetal urinary bladder
What is nephroptosis (dropped kidney)
layers of renal fascia dont fuse properly so abnormally motile kidney, can descend more than 3cm when supine –> standing
suprarenal glands unnaffected
course of ureter in pelvis, what crosses in:
- males
- females
- vas deferens
- uterine artery
water under the bridge, where arteries are anterior to ureter
what is the pubovesical/prostatic ligament (another attatchment)
wraps around neck of bladder and attatches to pubic symphisis
- in men, they have prostate directly underneath, so its called the puboprostatic ligament
how is stress incontinence caused
childbirth in women can weaken the ligament so neck of bladder to prolapse below pelvic floor
What are the 4 ligaments which meet at the umbilicus?
Which ligaments of the bladder will hold it in place? men v women
Female = Pubovesical ligament
Males = Puboprostatic Ligament
What is the link between the pubovesical ligament and stress incontinence?
Females after birth (parturition) will cause the pelvic floor muscles to weaken
This will cause the neck of bladder to prolapse slightly below the floor
internal walls of bladder
*Walls formed by detrusor muscle which contracts to empty bladder
left nd right ureters enter and its smooth muscle (trigone) extends to connect both the ureteric orifices
most inferior is the internal urethral orifice, trigone leads into it, guarded by internal urethral sphincter in men
*Lined by transitional epithelium
*Vesical mucosa: attached loosely to detrusor muscle (except at trigone)
*Full: mucosa stretched out
*Empty: mucosa folds
What is the arterial supply of the bladder?
Superior vesical artery (branch of umbillicul artery from anterior trunk of internal illiac)
inferior vesical arteries (branches of Internal iliac artery) - ONLY MEN
(Vaginal artery is equivalent of inferior vesical in males)
Venous drainage of bladder
Vesical venous plexus
Utero vaginal plexus which will drain into the internal iliac vein
(vesical is anything bladder)
What is the sympathetic innervation to the bladder?
Will be for urine retention/ contracts internal urethral sphincter during ejaculation
T10 - L2 = run through prevertebral plexuses to reach the inferior hypogastric plexus, and then the vesical plexus, surrounding the bladder.
PS innervation of bladder
Mictruition
Pelvic splanchnic nerves (S2 - S4) à run through inferior hypogastric plexus to vesical plexus, surrounding the bladder.
· Stimulates micturition
· Motor to detrusor muscle
· Inhibitory to internal urethral sphincter
How do visceral afferents innervate the bladder?
Involved in sensory and pain innervation
Stimulates by overdistension of the bladder
Travel with both:
*Sympathetic fibres (superior bladder)
*Parasympathetic (inferior bladder)timulates by overdistension of the bladder
When the detrusor muscle is stretched the bladder will contract and the internal urethral sphincter relaxes and urine flows into the urethra –> We learn to overcome this reflex in toilet training
Where does the female urethra extend from?
What implications can this have clinically?
Extends from external urethreal meatus to internal urethral meatus
4cm long = More prone to UTI’s
Epithelium of urethra
*Proximal 2/3s: Transitional epithelium
*Distal 1/3rd: Stratified squamous epithelium
label what u can
What are the different parts of the male urethra?
preprostatic, prostatic, membranous, spongy urethra
what controls the external urethral sphincters
voluntary control from puedendal nerve
what is Sacralpromontory
-Sacralpromontory: articulation with lumbar vertebrae
What the clinical significance of the iliac crest?
Demarcation of L4 allows clinicians to perform lumbarpuncture
muscles of posterior abdominal wall
psoas major and illiacus fuse to form iliopoas
label what u can
What type of joint is the pubic symphysis?
secondary cartilaginous joint
What is the distal attachment of the iliopsoas?
lesser trochanter of femur
label what u can
which one is longer, right or left crus? and whta levels do they span
right is longer - L1-L3
left - L1-L2
Identify the median, medial and lateral arcuate ligaments on the diaphragm.
Observe the muscle attachments
What nerve roots from the lumbar plexus? (basiaclly main innervation of posterior abdo wall)
Ventral rami of L1-L4
Lumbar plexus nerves are formed in the psoas major muscle and branches will run through the neurovascular place (between internal oblique and transversus abdominis)
What nerve roots comprise the lumbosacral plexus?
L4-S4
(Part of anterior rami of L4 will join up with nerve of L5 to form lumbar-sacral trunk)
label what u can from lubur plexus
Iliohypogastric
Ilioinguinal
Genitofemoral
Lateral femoral cutaneous nerve of thigh
Femoral
Obturator
What is the sensory and motor innervation of the iliohypogastric nerve (L1) ?
Sensory = Post lateral gluteal skin, skin over mons pubis
Motor = IO and TA
What is the sensory and motor innervation of the ilioinguinal nerve (L1)?
Sensory = Skin in upper medial thigh, skin over root of penis and anterior scrotum or mons pubis and labia majora
Motor = IO and TA
What is the sensory and motor innervation of the genitofemoral nerve (L1-L2)?
Sensory = Genital (skin of anterior scrotum/ skin of mons pubis + labia maj)
Femoral = Skin of upper anterior thigh
Motor
(Genital) = Cremaster muscle
Label the branches of the aorta
At what level does the inferior phrenic, middle suprarenal artery, renal artery, gonadal and lumbar artery arise from?
Inferior phrenic = T12
Middle Suprarenal = L1
Renal artery = L1/L2
Gonadal = L3
Lumbar = L4
What is an aortic aneurysm?
Dilation of the blood vessel
Weakening of the aortic wall
Increase occurrence in ageing pop = Atherosclerosis, High BP, Diabetes
Identify the branches of the IVC
What is the difference between the drainage of the right and left gonadal veins?
Right = drains into the IVC
Left drains into the left renal vein
