Abdomen 9B

Question 1

Thoracic Diaphragm contains? (6)

Answer 1

Musculotendinous structure that forms “roof: of abdominal cavity Caval foramen esophageal hiatus aortic hiatus central tendon muscular portions of diaphragm

Question 2

Three openings allow IVC, esophagus and aorta to pass through

Answer 2

1. caval foramen a. most anterior opening, IVC passes through 2. esophageal hiatus a. located “between” caval foramen and aortic hiatus, esophagus passes through 3. aortic hiatus a. most posterior opening, aorta passes through

Question 3

Central Tendon contains?

Answer 3

caval foramen (IVC passes through)

Question 4

3 muscular portions of diaphragm

Answer 4

sternal part costal part lumbar part

Question 5

Sternal Part of Diaphragm

Answer 5

two small sections of muscle that attach to xiphoid process

Question 6

Costal part of Diaphragm

Answer 6

arises from inferior six costal cartilage and ribs

Question 7

Lumbar Part of Diaphragm

Answer 7

arise from lateral & medial arcuate ligaments, also arises from upper lumbar vertebrae to form right and left crura a. lateral arcuate ligament - arches over quadratus lumborum b. medial arcuate ligament – arches over psoas c. right crus – forms esophageal hiatus, contributes to aortic hiatus d. left crus - contributes to aortic hiatus

Question 8

4 Muscles of the Posterior Wall of the Abdomen

Answer 8

1. Psoas major 2. Iliacus 3. Quadratus lumborum 4. Transverse abdominis

Question 9

Nerves that are visible along the posterior abdominal wall (7)

Answer 9

1. subcostal nerve 2. lumbar plexus (L1 – L4) a. iliohypogastric nerve b. ilioinguinal nerve c. lateral femoral cutaneous nerve d. femoral nerve e. obturator nerve f. genitofemoral nerve

Question 10

Suprarenal Glands (3)

Answer 10

A. Located superior aspect of each kidney B. Surrounded by fatty tissue C. “Separated” from the kidney via renal fascia

Question 11

Internal Features of Suprarenal Gland (2)

Answer 11

1. suprarenal cortex a. secretes cortisol, aldosterone and androgens 2. suprarenal medulla a. neural tissue similar to cells of sympathetic nervous system b. secrete catecholamines (epinephrine and norepinephrine)

Question 12

4 General Features of the Kidney

Answer 12

A. Located retroperitoneal B. Each kidney approximately 4” x 2” and 1” thick C. Each kidney is “in contact” with the diaphragm and posterior wall muscles (psoas, quadratus lumborum, transverse abdominis) D. Suprarenal glands located on superior portion of each kidney

Question 13

Right Kidney (3)

Answer 13

a. upper pole located anterior to 12th rib b. located “posterior” to ascending colon and liver c. right kidney is approximately one finger width above iliac crest

Question 14

Left Kidney (2)

Answer 14

a. upper pole located anterior to 11th and 12th rib b. located “posterior” to stomach, spleen, pancreas, jejunum and descending colon

Question 15

how do Kidney’s “move” with respiration?

Answer 15

1. kidneys descend (approximately 1+ inches) with inspiration 2. can palpate right easier than left when patient takes a breath in

Question 16

Renal Capsule and surrounding fatty layers

Answer 16

1. each kidney is surrounded by layer of fibrous capsule (renal capsule or true capsule) 2. the next layer is fat known as perirenal fat which is further surrounded by a layer of thin fibrous tissue known as renal fascia (false capsule) 3. a layer of fat known as pararenal fat surrounds the renal fascia a. collagen fibers pass through this layer to help “anchor” the kidney

Question 17

Renal Hilum

Answer 17

indention on medial side of kidney 1. entrance for renal pelvis, renal artery and vein

Question 18

2 Layers of the internal kidney

Answer 18

1. cortex a. contains 1-2 million nephrons (functional “filtering” unit of the kidney) 2. medulla a. contains 5 – 10 renal pyramids…apex of pyramid is known as renal papilla

Question 19

Blood supply to kidney for filtration

Answer 19

1. renal artery 2. segmental arteries 3. interlobar arteries 4. arcuate arteries 5. radiate arteries (interlobular) 6. afferent arteries 7. glomerular capillaries…blood is filtered here in Bowman’s capsule 8. efferent arteries…blood secrete waste products into tubule for excretion here 9. vasa recta…helps to remove excessive concentration of sodium, chloride and other solutes 10. venous return eventually drains into IVC

Question 20

Collecting duct pathway of the kidney

Answer 20

1. nephrons drain into collecting tubules 2. collecting tubules drain into renal papilla 3. renal papilla drain into each minor calyces 4. 5 - 10 minor calyces drain into major calyces 5. 2 or 3 major calyces drain into renal pelvis 6. renal pelvis drains into ureter which drains into bladder a. renal pelvis is a funnel shaped “duct” that is continuous with the ureter

Question 21

Nephron consists of? (4)

Answer 21

1. Renal corpuscle 2. Proximal convoluted tubule 3. Henle’s loop 4. Distal convoluted tubule

Question 22

Renal corpuscle

Answer 22

a. juxtomedullary renal corpuscle located near junction of cortex and medulla b. cortical renal corpuscle located in cortex c. renal corpuscle is 1st site for “filtering” blood

Question 23

Proximal convoluted tubule

Answer 23

a. Passive reabsorption occurs here b. substances that have been filtered into the tubule can pass back into the blood c. 65% of H20 and sodium that were filtered into Bowman’s capsule are reabsorbed from proximal convoluted tubule d. the reabsorption occurs passively as a result of osmotic gradients in the interstitial fluid of the medulla

Question 24

Function and 2 types of Henle’s Loop

Answer 24

a. Function is to maintain a gradient of osmotic pressure in the interstitial fluid of the medulla Ascending and Descending limb of Henle’s Loop

Question 25

Descending limb of Henle’s Loop is …

Answer 25

• permeable to H20 and NOT to sodium (and other solutes) • this H20 is reabsorbed from the tubule • fluid in tubule becomes more and more concentrated as it descends

Question 26

Ascending limb of Henle’s Loop is …

Answer 26

• permeable to sodium (and other solutes) and NOT to H20 • thus sodium is reabsorbed from the tubule • fluid in tubule becomes less and less concentrated as it ascends

Question 27

In the early (first 2/3) distal convoluted tubule…

Answer 27

(i) sodium is reabsorbed (ii) H20 is NOT permeable in this section thus NOT reabsorbed (iii) Because the sodium is leaving the urine…the urine becomes very diluted as it passes through the tubule

Question 28

In the late (distal 1/3) distal convoluted tubule

Answer 28

(i) H20 is reabsorbed……ONLY if ADH (antidiuretic hormone) is present…why? 1. ADH will make this section of the distal convoluted tubule permeable to H20 2. ADH also does this in the collecting duct (ii) Now the urine starts to become concentrated again

Question 29

2 Major functions of distal convoluted tubule

Answer 29

–secretion of waste products for excretion in the urine may occur in the distal convoluted tubule –reabsorption of sodium and H20 occurs here

Question 30

Collecting Tubule

Answer 30

1. multiple nephrons will empty into the collecting tubule 2. collecting tubule will descend to the renal papilla and drain into minor calyces 3. If ADH is present H20 will be reabsorbed out of collecting tubule as urine descends a. Thus the urine continues to become more and more concentrated

Question 31

Ureters

Answer 31

A. Smooth muscular tube…25 – 30 cm long B. Descend anterior along psoas and anterior to internal iliac arteries

Question 32

Three regions of constriction…potential for kidney stone to be lodged (Ureter)

Answer 32

1. junction of renal pelvis and ureter (ureteropelvic junction) 2. as ureter passes over pelvic brim 3. as the ureter enters the bladder