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SHB > Abdomen I, II, III, IV > Flashcards

Abdomen I, II, III, IV Flashcards

1
Q

What is the peritoneum?

A

a serous membrane

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2
Q

What are the 2 layers of the peritoneum?

A

1 parietal

2 visceral

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3
Q

what is the parietal layer of the peritoneum?

A

lines the anterior, posterior, lateral walls of the abdomen

inferior surface of diaphragm and pelvic cavity

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4
Q

What is the visceral layer of the peritoneum?

A

leaves the body wall to surround the abdominal viscera

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5
Q

What is between the parietal and visceral layers?

A

the peritoneal cavity

filled with serous fluid

allows for free movement of viscera

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6
Q

What is the peritoneal cavity divided into>

A

greater sac and lesser sac (omental bursa)

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7
Q

What is the greater sac?

A

accounts most of the space of the peritoneal cavity

once you open peritoneum in the cadaver = greater sac

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8
Q

What is the lesser sac?

A

small space posterior to the lsser omentum, stomac, liver, inside the greater omentum.

continous to the greater though the omental epiploic foramen

stomach rotation and the growth of liver is the main reason of tis sac

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9
Q

How do the greater and lesser sac communicate?

A

through epiploic foramen or foramen of Winslow

can stick hand in between

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10
Q

What is the difference in the peritoneum for men and women?

A 
men = closed cavity
women = fallopian tube open into peritoneal cavity
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11
Q

What enters the peritoneum during development?

A

the gut tube

suspended from posterior abdominal wall by dorsal mesentery (double layer of pertineu,)

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12
Q

Where is the ventral mesentery found?

A

only above the umbilicus

formation of liver divides it into lesser omentum and falciform ligament

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13
Q

What are the four folds that the peritoneum leaves the posterior abdominal wall as?

A

stomach = omentum- lesser and greater omentum
small intestine= mesentary
large intestine= meso colon- mesoappendix, transverse mesocolon, sigmoid mesocolon
organ as liver or spleen= ligament- falciform ligament

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14
Q

What organs are completed covered by visceral peritoneum and so freely mobile?

A 
1 stomach
2 1st part of duodenum
3 jejunum
4 ileum
5 appendix
6 transverse colon
7 sigmoid colon 
8 liver
9 spleen
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15
Q

which organs develop to be on posterior abdominal wall (retroperitoneal)?

A

SAD PUCKER

suprarenal glands
aorta
duodenum 2nd 3rd 4th parts
pancreas
ureter
colon
kidney
esophagus
rectum
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16
Q

what is a ligament?

A

double layer of peritoneum connects an organ with another or anterior abdominal wall

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17
Q

What is mesentery?

A

double layer of peritneum result from the invagination of the peritoneum by the intestine

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18
Q

What is omentum?

A

double layer of peritoneum passing from the stomach and first part of duodenum to adjacent organs

decends as 2 layer anterior and bends to 2 layer posterior

greater omentum- greater curvatures of stomach
lesser omentum - lesser curvature of stomach

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19
Q

What are derivitives of ventral mesentary?

A 
Falciform ligament (liver and outside) 
lessor omentum (stomach/liver)
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20
Q

What nerves supply the parietal peritoneum?

A

somatic nerves of overlying muscles and skin

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21
Q

What nerve supply the visceral peritoneum?

A

autonomic nerevs with underlying viscera

NO somatic innervation (cant feel pain) 
sympathetic innervation (sensitive to stretch, tension, ischemia)
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22
Q

What are the 3 parts of the gut tube and blood supply?

A

1 foregut - celiac trunk T12
2 midgut- superior mesenteric artery L1
3 hindgut- inferior mesenteric artery L3

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23
Q

What do the celiac trunk, superior mesenteric artery, inferior mesenteric artery have in common?

A

1 single unpaired branches of abdominal aorta
2 arise from anterior surface of abdominal aorta
3 anastomose with each other

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24
Q

What organs make up the foregut?

A 
1 stomach
2 liver
3 gallbladder
4 pancrease
5 spleen
6 1st half of duodenum
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25
Q

What arteries make up the foregut?

A

celiac trunk
1 splenic
2 left gastric
3 common hepatic

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26
Q

What organs make up the midgut?

A 
1 2nd half of duodenum
2 jejunum
3 ileum
4 cecum
5 ascending colon
6 2/3 transverse colon
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27
Q

What organs make up the hindgut?

A

1 left 1/3 of transverse colon
2 descneding colon
3 sigmoid colon
4 rectum

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28
Q

What arteries make up the midgut?

A

superior mesenteric:

  • ileocolic
  • right colic
  • middle colic
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29
Q

What arteries make up the hindgut?

A

inferior mesenteric:

  • left colic
  • sigmoid branches
  • superior rectal
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30
Q

What is the most dilated part of the gut tube?

A

stomach

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31
Q

What are the 2 borders with 2 omenta of the stomach?

A

greater and lesser

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32
Q

What are the 2 sacs of the stomach?

A

greater and lesser

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33
Q

What are the 2 surfaces of the stomach?

A

anterior and posterior

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34
Q

What are the 2 ends of the stomach?

A

cardiac and pyloric

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35
Q

What are the parts of the stomach?

A

1 cardia
2 fundus
3 body
4 pylorus (antrum, canal, sphincter)

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36
Q

What is the blood supply of the stomach?

A

celiac trunk

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37
Q

What makes up the stomach bed?

A

spleen

4 left

  • left kidney
  • left suprarenal
  • left colic flexure
  • left crus of diaphragm

4 transverse

  • transverse colon
  • transverse mesocolon
  • body of pancreas
  • splenic artery
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38
Q

What is the lesser omentum?

A

vental mesentery

double layer of peritoneum

extends from porta hepatis of liver to lesser curvature of stomach and 1st part of duodenum

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39
Q

What ligaments make up the lesser omentum?

A

hepatogastric and hepatoduodenal ligaments

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40
Q

What are the 3 structures at the free border of the lesser omentum?

A

1 bile duct
2 hepatic artery
3 portal vein (behind both)

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41
Q

What is the greater omentum?

A

dorsal mesentery

double layer of peritoneum hangs down from the greater curvature of stomach covering the transverse colon and other abdominal viscera

policeman of the abdomen

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42
Q

What ligaments make up the greater omentum?

A

1 gastrosplenic
2 gastrophrenic
3 gastrocolic
4 lienorenal (splenorenal)

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43
Q

What is the largest gland in the human body?

A

liver (derivitive of foregut)

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44
Q

What is the blood supply of the liver?

A

hepatic artery proper of celiac trunk

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45
Q

What area of the liver is not covered by peritoneum>

A

the bare area

between the upper and lower layers of corony ligaments

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46
Q

What are the five peritoneal ligaments of the liver?

A 
1 coronary
2 falciform
3 right triangular 
4 left triangular
5 lesser omentum
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47
Q

What are the 5 surfaces of the liver?

A 
1 right
2 anterior
3 posterior
4 superior 
5 inferior (visceral)
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48
Q

What are the 5 fissures of the liver?

A

H shaped

1 fissure for ligamentum venosum - ductus venosus
2 fissure for ligamentum teres (round lig) - oblitered umbilical vein
3 fossa of gall bladder
4 fissure for IVC
5 porta hepatis

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49
Q

Where does porta hepatis lie?

A

transveresely between quadrate and caudate lobes

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50
Q

How are the vessels arranged in the porta hepatis?

A

VAD (posterior to anterior)

portal Vein
hepatic Artery
hepatic Duct

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51
Q

What are the 4 lobes of the liver?

A

1 right
2 left
3 caudate
4 quadrate

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52
Q

What do the 4 lobes of the liver anatomically do?

A

falciform ligament, fissure for ligamentum teres and venosum = divide the liver into right anatomical lobe (contain the caudate and quadrate)

and left lobe

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53
Q

What do the 4 lobes of the liver functionally?

A

fossa of gallbladder and IVC- divide into right lobe and left functional (contain the caudate and quadrate lobe)

division based on blood supply

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54
Q

What is the significance of the right and left lobe division?

A

caudate and quadrate

right anatomical lobe contains caudate and quadrate but LEFT lobe functionally supplies their blood

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55
Q

What is the blood supply of the liver?

A

hepatic proper artery and portal vein
each divides to right and left branches

left hepatic artery and left branch of portal vein

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56
Q

What is the venous supply of the liver?

A

blood sinusoids- central veins- hepatic veins- IVC

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57
Q

What is the physiological breakdown of blood and oxygen supply to the liver?

A

hepatic artery = 25% blood and 50% oxygen

portal vein = 75% blood and 50% oxygen

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58
Q

What is the biliary system?

A

right and left hepatic ducts
common hipatic duct
gall bladder
common bile duct

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59
Q

What is the sphincer of oddi?

A

layer of circular muscle surrounding the lower end of the bile duct, pancreatic duct, and ampulla

controls the flow of bile and pancreatic secretions

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60
Q

What are the 3 parts of the gall bladder?

A

1 fundus
2 body
3 neck

drained by cystic duct

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61
Q

What is the fundus of the gall bladder?

A

meeting point between right linea semilunaris and 9th right costal cartilage

ACUTE INFLAMMATION: site of maximum tenderness

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62
Q

What is the body of the gall bladder?

A

lies in the gall bladder fossa on the inferior surface of the liver

stores bile acids

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63
Q

What is the neck of the gall bladder?

A

posteromedial wall with Hartmann’s pouch

GALL STONES common site

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64
Q

What is the blood supply of the foregut?

A

celiac trunk

the first unpaired branches of the abdominal aorta at level of T12 (very very short)

divides into 3

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65
Q

What are the 3 branches of the celiac trunk?

A
  1. left gastric (upwards)
  2. splenic (left tortuous)
    3 common hepatic (right)
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66
Q

Where does the left gastric artery run?

A

enters lesser omentum

branches to esophagus and stomach

ends by anastomosing with right gastric artery at lesser curve of stomach

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67
Q

Where does splenic artery run?

A

along superior border of pancreas

ends in lienorenal ligament

branch to spleen and pancreas

branch to stomach = short gastric and left gastroepiploic = both in gastrosplenic ligament

68
Q

What does left gastroepiploic anastome with?

A

right gastroepiploic at greater curvature of stomach

69
Q

What structures does common hepatic branch to?

A

stomach
duodenum
liver

70
Q

What does the common hepatic branch?

A

common hepatic -> gastroduodenal, superior pancreaticoduodenal, right gastromental

hepatic proper -> right gastric

right and left hepatic -> cystic artery branch of right hepatic A to the gall bladder

71
Q

where does supraduodenal atery come from?

A

branch of common hepatic that could come from gastroduodenal or hepatic artery proper

72
Q

What is the spleen?

A

large lymphoid organ related to hematopoiesis

73
Q

Where is the spleen?

A

between stomach and left kidney

connected by gastrosplenic (stomach) and lienorenal (kidney) ligaments

74
Q

What are the two surfaces of the spleen?

A
  1. diaphragmatic- separates it from left lung and 9th 10th 11th ribs
  2. visceral - contain the hilum which transmits splenic vessels and gives attachment to gastrosplenic and lienorenal ligaments
75
Q

what is the blood supply for the spleen?

A

celiac trunk -> splenic artery (tortuous for distension of stomach)
splenic vein -> inferior mesenteric vein IMV and unites with superior mesenteric vein SMV -> portal vein

76
Q

What is the longest part of the GIT?

A

the small intestine

etends from pylorus of stomach to ileocecal junctionq

77
Q

What makes up the small intestine?

A

duodenum
jejunum
ileum

78
Q

What is the relationship between the duodenum and the pancreas?

A

duodenum is C shaped tube surrounding head of pancrease

pancreas is in the C

both are at junction between foregut and midgut (celiac trunk and SMA)

79
Q

What is the duodenum?

A

first part of small intestine

extends from pylorus to duodenojejunal flexure

C shaped

shortest, widest, most fixed part of the small intestine

retroperitoneal except for beginning connected t iver by hepatoduodenal ligamment of lesser omentum

80
Q

What are the 4 parts of the duodenum?

A

1st - superior = lies anterolateral to L1. 1st inch attached to greater and lesser omenta like stomach (intraperitoneal) but rest is retroperitoneal. called duodenal cap

2nd- descending= right of L2-L3. receives major duodenal papilla and minor duodenal papilla. bile and pacreatic ducts empty

3rd- inferior= horizntal anterior to L3. crossed by the SMA and SMV

4th- ascending= ascends to left of L3 and L2. ends at duodenojejunal flexure where its tethered by suspensory ligament of duodenum (ligament of Treitz)

81
Q

Where are duodenum ulcers?

A

at the duodenal cap = 1st part of duodenum

82
Q

What is the pancreas?

A

elongated gland with endocrine (insulin and glycogen) and exocrine function (digestive enzymes)

across the posterior abdominal wall from the duodenum to the spleen

retroperitoneal organ except tail which is in the lienorenal ligament

83
Q

What are the four parts of the pancreas?

A

head- lies within C shaped concavity of the duodenum. SMA and SMV pass anterior to it

neck- anterior to beginning of the portal vein where splenic vein and SMV join to form portal vein

body- forms major portion of the stomach bed-splenic artery along upper border and splenic vein posterior

tail- ends in splenorenal (lienorenal) ligament at hilum of spleen

84
Q

What are the 2 ducts of the pancreas?

A

main pancreatic duct (wirsung)

accessory pancreatic duct (santorini)

85
Q

What does the main pancreatic duct drain?

A

the tail
body
neck
upper part of head

joins bile duct to form a short tube called hepatopancreatic ampulla

opens at 2nd part of duodenum

86
Q

what does the accessory pancreatic duct drain?

A

uncinate process and lower part of the head

opens at minor papilla

87
Q

Where does the jejunum and ileum run?

A

begins at duodenojejunal flexure
ends at ileocecal junction

completely covered by peritoneum

88
Q

What is the shape of the jejunum and ileum?

A

fan shaped

2 borders

  • attached border- crosses 3rd part of duodenum, aorta, IVC, right ureter, right psoas major
  • free border = encloses loops of jejunum and ileum

supplied by SMA

89
Q

What are the most important differences between the jejunum and ileum?

A

fat: jejunu, less // ileum more
color: jejunum deep red // ileum pink
vascular: jejunum more // ileum less
Lymphoid: jejunum few// ileum many

90
Q

Where does the large intestine run?

A

extends from caecum to anal canal
surrounds small intestine

includes cecum with appendix, colon, rectum, anal canal

91
Q

what is the blood supply of the large intestine?

A

SMA and IMA

92
Q

What are the appendices epiploicae of the large intestine?

A

small pouches filled with fat

absent in Cecum, Appendix and Rectum (CAR)

93
Q

What are the taeniae coli of the large intestine?

A

outer longitudinal muscle layer thickened to form 3 shorter bands

begin at base of appendix and end at sigmoid colon

94
Q

What are the saccultations (Haustra) of the large intestine?

A

between the taeniae coli and the colon bulges outwards forming 3 rows of pouches

95
Q

What is the cecum?

A

blind sac in the right iliac fossa superiorly continous with the ascending colon and medially receives the opening of the ileum and appendix

96
Q

What is the ileocecal valve?

A

guards the ileal opening into the cecum

If obstruction of SMA the arcade will keep supplying blood

has 2 lips

opening of the appendix lies 2 cm below it

97
Q

What is the appendix?

A

blind ending tube

rich in lymphoid tissue

suspended by mesoappendix

3 taeniae coli meet at the base of the appendix

retrocecal is common position

98
Q

what is the landmark for the appendix?

A

taeniae coli

99
Q

what is acute appendicitis?

A

acute inflammation of the appendix due to viral or bacterial infection

may result in thrombosis of the appendicular artery (from ileocolic artery) can lead to perforation of the appendix

right iliac fossa pain = differential diagnosis for appedix

Most have retrocecal appendix, second most common = pelvic

Rupture appendix = all contents of appendix will go over all of peritoneum

100
Q

What is McBurney;s point?

A

point of maximum tenderness in acute appendicitis

lies opposite the junction of lateral and middle thirds of a line joining the rt ASIS to the umbilicus

line from belly button to right inferior medial 2/3 and lateral 1/3

pain enter sinal cord through T10 segment

101
Q

What is Meckel’s diverticulum?

A 
2 feet from IC valvve
2 inches long
2% population
2% symptomaitc
2 types of ectopic tissue (gastric and pancreatic)
2 years of age at clinical rsenation
2 x more common in boys

remanent from vitalion duct

gives same symptoms as acute appendicitis

102
Q

What are the parasympathetics of the GIT?

A

+ peristalsis and - sphincters

foregut and midgut = vagus
hindgut = pelvic splanichnic nerves (paraympathetic sacral outflow S2,3,4)
- preganglionic, will relay in terminal ganglia of their organs

103
Q

What are the sympathetics of the GIT?

A
  • peristalsis and + sphincters

foregut and midgut- thoracic splanichnic nerves
- greater T5-T9 and lesser T10-T11 and least T12

hindgut- lumbar splanichnic nerves- abdominal part of sympathetic trunks
lumbar sympathics give off 3-4 lumbar splanichnic nerves
presynmaptic sympathetic

104
Q

What is the arterial supply of the midgut?

A

superior mesenteric artery SMA

  • runs downward to right iliac fossa
  • jejunal and ileal branches 12-15 branch to the left
105
Q

What are the branches of the SMA?

A 
1 inferior pancreaticoduodenal- 1/2 duodenum and pancreas
2 middle colic - right 2/3 of transverse colon
3 right colic- ascending colon
4 ileocolic- cecum and appendix
 - anterior cecal artery
- posterior secal artery
- appendicular artery
- ileal artery
106
Q

Where do the jejunal and ileal branches run?

A

in the mesentery

branch and anastomose to form series of arcades that send arteries to the intestine (vasa recta)

107
Q

What is the artery of the hindgut?

A 
inferior mesentric artery IMA
-unpaired branches of abdominal aorta at L3
down to LEFT iliac fossa
behind 3rd part of duodenum
crosses left common iliac artery 
becomes superior rectal artery

all three branches to the left

108
Q

What are the 3 branches of the IMA?

A

1 left colic- left 1/3 transverse colon and upper descending colon

2 sigmoid arteries (2-3) - lower of descneding colon and sigmoid colon

3 superior rectal- sigmoid colon and rectum

109
Q

What is the marginal artery?

A

arterial arcade along the colon

it interconnects the right , middle, left colic

110
Q

What is the portal vein?

A

blood collected from intestinal capillary bed passes through portal vein then through liver sinusoids (2n capillary bed)

to IVC

Between 2 sets of capillaries

111
Q

How does the portal vein begin and end?

A

as a VEIN (union of SMV and splenic vein)

ends as an ARTERY (divides into 2 branches right and left)

75% blood supply and 50% oxygen for liver

112
Q

What does the portal vein drain?

A

blood from the GIT tract, pancreas, spleen, gallbaldder to the liver

hepatic veins -> IVC

113
Q

where does the portal vein begin?

A

neck of pancreas by union of SMV and splenic vein

114
Q

Where is portal vein?

A

always posterior

most posterior structure in VAD at porta hepatis

115
Q

What are the major tributeries of portal vein?

A

superior mesenteric vein (SMV)
-veins similar to SMA branches and right gastroomental vein

splenic vein
- veins similar to splenic artery and IMV from hind gut

right and left gastric veins

cystic vein
- drain into right branch

paraumbilical veins
- drain to left branch

116
Q

What are the most important sites of portal-caval systemic anastomoses?

A

1 left gastric vein and the esophgeal vein of the azygos venous system

2 superior rectal vein and middle and inferior rectal veins

3 paraumbilical veins and radicles of the superficial epigastric veins

117
Q

What is liver cirrhosis?

A

progressive liver fibrosis

disrupts the portal blood flow leading to portal hypertension

  1. esophageal varices- hematemesis (puke blood)
  2. rectal varices - hemorrhoids (ass bleeding)
  3. caput medusae- varicose veins from umbilicus (medusa snake shit on your bellybutton)
118
Q

What are the layers of the posterior abdominal wall?

A

from posterior to anterior

1 bony layer
2 msucles
3 fascia
4 viceral layer
5 partial periotoneal layer
119
Q

What is in the bony layer of the posterior abdominal wall?

A

iliac bone (iliac fossa, crest) lumbar vertebrae last 2 ribs

120
Q

What is in the muscle layer of the PAW?

A

psoas major
psoas minor
iliacus
quadratus lumborum

fascia with same names

121
Q

What is in the visceral layer of the PAW?

A 
kidneys
ureters
suprarenal glands
abdominal aorta 
IVC (retroperiotoneal structures)
122
Q

Where is the lumbar plexus?

A

formed inside the psoas major

branches related to PAW muscles

123
Q

Iliacus

A

origin: superior 2/3 iliac fossa, ala of sacrum, anterior sacroiliac ligaments
insertion: lesser trochanter of femur and shaft inferior to it and to psoas ajor tendon
innervation: femoral nerve
action: flexes hip and stabilizes hip join, acts with psoas major

124
Q

Psoas major

A

origin transverse proesses of lumbar vertebrae, sides of bodies of T12-T5 vertebrae, interveming intevetrebral discs

insertion lesser trochanter of femur

innervation ventral rami of first four lumbar nerves

action acting superiorly with iliacus, flexes hip, acting inferiorly flexes vertebral column laterally, used to balance trunk in sitting position, actuing inferiorly with iliacus flexes trunk

125
Q

Psoas minor

A

origin vertebral margins of T12-L1 vertebrae, corresponding intervertebral disc

insertion pectinlea line, iliopectineal eminence

innervation ventral rami of first lumbar nerve

action flexes pelvis on vertebral column

126
Q

Qudratus lumborum

A

origin medial half o inferior border of 12th rib , tips of lumbar transverse processes

insertion iliolumbar ligament, inernal lip of iliac crest

innervation ventral rami of T12 and first four lumbar nerves

action extends and laterally flexes vertevral column, fixes 12th rib during inspiration

127
Q

What is the diaphragm?

A

chief muscle of respiration

fibromuscular partition between thorax and abdomen (umbrella)

right and left copula (right higher b/c liver)

central tendon = insertion of diaphragm

supplied by phrenic nerve C3 4 5

128
Q

What is the origin of the diaphragm?

A 
1 sternal part = xiphoid process
2 costal part = lower 6 costal cartilages
3 vertebral (lumbar) part - 2 crura and 5 ligaments
129
Q

What are the lumbar parts of the diaphragm?

A

1 right crus

  • larger, longer, stronger than left and arsies from bodies of upper 3 lumbar vertebrae
  • some fibers run up to form the esophageal hiatus by encirculing esophagus
  • others run down to form suspensory legament of duodenum

2 left crus
- arsies from bodies of upper 2 lumbar vertebrae

3 median arcuate ligament
- unites crura across aorta- forms aortic hiatus

4 medial arcuate ligament
- tendinous arch across upper part of psoas major

5 lateral arcuate ligament
-tendinous arch across the quadratus lumborum

130
Q

What forms the esophageal hiatus?

A

right crus

131
Q

What forms the suspensory ligament of duodenum?

A

right crus

132
Q

What forms the aortic hiatus?

A

median arcuate ligamemt

133
Q

What arch crosses the psoas major?

A

medial arcuate ligament

134
Q

What arch crosses the quadratus lumborum?

A

lateral arcuate ligament

135
Q

What are the openings of the diaphragm?

A

I 8 (ate) 10 Eggs At 12 (noon)

caval hiatus - IVC T8
esophageal hiatus- esophagus T10
Aortic hiatus- aorta (thoracic duct, azygos vein, greater splamicmic nerve) T 12

136
Q

Where is the lumbar plexus?

A

nerve plexus L1, 2, 3, 4

formed inside the psoas major

137
Q

What are the branches of the lumbar plexus?

A

1 subcostal nerve T12
2 iliohypogastric nerve L1
3 ilioinguinal nerve L1

All run in front of quadratus lumborum
pierce transverse abdominal muscle
run between it and internal oblique muscle

138
Q

What structure do iliohypogastric nerve and ilioinguinal nerve pierce?

A

internal oblique to run between it and external oblique

139
Q

What nerve accompanies the spermatic cord (or round ligament in uterus)?

A

ilioinguinal nerve

travels through inguinal canal and emerges through superficial inguinal ring

140
Q

Where is genitofemoral nerve?

A

L1 and L2

emerges on front of psoas muscle and descends on its anterior surface

genital branch enters inguinal canal and deep inguinal ring to spermatic cord

femoral branch supplies skin of femoral triangle

141
Q

Where is lateral femoral cutaneous nerve?

A

L2,3

runs in front of iliacus
comes from lateral side of psoas muscle

142
Q

Where is femoral nerve?

A

L2,3,4

emerges from lateral border of psoas major and descends int the groove between the psoas and iliacus

enters femoral triangle

143
Q

where is obturator nerve?

A

L2,3,4

descends along the medial border of the psoas muscle

runs forward on lateral wall of pelvis to thigh

144
Q

Where is the kidney?

A

Retroperitoneal organ on PAW opposite T12 to L3 vertebrae

right kieny lower than left becuase of liver

right kidney related to rib 12

left kidney related to ribs 11 and 12

hilum on medial border

145
Q

What goes through hilum of kidney?

A

anterior to posterior

VAP

renal Vein, renal Artery, Pelvis of ureter

146
Q

What is the strucuture of the kidney?

A

1 cortex- outer part and renal columns
2 medulla- inner party with pyramids and renal papilla apex
3 minor calyces - receive urine and emopy to major calyces

147
Q

What are the functional and anatomic units of the kidney?

A

nephrons

148
Q

what is the flow of urine in the kidney?

A

1 urine received by minor calyces
2 empty to major calyces
3 empty to renal pelvis of ureter

149
Q

What is the blood supply of the kidney?

A

renal arteries from abdominal aorta near L2

RIGHT renal is LONGER and passes posterior to IVC

gives inferior suprarenal artery before hilum then divides into 5 segemntal artries

150
Q

Where do the left and right renal veins open?

A

directky into IVC

151
Q

What is special about the left renal vein?

A

longer than right
passes anterior to aorta before orgin of SMA

receives 3 veins
1 left suprarenal vein
2 left gonadal vein
3 may give rise to inferior hemiazygos vein

152
Q

What is the ureter?

A

retroperitoneal muscular tube that begins with renal pelvis

extends from kidney to urinary bladder

153
Q

What are sites of constriction of ureter?

A

kidney stomes (renal calculi)

1 uretero-pelvic junction = joins renal pelvis

2 pelvic inlet = crosses pelvic brim over distal end of common iliac artery

3 ureterovesicular junction = enters wall of urinary bladder (narrowester point)

154
Q

What is the suprarenal gland?

A

retroperitoneal organ on the superomedial pole of the kidney

pyramidal on the the right and semilunar on the left

155
Q

What does the suprarenal gland produce?

A

3 steroids in cortex

medulla secrets epinephrine and norepinephrine

156
Q

What is the blood supply of the suprarenal gland?

A

1 superior suprarenal artery from the inferior phrenic artery

2 middle suprarenal artery from abdominal aorta

3 inferior suprarenal artery from the renal artery

drained via suprarenal vein - IVC on the RIGHT and LEFT renal vein on the left

157
Q

Where does the abdominal aorta bifurcate?

A

becomes left and right common iliac arteries anterior to L4

158
Q

What are the single branches of the abdominal aorta?

A

Celiac
SMA
IMA

all to gut tube

median sacral artery- fromback of aorta to sacrum for rectum and anal canal

159
Q

What are the paired branches of the abdominal aorta?

A 
inferior phrenic (diaphragm)
middle suprarenal and renal (kidney)
gonadal 
lumbar arteries
common iliac arteries (terminal branches)
160
Q

Where is the IVC?

A 
right side of L5
union of two common iliac veins
below bifurfactoin of aorta
longer than abdominal aorta 
to right of aorta
161
Q

What does the IVC recieve?

A

right gonadal and right suprarenal veins

(left side drained by left renal vein)

right and left renal veins
3rd and 4th lumbar veins 
inferior phrenic veins
hepatic veins
azygos vein (back of IVC at L2)
162
Q

Where does the left renal vein run?

A

posterior to the superior mesenteric artery and anterior to the abdominal aorta

163
Q

What is the cisterna chyli?

A

dialated lymphatic sac at the end of the thoracic duct

just right and posterior to aorta

formed by intestinal and lumbar lymph trunks

gives throacic duct

164
Q

Where does the thoracic duct drain?

A

between left subclavian and internal jugular vein

165
Q

Where is it common to get reflux?

A

Very easy to get reflux if weak lower esophageal end

166
Q

What does the portal vein not have?

A

Celiac trunk but NO celiac vein NO gastroduodenum

Diameter of portal = huge compared to any other vein in body- second after inferior vena cava

SHB (22 decks)

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