Abdomen - Lecture 4 Flashcards
Retroperitoneal
Posterior to the Peritoneal Cavity
What are the most notable Retroperitoneal Viscera?
- Kidneys
- Adrenal Glands
- Aorta
- Inferior Vena Cava
- Lymphatic Channels
- Nerves
What bones are located in the Posterior Wall of the Abdomen?
- Floating Ribs (11 and 12)
- Lumbar Vertebrae (L1-L5)
- Sacrum (5 fused bones)
- Pelvic Bones (Iliac Fossa and Iliac Crests)
What are the Muscles of the Posterior Wall of the Abdomen?
- Diaphragm (inserts L1-L3)
- Psoas Major (hip flexor from Lumbar spine to femur)
- Psoas Minor (in 50% of people)
- Quadratus Lumborum
- Iliacus (hip flexor from Iliac Fossa to Femur)
What muscle do the kidneys sit on top of?
Quadratus Lumborum
What muscles make up the Iliopsoas?
- Iliacus
- Psoas Major
* *3. Psoas Minor (if present)
Where does the Psoas Major Originate?
- Lateral Surfaces and Intervertebral Discs of T12-L5 Vertebrate
- Transverse Processes of L1-L5
Where does the Psoas Major Insert?
Lesser Trochanter of the Femur
Where nerves Innervate the Psoas Major?
Ventral Rami L1-L3
What action does the Psoas Major perform?
- Hip Flexion
2. Stabilizing Lumbar Vertebrate in relation to our posture
Which muscle in the abdominal cavity do only 50% of people have?
Psoas Minor
Where does the Psoas Minor originate?
Lateral Surfaces and Intervertebral Discs between of T12-L1
Where does the Psoas Minor insert?
- Pelvic Brim
2. Iliopubic Eminence
What nerves innervate the Psoas Minor?
Ventral Ramus of L1
What action does the Psoas Minor perform?
Weak Flexion of Lumbar Vertebral Column
Explain lower back pain from constantly sitting
- Sitting a lot means passive flexion
- Psoas muscle starts to shorten
- Shortened Psoas muscle means that it is weaker and pulls on its insertion in the Lumbar Vertebrae
Where does the Iliacus originate?
Mostly the Iliac Fossa, but also:
- Anterior Sacro-, Iliac, and Iliolumbar Ligaments
- Upper lateral surface of the Sacrum
Where does the Iliacus insert?
Lesser Trochanter of the Femur
What nerves innervate the Iliacus?
The Femoral Nerve (Ventral Rami L2-L4)
What action does the Iliacus perform?
Hip Flexion
What muscles make up the Hip Flexors?
Iliopsoas muscles:
- Psoas Major
- Iliacus
* *3. Psoas Minor (if present)
Where does the Quadratus Lumborum originate?
It originates INFERIORLY:
- Transverse process of L5
- Iliolumbar Ligament
- Iliac Crest
Where does the Quadratus Lumborum insert?
It inserts SUPERIORLY:
- Transverse Processes of L1-L4
- Rib 12
What nerves innervate the Quadratus Lumborum?
Ventral Rami T12-L4
What actions do the Quadratus Lumborum perform?
- Creates Posterior Body Wall
- Depress and Stabilize Rib 12
- Lateral Flexion of Trunk
What Tendinous structures attach the diaphragm to the skeleton?
- Right Crus
- Left Crus
3.
Where does the Right Crus attach?
- Diaphragm
2. L1-L3 Vertebral Bodies and Intervertebral Discs
Where does the Left Crus attach?
- Diaphragm
2. L1-L2 Vertebral Bodies and Intervertebral Discs
What structures pass through the diaphragm at the Aortic Hiatus and where is it located?
“Aorta AV TDs by T12”
- Located at T12 Vertebrate
- Aorta
- Azygos Vein
- Thoracic Duct
What Tendinous structure does the Esophagus pass through in the diaphragm?
A “sleeve” of the Right Crus
What structures pass through the diaphragm at the Esophageal Hiatus and where is it located?
“EVN 10”
- Located at T10
- Esophagus
- Vagus Nerve (Anterior and Posterior Vagal Trunks)
- Esophageal Branches of Left Gastric Artery and Vein along with some Lymphatic Vessels
What structures pass through the diaphragm at the Caval Opening and where is it located?
“PNI8ed”
- Located at the Central Tendon (T8)
- Inferior Vena Cava
- Right Phrenic Nerve
Which diaphragmatic opening is the only one to pass through muscle instead of a tendinous opening and why?
Esophageal Hiatus is the only one to pass through muscle because the other opening have blood vessels that you NEVER want to collapse
What has lower pressure, arteries or veins?
Veins
Which diaphragmatic openings are not able to collapse and why?
Aortic Hiatus and the Caval opening because they are held open by connective tissue and not muscle
What is the Median Arcuate Ligament?
Connective tissue between the Right Crus and Left Crus that holds the diaphragm open around T12 for the Aorta to pass through
What is the Medial Arcuate Ligament?
Very small Bilateral arches of connective tissue lateral to the Right Crus and Left Crus that hold the diaphragm open for the Psoas Major to pass through
What is the Lateral Arcuate Ligament?
Large bilateral arches of connective tissue that attach the diaphragm to Rib 12
What Viscera (organs) of the Urinary System are located on the posterior body wall?
- Kidneys
- Ureters
- Bladder
- Urethra
What is the function of the Kidneys?
- Filter Blood
2. Make Urine
What is the function of the Ureters?
Connection between Kidneys and Bladder to transport Urine
What is the function of the Bladder?
Storage of urine prior to excretion
What is the function of the Urethra?
Passageway of urine from bladder to outside that varies greatly between men and women
Where are the Kidneys located?
- Retroperitoneal
- Lateral to the vertebral column
- Extend from T12-L3 Vertebra
Which kidney sits lower and why?
Right Kidney because of the Liver
Which kidney is longer and more slender?
Left Kidney
What structures come in contact with the Right Kidney anteriorly?
Top-Down Order:
- Right Adrenal Gland
- Liver
- Descending part of Duodenum
- Transverse Colon (Right Colic Flexure)
- Small Intestine
What structures come in contact with the Left Kidney anteriorly?
Top-Down Order:
- Left Adrenal Gland
- Stomach
- Pancreas
- Spleen
- Transverse Colon (Left Colic Flexure)
- Descending Colon
- Jejunum
What structures come in contact with the Right Kidney posteriorly?
- Rib 12
- Diaphragm
- Psoas Major
- Quadratus Lumborum
- Transversus Abdominis
What structures come in contact with the Left Kidney posteriorly?
- Rib 11
- Rib 12
- Diaphragm
- Psoas Major
- Quadratus Lumborum
- Transversus Abdominis
What are the names of the Renal fat layers?
- Perinephric Fat
2. PerAnephric Fat
Perinephric Fat
- Directly surrounds Kidneys and the Adrenal Glands
2. Surrounded by Renal Fascia
What is the Renal Fascia?
- Extraperitoneal Fascia
- Superficial to the Perinephric Fat and the Aorta and IVC
- Deep to the Paranephric Fat
Paranephric Fat
- Superficial to the Renal Fascia
2. Posterior and Posterolateral to the Kidneys and Adrenal Glands
What is the outer region of the Kidney called?
Renal Cortex
What is the inner region of the Kidney called?
Renal Medulla
What extensions of the Renal Cortex stretch into the Renal Medulla?
Renal Columns
Where is the Loop of Henle located?
Renal Pyramid
Where are Collecting Ducts found?
Renal Pyramids
What is the tip of the Renal Pyramids called?
Renal Papilla
Where do the Collecting Ducts converge?
Renal Papilla
Describe the pathway of Urine
- Renal Papilla
- Minor Calyx
- Major Calyx
- Renal Pelvis
- Ureter
- Bladder
What is the Hilum of the Kidney?
- Entry point of Renal Artery
- Exit Point of Renal Vein
- Exit point of the Ureter
Where do the Renal Arteries come from?
Branch off of the Abdominal Aorta just below the SMA
Which Renal Artery is slightly higher?
Left Renal Artery because the Left Kidney sits higher
Which Renal Vein is longer and why?
Left Renal Vein is longer because it passes under the SMA to drain into the IVC
What is Nutcracker Syndrome?
If the Aorta or SMA has an aneurysm, the bulging causes blockage of the Right Renal Vein
What innervates the Kidneys?
Renal Plexus
What is responsible for Lymphatic Drainage of the Kidneys?
Lateral Aortic Nodes AKA Lumbar Nodes
-lymph nodes along the aorta
Where are the Adrenal Glands located?
Superior and Medial to the Kidneys
What actions do the Adrenal Glands perform?
Make hormones such as Epinephrine, Cortisol, and Aldosterone
What arteries provide blood to the Adrenal Glands?
- Superior Suprarenal Arteries
- Middle Suprarenal Arteries
- Inferior Suprarenal Arteries
Where do the Superior Suprarenal Arteries come from?
They branch off of the Inferior Phrenic Arteries that come directly off of the Abdominal Aorta just above the Celiac Trunk
Where do the Middle Suprarenal Arteries come from?
Directly from the Abdominal Aorta close to the SMA
Where do the Inferior Suprarenal Arteries come from?
Branch off of the Renal Artery
What are the Ureters?
Retroperitoneal Muscular tubes with collapsible lumen that transport urine from the Kidneys to the Bladder for storage
What are the Constriction Points of the Ureter?
- Uretopelvic Junction (where Renal Pelvis narrows and becomes Ureter)
- Pelvic Brim (where it crosses the Common Iliac Arteries)
- Where Ureter enters Bladder (Posterior portion of the Bladder)
What artery provides blood to the Upper End of the Ureter?
Renal Arteries
What artery provides blood to the Middle of the Ureter?
- Aorta
- Testicular/Ovarian Arteries
- Common Iliac Arteries
What artery provides blood to the Pelvic End (Inferior Portion) of the Ureter?
Internal Iliac Arteries
What nerves innervate the Ureters?
Compilation of Plexuses:
- Renal Plexus
- Aortic Plexus
- Superior Hypogastric Plexus
- Inferior Hypogastric Plexus
Where is the bladder located?
When empty: entirely in the Pelvis
When full: Pelvis and the Abdomen
Base of the bladder is shaped like
An inverted triangle
What is the Trigone?
A smooth triangular area of Smooth Muscle between the Ureter openings and the Internal Urethra Orifice
What is the Urethra?
A pathway that begins at the base of the bladder and extends out of the perineum as a means to expel urine
What are the sphincters of the Urethra?
Internal Urethral Sphincter (Pons controlled)
External Urethral Sphincter (Skeletal Muscle)
How long is the female Urethra?
About 4 cm
How long is the male urethra and what are the names of its parts?
About 20 cm long
- Pre-Prostatic (Bladder becoming Urethra)
- Prostatic (passes through Prostate)
- Membranous (Passes through the External Urethral Sphincter)
- Spongy (longest and passes through erectile tissue of the penis)
What are the functions of the Male Urethra?
- Urinary (Expels Urine)
2. Reproductive (Expels Semen)
What are the UNPAIRED branches of the Abdominal Aorta?
- Celiac Trunk (Foregut)
- Superior Mesenteric Artery (Midgut)
- Inferior Mesenteric Artery (Hindgut)
What are the PAIRED branches of the Abdominal Aorta?
- Inferior Phrenic Artery (Diaphragm)
- Middle Suprarenal Artery (Adrenal Glands)
- Renal Artery (Kidneys)
- Gonadal Artery (Ovary/Testis)
- Lumbar Artery (Posterior Abdominal Wall)
- Median Sacral Artery (Sacrum and Coccyx)
- Common Iliac Artery (Lower Abdominal Wall, Pelvis, Lower Limb)
Where does the Middle Sacral Artery supply blood to?
- Sacrum
2. Coccyx
Where does the Common Iliac Artery supply blood to?
- Lower Abdominal Wall
- Pelvis region
- Lower limbs
Name the branches that come off of the Abdominal Aorta from Superior to Inferior
- Inferior Phrenic Arteries
- Celiac Trunk
- Middle Suprarenal Arteries
- Superior Mesenteric Artery
- Renal Arteries
- Gonadal Arteries
- Lumbar Arteries
- Inferior Mesenteric Artery
- Median Sacral Artery
- Common Iliac Artery
What arteries come together to form the Median Sacral Artery?
Lumbar Arteries
Common Iliac Arteries branch into
- Internal Iliac (provides Pelvis and Posterior Abdominal Wall)
- External Iliac (becomes Femoral Artery and provides lower limb with blood)
What Abdominal Veins drain DIRECTLY into the IVC?
- Common Iliac Veins
- Lumbar Veins (drains 3rd and 4th Lumbar Vertebra)
- Iliolumbar Vein (drains 5th Lumbar Vertebrate)
- Ascending Lumbar Veins (drain 1st and 2nd Lumbar Vertebra)
- Right Gonadal Vein
- Renal Veins (also drains Left Gonadal and Left Suprarenal Veins so they don’t have to pass over the Aorta)
- Right Suprarenal Veins
- Inferior Phrenic Veins
- Hepatic Veins
Why don’t the Left Gonadal Vein and the Left Suprarenal Veins drain directly into the IVC?
On the left side, the Left Gonadal Vein and the Left Suprarenal Vein would have to pass over the Aorta, so to avoid this pressure difference they empty into the Left Renal Vein
What is the Lymphatic Drainage of the Posterior Abdominal Wall?
Both below drain into the Thoracic Duct
- Pre-Aortic Nodes
- Right and Left Lateral Aortic/Lumbar Nodes (along the Common Iliac Arteries)
Does a Plexus carry Sympathetic or Parasympathetic Fibers?
BOTH
Name the Abdominal Prevertebral Plexuses
- Celiac Plexus
- Aortic Plexus
- Superior Hypogastric Plexus
What kind of fibers are in the Abdominal Prevertebral Plexuses?
- Sympathetic Pre-Ganglionic Fibers (Efferent)
- Parasympathetic Pre-Ganglionic Fibers (Efferent)
- Visceral Afferent Fibers ( Organ Sensory)
Name the Abdominal Prevertebral Ganglia
- Celiac Ganglion
- Superior Mesenteric Ganglion
- Aorticorenal Ganglion
- Inferior Mesenteric Ganglion
* *Also the Lumbar Splanchnics and Sympathetic Trunk run here**
What controls Parasympathetics in the Abdomen?
- Vagus Nerve
2. Pelvic Splanchnic Nerves
What controls Sympathetics in the Abdomen
- Thoracic Splanchnics (Greater, Lesser, Least)
- Lumbar Splanchnic
- Sacral Splanchnics
Muscular (Somatic) Control in the Abdomen is mainly controlled by
Lumbar Plexus
What are the major terminal nerve branches of the Lumbar Plexus?
- Genitofemoral Nerve (Anterior)
- Obturator Nerve (Medial thigh)
- Iliohypogastric Nerve (Transversus Abdominus and Internal Oblique)
- Ilioinguinal Nerve (Transversus Abdominus and Internal Oblique)
- Femoral Nerve (Iliacus and Anterior Thigh)
Origin and Insertion of the Iliohypogastric Nerve
Origin: Ventral Ramus L1
Insertion: Internal Oblique and Transversus Abdominus
Origin and Insertion of the Ilioinguinal Nerve
Origin: Ventral Ramus L1
Insertion: Internal Oblique and Transversus Abdominus
Origin and Insertion of the Genitofemoral Nerve
Origin: Ventral Ramus L1 and L2 Insertion: 1. Creamaster Muscle (Men) 2. Labia Majora (Women) 3. Femur
Origin and Insertion of the Obturator Nerve
Origin: Ventral Ramus L2-L4
Insertion: Obturator Externus, Pectineus, and Medial Thigh Muscles
Origin and Insertion of the
Origin: Ventral Ramus L2-L4
Insertion: Iliacus, Pectineus, Anterior Thigh Muscles