Abdomen prosection book

Question 1

What causes cup shaped depression in minor calyces in renal pelvis?

Answer 1

-Renal papillae projecting into minor calyces
-Minor calyces unite to form two or 3 major calyces, which empty into renal pelvis

Question 2

Describe the course of the ureters

Answer 2

Renal pelvis–>anterior to psoas–> crossed by gonadal artery + vein –> Passes anterior to genitofemoral nerve –> enters pelvis anterior to external iliac artery

Descends on lateral pelvic wall –> anterior to internal iliac branches –> crossed by vas deferens/uterine artery –> enters bladder posterolaterally

Abdomen

-Start at the renal pelvis, most posterior of renal hilum structures
-Passes anterior to psoas, overlapping transverse processes of lumbar vertebrae
-Each ureter is crossed anteriorly by gonadal artery and vein
-Genitofemoral nerve passes behind ureter
-At pelvic brim, ureter passes anterior to external iliac

Pelvis

-Pelvic ureter then descends posteroinferiorly on lateral pelvic wall, anterior to branches of internal iliac arteries, and curves anteromedially to enter posterolateral surface of bladder
-Just before entering bladder ureter is crossed by vas deferens in male and uterine artery in female

General points
-Retroperitoneal for entire course
-Equal length of ureter in abdomen and pelvis

Question 3

Describe structures in renal hilum from anterior to posterior

Answer 3

-Renal vein
-Renal artery
-Renal pelvis

Question 4

Why is pain from kidney stones referred to testicles?

Answer 4

-Genitofemoral nerve passes behind ureter

Question 5

What different types of renal calculus are there?

Answer 5

-Calcium (oxalate or phosphate)
-Uric acid
-Struvite
-Cysteine

Question 6

Which is the most common form of renal calculus?

Answer 6

Calcium stones

Question 7

Describe the course of the abdominal aorta

Answer 7

-Starts in midline as it passes through the diaphragm at the level of T12
-Runs in retroperitoneum in front of lumbar vertebrae
-Bifurcates to the left of the midline at L4 into common iliac arteries

Question 8

What are the branches of the abdominal aorta?

Answer 8

Midline branches
-Coeliac trunk: lower border T12
-SMA: lower border L1
-IMA: L3

Paired
-Inferior phrenic (T12)
-Middle suprarenal (T12)
-Lumbar L1-L4
-Renal arteries L1-L2
-Gonadal arteries L2

Question 9

Describe the course of the IVC in the abdomen, including its relations to the aorta

Answer 9

-IVC has longer course than aorta as it forms at a lower level (L5) by the confluence of the iliac veins, behind right common iliac artery
-Runs in front of lumbar vertebrae on right of aorta
-Pierces central tendon of diaphragm at level of T8

Question 10

Describe the tributaries, relations and course of the portal vein

Answer 10

-Formed by SMV + SV
-Anterior to IVC, behind HOP + D1
-Tributaries: superior pancreaticoduocenal, cystic, R + left gastric
-Ascends in free edge lesser omentum
-Divides into L + R at porta hepatis

-Formed by confluence of SMV and splenic vein
-Lies in front of IVC, behind head of pancreas and first part duodenum
-Other tributaries are right and left gastric veins, superior pancreaticoduodenal vein, cystic vein and sometimes periumbilical vein in ligamentum teres (left umbilical vein remnant)
-Portal vein ascends within free edge lesser omentum (forming anterior border of foramen of wilmslow, lying behind bile duct and hepatic artery
-At the porta hepatis it divides into right and left branches for respective halves of liver

Question 11

What are the layers of the spermatic cord and scrotum, and from which layers of the abdominal wall are they derived?

Answer 11

As the testes descend through the inguinal canal with the vas deferens and neurovascular structures, they take a contribution from the abdominal wall layers, which become fascial coverings. The layers of the scrotum and cord are:

–> skin of scrotum derived from abdominal skin
–> dartos muscle from abdominal camper’s fascia
–> dartos fascia from abdominal scarpa’s fascia
–> external spermatic fascia from external oblique aponeurosis
–> cremasteric fascia from internal oblique aponeurosis
–> internal spermatic fascia from transversalis fascia
–> tunica vaginalis of the testes (and obliterated processus vaginalis of the cord) from abdominal peritoneum

Note the transversus abdominis does not contribute a layer to the cord or scrotum

Question 12

What is the clinical relevance of the fate of the right and left testicular veins?

Answer 12

Because of the more oblique entry of the right testicular vein into the inferior vena cava, it is less likely to allow backflow of blood: varicoceles are therefore more common on the left side