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Clinical Anatomy > Abdomen V > Flashcards

Abdomen V Flashcards

1
Q

What are suprarenal glands?

A

Endocrine glands - produce hormones

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2
Q

Where do the suprarenal glands lie?

A

Between sup pole kidney and diaphragm

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3
Q

Describe the differences in shape of the right and left gland

A

Right - pyramidal

Left - semilunar

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4
Q

What is the significance of the renal fascia surrounding the suprarenal glands?

A

Separates the glands from the kidneys, if kidneys are disturbed suprarenal gland is protected

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5
Q

What are the 2 parts of the suprarenal glands?

A

Cortex (outer) - yellow
derived from mesoderm and secretes corticosteroids and androgens

Medulla (inner) - brown
derived from neural crest
main source catecholamines - adrenaline and noradrenaline

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6
Q

Which 3 arteries supply the suprarenal glands?

A

Superior suprarenal arteries - off inferior phrenic (off aorta)
Middle suprarenal artery - off abdominal aorta
Inferior suprarenal artery - off renal artery

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7
Q

Why do the suprarenal glands have such a good blood supply?

A

As produce hormones need to go into blood

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8
Q

What is the venous drainage of the suprarenal glands?

A

Via left and right renal suprarenal veins
Left -> left renal veins
as aorta in way, safer to join renal vein instead of going over
Right -> IVC directly

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9
Q

What are the functions of the kidney?

A

Excretes most waste products of metabolism
Acts as sieve to filter blood
Controls water and electrolyte balance of body
Maintains acid-base balance body
Secretes hormones and renin into blood stream

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10
Q

How much blood does the kidney filter?

A

113-144 pints blood/hour
Blood flow to kidney is higher than to heart
Blood filtered 400x/day

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11
Q

Where are the waste products of metabolism from urine stored?

A

Stored in the bladder and expelled from body via urethra

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12
Q

What are the different functioning parts of the kidney?

A

Including medulla and cortex

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13
Q

What is the location of the kidneys?

A 
Primary retroperitoneal organs
Located at level of T12 - L3 
Ribs 11+12 left 
Ribs 12 right
Hila kidney - L1
Closely related to diaphragm and move with it on inspiration
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14
Q

Why is the right kidney slightly inferior to the left kidney?

A

A liver is on the RHS

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15
Q

What are the anterior relations of the left and right kidney?

A

Right - hepator-enal pouch + greater sac
fluid can build here
Liver
Left - stomach bed (lesser sac)

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16
Q

What are the posterior relations of the kidney?

A

Closely related to 11th and 12th rib
Muscles of the posterior abdominal wall
Medially have psoas minor if present + psoas major
Laterally have quadratus laborum
Lateral edge have transversus abdominis
Superior ribs are related to the diaphragm

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17
Q

What is the function of the renal coverings?

A

Fascial layers that
support the kidney
hold the kidneys in position against the posterior abd wall

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18
Q

What are the layers of the renal coverings?

A
  1. Renal capsule - closely adherent to surface
  2. Perinephric fat - w/in perineal space
  3. Renal fascia - condensation areolar connective tissue
    Continuous with transversalis fascia and fascia over diaphragm
  4. Paranephric fat - external to capsule (lots of it hence removed in donors)
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19
Q

What is the hilum of the kidney?

A

Entrance point of structures in the kidney
Vein, artery, ureter (anterior to posterior)
+ lymph vessels + sympathetic fibres

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20
Q

What does the renal cortex extend into?

A

Outer layer of kidney = renal cortex

Renal cortex extends into renal columns

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21
Q

Where are the renal columns located?

A

Renal columns located laterally to renal pyramids - extensions of cortex

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22
Q

Describe the renal pyramids

A

Each pyramid has a base - closely related to the cortex
Contains loops of nephrons and collecting ducts
Apex - tip of pyramid and runs into minor callices through papilla
Papilla is at the tip of the triangle opening into minor calyx

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23
Q

What is the renal space filled with?

A

Filled with perinephric fat

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24
Q

What structure does the minor callices come to form?

A

Come together as major calyx

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25
Q

What do the major callices come to form?

A

Form renal pelvis = Dilated superior portion ureter

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26
Q

What is the renal sinus?

A

Contains renal pelvis
Upper extended part of urethra
Perinephric fat continued into hilum, sinus and surrounds all structures

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27
Q

What happens to the renal artery after it enters the kidney?

A

Splits into 5 segmental arteries
4 anterior segmental arteries
1 posterior segmental artery
Segmental arteries give rise to lobar arteries
Interlobar arteries - run towards cortex
Arcuate arteries - arch over base pyramid
Interlobular arteries
Give off afferent glomerular arterioles - Bowman’s capsule

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28
Q

What are the segments of the kidney supplied by the different segmental arteries?

A
  1. Apical
  2. Caudal
  3. Anterior superior
  4. Anterior inferior
  5. Posterior
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29
Q

What is a lobe of the kidney?

A

Made of renal pyramid and corresponding superior cortex

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30
Q

Describe the venous drainage of the kidney

A

Follow arteries
Efferent glomerular venules drain interlobular veins -> arcuate -> interlobar veins -> multiple renal veins
Renal veins contribute to formation of L+R renal vein - don’t necessarily align to segmental arteries

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31
Q

Where does the right renal vein pass?

A

Passes posterior to the second part of duodenum and head of pancreas
All vessels of RHS go straight to IVC

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32
Q

What are the discrepancies of the left and right renal veins?

A

Left enters the iVC superior to the right renal vein
Left is 3x larger than the right renal veins
Left may be compressed by aortic/sup. mesenteric aneurysms as closely related
Receives left gonadal vein, inferior phrenic and suprarenal vein

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33
Q

What is nephroptosis?

A

Dropped kidney
Layers of renal fascia don’t fuse firmly inferiorly
hence, abnormally mobile kidneys may descend >3cm when body is erect

Suprarenal glands stay in place as lie in separate fascial compartment and more firmly attached to diaphragm

Symptoms intermittent pain in renal region
Relieved by lying down - appears to result from traction on renal vessels

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34
Q

List some congenital abnormalities?

A

Bifid renal pelvis and ureter (fairly common) - results from division ureteric bud - primordial renal pelvis + ureter
May be unilateral/bilateral - separate openings into bladder are uncommon

Horseshoe kidney -
when kidneys first formed, kidneys are close together in pelvis, 1/6000 fetuses inf. pole kidney fuse to form horseshoe

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35
Q

Describe the lymphatic drainage of the kidneys

A

Follow the renal veins
Drain into L+R lumbar nodes (caval + aortic)
near origin of renal artery

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36
Q

Where do the sympathetic nerves

arise and what is their function?

A

T10 - L2
Post ganglionic sympathetic from renal plexus - which follows renal arteries
Fn = vasomotor regulating blood flow and renin secretion

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37
Q

Is there PS nerve supply to the kidneys?

A

No evidence of PS supply

Some say from vagus nerve

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38
Q

Is renal function dependent on innervation?

A

Not dependent on innervation as regulated by hormones

Displayed by kidney transplants, kidneys still work despite nervous innervation being severed

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39
Q

What is staghorn canaliculi?

A

Build up of struvite - solid mass takes formation kidney itself
Caused by recurrent UTI that increase ammonia production, increase pH and decrease phosphate solubility

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40
Q

What is a ureter and its function?

A

Long, muscular tube
20-30cm
3mm diameter
Transports urine from kidney to urinary bladder (pelvis)
Begin as continuation renal pelvis - susceptible to damage as travel long way

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41
Q

Are the ureters intra or retroperitoneal?

A

Retroperitoneal lined w/ stratified transitional epithelium

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42
Q

What is the course of the ureters in the abdomen?

A
  1. Descends anterior to psoas major muscle - opposite tips lumbar transverse process
  2. Crosses anterior to genitofemoral nerve - nerve runs anterior to psoas major
  3. Obliquely crossed by gonadal vessels - as travel from abdominal aorta to pelvis
  4. Enters pelvis anterior to bifurcation common iliac artery to enter pelvis - L4/5
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43
Q

Describe the course of the ureter through the pelvis?

A
  1. Runs downward in front, on internal iliac artery to reach ischial spine
  2. Turns medially opposite ischial spine and forward to enter base bladder (upper lateral angle)
  3. Near termination (before enters bladder) crossed by:
    - vas deferens
    - uterine artery - water under the bridge, ureter lies underneath artery
  4. Passes obliquely through wall bladder for 3/4 inch before opening into bladder cavity
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44
Q

What is the importance of the ureters entering the bladder at an angle?

A

Helps prevent back-flow urine

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45
Q

What bony structures can be used to trace the ureters?

A

On film sacroiliac joint and ischial spine help to trace the course of the ureter

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46
Q

What are the 3 points of constriction on the ureters and their significance?

A
  1. Ureteropelvic junction - connection between renal pelvis and ureter
  2. Crossing ureter over external iliac/ common iliac artery
  3. Ureterovesical junction - site of entrance into bladder
    Stones can get stuck at these points
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47
Q

What are kidney stones?

A

Common clinical solid mass

Formed in kidney - may pass into ureter and impinge flow urine ->complete intermittent

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48
Q

What is the passage of kidney stones?

A

kidney -> renal pelvis -> ureter

Can cause excessive distension muscular tube

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49
Q

What is a ureteric calculus?

A

Causes sever pain (ureteric colic)
As it’s gradually forced down ureter by waves contraction to overcome obstruction

Pain referred from loin -> groin
Also lumbar region, hypogastric region, external genetalia, testes
Referred cutaneous areas that are also innervated by spinal cord segments and sensory ganglia, also supply ureter (T11-T12)

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50
Q

What is the arterial supply of the ureter?

A

Pick up branches from (sup to inf)

  • renal artery
  • gonadal artery
  • common iliac artery
  • internal iliac artery
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51
Q

What is the venous drainage of the ureters?

A

Occurs in corresponding veins to arteries

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52
Q

Where does the bladder originate?

A

Endodermal origin and develops from urogenital sinus

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53
Q

What is the bladder?

A

Distensible hollow organ capable holding 1L urine

Size, shape, position and relations vary according to content + content surrounding organs

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54
Q

What is the shape of the bladder?

A

3 Sided pyramid - apex points toward pubic symphysis

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55
Q

What does the apex of the bladder give rise to?

A

Median umbilical ligament
Runs towards umbilicus = remnant urachus - fibrous remnant of allantois
Fn - drain foetal urinary bladder

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56
Q

What is the direction of the base of the bladder?

A

Faces postero-inferiorly .˙. bladder has 2 inferolateral surfaces

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57
Q

What structure does the neck of the bladder surround?

A

Surrounds the urethra - fixed in position

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58
Q

What are the structures surrounding the bladder?

A

Bladder is on inside the anterior abdominal wall
At back can see seminal vesicles
Under bladder have prostrate

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59
Q

What is the function of the fibromuscular bands?

A

Ligaments hold the bladder neck in place
Sits above the pelvic fold
Neck supported by endopelvic fascia + levator ani muscle
Important as allows for continence

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60
Q

What is the pubovesical ligament?

A

Holds bladder in place in females

Wraps around neck + urethra - attaches it to pubic symphysis

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61
Q

How is stress incontinence after parturition caused?

A

May cause ligaments and pelvic floor to be weakened .˙. neck prolapses below floor
Occurs when intra-abdominal pressure is increased eg. coughing, sneezing

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62
Q

What is the puboprostatic ligament?

A

Wraps around prostate and attached to pubic symphysis

Neck surrounded by internal urethral sphincter (smooth muscle)

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63
Q

What muscle forms the walls of the bladder?

A

Detrusor muscles

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64
Q

What is the inner surface of the bladder lined by?

A

Transitional epithelium

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65
Q

Where are the attachments of the vesical mucosa?

A

Attached loosely to detrusor muscle

Except at trigone region

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66
Q

Describe the mucosa when the bladder is full and empty

A

Full - mucosa stretched out

Empty - mucosal folds

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67
Q

Describe the detrusor muscle and how it works to expel urine

A

Muscular layer urinary bladder - trabeculated appearance
When bladder stretched PS nervous stimulation occurs - causes contraction detrusor muscle
Causes bladder to expel urine through urethra

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68
Q

What is the trigone region?

A

Upside down triangular shaped smooth region
Mucosa stretched out and tightly adhered to underlying detrusor muscles
Least mobile part of bladder and is mesodermal in origin

69
Q

What are the entrance points of the ureters into the bladder called?

A

Ureteric orifices
Encircled by loops of detrusor muscles - prevents reflux
Slit like openings - ureter opens into bladder obliquely to prevent reflux

70
Q

What is the exit point of the bladder?

A

1 exit - internal urethral orifice (inf portion of bladder)
Involuntary muscle
Males have internal urethral sphincter which contracts during ejaculation to prevent backflow semen

71
Q

What is the inter-ureteric bar?

A

Smooth muscle is extended as inter-ureteric bar connecting 2 ureteric orifices

72
Q

What is the blood supply of the bladder?

A

Supplied by branches from internal iliac arteries:
i. Sup vesical artery (branch umbilical artery from ant trunk internal iliac)
Antero superior surface bladder

ii. Inf vesical artery (males only) - branch ant trunk internal iliac
Fundus + neck bladder
Vaginal artery equiv in females

73
Q

What is the venous drainage of bladder?

A

Vesical venous plexus
Drains into internal iliac veins

Communicates inferiorly w/ inferior prostatic plexus (males)
w/ uterovaginal plexus (females)

74
Q

Describe the PS innervation of the bladder + its function in bladder emptying

A

PS innervation causes micturition
Pelvic splanchnic nerves - S2-S4, pass through inf hypogastric to vesical plexus (surrounding bladder)
Synapses on/near bladder wall

Stimulates micturition
Motor supply to detrusor muscle
Inhibitory to internal urethral sphincter

75
Q

Describe the sympathetic innervation and its function relating to the emptying of the bladder

A

T10 - L2 (spinal nerves)
Run through and synapse pre-vertebral plexus to reach inferior hypogastric plexus + coeliac and superior hypogastric
Then goes to vesical plexus

Urine retention
Contracts internal urethral sphincter during ejaculation (prevents back-flow semen)/ self-consciousness (shy bladder)

76
Q

What do the visceral afferent fibres (sensory/pain) travel with?

A

Travel with both sympathetic fibres (sup. bladder) + PS fibres (inf. bladder)

Stimulated by stretching + over-distension bladder

77
Q

How does stretching of the bladder lead to the expulsion of urine?

A

Detrusor muscle stretched, bladder contracts + internal urethral sphincter relaxes .˙. urine flows into urethra
Overcome reflux during toilet training - babies can’t control going to toilet
reflex for bladder to automatically empty when full

78
Q

What is a vesicovaginal fistula/colovesical fistula?

A

Abnormal connection between bladder and vagina/rectum

Linked to gynaecological cancer or can occur during surgery

79
Q

How can bladder calculi occur?

A

Stones may pass into bladder
Stones get larger because of precipitation of salts on stones
Insufficient bladder emptying
Urine becomes infected

80
Q

Why is the bladder susceptible to cancer?

A

As lined w/ transitional epithelium

Cancer can spread to local structures

81
Q

What is stress incontinence?

A

Weakness pelvis floor (levator ani muscles) predisposed to ‘pelvic region prolapse’

82
Q

Describe the development of the urethra in a female

A

Develops from urogenital sinus

Corresponds to male urethra proximal opening of prostatic utricle and ejaculatory ducts

83
Q

What is the function of the urethra in females?

A

Transports urine from internal urethral meatus to external urethral meatus - passes through opening pelvic floor muscles

84
Q

Describe the urethra in females and its clinical significance

A

4cm long + 6mm diameter

.˙. UTI infection prone

85
Q

What is the cell lining of the female ureter

A

proximal 2/3 = transitional epithelium

distal 1/3 = stratified squamous epithelium

86
Q

In females, what is below the pelvic floor?

A

Deep perineal pouch - potential space in perineam

External urethral sphincter muscle lies in deep perineal pouch

87
Q

Describe the passage of the urethra in females

A

Passes through perineal membrane - inf border of perineal pouch
leaves body through external urethral orifice
Opens into vestibule vagina - cleft between labia majora

88
Q

What is the equivalent of the male prostate in females?

A

Equivalent = 2 paraurethral glands

Open into distal urethra

89
Q

Where does the urethral opening lie?

A

Lies posterior to clitoris and anterior to vaginal opening

Vestibule = area 2 labia majora

90
Q

What are the functions of the male urethra?

A

Transports urine + semen from bladder and ejaculatory ducts (vas deferens + duct seminal vesicle) respectively to external meatus of penis

91
Q

Describe the male urethra

A

20cm long

bends twice when flaccid

92
Q

What are the 4 parts of the urethra?

A
  1. preprostatic - just after neck bladder
  2. prostatic
  3. membranous
  4. spongy
93
Q

What does the preprostatic portion of the penis contain?

A

Contains internal urethral sphincter - not present in female

94
Q

What is voluntary control of the urethra by?

A

ANS

95
Q

Which part of the prostate does the urethra pass through?

A

Travels through part of anterior part of prostate gland - where prostatic + ejaculatory ducts open

96
Q

What is the ejaculatory duct?

A

Unification vas deferens (transports sperm) + seminal vesicle (prod. sperm)
Carried out of body, passage allowed through prostatic part
Maybe - prostatic part urine + semen travel through urethra at same time

97
Q

What is the function of the bulbourethral gland?

A

Produce pre-ejaculatory fluid

doesn’t enter membranous urethra, instead enters spongy urethra

98
Q

Describe the spongy layer of the penis

A

Runs through corpus spongiosum

Looks like sponge as during erection fills w/ blood + forms erection

99
Q

Where are the 2 bends in a flaccid penis and what is the clinical significance?

A

i. Below membranous urethra
ii. Distally to it

Important as if inserting catheter up to urethra need to know bend so not forcing catheter into penis

100
Q

What structure is distal to the spongy urethra?

A

Distally forms the navicular fossa (expansion)

101
Q

Where does urine/semen leave the penis?

A

Urine/semen will leave through external urethral orifice

102
Q

What are the boundaries of the posterior abdominal wall?

A

Superior boundary - floating ribs 11+12
significant portion abd cavity overlapped by thoracic wall

Midline - lumbar vertebrae (5) - support weight body

103
Q

What does the articulated lumbar skeleton form?

A

Lumbar lordosis = curving spine

They protrude into abdominal cavity + create paravertebral gutter

104
Q

Describe the lumbar vertebrae

A

Have large vertebral bodies - kidney shaped
No transverse foramina, costal facets, bifid spinous process
Have triangular shaped vertebral foramina

105
Q

What does the lumbar vertebral column articulate with?

A

Articulate with inferior sacrum
Inferior end spinal cord, formed by fusion sacral vertebral bodies (5)
Sacrum tapers inferiorly at apex

106
Q

What does the apex articulate with?

A

Articulates w/ coccyx

107
Q

What is the sacral promentary?

A

Top ridge between lumbar vertebrae + 1st sacral vertebrae

108
Q

What is the sacral canal?

A

Continuation spinal canal + runs through greater part sacrum

109
Q

What is the sacral foramina?

A

Holes in sacrum

110
Q

Where are the sacroiliac joints?

A

Lateral to the sacrum

Sacrum articulates with ilium

111
Q

Describe the ilium?

A

Upper part each ilium flares outwards as iliac fossa
Iliac crest = top ridge (L4) - where lumbar puncture taken

ASIS - gives attachment inguinal ligament
AIIS - gives attachment to quadricep muscles

112
Q

Which 3 bones make up the pelvis?

A

Ilium
Ischium
Pubis

113
Q

Where do the 2 pubis bones articulate?

A

Articulate at pubic symphysis - secondary cartilaginous joint

114
Q

Describe the ischium

A

Flared inferiorly at ischial tuberosity because sitting bone

115
Q

What do the bilateral + symmetrical (paired) groups of muscles connect?

A

Connect thoracic cage + thoracic vertebrae superiorly to the thoracic cage lower limb inferiorly

116
Q

What is the quadratus laborum?

A

Square shaped muscles
Lateral to lumbar transverse processes, psoas major + minor attaches to medial aspect iliac crest

Attachment - iliac crest, 12th rib, transverse process L1-L4
Nerves - T12 + L1-L4
Action - extends + laterally flexes vertebral column

117
Q

What is the psoas major?

A

Most medial and most prominent
Origin - transverse process T12-L4 (wide origin)
As fibres descend, fuse with fibres iliacus
Nerves - L1 - L3
Action - flexes thigh @ hip joint
flexes trunk ->lumbar plexus embedded in middle muscle belly

118
Q

What is the psoas minor?

A 
Not always present (absent 50%)
Runs in front of psoas major 
Attachment - vertebral bodies T12-L1
Nerves - L1
Action - assists flexion trunk
119
Q

What is the iliacus?

A

Lies w/in iliac fossa
Nerves - L2-L4
Action - flexion thigh at hip joint + flexion trunk
Inferiorly fibres join w/ psoas major to form iliopsoas muscle = primary flexor thigh

120
Q

Where does the iliopsoas insert?

A

Inserts into lesser trochanter

121
Q

What does the diaphragm bound?

A

Superior boundary of posterior abdominal region

Separates thoracic + abd cavities

122
Q

What are some features of the diaphragm?

A

Central tendon - has close relationship w/ pericardium heart
Domes - Lateral sides diaphragm have rounded appearances
Right dome higher than left because liver on RHS

123
Q

Where does the diaphragm attach posteriorly?

A

Posteriorly attached to bony landmarks eg. floating ribs

124
Q

Where does the midline of the diaphragm attach to?

A

Attached to lumbar vertebrae via extensions = crus
Left crus - slightly shorter than right crus
Right attached to L1 - L3/4
Left arises from L1-L2/3

125
Q

What does the right crus form?

A

Oesophageal hiatus

Fibres diaphragm forms sphincter of oesophagus through diaphragm

126
Q

What is the median arcuate ligament?

A

Where L+R crus connected @ midline

Forms aortic hiatus

127
Q

What is the medial arcuate ligament?

A

Lateral to median arcuate ligament - fascia psoas major

128
Q

What is the lateral arcuate ligament?

A

Further lateral - fascia quadratus laborum

129
Q

Describe the oesophageal hiatus

A

T10
Ant + post vagal trunks pass on top oesophagus + reach stomach
If have hiatus hernia of stomach through diaphragm, ant + post vagal trunk may be compressed
Formed by right crus

130
Q

Describe the caval opening

A

T8 - allows IVC through
In central tendon - right phrenic nerve travels through w/it
Goes through diaphragm to enter heart (right atrium)

131
Q

Describe the aortic hiatus

A

T12
Aorta runs behind median arcuate ligament
Entrence thoracic duct (lymph vessels)
Azygous vein comes in

132
Q

Describe how the left phrenic nerve attaches to the diaphragm

A

Has own entrance point on LHS central tendon

133
Q

What is the name of the plexus of somatic nerves of the posterior abdominal wall?

A

Lumbar plexus

134
Q

Where does the lumbar plexus arise?

A

From ventral rami - anterior branches of lumbar spinal nerves
L1-L3 (+part L4)

135
Q

What does the remainder of the ventral ramus of 4th + (All) 5th lumbar nerve unite to form?

A

Lumbosacral trunk

Joins ventral rami of 1st 4 sacral nerves to form sacral plexus (L4-S4)

136
Q

Which muscle do a majority of the nerves pass through?

A

Found in the bulk of the psoas major muscle

Branches arise from lateral border or come through anterior surface and run through neurovascular plane

137
Q

What does the neurovascular plane go through?

A

Transversus abdominis + along internal oblique

138
Q

Where is the subcostal nerve located?

A

Lies on quadratus laborum muscle

Below 12th rib

139
Q

Where does the iliohypogastric nerve lie?

A

Arises L1 - over surface quadratus laborum

140
Q

What is the function of the iliohypogastric nerve?

A

Gives off anterior cutaneous branch - innervation to skin @ L1
Gives motor innervation to transverse abdominis and internal oblique

141
Q

What level does the iliolingual nerve lie?

A

L1 - below iliohypogastric

142
Q

Describe the course of the ilioinguinal nerve and the functions

A

Takes oblique course + runs towards iliac crest

Pierces through and goes in between transversus abdominis + internal oblique - gives motor innervation to transversus abdominis + internal oblique

Travels through inguinal canal (superficial inguinal ring)
.˙. gives innervation (cutaneous) to:
labia + mons pubis female
root penis + scrotum males

143
Q

Where does the genitofemoral nerve arise?

A

L1/2 - Lies on top of psoas major

144
Q

What are the branches of the genitofemoral nerve and their functions?

A

Divides to give genital + femoral branches

Genital gives cutaneous + motor innervation to cremaster muscle scrotum

Femoral gives cutaneous innervation to anterior thigh

Enters into ilioinguinal canal + comes out superficial inguinal ring - gives cutaneous innervation to scrotum + labia majora

145
Q

Describe the lateral femoral cutaneous nerve

A

L2/3
Traversus iliacus muscle = passes posterior to inguinal ligament to enter thigh
Cutaneous innervation to lateral part thigh

146
Q

Describe the femoral nerve

A

L2-4
Travels between iliacus + psoas major
Descends laterally to external iliac artery
Supplies structures of lower limb - motor + sensory

147
Q

Describe the obturator nerve

A

L2-4 - emerges medial border of psoas major

Supplies muscles in lower limb and gives cutaneous innervation to medial thigh

148
Q

What is significant about the lumbosacral trunk?

A

Fibres L4/5 fuse and contribute to sacral plexus

149
Q

What are the 2 divisions of the ANS in abdomen?

A

Sympathetic NS - thoracolumbar outflow T1-L2/3

PS NS - Craniosacral outflow
CN3,7,9, X - S2-4

150
Q

List the nerve roots

A

Greater thoracic splanchnic nerves - T5-T9 (SNS)
Lesser thoracic splanchnic nerves - T10-T11 (SNS)
Least splanchnic nerves - T12 (SNS)
Lumbar splanchnic nerves - L1-L2(SNS)
Sacral splanchnic nerves (SNS)
Pelvic splanchnic nerves S2-S4 - (PNS)

151
Q

What is significant about the paravertebral ganglia?

A 
Contains both sympathetic and PS fibres 
Lie anterior and lateral to aorta + vertebral column
•	Coeliac plexus 
•	Superior mesenteric 
        plexus 
•	Renal plexus 
•	Inferior mesenteric 
        plexus 
•	Superior hypogastric 
        plexus – level of aortic 
        bifurcation 
•	Inferior hypogastric 
        plexus – L+R on either 
        side of rectum
152
Q

Describe the abdominal aorta

A

Enters abdomen by travelling through diaphragm
Passes inferiorly on posterior abdominal wall + deviates slightly to left + midline

Aorta - 13cm long
Terminates at L4
Main source blood in abdomen + pelvis - paired and unpaired vessels

153
Q

What are the unpaired arteries of the abdominal aorta?

A 
•	Coeliac trunk – T12 
•	Median sacral artery –  
        L4
•	Superior mesenteric 
        artery - L1
•	Inferior mesenteric artery 
        – L3
154
Q

What is the function and the branches of the coeliac artery?

A 
T12
Gives blood to structures of the foregut 
Common hepatic artery 
Splenic artery 
Left gastric artery
155
Q

What is the location of the median sacral artery?

A

L4
Remains retroperitoneal
Bottom in midline

156
Q

What is the function and the branches of the superior mesenteric artery?

A 
L1
Supplies midgut 
Inferior pancreaticoduodenal artery 
Jejunal and ileal branches 
Iliocolic + iliocaecal artery
Appendicular artery 
Right colic artery 
Middle colic artery
157
Q

What is the function and the branches of the inferior mesenteric artery?

A 
L3
Supplies structures of hindgut 
Left colic artery 
Sigmoid branches
Superior rectal artery
158
Q

Where do the paired branches begin?

A

Superior aspect

159
Q

What are the paired branches of the aorta?

A

Inferior phrenic artery - T12
Supplies undersurface of diaphragm

Middle suprarenal arteries - supply suprarenal glands

Renal arteries - supply kidney

Lumbar arteries

Gonadal arteries - develop in abdomen + descend into pelvis
Take BS w/ them

160
Q

What does the aorta bifurcate into?

A

L+R common iliac arteries @ L4

Common iliac arteries split into the internal and external iliac arteries

161
Q

What do the internal and external iliac arteries supply?

A

Internal supplies structures inside pelvis
Gives rise to anterior and posterior division

External iliac travels under iinguinal ligament + becomes femoral artery which supplies structures of lower limb

Give off different arteries to supply pelvic organs

162
Q

What is the positioning of the IVC?

A

Travels to right of aorta + transports deoxygenated blood to right atrium

163
Q

At what level does the IVC arise?

A

Formed at L5 - by union common iliac veins

164
Q

At what level does the iVC pierce the diaphragm?

A

T8 - Caval opening

to enter right atrium of heart

165
Q

What are the branches of the IVC?

A

Inf phrenic veins - drains inferior aspect diaphragm + enters directly into IVC
RIght suprarenal veins
Paired renal veins
Right gonadal veins - drain into IVC
Left gonadal veins - enters left renal vein

Median sacral vein 
Lumbar veins
Hepatic veins - 3
Venous blood from main GI tract gets transported through portal vein to get processed in liver
Enters back into IVC via 3 hepatic veins
166
Q

What is an aortic aneurysm?

A

Dilation of blood vessel
Causes weakening on aortic wall
Increased occurrence w/ ageing population as have atherosclerosis, high BP, diabetes

167
Q

Why does the aorta weaken as time goes on?

A

Abd aorta has lot of pressure - receives blood from LV all throughout life - as become older, vessel can weaken and bulge outwards

168
Q

Does an aneurysm have any symptoms?

A

Found by chance - wall weaker, can rupture - if happens very likely person will die

169
Q

Possible treatments of aneurysms or weakened vessels?

A

Can try to surgically repair w/ grafts

Clinical Anatomy (10 decks)

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