Anatomy Blue Boxes/Clinical Correlates Flashcards
What is pain in the pararenal region?
The kidneys are close in relation to the psoas major muscles which is why the extension of the hip joints may increase pain due to inflammation in the pararenal areas
What is posterior abdominal pain?
The iliopsoas has clinically important relations to the kidneys, ureters, cecum, appendix, sigmoid colon, pancreas, lumbar lymph nodes and nerves of the posterior abdominal wall. Thus, when any of these structures are diseased, movement of the iliopsoas causes pain - this is the basis of the iliopsoas test when intra-abdominal inflammation is suspected.
What is peritonitis and ascites?
When the gut becomes traumatically penetrated or ruptured, gas, fecal matter, and bacteria can enter the peritoneal cavity leading to infection and inflammation of the peritoneum called peritonitis. With this infection, will see the exudation of serum, fibrin, cells, and pus into the peritoneal cavity accompanied by pain in overlying skin and an increase in anterolateral abdominal wall tone.
When excess fluid accumulates in the peritoneal cavity, it is called ascitic fluid.
Signs of peritonitis include if the abdomen is drawn in as the chest expands (paradoxical abdominothoracic rhythm) as well as muscle rigidity. People with this condition commonly take shallow respirations to reduce intra-abdominal pressure and pain and lie with their knees flexed to relax their anterolateral abdominal muscles.
What is the spread of pathological fluids?
Peritoneal recesses determine the extent and direction of the spread of fluids that may enter the peritoneal cavity when the organ is diseased or injured
How does ascitic fluid flow?
The paracolic gutters provide pathways for the flow of ascitic fluid and spread of intraperitoneal infections. These gutters can facilitate the spread of purulent material into the pelvis, especially if the person is upright. This is why patients with peritonitis are placed in a sitting position to allow the flow of exudate into the pelvis where absorption of toxins is slow.
Peritoneal fluids can also extend into the subphrenic recess under the diaphragm.
What is the hepatorenal recess?
The posterosuperior extension of the sub hepatic space between the right part of the visceral surface of the liver, right kidney, and suprarenal gland. It is the gravity-dependent part of the peritoneal cavity in the supine position. It communicates with the right subphrenic recess
What are subphrenic abscesses?
Peritonitis can result in the formation of localized abscesses with a common site for pus to collect being the right or left subphrenic recess. When abscesses occur in this space, it is more common on the right side due to the frequency of ruptured appendices and perforated duodenal ulcers. Pus from theses abscesses drain into the hepatorenal recesses.
It can be treated by drainage with an incision inferior to, or through the bed of the 12th rib.
What is a perinephric abscess?
Pus and infection around the kidney - the spread and path of extension of these abscesses are determined by the attachments of the renal fascia. Can force its way into the pelvis between the loosely attached anterior and posterior layers of the renal fascia
What is nephroptosis?
Refers to a dropped kidney - it is different from an ectopic kidney (congenital misplaced kidney) by a ureter of normal length that has loose coiling or kinks because the distance to the bladder has been reduced. May see symptoms of intermittent pain due to traction on renal vessels.
Layers of renal fascia do not fuse firmly inferiorly to offer resistance, and thus, may see abnormally mobile kidneys descend more than normal when body is erect. When kidneys descend, the suprarenal remain in place because they are in their own separate fascial compartment
What are renal cysts?
Cysts in the kidney are common findings. Adult polycystic disease of the kidneys is an important cause of renal failure and will lead to markedly enlarged and distorted by cysts.
What are accessory renal vessels?
The embryonic kidneys receive their blood supply and venous drainage from successively more superior vessels. Usually the more inferior vessels degenerate as the superior ones take over, however, if they fail to degenerate, will see accessory renal arteries and veins. Variations in these vessels are seen in 30% of people so relatively common.
What is renal transplantation?
The preferred method of treatment for chronic renal failure. Can remove a kidney without damage to the suprarenal gland because they are in separate fascial compartments. The site for transplantation is in the iliac fossa of the greater pelvis and is favorable because traction is not placed on the surgically anastomosed vessels. The renal artery and vein are joined to the external iliac artery and vein and the ureter is sutured into the urinary bladder.
What are congenital anomalies of the kidneys and ureters?
Bifid renal pelvis and ureter are fairly common and due to division of the ureteric bud (which is the primordium of the renal pelvis and bud). The extent of the ureteral duplication depends on the completeness of this division and it may be unilateral or bilateral; separate openings into the bladder are uncommon. Complete division results in a supernumerary kidney.
An uncommon anomaly is a retrocaval ureter - it leaves the kidney and passes posterior to the IVC.
Th kidneys are close together in the embryonic pelvis and the inferior poles of the kidneys may fuse to form a horseshoe kidney that lies at the level of L3-L5 vertebrae since the root of the IMA prevents normal relocation of the kidneys. This horseshoe kidney shows no symptoms.
An ectopic pelvic kidney occurs when an embryonic kidney fails to enter the abdomen and lies anterior to the sacrum. A pelvic kidney in women can be injured during childbirth and they usually receive their blood supply from the aortic bifurcation or common iliac artery.
What are renal and ureteric calculi?
Calculi are composed of inorganic or organic acids or other materials and may form and become located in the calicos of the kidneys, ureters, or urinary bladders. A renal calculus can pass into the ureter and can cause excessive distension of the ureter leading to a ureteric calculus and acute obstruction of the ureter. Severe intermittent pain called ureteric colic can result due to hyper peristalsis in the ureter superior to the level of obstruction.
When pain is referred to the cutaneous areas, it is commonly T11-L2. As the stone progresses to the ureter, the pain passes “from the loin to the groin.” Pain can extend into the proximal anterior aspect of the thigh due to the genitofemoral nerve (L1, L2) and this is localized to the scrotum in males and the labia major in females.
Ureteric calculi can be observed and removed with a nephroscope or through lithotripsy which sends a shockwave to break the calculus up into small fragments that can pass into the urine
What is iatrogenic compromise of the ureteric blood supply?
Ureters may be injured in operations as a result of interrupting their blood supply - to prevent this, want to identify the ureters during their full course in the pelvis.
Longitudinal anastomoses between arterial branches to the ureter are usually adequate to maintain the blood supply along the length of the ureters, but may not be enough.
What is a cystocele?
A hernia of the bladder due to rupture of the fascial support of the vagina. This can occur due to loss of bladder support in females in damage from childbirth and other causalities ultimately leading to collapse of the bladder onto the anterior vaginal wall. When intraabdominal pressure increases, the anterior wall may protrude through the vaginal orifice into the vestibule.
