Block 2: Posterior Abdominal Region

Question 1

What is the peritoneum?

Answer 1

mesentery that suspends the viscera

Question 2

Parietal vs Visceral Peritoneum

Answer 2

Parietal: lines the abdominal wall
Visceral: lines the organs of the GI tract

Question 3

What structures are peritoneal?

Answer 3

Liver
Stomach 
Spleen 
Small intestines except duodenum (1st part) 
Transverse & Sigmoid Colon

Question 4

Describe fluidity of peritoneal vs retroperitoneal structures

Answer 4

peritoneal: some fluid in the cavity, organs can move around
retroperitoneal: structures are embedded and don’t move

Question 5

Retroperitoneal Structures

Answer 5

SADPUCKER

suprarenal (adrenal) gland 
aorta/IVC 
duodenum 
pancreas 
ureters  
colon 
kidneys 
esophagus

Question 6

When opening the abdominal cavity, how can you differentiate b/w visceral and parietal peritoneum?

Answer 6

visceral: shiny, glistening capsule on the surface of the organs
parietal: you can pull it off the abdominal wall

Question 7

First major branch of the aorta

Answer 7

celiac trunk

Question 8

Second major branch of the aorta

Answer 8

Superior Mesenteric Artery (SMA)

Question 9

What is the clinical significance of the angle of the SMA?

Answer 9

the “takeoff” is oblique

this makes it easy for emboli to happen at this juncture

Question 10

What is a frequent site of aneurysm? (AAA)

Answer 10

infra-aortic artery

Question 11

What are the minor lateral branches of the aorta?

Answer 11

diaphragmatic
adrenal 
gonadal 
lumbar 
ureteral

Question 12

Note the relationship b/w the IVC and the spine

Answer 12

the IVC is laterally to the right of the spine

Question 13

What’s the significance of the IVC being laterally to the right of the spine?

Answer 13

important for central line placement

easier to do on the right side b/c the vein is straighter than the artery

Question 14

location relationship b/w left renal vein and aorta

Answer 14

left renal vein crosses over the aorta

Question 15

Left gonadal vein drainage

Answer 15

into the left renal vein

Question 16

right gonadal vein drainage

Answer 16

into the IVC

Question 17

landmark for the SMA

Answer 17

just above the L renal is the takeoff for the SMA

Question 18

left adrenal vein drainage

Answer 18

into the left renal vein

Question 19

right adrenal vein drainage

Answer 19

directly into the IVC

Question 20

L renal vein vs R renal vein length

Answer 20

the left renal vein is longer than the right

Question 21

Ureter

Answer 21

long, smooth muscle that allows for peristalsis

Question 22

List the upper abdominal arterial supply for the ureters

Answer 22

renal artery
gonadal artery
aorta

Question 23

List the middle abdominal arterial supply for the ureters

Answer 23

gonadal and iliac arteries

Question 24

List the distal abdominal arterial supply for the ureters

Answer 24

internal iliac leading to vesical arteries

Question 25

Pelvic arterial supply for the ureters

Answer 25

superior and inferior vesical arteries

Question 26

What is the lymphatic drainage of the kidney?

Answer 26

Hilar Node

Question 27

Upper lymphatic drainage of the ureter

Answer 27

joins renal lymphatics to lumbar nodes

Question 28

Middle lymphatic drainage of the ureter

Answer 28

to iliac nodes

Question 29

Pelvic/Distal lymphatic drainage of the ureter

Answer 29

to internal iliac and vesical nodes

Question 30

What do lymphatics typically run with?

Answer 30

vasculature--particularly, arterial

Question 31

Cysterna Chyli

Answer 31

lymph collecting sac from many channels

Question 32

Significance of the cysterna chyli

Answer 32

starting point of the thoracic duct

Question 33

Cysterna Chyli Location

Answer 33

in front of L1 and L2

Question 34

Where is the cysterna chyli most likely to be injured?

Answer 34

in the area where the renal vein crosses over it

Question 35

Innervation of the kidneys

Answer 35

sympathetic fibers transmit pain, ~T12-L2

Question 36

Explain how pain near the kidneys is transmitted

Answer 36

the peritoneal lining above the kidney will get irritated/enflamed, causing pain

Question 37

From what embryonic layer do the kidneys originate?

Answer 37

mesoderm

Question 38

Metanephros

Answer 38

primordial kidneys, will mature into kidney

Question 39

Metanephros development is contingent on

Answer 39

ingrowth of the ureteric bud (coming from the cloaca) from below

Question 40

What happens if the metanephros does not bud?

Answer 40

renal agenesis (no kidney will form)

Question 41

What happens if the metanephros budding is incomplete?

Answer 41

dysplastic kidneys (kidneys will be present but not functional)

Question 42

What can if the metanephros buds and bifurcates but it happens at the wrong time?

Answer 42

duplicated ureters, renal pelvis

Question 43

Where do kidney stones get caught?

Answer 43

in the ureters

Question 44

Metanephros transforms into ______, which empty into _______, then narrows to form ______

Answer 44

1. calyces (major then minor) 2. renal pelvis 3. ureter

Question 45

What are the 3 points of narrowing of the ureters?

Answer 45

1. uteropelvic junction (UPJ) 2. pelvic brim (entering the pelvis, cross the bifurcation of the iliacs) 3. ureterovesical junction (junction with the bladder)

Question 46

F(x) of the kidney

Answer 46

filter blood, reabsorb water, creates urine

Question 47

Kidney arterial significance

Answer 47

the arteries in the kidney are not collaterized; they serve individual portions of the kidney, so taking out 1 portion would remove all arterial supply to the affected area