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FMS 501 - Anatomy > Ch18 - Posterior Abdominal Wall (PAW) and Kidneys > Flashcards

Ch18 - Posterior Abdominal Wall (PAW) and Kidneys Flashcards

1
Q

Diagram

A
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2
Q

Three muscular Parts of the Diaphgram

A
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3
Q

Central Tendon (moveable part)

A
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4
Q

Three Openings in Diaphragm

A
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5
Q

Caval opening (Hiatus)

A

“: IVC traverses at T8, in the central tendon. Diaphragm contraction opens IVC allowing more blood flow during inspiration.
”

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6
Q

Esophageal hiatus

A

“ vagal trunks traverse as well at T10”

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7
Q

Aortic Hiatus

A

“aorta and thoracic duct traverse at T12”

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8
Q

Innervation of the Diaphragm

A
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9
Q

Kehr’s sign

A

An enlarged spleen may refer pain to diaphragm.

88 of 199

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10
Q

“Development of the diaphragm”

A
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11
Q

The diaphragm is derived from which four embryonic tissues.

A
  1. Septum Transversum.
  2. Somatic Mesoderm.
  3. Dorsal mesentery of the esophagus.
  4. Pleuroperitoneal membranes.
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12
Q

Septum Transversum

A
  • the septum transversum gives rise to a major part of the diaphragm.
  • the craial-most part of the head mesoderm, is moved caudal to the future heart and pericardium, between these structures and the neck of the yolk sac. (Vol 1, 59 of 182)
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13
Q

Somatic mesoderm

A

“Somatic mesoderm from the embryo’s body wall grows inward toward the central tendon, forming the muscular peripheral parts of the diaphragm, where it attaches to the ribs, costal cartilages, and sternum.”

160 of 199

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14
Q

Esophagus mesentery

(Dorsal mesentery of the esophagus)

A

“acquires muscle forming cells and gives rise to the crura of the diaphragm. ”

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15
Q

Pleuroperitoneal Membranes

A
  • Two sheets of mesenchyme grow in the center of the “domes” of the diaphragm, to the left and right of the central tendon.
  • These pleuroperitoneal membranes partition the intra-embryonic coelom (remember the IEC?).
  • Above the membranes is the cranial “bicycle handlebars” part of the IEC.
  • Below the membranes are the left and right caudal limbs of the IEC = the coelomic ducts.
  • Formation of the pleuroperitoneal membranes is a crucial step in separating the thoracic cavity from the abdominal cavity.
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16
Q

Congenital Diaphragmatic Hernia

A
  • Faulty formation of the diaphragm that allows communication between thoracic and abdominal cavities is called congenital diaphragmatic hernia.
  • The culprit is usually malformation of a pleuroperitoneal membrane.
  • These are much more likely to occur on the left side than on the right, because the left pleuroperitoneal membrane is larger and closes later than does the right.
  • If the hernia is large enough, abdominal organs can bulge into the thoracic cavity, stunting the growth of the lungs (pulmonary hypoplasia).
  • This can be a life-threatening condition.
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17
Q

List Arteries and Veins of Posterior Abdominal Wall

A
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18
Q

Arteries of Posterior Abdominal Wall

A

“The abdominal aorta spans from T12 to L4, where it bifurcates into the right and left common iliac arteries. It has three types of arterial branches that supply “the gut, glands, and the wall.”

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19
Q

Veins of Posterior Abdominal Wall

A
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20
Q

Nutcracker syndrome

A
  • The relationship between the superior mesenteric artery (SMA) passing over the left renal vein can have rare consequences.
  • “Nutcracker syndrome” is a vascular compression pathology where the left renal vein is compressed within a “vise” between the SMA and abdominal aorta.
  • This uncommon disorder produces hematuria and left flank pain.”
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21
Q

Lumbar Plexus

A
  1. Iliohypogastric n. (L1)
  2. Ilioinguinal n. (L1)
  3. “Genitofemoral n. (L1, L2)
  4. Lateral cutaneous nerve of the thigh (L2, L3)
  5. “Femoral n. (L2, L3, L4)”
  6. Obturator n. (L2, L3, L4)
  7. Lumbosacral trunk (L4,5)
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22
Q

Lumbar Plexus & Its Dermatomes

A
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23
Q

Lumbar Plexus - Identify

A
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24
Q

Iliohypogastric nerve. (L1)

A
  • Innervates: muscles in the inferior part of the anterior abdominal wall; sensory from the skin above the pubis and lateral buttocks.
  • Best place to find it: anterior to quadratus lumborum, superior to the ilioinguinal nerve.
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25
Q

Ilioinguinal n. (L1)

A
  • Innervates: muscles in the inferior part of the anterior abdominal wall; sensory from skin of scrotum or labium majora.
  • Best place to find it: anterior to quadratus lumborum, inferior to iliohypogastric; runs along the iliac crest”
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26
Q

Genitofemoral n. (L1, L2)

A
  • Genital branch: through the deep inguinal ring, to innervate cremaster muscle in males.
  • Femoral branch: descends deep to the inguinal ligament; sensory from skin of anterior upper thigh
  • Best place to find it: pierces psoas major and descends on its anterior surface.”
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27
Q

Lateral cutaneous nerve of the thigh (L2, L3)

A
  • Sensory from the lateral skin of the entire thigh…“skinny jeans” nerve.
  • Best place to find it: passes under the inguinal ligament just medial to the anterior superior iliac spine (ASIS) ”
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28
Q

Femoral n. (L2, L3, L4)

A
  • Innervates: muscles of the anterior thigh (“quads”); sensory from skin of anterior thigh and on the medial leg.
  • Best place to find it: sandwiched between psoas major and iliacus muscles. ​
A big nerve!”
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29
Q

Obturator n. (L2, L3, L4)

A
  • Innervates: adductor muscles (medial thigh)
  • Best place to find it: medial to psoas major in the lateral wall of the pelvic cavity.
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30
Q

Lumbosacral trunk (L4,5)

A
  • Contributes the L4,5 segments to the sciatic nerve in the pelvis.
  • Best place to find it: medial to psoas major, on the ala of the sacrum.
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31
Q

Psoas major muscle

A
  • Long and thick; the “tenderloin”
  • Origin: lateral bodies, transverse processes of T12–L5; inserts: lesser trochanter of femur (with the iiacus muscle, now called iliopsoas) by a strong tendon
  • Action: main thigh flexor, laterally flexes vertebral column”
32
Q

Psoas minor

A

thin strip anterior to psoas major; absent in 40% of individuals

33
Q

Iliacus muscle

A
  • Originates in iliac fossa, fuses with the psoas major inferiorly, inserts on lesser trochanter
  • Action: flexes the thigh ”
34
Q

Quadratus lumborum muscle

A
  • Thick muscular sheet in the PAW; iliac crest up to rib 12 and transverse processes of lumbar vertebrae.
  • Enclosed between two layers of lumbar fascia, which join to form a thick sheet of lumbar fascia lateral to quadratus lumborum.
  • Action: laterally flexes the vertebral column, as when bending sideways. Stabilizes 12th rib during inspiration.
35
Q

Psoas major muscle

A
  • Long and thick; the “tenderloin”
  • Origin: lateral bodies, transverse processes of T12–L5; inserts: lesser trochanter of femur (with the iiacus muscle, now called iliopsoas) by a strong tendon.
  • Action: main thigh flexor, laterally flexes vertebral column.
36
Q

Muscles of PAW

37
Q

PAW Lymph Vessels

38
Q

Cisterna chyli

A

lies near T12, and is the beginning of the thoracic duct, and ascends along the abdominal-vertebral between the right crus of the diaphragm and the aorta, leaving through the aortic hiatus.

39
Q

Kidney - Identify Organs

40
Q

Kidneys - Gross external anatomy

A
  • Fist sized and bean-shaped retroperitoneal organs.
  • Lie T12–L3; right kidney is slightly lower than the left (due to the liver).
  • Fibrous renal capsule.
  • Renal Hilum and Renal sinus (cavity within kidney, accessed via the hilum): located at IV disc between L1 and L2
  • Renal vein is anterior to renal artery, which is anterior to renal pelvis (expanded upper part of ureter).
41
Q

Kidney - Anatomical Relationship

A
  • Anterior: right: right suprarenal gland, liver, descending duodenum, right colic flexure, small intestine; left: left suprarenal gland, stomach, pancreas, small intestine, spleen, left colic flexure, descending colon.
  • Posterior: both: diaphragm, psoas major, quadratus lumborum, thoracolumbar fascia, rib 12, T12 and L1 spinal nerves
42
Q

Kidney - Gross “internal” anatomy

A
  • Renal cortex: receives 90% of blood flow to kidney (receives ~20% of cardiac output!)
    • Lighter outer part just deep to capsule; where urine is made
    • Renal columns: extensions of cortex between renal pyramids
  • Renal medulla (composed of the dark colored renal pyramids)
    • Where urine is concentrated, or diluted
    • Renal papilla: apex of a renal pyramid; where the urine is excreted.
  • Minor calices (singular: calyx): where papilla excretes urine; 2–3 per major calyx”
43
Q

Renal Cortex

A
  • receives 90% of blood flow to kidney (receives ~20% of cardiac output!)
  • Lighter outer part just deep to capsule; where urine is made
  • Renal columns: extensions of cortex between renal pyramids
44
Q

Renal medulla

A
  • composed of the dark colored renal pyramids
  • Where urine is concentrated, or diluted
  • Renal papilla: apex of a renal pyramid; where the urine is excreted.
45
Q

Minor calices (singular: calyx)

A

where papilla excretes urine; 2–3 per major calyx”

46
Q

Major calices

A

where papilla excretes urine; 2–3 per major calyx”

47
Q

Renal vessels

A

Renal artery –> 5 segmental (arise in the sinus, dividing kidney into distinct vascular segments) -> lobar -> interlobar (in renal columns) -> arcuate (arch over base of pyramid) -> interlobular (in cortex) ”

48
Q

Kidney - Anatomy

49
Q

Accessory Renal Artery

A

About 30% of individuals have an accessory renal artery (usually a “polar” artery from development). This is important for surgery!

50
Q

Layers around the kidney

A
  • Renal capsule (outer layer of kidney)
  • Perirenal fat (aka Perinephric fat): surrounds the kidney and extends into the renal sinus
  • Renal fascia (Gerota’s fascia): encloses the kidneys, suprarenal glands and the perirenal fat
  • Pararenal fat (aka Paranephric fat): thickest posteriorly and an extension of the lumbar extraperitoneal fat; usually lots of it ”
  • Clinical Application:
    • All these layers must be traversed to reach the kidney during surgery. Also, the front and back layers of the renal fascia are not fused very tightly below the kidney, so a kidney can move inferiorly and this can kink the ureter and prevent urine from draining.
51
Q

Ureter

A
  • Muscular ducts that carry urine from the kidneys to the urinary bladder.
  • In the same sagittal plane as the tips of the transverse processes of the lumbar vertebrae (which helps identify ureters on x-rays).
  • Blood supply: from renal artery, abdominal aorta, and vessels in the pelvis; is segmental so surgeons must be careful of manipulation or accidental injury causing ischemia.
52
Q

Ureter - Anatomy

53
Q

kidney stones

A
  • Three narrowings along the course of the ureter, which are important as kidney stones frequently are lodged in these locations:
  1. The ureteropelvic junction (as pelvis of ureter narrows to become ureter proper)
  2. As it crosses over the pelvic brim and common iliac vessels.
  3. The passageway through the wall of the bladder”
54
Q

SUPRARENAL GLANDS ​


(AKA ADRENAL GLANDS)

A
  • Located between the kidney and the diaphragm .
  • The right one is pyramid-shaped, the left one crescent-shaped.
  • Two glands in one: “stress” hormones
  1. Cortex: from mesoderm and secretes corticosteroids and androgens
  2. Medulla: from neural crest cells and secretes catecholamines
  • Rich blood supply/many arteries (R/L superior, middle, inferior suprarenal aa); just one vein (the R/L suprarenal vein)
  • The suprarenal glands are also enclosed by the renal fascia”
55
Q

Identify Vessels

56
Q

Kidneys

57
Q

Fibrous (renal) capsule

A

Adherent to kidney

58
Q

Perirenal fat

A

Covers fibrous capsule

59
Q

Pararenal fat

A

Lies external to the renal fascia, and forms part of the retroperitoneal fat

60
Q

Renal (Gerota’s) fascia

A
  • Surrounds perirenal fat.
  • Covers kidneys, suprarenal glands, ureters, and renal vessels.
  • Continuouslaterally with transversalis fascia.
61
Q

Kidneys and Suprarenal Glands

62
Q

Kidneys & Ureters - 1

63
Q

Kidneys & Ureters - 2

64
Q

Ureters - 1

A

​

  • Muscular tubes that covey urine from the renal pelvis to the bladder through peristaltic (wavelike) contractions.
  • Three main points of constriction where kidney stones may become stuck
65
Q

Ureters - 2

66
Q

Internal Anatomy of the Kidney

A

Renal Hilum: entrance to kidney

  • site where renal artery, renal vein, and
  • enal pelvis pass to/from kidney

Renal Sinus: fat-filled cavity inside the kidney

  • Contains urine collecting system = calyces and renal pelvis

Renal medulla is the inner part of the kidney.

  • The renal medulla is split up into a number of sections, known as the renal pyramids

Renal cortex is the outer portion of the kidney between the renal capsule and the renal medulla

  • Cortical columns are projections of the renal cortex between the renal pyramids
67
Q

Internal Anatomy of the Kidney - Identify

68
Q

The renal papilla, the minor calyx, the major calyces, and the large renal pelvis.

69
Q

Internal Anatomy of the Kidney -

Renal Papilla, Minor Calyces, and Major Calyces.

A
  • The renal papilla is the location where the renal pyramids empty urine into the minor calyx.
  • The minor calyces funnel urine into the major calyces.
  • The major calyces funnel into the large renal pelvis.
70
Q

Muscles of Posterior Abdominal Wall - 1

A

Quadratus lumborum

  • Attachments: iliac crest; 12th rib & transverse processes of lumbar vertebrae.
  • Extends and laterally flexes lumbar spine

Psoas major (and minor if present)

  • Origin = bodies & transverse processes of vertebrae T12-L5
  • Lateral and superior portion laterally flexes spine

Iliacus

• Origin = iliac fossa

Iliospsoas

  • Psoas major and iliacus muscles unite and insert as iliopsoas on lesser trochanter of femur.
  • Primary flexor of thigh
71
Q

Muscles of Posterior Abdominal Wall - 2

72
Q

Diaphragm - 1

73
Q

Diaphragm - 2

74
Q

Openings of the Diaphragm

75
Q

Openings of the Diaphragm - 2

FMS 501 - Anatomy (10 decks)

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