deck_5703365 Flashcards
What are the 3 coverings of the kidney from the outside in? In which layer are the suprarenal glands enclosed?
- Paranephric adipose tissue2. Renal fascia***3. Perinephric adipose tissue (outside of renal capsule)
What is special about lumbar vertebrae?
Larger than any other vertebrae and bodies increase in size as you go down the vertebral column
What are the inferior and superior boundaries of the posterior abdominal wall?
L1 and S1 intervertebral discs
Surface of sacrum?
Anterior: concavePosterior: convex
What parts of the pelvic bone are part of the posterior abdominal wall?
Medial side of iliac fossae
What ribs are part of the posterior abdominal wall? How are they unique?
Ribs 11 and 12 Do not articulate with sternum, one single articular facet on head, no neck, no tubercle
Position of ribs in relation to kidneys?
Rib 11: posterior to superior part of left kidneyRib 12: posterior to superior part of both kidneys
Which of the 2 ribs serves as a point of attachment for numerous muscles and ligaments?
Rib 12
Differences between right and left kidneys?
- Right one is lower than left (because of liver)2. Left one is longer and more slender
Vertebral levels of kidneys when in supine position?
Right: L1 to L4Left: T12 to L3
What 5 structures are in contact with the anterior surface of the right kidney? Indicate which ones are separate from kidney by a layer of peritoneum.
- Right suprarenal gland (small part of the superior pole)2. **Liver (a large part of the rest of the upper part)3. Descending part of the duodenum (middle medial part)4. Right colic flexure (inferior pole on lateral side)5. **Intraperitoneal small intestine (inferior pole on small intestine)
What 6 structures are in contact with the anterior surface of the left kidney? Indicate which ones are separate from kidney by a layer of peritoneum.
- Left suprarenal gland (small part of the superior pole)2. **Stomach and spleen (a large part of the rest of the upper part) 3. Pancreas (middle part) 4. Left colic flexure (middle lateral part) 5. Descending colon (lower lateral part)6. **Jejunum (lower medial part)
What is in contact with both kidneys on posterior surface? 6 structures. What is posteriorly located but not in direct contact?
- Diaphragm2. Ribs (see other flashcard)3. Psoas major, quadratus lomborum, and transversus abdomonis (medial to lateral)4. Subcostal VAN5. Iliohypogastric nerve6. Ilio-inguinal nerve+ Costodiaphragmatic recesses
How are the kidneys and suprarenal glands separated?
Thin septum
What happens to the renal fascia laterally?
Anterior and posterior flaps of renal fascia fuse and may connect to the transversalis fascia
What happens to the renal fascia superiorly?
Anterior and posterior flaps of renal fascia fuse and blend with the fascia that covers the diaphragm
What happens to the renal fascia medially?
- Anterior layer: extends over the vessels of the renal hilum and fuses with connective tissue associated with aorta and IVC (may also connect to the renal fascia from the opposite side)2. Posterior layer: fuses with fascia covering the quadratus lomborum
What happens to the renal fascia inferiorly?
Covers the ureters
Where does adipose tissue accumulate around the kidneys?
Postero and posterolaterally
Other name for renal fascia?
Gerota’s fascia
Location of laparotomy for kidney surgery?
Flank region on the posterior-lateral side of kidneys (sometimes from anterior surface)
4 components of urinary system?
- Kidneys2. Ureters3. Urinary bladder4. Urethra
Is the urethra shorter in males or females? Implication?
Females => more susceptible to UTIs and cystitis
Location of ureters as they descend in posterior abdominal wall? What does displacement mean?
Medially at the level of the vertebral transverse processes anterior to the psoas major Displacement = pathology
Implication of fact that left kidney is higher than right one?
- Left one is more protected by the ribs2. Right one lies mostly under liver3. Left one lies mostly under stomach2. Right one is closer to the right iliac crest than the left one is the left iliac crest
What color do the kidneys appear on a CT scan?
Grey, unless they have contrast in them (white)
What 3 structures enter/exit the kidney at the renal hilum? Describe their location.
- Renal vein (superior/anterior)2. Renal artery (superior/posterior)3. Renal pelvis (inferior)4. Lymphatics5. Nerves
What is the renal pelvis?
Funnel shaped superior portion of ureter
7 structures of the kidney?
- Renal Fascia2. Cortex3. Medulla4. Renal sinus5. Minor calyces6. Major calices7. Renal pelvis
What is the renal capsule?
Fibrous tissue covering the kidney
What is the renal hilum continuous with internally?
Renal sinus
What is the renal cortex?
Continuous band of pale tissue that completely surrounds the renal medulla
What are renal columns?
Extensions of renal cortex into the renal medulla and dividing the medulla into renal pyramids
What are renal pyramids?
Discontinuous aggregations of triangular-shaped tissue with bases facing outward and apexes (aka renal papilla) facing inward toward the renal sinus
What are the renal papilla surrounded with?
Minor calyx
What are the minor calices of the kidneys? What about the major calices? How does this relate to the renal pelvis?
These receive urine and represent the proximal parts of the tube that will eventually form the ureterIn the renal sinus, several minor calices unite to form a major calyx, and two or three major calices unite to form the renal pelvis
What are both kidneys in contact with superiorly?
Diaphragm
Kidney poles’ location?
Superior medial side
% of CO received by kidneys?
25%
At what vertebral levels do the renal arteries arise from the abdominal aorta?
L1 to L2
Which renal artery is longer than the other? Which one arises higher?
Right one is longer Left one arises higher
What is located anterior to right renal artery?
IVC
Position of renal veins relative to renal arteries?
Anterior
Which renal vein is longer than the other?
Left one is longer
Position of aorta with regards to left renal vein?
Posterior
What vein drains into the left renal vein? Does this happen on the right?
Left gonadal vein and left suprarenal NOPE, right gonadal vein and right suprarenal veins drain into IVC directly
Describe the branching of the renal arteries. What do we call these?
Renal artery =>1. Apical segmental artery2. Anterosuperior segmental artery3. Anteroinferior segmental artery4. Posterior segmental artery5. Inferior segmental artery= segmental arterial support to each of the 5 segments of each kidneys (like lungs, like liver)
What are accessory renal arteries? What are these called?
These are common and arise from the abdominal aorta either above or below the primary renal arteries (can also supply kidneys without passing through hilum)= extrahilar arteries
Position of SMA with regards to left renal vein?
Anterior
Aneurysms in what 2 vessels could cause compression of the left renal vein? What do we call this? What would this cause?
- Aorta2. SMANutcracker angle Can cause enlargement of the left renal vein leading to enlargement of the left gonadal vein (leading to enlarged left scrotum in males = varicocele)
Lymph drainage of kidneys?
Lateral aortic (aka lumbar) nodes around the origin of the renal arteries
What is “special” about renal arteries?
They are END arteries
What does the segmentation of the kidneys allow for?
Partial nephrectomies
What do the suprarenal glands consist of? What does each contain?
- Outer cortex with cells to make steroid hormones2. Inner medulla with cells that make catecholamine hormones
Shape of suprarenal glands? Is one larger than the other?
Left: semilunar and LARGERRight: pyramid
What is located anterior to the right suprarenal gland?
- Right liver lobe2. IVC
What is located anterior to the left suprarenal gland?
- Stomach2. Pancreas3. Sometimes spleen
What is located posterior to suprarenal glands?
Diaphragm
Arterial blood supply to suprarenal glands? Asymmetry?
- Superior suprarenal arteries from the inferior phrenic arteries 2. Middle suprarenal artery from the abdominal aorta3. Inferior suprarenal arteries from the renal arteriesShorter on the left, longer on the right
Venous drainage of suprarenal glands?Asymmetry?
Single vein leaving hilum of each gland:- Right one drains into IVC directly and is short- Left one drains into left renal vein and is longer
What is meant by gonadal veins?
Testicular or ovarien veins
Is left or right varicocele more common?
LEFT
What part of the kidney is the peristaltic pacemaker? Rate?
Minor calices that have special smooth muscle 4 waves/min
What are ureters?
Muscular ducts with narrow lumens
How serious is blocked uretic flow?
VERY
What do patients develop with renal failure?
Uremia
Where does the renal pelvis become continuous with the ureters?
Ureteropelvic junction
What do the ureters pass anteriorly to inferiorly? At what level?
Beginning of external iliac artery or end of common iliac artery at the level of the pelvic brim
At what 3 levels are ureters constricted? What happens here?
- Ureteropelvic junction2. Pelvic brim3. Where the ureters enter the wall of the bladderHigh risk of kidney stones getting stuck
Blood supply of ureters? What to note?
Branches from:1. Renal arteries (upper end)2. Abdominal aorta or gonadal arteries or common iliac arteries (middle part)3. Internal iliac arteries (lower end) => arteries reaching the ureters divide into ascending and descending branches, which form longitudinal anastomosesIn the abdomen, blood supply to ureters arrives from their medial side, whereas in the pelvis blood arrives from their lateral side
Lymphatic drainage of ureters?
- Upper part: lateral aortic (lumbar) nodes2. Middle part: lymph nodes associated with the common iliac vessels => lumbar LNs => cistern chylo3. Inferior part: lymph nodes associated with the external and internal iliac vessels
On what bladder surface do the ureters connect?
Posterior/inferior surface of the bladder
How to see kidneys/ureters on X-ray? Can you see the whole length of the ureters?
Inject contrast via IV, which is then excreted by kidneys Cannot see whole length of the ureters because of the peristalsis taking place NORMALLYIf you do see this => pathology (pressure backing up the system)
Uteric innervation?
From the renal, aortic, superior hypogastric, and inferior hypogastric plexuses through nerves that follow the blood vessels with visceral efferent fibers from both sympathetic and parasympathetic sources, and visceral afferent fibers returning to T11 to L2 spinal cord levels
Uretic pain?
Referred to cutaneous areas supplied by T11 to L2 spinal cord levels (LLQ or LRQ)), most likely includes: 1. Posterior and lateral abdominal wall below the ribs and above the iliac crest2. Pubic region3. Scrotum in males and labia majora in females4. Proximal anterior aspect of the thigh
Kidney pain?
Referred to anterior and posterior flank
What 2 pains are often hard to distinguish for physicians? How to distinguish?
Referred pain of kidney stone in right ureter and direct pain from parietal peritoneum due to appendicitis would both be in LRQ and both in waves due to peristalsis Appendicitis: patients do not want to move because it makes the pain worse and will bend their knees toward the abdomen to try and relax it and also you can do the rebound sign test Kidney stones: very agitated and moving and do not guard their abdomen
What is a uteric colic?
Paroxysm of pain due to abrupt obstruction of ureter from a calculus or blood clot in most instances
What is the rebound sign test? What is this pain called?
To test whether parietal peritoneum is affected , press down (pain stays constant), and remove pressure (if affected, pain should get much worse due to friction between visceral and parietal peritoneum)=> 2nd level of pain
If you put a catheter in the urethra, can you reach the renal pelvis?
YUP
What kind of kidney stones are better to not break down with waves?
When they are in the lower pole as they may not be able to be excreted by peristalsis
What does diabetes increase the risk of?
Infections
What can recurrent UTIs be indicative of?
- Congenital malformation 2. Foreign object
Describe the pathway of the innervation of the adrenal medulla. What to note?
Preganglionic neuron in lateral ventral horn T5 to T9 spinal cord => anterior root => spinal nerve => white ramus communicans => paravertebral ganglion (no synapse) => greater thoracic splanchnic nerve exits => unpaired prevertebral (preaortic) celiac ganglion (no synapse) => periarterial plexus => synapse on adrenal medulla => release of NE and EPINote: some pregranglionic fibers do synapse at the celiac ganglion and postganglionic fibers innervate the blood vessels of the suprarenal glands
First branches of the abdominal aorta?
R and L inferior phrenic arteries
4 unpaired branches of the abdominal aorta? Which ones are visceral? Which ones are parietal? From where do they branch? At what level does each branch?
VISCERAL:1. Celiac trunk (anterior) - immediately inferior to aortic hiatus at L1 upper border2. SMA (anterior) - L1 lower border3. IMA (anterior) - L3PARIETAL: 4. Median sacral artery (posterior) - just superior to aortic bifurcation
6 paired branches of the abdominal aorta? Which ones are visceral? Which ones are parietal? From where do they branch? At what level does each branch?
VISCERAL:1. Middle suprarenal arteries (lateral) - superior to renal arteries2. Renal arteries (lateral) - L23. Gonadal arteries (anterior) - inferior to renal arteriesPARIETAL: 1. Inferior phrenic arteries (posterior) - immediately superior to celiac trunk2. Lumbar arteries (posterior) - 2 sets: one superior to IMA and one inferior to IMA3. Common iliac arteries (terminal) - L4
Location of median sacral artery in regards to the sacrum, coccyx, and sacral vertebrae?
Anterior
What are the 3 posterior branches of the abdominal aorta?
- Inferior phrenic arteries2. Lumbar arteries3. Median sacral artery
Level of IVC entering diaphragm? Most inferior level?
T8 to L5
Vertebral levels of abdominal aorta?
T12 to L4
Location of coming together of 2 common iliac veins to form IVC?
L5: posterior/inferior to abdominal aorta branching
2 unpaired branches of IVC? Which ones are visceral? Which ones are parietal?
- Right suprarenal2. Right gonadalBoth visceral
5 paired branches of IVC? Which ones are visceral? Which ones are parietal?
VISCERAL:1. Hepatic veins (right, middle, left)2. Renal veinsPARIETAL:1. Inferior phrenic veins2. Lumbar veins (5 of them)3. Common iliac veins
Do all lumbar veins drain into the IVC?
NOPEOnly the 3rd and 4th do5th: drains into iliolumbar vein 1st and 2nd drain into ascending lumbar veins connecting common iliac veins, iliolumbar veins, and lumbar veins with azygos and hemiazygos veins
Branches of the common hepatic artery? List in branching order.
SAME BRANCHING POINT:2. Gastroduodenal artery3. Hepatic proper artery
Branches of the gastroduodenal artery? List in branching order.
SAME BRANCHING POINT:1. Right gastro-epiploic artery2. Superior pancreatico-duodenal artery
What artery runs the risk of being perforated by a duodenal ulcer?
Gastroduodenal artery
What structures pass anteriorly to abdominal aorta?
- Pancreas and its splenic vein2. Left renal vein3. Inferior part of the duodenum
What structures pass posteriorly to abdominal aorta?
Lumbar veins that drain in IVC (3rd and 4th)
Structures located to the right of the abdominal aorta?
- Cisterna chyli 2. Thoracic duct3. Azygos vein4. Right crus of diaphragm5. IVC
Structures located to the left of the abdominal aorta?
Left crus of diaphragm + sympa chain
What structures pass anteriorly to the SMA?
- Splenic vein2. Neck of pancreas
What structures pass posteriorly to the SMA?
- Left renal vein2. Uncinate process of pancreas3. Inferior part of duodenum (actually marks the junction with the 4th part of the duodenum)
5 branches of the superior mesentery artery? From what side do they branch? List in branching order.
- Inferior pancreaticoduodenal artery - right side 2. Middle colic artery - right side3. Jejunal ileal branches - left side4. Right colic artery - right side5. Ileocolic artery - right side
Which of the 3 visceral unpaired branches of the abdominal aorta is the smallest?
IMA
3 branches of the IMA? From what side do they branch? List in branching order.
- Left colic artery 2. Branches to sigmoid colon (2-5)3. Superior rectal arteryALL on left side
2 branches of left colic artery?
- Ascending branches2. Descending branches
What are the 3 venous networks in the abdominal cavity?
- Portal2. Caval3. Azygos
What veins would drain the abdomen if the IVC was occluded?
Ascending lumbar veins
What does the median sacral vein drain into?
Left common iliac vein
2 types of abdominal LNs? What do each form?
- Pre-aortic: anterior to the aorta near celiac, SMA, and IMA => intestinal trunk2. Para-aortic = lumbar: right and left lateral => right and left lumbar trunks
What abdominal structures drain to the lumbar LNs?
- Body wall2. Kidneys3. Suprarenal glands4. Testes or ovaries
What abdominal structures drain to the pre-aortic LNs?
The viscera supplied by those vessels
What happens to the intestinal trunk and the R/L lumbar trunks? Where is this located?
Come together and form a confluence that, at times, appears as a saccular dilation (the cisterna chyli) => posterior to the right side of the abdominal aorta and anterior to the bodies of vertebrae L1 and L2
2 types of innervation to viscera? Describe each.
- Extrinsic innervation: ANS2. Intrinsic innervation: ENS
Describe the pathway of the greater splanchnic nerve.
5th to 9th/10th thoracic ganglia => crus of diaphragm to abdomen => prevertebral plexus => ends in celiac ganglion
Describe the pathway of the lesser splanchnic nerve.
9th and 10th OR 10th and 11th thoracic ganglia => crus of diaphragm to abdomen =>prevertebral plexus => ends in aorticorenal ganglion
Describe the pathway of the least splanchnic nerve.
12th thoracic ganglion => crus of diaphragm to abdomen => prevertebral plexus => ends in renal plexus
What does the greater splanchnic innervate?
Foregut/midgut and adrenal medulla
What does the lesser splanchnic innervate?
- Foregut/midgut2. Kidneys and upper ureters
What does the least splanchnic innervate?
Foregut/midgut
Parasympathetic innervation of the abdomen?
From the vagus nerve up to the left colic flexure and thepelvic splanchnic nerves from left colic flexure to rectum (pelvic splanchnics from S2-S4 to the pelvic plexus)
Describe the parasympathetic autonomic motor innervation pathway to the foregut and midgut.
Vagus nerve => unpaired prevertebral celiac ganglion (no synapse) => synapse in intramural ganglion => postganglionic enteric neuron => viscera
What is the 1st level of pain?
Referred pain
6 muscles of the posterior abdominal wall?
- Psoas major2. Psoas minor3. Iliacus4. Quadratus lomborum5. Transversus Abdominis6. Diaphragm
What does the psoas major become when it is joined by the iliacus?
Iliopsoas which attaches via a common tendon: iliopsoas tendon
Iliacus muscle:1. Origins2. Insertions3. Innervation4. Actions
- Upper two-thirds of iliac fossa, anterior sacro-iliac and iliolumbar ligaments, and upper lateral surface of sacrum (ala) 2. Lesser trochanter of femur 3. Femoral nerve (L2 to L4) 4. Flexion of thigh at hip joint and flexion of pelvis if thigh is fixed
Psoas major muscle:1. Origins2. Insertions3. Innervation4. Actions
- Lateral surface of bodies of T12 to L5 vertebrae, transverse processes of the lumbar vertebrae, and the intervertebral discs between T12 to L5 vertebrae 2. Lesser trochanter of the femur 3. Anterior rami of L1 to L3 4. Flexion of thigh at hip joint, flexion lateral bend of the lumbar vertebral column, allows us to walk, and to do situps if abdominal are weak (e.g. pregnant women)
Psoas minor muscle:1. Origins2. Insertions3. Innervation4. Actions
- Lateral surface of bodies of T12 and L1 vertebrae and intervening intervertebral disc 2. Pectineal line of the pelvic brim and iliopubic eminence 3. Anterior rami of L1 4. Weak flexion and lateral bend of lumbar vertebral column
Quadratus lomborum muscle:1. Origins2. Insertions3. Innervation4. Actions
- Transverse process of L5 vertebra, iliolumbar ligament, and iliac crest 2. Transverse processes of L1 to L4 vertebrae and inferior border of rib 12 3. Anterior rami of T12 to L44. Depress and stabilize rib 12 and some lateral bending of trunk
What nerve pierces the anterior surface of the psoas major?
Genitofemoral nerve
What is the liopubic eminence?
Junction of ilium and superior pubic ramus
What posterior abdominal wall muscle is absent in 40% of cases?
Psoas minor
What crosses the quatratus lomborum anteriorly?
Lateral arcuate ligament of the diaphragm
Attachments of the diaphragm?
- Xiphoid process2. Costal margin3. Ends of ribs 11 and 124. Ligaments that span across structures of the posterior abdominal wall5. Vertebrae of the lumbar region 6. Pericardium through central tendon
What is the posterior attachment of the diaphragm called? What does it attach to?
Median arcuate ligament to T8/T9
Blood supply of diaphragm? Which part is the largest blood supply?
- Superiorly: pericardiacophrenic and musculophrenic arteries (branching from the internal thoracic arteries), superior phrenic arteries (from thoracic aorta), and intercostal arteries2. Inferiorly: inferior phrenic arteries*** branching from the abdominal aorta
Innervation of diaphragm? Why?
Phrenic nerves that innervate it from its abdominal surface + peripheral areas are innervated by intercostal nerves Because the tissues that initially give rise to diaphragm are in anterior position on embryological disc before the head fold develops
What connects the diaphragmatic crura? Relation to aorta?
Median arcuate ligament, anterior to the aorta
How is the diaphragm anchored to the lumbar vertebrae?
Musculotendinous crura which blend with the anterior longitudinal ligament of the vertebral column (2 of them: L and R)
Which diaphragmatic crura is longest and broadest?
Right crus
Attachement of right crus of diaphragm?
L1 to L3 and intervening vertebral discs
Attachement of left crus of diaphragm?
L1 to L2 and intervening vertebral discs
What connects the diaphragmatic crura? Relation to aorta?
Median arcuate ligament, anterior to the aorta
Origins of the diaphragm?
- Sternum and xiphoid process anteriorly2. L1 to L3 lumbar vertebrae and the arcuate ligaments posteriorly3. Costal margin peripherally
What are the 3 ligaments of the diaphragm?
- Median arcuate ligament2. Medial arcuate ligament3. Lateral arcuate ligament
What is the medial arcuate ligament? Attachments?
Tendinous arch formed by the fascia covering the upper part of the psoas major muscle Attachments:- Medially: sides of L1 and L2- Laterally: transverse process of L1
Position of medial arcuate ligament relative to the diaphragmatic crura?
Lateral
What is the lateral arcuate ligament? Attachments?
Tendinous arch formed by a thickening of fascia covering the quadratus lomborum Attachments:- Medially: transverse process of L1- Laterally: rib 12
What are the domes of the diaphragm produced by?
- Liver on right + some contribution from right kidney and right suprarenal gland2. Fundus of stomach and spleen on left with contribution from left kidney and left suprarenal gland
Surface projection of right dome of diaphragm during expiration?
Rib 5
Surface projection of left dome of diaphragm during expiration?
5th ICS
Insertion of diaphragm?
Central tendon
What is an iliopsoas test? What is it used for? What could cause a positive test?
Performed when an intra-abdominal inflammation is suspected or to test theiliopsoas muscle itself. The patient lies on unaffected side and asked to flex the affected leg against the physician’s hand. If there is pain, it would indicate a positive psoas sign. An acutelyinflamed appendix could produce such a sign.
3 names for the covering of the psoas muscle? Pathology associated with it? What is this due to? What does this resemble?
“Psoas sock” = psoas fascia = psoas sheathCan thicken and become like a stocking-shaped tube (usually as a result of an abscess from tuberculosis in the lumbar region) => pus from the psoas abscess may travel down to the inguinal region presenting as a lump in the groin in the femoral triangle (could be due to one of many pathological conditions)Resembles enlarged inguinal lymph nodes
Relation to psoas major and iliacus to inguinal ligament?
Posterior
7 nerves of posterior abdominal wall? Origin of each?
- Subcostal nerve - T122. Iliohypogastric nerve - L13. Ilioinguinal nerve - L14. Lateral femoral cutaneous nerve - L2-L35. Genitofemora nerve - L1-L26. Femoral nerve - L2-L47. Obturator nerve - L2-L4
Sensory innervation of iliohypogastric nerve?
Posterolateral gluteal skin and skin in pubic region
Sensory innervation of ilioinguinal nerve?
Skin in the upper medial thigh, and either the skin over the root of the penis and anterior scrotum or the mons pubis and labium majus
Sensory innervation of genitofemoral nerve?
Genital branch—skin of anterior scrotum or skin of mons pubis and labium majus; femoral branch—skin of upper anterior thigh
Sensory innervation of Lateral femoral cutaneous nerve?
Skin on anterior and lateral thigh to the knee
Sensory innervation of obturator nerve?
Skin on medial aspect of the thigh
Sensory innervation of femoral nerve?
Skin on anterior thigh and medial surface of leg
What nerve passes at the corner created by the inguinal ligament and ASIS?
Lateral femoral cutaneous nerve
Nerve on medial side of psoas?
Obturator nerve
Is the posterior attachment of the diaphragm superior or inferior to the anterior attachment?
Inferior
Which 7 structures penetrate the diaphragm? At what vertebral level?
CAVAL OPENING: T8 in central tendinous portion 1. IVC 2. Right phrenic nerve 3. Right pericardiacophrenic arteryESOPHAGEAL HIATUS: T10 to left of midline4. Esophagus 5. Anterior and posterior vagal trunks6. Esophageal branches of left gastric arteryOTHER:6. Left phrenic nerve (through muscular part anterior to central tendon on left side)
Which structure passes posteriorly to the diaphragm from the thorax? At what vertebral level or position?
AORTIC HIATUS: T12 posterior to median arcuate ligament 1. Aorta 2. Thoracic duct 3. Optional azygos vein 4. Greater, lesser, and least splanchnics PLUS: 5. Sympathetic trunks (posterior to medial arcuate ligament)6. Hemiazygos vein (through left crus)7. Lymphatics
Which structure passes anteriorly to the diaphragm from the thorax? Position relative to ribs?
Superior epigastric vessels (just deep to the ribs)
Sensory innervation of phrenic nerves with regards to diaphragm?
Both pleural and peritoneal surfaces of the diaphragm
What 4 abdominal organs can go down in pelvis?
- Ureters2. Ileum3. Sigmoid colon4. Appendix
What 2 pelvic organs can go up in the abdomen?
- Urinary bladder2. Pregnant uterus (as high as xiphoid process)
Are there variations where the left renal vein passes posterior to the abdominal aorta instead of passing through the nutcracker angle?
YUP
Other name for jejunal ileal branches of the SMA? How many of these are there?
Intestinal arteriesUsually 15-18 of them total
What is the marginal artery of the colon?
Artery that anastomoses all of the branches of the SMA with IMA
What area of the colon is most at risk for becoming ischemic?
Splenic flexure because it receives blood supply for the end of the SMA and IMA
Are veins in the abdomen overall anterior or posterior to arteries?
Posterior
Vertebral level of SMV meeting the splenic vein?
L2 (slightly inferior to SMA)
What is very variable in the portal circulation?
Where the IMV meets the other veins
Which large vein and artery in the abdomen are not coupled?
IMA and IMV (IMV more lateral)
Is more cortex or more medulla in the liver?
More cortex
Other name for lumbar arteries?
Spinal arteries
What do the lumbar arteries supply?
Posterior abdominal wall
What part of the duodenum passes anteriorly to the aorta?
Inferior (3rd)
What 2 veins pass anteriorly to the aorta?
- Splenic vein2. Left renal vein
Does the IVC receive any tributaries from the gut?
NOPE
Path of IVC in abdomen?
Slightly to the right
Which is longer: IVC or abdominal aorta?
IVC
What nerve passes between the psoas and the iliacus muscles?
Femoral nerve
What 2 nerves are superior to the lateral cutaneous nerve of the thigh? What to note?
- Iliohypogastric nerve (highest)2. Ilioinguinal nerve (lowest)They come out as one nerve at L1
What muscles do the iliohypogastric and ilioinguinal nerves innervate?
Internal oblique and transversus abdominis
Possible variation of the suprarenal arteries?
Inferior one connects to the middle one
What needs to be ligated during a partial nephrectomy?
- Segmental arteries2. Veins3. Bile collecting system
Describe the parasympathetic autonomic motor innervation pathway to the hindgut and pelvis.
Preganglionic neuron in ventral horn of sacral spinal cord (S2-S4) => anterior root => spinal nerve => pelvic splanchnics => unpaired prevertebral ganglion (no synapse) => synapse in intramural ganglion => postganglionic neuron => viscera
Pathway of visceral sensory nerves of GIT?
Follow the parasympathetic and sympathetic innervation pathways back to spinal nerve => DRG => posterior root => dorsal horn of spinal cord
Pathway of abdominopelvic splanchnics to viscera?
Preganglionic neuron in lateral ventral horn spinal cord => anterior root => spinal nerve => white ramus communicans => paired paravertebral ganglia (no synapse and same level/up/down the spinal cord) => splanchnic nerve exiting the paravertebral ganglion => synapse in unpaired prevertebral ganglion => postganglionic enteric neuron => viscera
Sympathetic nerves inhibiting the ENS? What does each innervate? Vertebral level for each?
Abdominopelvic splanchnics:1. Greater splanchnic (T5-T9): foregut and midgut2. Lesser splanchnic (T10-T11): foregut and midgut3. Least splanchnic (T12): foregut and midgut4. Lumbar splanchnic (L1-L2): hindgut
Where does the right gastric artery branch from?
HEPATIC ARTERY PROPER (BUT VERY VARIABLE)
