Diaphragm, Kidney & Posteror Abdominal Wall Flashcards
What is the origin of the phrenic nerve?
C3-C5
What paralysis can be caused by damage to the phrenic nerve/cervical cord?
Paralyzed hemidiaphragm cannot contract (descend)
- remains high in thorax
- recognizable on - radiographic chest films
What foramena and hiatuses are in the diaphragm?
- Vena Cava foramen T8 (IVC)
- Esophageal Hiatus T10
- Aortic Hiatus T12
What are the Arcuate Ligaments or Lumbocostal arches?
- 1 median arcuate lig. arches over aorta - 2 medial arcuate ligs. arch over psoas mm. - 2 lateral arcuate ligs. arch over quadratus lumborum mm.
What are the Vessels of Diaphragm?
1) Pericardiacophrenic & superior phrenic aa
- supply superior surface (via int. thoracic a & thoracic aorta)
2) Inferior phrenic aa
- supply inferior surface (via abdominal aorta)
3) Musculophrenic aa
- supply periphery of diaphragm (via int. thoracic aa.)
4) Venous drainage is via accompanying vv to IVC
Where are the kidneys?
located lateral to vertebral column T12-L3
- superior pole of L kidney at 11th rib
- superior pole of R kidney at 12th rib
Kidneys are encapsulated by ___________
perirenal fat & renal fascia
During development, the kidneys ascend from ______
pelvis
What is the internal structure of the kidney?
Fibrous capsule Renal cortex = outer 1/3 Renal medulla = inner 2/3 contains renal pyramids
Renal papillae = receive apex of pyramids Minor calyces Major calyces Renal pelvis Ureter
What is the vasculature of the kidneys?
1) Renal Arteries
- R longer
- R passes post to IVC
Each divides at hilum into segmental aa
end arteries
2) Renal veins to IVC
anterior to arteries
L is longer
L passes anterior to aorta
What is the pathway of kidney/urine drainage?
Renal papillae = receive tips of pyramids (urine) to Minor Calyces to Major Calyces to Renal pelvis to Ureter to Urinary bladder to Urethra
What is the path of the ureters?
- Cross psoas major mm to enter bladder
- Run obliquely posterior to gonadal vessels
- Anterior to Ext. Iliac a.
Anomalies in the ureters
- Bifid renal pelvis & ureters is fairly common
* Retrocaval ureters – occasional
What is the vasculature of the ureters?
- Ureter Arteries – arise from 3-4 sources:
1) renal a.
2) testicular or ovarian a.
3) abdominal aorta
4) internal iliac a. (Pelvic cavity)
Veins of ureters drain into similarly named vv.
What is an Intravenous urogram (IVU)?
Patient is injected with iodinated contrast medium.
Media are excreted by glomerular filtration and by renal tubules.
Allows visualization of the ureters and bladder.
What are kidney stones (calculi)?
- Form in kidney & progress to renal pelvis
1) May spontaneously pass thru ureter into bladder
2) Usually associated with considerable pain
3) Larger stones my have to be surgically removed (~1cm)
4) May be subjected to ultrasonic crushing - via lithotripsy
How does Calculi Referred Pain work?
1) Waves of contraction force stone down thru ureter
2) Rhythmic pain occurs & is referred with descent of stone
3) Region of referred pain changes with level of obstruction
4) Gradually moves inferoanteriorly toward groin
- from side & back between ribs to pelvis to inguinal
- area of cutaneous innervation T11-12
Adrenal (Suprarenal) Glands
R gland – roughly triangular
Lies superior to R kidney, posterior to IVC
L gland – more semilunar
Lies superomedial to L kidney near hilum
What are Gross features: Adrenal (Suprarenal) Gland?
1) Fibrous capsule
2) Adrenal cortex = outer
produces adrenal steroids
3) Adrenal medulla = inner
portion that acts as sympathetic ganglion
What is the vasculature of the Adrenal (Suprarenal) Glands?
Richly vascularized due to endocrine function Suprarenal aa – 3 sources Sup. suprarenal aa (6-8) Inferior phrenic a Middle suprarenal aa (1+) Abdominal aa Inf. suprarenal aa (1+) Renal aa
What is the musculature of the posterior abdominal wall?
1) Transversus abdominus m.
2) Quadratus lumborum m.
3) Psoas major m
4) Iliacus m.
5) Psoas minor m.
6) Diaphragm
What is the Arterial Supply of Posterior Wall?
1) Lumbar aa. - 4 pairs of aa, brs of Abdominal Aorta (sup to bifurcation)
* aorta bifurcates at L4 (level of umbilicus)
What are the nerves of the posterior wall?
1) Ventral rami T12-L4
2) Lumbar plexus of nn.
located beneath fascia of posterior abd. mm.
3) ventral rami T12-L4
4) Lumbar plexus of nn.
note positions of the nerves relative to psoas major m.
- Symp. trunks posterior as well
- continuous with thoracic portions
Where is the Subcostal n. and what does it supply?
- ~1cm inferior to 12th rib
- Supplies sensory to ant./lat. abd. wall
- Supplies motor to abdominal mm.: EO, IO, TA, pyramidalis, RA, QL
Where are the Iliohypogastric & Ilioinguinal Nn. and what do they supply?
- Can arise from common trunk
- descend ant. to QL
- Iliohypogastric n. supplies skin of suprapubic region
- Ilioinguinal n. runs thru inguinal call to supply it
- Both also supply abd. mm.
Where is the genitofemoral n. and what does it supply?
- L1-L2
- Pierces psoas major m.
- descends along ant. surface
- Splits to femoral br. & genital br.
- Supplies skin inf. & med. to inguinal ligament
- Supplies cremaster m. (of spermatic cord)
Where is the Lateral Femoral Cutaneous N. and what does it supply?
- L2-L3
- Descends ant. to iliacus m.
- Passes deep to inguinal ring
- Inferior to ASIS
- Supplies ant./lat. skin of thigh
Where is the femoral n. and what does it supply?
- L2-L4
- Runs between iliacus & psoas major mm.
- Passes deep to inguinal ligament
- Inferior to ASIS
- Supplies sensory & motor to anterior thigh
Where is the Obturator N. and what does it supply?
- L2-L4
- Runs medial to psoas major mm.
- Passes thru obturator foramen
- Supplies sensory & motor to medial thigh
Where is the lumbosacral trunk and what does it supply?
- L4-5
- Large n. trunk crosses over ala of sacrum
- Descends into pelvis to help form sacral plexus
- Provides general contributions to both plexuses
