Diaphragm, Kidneys, and Posterior Abdominal Wall Flashcards
Fat and Fascia surrounding the kidneys (superficial to deep)
Transversalis fascia and peritoneum
Renal fascia - paranephric fat
Renal capsule - paranephric fat
Fibrous capsule of the kidney
The outermost layer of the kidney
Renal cortex
Outer 1/3 of the kidney
Renal medulla
Inner 2/3 of the kidney
Contains the Pyramids
Renal Papillae
Receive the apex of the pyramids
Sending urine to the calyces
Minor Calyces
Collect from the papillae and send to the major calyces
Major Calyces
Collect from the minor calyces and send to the renal pelvis
Renal Pelvis
Collect from the Major calyces and send to the ureter
Ureter
Send urine to the bladder
Kidney Position
Lateral to the vertebral column at the T12-13 level
Superior poles are uneven
Where are the superior poles of the kidneys
L = 11th rib
R = 12th rib
Right is more inferior because of the liver
Kidney drainage
Papilale -> minor calyces -> major calyces -> renal pelvis -> ureters -> urinary bladder -> urethra
Renal arteris
Right renal artery is longer, because the aorta is closer to the left kidney
R renal artery passes IVC posteriorly
Renal arteries divide into 5 segmental arteries at each hilum to supply the different lobes of the kidney
Renal veins
L is longer, because the IVC is closer to the right
L passes anterior to the aorta
Course of the Ureters
Leave the hilum of kidney
Cross Psoas major m anteriorly and enters the bladder
Runs medial and obliquely posterior to gonadal vessels
Anterior to the External Iliac artery
What the possible Variations of the ureters?
Bifid renal pelvis
Retrocaval ureters
Bifid renal pelvis
Multiple ureters
Farily common variation of ureters
Retrocaval ureters
R ureter wraps around the IVC
Occasional, but rare
Ureter vasculature
Arteries arise from 3-4 sources Renal artery Testicular or Ovarian arteries (gonadal arteries) Internal iliac artery Drains into similarly named veins
What is an intravenous urogram?
Patient is injected with iodinated contrast medium
Media are excreted by glomerular filtration and renal tubules
Allows fro visualization of the ureters and bladder
Kidney Stones
Form in kidney and progress to the renal pelvis
May spontaneously pass through ureter into bladder
Usually causes considerable pain
Stones >1cm may need to be removed surgically
May be subjected to ultrasonic crushing
Referred pain in kidney stones
Rhythmic waves of referred pain
Caused by contractions to move the stone down the ureters
Referred pain starts in the lower back
Pain moves around the side and toward the groin as stone progresses (T11-12)
Left Adrenal Gland
More semilunar
Lies superomedially to left kidney
Looks like it’s sliding off the top to the hilum
Right Adrenal Gland
Roughly triangular
Superiorly to right kidney
Adrenal gland structure
Fibrous capsule surround the adrenal cortex, which surrounds the medulla
Adrenal Cortex
Produces adrenal steroids
Adrenal Medulla
Acts as a sympathetic ganglion
What are the suprarenal arteries
Richly Vascularized
Superior suprarenal arteries
Middle suprarenal arteries
Inferior suprarenal arteries
Superior Suprarenal arteries
6-8 branches
From inferior phrenic arteries
Middle suprarenal arteries
1+ branch(es)
From abdominal aorta
Inferior Suprarenal arteries
1+ branch(es)
From renal artery
Diaphragm
Dome-shaped muscle that separates the thoracic cavity and abdominal cavity
What are the three openings of the diaphragm?
Vena cava foramen
Esophageal hiatus
Aortic hiatus
Vena cava foramen
Opening in the diaphragm
Where the IVC and Phrenic nerve travel through
At the T8 level
Esophageal hiatus
Where the esophagus enters
at T10 level
Aortic hiatus
Where aorta travels through
At T12 level
2 long cruca on either side
-L1-3 and intervertebral disc attachments
-posterior-inferior attachment of the diaphargm
What innervated the diaphragm?
Phrenic nerve
- goes through the Vena cava foramen with the IVC
- arises from C3-5
What can happen from a cervical spinal cord injury?
The phrenic nerve can be damaged, leading to paralysis of diaphragmatic respiration; more specifically inhalation, because diaphragm constriction causes inhalation.
What are the muscles on the posterior abdominal wall?
Diaphragm Transversus abdominus Psoas major Psoas minor Iliacus
Vasculature of the Posterior Abdominal wall
Lumbar arteries
-4 paris on the lateral aspects of the aorta (1st, 2nd, 3rd, 4th)
-superior to the bifurcation
Drains via the IVC
What are the nerves of the posterior abdominal wall?
Subcostal n Iliohypogastric n Ilioinguinal n Genitofemoral n Lateral femoral cutaneous n Femoral n Lumbosacral trunk
Subcostal n. level
T12
Subcostal n motor supply
External Oblique m Internal Oblique m Pyramidalis m Rectus abdominus m Quadratus lumborum m
Subcostal n sensory supply
Anterior/lateral abdominal wall
Subcostal n course
Emerge from 1 cm inferior to 12th rib
Iliohypogastric n level
L1
Iliohypogastric n motor supply
abdominal muscles
Iliohypogastric n sensory supply
Skin of suprapubic
Abdominal muscles
Iliohypogastric n course
Common trunk with ilioinguinal just inferior to medial arcurate ligament
Ilioinguinal n level
L1
Ilioinguinal n motor supply
Abdominal muscles
Ilioinguinal n sensory supply
Inguinal canal
Abdominal muscles
Ilioinguinal n course
Common trunk with iliohypogastric, just inferior to medial arcurate ligament
Genitofemoral n level
L1-L2
Genitofemoral n motor supply
Cremaster muscle
Genitofemoral n sensory supply
Skin inferior and medial to inguinal ligament
Genitofemoral n course
Pierces the Psoas major muscle, descends anteriorly and splits into genital and femoral branches
Lateral cutaneous femoral n level
L2-L3
Lateral cutaneous femoral n motor supply
none
Lateral cutaneous femoral n sensory supply
anterior/lateral skin of the thigh
Lateral cutaneous femoral n course
Descends anterior to iliacus muscle and passes deep to the deep inguinal ring inferior to ASIS
Femoral n level
L2-L4
Femoral n motor supply
Anterior thigh
Femoral n sensory supply
Anterior thigh
Femoral n course
Between iliacus m and Psoas major muscle inferiorly through the obturator foramen
Lumbosacral trunk level
L4-L5
Lumbosacral trunk supply
Provides general contributions to lumbar-sacral plexus
Lumbosacral trunk course
Trunk crosses over the ala of the sacrum, and descends into the pelvis to form the sacral plexus
