Diaphragm, Kidneys & Posterior Abdominal Wall Flashcards
1
Q
What is the principal muscle of respiration that is dome shaped and separates the thoracic cavity from the abdominal cavity?
A
Diaphragm
2
Q
The phrenic nerve originates from C - C spinal segements
A
C3-5
3
Q
What is the path of the phrenic nerve?
A
- originates at C3,4,5
- descends along ant. scalene
- through thoracic inlet
- inferiorly to diaphragm
- left side- thru m.
- right side- thru caval opening
4
Q
The left phrenic nerve passes through the _________
A
diaphragm m.
5
Q
The right phrenic never passes through the _____ ______
A
caval opening
6
Q
Sympathetic trunks pass ________ to the diaphragm
A
posterior
7
Q
What nerve supplies the right and left hemidiaphram?
A
phrenic
8
Q
What nerve supplies lateral borders of the diaphragm?
A
intercostal nerves
9
Q
The phrenic nerve is primarily ______
A
motor & 30% sensory
10
Q
Paralysis from cervical cord injuries results in ___________
A
paralysis of diaphragmatic respiration (lose inhalation ability bc inability to contract the diaphragm)
11
Q
When you have a paralyzed hemidiaphragm you cannot _____ (descend) the diaphragm
A
contract
- diaphragm remains high in throax
- recognizable on radiographic chest films
12
Q
When is hemidiaphragm paralysis due to phrenic nerve damage visible on film?
A
-only when you inspire (not seen with expiration)
13
Q
What vertebral level is the vena cava (caval opening) foramen found and what passes thru it?
A
- T8
- IVC
14
Q
What vertebral level is the esophageal hiatus and what passes thru it?
A
- T10
- esophagus
15
Q
What vertebral level is the aortic hiatus and what passes thru it?
A
- T12
- aorta
16
Q
The _____ crus of diaphragm is longer and broader and continues down to L3 vertebral level
A
right
17
Q
The _______ arcuate ligament(s) (lumbocostal arch) arches over the aorta (aorta hiatus)
A
Median arcuate ligament (1)
18
Q
The _______ arcuate ligament(s) arch over the psoas mm.
A
medial arcuate ligament (2- both sides)
19
Q
The ______ arcuate ligament(s) arch over quadratus lumborum mm.
A
lateral arcuate ligament (2-both sides)
20
Q
The ________ & _______ aa supply the superior surface of the diaphragm
A
-pericardiacophrenic
-superior phrenic
(via internal thoracic & thoracic aorta)
21
Q
The ______ ______ artery supplies the inferior surface
A
inferior phrenic (via abdominal aorta)
22
Q
What artery supplies the periphery of the diaphragm?
A
Musculophrenic aa (via int. thoracic aa.)
23
Q
Venous drainage of the diaphragm is via accompanying vv to the ________
A
Inferior Vena Cava (IVC)
24
Q
The superior epigastric vessels remain _______ to diaphragm inferiorly
A
anterior
25
The kidneys are retroperitoneal and located lateral to the vertebral column at ____ - ____
T12-L3
26
Which kidney is typically more superior?
left kidney, due to liver being on the right side (pushes kidney down)
27
The superior pole of the L kidney is at the ____th rib and the R kidney is at the _____ th rib
- 11
| - 12
28
What encapsulates the kidneys?
-peri-renal fat + renal fascia
29
The kidneys _____ from _____ during development
- ascend
| - pelvis
30
What results when the kidney remains anterior to the sacrum?
ectopic kidney
31
What results when the kidneys are below the IMA?
horseshoe kidney
32
Transplanted kidneys are placed in the ____ _____
lower abdomen (usually have 3 kidneys bc dont remove others)
33
What encapsulates the kidneys but not completely around the inferior surface b/c it continues on the ureters?
-renal fascia
34
What found external to the renal renal capsule and provides a cushion around renal fascia?
para-nephric fat
35
What is found internal to the renal capulse and completely encapsulates the kidney?
peri-nephric fat
36
The inferior vena cava is most ______
Anterior
37
What is the organization of arteries and veins anterior to posterior near the kidney?
```
(Anterior)
-Renal vein
-Renal artery
- Pelvis of ureter
Posterior
```
38
What are the functions of the kidneys?
- filter blood
- produce urine
- reduce blood volume, creating urine volume (pulls H2O) out of blood
- BP regulation (Blood volume dependent)
39
What are the 3 layers of the kidney?
- fibrous capsule (outer)
- Renal cortex- (outer 1/3)
- Renal medulla- (inner 2/3)
40
The renal medulla contains the renal _____
pyramids
41
Where does urine flow once it is produced in the nephron of the kidney?
- Renal papillae (@ apex of pyramids receive urine)
- minor calyces
- major calyces (2-3)
- renal pelvis
- ureter
- urinary bladder
- urethra
42
The kidney vasculature is __________
asymmetric
43
The _____ renal artery is longer and passes posterior to IVC
right
44
The renal arteries divide at ________ into _______ arteries
- hilum
| - segmental arteries (5 end arteries)
45
What do the segmental arteries supply?
- each lobe in the kidney
46
Renal veins are ______ to renal arteries
anterior
47
Renal veins drain to IVC, the _____ renal vein is longer and passes anterior to the aorta
Left
48
The ureters cross anterior to the _____ ______ mm to enter the bladder
psoas major
49
The ureters run _____ _____ to gonadal vessels and anterior to the ___ _____ artery
- obliquely posterior
| - ext. eiliac a.
50
The _____ renal pelvis & ureters are fairly common
bifid
51
Occasionally you can find this type of ureter that pass over the pelvic brim posterior to common or ext. iliac a or v.
Retrocaval ureter
52
What are the 3-4 sources that the ureter arteries arise from?
- renal a
- testicular or ovarian a.
- abdominal aorta
- internal iliac a. (pelvic cavity)
53
The veins of the ureters drain into _______ named vv.
similiarly
54
What test allows visualization of the ureters and bladder and detection of kidney stones?
Intravenous urogram (IVU)
- inject patient w/ iodinated contrast medium
- excreted by glomerular filtration + by renal tubules
55
What form in the kidney, progress to the renal pelvis and are usually associated w/ considerable pain in the ureter or urethra?
kidney stones (calculi)
56
What are the three ways that a kidney stone can be removed?
- spontaneously pass thru ureter into bladder
- larger than 1cm = surgically
- ultrasonically crushed = lithotripsy
57
Referred pain from a calculi (kidney stone) is associated with ______ __ _____ to force the stone down thru ureter
- waves of contraction (peristalsis)
58
Referred pain from a calculi is rhythmic pain that occurs & is referred w/ ______ of the stone and changes w/ _____ of obstruction.
- descent
| - level
59
Referred pain gradually moves ________ toward gron from side & back btw ribst to pelvis to _____ area (area of cutaneous innervation T11-T12)
- inferoanteriorly
| - inguinal
60
What glands sit on the superior poles of the kidneys?
Adrenal (suprarenal) glands
61
The _____ adrenal (suprarenal) gland is roughly triagular and lies superior to kidney, posterior to IVC
right
62
The _____ adrenal (suprarenal) gland is semilunar and lies superiormedial to kidney near hilum
left
63
What are the three layers of the adrenal gland?
- fibrous capsule
- adrenal cortex
- adrenal medulla
64
This surrounds the adrenal gland?
fibrous capsule
65
The _____ ____ is in the outer portion of the adrenal gland
adrenal cortex
66
The adrenal gland produces ____ _____ and modifies cells of the medulla
adrenal steroids
67
The _____ _____ is the inner portion of the adrenal gland that acts as a sympathetic ganglion
adrenal medulla
68
The adrenal medulla has _____ cells (modified neurons w/out axons) where preganglionic _______ synapse and produce ____ and ____ (endocrine function)
- chromaffin
- sympathetics
- norepinephrine
- epinephrine
69
The adrenal gland is ______ vascularized due to ______ funciton
- richly
| - endocrine
70
What are the three sources of the suprarenal aa?
- sup. suprarenal aa (6-8)
- middle suprarenal aa (1+)
- Inf. suprarenal aa (1+)
71
The sup. suprarenal artery (6-8) comes from the ____ ____ artery
inferior phrenic
72
The middle suprarental artery (1+) comes from the ______ aa
abdominal
73
The inf. suprarenal aa (1+) comes from the _____ aa
renal
74
What are the 6 muscles of the posterior abdominal wall?
- transversus abdominus (from ant to post abdominal wall)
- quadratus lumborum
- psoas major
- psoas minor
- iliacus
- diaphragm
75
What is the main arterial supply to the posterior abdominal wall?
Lumbar aa (4 pairs)
76
The lumbar aa (4 pairs) are branches of _____ _____ superior to the _____
- abdominal aorta
| - bifurcation
77
The abdominal aorta bicurcates at _____ the level of the _____
- L4
| - umbilicus
78
What are the main nerves of the posterior abdominal wall?
- Ventral rami (T12-L4)
-Lumbar plexus of nn
(beneath fascia of post. abd. mm.)
79
The sympathetic trunks are located _____ and continuous w/ _______ portions
- posterior
| - thoracic
80
This nerve is ~ 1cm inferior to 12th rib and supplies sensory to ant./lat. abdominal wall (hip)
Subcostal n. (T12)
81
The ________ nerve also supplies MOTOR to abominal mm; External oblique, Inferior oblique, Transversus abdominis, pyramidalis, Rectus abdominis, Quadratus lumborum
subcostal (T12)
82
The inferior extent of subcostal nerve (T12) is the ______ ______ branch that is halfway btw umbilicus and pelvis
anterior cutaneous
83
What vertebral level is the subcostal nerve?
T12
84
These 2 nerves can arise from a common trunk and descend anterior to quadratus lumborum
- Iliohypogastic & Ilioinguinal nn (L1) (sensory + motor)
85
What vertebral levels is the iliohypogastric and ilioinguinal nerves?
L1
86
The _______ nerve supplies skin of suprapubic region and abdominal mm
- iliohypogastric
87
The ______ nerve passes over ilium and runs thru inguinal canal to supply it and it supplies abdominal mm
ilioinguinal
88
The _____ nerve pierces psoas major m. and descends along the anterior surface to split into ______ branch and _____ branch (more medial)
- genitofemoral nerve (L1-L2)
- femoral
- genital
89
The genitofemoral nerve (L1-2) supplies skin inferior & medial to _______ ligament and the ______ m. (of spermatic cord)
- inguinal
| - cremaster
90
What vertebral level is the genitofemoral nerve?
L1-2
91
The ____ _____ ____ nerve descends anterior to iliacus m. and passes deep to inguinal ring (inferior to ASIS)
Lateral Femoral Cutaneous N (L2-3)
92
The Lateral Femoral cutaneous nerve (L2-3) supplies anterior/lateral skin of the ______
thigh
93
What nerve runs between iliacus & psoas major mm., passes deep to inguinal liagment and inferior to ASIS?
Femoral N (L2-4)
94
The Femoral nerve (L2-4) supplies sensory and motor to the ______ thigh
-anterior thigh (large nerve)
95
The femoral nerve is from what vertebral level?
L2-4
96
The ____ nerve runs medial to psoas major mm. and passes thru obturator foramen
obturator n (L2-4)
97
The obturator n (L2-4) supplies sensory and motor to _____ thigh
medial thigh
98
This large n trunk crosses over ala of sacrum and descends into pelvis to help form the sacral plexus?
- lumbosacral trunk (L4-5)
99
This nerve trunk provides general contributions to both plexuses (lumbar and sacral)?
lumbosacral trunk
