Diaphragm, Kidneys & Posterior Abdominal Wall Flashcards
Comes from the ventral rami of the cervical plexus of nerves
Phrenic nerve
Keep me breathing and alive
C3, C4, C5
Innervates the diaphragm, mostly motor but also sensory
Phrenic Nerve
What does the sensory fibers of the phrenic nerve anatomose with
Intercostal sensory fibers
Supplies R & L hemidiaphragms
Phrenic Nerve
Supplies lateral borders and some sensory
Intercostal Nerve
Sole motor innervation to the diaphragm
Phrenic nerve
What percent sensory is the phrenic nerve?
30%
Irritation to both the superior and inferior surfaces of the CENTRAL part of the diaphragm is carried by
Sensory fibers in the phrenic nerve
Irritation to the superior and inferior surfaces of the PERIPHERAL portions of the is carried by the
Intercostal nerve
Originate from C3-C5 spinal segments
Phrenic nerve
What happens to a paralyzed hemidiaphragm?
It cannot contract
+Remains high in thorax
+recognizable on radiographic chest films
Why do people with cervical cord injuries become paralyzed?
Paralysis of diaphragmatic respiration (phrenic nerve)
One side of the diaphragm
Hemidiaphragm
What happens during expiration?
Diaphragm raises & abdominal wall contracts
Aortic hiatus aperature
T12
Esophageal hiatus aperature
T10
Vena cava foramen aperature
T8
Arches over aorta
1 Median arcuate ligament
Arch over psoas mm
2 medial arcuate ligaments
Arch over the quadratus lumborum mm
2 lateral arcuate ligaments
- Supply superior surface (via int. thoracic a & thoracic aorta)
- Superior phrenic aa branch off aorta in thoracic cavity
Pericardiacophrenic & superior phrenic aa
Supply inferior surface (via abdominal aorta
Inferior phrenic aa
Supply periphery of diaphragm (via int. thoracic aa.)
Musculophrenic aa
Venous drainage is via accompanying
vv to IVC
Where is the superior pole of the left kidney?
11th rib
Where is the superior pole of the right kidney?
12th rib
Kidney locations
Lateral to vertebral column T12-L3
What is the located between the renal fascia and the kidney
Perirenal / perinephric fat
Where do kidneys ascend from during development?
Pelvis
Kidney remains anterior to sacrum
Ectopic pelvic
Kidney remains below IMA
Horseshoe
Placed in lower abdomen
transplanted kidneys
Another name for adrenal glands
Suprarenal
What is found between the two kidneys?
Vascular supply and drainage for the kidneys
Where things enter and exit through the kidney
Hilum
Anterior and posterior to retroperitoneal kidney
Renal fascia
Outside of renal fascia
Paranephric fat
Filters blood plasma that is excreted as urine
Kidney
Where tissues get exposure to blood. Capillary plexus in kidneys
Glomeruli
Outer 1/3 of kidney
Renal cortex
Inner 2/3 of kidney
Renal medulla
Where are the renal pyramids located
In the renal medulla
Receive apex of pyramids
Renal papillae
Order of urine
Renal papillae – Minor calyces– Major calyces – Renal pelvis – Ureter– Urinary bladder– Urethra
Collecting tip of kidney
Renal papillae
Which renal artery is longer?
Right
What passes post to IVC?
Right renal artery
Where do the renal veins attatch to?
IVC
Anterior to renal arteries
Renal veins
Which renal vein is longer
Left
Passes anterior to aorta
Left renal vein
Where do lymphatics drain?
Venous system
What happens after the GI tract absorbs?
Goes through portal system to the liver
Recieves (urine) at tips / apex of pyramids
Renal papillae
Final excretion out of the body
Urethra
Where do ureter arteries arise from ?
Renal Artery
Testicular or Ovarian Artery
Abdominal aorta or common iliac a.
Internal iliac artery (pelvic cavity)
Where do veins of ureters drain into
Similarly named vv
Another name for kidney stones
Calculi
Ultrasonic crushing of kidney stones
Lithotripsy
Form in kidney and progress to renal pelvis
Kidney stones
Moves inferoanteriorly towards groin
Pain of kidney stones
Where is the referred pain of kidney stones?
From side and back between ribs to pelvis to inguinal
-Area of cutanous innervation T11-12
- Roughly triangular
- Lies superior to R kidney posterior to IVC
Right Adrenal Gland
- Semilunar
- Lies superomedial to L kidney near hilum
Left adrenal gland
Parts of the adrenal gland
Fibrous capsule
Adrenal Cortex
Adrenal medulla
Produces adrenal steriods
Adrenal cortex
Act as sympathetic ganglion
Adrenal medulla
Why are the adrenal glands richly vascularized?
Because of their endocrine function
- Transversus abdominus m.
- Quadratus lumborum m.
- Psoas major m
- Iliacus m.
- Psoas minor m.
- Diaphragm
Posterior abdominal wall musculature
Where does the aorta bifurcate
L4
Level of umbilicus
L4
Ventral rami
T12-L4
Located beneath fascia of posterior abdominal muscles
Lumbar plexus of nerves
1 cm inferior to 12th rib
Subcostal nerve
- Supplies sensory to ant./lat. abd. wall
- Supplies motor to abdominal mm.: EO, IO, TA, pyramidalis, RA, QL
Subcostal nerve
- Can arise from common trunk
- Descend anteriorly to QL
Iliohypogastric & Ilioinguinal nerves
Supplies skin of suprapubic region
Iliohypogastric nerve
Runs through inguinal call to supply it
Ilioinguinal nerve
Supply abominal muscles
Iliohypogastric and Ilioinguinal nerves
- Pierces psoas major
- Descends along anterior surface
Genitofemoral Nerve
Splits to femoral branch and genital branch
Genitofemoral Nerve
Supplies skin inferiorly and medially to inguinal ligement
Genitofemoral Nerve
Supplies cremaster muscle (of spermatic cord)
Genitofemoral Nerve
- Descends anterior to iliacus muscle
- Passes deep to inguinal ring
- Inferior to ASIS
Lateral Femoral Cutaneous Nerve
Supplie anterior and lateral skin of thigh
Lateral Femoral Cutaneous Nerve
- Runs between Iliacus & psoas major
- Passes deep to inguinal ligament
- Inferior to ASIS
Femoral Nerve
Supplies sensory & motor to anterior thigh
Femoral Nerve
- Runs medial to psoas major muscle
- Passes through obturator foramen
Obturator Nerve
Supplies sensory & motor to medial thigh
Obturator Nerve
- Large nerve trunk, crosses over ala of sacrum
- Descends into pelvis to help from sacral plexus
Lumbosacral Trunk
Provides general contribution to both plexuses
Lumbosacral Trunk
What type of fat associated with the kidney extends into the hilum
perirenal / perinephric
what type of tissue is located outside the renal fascia
perarenal / peranephric fat