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Renal Pulm Dissection > Edissector Notecards > Flashcards

Edissector Notecards Flashcards

1
Q

The retroperitoneal space contains

A

Kidneys, ureters, adrenal glands, abdominal aorta, and inferior vena cava

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2
Q

The kidneys extend between what levels

A

T12 and L3 vertebrae

Right is slightly lower than the left because of the position of the liver

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3
Q

The right kidney is in contact with
The left kidney is in contact with
Posterior structures to kidneys

A

Serosal surface of the liver, the second part of the duodenum, the right colic flexure and the jejunum

Stomach, spleen, tail of pancreas, left colic flexure and jejunum

11th and 12th ribs, along with subcostal (T12) and iliohypogastric (L1) nerves. The muscles that form the posterior abdominal wall are directly behind the kidneys: the diaphragm, the psoas major, quadratus lumborum, and aponeurosis of the transversus abdominis muscle

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4
Q

Vasculature of the kidneys

A

Short right renal vein
Right renal artery is posterior to the right renal vein and IVC. Right renal artery is longer than the left renal artery
The renal pelvis lies posteriorly to the right renal artery
The left renal vein crosses anterior to the renal arteries and abdominal aorta and is longer than the right renal artery
Left renal artery lies posterior to the left renal vein
Arteries usually divide before reaching the hilum and accessory arteries are common

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5
Q

The renal hilum

A

Concave medial margin of the kidney containing, from anterior to posterior, the renal vein, the renal artery, and the renal pelvis

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6
Q

Nutcracker syndrome

A

The course of the left renal vein leaves it susceptible to compression between the abdominal aorta and superior mesenteric artery, similar to how a nutcracker operates. This impedes blood flow out through the renal vein and can lead to hematuria and flank pain.

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7
Q

course of the ureters

A

Leave the hilum and pass posterior to the testicular or ovarian vessels and crosses the anterior surface of the psoas major muscle
The pelvic part of the ureter crosses the common or external iliac artery near bifurcation. Remaining deep to the peritoneum, it descends along the lateral wall of the pelvis and curves anteromedially to the base of the bladder

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8
Q

Branches to the left renal vein

Branches of the left renal artery

A

Testicular/ovarian or the left suprarenal veins drain into it

Left renal artery branches to the ureter and suprarenal glands

*note testicular/ovarian vein drain into IVC on the right

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9
Q

abdominal aorta has three types of branches

A

Unpaired arteries to the GI tract- celiac trunk, superior mesenteric artery, inferior mesenteric artery
Paired arteries to the three pairs abdominal organs- suprarenal, renal, testicular/ovarian arteries
Paired arteries to the abdominal wall- inferior phrenic and lumbar arteries

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10
Q

lumbar artery

A

Four pairs of lumbar arteries supply the posterior abdominal wall
From the posterior aspect of the aorta passing deep to the psoas major muscle

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11
Q

Where does the abdominal aorta bifurcate

A

L4

Common iliac arteries arise from this bifurcation- supply blood to the pelvis and lower limbs

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12
Q

Ureteric arterial supply in the clinic

A

Arterial supply top the abdominal portion of the ureters arises from renal arteries, and less commonly from gonadal arteries, abdominal aorta, or common iliac arteries.
The ureteric arteries are small and delicate and may be damaged during surgery when ureters are retracted. Loss of blood supply can result in necrosis and urinary obstruction

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13
Q

Suprarenal glands in the clinic

A

If kidneys fail to ascend to its normal position during development, the suprarenal gland develops in its normal position lateral to the celiac trunk

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14
Q

Surface of the bladder covering

The wall consists of

A

The superior surface is covered by peritoneum; the posterior surface is covered by peritoneum and its superior part and by endopelvic fascia on its inferior part and the two inferolateral surfaces are covered by endopelvic fascia

Bundles of smooth muscle called the detrusor muscle

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15
Q 
The apex of the bladder
The body
The fundus
The neck
Trigone- definition and covering
A

Directed toward the anterior abdominal wall and attached to Urachus/median umbilical ligament.
Body is between the apex and fundus
The fundus is called the base of the bladder
The neck is where the urethra exits the bladder. Here the wall thickens to form the internal urethral sphincter
The mucous membrane lining all parts of the bladder is thrown into folds to accommodate expansion except for the mucous membrane over the trigone, which is smooth. The angles of the trigone are the internal urethral orifice and the two orifices of the ureter (making up the floor of the bladder)

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16
Q

Three portions of urethra in male

A

Prostatic urethra, membranous urethra, and spongy/penile urethra
The tip of the urethral orifice is at the tip of the glans penis

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17
Q

Parts of the kidney:

Renal capsule, renal cortex, renal medulla, renal sinus, renal papilla, minor calyx, major calyx, renal pelvis, ureter

A

Capsule- a fibrous capsule that covers kidney surface
Cortex- outer zone of kidney- 1/3 of its depth
Medulla- inner zone of kidney consists of pyramid and columns 2/3rd of its depth
Sinus- space within kidney that occupies renal pelvis, calices, vessels, nerves and fat
Papilla- apex of renal pyramid projects into minor calyx
Minor calyx- cup-like chamber that is beginning of extrarenal duct system. Several combine to form a major calyx.
Major calyx- two or three per kidney that combine to form renal pelvis
Renal pelvis- funnel-like end of ureter that lies within renal sinus
Ureter- muscular duct that carries urine from kidney to bladder

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18
Q

Kidney stones

A

Renal calculus may form in the calyces and renal pelvis. Small kidney stones may spontaneously pass through the ureter into the urinary bladder. Larger ones may lodge at one of three natural constrictions of the ureter: where the renal pelvis joins the ureter, where the ureter crosses the pelvic brim, and at the entrance of the ureter into the urinary bladder

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19
Q

Central tendon of diaphragm

A

Tendon is aponeurotic and shaped like a boomerang into which muscle fibers are inserted from all parts of the circumference of the inner aspects of the body wall. Dense, fibrous and the pericardium is firmly attached to its upper surface

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20
Q

Sternal part of diaphragm
Costal part
Lumbar part

A

Consists of two small Muscular slips arising from posterior surface of xiphoid process
Arises from deep surfaces of lower 6 costal cartilages on each side and inserts into the central tendon. The two costal parts form the right and left domes of the diaphragm
Arises as two crura from anterolateral surfaces of the first three lumbar vertebrae on the right and first two lumbar on the left, including their IV discs. Both crura embrace the aorta as it enters the abdominal cavity at the aortic hiatus and are joined by a tendinous band, the median arcuate ligament.

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21
Q

The right crus of the diaphragm

A

Larger and longer, extending from it L1-L3 and distally to central tendon. The esophageal hiatus is an opening in the right crus of the diaphragm at T10. The right crus muscle fibers decussate and surround the esophageal hiatus

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22
Q

The left crus of the diaphragm

A

Smaller, from L1-L2 and passes to the left of the esophageal hiatus

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23
Q

The arcuate ligaments

A

Thickening of fascia that serve as proximal attachments for some muscle fibers of the diaphragm:

  • the paired lateral arcuate ligament bridges the anterior surface of the quadratic lumborum muscle
  • the paired medial arcuate ligament bridges the anterior surface of the psoas major muscle
  • the unpaired median arcuate ligament bridges the anterior surface of the aorta at the aortic hiatus
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24
Q

three openings in the diaphragm

A

Vena caval foramen passes through the central tendon at T8
Esophageal hiatus passes through the right crus of the diaphragm at T10
Aortic hiatus passes behind the diaphragm at T12

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25
Q

Nerve supple to abdominal surface of diaphragm

A

Right and left phrenic nerves- each phrenic nerve provides motor innervation to one half of the diaphragm (hemidiaphragm). They supply most of the sensory innervation to the parietal peritoneum (abdominal) and parietal pleura (thoracic) surfaces of the diaphragm
The pleural and peritoneal coverings of the peripheral part of the diaphragm receive sensory fibers from the lower intercostal nerves T5-T11 and the subcostal nerve.

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26
Q

Efferent and afferent fiber levels that make up the phrenic nerve

A

C3-C5

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27
Q

Arteries over the surface of each hemidiaphragm

A

The superior phrenic arteries arise from the thoracic aorta while the inferior phrenic arteries arise immediately from the abdominal aorta below the diaphragm

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28
Q

Diaphragm in the clinic- referred pain and paralysis

A

Phrenic nerves arise from cervical spinal cord segments C3-C5. Therefore, pain from the diaphragm is referred to the shoulder region (supraclavicular nerve territory). The diaphragm is paralyzed in cases of high cervical (above C3) spinal cord injuries, but it is spared in low cervical spinal cord injuries. A paralyzed hemidiaphragm cannot contract (descend), so it will appear high in the thorax and chest radiograph.

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29
Q

Naris

A

External opening of nose, separated by lower border of nasal septum
Nasal cavity begins as naris and extends to choana, the opening of the nasopharynx

30
Q

nasal cavity separation

A

The nasal septum, composed of cartilage and bone and covered by mucous membrane, separates the two nasal cavities.

31
Q

Lateral wall of nasal cavity projections

A

Conchae- curved shelves of bone covered by mucous membrane that project from lateral nasal wall and greatly increase the respiratory surface of the nose
Inferior concha is the longest, middle concha, and superior concha is the shortest

32
Q

What separates the nasal cavity from the oral cavity

A

Soft palate

33
Q

The pharynx

A

Continuation of the digestive system posterior to the nasal and oral cavities, extending inferiorly posterior to the larynx to the beginning of the esophagus. The pharynx extends from base of the skull to the inferior border of the cricoid cartilage anteriorly and inferior border of C6 posteriorly.

34
Q

3 parts of the nasopharynx

A

Nasopharynx- posterior to the choanae and superior to the soft palate
oropharynx- posterior to the tongue between soft palate and epiglottis
laryngopharynx- continuous with oropharynx at the upper border of the epiglottis and narrows rapidly below at the level of the cricoid cartilage to become continuous with the esophagus at the border of the cartilage

35
Q

larynx

Laryngeal cavity extends

A

Extends from epiglottis anterior to laryngopharynx and inferiorly to the lower border of the cricoid cartilage where it becomes continuous with the trachea

From the laryngeal inlet (aditus) to the lower border of the cricoid cartilage where it continues with the trachea. Divided into 3 major parts:

  • vestibule, extends from laryngeal inlet to vestibular folds. The aperture between the vestibular folds is the rima vestibuli.
  • ventricle, or laryngeal sinus, is the recess between the vestibular and vocal folds. The aperture between the vocal folds is the rima glottidis: it is the narrowest part of the larynx and varies with movement of vocal cords during respiration and phonation.
  • the infraglottic cavity extends from vocal folds to lower border of cricoid cartilage.
36
Q

The portion of the pleura in direct contact with the lung, completely covering it
Transitions into

A

Visceral pleura
As the visceral pleura reflects off the lungs and onto the inner wall of the thoracic cavity, it is called parietal pleura
The transition between these two is called the root of the lung,

37
Q

Root of the lung contains

A

The primary bronchus
Pulmonary artery
Pulmonary veins

38
Q

Pleural cavity

A

In living body- Potential space and the visceral pleura touches the parietal pleura
Normally only contains a thin film of serous fluid that lubricates the serous surfaces and allows free movement of the lungs within the pleural cavity

39
Q

Subdivisions of the parietal pleura

A

Costal parietal pleura- lines inner surface of thoracic wall
Mediastinal parietal pleura- lines mediastinum
Diaphragmatic parietal pleura- lines superior surface of the diaphragm
Cervical parietal pleura (cupula)- extends superior to the first rib

40
Q

Lines of pleural reflection

Pleural recesses

A

Sharply folded areas where different divisions of parietal pleura meet. The lines are acute, and the inner surfaces of the parietal pleurae are usually in contact with one another

The potential spaces where parietal pleura contacts parietal pleura are called pleural spaces. Two costomediastinal recesses are posterior to sternum between costal parietal pleura and mediastinal parietal pleura. Two costodiaphragmatic recesses are located at the most inferior limits of the parietal pleura between the coastal parietal pleura and the diaphragmatic parietal pleura. *during inspiration, the inferior border of the lungs do not extend into the costodiaphragmatic recesses.

41
Q

The mediastinal pleura is continuous with the visceral pleura at

A

The root of the lung- attaches to the mediastinum.
*All other parts of the lung should slide freely against the parietal pleura. Pleural adhesions may occur between visceral and parietal pleurae. Pleural adhesions are the result of disease processes.

42
Q

Pleural cavity in the clinic

A

Under pathological conditions, the potential space of the pleural cavity my becomes a real space. If air enters the pleural cavity (pneumothorax), the lung collapses due to the elastic recoil of its tissue. Excess fluid may accumulate in the pleural cavity, compress the lung, and produce breathing difficulties. The fluid can be serous fluid (plural effusion) or blood resulting from trauma (hemothorax)

43
Q

Pleural effusion in the clinic

A

Only a thin layer of fluid normally separates the two layers of the pleura. Fluid can accumulate in the pleural space as a result of a large number of disorders, including infections, injuries, heart failure, cirrhosis, or liver failure, pneumonia, blood clots in lung blood vessels (pulmonary emboli), cancer and drugs. Symptoms may include difficulty breathing and chest pain, particularly when breathing and coughing. Diagnosis by chest x-ray, lab testing of fluid, CT scans. Large amounts of fluid are drained with a tube inserted into the chest

44
Q

Pleural tap (thoracocentesis)

A

The aspiration of pathological material from the pleural cavity (serous fluid, fluid mixed with tumor cells, blood, pus, etc) may be done through the intercostal space. The pleural tap is performed in the mid axillary line or slightly posterior to it, usually at spaces 6,7 or 8 to avoid penetrating abdominal viscera. A large-bore needle is inserted low in intercostal space to avoid injury to the intercostal nerve and vessels.

45
Q

What surface of the lung can you see in situ?

A

The costal surface

46
Q

The oblique fissure lies deep to what rib

The horizontal fissure lies deep to what rib

A

Lies deep to the fifth rib laterally and that is deep to the sixth costal cartilage anteriorly. AKA the major fissure.

The horizontal fissure lies deep to the fourth rib and fourth costal cartilage. AKA minor fissure

47
Q

What occupies the cupula of the pleura?

A

The apex of the lung- both sides rise as high as the neck of the first rib. Therefore, the apex of the lung and the cupula of the pleura lie superior to the plane of the superior thoracic aperture and are actually located in the neck

Superior thoracic aperture is bordered by the superior border of the manubrium, first pair of ribs, and superior border of the first thoracic vertebra

48
Q

Course of the phrenic nerve

Course of vagus nerve

A

Passes inferiorly in connective tissue between the mediastinal parietal pleura and the fibrous pericardium anterior to the root of the lung

Vagus nerve passes posterior to the root of the lung in the same connective tissue plane

49
Q

Irritation of the pleura in the clinic

A

Parietal pleura is innervated with pain fibers that originate from either intercostal or phrenic nerve. Can manifest differently depending on which part is involved. The visceral pleura is innervated by autonomic nerves and has no pain fibers

50
Q

The pulmonary plexus

A

Autonomic plexus formed from pulmonary branches of the vagus nerve and sympathetic trunk

51
Q

The pleural sleeve

A

The root of the lung, making up the transition between the mediastinal parietal pleura adhering to the fibrous pericardium and the visceral pleura on the lung surface. Covers the main bronchus, pulmonary artery, and pulmonary veins.

52
Q

Components in the root of the lung positioning

A

Pulmonary arteries and veins are anterior to the main bronchus, with the pulmonary artery superior to the vein. As these structures approach the lung and divide into their lobar branches, this order becomes mixed.

53
Q

Most of the inferior lobe lies

Most of the superior lobe lies

A

Posteriorly

Anteriorly

54
Q

Pinholes on the main bronchus at the hilum of the lung are from

A

The bronchial arteries, supplying lungs with oxygenated blood from the thoracic aorta.

55
Q

Right lung bronchi divisions

Left-Main bronchus divides into blank at what position?

A

Primary/main bronchus- to each lung
Secondary/lobar bronchus- to each lobe: right has a superior, middle and inferior lobar bronchi. the superior lobar bronchus passes superior to the right pulmonary artery, so it is called the eparterial bronchus

Divide into lobar bronchi at the posterior position in the hilum of the left lung. The left pulmonary artery divides into lobar arteries at the superioanterior position. The left pulmonary veins enter the hilum at the interioanterior position.

56
Q

Innervation of the lungs

A

Anterior and posterior pulmonary plexuses. Sympathetic contributions from right and left sympathetic trunks, while parasympathetic are from right and left vagus nerves.

57
Q

The right vagus nerve lies

A

Deep (medial) to the mediastinal parietal pleura overlying the trachea
Passes posterior to the root of the lung, unlike the phrenic nerve which passes anterior to the root of the lung.

58
Q

Arch of the azygos vein passes

What nerve passes near it?

A

Superior to the right main bronchus to drain into the superior vena cava. The right vagus nerve passes medial to the arch of the azygos vein.

59
Q

Compare the right and left main bronchus
The trachea bifurcates within what plane
What is inside the tracheal bifurcation?

A

The right is larger in diameter, shorter and oriented more vertically than the left main bronchus. the right lung is shorter, but has greater volume than the left lung

The horizontal plane passing through the sternal angle
The carina- specialized piece of tracheal cartilage.

60
Q

Bifurcation of the trachea in the clinic

A

During bronchoscopy, the carina serves as an important landmark because it lies between the superior ends of the right and left main bronchi. The carina is usually positioned slightly to the left of the median plane of the trachea. When foreign bodies are aspirated, they usually enter the right main bronchus because of leftward position of the carina, and because of the fact that the right main bronchus is wider and more vertically oriented than the left main bronchus.

61
Q

Boundaries of the posterior mediastinum

A 
Superior- horizontal plane through the sternal angle (T4-T5)
Posterior- bodies of vertebrae T5-T12
Anterior- pericardium
Lateral- mediastinal parietal pleura
Inferior- diaphragm
62
Q

Oblique pericardial sinus

A

Formed by reflection of serous pericardium onto the pulmonary veins

63
Q

Esophagus

Thoracic aorta orientation

A

The esophagus sits just to the right of the midline
The thoracic aorta is slightly left and posterior to the esophagus

The esophagus lies immediately posterior to the left atrium and part of the left ventricle- transesophageal echo*

64
Q

The right vagus nerve is found and makes up

Left vagus nerve is found and makes up

A

In the angle formed by the arch of the azygos and the SVC. Follows posteriorly to the root of the lung on the right. These nerve fibers spread out mostly on the posterior surface of the esophagus.

Crosses the left side of the arch of the aorta. Follows posteriorly to the root of the lung on the left and its fibers spread out mostly on the anterior part of the esophageal plexus

65
Q

Near the diaphragm, fibers of the esophageal plexus come together to form

A

The anterior and posterior vagal trunks. The trunks are found on the inferior part of the esophagus, just before they pass through the diaphragm to innervate a large part of the GI tract.

66
Q

The arch of the azygos arches where

Positioning of thoracic duct- course

A

Superior to the root of the right lung. Follow posteriorly to the azygos vein

Retract the esophagus to the left and look at the area between the azygos vein and the thoracic aorta. The duct lies immediately left to the azygos vein, posterior to the esophagus. Thin walled and easily torn and looks like a small vein without blood in it.
Passes through the diaphragm with the thoracic aorta. Drains superiorly into the junction of the left internal jugular vein and left subclavian vein.

67
Q

Posterior intercostal vein are tributaries to

A

Right side- tributaries to the azygos vein
Left side- drain into the hemiazygos vein or accessory azygos vein. These veins cross the bodies of the ninth and eighth thoracic vertebae, respectively, and terminate by draining into the azygos vein

68
Q

Posterior intercostal arteries

A

Branch from the thoracic aorta to their intercostal spaces. The right posterior intercostal arteries cross the midline on the anterior surface of the vertebral bodies

69
Q

The sympathetic trunk crosses
Ganglion
Communicates

A

The heads of ribs 2-9. Inferior to rib 9, the trunk lies on the sides of the thoracic vertebral bodies.
It has one sympathetic ganglion for each thoracic level.
Two rami communicates connect each intercostal nerve with its corresponding thoracic sympathetic ganglion, (more lateral one is white)

70
Q

Greater splanchnic nerve receives contributions from

Lesser splanchnic nerve arises from

A

The fifth through the ninth thoracic sympathetic ganglia and it is not completely formed until lower thoracic levels. It is found on the sides of the vertebral bodies T5-T9,, while the sympathetic trunk crosses the heads of ribs 5-9 (posterior to the greater splanchnic nerve.

The 10th and 11th thoracic sympathetic ganglia. The least splanchnic nerve arises from the 12th ganglia.

Renal Pulm Dissection (1 decks)

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