G24 Anatomy of the posterior amdominal viscera Flashcards
muscles to identify
quadratus lumborum rib 12 to iliac crest
psoas major and minor
iliacus
attachements of the Crus, ligaments of posterior wall
Right crus (forms esophageal hiatus) extends to L3 and left crus extends to L2 -start at the esophageal hiatus T12
leteral to crura, or out of body fo crura: splanchnic (greater and lesser pass thorugh)
lateral to vertebral bodies, sympathetic chain
-posterior to medial arcuate ligament
median arcuate ligament:
two medial arcuate ligaments: associated with psoas
lateral arcuate ligament crosses quadratus lumborum
thoracolumbar fascia: invests guadratus lumborum, and forms LATERAL arcuate ligament
Psoas fascia: invests…
-THICKENED superiorly and forms medial arcuate ligament
endoabdominal fascia or transversalis fascia: common in abdomen…where???
Nerves of posterior abdominal wall
superior to inferior::
Sympathetic chain
sgtart here
Subcostal: T12,
iliohypogastric (L1)
ilioinguinal (L1)
inferior
-lateral femoral cutaneous nerve (L2,3) subcutaneous inn to lateral part of the thig
femoral nerve: L2,3,4
Lumbosacral Trunk (L4,5) connects lumbar innervation to sacral innervation
pelvic
Obturator: L2,3,4- adductors of the thigh
Genitofemoral L1,2
-exits IN the body of the psoas major. (can look like tendon)
identify where tehse would b
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blood flow of abdominal aorta (main branches)
abdominal aorta (bifurcates at L4)
celiac trunk
SMA
IMA
renal arteries: L1 (R renal runs posterior to IVC)
paired middle suprarenal arteries (adrenal)
paired gonadal: gonads
posterolateral paired branches of abdominal aorta
inferior phrenic arterires: T12 (first in abdomen)
subcostal-L4 eventually L2 (enter abdomen)
-runs with deep to lateral arcuate ligament
3 suprarenal arteries
middle suprarenal arteries: to adrenal directly
superior suprarenal arteries: from inferior phrenic
inferior suprarenal arteriesL branches of the renal arteries
medial sacral: L4 between bifurcation of aorta across anterior sacrum
deep circumflex iliac artery: iliac crest: branch of external iliac
L4: closest palpable level of aorta
aneurysm of abdominal aorta
L4 can palpate and control a hemorrhage
- ultrasound to confirm, 90% fatal if unrecognized
- 50% fatal in recognized
- repair with graft
- rupture felt as back pain
veins of posterior abdominal wall
inferior vena cava
common iliacs bifurcate at L5
-right of midline
exits diaphragm through T8
- tributaries parallel the aortic branches except the portal system
- hepatic veins, return to systemic
- gonadal veins: right to IVC, left to left renal vein
- left suprarenal vein drains to left renal vein and right suprarenal dains to IVC
- median sacral vein drains to left common iliac
lymphatics
series of external and intenal iliac lymph nodes (pelvis and lower abdomen)
- drain to common iliac lymph nodes
- all drain superiorly through R and L lumbar nodes (also get lymph from post ab wall)
- cysterna chyle, internal thoracic duct
Kidneys EVERYTHING, peritoneum, location,
T12-L5
- right is slightly more inferior
- lobulated in children
- superior, lateral , medial borders
- left hylum at level of L1/L2 vertebral disc
- vain, artery, pelvis (attached to ureter) (most posterior)
- right renal artery longer, and POSTERIOR to IVC
retroperitoneal
-inferior kidney NOT protected by ribs
-Renal Fascia- gerota’s fascia
- perirenal fascia (closer to kidney)
- pararenal fascia
pararenal fat: same fat as everywhere
perirenal fat: fatty capsul surrounding kidney in the back fat
fascia is continuous around suprarenal as well
-you cant get infections spread from left to right or right to left but you can have kidney infections spread down into te kidney region,
right kidney: ass with liver, asc colon, duodenum
left kidney: spleen, stomach, jejunum, descending colon, pancreas
inside kidney
renal sinus: space within kidney (filled with fat)
- opens at hilum
- contains renal pelvis and vasc and nerves
- pelvis formed by calyces
pelvis funnel shaped
- major calyces
- minor calyces (more short tubes)
- renal papilla: end of each minor calyces
- renal papillae are the apices of the renal pyramids
renal capsule renal cortex renal medulla -pyramids -colums
kidney blood flow
right renal artery LONGER and run POSTERIOR to IVC
renal artery bifurcates into five segmental arteries,
eachis associated with a resectable segment
superior, anterosuperior anteroinferior inferior posterior
right renal vein shorter
left renal vein longer: between SMA and aorta
-also dains: left gonadal, left suprarenal
nutcracker syndrome
left renal vein compression between SMA and aorta
results in hematuria (blood in urine) and swelling of left scrotum due to engorgement of pampinform plexus of veins
-pampinform?
ureters and art supply
retroperitoneal
fibromuscular
-peristalsis
25-30cm
cross belvic brim (over external iliac)
CONSTRICTIONS: pass stone, constrictions problematic
- origin outside renal pelvis
- pelvic brim where they take an annular turn
- enter Bladder
arterial supply
primarily via renal arteris
-others are inconsistent
-lateral movement avoided
pelvic supply via inferior vesicular arteries or uterine in femails supply the pelvic portion
venus: parallel to art
anomalous renal anatomy and kidney transplant
horseshoe kidney: two inferior poles fuse and hooked onto IMA
pelvic kidney: failure to ascend
accessory renal arteries or bifid, dublicated , usually not bilateral
harvested via posterior approach, order of hilum structures
places in ILIAC FOSSA
uregter attaché to bladder and arteries to internal iliac
suprarenal glands
adrenal
superior poles of kidneys
-septum separating
slightly medial
same capsul of renal fat, also attached to crura
hila for veins and lympatics, aa not restricted to hila
Right suprarenal gland
- looks Pyramidal
- contacts IVC
left suprarenal gland: more like crecent
-associated with stomach, spleen, panc, left crus
cortex of suprarenal glands: derived from mesoderm “fatty look”
medulla of suprarenal gland,
-derived from neural crest,
linked to sympathetic ANS
three arterial supplies
- superior off phrenic artery
- middle off suprarenal aa via aorta
- inferior suprarenal off renal artery
single suprarenal vein
R: IVC
L: left renal vein
