Kidney, Ureter, Bladder and abdo wall

Question 1

What is the origin, insertion and action and innervation of the quadratus lumborum muscle?

Answer 1

Origin = the iliac crest 
Insertion = the 12th rib posteriorly and the L1-L4 transverse processes
Action = flex trunk to one side if only one side contracts or aids in forced expiration if both sides contract 
Innervation = T12 to L4 anterior rami of the spinal cord

Question 2

What is the origin insertion action and innervation of the iliapsoas muscles?

Answer 2

Psoas major:
origin = T12 to L4 vertebrae and intervertebral disks
insertion = the lesser trochanter of the femur
innervation = the lumbar plexus (L1 to L3)

Iliacus:
origin = iliac fossa
insertion = the lesser trochanter of the femur
innervation = the femoral nerve (L2-L4)

Action is to raise body to supine position or if just one side fires the action is to bend the trunk to that side.

Iliacus and Psoas join to form a common tendon before inserting onto the lesser trochanter.

Question 3

What are the main branches coming off the Aorta to supply aspects of the pelvis?

Answer 3

L1 = the left and right renal arteries (note these branch off before entering/supplying the kidney). At the anterior of the aorta the SMA is also seen branching off at this level
L2 = the gonadal arteries (testicular/ovarian arteries)
L4 = the bifurcation of the aorta into the common iliac arteries

Question 4

What is the pattern of arterial supply and drainage to the posterior abdominal wall?

Answer 4

There are 5 lumbar arteries (coming off the abdo aorta) and 5 lumbar veins (coming off the IVC) that supply the posterior abdo wall. (similar pattern to the intercostal arteries higher up in the thoracic cavity).

Question 5

What are the main functions of the urinary system?

Answer 5

• maintain pH within 1-2%
• maintain electrolyte balance
• produce hormones
• remove waste
• maintain blood pressure (regulate blood volume)

Question 6

What two fat pads surround the kidneys?

Answer 6

Peri-nephric fat (closest to the renal capsule) and para-nephric fat.

Question 7

What sits directly ontop attached to the kidneys?

Answer 7

The adrenal glands

Question 8

What is the position of the kidneys in the bod?

Answer 8

• retroperitoneal (not within the peritoneal cavity)
• right kidney at level of 12th rib
• left kidney at level of 11th rib
• right kidney slightly lower than left kidney due to the position of the liver
• both sit in front of the posterior ribs and ontop of the psoas muscle
• right kidney sits behind the liver, hepatic flexure of the colon
• left kidney sits behind the splenic flexure of the colon, the spleen, the stomach, the pancreas

Question 9

At what level does the ureter exit the kidney and the renal vessels enter the kidney?

Answer 9

L1. The renal vessels enter the kidney anterior to the ureter.

Question 10

Working from outside in what are the layers/structures within the kidney?

Answer 10

Renal capsule - cortex (contains glomerula and filtrating capillaries) - medulla (contains the loop of henle and the collecting ducts) - minor calcyces - major calcyces - renal pelvis - ureter

Question 11

What is the blood, nerve and lymph supply to the kidneys?

Answer 11

Arterial supply = anterior and posterior branches of left and right renal arteries at the level of L1
Venous drainage = left and right renal veins at the level of L1
Nerve = Renal plexus (complicated sympathetic supply) and vagus nerve (parasympathetic supply)
Lymph = para aortic nodes at L1

Question 12

Describe the path of travel of the ureters

Answer 12

Ureters are smooth muscle tubes carrying the urine from the kidney to the bladder. The urine is propelled by the smooth muscle contractions.

After exiting the renal pelvis at the level of L1, the ureters travel down the tips of the transverse processes on top of the psoas muscle and crosses the bifurcation of the common iliac arteries at the anterior sacro iliac joint to empty into the bladder at the ureteric openings at the “tips of the triangle” - the trigone.

Question 13

what are the 3 constrictions of the ureter?

Answer 13

PUJ - pelvic-ureteric junction (where the ureter enters the renal pelvis)

Where the ureters corss the bifurcation of the common iliac arteries

As they enter the bladder

Question 14

What is the blood, nerve and lymph supply to the 3 divisions (sup, mid and inf) of the ureters?

Answer 14

SUPERIOR
blood - renal artery and renal vein (L1)
nerve - renal plexus
lymph - para aortic nodes at L1

MIDDLE
blood - Gonadal arteries and vein (L2)
nerve - renal plexus
lymph - para aortic / iliac nodes

INFERIOR
blood - Superior vesical artery and veins (from internal iliac)
nerve - hypogastric plexuses (superior and inferior)
lymph - iliac nodes

Question 15

What muscle covers the bladder?

Answer 15

The detruser muscle

Question 16

The bladder sits within the pelvis but when it is full where does it rise up to?

Answer 16

The supra pubic region (above the pubis symphysis)

Question 17

The ureters enter the bladder at the trigone, what is the trigone? What is the line between the two entries of the ureters called? What is the significance of this area.

Answer 17

A region at the base (most anterior portion) of the bladder where there is no rugae - just thin mucous membrane.

The inter-ureteric crest. This area is the least mobile part of the bladder and so it is often the place for bladder infections.

Question 18

What is the blood, nerve and lymph supply to the bladder?

Answer 18

blood = superior and inferior vesical arteries and vasical veins off the internal iliac artery and vein
nerve = inferior hypogastric plexus (sympathetic = sacral sphlachnic and parasympathetic = pelvis sphlachnic)

Question 19

What are the different portions of the urethra in males and females?

Answer 19

males:
pre-prostatic urethra (very small as not a lot of room between the bladder and the prostate)
prostatic urethra (widest part)
membranous urethra (thinnest part)
spongy urethra (long part that travels out through corpus spongiosum in the penis)

Question 20

Describe the branching of the lumbar plexus and the nerve roots supplying each branch

Answer 20

iliohypogastric - L1,
ilioinguinal - L1

Genitofemoral - L1, L2
Lateral cutaneous nerve of the thigh -L2, L3

Femoral nerve - L2, L3, L4
Obturator nerve - L2, L3, L4

Question 21

What do the iliohypogastric and ilioinguinal nerves supply? (both sensory and motor)

What is their course/ what anatomical features can you use to identify them?

Answer 21

Iliohypogastric
motor = the transversus abdominis muscle and internal oblique muscle
sensory = the lateral gluteal region and the pubic skin

Ilioinguinal
motor = the transversus abdominis and internal oblique muscle
sensory = the medial thigh and the root of penis/ scrotum or mons pubis/labia majora

These two nerves are obviously the first to emerge from off the lumbar plexus recieving nerve supply from L1 roots and thus emerge lateral to the psoas muscle. These two nerves travel obliquely over quadratus lumborum to around the region of the top of the iliac crest.

They both pierce the transversus abdominis muscle and then ilioinguinal pierces the internal oblique muscle to enter into the inguinal canal to travel alongside the spermatic cord down into the testes.

Question 22

What does the genitofemoral nerve supply and what is its path?

Answer 22

Genitofemoral nerve has two branches - the genital branch and the femoral branch. We are only interested in the genital branch.

This branch supplies motor innervation to the cremasteric muscle and sensory innervation to the scrotum/mons pubis and anterior thigh.

Its path is easy to find and follow as it is the only nerve to travel on top of / anterior to psoas muscle.

Question 23

What does the lateral cutaneous nerve of the thigh and the femoral nerve supply and what is its path?

Answer 23

The lateral cutaneous nerve of the thigh and the femoral nerve both exit from the lumbar plexus lateral to the psoas muscle and travel on top of iliacus. The lateral cutaneous nerve of the thigh has an oblique path and then goes underneath the inguinal lig to enter the thigh where it only supplies sensory information to the lateral and anterior skin of the thigh.
A condition can occur where there is numbness of this region by compression underneath the inguinal lig. (Bernhardt -roth syndrome).

The femoral nerve is easily the biggest one visually! This supplies sensory info to the skin of the anterior and medial thigh and the motor innervation to muscle of the anterior thigh (quads).

Question 24

What is the innervation and path of the obturator nerve?

Answer 24

This is the only nerve to travel medial to the psoas muscle. It travels down into the pelvis and exits via the obturator canal (the space between obturator internus and externus muscles in the obturator foramen).

Once in the thigh it supplies sensory info to the medial thigh and motor innervation to the muscles of the medial compartment of the thigh.